{"title":"The conventional method of blood-loss calculation can underestimate true blood loss during laparoscopic pancreaticoduodenectomy: a dual-institute experience.","authors":"Masashi Tsunematsu, Yoshihiro Shirai, Ryoga Hamura, Koichiro Haruki, Kenei Furukawa, Shinji Onda, Michinori Matsumoto, Norimitsu Okui, Tomohiko Taniai, Toru Ikegami","doi":"10.1007/s00595-025-03040-y","DOIUrl":"10.1007/s00595-025-03040-y","url":null,"abstract":"<p><strong>Purpose: </strong>This study investigated whether blood loss (BL) was. truly less in patients undergoing laparoscopic pancreaticoduodenectomy (LPD) than in those undergoing open pancreaticoduodenectomy (OPD).</p><p><strong>Methods: </strong>A total of 98 patients undergoing pancreaticoduodenectomy between 2021 and 2023 were divided into OPD and LPD groups and compared. Estimated BL was calculated from the perioperative changes in hematocrit, hemoglobin, or red blood cell volume. Actual BL was calculated using the conventional method as the sum of the intraoperative aspirated blood volume and surgical gauze weight.</p><p><strong>Results: </strong>Actual BL was significantly lower in the LPD group than in the OPD group (150 [80-350] ml vs. 345 [150-700] ml, p = 0.003). However, there were no significant differences in the estimated BL calculated from the hematocrit (461 [187-626] ml vs. 351 [153-737] ml, p = 0.972), hemoglobin, or red blood cell volume. Estimated BL showed a stronger linear correlation with actual BL in the OPD group (r = 0.447-0.669) than in the LPD group (r = 0.158-0.417). OPD was not a significant factor in the increased estimated BL.</p><p><strong>Conclusions: </strong>The conventional method for calculating the BL in LPD may underestimate the actual loss, highlighting the need for a more accurate method of evaluation.</p>","PeriodicalId":22163,"journal":{"name":"Surgery Today","volume":" ","pages":"1393-1399"},"PeriodicalIF":1.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144032451","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}
{"title":"A higher preoperative cachexia index can result in the sufficient administration of S-1 adjuvant chemotherapy and lead to a good prognosis for elderly patients with stage II/III gastric cancer.","authors":"Kozo Miyatani, Tomohiro Takahashi, Shota Shimizu, Yuji Shishido, Takehiko Hanaki, Kyoichi Kihara, Tomoyuki Matsunaga, Manabu Yamamoto, Naruo Tokuyasu, Shuichi Takano, Teruhisa Sakamoto, Toshimichi Hasegawa, Hiroaki Saito, Yoshiyuki Fujiwara","doi":"10.1007/s00595-025-03038-6","DOIUrl":"10.1007/s00595-025-03038-6","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to clarify the significance of the relative dose intensity (RDI) of S-1 adjuvant chemotherapy (ACT) after gastrectomy in elderly patients with stage II/III gastric cancer (GC) and to determine whether the cachexia index (CXI) correlates with RDI.</p><p><strong>Methods: </strong>We enrolled 76 patients with stage II/III GC, aged > 70 years. The overall survival (OS) and disease-specific survival (DSS) of participants in the surgery alone, S-1 ACT completion (RDI ≥ 58%), and S-1 ACT non-completion (RDI < 58%) groups were compared. In addition, the clinicopathological determinants of RDI were examined.</p><p><strong>Results: </strong>The S-1 ACT completion group had better OS and DSS, while the prognoses of patients in the surgery alone and S-1 ACT non-completion groups did not differ significantly. S-1 ACT non-completion or surgery alone was identified as an independent poor prognostic factor for OS and DSS. Furthermore, a multivariate analysis revealed that a high preoperative CXI (≥ 75.5 for males and ≥ 79.4 for females) was an independent predictor of success in achieving an RDI ≥ 58%.</p><p><strong>Conclusions: </strong>A higher preoperative CXI can result in a higher RDI and improve the prognosis of elderly patients with stage II/III GC who underwent S-1 ACT.</p>","PeriodicalId":22163,"journal":{"name":"Surgery Today","volume":" ","pages":"1400-1410"},"PeriodicalIF":1.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144054734","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}
