Updates in Surgery最新文献_第9页

First world report of ICG fluorescence angiography integrated in the HUGO™ RAS system: assessment of bowel perfusion during fully robotic right hemicolectomy for cecal cancer. 在HUGO™RAS系统中集成ICG荧光血管造影的首个世界报告：评估盲肠癌全机器人右半结肠切除术期间的肠灌注。

IF 2.2 3区医学

Updates in Surgery Pub Date : 2025-09-01 Epub Date: 2025-04-24 DOI: 10.1007/s13304-025-02213-1

Claudio Fiorillo, Davide De Sio, Giuseppe Quero, Sergio Alfieri

引用次数: 0

Comparative clinical outcomes of ventral rectopexy versus STARR in the management of obstructed defecation syndrome: a clinical review. 腹侧直肠固定术与STARR治疗排便障碍综合征的临床效果比较：临床综述。

IF 2.2 3区医学

Updates in Surgery Pub Date : 2025-09-01 Epub Date: 2025-06-29 DOI: 10.1007/s13304-025-02314-x

Michele Schiano di Visconte

{"title":"Comparative clinical outcomes of ventral rectopexy versus STARR in the management of obstructed defecation syndrome: a clinical review.","authors":"Michele Schiano di Visconte","doi":"10.1007/s13304-025-02314-x","DOIUrl":"10.1007/s13304-025-02314-x","url":null,"abstract":"Obstructed defecation syndrome (ODS) is a multifactorial pelvic floor disorder commonly affecting women, characterized by straining, incomplete evacuation, and dependence on manual maneuvers. Among various surgical options, stapled transanal rectal resection (STARR) and laparoscopic or robotic ventral mesh rectopexy (LVMR/RVMR) are frequently employed. However, the comparative effectiveness of these procedures remains debated. This narrative review synthesizes evidence from 43 studies including randomized trials, cohort studies, registries, and systematic reviews published between 2004 and 2025. Clinical outcomes assessed include symptom relief, recurrence, quality of life (QoL), complications, and cost-effectiveness. The methodological quality of included studies was evaluated using the SANRA tool. Both STARR and LVMR/RVMR provide significant early symptom relief in ODS. STARR shows 70-90% short-term improvement, but recurrence rates up to 40% have been reported at 10 years. LVMR achieves durable functional outcomes with recurrence rates < 10%, superior QoL metrics, and fewer anatomical relapses. Mesh-related complications after LVMR are rare (~ 1.4%), but require long-term monitoring. Economically, while STARR has lower initial costs, LVMR/RVMR demonstrates greater long-term cost-effectiveness due to reduced reoperations. RVMR may enhance surgical precision, but increases upfront expenses. STARR remains a valid option for isolated rectocele or low-grade intussusception, whereas LVMR/RVMR is preferable for complex pelvic floor dysfunction. Current evidence favors ventral rectopexy for sustained outcomes, although methodological heterogeneity limits definitive conclusions. Prospective, standardized, long-term comparative trials are essential to optimize surgical strategies for ODS.","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":"1645-1655"},"PeriodicalIF":2.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529651","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}

引用次数: 0

Impact of analgesia modality on postoperative recovery after laparoscopic distal pancreatectomy. 镇痛方式对腹腔镜胰远端切除术术后恢复的影响。

IF 2.2 3区医学

Updates in Surgery Pub Date : 2025-09-01 Epub Date: 2025-05-30 DOI: 10.1007/s13304-025-02268-0

Giovanni Guarneri, Stefano Turi, Nicolò Pecorelli, Giuseppe Culicchia, Alessia Vallorani, Renato Meani, Luigi Beretta, Massimo Falconi

