Frontiers in Surgery最新文献

{"title":"Efficacy and safety of biliary stenting combined with ¹²⁵I seed implantation for the treatment of advanced extrahepatic cholangiocarcinoma.","authors":"Cai Cheng, Bo Wang, Chunmu Miao, Shengwei Li","doi":"10.3389/fsurg.2025.1608312","DOIUrl":"10.3389/fsurg.2025.1608312","url":null,"abstract":"<p><strong>Background: </strong>The implantation of ¹²⁵I seed is expected to improve the prognosis of patients undergoing stent placement for advanced extrahepatic cholangiocarcinoma (eCCA), but its efficacy and safety remain unclear.</p><p><strong>Methods: </strong>Forty advanced eCCA patients who received percutaneous transhepatic biliary stenting (PTBS) (control group) and 40 PTBS combined with ¹²⁵I seed implantation (¹²⁵I group) were retrospectively analyzed. Changes in serum biochemical indicators and tumor markers as well as the occurrence of complications were observed in the two groups, and the durations of stent patency and survival were compared.</p><p><strong>Results: </strong>The general information and preoperative baseline data did not significantly differ between the two groups (<i>P</i> < 0.05). Regardless of whether PTBS was combined with ¹²⁵I seed implantation, the ALT/AST levels of patients after operation were significantly lower, jaundice was relieved. And the improvements in postoperative liver function and jaundice in patients in ¹²⁵I group were better than those in control group. In addition, tumor markers in the two groups decreased significantly, and the decrease was more significant in patients in ¹²⁵I group. There was no significant difference in the total complication rate between the two groups. The stent patency time and overall survival of the patients in the ¹²⁵I group were longer than those in control group.</p><p><strong>Conclusion: </strong>Biliary stenting combined with ¹²⁵I seed implantation is a safe and effective treatment for patients with advanced eCCA, and it is superior to biliary stenting alone in improving liver function and prolonging the duration of stent patency and survival time.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"12 ","pages":"1608312"},"PeriodicalIF":1.6,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12497782/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145244279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Avoidable severe morbidity from wound dehiscence after cesarean section: Practice and experience from a tertiary referral hospital in a low-income setting, Tanzania-a mixed-methods study.","authors":"Andrew Hans Mgaya, Raymond Oyugi Samuel, Isaya Erasto Mhando, Hery Omary Kimwela, Hans Nathanael Mgaya","doi":"10.3389/fsurg.2025.1524507","DOIUrl":"10.3389/fsurg.2025.1524507","url":null,"abstract":"<p><strong>Introduction: </strong>This study aims to determine care-related risk factors and explore the perspectives of women and care providers about complete wound dehiscence after cesarean section at a tertiary referral and university hospital.</p><p><strong>Methods: </strong>A mixed-methods study was conducted at Muhimbili National Hospital in Dar es Salaam between April 2019 and December 2020. A case control survey compared the characteristics of interest of 131 cases of complete wound dehiscence with 393 randomly selected controls comprising cesarean deliveries between January 2015 and December 2020. In addition, six semistructured individual in-depth interviews with women, one focus group discussion with care providers, and unstructured direct observations were performed between July 2020 and December 2020. Pearson's Chi-square test and Fisher's exact test were used to determine the percentage difference of risk factors of complete wound dehiscence between cases and controls. Thereafter, a multivariate regression analysis determined the role of the independent risk factors. A thematic analysis was used to describe qualitative data.</p><p><strong>Results: </strong>Out of 524 women (131 cases and 393 controls), 75% of deliveries were performed by obstetric registrars and residents. Cases of complete wound dehiscence were more likely from cesarean deliveries performed by junior residents [odds ratio (OR) 1.8, 95% confidence interval (CI) 1.7-5.4]. Wound failure was characterized by complete wound dehiscence with intact sutures (70%) on loosely binding wound margins (62%) or avulsed from the fascial layers (38%). The perspectives of women and care providers were categorized into four themes: wound dehiscence as an indicator of the quality of care; effectiveness of clinical skill transfer and team work; maternal fear, stress, and socioeconomic burden; and significant external factors influencing care.