Surgery Today最新文献

Living donor liver transplantation using ABO-incompatible grafts for chronic and acute liver failure. 慢性和急性肝衰竭的活体肝移植使用abo不相容的移植物。

IF 1.7 4区医学

Surgery Today Pub Date : 2025-07-22 DOI: 10.1007/s00595-025-03100-3

Toru Ikegami, Masashi Tsunematsu, Kenei Furukawa, Shinji Onda, Michinori Matsumoto, Yoshihiro Shirai, Koichiro Haruki

{"title":"Living donor liver transplantation using ABO-incompatible grafts for chronic and acute liver failure.","authors":"Toru Ikegami, Masashi Tsunematsu, Kenei Furukawa, Shinji Onda, Michinori Matsumoto, Yoshihiro Shirai, Koichiro Haruki","doi":"10.1007/s00595-025-03100-3","DOIUrl":"https://doi.org/10.1007/s00595-025-03100-3","url":null,"abstract":"The introduction of rituximab, an anti-CD20 antibody, has changed the treatment strategies and outcomes for ABO-incompatible living donor liver transplantation (ABOi-LDLT) dramatically. Rituximab targets the CD20-positive B-cells that would differentiate into plasma cells, producing antibodies against A or B antigen-expressing cells and causing microvascular multiple thrombosis and graft necrosis or diffuse bile-duct necrosis. Now, the universal desensitization of the ABOi combination between the donor and recipient is performed by rituximab, and ABOi-LDLT has become the treatment of choice for end-stage liver disease. However, because rituximab takes 1-3 weeks to mediate its effects, complicated strategies are necessary to perform ABOi-LDLT for acute liver failure. For example, high-dose intravenous immunoglobulin (IVIG) or bortezomib may be used to alleviate the elevation of isoagglutinin titers. The diagnosis and treatment of antibody-mediated rejection (AMR) remain challenging. Treatment options include plasma exchange, high-dose IVIG, and bortezomib, but the optimal strategies have not been identified. In this review, we discuss standard ABOi-LDLT for chronic liver disease, ABOi-LDLT for acute liver failure, and the diagnosis and treatment of AMR.","PeriodicalId":22163,"journal":{"name":"Surgery Today","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144683218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Impact of extended prophylactic antibiotic administration on surgical site infections: A multicenter real-world data study. 延长预防性抗生素给药对手术部位感染的影响：一项多中心真实世界数据研究。

IF 1.7 4区医学

Surgery Today Pub Date : 2025-07-19 DOI: 10.1007/s00595-025-03101-2

Takeshi Yamada, Akihisa Matsuda, Takuya Nishino, Kay Uehara, Nobutoshi Hagiwara, Nobuyuki Sakurazawa, Yoichi Kawano, Akira Matsushita, Takao Shimizu, Keisuke Minamimura, Jun Akatsuka, Hiroshi Yoshida

{"title":"Impact of extended prophylactic antibiotic administration on surgical site infections: A multicenter real-world data study.","authors":"Takeshi Yamada, Akihisa Matsuda, Takuya Nishino, Kay Uehara, Nobutoshi Hagiwara, Nobuyuki Sakurazawa, Yoichi Kawano, Akira Matsushita, Takao Shimizu, Keisuke Minamimura, Jun Akatsuka, Hiroshi Yoshida","doi":"10.1007/s00595-025-03101-2","DOIUrl":"https://doi.org/10.1007/s00595-025-03101-2","url":null,"abstract":"Purposes: Despite guideline recommendations to discontinue prophylactic antibiotics within 24 h postoperatively, extended prophylaxis is sometimes administered in clinical practice, particularly in digestive surgeries with a high risk of surgical site infections (SSI). This multicenter retrospective study evaluated the characteristics of patients receiving extended prophylaxis and its effectiveness in preventing SSI.Methods: Clinical and administrative claims data from three hospitals were analyzed for patients undergoing elective esophageal, gastric, hepatic (with or without biliary reconstruction), pancreatic, colon, or rectal surgery between January 2021 and December 2023. The primary endpoint was SSI, defined as Clavien-Dindo grade ≥ 2 occurring within 30 days postoperatively. The incidence of SSI was compared between extended prophylaxis (continued on or after postoperative day 3) and standard prophylaxis.Results: This study included 2,938 patients, of whom 936 received extended prophylaxis. Prolonged surgical time was significantly associated with extended prophylaxis across various types of surgery. Extended prophylaxis was not associated with a reduction in SSI in most procedures and was linked to a higher incidence of SSI in colon cancer patients.Conclusion: Extended prophylaxis may not only be ineffective but also potentially harmful. These findings underscore the importance of adhering to evidence-based guidelines in the prevention of SSI.","PeriodicalId":22163,"journal":{"name":"Surgery Today","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144668559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Prophylactic negative pressure wound therapy with Prevena™ to prevent perineal surgical site infection. 预防性负压伤口治疗，预防会阴手术部位感染。

