Updates in Surgery最新文献

{"title":"Adherence to enhanced recovery protocol in emergency general surgery: a prospective observational study.","authors":"Marco Ceresoli, Chiara Fumagalli, Alan Biloslavo, Antonio La Greca, Antonella D'addiego, Mauro Zago, Savino Occhionorelli, Pietro Bisagni, Carlo Feo, Dario Tartaglia, Dario Parini, Matteo Runfola, Riccardo Somigli, Diego Visconti, Diego Mariani, Giuseppe Foti, Luca Gianotti, Andrea Mingoli, Enrico Lena, Valeria Fico, Michele Carlucci, Giovanni Pesenti, Domenico Lacavalla, Nicolò Fabbri, Massimo Chiarugi, Michele Ballabio, Giorgia Boschetto, Gianandrea Baldazzi, Elisabetta Pusceddu, Elisa Boetti, Mauro Santarelli, Diletta Cassini, Marco Braga","doi":"10.1007/s13304-025-02325-8","DOIUrl":"https://doi.org/10.1007/s13304-025-02325-8","url":null,"abstract":"<p><p>Enhanced recovery pathways (ERPs) are evidence-based, multimodal strategies designed to promote early recovery and to optimize surgical outcomes. While extensively implemented in elective surgery, their adaptation to emergency general surgery (EGS) raises challenges due to patient instability and limited preoperative time. The study aimed to evaluate the adherence to each ERPs item and the impact on short-term outcomes in patients undergoing emergency general surgery. This is a multicenter observational prospective study carried out in 13 Italian centers. Inclusion criteria targeted adults undergoing surgery for intestinal occlusion or perforation. Patients re-operated after elective surgery were excluded. The primary endpoints were the adherence to intraoperative ERP items and the compliance to the postoperative recovery pathway. Secondary endpoints were postoperative mortality, morbidity, and length of hospital stay. Between March 2023 and March 2024, 760 patients were analyzed. The highest adherence was observed for active warming (97%), PONV prevention (92%), and long-acting opioid avoidance (87%). The lowest adherence was found for invasive arterial pressure monitoring (35%), depth of anesthesia monitoring (34%), locoregional analgesia (31%), and minimally invasive surgery (26%). By postoperative day 3, 66% of patients tolerated solid diets and 58% had discontinued intravenous fluids. Postoperative mortality, morbidity, and major complications occurred in 3%, 33%, and 9% of patients, respectively. Median hospital stay was 7 days. This study underscores the adherence to ERP in EGS, highlighting the potential of ERP to improve perioperative outcomes in a high-risk population. Future research should prioritize strategies to enhance adherence, particularly to underutilized components as goal-directed fluid therapy and minimally invasive surgery and further optimize ERP protocols for emergency settings.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144620680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of medical treatment failure in patients with adhesive small bowel obstruction.","authors":"Sofía Bertona, María A Casas, Josefina Principe, Sofía Aramburu, Cristian A Angeramo, Andrés Zanfardini, Francisco Schlottmann","doi":"10.1007/s13304-025-02311-0","DOIUrl":"https://doi.org/10.1007/s13304-025-02311-0","url":null,"abstract":"<p><strong>Background: </strong>Small bowel obstruction (SBO) is a common cause of hospitalization worldwide with approximately 80% of cases resulting from surgical adhesions. While medical treatment is often advocated for SBO, some patients require surgical intervention. The aim of this study was to evaluate predictors of medical treatment failure in patients with adhesive SBO (ASBO).</p><p><strong>Methods: </strong>We performed a retrospective analysis of a consecutive series of patients with ASBO between 2014 and 2024. The sample was divided into two groups; patients who resolved with conservative treatment (G1) and those who required surgical intervention after initial conservative management (G2). Demographic and preoperative variables were compared between groups. A multivariable logistic regression analysis was performed to identify independent factors associated with medical treatment failure.