</p><p><strong>Conclusion: </strong>Complete wound dehiscence after cesarean section was highly associated with a suboptimal surgical technique, an ineffective structure and process of clinical skill transfer, and negative experience of care from patients and their families. The identified serious and preventable gaps in the quality of cesarean section stemmed from modifiable clinical and educational practices.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"12 ","pages":"1524507"},"PeriodicalIF":1.6,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12497777/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145244175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bladder paraganglioma: a 25-year systematic review unveils the benefits of early diagnosis in reducing surgical complications.","authors":"Qingqing Liu, Tong Wang, Wenlong Tu, Pengfei Zhou, Xionghui Wu, Huayan Lv","doi":"10.3389/fsurg.2025.1657833","DOIUrl":"10.3389/fsurg.2025.1657833","url":null,"abstract":"<p><strong>Background: </strong>Bladder paraganglioma (BPG) is a rare tumor frequently misdiagnosed before surgery. To raise awareness and improve early detection, we systematically reviewed clinical manifestations and treatment approaches reported in BPG case reports over the past 25 years. We aimed to identify factors that could facilitate timely diagnosis and reduce complications from misdiagnosis.</p><p><strong>Materials and methods: </strong>We searched PubMed for BPG case reports published between January 1, 2000, and December 31, 2024. Two independent reviewers extracted data and performed statistical analyses. Patients were categorized into two groups based on preoperative diagnosis: correctly diagnosed and misdiagnosed.</p><p><strong>Results: </strong>A total of 199 cases from 184 articles were included, with eighty patients (40.2%) preoperatively diagnosed with BPG and 119 (59.8%) misdiagnosed. Catecholamine-related symptoms were significantly more common in the correctly diagnosed group (60.0% vs. 21.8%, <i>p</i> < 0.001), whereas urinary symptoms were more prevalent in the misdiagnosed group (57.1% vs. 28.7%, <i>p</i> < 0.001). None of the misdiagnosed patients received preoperative <i>α</i>-adrenergic blockade therapy. There were significant differences in surgical approach selection between the two groups: 79.0% of patients in the misdiagnosed group underwent transurethral resection (TUR), while only 14.3% received partial cystectomy; conversely, in the correctly diagnosed group, 77.5% of patients underwent partial cystectomy, and only 15.0% underwent TUR. The correctly diagnosed group had more preoperative preparation (63.7% vs. 0%, <i>p</i> < 0.001), and lower incidences of intraoperative hypertensive crisis (17.5% vs. 40.3%, <i>p</i> < 0.001), discontinued surgeries (0% vs. 26.9%, <i>p</i> < 0.001), residual tumors (2.5% vs. 37.8%, <i>p</i> < 0.001), and reoperations (12.5% vs. 41.2%, <i>p</i> < 0.001). Catecholamine-related symptoms (OR = 3.98, <i>p</i> < 0.001) and hypertension (OR = 2.52, <i>p</i> = 0.015) predicted correct diagnosis while urinary symptoms (OR = 0.44, <i>p</i> = 0.031) were associated with misdiagnosis.</p><p><strong>Conclusion: </strong>More than half of BPG patients lack accurate preoperative diagnoses. Catecholamine-related symptoms were strongly associated with correct diagnosis, while urinary symptoms increased misdiagnosis. Patients with preoperative correct diagnosis more frequently received <i>α</i>-adrenergic blockade and underwent cystectomy rather than transurethral resection, with reduced hypertensive crises, surgery discontinuation, and residual tumors compared with those misdiagnosed. These findings highlight the need for structured catecholamine screening in bladder mass diagnostics and support our diagnostic flowchart to enhance early BPG detection.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"12 ","pages":"1657833"},"PeriodicalIF":1.6,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12497724/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145244172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing surgical trauma in robot-assisted pelvic fracture fixation: the role of the systemic immune-inflammatory index.","authors":"Zhang Yong-Tao, Niu Jing, Chen Xin-Zhi, Yang Hai-Liang, He Quan-Jie, Liu Huan","doi":"10.3389/fsurg.2025.1594928","DOIUrl":"10.3389/fsurg.2025.1594928","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to evaluate the association between the systemic immune-inflammation index (SII) and the degree of surgical invasiveness in patients undergoing robot-assisted fixation for anterior pelvic ring fractures.