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Ultrasound outcomes and surgical parameters of the double-layer purse-string uterine closure technique in cesarean delivery: a systematic review and meta-analysis of randomized trials.
IF 1.6 3区 医学
BMC Surgery Pub Date : 2025-02-08 DOI: 10.1186/s12893-025-02796-x
Mahsan Nabighadim, Maryam Vaezi, Mahsa Maghalian, Mojgan Mirghafourvand
{"title":"Ultrasound outcomes and surgical parameters of the double-layer purse-string uterine closure technique in cesarean delivery: a systematic review and meta-analysis of randomized trials.","authors":"Mahsan Nabighadim, Maryam Vaezi, Mahsa Maghalian, Mojgan Mirghafourvand","doi":"10.1186/s12893-025-02796-x","DOIUrl":"https://doi.org/10.1186/s12893-025-02796-x","url":null,"abstract":"<p><strong>Background: </strong>A cesarean scar defect is a structural abnormality in the myometrium at the site of a prior cesarean incision, primarily influenced by the closure technique. Purse-string uterine suturing (PSUS) may reduce the incidence of cesarean scar defects and improve uterine integrity. However, the literature presents inconsistent findings, necessitating a systematic evaluation. This systematic review and meta-analysis of randomized controlled trials (RCTs) aims to assess the impact of PSUS on ultrasound outcomes and surgical parameters related to cesarean scars.</p><p><strong>Methods: </strong>This systematic review and meta-analysis involved a search for relevant publications in English and Persian across multiple databases, including PubMed, the Cochrane Library, Google Scholar, Scopus, Web of Science, and SID. The search was unrestricted by date and included all available publications up to August 8, 2024. The risk of bias in the included studies was evaluated using the Risk of Bias 2 (ROB2) tool, while the certainty of the evidence was assessed through the GRADE approach. Meta-regression was employed to investigate potential risk factors for cesarean scar defects, and trial sequential analysis was conducted to mitigate Type I and Type II errors.</p><p><strong>Results: </strong>A total of 353 studies were identified through the search strategy, with 8 studies included in the analysis. The meta-analysis demonstrated a significant reduction in the rate of cesarean scar defects in the PSUS group compared to the control group (risk ratio [RR] 0.45, 95% confidence interval [CI] 0.36 to 0.58; 8 trials, 751 participants, I² = 0%, indicating no heterogeneity). Additionally, a shorter uterine incision length was observed in the PSUS group compared to the control group (MD -3.84, 95% CI -4.97 to -2.71; 4 trials, 438 participants, I² = 80%, suggesting substantial heterogeneity). The PSUS group also exhibited greater residual myometrium thickness (RMT) than the control group (MD 1.33, 95% CI 0.72 to 1.94; 5 trials, 417 participants, I² = 92%, indicating considerable heterogeneity). However, no statistically significant differences were found between the PSUS and control groups regarding operation time (p = 0.10, I² = 67%, suggesting moderate heterogeneity), length (p = 0.14, I² = 98%, indicating considerable heterogeneity), height (p = 0.10, I² = 76%, suggesting substantial heterogeneity) of incision defects, or blood loss during the procedure (p = 0.94, I² = 0%, indicating no heterogeneity).</p><p><strong>Conclusions: </strong>The use of PSUS during cesarean sections significantly reduces the occurrence of cesarean scar defects, indicating a clear clinical benefit with moderate certainty. However, the evidence for other ultrasound evaluation outcomes and surgical parameters remains of low to very low certainty. Therefore, further research is essential to validate these findings and assess the long-term clinical implications of integ","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"60"},"PeriodicalIF":1.6,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143374844","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
One stage transanal versus one stage laparoscopic-assisted transanal endorectal pull-through in managing Hirschsprung's disease in pediatric age group; a retrospective study.
