Langenbeck's Archives of Surgery最新文献

{"title":"Early mobilization program with nonweight-bearing brace improves functional capacity after diabetic foot ulcer surgery: a randomized controlled trial.","authors":"Xinyuan Qin, Lei Gao, Shuo Wang, Jiangning Wang","doi":"10.1007/s00423-025-03604-z","DOIUrl":"10.1007/s00423-025-03604-z","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to evaluate the effectiveness of early mobilization program with nonweight-bearing braces in improving functional outcomes and clinical indicators after diabetic foot ulcer surgery.</p><p><strong>Methods: </strong>We conducted a randomized trial involving patients with diabetic foot ulcers (DFUs) who underwent surgery at a tertiary university hospital. Participants were randomized to receive either early mobilization with nonweight-bearing braces or standard rehabilitation care. The primary outcome was the ability to walk a distance of three meters without human assistance upon hospital discharge. Secondary outcomes included activity of daily living (ADL), measured by the Barthel Index survey; reduction in lean body mass, assessed via thigh circumference on postoperative day 10 (POD 10); length of stay (LOS); and the incidence of postoperative complications such as deep venous thrombosis (DVT), pain, and wound dehiscence.</p><p><strong>Results: </strong>A total of 46 patients were enrolled, with 23 assigned to the early mobilization program with nonweight-bearing braces (intervention group) and 23 to the standard rehabilitation care group (control group). The primary outcome was achieved in 16 patients (69.6%) in the intervention group and 6 patients (26.1%) in the control group [RD43.5%, 95%CI (17.5%,69.5%); P = 0.003]. The intervention group demonstrated improved outcomes in ADL. Additionally, the intervention facilitated earlier discharge with a LOS of 12 days in the intervention group compared to 18 days in the control group.</p><p><strong>Conclusion: </strong>An early postoperative mobilization program with nonweight-bearing brace is demonstrated to be feasible and effective in improving functional capacity in patients with diabetic foot ulcers undergoing surgery.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"33"},"PeriodicalIF":2.1,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11723886/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950645","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":"The tumor distance to the main hepatic vessels is a predictor of recurrence-free survival and overall survival in hepatocellular cancer.","authors":"Schaima Abdelhadi, Johann S Rink, Matthias F Froelich, Flavius Șandra-Petrescu, Mohamad El-Ahmar, Hani Oweira, Nuh N Rahbari, Christoph Reissfelder, Emrullah Birgin","doi":"10.1007/s00423-024-03565-9","DOIUrl":"10.1007/s00423-024-03565-9","url":null,"abstract":"<p><strong>Introduction: </strong>The impact of the distance of the tumor from the main hepatic vessels (DTV), such as the Glissonean pedicle or hepatic veins, on oncological outcomes for Hepatocellular carcinoma (HCC) patients is relatively understudied. Therefore, the objective of this study was to explore the correlation between DTV and survival in patients with HCC after curative hepatic resection.</p><p><strong>Methods: </strong>Consecutive patients who underwent curative-intent liver surgery for HCC between April 2018 and May 2023 were identified from a prospective database. Univariate and multivariate Cox regression analysis were performed to identify independent predictors of recurrence-free survival (RFS). A ROC-curve was used to find the optimal cut-off value for DTV. According to the estimated cut-off value, patients were divided into 2 subgroups, then using the Kaplan-Meier survival curve, RFS and overall survival (OS) were estimated and compared between the 2 subgroups.</p><p><strong>Results: </strong>In univariate analysis, DTV, tumor size, resection margins, microvascular invasion (MVI) and tumor grading were associated with RFS. In multivariate analysis, DTV, tumor size, and MVI were confirmed as independent predictors of RFS. In the ROC-analysis the optimal cutoff value of DTV was 20 mm. Patients with a DTV < 20 mm had a larger tumor size and a more advanced histopathological grading. There was no difference in the presence of MVI in both groups, while a significantly more patients experienced recurrence after hepatectomy in the DTV < 20 mm group. Accordingly, patients with a DTV < 20 mm experienced a shorter median RFS and OS.</p><p><strong>Conclusion: </strong>DTV is a promising predictor of RFS and OS in HCC.