Updates in Surgery最新文献_第3页

Germline mutations of GCM2 cause a novel variant of hereditary primary hyperparathyroidism. GCM2的种系突变引起遗传性原发性甲状旁腺功能亢进的一种新变体。

IF 2.4 3区医学

Updates in Surgery Pub Date : 2025-05-06 DOI: 10.1007/s13304-025-02179-0

Maurizio Iacobone, Sara Watutantrige-Fernando, Stefania Zovato, Silvia Tognazzo, Silvia Dughiero, Veronica Augenti, Valentina Camozzi, Caterina Mian, Francesca Torresan, Claire Nomine-Criqui, Laurent Brunaud

{"title":"Germline mutations of GCM2 cause a novel variant of hereditary primary hyperparathyroidism.","authors":"Maurizio Iacobone, Sara Watutantrige-Fernando, Stefania Zovato, Silvia Tognazzo, Silvia Dughiero, Veronica Augenti, Valentina Camozzi, Caterina Mian, Francesca Torresan, Claire Nomine-Criqui, Laurent Brunaud","doi":"10.1007/s13304-025-02179-0","DOIUrl":"https://doi.org/10.1007/s13304-025-02179-0","url":null,"abstract":"Primary hyperparathyroidism (pHPT) occurs as hereditary disease in approximately 10% of cases. GCM2 germline mutations have been recently described as responsible for the development of a novel variant of hereditary pHPT. This study aimed to determine the features of GCM2-related pHPT. Demographics, laboratory, and surgical data were assessed in a series of 17 index cases carrying GCM2 mutations undergoing surgery for pHPT. The GCM2 germline pathogenic variant c.1181 A>C p.(Tyr394Ser) was detected in 59% of cases. GCM2-related pHPT was diagnosed at a median age of 57 years (range 32-82) with a Female/Male ratio 1.8. Preoperative median calcemia was 2.89 mmol/L (range 2.69-3.8). Family history of pHPT was absent in 65% of cases. Complete clinical, surgical and follow-up data were available for 13 patients. At initial surgery, bilateral neck exploration with subtotal parathyroidectomy was performed in 46% of patients; achieving cure in all cases at a median follow-up of 51 months (range 7-60). In the remaining cases undergoing selective parathyroidectomy, a persistent pHPT occurred in 3 cases; recurrent pHPT in 1 patient (after a disease-free interval of 4 years) while 3 are disease free at a mean follow-up of 21 months. Thus, at an overall prolonged follow-up (median 48 months, range 7-216), multiglandular involvement occurred in 77% of cases. GCM2 germline mutations may cause hereditary pHPT, even if it may mimic sporadic variant due to the absence of familial history and late onset. The main feature is multiglandular involvement, needing bilateral neck exploration and subtotal parathyroidectomy to achieve long-term cure.","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143997053","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}

引用次数: 0

The relationship between preoperative serum cystatin C levels and postoperative oncologic outcomes in patients with renal cell carcinoma: a systematic review and meta-analysis of 1641 patients. 肾细胞癌患者术前血清胱抑素C水平与术后肿瘤预后的关系：1641例患者的系统回顾和荟萃分析

IF 2.4 3区医学

Updates in Surgery Pub Date : 2025-05-06 DOI: 10.1007/s13304-025-02208-y

Shuai Lu, Yulin Wang, Zhongbao Zhou, Yong Zhang, Liqing Yang, Xudong Yang

{"title":"The relationship between preoperative serum cystatin C levels and postoperative oncologic outcomes in patients with renal cell carcinoma: a systematic review and meta-analysis of 1641 patients.","authors":"Shuai Lu, Yulin Wang, Zhongbao Zhou, Yong Zhang, Liqing Yang, Xudong Yang","doi":"10.1007/s13304-025-02208-y","DOIUrl":"https://doi.org/10.1007/s13304-025-02208-y","url":null,"abstract":"An increasing number of studies have indicated that cystatin C (CysC) may serve as an effective indicator for predicting the prognosis of renal cell carcinoma (RCC). However, there was currently a lack of meta-analysis examining the influence of serum CysC on the prognosis of RCC. From April 2016 to June 2024, we ultimately selected five retrospective studies including 1641 participants to evaluate the effect of serum CysC on patients with RCC. All data were analyzed using Review Manager version 5.3. The research findings primarily focused on overall survival (OS) and disease-free survival (DFS). Both univariate and multivariate analyses were conducted to evaluate the results. Five studies involving a total of 1641 patients were selected based on predefined eligibility criteria. Univariate analysis revealed that serum CysC levels were significantly correlated with OS (P < 0.00001) and DFS (P = 0.02) in postoperative patients with RCC. Elevated serum CysC levels were considered a reliable predictor of poor prognosis in patients with RCC. Multivariate analysis indicated that high serum CysC levels were an independent risk factor for OS (P < 0.00001) and DFS (P = 0.006) in postoperative patients with RCC, remaining unaffected by other factors. Our research results indicated that elevated serum CysC levels were associated with reduced OS and DFS in patients with RCC. However, caution must be exercised before making recommendations as this interpretation was based on very few clinical studies and small samples.","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144036095","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}

