BMC Surgery最新文献

{"title":"Safety and oncologic efficacy of robotic surgery compared to open surgery after neoadjuvant therapy for pancreatic cancer.","authors":"Pengyu Li, Hui Zhang, Juan Li, Peng Zhang, Qiang Xu, Wenjing Liu, Haomin Chen, Weijie Chen, Mingfei Wang, Yuqian Kan, Xinwei Cui, Yaqi Wang, Huadan Xue, Zhiyong Liang, Menghua Dai","doi":"10.1186/s12893-026-03942-9","DOIUrl":"10.1186/s12893-026-03942-9","url":null,"abstract":"<p><strong>Background: </strong>Neoadjuvant therapy (NAT) has become the recommended treatment approach for patients with borderline resectable or locally advanced pancreatic cancer. However, pancreatic peritumoral fibrosis and proximity of the tumor to major vessels make surgery after NAT challenging. The feasibility and safety of robotic approaches remain unclear.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on consecutive pancreatic cancer patients who underwent either open pancreatic surgeries (OPS) or robotic pancreatic surgeries (RPS) following NAT between February 2017 and April 2025. Outcomes, including R0 resection rates, postoperative complication rates, disease-free survival (DFS), and overall survival (OS), were compared between the two groups.</p><p><strong>Results: </strong>The rate of combined vascular resection and reconstruction was significantly higher in OPS group compared to RPS group following NAT. A total of 43 patients underwent surgical resection which did not require venous segmental resection and reconstruction, including 23 RPS and 20 OPS, were finally included in the analysis. The two groups were well balanced in baseline characteristics, except for BMI. In the RPS group, one case (4.3%) was converted into laparotomy. The RPS group was associated with longer operative time (340.0 min vs. 254.0 min, p = 0.015). The number of harvested lymph nodes was significantly higher in the RPS group compared to the OPS group(25 vs. 18, p = 0.049). There were no significant differences in R0 resection rates between the groups. The overall complication rate was significantly lower in the RPS group (21.7% vs. 55.0%, p = 0.024), while the rates of severe complications, clinically relevant pancreatic fistula, and postoperative hemorrhage did not differ between groups. Postoperative hospital stay was slightly shorter in the RPS group, though not statistically significant. There were no significant differences in DFS or OS.</p><p><strong>Conclusion: </strong>In carefully selected patients with pancreatic cancer following neoadjuvant therapy who did not require vascular segmental resection and reconstruction, a robotic approach appeared technically feasible and was associated with favorable short-term postoperative outcomes and a greater lymph node yield. These findings should be considered exploratory, and further prospective studies are warranted to better define the role of robotic surgery in this setting.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13617835/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148399777","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":"Perioperative factors associated with intraoperative circulatory decompensation during lung transplantation under initial VV-ECMO support: an exploratory single-center study.","authors":"Haoshuai Yang, Yang Hao, Shuoyan An, Jin Zhang, Weijie Zhu, Kunsong Su, Chaoyang Liang, Jing Li","doi":"10.1186/s12893-026-04008-6","DOIUrl":"10.1186/s12893-026-04008-6","url":null,"abstract":"<p><strong>Background: </strong>Intraoperative circulatory decompensation during lung transplantation is a life-threatening event that often necessitates a challenging transition from veno-venous (VV) to veno-arterial (VA) extracorporeal membrane oxygenation (ECMO). This study evaluated perioperative variables associated with decompensation under an explicitly exploratory observational framework.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 97 patients with end-stage lung disease undergoing lung transplantation with initial VV-ECMO support from January 2020 to December 2022. Intraoperative circulatory decompensation was redefined using objective hemodynamic and echocardiographic criteria; VV-to-VA conversion was recorded as a management consequence rather than as a defining criterion. Propensity score matching (PSM) was applied to balance confounding factors, resulting in 75 analyzed patients. Candidate models were revised as exploratory penalized models and internally assessed by repeated fivefold cross-validation and bootstrap optimism correction.