</p><p><strong>Results: </strong>A total of 225 patients were included; 125 (55.5%) belonged to G1 and 100 (45.5%) to G2. Demographic and laboratory variables were similar between groups, except for mean lactate levels, which were higher in G2 (G1: 0.5 vs G2: 1.1 mmol/L), p = 0.001). Patients in G1 had higher number of previous ASBO episodes (G1: 47 (37.6%) vs. G2: 20 (20.0%), p = 0.004). Previous open surgery (G1: 89 (71.2%) vs. G2: 86 (86%), p = 0.007) and open appendectomy (G1: 16 (12.8%) vs. G2: 24 (24%), p = 0.02) as surgical history were more frequent in G2. Time elapsed since symptoms onset was longer in G2 (G1: 2.2 vs. G2: 2.7 days, p = 0.001). An abrupt transition point (G1:86 (71%) vs. G2: 85 (86.7%), p = 0.005) and a beak sign (G1: 48 (39.6%) vs. G2: 52 (53%), p = 0.04) on CT scan were more frequently observed in G2. In the multivariate analysis, the presence of a transition point on CT (OR 2.25, IC 95% 1.07-4.71, p < 0.03), higher lactic acid levels (OR 1.37, IC 95% 1.07-1.77, p < 0.01), and history of previous open surgery (OR 2.55, IC 95% 1.23-5.30, p < 0.01) were independent predictors of treatment failure. History of multiple previous episodes of ASBO treated successfully with medical treatment (OR 0.43, IC 95% 0.23-0.84, p < 0.01) was associated with medical treatment success. After 50.8 months of follow-up, recurrence of ASBO was higher in G1 (G1: 16 (12.8%) vs G2: 1 (5%), p = 0.04).</p><p><strong>Conclusion: </strong>ASBO in patients with a transition point on CT, high lactic acid levels, and/or history of previous open operation is significantly less likely to respond to medical treatment. Closer monitoring and early consideration of surgical intervention in these patients might be reasonable to reduce potential morbidity and mortality associated with delayed surgery.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144620743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robot‑assisted cholecystectomy with the new da Vinci SP^® surgical system: first report in Spain with video.","authors":"Emilio Vicente, Yolanda Quijano, Valentina Ferri, Riccardo Caruso","doi":"10.1007/s13304-025-02275-1","DOIUrl":"https://doi.org/10.1007/s13304-025-02275-1","url":null,"abstract":"<p><p>Robotic surgery has significantly advanced over the last decade, proving to be a safe and feasible technique in minimally invasive surgery. The latest innovation in robotic-assisted surgery is the da Vinci single-port (SP^®) by Intuitive, designed for greater precision and ergonomic efficiency. This report is supposed to be the first Spanish case of robot-assisted cholecystectomy performed using the da Vinci SP^® system, detailing system specifications, docking configurations, and surgical outcomes. The procedure was completed without complications or technical failures, with an operative time of 38 min and a docking time of 10 min. The patient was discharged the following day, demonstrating the system's efficacy in routine cholecystectomy procedures.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144620744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Superior anal function in patients undergoing stoma closure within 6 months after LAR and analysis of factors associated with LARS syndrome: insights from experienced surgeons.","authors":"Heyuan Zhu, Hongfeng Pan, Zihan Tang, Pan Chi, Xiaojie Wang, Ying Huang","doi":"10.1007/s13304-025-02320-z","DOIUrl":"https://doi.org/10.1007/s13304-025-02320-z","url":null,"abstract":"<p><p>The present study aims to evaluate the impact of stoma closure timing on anal function following low anterior resection (LAR) in rectal cancer patients and to investigate the factors associated with the development of low anterior resection syndrome (LARS). There is currently a lack of clarity regarding this issue, necessitating a comprehensive comparison. Between January 2017 and December 2021, a major public medical center consecutively performed LAR with temporary stoma construction for patients with rectal cancer. The primary objective of this study was to investigate the optimal timing of stoma closure following LAR, with a particular focus on its impact on anal function. To achieve this goal, we compared baseline characteristics, short-term postoperative complications, long-term oncological outcomes, as well as 5-year overall survival (OS) rate and disease-free survival (DFS) rate between two groups of patients: the early stoma closure group (stoma closure time < 6 months) and the late stoma closure group (stoma closure time ≥ 6 months). The secondary objective was to explore factors associated with the development of