IF 1.7 4区医学

Surgery Today Pub Date : 2025-07-18 DOI: 10.1007/s00595-025-03102-1

Ryo Ohno, Gumpei Yoshimatsu, Yoshiro Itatani, Ryosuke Okamura, Yu Yoshida, Hisatsugu Maekawa, Nobuaki Hoshino, Koya Hida, Kazutaka Obama, Suguru Hasegawa

{"title":"Prophylactic negative pressure wound therapy with Prevena™ to prevent perineal surgical site infection.","authors":"Ryo Ohno, Gumpei Yoshimatsu, Yoshiro Itatani, Ryosuke Okamura, Yu Yoshida, Hisatsugu Maekawa, Nobuaki Hoshino, Koya Hida, Kazutaka Obama, Suguru Hasegawa","doi":"10.1007/s00595-025-03102-1","DOIUrl":"https://doi.org/10.1007/s00595-025-03102-1","url":null,"abstract":"Purpose: Surgical site infection (SSI) of perineal wounds after abdominoperineal resection (APR) or total pelvic exenteration (TPE) for pelvic malignancies is a common postoperative complication. Although several attempts have been made to prevent this complication, SSI of perineal wounds remain common. The efficacy of prophylactic negative-pressure wound therapy (NPWT) in abdominal surgery has been reported; however, few studies have focused on perineal wounds, where the incidence of SSI is particularly high. This study investigated the prophylactic effect of NPWT on closed perineal wounds after APR/TPE to prevent SSI.Methods: This study enrolled 127 consecutive patients with malignant tumors who underwent elective APR/TPE between January 2013 and December 2022. We used the Prevena™ incision management system (IMS) on the perineal wound in 10 patients for prophylactic NPWT (pNPWT group), whereas 117 patients underwent conventional primary closure (cPC group). We compared the incidence of perineal wound SSI between the groups and explored the risk factors associated with SSI.Results: Patients' backgrounds were essentially the same between the groups. There were no SSI cases in the pNPWT group, whereas 29 patients (25%) in the cPC group had SSI (P = 0.067). Exploratory analyses revealed that a body mass index ≥ 25, disinfection method, and neoadjuvant chemotherapy were significantly correlated with SSI in perineal wounds.Conclusion: Prophylactic NPWT for closed perineal wounds after APR/TPE in patients with malignancies can be effective in preventing SSI.","PeriodicalId":22163,"journal":{"name":"Surgery Today","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144660251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Reinforcement sutures for preventing anastomotic leakage following double-stapling anastomosis in rectal cancer surgery: a systematic review and meta-analysis. 加固缝线预防直肠癌手术双吻合器吻合后吻合口漏：系统回顾和荟萃分析。

IF 1.7 4区医学

Surgery Today Pub Date : 2025-07-17 DOI: 10.1007/s00595-025-03099-7

Koji Tamura, Takaaki Fujimoto, Kinuko Nagayoshi, Yusuke Mizuuchi, Kyoko Hisano, Kohei Horioka, Koji Shindo, Naoki Ikenaga, Kohei Nakata, Kenoki Ohuchida, Masafumi Nakamura

