BMC Surgery最新文献

{"title":"Comparative efficacy of double and triple arthrodesis in adult-acquired flatfoot deformity: a retrospective analysis.","authors":"Chaoqun Wang, Xugui Li, Shengnan Dong, Zexi Ling, Serafeim Tsitsilonis, Frank Graef, Khalil Alqiq, Tobias Gehlen","doi":"10.1186/s12893-026-04014-8","DOIUrl":"10.1186/s12893-026-04014-8","url":null,"abstract":"<p><strong>Background: </strong>Rigid adult-acquired flatfoot deformity (AAFD) often requires arthrodesis. While triple arthrodesis is standard, double arthrodesis has been proposed as an alternative. However, comparative evidence remains limited. This study compared their clinical efficacy, radiographic correction, and plantar pressure distribution.</p><p><strong>Methods: </strong>Patients who underwent double or triple arthrodesis for rigid AAFD in our department from April 2013 to December 2019 were retrospectively reviewed. Outcomes included AOFAS scores, Foot Function Index (FFI), radiographic parameters (Meary's angle [MA], talonavicular coverage angle [TCA], talus-first metatarsal angle [T1MA]), and plantar pressure measured via wireless insoles. Inter-group and intra-group comparisons were performed.</p><p><strong>Results: </strong>Twenty-two patients were included (12 double, 10 triple arthrodesis). Baseline characteristics were comparable (all P > 0.05). Double arthrodesis had significantly shorter operative time (59.42 ± 6.05 vs. 85.80 ± 6.32 min, P < 0.001). Complication rates (16.67% vs. 10.00%, P = 1.0) and fusion time were similar, with 100% fusion in both groups. Both procedures significantly improved all functional and radiographic parameters (P < 0.05). AOFAS midfoot scores improved from 19.82 ± 6.97 to 73.83 ± 12.56 (double) and 23.80 ± 18.47 to 66.70 ± 16.65 (triple); hindfoot scores from 15.55 ± 11.57 to 68.75 ± 17.50 and 19.00 ± 17.83 to 69.60 ± 9.57; FFI decreased from 59.55 ± 13.77% to 22.58 ± 18.60% and 60.00 ± 16.26% to 33.50 ± 12.98%. Postoperative radiographic improvements included MA (23.53 ± 14.13° to 10.51 ± 6.90° double; 21.79 ± 9.24° to 10.32 ± 7.75° triple), TCA (13.20 ± 7.65° to 4.84 ± 4.72°; 9.80 ± 6.98° to 4.84 ± 4.88°), and T1MA (22.83 ± 12.00° to 11.49 ± 8.39°; 24.66 ± 9.41° to 10.26 ± 5.20°), with no significant inter-group differences. Plantar pressure showed postoperative symmetry between operated and healthy feet in both groups, with inter-group differences only in the lateral plantar region (P = 0.037) and entire sole (P = 0.048) before correction for multiple comparisons; neither remained significant after correction.</p><p><strong>Conclusions: </strong>In this small cohort, no statistically significant differences were detected between the two procedures in short- to mid-term functional, radiographic, or plantar pressure outcomes, although operative time was shorter for double arthrodesis. Double arthrodesis may be considered a reasonable alternative in appropriately selected patients without significant CCJ involvement. However, these findings are exploratory and require confirmation in larger prospective studies.</p><p><strong>Level of evidence: </strong>Level Ⅲ.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13330461/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148377533","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}

{"title":"A prospective observational cohort study comparing perioperative outcomes, complications, and quality of life between surgical procedures for female stress urinary incontinence.","authors":"Jiali Jiang, Tangxiaoman Wang, Qiuya Deng, Yurong Zhang","doi":"10.1186/s12893-026-04011-x","DOIUrl":"10.1186/s12893-026-04011-x","url":null,"abstract":"<p><strong>Objective: </strong>To compare perioperative outcomes, complications, and quality of life between tension-free vaginal tape obturator (TVT-O) and retropubic tension-free vaginal tape exact (TVT-E) procedures for female severe stress urinary incontinence (SUI).</p><p><strong>Methods: </strong>This prospective cohort study enrolled women undergoing surgery for severe stress urinary incontinence (December 2023-February 2025). Patients were grouped by procedure (TVT-O vs. TVT-E). We compared perioperative data, complications, quality-of-life scores (ICI-Q-SF, IIQ-7, PISQ-12 at 6 and 12 months), and 12-month objective cure rates. Kaplan-Meier curves assessed cumulative recurrence.</p><p><strong>Results: </strong>Of 120 patients enrolled (TVT-O: 66; TVT-E: 54), baseline characteristics were comparable (P > 0.05). Operative time was significantly shorter in the TVT-O group (P < 0.001), with no significant differences in blood loss, catheterization time, or hospital stay. Complication rates were similar (TVT-O: 21.21% vs. TVT-E: 18.52%, P = 0.710), including specific complications like groin pain. Both groups showed significant postoperative quality-of-life improvements (P < 0.001), but between-group differences were not significant. At 12 months, objective cure rates and cumulative recurrence-free survival were comparable between groups.</p><p><strong>Conclusion: </strong>Both TVT-O and TVT-E are safe and effective for severe SUI, significantly improving quality of life. TVT-O offers shorter operative time with equivalent efficacy and complication rates to TVT-E.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13602776/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148383071","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}

