Langenbeck's Archives of Surgery最新文献

{"title":"Possible underestimation of non-operative management success in perforated diverticulitis with distant free air : Re: Cirocchi R, Matteucci M, Mari GM et al. (2026) The role of non-operative management (NOM) in perforated diverticulitis: a systematic review. Langenbecks Arch Surg 411:79.","authors":"Muzaffer Atlı","doi":"10.1007/s00423-026-04165-5","DOIUrl":"10.1007/s00423-026-04165-5","url":null,"abstract":"<p><p>The review reported a 27.8% success rate for non-operative management in patients with distant free air and, on that basis, suggested that early surgery should be strongly considered. When we examined the published data, we were unable to reproduce this estimate. Recalculating from the information given in the review, the numerator appeared to include only studies that reported this outcome, whereas the denominator also included patients from studies in which it was not reported; on a like-for-like basis the success rate is closer to 73% than to the reported 27.8%. Several values in the distant-free-air column of Table 5 of the review also correspond exactly to the complementary failure rates, which is compatible with a labelling or reporting error. These observations concern the distant-air subgroup specifically and require verification against the original data rather than establishing that the pooled analysis is incorrect. Given the clinical weight carried by this subgroup, clarification from the authors, and a correction if the discrepancies are confirmed, would be valuable.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"411 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13433541/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148664287","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":"Handgrip strength and diameter-product-derived psoas area estimate in end-stage liver cirrhosis: an exploratory single-center analysis.","authors":"Eugen Malamutmann, Christina Neuhaus, Lale Umutlu, Sophia T Schmitz, Miroslav Jalc, Christian G Klein, Jan Bednarsch, Ulf Neumann, Arzu Oezcelik","doi":"10.1007/s00423-026-04150-y","DOIUrl":"10.1007/s00423-026-04150-y","url":null,"abstract":"<p><strong>Background: </strong>Previous studies suggest that handgrip strength may correlate with muscle mass in cirrhosis, but validation across diverse transplant cohorts remains limited. We sought to validate whether previously reported correlations between handgrip strength and computed tomography (CT)-derived psoas-area estimates hold in a single-center cohort of liver transplant candidates and to explore whether a bedside prediction model could be derived.</p><p><strong>Methods: </strong>In this retrospective cohort study, 96 patients with end-stage liver cirrhosis undergoing transplant evaluation at University Hospital Essen (January 2020-December 2024) underwent standardized handgrip strength, 4-meter gait time, and diameter-product-derived psoas area estimates. Pearson correlation, multiple linear regression, and Cox proportional hazards analyses were performed with Benjamini-Hochberg correction for multiple comparisons.</p><p><strong>Results: </strong>Handgrip strength significantly correlated with total psoas area ([Formula: see text], 95% CI 0.16-0.51, [Formula: see text]). Multiple linear regression yielded a prediction model ([Formula: see text]) achieving 72% sensitivity and 68% specificity for sarcopenia detection (AUC = 0.74). In multivariate Cox regression, each 100 mm²/m² increase in psoas index reduced waiting list mortality by 15% (HR = 0.85, 95% CI 0.73-0.98, [Formula: see text]) and post-transplant mortality by 18% (HR = 0.82, 95% CI 0.71-0.95, [Formula: see text]).</p><p><strong>Conclusion: </strong>Handgrip strength shows a modest, statistically significant association with diameter-product-derived psoas area estimates in liver transplant candidates. The derived prediction model has limited accuracy ([Formula: see text], AUC = 0.74) and cannot defer clinically indicated CT imaging; it may assist in identifying candidates who warrant confirmatory imaging or closer nutritional follow-up.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"411 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13421185/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148620321","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":"Colon interposition after esophagectomy: a 15-year single-center experience.","authors":"Melissa Kemeter, Lucas Thumfart, Patrick Heger, Felix J Hüttner, Markus K Diener, Luca Giulini, Attila Dubecz","doi":"10.1007/s00423-026-04140-0","DOIUrl":"10.1007/s00423-026-04140-0","url":null,"abstract":"<p><strong>Background: </strong>Colonic interposition is the preferred option for alimentary tract reconstruction when a gastric conduit pull-up is not feasible. Aim of this study was to evaluate perioperative outcomes of patients undergoing colonic interposition for various indications in our tertiary-care center over a 15-year period.