引用次数: 0

A nomogram based on PNI and preoperative TACE can predict overall survival in patients with larger than 2 cm HCC after hepatectomy. 基于PNI和术前TACE的nomogram预测肝切除术后大于2 cm HCC患者的总生存期。

IF 2.4 3区医学

Updates in Surgery Pub Date : 2025-05-05 DOI: 10.1007/s13304-025-02194-1

Huizhi Zhang, Chunyu Zhang, Run Hu, Kai Lei, Xingxing Wang, Zuojin Liu

{"title":"A nomogram based on PNI and preoperative TACE can predict overall survival in patients with larger than 2 cm HCC after hepatectomy.","authors":"Huizhi Zhang, Chunyu Zhang, Run Hu, Kai Lei, Xingxing Wang, Zuojin Liu","doi":"10.1007/s13304-025-02194-1","DOIUrl":"https://doi.org/10.1007/s13304-025-02194-1","url":null,"abstract":"This study was to construct a nomogram based on prognostic nutritional index (PNI) and preoperative transcatheter arterial chemoembolization (TACE) to predict the overall survival (OS) of patients with hepatocellular carcinoma (HCC) larger than 2 cm after hepatectomy. 307 and 131 patients were included in the development and validation sets, respectively. The clinical endpoint was OS. Univariate and multivariate Cox regression analyses were used in the development set to screen independent risk factors for clinical endpoints. Independent risk factors were used to construct a nomogram. The C-index, calibration curves, and decision analysis curves were used to evaluate the predictive power of the nomogram in the development and validation sets. After univariate and multivariate Cox regression analysis, independent risk factors for OS included preoperative TACE, age, Barcelona Clinic Liver Cancer (BCLC) stage, PNI, tumor longest diameter, and alpha-fetoprotein (AFP). In the development set and the validation set, the C-index of the nomograms was 0.662 (95% confidence interval (CI): 0.624-0.699) and 0.659 (95% CI: 0.600-0.719), respectively. Calibration curves and decision analysis curves showed that the nomogram had an effective predictive ability. The nomogram based on PNI and preoperative TACE can effectively predict the OS of patients with HCC larger than 2 cm after hepatectomy.","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144051922","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}

引用次数: 0

Poor prognosis in stage III colorectal cancer with apical lymph node metastasis: a single-center retrospective study. 伴有根尖淋巴结转移的III期结直肠癌预后不良：一项单中心回顾性研究。