{"title":"Reinforcement sutures for preventing anastomotic leakage following double-stapling anastomosis in rectal cancer surgery: a systematic review and meta-analysis.","authors":"Koji Tamura, Takaaki Fujimoto, Kinuko Nagayoshi, Yusuke Mizuuchi, Kyoko Hisano, Kohei Horioka, Koji Shindo, Naoki Ikenaga, Kohei Nakata, Kenoki Ohuchida, Masafumi Nakamura","doi":"10.1007/s00595-025-03099-7","DOIUrl":"https://doi.org/10.1007/s00595-025-03099-7","url":null,"abstract":"Purpose: Anastomotic leakage (AL) is a major complication of anterior resection of rectal cancer. Reinforcement sutures at the anastomotic staple line may reduce the risk of AL; however, their efficacy remains uncertain. This meta-analysis evaluated the effectiveness of staple line reinforcement in preventing AL.Methods: A systematic review and meta-analysis were conducted following the PRISMA guidelines (PROSPERO registration; CRD42024581347). Literature published between January 2000 and August 2024 was searched. Randomized controlled trials (RCTs) and observational studies (OBSs) comparing reinforcement sutures with non-reinforcement sutures were included. The primary outcome was AL incidence, and secondary outcomes included reoperation rates, operative time, and mortality. Data were analyzed using a random-effects model.Results: One RCT and eight OBSs were included, with a meta-analysis performed only for OBSs. Reinforcement sutures significantly reduced AL (odds ratio [OR], 0.29; 95% confidence interval [CI] 0.18-0.46; p < 0.000001), with low heterogeneity (I2 = 0%). A subgroup analysis excluding diverting stoma (DS) creation confirmed reduced AL (OR, 0.41; 95% CI 0.27-0.62; p < 0.0001). The reoperation rate was also lower (OR, 0.32; 95% CI 0.14-0.72; p = 0.006). The mortality and operative time were unaffected.Conclusions: Reinforcement sutures can reduce the AL and reoperation rates in patients with rectal cancer undergoing stapled anastomosis. Large-scale RCTs are required to confirm the optimal benefits and long-term effects.","PeriodicalId":22163,"journal":{"name":"Surgery Today","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144660252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Comprehensive revenue comparison of pure robotic vs. hybrid robotic surgery for sigmoid colon and rectosigmoid cancer. 纯机器人与混合机器人手术治疗乙状结肠和直肠乙状结肠癌的综合收益比较。

IF 1.7 4区医学

Surgery Today Pub Date : 2025-07-15 DOI: 10.1007/s00595-025-03097-9

Toshiyuki Fukuda, Masakatsu Numata, Tatsunosuke Harada, Shota Izukawa, Yosuke Atsumi, Keisuke Kazama, Yusuke Suwa, Syo Sato, Takafumi Kumamoto, Tsutomu Sato, Aya Saito

{"title":"Comprehensive revenue comparison of pure robotic vs. hybrid robotic surgery for sigmoid colon and rectosigmoid cancer.","authors":"Toshiyuki Fukuda, Masakatsu Numata, Tatsunosuke Harada, Shota Izukawa, Yosuke Atsumi, Keisuke Kazama, Yusuke Suwa, Syo Sato, Takafumi Kumamoto, Tsutomu Sato, Aya Saito","doi":"10.1007/s00595-025-03097-9","DOIUrl":"https://doi.org/10.1007/s00595-025-03097-9","url":null,"abstract":"Purpose: Robotic surgery (RS) in colorectal procedures is growing but remains costly. This study evaluated the cost-saving potential of hybrid robotic surgery (hybrid RS), which integrates laparoscopic devices, compared to conventional RS (pure RS).Methods: This single-center retrospective study (2022-2024) compared pure RS and hybrid RS for sigmoid and rectosigmoid cancers. Propensity score matching minimizes bias. Total revenue is calculated as the total fee minus the total cost.Results: After matching, 20 patients (10 per group) were analyzed. Hybrid RS improved total revenue ($3515.15 vs. $3229.33) by reducing the total cost ($3652.45 vs. $4061.33), mainly through lower material costs for staplers and ultrasonic devices. The operative time was shorter, and the safety and pathological outcomes were comparable.Conclusions: Hybrid RS enhances cost efficiency by substituting expensive devices with affordable alternatives, supporting wider adoption of robotic surgery. Further validation using larger studies is necessary.","PeriodicalId":22163,"journal":{"name":"Surgery Today","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144638157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A graft-to-recipient weight ratio of less than 0.7% under portal venous hemodynamics monitoring is a risk factor for early graft loss after living donor liver transplantation. 门静脉血流动力学监测下移植物与受体重量比小于0.7%是活体肝移植术后早期移植物丢失的危险因素。

