Updates in Surgery最新文献

{"title":"Incidence and risk factors for early thyroxin supplementation therapy after hemithyroidectomy for benign conditions in Europe. A Eurocrine® registry-based study.","authors":"Jesús M Villar-Del-Moral, Juan I Arcelus-Martínez, Antonio Becerra-Massare, Nuria Muñoz-Pérez, María C Olvera-Porcel, Cristina Martínez-Santos","doi":"10.1007/s13304-025-02220-2","DOIUrl":"https://doi.org/10.1007/s13304-025-02220-2","url":null,"abstract":"<p><p>The incidence and risk factors of hypothyroidism after hemithyroidectomy (HT) remain poorly defined. Regarding its management, national or local policies may influence on early (first visit) prescription of replacement therapy (EPRT). Our aim was to identify factors influencing and explaining different prescription patterns across European countries. We conducted a retrospective, multicenter study using the Eurocrine^® database, focusing on patients undergoing HT for histologically-proven benign conditions. Analyzed variables included the country where surgery was performed, as well as epidemiological, clinical, surgical and pathological data. The dependent variable was EPRT, assessed 30-45 days after surgery. Associations between qualitative variables and the likelihood of receiving EPRT were tested using Chi-square or Fisher's exact tests. A multivariate logistic regression model was developed to identify independent predictors. 14,484 patients undergoing HT between 2015 and 2022 were included. Median age was 52 years, and 11,345 (78.3%) were female. The most common indication for surgery was excluding malignancy in 7873 cases (54.3%). Overall, 4653 patients (32.1%) received EPRT, with significant variability among countries, ranging from 3 to 95%. Independent risk factors for EPRT included female sex, older age, malignancy and thyrotoxicosis as surgical indications, Bethesda III cytology, thyroiditis on histology, and the country where HT was performed. One-third of European patients undergoing HT for confirmed benign conditions required EPRT. That prescription was more likely among older patients, those with suspected malignancy or thyrotoxicosis as surgical indications, suspicious cytology, and thyroiditis on histology. Additionally, the country where surgery was done played a significant role.</p>","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":"143987991","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":"Necrotizing soft tissue infections: a surgical narrative review.","authors":"Silvia Tedesco, Marta Di Grezia, Giuseppe Tropeano, Gaia Altieri, Giuseppe Brisinda","doi":"10.1007/s13304-025-02222-0","DOIUrl":"https://doi.org/10.1007/s13304-025-02222-0","url":null,"abstract":"<p><p>Necrotizing soft tissue infections represent a spectrum of diseases characterized by extensive necrosis involving the skin, subcutaneous tissues, fascia or muscles. These infections are generally severe and rapidly progressive, often accompanied by sepsis, septic chock, multiple organ failure and, ultimately, death. Several classifications have been developed based on multiple parameters, such as the anatomical location of the disease, the depth of the lesion or the microbiology. Numerous clinical factors predispose individuals to the development of necrotizing soft tissue infections. The clinical presentation is not always characterized by local signs and systemic symptoms of infection, which can lead to delays in both diagnosis ad treatment. Broad-spectrum antibiotic directed at the likely organisms is essential early in the treatment course, but do not substitute surgical management. Antibiotic therapy should be subsequently tailored to the etiologic micro-organism. Rapid recognition and early surgical intervention form the mainstay of management of necrotizing soft tissue infections. Initial surgical debridement should be promptly performed preferably at the presenting hospital, when adequate infrastructure and personnel are available. Transfer to a referral center may be necessary for definitive surgical and complex wound care. Most patients require more than one debridement. A multidisciplinary approach is also essential to improve the results in the treatment of these patients.