BMC Surgery最新文献

{"title":"The convenience of contrast-enhanced intraoperative ultrasonic cholangiography in liver resection: a study protocol for a randomized, prospective, off-label trial.","authors":"Takeshi Urade, Kentaro Oji, Masahiro Kido, Shohei Komatsu, Hidetoshi Gon, Kenji Fukushima, Shinichi So, Toshihiko Yoshida, Keisuke Arai, Hayata Sano, Sae Murakami, Takumi Fukumoto","doi":"10.1186/s12893-026-03818-y","DOIUrl":"https://doi.org/10.1186/s12893-026-03818-y","url":null,"abstract":"<p><strong>Background: </strong>Intraoperative cholangiography (IOC) is widely used to delineate biliary anatomy and confirm ductal integrity during liver resection. However, conventional radiographic IOC requires a C-arm set-up, may interrupt the operative workflow, and exposes patients and operating-room personnel to ionizing radiation. Contrast-enhanced intraoperative ultrasonic cholangiography (CE-IOUSC) combines intrabiliary injection of highly diluted perfluorobutane microbubbles (Sonazoid^®) with contrast harmonic ultrasonography, enabling real-time visualization that can be repeated on demand without radiation. We hypothesize that CE-IOUSC provides superior procedural convenience while maintaining biliary visualization and safety.</p><p><strong>Methods: </strong>This is a single-center, open-label, randomized, parallel-group, phase III comparative trial. Adults (≥ 20 years) scheduled for liver resection, including living donors, are eligible when cholecystectomy and transcystic catheterization via the cystic duct are feasible. After informed consent, participants are randomized 1:1 (stratified by liver condition: normal vs. impaired) to CE-IOUSC or conventional radiographic IOC using a computer-generated sequence. In both arms, cholangiography is performed twice-before and after bile duct division-with additional imaging permitted as clinically required. Conventional IOC uses diluted iothalamate contrast (Urografin^®) under C-arm fluoroscopy. CE-IOUSC uses 1,000-fold diluted Sonazoid^® administered through the cystic duct and evaluated using intraoperative ultrasonography in contrast mode. Cross-over \"rescue\" cholangiography with the alternative modality is allowed when the assigned method is unsuccessful or inadequate. The primary endpoint is the cumulative time required to complete intraoperative cholangiography, including any additional imaging and repeated attempts. Secondary endpoints include surgeon-rated usability (5-point Likert questionnaire completed by the primary operator immediately after surgery), detectability of biliary structures (segmental visualization rates assessed by predefined criteria), postoperative biliary complications (bile leak or stricture graded by Clavien-Dindo), cross-over rescue efficacy, and safety outcomes (procedure-related adverse events and perioperative laboratory changes). Outcomes will be analyzed primarily on an intention-to-treat basis.</p><p><strong>Discussion: </strong>This trial will quantify whether CE-IOUSC improves the efficiency and usability of intraoperative biliary imaging without compromising visualization or patient safety. The results will inform evidence-based adoption of ultrasound-based cholangiography as a practical alternative to conventional radiographic IOC in liver resection.</p><p><strong>Trial registration: </strong>Japan Registry of Clinical Trials (jRCT), jRCTs051230202.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147857540","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":"Prognostic nutritional index and long-term outcomes after coronary artery bypass grafting.","authors":"Haichang Xu, Weiqiang Li, Shen-An-Nan Chen, Shuaishuai Zhao, Chengtao Peng, Kang Huang, Xueliang Zhou, Qicai Wu","doi":"10.1186/s12893-026-03807-1","DOIUrl":"https://doi.org/10.1186/s12893-026-03807-1","url":null,"abstract":"<p><strong>Aims: </strong>This study examined whether preoperative prognostic nutritional index (PNI) was related to long-term major adverse cardiovascular events (MACE), all-cause mortality, and cardiovascular mortality in patients with coronary heart disease (CHD) undergoing coronary artery bypass grafting (CABG).