Current Issue : October-December Volume : 2025 Issue Number : 4 Articles : 6 Articles
Frailty in the elderly population is associated with increased vulnerability to stressors, including surgical interventions. This study compared machine learning (ML) models with a clinical bedside tool, the Gastrointestinal Surgery Frailty Index (GiS-FI), for predicting mortality and morbidity in elderly patients undergoing gastrointestinal cancer surgery. In a multicenter analysis of 937 patients aged ≥65 years, the performance of various predictive models including Random Forest (RF), Least Absolute Shrinkage and Selection Operator (LASSO), Stepwise Regression, K-Nearest Neighbors, Neural Network, and Support Vector Machine algorithms were evaluated. The overall 30-day mortality and morbidity rates were 6.1% and 35.7%, respectively. For mortality prediction, the RF model demonstrated superior performance with an AUC of 0.822 (95% CI 0.714–0.931), outperforming the GiS-FI score (AUC = 0.772, 95% CI 0.675–0.868). For morbidity prediction, all models showed more modest discrimination, with stepwise regression and LASSO regression achieving the highest performance (AUCs of 0.652 and 0.647, respectively). Our findings suggest that ML approaches, particularly RF algorithm, offer enhanced predictive accuracy compared to traditional clinical scores for mortality risk assessment in elderly cancer patients undergoing gastrointestinal surgery. These advanced analytical tools could provide valuable decision support for surgical risk stratification in this vulnerable population....
The most common anorectal disorders are fecal incontinence, functional anorectal pain, and functional defecation disorders. They are often presented by overlapping symptoms with various degrees of severity. Therefore, a personalized approach to the patient is crucial for diagnosing and determining the prognosis of the disease. Biofeedback training is appropriate to consider when the motoric function disorder is known, the patient could learn voluntary control of response, and this could further lead to an improvement in the condition. Biofeedback is recommended for short-term and long-term treatment of constipation in adults and fecal incontinence in adults. It could also be considered for treatment of specific cases of anorectal pain. As office biofeedback is often time-consuming and comes with a substantially high cost, there is an emerging trend of home biofeedback administration. However, only a few significant studies have been published on this new approach. Although comprehensive data are needed to evaluate the proper strategy and development of various treatment protocols for different types of defecation disorders, home biofeedback therapy offers a potentially effective tool in the personalized treatment of defecation disorders....
Background: Neurologically impaired children often face severe gastroesophageal reflux disease (GERD), feeding difficulties, and related challenges, profoundly impacting their quality of life (QoL) and that of their caregivers. Surgery is often necessary to alleviate symptoms in this population, and the success of surgical treatment, along with the achievement of clinical endpoints, must also consider the impact on QoL. The aim of this study is to evaluate the impact of fundoplication surgery on the QoL of both children and caregivers. Methods: All patients treated between 2010 and 2023 at the Pediatric Surgery Department of San Matteo Hospital in Pavia were included in the study. The modified 1996 O’Neill questionnaire was identified as a suitable model for a QoL survey. QoL assessments included caregiver-reported outcomes using validated questionnaires, focusing on physical, psychological, and social domains. Patients with a follow-up period of less than 12 months were excluded. As a secondary outcome, we evaluated the satisfaction of patients treated after 2020 who received integrated care through a multidisciplinary outpatient clinic. Results: Among the 77 patients, 42 were treated between 2010 and 2021. Of these, 16 participated in pre- and post-operative QoL evaluations, showing significant improvements in GERD resolution, feeding ease, and caregiver stress. From 2020, 35 patients benefited from a multidisciplinary approach; 12 underwent robotic fundoplication. Feeding ease scores improved significantly (mean increase from 37.5 to 84.2; p < 0.001), while caregiver stress scores decreased by 35% (p < 0.01). Conclusions: The combination of surgical and multidisciplinary interventions significantly enhances QoL for SNI children and their families. Integrated care models provide a framework for addressing complex needs and should be prioritized in clinical practice....