</p><p><strong>Results: </strong>In the matched descriptive comparison, pH and lactate remained robustly different after FDR correction, while highest intraoperative PASP, pulmonary valve VMAX, aortic valve VMAX, and heart rate were interpreted as exploratory signals. To reduce temporal bias, we separated a preoperative/peri-induction model from a secondary intraoperative monitoring model. In internal validation, the preoperative/peri-induction model achieved a repeated fivefold cross-validation AUC of 0.803 and a bootstrap optimism-corrected AUC of 0.813, with a Brier score of 0.151. The intraoperative monitoring model, which included highest intraoperative PASP, achieved a repeated fivefold cross-validation AUC of 0.853 and a bootstrap optimism-corrected AUC of 0.865, with a Brier score of 0.121.</p><p><strong>Conclusions: </strong>Lower preoperative arterial pH, higher lactate, and dynamic intraoperative pulmonary pressure changes were associated with clinically documented circulatory decompensation in this exploratory single-center cohort. These internally assessed findings require external validation before clinical implementation.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13617856/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148388310","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":"Wound complications and clinical efficacy of the direct anterior approach versus the posterolateral approach in total hip arthroplasty: a systematic review and meta-analysis of randomized controlled trials.","authors":"Wangjie Fu, Yong Deng, Jiongnan Xu, Keyi Chen, Luolong Wang, Songyu He, Jun Zhang","doi":"10.1186/s12893-026-04010-y","DOIUrl":"10.1186/s12893-026-04010-y","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The direct anterior approach (DAA) and the posterolateral approach (PLA) are commonly used surgical techniques in total hip arthroplasty (THA). However, whether DAA is associated with different wound complication rates compared with PLA remains controversial. This meta-analysis aimed to compare wound complications and clinical outcomes between DAA and PLA in THA based on randomized controlled trials.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A comprehensive search was conducted across six major electronic databases: PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), and Chongqing VIP Information (CQVIP). The search strategy encompassed studies indexed from database inception to 31 December 2025. The primary outcomes were wound complications, including incisional infection, hematoma, and delayed wound healing. Predefined eligibility criteria were applied during study screening. The risk of bias of the included studies was assessed using the revised Cochrane Risk of Bias tool for randomized trials (RoB 2). The PLA group was used as the control group. Data were extracted from the included randomized controlled trials (RCTs). A pooled statistical analysis was performed to estimate the rate of wound complications and to compare the clinical effects of DAA and PLA. The meta-analysis was conducted with Review Manager 5.3 and Stata 15.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 18 eligible RCTs, comprising 1,485 patients, were included. Compared with PLA, DAA was associated with decreased rates of incisional infection (RR = 0.48, P = 0.03, I&lt;sup&gt;2&lt;/sup&gt; = 0%) and a lower overall rate of wound complications (RR = 0.58, P = 0.04, I&lt;sup&gt;2&lt;/sup&gt; = 0%). No evidence of a significant difference between groups was observed for hematoma incidence, poor wound healing, or overall surgical complications. Regarding perioperative indicators, DAA demonstrated several advantages. DAA was associated with a shorter incision length (MD = -3.44, P &lt; 0.001, I&lt;sup&gt;2&lt;/sup&gt; = 97%), less intraoperative blood loss (MD = -76.74, P &lt; 0.001, I&lt;sup&gt;2&lt;/sup&gt; = 97%), and a shorter hospital stay (MD = -2.15, P &lt; 0.001, I&lt;sup&gt;2&lt;/sup&gt; = 95%). In terms of functional recovery, DAA demonstrated better early postoperative function. The DAA group had higher HHS at 1 month (MD = 5.87, P &lt; 0.001, I&lt;sup&gt;2&lt;/sup&gt; = 15%), 3 months (MD = 5.10, P &lt; 0.001, I&lt;sup&gt;2&lt;/sup&gt; = 95%), and 6 months (MD = 2.94, P &lt; 0.001, I&lt;sup&gt;2&lt;/sup&gt; = 92%). No significant difference was observed at 12 months. For pain outcomes, DAA was associated with lower VAS scores in the postoperative period, including at 1 day (MD = -0.84, P &lt; 0.001, I&lt;sup&gt;2&lt;/sup&gt; = 59%), 3 days (MD = -0.77, P &lt; 0.001, I&lt;sup&gt;2&lt;/sup&gt; = 76%), 7 days (MD = -0.85, P &lt; 0.001, I&lt;sup&gt;2&lt;/sup&gt; = 88%), 1 month (MD = -0.49, P = 0.002, I&lt;sup&gt;2&lt;/sup&gt; = 90%), 3 month (MD = -0.67, P = 0.02, I&lt;sup&gt;2&lt;/sup&gt; = 96%), and 6 month (MD = -0.12, P = 0.04, I&lt;sup&gt;2&lt;/sup&gt; = 75%).