LARS. A total of 323 patients diagnosed with rectal cancer who underwent LAR were included in this cohort study. Based on the ROC cutoff point, patients were divided into two groups: the early stoma closure group (< 6 months, N = 110) and the late stoma closure group (≥ 6 months, N = 199). No significant differences were observed in baseline patient characteristics between the two groups (p > 0.05). In the comparison of short-term postoperative complications, patients with stoma closure time ≥ 6 months had a higher incidence of anastomotic leakage following LAR (0.9% vs. 6.3%, p = 0.029) and a higher rate of neural invasion (5.5% vs. 13.5%, p = 0.03). Regarding long-term oncological functional outcomes, a significantly higher proportion of patients with stoma closure time ≥ 6 months experienced LARS (35.9% vs. 47.7%, p = 0.045). In terms of long-term oncological outcomes, no differences were observed in OS rate and DFS rate between the two groups (p > 0.05). Logistic regression analysis was performed to identify factors associated with LARS, and the results indicated that stoma closure time (OR = 1.27, 95% CI 0.89-1.43, p = 0.042), gender (OR = 0.50, 95% CI 0.31-0.84, p = 0.008), and tumor distance from the anal verge (OR = 0.86, 95% CI 0.75-0.98, p = 0.029) were independent risk factors of LARS occurrence. We have ascertained that the timepoint for optimal stoma closure following LAR is at 5.5 months postoperatively, at which juncture patients attain the most favorable anal function. Therefore, we advocate performing stoma closure surgery within 6 months after LAR. Moreover, this study results demonstrate that the timing of stoma closure, patient gender, and tumor distance from the anal verge are independent risk factors associated with the development of LARS.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144601665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Innovative rapid pathological assessment technology for hepatocellular carcinoma following comprehensive treatment guided by indocyanine green fluorescence imaging.","authors":"Changcheng Tao, Huiru Yang, Nan Hu, Bo Zheng, Zhiyu Lu, Weiqi Rong, Fan Wu, Liming Wang, Dayong Cao, Jianxiong Wu, Zhanhan Tu, Xuan Meng, Haizhen Lu, Hongguang Wang","doi":"10.1007/s13304-025-02301-2","DOIUrl":"https://doi.org/10.1007/s13304-025-02301-2","url":null,"abstract":"<p><strong>Background: </strong>Traditional pathological techniques for diagnosing liver cancer are limited by the need for examination of multiple points. Preoperative treatment can complicate the evaluation by causing tumor necrosis. The evolving treatment landscape requires precise, integrated, and comprehensive management to address the limitations, specifically in localization, sampling, and speed. This study aims to innovatively explore the use of indocyanine green (ICG) fluorescence imaging to guide accurate and rapid localization of residual cancer foci, facilitating rapid pathological sampling and evaluation, termed as rapid pathological technology.</p><p><strong>Patients and methods: </strong>In this prospective and observational study, patients undergoing surgical resection for HCC were enrolled. Traditional evaluation involved specimen fixation, sampling, sectioning, and microscopic observation, while rapid evaluation entailed fluorescence-guided rapid pathological sampling and evaluation post-dissection.</p><p><strong>Results: </strong>A total of 37 HCC patients were included, and 103 samples of varying fluorescence intensity were collected. Analysis revealed a significant negative correlation between fluorescence intensity and tumor necrosis ratio (ρ = -0.89, p < 0.001). Furthermore, logistic regression modeling yielded an AUC of 0.947, with a specificity of 0.900 and sensitivity of 0.930, indicating strong discriminatory power for tumor necrosis status. An optimal cut-off fluorescence intensity of ≥ 20.5 was identified for predicting partial tumor necrosis. The Youden index is 0.830. Decision curve analysis demonstrated the clinical utility of the prediction model for guiding treatment decisions regarding tumor necrosis.</p><p><strong>Conclusions: </strong>Rapid pathological evaluation using ICG fluorescence-guided resection specimens in liver cancer is feasible, enabling effective localization of residual cancer foci and enhancing the accuracy and efficiency of pathological sampling.