IF 1.7 4区医学

Surgery Today Pub Date : 2025-07-11 DOI: 10.1007/s00595-025-03103-0

Niang-Cheng Lin, Cheng-Yen Chen, Hao-Jan Lei, Hsin-Lin Tsai, Yi-Fan Tsou, Fang-Cheng Kuo, Meng-Hsuan Chung, Cheng-Yuan Hsia, Che-Chuan Loong, Shu-Cheng Chou, Shen-Chih Wang, Chinsu Liu

{"title":"A graft-to-recipient weight ratio of less than 0.7% under portal venous hemodynamics monitoring is a risk factor for early graft loss after living donor liver transplantation.","authors":"Niang-Cheng Lin, Cheng-Yen Chen, Hao-Jan Lei, Hsin-Lin Tsai, Yi-Fan Tsou, Fang-Cheng Kuo, Meng-Hsuan Chung, Cheng-Yuan Hsia, Che-Chuan Loong, Shu-Cheng Chou, Shen-Chih Wang, Chinsu Liu","doi":"10.1007/s00595-025-03103-0","DOIUrl":"https://doi.org/10.1007/s00595-025-03103-0","url":null,"abstract":"Purpose: To investigate the interaction between graft-to-recipient weight ratio (GRWR) and portal venous hemodynamics (PVH), with a net impact on the perioperative outcomes of living donor liver transplantation (LDLT).Methods: We analyzed, retrospectively, adult LDLT recipients divided into three groups according to their GRWR: Group 1, > 1.0% (n = 124); Group 2, 0.8 ~ 1.0% (n = 70); and Group 3, < 0.8% (n = 31).Results: The intraoperative PVH parameters did not differ significantly among the groups, but Group 3 had the highest number of patients needing portal inflow modulation to achieve optimal final portal pressure. Group 3 was also more prone to delayed recovery of liver function, a higher incidence of posttransplant kidney injury necessitating dialysis (16.1% vs. 3.2% for Group 1 and 4.3% for Group 2, p = 0.015) and a higher incidence of liver graft loss within 3 months post-LDLT (22.6% vs. 7.3% for Group 1 and 4.3% for Group 2, p = 0.007). Logistic regression analysis revealed that extremely small liver grafts (GRWR < 0.7%) were the most significant risk factor for early graft loss (HR: 16.951, 95% CI: 3.961 ~ 72.535). Survival analysis revealed comparable outcomes between patients who received liver grafts with a GRWR of 0.7 ~ 0.8% and those who received liver grafts with a GRWR > 0.8%. Patients with extremely small liver grafts had significantly lower graft survival rates (1-month, 3-months, and 1-year post-LDLT, of 66.7%, 50.0%, and 50.0%, respectively (p < 0.01).Conclusion: Under intraoperative PVH monitoring, the accepted GRWR in LDLT could be extended to 0.7%, but a GRWR < 0.7% remains a risk factor for early graft loss.","PeriodicalId":22163,"journal":{"name":"Surgery Today","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144609662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Trends, demographic patterns, and regional disparities in gastrostomy: a nationwide population-based cohort study in Japan from 2014 to 2022. 胃造口术的趋势、人口模式和地区差异：2014年至2022年日本全国人口队列研究

IF 1.7 4区医学

Surgery Today Pub Date : 2025-07-10 DOI: 10.1007/s00595-025-03085-z

Masamitsu Kido, Katsutoshi Shoda, Ken Inoue, Ryotaro Ishii, Reiko Kato, Daisuke Ichikawa