IF 2.4 3区医学

Updates in Surgery Pub Date : 2025-05-05 DOI: 10.1007/s13304-025-02219-9

Burak Dinçer, Ahmet Karayiğit, Fatma Markoç, Serdar Sarıdemir, Cihangir Özaslan

{"title":"Poor prognosis in stage III colorectal cancer with apical lymph node metastasis: a single-center retrospective study.","authors":"Burak Dinçer, Ahmet Karayiğit, Fatma Markoç, Serdar Sarıdemir, Cihangir Özaslan","doi":"10.1007/s13304-025-02219-9","DOIUrl":"https://doi.org/10.1007/s13304-025-02219-9","url":null,"abstract":"The impact of apical lymph node (ALN) status on the prognosis of colorectal cancer (CRC) remains controversial, and ALN status is not included in the current Tumor Node Metastasis (TNM) staging system. This study aimed to evaluate the effect of ALN status on recurrence and survival rates. In this retrospective study, 117 stage 3 CRC patients aged over 18 who underwent surgery between 2015 and 2024 and had their ALN status determined were evaluated. Patients with metastatic disease at diagnosis, those with undetermined ALN status, and those with concurrent malignancies were excluded. Patients were analyzed based on demographic, clinical, pathological, and survival data. The median age was 61 years (range: 33-83), and 60.7% of the patients were male. The pN stage was significantly more advanced (p < 0.001) and the number of metastatic lymph nodes was significantly higher (p = 0.003) in the ALN ( +) group. During a median follow-up of 46 months, 14 local recurrences, 31 systemic recurrences, and 27 cancer-related deaths were observed. Local recurrence, systemic recurrence, and cancer-related deaths were significantly more frequent in the ALN ( +) group (p = 0.027, p < 0.001, and p < 0.001, respectively). Locoregional disease-free survival, systemic disease-free survival and overall survival were significantly shorter in the ALN ( +) group (p = 0.011, p < 0.001, and p < 0.001, respectively). In multivariate analysis, SDFS and OS were found to be significantly shorter in the ALN ( +) and pN2 groups. ALN metastasis can be considered as an additional adverse prognostic factor in CRC beyond the pN stage.","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144034042","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}

引用次数: 0

Impact of en bloc extended R0 resections on oncological outcome of locally advanced adrenocortical carcinoma. 整体延长R0切除对局部晚期肾上腺皮质癌肿瘤预后的影响。

IF 2.4 3区医学

Updates in Surgery Pub Date : 2025-05-03 DOI: 10.1007/s13304-025-02215-z

Priscilla Francesca Procopio, Francesco Pennestrì, Antonio Laurino, Esther Diana Rossi, Giovanni Schinzari, Alfredo Pontecorvi, Carmela De Crea, Marco Raffaelli

{"title":"Impact of en bloc extended R0 resections on oncological outcome of locally advanced adrenocortical carcinoma.","authors":"Priscilla Francesca Procopio, Francesco Pennestrì, Antonio Laurino, Esther Diana Rossi, Giovanni Schinzari, Alfredo Pontecorvi, Carmela De Crea, Marco Raffaelli","doi":"10.1007/s13304-025-02215-z","DOIUrl":"https://doi.org/10.1007/s13304-025-02215-z","url":null,"abstract":"In locally advanced adrenocortical carcinoma (ACC) (ENSAT stage III - S-III) R0 surgery, involving en bloc extended resections, is the only potential curative treatment. We evaluated oncological outcomes and complications rate in S-III patients who underwent extended resection in comparison with stage I/II (S-I/II). Among 1098 adrenalectomies over 27 years (1997 -2024) in a tertiary referral center, medical records of ACC patients were reviewed, excluding stage IV and not-multivisceral resections in S-III patients. Forty-eight patients met the inclusion criteria: 6 S-I (12.5%), 36 S-II (75%) and 6 S-III (12.5%) patients. The latter patients' cohort underwent multivisceral en bloc resections (3 total nephrectomies, one renal vein thrombectomy, one splenopancreasectomy associated with total nephrectomy, left hemicolectomy and omentectomy, one liver S6-S7-S8 resection). Open adrenalectomy was scheduled in all S-III patients. Minimally-invasive approach was scheduled in 21 (50%) S-I/II patients. Conversion to open adrenalectomy was registered in 5 out these 21 patients. Locoregional and distant disease recurrences were registered in 19% of S-I/II vs 33.3% of S-III patients and 28.6% of S-I/II vs 66.7% of S-III patients, respectively (p = 0.420, p = 0.064). Postoperative complications were observed in 21.4% of S-I/II patients and 16.7% of S-III patients (p = 0.788). Kaplan-Meier DFS and OS curves were comparable among the two groups (p = 0.255, p = 0.459, respectively). After univariable analysis, hyperfunction and chemotherapy were significantly associated with locoregional disease recurrence (p = 0.02, p = 0.04, respectively). OS and DFS of S-III ACC patients undergoing extended en bloc R0 resections were comparable to those of S-I/II patients, without increased postoperative morbidity.","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144036389","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}

引用次数: 0

Short-term outcomes of minimally invasive gastrectomy in population with obesity versus population without obesity: the obesity paradox. 肥胖人群与非肥胖人群微创胃切除术的短期疗效：肥胖悖论。