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144062185","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":"Sequential comparison of single-stage laparoscopic common bile duct exploration combined with cholecystectomy.","authors":"Jiarui Liu, Xianglong Duan","doi":"10.1007/s13304-025-02205-1","DOIUrl":"https://doi.org/10.1007/s13304-025-02205-1","url":null,"abstract":"<p><p>Laparoscopic cholecystectomy (LC) combined with laparoscopic common bile duct exploration (LCBDE) is used to treat gallbladder (GB) stones combined with common bile duct (CBD) stones. Patients with GB stones combined with CBD stones who underwent single-stage LC + LCBDE surgery in our center from January 2020 to November 2023 were retrospectively analyzed and divided into LC-BDE and BDE-LC groups. LC-BDE was performed in patients with cystic duct diameter ≥ 0.5 cm, and BDE-LC was performed in patients with cystic duct diameter < 0.5 cm. Baseline data, preoperative conditions, operative details, postoperative hospitalization, postoperative care, and complication rates were compared between patients in the two groups. A total of 240 patients were included, including 72 in the LC-BDE group and 168 in the BDE-LC group. There was a significant difference between the two groups in terms of intraoperative blood loss (5 (0, 16) mL vs. 16 (10, 20) mL, P < 0.001). There were no statistically significant differences between the two groups in terms of operative time (130.2 (110.0, 168.6) min vs. 125.0 (105.0, 150.0) min, P = 0.112), and postoperative complications such as bile leakage (8.3 vs. 11.9%, P = 0.415). Different operative sequences of cholecystectomy and common bile duct exploration in the single-stage surgical treatment of GB stones combined with CBD stones were acceptable in terms of bile duct stone clearance and postoperative complication rates.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143999842","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":"Volume replacement procedure adopting biomaterial: early considerations from a multicentric study.","authors":"Andrea Vittorio Emanuele Lisa, Manuela Bottoni, Matteo Ghilli, Maria Donatella Mariniello, Mattia Intra, Laura Maria Belloni, Denise Mattar, Maria Cristina Cossu, Sabrina Montrone, Margherita Tamplenizza, Irini Gerges, Alessandro Tocchio, Benigno Acea, Manuela Roncella, Mario Rietjens","doi":"10.1007/s13304-025-02212-2","DOIUrl":"https://doi.org/10.1007/s13304-025-02212-2","url":null,"abstract":"<p><p>Breast cancer remains the most prevalent female cancer, affecting 2.3 million women worldwide in 2022 (WHO). Breast-conserving surgery aims to remove cancerous tissue while preserving the breast, often incorporating oncoplastic techniques for better cosmetic outcomes. The use of biomaterials for volume replacement, such as the REGENERA^™ biomimetic polyurethane-based patented scaffold, could make these procedures less invasive, with faster recovery and shorter operative times. This article presents preliminary data from a multicentric trial exploring the use of REGENERA^™ in breast reconstruction after breast-conserving surgery. This study included patients operated from 14^th June 2023 to 15^th May 2024. The involved centers are: Breast Surgery Unit, Santa Chiara Hospital, Pisa (Italy, ITA01), European Institute of Oncology, Milan (Italy, ITA02), and Hospital A Coruña, A Coruña (Spain, ESP01). For each patient, we evaluated the incidence of adverse events, changes in breast appearance (using photographs and anthropomorphic measurements), interference with ultrasounds and MRI, investigator's satisfaction, patient's pain (through VAS scale), and quality of life (using BREAST-Q questionnaire). Our early experience included 16 patients meeting the inclusion/exclusion criteria from the 3 centers (3 patients from ESP01, 7 from ITA01, and 6 from ITA02). No complications or allergies related to the device were observed, with a mean follow-up of 3 months. The only complication observed was 3 seromas accounting for 18.75% of patients, justifying the use of drains when REGENERA^™ is used. BREAST-Q questionnaire results at 1-month follow-up showed no statistical significant improvements except for the Psychosocial Well-Being Chest section, which moved from a pre-operative score of 23 to a post-operative score of 52.33. The REGENERA^™ scaffold shows promise as a novel biomaterial for volume replacement in breast-conserving surgery, with high patient satisfaction and minimal complications. Further research and long-term follow-up are necessary to fully evaluate its efficacy and safety. Trial registration: ClinicalTrials.gov (NCT05941299).</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144034854","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 multidrug-resistant microorganisms in bile on postoperative outcomes and long-term survival in patients with periampullary malignancies.","authors":"Ilgar Aghalarov, Sebastian Homann, Jennifer Niescery, Iustin Georgevici, Orlin Belyaev, Waldemar Uhl, Torsten Herzog","doi":"10.1007/s13304-025-02204-2","DOIUrl":"https://doi.org/10.1007/s13304-025-02204-2","url":null,"abstract":"<p><p>Preoperative biliary drainage (PBD) and antibiotic therapy due to cholangitis contribute toward bile contamination with multidrug-resistant organisms (MDROs) and increase the risk of infectious complications. However, little is known about the impact of MDROs in bile on postoperative