Surgery Open Digestive Advance最新文献

{"title":"Perforated jejunal diverticulitis complicated by mesenteric abscess: An unusual surgical emergency","authors":"Salah Haddad ,&nbsp;Rany Elaifia ,&nbsp;Mustpha Doukali ,&nbsp;Majd Makhbouch ,&nbsp;Oussama Baraket ,&nbsp;Sami Bouchoucha ,&nbsp;Dorsaf Nouri","doi":"10.1016/j.soda.2026.100250","DOIUrl":"10.1016/j.soda.2026.100250","url":null,"abstract":"<div><h3>Introduction and importance</h3><div>Jejunal diverticulosis is a rare condition that is often asymptomatic but can lead to serious complications such as diverticulitis, perforation, and intra-abdominal abscess. Due to its rarity and nonspecific clinical presentation, diagnosis is often delayed, increasing morbidity and mortality.</div></div><div><h3>Case presentation</h3><div>We report the case of a diabetic patient with a history of abdominal surgery who presented with upper abdominal pain that had been evolving for five days. The clinical examination was nonspecific and the patient was hemodynamically stable. Laboratory tests revealed a marked inflammatory response and acute renal failure. Abdominal computed tomography revealed a large mesenteric abscess adjacent to the first jejunal loop, associated with necrotic and perforated jejunal diverticula. Emergency surgery revealed multiple perforated jejunal diverticula with segmental intestinal necrosis and a mesenteric abscess. Segmental jejunal resection with primary end-to-end anastomosis was performed. Postoperative recovery was favorable.</div></div><div><h3>Clinical discussion</h3><div>Perforated jejunal diverticulitis is a rare but potentially fatal cause of acute abdomen. Imaging, particularly computed tomography, plays a key role in diagnosis. Surgical resection of the affected intestinal segment with primary anastomosis remains the treatment of choice in complicated cases, while extensive resection should be avoided in order to prevent short bowel syndrome.</div></div><div><h3>Conclusion</h3><div>Jejunal diverticulitis should be considered in the differential diagnosis of acute abdomen, particularly in patients who have undergone previous abdominal surgery and present with signs of inflammation. Early diagnosis and prompt surgical management are essential to improve outcomes in this rare condition.</div></div>","PeriodicalId":101190,"journal":{"name":"Surgery Open Digestive Advance","volume":"21 ","pages":"Article 100250"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147656814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic-assisted Hartmann’s reversal for complicated diverticulitis: Operative technique and key steps","authors":"Myeong Hwak Choe,&nbsp;Richa Sandeep,&nbsp;MHA Jackie Liang,&nbsp;Charles Sabbagh,&nbsp;Patricio B. Lynn","doi":"10.1016/j.soda.2026.100260","DOIUrl":"10.1016/j.soda.2026.100260","url":null,"abstract":"<div><div>Hartmann’s reversal remains one of the most technically challenging procedures in colorectal surgery, with low reversal rates and substantial morbidity driven by dense adhesions, distorted pelvic anatomy, and difficulty identifying and mobilizing the rectal stump. Although minimally invasive surgical (MIS) approaches have demonstrated lower postoperative morbidity, fewer anastomotic leaks, and shorter hospitalization compared to open surgery, robotic-assisted Hartmann’s reversal remains technically demanding and requires careful operative planning and standardized technique. We present the case of a 54-year-old woman with a history of hysterectomy and recurrent complicated diverticulitis associated with pericolic abscess formation who underwent an emergent Hartmann’s procedure after failure of conservative medical management for a recurrent diverticular abscess not amenable to percutaneous drainage. Following postoperative recovery, she returned nine months later for restoration of intestinal continuity, and a robotic approach was selected given the anticipated technical complexity of reversal. This video demonstrates our standardized robotic technique for Hartmann’s reversal with emphasis on trocar placement, adhesiolysis, pelvic dissection, rectal stump identification, and restoration of intestinal continuity. Key operative steps are presented sequentially to facilitate reproducibility and improve understanding of the technical nuances associated with this operation. MIS approaches may improve recovery by reducing surgical trauma, shortening hospitalization, and supporting Enhanced Recovery After Surgery (ERAS) pathways focused on early mobilization, multimodal analgesia, and accelerated return of bowel function.