Langenbeck's Archives of Surgery最新文献

{"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":"<p><strong>Background: </strong>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.</p><p><strong>Objective: </strong>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.</p><p><strong>Materials and methods: </strong>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.</p><p><strong>Results: </strong>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 < 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.</p><p><strong>Conclusions: </strong>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}

{"title":"Optimal timing of ileostomy closure after rectal surgery: A Bayesian network meta-analysis of randomized controlled trials.","authors":"Zikai Zhou, Siyi Wang, Jiahao Zhou, Jun Huang, Xiangbing Deng, Ziqiang Wang, Wenjian Meng, Qingbin Wu","doi":"10.1007/s00423-026-04133-z","DOIUrl":"10.1007/s00423-026-04133-z","url":null,"abstract":"<p><strong>Purpose: </strong>Temporary ileostomy is commonly performed to protect rectal anastomosis after rectal surgery, yet the optimal timing of reversal remains unsettled. This study compared postoperative outcomes among early, intermediate, and late ileostomy closure and assessed the safety of early closure in selected patients.</p><p><strong>Methods: </strong>PubMed, Web of Science, and Embase were systematically searched from inception to June 21, 2026. Randomized controlled trials comparing different timing strategies for ileostomy closure were included. Closure timing was categorized according to the reported median or mean interval from primary surgery to reversal as early (≤ 35 days), intermediate (> 35 and ≤ 120 days), and late (> 120 days) based on the median or mean interval. The primary outcomes were total postoperative complications and major complications. A Bayesian network meta-analysis was performed.</p><p><strong>Results: </strong>Ten randomized trials involving 871 patients (316 early, 312 intermediate, and 243 late) were included. Total postoperative complications were comparable among the three groups. Compared with intermediate closure, early closure was associated with higher risks of major complications (odds ratio [OR] 5.30, 95% credible interval [CrI] 1.30-63.00) and wound complications (OR 4.80, 95%CrI 1.10-35.00), but a lower risk of stoma-related complications (OR 0.086, 95%CrI 0.0057-0.82). No significant differences were observed between early and late closure or between intermediate and late closure. In patients without clinical or radiological evidence of anastomotic leakage, total and major complication rates were similar across groups.</p><p><strong>Conclusion: </strong>Early ileostomy closure may be feasible and safe in carefully selected patients without evidence of anastomotic leakage, reducing stoma-related complications at the expense of increased wound complications.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13631017/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148412336","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":"Conversion of a sigma rectum pouch to a continent cutaneous urinary diversion - enhancing quality of life through a bowel-sparing surgical approach.","authors":"Margarete Teresa Walach, Raimund Stein, Malin Nientiedt","doi":"10.1007/s00423-026-04110-6","DOIUrl":"10.1007/s00423-026-04110-6","url":null,"abstract":"<p><strong>Purpose: </strong>The sigmoid rectum pouch (SRP) is a continent anal urinary diversion that may cause long-term complications requiring revision. This study describes our bowel-sparing surgical (BSS) technique for conversion to a continent cutaneous urinary diversion (CCUD) and evaluates functional outcomes and quality of life (QOL).</p><p><strong>Methods: </strong>We retrospectively analysed all patients undergoing SRP-to-CCUD conversion at our tertiary referral center between 2015 and 2020. Clinical records and follow-up data were reviewed. Endpoints included serum creatinine, urinary tract infections, pouch capacity, urinary continence (International Consultation on Incontinence Questionnaire [ICIQ]), fecal continence (Wexner score), and QOL (EuroQol-5D-5 L). Descriptive statistics were applied.</p><p><strong>Results: </strong>Seven patients underwent conversion at a mean age of 32 years with a mean follow-up of 91 months. All procedures were successfully completed using a BSS approach preserving bowel length. No severe postoperative complications (≥ CDC 3) occurred. Renal function remained stable (mean preoperative serum creatinine 0.92 vs. 1.00 mg/dL postoperatively). Severe urinary tract infections decreased postoperatively. One-third of patients achieved full urinary continence, one-third mild, and one-third moderate incontinence. Fecal continence remained stable (four patients with perfect, three with good continence). QOL was favorable (mean EQ-5D-5 L index 0.93; mean VAS 76), with all patients reporting subjective improvement.</p><p><strong>Conclusion: </strong>BSS conversion of SRP to CCUD is a feasible option in selected patients, preserving bowel length while maintaining renal function, acceptable continence, and good QOL.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"411 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13346211/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148405165","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 hospital volume and mortality after elective oesophageal cancer resection in Switzerland: a retrospective national registry study from 2013 to 2022.","authors":"Yanic Ammann, Rene Warschkow, Marie Klein, Kristjan Ukegjini, Ignazio Tarantino, Thomas Steffen","doi":"10.1007/s00423-026-04125-z","DOIUrl":"10.1007/s00423-026-04125-z","url":null,"abstract":"<p><strong>Purpose: </strong>The association between a high annual hospital-specific case volume and improved postoperative outcomes after oesophageal cancer resection (OCR) is well described. The Swiss government started centralisation of OCR in 2013. This study investigates this centralisation in terms of the annual hospital-specific case volume of OCR (hospital volume) and its effect on short-term postoperative outcomes.