Frontiers in Surgery最新文献

{"title":"Stent-assisted coil embolization of ruptured vertebral artery dissected aneurysm with severe stenosis of bilateral vertebral artery V4 segment by the transmountain technique: a case report and review of the literatures.","authors":"Guangzhi Hao, Zijun Zhang, Yuwei Han, Yu Huan, Yushu Dong, Haiyang Zhao, Guobiao Liang","doi":"10.3389/fsurg.2025.1442122","DOIUrl":"10.3389/fsurg.2025.1442122","url":null,"abstract":"<p><p>A 46-year-old woman presented with acute head and neck pain for 10 h. Head CT showed subarachnoid hemorrhage (SAH) and digital subtraction angiography (DSA) identified a ruptured dissected aneurysm of the right vertebral artery with severe artery stenosis. Moreover, an unruptured dissecting aneurysm and severe vascular stenosis were also found in the left vertebral artery. How to deal with ruptured bleeding aneurysm and prophylactically deal with contralateral unruptured dissecting aneurysm and the stenosis of the vertebral artery has become a thorny problem. By adopting the Transmountain technique, we used a single Enterprise-2 stent to cover the neck of the right ruptured vertebral artery dissection aneurysm and the severe stenosis of the distal vessel, while bypassing the vertebrobasilar artery junction to continue covering the severe stenosis and the unruptured dilated dissection of the contralateral vertebral artery. This new stent-assisted approach may provide a reference for clinicians in the treatment of complex dissection aneurysms.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"12 ","pages":"1442122"},"PeriodicalIF":1.6,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11872894/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540976","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":"Clinical analysis of percutaneous endoscopic unilateral laminotomy for bilateral decompression for single segment degenerative lumbar spinal stenosis: a systematic review and single-arm meta-analysis.","authors":"Tianqi Jiang, Zhijun Chen, Yitong Luo, Xinyue Tian, Yanni Zhou, Yanqiang Huan, Yongxiong He","doi":"10.3389/fsurg.2025.1458366","DOIUrl":"10.3389/fsurg.2025.1458366","url":null,"abstract":"<p><strong>Background: </strong>In recent years, percutaneous endoscopic unilateral laminotomy for bilateral decompression (PE-ULBD) has been used to treat degenerative lumbar spinal stenosis (LSS) and has achieved good results. Some researchers have conducted statistical analysies and evaluated the efficacy of this technology. In this systematic review and single-arm meta-analysis, the effectiveness of PE-ULBD as a surgical method for treating single segment LSS was evaluated from the perspective of evidence-based medicine. The aim was to provide a scientific basis for the clinical application of this technology in LSS treatment.</p><p><strong>Methods: </strong>A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of 396 studies published before May 29, 2024 were collected from the PubMed, Web of Science, Embase, Cochrane Library, China National Knowledge Infrastructure(CNKI), and WanFang databases.</p><p><strong>Results: </strong>Eight retrospective studies were found with 287 patients who met the inclusion criteria set for the systematic review and single-arm meta-analysis. We used the methodological index for non-randomized studies (MINORS) scale to evaluate the quality of the included studies. The results indicated that significant difference in VAS scores between preoperative and postoperative back and leg pain and the difference between the control results recorded before and after the two types of pain scores was statistically significant (<i>P</i> < 0.05). In addition, the difference between the Oswestry Disability Index (ODI) scores recorded in the different groups before and after surgery was statistically significant (<i>P</i> < 0.05). Although the results showed high heterogeneity, a sensitivity analysis showed that there was no significant deviation in other results except for the VAS and ODI score for leg pain in the preoperative and three-month postoperative groups. Secondary clinical outcomes included an average operational time of 97.15 min (95% CI = 82.83, 111.47), an average intraoperative bleeding volume of 26.52 ml (95% CI = 10.51, 42.52), an average hospital stay of 4.16 days (95% CI = 2.96, 5.35), and an incidence of complications of 0.10 (95% CI = 0.06, 0.14).</p><p><strong>Conclusion: </strong>Our results indicate that the PE-ULBD technique has significant short and long-term clinical efficacy for the treatment of single-segment LSS and is worthy of clinical application and promotion.