Updates in Surgery最新文献

{"title":"Esophageal high-resolution manometry and 24 h pH-impedance monitoring normative values in patients with obesity candidate for bariatric and metabolic surgery.","authors":"Salvatore Tolone, Edoardo Vincenzo Savarino, Nicola De Bortoli, Francesco Saverio Lucido, Claudio Gambardella, Luigi Brusciano, Simona Parisi, Gianmattia Del Genio, Roberto Ruggiero, Ludovico Docimo","doi":"10.1007/s13304-025-02167-4","DOIUrl":"https://doi.org/10.1007/s13304-025-02167-4","url":null,"abstract":"<p><p>Obesity is linked to increased risk of gastroesophageal reflux disease (GERD) and esophageal motility disorders, both of which may impact outcomes in metabolic and bariatric surgery (MBS). GERD pathophysiology in obesity includes elevated intraabdominal pressure and altered esophagogastric junction (EGJ) function. High resolution manometry (HRM) and 24-h esophageal pH-impedance (MII-pH) monitoring are vital in evaluating GERD, yet normative values specific to populations with obesity are limited, risking misdiagnosis if lean data are used. This study establishes normative HRM and MII-pH values in asymptomatic individuals with obesity, compared to normal-weight controls, to guide accurate diagnosis and treatment. A retrospective analysis was conducted on asymptomatic patients with obesity (BMI ≥ 30) and normal-weight controls (BMI 20-25) who underwent HRM and MII-pH prior to MBS between 2015 and 2024. Exclusion criteria included GERD symptoms, esophagitis, and prior gastrointestinal surgery. Key HRM parameters (LES pressure, EGJ morphology) and MII-pH metrics (acid exposure time, reflux episodes) were recorded and analyzed. Of the 96 patients with obesity and 25 normal-weight participants, significant differences in HRM and MII-pH results were observed. Individuals with obesity showed increased intra-gastric pressure, gastroesophageal pressure gradient, and higher acid exposure time. While LES pressure and EGJ morphology were similar to controls, participants with obesity exhibited distinct reflux patterns, especially postprandial, suggesting obesity-specific physiological changes. This study establishes normative HRM and MII-pH values for asymptomatic individuals with obesity, highlighting critical differences from normal-weight controls. Obesity-specific diagnostic criteria are essential for accurate GERD diagnosis, particularly for MBS candidates, to improve management and predict potential postoperative complications.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626199","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":"Does the surgical approach affect the incidence of postoperative atrial fibrillation after thoracic surgery? A systematic review and meta-analysis.","authors":"Debora Brascia, Giuseppe Mangiameli, Veronica Maria Giudici, Emanuela Re Cecconi, Matilde Luppichini, Giuseppe Marulli","doi":"10.1007/s13304-025-02164-7","DOIUrl":"https://doi.org/10.1007/s13304-025-02164-7","url":null,"abstract":"<p><p>Postoperative atrial fibrillation (PAF) is a common complication after lung resection, since surgical stress may act as a trigger. The VATS approach reduces surgical stress and alleviates inflammation and oxidative stress commonly associated with open lung surgery. However, only a few studies have investigated the possible impact of the surgical approach on the incidence of PAF. A literature review was performed through PubMed, EMBASE, and Google Scholar in March 2024, to identify any study published since 2000 evaluating the role of the VATS vs the open approach to perform lung resections as a risk factor for postoperative atrial fibrillation. Pooled odds ratio (OR) estimates with 95% confidence intervals (CIs) were calculated. Twenty-one studies, including 59,101 patients, met the criteria for inclusion. Both propensity-matched and non-matched data showed that VATS was associated with a significant reduction in PAF compared to open thoracotomy (OT) (OR 0.73; 95% CI 0.58-0.91; I2 = 10.1%, p = 0.349). A meta-regression was conducted to explore contributing factors, showing the geographic regions in which the studies were conducted may be a significant source of heterogeneity. Subgroup analyses revealed less heterogeneity in studies conducted in Europe and on those focused solely on lobectomy. Postoperative atrial fibrillation risk following VATS is significantly lower than OT. Further prospective randomized controlled trials with large sample sizes are needed to confirm these findings.