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To establish the severity of pancreatitis, there are many scoring systems, the most used are the Marshall and APACHE II systems, each one has advantages and disadvantages; but with good relation regarding mortality and prediction of complications. In populations with low barometric pressures produced by a decrease in atmospheric pressure, there is a decrease in partial pressure of oxygen, in these cases scores which take arterial oxygen partial pressure as one of their variables, may be overestimated. A diagnostic trial study was designed to evaluate the performance of APACHE II, Marshall and BISAP in a city 2640 m above sea level. A ROC analysis was performed to estimate the AUC of each of the scores, to evaluate the performance in predicting unfavorable outcomes (defined as the need for percutaneous drainage, surgery, or mortality) and a non-parametric comparison was made between the AUC of each of the scores with the DeLong test. From January 2018 to December 2019, data from 424 patients living in Bogota, with a diagnosis of gallstone pancreatitis was collected consecutively in a hospital in Bogota, Colombia. The ROC analysis showed AUC for predicting adverse outcomes for APACHE II in 0.738 (95% CI 0.647–0.829), Marshall in 0.650 (95% CI 0.554–0.746), and BISAP in 0.744 (95% CI 0.654–0.835). The non-parametric comparison to assess whether there were differences between the different AUC of the different scores showed that there is a statistically significant difference between Marshall and BISAP AUC to predict unfavorable outcomes (p=0.032). The mortality in the group of patients studied was 5.8%. We suggest the use of BISAP to predict clinical outcomes in patients with a diagnosis of biliary pancreatitis in populations with decreased atmospheric pressure because it is an easy-to-use tool and does not require arterial oxygen partial pressure for its calculation.

Background Empirical antibiotic therapy is often initiated during the hospital stay while awaiting laparoscopic cholecystectomy. This approach is generally justified in patients with moderate (Tokyo II) and severe (Tokyo III) acute cholecystitis, where organ dysfunction occurs as a result of the inflammatory or infectious process. However, there is no clear consensus regarding the use of antibiotics in patients with mild (Tokyo I) cholecystitis. This study aimed to evaluate the impact of preoperative antibiotic use on outcomes in patients with acute cholecystitis. Methods A systematic review of PubMed, Embase and Cochrane was conducted following the PRISMA methodology. Studies were eligible for inclusion if they were randomized controlled trials or non-randomized comparative studies evaluating the use or non-use of preoperative antibiotics in patients with acute cholecystitis. Eligible studies were required to provide at least one of the following datasets: postoperative complication rate, postoperative infectious complication rate, or positive culture rate. The synthesis reports were prepared using the Synthesis Without Meta-analysis (SWiM) framework. Results A total of 622 articles were initially identified, of which 2 met the inclusion criteria. These two articles included 331 patients. They reported higher rates of postoperative complications and bacterobilia in the group that received preoperative antibiotics; however, the differences were not statistically significant ( p  > 0.05). Conclusion Based on current evidence, no recommendation can be made regarding the therapeutic use of antibiotics in mild acute cholecystitis while awaiting laparoscopic cholecystectomy.

Background The laparoscopic cholecystectomy is the treatment of choice for patients with benign biliary disease. It is necessary to evaluate survival after laparoscopic cholecystectomy in patients over 80 years old to determine whether the long-term mortality rate is higher than the reported recurrence rate. If so, this age group could benefit from a more conservative approach, such as antibiotic treatment or cholecystostomy. Therefore, the aim of this study was to evaluate the factors associated with 2 years survival after laparoscopic cholecystectomy in patients over 80 years old. Methods We conducted a retrospective observational cohort study. We included all patients over 80 years old who underwent laparoscopic cholecystectomy. Survival analysis was conducted using the Kaplan‒Meier method. Cox regression analysis was implemented to determine potential factors associated with mortality at 24 months. Results A total of 144 patients were included in the study, of whom 37 (25.69%) died at the two-year follow-up. Survival curves were compared for different ASA groups, showing a higher proportion of survivors at two years among patients classified as ASA 1–2 at 87.50% compared to ASA 3–4 at 63.75% ( p  = 0.001). An ASA score of 3–4 was identified as a statistically significant factor associated with mortality, indicating a higher risk (HR: 2.71, CI95%:1.20–6.14). Conclusions ASA 3–4 patients may benefit from conservative management due to their higher risk of mortality at 2 years and a lower probability of disease recurrence.

