Langenbeck's Archives of Surgery最新文献

{"title":"A comparative evaluation of the GINI index and the modified Glasgow prognostic score in predicting postoperative sarcopenia in rectal cancer patients undergoing NACRT.","authors":"Mehmet Kemal Yener, Hüseyin Kılavuz, Burak Bilir, Ayşe Gökçe, Bilir Yıldız, Ali Erol, Alper Sözütek","doi":"10.1007/s00423-026-04132-0","DOIUrl":"10.1007/s00423-026-04132-0","url":null,"abstract":"<p><strong>Objective: </strong>Postoperative sarcopenia following neoadjuvant chemoradiotherapy for locally advanced rectal cancer negatively affects recovery and oncological outcomes. Both the Global Immune Nutrition and Inflammation Index (GINI) and the modified Glasgow Prognostic Score (mGPS) are derived from routine laboratory data. There are no studies comparing the performance of these scores and indices in predicting sarcopenia in patients with CT-confirmed sarcopenia. The aim of this study is to determine which of these two indices is a more specific predictor of postoperative sarcopenia in patients who underwent surgery after NACRT in this patient population.</p><p><strong>Methods: </strong>This single-center retrospective cohort study (January 2019-December 2025) included 134 adults with locally advanced rectal adenocarcinoma who underwent total mesorectal excision after completing standard 5-fluorouracil/leucovorin/oxaliplatin-based neoadjuvant chemoradiotherapy (NACRT). GINI and mGPS values were calculated from fasting blood samples collected one month after NACRT. Postoperative sarcopenia was defined using gender-specific skeletal muscle index (SMI) cutoff values at the level of the third lumbar vertebra, as determined by CT scans performed three to six months after surgery.</p><p><strong>Results: </strong>The prevalence of postoperative sarcopenia was 30.6% (41/134). Sarcopenic patients had lower albumin levels (35.76 vs. 38.07 g/L; p = 0.046) and higher GINI values (median 146.70 vs. 68.39; p = 0.018); there was no difference between mGPS categories (p = 0.558). The GINI index yielded an AUC value of 0.629 (95% CI 0.541-0.711; sensitivity 48.78%, specificity 79.57% when the cutoff value was > 156.25; Nagelkerke R² = 0.140), whereas mGPS showed no discriminatory power (AUC 0.551; p = 0.307). In the adjusted analysis, a high GINI value independently predicted sarcopenia (aOR 4.93, 95% CI 1.72-14.13; p = 0.003).</p><p><strong>Conclusion: </strong>In patients with locally advanced rectal cancer, a high GINI value after NACRT was independently associated with sarcopenia assessed by postoperative CT, whereas no such association was found with mGPS. Moderate discriminatory performance and a wide 95% confidence interval indicate that the GINI, in its current form, is insufficient as a standalone clinical decision-making tool; therefore, these findings should be considered hypothesis-generating and must be supported by a prospective, multicenter validation study before being implemented in clinical practice.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13658351/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148471443","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":"Leukoglycemic index and inflammatory markers in acute abdominal pain: Comparison of non-specific pain and acute appendicitis severity.","authors":"Muhammet Ali Erinmez, Erkan Güler, Rojhat Kurt","doi":"10.1007/s00423-026-04151-x","DOIUrl":"10.1007/s00423-026-04151-x","url":null,"abstract":"<p><strong>Purpose: </strong>The diagnosis of acute appendicitis and the early identification of complicated disease remain challenging in emergency practice. This study aimed to evaluate the potential role of the leukoglycemic index (LGI) in distinguishing acute appendicitis from non-specific acute abdominal pain and to explore its performance in identifying complicated appendicitis, in comparison with commonly used inflammatory markers.</p><p><strong>Methods: </strong>This retrospective study included adult patients presenting with acute abdominal pain between 2017 and 2024. Patients were categorized as controls with non-specific abdominal pain, non-complicated acute appendicitis, or complicated acute appendicitis. LGI, white blood cell count (WBC), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) were calculated at admission. Multivariable logistic regression and receiver operating characteristic (ROC) analyses were performed.