{"title":"Splenic vein resection is not a risk factor for delayed gastric emptying after pancreaticoduodenectomy with combined resection of the portal or superior mesenteric vein.","authors":"Koki Maeda, Naohisa Kuriyama, Motonori Nagata, Yasutaka Ichikawa, Maito Tachibana, Tatsuya Sakamoto, Benson Kaluba, Haruna Komatsubara, Daisuke Noguchi, Takahiro Ito, Kazuyuki Gyoten, Aoi Hayasaki, Takehiro Fujii, Yusuke Iizawa, Yasuhiro Murata, Akihiro Tanemura, Masashi Kishiwada, Shugo Mizuno","doi":"10.1007/s00595-025-03032-y","DOIUrl":"10.1007/s00595-025-03032-y","url":null,"abstract":"<p><strong>Purpose: </strong>This study clarified the influence of the splenic vein (SV) on delayed gastric emptying (DGE) in patients who underwent pancreaticoduodenectomy (PD) combined with portal vein (PV) and superior mesenteric vein (SMV) resections.</p><p><strong>Methods: </strong>A total of 147 patients who underwent open subtotal stomach-preserving pancreaticoduodenectomy (SSPPD) with PV/SMV resection were included in this study and classified into two groups: SV resection (n = 101) and preservation (n = 46). The incidence of DGE was compared between groups. Univariate and multivariate analyses were used to identify the risk factors for DGE.</p><p><strong>Results: </strong>There was no significant difference in the incidence of Grade B or C DGE between the SV resection and preservation groups (19.8 vs. 19.6%, respectively; p = 0.973). Multivariate analysis revealed that intra-abdominal abscess (odds ratio, 3.355; 95% confidence interval, 1.324-8.500; p = 0.011) was the only independent risk factor for DGE.</p><p><strong>Conclusion: </strong>SV resection did not affect the incidence of DGE after SSPPD with PV/SMV resection. There may be no need to insist on preserving the veins associated with gastric venous flow out of concern for DGE.</p>","PeriodicalId":22163,"journal":{"name":"Surgery Today","volume":" ","pages":"1411-1420"},"PeriodicalIF":1.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144014321","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}
{"title":"Association between the preoperative Midkine (+)/CEA (+) level and poor prognosis in colorectal cancer patients.","authors":"Mitsunori Ushigome, Hideaki Shimada, Masaaki Ito, Kimihiko Yoshida, Takayuki Suzuki, Satoru Kagami, Yasuyuki Miura, Tomoaki Kaneko, Akiharu Kurihara, Kimihiko Funahashi","doi":"10.1007/s00595-025-03044-8","DOIUrl":"10.1007/s00595-025-03044-8","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the clinicopathological and prognostic significance of preoperative serum Midkine levels in patients with colorectal cancer.</p><p><strong>Methods: </strong>Preoperative Midkine levels were analyzed using an enzyme-linked immunosorbent assay in 78 patients with colorectal cancer, at stages 0 (n = 2), I (n = 19), II (n = 25), III (n = 24), and IV (n = 8). Using a cut-off value of 421 pg/mL, the patients were divided into a Midkine(+) group and a Midkine(-) group. Clinicopathological factors and prognosis were compared between the two groups, using univariate and multivariate analyses.</p><p><strong>Results: </strong>The overall positive rates were 46%, 32%, and 21% for CEA, Midkine, and CA19-9, respectively. The positive rate of the Midkine/CEA combination was 55%. The positive rates at stage 0/I were 19%, 19%, and 5% for CEA, Midkine, and CA19-9, respectively. The Midkine(+) group showed poor survival, but the differences were not significant. The Midkine (+)/CEA (+) group had significantly worse relapse-free survival (RFS) (p = 0.02). The Midkine (+)/CEA (+) level was an independent risk factor for RFS (p = 0.04) and overall survival (p = 0.03).</p><p><strong>Conclusion: </strong>The Midkine (+)/CEA (+) combination may be an indicator of poor prognosis for patients with colorectal cancer.</p>","PeriodicalId":22163,"journal":{"name":"Surgery Today","volume":" ","pages":"1421-1429"},"PeriodicalIF":1.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144028027","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}
Surgery TodayPub Date : 2025-10-01Epub Date: 2024-11-20DOI: 10.1007/s00595-024-02958-z
Ji Hyeong Song, Yoonsoo Shin, Kyung Ha Lee, Ji Yeon Kim, Jin Soo Kim
