Langenbeck's Archives of Surgery最新文献

{"title":"Outcomes of living donor liver transplantation in elderly Egyptian patients: a retrospective study.","authors":"Ahmed Abdelrafee, Mohamed Abdelwahab, Amr Sanad, Ahmed Shehta, Mohamed Eldesoky, Mahmoud A Ali, Mohamed A Elmorshedi, Adel Ali Hassan, Waleed M R Elsarraf","doi":"10.1007/s00423-026-04166-4","DOIUrl":"https://doi.org/10.1007/s00423-026-04166-4","url":null,"abstract":"<p><strong>Purpose: </strong>Although the results of living donor liver transplantation (LDLT) in the elderly have been reported worldwide, there is still a dearth of information on elderly patients in Egypt. The purpose of this study is to investigate the clinical outcomes of LDLT in this growing population group.</p><p><strong>Methods: </strong>This was a retrospective study that evaluated all LDLT patients at the Gastrointestinal Surgical Center, Mansoura University, from January 2009 to December 2023. Based on the recipient's age, two patient cohorts were created: younger (< 60) and elderly (≥ 60). Demographics, liver disease etiology, MELD score, surgical duration, blood loss, and early and late post-transplant outcomes (complications, graft survival, and patient survival) were compared between the two groups. Propensity score matching (PSM) was done to improve the baseline covariates imbalance.</p><p><strong>Results: </strong>Among 967 LDLT operations, 110 patients were classified in the elderly group (≥ 60 years). Hepatocellular carcinoma (HCC) was markedly more prevalent in the elderly group (44.6% vs. 30.5%, p = 0.002). After PSM analysis, the occurrence of early post-transplant problems was greater in the elderly group (65.5% vs. 51.9%, p = 0.033). Major complications were comparable between both groups (p = 0.763). Importantly, there was no statistically significant difference in 90-day mortality (p = 0.697) or in the 1, 3, and 5-year survival rates (p = 0.660) between the two matched groups.</p><p><strong>Conclusion: </strong>Living donor liver transplantation for carefully selected elderly recipients yields comparable early survival outcomes to younger recipients. However, the elderly cohort faces a significantly higher risk of early morbidity and not statistically significant lower graft survival. Rigorous selection and targeted perioperative care are therefore essential.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"411 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148891882","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":"Longitudinal changes in bioelectrical impedance-derived body composition after sleeve gastrectomy in patients with class III obesity.","authors":"Lisa Lippmann, Hermann Kissler, Utz Settmacher, Falk Rauchfuss, Felix Dondorf, Oliver Rohland, Laura Schwenk, Aladdin Ali Deeb, Astrid Bauschke, Michael Ardelt","doi":"10.1007/s00423-026-04232-x","DOIUrl":"10.1007/s00423-026-04232-x","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;Weight loss after bariatric surgery is commonly reported using anthropometric parameters; however, these measures do not distinguish between changes in fat mass, lean tissue, and body water. Bioelectrical impedance analysis (BIA) enables a more detailed assessment of body composition and may provide additional information regarding postoperative physiological adaptations. The present study aimed to evaluate longitudinal changes in BIA-derived body composition over a 24-month follow-up after sleeve gastrectomy (SG) in patients with class III obesity. In addition, exploratory subgroup analyses according to sex and baseline body mass index (BMI) were performed to investigate potential differences in postoperative body composition trajectories.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This retrospective observational study included 49 patients who underwent laparoscopic SG at a tertiary bariatric center. Body composition was assessed preoperatively and at regular postoperative follow-up visits using standardized multifrequency BIA. Parameters included body weight, BMI, fat mass, fat-free mass, skeletal muscle mass, total body water, extracellular water-to-total body water ratio (ECW/TBW), phase angle (PhA), visceral adipose tissue estimate, and resting energy expenditure. Longitudinal changes were evaluated throughout the 24-month observation period. Subgroup analyses should be interpreted with caution because of the limited sample size.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Substantial reductions in body weight, BMI, fat mass, visceral adipose tissue estimate, fat-free mass, skeletal muscle mass, total body water, and estimated resting energy expenditure were observed during follow-up. The largest changes occurred during the first postoperative year and subsequently stabilized. Phase angle decreased during the early postoperative period before showing partial recovery over time. Exploratory subgroup analyses suggested differences in absolute body composition trajectories between men and women as well as between patients with baseline BMI below and above 50 kg/m²; however, these findings should be interpreted within the context of the observational study design and limited statistical power.