BackgroundNonagenarian patients are an age group in progressive growth. In this age group, indications for surgical procedures, including cholecystectomy, will be increasingly frequent, as biliary pathology and its complications are frequent in this population group. The main objective of this study was to analyze the safety and outcomes of laparoscopic cholecystectomy in patients older than 90 years.MethodsA retrospective observational cohort study was designed. This study involved 600 patients that were classified in 4 age groups for analysis (under 50 years, 50–69 years, 70–89 years, and over 90 years). Demographic, clinical, paraclinics, surgical, and outcome variables were compared according to age group. A multivariate analysis, which included variables considered clinically relevant, was performed to identify factors associated with mortality and complications classified with the Clavien–Dindo scale.ResultsThe patients evaluated had a median age of 65.0 (IQR 34.0) years and there was a female predominance (61.8%). A higher complication rate, conversion rate, subtotal cholecystectomy rate, and prolonged hospital stay were found in nonagenarians. The overall mortality rate was 1.6%. Mortality in the age group over 90 years was 6.8%. Regression models showed that age over 90 years (RR 4.6 CI95% 1.07–20.13), presence of cholecystitis (RR 8.2 CI95% 1.29–51.81), and time from admission to cholecystectomy (RR 1.2 CI95% 1.10–1.40) were the variables that presented statistically significant differences as risk factors for mortality.ConclusionCholecystectomy in nonagenarian patients has a higher rate of complications, conversion rate, subtotal cholecystectomy rate, and mortality. Therefore, an adequate perioperative assessment is necessary to optimize comorbidities and improve outcomes. Also, it is important to know the greatest risk for informed consent and choose the surgical equipment and schedule of the procedure.

Purpose Colorectal cancer is the third most common cancer and the second leading cause of cancer-related deaths worldwide, according to GLOBOCAN 2022. Lymph node metastasis is a well-recognized prognostic factor in colorectal cancer. While the relationship between ABO blood group, Rhesus (Rh) type, and lymphatic spread has been studied in other gastrointestinal tumors, limited research exists on colorectal cancer. This study primarily aimed to investigate the association between lymph node metastasis and ABO blood group, as well as the relationship between microsatellite instability (MSI) and ABO blood group. Methods . A retrospective observational cohort study was conducted, including all patients who underwent elective colorectal resections with curative intent for malignant colorectal tumors between March 2017 and March 2023. Eligible patients had documented ABO blood group and Rh type, along with pathology reports from surgical specimens. Results . The study included 270 patients, with a median age of 74.5 years-old. The cohort was predominantly female (50.4%). Lymph node metastasis was observed in 156 patients (57.7%). A binary logistic regression model identified factors associated with lymphatic spread: rectal tumor location (OR: 3.85, 95% CI: 1.14–15.60), poorly differentiated tumors (OR: 6.84, 95% CI: 1.37–53.80), invasion depth T3 (OR: 4.88, 95% CI: 1.72–16.90) and T4 (OR: 16.20, 95% CI: 4.78–65.60), and extramural vein invasion (OR: 7.17, 95% CI: 1.37–53.80). Notably, the AB blood group (OR: 0.12, 95% CI: 0.01–0.65) was associated with a lower likelihood of lymph node metastasis, suggesting a potential protective effect. A separate binary logistic regression analysis evaluating factors related to MSI found no statistically significant associations, including for ABO blood group and Rh antigen. Conclusions Our findings suggest that the AB blood group is associated with a reduced likelihood of lymph node metastasis compared to other blood groups. However, the existing literature on the relationship between blood group and lymph node metastasis is inconsistent. Further research is necessary to clarify the prognostic role of ABO blood group in colorectal cancer.