IF 1.6 3区 医学
BMC Surgery Pub Date : 2025-02-08 DOI: 10.1186/s12893-025-02768-1
Ahmed Elrouby, Sameh Shehata, Saber Waheeb, Ahmed Khairi, Doaa AbdAl-Aziz, Baher Looka
{"title":"One stage transanal versus one stage laparoscopic-assisted transanal endorectal pull-through in managing Hirschsprung's disease in pediatric age group; a retrospective study.","authors":"Ahmed Elrouby, Sameh Shehata, Saber Waheeb, Ahmed Khairi, Doaa AbdAl-Aziz, Baher Looka","doi":"10.1186/s12893-025-02768-1","DOIUrl":"https://doi.org/10.1186/s12893-025-02768-1","url":null,"abstract":"<p><strong>Background: </strong>The management of Hirschsprung's disease has evolved from the conventional route to the minimally invasive route in one stage either from the pure transanal route or with the assistance of laparoscopy. Our study compared the surgical and functional outcomes of both approaches.</p><p><strong>Methods: </strong>Our retrospective study included 72 pediatric patients presented with Hirschsprung's Disease to Elshatby University Hospital, 40 patients were treated by TAERPT (Group A) and 32 patients were treated by LAERPT (Group B). The two groups were compared as regards the personal data, the operative data, and the post-operative outcomes including the time of passage of stools, time of tolerating oral feeding, the duration of hospital stay, and the development of any early postoperative complications. Moreover, the frequency of defecation, constipation, enterocolitis, anastomotic stricture, and continence were assessed.</p><p><strong>Results: </strong>The age at operation was significantly lower (p < 0.001<sup>*</sup>) in patients of Group A (13.95 ± 18.18) than in patients of Group B (32.03 ± 16.20). The total operative duration was not different between the two groups, however, a significantly shorter duration of the anal part (p < 0.001<sup>*</sup>) in Group B (47.81 ± 18) than in Group A (96.50 ± 38.60) was recorded. A significantly longer colonic segment (p < 0.001<sup>*</sup>) was resected in Group A (28 ± 4.05) than in Group B (22.70 ± 8.12). The hospital stay was significantly shorter in Group B (5.78 ± 2.41) than in Group A (7.20 ± 2.78). (p = 0.001*) The excised segment revealed a proximal aganglionic zone in four patients denoting a missed segment; three in Group B and only one patient in Group A. There were no differences as regards the early and late follow-up parameters.</p><p><strong>Conclusions: </strong>Endorectal pull-through for the treatment of Hirschsprung's disease could be approached either completely transanal or with the assistance of laparoscopy with nearly similar surgical and functional outcomes, however a longer operative duration with a shorter anal stage is recorded with the laparoscopic assistance. Furthermore, a shorter hospital stay could be achieved with the aid of laparoscopy.</p><p><strong>Trial registration: </strong>Protocol ID: 0306356, Registration number: NCT06419998, 20/05/2024 - Retrospectively registered.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"59"},"PeriodicalIF":1.6,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143374839","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
Efficacy of an artificial intelligence preoperative planning system for assisting in revision surgery after artificial total hip arthroplasty.
