BMC Surgery最新文献

{"title":"Efficacy of intraperitoneal positive pressure gas expulsion in laparoscopic transabdominal preperitoneal hernioplasty: a retrospective cohort study.","authors":"Wanpeng He, Bo Chen","doi":"10.1186/s12893-025-02965-y","DOIUrl":"10.1186/s12893-025-02965-y","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the effects of the pneumoperitoneum positive-pressure exhaust technique on mesh fixation and postoperative recovery in laparoscopic transabdominal preperitoneal prosthetic (TAPP) hernia repair.</p><p><strong>Methods: </strong>A retrospective cohort analysis was conducted on 655 patients who underwent TAPP between January 2019 and December 2023. Patients were divided into a direct suture group (n=304) and a positive-pressure exhaust group (n=351) on the basis of preperitoneal space management. In the exhaust group, a 20G needle or drainage tube was placed percutaneously before peritoneal closure. After suturing, 12 mmHg pneumoperitoneum pressure was maintained to evacuate residual gas from the preperitoneal space through the externalized needle/tube. The primary outcomes included postoperative complications (bleeding, mesh infection, seroma, reoperation) and hospitalization duration.</p><p><strong>Results: </strong>Baseline characteristics were not significantly different (P>0.05). Although not statistically significant, there were clinically meaningful differences between the groups; the exhaust group had lower seroma (11.97% vs. 16.78%, P=0.079) and mesh infection (0.28% vs. 1.32%, P=0.189) incidence rates than the direct suture group did. The exhaust group had a significantly shorter hospital stay than the direct suture group (median 7 vs. 7 days, P=0.013) and had a 0% recurrence rate at the 1-year follow-up (vs. 1.32% for the direct suture group).</p><p><strong>Conclusion: </strong>The positive-pressure exhaust technique facilitates mesh fixation by eliminating dead space through improved tissue apposition. This simple, cost-effective approach may reduce the risk of recurrence, although larger prospective studies are needed to validate its long-term efficacy.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"231"},"PeriodicalIF":1.6,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12117678/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144163313","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":"The feasibility and safety of ventral hernia repairs under local anaesthesia: a systematic review.","authors":"Sarah Michael, Afifa Naseer, Munir Tarazi, Bhamini Vadhwana","doi":"10.1186/s12893-025-02931-8","DOIUrl":"10.1186/s12893-025-02931-8","url":null,"abstract":"<p><strong>Background: </strong>Ventral hernias represent a significant global healthcare burden. Repair under local anaesthesia (LA) provides benefits to patients, hospitals and economies. While inguinal hernia repair under LA has been established, this has not translated to other abdominal wall hernias. This systematic review evaluates the feasibility, safety, and efficacy of performing these repairs under LA.</p><p><strong>Methods: </strong>A systematic review was conducted using OVID^® EMBASE and MEDLINE to review articles published between 1966 and 2023. Thirty-three papers were included examining variables such as type of hernia, complications, cost-effectiveness, LA used and length of stay. All papers were quality assessed using the ROBINS-I tool. Papers assessing inguinal hernias were excluded.</p><p><strong>Results: </strong>13,491 patients underwent ventral hernia repair under LA. Complication rates for LA repairs are low, with wound infections and hematomas ranging from 0.3 to 2%. Recurrence rates were also low (0.3-2.5%). Early mobilisation and same-day discharge were notable benefits, with over 97% of patients ambulatory within hours. Postoperative pain was minimal, contributing to high patient satisfaction rates (90-97%). LA repairs proved especially beneficial for high-risk groups, including elderly and frail patients. However, these findings were only seen in hernia defects less than 5 cm. Heterogeneity among study populations, small sample sizes, and lack of standardisation in LA administration were noted.</p><p><strong>Conclusion: </strong>This review supports the broader implementation of LA for ventral hernia repairs in small defects (< 5 cm), demonstrating its safety, feasibility, and patient acceptability. Careful patient selection for standardisation of best practices for LA hernia repairs offers the potential for significant cost-savings with overall favourable outcomes.