Background Gastric cancer (GC) incidence in older adults is usually higher than in the general population. Whereas surgical resection accompanied by an extended lymphadenectomy is the current standard treatment for GC, the impact of the extent of lymphadenectomy on survival in older adult patients has not been sufficiently studied and may be associated with a higher rate of complications in this group of patients. Materials and methods An observational retrospective cohort study was performed in patients aged ≥ 75 years with a diagnosis of GC who underwent gastrectomy with curative intent to evaluate the influence of the number of retrieved lymph nodes (< 25 vs. ≥25) on postoperative morbidity and mortality and overall survival (OS). Results A total of 122 patients were included in this study; 64 were included in the group with ≥ 25 retrieved lymph nodes and 58 in the group with < 25 retrieved nodes. Patients were predominantly male (61.5%) with a median age of 79.00 (IQR: 77.00–81.00) years. The lymph node ratio was an independent risk factor for OS (HR, 8.79; 95% CI, 2.35–32.85; p  = 0.001), whereas the number of retrieved lymph nodes was not associated with differences in OS and was not identified as an independent risk factor for major postoperative complications. Conclusion We did not identify that a higher number of retrieved lymph nodes was associated with an improvement in overall survival in patients aged ≥ 75 years; however, we observed a high rate of major postoperative complications in this population. Surgical decision-making in older patients with GC should be individualized, and the risk–benefit ratio must be carefully considered.

Background This study aims to identify which risk factors are associated with the appearance of an incisional hernia in a stoma site after its closure. This in the sake of identifying which patients would benefit from a preventative intervention and thus start implementing a cost-effective protocol for prophylactic mesh placement in high-risk patients. Methods A systematic review of PubMed, Cochrane library, and ScienceDirect was performed according to PRISMA guidelines. Studies reporting incidence, risk factors, and follow-up time for appearance of incisional hernia after stoma site closure were included. A fixed-effects and random effects models were used to calculate odds ratios’ estimates and standardized mean values with their respective grouped 95% confidence interval. This to evaluate the association between possible risk factors and the appearance of incisional hernia after stoma site closure. Results Seventeen studies totaling 2899 patients were included. Incidence proportion between included studies was of 16.76% (CI95% 12.82; 21.62). Out of the evaluated factors higher BMI ( p  = 0.0001), presence of parastomal hernia ( p  = 0.0023), colostomy ( p  = 0,001), and end stoma ( p  = 0.0405) were associated with the appearance of incisional hernia in stoma site after stoma closure, while malignant disease ( p  = 0.0084) and rectum anterior resection ( p  = 0.0011) were found to be protective factors. Conclusions Prophylactic mesh placement should be considered as an effective preventative intervention in high-risk patients (obese patients, patients with parastomal hernia, colostomy, and end stoma patients) with the goal of reducing incisional hernia rates in stoma site after closure while remaining cost-effective.

Background Laparoscopic cholecystectomy is the gold standard for managing acute cholecystitis. However, in high-risk surgical patients, percutaneous cholecystostomy is frequently used either as a bridge to surgery or as definitive treatment. When employed as a bridge to surgery, the optimal timing for laparoscopic cholecystectomy after cholecystostomy remains unclear. Methods A critical review of the literature was conducted, focusing particularly on the article published by Spaniolas, et al., presented at SAGES 2024, to evaluate the optimal timing for performing laparoscopic cholecystectomy after a cholecystostomy, according to the available evidence. Results The available literature was found to be limited. The timing thresholds vary across studies, preventing a pooled evaluation of the effect size. The study by Spaniolas, et al. has several limitations, including the exclusion of subtotal cholecystectomies from the composite endpoint and the introduction of implausible variables in the logistic regression model. Conclusion Ideally, the procedure should be performed when it is least technically demanding, minimizing the need for rescue procedures (such as subtotal cholecystectomy, antegrade cholecystectomy, or conversion to open surgery) and reducing complications. This topic is increasingly relevant in clinical practice. However, the current scientific evidence remains limited.