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"31"},"PeriodicalIF":2.1,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11717872/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950660","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":"Cost analysis of laparoscopic total versus open total gastrectomy in gastric cancer.","authors":"Max M Maurer, Sebastian Knitter, Axel Winter, Ramin Raul Ossami Saidy, Eva M Dobrindt, Philippa Seika, Paul V Ritschl, Jonas Raakow, Judith Reinus, Johann Pratschke, Christian Denecke","doi":"10.1007/s00423-024-03562-y","DOIUrl":"10.1007/s00423-024-03562-y","url":null,"abstract":"<p><strong>Purpose: </strong>Despite ongoing discussions concerning clinical equivalence of laparoscopic total gastrectomy (LTG) compared to open total gastrectomy (OTG) in gastric cancer (GC) surgery, complementary evidence regarding financial implications is sparse. The aim of this study was to compare hospital associated expenses and perioperative outcomes between both approaches.</p><p><strong>Methods: </strong>Clinicopathological and financial data from 80 consecutive GC patients undergoing LTG or OTG between 2015 and 2022 were investigated. Patient baseline characteristics, perioperative results, long-term outcomes and financial expenses up to 30 days after discharge were compared. A binary logistic regression model to identify individual cost drivers was performed.</p><p><strong>Results: </strong>LTG was associated with significantly prolonged operating time (281 min vs. 245 min, p < 0.02). However, LTG demonstrated a trend towards lower total (18,708 € vs. 22,810 €, p = 0.11) and median daily (1,516 € vs. 1,721 €, p = 0.25) expenses, yet not reaching statistical significance. Decreased ICU costs emerged as the greatest single cost reducer in LTG (962 € vs. 2,147 €, p = 0.10). Hospital length of stay ≥ 15 days was the only independent cost driver for increased expenses (HR [95% CI] = 13,2 [3.0-58.9], p < 0.01). Ultimately, patients undergoing LTG and OTG demonstrated similar outcomes in terms of perioperative morbidity (n = 8, 13% vs. n = 3, 17%, p = 0.70), median number of resected lymph nodes (n = 32 vs. n = 33, p = 0.72), absence of 90-day mortality, and long-term survival (p = 0.47).</p><p><strong>Conclusion: </strong>Although typically involving longer operating times, LTG tends to be linked with decreased hospital costs, yet not reaching statistical significance. The ongoing establishment of LTG seems not to pose additional financial burdens for surgical departments.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"30"},"PeriodicalIF":2.1,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11711782/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950641","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":"Establishing reference curves for vital tissue perfusion using quantitative near-infrared fluorescence imaging with indocyanine green.","authors":"Floris P Tange, Roderick C Peul, Pim van den Hoven, Stefan Koning, Mo W Kruiswijk, Robin A Faber, Pieter S Verduijn, Carla S P van Rijswijk, Hidde A Galema, Denise E Hilling, Sam P J van Dijk, Tessa M van Ginhoven, Stijn Keereweer, Marc A M Mureau, Eline A Feitsma, Milou E Noltes, Schelto Kruijff, Caroline Driessen, Michael P Achiam, Abbey Schepers, Jan van Schaik, J Sven D Mieog, Alexander L Vahrmeijer, Jaap F Hamming, Joost R van der Vorst","doi":"10.1007/s00423-024-03589-1","DOIUrl":"10.1007/s00423-024-03589-1","url":null,"abstract":"<p><strong>Purpose: </strong>Assessment of tissue perfusion using near-infrared fluorescence (NIR) with indocyanine green (ICG) is gaining popularity, however reliable and objective interpretation remains a challenge. Therefore, this study aimed to establish reference curves for vital tissue perfusion across target tissues using this imaging modality.</p><p><strong>Methods: </strong>Data from five prospective study cohorts conducted in three Dutch academic medical centres between December 2018 and June 2023 was included. Quantitative analysis using time-intensity curves was performed in ten target tissues, including the colon, ileum, gastric conduit, deep inferior epigastric artery perforator (DIEP) flap, skin of the foot, trachea, sternocleidomastoid muscle (SCM), carotid artery, parathyroid gland, and skin of the neck.