Updates in Surgery最新文献

{"title":"Commentary on: \"Efficacy and safety of terlipressin infusion during liver surgery: a meta-analysis\".","authors":"Renu Sah, Ankita Mathur, Venkata Dileep Kumar Veldi","doi":"10.1007/s13304-025-02257-3","DOIUrl":"https://doi.org/10.1007/s13304-025-02257-3","url":null,"abstract":"","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086622","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":"Effectiveness of Systemic Inflammation Response Index (SIRI) Neutrophil-Lymphocyte Ratio (NLR), Derived Neutrophil-Lymphocyte Ratio (dNLR), and Systemic Immune Inflammation Index (SII) for predicting prognosis of acute diverticulitis.","authors":"Yasin Alper Yıldız","doi":"10.1007/s13304-025-02241-x","DOIUrl":"https://doi.org/10.1007/s13304-025-02241-x","url":null,"abstract":"<p><p>There are many applications to emergency services due to acute colonic diverticulitis. It is necessary to decide whether these patients are complicated, to quickly predict their prognosis, and to decide whether medical or invasive treatment is necessary. We planned to research effectiveness NLR, NLR, SII, and SIRI values calculated using hemogram data can predict the prognosis of acute diverticulitis. We managed a retrospective scanning with patients who applied with a diagnosis of acute diverticulitis between 06/2020 and 04/2023. Demographic data (age, gender, previous surgery, comorbid diseases), tomographic Hinchey classification, location of diverticulitis, applied treatment, and obtained from blood parameters at presentation to the emergency department WBC, CRP, NLR, dNLR, SII, SIRI parameters were recorded from the electronically registered patient files. According to the Hinchey classification, those with Hinchey 0 and 1a were included in the noncomplicated group A class because they were followed up with outpatient medical follow-up. Those with Hinchey 1b,2,3,4 were included in the complicated GROUP B class. Differences in WBC, CRP, NLR, dNLR, SIRI, SII values between the complicated and noncomplicated groups were evaluated statistically. There were 286 patients with acute diverticulitis on the dates indicated. The number of patients eligible for the study was eighty-two. According to Hinchey's classification, 56 patients had noncomplicated acute diverticulitis (SAD) and 26 patients had complicated diverticulitis (CAD). These diagnoses were given based on tomography findings and clinical evaluations. The hospital stay was longer in the CAD group compared to the SAD group (p < 0.001) statistically significantly. The rate of surgical procedures and percutaneous interventions in the CADs was higher than SADs (p: 0.040) statistically significantly. WBC (white blood cell), NLR, dNLR, SIRI, SII and CRP parameters were higher in CADs than in SADs as statistically significant. Spearman's correlation analysis showed between the Hinchey classification and the NLR, dNLR, SII, SIRI, CRP, WBC parameters with high correlation as positive. Determination of values SIRI (2.42), NLR (3.35), SII (907.44) dNLR (4.63), CRP (15.25) WBC (11.16) and specificity and fractionation of these values ROC analysis was performed for this purpose. Highest AUC (area under the curve) value was found in WBC [0.807 0.703-0.910)], SIRI [0.786 (, 0.681-0.892)], SII [0.767 (0.654-0.880)], NLR [0.740 (0.624-0.854)], dNLR [0.739 (0.625-0.853)]. This study showed that there are SII, SIRI dNLR, NLR, CRP, and WBC values in patients presenting with acute diverticulitis a very high correlation with Hinchey classification in distinguishing complicated and non-complicated acute diverticulitis (p < 0.01). These data were higher in CADs than in SADs statistically significantly. The use of these data can both prevent unnecessary radiation in patients suspected of acute diverticulitis","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144080752","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 standardized technique for laparoscopic total colectomy in acute severe ulcerative colitis: a technical note.","authors":"Carlo Alberto Manzo, Caterina Baldi, Leonardo Lorusso, Valerio Celentano, Gianluca Matteo Sampietro","doi":"10.1007/s13304-025-02247-5","DOIUrl":"https://doi.org/10.1007/s13304-025-02247-5","url":null,"abstract":"<p><p>Ulcerative colitis (UC) often necessitates total colectomy in cases of medically refractory disease or complications, with over one-third of patients undergoing surgery despite advances in medical therapy. Standardization in colectomy techniques is crucial to improving surgical outcomes, enhancing reproducibility, and addressing variability in practices. This study revisits laparoscopic total colectomy, emphasizing a \"critical view of safety\" approach to streamline the procedure, reduce anatomical disorientation, and overcome steep learning curves for trainees. The proposed technique divides the procedure into two phases: left colectomy and right/transverse