{"title":"Impact of analgesia modality on postoperative recovery after laparoscopic distal pancreatectomy.","authors":"Giovanni Guarneri, Stefano Turi, Nicolò Pecorelli, Giuseppe Culicchia, Alessia Vallorani, Renato Meani, Luigi Beretta, Massimo Falconi","doi":"10.1007/s13304-025-02268-0","DOIUrl":"10.1007/s13304-025-02268-0","url":null,"abstract":"In the context of enhanced recovery pathways (ERP) for colorectal surgery, thoracic epidural analgesia (TEA) delays recovery compared to opioid-based patient-controlled intravenous analgesia (PCA). Limited evidence is available for laparoscopic pancreatic surgery. The objective of this study was to evaluate the impact of different analgesic modalities on the time to functional recovery (TFR) following laparoscopic distal pancreatectomy (LDP). Clinical data for consecutive patients undergoing LDP were reviewed. All patients were treated within an ERP including a multimodal analgesia protocol. The main analgesic techniques used were TEA, intravenous morphine PCA, and patient-controlled sublingual sufentanil tablet system (SSTS). TFR was defined as postoperative days (PODs) needed to achieve adequate mobilization, return of gastrointestinal function, sufficient oral intake with no need for intravenous infusion, and adequate pain control with oral analgesia. Overall, 336 patients were included; 109 (32%) patients received TEA, 124 (37%) PCA, and 103 (31%) SSTS. TFR was significantly shorter for the SSTS group with median of 4 [IQR 3-5] days compared to 5 [4-6] days in both the TEA and PCA groups (p < 0.001). This difference was due to faster time to sufficient oral intake and adequate pain control with oral analgesia. On POD1, patients treated with TEA had better pain control compared to other modalities; the median NRS pain score at rest was 0 [0-3] compared to 2 [0-4] for both PCA and SSTS groups (p = 0.003). Multivariate regression showed that SSTS was associated with a 17% reduction (95% CI - 29 to - 5; p = 0.005) of TFR compared to TEA. Patients treated with SSTS had a significantly shorter TFR after LDP compared with other analgesic modalities with no difference in adverse events.","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":"1515-1524"},"PeriodicalIF":2.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188075","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}

引用次数: 0

The resilient strength of thoracic surgical research in Italy. 意大利胸外科研究的弹性强度。

IF 2.2 3区医学

Updates in Surgery Pub Date : 2025-09-01 DOI: 10.1007/s13304-025-02360-5

Vittorio Aprile, Marcello Carlo Ambrogi, Marco Lucchi

引用次数: 0

How aging may impact the failure to rescue after colorectal laparoscopic surgery. Analysis of 1000 patients in a single high-volume center. 年龄对结直肠癌腹腔镜手术后抢救失败的影响。在单个大容量中心对1000例患者进行分析。

IF 2.2 3区医学

Updates in Surgery Pub Date : 2025-09-01 Epub Date: 2025-03-31 DOI: 10.1007/s13304-025-02173-6

Rosa Marcellinaro, Aldo Rocca, Pasquale Avella, Michele Grieco, Domenico Spoletini, Massimo Carlini

{"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":"10.1007/s13304-025-02173-6","url":null,"abstract":"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.","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":"1345-1356"},"PeriodicalIF":2.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12420770/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Comparing Wafi ileostomy to Brooke ileostomy in stage 3 rectal cancer: a prospective cohort study. 比较Wafi回肠造口术和Brooke回肠造口术治疗3期直肠癌：一项前瞻性队列研究。

IF 2.2 3区医学

Updates in Surgery Pub Date : 2025-09-01 Epub Date: 2025-06-24 DOI: 10.1007/s13304-025-02305-y

W Attallaah, M Gachabayov, A Bulut, O Verdiyev, M Javadov, E Barzola, O Inanc, A Kajmolli, R Bergamaschi