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"12 ","pages":"1458366"},"PeriodicalIF":1.6,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11873088/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540946","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":"Development and evaluation of a 3D ensemble framework for automatic diagnosis of early osteonecrosis of the femoral head based on MRI: a multicenter diagnostic study.","authors":"Miao Yang, Fuchou Hsiang, Chengfan Li, XiaoYi Chen, Changqing Zhang, Guangchen Sun, Qiliang Lou, Wenhui Zhu, Hongtao Zhao, Feng Liu, Xuehai Ding, Jun Xu","doi":"10.3389/fsurg.2025.1555749","DOIUrl":"https://doi.org/10.3389/fsurg.2025.1555749","url":null,"abstract":"<p><strong>Background: </strong>Efficient and reliable diagnosis of early osteonecrosis of the femoral head (ONFH) based on MRI is crucial for the formulation of clinical treatment plans. This study aimed to apply artificial intelligence (AI) to achieve automatic diagnosis and visualization of early ONFH, thereby improving the success rate of hip-preserving treatments.</p><p><strong>Method: </strong>This retrospective study constructed a multicenter dataset using MRI data of 381 femoral heads from 209 patients with ONFH collected from four institutions (including 239 early ONFH cases and 142 non-ONFH cases). The dataset was divided into training, validation, and internal and external test datasets. This study developed a 3D ensemble framework to automatically diagnose early osteonecrosis of the femoral head based on MRI and utilized 3D Grad-CAM to visualize its decision-making process. Finally, the diagnostic performance of the framework was experimentally evaluated on the MRI dataset and compared with the diagnostic results of three orthopedic surgeons.</p><p><strong>Results: </strong>On the internal test dataset, the 3D-ONFHNet framework achieved overall diagnostic performance with an accuracy of 93.83%, sensitivity of 89.44%, specificity of 95.56%, F1-score of 87.67%, and AUC of 95.41%. On the two external test datasets, the framework achieved overall diagnostic accuracies of 87.76% and 87.60%, respectively. Compared to three orthopedic surgeons, the diagnostic performance of the 3D-ONFHNet framework was comparable to that of senior orthopedic surgeons and superior to that of junior orthopedic surgeons.</p><p><strong>Conclusions: </strong>The framework proposed in this study can generate staging results for early ONFH and provide visualizations of internal signal changes within the femoral head. It assists orthopedic surgeons in screening for early ONFH on MRI in a clinical setting, facilitating preoperative planning and subsequent treatment strategies. This framework not only enhances diagnostic efficiency but also offers valuable diagnostic references for physicians.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"12 ","pages":"1555749"},"PeriodicalIF":1.6,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11868283/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540968","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":"Case Report: Traumatic obturator hip dislocation with subtrochanteric fracture in an 8-year-old child.","authors":"Shuming Huang, Kanghao Fang, Hailin Xing, Shuhua Lan, Quanzhou Wu","doi":"10.3389/fsurg.2025.1531518","DOIUrl":"https://doi.org/10.3389/fsurg.2025.1531518","url":null,"abstract":"<p><strong>Background: </strong>Obturator-type hip dislocation is a rare condition in pediatric patients, with the simultaneous occurrence of an ipsilateral subtrochanteric femoral fracture being exceptionally uncommon. Although various treatment methods have been described for hip dislocation or subtrochanteric femoral fractures, managing these injuries remains challenging due to the potential risk of femoral head avascular necrosis and concerns about fixation stability.</p><p><strong>Case presentation: </strong>An 8-year-old boy sustained a traumatic obturator hip dislocation and an ipsilateral subtrochanteric fracture following a fall from a height. Closed manual reduction of the hip dislocation was performed under general anesthesia, followed by internal fixation of the fracture using an adult proximal humerus locking plate. After 3 years of follow-up, the patient showed complete fracture healing and achieved a full, painless range of hip motion without any complications.</p><p><strong>Conclusion: </strong>This case describes a rare instance of traumatic obturator-type hip dislocation with an ipsilateral subtrochanteric femoral fracture in a child. It highlights an effective treatment approach for managing this complex injury.