</p><p><strong>Methods: </strong>This study enrolled patients aged 18-80 years with anterior pelvic ring fractures who underwent INFIX internal fixation, either with or without robotic assistance, between July 2022 and December 2023. Participants were categorized into two groups based on the use of robot-assisted techniques. Exclusion criteria included the presence of multiple fractures requiring additional internal fixation, pre-existing infections, or underlying conditions that could influence inflammatory blood markers. Operative duration, intraoperative blood loss, and incidence of lateral femoral cutaneous nerve (LFCN) injury were documented. The SII was assessed both pre- and postoperatively. Statistical analyses were performed using t-tests. Receiver operating characteristic (ROC) curves were generated to evaluate the predictive performance of SII regarding surgical invasiveness, with optimal cut-off values determined using the Youden index.</p><p><strong>Results: </strong>A total of 41 patients were included in the study. No significant differences in gender or age were observed between the robot-assisted and non-robot-assisted groups. Compared to the non-robot-assisted group, the robot-assisted group demonstrated significantly shorter operative duration, reduced intraoperative bleeding, and a lower incidence of LFCN palsy (<i>P</i> < 0.05). In addition, the postoperative SII was significantly lower in the robot-assisted group (<i>P</i> < 0.05). ROC curve analysis revealed that postoperative SII exhibited a predictive capability for surgical invasiveness, with an optimal cut-off value of 745.15 (area under the curve = 0.81; sensitivity, 75%; specificity, 83.3%).</p><p><strong>Conclusion: </strong>The findings suggest that the postoperative SII may serve as a valuable biomarker reflecting the degree of surgical invasiveness associated with robot-assisted or conventional INFIX procedures for anterior pelvic ring fractures. A postoperative SII value exceeding 745.15 demonstrates promising predictive utility for elevated surgical trauma, with a specificity of 83.3% and sensitivity of 75%.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"12 ","pages":"1594928"},"PeriodicalIF":1.6,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12497695/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145244201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"22 years of Minimal Incision Vertical Endoscopic Lift: a journey in endoscopic facial rejuvenation.","authors":"Alessandro Gennai, Mattia Colli, Leonardo Gaggio","doi":"10.3389/fsurg.2025.1634862","DOIUrl":"10.3389/fsurg.2025.1634862","url":null,"abstract":"<p><strong>Introduction: </strong>The Minimal Incision Vertical Endoscopic Lifting (MIVEL) is a minimally invasive facial rejuvenation technique that repositions tissues with minimal scarring, reduced recovery time, and long-lasting results, while achieving a natural appearance. This study aims to describe the updated MIVEL procedure, focusing on its evolution over 22 years and providing methodological details. This includes refining the indications, identifying key fixation points for reproducible results, and highlighting the long-term success of MIVEL as an effective approach for facial rejuvenation with minimal scarring and reduced complications.</p><p><strong>Methods: </strong>This retrospective analysis encompasses a comprehensive review of 784 patients who underwent MIVEL between 2001 and 2023. The MIVEL technique involves small incisions, endoscopic guidance, and vertical lifting to reposition facial tissues. Preoperative and postoperative photographs, patients' demographic data, and complication rates were analyzed. Included patients were those seeking facial rejuvenation without extensive skin excision and attending all follow-up visits up to at least one year postoperatively. Patients were categorized into three MIVEL groups (I, II, III) of dissection, based on their age and related aging signs.