</p><p><strong>Methods: </strong>Following institutional board approval, all consecutive patients who underwent colonic interposition for esophageal replacement were identified from a prospectively maintained database. Comprehensive chart review and descriptive statistical analyses were performed.</p><p><strong>Results: </strong>Ninety-three patients (62 men, 31 women, median age 65 years, IQR 55.5-72) underwent colonic interposition between January 2009 and December 2023. Benign disease was present in 17.2%, whereas malignancy accounted for 82.8%. A hand-sewn cervical anastomosis was performed in 96.8% of patients. The colonic graft, predominantly based on the left colic artery (89.2%) was routed through the posterior mediastinum in 51.6% and via the retrosternal route in 47.3%. Median operative time was 303 min (IQR 247.5-364). Major complications included anastomotic leakage (28%), anastomotic stenosis (30.1%), pleural empyema (11.8%), and postoperative bleeding (10.8%). The reoperation rate was 38.7%, with a median hospital stay of 29 days (IQR 20-63). In-hospital mortality was 18.3%.</p><p><strong>Conclusion: </strong>Colonic interposition after esophagectomy is associated with substantial morbidity and mortality, particularly in the salvage and secondary reconstruction setting, and should be confined to experienced, high-volume centers.</p><p><strong>Clinical registration number: </strong>FMS_D_007.23-I-1.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"411 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13407936/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148592423","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":"Prognostic implications of superior mesenteric vein/portal vein resection and histologic venous invasion in BR/LA PDAC after neoadjuvant therapy.","authors":"Jingcheng Zhang, Lei Ren, Carsten Jäger, Alper Doğruöz, Helmut Friess, Ihsan Ekin Demir, Florian Scheufele","doi":"10.1007/s00423-026-04145-9","DOIUrl":"10.1007/s00423-026-04145-9","url":null,"abstract":"<p><strong>Background: </strong>Superior mesenteric vein/portal vein (SMV/PV) resection is often required in borderline resectable or locally advanced pancreatic ductal adenocarcinoma (BR/LA PDAC) after neoadjuvant therapy (NAT), but its prognostic relevance and the role of histopathologic venous invasion remain unclear.</p><p><strong>Methods: </strong>We retrospectively analyzed BR/LA PDAC patients undergoing pancreatectomy after NAT and compared perioperative and oncologic outcomes between patients requiring SMV/PV resection and those with venous preservation. Subgroup analyses assessed histopathologic venous invasion within the resection cohort. Kaplan-Meier analysis was used to evaluate overall survival (OS) and disease-free survival (DFS), and Cox regression was used to identify factors associated with OS.</p><p><strong>Results: </strong>Among 117 patients, 65 (55.6%) underwent SMV/PV resection and 52 (44.4%) had venous preservation. Although baseline demographic and clinical characteristics were broadly similar, the resection cohort showed greater local anatomic and operative complexity. Postoperative morbidity and mortality did not differ significantly between groups. Median OS was similar between the SMV/PV resection and preservation groups (16.0 vs. 22.0 months; P = 0.965), as was median DFS (10.0 vs. 12.0 months; P = 0.843). Within the resection cohort, histopathologically confirmed venous invasion was associated with significantly shorter OS (8.3 vs. 24.0 months; P < 0.0001) and DFS (5.0 vs. 17.0 months; P = 0.0002), whereas survival was similar between patients with venous preservation and those who underwent resection without venous invasion. R0 resection was associated with longer OS and DFS than R1 resection. In multivariable analysis, R1 resection and histopathologically confirmed SMV/PV invasion were independently associated with poorer OS.</p><p><strong>Conclusions: </strong>In our cohort, patients requiring SMV/PV resection had outcomes broadly comparable to those with venous preservation despite greater operative complexity. Histopathologic venous invasion and R1 status were associated with worse OS and DFS. These findings support interpreting SMV/PV resection primarily as a marker of local anatomic disease extent rather than an independent adverse prognostic factor.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"411 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13400680/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148579245","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":"Association of perioperative bioactive adrenomedullin with early postoperative organ dysfunction after major hepatic resection: An exploratory observational study.","authors":"Jan Bardenhagen, Courtney Metz, Christine Torrey, Tarik Ghadban, Mara R Goetz, Fiete Gehrisch, Jakob R Izbicki, Asmus Heumann, Thilo Hackert, Valerie Isabel Nottberg","doi":"10.1007/s00423-026-04148-6","DOIUrl":"10.1007/s00423-026-04148-6","url":null,"abstract":"<p><strong>Purpose: </strong>To explore the association between perioperative bioactive adrenomedullin (bioADM) and early postoperative organ dysfunction after major hepatic resection, using the Sequential Organ Failure Assessment (SOFA) score as a measure of organ dysfunction severity.