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/stron","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13613858/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148387848","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":"Robotic versus laparoscopic surgery in hepatobiliary procedures: a scoping review.","authors":"Jerónimo Cárdenas Montoya, Mariana González Garcés, Mario Andrés Torres Torres, Erwin Hernando Hernández Rincón, Diego Orlando Sierra Barbosa","doi":"10.1186/s12893-026-03907-y","DOIUrl":"10.1186/s12893-026-03907-y","url":null,"abstract":"<p><strong>Background: </strong>Robotic platforms have expanded the technical capabilities of minimally invasive hepatobiliary surgery. However, their clinical value compared with laparoscopy remains heterogeneous and appears to vary according to procedural complexity, anatomical constraints, and institutional experience.</p><p><strong>Methods: </strong>A procedure-stratified scoping review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews and the Joanna Briggs Institute Manual for Evidence Synthesis. PubMed, Scopus, and Web of Science were searched for comparative studies published between 2019 and 2025 evaluating robotic versus laparoscopic hepatobiliary surgery. Evidence was synthesized using a procedure-specific analytical framework to account for heterogeneity in technical complexity and outcome reporting.</p><p><strong>Results: </strong>Seventy studies met inclusion criteria, the majority of which were retrospective. In technically demanding procedures, particularly major hepatectomy and resections of posterosuperior liver segments, robotic surgery was more frequently associated with lower intraoperative blood loss and reduced conversion to open surgery. Operative time was generally longer for robotic procedures across most indications. Overall perioperative morbidity, mortality, and early oncological outcomes were comparable between robotic and laparoscopic approaches. Postoperative recovery outcomes were inconsistently reported and heterogeneous, while procedural costs were consistently higher for robotic surgery.</p><p><strong>Conclusions: </strong>Robotic hepatobiliary surgery may offer context-dependent advantages in anatomically complex procedures, particularly in settings with appropriate surgical expertise. However, given the predominance of retrospective and heterogeneous evidence, these findings should be interpreted cautiously. Overall, robotic and laparoscopic approaches demonstrate comparable safety and effectiveness across most indications. These findings support a procedure-based and context-sensitive integration of robotic technology rather than universal adoption.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13613746/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148388361","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":"Robotic vs. laparoscopic resection for rectal cancer with neoadjuvant chemoradiotherapy: perioperative outcomes and survival.","authors":"Weili Zhang, Jianhong Peng, Yingting Situ, Weifeng Wang, Ruowei Wang, Xiaojun Wu, Zhenhai Lu, Yuan Li, Jinghua Tang, Junzhong Lin, Peirong Ding, Zhizhong Pan","doi":"10.1186/s12893-026-03956-3","DOIUrl":"10.1186/s12893-026-03956-3","url":null,"abstract":"<p><strong>Background: </strong>Although the safety and effectiveness of robot-assisted surgery for rectal cancer have been demonstrated, its peri-operative safety and long-term survival benefit in patients who have received neoadjuvant chemoradiotherapy (NCRT) remain unclear.</p><p><strong>Method: </strong>A retrospective cohort of 463 consecutive rectal-cancer patients who underwent either robot-assisted anterior resection or laparoscopic anterior resection after NCRT at Sun Yat-sen University Cancer Center from June 2016 to August 2023 was analyzed. Propensity-score matching (PSM) was applied to balance baseline variables that could affect surgical outcomes and survival. Peri-operative parameters, complication rates, and pathological findings were compared, and 5-year overall survival (OS) and disease-free survival (DFS) were calculated.</p><p><strong>Result: </strong>A total of 121 patients undergoing robotic-assisted surgery and 342 patients undergoing laparoscopic surgery were included in the study. Operative time was longer in the robot-assisted group both before and after matching. Before matching, the robot-assisted group showed a lower rate of ileostomy (65.3% vs 76.6%, P = 0.021), an advantage that disappeared after PSM (65.3% vs 75.2%, P = 0.063). In the matched cohort, the 5-year DFS was 89.8% for robot-assisted versus 82.3% for laparoscopic (P = 0.130), whereas the 5-year OS was higher in the robot-assisted group than in the laparoscopic group (96.8% vs 86.8%; P = 0.019). In the primary preoperative covariate-adjusted Cox model after PSM, the association between robot-assisted surgery and OS was attenuated and did not reach conventional statistical significance (HR = 0.231, 95% CI 0.052-1.015; P = 0.052).</p><p><strong>Conclusions: </strong>Robot-assisted and laparoscopic surgery showed comparable perioperative outcomes and DFS after NCRT for rectal cancer. Although an apparent OS difference was observed in the matched cohort, this finding was attenuated in the primary preoperative covariate-adjusted Cox model and should be interpreted cautiously given the potential for residual confounding.