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"229"},"PeriodicalIF":1.6,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12105344/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144152679","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":"Predictive model for recurrence of incisional hernia constructed by CT abdominal wall imaging features.","authors":"Qi He, Yunhua Wu, Gexin Xu, Zhixing Zhang, Dejan Gao, Lingzhi Nie, Qingguo Du","doi":"10.1186/s12893-025-02838-4","DOIUrl":"10.1186/s12893-025-02838-4","url":null,"abstract":"<p><strong>Background: </strong>The recurrence rate after incisional hernia surgery is the most important concern for patients and surgeons, which not only causes pain to the patient but also adds additional medical costs. This study aims to investigate CT imaging features based on abdominal wall mechanics for recurrence after incisional hernia surgery.</p><p><strong>Materials and methods: </strong>We collected data from patients who were diagnosed with incisional hernia and underwent hernia repair from January 2017 to January 2022 in Shanxi Provincial People's Hospital. Based on Laplace's equation, an equation for spherical wall pressure, we further measured the preoperative abdominal wall thickness and abdominal wall radius of the patients by CT and measured the abdominal wall muscle area and visceral fat area at the third lumbar level by using Slice-O-Matic 5.0 software, and the sarcopenia index was further obtained by dividing the muscle area by the square of the height. Then, we analyzed their relationship with the postoperative recurrence of incisional hernia.</p><p><strong>Results: </strong>By univariate and multifactorial analyses, we found that excessive visceral adiposity, high BMI and sarcopenia were independent risk factors for incisional hernia recurrence. In further stratified analysis, we also found that patients with combined sarcopenia had a higher probability of recurrence. Our results found that visceral fat was a higher risk factor for incisional hernia recurrence than BMI.</p><p><strong>Conclusion: </strong>This study was a retrospective study. Based on the Laplace equation, sarcopenia and visceral fat are independent risk factors for recurrence after incisional hernia.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"227"},"PeriodicalIF":1.6,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12102878/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144014","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":"Hepato-pancreato-biliary surgical capacity in East and South African countries: a regional assessment survey.","authors":"Mohamed Daffalla Awadalla Gismalla, T K Marumo, Nebiat E Mekonnen, Ahmed AbdElrahman-Abdalla Abd Elrahman","doi":"10.1186/s12893-025-02962-1","DOIUrl":"10.1186/s12893-025-02962-1","url":null,"abstract":"<p><strong>Backgrounds: </strong>Hepato-pancreato-biliary (HPB) services are not widely recognized in African countries. This survey seeks to assess the current status of HPB surgery in East and Southern Africa.</p><p><strong>Methods: </strong>The Surgeons Overseas Personnel, Infrastructure, Procedure, Equipment, and Supplies (PIPES) survey assessed HPB capacity in East and South African countries. The PIPES score was calculated for hospitals; a higher score indicates greater capacity.</p><p><strong>Results: </strong>Twenty-five responses from 10 countries completed the survey, yielding a median score of 41 (range 18-57). 80% of hospitals are government-operated. Functioning X-ray machines and pre-tested blood banks are the most commonly available resources in 23 (92%) and 20 (80%) hospitals. The most common procedure is open cholecystectomy, performed in 24 (96%) hospitals, while laparoscopic cholecystectomy, distal pancreatectomy, and non-anatomic hepatic resections were conducted in 22 (92%) hospitals. The Whipple operation and liver resection were carried out in 20 (80%) hospitals. Interventional radiology is available in 5 (20%) centers, and liver transplantation was noted in 3 (12%) hospitals. Electrosurgery is available in 25 hospitals, and energy devices are accessible in 19.</p><p><strong>Conclusion: </strong>This study highlights the HPB surgery services in East and Southern African countries. Despite limited resources, certain HPB services are accessible.