</p><p><strong>Methods: </strong>This prospective, observational single-center study included 17 patients undergoing major hepatic resection between January and June 2023. BioADM was measured preoperatively and on postoperative days (POD) 1, 2, 3, and 5. Associations with SOFA were assessed using Spearman's rank correlation. Secondary exploratory analyses evaluated organ-specific and overall postoperative outcomes.</p><p><strong>Results: </strong>Perioperative bioADM was associated with postoperative organ dysfunction severity as reflected by SOFA. Correlations were weak at baseline and POD1 but became moderate to strong from POD2 onward, including POD2 (ρ = 0.74, p = 0.001), POD3 (ρ = 0.64, p = 0.012), and POD5 (ρ = 0.67, p = 0.008). Exploratory secondary analyses suggested associations with vasopressor requirement and renal deterioration, particularly dialysis requirement. In contrast, bioADM showed no consistent association with major complications, Clavien-Dindo grade, 30-day Comprehensive Complication Index, or 30-day mortality.</p><p><strong>Conclusion: </strong>In this small exploratory cohort (n = 17), perioperative bioADM was associated with early postoperative organ dysfunction after major hepatic resection, particularly from POD2 onward, but not with broader measures of postoperative morbidity or short-term mortality. Given the limited sample size and low number of events, these findings are hypothesis-generating and require validation in larger prospective cohorts before any conclusions regarding clinical utility can be drawn.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"411 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13400470/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148579302","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":"Indocyanine green fluorescence kinetics during hypothermic oxygenated machine perfusion might predict graft function after liver transplantation.","authors":"Mareike Franz, Jörg Arend, Antonia Bollensdorf, Frederike Stelter, Ahmed Sanin, Thomas Wartmann, Ulf D Kahlert, Verena Keitel-Anselmino, Theresa Florian, Roland Croner","doi":"10.1007/s00423-026-04158-4","DOIUrl":"10.1007/s00423-026-04158-4","url":null,"abstract":"<p><strong>Background: </strong>This study evaluates whether indocyanine green (ICG) fluorescence during hypothermic oxygenated machine perfusion (HOPE) can predict early allograft dysfunction (EAD) after liver transplantation.</p><p><strong>Methods: </strong>Seventeen donor livers underwent HOPE before transplantation. After one hour, ICG was administered via the portal line. Perfusate samples were collected every five minutes for 50 min; liver tissue and bile samples were obtained during perfusion and after reperfusion. Fluorescence intensity (FI) was quantified using standardized microplate analysis. Associations with donor characteristics and clinical outcomes were analyzed.</p><p><strong>Results: </strong>EAD occurred in 29.4% of recipients and primary non-function in 5.9%. Perfusate FI differed significantly between EAD and non-EAD grafts at 40 and 45 min (p = 0.006; p = 0.05). FI in post-reperfusion liver biopsies was higher in dysfunctional grafts (p = 0.01). Bile fluorescence showed no predictive value. ROC analysis demonstrated strong discrimination for perfusate samples at 40 and 45 min (AUC 0.875; 0.889) and for post-reperfusion tissue (AUC 0.886). Donor variables did not correlate with ICG kinetics.</p><p><strong>Conclusion: </strong>In this exploratory pilot study, perfusate fluorescence measurements during HOPE were associated with EAD. These findings suggest that fluorescence- based assessment during machine perfusion may provide functional information on graft quality.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"411 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13391663/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148549851","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 30-day postoperative complications following sleeve gastrectomy vs. one-anastomosis gastric bypass.","authors":"Michal Ness Kievsky, Arik Dahan, Carmil Azran","doi":"10.1007/s00423-026-04137-9","DOIUrl":"https://doi.org/10.1007/s00423-026-04137-9","url":null,"abstract":"<p><strong>Background: </strong>Metabolic Bariatric Surgery (MBS) is highly effective in promoting weight loss and weight loss maintenance in patients with obesity. Worldwide, the predominant MBS was sleeve gastrectomy (SG), followed by the Roux-en-Y bypass, while One-anastomosis gastric bypass (OAGB, mini-gastric bypass) only accounted for 4.3% of the surgeries. Conversely, In Israel alone in 2020 OAGB accounted for 63.7% of all bariatric surgeries, followed by SG. This provides a genuine opportunity to compare postoperative complications amongst these bariatric procedures.