outcomes and long-term survival in patients with periampullary malignancies. This retrospective single-center study investigated the impact of bile contamination with MDROs on the incidence, postoperative outcomes, and long-term survival in periampullary malignancies in a German tertiary pancreatic center between 2011 and 2015. A total of 428 patients underwent curative and palliative surgery for periampullary malignancies. At least one multidrug-resistant organism in bile was detected in 72 cases (16.8%). Patients with MDROs were significantly older, had a higher frequency of PBD, preoperative antibiotic therapies, non-standard single-shot antibiotics perioperatively, and prolonged antibiotic therapy postoperatively as opposed to the non-MDRO group. The incidence of surgical site infection was significantly higher in the MDRO group. Survival in papillary cancer was significantly worse in the MDRO group compared to the non-MDRO group. Patients with postoperative sepsis had significantly higher risk (hazard ratio 4.59) for postoperative death. Bile contamination with MDROs is associated with a significant increase of surgical site infection, leading to high mortality and poor long-term survival. Tailored antibiotic therapy may improve the survival rate.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143999841","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 times they are a-changin'.","authors":"Dejan Ignjatovic, Bojan Vladimir Stimec","doi":"10.1007/s13304-025-02209-x","DOIUrl":"https://doi.org/10.1007/s13304-025-02209-x","url":null,"abstract":"","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144039622","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 world report of ICG fluorescence angiography integrated in the HUGO™ RAS system: assessment of bowel perfusion during fully robotic right hemicolectomy for cecal cancer.","authors":"Claudio Fiorillo, Davide De Sio, Giuseppe Quero, Sergio Alfieri","doi":"10.1007/s13304-025-02213-1","DOIUrl":"https://doi.org/10.1007/s13304-025-02213-1","url":null,"abstract":"<p><p>Indocyanine green (ICG) fluorescence angiography has rapidly spread due to its application in colorectal surgery in evaluating tissue perfusion. Simultaneously, new robotic platforms have been developed recently and used to perform several surgical procedure. We present the first application of the ICG fluorescence system RUBINA integrated in the HUGO RAS system in general surgery.A fully robotic right hemicolectomy was performed for a male patient suffering from cecal cancer using the HUGO RAS system. ICG fluorescence was used to assess tissue perfusion of the ileal and colic stumps before and after ileocolic anastomosis. The ICG fluorescence clearly showed with different modalities a good perfusion of the anastomosis. Moreover, the use of the integrated system with the HUGO platform was safe and easy to interpret in real-time.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144047313","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":"Sphincter-preserving total fistulectomy with resection of the anoderm and skin and intersphincteric space closure for anal fistula.","authors":"Yoshiro Iida, Katuhiko Honda, Hideo Saitou, Yoshinori Munemoto, Reiko Iida, Akiyosi Tanaka","doi":"10.1007/s13304-025-02195-0","DOIUrl":"https://doi.org/10.1007/s13304-025-02195-0","url":null,"abstract":"<p><p>Non-cure, recurrence and faecal incontinence have often been a major challenge in patients after surgical treatment for anal fistula. To overcome these problems, we have developed a sphincter-preserving total fistulectomy procedure involving resection of the anoderm and skin with intersphincteric space closure (TFRAS). The purpose of the present study was to evaluate this TFRAS technique. TFRAS was performed in 618 patients. The method involved excision of the anoderm and skin, including the internal opening, total removal of the fistula tract while preserving the sphincter, closure of the resulting intersphincteric space and open wound. The Parks classification was used, and subcutaneous, supralevatoric, and unclassifiable fistulas not included in this classification were newly defined and evaluated. The postoperative cure rate was 97.7% and the recurrence rate was 0.7%. The non-cure rate was significantly higher for supralevatoric fistulas and the recurrence rate was significantly higher for unclassifiable fistulas. No cases of postoperative solid faecal incontinence were observed, and the faecal incontinence rate was 0.7%. The mean postoperative Cleveland Clinic Faecal Incontinence (CCFI) score was 0.9, and the highest value of 8 was observed in only one case. No significant differences were found between the classifications based on faecal incontinence rates and the CCFI score. There was no significant difference in CCFI score between patients who underwent TFRAS at only one site and those who did so at two or more sites. TFRAS is considered a useful technique for anal fistulas, offering a high cure rate, a low recurrence rate, and no severe postoperative faecal incontinence.