</div></div>","PeriodicalId":101190,"journal":{"name":"Surgery Open Digestive Advance","volume":"21 ","pages":"Article 100260"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148934853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An unusual cause of recurrent abdominal pain: Tracheoesophageal fistula","authors":"F. Baixeras ,&nbsp;B. Malgras ,&nbsp;AC Ezanno","doi":"10.1016/j.soda.2026.100256","DOIUrl":"10.1016/j.soda.2026.100256","url":null,"abstract":"","PeriodicalId":101190,"journal":{"name":"Surgery Open Digestive Advance","volume":"21 ","pages":"Article 100256"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148178010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endobiliary clip migration after left hepatectomy: a surprising cause of postoperative biliary fistula","authors":"Alexandra Nassar ,&nbsp;Antoine Guilloux ,&nbsp;Chetana Lim ,&nbsp;Eric Savier","doi":"10.1016/j.soda.2026.100252","DOIUrl":"10.1016/j.soda.2026.100252","url":null,"abstract":"<div><div>A 67-year-old male underwent a laparoscopic left hepatectomy with hepatic pedicle lymphadenectomy and cholecystectomy for a cholangiocarcinoma located in segment 3. The left bile duct was sectioned during parenchymal transection between 10mm Hem-o-lok® clips. Postoperative course was uneventful until post-operative day (POD) 5, when a biliary fistula appeared through the surgical drain following a transient peak of bilirubin (total/conjugated = 45/38 μM) mimicking choledochal migration. Biliary MRI at POD 13 revealed a leak from the left hepatic duct. Endoscopic ultrasound at POD 24 revealed material in the common bile duct (CBD). Following sphincterotomy, Hem-o-lok® clips were extracted from the CBD, including one measuring 10 mm long. A plastic stent was placed to cover the fistula, which resolved 5 days later. This is the first description of Hem-o-lok® clip migration from the left hepatic bile duct into the CBD, resulting in postoperative biliary fistula.</div></div>","PeriodicalId":101190,"journal":{"name":"Surgery Open Digestive Advance","volume":"21 ","pages":"Article 100252"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147656817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determinants of preoperative care timelines in emergency abdominal surgery in Tanzania","authors":"Daniel W. Kitua,&nbsp;Sudi M. Shabani,&nbsp;Nashivai E. Kivuyo,&nbsp;Ally H. Mwanga,&nbsp;Mungeni A. Misidai,&nbsp;Fransia M. Arda,&nbsp;Georvin M. Haule,&nbsp;Humphrey G. Medarakini,&nbsp;Yona Ringo,&nbsp;Larry O. Akoko","doi":"10.1016/j.soda.2026.100261","DOIUrl":"10.1016/j.soda.2026.100261","url":null,"abstract":"<div><h3>Background</h3><div>Emergency abdominal surgical conditions are common and require timely intervention to reduce the morbidity and mortality associated with delays. However, the magnitude, timing, and determinants of preoperative care delays remain underexplored in Sub-Saharan Africa.</div></div><div><h3>Objective</h3><div>To describe preoperative care timelines and identify factors associated with delays in the management of emergency abdominal surgical conditions.</div></div><div><h3>Methods</h3><div>A cross-sectional study was conducted at Muhimbili National Hospital, Dar es Salaam, Tanzania, including consecutively sampled adult patients who underwent emergency abdominal surgery between 1st January and 31st December 2024. Preoperative timelines were categorised into three intervals: T1 (symptom onset to hospital arrival), T2 (hospital arrival to surgical decision), and T3 (surgical decision to the initiation of surgery). Sociodemographic and clinical characteristics were evaluated as determinants of the preoperative interval duration using median (τ = 0.5) quantile regression analysis.