</p><p><strong>Aim: </strong>In this retrospective study we reviewed medical records of 2765 patients who have undergone SG or OAGB in the Herzliya Medical Center (HMC) between the years 2018-2020, and compared 30-day postoperative complications between the two procedures.</p><p><strong>Methods: </strong>The 30-day timeframe was divided into two periods, the first consisting of hospitalization and included complications such as need for blood or plasma infusion during surgery, cardiorespiratory complications. The second period extended from discharge until the end of the 30th postoperative day and included complications such as surgical wound infection and other infections.</p><p><strong>Results: </strong>During hospitalization, 1.7% of SG patients had complications and 2.2% of OAGB patients had complications (p = 0.374). In the second period, 3.8% of SG patients and 4.1% of OAGB patients had complications (p = 0.907).</p><p><strong>Conclusion: </strong>These results indicate that there was no difference in the 30-day postoperative complication rate between these two types of bariatric procedures.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148536214","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":"Impairment of preoperative activities of daily living predicts poor prognosis after surgery for perihilar cholangiocarcinoma.","authors":"Takashi Ofuchi, Kosuke Mima, Hiromitsu Hayashi, Kosuke Kanemitsu, Yuki Adachi, Takuya Tajiri, Taichi Horino, Rumi Itoyama, Yuki Kitano, Hirohisa Okabe, Masaaki Iwatsuki","doi":"10.1007/s00423-026-04142-y","DOIUrl":"https://doi.org/10.1007/s00423-026-04142-y","url":null,"abstract":"<p><strong>Purposes: </strong>Perihilar cholangiocarcinoma (PHC) is a rare malignancy with rising incidence and mortality. With global population aging, more patients present with impaired activities of daily living (ADL), potentially influencing surgical outcomes. This study aimed to assess the association between preoperative Barthel Index (BI) scores, a measure of ADL, and survival outcomes after PHC surgery.</p><p><strong>Methods: </strong>We retrospectively analyzed 88 patients who underwent PHC resection from 2005 to 2020. Preoperative ADL was evaluated using the BI (range 0-100), with scores ≤ 95 defined as impaired. Cox proportional hazards regression was used to assess the impact of ADL on survival, adjusting for confounders.</p><p><strong>Results: </strong>Among the 88 patients, 29 (33%) had impaired preoperative ADL (BI ≤ 95). Multivariable analysis revealed that impaired ADL was independently associated with worse overall survival (HR: 1.90, 95% CI: 1.05-3.40, P = 0.031) and recurrence-free survival (HR: 2.35, 95% CI: 1.36-4.07, P = 0.002).</p><p><strong>Conclusions: </strong>Impaired preoperative ADL is linked to poor prognosis in PHC patients. Efforts to maintain or improve perioperative ADL may enhance long-term outcomes after surgery.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148536257","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":"Spinal anesthesia in laparoscopic colorectal surgery: analgesia and recovery outcomes - a cohort study and systematic review of randomized controlled studies.","authors":"Eleonora Bianchi, Anne Seidl, Elena Krombholz, Michael C Frey, Isabelle Obrecht, Simone Hasler-Gehrer, Andreas Keerl, Andrea R Kopp Lugli, Andrea Wirsching, Antonio Nocito","doi":"10.1007/s00423-026-04152-w","DOIUrl":"https://doi.org/10.1007/s00423-026-04152-w","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Spinal anesthesia has been increasingly discussed as an adjunct to general anesthesia in laparoscopic colorectal surgery due to its potential to enhance early analgesia and reduce opioid exposure. Whether these benefits translate into improved postoperative bowel recovery remains unclear, and existing evidence is limited by heterogeneous study designs and small sample sizes. This study combines prospective cohort data with a systematic review and meta-analysis of randomized controlled trials to evaluate the effects of spinal anesthesia on pain, opioid use, and bowel function.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;All consecutive patients undergoing elective laparoscopic colorectal resection without ostomy formation between October 2021 and December 2024 were included in a prospective cohort and offered spinal anesthesia. Outcomes were compared between patients receiving spinal anesthesia and controls managed with general anesthesia alone. Primary endpoints were postoperative bowel recovery (time to flatus, stool, full oral diet) and prolonged postoperative ileus. Secondary endpoints included pain scores, opioid consumption, length of stay and postoperative complications.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Meta-analysis: &lt;/strong&gt;A systematic search of Medline (Ovid), EMBASE, CINAHL, the Cochrane Library, Web of Science and Scopus from inception to October 2023 identified randomized controlled trials comparing colorectal surgery with and without single-shot spinal anesthesia. Outcomes of interest included time to oral diet, flatus and stool, pain scores at 24 h, opioid use within 24 h and length of hospital stay. Meta-analyses were performed using random-effects models.