Langenbeck's Archives of Surgery最新文献

{"title":"Intraoperative biodegradable stent placement to reduce complications after pancreatoduodenectomy - Interim results from a randomised clinical trial.","authors":"Waqas Farooqui, Jan Henrik Storkholm, Paul Suno Krohn, Luit Penninga, Christian Snitkjaer, Stefan Kobbelgaard Burgdorf","doi":"10.1007/s00423-026-04072-9","DOIUrl":"https://doi.org/10.1007/s00423-026-04072-9","url":null,"abstract":"<p><strong>Introduction: </strong>Postoperative pancreatic fistula (POPF) remains a major cause of morbidity after pancreatoduodenectomy (PD), with an incidence of more than 30% in patients with small pancreatic ducts. Evidence supporting preventive measures remains limited. Biodegradable stent placement across the pancreaticojejunostomy (PJ) may reduce the POPF. This study represents the first randomised controlled trial evaluating biodegradable stents in patients with high-risk pancreaticojejunostomies.</p><p><strong>Methods: </strong>This single centre, patient- and assessor-blinded, randomised clinical trial included patients undergoing PD with a main pancreatic duct < 5 mm. Patients were randomised 1:1 to receive a fast-degrading (12-day) ARCHIMEDES biodegradable stent or no stent. The primary endpoint was Clinically relevant postoperative pancreatic fistula CR-POPF. Secondary outcomes included biliary leakage, major complications (Clavien-Dindo ≥ III), length of stay, readmission, and mortality.</p><p><strong>Results: </strong>In this interim analysis, 50 patients were randomised (26 received a stent, 24 no-stent). Baseline characteristics including Fistula Risk Score (FRS) were comparable. Patients were mainly operated for malignancies. CR-POPF incidence was lower in stent-group compared to no-stent group. However, this difference was not significant (11,50% vs. 25%, p = 0,20). Biliary leakage and intraoperative blood loss were similar between groups. Two cases of mild, self-limiting postoperative pancreatitis occurred in the stent group. No 30- or 90-day mortality was observed. Median length of stay and readmission rates did not differ significantly.</p><p><strong>Conclusion: </strong>Interim results from the first blinded, randomised trial with a biodegradable stent, showed no significant reduction in CR-POPF, but a trend towards reducing them. Completing the inclusion and initiating larger multicentre trials are needed to clarify its clinical benefit.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High interobserver reliability of neutrophil phenotyping based on visual determination of CD16/CD62L expression patterns.","authors":"Christian Thomas Hübner, Emma de Fraiture, Frederique van Eerten, Felix Karl-Ludwig Klingebiel, Nathalie Piaz, Hans-Christoph Pape, Leo Koenderman, Michel Paul Johan Teuben, Falco Hietbrink","doi":"10.1007/s00423-026-04074-7","DOIUrl":"https://doi.org/10.1007/s00423-026-04074-7","url":null,"abstract":"<p><strong>Introduction: </strong>Analysis of neutrophil surface expression markers offers relevant insights into the inflammatory response following trauma. Recently a neutrophil phenotype classification based on CD16 and CD62L expression has been established. A seven-category visual classification system based on pattern recognition has been introduced for bedside use, but interobserver reliability has not been assessed to date.</p><p><strong>Methods: </strong>In this study, 40 participants with varying medical backgrounds were asked to classify 50 CD16/CD62L dot plots using the seven-category scoring system. Participants received a standardized instruction manual for pattern recognition and category classification. Classification accuracy was compared to a predefined gold standard, and interobserver agreement was assessed using Fleiss' Kappa. Additionally, categories were grouped into \"low\" (0-3) and \"high\" (4-6) inflammatory states to evaluate clinical applicability.</p><p><strong>Results: </strong>Agreement across the seven-category scale was moderate overall (κ = 0.473), with higher consistency observed in more extreme phenotypes. Categories 0, 1, and 3 were most frequently confused, whereas plots obtained during severe inflammation (4, 5, 6) were rarely misclassified as non-inflammatory. When grouped into binary low versus high inflammatory states, agreement improved to almost perfect (κ = 0.836).</p><p><strong>Discussion: </strong>Binary classification of neutrophil phenotypes, and thus identification of severe inflammation after trauma, is reliable across different observer levels and appears well suited for clinical application. The full seven-category scoring system offers greater resolution but shows higher interobserver variability. These findings support the use of simplified immune phenotyping at the bedside, while preserving the full classification system for research settings.