IF 1.6 3区 医学
BMC Surgery Pub Date : 2025-02-07 DOI: 10.1186/s12893-024-02752-1
Jiaqing Zhu, Shanbin Zheng, Jiahao Sun, Bowen Ma, Chiyu Zhang, Chao Zhang, Jirong Shen, Tianwei Xia
{"title":"Efficacy of an artificial intelligence preoperative planning system for assisting in revision surgery after artificial total hip arthroplasty.","authors":"Jiaqing Zhu, Shanbin Zheng, Jiahao Sun, Bowen Ma, Chiyu Zhang, Chao Zhang, Jirong Shen, Tianwei Xia","doi":"10.1186/s12893-024-02752-1","DOIUrl":"10.1186/s12893-024-02752-1","url":null,"abstract":"<p><strong>Objective: </strong>To explore the early efficacy of an artificial intelligence preoperative planning system (AIHIP system) for assisting in hip revision surgery.</p><p><strong>Methods: </strong>The clinical data of 25 patients (26 hips) who underwent hip revision between June 2019 and December 2023 and who met the selection criteria were retrospectively analyzed. There were 13 males and 12 females; the ages ranged from 44 to 90 years, with a mean of 69.1 years. The patients' replacement of prosthesis model, operation time, hospitalization time, postoperative time out of bed, etc., as well as the occurrence of adverse events such as postoperative infection, fracture, and loosening of the prosthesis were recorded. The Harris Hip score (HHS) was used to evaluate the function of the affected limbs preoperatively, and 1 week and 6 months postoperatively, and hip mobility was compared preoperatively and 6 months postoperatively.</p><p><strong>Results: </strong>All 25 patients were followed up for 6 to 59 months, with an average of 25.3 months. Except for one patient who developed a thigh hematoma (treated with incision and drainage and decompression) and hip dislocation in one hip (repaired), the remaining patients experienced no adverse events such as loosening of the prosthesis or infection. The postoperative acetabular cup type matching degree completely matched 25 hips, not matching 1 hip (+ 2 number), for a matching rate of 96.15%; the femoral stem type matching degree completely matched 25 hips, generally matching 1 hip (-1 number), for a matching rate of 100%. The Harris scores were 54.7 ± 9.6 and 89.6 ± 7.0 at 1 week and 6 months after surgery, respectively, which were significantly improved (P < 0.05) compared with the preoperative scores of 33.5 ± 8.3, and further improved at 6 months after surgery compared with the 1-week period (P < 0.05). The patients' hip function was evaluated according to the Harris score at 6 months after surgery, and they were assigned to 23 good hips and 3 medium hips, which could satisfy daily life needs. Hip mobility at 6 months after surgery was 111.15 ± 9.72°, and the difference was statistically significant compared with the preoperative value of 79.42 ± 17.51° (t = -8.077, P < 0.001).</p><p><strong>Conclusion: </strong>AIHIP system-assisted treatment of THA postoperative revision patients can improve the precision of revision surgery, and reduce the difficulty of surgery, in patients with good postoperative recovery and satisfactory early outcomes.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"58"},"PeriodicalIF":1.6,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143371158","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 impact of death and caring for the dying and their families on surgeons - an AI assisted systematic scoping review.
IF 1.6 3区 医学
BMC Surgery Pub Date : 2025-02-05 DOI: 10.1186/s12893-025-02792-1
Jun Rong Tan, Yun Ting Ong, Victoria Jia En Fam, Annushkha Sinnathamby, Nila Ravindran, Yaoyi Ng, Lalit Kumar Radha Krishna
{"title":"The impact of death and caring for the dying and their families on surgeons - an AI assisted systematic scoping review.","authors":"Jun Rong Tan, Yun Ting Ong, Victoria Jia En Fam, Annushkha Sinnathamby, Nila Ravindran, Yaoyi Ng, Lalit Kumar Radha Krishna","doi":"10.1186/s12893-025-02792-1","DOIUrl":"10.1186/s12893-025-02792-1","url":null,"abstract":"<p><strong>Context: </strong>Surgeons are taking central roles in caring for patients leaving them prone to the emotional turmoil and grief of patients and families and the moral, psychological and existential distress of members of the interprofessional team and trainees. This has implications on patient safety and surgeon welfare.</p><p><strong>Objectives: </strong>A systematic scoping review was carried out to address the primary research question \"what is known of the effects of caring for the dying and the impact of patient's death on surgeons?\". It is hoped that the insights gained will better guide support and assessment of surgeons in their evolving roles.</p><p><strong>Methods: </strong>Guided by the Systematic Evidence-based Approach (SEBA), we conducted a systematic scoping review (SSR). This review included articles published between 1st January 2000 and 2nd September 2024 on Pubmed, Embase, Scopus, Google Scholar, ERIC databases. To enhance trustworthiness and enhance the comprehensiveness of our review the articles identified were also evaluated using ChatGPT 4o and Notebook LM. The findings of these assistive processes were compared with the independent thematic and content analysis carried out by the two research teams.</p><p><strong>Results: </strong>In total, 4966 titles and abstracts were identified, 174 full-text articles were reviewed, and 26 full-text articles analysed. With the findings of the assistive analysis by the AI tools echoing the findings of the research teams- two key domains were identified: (1) the impact on personhood, (2) predisposing factors.</p><p><strong>Conclusion: </strong>This AI assisted SSR in SEBA confirms that surgeons do suffer from the cumulative effects of caring for dying patients and their families and from the death of the patient and supporting the family and members of the interprofessional team and trainees. Without timely and personalized support surgeons are prone to depression, burnout, and substance abuse, and compromises to patient and family experiences, outcomes, safety and satisfaction. The need for effective longitudinal and personalized assessment tools is clear.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"56"},"PeriodicalIF":1.6,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11796083/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257094","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
The prognostic value of the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in colorectal cancer and colorectal anastomotic leakage patients: a retrospective study.