{"title":"Long-term outcomes after surgical repair of anomalous origin of one pulmonary artery from the aorta in infants younger than 6 months.","authors":"Yu Zhu, Yixuan Cai, Ming Ye, Gang Chen, Xiao Shen, Huifeng Zhang, Yaping Mi","doi":"10.1186/s12893-026-03972-3","DOIUrl":"10.1186/s12893-026-03972-3","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to summarize the clinical characteristics and long-term surgical outcomes of infants younger than 6 months with anomalous origin of one pulmonary artery from the aorta (AOPA) and to identify factors associated with reoperation.</p><p><strong>Methods: </strong>Infants younger than 6 months who underwent surgical repair for AOPA between January 2013 and December 2020 were retrospectively included. Long-term follow-up data were analyzed. Patients were stratified according to reoperation status and use of patch reconstruction during the primary operation, and preoperative, intraoperative, and postoperative variables were compared.</p><p><strong>Results: </strong>Fifteen infants were enrolled, including 14 with anomalous origin of the right pulmonary artery and 1 with anomalous origin of the left pulmonary artery. All survived to hospital discharge. The median follow-up time was 65 months (IQR 39-97 months). During follow-up, reimplanted pulmonary artery branches remained smaller than normal. Five patients (33.3%) required reintervention. Patients in the reoperation group had lower preoperative pulmonary artery z scores. In the patch-repaired group, abnormal pulmonary artery branches had lower z scores and higher flow velocities at first discharge. Patients operated on at ≤ 1 month of age had a higher risk of reoperation and demonstrated smaller pulmonary artery z scores and faster flow velocities at first discharge.</p><p><strong>Conclusions: </strong>Surgical repair of AOPA in early infancy yields favorable outcomes. Younger age at surgery and smaller branch pulmonary arteries are associated with an increased risk of reoperation.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13602596/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148383023","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}

{"title":"Minimally invasive surgical strategies for gallbladder stones with concomitant common bile duct stones: a systematic review and network meta-analysis.","authors":"Ziwen Liao, Xueyuan Zhu, Yahui Wang, Jiao'an Pang, Jun Fu, Jingxuan Wei, Yuan Yu","doi":"10.1186/s12893-026-04003-x","DOIUrl":"10.1186/s12893-026-04003-x","url":null,"abstract":"<p><strong>Background: </strong>Approximately 10-20% of patients with gallstones present with concomitant common bile duct stones (CBDS). Although T-tube drainage (TTD) has traditionally been used after bile duct exploration, clinical practice is increasingly shifting toward T-tube-free minimally invasive strategies to enhance postoperative recovery. This study evaluated the effectiveness and safety of these approaches using a network meta-analysis (NMA).</p><p><strong>Methods: </strong>PubMed, Web of Science, Embase, and the Cochrane Library were searched from inception to October 2025. Randomized controlled trials (RCTs) and cohort studies were analyzed in parallel using separate frequentist NMAs. Interventions included laparoscopic cholecystectomy (LC) + laparoscopic common bile duct exploration (LCBDE) + TTD, LC + LCBDE + primary suture (PS), LC + laparoscopic transcystic common bile duct exploration (LTCBDE), and LC + endoscopic retrograde cholangiopancreatography (ERCP) performed as either a single-stage or two-stage strategy. Treatment effects were expressed as risk ratios (RRs), odds ratios (ORs), and mean differences (MDs), with treatment rankings estimated using the surface under the cumulative ranking curve (SUCRA).