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626195","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":"Diagnosis and management of caustic ingestion: an interdisciplinary nationwide cross-sectional survey from the Italian society of endoscopic surgery and new technologies (SICE), the Italian society of digestive endoscopy (SIED), the world society of emergency surgery-Italy chapter (WSESit), and the Italian society of surgical endoscopy and digestive diseases (ISSE).","authors":"Alessio Giordano, Manuela Mastronardi, Mauro Podda, Luigi Bonavina, Diego Cuccurullo, Gabriele Anania, Carlo Bergamini, Giuseppe Galloro, Cesare Hassan, Maria Caterina Parodi, Ferdinando Agresta, Giulia Montori, Massimo Sartelli, Fausto Catena, Paola Fugazzola, Luca Ansaloni, Emanuele Marciano, Girolamo Geraci, Attilio Maurano, Manuela Avellino, Arianna Massella, Beatrice Orlandini","doi":"10.1007/s13304-025-02166-5","DOIUrl":"https://doi.org/10.1007/s13304-025-02166-5","url":null,"abstract":"<p><p>Caustic ingestion (CI) in adults represents a potentially life-threatening condition. Diagnosis and management of CI in real life remain challenging. The aim of the survey is to evaluate on a national scale the multidisciplinary management of these patients. 24-item online Survey was sent to the mailing lists and social media of Italian Society of Endoscopic Surgery and New Technologies, Italian Society of Digestive Endoscopy, World Society of Emergency Surgery-Italy Chapter, and Italian Society of Surgical Endoscopy and Digestive Diseases. Overall, 240 subjects answered to the survey, corresponding to 22.1% of the total members of the scientific societies involved. 131 (54.5%) respondents evaluated fewer than ten CI patients per year. The recommendations provided by the WSES and SIED guidelines were followed by 133 (55.2%) and 83 (34.4%) participants, respectively. Emergency surgery was advocated by 180 (77.6%) of the respondents for patients with transmural necrosis or signs of perforation, using minimally invasive surgery in 47% of the cases and considering initial esophagojejunal anastomosis as safe in 33 (14.2%) of the responses. Our study is the first to provide real-life data on how the management of CI varies across Italian physicians, according to regional, institutional, and specialty-related factors. This survey highlights the need for standardized and uniform guidelines.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626190","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 plastic surgery: an innovative role of Chat GPT in plastic surgery practices.","authors":"Esmaeil Mehraeen, Niloofar Attarian, Amir Tabari, SeyedAhmad SeyedAlinaghi","doi":"10.1007/s13304-025-02149-6","DOIUrl":"https://doi.org/10.1007/s13304-025-02149-6","url":null,"abstract":"<p><p>The proliferation of artificial intelligence (AI) in the healthcare sector is a present reality. The potential applications of Chat GPT in medicine are currently undergoing intense examination. This article seeks to examine the innovative capabilities and applications of Chat GPT in this field, highlighting its potential to revolutionize patient care and decision-making processes. PubMed, Scopus, Embase, Google Scholar, and Web of Science were searched by conducting a keyword search to locate studies examining the application of Chat GPT in the realm of plastic and reconstructive surgery. The titles, abstracts, and conclusions of the studies were scrutinized to select those most closely aligned with the focus of our study. This investigation involved a comprehensive review of 15 relevant articles from diverse geographical regions predominantly comprising original studies alongside five review articles. This study illustrates the significant promise of integrating Chat GPT across diverse areas of plastic surgery, encompassing research, surgeon and patient education, and clinical practice. However, the incorporation of Chat GPT into plastic surgery necessitates diligent oversight and the formulation of explicit guidelines and caution is necessary.