colectomy, each featuring five standardized critical views. These views provide a clear framework for key anatomical landmarks, including the pancreas, splenic hilum, Gerota's fascia, and middle colic vessels. Patient positioning and trocar placement are also standardized to ensure procedural consistency. The adoption of this refined, minimally invasive approach aligns with ECCO guidelines, offering advantages, such as fewer perioperative complications, shorter hospital stays, and preserved fertility. This method minimizes inter-surgeon variability, facilitating reproducibility in elective and emergency settings. Collaborative multi-disciplinary care among surgeons, gastroenterologists, and specialized nurses further supports timely surgical decision-making and improved post-operative outcomes.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144080750","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 preoperative use of biologics on 30-day surgical morbidity and mortality in patients with Crohn's disease undergoing ileocolectomy: National Surgical Quality Improvement Program database analysis.","authors":"Fady Daniel, Zakaria El Kouzi, Jamil Mrad, Mohamad Ali Ibrahim, Ala I Sharara, Walaa El Sheikh, Mohamad Khalife, Hani Tamim","doi":"10.1007/s13304-025-02238-6","DOIUrl":"https://doi.org/10.1007/s13304-025-02238-6","url":null,"abstract":"<p><p>Preoperative use of biologics has been inconsistently reported to be associated with increased frequency of infectious and surgical anastomotic complications in inflammatory bowel disease patients. We aimed to evaluate the rates of 30-day postoperative morbidity and mortality in Crohn's disease patients exposed preoperatively to biologics. Data were collected from the NSQIP (National Surgical Quality Improvement Program). Crohn's disease patients undergoing open or laparoscopic ileocolectomy were identified using corresponding ICD 10 and CPT Codes from the NSQIP Participant Use Data File (PUF) for 2021. Patients were divided based on the preoperative use of biologics (group 1) and (group 2) for whom no biologics were used. A total of 910 patients (female n = 473; 52%, mean age of 42.3 ± 16.1) were included. The group 1 patients were significantly younger (40.30 years ± 15.33) than group 2 (43.58 years ± 16.8, p = 0.002) and had significantly slightly higher ASA III and IV scores (97.4% vs. 97.2%, p = 0.004). On the other hand, group 2 had a significantly higher prevalence of hypertension (20.2% vs. 12.8%, p = 0.003) and chronic obstructive pulmonary disease (2.6% vs. 0%, p = 0.001). No significant difference in remaining preoperative variables, surgical approach (laparoscopic vs. open), and comorbidities were found between the two groups. Only a significant prevalence of deep vein thrombosis and thromboembolism was found in patients exposed to biologics (1.1% vs. 0%, p = 0.027). Crohn's disease patients undergoing ileocolectomy and exposed preoperatively to biologics did not show a significant increase in 30-day postoperative morbidity and mortality. The outcomes did not support the concept that biological agents increase septic complications.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144080731","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":"Predictive value of modified frailty index-5 to major complications after videothoracoscopic pulmonary resections.","authors":"Muhammet Sayan, Mahir Fattahov, Fevzi Oguzhan Temirkaynak, Nazmiye Koska, Bengisu Artiran, Muhammet Tarik Aslan, Gunel Ahmadova, Aysegul Kurtoglu, Irmak Akarsu, Ismail Cuneyt Kurul, Ali Celik","doi":"10.1007/s13304-025-02232-y","DOIUrl":"https://doi.org/10.1007/s13304-025-02232-y","url":null,"abstract":"<p><p>Although minimally invasive methods have become widespread, pulmonary resections due to lung cancer continue to be an important cause of postoperative morbidity. Herein, we have investigated the predicting efficacy of modified frailty index-5 (MFI-5) for postoperative complications in patients who underwent pulmonary resection by VATS for non-small cell lung cancer (NSCLC). We retrospectively reviewed the data of patients who underwent VATS lobectomy/segmentectomy for NSCLC. MFI-5 score was calculated according to hypertension, diabetes mellitus, chronic obstructive pulmonary disease, congestive heart failure, and functional independence status. Major postoperative complications were determined based on Clavien-Dindo classification. The predictive efficacy of MFI-5 score for major complications was tested by univariate and multivariate logistic regression analysis. A total of 336 patients were included in the study. The mean age was 65.6 ± 9.8 years. MFI-5 score was zero in 126 (37.5%) patients and positive in 210 patients. The major complication rate was 25.9%. Multivariate analysis showed that 2 and higher MFI-5 score significantly predicted the presence of postoperative major complications (p: 0.004, OR: 4.3, 1.58-12.5 95% CI). The MFI-5 score can significantly predict the presence of major postoperative complications, including 30-day mortality, in patients undergoing VATS pulmonary resection for NSCLC. Clinical registration 2024-324, approved by Gazi University Local Ethics Committee.