</p><p><strong>Results: </strong>Fifty-two studies including 11,327 patients (19 RCTs and 33 cohort studies) were included. Parallel analyses demonstrated generally consistent findings between randomized and observational evidence. In the RCT network, T-tube-free strategies achieved comparable stone clearance and overall safety compared with TTD. LC + LTCBDE showed the highest SUCRA ranking probabilities for operative time (MD - 47.01 min; SUCRA 96.4%) and length of hospital stay (MD - 5.78 days; SUCRA 86.9%). LC + LCBDE + PS was also associated with shorter operative time (MD - 20.02 min; SUCRA 51.8%) and shorter length of hospital stay (MD - 3.03 days; SUCRA 33.8%). Long-term outcomes and postoperative complication rates were generally comparable across strategies. Differences in SUCRA ranking probabilities were observed for postoperative pancreatitis-related outcomes, with LC + ERCP (two-stage) showing a lower ranking probability (SUCRA 15.8%).</p><p><strong>Conclusions: </strong>T-tube-free minimally invasive strategies achieved stone clearance and overall perioperative safety broadly comparable to those of TTD in patients with gallbladder stones and concomitant common bile duct stones. LC + LTCBDE and LC + LCBDE + PS were associated with shorter operative time and hospital stay in some network comparisons. Overall, treatment selection should remain individualized according to biliary anatomy, stone burden, patient condition, and institutional expertise.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13602641/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148383045","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}

{"title":"Revised cardiac risk index and adverse outcomes in patients undergoing surgical stabilization of rib fractures.","authors":"Yu-Hao Wang, Chien-An Liao, Ling-Wei Kuo, Sheng-Yu Chan, Szu-An Chen, Yu-San Tee, Chi-Tung Cheng, Chien-Hung Liao, Chih-Yuan Fu, Shih-Ching Kang, Chi-Hsun Hsieh, Thomas M Scalea, Marcelo A F Ribeiro","doi":"10.1186/s12893-026-03999-6","DOIUrl":"10.1186/s12893-026-03999-6","url":null,"abstract":"<p><strong>Background: </strong>Surgical stabilization of rib fractures (SSRF) is increasingly performed in patients with severe rib fractures or flail chest. It has been shown to reduce ventilator days and pulmonary complications. Nevertheless, SSRF carries perioperative morbidity, particularly pulmonary and cardiac events, and the optimal preoperative cardiac risk stratification tool for this population has not been established. This study evaluated the association between the Revised Cardiac Risk Index (RCRI) and in-hospital mortality and cardiopulmonary complications in SSRF patients.</p><p><strong>Methods: </strong>This retrospective cohort study used the ACS-TQIP National Trauma Data Bank (2019-2023) to identify adult patients undergoing SSRF. Patients with AIS ≥ 2 in non-thoracic regions, blunt cardiac injury (AIS ≥ 2), or aortic injury were excluded. Because SSRF is an intrathoracic procedure, each patient carried a minimum RCRI of 1; patients were stratified into RCRI = 1, RCRI = 2, and RCRI ≥ 3. The primary outcomes were in-hospital mortality and a composite of cardiopulmonary complications (myocardial infarction, cardiac arrest, pneumonia, ARDS, deep vein thrombosis, and pulmonary embolism). Modified Poisson regression with robust standard errors estimated adjusted risk ratios (RRs), with RCRI = 1 as the reference and adjustment for demographics, regional and chest AIS, fixation details, and comorbidities.</p><p><strong>Results: </strong>After exclusions, 6,139 patients were analyzed (RCRI = 1, n = 4,678; RCRI = 2, n = 1,208; RCRI ≥ 3, n = 253). Adverse outcomes increased stepwise with higher RCRI in both unadjusted and adjusted analyses. Compared with RCRI = 1, RCRI ≥ 3 was associated with significantly higher adjusted risks of in-hospital mortality (RR 3.34, 95% CI 2.06-5.43, p <0.001) and cardiopulmonary complications (RR 3.42, 95% CI 2.08-5.62; both p < 0.001), as well as myocardial infarction (RR 9.28, 95% CI 2.84-30.34, p < 0.001) and pneumonia (RR 5.85, 95% CI 2.72-12.59, p < 0.001). RCRI = 2 was also associated with increased mortality (RR 2.13, 95% CI 1.50-3.04, p < 0.001) and cardiopulmonary complications (RR 1.72, 95% CI 1.20-2.48, p = 0.003).</p><p><strong>Conclusions: </strong>RCRI is a simple, readily available bedside tool that independently stratifies the risk of in-hospital mortality and cardiopulmonary complications in patients undergoing SSRF. Incorporating the RCRI into preoperative assessment may help identify high-risk patients and guide perioperative management.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13487973/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148377586","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}