</p><p><strong>Methods: </strong>National inpatient registry data of all hospitals providing OCR (ICD codes C15 and at least one of the CHOP codes starting with 424, 425, or 426) between 2013 and 2022 in Switzerland were analysed. The primary endpoint was in-hospital mortality. Secondary endpoints were postoperative complications and length of hospital stay (LOS).</p><p><strong>Results: </strong>1'535 cases were identified. The annual number of hospitals providing OCR ranged between 30 in 2013 and 14 in 2021. Hospital volume varied between one and 40 patients per year. Overall mortality was 5.3% (n = 81) declining from 9.3% in 2013 to 3.8% in 2022 (t=-0.511, p = 0.040). Increasing hospital volume was associated with lower risk for mortality (odds ratio (OR) = 0.723, 95% confidence interval (CI) 0.53 to 0.98, p = 0.037) and postoperative complications (OR = 0.705, 95%CI: 0.62 to 0.83, p < 0.001). There was no association of hospital volume with LOS (β = 0.007, 95%CI -0.093 to 0.108, p = 0.889). However, there were significant differences across quantiles (joint p < 0.001).</p><p><strong>Conclusions: </strong>Higher hospital volume is associated with lower mortality and fewer postoperative complications following OCR, whereas no association was observed with LOS.</p><p><strong>Clinical trial registration: </strong>ClinicalTrials.gov, NCT07022652, https://clinicaltrials.gov/search?id=NCT07022652 .</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624032/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148397059","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":"Peripheral hepatojejunostomy for unresectable malignant biliary obstruction: is it still a valid strategy?","authors":"Mohammad H Fard-Aghaie, C H Stephan, S Imdahl, G A Stavrou, J Laengle, K C Wagner, T Hackert, K J Oldhafer","doi":"10.1007/s00423-026-04124-0","DOIUrl":"10.1007/s00423-026-04124-0","url":null,"abstract":"<p><strong>Purpose: </strong>Peripheral hepatojejunostomy (HJ) is rarely performed today but may offer durable internal biliary drainage in patients with hilar or intrahepatic malignancy deemed unresectable at laparotomy. Abandoning resection leaves the question of how best to secure biliary continuity. In this retrospective study, we evaluated whether HJ remains a valid option by detailing indications, technique, and short-term outcomes in patients in whom curative resection was abandoned intraoperatively.</p><p><strong>Methods: </strong>We retrospectively analysed 20 consecutive patients treated at our centre between 2010 and 2024. In all cases, planned curative resection was abandoned intraoperatively, and a HJ was constructed to drain segmental intrahepatic ducts. Data on preoperative biliary interventions, operative technique, perioperative outcomes, and follow-up were collected.</p><p><strong>Results: </strong>Among 20 patients (median age 71 years, IQR 62-77), 10 (50%) underwent bilateral HJ. There were no intraoperative deaths. Ninety-day mortality was 15%; overall morbidity was 50%, with major complications (Clavien-Dindo ≥ III) in 20%. Median overall survival after HJ was 8 months (IQR 4-20).</p><p><strong>Conclusion: </strong>Peripheral HJ remains a selective option for internal biliary drainage when curative resection is abandoned intraoperatively. In selected patients, it can provide durable palliation while reducing reliance on long-term external drainage and repeated biliary interventions. This technique may warrant reconsideration in selected contemporary practice settings.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13342167/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148391267","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":"Triangular anastomosis enhances early patency of small middle hepatic vein tributaries in right lobe living donor liver transplantation.","authors":"Chi-Yi Chen, Qi-Ming Zheng, Ji-San Sun, Yan Xie, Hong-Hai Wang, Qing-Jun Guo, Li Zhang, Wen-Tao Jiang","doi":"10.1007/s00423-026-04128-w","DOIUrl":"10.1007/s00423-026-04128-w","url":null,"abstract":"<p><strong>Background: </strong>In right-lobe living donor liver transplantation (LDLT) without middle hepatic vein (MHV) inclusion, conventional anastomosis results in poor early patency of MHV tributaries ≤ 5 mm, which may cause graft congestion and dysfunction, especially in recipients with marginal graft-to-recipient weight ratio (GRWR). This study evaluated the safety and efficacy of a novel triangular anastomosis for small MHV tributary reconstruction.</p><p><strong>Methods: </strong>A single-center, two-period comparative study enrolled 42 adult LDLT recipients (May 2019-December 2025). Period 1 (2019-2023) comprised 24 patients undergoing conventional anastomosis; Period 2 (2023-2025) included 18 patients receiving triangular anastomosis for MHV tributaries ≤ 5 mm (standard reconstruction for > 5 mm). Primary endpoint was 7-day patency of ≤ 5 mm tributaries; secondary endpoints included graft function, complications, and 1-year survival. Patency was analyzed by generalized estimating equations (GEE), and survival by Kaplan-Meier method.