</p><p><strong>Results: </strong>The average age of patients was 50.5 years, with the majority falling in the MIVEL II group (53.1 years). MIVEL I was primarily performed on younger patients (21-35 years), while MIVEL III was reserved for those over 55 years. Adjunctive procedures, such as guided Superficial Enhanced Fat Fluid Injection (SEFFI), blepharoplasty, and neck lift, were commonly combined with the MIVEL procedure. The complication rates were low, with transient issues like neuropraxia and periocular ecchymosis being the most common. No cases of severe complications like skin necrosis or permanent nerve injury were reported.</p><p><strong>Discussion: </strong>MIVEL has proven to be a highly effective and well-tolerated technique for the rejuvenation of the upper and middle thirds of the face. Its minimally invasive nature reduces recovery times and minimal scarring while providing lasting and natural-looking results. The 22-year experience underscores the reliability and high patient satisfaction associated with MIVEL, making it a preferred choice for facial rejuvenation surgery. Future directions include further refining the technique and exploring its applicability to other facial and neck rejuvenation areas.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"12 ","pages":"1634862"},"PeriodicalIF":1.6,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12497704/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145244203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Supination adduction stage 2 associated with transverse fracture of the lateral malleolus and rupture of the anterior talofibular ligament: a case report and literature review.","authors":"Jingxuan Wang, Kangyong Yang, Zhenjiang Liu, Ke Jie, Biqing Huang, Shiheng Wang, Zhihong Mo, Yunxuan Zou","doi":"10.3389/fsurg.2025.1658026","DOIUrl":"10.3389/fsurg.2025.1658026","url":null,"abstract":"<p><strong>Background: </strong>Supination-adduction (SAD) type ankle fractures occur when the ankle is subjected to inversion forces while in a supinated position, leading to transverse fractures of the lateral malleolus or lateral ligament injuries, often accompanied by vertical fractures of the medial malleolus. Unlike the typical SAD pattern, the concurrent occurrence of a transverse lateral malleolus fracture combined with rupture of the Anterior Talofibular Ligament (ATFL) is uncommon and has not been reported in the literature; such injuries are frequently missed in clinical practice, which in turn affects clinicians' treatment decisions and the recovery of ankle joint stability and function.</p><p><strong>Case presentation: </strong>This report describes a case of an adult Asian female patient who sustained a left ankle injury due to a missed step, resulting in swelling and pain. The initial diagnosis was a left double ankle fracture (SAD stage 2). During surgery, after stabilizing the medial and lateral malleoli, fluoroscopy revealed that the talus could not be reduced. An extended incision identified the ATFL rupture, which was subsequently repaired using the Broström-Gould technique. Post-repair fluoroscopy confirmed satisfactory reduction of the talus and proper alignment of the ankle joint. After two weeks of cast immobilization, the patient began gradual rehabilitation exercises. At the 18-month follow-up, the patient exhibited good ankle function, achieving an American Orthopaedic Foot and Ankle Society Ankle - Hindfoot Scale of 100.</p><p><strong>Conclusion: </strong>This report shares the clinical experience in diagnosing and treating occult injuries of the ATFL in a case of SAD stage 2 ankle fracture to enhance awareness and prevent missed diagnoses in similar injuries. We emphasize that in SAD stage 2 fractures showing unexplained talar tilt after fixation, clinicians should suspect and evaluate for occult ATFL injury to avoid missed diagnoses and optimize treatment decisions.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"12 ","pages":"1658026"},"PeriodicalIF":1.6,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12498156/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145244288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intracorporeal circular-stapled gastroduodenostomy for billroth I reconstruction in total laparoscopic distal gastrectomy.","authors":"Ying Yang, Linsen Zhou, Jing Zhuang, Yizhou Sun, Yuemei Ding, Haohai Jiang","doi":"10.3389/fsurg.2025.1635611","DOIUrl":"10.3389/fsurg.2025.1635611","url":null,"abstract":"<p><strong>Objectives: </strong>While laparoscopic distal gastrectomy (LDG) has gained acceptance for early gastric cancer, challenges persist in intracorporeal circular-stapled gastroduodenostomy during totally laparoscopic distal gastrectomy (TLDG). This study introduces a novel technique using a laparoscopic purse-string suture clamp (Lap-PSC) and multifunctional sealing cap (MSC) to simplify Billroth I circular-stapled anastomosis.