</p><p><strong>Results: </strong>A total of 178 patients were included in this study, representing 303 target tissues. Three different patterns of reference curves were identified based on a subjective assessment. Seven out of ten tissues showed a reference curve with rapid inflow (median time-to-max (tmax): 13.0-17.8 s, median maximum-normalized-slope (slope norm): 10.6-12.6%/sec), short outflow (median area-under-the-curve of tmax + 60 s (AUC60): 65.0-85.1%) followed by a gradual/absent outflow. Secondly, the DIEP flap and SCM tissue showed a reference curve with longer inflow (median tmax: 24.0, 22.0 s, median slope norm: 9.3, 9.7%/sec respectively) and reduced outflow (median AUC60: 89.1, 89.0% respectively). Thirdly, the skin of the foot showed slow inflow (median tmax 141.1 s, median norm slope 2.1%/sec) without outflow.</p><p><strong>Conclusion: </strong>This study demonstrates reference curves for vital tissue perfusion of multiple target tissues identified with ICG NIR fluorescence imaging, providing a critical step towards the clinical implementation of this technique.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"28"},"PeriodicalIF":2.1,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11706885/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950652","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 different liver fibrosis scores following sleeve gastrectomy.","authors":"Heilberger Alexander, Rauchfuss Falk, Settmacher Utz, Dondorf Felix, Ali Deeb Aladdin, Kissler Hermann, Schwenk Laura, Bruns Johanna, Ardelt Michael","doi":"10.1007/s00423-024-03569-5","DOIUrl":"https://doi.org/10.1007/s00423-024-03569-5","url":null,"abstract":"<p><strong>Purpose: </strong>The prevalence of obesity, along with that of its associated health conditions, including cardiovascular diseases, diabetes mellitus, and liver diseases, such as non-alcoholic fatty liver disease (NAFLD), is increasing annually. Bariatric surgery is indicated for the treatment of obesity if conservative treatment fails. While various liver fibrosis scores have been proposed for assessing liver function, they are typically used prior to bariatric surgery. This study aimed to determine whether fibrosis scores calculated from non-invasive parameters are effective in monitoring liver function after bariatric surgery.</p><p><strong>Methods: </strong>This study analyzed data from 151 patients who underwent sleeve gastrectomy (SG) and were followed up at 3, 6, 9, 12, 24, and 36 months postoperatively. From the routinely collected parameters, liver fibrosis scores (APRI, Fib-4, BARD, Forns index [FORNS], Lok score [LOK], and NAFLD scores) were calculated retrospectively and compared to diabetes status % excess weight loss (%EWL) and % total weight loss (%TWL) over a 3-year follow-up period.</p><p><strong>Results: </strong>After SG, APRI, FORNS, and NAFLD scores showed significant improvements, whereas Fib-4, BARD, and LOK scores did not improve. Similarly, body mass index, %EWL, %TWL, and diabetes status also improved significantly. Throughout the 3-year follow-up period, only the APRI and NAFLD scores showed significant improvement.</p><p><strong>Conclusion: </strong>Only APRI and NAFLD scores changed significantly after SG. Thus, these two scores may be used to reflect and monitor liver function in patients who have undergone SG.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"29"},"PeriodicalIF":2.1,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950637","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":"An assessment of the efficacy and safety of balloon nephrostomy traction in minimizing postoperative bleeding of percutaneous nephrolithotomy: a randomized controlled clinical trial.","authors":"Akbar Nouralizadeh, Mohammad Mehdi Darzi, Ali Adib, Amir H Kashi","doi":"10.1007/s00423-024-03599-z","DOIUrl":"10.1007/s00423-024-03599-z","url":null,"abstract":"<p><strong>Purpose: </strong>Percutaneous nephrolithotomy (PCNL) as an established procedure for treatment of large kidney stones, can trigger life threatening complications. Postoperative hemorrhaging is one of the main complications of PCNL. This study investigates the effectiveness of balloon nephrostomy in reducing hemorrhage in the postoperative phase of PCNL.</p><p><strong>Methods and materials: </strong>A total of 102 patients underwent routine PCNL and then they were randomly allocated to intervention and control groups. For the intervention group, a balloon nephrostomy tube was inserted under guidance of fluoroscopy, gentle traction was applied on the nephrostomy and then it was fixed to skin under mild traction. A conventional nephrostomy tube was inserted in the control group without additional traction. Blood loss was estimated by hemoglobin drop in the first 24 h after surgery. Hemoglobin level drop was the primary endpoint of interest. Secondary endpoints were postoperative complications and were compared between treatment groups.