Updates in Surgery最新文献

{"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}

{"title":"Comparative study of three-port vs four-port laparoscopic cholecystectomy in a cohort study: a surgical task load survey.","authors":"Ali Javidi, Erfan Sheikhbahaei, Ashkan Mortazavi, Farjam Khosravi, Ali Mohammad Mokhtari, Mohammad Eslamian","doi":"10.1007/s13304-025-02308-9","DOIUrl":"https://doi.org/10.1007/s13304-025-02308-9","url":null,"abstract":"<p><p>The three-port laparoscopic cholecystectomy (LC) approach is gaining attention for its perceived benefits, although it is not widely accepted outside of clinical trials. The present investigation aims to compare the outcomes of three-port LC (3PLC) and four-port LC (4PLC) methods, focusing on their safety, efficacy, and workload. This multicenter investigation was performed between March 2021 and April 2022. Demographic data, procedural outcomes, visual analog scale regarding postoperative pain, and the level of satisfaction were collected and compared. In addition, the Surgery-TLX and Borg's CR10 tools were utilized to assess the surgeon's workload. Of 169 patients who enrolled in the study, 84 individuals underwent 3PLC, and 85 cases had 4PLC. The three-port LC indicated a significantly shorter duration of operation compared to the four-port (63.55 vs. 69.08 min respectively, p = 0.001). The hospital length of stay and the mean pain score on day 1 were also lower in the 3PLC (1.14 days vs. 1.79 days, p < 0.001 and 1.85 vs. 2.52, p = 0.004, respectively). The mean level of satisfaction on day 7 was higher in the 3PLC. The Borg's CR10 scale showed that surgeons experienced more physical discomfort and pain in the left shoulder, left forearm, and trunk after 4PLC. The surgery-TLX scale in our study indicated increased mental demands and distraction, but less situational awareness in the surgeons after 4PLC. The 3PLC technique could serve as a safe and feasible laparoscopic technique and does not cause more complications than the conventional 4PLC.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144561300","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":"From scarless surgery to legal pressure: The obligation for cosmetic outcomes in minimally invasive procedures?","authors":"Marco Di Paolo, Naomi Iacoponi, Ugo Boggi","doi":"10.1007/s13304-025-02316-9","DOIUrl":"https://doi.org/10.1007/s13304-025-02316-9","url":null,"abstract":"","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144565273","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":"A SICE (Società Italiana di Chirurgia Endoscopica e Nuove Tecnologie) observational prospective multicenter study on lymphadenectomy during right hemicolectomy: Should anatomical variability of the right colic artery influence the surgical strategy?-CoDIG 2 database (ColonDx Italian Group).","authors":"G Anania, A Campagnaro, G Resta, S Pedon, G Silecchia, D Cuccurullo, J Randolph, A De Troia, M Chiozza, S Marino, R Cirocchi","doi":"10.1007/s13304-025-02312-z","DOIUrl":"https://doi.org/10.1007/s13304-025-02312-z","url":null,"abstract":"<p><p>Colon cancer is a worldwide common disease in both gender. Surgery is the best option for the treatment of advanced colon cancer without distant metasisis, but some aspects are still debated, such as the extent of lymphadenectomy. In Japanese guidelines the gold standard was D3 dissection to remove the central lymphonodes (203,213,223), but in 2009 Hoenberger et al. introduced the concept of complete mesocolic excision (CME) in which surgical dissection should follow the embryological planes in order to remove mesentery entirely. This way to prevent leakege of cancer cells and collect more lymphonodes. However, it is not possibile to verify that CME has improved onclogical survival, so our tudy shows how lymphadenectomy is currently performed in major italian centers against an unclear indication on the type of lymphadenectomy that should be performed during right hemicolectomy (RH). CoDIG2 is observational multicenter national study that involves 76 italian general surgery ward highly specialized in colorectal surgery. Each centers was asked not to modify their traditional surgical and clinical practice. Exclusion criteria were: aged < 18 years old, emergency surgery, laparotomic RH, ASA > IV and pregnant women. The aim of study was comparing the risk of postoperative complicationd during RH related to lymphadenectomy performed and the differences between CoDIG 1 study coducted 4 years ago. 788 patients was enrolled. The most used surgical technique was laparoscopic (82.1%) with intracorporeal (73.4%) side-to-side (98.7%) isoperistaltic (96.0%) anastomosis. Comparison between CoDIG1 and CoDIG2 shows a stable trend in surgical technique and complications, with the exception of the robotic approach which has been increasing in recent years (7.7% vs 12.3%). About lymphadenectomy the integrity of mesocolic sail has been in 88.3% of cases and the average lymph nodes harvest was 23, more frequently collected along colic vessels. Instead, sampling of lymph nodes at the origin of the colic vessels was more difficult and associated with more complications, even if the robotic surgery was most used. This analysis show a promising trend regarding how lymphadenectomy is performed in Italy to achieve the oncological outcomes in the RH, even if the technique to achieve a higher lymph nodes count has not been standardized yet.