</p><p><strong>Results: </strong>A total of 642 patients were analyzed, including 320 with acute appendicitis and 322 controls. Among patients with appendicitis, 179 (55.9%) had non-complicated and 141 (44.1%) had complicated disease. LGI was significantly higher in patients with acute appendicitis compared with controls (p < 0.001) and was independently associated with appendicitis in the adjusted multivariable model (OR 60.0, p < 0.001), with diagnostic performance comparable to WBC (AUC 0.844 vs. 0.867). In addition, age, sex, and comorbidity status were also significantly associated with appendicitis in the adjusted analysis. In patients with complicated appendicitis, LGI, NLR, WBC, and SII were significantly elevated compared with non-complicated cases (all p < 0.001). In ROC analysis for complicated appendicitis, LGI demonstrated good discriminative ability (AUC 0.857), while WBC showed an AUC of 0.826; NLR and SII showed the highest overall performance (AUC 0.951 and 0.931, respectively).</p><p><strong>Conclusions: </strong>LGI is independently associated with acute appendicitis and demonstrates diagnostic performance broadly comparable to white blood cell count. However, it does not outperform simpler, routinely available markers, and its clinical utility remains uncertain. In addition, its potential incremental value beyond established inflammatory markers was not formally assessed and therefore cannot be inferred from the present data. LGI may be considered as a complementary parameter requiring further validation.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13593719/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148471459","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 between clinically relevant antibiotic-resistant biliary colonization and liver-specific complications following perihilar cholangiocarcinoma resection.","authors":"Faruk Koca, Hanan El Youzouri, Svenja Sliwinski, Konstantin Uttinger, Ursula Pession, Ekaterina Petrova, Dirk Walter, Michael Hogardt, Volkhard A J Kempf, Andreas A Schnitzbauer, Armin Wiegering, Tamás Benkö","doi":"10.1007/s00423-026-04157-5","DOIUrl":"10.1007/s00423-026-04157-5","url":null,"abstract":"<p><strong>Background: </strong>International guidelines recommend first-generation cephalosporins for preoperative antibiotic prophylaxis in patients undergoing resection for perihilar cholangiocarcinoma (pCCA). Knowledge on the resistance profile of biliary bacteria and its impact on liver-specific complications is limited. This study aimed to evaluate the biliary microbial spectrum, particularly focusing on the impact of resistant bacteria on liver-specific complications following pCCA resection.</p><p><strong>Methods: </strong>This is a retrospective, single-center, observational study. All patients with resected pCCA at the University Hospital Frankfurt from July 2005 to December 2022 were included. The microbial spectrum was analyzed using intraoperative bile swabs.</p><p><strong>Results: </strong>From 118 patients, 104 had an intraoperative bile swab taken. Microorganisms (bacteria, fungi) were detected in 89.4% of cases. 24% of the samples contained clinically relevant antibiotic-resistant bacteria, which were related with more severe postoperative bile leaks requiring relaparotomy (24% versus 8.8%, p = 0.055) and posthepatectomy liver failure (48% versus 25.3%, p = 0.031). 76.9% of the microbial isolates were resistant to in-house standard antibiotic prophylaxis with cefuroxime.</p><p><strong>Conclusion: </strong>Biliary colonization with clinically relevant antibiotic-resistant bacteria is associated with liver-specific complications.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"411 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13379436/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148471495","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":"Anatomical dissection approaches in right hemicolectomy with complete mesocolic excision: characteristics of surgical outcomes from a systematic review and Bayesian network meta-analysis.","authors":"Daichi Kitaguchi, Antonello Forgione, Chiara Innocenzi, Yuchuan Yang, Federico Espínola, Ian Dox, Mariano Giménez, Tatsuya Oda, Jacques Marescaux","doi":"10.1007/s00423-026-04131-1","DOIUrl":"10.1007/s00423-026-04131-1","url":null,"abstract":"<p><strong>Background: </strong>Several anatomical dissection approaches have been proposed for right hemicolectomy (RHC) with complete mesocolic excision (CME). Even though all are considered safe, the evidence-based guiding selection remains limited. We aimed to systematically review the literature and perform a Bayesian network meta-analysis to compare their relative characteristics.