IF 1.6 3区 医学
BMC Surgery Pub Date : 2025-02-05 DOI: 10.1186/s12893-024-02708-5
Nuo Xu, Jian-Xin Zhang, Jia-Jie Zhang, Zhuo Huang, Lian-Chun Mao, Zhi-Yong Zhang, Wei-Dong Jin
{"title":"The prognostic value of the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in colorectal cancer and colorectal anastomotic leakage patients: a retrospective study.","authors":"Nuo Xu, Jian-Xin Zhang, Jia-Jie Zhang, Zhuo Huang, Lian-Chun Mao, Zhi-Yong Zhang, Wei-Dong Jin","doi":"10.1186/s12893-024-02708-5","DOIUrl":"10.1186/s12893-024-02708-5","url":null,"abstract":"<p><strong>Objective: </strong>The purpose of this study was to investigate the influence and predictive value of preoperative peripheral blood neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) index on the prognosis of colorectal anastomotic leakage (CAL) patients.</p><p><strong>Methods: </strong>This study retrospectively analyzed the clinical data of 1016 patients who underwent radical resection for colorectal cancer at a single center between January 1, 2007 and December 31, 2023. In this study, NLR and PLR were analyzed before surgery. Kaplan-Meier survival analysis was performed according to the postoperative survival status of the patients. Nomogram and calibration curve were established by proportional hazards model (COX) to verify its predictive value.</p><p><strong>Results: </strong>A total of 890 patients with colorectal cancer, 102 patients with CAL, and 788 patients with non- anastomotic leakage (AL) colorectal cancer were enrolled for a median follow-up of 96 months (quartile range 33-133). In this study, COX regression analysis showed that preoperative NLR and PLR could predict the prognosis of CAL patients, and the optimal cut-off points of NLR and PLR were 2.89 and 157.62, respectively. Kaplan-Meier survival curve results showed that 5-year overall survival (OS) and disease-free survival (DFS) in the low NLR and PLR group were significantly higher than those in the high NLR and PLR group. OS and DFS were divided into high, low NLR and PLR groups. Finally, based on COX model, a nomogram analysis was conducted to analyze the risk factors affecting OS and DFS, and the accuracy and practicality of the model were verified by calibration curve and decision curve.</p><p><strong>Conclusion: </strong>Preoperative NLR and PLR can predict the long-term prognosis of colorectal cancer (CRC) and CAL patients, and patients with NLR ≥ 2.89 and PLR ≥ 157.62 have poor survival prognosis. Nomogram and calibration curve analysis will further improve the accuracy of OS and DFS prediction.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"57"},"PeriodicalIF":1.6,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11796187/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257099","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
The surgical time-out: the relationship between perceptions of a safety-task anchor and surgical team workflow.