</p><p><strong>Trial registration: </strong>ChiCTR2400082814.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144576361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-world use of polidocanol foam sclerotherapy for hemorrhoidal disease: insights from an international survey and systematic review with clinical practice recommendations.","authors":"Taharam Fazal, Salafa Fazal, Azka Mustaan","doi":"10.1007/s13304-025-02322-x","DOIUrl":"https://doi.org/10.1007/s13304-025-02322-x","url":null,"abstract":"","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144584995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of single and double stapling anastomosis in restorative surgery for ulcerative colitis: short- and long-term outcomes and functional results.","authors":"Serena Perotti, Michela Mineccia, Federica Gonella, Filippo Pepe, Paolo Massucco, Alessandro Ferrero","doi":"10.1007/s13304-025-02294-y","DOIUrl":"https://doi.org/10.1007/s13304-025-02294-y","url":null,"abstract":"<p><strong>Background: </strong>Ulcerative colitis (UC) often requires surgery, with restorative proctocolectomy and ileal pouch-anal anastomosis (IPAA) considered the standard treatment. While the double-stapled (DS-IPAA) anastomotic technique remains commonly used, single-stapled (SS-IPAA) techniques, including transanal IPAA (ta-IPAA) and transanal transection with single-stapled anastomosis (TTSS), are gaining popularity. This study compares short-term, long-term, and functional outcomes between DS-IPAA and SS-IPAA in UC patients.</p><p><strong>Methods: </strong>In this retrospective cohort study, 80 UC patients who underwent a three-stage restorative procedure at a single IBD referral center from June 2018 to June 2023 were analyzed. The patients were divided into two groups: Group 1 (40 DS-IPAA) and Group 2 (40 SS-IPAA, including ta-IPAA and TTSS). The key outcomes assessed included early and late postoperative complications, functional outcomes (measured using the Ileoanal Pouch Syndrome Severity Score, Low Anterior Resection Syndrome score, and IBDQ-32), and quality of life.</p><p><strong>Results: </strong>The perioperative complications were similar between the groups. The SS-IPAA group had a significantly shorter hospital stay (6 vs. 8 days, p = 0.008). No significant difference in readmission rates was observed (7.5% DS-IPAA vs. 5.0% SS-IPAA, p = 0.644). The long-term results revealed a higher incidence of cuffitis in the DS-IPAA group (p = 0.002). The functional outcomes were significantly worse in DS-IPAA group, with worse IPSS scores (p = 0.003), higher incidence of major (37.5% vs. 17.5%, p = 0.007), and lower median IBDQ-32 (176 vs. 208, p < 0.001).</p><p><strong>Conclusions: </strong>This study supports SS-IPAA as a favorable surgical option for UC patients, with implications for individualized surgical decision-making in specialized centers.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144567876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Custom-made life-saving asymmetrical Y-stent for restenosis after carinal resection and reconstruction for tracheal cancer.","authors":"Leonardo Teodonio, Valentina Peritore, Claudio Andreetti","doi":"10.1007/s13304-025-02319-6","DOIUrl":"https://doi.org/10.1007/s13304-025-02319-6","url":null,"abstract":"<p><p>We report the case of a 50-year-old male treated with carinal resection and neocarina reconstruction for tracheal mucoepidermoid carcinoma. One month postoperatively, the patient developed severe respiratory failure due to restenosis and excessive dynamic airway collapse (EDAC) at the trachea-right main bronchus anastomosis. Initial management with balloon dilatation and a standard Dumon silicone stent failed due to stent migration. Given the complex postoperative airway anatomy, we designed a custom-made asymmetrical Y-shaped silicone stent. The stent successfully restored airway patency and prevented migration by anchoring in the right upper lobe bronchus. The patient was discharged in stable condition, and follow-up bronchoscopy confirmed long-term stent stability and airway patency. This case demonstrates that custom-designed stents can provide a life-saving solution in patients with complex post-surgical airway anatomy. Personalized stenting may be essential when conventional devices fail to address anatomical variability, especially after extensive airway reconstruction.