Updates in Surgery最新文献

{"title":"\"We were already there where the narrow path …\" Benign tracheal stenosis treatment: narrative review on the state of the art and future direction.","authors":"Giacomo Cusumano, Daniele Salvatore Paternò, Alberto Terminella, Massimiliano Sorbello, Luigi La Via","doi":"10.1007/s13304-025-02234-w","DOIUrl":"https://doi.org/10.1007/s13304-025-02234-w","url":null,"abstract":"<p><p>Acquired benign tracheal stenosis represents a challenging condition characterized by narrowing of the tracheal lumen, with post-intubation and post-tracheostomy stenosis accounting for approximately 90% of acquired cases. This comprehensive review examines current treatment strategies, from conservative management to surgical reconstruction, highlighting their indications, limitations, and outcomes based on recent clinical evidence. Conservative management, including humidification, corticosteroid therapy, and treatment of underlying conditions, plays a crucial role in selected cases with mild stenosis. Endoscopic techniques, such as dilation, laser treatment, and airway stenting, offer minimally invasive options with success rates varying from 40 to 80%, depending on patient selection. Surgical approaches, including tracheal resection with primary anastomosis and laryngotracheal reconstruction, remain the gold standard for definitive treatment, with success rates exceeding 90% in specialized centers. The choice of treatment modality depends on various factors, including stenosis length, location, severity, and patient characteristics. Emerging treatments, including tracheal replacement, bioengineered tracheal replacements, three-dimensional printing technology, and cell therapy approaches, show promise in addressing the limitations of traditional techniques, though long-term data remains limited. The integration of various biotechnology approaches has led to the development of hybrid solutions, combining 3D-printed scaffolds with cellular components and growth factors. However, significant challenges remain in the translation of these technologies to clinical practice, including issues of vascularization, immune response, and long-term stability. This review provides an up-to-date analysis of available treatment options and future directions in tracheal stenosis management.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144235355","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":"Folic acid deficiency as a modifiable risk factor for anastomotic leak in patients undergoing colorectal cancer surgery.","authors":"Andrea Chirivella-Fernandez, Javier Rivera-Castellano, Ester Ramírez-Caballero, Samuel Morales-Díaz, Luciano Delgado-Plasencia","doi":"10.1007/s13304-025-02273-3","DOIUrl":"https://doi.org/10.1007/s13304-025-02273-3","url":null,"abstract":"<p><p>Sarcopenia predicts negative outcomes in colorectal surgery, including anastomotic leakage (AL). Folic acid (FA) is essential for cellular processes such as DNA synthesis and tissue repair, which may indicate that it could impact anastomotic healing. The objective of this study was to evaluate the association between preoperative blood levels of FA, sarcopenia defined radiologically by psoas density, and postoperative outcomes in patients undergoing resection for colorectal cancer. A prospective study was conducted on patients undergoing oncological colorectal resection with anastomosis between June 2022 and November 2024. FA levels and the average psoas density at the L3 level on computed tomography (CT) were analyzed. Postoperative complications were recorded. Of the 250 patients that were analyzed, 12% had low FA levels (< 2.7 ng/ml) and 16% were diagnosed with sarcopenia. Furthermore, low FA levels were associated with a higher risk of sarcopenia diagnosis [RR 4.63 (95% CI 2.26-9.49)], and radiological sarcopenia was associated with an increased risk of AL [RR 1.98 (95% CI 1.3-2.83)]. Low FA levels are associated with an increased risk of sarcopenia, therefore FA deficiency could be considered a modifiable risk factor for sarcopenia and, consequently, its supplementation preoperatively could reduce the risk of anastomotic dehiscence in colorectal cancer patients.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144217074","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":"The terminal ileal vein approach: a novel and simple technique for locating the superior mesenteric vein and en bloc resection of the ileal mesentery in laparoscopic right hemicolectomy.","authors":"Yi-Jun Liao, Si-Yuan Mi, Da Kang, Xin Tang, Gong Chen, Zhi-Zhong Pan, Rong-Xin Zhang","doi":"10.1007/s13304-025-02263-5","DOIUrl":"https://doi.org/10.1007/s13304-025-02263-5","url":null,"abstract":"<p><p>Laparoscopic right hemicolectomy (Lap-RHC) presents technical challenges due to the complex vascular anatomy of the mesentery, which increases the risk of intraoperative bleeding and complicates surgical navigation. Accurate identification of the superior mesenteric vein (SMV) is crucial for maintaining surgical safety and achieving optimal oncological outcomes. To address these challenges, this study proposes the terminal ileal vein (TIV) approach, a novel technique designed to facilitate precise SMV identification and enable en bloc resection of the ileal mesentery while preserving mesenteric integrity. This retrospective cohort study evaluated a novel TIV approach compared to the traditional ileocolic vascular pedicle (IVP) approach for SMV identification and en bloc mesentery resection in patients with right-sided colon cancer. A total of 196 patients underwent Lap-RHC between 2022 and 2023, with 67 patients matched by propensity score included in both groups. The TIV approach involves initiating dissection at the TIV to accurately locate the SMV and facilitate en bloc resection of the ileal mesentery. In the balanced cohort, statistically significant differences were observed between groups regarding operation times (186 [120-299] vs. 210 [146-375] minutes, p = 0.001) and intraoperative blood loss (50 [20-400] vs. 70 [20-600] mL, p = 0.033). Differences were also found for time to urinary catheter removal (1 [1-3] vs. 2 [1-5] days, p = 0.012) and postoperative hospital stays (6 [5-12] vs. 7 [5-15] days, p = 0.006). The calculated importance proportion of the TIV approach related to these perioperative variables was between 15 and 25%. In this retrospective cohort, the TIV approach demonstrated reproducible entry into the mesenteric dissection plane and was accompanied by perioperative outcome differences that may reflect technical simplification. Further prospective investigation is needed to determine its clinical utility.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144217075","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":"Changes in cognitive status after parathyroidectomy-a prospective panel study.","authors":"Milan Jovanovic, Katarina Tausanovic, Nikola Slijepcevic, Branislav Rovcanin, Ksenija Jovanovic, Matija Buzejic, Sara Ivanis, Vladan Zivaljevic","doi":"10.1007/s13304-025-02243-9","DOIUrl":"https://doi.org/10.1007/s13304-025-02243-9","url":null,"abstract":"<p><p>There has been a growing interest in the effects of primary hyperparathyroidism and parathyroidectomy on nonclassic symptoms, including impaired cognitive status. We have evaluated the cognitive status of patients with primary hyperparathyroidism before and after parathyroidectomy and to assess the impact of various factors on cognitive function during the perioperative period. During a two-year period, a panel study was conducted at our institution. The study included patients scheduled for parathyroidectomy without previous parathyroid or thyroid surgery. Basic demographic data of interest and relevant clinical data were collected. Cognitive status was assessed in interviews before surgery, one month, and six months following surgery using a Mini-Mental State Examination (MMSE). A total of 94 patients (83 females) with pHPT were included in the study, with an average age of 60.2 years. The average preoperative calcium and PTH levels were 2.98 mmol/L and 307.9 ng/mL, respectively. There was a significant improvement in MMSE score six months after parathyroidectomy (from 27.93 to 28.87, p < 0.001). Preoperatively, 7.5% of patients had a pathological MMSE score (≤ 25), and six months after parathyroidectomy, only one patient had a mild disorder. Based on the multivariable mixed effect modelling, age and lower level of education were independent predictors. There is a significant improvement in cognition following parathyroidectomy, and this improvement has stable progression up to six months after surgery. Apart from age and level of education, no other variables affect cognitive status during the perioperative period.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144217073","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":"Ex situ right posterior sectionectomy (H6,7) as liver graft reduction to overcome mismatch for small-body size adult.","authors":"Pietro Addeo, Pierre De Mathelin, Chloe Paul, Philippe Bachellier","doi":"10.1007/s13304-025-02269-z","DOIUrl":"https://doi.org/10.1007/s13304-025-02269-z","url":null,"abstract":"<p><p>Small body size has been associated with an increased hazard ratio for mortality and dropout on the liver transplantation (LT) waitlist especially in female candidates. These findings could be explained by differences in anthropometric between genders, mainly due to smaller right anteroposterior diameter (RAP) of the right abdominal cavity in female. Reduction of graft volume by partial hepatectomy namely ex situ right posterior liver sectionectomy (H6,7) has been recently described to reduce liver grafts in adults. At our center, 4 female recipients, median RAP of 14 cm underwent LT with liver undergoing H6,7 graft reduction. Upon reduction, the graft weight passed from a median of 1654 g (range, 1640-1800) to 1365 g (range, 1230-1450) while the ratio graft weight/RAP passed from 114 g/cm (mean 111, range 102-120) to 93.3 g/cm (mean 92, range 82-98.5). The median cold ischemia time was 411 min (range, 343-478 min) and at a median follow-up of 268 days, all patients were alive with no vascular nor biliary complications and no retransplantation. Ex situ right posterior liver sectionectomy (H6, 7) represents a valid technical option to overcome mismatch for small-body size adult during liver transplantation. The need for this procedure remains exceptional and limited to small-body size adult recipient in urgent need for LT (i.e., fulminant liver failure, impairment of general conditions, ACLF, cancers, etc.) in which split liver transplantation could not be realized and/or is not available.