Langenbeck's Archives of Surgery最新文献

{"title":"Outcome after vacuum-assisted closure in patients with anorectal malformations-a multi-center comparative study.","authors":"L-M Borsch, M Bouzidi, B Ludwikowski, M Bottländer, L Wennemann, J Dingemann, N Schukfeh","doi":"10.1007/s00423-026-04334-6","DOIUrl":"10.1007/s00423-026-04334-6","url":null,"abstract":"<p><strong>Purpose: </strong>In patients with anorectal malformations (ARM), perineal wound complications following posterior sagittal anorectoplasty (PSARP) remain a challenge with an occurrence of 22%-43%. In adults, vacuum-assisted closure (VAC) aims to support wound healing after colorectal procedures. In children evidence is limited, suggesting a potential benefit of VAC therapy after PSARP. We aimed to evaluate the impact of VAC therapy on outcomes after PSARP in a multicenter comparative study.</p><p><strong>Methods: </strong>All consecutive patients who underwent PSARP from 01/2018-12/2025 in two participating pediatric surgical departments were included. Complications including postoperative perineal wound dehiscence were analyzed. The study was approved by the local ethics committee (approval number: 12354-BO-K-2026).</p><p><strong>Results: </strong>48 patients were included: 26 with and 22 without VAC therapy. Baseline characteristics, follow-up duration and the interval until first follow-up were comparable between cohorts respectively. Postoperative outcomes did not differ significantly between groups. Stool smearing occurred in none of the patients in the VAC cohort and in one patient in the non-VAC cohort (p > 0.99). No incontinence was observed in either cohort (p > 0.99). Perineal wound dehiscence occurred in two patients (8%) in the VAC and in one (5%) in the non-VAC cohort (p > 0.99).</p><p><strong>Conclusion: </strong>In our study, VAC therapy was associated with comparable rates of postoperative wound dehiscence after PSARP compared to the non-VAC cohort and to previous reports. Larger, prospective studies are required to confirm our findings.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"411 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13676629/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149216425","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":"Ex-vivo right posterior sectionectomy for large-for-size mismatch in pediatric liver transplant recipients.","authors":"Andrea Della Penna, Steffen Hartleif, Markus Quante, Silvio Nadalin","doi":"10.1007/s00423-026-04320-y","DOIUrl":"10.1007/s00423-026-04320-y","url":null,"abstract":"<p><strong>Purpose: </strong>Large-for-size mismatch remains a major challenge in pediatric and small recipient liver transplantation, particularly when full-size deceased-donor grafts are allocated and conventional splitting is not feasible.</p><p><strong>Methods: </strong>We performed a single-center retrospective analysis of seven pediatric and adolescent recipients who underwent deceased donor liver transplantation (DDLT) with ex-vivo right posterior sectionectomy (RPS) between 2018 and 2022. Grafts were considered oversized based on an integrated surgical assessment including graft-to-recipient weight ratio (GRWR), recipient abdominal anatomy, graft morphology, and expected graft fit.</p><p><strong>Results: </strong>Median GRWR decreased from 4.7% to 2.2%, allowing graft implantation in all cases. Primary abdominal closure was achieved in six recipients, while one required delayed closure for large-for-size syndrome (LFS). No cases of severe LFS with hemodynamic, ventilatory, or graft perfusion compromise were observed. Major complications occurred in three patients, including one biliary complication requiring surgical revision, one primary graft failure requiring retransplantation, and one death unrelated to graft size or transplant surgery. At a median follow-up of 59.5 months among surviving recipients, six of seven patients were alive; five retained their original graft, while one was alive with a functioning second graft after retransplantation.</p><p><strong>Conclusion: </strong>Ex-vivo RPS appears to be a technically feasible rescue graft reduction strategy in highly selected pediatric recipients when conventional graft reduction techniques are not feasible. Given the limited cohort size and the occurrence of primary graft failure and mortality, its safety and efficacy require further evaluation.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"411 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13669043/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182845","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":"Clarifying statistical comparisons and procedural change in the TAPP learning curve.","authors":"Tuğberk Tok, Ahmet Furkan Mazlum","doi":"10.1007/s00423-026-04335-5","DOIUrl":"10.1007/s00423-026-04335-5","url":null,"abstract":"<p><strong>Purpose: </strong>To clarify the interpretation of chronological changes reported in a recent study of laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair.</p><p><strong>Methods: </strong>We reconstructed selected contingency tables using only aggregate counts reported in the published article. These calculations do not reproduce the original patient-level analysis. We also considered how concurrent changes in operative practice may contribute to the interpretation of decreasing operative time.</p><p><strong>Results: </strong>For complications occurring in 8, 4, and 2 of 42 patients across the three phases, the published counts yield an overall Pearson chi-square p = 0.105 and a two-sided Fisher-Freeman-Halton exact p = 0.135, whereas the article reports p = 0.048. An ordered trend remains detectable (p = 0.038), consistent with a temporal decline in complications. Operative time also decreased substantially across phases. Concurrent reduction in mesh fixation may have contributed to, but does not negate, this improvement.</p><p><strong>Conclusion: </strong>The published aggregate data warrant clarification of the statistical procedure underlying the reported overall comparison. Distinguishing overall group differences from ordered temporal trends and considering concurrent procedural adaptation may refine interpretation of the observed learning process.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"411 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652919/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149149333","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":"Neuromonitoring of perioperative microembolization and its association with postoperative stroke after carotid endarterectomy.","authors":"Mohammed Al-Falahi, Jelle Frankort, Gabriel Schima, Bernhard Hruschka, Quentin Cappel, Werner Mess, Christian Uhl, Alexander Gombert, Panagiotis Doukas","doi":"10.1007/s00423-026-04324-8","DOIUrl":"https://doi.org/10.1007/s00423-026-04324-8","url":null,"abstract":"<p><strong>Purpose: </strong>This study aims to assess whether perioperative microembolization can identify patients at risk for postoperative stroke.</p><p><strong>Methods: </strong>A total of 257 carotid endarterectomy procedures in 254 patients were analyzed (154 symptomatic, 103 asymptomatic). Neuromonitoring, combining transcranial Doppler ultrasonography and continuous electroencephalography, was utilized to evaluate cerebral perfusion and detect microembolic signals (MES). Monitoring covered the entire intraoperative phase and a standardized 20-minute postoperative observation window.</p><p><strong>Results: </strong>Postoperative stroke occurred in seven patients, six of whom were symptomatic prior to the procedure. In exploratory penalized regression analyses, higher postoperative MES counts (OR 1.02 per MES, 95% CI 1.01-1.04; p < 0.001) and an intraoperative burden of ≥ 10 MES (OR 6.06, 95% CI 1.40-34.78; p = 0.016) were associated with postoperative stroke. Symptomatic patients exhibited a significantly higher embolic burden (6.7 ± 13.3 vs. 2.2 ± 5.0, p = 0.004).</p><p><strong>Conclusion: </strong>Beyond its role in guiding selective shunting, transcranial Doppler monitors the occurrence of microembolization, which could serve as a potential indicator of perioperative stroke. In this exploratory analysis, both an intraoperative burden of 10 or more MES and sustained postoperative microembolization were associated with postoperative stroke. Given the low number of events, these findings are hypothesis-generating and require prospective validation before they can guide perioperative management.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"411 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13653865/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149166410","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":"Comparison of the short-term efficacy of percutaneous endoscopic transforaminal lumbar interbody fusion with the application of a expandable versus PEEK cage for the treatment of lumbar degenerative disease.","authors":"Hao Han, Qi Lu, Yu Kong, Yiming Li, Weiqing Kong, Jie Li, Long Yang, Guangchao Cao","doi":"10.1007/s00423-026-04326-6","DOIUrl":"10.1007/s00423-026-04326-6","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aimed to compare the short-term clinical efficacy of percutaneous endoscopic transforaminal lumbar interbody fusion (PE-TLIF) using expandable cages versus conventional static polyetheretherketone (PEEK) cages in the treatment of lumbar degenerative disease (LDD).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A total of 67 patients diagnosed with lumbar degenerative disease who underwent PE-TLIF treatment at Xuzhou Central Hospital between February 2020 and December 2023 were enrolled for retrospective analysis. All patients were stratified into two groups based on the type of interbody fusion cage implanted: the expandable cage group (n = 31) and the conventional static PEEK cage group (n = 36). In the expandable group, the cohort consisted of 17 males and 14 females with a mean age of 62.48 ± 7.33 years, while the static group included 14 males and 22 females with a mean age of 60.89 ± 7.56 years. Perioperative indicators including operation duration, intraoperative blood loss, postoperative drainage volume, and postoperative hospital stay were systematically documented and