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Sleeve gastrectomy was associated with marked longitudinal changes in BIA-derived estimates of body composition during the first 24 postoperative months. Besides the expected reduction in fat mass, decreases in fat-free mass and skeletal muscle mass as well as transient changes in phase angle were observed. These findings emphasize the importance of longitudinal body composition assessment following bariatric surgery. Future studies should investigate whether structured nutritional and exercise interventions may further improve postoperative body composition outcomes. Because body composition was assessed exclusively by BIA, the results should be interpreted as impedance-derived estimates rather than direct measure","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"411 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13526037/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148857379","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":"A Validated, explainable machine learning-based preoperative risk model for microvascular invasion in hepatocellular carcinoma.","authors":"Liu-Xin Zhou, Jin-Hong Cai, Chang-Ren Zhu, Tian-Ci Luo, Tian-Ming Gao, Kun-Qing Xiao, Sheng Ding, Chen Chen, Bao-Yu Wan, Hao Dong, Song-Song Fan, Dou-Sheng Bai, De-Cai Yu, Guo-Qing Jiang","doi":"10.1007/s00423-026-04143-x","DOIUrl":"10.1007/s00423-026-04143-x","url":null,"abstract":"<p><strong>Purpose: </strong>This investigation aimed to develop and validate a diagnostic algorithm for preoperatively assessing the likelihood of microvascular invasion (MVI) in patients with hepatocellular carcinoma (HCC).</p><p><strong>Methods: </strong>Clinical and pathological information of patients with HCC who underwent curative resection was collected from two medical centers. Data from Nanjing Drum Tower Hospital were randomly split into training (80%) and internal validation (20%) cohorts, while data from Northern Jiangsu People's Hospital were employed as an independent external validation cohort. Feature engineering was performed using recursive feature elimination (RFE) within the training cohort. Various machine learning models were applied, and their performance was evaluated through diverse metrics, such as receiver operating characteristic (ROC) curves. Additionally, the Shapley Additive Explanations (SHAP) method, together with tumor differentiation, Ki-67, and other relevant markers, were employed to enhance model interpretability and reliability.</p><p><strong>Results: </strong>Among the 1106 patients enrolled, 315 were pathologically confirmed to have MVI. RFE identified tumor diameter, alpha-fetoprotein (AFP), gamma-glutamyl transferase (GGT), and pan-immune-inflammation value (PIV) as key determinants of MVI risk in patients with HCC. With these variables, the XGBoost model reached area under the curve (AUC) values of 0.893 in the training cohort, 0.845 in the internal validation cohort, and 0.793 in the external validation cohort. Correlation analyses revealed that the risk score showed significant associations with tumor differentiation and the expression of Ki-67 proliferation index, Glypican-3 (GPC3), Cytokeratin 19 (CK19), and Vascular endothelial growth factor receptor 2 (VEGFR2).</p><p><strong>Conclusion: </strong>An XGBoost model incorporating tumor diameter, AFP, GGT, and PIV exhibited robust performance in assessing preoperative MVI among HCC patients.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"411 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13525009/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148850891","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":"Efficacy and clinical outcomes of proximal splenic artery embolization in patients with chemotherapy induced thrombocytopenia.","authors":"Daniel Körfer, Madelon Dijkstra, Brian Schiro, Constantino Pena, Gina Landinez, Govindarajan Narayanan, Alex Powell, Ripal Gandhi","doi":"10.1007/s00423-026-04144-w","DOIUrl":"10.1007/s00423-026-04144-w","url":null,"abstract":"<p><strong>Purpose: </strong>This retrospective study aims to investigate efficacy and clinical outcomes of proximal splenic artery embolization (PSAE) in patients with chemotherapy induced thrombocytopenia (CIT).</p><p><strong>Methods: </strong>PSAE was performed in thirteen patients with CIT (6:7, M:F; median age: 55y; range: 39-76y) with underlying malignancy (colorectal carcinoma: n = 6; pancreatic carcinoma: n = 3; other: n = 4). Median platelet counts were calculated prior to chemotherapy, at nadir resulting in chemotherapy discontinuation, prior to SAE, immediately and at the maximum following SAE. Additionally, the time until re-initiation of chemotherapy was calculated.