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144079813","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":"Role of intraoperative indocyanine green roadmap as a safety measure in emergent laparoscopic cholecystectomy.","authors":"R Carramiñana-Nuño, V Borrego-Estella, A Millán-Mateos, L Medina-Mora, M Gasós-García, D Otero-Romero, M M Soriano-Liébana, N Lete-Aguirre, P Palacios-Gasós","doi":"10.1007/s13304-025-02240-y","DOIUrl":"https://doi.org/10.1007/s13304-025-02240-y","url":null,"abstract":"<p><p>Acute cholecystitis is a growing pathology, with high surgical risk due to the related patients' comorbidity. The gold standard treatment is laparoscopic cholecystectomy, which, despite its high volume, still presents elevated rates of biliary tract injury. Standardization of the procedure and accurate identification of the anatomical structures of the biliary tree are the key in avoiding severe complications associated with this injury. Innovation in minimally invasive technologies, such as infrared indocyanine green as a radiotracer to delimit the biliary anatomy, could reduce the rate of biliary tract lesions. A single-center case-control study was conducted, including patients undergoing emergency surgery between November 2023 and November 2024 for acute cholecystitis (Tokyo Guidelines 2018 criteria). Eighty-seven patients were allocated into two groups: emergency laparoscopic cholecystectomy with or without intraoperative indocyanine green cholangiography. The primary aim was to evaluate ICG's impact on reducing bile duct injury. Secondary outcomes included operative time, hospital stay, and conversion rates. The mean operative time (93 min vs. 104.6 min, p = 0.087), ASA scale (p = 0.302) and Charlson comorbidity index (2.55 vs. 2.84; p = 0.58) were not significantly different when comparing both groups. The control group showed duplicated preoperative CRP values as compared to the ICG group (138.24 mg/l vs. 71.02 mg/l; p = 0.06), and a higher median hospital stay (5 days ± 3 vs. 3 days ± 1.75; p = 0.001). The control group showed a greater need for conversion to open surgery (14.3% vs. 0%; p = 0.015). Trends towards fewer bile duct injuries (0% vs. 4.1%; p = 0.208) and fewer complications (15.87% vs. 18.4%; p = 0.752) in the ICG group were not statistically significant. The use of ICG may reduce the need for conversion to open surgery and median hospital stay. However, its use has not been proven to reduce bile duct injury, postoperative complications, or operative time.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144079816","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 impact of the COVID-19 pandemic on emergency general surgery outcomes: a retrospective analysis of seven procedures.","authors":"Nihal Sriramaneni, Julia Botvinov, Aziz M Merchant","doi":"10.1007/s13304-025-02225-x","DOIUrl":"https://doi.org/10.1007/s13304-025-02225-x","url":null,"abstract":"<p><p>Current research has examined emergency general surgery (EGS) rates and COVID-19 complications for some procedures, but none have explored complications for all seven EGS procedures before and during the pandemic. Our study addresses this gap, aiming to understand how pandemic-related challenges impact patient outcomes. Utilizing data from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) spanning 2018 to 2021, we conducted a retrospective cohort study with analysis of open and laparoscopic partial colectomy, enterectomy, cholecystectomy, operative management of peptic ulcer disease, adhesiolysis, appendectomy, and laparotomy. Patient outcomes, including 30-day mortality and morbidity, were assessed. The likelihood of complications in EGS has risen compared to pre-COVID levels. Specifically, there is a greater risk of morbidity in open EGS cases intra-COVID compared to laparoscopic, particularly in colectomy and appendectomy procedures. Conversely, laparoscopic procedures have seen a decrease in readmissions, notably in cases involving cholecystectomy and colectomy. The study highlights a rise in complications for EGS intra-COVID, with open procedures demonstrating higher risks than laparoscopic counterparts.