compared between the two groups, and surgical complications were continuously monitored and recorded. For clinical functional assessment, the visual analog scale (VAS) for low back and leg pain and the Oswestry Disability Index (ODI) were evaluated preoperatively, as well as at 1 day, 1 month, 6 months, and 1 year postoperatively. Radiological parameters, including intervertebral disc height (IDH), intervertebral foraminal height (IFH), segmental surgical lordosis (SSL), and lumbar lordosis (LL), were measured before surgery and at the 1-year postoperative follow-up. The Bridwell fusion grading system was adopted to assess the status of intervertebral fusion at the final follow-up, and the modified MacNab criteria were utilized to comprehensively evaluate the overall clinical therapeutic efficacy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;There were no statistically significant differences in the general information of gender, age, surgical segment, and BMI between the expandable group and the static group (all P&gt;0.05). The differences between the two groups were not statistically significant in terms of operative time, intraoperative hemorrhage, postoperative drainage and postoperative hospitalization time (all P&gt;0.05). The low back pain VAS scores of both groups improved at all follow-up time points after operation compared to the preoperative period, and the low back pain VAS scores were lower in the expandable group than in the static group at 1 day and 1 month after operation, and the differences between the two groups were not statistically significant when comparing the other time points. The VAS scores of lower limb pain in both groups at each postoperative follow-up time points were improved compared with the preoperative period in both groups (P&lt;0.0001) and the differences in lower limb pain VAS scores between the two groups at all postoperative t","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"411 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13649943/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137216","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":"External validation of the Pre-operative Predictive (PROP) score for feasibility of complete cytoreduction in colorectal peritoneal metastases: a single-centre experience.","authors":"Christoph Steidle, Can Yurttas, Marco Huth, Arnold Radtke, Jan Keck, Philipp Horvath","doi":"10.1007/s00423-026-04306-w","DOIUrl":"10.1007/s00423-026-04306-w","url":null,"abstract":"<p><strong>Purpose: </strong>Colorectal peritoneal metastases (PM) remain a major therapeutic challenge. Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) offers prolonged survival in selected patients. Accurate preoperative assessment of resectability is crucial to avoid non-beneficial surgery. The Preoperative Predictive Score (PROP) integrates nine preoperative clinical and radiologic parameters to predict the completeness of cytoreduction (CC). This study aimed to externally validate the PROP Score in an independent European single-centre cohort.</p><p><strong>Methods: </strong>63 Patients undergoing CRS ± HIPEC for colorectal PM between 2012 and 2022 were retrospectively analysed. PROP scores were calculated from preoperative data and compared with intraoperative CC scores (CC-0, CC-1, CC-2/3). Statistical analysis included χ², Spearman correlation, and receiver operating characteristic (ROC) curve evaluation.</p><p><strong>Results: </strong>Sixty-three patients were included (CC-0 = 41; CC-1 = 13; CC-2/3 = 9). Median PROP values increased with lower resectability (3.4 vs. 7.2 vs. 10.8; p < 0.001). A cutoff ≥ 6 predicted incomplete cytoreduction with 78% sensitivity and 90% specificity (AUC = 0.919). PROP correlated strongly with the Peritoneal Cancer Index (ρ = 0.673; p < 0.001). No 30- or 90-day mortality was observed.</p><p><strong>Conclusion: </strong>The PROP Score reliably predicts the likelihood of complete cytoreduction in colorectal PM using solely preoperative parameters. Moreover it is the first score which is able to preoperatively discriminate patients with a future CC-0 und CC-1 resection. Its external validation supports evidence-based patient selection for CRS ± HIPEC, optimizing surgical decision-making and resource utilization.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"411 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652938/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149147552","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":"Weight-loss and body-composition trajectories after bariatric surgery may follow different timelines.","authors":"Roberta Albanese, Federica Tomaselli, Damiano Tambasco","doi":"10.1007/s00423-026-04279-w","DOIUrl":"10.1007/s00423-026-04279-w","url":null,"abstract":"<p><p>Weight stability is commonly used as a practical marker after bariatric surgery and may influence the timing of subsequent elective procedures. Recent longitudinal body-composition data show that changes in body weight, fat mass, fat-free mass, skeletal muscle mass, and phase angle may follow non-parallel temporal trajectories. These observations