{"title":"Comparing Wafi ileostomy to Brooke ileostomy in stage 3 rectal cancer: a prospective cohort study.","authors":"W Attallaah, M Gachabayov, A Bulut, O Verdiyev, M Javadov, E Barzola, O Inanc, A Kajmolli, R Bergamaschi","doi":"10.1007/s13304-025-02305-y","DOIUrl":"10.1007/s13304-025-02305-y","url":null,"abstract":"The aim of this study was to compare Wafi ileostomy to Brooke ileostomy in patients undergoing elective resection for stage 3 rectal cancer in terms of ileostomy creation and reversal-related complications. This was a prospective cohort study enrolling consecutive patients with stage 3 distal rectal cancer undergoing elective TME with Wafi or Brooke ileostomy at a median 8-week interval following neoadjuvant chemoradiation in two institutions. Wafi ileostomy was defined as the insertion of a soft polyvinylchloride spiral endotracheal tube into the afferent limb of the terminal ileum with a flexible rubber band passed behind the backwall of its efferent limb to occlude. Brooke ileostomy was defined as the exteriorization of the terminal ileum afferent limb through the abdominal wall (then everted and sutured to the skin) with the efferent limb acting as mucous fistula. Propensity score matching with a 1:1 ratio was employed to compare diagnosis-matched patients for age, gender, and American Society of Anesthesiologists score. During 5 years, 110 patients underwent TME with Wafi ileostomy, whereas 116 patients underwent TME with Brooke ileostomy. Propensity score matching left 99 Wafi and 99 Brooke comparable patients. Wafi ileostomy was reversed (tube removed at bedside) at median postoperative day (POD) 14 (same hospital stay) as compared to 150 days of ileostomy reversal (second surgery) in the Brooke ileostomy group (p < 0.001). Ileostomy-related overall complication rates were significantly lower in Wafi ileostomy patients (6% vs. 24%, p = 0.001). On multivariable logistic regression, dehydration was found to be associated with increased emergency room visits and readmissions in Brooke ileostomy patients (OR = 1.24 (1.03, 3.92); p = 0.044). Compared to Brooke, Wafi ileostomy with its reversal at bedside without need for a second surgery was associated with fewer complications.","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":"1357-1362"},"PeriodicalIF":2.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12420713/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144476887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Anterior component separation versus posterior component separation with transversus abdominis release for large ventral hernias: a randomized controlled study. 前成分分离与后成分分离联合腹侧释放治疗大腹疝：一项随机对照研究。

IF 2.2 3区医学

Updates in Surgery Pub Date : 2025-09-01 Epub Date: 2025-05-13 DOI: 10.1007/s13304-025-02229-7

Zaza Demetrashvili, Irakli Pipia, Lali Patsia, George Kenchadze, Luka Tkhelidze, George Kamkamidze

{"title":"Anterior component separation versus posterior component separation with transversus abdominis release for large ventral hernias: a randomized controlled study.","authors":"Zaza Demetrashvili, Irakli Pipia, Lali Patsia, George Kenchadze, Luka Tkhelidze, George Kamkamidze","doi":"10.1007/s13304-025-02229-7","DOIUrl":"10.1007/s13304-025-02229-7","url":null,"abstract":"The aim of this study was to analyze outcomes of open anterior component separation technique (ACST) and posterior component separation technique with transversus abdominis release (TAR) for midline large ventral hernias. From December 2016 to July 2022, patients over 18 years of age, who underwent elective surgery for midline large ventral hernia via open component separation technique (ACST and TAR), were enrolled in this study. Preoperative and intraoperative factors, also hospital stay days, Surgical Site Occurrences (SSO), hernia recurrence and quality of life (QoL) were determined in ACST and TAR groups. To determine QoL we used the Carolinas Comfort Scale (CCS). Data of 43 patients (22 patients from ACST group and 21-from TAR group) were analyzed. Bivariate analysis showed that the proportions of SSO in TAR group (4 out of 21; 19%) was significantly lower than in ACST group (11 out of 22; 50%) (OR 1.87, 95% CI 1.07-3.24, p = 0.033). Seroma was the most frequent SSO, ranging from 9.5% to 40.9% among the groups, respectively (P = 0.018). There was no significant difference between the groups in terms of surgical site infection (SSI), hematoma, wound dehiscence, skin necrosis, hernia recurrence and QoL. Our study revealed that when comparing the ACST and TAR groups for large midline ventral hernia, there was no significant difference in terms of hernia recurrence and QoL. TAR was associated with significantly less SSO than ACST. This can be considered as an advantage of TAR, making it more preferable than ACST.","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":"1657-1664"},"PeriodicalIF":2.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144051853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Mitigating 'inevitable' anastomotic leaks in left-sided colorectal surgery: a combined strategy using indocyanine green fluorescence, intraoperative colonscopy and patient risk profiling. 减轻左侧结直肠手术中“不可避免的”吻合口泄漏：使用吲哚菁绿荧光、术中结肠镜检查和患者风险分析的联合策略

