Surgery最新文献

{"title":"Fluorescence-guided surgery in Latin America: A multinational survey of adoption, barriers, and collaboration.","authors":"Rene Aleman, Ana Carrasquilla, Homero Rodriguez-Zentner, Enrique Lanzarini, Diego Sinagra, Alberto Rancati, Federico Marinelli, Javier Ghiselli, Maria Agustina Gorreri, Julio Aleman, Fernando Dip","doi":"10.1016/j.surg.2026.110452","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110452","url":null,"abstract":"<p><strong>Background: </strong>Fluorescence-guided surgery has expanded across multiple surgical specialties, but current patterns of adoption and implementation in Latin America remain incompletely described. This study assessed current use, perceived value, barriers, and readiness for regional collaboration.</p><p><strong>Methods: </strong>We conducted a multinational observational survey distributed to 100 surgeons in Latin America. The invited cohort represented a purposive convenience sample identified through regional professional networks. Survey domains included institutional availability, clinical indications, platform use, workflow access, perceived safety and benefit, barriers to implementation, reimbursement, and interest in collaborative data initiatives.</p><p><strong>Results: </strong>Among surveyed respondents, fluorescence-guided surgery is established in parts of Latin America but not yet standardized. Use was most often selective rather than routine, indicating that access is present in many institutions but remains indication dependent. Adoption was concentrated in high-resource settings, particularly tertiary and specialized centers in major metropolitan areas. Clinical use spanned biliary, breast, urologic, and gastrointestinal perfusion applications, with indocyanine green as the dominant fluorophore. Operational access remained constrained, with many respondents reporting shared or inconsistent operating room availability. Barriers were primarily economic and logistical, including limited operating room access, equipment cost, indocyanine green cost, and absent or uncertain reimbursement. Surgeons nevertheless reported favorable safety perceptions, perceived clinical benefit, and strong willingness to participate in regional registries and data sharing.</p><p><strong>Conclusion: </strong>Among surveyed surgeons and participating practice settings, fluorescence-guided surgery implementation was heterogeneous and most often selective rather than routine. The findings should not be interpreted as regional prevalence estimates. Broader implementation may depend on operational access, financing, training, and coordinated data collection in more representative regional cohorts.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110452"},"PeriodicalIF":3.2,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148798037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative effectiveness of sphincter-sparing and non-sphincter-sparing procedures for complex anal fistulas: A systematic review and network meta-analysis of postoperative incontinence, pain, and quality of life.","authors":"Mohamad Sadek Zoghbi, Lama Hamade, Dima Itani, Yomna El Zibaoui, Moustafa Moussally, Emre Gorgun","doi":"10.1016/j.surg.2026.110469","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110469","url":null,"abstract":"<p><strong>Background: </strong>In complex anal fistulas, treatment should achieve healing while preserving continence and quality of life. However, direct comparative evidence across sphincter-preserving, sphincter-dividing/reconstructive, and seton-based approaches remains limited. We compared these techniques for postoperative fecal incontinence, pain, quality of life, and recurrence.</p><p><strong>Methods: </strong>We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Network Meta-Analysis checklist to report our study. We searched PubMed, Embase, and CENTRAL until August 2025. We included randomized controlled trials and nonrandomized controlled trials in adults with complex cryptoglandular anal fistulas. We extracted data via Research Electronic Data Capture and performed risk-of-bias evaluation via Risk of Bias 2/ROBINS-I. We performed data analysis using MetaXL with setonas the reference technique. We used Grading of Recommendations Assessment, Development, and Evaluation to rate the certainty of our evidence.