BMC Surgery最新文献

{"title":"A modified ureteroileal anastomosis can reduce the incidence of ureteroileal anastomotic stricture.","authors":"Shijie Zhang, Hao Liang, Lei Liu, Peixin Li, Qingya Yang, Sifeng Qu, Jingchao Liu, Benkang Shi, Nianzhao Zhang, Jun Chen","doi":"10.1186/s12893-025-03226-8","DOIUrl":"https://doi.org/10.1186/s12893-025-03226-8","url":null,"abstract":"<p><strong>Background: </strong>Ileal conduit is widely used as a urinary diversion procedure after radical cystectomy. However, ureteroileal anastomotic stricture (UIAS) remains a threatening complication. Here we introduce a novel technique, Chen ureteroileal anastomosis, and compare its postoperative complications to Bricker anastomosis, with a specific focus on the incidence of UIAS.</p><p><strong>Methods: </strong>A rat model was established to investigate morphological and histological alterations of the ileum in urine-stimulated environment. A double-center retrospective cohort of 124 patients undergoing laparoscopic radical cystectomy with ileal conduit between February 2017 to December 2023 was analyzed. All surgeries were performed by a regular surgical team. The demographic characteristics, clinicopathological characteristics, perioperative indicators, and postoperative complications between the two groups were recorded, assessed and compared by an independent committee.</p><p><strong>Results: </strong>Following long-term exposure to urine, the muscular layer of the rat ileum underwent thinning and fibrosis. The two groups were comparable in all demographic and clinicopathological variables. No significant differences were observed in terms of operation time, transfusion rate, length of stay and follow-up time. Median follow-up time was 35 months (IQR, 24-42) in the Chen group and 38 months (IQR, 26-48) in the Bricker group. The rate of UIAS was significantly lower in the Chen group (1.7% vs. 13.6%, p = 0.036, 95%CI: -0.208, -0.030). Other complications were comparable.</p><p><strong>Conclusions: </strong>In this study, we observed that Chen ureteroileal anastomosis significantly reduced the incidence of UIAS compared with Bricker ureteroileal anastomosis. No difference was observed in other postoperative complications.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"462"},"PeriodicalIF":1.8,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145259695","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":"A meta-analysis of efficacy and safety of parietal pleurectomy versus pleural abrasion in treating spontaneous pneumothorax.","authors":"Kai Yang, Chen Wang, Qi Wang, Yongzhi Liu, Wei Cao, Jinlong Zhang, Haochi Li, Dacheng Jin, Yunjiu Gou","doi":"10.1186/s12893-025-03157-4","DOIUrl":"https://doi.org/10.1186/s12893-025-03157-4","url":null,"abstract":"","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"464"},"PeriodicalIF":1.8,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145259783","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":"Nomogram predictive model for the incidence and risk factors of persistent fever after cardiovascular surgery.","authors":"Feng Zang, Guangxu Mao, Ziyao Quan, Yongfeng Shao, Sheng Zhao, Liyun Wang, Zhanjie Li, Zhongqiu You, Lu Liu, Wensen Chen","doi":"10.1186/s12893-025-03161-8","DOIUrl":"https://doi.org/10.1186/s12893-025-03161-8","url":null,"abstract":"","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"466"},"PeriodicalIF":1.8,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145259711","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 validation of a nomogram for predicting 30-day major complications in elderly patients undergoing major abdominal surgery.","authors":"Maimaiti Mijiti, Tingting Yuan, Kurexi Adilai, Taati Zhaenhaer, Rui Yan","doi":"10.1186/s12893-025-03227-7","DOIUrl":"https://doi.org/10.1186/s12893-025-03227-7","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the risk factors related to postoperative major complications in elderly patients undergoing major abdominal surgery, and to construct and validate a nomogram risk prediction model.</p><p><strong>Methods: </strong>This study analyzed data from 380 elderly patients who underwent major abdominal surgery at the Affiliated Cancer Hospital of Xinjiang Medical University between April and November 2023. The cohort was randomly divided into training and validation sets. Variable selection was performed using Lasso regression, followed by univariate and multivariate logistic regression to identify predictors of major postoperative complications. A nomogram-based risk prediction model was subsequently developed and its predictive performance rigorously evaluated.</p><p><strong>Results: </strong>This study analyzed clinical data from 370 elderly patients undergoing major abdominal surgery, of whom 104 (28.1%) developed major complications. Patients were randomly divided into training (n = 259) and validation (n = 111) cohorts in a 7:3 ratio. Using Lasso regression followed by univariate and multivariate logistic regression, gender, ASA classification, CFS, and CCI were identified as significant predictors of major postoperative complications (p < 0.05). The predictive model demonstrated strong performance, with AUCs of 0.884 (95%CI: 0.840-0.929) in the training cohort and 0.855 (95%CI: 0.784-0.927) in the validation cohort.