{"title":"Correlation between inflammatory markers and enhanced recovery after surgery (ERAS) failure in laparoscopic colectomy.","authors":"Ji Hyeong Song, Yoonsoo Shin, Kyung Ha Lee, Ji Yeon Kim, Jin Soo Kim","doi":"10.1007/s00595-024-02958-z","DOIUrl":"10.1007/s00595-024-02958-z","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate inflammatory markers to identify patients at risk of enhanced recovery after surgery (ERAS) failure following laparoscopic colectomy.</p><p><strong>Methods: </strong>We included patients who underwent laparoscopic colectomy between September 2020 and February 2023. ERAS failure was defined as intolerance of a soft diet on postoperative day (POD) 2, postoperative stay > 7 days, or readmission within 30 days postoperatively. Inflammatory markers were analyzed immediately postoperatively and on POD 1 and 3. All patients were subjected to the ERAS protocol and divided into success and failure groups.</p><p><strong>Results: </strong>Data from 402 patients (success, 330; failure, 72) were analyzed. The neutrophil-to-lymphocyte ratio (p < 0.001), platelet-to-lymphocyte ratio (p = 0.004), monocyte-to-lymphocyte ratio (p = 0.041), and C-reactive protein-to-albumin ratio (CAR; p < 0.001) were elevated in the failure group on POD 3. The immediate postoperative CAR was higher in the failure group (p = 0.045). ERAS failure occurred more frequently in patients with body mass index < 20 (p < 0.001), right colon tumors (p = 0.012), and longer operative time (p < 0.001).</p><p><strong>Conclusions: </strong>This study demonstrated that inflammatory markers are associated with ERAS failure. Among the inflammatory markers, CAR might be the most potent indicator of ERAS failure following laparoscopic colectomy.</p>","PeriodicalId":22163,"journal":{"name":"Surgery Today","volume":" ","pages":"1353-1360"},"PeriodicalIF":1.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12446132/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142676838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Comparison of the surgical difficulty between segment 7 and 8 partial liver resection untilizing the laparoscopic and open approaches.","authors":"Hidetoshi Gon, Akihiro Fujisawa, Shohei Komatsu, Motofumi Tanaka, Kenji Fukushima, Takeshi Urade, Toshihiko Yoshida, Keisuke Arai, Jun Ishida, Yoshihide Nanno, Daisuke Tsugawa, Hiroaki Yanagimoto, Hirochika Toyama, Masahiro Kido, Takumi Fukumoto","doi":"10.1007/s00595-025-03037-7","DOIUrl":"10.1007/s00595-025-03037-7","url":null,"abstract":"<p><strong>Purpose: </strong>We aimed to investigate the differences in surgical difficulty between laparoscopic partial liver resections of segments 7 and 8.</p><p><strong>Methods: </strong>We analyzed 173 patients who underwent partial liver resections of segments 7 or 8 between 2010 and 2022 at two institutions. We investigated differences in the surgical outcomes of each procedure using propensity score matching. We compared these outcomes with those of open partial liver resections for segments 7 and 8 to determine whether the differences were unique to the laparoscopic approach.</p><p><strong>Results: </strong>Thirty and 54 patients underwent laparoscopic partial liver resections of segments 7 and 8. In the matched cohort (22 in each group), the operation time was significantly longer (377 vs. 278 min, P = 0.020) and the proportion of postoperative complications significantly higher in segment 7 (27% vs. 0%, P = 0.008). Forty-one and 48 patients underwent open partial liver resections of segments 7 and 8, respectively. There were no significant differences in the surgical outcomes between the segments in the matched cohort (20 in each group).</p><p><strong>Conclusions: </strong>Laparoscopic partial liver resections of segment 7 may be more challenging than that of segment 8. This difference in difficulty was not observed in open partial liver resections.</p>","PeriodicalId":22163,"journal":{"name":"Surgery Today","volume":" ","pages":"1383-1392"},"PeriodicalIF":1.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144011109","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}
