Conversion to open surgery in obese patients undergoing minimally invasive distal pancreatectomy: results from a multicenter analysis

\ua9 2024. Background: Although minimally invasive distal pancreatectomy (MIDP) is considered a standard approach it still presents a non-negligible rate of conversion to open that is mainly related to some difficulty factors, as obesity. The aim of this study is to analyze the preoperative factors associated with conversion in obese patients with MIDP. Methods: In this multicenter study, all obese patients who underwent MIDP at 18 international expert centers were included. The preoperative factors associated with conversion to open surgery were analyzed. Results: Out of 436 patients, 91 (20.9%) underwent conversion to open, presenting higher blood loss, longer operative time and similar rate of major complications. Twenty (22%) patients received emergent conversion. At univariate analysis, the type of approach, radiological invasion of adjacent organs, preoperative enlarged lymphnodes and ASA ≥ III were significantly associated with conversion to open. At multivariate analysis, robotic approach showed a significantly lower conversion rate (14.6 % vs 27.3%, OR = 2.380, p = 0.001). ASA ≥ III (OR = 2.391, p = 0.002) and preoperative enlarged lymphnodes (OR = 3.836, p = 0.003) were also independently associated with conversion. Conclusion: Conversion rate is significantly lower in patients undergoing robotic approach. Radiological enlarged lymphnodes and ASA ≥ III are also associated with conversion to open. Conversion is associated with poorer perioperative outcomes, especially in case of intraoperative hemorrhage

An Epidemiologic Investigation of Potential Risk Factors for Nodding Syndrome in Kitgum District, Uganda

<div><p>Introduction</p><p>Nodding Syndrome (NS), an unexplained illness characterized by spells of head bobbing, has been reported in Sudan and Tanzania, perhaps as early as 1962. Hypothesized causes include sorghum consumption, measles, and onchocerciasis infection. In 2009, a couple thousand cases were reportedly in Northern Uganda.</p><p>Methods</p><p>In December 2009, we identified cases in Kitgum District. The case definition included persons who were previously developmentally normal who had nodding. Cases, further defined as 5- to 15-years-old with an additional neurological deficit, were matched to village controls to assess risk factors and test biological specimens. Logistic regression models were used to evaluate associations.</p><p>Results</p><p>Surveillance identified 224 cases; most (95%) were 5–15-years-old (range = 2–27). Cases were reported in Uganda since 1997. The overall prevalence was 12 cases per 1,000 (range by parish = 0·6–46). The case-control investigation (n = 49 case/village control pairs) showed no association between NS and previously reported measles; sorghum was consumed by most subjects. Positive onchocerciasis serology [age-adjusted odds ratio (AOR₁) = 14·4 (2·7, 78·3)], exposure to munitions [AOR₁ = 13·9 (1·4, 135·3)], and consumption of crushed roots [AOR₁ = 5·4 (1·3, 22·1)] were more likely in cases. Vitamin B6 deficiency was present in the majority of cases (84%) and controls (75%).</p><p>Conclusion</p><p>NS appears to be increasing in Uganda since 2000 with 2009 parish prevalence as high as 46 cases per 1,000 5- to 15-year old children. Our results found no supporting evidence for many proposed NS risk factors, revealed association with onchocerciasis, which for the first time was examined with serologic testing, and raised nutritional deficiencies and toxic exposures as possible etiologies.</p></div

Frequency of nodding syndrome cases and village controls with positive exposures or presence of clinical findings.

<p>Statistically significant values are in bold.</p><p>CI: Confidence interval. OR: odds ratio.</p>*<p>Percent with exposure is calculated by number of cases with a positive exposure divided by number of cases, or number of controls exposed divided by number of controls.</p>‡<p>Odds ratio calculated as odds of positive exposure in cases versus odds of exposure in controls.</p>†<p>AOR₁: Odds ratio adjusted for age. Note: additional models 2 (adjusted for age, munitions, roots) and 3 (adjusted for age, measles, sorghum, onchocerciasis skin snip positive) are available in an online appendix Table 5.</p>?<p>Missing data existed for the following exposure variables: malaria, malnutrition, pneumonia, diarrhea, head injury, crushed leaves, roots, flowers, inhaled medicine (number of cases responding to question = 50); swimming in the river or pond, visual or auditory hallucinations (cases = 49); skin nodules (cases = 48); low height for age, low BMI for age (cases = 45, controls = 48); all data used for frequencies, data from available matched pairs used for matched analyses.</p>+<p>Firth’s correction.</p>**<p>low BMI-for-age z-score: <−2 SD, an indicator of acute malnutrition; low height-for-age z-score: <−2SD, chronic malnutrition.</p><p>Unadjusted and adjusted odds of positive exposure or clinical finding in a case versus control.</p

Prevalence and mean socio-demographic characteristics of nodding syndrome case patients and control subjects aged 5 to 15 years in Kitgum District, Uganda.

∧<p>51 total cases were enrolled; 49 matched to 49 village controls, and 44 matched to 44 household controls.</p><p>McNemar’s, Stuart’s <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0066419#pone.0066419-Agresti1" target="_blank">[27]</a>, and paired t tests were performed to obtain significance level.</p>*<p>p<0.05.</p>**<p>p<0.001.</p