</p><p><strong>Results: </strong>We included 2,972 patients across 43 studies. For fecal incontinence, adipose-derived stem cells plus fibrin glue and video-assisted anal fistula treatment combined with ligation of the intersphincteric fistula tract showed the most consistent reductions compared with seton (moderate-high certainty). For pain, the JUMP seton technique (described by Khoshnevis et al) and video-assisted anal fistula treatment combined with ligation of the intersphincteric fistula tract were associated with lower pain scores (moderate certainty). Soluble N-ethylmaleimide-sensitive factor attachment protein receptor, video-assisted anal fistula treatment combined with ligation of the intersphincteric fistula tract, and ligation of the intersphincteric fistula tract plus platelet-rich plasma showed higher quality-of-life scores compared with seton (moderate certainty). Recurrence was lower with adipose-derived stem cells plus fibrin glue (relative risk, 0.02) and acellular dermal matrix (relative risk, 0.08) compared with seton. Randomized controlled trial-only sensitivity analyses were consistent with low inconsistency.</p><p><strong>Conclusions: </strong>Ligation and adhesive-based approaches showed an advantage over seton-based techniques in terms of fecal incontinence, pain, and quality-of-life results with comparable recurrence rates. These results highlight the importance of careful patient selection and choosing specific surgical approaches to improve patients' outcomes.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110469"},"PeriodicalIF":3.2,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148866845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing and validation of definitions of postoperative acute pancreatitis after pancreatoduodenectomy and proposal for Atlanta-Helsinki grading system.","authors":"Tiia Ojala, Akseli Bonsdorff, Helka Parviainen, Timo Tarvainen, Jukka Sirén, Arto Kokkola, Ville Sallinen","doi":"10.1016/j.surg.2026.110466","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110466","url":null,"abstract":"<p><strong>Background: </strong>Postoperative acute pancreatitis has been recognized as an important complication following pancreatic surgery, yet multiple, partly overlapping definitions exist. This study aimed to compare the most used definitions of postoperative acute pancreatitis and to evaluate the clinical relevance of their individual components.</p><p><strong>Methods: </strong>All patients undergoing pancreatoduodenectomy between January 2013 and December 2021 at the Helsinki University Hospital were retrospectively analyzed. Postoperative biochemical and radiological data were collected, and established definitions of postoperative acute pancreatitis were identified from the literature and assessed in relation to short-term postoperative outcomes.</p><p><strong>Results: </strong>Among 704 patients, the incidence of postoperative acute pancreatitis was 11.9%, 41.2%, and 17.6% according to the International Study Group for Pancreatic Surgery definition of postpancreatectomy acute pancreatitis, the Atlanta-adapted framework, and Connor's definition, respectively. These definitions utilize biochemical and/or radiological criteria. Up to 61.9% of patients with radiological signs of pancreatitis had no concomitant hyperamylasemia. Regardless of definition, both postoperative acute pancreatitis and postoperative hyperamylasemia were associated with increased postoperative morbidity. The Atlanta-adapted framework demonstrated the highest discriminative ability for severe postoperative complications (Clavien-Dindo IIIa or worse) (area under the curve, 0.68 [0.64-0.73]) compared with International Study Group for Pancreatic Surgery postpancreatectomy acute pancreatitis (area under the curve, 0.60 [0.55-0.65]) and Connor's definition (area under the curve, 0.62 [0.57-0.67]). A graded Atlanta-based classification (Atlanta-Helsinki classification-0: none, A: hyperamylasemia only; B: radiological findings only; and C: both) showed a stepwise increase in severe postoperative complication rates, occurring in 12.3%, 15.0%, 44.6%, and 56.3% of patients, respectively.</p><p><strong>Conclusion: </strong>Postoperative acute pancreatitis, irrespective of definition, is associated with increased postoperative morbidity after pancreatoduodenectomy. The proposed Atlanta-Helsinki graded classification offers a practical basis for both clinical use and future research.