{"title":"Trends, demographic patterns, and regional disparities in gastrostomy: a nationwide population-based cohort study in Japan from 2014 to 2022.","authors":"Masamitsu Kido, Katsutoshi Shoda, Ken Inoue, Ryotaro Ishii, Reiko Kato, Daisuke Ichikawa","doi":"10.1007/s00595-025-03085-z","DOIUrl":"https://doi.org/10.1007/s00595-025-03085-z","url":null,"abstract":"Purpose: This study explored the trends, demographic patterns, and regional disparities in gastrostomy procedures using Japanese nationwide receipt databases.Methods: Age- and sex-stratified data on gastrostomy procedures from 2014 to 2022 were analyzed using Jonckheere-Terpstra tests and Poisson regression models. The number of inpatient gastrostomies, surgeons, physicians in gastroenterology, and neurologists (with and without board certification) were assessed by prefecture. Disparities across 47 prefectures and urban-rural disparities were quantified using Gini coefficients and unpaired t-tests. Correlations were assessed using Pearson's correlation method.Results: The average annual number of gastrostomies was 55,577 (rate: 44.0 per 100,000), with a slight male predominance (male-to-female ratio, 1:0.9). A minor peak occurred in the 0-4 year-old age group (9.6 procedures), followed by a sharp increase after 40 years old, peaking at ≥ 90 years (374.8 procedures). The age-adjusted rates declined overall (risk ratio: 0.957-0.959, P < 0.0001), particularly among the elderly. The Gini coefficient showed low inequality for gastrostomies. The number of gastrostomies was significantly higher in rural than in urban regions. Moderate correlations were found between the number of gastrostomies and the number of surgeons and physicians in gastroenterology without board certification.Conclusion: This study highlights demographic and regional disparities in gastrostomy practices in Japan.","PeriodicalId":22163,"journal":{"name":"Surgery Today","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144601629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Prevalence of median arcuate ligament syndrome and associated visceral artery aneurysms: Insights from computed tomography radiology reports in a single institution and management strategies. 中弓韧带综合征和相关内脏动脉瘤的患病率：来自单一机构和管理策略的计算机断层放射学报告的见解。

IF 1.7 4区医学

Surgery Today Pub Date : 2025-07-10 DOI: 10.1007/s00595-025-03074-2

Yusuke Endo, Kazunori Inuzuka, Masaki Sano, Kazuto Katahashi, Hajime Tsuyuki, Nozomu Ishikawa, Hiroya Takeuchi, Naoki Unno

{"title":"Prevalence of median arcuate ligament syndrome and associated visceral artery aneurysms: Insights from computed tomography radiology reports in a single institution and management strategies.","authors":"Yusuke Endo, Kazunori Inuzuka, Masaki Sano, Kazuto Katahashi, Hajime Tsuyuki, Nozomu Ishikawa, Hiroya Takeuchi, Naoki Unno","doi":"10.1007/s00595-025-03074-2","DOIUrl":"https://doi.org/10.1007/s00595-025-03074-2","url":null,"abstract":"Purpose: This study investigated the prevalence of median arcuate ligament syndrome (MALS) and its association with visceral artery aneurysms based on radiological computed tomography (CT) reports from a single institution.Methods: Among 392,111 abdominal CT scans (211,685 unique patients), 128 (0.06%) of celiac artery stenosis caused by MAL compression were identified after excluding calcified stenosis.Results: Of 128 patients, 18 (14.1%) were symptomatic and presented with abdominal pain, discomfort, or bowel irregularities. Two symptomatic patients underwent MAL release surgery, while the other 16 were managed conservatively with medication. Aneurysmal formation secondary to celiac artery stenosis was observed in 54 cases (42.2%), with no reported rupture or dissection. Pancreaticoduodenal artery aneurysms were identified in 6 cases (4.7%), which were treated with endovascular intervention or MAL release. Over a mean follow-up period of 57 months (100 patients), no recurrence or new aneurysm formation was observed. A positive correlation (r = 0.52) was found between the stenosis rate and post-stenotic vessel diameter, highlighting a potential link between stenosis severity and aneurysm formation.Conclusion: The prevalence was low, with most cases being asymptomatic. Further studies are needed to better understand the role of MAL release in managing pancreaticoduodenal aneurysms and preventing aneurysm formation.","PeriodicalId":22163,"journal":{"name":"Surgery Today","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144601628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Impact of preoperative biliary drainage on postoperative outcomes in patients who undergo major hepatectomy after portal vein embolization for perihilar cholangiocarcinoma. 术前胆道引流对肝切除术门静脉栓塞治疗肝门周围胆管癌患者术后预后的影响。

IF 1.7 4区医学

Surgery Today Pub Date : 2025-07-08 DOI: 10.1007/s00595-025-03080-4

Noriyuki Kitagawa, Akira Shimizu, Koji Kubota, Tsuyoshi Notake, Takahiro Yoshizawa, Kiyotaka Hosoda, Hikaru Hayashi, Shigeki Hayashi, Yuji Soejima