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144561299","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":"Liver resection following neoadjuvant immunotherapy: a single center retrospective study.","authors":"Vanja Podrascanin, Markus Ammann, Yawen Dong, Cornelius A Thiels, Susanne G Warner, Mark J Truty, Michael L Kendrick, Rory L Smoot, David M Nagorney, Patrick P Starlinger","doi":"10.1007/s13304-025-02310-1","DOIUrl":"https://doi.org/10.1007/s13304-025-02310-1","url":null,"abstract":"<p><p>Liver resection remains an important treatment approach in both primary and metastatic liver malignancies. However, the impact of neoadjuvant immune checkpoint inhibitor (ICI) therapy on surgical outcomes remains incompletely explored. This study aimed to evaluate safety and surgical and oncological outcomes of liver resections after neoadjuvant immunotherapy. This retrospective single-institution analysis included a total of 20 patients receiving immunotherapy (Pembrolizumab, Durvalumab or Atezolizumab) prior to hepatic resection at Mayo Clinic Rochester from February 2019 until October 2023. Surgical outcomes as well as radiological and pathological response were assessed. A total of 20 patients were identified. The cohort comprised primary liver cancer (n = 5), colorectal cancer liver metastasis (CRLM) (n = 4), and non-CRLM (n = 11). Overall, severe postoperative morbidity was observed in 4 patients, with 2 cases of post hepatectomy liver failure (PHLF Grade B) and no postoperative mortality within 90 days. Histopathological examination delineated complete pathological response (pCR) response in 10 out of 16 evaluated patients, of whom one experienced recurrence within our follow-up period. Radiological response did not correlate with pathological response. Neoadjuvant ICI therapy showed excellent pathological response rates in highly selected patients, while maintaining surgical safety and expected postoperative morbidity. Standard radiological assessment appears to be insufficient to predict pCR.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144561301","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":"Management of rectal prolapse in octogenarians: lesson learned in 13 years' experience from a high-volume center.","authors":"Giulia De Carlo, Mikhael Belkovsky, Kristen A Ban, Tracy L Hull, Anna R Spivak","doi":"10.1007/s13304-025-02313-y","DOIUrl":"https://doi.org/10.1007/s13304-025-02313-y","url":null,"abstract":"<p><p>When treating rectal prolapse, traditionally perineal procedures are recommended for elderly patients, while abdominal approaches are usually preferred in healthier and younger ones. We hypothesize that octogenarian patients can be safely treated with abdominal approaches. Our study aimed to evaluate the safety of abdominal procedures in the treatment of rectal prolapsed and to evaluate the recurrence rate. We conducted a retrospective IRB approved review of all patients ≥ 80 years old who underwent rectal prolapse surgery from 2010 to 2023 in our tertiary referral center. Patients were grouped according to the approach used to treat the prolapse (perineal or abdominal). Of the 164 patients included, abdominal approaches were performed in 58 (35.4%) and perineal in 106 (64.6%). Comparing the two approaches, no differences were observed in the female sex (96.6% vs 93.4%. p = 0.5), mean BMI (22.7 vs 23.8 kg/m², p = 0.14), mean ASA class (2.9 vs 2.72, p = 0.4), comorbidities and history of prior rectal prolapse surgery. No differences were found in the use of general anesthesia (100% vs 93.4% p = 0.052) hospitalization course, 30-day morbidity, and mortality rates. Rectal prolapse recurrence was significantly more common following perineal procedures (8.6% vs 18.9%, p = 0.001), with a mean follow-up period of 6.8 months. When treating rectal prolapse in octogenarians, abdominal approaches are safe and have a lower recurrence rate. We recommend for abdominal approaches whenever possible and limiting perineal approaches exclusively to patients with non-permissible risk for general anesthesia or abdominal surgery.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144545044","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":"Anatomical variations of the hepatic artery in duodenopancreatectomy: tips and tricks in the minimally invasive surgical approach.","authors":"Alberto García-Picazo, Patricia Sánchez-Velázquez, Fernando Burdio, Benedetto Ielpo","doi":"10.1007/s13304-025-02307-w","DOIUrl":"https://doi.org/10.1007/s13304-025-02307-w","url":null,"abstract":"<p><p>Anatomical variations of the hepatic artery (HA) are frequent (25-45%), representing a special challenge in minimally invasive surgery. Preoperative knowledge of these variations is essential in pancreaticoduodenectomy (PD) to avoid vascular injury and without compromising mesopancreas resection. Patients with anatomical variants of HA, who underwent PD, were selected including robotic and laparoscopy surgery. In all cases, the \"Artery First\" approach of the superior mesenteric artery (SMA) was performed allowing the identification of the origin of arterial variants and the gastroduodenal artery to be sectioned. The objective of this multimedia article is to describe the different surgical approaches, including some tips and trick in case of vascular variants.