Updates in Surgery最新文献

{"title":"Endoscopic radial incision combined with local injection of triamcinolone acetonide for refractory esophageal stenosis after endoscopy submucosal dissection.","authors":"Hoi-Ioi Ng, Yi Liu, Yong Liu, Li-Zhou Dou, Shun He, Gui-Qi Wang","doi":"10.1007/s13304-025-02069-5","DOIUrl":"https://doi.org/10.1007/s13304-025-02069-5","url":null,"abstract":"<p><p>Refractory esophageal stenosis (RES) after endoscopic submucosal dissection (ESD) is challenging in clinical practice. This study aimed to evaluate endoscopic radial incision (ERI) combined with the local injection of triamcinolone acetonide for RES and to assess its safety and efficacy. A total of nine patients (five males; age range: 50-76 years) who underwent ERI + triamcinolone acetonide for RES after ESD between August 2019 and November 2022 were analyzed. The primary endpoint was the duration of treatment. The length of the stenosed portion, procedure time, sessions of endoscopic therapy, effectiveness rate, success rate, dysphagia grade, complications, and quality of scores were also analyzed. The effectiveness and success rates were 100% and 88.9%, respectively. The mean number of sessions of ERI + triamcinolone acetonide was 2.2 (1.0-4.0). The mean procedure time was 25.9 ± 3.8 min. No severe complications, including bleeding or perforation, were observed during the perioperative period. Dysphagia symptoms were relieved in all patients after endoscopic treatment. Patients had significantly better functional scales for social functioning and global health status and lower rates of fatigue, gastrointestinal symptoms, and financial difficulties after treatment. ERI + triamcinolone acetonide can be considered a safe and effective treatment for RES after ESD. Larger prospective clinical trials are needed to confirm its utility.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143415281","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":"Implications of robotic platforms for repeat hepatectomies: a propensity score matched study of clinical outcomes.","authors":"Bhavya Bansal, Tara M Pattilachan, Sharona Ross, Maria Christodoulou, Iswanto Sucandy","doi":"10.1007/s13304-025-02117-0","DOIUrl":"https://doi.org/10.1007/s13304-025-02117-0","url":null,"abstract":"<p><p>Robotic surgical approaches have demonstrated improved outcomes in primary hepatectomies. However, data on their effectiveness in redo hepatectomies (subsequent liver resections) are limited. This study aims to compare the outcomes of patients undergoing primary and redo robotic hepatectomies, with additional analysis comparing outcomes of robotic versus open redo hepatectomies. With IRB approval, we prospectively followed 101 patients from a parent population of 465, who were classified as either primary (non-redo) or redo robotic hepatectomy patients between 2013 and 2023. A Propensity Score Matched (PSM) analysis was conducted to compare perioperative variables between the two cohorts, using age, sex, BMI, IWATE score, tumor size, and tumor type as matching variables. Data are presented as median (mean ± standard deviation). Significance was accepted at p ≤ 0.05. After 3:1 PSM analysis (3 primary patients to 1 robotic redo patient), no significant differences were observed in pre-, intra-, or postoperative variables, except for the Model for End-Stage Liver Disease (MELD) score (p = 0.022). Additional analysis comparing robotic and open redo hepatectomies showed similar perioperative outcomes, with the robotic approach demonstrating comparable safety and feasibility. Length of stay, blood loss, operative duration, morbidity, and mortality showed no significant differences between the two groups. Major complications (Clavien-Dindo score ≥ III) occurred in 4% of non-redo patients, with none observed in the redo group. The findings suggest that patients undergoing redo robotic hepatectomies achieve outcomes comparable to those of primary hepatectomy patients. This indicates the potential of robotic platforms to mitigate the added complexities and risks associated with redo hepatectomies. Further multi-center collaboration is necessary to validate these findings.