Updates in Surgery最新文献

{"title":"Will the autofluorescence take over inadvertent parathyroidectomy? Results from a multicentre cohort study.","authors":"Diego Barbieri, Pietro Indelicato, Simone De Leo, Claudia Moneta, Silvia Coccia, Giacomo Gazzano, Leone Giordano, Francesca Lira Luce, Davide Canta, Laura Fugazzola, Mario Bussi, Gianlorenzo Dionigi, Matteo Trevisan","doi":"10.1007/s13304-025-02083-7","DOIUrl":"10.1007/s13304-025-02083-7","url":null,"abstract":"<p><strong>Background: </strong>Recently, several devices exploiting the near-infrared autofluorescence (NIR-AF) of parathyroid glands (PGs) have been developed. Nevertheless, their impact on both preserving PGs from inadvertent surgical dissection and on post-surgical hypoparathyroidism (hypoPTH) is controversial.</p><p><strong>Methods: </strong>A retrospective study of 845 patients undergoing thyroid surgery in 2 academic tertiary centres was conducted. In 291 patients, a NIR-AF device was used during surgery to identify PGs. The characteristics of the cohort were examined. The number of PGs identified during surgery, missed PGs, auto-transplants, inadvertent parathyroidectomies, as well as the occurrence of transient and permanent hypoPTH, were analysed.</p><p><strong>Results: </strong>The use of NIR-AF device resulted in a higher identification of PGs (92% versus 88%, p = 0.0008), and a significant reduction in the number of PGs inadvertently removed and detected on histopathological examination (4.7% versus 6.5%, p = 0.045). An increase in PG auto-transplantations was observed in the NIR-AF + group (10.4% versus 3.5%, p < 0.0001). The use of NIRAF did not significantly impact the occurrence of either transient or permanent hypoPTH.</p><p><strong>Conclusion: </strong>Intraoperative NIR-AF detection is a promising technology to reduce incidental parathyroidectomies in thyroid surgery. The impact of this technology on the occurrence of post-surgical hypoPTH needs to be furtherly investigated.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":"369-380"},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143012366","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":"Positive margins after breast-conserving surgery: is it possible to hang up the scalpel in the era of precision medicine?","authors":"Gianluca Franceschini, Sabatino D'Archi, Alba Di Leone, Riccardo Masetti","doi":"10.1007/s13304-025-02067-7","DOIUrl":"10.1007/s13304-025-02067-7","url":null,"abstract":"","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":"265-266"},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143012413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of survival between lobectomy and trisegmentectomy for clinical stage T1c-2aN0M0 non-small cell lung cancer in the left upper segment of the lung.","authors":"Tatsuo Nakagawa, Ei Miyamoto, Yuki Ohsumi, Masashi Gotoh, Tomoaki Matsuoka, Masashi Kobayashi, Mitsugu Omasa, Norihito Okumura","doi":"10.1007/s13304-024-02007-x","DOIUrl":"10.1007/s13304-024-02007-x","url":null,"abstract":"<p><p>Left upper trisegmentectomy is expected to be as curative as lobectomy for lung cancer because the left upper lobe is anatomically the same as the combined upper and middle lobes of the right lung and the procedure can provide a sufficient surgical margin. In the present multicenter study, we compared the results of trisegmentectomy and lobectomy in patients with clinical stage T1c-2aN0M0 left upper lung cancer. We retrospectively analyzed the outcomes of patients with clinical stage T1c-2aN0M0 lung cancer in the left upper segment who underwent lobectomy or trisegmentectomy between January 2006 and June 2022. The trisegmentectomy group (S group) and lobectomy group (L group) comprised 33 and 132 patients, respectively. Comparisons of postoperative survival revealed no significant differences in overall survival (p = 0.761) or disease-free survival (p = 0.508) between the two groups. There were also no significant differences in survival after adjustment for clinical factors by Cox proportional hazards models and propensity score matching. Local recurrence was significantly more predominant in the S group than in the L group (p = 0.006). The S group had a worse postoperative survival than the L group when the tumor was located in anterior segment. Trisegmentectomy can provide an equivalent postoperative survive to lobectomy in patients with clinical stage T1c-2aN0M0 left upper segment lung cancer except in patients with tumor in anterior segment.