Botulinum toxin(ATGC Co)

Data concerning prehabilitation in abdominal wall surgery (AWS) remain scarce and controversial. This study aimed to compare the postoperative short- and midterm outcomes between patients with prehabilitation and those without prehabilitation before AWS.

All consecutive patients who underwent surgery for primary/incisional, midline/lateral, and parastomal hernias between October 2021 and October 2024 were retrospectively included. Patients who underwent prehabilitation (including nutritional support, psychological support, and physical preparation) were compared with those who did not undergo prehabilitation. The primary outcome was 30-day morbidity.

A total of 315 patients were included: 114 with prehabilitation and 201 without prehabilitation. Preoperative and intraoperative characteristics were similar in both groups, except for the higher botulinum toxin injection (BTI) rate (71/114 in the prehabilitation group vs 18/201 in the no-prehabilitation group; P <.001) and larger median hernia size (10 cm in the prehabilitation group vs 6 cm in the no-prehabilitation group; P <.001). There were no differences between both groups in complication rates (35/114 in the prehabilitation group vs 61/201 in the no-prehabilitation group; P =.948), major complications (15/114 in the prehabilitation group vs 28/201 in the no-prehabilitation group; P =.848), surgical site occurrences (23/114 in the prehabilitation group vs 40/201 in the no-prehabilitation group; P =.953), and median length of stay (3 days in the prehabilitation group vs 2 days in the no-prehabilitation group; P =.707). In contrast, the recurrence rate was lower in patients in the prehabilitation group than in those in the no-prehabilitation group (2/114 vs 14/201, respectively; P =.043; median follow-up: 16 months [95% CI, 15-17]). Among patients who received BTI, patients in the prehabilitation group had a lower complication rate than those in the no-prehabilitation group (20/71 vs 10/18, respectively; P =.028). Prehabilitation was independently associated with a decreased morbidity rate among patients who received BTI (odds ratio, 0.3 [95% CI, 0.1-0.9]; P =.027).

Prehabilitation did not decrease postoperative morbidity in the overall cohort but was associated with a lower midterm recurrence rate. In the BTI subgroup, patients in the prehabilitation group had less complications, suggesting a potential benefit of coupling BTI with a prehabilitation pathway.

Delayed gastric conduit emptying (DGCE) is a common functional complication after esophagectomy that significantly impairs the quality of life. Despite its clinical burden, standardized management protocols are lacking, and treatment approaches often rely on individual surgeon preference. This review aimed to evaluate the evidence on procedural interventions for established late DGCE to inform clinical decision-making.

A systematic review was conducted across 5 databases, identifying 26 studies on DGCE interventions. Studies were assessed for quality using the Newcastle-Ottawa Scale, emphasizing the inclusion criteria that focused on procedural efficacy and outcome reporting.

A total of 26 studies encompassing diverse treatment modalities were included. Endoscopic approaches, such as botulinum toxin injection and balloon dilatation, have emerged as preferred first-line interventions, with success rates ranging from 50.0% to 100.0%. A hybrid approach combining both modalities demonstrated enhanced efficacy and lower recurrence, with success rates reaching 100.0%. Gastric peroral endoscopic myotomy showed promise for treatment-resistant DGCE, with experienced centers reporting success in 77.2% of refractory cases. Surgical options for gastric conduit revision were reserved for cases of DGCE with structural abnormalities, although the surgical options were associated with higher risks and complications. Significant heterogeneity in outcome definitions and reporting limited the comparability between studies.

This comprehensive evaluation provides valuable insights to assist clinicians in navigating current management strategies for DGCE. High-quality comparative studies are essential to refine treatment protocols and improve long-term patient outcomes.