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143410749","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 to: Immediate repair of the recurrent laryngeal nerve during thyroid surgery via a tension-free end-to-side anastomosis with the Vagus.","authors":"Mehmet Eşref Ulutaş","doi":"10.1007/s13304-025-02132-1","DOIUrl":"https://doi.org/10.1007/s13304-025-02132-1","url":null,"abstract":"","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143410465","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":"Omental patch as prevention for bile leak in patients undergoing subtotal cholecystectomy: a propensity score analysis.","authors":"Camilo Ramírez-Giraldo, Violeta Avendaño-Morales, Alejandro González-Muñoz, Isabella Van-Londoño, Juan Felipe Díaz-Castrillón, Andrés Isaza-Restrepo","doi":"10.1007/s13304-025-02129-w","DOIUrl":"https://doi.org/10.1007/s13304-025-02129-w","url":null,"abstract":"<p><p>Subtotal cholecystectomy is one of the most frequent bail-out procedures performed during difficult cholecystectomy. A common complication to this procedure is bile leak, and thus multiple strategies have been created to avoid its appearance. This study aims to evaluate the effectivity of using an omental patch as bile leak prevention in patients undergoing subtotal cholecystectomy. A retrospective cohort study including patients who underwent subtotal cholecystectomy between 2014 and 2022 was performed. 17 patients had an omental patch, while 378 did not; the latter were included to evaluate surgical outcomes with bile leak as a primary outcome using a propensity score matching analysis (PSM). Patients' median age in both groups after PSM was 71.00 (IQR: 59.00-81.00) and 69.00 (IQR: 61.75-80.25) years, respectively. The dominant sex in both groups was male. In most cases surgical procedure indication was cholecystitis. Patients who had an omental patch did not present statistically significant differences for bile leak rates compared to patients who did not (29.4% versus 17.6%, p = 0.456, respectively). Similar results were observed when evaluating the need for postoperative ERCP for bile leak management (23.5 versus 5.9%, p = 0.078). A statistically significant higher proportion of major complications were observed in patients who had an omental patch (47.1% versus 19.1%, p = 0.038). Pedicled omental patch was not an effective measure for preventing bile leak, and it even presented a higher rate of complications. It is thus imperative to continue evaluating other strategies for the prevention of bile leak during subtotal cholecystectomy.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400061","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 role of the comprehensive complication index in the prediction of tumor-related death in transplanted patients with hepatocellular carcinoma.","authors":"Quirino Lai, Fabio Melandro, Alessandro Vitale, Davide Ghinolfi, Laurent Coubeau, Riccardo Pravisani, Greg Nowak, Federico Mocchegiani, Marco Vivarelli, Massimo Rossi, Bo-Göran Ericzon, Umberto Baccarani, Paolo De Simone, Umberto Cillo, Jan Lerut","doi":"10.1007/s13304-025-02101-8","DOIUrl":"https://doi.org/10.1007/s13304-025-02101-8","url":null,"abstract":"<p><p>Liver transplantation (LT) is the primary treatment for selected patients with hepatocellular carcinoma (HCC). However, HCC-related mortality post-LT remains a significant concern, with up to 10% of cases reported in international series. Identifying risk factors for adverse clinical outcomes is essential. We hypothesized that post-LT HCC-related mortality rates are higher in patients with a high (≥ 42) Comprehensive Complication Index (CCI) calculated at discharge. This study aims to compare post-LT HCC-related mortality rates between two groups of patients with high versus low CCI following LT for HCC. This study included data from seven collaborative European centers. A cohort of 1121 HCC patients transplanted between 2005 and 2019, surviving more than six months post-LT, was analyzed retrospectively. Patients were divided into two groups based on the CCI at discharge: Low-CCI Group (n = 942, 84.0%) and High-CCI Group (n = 179, 16.0%). An inverse probability of treatment weighting (IPTW) approach was applied for analysis. In the post-IPTW cohort, four multivariable logistic regression models with mixed effects identified independent risk factors for HCC-related death, overall death, recurrence, and early recurrence. A CCI score of ≥ 42 emerged as an independent risk factor across all models. Specifically, CCI ≥ 42 was associated with increased odds of HCC-related death (OR = 3.35; P < 0.0001), overall death (OR = 2.63; P < 0.0001), overall recurrence (OR = 2.09; P = 0.001), and early recurrence (OR = 1.88; P = 0.02). A CCI score at discharge should be considered a critical factor for recurrence and HCC-related mortality risk. Incorporating CCI into standard post-LT predictive models may enhance prognostic accuracy for adverse HCC outcomes.