IF 2.2 3区医学

Updates in Surgery Pub Date : 2025-09-01 Epub Date: 2025-04-29 DOI: 10.1007/s13304-025-02218-w

Alberto Patriti, Marcella Lodovica Ricci, Emilio Eugeni, Pier Paolo Stortoni, Maria Elena Serio, Antonella Scarcelli, Alessio Pigazzi, Roberto Montalti

{"title":"Mitigating 'inevitable' anastomotic leaks in left-sided colorectal surgery: a combined strategy using indocyanine green fluorescence, intraoperative colonscopy and patient risk profiling.","authors":"Alberto Patriti, Marcella Lodovica Ricci, Emilio Eugeni, Pier Paolo Stortoni, Maria Elena Serio, Antonella Scarcelli, Alessio Pigazzi, Roberto Montalti","doi":"10.1007/s13304-025-02218-w","DOIUrl":"10.1007/s13304-025-02218-w","url":null,"abstract":"This study aimed to identify patient-specific risk factors and intraoperative findings obtained from indocyanine green fluorescence angiography (ICG-FA) and intraoperative colonoscopy (IOC), using a structured endoscopic grading scale, to guide surgical decisions and minimize the risk of anastomotic leakage in colorectal surgery. One hundred-eleven patients undergoing elective left-sided colorectal resections were evaluated intraoperatively using both ICG-FA and IOC, with anastomoses classified by a new endoscopic grading scale (Grades 1-5). Anastomoses classified as suboptimal (grade > 3) were taken down and reconstructed or repaired. The primary aim of the study was to determine the rate of anastomotic leakage (AL) using this integrated strategy and subsequently to identify patient-specific risk factors associated with AL. Among 111 patients, 102 patients (91.8%) at the IOC were classified as Grade 1, 4 patients (3.6%) as Grade 2, 4 patients (3.6%) as Grade 3, and 1 patient (0.9%) as Grade 4. The overall AL rate was 10.8% (12 patients). On multivariate logistic regression analysis, only anastomotic level ≤ 12 cm emerged as an independent risk factor of AL (OR 0.064, 95% CI 0.008-0.517, p = 0.010). Among patients who developed an AL, 3 (25%) required surgical intervention, the others were managed endoscopically or conservatively. An integrated approach involving ICG-FA and IOC may aid to construct a technically optimal colorectal anastomosis. Nevertheless, anastomotic leakage can still occur due to factors unrelated to intraoperative technique, particularly low anastomosis height. These factors should prompt routine consideration of protective loop ileostomy and pelvic drainage to mitigate AL clinical consequences.","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":"1375-1384"},"PeriodicalIF":2.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143984213","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}

引用次数: 0

Does adjuvant therapy improve survival in patients undergoing pancreaticoduodenectomy for distal cholangiocarcinoma? A systematic review, meta-analysis and meta-regression. 辅助治疗是否能提高远端胆管癌胰十二指肠切除术患者的生存率？系统回顾、元分析和元回归。

IF 2.2 3区医学

Updates in Surgery Pub Date : 2025-09-01 DOI: 10.1007/s13304-025-02383-y

G Nappo, V D'Ambra, C Ricci, M Pagnanelli, V Rebasti, G Alves, S Crippa, L Rimassa, R Casadei, A Zerbi