The impact of age on perioperative morbidity and long-term oncologic outcomes in colorectal cancer remains controversial. Although aging is linked to greater comorbidity and functional decline, advances in perioperative care have challenged the idea that older patients have worse outcomes. This study evaluated surgical and oncologic results in patients aged ≥ 75 years compared with younger individuals. We conducted a retrospective cohort study including patients who underwent colorectal resection with primary anastomosis between 2015 and 2022. Patients were grouped by age (< 75 vs. ≥ 75 years) and matched 1:1 using propensity scores based on preoperative clinical and tumor-related variables. Major complications (Clavien-Dindo grade ≥ III) were analyzed using logistic regression, and OS and RFS were assessed using Kaplan-Meier curves and Cox proportional hazards models. Of 651 eligible patients, 272 were included in the matched cohort. No statistically significant differences were found between age groups in hospital stay (4.5 vs. 4.0 days; p = 0.270), reintervention (13.2% vs. 8.8%; p = 0.333), major complications (14.0% vs. 8.8%; p = 0.252), or 30-day perioperative mortality (3.7% vs. 0.7%; p = 0.216), although perioperative mortality was numerically higher among patients aged ≥ 75 years. Age ≥ 75 years was not significantly associated with major complications in multivariable analysis (OR 1.73; 95% CI 0.79-3.94). Five-year OS and RFS also did not differ significantly between groups. Older age was not associated with statistically significant differences in major complications or long-term oncologic outcomes in this matched cohort. However, clinically meaningful differences, particularly in short-term perioperative risk, cannot be excluded. Chronological age alone should not preclude curative-intent surgery.

IntroductionBile fluid is aseptic under normal conditions; however, in the presence of cholecystitis, its susceptibility to bacterial colonisation varies, with reported rates of 20%–70% of cases. This process is referred to as bactibilia and/or bacteriobilia and can be considered a secondary complication of biliary stasis and cholecystitis in general. In the management of acute cholecystitis, the antibiotic regimen should be prescribed based on the presumed pathogens involved, taking into consideration the risk factors for resistance patterns according to demographics and local exposure. The aim of this study is to determine the predictive factors for bile culture positivity and antibiotic resistance in patients who underwent laparoscopic cholecystectomy in the Méderi Hospital Network. We hope to develop a predictive model that allows us to better guide antibiotic therapy.Methods and analysisThis is a prospective observational cohort study with prognostic prediction model. Patients who will undergo laparoscopic cholecystectomy and have bile cultures taken in the Méderi Hospital Network during the study period will be included. The dependent variables will be positive bile culture and antibiotic resistance, and the predictive variables will be age, presence of diabetes, diagnosis of choledocholithiasis, diagnosis of cholecystitis and severity of cholecystitis according to the Tokyo criteria. The minimum sample size has been calculated at 703 patients. Follow-up will continue until a control appointment 15 days after the procedure. The primary outcomes are bile culture positivity and phenotypical antibiogram resistance. For each outcome, a multivariate logistic regression will be performed using frequentist and Bayesian prediction techniques.Ethics and disseminationThis study was approved by the Méderi network research department committee (CIMED) and by Universidad del Rosario’s Research Ethics Committee (CEI-UR; DVO005 2555-CV1837). Written informed consent is required for participation. The results will be disseminated through the submission of an academic article to a high-impact scientific journal, presentations at academic conferences, and sharing with our institution's faculty to inform antimicrobial therapy management based on local epidemiological data.Trial registration number NCT06314399.