Acute pancreatitis (AP) is one of the gastrointestinal pathologies that most frequently requires hospital admission; about half of all deaths occur within the first two weeks and are caused by multi-organ failure. Predicting the degree of severity of AP before 48 h is a challenge. Background/Objectives: Having an early marker, before 48 h after admission, could be useful to avoid or diagnose early complications such as organ failure (OF). A few sentences could place the question addressed in a broader context and highlight the purpose of the study. Methods: A retrospective study conducted in a thirdlevel hospital, during the period from August 2019 to June 2021. Patients aged >18 years, with a diagnosis of PA, who had a complete clinical history and complete biochemical and imaging data were included. The scores of the APACHE II, BISAP, revised Atlanta classification, and modified Marshall scales were recorded. Results: Of the 103 patients included, 60% were women, the mean age was 47.76 years, and the hospital stay was 8 days (IQR 6–12); the most frequent etiology was biliary in 46 (44.7%) patients; the most frequent BMI was overweight with 34 (33%) patients; and 38 (36.9%) patients had a systemic inflammatory response at admission. Hypoalbuminemia was observed in 34 (33%) of the 103 patients at admission; of these, 42 (40.8%) had an APACHE II score > 8 points, 17 (16.3%) a BISAP score > 2, 57 (54.8%) patients were classified as moderate AP according to the revised Atlanta classification, and 54 patients had a score according to the modified Marshall score > 2. A statistically significant difference in the development of death was observed between patients with hypoalbuminemia versus those with normal serum albumin levels. Conclusions: In this study, we show the usefulness of hipoalbuminemia (<3.5 g/dL) at hospital admission in patients with AP, as a severity and mortality indicator. With the results obtained, we conclude that low albumin levels are a good predictor of severity and are useful for establishing timely treatment and close follow-up....
Synchronous colorectal cancer (SCRC) is characterized by the simultaneous occurrence of two or more primary colorectal malignancies, diagnosed either preoperatively, intraoperatively, or within six months postoperatively. The rare prevalence of SCRC makes it an uncommon scenario among colorectal malignancies. Since the majority of SCRC patients have been reported to have two concurrent malignancies, triple synchronous malignancies are extremely rare. We report the case of a 65-year-old male individual presenting with a history of abdominal pain, anemia, anorexia, and unintentional weight loss. He was diagnosed with synchronous colorectal cancer with three distinct tumors: two located in the splenic flexure and sigmoid colon, respectively, and another in the rectum that caused partial obstruction. This case highlights the importance of intraoperative evaluation and an appropriate choice of surgical intervention in colorectal cancer. The early identification and proper management of multiple colorectal cancers remain essential for better survival rates....
Background and Objectives: Hepatolithiasis (HL), or intrahepatic bile duct stone disease, shows regional variation and is a rare condition in Western countries. While cases from East Asia are often linked to chronic biliary infections and brown pigment stones, Western HL more frequently involves cholesterol or black pigment stones, typically in the context of prior cholecystectomy, biliary interventions, or congenital anomalies. The disease is generally associated with significant morbidity, including recurrent cholangitis, biliary strictures, and risk of cholangiocarcinoma. This study aimed to characterize HL disease in an Italian case series. Materials and Methods: We retrospectively reviewed 1450 patients with biliary stone disease treated between 2010 and 2024. HL was diagnosed in 14 patients (0.96%). Clinical records, imaging (ultrasound, CT, magnetic resonance cholangiopancreatography—MRCP, cholangiography), bile cultures, and stone composition (categorized as cholesterol, brown pigment, black pigment, or mixed using FTIR/XRD) were analyzed. Results: Among the 14 patients (mean age: 60.1 years; 64.3% female), 71.4% presented with recurrent cholangitis, while 28.6% were asymptomatic. Stones were left-sided in 57.1%, right-sided in 21.4%, and bilateral in 21.4%. Stone composition was cholesterol/mixed in 50%, brown pigment in 35.7%, and black pigment in 14.3%. Risk factors for bile stasis were present in 71.4% of cases. Bile cultures (available in nine cases) were positive in 77.8%. MRCP was highly effective for diagnosis. Hepatectomy achieved complete resolution in 35.7% of patients with unilobar disease; endoscopic/percutaneous therapy had a 44.4% recurrence rate. Interestingly, no cholangiocarcinoma was observed over a median follow-up of 4.8 years. Conclusions: Western HL is a rare, heterogeneous disease with distinct features. Cholesterol-predominant, infection-negative cases suggest a metabolic or surgical etiology. Hepatectomy offers durable outcomes in unilobar disease. Advanced imaging (MRCP, cholangioscopy) and personalized strategies are key to effective management....
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