</p><p><strong>Results: </strong>The mean first 24-hour hemoglobin drop was 0.9 ± 0.2 mg/dL in the intervention group and 2.1 ± 0.2 mg/dL in the control group which was statistically significant (< 0.001). Although blood transfusion was more common in the control group (8% versus 0%), it was not statistically significant. There were no statistically significant differences between intervention and control groups regarding the postoperative complications.</p><p><strong>Conclusion: </strong>In conclusion, the results of the present study show the effectiveness of the application of balloon nephrostomy in decreasing PCNL postoperative bleeding without considerable complication.</p><p><strong>Trial registration no: </strong>IRCT20160406027253N2.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"26"},"PeriodicalIF":2.1,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950378","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":"Outcomes after index cholecystectomy: a UK longitudinal multi-centre cohort Study.","authors":"Aditya Borakati, S Frances Hughes, Hemant M Kocher, Humza Malik, Humza Malik","doi":"10.1007/s00423-024-03567-7","DOIUrl":"10.1007/s00423-024-03567-7","url":null,"abstract":"<p><strong>Purpose: </strong>International guidelines for management of acute biliary pathology recommend emergency cholecystectomy (EmC), citing improved outcomes compared to elective cholecystectomy (ElC) based on trials which may not reflect the capacity constraints in clinical practice, nor selection based on multiple prior attendances with emergency biliary pathology or attendances following a decision for ElC. We therefore conducted a longitudinal retrospective study evaluating all attendances with biliary pathology prior to cholecystectomy with the aim of assessing whether EmC is justified in this context.</p><p><strong>Methods: </strong>Data was collected on patients undergoing cholecystectomy between 2016 and 2021 at four centres. Patients who had an emergency presentation with a biliary pathology prior to cholecystectomy up to 2010 were included. Patients were divided into EmC and ElC groups, EmC was defined as cholecystectomy occurring during an emergency admission with biliary pathology. Multilevel regression modelling was used to identify independent predictors for time to surgery from index presentation, number of re-attendances and length of stay (LoS).</p><p><strong>Results: </strong>2,056 patients were included: 1,786 (86.9%) had ElC and 270 (13.1%) EmC. EmC was independently associated with a reduction in time to surgery (-112.32 days [95% CI -140.22 to -84.42]). However, there was a significant increase in both post-operative and overall LoS (+ 3.34 days [95% CI 1.81-4.86]) across all admissions with EmC. EmC did not significantly reduce rates of emergency re-attendance prior to surgery overall.</p><p><strong>Conclusion: </strong>Although EmC reduces time to surgery, it does not reduce the number of emergency re-attendances and increases LoS. In the context of limited emergency theatre capacity, it may be beneficial to prioritise those who benefit most from EmC.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"27"},"PeriodicalIF":2.1,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950655","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":"Thyroid surgery under nerve auto-fluorescence & artificial intelligence tissue identification software guidance.","authors":"Fernando Dip, Rene Aleman, Alberto Rancati, Gustavo Eiben, Raul J Rosenthal, Diego Sinagra","doi":"10.1007/s00423-024-03597-1","DOIUrl":"10.1007/s00423-024-03597-1","url":null,"abstract":"<p><p>Thyroid cancer is a common malignancy that requires comprehensive clinical evaluation prior to adequate surgical management. Over the last three decades thyroid surgery has tripled and is considered one of the most commonly performed procedures in general surgery. These procedures are associated with potential postoperative complications with significant deterioration in the patient's quality of life. While the current rates of recurrent laryngeal nerve injury following thyroidectomy have decreased secondary to intraoperative neuromonitoring, thyroid surgery remains the leading cause of iatrogenic injury. The authors herein present a case of a thyroid nodule with cervical lymph node involvement undergoing total thyroidectomy guided by near-ultraviolet (NUV) imaging nerve auto-fluorescent technology to visualize, identify and protect vital structures.