Updates in Surgery最新文献

{"title":"Portal vein pressure after PVE: a promising metric with scope for broader validation.","authors":"Muhammad Hamza, Farrah Gardezi, Javed Iqbal","doi":"10.1007/s13304-025-02421-9","DOIUrl":"https://doi.org/10.1007/s13304-025-02421-9","url":null,"abstract":"","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145087667","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":"Transforming robotic hepatectomy outcomes: a comparative analysis before and after ERAS protocol implementation.","authors":"Kristina Milivojev Covilo, Stella J Pagano, Sharona B Ross, Alona Bilik, Garnet Vanterpool, Iswanto Sucandy","doi":"10.1007/s13304-025-02399-4","DOIUrl":"https://doi.org/10.1007/s13304-025-02399-4","url":null,"abstract":"<p><p>Since its development, Enhanced Recovery After Surgery (ERAS) protocol has generally improved patient outcomes and enhanced peri-operational organization. The protocol includes less intraoperative invasiveness and enhances perioperative mobility and nutrition. Robotic technology has demonstrated similar benefits, particularly in complex hepatobiliary resections. This study describes comparative outcomes of robotic hepatectomy before and after ERAS protocol implementation in our program. With Institutional Review Board (IRB) approval, 609 patients who underwent robotic liver resection between 2013 and 2024 were retrospectively analyzed. A total of the first 65 patients were excluded to eliminate the impact of a learning curve. The remaining 544 patients were divided into 2 groups based on ERAS protocol use. Propensity score matching 1:2 was applied according to age, BMI, tumor size, tumor type, and extent of liver resection. Perioperative outcomes of pre-ERAS and post-ERAS groups were compared. Patients in the post-ERAS group more frequently had coronary artery disease (5.7% vs. 10.6%) and hypertension (5.7% vs 57%), whereas patients in the pre-ERAS group more frequently had heart disease (46.2% vs 11.1%). Estimated blood loss (EBL) decreased (214.7(150.0) ± 250.9 vs. 141.7(100.0) ± 151.5) in the post-ERAS group. A decrease in 90-day readmission rate was also observed in the post-ERAS group (22.6% vs. 13.4%). A propensity score-matched comparison of robotic hepatectomy outcomes before and after ERAS protocol showed improvement in perioperative outcomes, with lower estimated blood loss and fewer 90-day readmissions.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145087723","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":"Skin-to-portal junction distance as a simple CT-based predictor of pancreatic fistula after pancreaticoduodenectomy: a validated model.","authors":"Shinichi Ikuta, Tsukasa Aihara, Takayoshi Nakajima, Masataka Fujikawa, Naoki Yamanaka","doi":"10.1007/s13304-025-02397-6","DOIUrl":"https://doi.org/10.1007/s13304-025-02397-6","url":null,"abstract":"<p><p>Clinically relevant postoperative pancreatic fistula (CR-POPF) remains a significant concern after pancreaticoduodenectomy (PD), increasing morbidity and mortality. This retrospective study evaluated the skin-to-portal junction distance (SJD), a simple CT-based metric, as a predictor of CR-POPF and developed a validated predictive model for risk stratification. The study included 305 patients undergoing open PD, divided into training (n = 214) and validation (n = 91) cohorts. Sex-specific SJD cutoffs were determined using receiver operating characteristic analysis. Logistic regression identified CR-POPF risk factors and built the model, assessed by area under the curve (AUC), calibration plots, and decision curve analysis (DCA). CR-POPF occurred in 23.9% of patients overall, with incidences of 23.4% and 25.3% in the training and validation cohorts, respectively. High SJD (≥ 78 mm for males, ≥ 64 mm for females; odds ratio [OR] 5.140), main pancreatic duct diameter ≤ 3 mm (OR 2.720), non-pancreatic ductal adenocarcinoma (OR 3.820), and soft pancreatic texture (OR 2.660) were independent predictors. The model achieved AUCs of 0.832 in the training cohort and 0.806 in the validation cohort, with good calibration and clinical utility as shown by DCA. These results compared favorably with the Fistula Risk Score (FRS) and alternative-FRS. The high SJD group had a higher incidence of CR-POPF (36.3% vs. 14.1%, p < 0.001), longer operative time (p = 0.004), greater blood loss (p = 0.047), and more major complications of Clavien-Dindo grade ≥ III (p < 0.001). SJD is a simple, objective predictor of CR-POPF. The validated model facilitates perioperative risk stratification; however, external validation is needed.