IF 1.6 3区 医学
BMC Surgery Pub Date : 2025-02-05 DOI: 10.1186/s12893-025-02789-w
Vivian J Zagarese, Ivan Hernandez, Neil M A Hauenstein, Roseanne J Foti, Sarah H Parker
{"title":"The surgical time-out: the relationship between perceptions of a safety-task anchor and surgical team workflow.","authors":"Vivian J Zagarese, Ivan Hernandez, Neil M A Hauenstein, Roseanne J Foti, Sarah H Parker","doi":"10.1186/s12893-025-02789-w","DOIUrl":"10.1186/s12893-025-02789-w","url":null,"abstract":"<p><strong>Background: </strong>The surgical time-out is a critical safety measure used in the operating room (OR). We examined the mediating relationship of the length of the time-out between team perceived usefulness of the time-out, and the rate at which the circulating nurse left the OR to retrieve instruments.</p><p><strong>Methods: </strong>60 cardiac surgical teams were observed performing their work. The length of the time-out and the rate at which the circulating nurse left the OR was obtained by observation of the surgical team. We administered a survey with a 7-point Likert scale to assess the surgical staff's perceived usefulness of the time-out at the end of the surgery. An analysis was conducted to test if length of the time-out mediated the relationship between perceived usefulness of the time-out and rate at which the nurse leaves the OR to retrieve an instrument useful for the surgery.</p><p><strong>Results: </strong>The relationship of the length of the time-out with the rate at which the nurse leaves the OR was non-significant (β = 0.089, p = .496). However, the relationship between perceived usefulness of the time-out with the length of the time-out was significant (β = 0.346, p < .05) and the effect between perceived usefulness of the time-out and the rate at which the nurse left the OR was statistically significant (β= - 0.424, p = < 0.001).</p><p><strong>Conclusion: </strong>In this study we explore how surgical teams' attitudes towards the usefulness of the time-out affect its utilization, and how attitudes about time-outs are related to the important process measure of rate at which the circulating nurse leaves the OR. The full mediation model was not supported by the data; however, there appears to be a relationship between the perceived usefulness of the time-out and the rate at which the circulating nurse leaves the OR.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"55"},"PeriodicalIF":1.6,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11796080/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257107","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
Clinical advances in kidney autotransplantation: a review.
IF 1.6 3区 医学
BMC Surgery Pub Date : 2025-02-05 DOI: 10.1186/s12893-024-02754-z
Shengjie Lin, Jingci Gai, Shangjin Huang, Yingzhen He, Da Hao, Shuhang Luo, Yilong Lin, Jiang Qiu, Jun Li, Changxi Wang, Chenglin Wu
{"title":"Clinical advances in kidney autotransplantation: a review.","authors":"Shengjie Lin, Jingci Gai, Shangjin Huang, Yingzhen He, Da Hao, Shuhang Luo, Yilong Lin, Jiang Qiu, Jun Li, Changxi Wang, Chenglin Wu","doi":"10.1186/s12893-024-02754-z","DOIUrl":"10.1186/s12893-024-02754-z","url":null,"abstract":"<p><p>Kidney autotransplantation is a surgical procedure with multiple indications and advancing technological approaches. Kidney autotransplantation is used to address complex kidney-related diseases including renal vascular lesions, ureteral diseases, tumors, loin pain-hematuria syndrome, and conditions affecting a solitary kidney or both kidneys. Renal artery lesions, including aneurysms and stenoses, often necessitate kidney autotransplantation in cases involving renal artery bifurcation or distant failure of endovascular repair. Complex ureteral lesions such as ureteral avulsions are commonly treated with kidney autotransplantation. Renal tumors, especially centrally located tumors or those involving the renal hilum, are treated using this technique while preserving renal function. It is worth emphasizing that this would be a rarely used last-resort technique in the modern era of minimally invasive nephron-sparing surgery. Kidney autotransplantation may be indicated for the rare condition of loin pain-hematuria syndrome when conservative measures fail. Additionally, individuals with solitary or bilateral kidney disease benefit from kidney autotransplantation to preserve their renal function. Traditional open-kidney autotransplantation involves renal extraction, workbench repair, and renal reimplantation. Technological advancements have introduced minimally invasive techniques including laparoscopic- and robot-assisted kidney autotransplantation, which reduce surgical trauma and recovery times. These techniques have shown promising outcomes, and robotic platforms have the potential to further reduce complications. In this study, we reviewed diverse indications and recent technological innovations in the field of kidney autotransplantation.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"54"},"PeriodicalIF":1.6,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11796257/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257091","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
Pancreatic exocrine insufficiency after pancreatic resection: a systematic review.