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144192293","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":"Impact of analgesia modality on postoperative recovery after laparoscopic distal pancreatectomy.","authors":"Giovanni Guarneri, Stefano Turi, Nicolò Pecorelli, Giuseppe Culicchia, Alessia Vallorani, Renato Meani, Luigi Beretta, Massimo Falconi","doi":"10.1007/s13304-025-02268-0","DOIUrl":"https://doi.org/10.1007/s13304-025-02268-0","url":null,"abstract":"<p><p>In the context of enhanced recovery pathways (ERP) for colorectal surgery, thoracic epidural analgesia (TEA) delays recovery compared to opioid-based patient-controlled intravenous analgesia (PCA). Limited evidence is available for laparoscopic pancreatic surgery. The objective of this study was to evaluate the impact of different analgesic modalities on the time to functional recovery (TFR) following laparoscopic distal pancreatectomy (LDP). Clinical data for consecutive patients undergoing LDP were reviewed. All patients were treated within an ERP including a multimodal analgesia protocol. The main analgesic techniques used were TEA, intravenous morphine PCA, and patient-controlled sublingual sufentanil tablet system (SSTS). TFR was defined as postoperative days (PODs) needed to achieve adequate mobilization, return of gastrointestinal function, sufficient oral intake with no need for intravenous infusion, and adequate pain control with oral analgesia. Overall, 336 patients were included; 109 (32%) patients received TEA, 124 (37%) PCA, and 103 (31%) SSTS. TFR was significantly shorter for the SSTS group with median of 4 [IQR 3-5] days compared to 5 [4-6] days in both the TEA and PCA groups (p < 0.001). This difference was due to faster time to sufficient oral intake and adequate pain control with oral analgesia. On POD1, patients treated with TEA had better pain control compared to other modalities; the median NRS pain score at rest was 0 [0-3] compared to 2 [0-4] for both PCA and SSTS groups (p = 0.003). Multivariate regression showed that SSTS was associated with a 17% reduction (95% CI - 29 to - 5; p = 0.005) of TFR compared to TEA. Patients treated with SSTS had a significantly shorter TFR after LDP compared with other analgesic modalities with no difference in adverse events.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188075","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":"Systematic review and network meta-analysis of cryptoglandular complex anal fistula treatment: evaluation of surgical strategies.","authors":"Isabel Sierra Fernández, Zutoia Balciscueta Coltell, Natalia Uribe Quintana","doi":"10.1007/s13304-025-02270-6","DOIUrl":"https://doi.org/10.1007/s13304-025-02270-6","url":null,"abstract":"<p><strong>Background: </strong>Several surgical approaches are available for managing complex cryptoglandular perianal fistulas. However, a gold standard surgical technique has not yet been established. This network meta-analysis aims to assess and compare postoperative failure and anal incontinence pooled rates for different available surgical techniques for complex cryptoglandular anal fistulas.</p><p><strong>Methods: </strong>Systematic searches were carried out on Pubmed, Ovid, the Cochrane Library database and ClinicalTrials.gov up to June 2023. All randomized comparative trials of nine surgical techniques for cryptoglandular complex perianal fistulas in adult patients were included. A systematic review and network meta-analysis was conducted using the PRISMA-NMA methodology. The endorectal advancement flap was used as the control technique, and the odds ratios (ORs) were calculated through pairwise and network meta-analysis with random effects.</p><p><strong>Results: </strong>16 randomized trials were included in this study. Network meta-analysis was conducted for each outcome. Techniques, such as cutting seton, fistulotomy with sphincter reconstruction, LIFT, and VAAFT, obtained similar results in terms of technique failure to the transanal advancement flap with no statistically significant differences. PLUG (OR = 3.6 [95%CI 1.1-11.5]), fibrin glue (OR = 7.5 [95%CI 2.2-25], and platelet-rich plasma (PRP) (OR = 11.5[95%CI 1.3-99]) demonstrated a statistically significant increase in the pooled failure rate. For anal incontinence, only the cutting seton technique exhibited a higher risk of postoperative incontinence (OR = 8.6 [95%CI 1-72.5]).