{"title":"Prognostic significance of the liver stiffness value on magnetic resonance imaging elastography in patients undergoing hepatectomy for hepatocellular carcinoma.","authors":"Hiroto Chiba, Naoya Sato, Atsushi Ozeki, Ryota Sugawara, Takayasu Azuma, Shigeyuki Tsukida, Makoto Muto, Junichiro Haga, Yasuhide Kofunato, Teruhide Ishigame, Takashi Kimura, Akira Kenjo, Shigeru Marubashi","doi":"10.1007/s00595-025-03034-w","DOIUrl":"10.1007/s00595-025-03034-w","url":null,"abstract":"<p><strong>Synopsis: </strong>This study shows the utility of magnetic resonance imaging elastography as an independent predictor of the postoperative recurrence of hepatocellular carcinoma.</p><p><strong>Purpose: </strong>Accurate assessment of postoperative recurrence risk is crucial for the perioperative management of patients undergoing surgical resection for hepatocellular carcinoma (HCC). Magnetic resonance imaging elastography (MRE) has emerged as a noninvasive tool for assessing liver fibrosis. This study evaluated whether MRE independently predicts HCC recurrence more effectively than well-known oncological factors, including pathological findings.</p><p><strong>Methods: </strong>The subjects of this retrospective observational study were HCC patients who underwent preoperative MRE and hepatectomy between 2013 and 2023. Data collected included demographics, laboratory findings, imaging, pathology, operative details, and prognosis. Patients were followed up for at least 1 year after hepatectomy or until recurrence.</p><p><strong>Results: </strong>Recurrence developed in 46 of 100 patients. Multivariable Cox regression analysis for overall recurrence identified MRE ≥ 3.7 kPa (hazard ratio [HR] 3.161, p = 0.021), the FIB-4 index (HR 3.176, p = 0.001), tumor size > 5 cm (HR 5.893, p < 0.001), invasive growth pattern (HR 2.375, p = 0.036), METAVIR F3-4 (HR 2.562, p = 0.046), and venous invasion (HR 10.622, p < 0.001) as risk factors. The recurrence-free rate at 1 year for patients with MRE ≥ 3.7 kPa was lower than for those with MRE < 3.7 kPa (72.0% vs. 92.0%, p = 0.017).</p><p><strong>Conclusions: </strong>Preoperative MRE predicts postoperative HCC recurrence, underscoring its utility in risk stratification.</p>","PeriodicalId":22163,"journal":{"name":"Surgery Today","volume":" ","pages":"1361-1372"},"PeriodicalIF":1.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143773264","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}
{"title":"Increased risk of postoperative pancreatic fistula in patients with chronic steroid usage undergoing pancreatectomy.","authors":"Wataru Fujii, Yoshito Tomimaru, Shogo Kobayashi, Hidenori Takahashi, Kazuki Sasaki, Shinichiro Hasegawa, Daisaku Yamada, Hirofumi Akita, Takehiro Noda, Tetsuhisa Kitamura, Yuichiro Doki, Hidetoshi Eguchi","doi":"10.1007/s00595-025-03028-8","DOIUrl":"10.1007/s00595-025-03028-8","url":null,"abstract":"<p><strong>Purpose: </strong>Chronic steroid use may increase the risk of postoperative complications; however, its impact on postoperative outcomes after pancreatectomy has not been fully investigated. This study investigated the impact of chronic steroid use on surgical outcomes, particularly postoperative pancreatic fistulas (POPF).</p><p><strong>Methods: </strong>A retrospective analysis of 656 patients who underwent pancreatectomy between 2010 and 2021 was conducted. Patients who had been using steroids for ≥ 1 month at the time of surgery were classified into the steroid group. Postoperative outcomes were compared between the steroid-treated and non-steroid-treated groups.</p><p><strong>Results: </strong>Of the 656 patients, 17 (2.6%) were in the steroid group, which exhibited a significantly higher POPF rate than the non-steroid group (70.6% vs. 26.3%, p = 0.0002). A multivariate analysis identified chronic steroid use as an independent risk factor for POPF (odds ratio 4.718, 95% confidence interval 1.510-14.742; p = 0.0051). The results were confirmed using a propensity score matching analysis.</p><p><strong>Conclusion: </strong>The risk of POPF was significantly increased after pancreatectomy in patients with chronic steroid use compared to those without chronic steroid use, and chronic steroid use was an independent factor significantly associated with POPF.</p>","PeriodicalId":22163,"journal":{"name":"Surgery Today","volume":" ","pages":"1446-1453"},"PeriodicalIF":1.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144038468","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}