IF 1.6 3区 医学
BMC Surgery Pub Date : 2025-02-03 DOI: 10.1186/s12893-025-02787-y
Marcello Di Martino, Ángela de la Hoz Rodriguez, Andrea Saibanti, Guillermo Salvador Camarmo, Nico Pagano, Elena Martín-Pérez, Matteo Donadon
{"title":"Pancreatic exocrine insufficiency after pancreatic resection: a systematic review.","authors":"Marcello Di Martino, Ángela de la Hoz Rodriguez, Andrea Saibanti, Guillermo Salvador Camarmo, Nico Pagano, Elena Martín-Pérez, Matteo Donadon","doi":"10.1186/s12893-025-02787-y","DOIUrl":"10.1186/s12893-025-02787-y","url":null,"abstract":"<p><strong>Introduction: </strong>Pancreatic exocrine insufficiency (PEI) is a condition defined by a reduction in pancreatic exocrine activity that impairs normal digestion. Despite established guidelines recommendations, precise diagnosis of PEI after pancreatic resection are infrequently achieved. This review aims to provide a comprehensive overview of the methodology and accuracy of diagnostic tools available for evaluating PEI after pancreatic resection.</p><p><strong>Methods: </strong>A review of PEI diagnostic tests was conducted using a combined text and MeSH search strategy to identify relevant articles focused on post-pancreatectomy PEI diagnosis.</p><p><strong>Results: </strong>The literature search yielded 4,874 records, and 30 studies were included in the analysis, with a total of 2,305 patients. The reported frequency of PEI across the included studies varied widely, though more than two-thirds of included papers reported an incidence of PEI above 65% in patients who underwent pancreatoduodenectomy or distal pancreatectomy. The faecal elastase-1 (FE-1) test was the most frequently used test for diagnosing post-pancreatectomy PEI. Six studies compared the diagnostic accuracy of FE-1 with faecal fat tests or 13 C breath tests, finding no significant differences. Five studies reported on micronutrient deficiencies.</p><p><strong>Conclusion: </strong>The FE-1 test is the most commonly used diagnostic tool for post-pancreatectomy PEI; however, well-designed studies comparing the diagnostic accuracy of various tests for PEI are lacking. Additionally, few studies report on micronutrient deficiencies, variations in anthropometric data or PEI-related patient-reported outcomes. Future studies should aim to establish a gold standard for diagnosis and severity assessment of post-pancreatectomy PEI and provide guidance for tailored pancreatic enzyme replacement therapy.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"53"},"PeriodicalIF":1.6,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11789297/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123899","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
Allograft tolerance after adult living donor liver transplantation: a case-control study.