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145081861","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":"Robotic adrenalectomy: comparison of DaVinci, HUGO™-RAS and Versius^® platforms-a preliminary retrospective analysis.","authors":"Priscilla Francesca Procopio, Francesco Pennestrì, Pierpaolo Gallucci, Antonio Laurino, Annamaria Martullo, Carmela De Crea, Marco Raffaelli","doi":"10.1007/s13304-025-02414-8","DOIUrl":"https://doi.org/10.1007/s13304-025-02414-8","url":null,"abstract":"<p><p>Robot-assisted adrenalectomy (RAA) has emerged as an advantageous approach in challenging cases and suspicious lesions, although high costs represent the main drawback to its broader application. Besides Da-Vinci, new platforms have been recently launched on the market and need to be validated in clinical practice. DaVinci, HUGO™-RAS and Versius^® platforms were introduced in our center in 2012, 2022, and 2024, respectively. We aimed to compare the perioperative outcomes of these robotic platforms. Among 730 adrenalectomies (2012-2024), 149 (20.4%) RAAs were performed. All procedures performed by means of HUGO™-RAS and Versius^® platforms were compared with similar procedures (in terms of patient's and lesion's features) performed with the DaVinci technology in the same period (2022-2024). Ten patients were included in each group. Patients' and lesions' features were similar. Median BMI and lesions' size were 27.9, 24.9, and 26.1 kg/m² and 42.5, 42.5, and 32.5 mm in DaVinci, HUGO™-RAS, and Versius^® groups, respectively (p = 0.360, p = 0.236). The groups were comparable for docking time, console time, and operative time (5 vs. 5 vs. 7 min, p = 0.059, 58.5 vs. 58 vs. 39 min, p = 0.393, 109.5 vs. 110.5 vs. 104.1 min, p = 0.668, respectively). No conversion or perioperative complications were registered. Postoperative hospital stays were similar (2 days in all groups, p = 0.629). RAA, whatever platform is used, confirmed to be a safe and effective approach, potentially expanding indications for minimally invasive adrenalectomy. Even though new platforms have been applied in less demanding cases in our learning curve phase, the introduction of new different platforms may lead to a costs reduction, thus to a broader diffusion of RAA.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145081933","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":"Analysis on clinicopathological characteristics and prognostic factors of adenoma-associated gallbladder carcinoma.","authors":"Rui-Qi Zou, Fei Liu, Si-Qi Yang, Yu-Shi Dai, Hai-Jie Hu, Fu-Yu Li","doi":"10.1007/s13304-025-02413-9","DOIUrl":"https://doi.org/10.1007/s13304-025-02413-9","url":null,"abstract":"<p><p>Gallbladder adenomas are relatively rare in clinical practice, which have tendency of malignant transformation. There might be differences in biological characteristics and prognosis between gallbladder carcinoma (GBC) associated and not associated adenoma. Few related literatures have been reported. All consecutive patients who underwent curative-intent resection for GBC at our institution between 2009 and 2021 were retrospectively analyzed. Clinicopathological characteristics and overall survival (OS) were compared between the two groups, including a propensity score-matched analysis. The clinicopathologic data and OS of 359 GBC patients were retrospectively analyzed, including 88 adenoma-associated GBC (AAGBC) and 271 conventional GBC cases. The clinicopathological characteristics and prognosis of AAGBC are significantly different from those of conventional GBC. AAGBC showed relatively earlier tumor stage, lower incidence of liver invasion and lymph node metastasis, better tumor differentiation degree, lower tumor marker levels and lower gallstone correlation (all P < 0.05). Meanwhile, the OS of AAGBC patients were significantly better (40.0 vs. 26.0 months, P < 0.001). Survival differences persisted even after propensity score matching (40.0 vs. 34.0 months, P = 0.038). Differences on tumor marker levels and tumor differentiation degree also remains significantly. Further multivariate analysis determined that tumor stage, tumor differentiation degree, vascular invasion and surgical margin were independent prognostic factors of AAGBC patients. No significant difference was found in clinicopathological characteristics and survival among AAGBC from three different adenoma sub-types. AAGBC are often found in the relatively early stage, and exhibit milder biological behaviors and better prognosis. However, it is still far from optimistic. Therefore, patients with gallbladder adenoma should be regularly followed up and those of high malignant transformation risk should be promptly performed laparoscopic cholecystectomy.