</p><p><strong>Conclusion: </strong>This model is helpful for the clinical prediction of major postoperative complications in elderly patients undergoing major abdominal surgery and assists clinicians in choosing individualized treatment plans to reduce the incidence of serious complications and improve the quality of postoperative recovery of patients.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"463"},"PeriodicalIF":1.8,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145259722","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 validation of an interpretable shap-based machine learning model for predicting postoperative complications in laryngeal cancer.","authors":"Changling Li, Chenyang Xu, Jinzhuang Xu, Wenhua Song, Zhenbin Yu, Ziwei Zhang, Dongmin Wei, Wenming Li, Ye Qian, Dapeng Lei","doi":"10.1186/s12893-025-03213-z","DOIUrl":"https://doi.org/10.1186/s12893-025-03213-z","url":null,"abstract":"<p><strong>Objective: </strong>Postoperative complications remain a major concern in laryngeal cancer surgery, often requiring invasive interventions or intensive care. This study aimed to develop and validate an interpretable machine learning (ML) model to preoperatively predict Clavien-Dindo Grade ≥ III complications and support risk-informed perioperative decision-making.</p><p><strong>Methods: </strong>We conducted a retrospective study using a temporally split cohort of laryngeal cancer patients. Postoperative complications were graded using the Clavien-Dindo (CD) classification. Eight ML algorithms were trained and evaluated using receiver operating characteristic (ROC) curves, calibration plots, and decision curve analysis (DCA). Model interpretability was assessed using SHapley Additive exPlanations (SHAP). A web-based calculator was deployed for clinical use.</p><p><strong>Result: </strong>The random forest (RF) model achieved the best performance, with an area under the curve (AUC) of 0.935 in the training set and 0.842 in the test set. The model demonstrated robust sensitivity and specificity for both surgical and medical complications. Calibration curves indicated strong agreement between predicted and actual outcomes. SHAP analysis identified eight key predictors-such as vocal cord mobility, tumor subsite, and nutritional status-that contributed most to risk estimation. A user-friendly web calculator was developed and is accessible at: https://qilushiny.shinyapps.io/qilupredicate/ .</p><p><strong>Conclusion: </strong>We developed a clinically interpretable ML model that accurately predicts major postoperative complications in patients undergoing laryngeal cancer surgery. This tool provides individualized risk assessments that can guide surgical planning, optimize perioperative strategies, and enhance shared decision-making. Prospective multicenter validation is needed to confirm its utility in routine practice.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"469"},"PeriodicalIF":1.8,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145259747","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":"Degenerative lumbar spinal stenosis with osteoporotic vertebral fracture involving endplate: a retrospective study.","authors":"Qiang Zhang, Zhe Chen, Yazhou Lin, Jianru Qiu, Libo Xu, Wenjian Wu, Yu Liang","doi":"10.1186/s12893-025-03145-8","DOIUrl":"https://doi.org/10.1186/s12893-025-03145-8","url":null,"abstract":"<p><strong>Objective: </strong>Degenerative lumbar spinal stenosis (LSS) accompanied by osteoporotic vertebral fractures (OVFs) involving the endplate is relatively uncommon and presents therapeutic challenges. This study aims to evaluate the clinical outcomes of surgical treatment in such cases.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on nine patients diagnosed with LSS and endplate-involved OVFs who underwent surgery at Ruijin Hospital between July 2015 and December 2022. Patients received either decompression with kyphoplasty or fusion with kyphoplasty. All patients were followed for a minimum of 12 months. Clinical outcomes were assessed using the Visual Analog Scale (VAS) and Japanese Orthopaedic Association (JOA) scores. Radiographic evaluations, including X-rays and CT scans, were used to assess implant stability, cage subsidence, and fusion status.