</p><p><strong>Methods: </strong>This single-center retrospective cohort study analyzed 550 patients with CHD who underwent CABG at the First Affiliated Hospital of Nanchang University between January 2014 and August 2025. PNI was treated as both a continuous variable and tertiles. Multivariable Cox models were used to evaluate its associations with study outcomes, and Kaplan-Meier as well as receiver operating characteristic (ROC) analyses were additionally performed. Subgroup analyses, a sensitivity analysis excluding patients with chronic kidney disease (CKD), and supplementary comparisons with the Geriatric Nutritional Risk Index (GNRI) and EuroSCORE II were also undertaken.</p><p><strong>Results: </strong>Over a median follow-up of 46.1 months, 113 patients developed MACE, 94 died from any cause, and 61 died from cardiovascular causes. After multivariable adjustment, higher PNI remained independently related to lower risks of MACE (HR per 1-unit increase: 0.948, 95% CI 0.917-0.979; P = 0.001), all-cause mortality (HR 0.938, 95% CI 0.904-0.973; P < 0.001), and cardiovascular mortality (HR 0.939, 95% CI 0.900-0.980; P = 0.004). Patients in the highest tertile had lower risks of MACE and cardiovascular mortality than those in the lowest tertile. Similar overall patterns were observed in subgroup, quartile, and sensitivity analyses. Although PNI was significantly correlated with all three outcomes, its discriminatory performance was modest (AUCs: 0.596 for MACE, 0.616 for all-cause mortality, and 0.608 for cardiovascular mortality). GNRI and EuroSCORE II yielded numerically higher AUC values, and the combination of PNI with EuroSCORE II also showed a numerical improvement, but none of these differences reached statistical significance.</p><p><strong>Conclusion: </strong>Lower preoperative PNI corresponded to higher long-term risks of MACE, all-cause mortality, and cardiovascular mortality after CABG. However, these findings should be interpreted cautiously due to the single-center retrospective design and the limited discriminatory performance of PNI.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147844499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative sleep disturbance and postoperative delirium in elderly joint replacement patients: a prospective cohort study.","authors":"Jiawei Han, Qianyu Yang, Yanan Zhao, Lu Chen, Zixuan Wang, Jiayu Zhu, Xuesen Su, Shouyuan Tian","doi":"10.1186/s12893-026-03797-0","DOIUrl":"https://doi.org/10.1186/s12893-026-03797-0","url":null,"abstract":"<p><strong>Background: </strong>Postoperative delirium (POD) represents a frequent complication among patients undergoing joint replacement surgery. While sleep disturbance is prevalent during the perioperative period, its relationship with POD has not been fully clarified. To this end, the present study was conducted to investigate the association between preoperative sleep disturbance and POD in elderly patients undergoing joint replacement.</p><p><strong>Methods: </strong>This prospective cohort study recruited 200 patients undergoing elective knee or total hip replacement surgery between April 10th and July 15th, 2025, retrospectively registered with the Chinese Clinical Trial Registry (ChiCTR2500113120) on November 25, 2025. Specifically, preoperative subjective sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) on the day of admission. POD was assessed twice daily using the Chinese version of the 3-Minute diagnostic assessment for delirium based on the Confusion Assessment Method (3D-CAM) within the first postoperative week. Multivariable logistic regression was performed to examine the association between preoperative sleep disturbance and POD, adjusting for age, sex, American Society of Anesthesiologists (ASA) classification, alcohol consumption, smoking,comorbidity, education level, type of anesthesia and PCIA.</p><p><strong>Results: </strong>Preoperative sleep disturbance was observed in 69 of 200 patients (35%), with POD present in28 patients (14%). Followingmultivariable adjustment, preoperative sleep disturbance was independently associated with the occurrence of POD (OR: 2.84, 95% CI: 1.24-6.50, P = 0.013). The RCS curve revealed a significant positive linear association: as the PSQI score increased, POD risk increased gradually (P for overall = 0.036, P for nonlinear = 0.190). Exploratory subgroup analyses indicated a significant association between preoperative sleep disturbance and POD among patients under 80 years of age, females, patients with a normal BMI, and those with an ASA Ⅱ.</p><p><strong>Conclusion: </strong>In elderly patients undergoing elective knee or total hip replacement surgery, preoperative sleep disturbance is independently associated with an increased risk of POD.