{"title":"Low excision and high suspension hemorrhoidectomy versus conventional Milligan-Morgan hemorrhoidectomy for mixed hemorrhoids: a 12-month prospective randomized controlled trial.","authors":"Yingzi Shu, Heng Deng, Jing Zhu, Cheng Zhang, Peiyang Sun, Feifei Wang, Hui Liu","doi":"10.1186/s12893-026-04006-8","DOIUrl":"10.1186/s12893-026-04006-8","url":null,"abstract":"<p><strong>Background: </strong>Mixed hemorrhoids represent a highly prevalent benign anorectal disorder. Milligan-Morgan hemorrhoidectomy (MM) is the gold-standard treatment but carries substantial risks of severe postoperative pain, delayed recovery, and anal dysfunction due to extensive tissue resection. Low excision and high suspension hemorrhoidectomy (LEHS) is a refined, function-preserving technique, yet high-quality long-term comparative evidence remains limited. This study aimed to assess the efficacy, safety, and anal functional outcomes of LEHS versus MM for grade III-IV mixed hemorrhoids over 12 months.</p><p><strong>Methods: </strong>This single-center, prospective, randomized, non-inferiority trial enrolled 120 eligible patients between January 2024 and June 2024, randomized 1:1 to LEHS or MM groups with allocation concealment and blinded outcome assessment. Primary outcomes were 12-week clinical effective rate and 12-month hemorrhoid recurrence rate; secondary outcomes included perioperative indicators, pain scores, recovery metrics, complications, anorectal manometry, and patient satisfaction. Statistical analysis was performed via SPSS 26.0 with a -10% non-inferiority margin (P < 0.05).</p><p><strong>Results: </strong>Baseline characteristics were well balanced between groups (all P > 0.05). The 12-week effective rate (96.4% vs. 92.9%) and 12-month recurrence rate (1.8% vs. 5.4%) confirmed LEHS non-inferiority (both P > 0.05). LEHS yielded longer operative time, less blood loss, lower VAS pain scores, faster recovery, fewer complications (14.8% vs. 33.3%, P = 0.027), and more favorable anorectal physiology (all P < 0.001), with higher patient satisfaction.</p><p><strong>Conclusions: </strong>LEHS is non-inferior to MM in clinical efficacy and long-term recurrence control for grade III-IV mixed hemorrhoids, with superior safety, faster recovery, and better-preserved anal function without excessive hypertonia. It is a reliable, minimally invasive surgical alternative worthy of clinical promotion.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov, NCT07495046 (Registered: March 2026, retrospectively registered).</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13599113/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148377550","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}

{"title":"A nomogram for predicting early- and mid-term native liver survival after surgery in patients with type III biliary atresia: a single-center retrospective study.","authors":"Sijin Li, Jixiao Zeng, Xiaogang Xu, Boyuan Tao, Zhihua Ye, Menglong Lan, Hong Zhang, Yuanyuan Luo, Zijian Liang, Zhizu Zhong, Lini Wen, Shuoshuo Guo, Fei Liu","doi":"10.1186/s12893-026-03985-y","DOIUrl":"10.1186/s12893-026-03985-y","url":null,"abstract":"<p><strong>Background: </strong>Biliary atresia (BA) is a severe obstructive biliary disease. This study aimed to explore the independent risk factors influencing the prognosis of BA in children who underwent Kasai portoenterostomy (KPE) and to construct a nomogram for predicting the prognosis.</p><p><strong>Methods: </strong>The clinical data of patients with type III BA who underwent KPE at Guangzhou Women and Children's Medical Center from June 2016 to May 2024 were retrospectively analyzed. Univariate and multivariate Cox regression analyses were used to screen for independent risk factors. A nomogram was constructed using the screened variables to predict postoperative early- and mid-term native liver survival (NLS). The predictive efficacy of the model was evaluated using the concordance index (C-index), receiver operating characteristic (ROC) curve and area under the curve (AUC), and calibration curves.</p><p><strong>Results: </strong>Two hundred patients with type III BA whose clinical data were available were randomly divided into training and validation cohorts at a ratio of 7:3. Age at surgery, recurrent cholangitis, early bile drainage (EBD), and aspartate aminotransferase (AST) level within 1 month after surgery were identified as independent risk factors (all P < 0.05), and a nomogram was constructed using these factors. The C-index was 0.76 (95% CI: 0.71, 0.80) for the training cohort and 0.69 (95% CI: 0.57, 0.75) for the validation cohort. Excellent discrimination and calibration were observed for both groups.</p><p><strong>Conclusion: </strong>The nomogram constructed using variables such as age at surgery, recurrent cholangitis, EBD, and postoperative AST level can accurately predict the probability of NLS after surgery, providing a quantifiable assessment tool for clinical individualized clinical management.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13599080/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148377477","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}