</p><p><strong>Results: </strong>The study included 1 male and 8 female patients, aged 72 to 81 years (mean: 76.3 ± 5.2 years). Two patients underwent decompression and kyphoplasty, six underwent fusion and kyphoplasty, and one patient received posterolateral fusion and kyphoplasty due to an enlarged disc space and cage instability. Significant postoperative improvements in VAS and JOA scores were observed and maintained throughout the follow-up period. Radiological follow-up exceeding 12 months revealed no intervertebral height loss or segmental instability in patients who underwent decompression and kyphoplasty. All patients in the fusion group achieved successful fusion without notable complications such as implant loosening or cage subsidence. The patient who underwent posterolateral fusion also experienced no complications, including screw loosening, vertebral height loss, or hardware failure.</p><p><strong>Conclusion: </strong>Degenerative LSS combined with OVF involving the endplate is a complex clinical condition. Both decompression with kyphoplasty and fusion with kyphoplasty are effective surgical strategies, providing significant and sustained clinical improvement.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"459"},"PeriodicalIF":1.8,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145259757","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":"Uniportal versus multiportal robotic-assisted thoracic surgery pulmonary resections: a propensity score-matched analysis.","authors":"Ting-Fang Kuo, Shuenn-Wen Kuo, Mong-Wei Lin, Ke-Cheng Chen, Pei-Ming Huang, Jang-Ming Lee","doi":"10.1186/s12893-025-03221-z","DOIUrl":"https://doi.org/10.1186/s12893-025-03221-z","url":null,"abstract":"<p><strong>Background: </strong>Uniportal robotic-assisted thoracic surgery (URATS) has been increasingly adopted in some centers; however, its global acceptance and clinical impact remain uncertain. This study compared the perioperative outcomes of URATS and multiportal robotic-assisted thoracic surgery (MRATS) pulmonary resections.</p><p><strong>Methods: </strong>Eighteen patients who underwent URATS pulmonary resection between February 2023 and April 2024 were compared with 54 patients who underwent MRATS pulmonary resection between February 2016 and February 2023. Propensity score matching, incorporating age, sex, frailty index, clinical tumor size, nodal stage, operative side, prior treatment, and surgical procedure, was performed to reduce confounding. Perioperative outcomes were analyzed in 18 matched patient pairs.</p><p><strong>Results: </strong>The URATS group had significantly lower analgesic requirements intraoperatively (12.5 [10.5-13.1] vs. 19 [12.3-21.5] mg; P = 0.02) and on the operative day (1.0 [0-3.1] vs. 4.2 [2.0-6.3] mg; P = 0.005). They also had shorter intensive care unit stay (0 [0-0] vs. 1 [0-2] day; P = 0.03) and postoperative hospital stay (4 [2-7] vs. 7 [5-11] days; P = 0.003). However, the docking time was longer in the URATS group than in the MRATS group (11 [8-15] vs. 7 [5-8] min, P = 0.006).</p><p><strong>Conclusion: </strong>URATS appears to be a feasible approach. Lower analgesic requirements in the immediate postoperative period and shorter hospital stays may indicate improved postoperative recovery compared with MRATS.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"465"},"PeriodicalIF":1.8,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145259705","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":"Piriformis syndrome: a systematic review of case reports.","authors":"Giovanni Monteleone, Giorgio Stevanato, Maurizio Alimandi, Edoardo Cappa, Roberto Sorge","doi":"10.1186/s12893-025-03202-2","DOIUrl":"https://doi.org/10.1186/s12893-025-03202-2","url":null,"abstract":"<p><strong>Background: </strong>To study the medical history, diagnosis, management, and treatment results of piriformis syndrome (PS).</p><p><strong>Methods: </strong>Articles published between 1980 and 2024 reporting cases of PS or piriformis muscle sciatica (PMs) case/case series were included. We excluded articles that did not report anagraphic data for singular cases, diagnostic procedure, therapy, and outcome for each case. We searched PubMed database and we retrieved articles from references. We used the Preferred Reporting Items of Systematic Reviews (PRISMA) guidelines to conduct a systematic review of the literature to identify all published cases of PS or piriformis muscle sciatica (PM). Data for all cases were collected in a database and analysed using statistical software (Statistical Package for the Social Sciences for Windows).</p><p><strong>Results: </strong>Of the 235 articles screened, 97 were included. Data from 212 patients (117 females and 95 males, mean age 43.6 ± 14.8) were collected. 38.2% of the patients in this study had a history of blunt / indirect pelvic trauma or piriform muscle (PM) stress due to vigorous physical activity/sport. 9.0% (19/212) of the patients had previously failed lumbar spine surgery. Before treatment, the diagnosis of PS/PMs was corroborated in 29.7% of patients by intrapelvic magnetic resonance imaging (MRI); 50.5% of the patients had a PS clinical diagnosis. Conservative treatments were effective in treating PS/PMs in 41.1% of patients; 58.9% of patients required surgical treatments. In the group of patients with PS diagnosis made without instrumental finding, the OR of surgical treatment failure occurrence was 5.3. After treatment, the most frequent causes of PS/PMs identified by intraoperative or instrumental findings were the anatomical variant of PM or SN (12.7%) followed by pyomyositis (9.4%) and PM hypertrophy (7.5%). 