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":"523-532"},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142393709","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":"How aging may impact the failure to rescue after colorectal laparoscopic surgery. Analysis of 1000 patients in a single high-volume center.","authors":"Rosa Marcellinaro, Aldo Rocca, Pasquale Avella, Michele Grieco, Domenico Spoletini, Massimo Carlini","doi":"10.1007/s13304-025-02173-6","DOIUrl":"https://doi.org/10.1007/s13304-025-02173-6","url":null,"abstract":"<p><p>This study aimed to evaluate the FTR after laparoscopic colorectal surgery in an Italian high-volume centre. A retrospective analysis was conducted in a consecutive series of patients who underwent elective laparoscopic colorectal surgery for neoplastic disease between January 2010 and December 2023 at the General Surgery Department of the San Eugenio Hospital, Rome, Italy. Patients were grouped by age in adult (vs. < 75 years) and elderly group (≥ 75 years). A multivariate analysis of the predictive factors of complications was performed. A total of 1,000 patients met the inclusion criteria, excluding those who underwent open or robotic surgery, either in emergency or elective settings. 53 patients (5.3%) experienced major complications. The mean age of patients with no or mild complications was 65.60 years (± 10.61), whereas patients with severe complications were older (69.94 years ± 12.02, p = 0.0041). Gender distribution and BMI do not represent a risk factor for major complications (p = 0.2555 and p = 0.2686, respectively), unlike the ASA score III or IV (p = 0.0001). The overall FTR rate for adult patients is 9%, while it is slightly higher at 10% for elderly patients. No statistical differences were found between the 2 groups. Elderly patients had more frequent FTR due to infective complications, while the FTR rate for cardiovascular disease was more frequent in the adult group. Minimally invasive approach, skilled team, well-established rapid response and standardized complication management protocols can positively impact FTR regardless of patients' age.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754735","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":"Parastomal Hernia: direct repair versus relocation: is stoma relocation worth the risk? A comparative meta-analysis and systematic review.","authors":"Ahmed Abdelsamad, Mohammed Khaled Mohammed, Mohamed Badr Almoshantaf, Aya Alrawi, Ziad A Fadl, Ziad Tarek, Nada Osama Aboelmajd, Torsten Herzog, Florian Gebauer, Nada K Abdelsattar, Taha Abd-ElSalam Ashraf Taha","doi":"10.1007/s13304-025-02155-8","DOIUrl":"https://doi.org/10.1007/s13304-025-02155-8","url":null,"abstract":"<p><p>Parastomal hernia is a prevalent and challenging complication in patients with stomas, frequently necessitating surgical intervention. The two primary approaches to parastomal hernia repair- direct repair without relocation and stoma relocation- offer distinct benefits and drawbacks. This systematic review and meta-analysis aimed to compare the efficacy and safety of stoma relocation versus direct repair in managing parastomal hernia. Following PRISMA guidelines, we conducted a systematic review and meta-analysis of studies involving adult patients (≥ 18 years) with parastomal hernia who underwent either stoma relocation or direct repair, with a focus on clinically relevant outcomes. A comprehensive search of Web of Science, PubMed, Scopus, and Cochrane Library databases was conducted up to September 2024. Key short-term outcomes (operative time, surgical site infection, urinary tract infection, bowel obstruction, length of hospital stay, and overall complications) and long-term outcomes (re-admission, recurrence, re-operation, and mortality) were extracted. Statistical analysis included