</p><p><strong>Results: </strong>Baseline and intraoperative characteristics were well balanced. The 7-day patency of ≤ 5 mm tributaries was significantly higher in Period 2 (75.0% vs. 26.7%, GEE-adjusted P = 0.032), with no significant 30-day patency difference. Time to total bilirubin normalization was shorter (7.10 ± 3.28 vs. 11.17 ± 3.24 days, P = 0.009). Complication and 1-year survival rates were comparable between groups (both P > 0.05).</p><p><strong>Conclusions: </strong>Within the limitations of this small single-center cohort, triangular anastomosis improves early patency of small MHV tributaries and may contribute to earlier graft functional recovery without additional risks. It is a safe and feasible option for high-risk small venous reconstruction in MHV-excluded right-lobe LDLT with marginal GRWR. However, these findings are preliminary, and larger studies with longer follow-up are needed to confirm long-term efficacy.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13627178/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148382352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of large language models in the writing of surgical reviews: fact or fantasy?","authors":"Daphne E DeTemple, Simon Störzer, Sahar Arbabzadah, Anna Riddermann, Felix Gronau, Kai Timrott, Hüseyin Bektas, Moritz Kleine","doi":"10.1007/s00423-026-04095-2","DOIUrl":"10.1007/s00423-026-04095-2","url":null,"abstract":"<p><strong>Background: </strong>Amidst the current enthusiasm concerning artificial intelligence and its possible application in the composition of different kinds of scientific and non-scientific written documents, we evaluated the usage of artificial intelligence for writing surgical short reviews.</p><p><strong>Methods: </strong>In order to assess the formal and content quality of AI-generated texts compared to human written texts, ten AI-based text generators (five chatbots and five content creators) and four surgeons in training received the same prompt for a short scientific article on a liver surgery theme. All texts were anonymized and subsequently evaluated by three experienced liver surgeons based on a pre-defined scoring scheme, as well as for quality of references and readability according to readability indices. Furthermore, all texts were tested for plagiarism using PlagScan.</p><p><strong>Results: </strong>Overall percentage of correct assessment for AI/non-AI generation by experienced surgeons lay at 78.57%. Human written text had a mean word count of 1054 versus 874 in AI-generated text, with a higher mean Flesh Reading Ease Score (FRE, 26.2 ± 5.1 versus 17.7 ± 6.1). References were PubMed-listed in 100% for human versus 46% for AI-generated text, with only one non-human text reaching 100% formally correct citation of references. PlagScan found 6.4%±1.3 mean resemblance to existing texts for human versus 7.6%±4.5 for AI-generated text.</p><p><strong>Discussion: </strong>Overall, AI could already mislead experienced scientific surgeons in 26.7% of cases into believing it to be human. However, formal requirements, especially considering referencing, are still in great need of improvement with only one of AI-generated articles fulfilling our quality requirements.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"411 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331823/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148376258","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":"Antibiotic stewardship in non-perforated gangrenous appendicitis: outcomes of single-dose versus postoperative therapy in a retrospective cohort study.","authors":"Cihan Ozen, Ali Yalcinkaya, Maiken Cecilie Eberhard, Annette Geest Soerensen, Bade Ozen, Anders Oest, Deniz Karasoy, Peter Derek Christian Leutscher, Kathrine Holte","doi":"10.1007/s00423-026-04129-9","DOIUrl":"10.1007/s00423-026-04129-9","url":null,"abstract":"<p><strong>Purpose: </strong>Nonperforated gangrenous appendicitis (NGA) is a severe inflammatory condition without perforation, and the optimal duration of postoperative antibiotic therapy remains debated. This study aimed to compare outcomes between single-dose antibiotic therapy (SDAT) and postoperative antibiotic therapy (POAT).</p><p><strong>Methods: </strong>This retrospective study compared outcomes among 242 adult patients diagnosed histopathologically with NGA after laparoscopic appendectomy who received SDAT versus POAT antibiotics. Demographic characteristics, clinical scores, inflammatory biomarkers, antibiotic regimens, and postoperative surgical infectious complications (PSCs) within 30 days were evaluated. To address group non-homogeneity, regression analyses were performed, and propensity score matching (PSM) was applied as a sensitivity analysis.</p><p><strong>Results: </strong>Among the cohort, 68.2% received SDAT and 31.8% received POAT. In the unadjusted analysis, SDAT was associated with significantly shorter hospital stays (14 vs. 79 h; p < 0.001), and PSC rates were lower in the SDAT group (3.6% vs. 11.7%; p = 0.022). However, POAT patients had higher baseline severity markers, older age, elevated CRP, and higher ASA and q-SOFA scores. After propensity score matching on these variables, PSC rates were comparable between groups (11.3% vs. 9.7%; OR 0.84, 95% CI 0.27-2.66; p = 0.769), with no significant differences in intra-abdominal abscess or surgical site infection rates.</p><p><strong>Conclusions: </strong>These findings suggest that SDAT is a sufficient antibiotic strategy for non-perforated gangrenous appendicitis and supports its use as routine practice in line with antibiotic stewardship principles. However, given the retrospective design, causal inference is limited, and prospective multicentre studies are warranted to confirm these findings.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13633304/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148376324","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}