Surgery最新文献

{"title":"Postpancreatectomy acute pancreatitis-Are we there yet?","authors":"Saxon Connor","doi":"10.1016/j.surg.2026.110494","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110494","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110494"},"PeriodicalIF":3.2,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148832470","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":"Laparoscopic liver resection versus radiofrequency ablation for solitary small hepatocellular carcinoma in elderly patients: A multicenter propensity score-matched study.","authors":"Shiye Yang, Jinkai Feng, Min Zou, Xiaojie Gan, Jixiang Zhang, Aixian Zhang, Chenyun Xia, Xiaochun Gu, Lin Gong, Juan Yao, Zhibing Ming","doi":"10.1016/j.surg.2026.110481","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110481","url":null,"abstract":"<p><strong>Background: </strong>The optimal local treatment for solitary small hepatocellular carcinoma in elderly patients remains unclear. This multicenter propensity score-matched study compared perioperative and long-term outcomes between laparoscopic liver resection and radiofrequency ablation in this population.</p><p><strong>Methods: </strong>Elderly patients (defined as age ≥70 years) with solitary hepatocellular carcinoma ≤3 cm who underwent laparoscopic liver resection or radiofrequency ablation at 8 tertiary centers were included. Propensity score matching (1:1) balanced baseline characteristics. Perioperative outcomes, overall survival, and disease-free survival were compared. Independent prognostic factors were identified by Cox regression.</p><p><strong>Results: </strong>After propensity score matching, 102 patients were included in each group. Laparoscopic liver resection was associated with longer operative time, higher blood loss, longer hospital stay, and more overall complications (all P < .05), but 90-day mortality did not differ. Laparoscopic liver resection achieved superior overall survival (median, not reached versus 67.5 months, 5-year: 65.7% vs 50.0%; P = .005) and disease-free survival (median, 36.8 vs 21.3 months, 5-year: 40.2% vs 34.3%; P < .001). On multivariate analysis, radiofrequency ablation was an independent risk factor for worse overall survival (hazard ratio, 2.18; P = .011) and disease-free survival (hazard ratio, 2.42; P = .001). Subgroup analyses showed that the survival benefit of laparoscopic liver resection was pronounced in patients with no portal hypertension, American Society of Anesthesiologists physical status I-II, Child-Pugh A, model for end-stage liver disease ≤9, platelet >100 × 10⁹/L, albumin >35 g/L, tumor >2 cm, no lesion contact with Glissonian pedicles, and the absence of cirrhosis.</p><p><strong>Conclusion: </strong>In selected elderly patients with solitary small hepatocellular carcinoma, laparoscopic liver resection provides superior long-term overall survival and disease-free survival compared with radiofrequency ablation, despite a higher rate of specific complications including posthepatectomy liver failure and ascites and a numerically higher 90-day mortality. Laparoscopic liver resection should be considered first line in surgically fit elderly patients, especially those with good performance status and favorable liver function. Radiofrequency ablation may be considered a valid alternative in patients with high surgical risks or tumors ≤2 cm, as it achieved comparable oncologic outcomes with significantly lower morbidity and faster recovery.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110481"},"PeriodicalIF":3.2,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148881669","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 chronic beta-blocker versus renin-angiotensin inhibitor use on outcomes after blunt pelvic trauma.","authors":"Zeyanna Dhalla, Kaitlin Nunn, Victoria Teoh, Diana Arellano","doi":"10.1016/j.surg.2026.110475","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110475","url":null,"abstract":"<p><strong>Background: </strong>Chronic cardiovascular medications, including β-blockers and renin-angiotensin system inhibitors, may modify the physiologic response to trauma. The purpose of this study is to compare outcomes of pelvic fracture patients with preinjury β-blockers versus renin-angiotensin system inhibitor use after blunt pelvic trauma.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted using TriNetX. Data was collected from 2015 to 2025, with a total sample size of n = 442,947 distributed across 16 comparison groups. Propensity score matching was applied to yield equitable cohorts based on medical comorbidities. Patient groups were mutually exclusive, such that individuals were classified as taking either a β-blocker or a renin-angiotensin system inhibitor, with exclusion of patients receiving both therapies or an antiplatelet treatment. Comparisons were made with outcomes that include hemorrhage, infections, pneumonia, sepsis, deep vein thrombosis, pulmonary embolism, respiratory ventilation, and mortality.</p><p><strong>Results: </strong>The β-blocker group demonstrated higher rates of adverse events, including hemorrhage, infections, pneumonia, sepsis, deep vein thrombosis, pulmonary embolism, respiratory ventilation, and mortality, relative to the renin-angiotensin system inhibitor group. The differences were most pronounced when renin-angiotensin system inhibitors were compared with metoprolol and labetalol, where nearly all outcomes were significantly worse in the β-blocker cohorts. In contrast, no significant differences were observed when compared with carvedilol or atenolol.