</p><p><strong>Methods: </strong>A single-center retrospective analysis was conducted on 47 gastric cancer patients undergoing TLDG with Lap-PSC and MSC between September 2022 and June 2024. Surgical procedures involved D2 lymph node dissection, a 5 cm upper abdominal incision for specimen extraction, and intracorporeal circular-stapled anastomosis using Lap-PSC for duodenal purse-string suturing and MSC for pneumoperitoneum maintenance. Postoperative outcomes, complications, and anastomotic integrity were evaluated.</p><p><strong>Results: </strong>All 47 patients underwent successful TLDG with negative resection margins. Mean operative time was 148.3 ± 41.4 min. One patient (2.1%) experienced postoperative gastroparesis, and one patient (2.1%) experienced postoperative pneumonia. No anastomotic leaks, strictures, or perioperative deaths occurred. Median follow-up was 21.4 months (range: 13-34), with no recurrence or anastomosis-related complications.</p><p><strong>Conclusion: </strong>TLDG with Circular-Stapled Gastroduodenostomy for Billroth I anastomosis demonstrates technical feasibility and safety, combining the precision of open surgery with laparoscopic minimally invasive benefits. The technique simplifies intracorporeal circular-stapled anastomosis, avoids excessive tension, and may reduce ischemic risks associated with linear stapler methods.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"12 ","pages":"1635611"},"PeriodicalIF":1.6,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12491168/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145232108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic-assisted bronchoscopic localization for small pulmonary nodules: a novel approach to minimally invasive surgery.","authors":"Qiduo Yu, Haoshuai Yang, Jingyu Chen, Fanjia Kong, Jin Zhang, Zhoujunyi Tian, Zhenrong Zhang, Chaoyang Liang","doi":"10.3389/fsurg.2025.1641868","DOIUrl":"10.3389/fsurg.2025.1641868","url":null,"abstract":"<p><strong>Background: </strong>Precise intraoperative localization of small pulmonary nodules is crucial for minimally invasive lung surgery. Robotic bronchoscopy, combining electromagnetic navigation and fluorescence marking, addresses limitations of traditional methods.</p><p><strong>Methods: </strong>This feasibility study included 10 patients (mean age 58) with ground-glass/partially solid nodules (mean diameter 1.42 cm). Using the Monarch® robotic system, nodules were intraoperatively marked with fluorescent dye (indocyanine green/methylene blue). Segmentectomy (4) or wedge resection (6) was performed, with lobectomy added if needed.</p><p><strong>Results: </strong>All nodules were successfully localized (mean time 16.9 min) without complications. Resected specimens confirmed central nodule placement. Pathology identified primary lung cancer in all cases: 1 adenocarcinoma <i>in situ</i>, 3 microinvasive, and 6 invasive. Lobectomy was avoided in 4 segmentectomy cases but required in 5/6 wedge resections.</p><p><strong>Conclusion: </strong>Robotic bronchoscopic localization enables safe, precise intraoperative marking, minimizing healthy tissue resection. This pilot study supports its clinical potential, warranting larger trials for validation.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"12 ","pages":"1641868"},"PeriodicalIF":1.6,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12491215/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145232210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence and risk factors contributing to ileus after posterior approach for lumbar surgery: a retrospective study.","authors":"Rui Bao, GuoLei Liang, YiNan Liu, Dan Wang, Rui Ma, YiZhi Cui, YangYang Tian, Le Wang, Fulin Guan","doi":"10.3389/fsurg.2025.1528409","DOIUrl":"10.3389/fsurg.2025.1528409","url":null,"abstract":"<p><strong>Objective: </strong>This retrospective study aimed to identify the incidence and possible predictive factors associated with ileus after posterior approach for lumbar surgery.