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"12 ","pages":"1531518"},"PeriodicalIF":1.6,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11868055/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540943","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":"Case Report: Intracranial ectopic schwannoma originating from the internal carotid artery wall.","authors":"Zhige Guo, Wahafu Alafate, Wu Gan","doi":"10.3389/fsurg.2025.1475191","DOIUrl":"10.3389/fsurg.2025.1475191","url":null,"abstract":"<p><p>This case report presents a rare instance of an ectopic schwannoma originating from the internal carotid artery wall in a 21-year-old male, initially misdiagnosed as an anterior clinoid meningioma. The patient presented with intermittent headaches and dizziness for over two years, aggravated for the past month. Brain MRI revealed a mass above the left side of the parasellar region, hypointense on T1-weighted images and heterogeneously hyperintense on T2-weighted and T2 FLAIR sequences. The operation involved a left frontotemporal craniotomy, and the tumor was found to be compressing and displacing the ipsilateral optic nerve and internal carotid artery. The tumor was completely resected, and postoperative MRI confirmed no residual tissue. Histopathological examination confirmed the diagnosis of schwannoma. This case is unique in its origin from the internal carotid artery wall and its favorable prognosis, with complete functional recovery and resolution of symptoms. The report emphasizes the importance of careful surgical approach and the excellent prognosis of paraclinoid region schwannomas.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"12 ","pages":"1475191"},"PeriodicalIF":1.6,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11865071/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143523285","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":"Case Report: Bicondylar conjoined Hoffa fracture with incarcerated patella.","authors":"Wissem Mansouri, Jean Darnaudet, Romain Huguet, Alban Fouasson-Chailloux, Vincent Crenn","doi":"10.3389/fsurg.2025.1480070","DOIUrl":"10.3389/fsurg.2025.1480070","url":null,"abstract":"<p><strong>Case: </strong>Hoffa fractures, uncommon injuries of the femoral condyle, sometimes involve both condyles, forming bicondylar fractures, typically from high-velocity trauma. We describe a 17-year-old male with an open conjoined bicondylar Hoffa fracture and a patellar fracture with incarceration following a road traffic accident. Emergency treatments included debridement, irrigation, and cannulated screw fixation. Postoperative care involved controlled range-of-motion exercises and specialized rehabilitation.</p><p><strong>Conclusion: </strong>Despite its rare and severe nature, this conjoined bicondylar Hoffa fracture with patellar incarceration was successfully managed, showing excellent recovery. CT scans are vital for accurate injury definition and surgical planning. Anatomical reduction and rigid fixation enable early mobilization and excellent long-term outcomes.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"12 ","pages":"1480070"},"PeriodicalIF":1.6,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11865261/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143523284","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":"Partial cricotracheal resection for treatment of subglottic stenosis: complications and outcomes.","authors":"Jeroen Meulemans, Laila Mouqni, Noah Ostyn, Davide Di Santo, Greet Hens, Vincent Vander Poorten, Christophe Dooms, Nico De Crem, Paul De Leyn, Ann Goeleven, Pierre Delaere","doi":"10.3389/fsurg.2025.1559943","DOIUrl":"10.3389/fsurg.2025.1559943","url":null,"abstract":"<p><strong>Purpose: </strong>Subglottic stenosis (SGS) is defined as an obstruction of the subglottic area, potentially extending towards the first tracheal rings. Although endoscopic procedures are frequently preferred as first-line treatment, (partial) cricotracheal resection (PCTR) offers the most durable results. This study aims at reporting and analysing complications and respiratory and vocal outcomes after PCTR.</p><p><strong>Methods: </strong>For this retrospective cohort analysis, the files of 37 patients with SGS who underwent PCTR in a tertiary referral center were reviewed. Patient- and stenosis-characteristics along with postoperative outcomes and complications were analyzed using descriptive statistics.</p><p><strong>Results: </strong>The majority of patients were female (95%), which reflects the high incidence of idiopathic SGS in our patient group (89.2% vs. 2.7% postintubation SGS and 8.1% SGS related to systemic inflammatory disease). Most patients presented with a Cotton grade II (35.1%) and III (54.1%) stenosis, with a mean craniocaudal stenosis length of 17.5 mm. The vast majority of patients (89.2%) had undergone previous endoscopic procedures. The most common complication after PCTR was fibrin deposit/granulation tissue formation at the anastomotic site (<i>n</i> = 15, 40.5%). Other complications were rare, with anastomotic dehiscence, postoperative haemorrhage and vocal cord paralysis each in 1 patient (2.7%), temporary tracheostomy in 2 patients (5.4%), and postoperative wound infection in 3 patients (8.1%). During follow-up, only 2 patients (5.4%) developed restenosis which was successfully salvaged by endoscopic procedures. No patients were long-term tracheostomy dependent. Post-operative mean peak expiratory flow (PEF) percentage showed a 43.7% increase compared to pre-operative. For the mean increase in maximum inspiratory flow (MIF) at 50% this was 1.3 L/s. VHI (voice handicap index) scores increased significantly from baseline preoperative score of 27.5 (±23.7) to a mean value of 54.9 (±18.7) (p = 0.002) 1-month postoperatively but decreased below preoperative scores after 2 years (22.2 ± 18.1, <i>p</i> = 0.036).