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144545043","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":"First Touch course-the impact of a nation-wide boot camp on the transition to Surgical residency.","authors":"Sofia Gaspar Reis, Mário Rui Gonçalves, Constança Azevedo, Ana Ruivo, Gonçalo Guidi, Ricardo Marinho, Joana Pinto Teles, Ana Sofia Domingos, André Luís Borges, Filipe Rodrigues Quintas, Liliana Grilo Miranda, António Oliveira, José Novo de Matos","doi":"10.1007/s13304-025-02265-3","DOIUrl":"https://doi.org/10.1007/s13304-025-02265-3","url":null,"abstract":"<p><p>Surgical residents face numerous challenges and undergo significant changes at the beginning of their residency. Although there are several courses throughout residency, it is difficult to address all of them in a single activity. Boot camps (BC) have been a way for easing this transition period. Our team developed the \"First Touch Course\" boot camp in 2017 to join all residents of the same year, before they initiate Surgical residency. Since then, 8 editions have been organised (one per year) with the participation of a total of 481 residents. Eighty-four residents have enrolled in the last two editions, mainly from General Surgery, Gynecology and Urology. The present study analysed the 2023 and 2024 editions to evaluate the impact of this BC on residents' preparedness and confidence to face residency. More than 71% of the participants rated the course as excellent and 100% considered it exceeded their expectations. Almost 100% considered it will have a significant impact and more than 75% felt better prepared to start residency after the course. More than 73% believe that having a laparoscopic simulator will be useful for continuous skills acquisition. This is the first nationwide, multi-speciality boot camp that promotes continuing education, providing each resident with a personal laparoscopy simulator and laparoscopic instruments, allowing for home-based training. This study highlights the importance and impact of this kind of boot camps in preparing residents for the early stages of surgical residency and the impact it may have on basic skills acquisition.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529653","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":"Polidocanol foam for hemorrhoids: promising, yet premature without long-term evidence.","authors":"Muhammad Zahir Shah, Azka Mustaan","doi":"10.1007/s13304-025-02315-w","DOIUrl":"https://doi.org/10.1007/s13304-025-02315-w","url":null,"abstract":"","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529654","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 robotic liver resection in obese vs. non-obese patients: a multicentric propensity score-matched analysis of perioperative outcomes.","authors":"Antonella Delvecchio, Silvio Caringi, Michele Tedeschi, Francesca Ratti, Paolo Magistri, Andrea Belli, Graziano Ceccarelli, Francesco Izzo, Marcello Giuseppe Spampinato, Nicola de'Angelis, Patrick Pessaux, Tullio Piardi, Fabrizio Di Benedetto, Luca Aldrighetti, Riccardo Memeo","doi":"10.1007/s13304-025-02303-0","DOIUrl":"https://doi.org/10.1007/s13304-025-02303-0","url":null,"abstract":"<p><p>Obesity poses unique challenges in liver surgery, potentially affecting perioperative outcomes. While laparoscopic liver resection (LLR) has demonstrated clear benefits over open surgery, evidence regarding the impact of body mass index (BMI) on robotic liver resection (RLR) outcomes remains limited. This study aims to evaluate the influence of BMI on perioperative outcomes following RLR. A retrospective, multicenter analysis was conducted on patients undergoing RLR. A 3:1 propensity score matching (PSM) was performed to minimize confounding factors, creating two well-balanced groups: patients with BMI <30 and BMI ≥30. Perioperative outcomes, including operative time, blood loss, conversion rates, postoperative complications and R0 resection were compared between the two groups. After PSM, 472 patients were included (BMI <30: n = 354; BMI ≥30: n = 118). No significant differences were observed in operative time (244 ± 107 min vs. 256±120 min, p=0.271), blood loss (225 ± 254 mL vs. 201 ± 186 mL, p = 0.273), or conversion rates (4.5 vs. 3.4%, p=0.601). Overall postoperative complications were comparable between the two groups (14.4% vs.19.5%, p=0.203). ICU stay and hospital length of stay were similar between groups. R0 resection rate was comparable between the groups (95.4 vs. 95.4%, p = 1.000). The 90-day mortality rate was low in both groups (0.3 vs. 0%, p = 0.987). Our findings suggest that RLR is a safe and effective approach for patients regardless of BMI. Despite concerns regarding surgical complexity in obese patients, the robotic approach provides comparable perioperative outcomes in both obese and non-obese patients.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529652","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}