</p><p><strong>Methods: </strong>A comprehensive search of PubMed, Embase, and the Cochrane Library was completed through August 2025. Eligible studies included adult patients undergoing minimally invasive RHC with CME, with the predominant dissection direction defined as medial-to-lateral (MtL), lateral-to-medial (LtM), cranial-to-caudal (CtC), or caudal-to-cranial, also known as the bottom-to-up (BtU) approach. The primary outcome was the number of harvested lymph nodes (LNs). Secondary outcomes included operative time, blood loss, and conversion to open surgery.</p><p><strong>Results: </strong>Fourteen studies including 2,947 patients were analyzed (MtL: 1,539; LtM: 401; CtC: 291; BtU: 716). No significant pairwise differences were observed in lymph node harvest, although ranking analysis indicated that BtU was the most favorable approach. Secondary outcomes did not show any significant differences, although BtU tended to reduce operative time as compared to MtL. LtM ranked worst and was associated with a significantly higher open conversion rate versus BtU (RR: 26.84, 95% CrI: 2.29-2014.36) and MtL (RR: 8.27, 95% CrI: 1.07-216.68).</p><p><strong>Conclusion: </strong>No significant differences in LN harvest were observed among the four approaches. The BtU approach showed a non-significant trend toward a shorter operative time, whereas LtM was associated with a significantly higher rate of conversion to open surgery. Overall, the available evidence does not demonstrate clear superiority of any single approach, and further prospective studies are needed to confirm these findings.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13658480/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148471526","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":"Actual 10-year survival after total pancreatectomy: a multicenter study.","authors":"Yusuke Kawachi, Jun Sakata, Tomohiro Katada, Kazuyasu Takizawa, Yuki Hirose, Tatsuya Nomura, Naoyuki Yokoyama, Chie Kitami, Takashi Aono, Susumu Suzuki, Masahiro Minagawa, Hirosuke Ishikawa, Takuya Ando, Shun Abe, Hiroshi Ichikawa, Mae Nakano, Yoshifumi Shimada, Takashi Kobayashi, Toshifumi Wakai","doi":"10.1007/s00423-026-04141-z","DOIUrl":"10.1007/s00423-026-04141-z","url":null,"abstract":"<p><strong>Purpose: </strong>Total pancreatectomy (TP) has attracted increasing attention because short-term outcomes have improved. However, long-term data remain limited. This study evaluated long-term outcomes after TP, focusing on actual 10-year survivors and causes of death.</p><p><strong>Methods: </strong>This study included patients who underwent elective TP for pancreatic disease and were followed for at least 10 years or until death. Patients were classified as 10-year survivors or non-survivors. Clinicopathological characteristics, long-term survival, and causes of death were analyzed.</p><p><strong>Results: </strong>Forty-nine patients were included. Single-stage TP was performed in 30 patients (61.2%) and completion TP in 19 (38.8%). Pancreatic ductal adenocarcinoma accounted for 57.1% of indications for TP. R0 resection was achieved in 87.8% of patients, with no in-hospital mortality. The actual 5- and 10-year overall survival rates were 28.6% and 18.4%, respectively. Nine patients (18.4%) were actual 10-year survivors; none underwent vascular resection and reconstruction (p = 0.019), multivisceral resection (p = 0.322), or R1/2 resection (p = 0.577). One-third of the 10-year survivors had non-invasive intraductal papillary mucinous neoplasms (p = 0.016). In multivariate analysis, vascular resection and reconstruction was associated with worse overall survival (p = 0.016). Most deaths occurred within 5 years after TP and were mainly attributable to disease progression.</p><p><strong>Conclusion: </strong>Long-term outcomes after TP appear to be influenced predominantly by oncological factors. Actual 10-year survivors were observed mainly among patients with benign or more favorable tumor characteristics who did not require extended resection. Given the heterogeneity of underlying diseases and surgical indications, these findings should be interpreted as primarily descriptive.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13661640/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148471519","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":"Preventing Crohn's recurrence, Kono-S and extended mesenteric excision: network meta-analysis category.","authors":"Talia Shepherd, Devansh Shah, Joseph Do Woong Choi, Toufic El-Khoury, Nimalan Pathma-Nathan, Amy Cao, James Wei Tatt Toh","doi":"10.1007/s00423-026-04103-5","DOIUrl":"10.1007/s00423-026-04103-5","url":null,"abstract":"<p><p>IntroductionCrohn's disease (CD) is a complex disease with rising incidence that is usually treated with medical management. However, surgery plays an important role for medically refractive