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"226"},"PeriodicalIF":1.6,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12102894/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144133093","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":"Impact of age on outcomes and hospital costs of urgent laparoscopic cholecystectomy for acute cholecystitis: a retrospective cohort study.","authors":"Yu-Ming Kao, Chih-Ying Lu","doi":"10.1186/s12893-025-02963-0","DOIUrl":"10.1186/s12893-025-02963-0","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to compare the clinical outcomes and hospital costs between younger and older adult with acute cholecystitis patients who received urgent laparoscopic cholecystectomy.</p><p><strong>Methods: </strong>A 3-year retrospective study was conducted. Patients admitted to surgical units for urgent laparoscopic cholecystectomy at Chi-Mei Hospital from January 1, 2019, to December 31, 2021, were included. Patients' baseline data were collected from medical records review. Postoperative complications are defined by the Clavien-Dindo classification as being greater than grade I. Total costs during admission were also collected based on disease-related groups (DRG system).</p><p><strong>Results: </strong>Among 300 patients selected, 68.3% (n = 205) were aged < 60 years, 19.3% (n = 58) were aged between 60 and 69 years, and 12.3% (n = 37) were aged ≥ 70 years. Patients aged ≥ 70 years had higher rates of comorbidities, higher ASA levels, and lower platelet counts than those in patients aged < 60 years. After adjusting for possible confounders in the multivariable models, older age was significantly associated with longer hospital stays (length of stay, or LOS) (β = 0.56 for patients aged 60-69 years and 1.30 for those aged ≥ 70 years) and correspondingly higher hospital costs (β = 219.69 for patients aged 60-69 years and 302.48 for ≥ 70 years) compared to those for patients aged < 60 years. No significant associations were found between older age and the occurrence of postoperative complications.</p><p><strong>Conclusions: </strong>Urgent LC with adequate perioperative care is feasible for treating acute cholecystitis in older adult patients. Older age is independently associated with longer LOS and higher costs but not with short-term postoperative complications.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"228"},"PeriodicalIF":1.6,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12102837/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144143773","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":"Exploration of umbilical hernia incidence and etiology in 753 cases of single-incision laparoscopic surgery: a retrospective analysis.","authors":"Peng Chen, Jingyi Jiao, Huimin Xue, Xiaojun Zhu, Xiaojuan Wang, Peng Wang","doi":"10.1186/s12893-025-02958-x","DOIUrl":"10.1186/s12893-025-02958-x","url":null,"abstract":"<p><strong>Purpose: </strong>The rising popularity of Single Incision Laparoscopic Surgery (SILS) brings concerns regarding a higher incidence of postoperative incisional hernias due to the enlarged umbilical incision compared to conventional laparoscopy. This study aims to explore the occurrence of incisional hernias following single-port laparoscopic surgery and identify associated risk factors.</p><p><strong>Methods: </strong>The patient cohort included individuals who underwent cholecystectomy and inguinal hernia repair procedures using the SILS technique. Follow-up assessments were conducted via written correspondence, telephone interviews, and clinical examinations. Univariate and multivariate analyses were employed to investigate the impact of demographic variables and surgical parameters, including age, gender, BMI, ASA score, operative duration, pre-existing umbilical hernia, and the occurrence of postoperative incisional hernia.