risk ratios (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes. Six studies were included, encompassing both laparoscopic and open-surgical techniques. Direct repair was associated with a significantly shorter operative time (MD: 115 min, 95% CI: 95.71 to 134, P < 0.00001) and a reduced length of hospital stay (MD: 2 days, 95% CI: 0.40 to 3.9, P = 0.02). While reoperation rates were significantly lower in the relocation group (RR: 0.15, 95% CI: 0.03 to 0.62, P = 0.009), other outcomes-including recurrence, re-admission, and overall complication rates-showed comparable results between the two approaches. Notably, there were no significant differences in surgical site infection, urinary tract infection, bowel obstruction, or mortality rates. Direct repair may be advantageous for reducing operative time and hospital stay, whereas stoma relocation appears beneficial in reducing reoperation rates. Future research should focus on developing standardized techniques and incorporating patient-specific factors to inform optimal surgical decision-making in parastomal hernia repair.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753876","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":"Protocol for an international multicenter, prospective, observational, non-competitive, study to validate and optimise prediction models of 90-day and 1-year allograft failure after liver transplantation: The global IMPROVEMENT Study.","authors":"Alfonso W Avolio, Gabriele Spoletini, Umberto Cillo, Kristopher Croome, Gabriel Oniscu, Patrizia Burra, Martin De Santibanes, Hiroto Egawa, Mikel Gastaca, Zhiyong Guo, Quirino Lai, Paulo N Martins, Wojciech G Polak, Cristiano Quintini, Mohamed Rela, Gonzalo Sapisochin, Julio Wiederkehr, Riccardo Pravisani, Deniz Balci, Ian Leipnitz, Ilka Boin, Felix Braun, Lucio Caccamo, Stefania Camagni, Amedeo Carraro, Matteo Cescon, Zhishui Chen, Olga Ciccarelli, Luciano De Carlis, Deng Feiwen, Fabrizio Di Benedetto, Burcin Ekser, Giuseppe Maria Ettorre, Marta Garcia-Guix, Davide Ghinolfi, Michal Grat, Salvatore Gruttadauria, John Hammond, Zemin Hu, Sunhawit Junrungsee, Michael Lesurtel, Jean Yves Mabrut, Daniel Maluf, Vincenzo Mazzaferro, Gilberto Mejia, Artem Monakhov, Bunthoon Noonthasoot, Silvio Nadalin, Brian M Nguyen, Nguyen Quang Nghia, Madhukar Patel, Thamara Perera, Marcos Vinicius Perini, Carlo Pulitano, Renato Romagnoli, Ephrem Salame, Gupta Subhash, Surendran Sudhindran, Takashi Ito, Francesco Tandoi, Giuliano Testa, Timucin Taner, Giuseppe Tisone, Giovanni Vennarecci, Marco Vivarelli, Diana Giannarelli, Tina Pasciuto, Marco Maria Pascale, Vatche Agopian","doi":"10.1007/s13304-025-02078-4","DOIUrl":"https://doi.org/10.1007/s13304-025-02078-4","url":null,"abstract":"<p><p>More liver transplants (LT) are performed worldwide thanks to extended criteria donors (ECD). This is paralleled by a supposed increased risk of allograft failure (AF) at 90 and 365 days. This study has been designed to portray the LT practice worldwide and investigate models of AF prediction and the impact of risk mitigation strategies for further improving graft and patient outcomes. This is a multicenter, international, non-competitive, observational two segment study on consecutive LTs over two periods (2017-2019 and 2022-2024). A steering committee of LT experts defined the study protocol. The prospective segment will enroll 750 patients from 15 high-volume LT centers (50 per center), and the retrospective segment will enrol 4200 patients from 56 LT centers (75 per center). To provide a snapshot of the LT activity globally and to develop new algorithms for the timely prediction of AF at 90 and 365 days post-LT. The study also aims (1) to validate the existing predictive models and (2) to investigate the best time for re-transplantation, paying attention to the differences in AF and Ischemic cholangiopathy according to the donor types and mitigation strategies implemented in the various settings. Since the adoption of machine perfusion has increased in different proportions worldwide, models will be adjusted according to this parameter. Finally, retrospective and prospective data will be available for further stratifications and modelling according to the degree of decompensation at transplant, gender match, postoperative complications and their management. This protocol was approved by Fondazione Policlinico Universitario Agostino Gemelli IRCCS Ethics Committee (study ID: 4571) and the Institutional Review Board of the University of California, Los Angeles. The provisional study protocol was submitted to the main scientific international societies in the transplant field. Results will be published in international peer-reviewed journals and presented at congresses.