cases, or Crohn's related complications. New techniques such as extended mesenteric excision (EME), and Kono-S anastomosis (KSA) are being increasingly adopted. However, their potential for reducing CD recurrence remains unclear.MethodStudies were identified through searching Medline, Embase, Cochrane Library and JBI EBP from database inception to January 2025. Studies where patients with CD had intestinal resection and underwent at least two of four interventions being KSA, other anastomosis, EME and/or limited mesenteric excision (LME) were included. Two investigators independently identified studies and abstracted data. RCT quality was assessed using Cochrane Risk of Bias 2 tool and cohort study quality assessed using Newcastle Ottawa Scale. The study adhered to PRISMA guidelines. Bayesian network meta-analysis was conducted to assess risk of surgical and endoscopic recurrence at 5 years and 6-12 months respectively.ResultsThirteen studies composed of 3 RCTs and 10 cohort studies (n = 2,044) were included, assessing surgical and/or endoscopic recurrence after KSA, other anastomosis, EME or LME. There was statistically significant reduction in surgical recurrence in KSA compared to other anastomosis (odds ratio 0.07, 95% credible interval) but not EME compared to LME. There was no difference in endoscopic recurrence in any groups.ConclusionKSA was associated with reduced surgical recurrence compared with other anastomosis, but not endoscopic recurrence. There were insufficient studies to support similar improvement in recurrence in EME over LME.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13658377/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148456196","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":"Standard TAPP with flat mesh versus TAPP with flat mesh plus mesh plug for inguinal hernia repair: a preliminary single-center randomized experience.","authors":"Morteza Azadbakht, Mohammadali Hassanvand","doi":"10.1007/s00423-026-04136-w","DOIUrl":"10.1007/s00423-026-04136-w","url":null,"abstract":"<p><strong>Background: </strong>Inguinal hernia repair is a common surgical procedure. While laparoscopic transabdominal preperitoneal (TAPP) repair is widely adopted, the comparative efficacy of standard flat mesh alone versus flat mesh plus mesh plug augmentation remains an area of ongoing clinical evaluation. This study aimed to compare these two techniques with respect to recurrence, postoperative pain, and patient recovery.</p><p><strong>Methods: </strong>In this preliminary, single-center randomized trial, 63 patients undergoing TAPP repair for inguinal hernia were randomly assigned to either a standard TAPP with flat mesh alone group (n = 33) or a TAPP with flat mesh plus mesh plug augmentation group (n = 30). A single surgeon performed all procedures. Demographics, operative details, time to return to work, postoperative pain (measured via a Visual Analog Scale [VAS]), patient satisfaction, and hernia recurrence were documented during hospitalization and at follow-up intervals over 12 months. Statistical analysis was performed using SPSS v26, employing t-tests, Mann-Whitney U tests, and Chi-square tests where appropriate.</p><p><strong>Results: </strong>The cohorts were comparable regarding age, Body mass index (BMI), and baseline clinical characteristics. The recurrence rate was significantly higher in the standard TAPP with flat mesh alone group, reaching 12.1% at 3 months and 21.2% at 6 and 12 months, whereas no recurrences (0%) occurred in the mesh plug-augmented group (p < 0.05). Although early postoperative pain scores were similar between the groups, chronic pain outcomes significantly favored the mesh plug-augmented cohort; 0% reported chronic pain at 12 months compared to 21.2% in the standard TAPP group (p < 0.05). Consequently, overall patient satisfaction was significantly higher in the mesh plug-augmented group (96.7% \"very satisfied\") than in the standard TAPP group (81.8% \"very satisfied\"). The standard TAPP group demonstrated a trend toward a shorter time to return to work (93.9% resuming within 1-3 days), but this difference did not reach statistical significance (p > 0.05).</p><p><strong>Conclusion: </strong>TAPP repair with flat mesh plus mesh plug augmentation was associated with significantly lower recurrence rates (0% vs. 21.2%) and lower chronic pain rates (0% vs. 21.2%) compared to standard TAPP with flat mesh alone. However, given the small sample size, lack of an a priori sample size calculation, and single-center design, these findings should be interpreted strictly as hypothesis-generating. Larger, adequately powered multicenter trials are required to confirm whether routine mesh plug augmentation confers a definitive clinical advantage.