</p><p><strong>Patients and methods: </strong>A total of 267 patients who underwent a posterior approach for lumbar surgery between 2012 and 2020 were analyzed in this study. The differences between the two groups and the risk factors of ileus were explored.</p><p><strong>Results: </strong>Patients' characteristics showed no significant differences between the two groups. This revealed that gender, age, smoking, hypertension, and diabetes were not associated with postoperative ileus (POI). Patients with POI would increase length of hospital stay significantly (<i>p</i> = 0.015). Operative segment [odds ratio (OR): 1.40, 3.33; <i>p</i> = 0.04 and 0.02], postoperative blood potassium (OR: 0.92, 0.31; <i>p</i> = 0.04), and previous abdominal surgery (OR: 3.02, <i>p</i> = 0.01) were significant independent risk factors for POI. Operation time, blood loss, and anesthesia type were not considered risk factors for POI.</p><p><strong>Conclusion: </strong>Postoperative ileus can increase the length of hospital stay significantly. Operative segment, postoperative blood potassium, and previous abdominal surgery were significantly associated with POI, which should be highlighted in the preoperative evaluation.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"12 ","pages":"1528409"},"PeriodicalIF":1.6,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12491330/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145232061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Arthroscopic partial repair versus debridement combined with acromioplasty alone for irreparable rotator cuff tears in the elderly.","authors":"Ning Li, Lu Sun, Zhongyuan Zhang, Hanwei Kang, Hongjiang Jiang, Liwu Qin","doi":"10.3389/fsurg.2025.1615015","DOIUrl":"10.3389/fsurg.2025.1615015","url":null,"abstract":"<p><strong>Objective: </strong>To compare postoperative outcomes of arthroscopic partial repair vs. debridement combined with acromioplasty in elderly patients with irreparable rotator cuff tears, focusing on pain relief, functional improvement, and quality-of-life enhancement.</p><p><strong>Methods: </strong>Between January 2019 and March 2022, 41 patients (partial repair group, <i>n</i> = 21; debridement group, <i>n</i> = 20) with irreparable rotator cuff tears were prospectively enrolled. Functional outcomes [Constant-Murley Score [CMS], University of California Los Angeles Score [UCLA]) were assessed preoperatively and 12 months postoperatively. Visual Analog Scale (VAS) scores were recorded at 2 and 6 weeks. Magnetic resonance imaging (MRI) and anteroposterior x-rays were used to measure global fatty degeneration index (GFDI) and acromiohumeral distance (AHD). Tendon healing was evaluated using the Sugaya classification system.</p><p><strong>Results: </strong>All surgeries were completed without complications. Follow-up averaged 14.1 months (range, 12-18 months). Postoperative CMS (partial repair: 43.57-70.86 vs. debridement: 42.55-58.95) and UCLA scores (partial repair: 8.67-21.43 vs. debridement: 8.30-18.40) improved significantly in both groups (<i>P</i> < 0.05), with greater enhancements in muscle strength and range of motion favoring partial repair. VAS scores were higher in the partial repair group at 2 weeks (3.1 ± 0.8 vs. 2.1 ± 0.7, <i>P</i> < 0.05) but equivalent at 6 weeks (<i>P</i> > 0.05). Postoperative GFDI increased in both groups (<i>P</i> < 0.05) without intergroup differences. AHD remained stable in the partial repair group (<i>P</i> > 0.05) but decreased in the debridement group (<i>P</i> < 0.05), with higher AHD persisting in the partial repair subgroup (<i>P</i> < 0.05). Subgroup analysis revealed no differences in outcomes between re-tear and non-re-tear patients. Preoperative AHD correlated positively with postoperative CMS and UCLA scores (<i>P</i> < 0.05), while Sugaya classification and preoperative GFDI showed no association with functional outcomes.</p><p><strong>Conclusion: </strong>Arthroscopic partial repair yielded superior functional outcomes compared to debridement combined with acromioplasty in elderly patients with irreparable rotator cuff tears, particularly enhancing shoulder strength and range of motion while preserving AHD. Early postoperative pain should be anticipated. Preoperative AHD emerged as a predictor of functional recovery.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"12 ","pages":"1615015"},"PeriodicalIF":1.6,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12491229/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}