</p><p><strong>Conclusion: </strong>PCTR is an efficient treatment for SGS, with low complication rates, a low rate of long-term restenosis and good vocal outcomes.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"12 ","pages":"1559943"},"PeriodicalIF":1.6,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11865094/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143523286","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":"Influence of spine biomechanics and sagittal balance on the outcome of lumbar discectomy.","authors":"José Poblete Carrizo, Jesús Martínez, Julio González, Alejandra Mosteiro, Ramon Torné, Alberto Di Somma, José Ríos, Joaquim Enseñat, Salvador Fuster","doi":"10.3389/fsurg.2025.1494780","DOIUrl":"10.3389/fsurg.2025.1494780","url":null,"abstract":"<p><strong>Purpose: </strong>Spine biomechanics, particularly sagittal balance and spino-pelvic angulation are determinant factors in the understanding of lumbar degenerative disease. These concepts translated into objective measurements are progressively being integrated into clinical practice. The present study explores them as prognostic factors in patients undergoing lumbar microdiscectomy, which could help identify those at higher risk of surgical failure.</p><p><strong>Methods: </strong>Prospective analysis of patients treated with lumbar microdiscectomy (<i>n</i> = 52) and healthy control subjects (<i>n</i> = 45) in a single tertiary centre. Follow up of 12 and 24 months after surgery, with radicular and lumbar pain evaluation according to the Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI). Comparison of several objective spinal biomechanic factors, measured by a single experienced radiologist. Assessment of spinal sagittal balance as a prognostic factor after lumbar discectomy.</p><p><strong>Results: </strong>Compared to healthy individuals, patients with symptomatic lumbar disc herniation showed lower thoracic kyphosis (39.03 vs. 34.42° <i>p</i> = 0.034), lower thoraco-lumbar transition T10-L2 angulation (6.79 vs. 2.08° <i>p</i> = 0.005), lower lumbar lordosis (59.54 vs. 48.36° <i>p</i> < 0.001) and lumbo-sacral angulation L4-S1 (40.20 vs. 29.16° <i>p</i> < 0.001), lower pelvic incidence (54.71vs 49.86° <i>p</i> = 0.014) and lower sacral slope (42.07 vs. 33.34° <i>p</i> < 0.001). Sagittal balance (SVA) was negative in healthy subjects -3.09 mm and positive lumbar-disc patients 15.04 (<i>p</i> = 0.013). Noteworthy, the radicular and lumbar pain and disability outcomes 12 and 24 months after surgery were significantly better in the group with normal sagittal balance (ODI 14.52 vs. 40.06 <i>p</i> < 0.001; radicular VAS 2.74 vs. 5.58 <i>p</i> < 0.001; lumbar VAS 3.61 vs. 4.06 <i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>Lumbar degenerative disc disease represents a major burden for healthcare systems; thus, its management is determinant. Lumbar discectomy shows overall positive results, with a significant reduction of pain and disability in the majority of cases. However, a subgroup of patients, still not well defined, may experience persistent pain after the intervention. The use of objective measurements of sagittal balance may help identify these patients for which simple discectomy may not suffice and contribute to treatment planification.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"12 ","pages":"1494780"},"PeriodicalIF":1.6,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11861076/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143515321","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":"Septoplasty: defining a desirable clinical outcome according to baseline symptom scores.","authors":"Rolf Haye, Liv Kari Døsen, Magnus TarAngen, Caryl Gay, Are Hugo Pripp, Olga Shiryaeva","doi":"10.3389/fsurg.2025.1471526","DOIUrl":"10.3389/fsurg.2025.1471526","url":null,"abstract":"<p><strong>Objective: </strong>The results of septoplasty are usually reported as statistically significant improvements in baseline scores, but these may be difficult to interpret clinically. A measure called the desirable clinically important difference (DCID) has been developed to serve as a guideline to assist in clinically interpreting improvement in scores. So far, DCID has only been calculated for whole cohorts. As individual patients have different baseline and improvement scores, such measures are not helpful to individuals. Our aim was to establish a DCID according to baseline scores, which should help assess individual results.