</div></div><div><h3>Results</h3><div>The median T1 was 48.0 h (IQR: 12.0–96.0), T2 was 5.0 h (IQR: 3.0–6.0), and T3 was 2.0 h (IQR: 1.0–3.0). Shorter T1 was observed among patients with no formal education (aβ=−34.0 h; 95% CI: −59.8 to −8.3) and those with secondary education (aβ=−34.0 h; 95% CI: −66.3 to −1.7). Longer T1 was associated with out-of-pocket payment (aβ=+28.0 h; 95% CI: 5.0–51.0) and non-traumatic conditions (aβ=+40.0 h; 95% CI: 12.6–67.5). Prolonged T2+T3 was associated with bowel obstruction cases (aExp[β]=1.27; 95% CI:1.17–1.39), while hypothermia (aExp[β]=0.94; 95% CI: 0.88–0.99) and moderate anemia (aExp[β]=0.84; 95% CI: 0.72–0.98) were associated with shorter in-hospital timelines.</div></div><div><h3>Conclusion</h3><div>Substantial pre-hospital delays persist, especially among patients with non-traumatic conditions and among the uninsured. Strengthening emergency capacity, decentralizing essential surgical services to lower-level facilities, expanding universal health insurance coverage, and leveraging established trauma care pathways for nontraumatic emergencies may mitigate these delays.</div></div>","PeriodicalId":101190,"journal":{"name":"Surgery Open Digestive Advance","volume":"21 ","pages":"Article 100261"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148934858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Minimally invasive management of type IV Mirizzi syndrome using a laparo-endoscopic approach and ICG fluorescence (with video)","authors":"César Muñoz ,&nbsp;Carlidia Ortega ,&nbsp;Guillermo Sepulveda","doi":"10.1016/j.soda.2025.100245","DOIUrl":"10.1016/j.soda.2025.100245","url":null,"abstract":"<div><div>Type IV Mirizzi syndrome is a rare and particularly complex biliary condition characterized by a cholecystocholedochal fistula caused by an impacted gallstone that completely obstructs the bile duct lumen. This scenario produces severe chronic inflammation, dense adhesions at the hepatic hilum, and a very limited healthy ductal segment available for reconstruction. Open surgery has traditionally been the preferred approach. However, recent advances in minimally invasive surgery and the incorporation of fluorescence-guided technology using indocyanine green (ICG) have enabled selected cases to be managed laparoscopically with precision and safety in experienced centers.</div><div>A 73-year-old woman with a history of hypertension and type 2 diabetes who presented with two weeks of jaundice and right upper quadrant pain. Computed tomography and MR cholangiography revealed an atrophic gallbladder with an impacted stone compressing the common hepatic duct, associated with upstream biliary dilation findings consistent with type IV Mirizzi syndrome. Endoscopic retrograde cholangiopancreatography confirmed the diagnosis and allowed placement of an 8.5 Fr plastic biliary stent, resulting in clinical improvement.</div><div>Definitive surgical treatment was performed laparoscopically and consisted of subtotal cholecystectomy, resection of the extrahepatic bile duct up to the biliary confluence, and Roux-en-Y hepaticojejunostomy reconstruction. ICG fluorescence imaging was used throughout the dissection and anastomosis to enhance visualization of biliary structures under near-infrared light. The postoperative course was uneventful, with discharge on the third day. This case highlights the feasibility and safety of a minimally invasive, fluorescence-guided approach for complex Mirizzi syndrome, offering reduced morbidity and faster recovery compared with traditional open surgery.</div></div>","PeriodicalId":101190,"journal":{"name":"Surgery Open Digestive Advance","volume":"21 ","pages":"Article 100245"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147404229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laparoscopic repair of strangulated diaphragmatic hernia (with video)","authors":"Antoine Mathivet ,&nbsp;Martin M. Bertrand","doi":"10.1016/j.soda.2025.100214","DOIUrl":"10.1016/j.soda.2025.100214","url":null,"abstract":"","PeriodicalId":101190,"journal":{"name":"Surgery Open Digestive Advance","volume":"20 ","pages":"Article 100214"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145425755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic management of a complicated sleeve gastroplasty in a patient with a pancreatic intraductal papillary mucinous tumor (with video)","authors":"Maroon Tohmeh ,&nbsp;Marc Haber ,&nbsp;Adel Abou-Mrad","doi":"10.1016/j.soda.2025.100240","DOIUrl":"10.1016/j.soda.2025.100240","url":null,"abstract":"<div><div>Bariatric