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147845113","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":"Laparoscopic endostapler partial cecal resection in complicated appendicitis with appendiceal base involvement: a single-center retrospective study.","authors":"Runjie Hou, Kaimeng Wang, Jing Guo, Yuan Zhang, Mingyue Du, Jiwei Hao, Yongqiang Wang, Pengcheng Liu, Xiaobiao Song, Jijun Wang","doi":"10.1186/s12893-026-03786-3","DOIUrl":"https://doi.org/10.1186/s12893-026-03786-3","url":null,"abstract":"<p><strong>Background: </strong>Acute appendicitis (AA) is a common cause of acute abdomen. Appendiceal base gangrene or perforation represents a severe form of complicated appendicitis, in which secure closure of the appendiceal stump is crucial for surgical management, and no standardized optimal strategy has yet been established.</p><p><strong>Objective: </strong>This study aimed to evaluate the safety and feasibility of laparoscopic endostapler partial cecal resection in patients with complicated appendicitis involving appendiceal base gangrene or perforation.</p><p><strong>Methods: </strong>A retrospective study was conducted on consecutive patients who underwent surgical treatment for appendicitis at our center between January 2021 and January 2025. Patients classified as Gomes grade 3B (appendiceal base gangrene or perforation) were identified based on intraoperative findings. Baseline characteristics and perioperative outcomes were collected. Exploratory analyses across appendicitis subtypes were performed to provide contextual information. A single-arm descriptive analysis was conducted in the Gomes grade 3B cohort. The primary outcomes were postoperative complications and readmission assessed over a 3-month follow-up period.</p><p><strong>Results: </strong>A total of 785 patients were included in the analysis, including 484 with uncomplicated appendicitis and 301 with complicated appendicitis, of whom 277 did not involve the appendiceal base and 24 were classified as Gomes grade 3B. In the Gomes grade 3B cohort, all patients successfully underwent laparoscopic surgery without conversion to open surgery or intraoperative complications. The mean operative time was 123.33 ± 16.59 min. The median time to oral intake was 3.0 days (2.5-3.0), and the median length of hospital stay was 5.0 days (5.0-5.0). Postoperative complications occurred in three patients (12.50%), all classified as Clavien-Dindo grade I-II. No severe complications (Clavien-Dindo grade III-V) or readmissions were observed during the 3-month follow-up period.</p><p><strong>Conclusions: </strong>Laparoscopic endostapler partial cecal resection showed technical feasibility and acceptable short-term safety in patients with complicated appendicitis with appendiceal base involvement. This technique may represent a potential surgical option for this specific patient population, although further studies are required.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147845120","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":"Efficacy observation of wound care ointment (suile) on incision healing after mixed hemorrhoid surgery.","authors":"Baozhen He, Qinghua Bai, Eslam Ghaleb, Xiaoli Wu, Weifeng Mao, Wu Zhang","doi":"10.1186/s12893-026-03811-5","DOIUrl":"https://doi.org/10.1186/s12893-026-03811-5","url":null,"abstract":"<p><strong>Background: </strong>Postoperative complications, including severe pain, perianal edema, and prolonged wound healing, significantly impact patient recovery following mixed hemorrhoid surgery. This study aimed to evaluate the clinical efficacy of a topical wound care ointment (Suile) in promoting postoperative recovery and tissue remodeling.</p><p><strong>Methods: </strong>In this randomized controlled trial, 78 patients with stage III-IV mixed hemorrhoids were enrolled and allocated to either a treatment group (topical Suile ointment containing bismuth subgallate and borneol) or a control group (standard povidone-iodine care). Primary and secondary outcomes included pain intensity (Visual Analog Scale, VAS), wound edema scores, scar formation (Vancouver Scar Scale, VSS), and clinical cure rate. Data were analyzed using repeated-measures ANOVA with Bonferroni post-hoc corrections to assess longitudinal recovery patterns.