</p><p><strong>Methods: </strong>Patients (<i>n</i> = 934) rated their nasal obstruction using a visual analog scale (VAS) preoperatively and 6 months postoperatively. A global rating of outcome (categorized as completely, much, or somewhat improved, unchanged, or worse) served as the anchor for postoperative evaluation. The improvement in VAS score corresponding to the \"much improved\" rating was defined as the borderline value between \"much\" and \"somewhat improved.\" Receiver operating characteristics were used to establish this borderline value. The DCID is the difference between the borderline and baseline VAS scores. The relative DCID is calculated by dividing the numeric DCID by the baseline VAS score. The cohort was divided into three subgroups (moderate, severe, very severe) according to preoperative severity of nasal obstruction (VAS score) for assessing the relation between DCID and baseline obstruction severity.</p><p><strong>Results: </strong>The DCID increased with increasing severity of baseline nasal obstruction: 27.5 (moderate), 44.5 (severe), and 56.0 (very severe), as did the relative DCID: 49.6% (moderate), 56.8% (severe), and 61.3% (very severe).</p><p><strong>Conclusion: </strong>The relative DCID can be a guide for assessing improvement following septoplasty according to baseline scores of nasal obstruction and for planning surgery. A 49% improvement from baseline is indicative of clinical success for a patient with moderately obstructed nasal breathing, whereas patients with very severe obstruction require a 61% improvement.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"12 ","pages":"1471526"},"PeriodicalIF":1.6,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11860878/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143515337","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":"Laparoscopic suture repair for perforated peptic ulcer disease: a meta-review and trial sequential analysis.","authors":"S I Panin, T V Nechay, I V Sazhin, K Yu Melnikov-Makarchuk, A V Sazhin, A V Puzikova, A N Akinchits, A V Bykov","doi":"10.3389/fsurg.2025.1496192","DOIUrl":"10.3389/fsurg.2025.1496192","url":null,"abstract":"<p><strong>Background: </strong>The number of systematic reviews (SRs) and meta-analyses in surgery is growing exponentially. Meta-epidemiology, as a form of evidence synthesis, allows for the pooling of data and assessment of the diversity present in multiple and overlapping SRs.</p><p><strong>Aim of the research: </strong>This study aimed to summarize evidence from systematic reviews of randomized controlled trials and reanalyze outcome data on laparoscopic suture repair of perforated peptic ulcers using trial sequential analysis (TSA).</p><p><strong>Materials and methods: </strong>The Cochrane Library, PubMed, Embase, CINAHL, eLibrary, and ClinicalTrials.gov were searched before 1 June 2024. A meta-epidemiological approach and TSA were used.</p><p><strong>Results: </strong>In total, 16 relevant Cochrane and non-Cochrane SRs that addressed laparoscopic repair of perforated peptic ulcers (PPUs) were identified and critically appraised. Three overlapping reviews of RCTs met the inclusion criteria. Their pooled results showed a lower postoperative pain score after laparoscopic repair compared with open closure on postoperative day 1 as the only significant outcome. There were no significant differences in other clinical outcomes. The re-analyses of meta-analytic findings and adjustments of sample size by TSA confirmed that laparoscopic repair was associated with less postoperative pain [100% of the diversity-adjusted required information size (DARIS) was reached]. The calculated DARIS for operative time and hospital stay were 40.1% and 14.6%, respectively, and the TSA showed neither significant benefit nor harm of laparoscopic surgery in the attained information size in the meta-analysis. Further trials with regard to mortality, surgical site infection, and intra-abdominal abscess are not very promising because the DARIS did not exceed 5% after combining the results of eight RCTs.</p><p><strong>Conclusion: </strong>Summarization of evidence from systematic reviews and reanalysis using TSA confirmed sufficient evidence for only one outcome, namely, that laparoscopic suture repair of PPUs is accompanied by lower pain scores at 24-72 h. Regarding the issues of postoperative complications and mortality, achieving DARIS through additional studies seems unpromising.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"12 ","pages":"1496192"},"PeriodicalIF":1.6,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11861353/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143515324","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}