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13613712/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148388294","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":"Early graft function after intraoperative assessment-guided selective ligation of segment 5/8 veins in adult right lobe living donor liver transplantation: a retrospective cohort study.","authors":"Feyza Sonmez Topcu, Emrah Sahin, Ender Anilir, Abuzer Dirican, Bülent Ünal","doi":"10.1186/s12893-026-04021-9","DOIUrl":"10.1186/s12893-026-04021-9","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Reconstruction of segment 5 and/or segment 8 anterior sector veins ≥ 5 mm is widely recommended in adult right lobe living donor liver transplantation (LDLT) to prevent venous congestion. Whether this approach is universally required, or whether selective ligation guided by intraoperative findings is acceptable in lower-risk recipients, remains unresolved.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This single-centre retrospective cohort study included adult recipients who underwent right lobe LDLT without inclusion of the middle hepatic vein at a high-volume transplant centre (approximately 150 adult LDLTs per year) between November 2021 and May 2025. Eligible patients had intraoperatively measured segment 5 and/or segment 8 veins ≥ 5 mm. Venous management was determined intraoperatively and was not randomized: reconstruction was preferred in recipients judged at higher risk of congestion, and all recipients with graft-to-recipient weight ratio (GRWR) &lt; 0.8 were managed in the reconstruction group. The primary endpoints were postoperative day 7 (POD7) international normalized ratio (INR), total bilirubin, and ascites volume. Multivariable adjustment was prespecified for postoperative ascites only, adjusting for ligation status, MELD score, and GRWR. Prespecified sensitivity analysis restricted to GRWR ≥ 0.8 was performed. Partial Olthoff early allograft dysfunction (EAD) and approximate ILTS-iLDLT small-for-size syndrome (SFSS) were assessed as secondary analyses.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 170 recipients were included (16 selective ligation; 154 reconstruction). Baseline variables did not differ statistically, but all 20 recipients with GRWR &lt; 0.8 were in the reconstruction group. POD7 outcomes were comparable: INR 1.24 vs. 1.27 (p = 0.80), bilirubin 1.46 vs. 1.70 mg/dL (p = 0.35), ascites 1100 vs. 1250 mL (p = 0.89). In multivariable analysis (n = 91), selective ligation was not independently associated with ascites (β = 0.202; 95% CI - 0.359 to + 0.764; p = 0.476); MELD was the only significant predictor (p = 0.024). The GRWR ≥ 0.8 sensitivity analysis confirmed these findings. Partial Olthoff EAD was 25.0% vs. 15.7% (p = 0.42); approximate SFSS was 27.3% vs. 24.7% (p = 1.00). Post-hoc power for the ascites comparison was 80% only for Cohen's d ≥ 0.90, far larger than the observed d = 0.02.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In carefully selected recipients with adequate graft volume and favourable intraoperative findings, selective ligation of segment 5 and/or 8 veins ≥ 5 mm was not associated with worse early graft function in this cohort. Given the small ligation group, non-randomized allocation, and substantial missing data, these preliminary results are consistent with the feasibility of selective ligation in a selected lower-risk subgroup but cannot establish its safety, clinical applicability, or equivalence to reconstruction. Prospective, adequately powered, multicentre validation is required befo","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13483493/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148388307","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":"Catheter-related thrombosis in cancer patients with tunnelled non-cuffed centrally inserted central catheters: a retrospective cohort study.","authors":"Thomas Douchy, Veerle Boecxstaens, Daphne Hompes, Godelieve Alice Goossens","doi":"10.1186/s12893-026-04013-9","DOIUrl":"10.1186/s12893-026-04013-9","url":null,"abstract":"<p><strong>Background: </strong>Peripherally inserted central catheters (PICCs) are widely used in oncology but are associated with higher rates of catheter-related thrombosis compared to other central venous access devices. Tunnelled non-cuffed centrally inserted central catheters (tnc-CICC) may offer a safer alternative in patient at high risk of thrombosis.</p><p><strong>Methods: </strong>This retrospective cohort study evaluated 193 tnc-CICCs placed in 182 cancer patients at a tertiary oncology unit between January 2021 and December 2022. Primary outcomes is catheter-related thrombosis; secondary outcomes are procedural duration and complication rates. Data were analysed using non-parametric statistical methods.