{"title":"Does adjuvant therapy improve survival in patients undergoing pancreaticoduodenectomy for distal cholangiocarcinoma? A systematic review, meta-analysis and meta-regression.","authors":"G Nappo, V D'Ambra, C Ricci, M Pagnanelli, V Rebasti, G Alves, S Crippa, L Rimassa, R Casadei, A Zerbi","doi":"10.1007/s13304-025-02383-y","DOIUrl":"https://doi.org/10.1007/s13304-025-02383-y","url":null,"abstract":"The role of adjuvant therapy (AT) after pancreaticoduodenectomy (PD) for distal cholangiocarcinoma (DC) remains controversial. This systematic review and meta-analysis aimed to evaluate the impact of AT on overall survival (OS) and disease-free survival (DFS) in patients with resected DC. A systematic review was conducted following PRISMA guidelines (PROSPERO: CRD42024561780). PubMed, Scopus, Web of Science, and Cochrane databases were searched for studies published between January 2000 and August 2023. Eligible studies included patients who underwent PD for DC, comparing AT to follow-up (FUP) alone. Primary endpoints were OS and DFS, analyzed using hazard ratios (HR) with 95% confidence intervals (CI). Meta-regression explored potential sources of heterogeneity. The analysis included 22 studies with 7078 patients (3860 FUP group, 3218 AT group): of the studies, only 3 (13.6%) were RCTs (even if none of them was specifically designed for DC). AT significantly improved OS (HR 0.80; 95% CI 0.73-0.89; p < 0.001) and DFS (HR 0.84; 95% CI 0.74-0.96; p = 0.023) compared to FUP. Subgroup analysis showed a greater benefit for chemo-radiotherapy (OS HR 0.81; 95% CI 0.72-0.91) over chemotherapy alone (OS HR 0.78; 95% CI 0.64-0.94). High heterogeneity (I2 = 98%) was identified among the included studies. This meta-analysis demonstrates that AT is associated with improved survival outcomes in patients undergoing PD for DC. However, the significant limitations of the existing literature, particularly the lack of RCTs designed specifically for DC, necessitate caution, especially on which type of chemotherapy should be adopted.","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144970734","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}

引用次数: 0

The role of video-assisted thoracoscopy in chest trauma: a retrospective monocentric experience. 视频辅助胸腔镜在胸部创伤中的作用：单中心经验回顾。

IF 2.2 3区医学

Updates in Surgery Pub Date : 2025-09-01 Epub Date: 2024-09-30 DOI: 10.1007/s13304-024-02003-1

Duilio Divisi, Gino Zaccagna, Stefania De Sanctis, Maurizio Vaccarili, Gabriella Di Leonardo, Adele Lucchese, Andrea De Vico

{"title":"The role of video-assisted thoracoscopy in chest trauma: a retrospective monocentric experience.","authors":"Duilio Divisi, Gino Zaccagna, Stefania De Sanctis, Maurizio Vaccarili, Gabriella Di Leonardo, Adele Lucchese, Andrea De Vico","doi":"10.1007/s13304-024-02003-1","DOIUrl":"10.1007/s13304-024-02003-1","url":null,"abstract":"Video-assisted thoracoscopy (VAT) plays an essential role in the exploration of pleural cavity after thoracic trauma, although some doubts about the precise and specific indications persist. This study examines the eligibility criteria for videothoracoscopy and establishes the ideal timing for VAT. Between January 2011 and November 2022, we observed 923 polytraumatized patients. All patients underwent computed tomography (CT) scan total body with and without contrast enhancement. Two hundred and nine patients carried out VAT within 10 ± 2 h of injury while 8 patients after 20 ± 1 h. The Injury Severity Score (ISS) was 31 ± 1 and the Glasgow Coma Scale was 14.1 ± 0.3 upon arrival at the hospital. One hundred and nineteen patients displayed hemothorax (55%), 62 hemopneumothorax (28.5%), 21 penetrating wound (9.6%), 10 pneumothorax (4.6%) and 5 chylothorax (2.3%). In 18 patients (8.3%) without vascular, diaphragmatic, or parenchymal lesion the treatment consisted in chest tube placement. VAT was converted to video-assisted thoracoscopic surgery (VATS) in 190 patients (87.5%), to open surgery in 8 (3.7%) and to laparoscopy in 1 (0.5%). Twelve patients (5.5%) with diaphragm ruptures < 5 cm in diameter were treated by separate stitches suture in VATS. Only eight postoperative complications (4 pneumonia, three atelectasis and one pulmonary embolism) out of 217 VAT, positively resolved with medical treatment, were noted exclusively in patients undergoing minimally invasive approach 20 ± 1 h after trauma. Early VAT in selected patients is a safe and easy procedure that ensure a quick diagnosis of lesions and an accurate management of the most thoracic injuries among trauma patients. The prompt identification of injuries, to avoid life-threatening conditions requiring rapid intervention, responds to medico-legal needs to which VAT fulfills.","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":"1295-1304"},"PeriodicalIF":2.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142354712","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}

引用次数: 0