</p><p><strong>Results: </strong>By day 28, the treatment group demonstrated a significantly higher clinical cure rate compared to the control group (69.23% vs. 35.90%, P < 0.01). Repeated-measures ANOVA revealed highly significant improvements in the treatment group for both pain and scar formation. Specifically, VAS scores were significantly lower in the Suile group from days 3 to 14 (P < 0.001), with a large effect size at the primary endpoint (day 7, Cohen's d = 0.88). Furthermore, Suile application led to significantly superior scar outcomes (VSS scores) by the end of the follow-up period (Group effect P < 0.001; day 28 P < 0.001). While wound edema scores were lower in the treatment group at several time points, the overall group effect for edema did not reach statistical significance (P = 0.146). No serious adverse events were reported.</p><p><strong>Conclusion: </strong>Topical application of Suile ointment significantly alleviates postoperative pain, enhances the quality of scar formation, and accelerates overall wound healing after mixed hemorrhoid surgery. These findings suggest that Suile is a safe and effective therapeutic option for optimizing postoperative recovery in proctological practice.</p><p><strong>Trial registration: </strong>Chinese Clinical Trial Registry (ChiCTR), ChiCTR2600123181. Registered on 22 April 2026. Retrospectively registered.The trial was registered retrospectively due to administrative delays; however, the study protocol and outcomes were defined prior to patient enrollment.\"</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147845146","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":"Neuroendoscopic-assisted abdominal wall puncture technique in ventriculoperitoneal shunt surgery: implication for clinical treatment.","authors":"Jie Wu, Gongbo Li, Guoqing Wu, Zhen Zhang, Jiao Yang, Lichun Lu, Chen Wang, Wenyu Zhu","doi":"10.1186/s12893-026-03783-6","DOIUrl":"https://doi.org/10.1186/s12893-026-03783-6","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Ventriculoperitoneal shunt surgery (VPS) remains a mainstay for the treatment of hydrocephalus. This study compared the short-term efficacy and perioperative safety of a neuroendoscopic-assisted abdominal wall puncture technique for distal catheter placement with laparoscopy-assisted open laparotomy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a single-center, non-randomized, time-sequence controlled cohort study. Patients who underwent VPS with distal catheter placement via laparoscopy-assisted open laparotomy between January 2020 and December 2021 were assigned to the Open Laparotomy Group (OLG), whereas those treated using the neuroendoscopic-assisted abdominal wall puncture approach between January 2022 and April 2025 were assigned to the Abdominal Wall Puncture Group (APG). Perioperative inflammatory markers, operative parameters, and early radiological and functional outcomes were compared between groups. Intraoperative technical difficulties, peritoneal adhesions, and complications were descriptively recorded. Safety of CO₂ pneumoperitoneum was monitored by postoperative head CT.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Clinical trial registration: &lt;/strong&gt;not applicable.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Sixty-nine patients were included (APG, n = 34; OLG, n = 35). On postoperative day 1 and day 3, white blood cell and neutrophil counts were significantly lower in the APG than in the OLG (all p &lt; 0.05). The Evans index and Activities of Daily Living (ADL) scores were comparable between groups preoperatively and at 3 days postoperatively (all p &gt; 0.05), while both measures improved from baseline within each group (all p &lt; 0.05). Compared with the OLG, the APG was associated with reduced intraoperative blood loss (p = 0.023), shorter operative time (p = 0.040), and shorter postoperative length of stay (p = 0.016). No intraoperative visceral injury or catheter malposition requiring revision occurred in either group. Peritoneal adhesions were observed in 3 OLG patients and 2 APG patients, none requiring conversion. In the APG, postoperative head CT on day 1 showed no intraventricular or subdural air. The incidence of distal shunt obstruction within 3 months was low and did not differ significantly between groups (p = 0.115).