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144567877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neoadjuvant chemoradiotherapy with or without preoperative immunotherapy for locally advanced rectal cancer: a system review and meta-analysis.","authors":"Xuefeng Cheng, Jie Yang, Yu Shen, Xiangbing Deng, Ziqiang Wang","doi":"10.1007/s13304-025-02309-8","DOIUrl":"https://doi.org/10.1007/s13304-025-02309-8","url":null,"abstract":"<p><p>For locally advanced rectal cancer (LARC), adding immunotherapy after patients receive standard neoadjuvant chemoradiotherapy (nCRT) or short-course radiotherapy (SCRT) is a new method. This study aims to evaluate the efficacy and safety of the combination of nCRT/SCRT and immunotherapy on LARC patients based on the current published studies. A comprehensive electronic search of literature up to December 1, 2024 was carried out in Pubmed, the Cochrane Library, Web of Science, Google Scholar databases and Embase. Studies comparing the nCRT/SCRT with preoperative immunotherapy (nCRT/SCRT + IMT group) and nCRT/SCRT alone (nCRT/SCRT group) were included. The primary outcome was the pathological complete response (pCR) rate. Three randomized control trials and one retrospective study, involving 692 LARC patients, were included. The pooled pCR rate was 40.6% (134/330) in the nCRT/SCRT + IMT group and 22.5% (66/293) in the nCRT/SCRT group (RR = 1.68, 95% CI 1.11-2.55, p = 0.01). The pTRG 0-1 rate was 69.0% (180/261) in the nCRT/SCRT + IMT group and 47.1% (106/225) in the nCRT/SCRT group (RR = 1.43, 95% CI 1.22-1.68, p < 0.001). The major adverse events rate (grade 3-4) were comparable between the nCRT/SCRT + IMT group and the nCRT/SCRT group (61/194, 31.4% vs 51/197, 25.9%, RR = 1.22, 95% CI 0.90-1.65; P = 0.20). Preoperative immunotherapy in combination with standard nCRT/SCRT may improve the tumor regression and increase the pCR rate in selected LARC patients without additional major treatment adverse events.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144567878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative outcomes of sphincteroplasty and sacral neuromodulation in postmenopausal women with late-onset fecal incontinence following obstetric trauma: a retrospective study.","authors":"Alessandro Bergna, Andrea Rusconi, Jacques Megevand, Ettore Lillo, Massimo Amboldi, Alessio Lanzaro, Leonardo Lenisa, Ezio Ganio","doi":"10.1007/s13304-025-02317-8","DOIUrl":"https://doi.org/10.1007/s13304-025-02317-8","url":null,"abstract":"<p><p>Fecal incontinence (FI) is a debilitating condition that commonly affects postmenopausal women, particularly those with a history of obstetric trauma. To date, there are few studies directly comparing SP and SNM, which present many discrepancies in the inclusion criteria, such as age, etiology, and elapsed time from the onset of the condition. This retrospective study aims to compare the clinical outcomes of the two procedures most widely performed in the management of FI: sphincteroplasty and sacral neuromodulation (SNM). The inclusion criteria were established to ensure a representative sample of a well-defined patient population affected by fecal incontinence: postmenopausal women with late onset of FI after previous obstetric trauma. A cohort of 58 women aged 65 and older treated consecutively at the Humanitas San Pio X Hospital between January 2016 and December 2022 was analysed. Thirty-five women underwent sphincteroplasty, while 23 received SNM. Outcomes were evaluated based on the functional outcomes and the incidence of adverse events. Statistical Analysis did not show any statistically significant differences between the two groups (SP and SNM) in terms of baseline characteristics and 2-year functional outcomes. Both techniques were effective in the treatment of FI according to the Cleveland Clinic Incontinence Score registrations over the 2-year follow-up. No differences were found between the two techniques in terms of both early and late complication rates. Therefore, SP and SNM proved to be safe and effective treatments for late-onset FI in postmenopausal women with a history of obstetric trauma, yielding favourable outcomes at 24 months.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144567875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}