</p><p><strong>Results: </strong>The overall thrombosis rate was 1% (0.18 per 1,000 catheter days), significantly lower than reported PICC-associated thrombosis rates. No major intraoperative complications occurred. The overall complication rate was 19.7%, with catheter malfunction (9.3%), migration (5.2%) and bloodstream infections (4.1%) being the most common. Median procedural time was 34 min, with no significant difference based on operator experience.</p><p><strong>Conclusions: </strong>Off label use of PICCs as tnc-CICCs seems safe and effective. It provides an alternative to PICCs in oncology patients at high risk of thrombosis, even when placed by operators with low experience levels. These findings support the inclusion of tnc-CICCs in vascular access algorithms for cancer patient at high risk of thrombosis and suggest feasibility for nurse-led insertion programs.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13613733/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148388276","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":"Surgical outcomes of cubital tunnel syndrome with acute symptom exacerbation caused by elbow ganglion cysts: a retrospective case series of 32 patients.","authors":"Xu-Cheng Guo, Hang Zhang, Jing Wang, Ji-Kun Hao, Jie Ren, Xiao-Chen Shi, Rui Cong, Hang Xian","doi":"10.1186/s12893-026-04023-7","DOIUrl":"10.1186/s12893-026-04023-7","url":null,"abstract":"<p><strong>Background: </strong>Cubital tunnel syndrome (CuTS) caused by elbow ganglion cysts, characterized by abrupt onset or sudden exacerbation of ulnar nerve symptoms, is a rare condition with few reported cases. The current study aims to retrospectively assess the surgical treatment outcomes of patients with CuTS with acute symptom exacerbation caused by ganglion cysts from elbow joint.</p><p><strong>Methods: </strong>From January 2023 to June 2024, patients diagnosed with CuTS with acute symptom exacerbation who were admitted to our hospital and followed up. Routine X-ray was performed to evaluate the degeneration of the elbow joint. Ultrasound test was used to evaluate the morphology of the ulnar nerve and ganglion cysts, especially in the elbow joint. Sensory deficit assessment of little finger according to British Medical Research Council Sensory Function Assessment Standards (BMRCS) and motor function assessment according to Medical Research Council (MRC) Scale for interosseous muscles strength were introduced. Surgical interventions including anterior subcutaneous transposition of the ulnar nerve and ganglion cyst resection were performed. Visual analogue scale (VAS) score was used to evaluate the pain of the patients. All the above parameters were collected and analyzed at the time points of pre-operation and final follow-up.</p><p><strong>Results: </strong>A total of 32 patients was followed up with a mean age of 54.94 years, including 6 females and 26 males with 10 left and 22 right limbs affected. The period of follow-up ranges from 6 to 22 months (11.6 ± 5.4 months) post-operation. The X-ray indicated that 30 patients had osteoarthritis of the elbow joint. The symptom duration ranges from 0.5 to 24 months (6.0 ± 5.5 months). There were 4 cases of intraneural cysts and 28 cases of extraneural cysts according to ultrasound findings. In terms of sensory recovery, 18 cases (56.25%) achieved ≥ S3 + recovery, and of muscle strength recovery, 19 cases (59.375%) achieved ≥ M4 recovery post-operation. The parameters of sensory and muscle strength recovery above showed significant improvement (P = 0.0000038, and 0.0001318). The patients got significant pain relief after surgery according to the VAS scale with 16 cases (50%) experiencing complete disappearance of pain (P = 0.0000017).</p><p><strong>Conclusions: </strong>For CuTS caused by elbow ganglion cysts presenting with abrupt onset or sudden exacerbation of symptoms, accurate diagnosis and surgical treatment was associated with improvement in pain and neurological parameters, though complete functional recovery is not guaranteed. In addition, distinguishing between intraneural and extraneural cysts may be informative for postoperative surveillance and individualized follow-up planning.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13613784/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148383030","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":"Diagnostic performance of RIPASA versus modified Alvarado score in acute appendicitis: a prospective diagnostic accuracy study from a tertiary centre in India.","authors":"Harkirat Singh, Rajendra Kumar Yadav, Farukh Khan, Garima Agarwal, Shalu Gupta, Vinay Garg","doi":"10.1186/s12893-026-04020-w","DOIUrl":"10.1186/s12893-026-04020-w","url":null,"abstract":"<p><strong>Purpose: </strong>Acute appendicitis is a common surgical emergency. Clinical scores assist risk stratification where routine advanced imaging is impractical. The Alvarado score's performance in Asian populations is debated. The Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) score was developed for Asian settings. This study prospectively compared RIPASA and the Modified Alvarado Score (MAS) against histopathological examination (HPE) in an Indian tertiary centre.