</p><p><strong>Conclusion: </strong>Prior use of β-blockers is correlated with significantly worse rates of hemorrhage, infection, and thromboembolic events after a traumatic pelvic fracture when compared with renin-angiotensin system inhibitors. This could be due to renin-angiotensin system inhibitors attenuating the post-traumatic inflammatory response system by blocking angiotensin II, which causes inflammation, oxidative stress, endothelial dysfunction, and vasoconstriction. These findings suggest that chronic cardiovascular therapy type may influence post-pelvic trauma outcomes, underscoring the need for further investigation.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110475"},"PeriodicalIF":3.2,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148798102","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":"Beyond the operating room: Adverse events and outcomes after colorectal surgery.","authors":"Eden Sheinin, Summer Hardy, Naomi Gurewitsch, Peter Shamamian","doi":"10.1016/j.surg.2026.110474","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110474","url":null,"abstract":"<p><strong>Background: </strong>Clinical outcome measures, including length of stay and mortality, are indicative of the quality and safety of care provided to hospitalized patients. Adverse events demonstrate opportunities to improve quality and safety and thus clinical outcomes. We sought to investigate the impact of adverse events on patient outcomes in colorectal surgery patients.</p><p><strong>Methods: </strong>A retrospective analysis of colorectal patients captured in the National Surgical Quality Improvement Program from January to December 2024 in a large, urban hospital was completed. Adverse events were defined as postoperative events in the National Surgical Quality Improvement Program and validated events identified by the Pascal Metrics Risk Trigger Monitoring program. Adverse events were categorized, and associations between adverse event categories and patient outcomes were investigated. The performance of the National Surgical Quality Improvement Program and Pascal in identifying adverse events and their association with outcomes was compared.</p><p><strong>Results: </strong>Of the 298 patients, 40.9% had ≥1 adverse event reported (n = 122), with 4.2 events on average per case. Patients with reported adverse events had 15.4 times higher mortality (P < .01). The number of adverse events was positively associated with length of stay (Spearman, 0.61; P < .01). National Surgical Quality Improvement Program and Pascal identified different adverse events for the same patient in 61.5% of cases. The National Surgical Quality Improvement Program identified most procedure/surgery-related events and nosocomial infections, whereas Pascal excelled in patient care and safety and medication-related events.</p><p><strong>Conclusion: </strong>When using 2 rigorous complementary adverse event-reporting mechanisms, colorectal surgery patients have a high incidence of adverse events (40.9%). The number of adverse events was significantly associated with longer length of stay and mortality (P < .01). The use of complementary adverse event identification systems is essential to comprehensively identify adverse events and assess their associated outcomes.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110474"},"PeriodicalIF":3.2,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148813928","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":"Does robotic surgery influence time to surgery and outcomes in stage I-II non-small cell lung cancer?","authors":"Ony Otiocha, Koffi Wima, Catherine G Pratt, Peterson Pathrose, Carla F Justiniano, Christine E Haugen, Ralph C Quillin, Robert M Van Haren","doi":"10.1016/j.surg.2026.110472","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110472","url":null,"abstract":"<p><strong>Background: </strong>Robotic-assisted surgery is increasingly used for early stage non-small cell lung cancer resection, yet its impact on time to surgery and outcomes remains unclear.</p><p><strong>Methods: </strong>Using the National Cancer Database (2010-2022), adults with clinical stage I-II non-small cell lung cancer who underwent initial resection by open, video-assisted thoracoscopic surgery, or robotic-assisted surgery were identified for a retrospective cohort study. Prolonged time to surgery was defined as surgery >8 weeks after diagnosis. Multivariable logistic regression identified factors associated with longer time to surgery and short-term outcomes, such as length of hospital stay, 30-day readmission, and 30-/90-day mortality. Overall survival was assessed using Kaplan-Meier analysis, and Cox hazards regression evaluated adjusted hazard of death in robotic cases.</p><p><strong>Results: </strong>Among 173,170 patients, 22.9% experienced longer time to surgery. Robotic-assisted surgery, academic centers, non-White race, nonprivate insurance, and lower socioeconomic status were independently associated with increased time to surgery. Across all patients, increased time was independently associated with higher 30-day mortality and 90-day mortality. While robotic-assisted surgery was associated with higher odds of longer time to surgery, it was independently associated with lower 30-day and 90-day mortality. Within the robotic subgroup, longer time to surgery was independently associated with increased 90-day mortality and worse overall survival.</p><p><strong>Conclusion: </strong>Robotic resection is associated with favorable short-term outcomes but more frequent longer time-to-surgery intervals and worse overall survival. Targeted strategies to reduce time to surgery in robotic-assisted surgery are warranted.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110472"},"PeriodicalIF":3.2,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148798040","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":"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}