Langenbeck's Archives of Surgery最新文献

{"title":"Indocyanine green (ICG) guided thyroidectomy versus conventional thyroidectomy and the impact on parathyroid function preservation: an updated GRADE-assessed systematic review and meta-analysis.","authors":"Ahmed Wael Moftah, Abdo Mohamed Abdalhy, Hammam Majed Alsousi, Abdalrahman Salah Shehata, Mahmoud Ashraf Hussein, Yasser Ashraf Gamal, Myame Ayman, Israa A Solah, Hebatalla Aly","doi":"10.1007/s00423-026-04210-3","DOIUrl":"https://doi.org/10.1007/s00423-026-04210-3","url":null,"abstract":"<p><strong>Background: </strong>Thyroidectomy carries a significant risk of parathyroid gland injury, with transient hypoparathyroidism occurring in 15-50% of cases and permanent hypoparathyroidism in up to 5%, resulting in lifelong morbidity. Near-infrared (NIR) autofluorescence imaging combined with indocyanine green (ICG) fluorescence angiography has emerged as an intraoperative adjunct for parathyroid identification and perfusion assessment, but its comparative efficacy over conventional white-light surgery remains to be comprehensively quantified.</p><p><strong>Methods: </strong>A systematic search across five databases through January 2026 identified randomized controlled trials and observational studies comparing NIR autofluorescence with ICG imaging versus conventional thyroidectomy without fluorescence guidance. Outcomes included inadvertent parathyroid removal, permanent and transient hypoparathyroidism, permanent and transient hypocalcemia, postoperative parathyroid hormone (PTH) levels, postoperative serum calcium levels, and operative time. Meta-analysis utilized a random-effects model to calculate pooled risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs). Certainty of evidence was assessed using the GRADE approach.</p><p><strong>Results: </strong>Eleven studies encompassing 2,203 patients (ICG: n = 897; Control: n = 1,306) were included. ICG-guided NIR imaging significantly reduced inadvertent parathyroid removal (RR 0.43, 95% CI 0.30-0.61, p = 0.002; I²=0%) and permanent hypocalcemia (RR 0.25, 95% CI 0.17-0.37, p = 0.004; I²=0%). A non-significant trend toward reduced permanent hypoparathyroidism was observed under our pre-specified random-effects model (RR 0.45, 95% CI 0.20-1.02, p = 0.054). A post-hoc sensitivity analysis using a fixed-effect model yielded a statistically significant result (RR 0.50, 95% CI 0.36-0.71, p < 0.001); however, this finding should be interpreted with caution, as it did not correspond to our primary pre-specified analytical approach. ICG guidance was associated with significantly higher postoperative PTH levels (MD 5.45 pg/mol, 95% CI 0.26-10.64, p = 0.042) and serum calcium levels (MD 0.06 mmol/L, 95% CI 0.01-0.11, p = 0.033). No significant differences were noted in transient hypoparathyroidism (RR 0.56, 95% CI 0.21-1.53, p = 0.185) or transient hypocalcemia (RR 0.67, 95% CI 0.33-1.34, p = 0.182), both characterized by substantial heterogeneity (I²=78.4% and 75.4%, respectively). Operative time was comparable between groups (MD 0.08 min, 95% CI - 18.25 to 18.42, p = 0.989).</p><p><strong>Conclusions: </strong>NIR autofluorescence with ICG imaging is associated with a reduction in inadvertent parathyroid removal and permanent hypocalcemia, supported by high and moderate certainty evidence respectively, along with improvements in postoperative PTH and calcium levels (moderate certainty). Evidence for benefit in permanent hypoparathyroidism was directionally favorable but of","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"411 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13630843/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111504","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":"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":"<p><strong>Purpose: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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":"Altered tibialis anterior tendon mechanics in hallux valgus: a shear-wave elastography study integrating distal insertion patterns.","authors":"Recep Taskin, Bahadir Reis, Erdem Ozkan, Fatih Ugur, Mehmet Ali Sabir, Murat Topal","doi":"10.1007/s00423-026-04181-5","DOIUrl":"10.1007/s00423-026-04181-5","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;While distal tibialis anterior tendon (TAT) insertion variants have been associated with hallux valgus, the in vivo mechanical behavior of the tendon has not been adequately investigated. This study aimed to evaluate tibialis anterior tendon stiffness using shear-wave elastography (SWE) in patients with hallux valgus and healthy controls, to examine its relationship with radiographic deformity parameters, distal insertion patterns, and body mass index, and to assess measurement reliability.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;In this prospective case-control study, 105 patients with radiographically confirmed hallux valgus and 98 age- and gender-matched healthy controls were enrolled. Tibialis anterior tendon elasticity was measured using shear-wave elastography on the index side. Hallux valgus angle (HVA) and intermetatarsal angle (IMA) were obtained from weight-bearing foot radiographs. Distal TAT insertion types were evaluated ultrasonographically. Correlations between tendon elasticity and radiographic parameters and body mass index were analyzed. Intra- and inter-observer reliability were assessed using intraclass correlation coefficients (ICC), standard error of measurement (SEM), minimal detectable change (MDC), and Bland-Altman analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Tibialis anterior tendon elasticity was significantly lower in the hallux valgus group compared with controls (11.07 ± 3.61 vs. 12.71 ± 3.86 kPa; p = 0.004; Cohen's d = - 0.44). In correlation analyses, tendon elasticity showed a weak, non-significant association with hallux valgus angle in the hallux valgus group (r = 0.19, p = 0.065) and no significant association with intermetatarsal angle in this subgroup (r = 0.12, p = 0.243). When all participants were analyzed together, a weak but statistically significant positive correlation was observed between tendon elasticity and intermetatarsal angle (r = 0.20, p = 0.006), whereas no significant correlation was found with hallux valgus angle (r = - 0.10, p = 0.194). Distal insertion analysis demonstrated that Type 5 was the most prevalent insertion pattern (75.7%) and was associated with markedly lower tendon elasticity (10.84 ± 3.25 kPa) compared with Types 1-3 (16.43-17.29 kPa). No significant association was identified between body mass index and tendon elasticity in the hallux valgus group (r = - 0.17, p = 0.087) or in the overall cohort (r = - 0.12, p = 0.113). Measurement reliability was excellent, with intra-observer and inter-observer ICC values of 0.93 and 0.91, respectively, and low measurement error (SEM &lt; 1 kPa).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Hallux valgus was associated with lower tibialis anterior tendon elasticity on shear-wave elastography; however, tendon elasticity showed only weak or non-significant correlations with radiographic deformity severity. Therefore, TAT stiffness should not be interpreted as a primary determinant of first metatarsal varus or hallux valgus severity","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"411 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13658456/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149170782","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}