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 242 patients were included in the cohort (153 with spinal anesthesia, 89 controls). Spinal anesthesia resulted in markedly reduced early opioid use and lower pain scores within the first 12 h postoperatively (e.g., NRS 0-3 h: 0 vs. 4, p &lt; 0.001). However, time to flatus, stool and full oral diet were comparable between groups, and the incidence of prolonged postoperative ileus remained low and similar (5% vs. 6%). Major postoperative complications were the only independent predictor of prolonged ileus in multivariate analysis (OR 8.55, p = 0.001). The meta-analysis included five randomized trials comprising 338 patients. Spinal anesthesia was consistently associated with reduced pain at 24 h (SMD: -0.749, 95% CI -1.219 to -0.279, p-value: 0.002) and lower opioid requirements within 24 h (SMD: -1.994, 95% CI -2.315 to -1.673, p-value &lt; 0.001); respectively but showed no significant effect on postoperative bowel recovery or length of stay.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Across both prospective cohort data and randomized evidence, spinal anesthesia offers clear early analgesic benefits and reduces postoperative opioid use in laparoscopic colorectal surgery, but does not improve bowel recovery or reduce prolonged postoperative ileu","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148520259","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":"Evaluating CASS and BATSS scores for predicting laparotomy in blunt abdominal trauma: meta-analysis from low- and middle-income countries.","authors":"Chris Lovis Bwambale, Elna Owembabazi, Jackson Kakooza, Bienfait Vahwere Mumbere, Theoneste Hakizimana, Prosper Akankwasa, Catherine R Lewis, Michael Mugenyi, Demoz Abraha","doi":"10.1007/s00423-026-04101-7","DOIUrl":"https://doi.org/10.1007/s00423-026-04101-7","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Early identification of intra-abdominal injury (IAI) following blunt abdominal trauma (BAT) is critical to reducing mortality in low- and middle-income countries (LMICs) where access to contrast-enhanced computed tomography (CECT) is limited. The Clinical Abdominal Scoring System (CASS) and the Blunt Abdominal Trauma Scoring System (BATSS) are used to guide triage and operative decision-making; however, their diagnostic accuracy in LMICs remains uncertain and inconsistently reported. The objective of this study was to evaluate the pooled diagnostic accuracy of CASS and BATSS in predicting the need for laparotomy or the presence of IAI in adult BAT patients in LMICs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a systematic review and meta-analysis in accordance with PRISMA 2020 guidelines. PubMed, Web of Science, Scopus, and Lens.org were searched from January 2009 to January 2025. Eligible studies evaluated adult patients with BAT in LMICs and reported diagnostic accuracy of CASS or BATSS for predicting IAI or need for laparotomy using CECT, laparotomy, or composite reference standards. Random-effects meta-analyses were used to pool sensitivity, specificity, and diagnostic odds ratios (DORs). Heterogeneity and publication bias were formally assessed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Twelve studies encompassing 2,148 patients met inclusion criteria, including 7 BATSS studies and 5 CASS studies. For BATSS, pooled sensitivity was 57.9% and specificity 86.5%, with a pooled DOR of 70.1 (95% CI: 9.38-520.61). For CASS, pooled sensitivity was 77.2%, specificity was 90.6%, and pooled DOR was 50.4 (95% CI: 6.59-384.91). Substantial heterogeneity was observed for both systems (I²=88.5% for BATSS; I²=74.6% for CASS). BATSS showed better pooled performance at a cut-off ≥ 12; however, variation in thresholds across studies limited direct comparability of pooled estimates. Publication bias was detected for BATSS but not for CASS, indicating that BATSS estimates may be vulnerable to small-study effects or selective publication.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Based on a limited evidence base, both CASS and BATSS appear to have diagnostic value for identifying IAI in adult BAT patients in LMICs, although neither should be used as a standalone decision tool. CASS may be more useful for initial rule-out triage where imaging is unavailable, whereas BATSS may support rule-in decisions for definitive imaging or surgical intervention; however, these interpretations should be made cautiously because of high heterogeneity, small study numbers, variable thresholds, and publication bias affecting BATSS. Local validation, threshold optimization, and prospective multicenter evaluation are essential before routine implementation. When cautiously integrated into structured trauma protocols, these scoring systems may support triage and imaging prioritization in resource-constrained settings, but current pooled estimates should be interpreted","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148520279","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}