{"title":"Fulminant truncal necrotizing fasciitis of perianal origin with mediastinal extension: a case report.","authors":"Haoyan Li, Chaoyun Chen, Ziwen Wang, Huacong Zhu, Lisi Jian, Lu Zhou, Shiwei Chen, Yang Li","doi":"10.1186/s12893-026-04001-z","DOIUrl":"10.1186/s12893-026-04001-z","url":null,"abstract":"<p><strong>Background: </strong>Necrotizing fasciitis (NF) is a rare but life-threatening soft-tissue infection characterized by rapidly progressive necrosis of the fascia and subcutaneous tissue. Early manifestations are often nonspecific, and delayed diagnosis is associated with substantial mortality. Early recognition and immediate intervention are critical to improving outcomes.</p><p><strong>Case presentation: </strong>A 34-year-old man presented with progressive left lower abdominal pain and persistent perianal discomfort 5 days after radical drainage of a perianal abscess combined with internal hemorrhoid ligation. Despite initial treatment with antibiotics, glycemic control, and fluid resuscitation, his condition continued to deteriorate, and he was subsequently transferred to our hospital for definitive treatment. Emergency debridement demonstrated extensive spread of infection from the ischiorectal fossa through the obturator and abdominal fascial planes to the contralateral gluteal region and mediastinal/para-mediastinal fascial planes. Microbiological cultures confirmed type I polymicrobial infection involving Escherichia coli, Enterococcus raffinosus, and Candida albicans. Postoperatively, the patient developed early hypoxemic respiratory failure requiring invasive mechanical ventilation. The lowest documented PaO₂/FiO₂ ratio was 98.6 mmHg, and oxygenation improved after ventilatory optimization, increased PEEP, fluid restriction, and diuretic therapy. He was successfully extubated on postoperative day 3 and subsequently transitioned to high-flow nasal oxygen. Following combined anti-infective therapy, organ support, and nutritional management, the patient recovered and was discharged.</p><p><strong>Conclusions: </strong>NF can affect any body region, with the perineum, lower limbs, and postoperative wounds being most common. The disease can rapidly progress to systemic infection, sepsis, and multiple organ dysfunction syndrome. Early diagnosis, urgent surgical intervention, and multidisciplinary management are crucial for favorable outcomes.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13656495/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148370507","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}

{"title":"Minimally invasive adrenalectomy for Cushing's syndrome and mild autonomous cortisol secretion: a 20-year experience from a tertiary endocrine surgery center.","authors":"Irem Karatas, Eray Koc, Yalin Iscan, Ummu Mutlu, Hulya Hacisahinogullari, Sidar Bagbudar, Ismail Cem Sormaz, Nihat Aksakal, Arzu Poyanli, Fatih Tunca, Yasemin Senyurek","doi":"10.1186/s12893-026-04015-7","DOIUrl":"10.1186/s12893-026-04015-7","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Cushing's syndrome is a systemic disorder caused by prolonged exposure to excessive glucocorticoids and is associated with significant morbidity and increased mortality. Minimally invasive adrenalectomy has become the preferred surgical approach for adrenal tumors due to favorable perioperative outcomes. This study aimed to evaluate the clinical characteristics, surgical outcomes, and histopathological findings of patients who underwent minimally invasive adrenalectomy for overt Cushing's syndrome and mild autonomous cortisol secretion (MACS).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This retrospective study included 114 consecutive patients who underwent minimally invasive adrenalectomy between January 2006 and December 2025 at our institution. The diagnosis of cortisol excess was established through multidisciplinary evaluation. Hormonal assessment consisted of late-night salivary cortisol measurements, 24-hour urinary free cortisol levels, adrenocorticotrophic hormone (ACTH), and a 1-mg dexamethasone suppression test. Patients with typical clinical features of hypercortisolism and abnormal hormonal findings were classified as having overt Cushing's syndrome, whereas patients without overt Cushingoid features but with a post-dexamethasone suppression test cortisol level &gt; 1.8 µg/dL were classified as having