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110466"},"PeriodicalIF":3.2,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148707867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robot-assisted surgery combined with enhanced recovery after surgery in the treatment of hiatal hernia in children.","authors":"Daiwei Zhu, Zebing Zheng, Chengyan Tang, Xingrong Xia, Yuan Gong, Lu Huang, Qing Du, Wankang Zhou, Zeping Li, Yu Liao, Yuanmei Liu, Zhu Jin","doi":"10.1016/j.surg.2026.110417","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110417","url":null,"abstract":"<p><strong>Background: </strong>To explore the efficacy of combining robot-assisted surgery with perioperative measures of enhanced recovery after surgery in children with hiatal hernia.</p><p><strong>Methods: </strong>Seventy-two children with hiatal hernia who underwent surgical treatment in our department between January 2014 and December 2024 were retrospectively enrolled. The patients were divided into 3 groups according to the period of admission. Group A (n = 29) received conventional laparoscopic surgery and conventional perioperative management; group B (n = 27) received conventional laparoscopic surgery and the enhanced recovery after surgery protocol; and group C (n = 16) received robotic-assisted surgery and the enhanced recovery after surgery protocol. The collected data included age at surgery, weight at surgery, operation time, intraoperative blood loss, postoperative inflammatory markers, time to first postoperative bowel movement, postoperative pain assessment, postoperative hospital stay, postoperative complications, and hospitalization costs.</p><p><strong>Results: </strong>No significant differences were observed in age at surgery, weight at surgery, and operative time (P > .05). Group C was associated with a significantly reduced intraoperative blood loss compared with groups A and B (P < .05). Groups B and C were associated with a significantly shorter postoperative hospital stay and an earlier time to first postoperative bowel movement compared with group A (P < .05). No statistically significant difference was observed in the complication rates among the 3 groups (P > .05). The hospitalization cost in group C was significantly higher than that in groups A and B (P < .05). As for inflammatory markers, the C-reactive protein level on postoperative day 1 was significantly lower in groups B and C compared with group A (P < .05), whereas the white blood cell levels did not differ significantly among the 3 groups (P > .05). Comparisons of postoperative pain scores among the 3 groups revealed that groups B and C had significantly lower scores at both 6 and 24 hours postoperatively compared with group A (P < .05).</p><p><strong>Conclusion: </strong>Robot-assisted surgery in the treatment of hiatal hernia in children demonstrates safety and efficacy, offering distinct advantages in meticulous anatomic exposure and accurate suturing. In combination with the enhanced recovery after surgery protocol, it reduces surgical trauma, alleviates postoperative pain, and promotes early recovery. This combined approach is recommended for clinical application.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110417"},"PeriodicalIF":3.2,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148670374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"No need for mesh in the repair of hiatal hernias: Autologous tissue hiatoplasty techniques for the repair of the complex diaphragmatic defect.","authors":"Adrian E Park, Norbert A M Hootsmans","doi":"10.1016/j.surg.2026.110387","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110387","url":null,"abstract":"<p><strong>Background: </strong>Laparoscopic repair of complex diaphragmatic defects from a giant paraesophageal hernia or recurrent hiatal hernia remains challenging. Several techniques, including mesh use and diaphragmatic relaxing incisions, have been used to achieve reduced tension closure of the esophageal hiatus. In this report, we review multiple autologous tissue flap techniques for use in bridging versus onlay reinforcement to achieve closure of the crural defect with reduced tension.</p><p><strong>Discussion: </strong>The falciform ligament flap, left triangular ligament flap, pars flaccida flap, sac hiatoplasty, and ligamentum teres flap offer multiple options for closure of complex diaphragmatic defects using well-vascularized autologous tissue. These are viable and reproducible techniques and may obviate the need for mesh use or diaphragmatic relaxing incisions, with their associated risks.