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical application of disposable tracheostomy cannulae.","authors":"Qianqin Gao, Yafang Wang, TingTing Guo, Xiaochun Wang, HuiHui Hu, Jisong Zhang, Guimei Wang, Enguo Chen","doi":"10.1007/s00423-026-04070-x","DOIUrl":"https://doi.org/10.1007/s00423-026-04070-x","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the clinical application value of a novel disposable cuffless tracheostomy cannula during the decannulation transition period in high-risk patients, and to evaluate its efficacy and safety in maintaining airway patency, reducing decannulation-related risks, and improving patient outcomes.</p><p><strong>Methods: </strong>This study was a prospective observational study enrolling 35 patients with high-risk airways admitted between June 2023 and April 2025. All patients had a history of tracheostomy and had been weaned from mechanical ventilation. According to clinical conditions, the disposable cuffless tracheostomy cannula was inserted as a transitional airway support after removal of T-tubes, tracheal stents, metal cannulas, or endotracheal tubes. Routine capping observation was performed for 48-72 h postoperatively, and the device was removed after tolerance assessment. The primary outcome was decannulation success rate; secondary outcomes included the incidence of airway events requiring reintervention at 30 days, 90 days, and during long-term follow-up after decannulation.</p><p><strong>Results: </strong>Among the 35 patients, the pre-insertion statuses were as follows: T-tube placement in 10 cases, metal cannula in 21 cases, endotracheal tube in 2 cases, and spontaneous breathing via nose and mouth in 2 cases. The disposable cannula was successfully removed with complete weaning from the artificial airway in 32 patients, yielding a decannulation success rate of 91.4%. Three patients developed dyspnea within 72 h after removal of the disposable cannula and were defined as decannulation failure, caused by upper tracheal stenosis and hypoxemia due to sputum obstruction. Among the 32 successfully decannulated patients, the median follow-up duration was 9 months. During follow-up, 8 patients (25%) developed recurrent airway stenosis requiring reintervention, with a median onset time of 16 days (range: 1-75 days) after decannulation; the remaining 24 patients maintained airway patency without further intervention.</p><p><strong>Conclusion: </strong>The disposable cuffless tracheostomy cannula demonstrates high clinical value during the decannulation transition period in high-risk patients. It provides a safe transitional window for unstable airway conditions after decannulation, effectively identifying patients at risk of acute decompensation and avoiding severe airway events caused by direct decannulation. The device is easy to operate, minimally invasive, and preserves phonation function, making it suitable for high-risk populations with tracheal stenosis, repeated intubation history, and removal of airway supports. Further validation of its application value and scope in larger samples and multidisciplinary populations is warranted.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of preoperative skeletal muscle mass on the healing time of postoperative pancreatic fistula after pancreaticoduodenectomy.","authors":"Takuro Takeuchi, Yoshito Tomimaru, Hirofumi Akita, Yosuke Mukai, Kazuki Sasaki, Shinichiro Hasegawa, Daisaku Yamada, Takehiro Noda, Yuichiro Doki, Hidetoshi Eguchi","doi":"10.1007/s00423-026-04029-y","DOIUrl":"https://doi.org/10.1007/s00423-026-04029-y","url":null,"abstract":"<p><strong>Background: </strong>Postoperative pancreatic fistula (POPF) is a serious complication following pancreaticoduodenectomy (PD). While numerous studies have investigated POPF incidence and risk factors, few have focused on POPF healing time (POPF-HT). Skeletal muscle mass has been increasingly recognized as an endocrine organ involved in interorgan communication. The aim of this study was to evaluate how skeletal muscle mass influenced the healing time of POPF after PD.</p><p><strong>Methods: </strong>This investigation included patients who developed POPF of grade B-C after PD with pancreaticojejunostomy during the study period. POPF-HT was defined as the duration from the date of PD to the removal of all drains placed for POPF treatment. Skeletal muscle mass was assessed based on preoperative computed tomography images. Clinical factors associated with POPF-HT were analyzed, including skeletal muscle index (SMI).