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13649815/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148447800","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":"Early postoperative complication profile and acute hypothalamic dysfunction grading after surgery for adult intraventricular craniopharyngiomas: a single-center retrospective cohort study.","authors":"Uygun Altibayev, Jakhongirmirzo Yoldoshev, Gayrat Kariev, Bipin Chaurasia, Alvaro Campero, Abhidha Shah","doi":"10.1007/s00423-026-04146-8","DOIUrl":"10.1007/s00423-026-04146-8","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Intraventricular craniopharyngiomas in adults are rare lesions, and their surgical treatment is associated with a risk of hypothalamic, cognitive, and seizure-related morbidity. Early postoperative complications in this subgroup remain insufficiently characterized.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To characterize the frequency and pattern of early postoperative complications in adults with intraventricular craniopharyngiomas, with particular focus on early postoperative MMSE change, new-onset seizures, and the severity of acute diencephalic syndrome (DS) according to an original four-stage grading scale.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;We retrospectively analyzed 62 adult patients older than 45 years who underwent microsurgical treatment via either a transcallosal approach (n = 30) or a transcortical transventricular approach (n = 32) between 2015 and 2025. Early postoperative outcomes included MMSE change, new-onset seizures within 30 days, and DS severity. DS was graded using a four-stage scale incorporating level of consciousness, thermoregulation, water-electrolyte and endocrine disturbances, autonomic-hemodynamic instability, and respiratory dysfunction. Comparisons between surgical approaches were considered exploratory because approach selection was non-randomized.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In the overall cohort, the mean MMSE score decreased from 27.4 ± 2.1 preoperatively to 24.8 ± 3.5 in the early postoperative period (p &lt; 0.05). Early postoperative MMSE decline ≥ 3 points was observed in 17 patients (27%). This decline was numerically more frequent after the transcallosal approach than after the transcortical approach (33% vs. 22%), but the difference was not statistically significant (p = 0.29). New-onset postoperative seizures occurred in 9 patients (15%) and were numerically more frequent after the transcortical approach (22% vs. 7%, p = 0.09), particularly in patients with large tumors. Acute DS of varying severity developed in 47 patients (76%). Severe-to-critical DS, defined as stages III-IV, occurred in 5 patients (8%) and was associated with destruction of the third ventricular floor (p = 0.02). No severe-to-critical DS was observed when the third ventricular floor was preserved, whereas after gross-total resection with floor destruction, severe-to-critical DS occurred in 4 of 13 patients (31%), including two fatal stage IV cases.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Early postoperative morbidity after surgery for adult intraventricular craniopharyngiomas includes screening-based MMSE decline, new-onset seizures, and acute diencephalic dysfunction. Approach-related differences in MMSE decline and seizure incidence were numerical and should be interpreted cautiously because of baseline differences between groups. Severe-to-critical DS was closely related to destruction of the third ventricular floor and was most frequent after gross-total resection in this anatomical subgroup. T","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13658334/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148447740","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":"Suture-suspension single-incision laparoscopic cholecystectomy versus conventional multiport laparoscopic cholecystectomy: a single-center, prospective, randomized controlled clinical study.","authors":"Yingan Zhao, Shuai Han, Jinghui Zhang, Yini Xu, Jianfeng Lu, Siming Zheng","doi":"10.1007/s00423-026-04127-x","DOIUrl":"10.1007/s00423-026-04127-x","url":null,"abstract":"<p><strong>Purpose: </strong>Single-incision laparoscopic cholecystectomy (SILC) shows superior cosmetic outcomes but greater technical difficulty. This study aimed to compare the short-term outcomes of the suture-suspension SILC versus conventional conventional multiport laparoscopic cholecystectomy (CMLC) and to analyze the risk factors of difficult SILC.