</p><p><strong>Results: </strong>Technical success was 100%, with no adverse events or 30-day mortality. Vascular plugs (n = 9) and coils (n = 11) were the most frequently used devices. Median platelet count pre-chemotherapy was 201 × 10(9)/L (range: 100-423 × 10(9)/L), platelet count nadir was 45 × 10(9)/L (range: 21-69 × 10(9)/L), and pre-SAE platelet count was 82 × 10(9)/L (range: 45-171 × 10(9)/L). After proximal SAE, median platelet count increased significantly (110 × 10(9)/L; range: 68-169 × 10(9)/L) compared to pre-procedure platelet count (p = 0.027). Median platelet count at the maximum at follow-up was 191 × 10(9)/L (range: 31-518 × 10(9)/L). Chemotherapy was re-initiated after a median of 15 days (range: 7-50d).</p><p><strong>Conclusion: </strong>Proximal SAE is a safe and effective treatment option in patients with CIT, with potential benefits in early re-initiation of chemotherapy. Further studies should be conducted to evaluate the longer-term effects of the procedure, further identify eligible patients, and compare to distal SAE.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"411 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13521999/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148840537","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":"Lithium-associated hyperparathyroidism: a systematic review of prevalence and surgical outcomes.","authors":"Reza Alidousti Shahraki, Adrian D Meehan, Göran Wallin, Kosmas Daskalakis","doi":"10.1007/s00423-026-04200-5","DOIUrl":"https://doi.org/10.1007/s00423-026-04200-5","url":null,"abstract":"<p><strong>Purpose: </strong>Lithium remains one of the most effective maintenance treatments for bipolar disorder. However, disturbances in calcium homeostasis including hypercalcemia and lithium-associated hyperparathyroidism (LHPT) have increasingly been recognized as endocrine complications of chronic lithium therapy. The prevalence, pathophysiology, and optimal surgical management of LHPT remain incompletely defined. This systematic review aims to synthesize the available evidence on prevalence, pathophysiology, and surgical outcomes in LHPT.</p><p><strong>Methods: </strong>We conducted a systematic review according to PRISMA guidelines. Five databases (MEDLINE, Embase, Cochrane Library, Web of Science, and PsycINFO) were searched. Studies reporting hypercalcemia or hyperparathyroidism in adult patients receiving lithium therapy were eligible for inclusion. Surgical case series reporting parathyroidectomy in LHPT were analyzed separately.</p><p><strong>Results: </strong>A total of 5,483 records were identified, of which 125 studies met the inclusion criteria. Hypercalcemia occurred in 7.2% (423/5,853) and HPT was confirmed in 4.8% (156/3,239) of lithium-treated patients. Multiglandular disease was identified in 25-83% of surgical cases, substantially higher than the 15-20% observed in sporadic HPT. Bilateral neck exploration was performed in the majority of surgical series. Postoperative cure rates ranged from 58% to 100%, with recurrence rates of approximately 16% at 10 years.</p><p><strong>Conclusion: </strong>LHPT represents a clinically significant endocrine complication characterized by heterogeneous pathological patterns. The elevated prevalence of multiglandular disease has important implications for surgical planning. Given the high proportion of multiglandular involvement, surgeons should maintain a low threshold for bilateral neck exploration, particularly in patients with prolonged lithium exposure or intraoperative findings suggestive of multiple gland involvement.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"411 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13481389/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148795144","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":"Perioperative outcome and predictors of success after tracheal resection.","authors":"Laura V Klotz, Birgit Khandanpour, Martin E Eichhorn, Werner Schmidt, Markus Scheiner, Dennis Aliev, Feyza Özkan, Judith M Brock, Konstantina Kontogianni, Hans Hoffmann, Felix J F Herth, Hauke Winter, Florian Eichhorn","doi":"10.1007/s00423-026-04175-3","DOIUrl":"10.1007/s00423-026-04175-3","url":null,"abstract":"<p><strong>Purpose: </strong>Tracheal stenosis (TS) leads to progressive ventilatory restriction and endoscopic interventions for symptomatic relief have often palliative character. Resection of the narrowed segment can result in sustainable long-term outcome. We analyzed our experience in tracheal reconstructive surgery with focus on perioperative management and procedural morbidity.