</p><p><strong>Results: </strong>The mean POPF-HT was 40 ± 15 days (median: 37 days; range: 21-105 days). Compared to those with high SMI, patients with low SMI had a significantly longer POPF-HT (46 ± 18 days vs. 37 ± 11 days, p = 0.0101). In univariate analysis, low SMI was significantly associated with prolonged POPF-HT (hazard ratio: 0.5655, 95% confidence interval: 0.3687-0.8673, p = 0.0090). Kaplan-Meier curves confirmed that patients with low SMI exhibited significantly delayed cumulative POPF healing (p = 0.0065).</p><p><strong>Conclusion: </strong>Decreased skeletal muscle mass is significantly associated with prolonged POPF-HT after PD. Therefore, preoperative SMI may serve as a potentially modifiable factor associated with POPF-HT.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of adding a superficial parasternal intercostal plane block to the serratus anterior plane block on postoperative analgesic outcomes in breast cancer surgery: a prospective, randomized, double-blind trial.","authors":"Fazil Ahmet Akbulut, Hüsnü Kürşad, Muhammed Emin Sözüak, Ali Ahiskalioglu","doi":"10.1007/s00423-026-04065-8","DOIUrl":"https://doi.org/10.1007/s00423-026-04065-8","url":null,"abstract":"<p><strong>Background: </strong>Breast cancer surgery is frequently associated with moderate to severe postoperative pain. While the serratus anterior plane block (SAPB) provides effective anterolateral chest wall analgesia, it may inadequately cover the anterior intercostal nerve branches. This study aimed to determine whether adding a superficial parasternal intercostal plane block to SAPB improves postoperative opioid consumption, pain scores, and dermatomal sensory coverage.</p><p><strong>Methods: </strong>In this prospective, randomized, double-blind trial, 64 patients aged 18-65 years undergoing elective breast surgery were randomly allocated into two groups. Group S (n = 32) received a preoperative SAPB with 30 mL of 0·25% bupivacaine combined with a parasternal injection of 10 mL saline. Group S + P (n = 32) received a SAPB with 30 mL of 0·25% bupivacaine plus a parasternal block with 10 mL of 0·25% bupivacaine. All patients were managed with an identical multimodal postoperative analgesia protocol. The primary outcome was postoperative opioid consumption. Secondary outcomes included visual analogue scale (VAS) pain scores, dermatomal sensory analysis and side effects.</p><p><strong>Results: </strong>Baseline demographic characteristics and surgical variables were comparable between groups (p > 0·05). Sensory blockade of the T3, T4, and T5 dermatomes was significantly more frequent in the S + P group than in the S group (p < 0·05). However, postoperative VAS pain scores at rest and during movement, as well as total opioid consumption, were comparable between groups (p > 0·05).</p><p><strong>Conclusions: </strong>Although the addition of a superficial parasternal intercostal plane block to SAPB resulted in wider anterior chest wall dermatomal coverage, it did not confer additional benefit in terms of postoperative pain scores or opioid consumption under a multimodal analgesia regimen. These findings suggest that SAPB-based strategies, when combined with systemic analgesics, may provide sufficient postoperative analgesia in patients undergoing mastectomy.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advanced liver dissection with left triangular ligament section for enhanced surgical access to right posterior lesions.","authors":"Quentin Chenevas-Paule, Sarah Moenne-Loccoz, Giorgio Bianchi, Alexandre Lamercerie, Julio Abba, Mircea Chirica, Edouard Girard","doi":"10.1007/s00423-026-04044-z","DOIUrl":"https://doi.org/10.1007/s00423-026-04044-z","url":null,"abstract":"<p><strong>Background: </strong>Laparoscopic liver resection (LLR) has gained worldwide acceptance over the past decade, though its adoption remains incomplete due to technical challenges. These challenges, particularly in replicating traditional open surgery techniques, make controlling hemostasis and liver mobilization more difficult. The IWATE scoring system classifies the complexity of LLR, with expert-level procedures involving difficult-to-access segments. This study investigates whether extensive dissection around the inferior vena cava (IVC), including sectioning the left triangular ligament, improves liver rotation and access to right posterior lesions, potentially enhancing surgical exposure in LLR.