IF 2.4 3区医学

Updates in Surgery Pub Date : 2025-05-03 DOI: 10.1007/s13304-025-02144-x

Marco Milone, Anna D'Amore, Gian Luca Baiocchi, Fabio Cianchi, Giovanni De Manzoni, Stefano De Pascale, Maurizio Degiuli, Giorgio Ercolani, Giovanni Ferrari, Laura Fortuna, Romario Uberto Fumagalli, Monica Gualtierotti, Federico Marchesi, Andrea Peri, Francesco Puccetti, Marco Realis Luc, Rossella Reddavid, Riccardo Rosati, Leonardo Solaini, Fabio Staderini, Marina Valente, Jacopo Viganò, Ugo Elmore, Simone Giacopuzzi

{"title":"Short-term outcomes of minimally invasive gastrectomy in population with obesity versus population without obesity: the obesity paradox.","authors":"Marco Milone, Anna D'Amore, Gian Luca Baiocchi, Fabio Cianchi, Giovanni De Manzoni, Stefano De Pascale, Maurizio Degiuli, Giorgio Ercolani, Giovanni Ferrari, Laura Fortuna, Romario Uberto Fumagalli, Monica Gualtierotti, Federico Marchesi, Andrea Peri, Francesco Puccetti, Marco Realis Luc, Rossella Reddavid, Riccardo Rosati, Leonardo Solaini, Fabio Staderini, Marina Valente, Jacopo Viganò, Ugo Elmore, Simone Giacopuzzi","doi":"10.1007/s13304-025-02144-x","DOIUrl":"https://doi.org/10.1007/s13304-025-02144-x","url":null,"abstract":"This study aims to compare the short-term outcomes after minimally invasive gastrectomy between obese and non-obese population. Our analysis included data of 713 patients from ten departments of surgery. They were divided in non-obese group and obese group with 617 and 96 patients respectively. Significant differences were found in terms of mortality at 90 days (obese: 0 vs non-obese: 27, p = 0.037). Intraoperative data showed no significant differences in terms of conversion (obese: 4 vs non-obese: 43, p = 0.303). About postoperative complications, significant differences between the two groups were found only in terms of surgical infection (obese: 13 vs non-obese: 38, p = 0.009). About oncological outcomes, no differences were found about retrieved lymph nodes (obese: 30.71 ± 18.44 vs non-obese: 32.93 ± 17.62, p = 0.596) and about surgical radicality (R0) (obese:94 vs non-obese:594, p = 0.415). Obesity doesn't worsen postoperative outcomes and minimally invasive gastrectomy in obese patients is related to a lower postoperative mortality.","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144037799","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}

引用次数: 0

Combined general and neuraxial anesthesia versus general anesthesia alone for laparoscopic cholecystectomy: a meta-analysis of pain control and hemodynamic stability. 腹腔镜胆囊切除术中全身和神经轴向联合麻醉与单独全身麻醉：疼痛控制和血流动力学稳定性的荟萃分析。

IF 2.4 3区医学

Updates in Surgery Pub Date : 2025-05-01 DOI: 10.1007/s13304-025-02217-x

Cecilio Armengol-García, Valeria Blandin-Alvarez, Cynthia López-García, Eduardo Flores-Villalba

{"title":"Combined general and neuraxial anesthesia versus general anesthesia alone for laparoscopic cholecystectomy: a meta-analysis of pain control and hemodynamic stability.","authors":"Cecilio Armengol-García, Valeria Blandin-Alvarez, Cynthia López-García, Eduardo Flores-Villalba","doi":"10.1007/s13304-025-02217-x","DOIUrl":"https://doi.org/10.1007/s13304-025-02217-x","url":null,"abstract":"Combined general and neuraxial anesthesia (CGNA) is an alternative technique that may enhance intraoperative outcomes and reduce postoperative pain in patients undergoing laparoscopic cholecystectomy. In this meta-analysis, we aimed to compare the perioperative outcomes of CGNA with those of general anesthesia alone. A systematic search of PubMed, Cochrane, Scopus, Web of Science, and gray literature was conducted from inception to July 2024. We evaluated postoperative pain at 2, 4, 6, and 12 h after surgery using the Visual Analogue Scale. Intraoperative outcomes, including systolic, diastolic, and mean arterial pressure, were assessed at the 30-minute mark during surgery. Data analysis was performed using R software. Quality assessment was carried out using Cochrane's risk of bias tools. Finally, the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework was applied to describe the certainty of our findings. We meta-analyzed nine studies, encompassing a total of 724 patients. The analysis of postoperative pain revealed a significant reduction at 2, 4, 6, and 12 hours in the combined general and neuraxial anesthesia group, with the most pronounced effect occurring within the first four hours. Hemodynamic parameters showed a significant difference only in mean arterial pressure at 30 min during surgery, based on sensitivity analysis and the inclusion of only randomized controlled trials. Other vital signs, as well as the duration of surgery, anesthesia time, and rates of postoperative nausea and vomiting, were comparable between the two groups. A combined general and neuraxial anesthetic approach may improve postoperative pain relief and minimize hemodynamic stress during laparoscopic cholecystectomy and pneumoperitoneum-induced stress.","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144034036","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}