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110387"},"PeriodicalIF":3.2,"publicationDate":"2026-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148369938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of surgical approach on gastric cancer surgery based on textbook outcome: Open, laparoscopic, and robotic surgery-A retrospective cohort study.","authors":"Elisenda Garsot Savall, Arantxa Clavell, Sebastià Videla, Natalia Pallarès, Cinta Hierro, Cristina Bugés, Sergio Alonso, Marta Viciano","doi":"10.1016/j.surg.2026.110205","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110205","url":null,"abstract":"<p><strong>Background: </strong>Gastric cancer surgery is evolving toward minimally invasive techniques such as laparoscopic and robotic gastrectomy. This study assesses surgical quality through the textbook outcome, a composite measure reflecting optimal perioperative results. We compared textbook outcome achievement across open gastrectomy, laparoscopic gastrectomy, and robotic gastrectomy, and its association with 1-year mortality.</p><p><strong>Methods: </strong>A retrospective cohort of patients with gastric or esophagogastric junction cancer undergoing curative gastrectomy between 2014 and 2023 at a tertiary center was analyzed. Surgical approaches included open gastrectomy, laparoscopic gastrectomy, and robotic gastrectomy. Textbook outcome was used to evaluate surgical quality. Inverse probability weighting balanced baseline characteristics across groups. Multivariable logistic regression and weighted Cox models explored associations between surgical approach, textbook outcome, and 1-year mortality.</p><p><strong>Results: </strong>Two hundred patients were included: 53 open gastrectomy, 103 laparoscopic gastrectomy, and 44 robotic gastrectomy. After inverse probability weighting adjustment, minimally invasive approaches showed superior outcomes. Textbook outcome was achieved in 31.4% (95% confidence interval: 15.2%-53.9%) of open gastrectomy, 56.8% (95% confidence interval: 46.5%-66.6%) of laparoscopic gastrectomy, and 68.6% (95% confidence interval: 51.5%-81.8%) of robotic gastrectomy patients, mainly due to higher R0 resection rates and adequate lymphadenectomy (≥15 nodes). Hospital stay was shorter in laparoscopic gastrectomy and robotic gastrectomy. Achieving textbook outcome was independently associated with higher 1-year survival across all approaches.</p><p><strong>Conclusion: </strong>This is the first Western study evaluating surgical quality using textbook outcome across gastrectomy approaches. Both laparoscopic gastrectomy and robotic gastrectomy achieved higher textbook outcome rates than open gastrectomy, with robotic gastrectomy showing the best outcomes, largely driven by improved oncological resection. Textbook outcome achievement correlated with significantly improved 1-year overall survival.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110205"},"PeriodicalIF":2.7,"publicationDate":"2026-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147724029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Questioning adjuvant therapy and surveillance in octogenarians after right hemicolectomy","authors":"Giovanni Taffurelli MD, PhD ,&nbsp;Isacco Montroni MD, PhD ,&nbsp;Federico Ghignone MD ,&nbsp;Francesca Sivieri MD ,&nbsp;Davide Zattoni MD ,&nbsp;Giacomo Frascaroli MD ,&nbsp;Federico Mazzotti MD ,&nbsp;Giampaolo Ugolini MD, PhD","doi":"10.1016/j.surg.2025.110053","DOIUrl":"10.1016/j.surg.2025.110053","url":null,"abstract":"<div><h3>Background</h3><div>As the population ages, more octogenarians are diagnosed with colorectal cancer. Their high comorbidity and mortality risk complicate decisions on adjuvant therapy and surveillance. This study compared outcomes of right hemicolectomy in older versus younger patients and identified predictors of noncancer mortality.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 400 patients undergoing elective laparoscopic right hemicolectomy for stage I–III right-sided colon cancer at a tertiary center (2017–2024). Patients were stratified by age (&lt;80 vs ≥80 years); those aged ≥70 years were screened for frailty. Outcomes included short-term morbidity, disease-free survival, overall survival, and noncancer mortality. Fine-Gray regression identified predictors of noncancer death.</div></div><div><h3>Results</h3><div>Of 400 patients, 180 (45%) were aged ≥80 years. Octogenarians had higher comorbidity (Age-Adjusted Charlson Comorbidity Index &gt;6 in 68.3% vs 22.3%, <em>P</em> &lt; .001). Laparoscopic surgery was safe across groups, with similar conversion and leak rates but different 90-day mortality (4.4% vs 0%, <em>P</em> = .002). Disease-free survival was comparable (55.2 vs 54.6 months, <em>P</em> = 1.000), but overall survival was lower in older patients (62 vs 91 months, <em>P</em> &lt; .001). Age ≥80 years (subdistribution hazard ratio 4.55, 95% confidence interval 1.63–12.7) and Age-Adjusted Charlson Comorbidity Index &gt;6 (subdistribution hazard ratio 2.45, 95% confidence interval 1.15–6.0) independently predicted noncancer mortality, which reached 40.4% at 5 years in patients aged ≥80 years with high comorbidity.