</p><p><strong>Methods: </strong>Dissections were performed at the Laboratory of Anatomy of the French Alps University. A formalin-preserved cadaveric model was developed to establish steps for liver dissection and liver rotation measurement, considering the inferior vena cava (IVC) as the vertical axis. Three key dissection steps were defined, focusing on the ligaments and the IVC. Liver rotation was measured using 30 newtons traction applied via the round ligament.</p><p><strong>Results: </strong>30 dissections were conducted. The rotation angles, measured before and during the three surgical dissection steps, progressively increased with median values of 36°, 45°, 71°, and 87°. Angulation gains of 9° [6-13], 19° [17-31], and 13° [10-21] were observed between each surgical step, with a negative correlation found between liver weight and the angle of rotation during the later steps.</p><p><strong>Conclusions: </strong>Extensive dissection of the IVC, combined with sectioning of the left triangular ligament, is a useful surgical maneuver to increase liver rotation, providing better access to posterior liver segments during laparoscopy.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contemporary management pathways in liver trauma: predominant and successful use of non-operative strategies at a high-volume tertiary center.","authors":"Bruno Cirillo, Gioia Brachini, Roberto Cirocchi, Chiara Tranfaglia, Andrea Mingoli, Lina De Paola, Eleonora Lori, Salvatore Sorrenti, Antonio Pesce","doi":"10.1007/s00423-026-04051-0","DOIUrl":"https://doi.org/10.1007/s00423-026-04051-0","url":null,"abstract":"","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147775461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In-hospital outcomes following sleeve gastrectomy and Roux-en-Y gastric bypass: a real-world multicenter study in Germany.","authors":"Sarah Krieg, Claus F Eisenberger, Andreas Krieg, Karel Kostev","doi":"10.1007/s00423-026-04064-9","DOIUrl":"10.1007/s00423-026-04064-9","url":null,"abstract":"","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"411 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13133212/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147775207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Observation of patency rates in patients with arteriovenous fistula stenosis treated with paclitaxel-coated high-pressure balloon angioplasty.","authors":"Wenbin Mao, Xiaoping Li","doi":"10.1007/s00423-026-04000-x","DOIUrl":"https://doi.org/10.1007/s00423-026-04000-x","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to observe the patency outcomes in patients with arteriovenous fistula (AVF) stenosis treated with paclitaxel-coated high-pressure balloon angioplasty.</p><p><strong>Methods: </strong>Eighty patients with AVF stenosis were randomly assigned to two groups (n = 40 each). The control group underwent conventional balloon angioplasty, while the observation group received paclitaxel-coated high-pressure balloon angioplasty. Baseline characteristics were recorded. Changes in vascular diameter, dialysis blood flow, and peak systolic velocity at the stenotic site were compared pre- and post-treatment. Surgical success rate and restenosis rates were recorded. Fistula patency was followed at multiple postoperative time points, and postoperative quality of life was assessed using the WHOQOL-BREF scale.</p><p><strong>Results: </strong>Baseline characteristics were comparable between the two groups (P > 0.05). Following the treatment, the observation group demonstrated greater improvements in vascular diameter, dialysis blood flow, and peak systolic velocity than the control group (P < 0.05). Although technical success did not differ markedly, the observation group experienced a lower rate of restenosis (P < 0.05). Fistula patency rates at 3-9 months postoperatively showed no significant difference (P > 0.05), but at 12 months, the observation group exhibited higher patency rates (P < 0.05). Postoperative quality-of-life scores were higher in the observation group (P < 0.05).</p><p><strong>Conclusion: </strong>Paclitaxel-coated high-pressure balloon angioplasty may offer notable benefits for AVF stenosis, including enhanced long-term patency, and reduced restenosis, ultimately contributing to better patient-reported quality of life.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ropivacaine with dexmedetomidine in a thoracic paravertebral nerve block for prolongation of operative analgesia in thoracic orthopaedic patients.","authors":"Hongquan Jin, Tianfang Qu, Shuang Li, Jiayu Xu, Yi Lin","doi":"10.1007/s00423-026-04059-6","DOIUrl":"https://doi.org/10.1007/s00423-026-04059-6","url":null,"abstract":"","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}