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145081868","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":"Unappreciated, undervalued, and working in a toxic environment: the silent struggles of some surgeons.","authors":"Michael El Boghdady","doi":"10.1007/s13304-025-02396-7","DOIUrl":"https://doi.org/10.1007/s13304-025-02396-7","url":null,"abstract":"","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145076216","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":"Rethinking postoperative antibiotics in complicated appendicitis: is less enough? Reply to the Commentary on: \"Postoperative antibiotic strategies in acute complicated appendicitis: a systematic review\".","authors":"Michael El Boghdady","doi":"10.1007/s13304-025-02394-9","DOIUrl":"https://doi.org/10.1007/s13304-025-02394-9","url":null,"abstract":"","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145081898","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":"Preoperative smoking cessation interventions and their effects on smoking abstinence and postoperative outcomes: a systematic review and meta-analysis.","authors":"Sultan Alhabdan, Abdalkareem Alashjaai, Yusuff Adebayo Adebisi","doi":"10.1007/s13304-025-02409-5","DOIUrl":"https://doi.org/10.1007/s13304-025-02409-5","url":null,"abstract":"<p><p>Smoking is a significant risk factor for postoperative complications, including cardiovascular, pulmonary, and wound-related issues. Pre-operative smoking cessation is widely recommended to mitigate these risks, but the effectiveness of different interventions remains uncertain. This study aims to evaluate the effectiveness of pre-operative smoking cessation interventions in reducing smoking rates and postoperative complications across various surgical settings. A comprehensive search was conducted across databases including Medline/PubMed, Embase, CINAHL, And CENTRAL, up to July 2024, following PRISMA guidelines. Randomized controlled trials (RCTs) assessing the effectiveness of pre-operative smoking cessation interventions were included. Data were extracted on intervention types, smoking cessation outcomes, and postoperative complications. The Cochrane Collaboration tool was used to assess the risk of bias, and a random-effects meta-analysis was performed to pool the results. Certainty of evidence was assessed using the GRADE approach. Out of 9,188 studies identified, 24 met the inclusion criteria, encompassing 4,763 patients. The pooled analysis revealed that pre-operative smoking cessation interventions probably increase the likelihood of smoking cessation before surgery (RR = 1.98, 95% CI: 1.53-2.56; moderate-certainty evidence), although there was heterogeneity among the studies (I²= 83.30%). Additionally, these interventions probably reduce overall postoperative complications by 27% (RR = 0.73, 95% CI: 0.58-0.94; moderate-certainty evidence), with moderate heterogeneity (I² = 49.06%). However, they may have a non-significant impact on wound-related complications (RR = 0.63, 95% CI: 0.33-1.20; low-certainty evidence). Preoperative smoking cessation interventions probably increase short-term abstinence and likely to reduce the risk of overall postoperative complications. However, their impact on wound-related complications may be limited and remains uncertain.