{"title":"Impact of preoperative biliary drainage on postoperative outcomes in patients who undergo major hepatectomy after portal vein embolization for perihilar cholangiocarcinoma.","authors":"Noriyuki Kitagawa, Akira Shimizu, Koji Kubota, Tsuyoshi Notake, Takahiro Yoshizawa, Kiyotaka Hosoda, Hikaru Hayashi, Shigeki Hayashi, Yuji Soejima","doi":"10.1007/s00595-025-03080-4","DOIUrl":"https://doi.org/10.1007/s00595-025-03080-4","url":null,"abstract":"Purpose: The influence of preoperative biliary drainage (PBD) and portal vein embolization (PVE) on the occurrence of post-hepatectomy liver failure (PHLF) remains unclear. We evaluated their influence on postoperative outcomes, focusing on PHLF, in patients who underwent major hepatectomy for perihilar cholangiocarcinoma (PHCC).Methods: A total of 240 patients underwent major hepatectomy for PHCC between January 1990 and March 2021. We evaluated the influence of PBD on short-term outcomes in all patients and in a subgroup (n = 111) that received PVE.Results: Although the incidence of grade B/C PHLF in patients with PBD was higher than that in those without PBD, a multivariable analysis identified PVE (OR 3.98, 95% CI 1.9-8.4; p < 0.001) and organ/space surgical site infection (SSI) (OR 3.48, 95% CI 1.6-7.4; p = 0.001), but not PBD, as independent risk factors for grade B/C PHLF. A multivariate analysis of patients who underwent PVE revealed that organ/space SSI was an independent risk factor for grade B/C PHLF (OR 4.5, 95% CI 1.6-12.7; p = 0.005).Conclusion: PBD did not have a negative impact on the occurrence of PHLF in patients undergoing PVE for an initially inadequate future liver remnant volume, provided that appropriate antimicrobial prophylaxis was selected.","PeriodicalId":22163,"journal":{"name":"Surgery Today","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144584948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Clinical factors associated with surgical interventions in patients with intestinal obstruction caused by abdominal tuberculosis. 腹部结核性肠梗阻手术治疗的临床因素分析。

IF 1.7 4区医学

Surgery Today Pub Date : 2025-07-08 DOI: 10.1007/s00595-025-03098-8

Shinya Urakawa, Hidemi Nishi, Daishi Yoshimura, Kazuya Sakata, Kimimasa Ikeda, Shoji Hashimoto, Yuki Han, Yoshitaka Tamura, Takayuki Nagai, Satoru Miyazaki

{"title":"Clinical factors associated with surgical interventions in patients with intestinal obstruction caused by abdominal tuberculosis.","authors":"Shinya Urakawa, Hidemi Nishi, Daishi Yoshimura, Kazuya Sakata, Kimimasa Ikeda, Shoji Hashimoto, Yuki Han, Yoshitaka Tamura, Takayuki Nagai, Satoru Miyazaki","doi":"10.1007/s00595-025-03098-8","DOIUrl":"https://doi.org/10.1007/s00595-025-03098-8","url":null,"abstract":"Purpose: Abdominal tuberculosis (TB), including Intestinal TB (ITB) and peritoneal TB (PTB), can cause intestinal strictures, leading to obstructions. However, the surgical indications for TB-related intestinal obstructions are yet to be established. This study investigates the clinical factors associated with these surgical interventions.Methods: Eighty-eight consecutive patients with ITB or PTB were enrolled in this study. The severity of abdominal TB was evaluated by the number of computed tomography (CT) findings of ascites, peritoneal nodules > 10 mm, intestinal wall thickening, and peritoneal or omental thickening.Results: Intestinal obstructions were diagnosed in 25 patients. The median duration of non-operative management was 11 (2-35) days, and 10 of the 25 patients required surgical intervention after non-operative management. The surgery group had a higher frequency of more CT features (70% vs. 13.3%, P = 0.0038) and a lower frequency of antitubercular therapy (ATT; 50% vs. 100%, P = 0.0075) than the non-surgery group. The severity of lung TB had no impact on the need for surgery and there was discrepancy between the chest and abdominal CT findings.Conclusion: Long-term non-operative management may be required for abdominal TB and the need for surgical intervention is associated with the ATT and CT findings.","PeriodicalId":22163,"journal":{"name":"Surgery Today","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144592425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0