</p><p><strong>Results: </strong>A total of 753 patients completed follow-up, with a mean duration of 60.2 months and variance: 51.26. Among them, 342 (45.4%) underwent cholecystectomy, while 411 (54.6%) underwent inguinal hernia repair. The study cohort comprised 405 women (53.8%) and 348 men (46.2%), with a mean age of 40 years (range 10-83 years) at the time of surgery. Only one patient (0.13%) required conversion to conventional laparoscopy for surgical access. Intraoperative complications occurred in 0.1% of cases, while postoperative complications occurred in 1.6%. Incisional hernias developed in 10 patients (1.3%), with a notably higher incidence of 5.9% among obese patients than normoweight patients. Additionally, 23.1% of patients with pre-existing umbilical hernias experienced incisional hernia during the follow-up period. Multivariate analyses revealed that obesity(OR: 18.56, Cl:5.76-86.42, p value:0.003), pre-existing umbilical hernia(OR:16.32,Cl:4.26-61.68, p value:0,002), diabetes(OR:2.42, Cl:1.86-20.42, p value:0.496), and hypertension(OR:1.96, Cl:0.72-12.64,p value:0.924) were significantly associated with incisional hernia incidence. However, gender, age, type of surgery (inguinal hernia repair vs. cholecystectomy), presence of acute inflammation, and duration of surgery did not show statistically significant associations with incisional hernia occurrence.</p><p><strong>Conclusion: </strong>Detecting incisional hernias necessitates an extended follow-up period. In the univariate analysis, obesity and pre-existing umbilical hernias were linked to an elevated risk of this complication. Following meticulous patient selection, Single Incision Laparoscopic Surgery (SILS) presents a secure method for performing cholecystectomy and inguinal hernia repair.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"224"},"PeriodicalIF":1.6,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12096569/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129294","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":"Open radical cystectomy and ileal loop diversion under combined spinal-epidural anaesthesia for the elderly and frail.","authors":"Sahin Kilic, Tayfun Sugur, Hayri Fatih Metinyurt, Yigit Demir, Eray Ozturk, Murat Sambel","doi":"10.1186/s12893-025-02947-0","DOIUrl":"10.1186/s12893-025-02947-0","url":null,"abstract":"<p><strong>Background: </strong>The association between prolonged general anaesthesia duration in radical cystectomy (RC) and increased complication rates is well established. This study compared clinical outcomes of open RC performed under combined spinal-epidural anaesthesia (CSEA) versus general anaesthesia in elderly and frail patients.</p><p><strong>Methods: </strong>A retrospective evaluation was conducted on data from patients who underwent open RC at our institution between February 2023 and October 2024. Patients with missing data or previous open abdominal surgery, who underwent additional surgical intervention during RC, or who underwent different urinary diversions from ileal loop diversion were excluded. The study comprised two cohorts, designated as CSEA and general anaesthesia groups. Various demographics, including age, body mass index (BMI), comorbidities, pre-and postoperative blood values, operative times, estimated blood loss, and recovery parameters, were retrospectively analyzed.</p><p><strong>Results: </strong>The CSEA group had a higher mean age than the general anaesthesia group (72.40 ± 9.79 vs. 64.40 ± 10.70 years, p = 0.098), though this difference was not statistically significant. BMI values were similar for both groups (25.50 ± 2.80 and 25.34 ± 4.20 kg/m², p = 0.922). The prevalence of comorbidities was significantly higher in the CSEA group (100% vs. 40%, p = 0.011). The mean preoperative albumin level was lower in the CSEA group (3.23 ± 0.68 vs. 3.97 ± 0.51 mg/dL, p = 0.013). Duration of surgery, estimated blood loss and need for blood transfusion were similar between both groups (p > 0.05). Postoperative oral feeding initiation time was significantly earlier in the CSEA group (1 day and 3 days, p < 0.001). Visual Analog Scale (VAS) scores were significantly lower in the CSEA group (3.0 vs. 4.6, p = 0.004). The number of lymph node removals was significantly higher in the CSEA group (28.80 ± 7.77 vs. 12.90 ± 7.13, p < 0.001). Locally advanced disease rate was more common in the CSEA group (80% vs. 20%, p < 0.010). However, Clavien-Dindo Grade ≥ III complication rates and length of hospitalization were similar between the groups (p > 0.05).</p><p><strong>Conclusions: </strong>Open RC under CSEA is a preferable option for elderly patients and those with comorbidities who are not suitable for general anaesthesia. It offers advantages in postoperative bowel function recovery and pain management compared with general anaesthesia.</p><p><strong>Trial registration: </strong>retrospectively registered.