surgery is an effective treatment for morbid obesity, but procedures like sleeve gastrectomy may lead to complications, including gastroesophageal reflux disease (GERD), esophageal motility disorders, and hiatal hernia. These complications can be particularly challenging in patients requiring long-term pancreatic surveillance, such as those with intraductal papillary mucinous neoplasms (IPMN), where preserving gastric continuity is essential for endoscopic access. This report presents a case of a 64-year old woman with a history of laparoscopic sleeve gastrectomy who developed severe GERD, dysphagia, and postprandial chest pain. Diagnostic workup revealed a large hiatal hernia, gastric sleeve stenosis, and a proximal esophageal diverticulum. Given the complexity of her altered anatomy and need for continued IPMN surveillance, a robotic surgical approach was employed. The patient underwent successful robotic hiatal hernia repair with resection of an 8 cm intrathoracic esophageal diverticulum. Postoperative recovery was uneventful, and she remained symptom-free at 1-year follow-up. This case highlights the value of a robotic approach in managing complex post-bariatric complications while preserving access for essential diagnostic surveillance.</div></div>","PeriodicalId":101190,"journal":{"name":"Surgery Open Digestive Advance","volume":"20 ","pages":"Article 100240"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145693543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical management of jejuno-jejunal intussuception 7 years after Roux-en-Y gastric bypass (with video)","authors":"Anaïs Prelot-Claudon ,&nbsp;Antoine Mathivet ,&nbsp;Pr Martin M Bertrand","doi":"10.1016/j.soda.2025.100241","DOIUrl":"10.1016/j.soda.2025.100241","url":null,"abstract":"","PeriodicalId":101190,"journal":{"name":"Surgery Open Digestive Advance","volume":"20 ","pages":"Article 100241"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145624674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patterns of traumatic liver injury and mortality: A five-year study at shahid rajaei hospital (2018–2023)","authors":"M. Yadollahi ,&nbsp;S. Hamedani","doi":"10.1016/j.soda.2025.100211","DOIUrl":"10.1016/j.soda.2025.100211","url":null,"abstract":"<div><h3>Background</h3><div>The liver is the most commonly afflicted organ in abdominal trauma, manageable conservatively or operatively. However, debate persists over case selection for operative management. We aimed to evaluate our experience with liver trauma management and provide insights for improved case management.</div></div><div><h3>Methods and Materials</h3><div>In this retrospective cross-sectional study, all patients with traumatic liver injury over a five-year period were evaluated. Imaging studies were reassessed by radiologists to calculate the Injury Severity Score (ISS). Treatment trends and comparisons between operatively and non-operatively managed patients were analyzed.</div></div><div><h3>Results</h3><div>A total of 209 patients (mean age 34.72 ± 16.1 years, 79.4 % male) included 45.9 % (<em>n</em> = 96) managed non-operatively and 54.1 % (<em>n</em> = 113) operatively, with 23.9 % (<em>n</em> = 50) mortality. AAST Grade V injuries occurred in 1.9 % (<em>n</em> = 4); 48.3 % (<em>n</em> = 101) had ISS ≥25. AAST predicted operative need (<em>P</em> = 0.037) but not mortality (<em>P</em> = 0.217); ISS predicted mortality (<em>P</em> = 0.041) but not operative management (<em>P</em> = 0.432). Operative predictors included penetrating trauma (aOR=5.12, <em>P</em> = 0.011), transfusion (aOR=1.58, <em>P</em> &lt; 0.001), volume resuscitation (aOR=1.89, <em>P</em> &lt; 0.001), catecholamine use (aOR=2.97, <em>P</em> = 0.017), and AAST IV/V (aOR=4.25, <em>P</em> = 0.006). Mortality correlated with age, lower Glasgow Coma Scale (GCS), and transfusion needs.</div></div><div><h3>Conclusion</h3><div>ISS excels in mortality prediction, while AAST and resuscitation markers guide operative decisions. Integrating these enhances trauma care precision.</div></div>","PeriodicalId":101190,"journal":{"name":"Surgery Open Digestive Advance","volume":"19 ","pages":"Article 100211"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144138265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}