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143383139","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 effectiveness of two-step percutaneous transhepatic choledochoscopic lithotripsy for hepatolithiasis: a retrospective study.","authors":"Peng Chen, Mingxin Bai, Ruotong Cai, Meiling Chen, Zheyu Zhu, Feifan Wu, Yunbing Wang, Xiong Ding","doi":"10.1007/s13304-025-02118-z","DOIUrl":"https://doi.org/10.1007/s13304-025-02118-z","url":null,"abstract":"<p><p>The study was designed to compare the effectiveness of two-step percutaneous transhepatic choledochoscopic lithotripsy (T-PTCSL) with laparoscopic anatomical hepatectomy combined with choledocholithotomy (LAHC) for patients with hepatolithiasis. From January 2020 to September 2023, 98 patients who underwent LAHC (n = 40) or T-PTCSL (n = 58) for hepatolithiasis in our hospital were included in this study. Their perioperative and long-term outcomes were analyzed. There was no statistical difference between the two groups in stone clearance rates (90.0% vs. 84.5%, P = 0.429) and postoperative complication rates (35.0% vs. 22.4%, P = 0.170). The T-PTCSL group had significantly shorter operative time, postoperative hospitalization, and intake time (all P < 0.001). Postoperative biochemical indices showed lower ALB, ALT, AST, and WBC in the T-PTCSL group compared to the LAHC group (all P < 0.05). Multivariate logistic regression indicated age as an independent risk factor for stone clearance (OR = 0.94, 95% CI = 0.89-0.99, P = 0.049). Subgroup analysis showed no significant impact of gender and type of stone distribution on stone clearance (all P > 0.05). The KM curve analysis revealed no significant difference in stone recurrence between the groups (log-rank P = 0.925). Hemoglobin concentration was significantly associated with time-to-stone recurrence (TR = 1.02, 95% CI = 1.01-1.04, P < 0.05) in the multivariate Accelerated Failure Time Model. T-PTCSL may be an alternative option to LAHC. Compared with LAHC, T-PTCSL offers favorable postoperative recovery and less surgical injury for patients with hepatolithiasis, as well as equivalent effectiveness of stone clearance and recurrence.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143391857","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":"Surgical techniques using low-power monopolar scissors in robotic-assisted thoracic surgery.","authors":"Tatsuo Nakagawa, Yuki Ohsumi, Ei Miyamoto, Masashi Gotoh","doi":"10.1007/s13304-025-02099-z","DOIUrl":"https://doi.org/10.1007/s13304-025-02099-z","url":null,"abstract":"<p><p>We analyzed the electrical characteristics of the da Vinci system's low-power monopolar coagulation mode with an electrocautery analyzer to determine its suitability as an alternative to monopolar soft coagulation mode. The voltage at the plateau of the power limit between 15 and 16 W and between 23 and 24 W of the forced coagulation mode of the da Vince system was close to that of the effect 8 and 10 of the soft coagulation mode, respectively. Experiments using chicken meat and an infrared thermographic camera confirmed the safety and effectiveness of low-power monopolar coagulation mode showing no carbonization at temperatures below 90 °C. In 73 robotic-assisted lung resection using low-power coagulation mode, no electric spark or carbonization was observed and all cauterizations were similar to soft coagulation mode. In conclusion, Forced coagulation mode of the da Vinci system can be used as an alternative to monopolar soft coagulation mode with appropriate effect and power limit settings.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143374818","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":"LapAppendectomy4all: validation of a new methodology for laparoscopic appendectomy simulation and training.","authors":"Mário Rui Gonçalves, Ricardo Marinho, Sofia Gaspar Reis, Ricardo Viveiros, Manuel Moutinho Teixeira, Ana Kam Andrade, Maria do Carmo Girão, Pedro Pina-Vaz Rodrigues, Miguel Castelo-Branco Sousa","doi":"10.1007/s13304-025-02127-y","DOIUrl":"https://doi.org/10.1007/s13304-025-02127-y","url":null,"abstract":"<p><p>Appendectomy, whether open or minimally invasive (MIS) is one of the most frequent procedures performed by young residents. We designed and tested a new methodology and a new inexpensive silicone model for Laparoscopic Appendectomy (LA) simulation. This study aimed to assess their fidelity, usefulness and educational value in an introduction to laparoscopy course. The course was open to first-year general surgery residents. The group was divided in two and one of the groups watched a video of the procedure before the simulation. Individual performances were assessed directly on the models, using a specific assessment scale. Participants answered a questionnaire at the end of the course for evaluation. Thirty-five residents participated in this study. Execution, quality, and global performance were higher in the group that had more experience with the model. Thirty-two trainees (91%) answered the questionnaire. There was a strong agreement that the model was adequate for this type of course and face and content validity was considered high/very high. Participants strongly agreed that this model gives more confidence to perform a real LA and almost 97% (n = 31) considered they have learned solid foundations about LA. This study shows face, content and construct validation and also educational value for this new low-cost, laparoscopic appendectomy model. The integration of this model in an introduction to laparoscopy course showed good results in regard to an increase of confidence among first-year surgery residents. It can be a valuable tool for learning and training laparoscopic appendectomy.