describe body-composition remodeling but do not establish that physiological recovery follows the same pattern or that body-composition measures can define readiness for further surgery. Whether persistent changes in these parameters correspond to clinically meaningful differences in nutritional reserve, muscle function, resilience to operative stress, or postoperative risk remains uncertain. Evidence of differential remodeling of adipose and skeletal muscle compartments, together with recognized nutritional deficiencies after bariatric surgery, provides a rationale for further investigation. Future longitudinal studies should integrate body composition with muscle strength, physical performance, dietary intake, inflammatory markers, objective activity measures, and postoperative outcomes. Such studies could determine whether physiological recovery has a timeline distinct from weight stabilization and whether a multidimensional assessment may eventually improve evaluation before subsequent elective surgery.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"411 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13646013/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127943","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":"Survival outcomes following total intravenous versus volatile anesthesia in esophagogastric cancer surgery: a systematic review and meta-analysis.","authors":"Efstathia Liatsou, Alexandra Pliakopanou, Dimitrios Liatsos, Elisabeth Nagy, Ioannis Karniadakis, Kaveh Khodakaram, Dimitrios Schizas, Ioannis Rouvelas","doi":"10.1007/s00423-026-04329-3","DOIUrl":"10.1007/s00423-026-04329-3","url":null,"abstract":"<p><strong>Purpose: </strong>Esophagogastric cancers remain among the leading causes of cancer-related mortality worldwide. Surgical resection represents the primary curative treatment strategy; however, perioperative factors may influence long-term oncological outcomes. Experimental and clinical evidence suggests that anesthetic techniques may affect tumor progression and recurrence through immunological and oncological pathways. Total intravenous anesthesia (TIVA) has been proposed to exert immunomodulatory and antitumor effects compared to volatile anesthesia (VA), although evidence remains inconclusive. This systematic review and meta-analysis aimed to evaluate the impact of TIVA versus volatile anesthesia on survival outcomes in patients undergoing esophagogastric cancer surgery.</p><p><strong>Methods: </strong>A systematic review and meta-analysis was conducted according to PRISMA 2020 guidelines. PubMed and Scopus were searched for studies published between 2010 and 2025 comparing TIVA with volatile anesthesia in adult patients undergoing curative surgery for esophageal or gastric cancer. The primary outcome was overall survival (OS). Secondary outcomes included recurrence-free survival (RFS), early mortality, operation time, and postoperative hospital stay. Pooled hazard ratios (HR), risk ratios (RR), and mean differences (MD) with 95% confidence intervals (CI) were calculated using random-effects models.</p><p><strong>Results: </strong>Thirteen studies (3 randomized controlled trials and 10 retrospective studies) involving 264,543 patients were included. Of these, 41,977 patients received TIVA and 222,566 received volatile anesthesia. Pooled analysis of eight studies demonstrated significantly improved overall survival with TIVA (HR 0.80, 95% CI 0.69-0.93; p = 0.003). Subgroup analysis showed a significant survival benefit in patients undergoing gastrectomy (HR 0.74, 95% CI 0.60-0.91; p < 0.004), whereas no significant difference was observed for esophagectomy (HR 0.89, 95% CI 0.73-1.10; p = 0.29). TIVA was associated with non-significant trends toward improved recurrence-free survival (HR 0.91, 95% CI 0.77-1.06; p = 0.22) and reduced early mortality (HR 0.90, 95% CI 0.77-1.05; p = 0.17). No statistically significant differences were observed in operation time (MD - 3.81 min, 95% CI - 10.75 to 3.13) or hospital stay (MD - 0.19 days, 95% CI - 0.39 to 0.00; p = 0.06).</p><p><strong>Conclusions: </strong>TIVA may be associated with improved long-term survival outcomes compared with volatile anesthesia in patients undergoing esophagogastric cancer surgery, particularly among patients undergoing gastrectomy. Given the predominance of retrospective evidence and methodological heterogeneity, further high-quality prospective randomized studies are required to clarify the oncological impact of anesthetic techniques in upper gastrointestinal cancer surgery.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"411 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13649908/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137176","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":"Bile does not increase the aggressiveness of pancreatic fluid towards fibrin-based sealants in a short-term ex-vivo setting.","authors":"Nora Katharina Drees, Julian Malzkorn, Britta Majchrzak-Stiller, Johanna Strotmann, David Wiedemann, Chris Braumann, Waldemar Uhl, Philipp Höhn","doi":"10.1007/s00423-026-04300-2","DOIUrl":"10.1007/s00423-026-04300-2","url":null,"abstract":"<p><strong>Purpose: </strong>Postoperative pancreatic fistulas are among the most serious complications of pancreatic surgery. Biliary fistulas, though usually less severe, can occur after pancreaticoduodenectomy and, when combined with pancreatic fistulas, increase morbidity and mortality. This study is the first to investigate, whether bile enhances the harmful effects of pancreatic fluid on sealant integrity in a short-term ex vivo model using a fibrin-based sealant, thereby contributing to fistula formation.