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143606503","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":"Systemic effect of sympathectomy in the treatment of localized hyperhidrosis.","authors":"Mehmet Çetin, Furkan Süral, İlteriş Türk, Necati Solak, Kenan Sönmez, Koray Aydoğdu","doi":"10.1007/s13304-025-02163-8","DOIUrl":"https://doi.org/10.1007/s13304-025-02163-8","url":null,"abstract":"<p><p>Hyperhidrosis is thought to result from excessive stimulation of sweat glands due to increased sympathetic activity; however, data on systemic responses following bilateral thoracic sympathectomy as the definitive treatment have not yet been sufficiently evaluated. This study, designed as a prospective cohort investigation, included 24 patients who underwent sympathectomy for palmar and axillary hyperhidrosis at our center in 2023, along with an age-matched control group of equal size. In the sympathectomy group, pupillometry measurements were performed 1 day before surgery and on the 7th postoperative day, while the control group underwent measurements at corresponding intervals. Data from the sympathectomy group were analyzed both preoperatively and postoperatively and compared with the control group. According to the Hyperhidrosis Disease Severity Scale, all patients had severe hyperhidrosis. Sympathectomy was performed at the T3 level in 9 patients and at both T3 and T4 levels in 15 patients. The postoperative satisfaction rate was recorded as 95.8%. No statistically significant differences were observed between preoperative pupillometry measurements of the sympathectomy group and those of the control group. However, when comparing preoperative and postoperative data within the sympathectomy group, significant differences favoring increased parasympathetic activity were noted in the latency of contractions and photopic low values (p = 0.016 and p = 0.038, respectively). Our study is one of the pioneering works to objectively demonstrate, through a quantitative method, that sympathectomy for hyperhidrosis enhances the parasympathetic system response in the ocular region.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143597963","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":"Technical note: biliary reconstruction in living-donor liver transplant.","authors":"Henrik Petrowsky, Cristiano Guidetti, Stefano Di Sandro, Fabrizio Di Benedetto","doi":"10.1007/s13304-024-02057-1","DOIUrl":"https://doi.org/10.1007/s13304-024-02057-1","url":null,"abstract":"<p><p>Biliary reconstruction is key point to successful outcomes in living-donor liver transplantation (LDLT). Despite the different described technique, a high rate of biliary complication is reported in this procedure. Many mitigation strategies have been presented but still there is no consensus on the best option for biliary reconstruction in LDLT. We herein present three different techniques that can be used after adequate evaluation of grafts' and recipients' characteristics.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143587203","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 postoperative recurrent postoperative ileus on the prognosis of colorectal cancer: a propensity score matched study.","authors":"Run Xie, Cuiping Qiu, Runsheng Lai, Zhipeng Que, Shuangming Lin, Dongbo Xu","doi":"10.1007/s13304-025-02142-z","DOIUrl":"https://doi.org/10.1007/s13304-025-02142-z","url":null,"abstract":"<p><p>To assess the correlation between recurrent postoperative ileus (RPOI) and clinical prognosis in patients with colorectal cancer after radical surgery. A retrospective analysis of 682 stage I-III colorectal cancer patients undergoing surgery at Longyan First Hospital, Fujian Medical University (January 2016-December 2018), identified 50 patients (7.3%) with RPOI and 632 (92.7%) without. The primary endpoints were 3-year recurrence-free survival (RFS) and 3-year overall survival (OS). RFS and OS were compared using the Kaplan-Meier method. A Cox regression model was leveraged to appraise independent prognostic factors. The 3-year RFS rate in the RPOI group was 70.3%, significantly lower than that in the non-RPOI group (82.2%, P = 0.032); the 3-year OS rate in the RPOI group was 71.2%, also significantly lower than that in the non-RPOI group (90.7%, P = 0.004). After propensity score matching (PSM), the results remained unchanged. Univariate regression analysis indicated that lymphovascular invasion, nerve invasion, pT stage, pN stage, pTNM stage, preoperative serum carcinoembryonic antigen levels, RPOI, and serum albumin levels on the first postoperative day (POD 1) were associated with RFS in colorectal cancer patients (all P < 0.05). Multivariate analysis confirmed RPOI (HR = 2.240, 95% CI: 1.104-4.544, P = 0.025) as an independent negative prognostic factor for RFS. Patients who develop RPOI after radical colorectal cancer surgery experience longer intervals before their first postoperative chemotherapy, longer hospital stays, and poorer RFS and OS.