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144017193","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":"Conditional survival after liver resection for early-stage hepatocellular carcinoma.","authors":"Yi-Hao Yen, Sin-Hua Moi, Yueh-Wei Liu, Chee-Chien Yong, Chih-Chi Wang, Wei-Feng Li, Chih-Yun Lin","doi":"10.1007/s13304-025-02226-w","DOIUrl":"https://doi.org/10.1007/s13304-025-02226-w","url":null,"abstract":"<p><p>Conditional survival (CS) is a measure of prognosis of patients who have already survived several years since diagnosis. However, few studies have investigated the CS of patients who underwent liver resection (LR) for early-stage hepatocellular carcinoma (HCC). We enrolled 942 consecutive patients who underwent LR for HCC with pathology-defined American Joint Committee on Cancer (AJCC) 7th edition stage 1 or 2 disease. The three-year CS was calculated as CS = S(x + 3)/S(x) and represented the probability of surviving an additional three years, given that the patient had already survived x years. The one-, three-, and five-year survival rates were 97.1%, 86.7%, and 76.1%, respectively, and were lower in cases with AJCC stage 2 disease, alpha-fetoprotein level of ≥ 20 ng/ml, presence of cirrhosis, anti-hepatitis C virus positivity, age > 65 years, and Model for End-Stage Liver Disease score of > 9. However, the three-year CS indicated that these variables were associated with shortened survival only in the first two years. From the third year after LR, the probability of survival of patients was similar between subgroups. CS is useful for providing a dynamic evaluation of survival during postoperative follow-up.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144051923","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":"Anterior component separation versus posterior component separation with transversus abdominis release for large ventral hernias: a randomized controlled study.","authors":"Zaza Demetrashvili, Irakli Pipia, Lali Patsia, George Kenchadze, Luka Tkhelidze, George Kamkamidze","doi":"10.1007/s13304-025-02229-7","DOIUrl":"https://doi.org/10.1007/s13304-025-02229-7","url":null,"abstract":"<p><p>The aim of this study was to analyze outcomes of open anterior component separation technique (ACST) and posterior component separation technique with transversus abdominis release (TAR) for midline large ventral hernias. From December 2016 to July 2022, patients over 18 years of age, who underwent elective surgery for midline large ventral hernia via open component separation technique (ACST and TAR), were enrolled in this study. Preoperative and intraoperative factors, also hospital stay days, Surgical Site Occurrences (SSO), hernia recurrence and quality of life (QoL) were determined in ACST and TAR groups. To determine QoL we used the Carolinas Comfort Scale (CCS). Data of 43 patients (22 patients from ACST group and 21-from TAR group) were analyzed. Bivariate analysis showed that the proportions of SSO in TAR group (4 out of 21; 19%) was significantly lower than in ACST group (11 out of 22; 50%) (OR 1.87, 95% CI 1.07-3.24, p = 0.033). Seroma was the most frequent SSO, ranging from 9.5% to 40.9% among the groups, respectively (P = 0.018). There was no significant difference between the groups in terms of surgical site infection (SSI), hematoma, wound dehiscence, skin necrosis, hernia recurrence and QoL. Our study revealed that when comparing the ACST and TAR groups for large midline ventral hernia, there was no significant difference in terms of hernia recurrence and QoL. TAR was associated with significantly less SSO than ACST. This can be considered as an advantage of TAR, making it more preferable than ACST.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144051853","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":"Conundrum of station 13 lymph nodes in Gallbladder Carcinoma: Retrospective tryst with a forgotten entity.","authors":"Mayank Tripathi, Kumar Vineet, Nitesh Joshi, Ankita Pal, Tejas Vispute, Akhil Kapoor, Paramita Paul","doi":"10.1007/s13304-025-02237-7","DOIUrl":"https://doi.org/10.1007/s13304-025-02237-7","url":null,"abstract":"<p><p>Gallbladder cancers are one of the lethal cancers with dismal prognosis. There is discrepancy between various biliary societies regarding extent of regional lymph nodes of gallbladder. Some consider station 13 as regional nodes, whereas others consider it as distant metastatic node. This is a retrospective analysis of disease-free survival of stage IIIB and IVB-M0 patients in gall bladder cancer with positive station 13 lymph node. Electronic medical records of patients were used to retrieve the data. The mean and median disease-free survival of gallbladder carcinoma patients with station 13 lymph-node positivity is 16.2 months (95% CI 11.57-20.85 months) and 12 months (95% CI 9.57-14.43 months), respectively. Disease-free survival of Stage IIIB and IVB-M0 gallbladder carcinoma patients with station 13 lymph-node positivity is better than overall survival of stage IVB-M1 patients and supports the inclusion of station 13 lymph node as regional lymph-nodal basin of gall bladder carcinoma. This study paves the way for a large prospective study to consider station 13 lymph node as regional lymph node in gallbladder cancer.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144034722","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}