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721344","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":"Letter to the editor: simultaneous treatment of large hiatal hernias during Roux‑en‑Y gastric bypass: technical considerations and outcome.","authors":"Aiman Irfan, Waleed Ahmad, Aparajith Sathish Kumar","doi":"10.1007/s13304-025-02168-3","DOIUrl":"https://doi.org/10.1007/s13304-025-02168-3","url":null,"abstract":"","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143711024","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":"Effect of Helicobacter pylori infection on metabolic and bariatric surgical complications: a systematic review and meta-analysis.","authors":"Mohammad Kermansaravi, Rohollah Valizadeh, Shahab ShahabiShahmiri, Roxanna Zakeri, Saeed Safari, Foolad Eghbali, Behnood Farazmand, Masoumeh Shahsavan, Amirhossen DavarpanahJazi, Sjaak Pouwels","doi":"10.1007/s13304-025-02151-y","DOIUrl":"https://doi.org/10.1007/s13304-025-02151-y","url":null,"abstract":"<p><p>More papers have discussed the importance of preoperative detection and eradication of Helicobacter pylori (HP) in patients before and after Metabolic and Bariatric Surgery (MBS). This systematic review and meta-analysis aimed to evaluate the role of preoperative H. pylori eradication vs non-treatment in the development of post-op complications in the setting of bariatric and metabolic surgery. This study aimed to evaluate the effect of Helicobacter pylori (HP) on metabolic and bariatric surgical complications through a systematic review and meta-analysis. A systematic search on the influence of HP infection on postoperative complications in bariatric surgery was conducted. The methodological quality of the included studies was rated using the Newcastle-Ottawa Rating scale. In case of consistent reporting of the data, a meta-analysis was performed. A total of 19 studies containing 261,186 patients were included. The mean age of the patients was 41.88 ± 7.40 years with a mean BMI of 45.53 ± 3.16 kg/m². The mean follow-up was 21.72 months (range: 1-96 months). Testing for HP infections was often done using an esophagogastroduodenoscopy in combination with biopsy (42%). A urea breath test (59%) was the most common tool to confirm eradication. To eradicate HP, 2 weeks of PPI with antibiotics, 1 week of PPI with antibiotics, and PPI alone without antibiotics were used in 18 (67%), 3 (11%), and 6 (22%) studies, respectively. The prevalence of complications among patients with positive/negative HP was not significantly different (P > 0.05). In HP patients without preoperative eradication, odds ratio of bleeding was 1.48 (95% CI 0.80-2.73), ulcer was 6.88 (95% CI 5.60-8.45), leakage was 1.73 (95% CI 0.81-3.68), stricture was 1.13 (95% CI 0.30-4.21), and abscesses was 3.01 (95% CI 0.85-10.65). Helicobacter pylori infection is associated with potential postoperative complications, and therefore, it needs adequate treatment.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143711120","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":"Ambulatory inguinal hernia repair in Portugal - a multicenter prospective cohort study.","authors":"","doi":"10.1007/s13304-025-02084-6","DOIUrl":"https://doi.org/10.1007/s13304-025-02084-6","url":null,"abstract":"<p><p>Ambulatory surgery is the recommended approach for elective inguinal hernia repair for most people. However, the relative use of this procedure in Portugal and its related outcomes are unknown. We aimed to assess complication rates in patients undergoing ambulatory and inpatient surgery. Prospective multicentric cohort study