MACS. Demographic characteristics, clinical manifestations, radiological findings, surgical approach, postoperative complications, histopathological and clinical outcomes were analyzed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The mean age of the patients was 47.8 ± 12.4 years, and the female-to-male ratio was 100:14. Adrenalectomy was performed on the right adrenal gland in 43 patients (37.7%), on the left adrenal gland in 62 patients (54.4%), and bilaterally in 9 patients (7.9%). Transabdominal laparoscopic adrenalectomy (TLA) was performed in 111 patients (97.4%), and posterior retroperitoneoscopic adrenalectomy (PRA) was performed in 3 patients (2.6%), with no conversion to open surgery. The mean hospital stay was 4 days. Postoperative complications were rare and mostly minor, with no mortality or major complications. Histopathology revealed adrenocortical adenoma in 76 cases (61.8%), hyperplasia in 39 (31.7%), carcinoma in 3 (2.4%), and other benign lesions in 5 (4.1%). Among patients with available postoperative hormonal follow-up, biochemical remission was achieved in 88.8% of patients, while profound cortisol suppression (&lt; 2 µg/dL) was observed in 75.0% of patients. Adrenalectomy was also associated with significant postoperative improvements in metabolic parameters, particularly LDL cholesterol and triglyceride levels.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Minimally invasive adrenalectomy is a safe and effective treatment option for patients with overt Cushing's syndrome and MACS. The low complication rate and absence of perioperative mortality observed in this study support the role of minimally invasive surgery in app","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13599287/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148377566","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}

{"title":"Comparative surgical outcomes of pterional, supraorbital, and endoscopic endonasal approaches for tuberculum sellae meningiomas: a systematic review and network meta-analysis.","authors":"Ali Msheik, Amr El Mohamad, Ali Sulaiman, Amro Alhajali, Ali Ayyad","doi":"10.1186/s12893-026-03882-4","DOIUrl":"10.1186/s12893-026-03882-4","url":null,"abstract":"<p><strong>Background: </strong>The optimal surgical corridor for tuberculum sellae meningiomas (TSMs) remains a subject of ongoing debate. While the pterional (PT) approach is the traditional gold standard, the endoscopic endonasal approach (EEA) and supraorbital (SO) keyhole approach have emerged as viable alternatives.</p><p><strong>Objective: </strong>To comparatively evaluate the surgical outcomes and complication profiles of the PT, SO, and EEA techniques for the management of TSMs.</p><p><strong>Methods: </strong>A systematic literature search was conducted across PubMed, Embase, Scopus, Web of Science, and Cochrane databases through March 2026. Frequentist random-effects network meta-analysis was performed to compare gross total resection (GTR), visual improvement, and complications. Treatment rankings were estimated using Surface Under the Cumulative Ranking Curve (SUCRA) scores.</p><p><strong>Results: </strong>Six retrospective comparative studies involving 205 patients were included. Network meta-analysis showed no statistically significant differences between approaches for gross total resection (PT vs. EEA: RR 1.21, 95% CI 0.85-1.73; SO vs. EEA: RR 1.04, 95% CI 0.86-1.24). SUCRA rankings suggested only exploratory numerical patterns, with PT ranking highest for GTR and SO showing a non-significant trend for visual improvement compared with EEA (RR 1.30, 95% CI 0.95-1.76). These rankings were not supported by statistically significant pairwise differences and should be interpreted cautiously because of sparse evidence, retrospective study designs, and wide confidence or prediction intervals. Secondary outcomes, including cerebrospinal fluid leak, diabetes insipidus, and tumor recurrence, were imprecisely estimated and broadly comparable across approaches.</p><p><strong>Conclusion: </strong>Available retrospective comparative evidence suggests that pterional, supraorbital, and endoscopic endonasal approaches may provide broadly comparable outcomes for TSMs, but the certainty of evidence is limited. No approach demonstrated statistically significant superiority. Surgical corridor selection should remain individualized according to tumor anatomy, including lateral extension, vascular encasement, and optic canal involvement, as well as institutional expertise and surgeon experience.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13637418/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148377619","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}