</p><p><strong>Methods: </strong>From October 2023 to September 2024, 120 patients with symptomatic cholelithiasis were enrolled and randomly assigned to either the suture-suspension SILC group (60 patients) or the conventional CMLC group (60 patients). The primary outcome was operative time. Secondary outcomes included intra-operative blood loss, postoperative hospitalization duration, time to first flatus, 24-hour postoperative pain score, incidence of postoperative complications (bile leakage, hemorrhage, wound infection), and subjective satisfaction.</p><p><strong>Results: </strong>Compared to the conventional CMLC, suture-suspension SILC showed no significant differences in operative time (P > 0.05) or intra-operative blood loss (P > 0.05). However, the time to first flatus (1.20 ± 0.443 days), duration of postoperative hospitalization (1.58 ± 0.889 days), and the 24-hour postoperative pain score (3.92 ± 1.225) in the suture-suspension SILC group were all significantly lower than those in the CMLC group (P ≤ 0.05). The subjective satisfaction score (3.98 ± 0.431 points) in the suture-suspension SILC group was significantly higher than that in the CMLC group (3.32 ± 0.469 points, P < 0.001). No postoperative complications occurred in either group. Thickened gallbladder wall, elevated white blood cell (WBC) count, and pericholecystic effusion were identified as factors associated with the operative time of SILC (P ≤ 0.05). A gallbladder wall thickness exceeding 4.375 mm was associated with an operative time longer than the average for the suture-suspension SILC procedure.</p><p><strong>Conclusion: </strong>The suture-suspension method renders SILC short-term outcomes comparable to those of conventional CMLC. However, the choice of surgical technique should be made cautiously in cases of severe gallbladder inflammation.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13368970/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148430185","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":"Classifying the structural heterogeneity of peritoneal adhesions by histopathological extracellular matrix characteristics.","authors":"Marcella Steffani, Jara Tigges, Zoé Clees, Katharina Garhammer, Philipp-Alexander Neumann, Dirk Wilhelm, Marc Martignoni, Norbert Hüser, Rebekka Dimpel, Daniel Reim, Marcus Feith, Bianca Grosser, Helmut Friess, Marie-Christin Weber","doi":"10.1007/s00423-026-04130-2","DOIUrl":"10.1007/s00423-026-04130-2","url":null,"abstract":"<p><strong>Background: </strong>Peritoneal adhesions are a common complication following abdominal surgery and contribute substantially to long-termmorbidity, including bowel obstruction, chronic pain, and infertility. Their diverse clinical presentation, ranging from thin strands todense obstructive bands, suggests multiple underlying pathomechanisms. We propose a histopathological framework for classifyingperitoneal adhesions based on extracellular matrix characteristics, providing a microscopic correlation to clinical heterogeneity andsupporting translational research on adhesion prevention.</p><p><strong>Methods: </strong>In this study, adhesions from 77 patients were examined histologically. Masson's Trichrome staining was used to visualize the extracellular matrix, enabling classification into five clusters based on qualitative histological analysis: stringy, dense, loose, fatty, and mixed.</p><p><strong>Results: </strong>The \"stringy\" and \"dense\" clusters exhibited the highest extracellular matrix fraction and vessel area, whereas the\"loose\" and \"fatty\" clusters displayed lower ECM density and vascularity. Immunohistochemical staining for αSMA (myofibroblasts) and PGP9.5 (nerve fibers) further revealed cluster-specific differences in myofibroblast presence and innervation. Cluster distribution was significantly associated with clinical parameters, including adhesion load and prior peritonitis.</p><p><strong>Conclusions: </strong>This is the first study to systematically categorize peritoneal adhesions byextracellular matrix characteristics, identifying five distinct histopathological phenotypes. Our findings highlight the structural andcellular diversity of adhesions, offering new insights with potential implications for understanding adhesion pathophysiology andguiding future therapeutic strategies. Validation in larger cohorts will be essential to confirm this framework and establish its clinicalutility.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"411 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13354687/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148422291","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}