included consecutive patients undergoing elective inguinal hernia repair in mainland Portugal (October-December 2019). The primary outcome was the post-operative complication rate (any Clavien-Dindo grade) among patients undergoing ambulatory and inpatient surgery. A logistic regression analysis was performed to adjust for patient and disease-related co-variables. Eight hundred twenty-eight patients (89.1% of males) were included from thirty-three hospitals, of which seven hundred sixteen (86.4%) had unilateral hernias. Four hundred thirty-three (52.2%) were operated on as day cases and three hundred ninety-five (47.7%) with overnight stays. There were no significant differences in post-operative complication rate between patients undergoing ambulatory and overnight stay surgery, both in unadjusted (9.9% vs. 11.1%; p = 0.650) and adjusted (odds ratio: 1.08 [95% CI 0.66-1.76]) analyses. Ambulatory surgery was only performed in half of the patients, although this procedure is not associated with an increased risk of complications. These results should promote the expanded use of ambulatory surgery in patients eligible for elective inguinal hernia repair.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143711113","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":"Protective ileostomy creation after anterior resection of the rectum (PICARR): a decision-making exploring international survey.","authors":"Andrea Balla, Federica Saraceno, Marika Rullo, Salvador Morales-Conde, Eduardo M Targarona Soler, Salomone Di Saverio, Mario Guerrieri, Pasquale Lepiane, Nicola Di Lorenzo, Michel Adamina, Isaias Alarcón, Alberto Arezzo, Jesus Bollo Rodriguez, Luigi Boni, Sebastiano Biondo, Francesco Maria Carrano, Manish Chand, John T Jenkins, Justin Davies, Salvadora Delgado Rivilla, Paolo Delrio, Ugo Elmore, Eloy Espin-Basany, Alessandro Fichera, Blas Flor Lorente, Nader Francis, Marcos Gómez Ruiz, Dieter Hahnloser, Eugenio Licardie, Carmen Martinez, Monica Ortenzi, Yves Panis, Carlos Pastor Idoate, Alessandro M Paganini, Miguel Pera, Roberto Perinotti, Daniel A Popowich, Timothy Rockall, Riccardo Rosati, Alberto Sartori, Daniele Scoglio, Mostafa Shalaby, Vicente Simó Fernández, Neil J Smart, Antonino Spinelli, Patricia Sylla, Pieter J Tanis, Javier Valdes Hernandez, Steven D Wexner, Pierpaolo Sileri","doi":"10.1007/s13304-025-02111-6","DOIUrl":"https://doi.org/10.1007/s13304-025-02111-6","url":null,"abstract":"<p><p>In our previous survey of experts, surgeon's decision-making process (DMP) about protective ileostomy (PI) creation after anterior resection was investigated. Based on our previous data, a multiple choice questionnaire has been developed. The aim is to perform a quantitative analysis of the results obtained from an international survey and to describe the clinical practice worldwide. Ten questions were related to participants' demographics and, 20 questions (of which 17 Likert scale questions) investigated the DMP regarding PI creation. To evaluate the tendency of the answers in the Likert-type questions, the mean of the answers obtained was compared with the mean point of the Likert scale. The survey was completed by 1019 physicians. Neoadjuvant chemoradiotherapy and distance of the anastomosis from the anal verge ≤ 10 cm were each considered alone sufficient to justify creation of a PI, with statistically significant differences in comparison to the mean point of the scales in (p =  < 0.0001 in both cases). Total Mesorectal Excision alone was not considered a factor sufficient to create a PI (p = 0.416). Most of the participants agree to define their approach to create a PI \"tailored\" to patients' risk factors (p =  < 0.0001) and \"influenced by my experience\" in case of patients with low/moderate risk of anastomotic leakage (p =  < 0.0001). This study provides useful insights on the worldwide clinical practice regarding creation of PI following anterior resection. Given the lack of standardization and evidence-based guidelines, this analysis may be helpful to assist surgeons' practice.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692979","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}