IF 1.6 3区 医学
BMC Surgery Pub Date : 2025-01-30 DOI: 10.1186/s12893-025-02780-5
Mohamed S Habl, Moataz Maher Emara, Reham A Zayed, Ahmed M Sultan, Ahmed Elsabagh, Ahmed Marwan Elsaid, Ehab E Abdel-Khalek, Mohamed M El-Saadany, Mohamed Abdel Wahab, Ahmed Shehta
{"title":"Allograft tolerance after adult living donor liver transplantation: a case-control study.","authors":"Mohamed S Habl, Moataz Maher Emara, Reham A Zayed, Ahmed M Sultan, Ahmed Elsabagh, Ahmed Marwan Elsaid, Ehab E Abdel-Khalek, Mohamed M El-Saadany, Mohamed Abdel Wahab, Ahmed Shehta","doi":"10.1186/s12893-025-02780-5","DOIUrl":"10.1186/s12893-025-02780-5","url":null,"abstract":"<p><strong>Background: </strong>To investigate the incidence and potential predictors of immune tolerance among adult living donor liver transplant (LDLT) recipients.</p><p><strong>Methods: </strong>This case-control study included adult recipients who underwent LDLT between May 2004 and January 2018, with at least a 5-year follow-up after LDLT. We divided the study recipients into two groups: Group 1 (Tolerance Group) included recipients who achieved operational or prope tolerance for at least one year; Group 2 (Control Group) included recipients who did not achieve tolerance. We used logistic regression analysis to study the potential predictors of tolerance after LDLT.</p><p><strong>Results: </strong>We included 368 recipients, 275 (74.7%) in Group 1 and 93 (25.3%) in Group 2. Operational tolerance occurred in 13/275 (4.7%) recipients and prope tolerance in 262/275 (95.3%) recipients. Age was significantly higher in Group 1. The median time for tolerance among the study recipients was 60 months (36-168). During follow-up, Group 1 showed lower serum levels of bilirubin, liver enzymes, alkaline phosphatase, and gamma-glutamyl transferase. Group 1 had a lower incidence of acute cellular rejection (ACR), recurrent viral hepatitis, and biliary complications. Logistic regression identified preoperative MELD, indication for LDLT, ACR, recurrent viral hepatitis, and biliary complications as significant predictors for allograft tolerance after LDLT.</p><p><strong>Conclusion: </strong>Allograft tolerance occurred in 74.7% of this cohort. We suggest that the MELD score, indication for LT, ACR, recurrent viral hepatitis, and biliary complications are predictors of allograft tolerance after LDLT.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"52"},"PeriodicalIF":1.6,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11783700/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069101","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
Radiofrequency ablation combined with immunotherapy to treat hepatocellular carcinoma: a comprehensive review.
IF 1.6 3区 医学
BMC Surgery Pub Date : 2025-01-29 DOI: 10.1186/s12893-025-02778-z
Gui-Lin Xie, Zhi-Han Zhong, Tai-Wei Ye, Zun-Qiang Xiao
{"title":"Radiofrequency ablation combined with immunotherapy to treat hepatocellular carcinoma: a comprehensive review.","authors":"Gui-Lin Xie, Zhi-Han Zhong, Tai-Wei Ye, Zun-Qiang Xiao","doi":"10.1186/s12893-025-02778-z","DOIUrl":"10.1186/s12893-025-02778-z","url":null,"abstract":"<p><strong>Background and aim: </strong>Hepatocellular carcinoma (HCC) is a highly immunogenic tumor and the third leading cause of cancer-related deaths worldwide with an increasing incidence. Therefore, the combination of immunotherapy with other approaches, such as anti-angiogenic agents and local area therapy, has become a new strategy for HCC treatment.</p><p><strong>Methods: </strong>We searched PubMed and Web of Science and extracted publications relating to the radiofrequency ablation (RFA) and immunotherapy. The search terms were: \"radiofrequency ablation\", \"immunotherapy\" and \"hepatocellular carcinoma\", and manual searches of eligible articles from literature reference lists were performed. We then thoroughly reviewed the literature on ablation combined with immunotherapy for HCC, analyzed the relevant mechanism, and explored the safety and effectiveness of this form of combination therapy.</p><p><strong>Results: </strong>RFA combined with immunotherapy in HCC is reported to have good efficacy and controllable safety. On the one hand, RFA can induce the immunogenic substances including Ficolin-3, IL-1 and heat shock protein and regulate the immune cells by mediating the Th1/Th2 ratio, increasing Th17 cells, etc. On the other hand, RFA treatment can lead to tumor immune microenvironment reconstruction, increasing the proportion of functional T cells and upregulate PD-1 in T cells in distant tumors without RFA. This combined strategy has the ability to enhance the anti-tumor immune response through synergies, significantly reduce the risk of recurrence and improve survival.</p><p><strong>Conclusions: </strong>RFA combined with immunotherapy yields a good synergistic effect: it can further strengthen anti-tumor response, delay distant tumor growth, reduce tumor recurrence and metastasis, providing new options for HCC systemic treatment.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"47"},"PeriodicalIF":1.6,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11776151/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061298","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
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