47.6% of the patients had no instrumental or intraoperative findings.</p><p><strong>Conclusions: </strong>Intrapelvic MRI was the instrumental examination most frequently used to confirm the diagnosis of PS/PMs prior to treatment. The PS causes most frequently identified were the anatomical variant of PM or SN. In the group of patients with PS diagnosis made without instrumental finding, the OR of surgical treatment failure occurrence was 5.3. To reduce the number of cases of persistent pain after treatment for suspected PS, it is advisable to support the clinical diagnosis through all available instrumental diagnostic procedures. However, considering all the risks that SN surgery can cause, all nonsurgical treatments should be encouraged prior to surgery.  TRIAL REGISTRATION: PROSPERO Reg. No. CRD42025641061.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"468"},"PeriodicalIF":1.8,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145259738","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":"Successful use of ovarian vein as a ureteral substitute for long-segment ureteral stricture post-pelvic radiotherapy: a case report.","authors":"Wenqiang Cai, Yan Wang, Xinyan Yan, Pingping Zhou, Xiaqin Huo, Weilin Pu","doi":"10.1186/s12893-025-03185-0","DOIUrl":"https://doi.org/10.1186/s12893-025-03185-0","url":null,"abstract":"<p><strong>Background: </strong>Long-segment ureteral stricture secondary to radiotherapy for female pelvic malignancies represents a severe complication, significantly impairing patients' renal function and quality of life. Despite the availability of multiple treatment modalities, this condition remains challenging to manage, with high recurrence rates and perioperative complication rates.</p><p><strong>Case presentation: </strong>We report a 57-year-old female patient who underwent surgical treatment for cervical malignancy. After postoperative pelvic radiotherapy, the patient developed long-term left ureteral stricture. Both transurethral ureteral stenting and ureterocystostomy failed to achieve satisfactory results. Finally, the left ureter was successfully reconstructed using the ovarian vein. The patient's postoperative course was uneventful, and no ureteral fistula or restenosis occurred during the 3-year follow-up.</p><p><strong>Conclusions: </strong>Although current evidence suggests that ovarian vein substitution for the ureter in treating radiation-induced long-segment ureteral stricture yields favorable prognosis at 3 years postoperatively, its long-term efficacy still requires further in-depth research.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"460"},"PeriodicalIF":1.8,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145259760","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":"Comparative efficacy of erector spinae plane block versus surgeon-performed intraoperative intercostal nerve block in video-assisted thoracoscopic surgery: a retrospective analysis.","authors":"Soner Kına, Güntuğ Batıhan, Hüseyin Türkan, Yekta Bektaş","doi":"10.1186/s12893-025-03178-z","DOIUrl":"https://doi.org/10.1186/s12893-025-03178-z","url":null,"abstract":"<p><strong>Background: </strong>Video-assisted thoracoscopic surgery (VATS) offers reduced postoperative pain and faster recovery, yet optimal analgesia remains essential. Regional anesthesia techniques, such as the erector spinae plane (ESP) block and intercostal nerve block (ICNB), are commonly employed. This study compares preoperative ESP block with surgeon-performed intraoperative ICNB in VATS patients.</p><p><strong>Methods: </strong>In this retrospective study, 82 patients (≥ 18 years; ASA I-III) underwent elective VATS between January 2020 and December 2022 were analyzed. Forty patients received a postoperative ESP block and 42 an intraoperative ICNB. Primary outcomes included postoperative pain scores using the Visual Analog Scale, postoperative peak expiratory flow (PEF), postoperative IV opioid analgesic use, drainage time, and hospital length of stay.</p><p><strong>Results: </strong>Baseline demographics were similar. VAS scores were comparable at postoperative 1, 3, 6, 12 and 24 h. At postoperative 48 h, the ICNB group had significantly lower VAS scores (4.17 ± 1.03 vs. 4.78 ± 1.03; p = 0.00987). No significant differences were observed in postoperative iv opioid analgesic use, drainage time or hospital stay.</p><p><strong>Conclusions: </strong>Both techniques provide effective early analgesia in VATS, with ICNB showing prolonged pain relief. Further prospective studies are warranted.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"461"},"PeriodicalIF":1.8,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145259697","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}