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070635","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 effect of mesh type on pain, quality of life and postoperative complications in patients undergoing total extraperitoneal (TEP) technique for laparoscopic inguinal hernia repair.","authors":"Burak Sakar, Kemal Eyvaz, Arzu Karaveli, Omer Celik, Turan Can Yıldız, Ali Celik, Nedim Akgul","doi":"10.1007/s13304-025-02400-0","DOIUrl":"https://doi.org/10.1007/s13304-025-02400-0","url":null,"abstract":"<p><p>This study aims to compare the effects of anatomical polypropylene mesh (APM) and non-anatomical polypropylene mesh (NAPM) on postoperative pain, quality of life, and complications in patients undergoing inguinal hernia repair using the laparoscopic total extraperitoneal (TEP) technique. In this single-center, retrospective study, data from 88 patients who underwent surgery using the TEP technique between January and November 2023 and met the eligibility criteria were analyzed (APM group: n = 44; NAPM group: n = 44). The primary endpoint of the study was to compare the effect of APM and NAPM mesh types on postoperative 6th-hour VAS scores. The comparison of SF-36 questionnaire results and VAS scores at other time points was defined as the secondary endpoints of the study. The mean (SD) postoperative 6th-hour VAS score was significantly lower in the APM group than in the NAPM group [2.20 (0.90) vs. 2.98 (1.19); p = 0.001]. In addition, the mean (SD) VAS scores at the 1st hour, 24th hour, and 10th day were significantly lower in favor of the APM group (p = 0.008, p = 0.001, and p = 0.030, respectively). However, the mean (SD) VAS scores at the 3rd postoperative month were similar between the groups (p = 0.909). No significant difference was observed between the two groups in the SF-36 questionnaire results (p > 0.05). The postoperative complication rates were similar between the groups (APM: 13.7%, NAPM: 11.4%; p = 0.603). The operation time was significantly shorter in the APM group (p = 0.018). The use of APM for laparoscopic inguinal hernia repair reduces early postoperative pain and shortens operation time. However, it offers similar results to NAPM in terms of quality of life and development of postoperative complications. These findings suggest that APM may be an effective alternative to laparoscopic inguinal hernia repair; however, we are of the opinion that larger-scale, prospective, and randomized-controlled studies are needed to better evaluate long-term outcomes.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145065694","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":"Pancreatic anastomosis in minimally invasive pancreaticoduodenectomy: a systematic review of detailed techniques.","authors":"Marzia Tripepi, Isabella Frigerio, Roberto Girelli, Alessandro Giardino, Giovanni Butturini","doi":"10.1007/s13304-025-02381-0","DOIUrl":"https://doi.org/10.1007/s13304-025-02381-0","url":null,"abstract":"<p><p>Minimally invasive pancreaticoduodenectomy is gaining success among surgeons also for the increasing use of robotic approach. Ideal candidates are patients with small, confined tumor and dilatated Wirsung duct which is a quite rare clinical conditions: in fact, most of minimally invasive pancreaticoduodenectomies are performed for periampullary cancer, easy to remove but with soft pancreatic remnant and tiny Wirsung duct. The result is the technical challenge of the pancreatico-enteric reconstructions. Moreover, most authors reported quite acceptable rate of clinically relevant post-operative pancreatic fistula after these complex procedures without detailed description of their reconstruction techniques. A systematic search of the literature was performed identifying relevant articles between 2012 and July 2023 about minimally invasive pancreaticoduodenectomy. The inclusion criteria were studies giving a detailed description (including iconography) of the pancreatic anastomosis during laparoscopic or robotic pancreatoduodenectomy. The aim of this review is to focus on the technical aspects of pancreatico-enteric reconstruction, considering only those studies reporting detailed description of the anastomosis with clear illustrations with the intent to allow to readers to successfully reproduce the technique. Among all reported studies, the double layer pancreaticojejunostomy with duct-to-mucosa, in association with duct stenting, is the preferred anastomosis. According with this review the double layer pancreaticojejunostomy with duct-to-mucosa is the preferred anastomosis during minimally invasive pancreaticoduodenectomy. Other RCT should be advocated to reach strong evidence for a uniformly adopted reconstruction method.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145030605","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}