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143374800","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 implementation of eras in Belgian esophageal surgery centers.","authors":"Yaliva Dorreman, Hanne Vanommeslaeghe, Piet Pattyn, Claude Bertrand, Lieven Depypere, Hans Van Veer, Philippe Nafteux, Yves Van Nieuwenhove, Elke Van Daele","doi":"10.1007/s13304-025-02063-x","DOIUrl":"10.1007/s13304-025-02063-x","url":null,"abstract":"<p><p>Esophagectomy for cancer is a highly invasive procedure with significant post-operative morbidity and mortality. The literature suggests a clear volume outcome correlation. Since 2019, esophageal surgery has been centralized in Belgium. In 2019, enhanced recovery after surgery (ERAS) guidelines were published for esophagectomy. The purpose of this study was to evaluate the level of implementation of these ERAS guidelines in Belgium. Surgeons from centralized esophageal surgery centers in Belgium were questioned. A Delphi questionnaire regarding peri-operative ERAS care and center-specific outcome data were sent to all participating surgeons. An ERAS scoring system was created to estimate and compare the level of ERAS implementation. Length of stay, post-operative pneumonia, anastomotic leakage and 30-day and 90-day mortality were evaluated. A high response rate of 94.1% was achieved. All surgeons used a peri-operative protocol in their center. The mean ERAS score for Belgian surgeons was 15.5 out of 20. The highest ERAS score per center is 18.6. Anastomotic leakage rate is 14.6% and post-operative pneumonia rate is 20.8% in Belgium. The mean length of stay is 12 days. Mortality after 30 days and 90 days are, respectively, 3.2% and 6.6%. This study gives an overview of the Belgian situation regarding the implementation of ERAS protocols in esophageal surgery centers. The overall implementation of ERAS guidelines in Belgium is good, but there is room for improvement in terms of uniformity nationally.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143374824","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":"Voiding dysfunction after surgery for colorectal deep infiltrating endometriosis: an updated systematic review and meta-analysis.","authors":"Alexandra Madar, Adrien Crestani, Patrick Eraud, Andrew Spiers, Alin Constantin, Fréderic Chiche, Elise Furet, Pierre Collinet, Cyril Touboul, Benjamin Merlot, Horace Roman, Yohann Dabi, Sofiane Bendifallah","doi":"10.1007/s13304-025-02124-1","DOIUrl":"https://doi.org/10.1007/s13304-025-02124-1","url":null,"abstract":"<p><p>To define the risk factors of post-operative voiding dysfunction according to the type of surgical procedure performed. A systematic review through PubMed, the Cochrane Library, and Web of Science databases was performed. The Medical Subject Headings terms aimed for English articles about colorectal endometriosis surgery and voiding dysfunction published until December 26, 2022 were used. The primary outcome was the occurrence of post-operative voiding dysfunction. Secondary outcome was the presence of a persistent voiding dysfunction at 1 month. MeSH terms included ''deep endometriosis'', ''surgery'', or ''voiding dysfunction''. Two reviewers (AM, PE) assessed the quality of each article independently. A Study Quality Assessment Tool was used to provide rating of the quality of the included studies. 22 studies were included in the final analysis. Rectal shaving was associated with less voiding dysfunction than segmental resection (OR 0.33; 95%CI [0.20: 0.54]; I² = 0%; p < 10^-3). No difference was found between rectal shaving and discoid excision (OR 0.44; 95%CI [0.07: 2.84]; I² = 55%; p = 0.39), nor between discoid excision and segmental resection (OR 0.44; 95%CI [0.18: 1.09]; I² = 49%; p = 0.08). Conservative surgery (i.e., shaving and discoid) was associated with less voiding dysfunction than radical surgery (i.e., segmental resection) (OR 0.37; 95%CI [0.25: 0.55]; I² = 0%; p < 10^-3). Regarding persistent voiding dysfunction, rectal shaving and discoid excision were less associated with voiding dysfunction than segmental resection (respectively, OR 0.30; 95%CI [0.14: 0.66]; I² = 0%; p = 0.003 and OR 0.13; 95%CI [0.03: 0.57]; I² = 0%; p = 0.007). Conservative bowel procedures are associated with lower rates of persistent post-operative voiding dysfunction and should be considered first when possible.Trial registration: Our meta-analysis was registered under the PROSPERO number: CRD42023395356.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143371213","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}