</p><p><strong>Methods: </strong>We developed and validated an improved ex-vivo setup to simulate the conditions during pancreatic surgery: the physiological incubation bio-simulator 2 (PIBS 2). A defined defect in porcine pleura was sealed with the fibrin sealant TachoSil^® and exposed to various fluids from human origin (pancreatic fluid, bile fluid and a combination of both) for 60 min in a physiological environment. Electrolyte solution served as control. We evaluated the overall leakage rates and time to leakage. Results were plotted as Kaplan-Meier survival curves and analyzed using the log-rank test (Mantel-Cox) and Fisher's exact test.</p><p><strong>Results: </strong>PIBS 2 achieved stable defect closure for the electrolyte solution. Pancreatic fluid demonstrated the highest leakage rates (75%) and significantly impaired sealant stability (p < 0.001), whereas bile fluid alone showed no significant effect on sealant integrity (p = 0.63). When combined, bile and pancreatic fluid resulted in a significantly lower leakage rate compared to pancreatic fluid alone (47% vs. 75%, p = 0.041; odds ratio 3.31).</p><p><strong>Conclusion: </strong>This study replicates previous results, showing that pancreatic fluid is highly aggressive towards fibrin-based sealants. In contrast to clinical findings, the addition of bile did not significantly increase this effect in this ex-vivo model, suggesting that morbidity in patients with combined fistulas may not be primarily caused by increased aggressiveness of pancreatic fluid after its combination with bile.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"411 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13645887/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127979","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":"Quality of life and functional outcomes after low anterior rectal resection with total mesorectal excision: a propensity score-matched comparison of robotic-assisted versus open surgery.","authors":"Frederick Bröcker, Susanne Merkel, Anne Jacobsen, Klaus Weber, Axel Denz, Robert Grützmann, Georg F Weber, Maximilian Brunner, Christian Krautz","doi":"10.1007/s00423-026-04314-w","DOIUrl":"10.1007/s00423-026-04314-w","url":null,"abstract":"<p><strong>Background: </strong>Robotic-assisted surgery (RAS) for rectal cancer is increasingly adopted. However, a recent systematic review highlighted a significant gap in the literature regarding quality of life (QOL) after different total mesorectal excision (TME) techniques, with open TME being particularly underrepresented. This study aimed to compare QOL and anorectal function between robotic-assisted and open low anterior rectal resection with TME.</p><p><strong>Methods: </strong>Patients who underwent low anterior rectal resection with TME and primary anastomosis between 2006 and 2021 at a single tertiary centre were identified. Propensity score matching was performed based on sex, age, BMI, UICC stage and tumour height. After excluding patients without QOL follow-up or with a persistent diverting stoma, 40 patients per group were available. QOL was assessed using the EORTC QLQ-C30, QLQ-CR29, and LARS score.</p><p><strong>Results: </strong>In the matched cohort, baseline characteristics were well balanced except for tumour height (p = .002), with more lower-third tumours in the open group. No significant differences were observed in any EORTC QLQ-C30 domain, including global health status (66.5 vs. 71.7, p = .197). QLQ-CR29 showed comparable outcomes for most domains; however, sexual interest was significantly lower in the RAS group for women (88.1 vs. 55.6, p = .008). LARS scores were similar between groups (24.4 vs. 25.6, p = .765). Perioperative outcomes including morbidity (10.0% vs. 22.5%, p = .130) and anastomotic leakage (2.5% vs. 5.0%, p = .526) did not differ significantly.</p><p><strong>Conclusions: </strong>Robotic-assisted and open low anterior rectal resection with TME resulted in comparable QOL and anorectal function across all assessed domains. Notably, approximately one third of patients in both groups reported major LARS, underscoring the persistent functional burden irrespective of surgical approach. By providing direct comparative data on open TME - an approach underrepresented in the literature - these findings contribute to closing an important evidence gap.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"411 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13642495/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111559","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}