</div></div><div><h3>Conclusions</h3><div>Laparoscopic right hemicolectomy is safe in octogenarians, with recurrence outcomes comparable to younger patients. However, competing noncancer mortality in those with significant comorbidities limits the benefit of adjuvant therapy and intensive surveillance. Postoperative management should be tailored to comorbidity burden rather than age alone.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"Article 110053"},"PeriodicalIF":2.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145980612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analyzing costs versus savings using fluorescence angiography with indocyanine green for colorectal surgery in the United States: Multifaceted meta-analysis and cost analysis","authors":"Patrick Goldhawk-White BSc ,&nbsp;Kevin White MD, PhD ,&nbsp;Manish Chand MBA, PhD ,&nbsp;Danny A. Sherwinter MD ,&nbsp;Steven Wexner MD, PhD(Hon)","doi":"10.1016/j.surg.2025.110072","DOIUrl":"10.1016/j.surg.2025.110072","url":null,"abstract":"<div><h3>Background</h3><div>Indocyanine green fluorescence angiography is being increasingly used in colorectal surgery to reduce anastomotic leak risk, but few studies have analyzed its cost efficacy. In this study, cost modeling was used to compare costs in the United States using versus not using indocyanine green fluorescence angiography.</div></div><div><h3>Methods</h3><div>Exhaustive searches of PubMed/MEDLINE, EMBASE, and Scopus were used to identify all meta-analyses and randomized controlled trials assessing the effectiveness of indocyanine green fluorescence angiography in reducing anastomotic leaks. Additionally, we conducted our own meta-analysis restricted to randomized controlled trials with ≥100 patients in both indocyanine green fluorescence angiography and control groups. Three years (2021–2023) of Medicare Provider Analysis and Review billing data were then employed to identify direct health care costs. Minimum, intermediate, and maximum cost analysis models were created using indocyanine green fluorescence angiography–associated anastomotic leak reduction rates identified by synthesizing the results of meta-analyses and randomized controlled trials, procedural and complication-related costs identified via Medicare Provider Analysis and Review, and $225 as the per-unit cost of indocyanine green administration.</div></div><div><h3>Results</h3><div>Synthesis of the results of our own and 19 published meta-analyses revealed a 51.9% reduction in anastomotic leak rate with indocyanine green fluorescence angiography, whereas 5 meta-analyses restricted to randomized controlled trials, including our own, revealed level 1 evidence of at least a 36.5% reduction. Minimum and maximum cost analysis models were generated using conservative anastomotic leak reduction rates of 35% and 50%, from which mean per-patient cost reductions ranged from $962 to $1,138, and overall health care system savings ranged from $71 million to $84 million.</div></div><div><h3>Conclusion</h3><div>For anastomotic assessments in colorectal surgery, indocyanine green fluorescence angiography reduces direct per-patient health care costs in the United States by $962 to $1,138. Additional savings may be derived from reduced rehospitalization and reoperation rates.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"Article 110072"},"PeriodicalIF":2.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term parietal complications following surgery for inflammatory colitis: An underestimated issue","authors":"Océane Lelièvre MD ,&nbsp;Solafah Abdalla MD, PhD ,&nbsp;Aurélien Amiot MD, PhD ,&nbsp;Antoine Meyer MD, PhD ,&nbsp;Franck Carbonnel MD, PhD ,&nbsp;Christophe Penna MD, PhD ,&nbsp;Stéphane Benoist MD, PhD ,&nbsp;Antoine Brouquet MD, PhD","doi":"10.1016/j.surg.2026.110082","DOIUrl":"10.1016/j.surg.2026.110082","url":null,"abstract":"<div><h3>Background</h3><div>Surgical management of inflammatory colitis often requires a staged approach with multiple procedures. Data on incidence, risk factors, and management of parietal complications remain limited.