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143587204","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 on: \"Comparative analysis of scoring systems for predicting mortality in Fournier gangrene: single center, 15 years experience\".","authors":"Firas F Alkaff, Yufi A Azmi, Abdul K R Purba","doi":"10.1007/s13304-025-02165-6","DOIUrl":"https://doi.org/10.1007/s13304-025-02165-6","url":null,"abstract":"","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574282","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":"Development and risk stratification of a prognostic nomogram for hepatoblastoma: analysis of the SEER database.","authors":"Wenqi He, Zhengbing Yang","doi":"10.1007/s13304-025-02140-1","DOIUrl":"https://doi.org/10.1007/s13304-025-02140-1","url":null,"abstract":"<p><p>Hepatoblastoma, the most common primary liver malignancy in children, exhibits significant clinical and biological heterogeneity, leading to varying prognoses. This study aimed to identify independent prognostic factors for overall survival in pediatric hepatoblastoma patients, develop and validate a nomogram prediction model, and establish a risk stratification system. We conducted a retrospective analysis of patients aged ≤18 years with hepatoblastoma using data from the Surveillance, Epidemiology, and End Results (SEER) database (2000-2020). Univariate and multivariate Cox regression analyses identified age, race, tumor stage, tumor size, surgery, and chemotherapy as independent prognostic factors. We developed a nomogram prediction model based on these factors, which underwent internal and external validation. The model accurately predicts 1-, 3-, and 5-year overall survival rates. We also established a risk classification system that stratifies patients into low, intermediate, and high-risk groups. Subgroup analysis revealed that low-risk patients had better survival outcomes with hepatectomy, while intermediate-risk patients benefited more from liver transplantation. The developed nomogram enables individualized prediction of overall survival rates in pediatric hepatoblastoma patients, and the risk stratification system can guide early and accurate prognostic assessment.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567607","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 conservative management of acute appendicitis in pediatric age: a monocentric experience.","authors":"Martina Monti, Marco Agamennone, Michela Cing Yu Wong, Maria Grazia Calevo, Giuseppe Losurdo, Stefano Avanzini, Girolamo Mattioli","doi":"10.1007/s13304-025-02136-x","DOIUrl":"https://doi.org/10.1007/s13304-025-02136-x","url":null,"abstract":"<p><p>Historically, appendectomy was the standard treatment for acute appendicitis (AA). Recently, interest has grown in conservative management of uncomplicated AA (UA). This study compared outcomes between non-operative management (NOM) and appendectomy, exploring preoperative factors to guide optimal UA management. In a monocentric retrospective study, we reviewed data on 774 pediatric patients with a primary diagnosis of AA from July 2017 to July 2022. We analyzed demographic, clinical, laboratory, and ultrasound data at first and last admission. Operated patients were stratified by management type and surgery timing. Minimum follow-up was 6 months. Of the 530 children (68.5%) who underwent surgery at first admission, 316 had UA and 214 had CA. The 244 patients (31.5%) not indicated for surgery received intravenous antibiotics. Of these, 104 underwent appendectomy at second admission, with 9 presenting CA, requiring multiple antibiotic therapy and a hospital stay of 9.1 ± 3.1 days. Twenty-eight underwent surgery at their third admission and 112 never underwent surgery. In conclusion, more invasive approach may be preferable for patients with significant clinical signs at first presentation, minimizing hospital stay, costs, antibiotic use, and complications. Further studies on NOM in acute appendicitis are essential to optimize its use.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543622","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}