{"title":"The minimum apparent diffusion coefficient value on preoperative magnetic resonance imaging in resectable pancreatic cancer: a new prognostic factor for biologically borderline resectable pancreatic cancer.","authors":"Michinori Matsumoto, Masashi Tsunematsu, Ryoga Hamura, Koichiro Haruki, Kenei Furukawa, Yoshihiro Shirai, Tadashi Uwagawa, Shinji Onda, Tomohiko Taniai, Yoshiaki Tanji, Mitsuru Yanagaki, Toru Ikegami","doi":"10.1007/s00595-025-03050-w","DOIUrl":"10.1007/s00595-025-03050-w","url":null,"abstract":"<p><strong>Purpose: </strong>To identify the prognostic factors that can define biologically borderline resectable pancreatic cancer (BRPC) in resectable pancreatic cancer (RPC) patients.</p><p><strong>Methods: </strong>This retrospective study included 121 R/BRPC patients who underwent upfront surgery. Univariate and multivariate analyses were conducted to investigate the relationship between preoperative factors and overall survival (OS) for RPC. The OS of RPC patients was stratified based on a score, with each independent prognostic factor receiving 1 point. The OS of the R/BRPC patients was compared based on their scores.</p><p><strong>Results: </strong>Overall, 113 and eight patients had RPC and BRPC. Serum CA19-9 > 500 U/mL (p = 0.048), maximum tumor diameter > 30 mm (p = 0.01), superior mesenteric/portal vein contact < 180° (p = 0.04), and minimum apparent diffusion coefficient (ADC<sub>min</sub>) ≤ 1020 × 10<sup>-6</sup> mm<sup>2</sup>/s (p = 0.01) were identified as independent prognostic factors in RPC patients. RPC patients with a score of 0 had a significantly better prognosis than those with scores of 1 and 2-4 and BRPC patients (median OS: 99.3, 35.1, 19.0, and 8.4 months; p = 0.007, p < 0.001, and p = 0.003, respectively). No significant difference in the prognosis was observed between BRPC and RPC patients with scores of 1 and 2-4.</p><p><strong>Conclusions: </strong>Preoperative ADC<sub>min</sub> in RPC may be a new prognostic factor for biological BRPC.</p>","PeriodicalId":22163,"journal":{"name":"Surgery Today","volume":" ","pages":"1461-1470"},"PeriodicalIF":1.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144047355","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}
{"title":"Use of a zipline skin closure device in gastroenterological surgery: a multicenter randomized controlled trial assessing wound infection incidence, operation time, and cosmesis.","authors":"Ayato Obana, Takuya Minagawa, Ayako Shimada, Junko Mukohyama, Yuki Hirano, Sojun Hoshimoto, Takashi Oyama, Tsuruta Masashi, Takashi Ishida, Takuya Tamura, Kyoichi Matsuzaki, Mitsuru Takaku, Hirotoshi Ohara, Motoi Koyama, Masahiro Shinoda, Tatsushi Suwa, Osamu Itano","doi":"10.1007/s00595-025-03043-9","DOIUrl":"10.1007/s00595-025-03043-9","url":null,"abstract":"<p><p>Subcuticular sutures, which are effective and cosmetically advantageous in gastroenterological surgery, are time-consuming and heavily dependent on the surgeon's technical expertise. This study aims to evaluate whether Zipline skin closure could be an alternative to subcuticular sutures in gastroenterological surgery. A multicenter randomized controlled trial (UMIN000048169) was conducted on 76 patients who underwent elective gastroenterological surgery. The patients were randomized to either the Zipline group (N = 35) or the subcuticular suture group (N = 41). Primary outcomes included skin closure time and secondary outcomes included postoperative wound complications and cosmetic results, assessed 6 months post-surgery, using the Stony Book Scar Evaluation Scale (SBSES). The Zipline group demonstrated significantly shorter closure times than the suture group (median: 438 s [406-526] vs. 575 s [537-638]; p = 0.003). This difference was more pronounced for incisions > 55 mm (median:399 s [307-533] vs. 605 s [493-736]; p = 0.001). No significant differences were observed in wound infection rates (5.7% vs. 2.4%; p = 0.46) or SBSES scores (median: 4.0 [4.0-5.0] vs. 4.0 [3.0-5.0; p = 0.82) between the two groups. The Zipline device reduced the skin closure time in gastroenterological surgery significantly, particularly for large incisions, without compromising wound healing or cosmetic outcomes. These findings suggest that the Zipline system may be a viable alternative to traditional subcuticular sutures in gastroenterological procedures, potentially promoting operating room efficiency without compromising surgical quality or patient outcomes.</p>","PeriodicalId":22163,"journal":{"name":"Surgery Today","volume":" ","pages":"1488-1496"},"PeriodicalIF":1.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144043403","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}
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