</p><p><strong>Methods: </strong>Prospective diagnostic accuracy study of 62 patients undergoing appendicectomy for suspected acute appendicitis at S.M.S. Medical College, Jaipur (January-December 2024). Pre-operative demographics, symptoms, signs and laboratory parameters were recorded; RIPASA (cut-off ≥ 7.5) and MAS (cut-off ≥ 7) were calculated. HPE was the reference standard. Outcomes were sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and area under the receiver operating characteristic curve (AUC) with standard error (SE) and 95% confidence interval (CI). AUCs were compared using DeLong's test, and paired sensitivities and specificities using McNemar's test.</p><p><strong>Results: </strong>Participants were predominantly males (71.0%); mean age 30.66 years. HPE confirmed appendicitis in 56/62 (90.3%); negative appendicectomy rate 9.7%. RIPASA ≥ 7.5: sensitivity 94.6%, specificity 66.7%, PPV 96.4%, NPV 57.1%, AUC 0.921 (SE 0.052; 95% CI 0.820-1.000; p = 0.001). MAS ≥ 7: sensitivity 71.4%, specificity 83.3%, PPV 97.6%, NPV 23.8%, AUC 0.821 (SE 0.083; 95% CI 0.659-0.984; p = 0.010). DeLong's test showed superior discrimination for RIPASA (p = 0.030). McNemar's test demonstrated higher sensitivity for RIPASA (p = 0.0009), with no significant difference in specificity (p = 1.000).</p><p><strong>Conclusion: </strong>RIPASA demonstrated higher sensitivity and better diagnostic discrimination than MAS in this tertiary surgical cohort, while MAS showed higher specificity. RIPASA may help reduce missed diagnoses in similar high-prevalence emergency settings, although further validation in broader patient populations is warranted.</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/PMC13602749/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148383049","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":"Tranexamic acid as an alternative to epinephrine in WALANT carpal tunnel release: a randomized clinical trial.","authors":"Lincoln Kamimura, Martha Cecilia Castano-Betancourt, Marcelo Claudiano de Castro, Cristiano Almeida Bastos, Carolina Isper, Ewerton Alexandre Galdeano, Helton Hiroshi Hirata","doi":"10.1186/s12893-026-03976-z","DOIUrl":"10.1186/s12893-026-03976-z","url":null,"abstract":"<p><strong>Background: </strong>Carpal tunnel release can be performed using the WALANT (Wide-Awake Local Anesthesia No Tourniquet) technique, in which epinephrine is commonly used to improve intraoperative hemostasis. However, concerns regarding vasoconstrictor-related complications persist. This study aimed to compare tranexamic acid (TA) with epinephrine for bleeding control during WALANT carpal tunnel release.</p><p><strong>Methods: </strong>A prospective randomized study including 53 patients with carpal tunnel syndrome was conducted. Patients were randomized to WALANT with epinephrine (n = 27) or tranexamic acid (n = 26). Surgical time, intraoperative hemostasis, patient satisfaction, and postoperative complications were recorded. Clinical outcomes were assessed using specific clinical tests and the Boston Carpal Tunnel Questionnaire preoperatively and at 30 days.</p><p><strong>Results: </strong>No severe bleeding or ischemic complications were observed in either group. One infection occurred in the epinephrine group requiring surgical debridement. Greater difficulty in achieving intraoperative hemostasis was observed in the TA group, resulting in longer surgical times (29.3 ± 10.5 min vs. 21.4 ± 6.9 min; P < 0.001). Patient satisfaction and functional outcomes were high and comparable between groups.</p><p><strong>Conclusion: </strong>Carpal tunnel release performed using the WALANT technique with either epinephrine or tranexamic acid was associated with similar short-term functional improvement and patient satisfaction. No major complications were observed in either group. However, the use of tranexamic acid was associated with greater difficulty in achieving intraoperative hemostasis and longer surgical times.</p><p><strong>Trial registration: </strong>The trial protocol is available in the trial registry at Brazilian Clinical Trials Registry (ReBec) under registration number RBR2njtg49, date of registration 11/07/2025 (retrospectively registered). https://ensaiosclinicos.gov.br/rg/RBR2njtg49 .</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/PMC13602671/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148383009","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}