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;In this non-randomized, time-sequence cohort, neuroendoscopic-assisted abdominal wall puncture for distal catheter placement was associated with less perioperative blood loss, lower early postoperative inflammatory markers, and shorter operative time and hospital stay, while achieving similar early radiological and functional improvement and short-term shunt patency compared with laparoscopy-assisted open laparotomy. However, given the limited sample size, the non-randomized design, and the short (3-month) follow-up, these results support only preliminary conclusions. Longer-term follow-up (e.g., ≥ 1-2 years) is required to evaluate late complications and shunt durability, including","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147845087","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":"Association between intraoperative irrigation volume and postoperative abdominal abscess in perforated peptic ulcer.","authors":"Atsushi Tabeta, Yusuke Tsutsumi, Hiromasa Hoshi, Akira Endo, Koji Ito, Tomohiro Akutsu, Hikaru Odera, Hideto Shiraki, Kei Ito, Takeshi Yokoyama, Yasukazu Narita, Taro Masuda, Akira Suekane, Koji Morishita","doi":"10.1186/s12893-026-03813-3","DOIUrl":"https://doi.org/10.1186/s12893-026-03813-3","url":null,"abstract":"<p><strong>Background: </strong>Perforated peptic ulcer is a critical emergency disease requiring surgery, and postoperative intra-abdominal abscess (IAA), an organ/space surgical site infection (SSI), is a common complication. Intraoperative irrigation is a common IAA prevention approach; however, scientific evidence supporting its effectiveness is lacking. We aimed to investigate the association between intraoperative irrigation volume and IAA using multicentre data.</p><p><strong>Methods: </strong>This multicentre retrospective cohort study was conducted between January 2011 and December 2023. The study included patients aged ≥ 18 years who underwent laparotomy or laparoscopy for perforated peptic ulcer, defined as perforation of a gastric or duodenal ulcer. The primary and secondary outcomes were IAA incidence and superficial incisional SSI, respectively, and their association with the intraoperative irrigation volume was determined through multivariable logistic regression analyses.</p><p><strong>Results: </strong>The study included 478 patients with a median age of 66 years (interquartile range [IQR]: 54-75 years), 344 (72.0%) of whom were males. The median irrigation volume was 7.0 (IQR: 5-10) L. Among the 478 patients, IAA and superficial incisional SSI occurred in 52 (10.9%) and 71 (14.9%), respectively. The irrigation volume and the outcomes exhibited no significant association (for IAA: adjusted odds ratio [AOR] = 1.04, 95% confidence interval [CI] = 0.97-1.11, p = 0.25; for superficial incisional SSI: AOR = 1.07, 95% CI = 1.00-1.14, p = 0.053).</p><p><strong>Conclusions: </strong>There was no statistically significant association between increased intraoperative irrigation volume and a decreased incidence of postoperative IAA formation. These findings suggest that alternative strategies, rather than uncontrolled high-volume irrigation, are required for IAA prevention.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147845065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of prognostic factors for R1/R2 resection in patients with hilar cholangiocarcinoma.","authors":"Zepu Wang, Chuncheng Wang, Meijian Yang, Dan Lv, Yanhui Peng","doi":"10.1186/s12893-026-03776-5","DOIUrl":"https://doi.org/10.1186/s12893-026-03776-5","url":null,"abstract":"<p><strong>Objective: </strong>To identify prognostic factors and develop a predictive tool for patients with hilar cholangiocarcinoma (HCCA) undergoing R1 or R2 resection, thereby informing patient selection and individualized treatment decisions.</p><p><strong>Methods: </strong>A retrospective analysis was conducted of HCCA patients who underwent R1 or R2 resection at a single center. Independent prognostic factors were identified using Cox regression analysis, and a predictive nomogram was constructed using R software.</p><p><strong>Results: </strong>Multivariate analysis identified four independent prognostic factors: surgical margin status (P = 0.002), tumor differentiation grade (P = 0.030), vascular invasion (P < 0.001), and adjuvant therapy (P = 0.023). The nomogram based on these factors demonstrated favorable discriminatory ability, with a C-index of 0.780. Time-dependent receiver operating characteristic (ROC) analysis yielded areas under the curve (AUC) of 0.904 (95% confidence interval [CI]: 0.831-0.966) and 0.822 (95% CI: 0.736-0.897) for predicting 1-year and 2-year survival, respectively. Patients stratified into high-risk and low-risk groups by the nomogram showed significantly different survival outcomes (1-year survival: 44% vs. 92.5%; 2-year survival: 20% vs. 52.8%).