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"222"},"PeriodicalIF":1.6,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12096728/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121324","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":"Effectiveness of negative pressure wound therapy in Ludwig's angina: a retrospective study of 18 cases.","authors":"Shu-Jun Chen, Ning Ji, Yu-Xuan Chen, Jian-Rui Xiao, Xiao-Zong Wei, Yan-Kun Liu","doi":"10.1186/s12893-025-02957-y","DOIUrl":"10.1186/s12893-025-02957-y","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the effectiveness of negative pressure wound therapy (NPWT) for Ludwig's angina (LA).</p><p><strong>Methods: </strong>We retrospectively reviewed 18 patients with LA admitted to the 82nd Group Army Hospital of PLA between October 2014 and October 2021. All patients underwent surgical drainage and debridement within 6 h after admission. A minimally invasive approach involving bilateral small incisions in the submandibular area was used to perform the procedure. An NPWT device was applied for positive drainage of the involved spaces after debridement. Postoperatively, the patients received the appropriate supportive care and antibiotic therapy. Data collection encompassed sex, age, systemic diseases, dressing change frequency, NPWT duration, wound healing time, and ICU stay length. Follow-up was performed to evaluate recurrence, scarring, and neck mobility. For comparative analysis, control data were obtained from LA patients treated with conventional surgical drainage between January 2008 and September 2014. Descriptive statistics and Student's t-test were employed for statistical analysis.</p><p><strong>Results: </strong>In the NPWT group, all patients had uneventful courses during hospitalization and were discharged upon complete wound healing. Fifteen patients required only a single session of surgical debridement with NPWT, while the remaining three underwent two procedures. Upon NPWT device removal, all infectious cavities exhibited clean wounds with mature granulation tissue formation. Compared to the conventional surgery group, the NPWT group demonstrated a significantly shorter wound healing time (15.33 ± 3.93 vs. 19.50 ± 2.17 days; p = 0.025), reduced ICU stay duration (0.61 ± 0.61 vs. 2.17 ± 0.75 days; p < 0.001) and markedly fewer dressing changes (2.17 ± 0.38 vs. 17.00 ± 3.16; p < 0.001).</p><p><strong>Conclusions: </strong>NPWT demonstrated excellent effectiveness in the management of LA. Compared to conventional surgical debridement and drainage, it offers several distinct clinical advantages, including accelerated wound healing, shortened ICU stays, and reduced dressing change frequency. These benefits are clinically linked to both reduced postoperative pain perception and decreased nursing workload. Additionally, smaller incisions result in less surgical trauma and improved cosmetic outcomes. NPWT should be considered as a viable approach in the management of LA. Future randomized controlled trials are needed to confirm NPWT's superiority in larger cohorts.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"223"},"PeriodicalIF":1.6,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12096496/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121391","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":"Postoperative outcomes after minimally invasive esophagectomy: an international cohort study from the Oesophagogastric Anastomosis Audit (OGAA).","authors":"","doi":"10.1186/s12893-025-02941-6","DOIUrl":"10.1186/s12893-025-02941-6","url":null,"abstract":"<p><strong>Objective: </strong>To compare the postoperative pulmonary complications (PPC) after minimally invasive or open transthoracic esophagectomy for esophageal cancer in an international, multicenter cohort. Ongoing debate exists around the optimal surgical approach for esophageal cancer, with limited data assessing the external validity of randomised trials on outcomes of MIE METHODS: Patients undergoing open (OE, n = 744), hybrid (HE, n = 500), and totally minimally invasive esophagectomy (TMIE, n = 540) for esophageal cancer were identified from the international, prospective Oesophagogastric Anastomosis Audit (OGAA). Multivariable models were used to investigate PPC (primary outcome) as well as overall complications, major complications, anastomotic leak and 90-day mortality (secondary outcomes).