引用次数: 0

Evaluation of the white test effectiveness for the prevention of bile leakage after liver resection: multicenter randomized controlled study. 白试验预防肝切除术后胆漏的有效性评价：多中心随机对照研究。

IF 2.4 3区医学

Updates in Surgery Pub Date : 2025-04-30 DOI: 10.1007/s13304-025-02210-4

Oleg G Skipenko, Arkady L Bedzhanyan, Nikita K Chardarov, Irina B Ermak, Andrew D Ermak, Oleg O Rummo, Dzmitry A Fedoruk, Oleg G Kotenko, Airazat M Kazaryan

{"title":"Evaluation of the white test effectiveness for the prevention of bile leakage after liver resection: multicenter randomized controlled study.","authors":"Oleg G Skipenko, Arkady L Bedzhanyan, Nikita K Chardarov, Irina B Ermak, Andrew D Ermak, Oleg O Rummo, Dzmitry A Fedoruk, Oleg G Kotenko, Airazat M Kazaryan","doi":"10.1007/s13304-025-02210-4","DOIUrl":"https://doi.org/10.1007/s13304-025-02210-4","url":null,"abstract":"Bile leakage is a common complication after liver resection. It often requires repeated interventions or surgery and prolongs the patient's recovery. The aim of the study was to assess the effectiveness of the leakage test with fat emulsion (the White Test) in preventing postoperative biliary complications. A multicenter (3 hospitals) randomized controlled trial was performed from February 2011 to May 2016. The trial involved only the patients scheduled for major hepatectomies. After liver transection and control of biliary tree leak-proofness, the patients were randomized into two groups-with and without applying the White Test. A comparative assessment of all the White Test participants was conducted. Forty-three patients formed the study group, and 36 patients were included in the control group. The White Test revealed sites of bile leakage (the positive White Test) in 37.2% (16/43) of the patients in the study group. These leakage sites were sealed intraoperatively. One of those patients (6.2%; 1/16) still developed bile leakage after surgery. Bile leakage was still observed in 7.4% (2/27) of patients after the negative White test. The incidence of postoperatively revealed bile leakage in the study and control groups did not have a statistically significant difference: 7% (3/43) and 8.3% (3/36), respectively. All bile leaks were grade B. This study demonstrated that the White Test did not provide any benefit in preventing postoperative bile leakage; therefore, other methods, such as ICG, should be further investigated.","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144036014","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}

引用次数: 0

Mitigating 'inevitable' anastomotic leaks in left-sided colorectal surgery: a combined strategy using indocyanine green fluorescence, intraoperative colonscopy and patient risk profiling. 减轻左侧结直肠手术中“不可避免的”吻合口泄漏：使用吲哚菁绿荧光、术中结肠镜检查和患者风险分析的联合策略

IF 2.4 3区医学

Updates in Surgery Pub Date : 2025-04-29 DOI: 10.1007/s13304-025-02218-w

Alberto Patriti, Marcella Lodovica Ricci, Emilio Eugeni, Pier Paolo Stortoni, Maria Elena Serio, Antonella Scarcelli, Alessio Pigazzi, Roberto Montalti