</p><p><strong>Conclusion: </strong>The developed nomogram effectively predicts prognosis following R1 or R2 resection for HCCA, demonstrating good discrimination and short-term predictive accuracy. It serves as a useful tool for postoperative risk stratification and personalized management planning.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147845054","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":"Effectiveness of protocol-based medical treatment in selected uncomplicated acute appendicitis: a retrospective cohort study.","authors":"Sami Dogan","doi":"10.1186/s12893-026-03767-6","DOIUrl":"https://doi.org/10.1186/s12893-026-03767-6","url":null,"abstract":"<p><strong>Objective: </strong>To describe the short-term treatment outcomes and intermediate-term appendectomy rates following protocol-based medical treatment in carefully selected patients with uncomplicated acute appendicitis without appendicolith.</p><p><strong>Methods: </strong>This single-arm retrospective cohort study was conducted at a single tertiary center. Patients with uncomplicated acute appendicitis without appendicolith on computed tomography (CT) were treated following a standardized protocol consisting of intravenous antibiotics, a 48-hour in-hospital observation period, and systematic follow-up. The primary outcome was treatment success during initial hospitalization, defined as symptom resolution and discharge without the need for appendectomy. Secondary outcomes included appendectomy rates and complications during the follow-up period.</p><p><strong>Results: </strong>Sixty-eight patients received protocol-based medical treatment. All 68 patients (100%) completed initial hospitalization successfully without requiring appendectomy. During a median follow-up of 2.8 years, six patients (8.8%) underwent appendectomy; however, only one of these (1.5%) represented true symptomatic recurrence, while the remaining five (7.4%) underwent surgery for non-clinical reasons including patient preference, anxiety, and pregnancy-related concerns. No major complications were observed among patients managed with antibiotics.</p><p><strong>Conclusion: </strong>Protocol-based medical treatment achieved complete short-term treatment success in this selected cohort of patients with uncomplicated acute appendicitis without appendicolith. The overall appendectomy rate during follow-up remained low, with true symptomatic recurrence observed in only one patient. These findings, while limited by the single-arm observational design and small sample size, supported the feasibility of this approach when combined with reliable imaging assessment, systematic patient selection, and structured follow-up.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147845058","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":"Multiple symmetric lipomatosis (Madelung disease) presenting as cervical lipomatous mass in a middle-aged male with alcohol use in Nepal: A Case Report.","authors":"Suzita Hirachan, Adheesh Bhandari","doi":"10.1186/s12893-026-03789-0","DOIUrl":"https://doi.org/10.1186/s12893-026-03789-0","url":null,"abstract":"<p><p>Multiple symmetric lipomatosis (MSL), or Madelung disease, is a rare disorder characterized by symmetrical, non-encapsulated adipose tissue deposition, predominantly involving the neck and upper trunk. It is strongly associated with chronic alcohol consumption.We report a 33-year-old male with a history of regular alcohol intake presenting with a progressively enlarging cervical mass. Imaging revealed bilateral, symmetrical lipomatous deposits consistent with MSL. The patient underwent surgical excision under general anesthesia with satisfactory cosmetic and functional outcomes.This report highlights the clinical presentation, diagnostic approach, and management of MSL, emphasizing the importance of early recognition. A short-term follow-up showed no recurrence; however, long-term surveillance and alcohol cessation remain essential to reduce recurrence risk.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822876","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}