</p><p><strong>Results: </strong>PPC rates were lower after TMIE compared to OE and HE (28% vs 37% vs 39%, p = 0.002), even on adjusted analyses compared to OE (odds ratio (OR): 0.60, CI_95%: 0.45-0.78). TMIE was also associated with significantly lower overall complications (OR: 0.68, CI_95%: 0.52-0.88) compared to OE, but not for major complications (OR: 0.90, CI_95%: 0.67-1.21), anastomotic leak (OR: 1.39, CI_95%: 0.96-2.01) and 90-day mortality (OR: 0.49, CI_95%: 0.22-1.04). Sensitivity analyses by underlying respiratory disease, neoadjuvant chemoradiotherapy or high-volume centers confirmed above findings.</p><p><strong>Conclusion: </strong>This study provides real-world data that TMIE was associated with lower 90-day PPC than OE and HE approaches, especially in patients with underlying respiratory disease or receiving neoadjuvant chemoradiotherapy. These warrant a further review into causes and mechanisms in selected patients, and that quality assurance in delivery of TMIE is probably of major importance. The ideal surgical approach remains unclear, and ongoing trials will provide more evidence within a few years that may clarify the optimum approach to locally advanced esophageal cancers.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"225"},"PeriodicalIF":1.6,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12096545/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144210049","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 laparoscopic and robotic anterior lumbar interbody fusion: a systematic review and future directions.","authors":"Isabella Decker, Mohamad Bakhaidar, Summer Shabana, Meriem Boukhiam, Sabino Zani, Muhammad Abd-El-Barr","doi":"10.1186/s12893-025-02890-0","DOIUrl":"10.1186/s12893-025-02890-0","url":null,"abstract":"<p><strong>Introduction: </strong>Anterior Lumbar Interbody Fusion (ALIF) is a commonly performed spine surgery procedure used to treat lumbar conditions such as degenerative disc disease, spondylolisthesis, and spinal deformities. Traditionally, it has been performed using open and mini-open surgical techniques. Recently, however, laparoscopic and robotic-assisted ALIF have gained attention for their potential benefits, including shorter recovery times, fewer complications, and improved patient outcomes. However, the safety, effectiveness, and long-term outcomes of these newer techniques remain to be fully compared to conventional methods.</p><p><strong>Methods: </strong>The systematic review was conducted in accordance with the PRISMA 2020 guidelines. MEDLINE and Cochrane databases were searched for studies on laparoscopic and robotic approaches to the anterior spine, with a focus on ALIF. Article selection and data extraction were independently conducted by two reviewers. Studies involving animal models, non-ALIF robotic techniques, or non-English publications were excluded.</p><p><strong>Results: </strong>A total of 650 articles were initially identified. After screening, a full-text review was conducted on 80 articles, of which 48 studies met the inclusion criteria: 42 focused on laparoscopic ALIF (L-ALIF) and 6 on robotic-assisted ALIF (R-ALIF). Laparoscopic ALIF achieved similar outcomes to mini-open methods, offering limited consistent benefits while presenting challenges such as a steep learning curve and a higher risk of retrograde ejaculation. Data on robotic-assisted ALIF, though limited, indicated improved precision and a reduced rate of intraoperative complications. However, high costs, logistical challenges, and the lack of substantial long-term outcome data remain significant barriers to the broader adoption of this technique in spine surgery.</p><p><strong>Conclusion: </strong>L-ALIF and R-ALIF present promising minimally invasive alternatives to mini-open ALIF approaches. L-ALIF yields outcomes similar to mini-open techniques, though its technical demands warrant careful consideration. R-ALIF shows potential for improved precision and reduced complications, but logistical and financial constraints limit its wider adoption. Future studies should focus on multicenter prospective trials, alongside efforts to reduce costs and enhance training, to refine the role of these techniques in optimizing patient outcomes.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"219"},"PeriodicalIF":1.6,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12093694/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112192","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}