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"23"},"PeriodicalIF":2.1,"publicationDate":"2025-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927456","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":"Preoperative prediction of the selection of the NOTES approach for patients with symptomatic simple renal cysts via an interpretable machine learning model: a retrospective study of 264 patients.","authors":"Yuanbin Huang, Xinmiao Ma, Wei Wang, Chen Shen, Fei Liu, Zhiqi Chen, Aoyu Yang, Xiancheng Li","doi":"10.1007/s00423-024-03586-4","DOIUrl":"https://doi.org/10.1007/s00423-024-03586-4","url":null,"abstract":"<p><strong>Background: </strong>There are multiple surgical approaches for treating symptomatic simple renal cysts (SSRCs). The natural orifice transluminal endoscopic surgery (NOTES) approach has gradually been applied as an emerging minimally invasive approach for the treatment of SSRCs. However, there are no clear indicators for selecting the NOTES approach for patients with SSRCs. We aimed to investigate the preoperative clinical determinants that influence the selection of the NOTES approach in patients with SSRCs and to construct a prediction model to assist the surgeons in selecting the NOTES approach.</p><p><strong>Methods: </strong>Clinical data from 264 patients with SSRCs from a single-center medical institution were included. Predictors were analyzed via the least absolute shrinkage and selection operator and multivariable logistic regression. Various machine learning classification algorithms were evaluated to determine the optimal model. An interpretive framework for personalized risk assessment was developed via SHapley Additive exPlanations (SHAP).</p><p><strong>Results: </strong>Preoperative factors predicting the selection of the NOTES approach included cyst growth, the presence of renal calculus, body mass index, history of diabetes, history of cerebrovascular disease, hemoglobin level, and the platelet (PLT) count. The logistic classification model was identified as the optimal model, with area under the curve of 0.962, an accuracy of 0.868, a sensitivity of 0.889, and a specificity of 1.000 in the test set.</p><p><strong>Conclusion: </strong>A logistic regression model was constructed and tested via the SHAP method, providing a scientific basis for selecting the NOTES approach for patients with SSRCs. This method offers effective decision support for doctors in choosing the NOTES approach.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"22"},"PeriodicalIF":2.1,"publicationDate":"2025-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927454","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":"Left-lateral decubitus jackknife position for laparoscopic resection of right posterior liver tumors: A safe and effective approach.","authors":"Xiaohan Kong, Zheyu Niu, Heng Wang, Meng Liu, Chaoqun Ma, Jun Lu, Xu Zhou, Huaqiang Zhu","doi":"10.1007/s00423-024-03595-3","DOIUrl":"https://doi.org/10.1007/s00423-024-03595-3","url":null,"abstract":"<p><strong>Purpose: </strong>To compare outcomes of LLR in VI/VII of the liver in Left-lateral Decubitus Jackknife Position (LDJP) and traditional Supine Position (SP). We used propensity score matching (PSM) to analyze clinical outcomes.</p><p><strong>Patients & methods: </strong>This study retrospectively analyzed patients undergoing LLR for liver tumors in segments VI and/or VII at Shandong Provincial Hospital from 2018 to 2023. A total of 218 cases were included (LDJP, n = 94; SP, n = 124). Matched 1:1 PSM groups were created and clinical indicators compared between groups.</p><p><strong>Results: </strong>218 LLR patients, 94 LDJP and 124 supine. After 1:1 PSM, each group had 62 patients. No significant differences in clinical or laboratory parameters. All surgeries were successful, 1 LDJP conversion to open resection and 4 SP conversions (P = 0.375). LDJP average surgery duration: 220.6 ± 29.9 min, supine position: 262.6 ± 35.6 min (P < 0.001). LDJP perioperative blood loss: 169.0 ± 74.4 mL, supine position: 231.6 ± 84.6 mL (P < 0.001). Four LDJP patients required intraoperative blood transfusion compared to 16 supine position patients (P = 0.012). All cases had negative margins postoperatively. No significant differences in postoperative complications (8 LDJP vs 9 supine, P = 0.675) or length of hospital stay (25 LDJP vs 26 supine, ≥ 7 days) (P = 1.000).</p><p><strong>Conclusion: </strong>Laparoscopic partial hepatectomy in LDJP for hepatic VI/VII tumor safe and feasible. Reduces operative time, blood loss, transfusion requirement, improving outcomes.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"25"},"PeriodicalIF":2.1,"publicationDate":"2025-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927453","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}