</p><p><strong>Methods: </strong>We conducted a retrospective study of prospectively obtained clinical data from patients undergoing tracheal surgery at the Thoraxklinik Heidelberg between July 2000 and September 2023. Aim of the study was to identify clinical variables with impact on the perioperative course and individual outcome.</p><p><strong>Results: </strong>138 patients underwent tracheal surgery for TS in our department. Main indications were post-tracheostomy stenosis (n = 77, 55.8%), malignant tracheal tumor (n = 27, 19.6%) and idiopathic tracheal stenosis (n = 22, 15.9%). The latter was observed more frequently in females (95.2%, p < 0.001). Most patients were extubated in the surgical theatre (83.3%) or immediately in the early postoperative period (< 24 h, 8.7%). No 30-day or 90-day mortality was observed. 13 patients (9.4%) developed symptomatic tracheal restenosis. Only seven patients (5.1%) required endoscopic intervention. Postoperative prolonged ventilation (> 24 h postop) was associated with development of anastomotic insufficiency and wound infections. Female sex and history of idiopathic stenosis were significant risk factors for recurrent stenosis.</p><p><strong>Conclusion: </strong>Reconstructive surgery for TS results in favorable functional outcome in selected patients and is associated with a low morbidity and mortality. Patient selection and perioperative management requires an experienced multidisciplinary team.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"411 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13469379/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148721208","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":"Methodological and bibliographical discrepancies in \"Integrating cruroplasty with laparoscopic sleeve gastrectomy: a strategy to mitigate GERD symptoms in obese patients. A randomized control trial\".","authors":"Feruzjon Bobosharipov","doi":"10.1007/s00423-026-04190-4","DOIUrl":"10.1007/s00423-026-04190-4","url":null,"abstract":"","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"411 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13461657/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148706718","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":"Feasibility and safety of laparoscopic small bowel resections with intracorporal anastomosis in emergency settings - a retrospective single centre study.","authors":"Jasmin Monika Martina Schmitt, Christoph-Thomas Germer, Sven Flemming, Johan Friso Lock, Florian Seyfried","doi":"10.1007/s00423-026-04188-y","DOIUrl":"10.1007/s00423-026-04188-y","url":null,"abstract":"<p><strong>Introduction: </strong>Minimally invasive surgery (MIS) is increasingly applied in complex abdominal surgery and has been associated with potential benefits compared with the open approach (OS). However, evidence on the feasibility and safety on MIS small bowel resections (SBR) in the emergency setting remains limited.</p><p><strong>Methods: </strong>The study included patients requiring emergency SBR with primary anastomosis between 01/2020 and 04/2025; data were collected from the hospital information system at a tertiary referral centre. Patient outcomes of MIS vs. open SBR with anastomosis were compared before and after propensity score matching (PSM).</p><p><strong>Results: </strong>Overall, 45 patients with SBR for isolated small bowel pathology were identified, of whom 7 (15.6%) underwent MIS. Of these (3 females, 4 males; median 70, range 29-77 years), six were diagnosed with haemorrhagic small bowel infarction and one with obstructive ileus. Postoperative Comprehensive Complication Index (CCI; median 8.7, range 0-30.8; p = 0.04) and time to first flatus (median 2, range 1-4 days; p = 0.02) were lower after MIS compared to OS. Postoperative diet progression (median 4.5, range 2-7 days) and length of stay (median 6.5 days, range 4-12 days) did not differ (length of stay: p = 0.34, diet progression: p = 0.11). There were no anastomotic leaks or revisional surgeries after MIS. The costs for MIS were lower compared to OS (EUR 5,975 vs. EUR 8,925). There were no group differences after PMS.</p><p><strong>Conclusion: </strong>Our data suggest that laparoscopic small bowel resections with intracorporal anastomosis in an emergency setting are feasible and safe in highly selected cases.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"411 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13461866/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148706408","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":"Reduction of postoperative care unit observation time following carotid endarterectomy: a targeted approach.","authors":"Alexandru Barb, Armend Salihi, Johannes Hatzl, Moritz Sebastian Bischoff, Sarah Dehne, Markus Alexander Weigand, Dittmar Böckler","doi":"10.1007/s00423-026-04109-z","DOIUrl":"10.1007/s00423-026-04109-z","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the safety and feasibility of reducing the postoperative care unit (POCU) observation period from four hours to two hours following carotid endarterectomy (CEA) for asymptomatic, high grade carotid stenosis.