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144064832","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":"Predicting conversion to tailor patient expectations and perioperative pain management in ileocecal resection for Crohn's disease.","authors":"Michele Carvello, Annalisa Maroli, Dakshita Wickramasinghe, Francesca Di Candido, Arianna Dal Buono, Alessandro Armuzzi, Janindra Warusavitarne, Antonino Spinelli","doi":"10.1007/s13304-025-02171-8","DOIUrl":"https://doi.org/10.1007/s13304-025-02171-8","url":null,"abstract":"<p><p>This study aims to identify risk factors of conversion to open surgery for patients undergoing minimally invasive surgery for their CD and to develop a predictive scoring system. Data from patients undergoing minimally invasive resection for their CD were collected in two European referral centers. The scoring system was developed from a logistic regression model including clinical and operative variables and its performance was evaluated using receiver operating characteristics (ROC) area under the curve (AUC). The study included 309 patients including surgery for recurrence. Conversion to open surgery occurred in 21% (65/309) of patients. The logistic regression analysis identified male sex, BMI, preoperative evidence of multiple disease localizations and abscess or perforation, and previous surgery for CD as independent risk factors for conversion. The risk score values in the converted group were significantly higher compared to non-converted group (MD = - 20.40; 95%CI - 14.12 to - 26.69; p < 0.0001). In the ROC analysis, the score achieved an AUC of 0.80 (SE = 0.03; 95%CI 0.74-0.86; p < 0.0001). Male sex, BMI, preoperative evidence of multiple disease localizations and abscess or perforation, and previous surgery for CD were associated with an increased risk of conversion to open surgical approach in patients undergoing minimally invasive surgery and were used to develop a predictive score. The results of this study might be useful to tailor patient expectations and perioperative pain management in ileocecal resection for Crohn's disease.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143997055","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":"Clinical impact of closed-incision negative-pressure therapy in DIEP flap breast reconstruction's donor site.","authors":"Giuseppe Angelo Giovanni Lombardo, Francesco Ciancio, Francesco Ruben Giardino, Alessio Stivala, Dario Melita, Paolo Marchica, Rosario Ranno, Domenico Marrella","doi":"10.1007/s13304-025-02207-z","DOIUrl":"https://doi.org/10.1007/s13304-025-02207-z","url":null,"abstract":"<p><p>The donor-site wound from deep inferior epigastric perforator flap breast reconstruction differs from abdominoplasty due to higher positioning and tension, potentially affecting healing. Closed-incision negative-pressure therapy has been proposed to improve wound healing and reduce complications. This study aimed to evaluate the impact of this tool on donor-site wound's complications and scar-related patient outcomes. This retrospective cohort study included 140 patients who underwent delayed deep inferior epigastric perforator flap breast reconstruction between September 2020 and March 2023. Patients were assigned to Group A (closed-incision negative-pressure therapy) or group B (micropore tape dressings). Both groups received standardized perioperative care. Complications were analyzed, and scar were assessed 1 year postoperatively using SCAR-Q. Statistical significance was set at p ≤ 0.05. There were no significant differences between the two groups in baseline characteristics. Wound dehiscence was significantly lower in Group A compared to Group B (p = 0.0003). The mean time to wound healing after dehiscence was similar between groups (p = 0.270). No significant differences were found in other complications, such as infection or hematoma. Concerning SCAR-Q, patients in Group A reported significantly better outcomes on the symptom scale (p = 0.03), whereas no significant differences were observed for appearance or psychosocial impact. Closed-incision negative-pressure therapy reduced the rate of wound dehiscence but did not significantly improve scar quality or other complications. Given the limited benefits and lack of cost-effectiveness data, this tool should be considered for further study rather than routine clinical use in low-risk deep inferior epigastric perforator flap patients.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144048611","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}