</p><p><strong>Conclusion: </strong>Our research highlights effective therapeutic approaches for complex anal fistulas, stressing the need to customize treatment based on location, anatomy, patient characteristics, and preferences. However, it advises against using plugs, fibrin glue, PRP therapy due to lower healing rates, and the seton technique because of its potential impact on anal continence. PROSPERO number CRD42022304345.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144181240","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":"Perioperative blood transfusion is an independent risk factor for ileus following minimally invasive elective colectomy for cancer.","authors":"Kristina H-T La, Yosef Y Nasseri, Rachel Ma, Vincent Xu, Paola Solís Pazmiño, Abbas Smiley, Joshua Ellenhorn, Sean Langenfeld, Robert Bergamaschi, Moshe Barnajian","doi":"10.1007/s13304-025-02260-8","DOIUrl":"https://doi.org/10.1007/s13304-025-02260-8","url":null,"abstract":"<p><p>We aim to investigate the correlation between perioperative blood transfusion and postoperative ileus in patients who have undergone minimally invasive elective colectomy for cancer. This is a retrospective study using the 2016-2020 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Patients with colon cancer who underwent elective laparoscopic or robotic colectomy were selected. Perioperative transfusion was defined as receiving one or more units of whole/packed RBCs within 72 h of onset of operation. Using multivariable logistic regression with backward elimination, comorbidities, and intraoperative and postoperative variables were analyzed to identify risk factors for postoperative ileus. 48,728 patients were included with a mean age of 64.7 years, 52.3% were males, and a mean BMI of 28.8 kg/m². Overall, men had a higher rate of ileus than women (13 and 7.6%, respectively, P = 0.0001). There was no difference in rates of ileus following robotic and laparoscopic surgery (10.4 and 10.4%, respectively, P = 0.8). Of the 2960 patients who had a blood transfusion, 516 (17.4%) had an ileus, whereas of the 45,768 patients who did not have a blood transfusion, 4569 (10.0%) had an ileus (P = 0.0001). On multivariable logistic regression analysis, patients with blood transfusions were 1.37 times more likely to develop an ileus (95% CI 1.2-1.5, P = 0.0001). Perioperative blood transfusion is an independent risk factor for ileus following minimally invasive colectomy for cancer.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144174980","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":"Assessment of mesh displacement following laparoscopic enhanced view totally extraperitoneal technique: comparing mesh fixation and non-fixation in difficult inguinal hernias.","authors":"Abdullah Hilmi Yilmaz, Mehmet Esref Ulutas","doi":"10.1007/s13304-025-02271-5","DOIUrl":"https://doi.org/10.1007/s13304-025-02271-5","url":null,"abstract":"<p><strong>Background: </strong>Mesh fixation, one of the controversial issues of laparoscopic surgery, has not been investigated in the enhanced view-totally extraperitoneal (eTEP) technique. This study aimed to compare mesh fixation (FX) and non-fixation (NFX) in difficult cases in the eTEP technique.</p><p><strong>Methods: </strong>A total of 61 consecutive patients diagnosed with inguinal hernias who underwent the eTEP procedure were randomized for the study. The groups were FX and NFX. The primary outcome was mesh displacement; secondary outcomes were recurrence, return to normal life, pain, and postoperative findings.</p><p><strong>Results: </strong>Mesh displacement, recurrence, mean operative time, length of stay, pneumoperitoneum, and postoperative complications were similar. VAS scores were higher in the FX group (p = 0.017, p < 0.001, p < 0.001, respectively). Return to normal life was more days in the FX group (p = 0.02). The mesh displacement at 6 months was higher than at 1 month in both groups (p < 0.001).</p><p><strong>Conclusions: </strong>There is no increased risk of mesh displacement and recurrence in difficult cases, such as scrotal and recurrent hernias, without mesh fixation. With the eTEP technique, mesh fixation can be safely avoided for less pain and a faster return to normal life.</p><p><strong>Trial registration: </strong>Clinicaltrials number: NCT06417359.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144161142","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":"Comment on: \"Clinical impact of closed-incision negative-pressure therapy in DIEP flap breast reconstruction's donor site\".","authors":"Qi Xu","doi":"10.1007/s13304-025-02274-2","DOIUrl":"https://doi.org/10.1007/s13304-025-02274-2","url":null,"abstract":"","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144161126","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}