</p><p><strong>Design: </strong>Monocentric, retrospective-prospective observational cohort study.</p><p><strong>Methods: </strong>The study evaluated the impact of reducing the routine POCU observation period following CEA on patient safety and early postoperative outcomes. No changes in surgical technique and anesthetic management were implemented during the study period. Beginning in March 2024, a revised postoperative monitoring protocol was implemented at our institution, reducing the standard postoperative observation time from four to two hours. For the patient cohort one year prior, between January 2023 and February 2024, a retrospective analysis was conducted. For the patients undergoing surgery from March 2024 onward, a standardized postoperative protocol was implemented in order to evaluate the new clinic standards.</p><p><strong>Results: </strong>During the study period, 382 patients underwent CEA. Of these, 209 patients (54.7%) were excluded, predominantly due to symptomatic carotid stenosis. Overall, 173 patients (45.3%) met the inclusion criteria and were included in the analysis, with 87 assigned to Group I (4-hour monitoring) and 86 to Group II (2-hour monitoring).The overall incidence of postoperative complications during POCU stay did not differ significantly between the two groups (23% vs. 25.6%, p = .76). The majority of events occurred within the first 100 minutes after surgery. Postoperative bleeding requiring readmission to the POCU and surgical revision occurred in two cases (2.3%) in Group I and in one case (1.2%) in Group II (p = 1). Transient neurologic deficits were observed in two patients (2.3%) in Group I and in one patient (1.2%) in Group II (p = 1). In all cases, neurologic symptoms resolved spontaneously during hospital stay.</p><p><strong>Conclusion: </strong>Shortening the POCU observation period after CEA in asymptomatic patients appears safe and is not associated with an increased risk of complications.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"411 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13452744/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148697769","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":"Analyzing audience participation at the 43rd workshop of the german surgical working group on endocrinology (CAEK): gender balance in academic discussion dynamics in endocrine surgery.","authors":"Anna Mikl, M Kießler, M Berlet, M Martignoni, H Friess, C Chiapponi","doi":"10.1007/s00423-026-04176-2","DOIUrl":"10.1007/s00423-026-04176-2","url":null,"abstract":"<p><strong>Introduction: </strong>Although many surgical fields remain male dominated, the rising number of female medical students and physicians raises important questions about engagement dynamics within academic and professional settings. Endocrine Surgery (ES) currently demonstrates high rates of female representation among its fellows all over the world. This study examines gender differences in audience participation at the 43rd Workshop of the Surgical Working Group on Endocrinology (CAEK).</p><p><strong>Methods: </strong>Lecture sessions of the 43rd Workshop of the CAEK were prospectively observed and analyzed. The study recorded the gender appearance of chairs, speakers, participants asking the first question following each lecture and whether this influenced subsequent audience participation. Gender distributions among attendees and question patterns were compared.</p><p><strong>Results: </strong>A total of 385 participants (52% female, 48% male) attended the conference. 37 sessions were included. Overall, 63 questions were recorded. 34 (54%) came from women and 29 (46%) from men. The first question was posed by a male participant in 14 sessions (51.9%) and by a female participant in 13 sessions (48.1%). When discussion was started by a man, 65.9% of subsequent questions came from other men. 90.9% of follow-up questions came from women, when discussion was opened by another woman.</p><p><strong>Conclusion: </strong>Female participation at the 43rd Workshop CAEK was well balanced, although the gender of the first questioner influenced subsequent audience engagement, as observed in other studies. These findings suggest equitable academic engagement in endocrine surgery in Germany, while indicating that the gender of the first questioner is associated with subsequent audience participation.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"411 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13452862/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148697822","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}