</div></div><div><h3>Methods</h3><div>All adult patients who underwent surgery for inflammatory colitis between March 2010 and May 2024 were included. The primary endpoint was the incidence of incisional hernia, parastomal hernia, or stoma prolapse after complete surgical treatment. Risk factors were assessed, with age, body mass index ≥25 kg/m², and permanent stoma retained for multivariate analysis.</div></div><div><h3>Results</h3><div>One hundred nine patients underwent surgery for refractory colitis (<em>n</em> = 32; 29%), severe acute colitis (<em>n</em> = 58; 54%), and dysplasia (<em>n</em> = 19; 17%). Single or staged procedures resulted in 73 ileal pouch-anal anastomoses (67%), 23 ileorectal anastomoses (21%), and 13 nonrestorative proctocolectomies with end ileostomy (12%). Eighty-four patients (77%) had temporary stomas, and 19 (17%) had permanent stomas. The median follow-up was 44 (interquartile range: 21–91) months. Twenty-five patients (23%) developed parietal complications after a median of 25 (interquartile range: 11–35) months: 22 (20%) incisional hernia, 4 (3.6%) parastomal hernia, and 3 (2.8%) stoma prolapse. None of the 4 patients with prophylactic biological mesh placement during stoma closure developed complications. Twenty patients underwent abdominal wall repair, with 6 (30%) recurrences and 3 (15%) redo surgeries. Permanent stoma was the only independent risk factor (odds ratio = 4.35, 95% confidence interval: 1.24–15.7; <em>P</em> = .022).</div></div><div><h3>Conclusion</h3><div>Nearly one-quarter of patients with inflammatory colitis develop parietal complications after surgery, with high recurrence after repair. Prophylactic mesh placement during stoma closure should be studied.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"Article 110082"},"PeriodicalIF":2.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"National trends in conduit selection for redo coronary arterial bypass grafting","authors":"Bennet S. Cho MD ,&nbsp;Nguyen K. Le MD, MS ,&nbsp;Troy Coaston BS ,&nbsp;Esteban Z. Aguayo MD ,&nbsp;Oh Jin Kwon MD ,&nbsp;Saad Mallick MD ,&nbsp;Giselle Porter BS ,&nbsp;Peyman Benharash MD, MS","doi":"10.1016/j.surg.2025.110043","DOIUrl":"10.1016/j.surg.2025.110043","url":null,"abstract":"<div><h3>Background</h3><div>Redo coronary arterial bypass grafting is a high-risk operation associated with significant morbidities. Although conduit selection remains a critical factor influencing post–coronary arterial bypass grafting outcomes, the trends in vessel utilization in redo operations remain poorly characterized. We used a nationally representative database to examine contemporary trends in conduit selection in redo versus first-time coronary arterial bypass grafting and risk factors of mortality among patients with repeat bypasses.</div></div><div><h3>Methods</h3><div>Using the 2016–2021 Nationwide Readmissions Database, we identified adult patients undergoing isolated coronary arterial bypass grafting, stratified into <em>F</em><em>irst-time</em> and <em>R</em><em>edo</em> cohorts. The primary outcome was in-hospital mortality; secondary outcomes included perioperative complications, postoperative length of stay, hospitalization costs, nonhome discharge, and 30-day nonelective readmissions. Temporal trends in conduit use (internal mammary artery, radial artery, and saphenous vein) were assessed.</div></div><div><h3>Results</h3><div>Among 928,925 patients, 5.3% underwent redo coronary arterial bypass grafting. From 2016 to 2021, the use of the internal mammary artery, radial artery, and saphenous vein increased in both cohorts (<em>P</em> &lt; .001). Redo status was associated with higher likelihood of developing complications, longer length of stay (β + 6.2 days), and increased costs (β + $11,100), but lower odds of in-hospital mortality (adjusted odds ratio: 0.75). Internal mammary artery use was independently associated with reduced odds of mortality (adjusted odds ratio: 0.57).</div></div><div><h3>Conclusion</h3><div>Redo coronary arterial bypass grafting is modestly increasing nationwide and remains associated with greater morbidity and resource use, compared with first-time coronary arterial bypass grafting. Nonetheless, adjusted mortality is lower in redo coronary arterial bypass grafting, potentially reflecting careful patient selection and intensive perioperative care. Arterial conduit use, especially internal mammary artery, may confer survival benefits and warrants further study in the redo setting.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"Article 110043"},"PeriodicalIF":2.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145941375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}