{"title":"Mitigating 'inevitable' anastomotic leaks in left-sided colorectal surgery: a combined strategy using indocyanine green fluorescence, intraoperative colonscopy and patient risk profiling.","authors":"Alberto Patriti, Marcella Lodovica Ricci, Emilio Eugeni, Pier Paolo Stortoni, Maria Elena Serio, Antonella Scarcelli, Alessio Pigazzi, Roberto Montalti","doi":"10.1007/s13304-025-02218-w","DOIUrl":"https://doi.org/10.1007/s13304-025-02218-w","url":null,"abstract":"This study aimed to identify patient-specific risk factors and intraoperative findings obtained from indocyanine green fluorescence angiography (ICG-FA) and intraoperative colonoscopy (IOC), using a structured endoscopic grading scale, to guide surgical decisions and minimize the risk of anastomotic leakage in colorectal surgery. One hundred-eleven patients undergoing elective left-sided colorectal resections were evaluated intraoperatively using both ICG-FA and IOC, with anastomoses classified by a new endoscopic grading scale (Grades 1-5). Anastomoses classified as suboptimal (grade > 3) were taken down and reconstructed or repaired. The primary aim of the study was to determine the rate of anastomotic leakage (AL) using this integrated strategy and subsequently to identify patient-specific risk factors associated with AL. Among 111 patients, 102 patients (91.8%) at the IOC were classified as Grade 1, 4 patients (3.6%) as Grade 2, 4 patients (3.6%) as Grade 3, and 1 patient (0.9%) as Grade 4. The overall AL rate was 10.8% (12 patients). On multivariate logistic regression analysis, only anastomotic level ≤ 12 cm emerged as an independent risk factor of AL (OR 0.064, 95% CI 0.008-0.517, p = 0.010). Among patients who developed an AL, 3 (25%) required surgical intervention, the others were managed endoscopically or conservatively. An integrated approach involving ICG-FA and IOC may aid to construct a technically optimal colorectal anastomosis. Nevertheless, anastomotic leakage can still occur due to factors unrelated to intraoperative technique, particularly low anastomosis height. These factors should prompt routine consideration of protective loop ileostomy and pelvic drainage to mitigate AL clinical consequences.","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143984213","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}

引用次数: 0

Modified Smead-Jones suture for closure of emergency midline laparotomy incision: systematic review and meta-analysis. 改良Smead-Jones缝线缝合急诊剖腹中线切口：系统回顾和荟萃分析。

IF 2.4 3区医学

Updates in Surgery Pub Date : 2025-04-29 DOI: 10.1007/s13304-025-02192-3

Mahmoud Diaa Hindawi, Ruaa Mustafa Qafesha, Ahmed Hamdy G Ali, Hazim Alkousheh, Hatem Eldeeb, Haitham Salem, Abd-Elfattah Kalmoush, Amr Elrosasy

{"title":"Modified Smead-Jones suture for closure of emergency midline laparotomy incision: systematic review and meta-analysis.","authors":"Mahmoud Diaa Hindawi, Ruaa Mustafa Qafesha, Ahmed Hamdy G Ali, Hazim Alkousheh, Hatem Eldeeb, Haitham Salem, Abd-Elfattah Kalmoush, Amr Elrosasy","doi":"10.1007/s13304-025-02192-3","DOIUrl":"https://doi.org/10.1007/s13304-025-02192-3","url":null,"abstract":"Midline laparotomy incision is mostly used in emergent surgery, especially in hemodynamic instability patients. We aim to compare the Modified Smead-Jones (MSJ) and Smead-Jones (SJ) sutures against conventional continuous suture in midline laparotomy closure. PubMed, Scopus, Web of Science, and Ovoid were searched. We utilized Revman 5.4.1 for statistical analysis. Five studies involving 403 patients were included. Compared to continuous sutures, MSJ showed a significant reduction in wound dehiscence, wound infection, and hospital stay (RR = 0.29, 95% CI [0.14-0.59], p = 0.0006), (RR = 0.41, 95% CI [0.26-0.65], p = 0.0002), and (MD = - 4.50, 95% CI [- 5.43 to - 3.57], p = 0.00001). Conversely, the SJ subgroup showed no statistically significant difference in wound dehiscence, wound infection, and hospital stay. Also, both techniques, MSJ and SJ, showed no significant difference in incisional hernia risk (RR = 0.17, 95% CI [0.02-1.33], p = 0.09) and (RR = 5.16, 95% CI [0. 26-103.27], p = 0.28), respectively. MSJ follows the same far-near-near-far pattern as SJ but is applied continuously rather than interrupted. The MSJ suture technique might be promising in reducing wound dehiscence, infection, and hospital stay compared to conventional continuous closure. However, future large-scale RCTs with standardized methodologies and extended follow-up are essential to determine whether MSJ should be established as the preferred technique for midline laparotomy closure.","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144048356","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}

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