BMC Surgery最新文献

{"title":"Postoperative bile leak after hepato-pancreato-biliary surgery in malignant biliary obstruction: rates, treatments, and outcomes in a high-volume tertiary referral center.","authors":"Bálint Kokas, Lőrinc Ulmann, Petra Rozman, Nelli Farkas, Attila Szijártó, Ákos Szücs","doi":"10.1186/s12893-024-02721-8","DOIUrl":"10.1186/s12893-024-02721-8","url":null,"abstract":"<p><strong>Background: </strong>Biliary leakage is a serious complication of hepato-pancreato-biliary operations, increasing morbidity and mortality, and challenging clinicians.</p><p><strong>Objective: </strong>This study aims to evaluate the incidence of bilioenteric anastomotic leakage, treatment options, and their outcomes at a high-volume tertiary referral center.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted to analyze the outcomes of patients who underwent biliary anastomosis formation between 2016 and 2021. Data from patients with malignant biliary obstruction was analyzed collectively and in two homogenous cohorts: distal malignant (DM) group with distal biliary obstruction undergoing pancreatic head resection, proximal malignant (PM) group with perihilar biliary obstruction undergoing perihilar biliary resection without liver resection.</p><p><strong>Results: </strong>724 patients were found. After exclusions, 410 remained in the DM and 41 in the PM group. In the DM group the leak rate was 5.6% (23/410). Mortality was 3.9%, in patients with anastomotic failure 26% (6/23) vs no failure 2.6% (10/387) (p‹0.0001). Leak rate in the ASA III and ASA I-II patients were 52.2% (12/23) vs 48.8% (11/23), (p = 0.597). Leak rates were higher in the PM group 14,6% (6/41), mortality was 4.9% (2/41). All leaks in the PM group occurred in ASA III patients (6/6). No statistically significant associations were found between leak rates and factors such as patient age, preoperative serum bilirubin levels, preoperative or intraoperative biliary drainage, cholangitis, blood transfusion, postoperative pancreatic fistula, or bile duct dilation in either group. Bile leaks (n = 29) were treated conservatively (n = 9) with percutaneous transhepatic drainage (n = 3) or reoperation with (n = 16) or without (n = 10) external biliary drainage. Clinical success rates were slightly higher after reoperation with external drainage.</p><p><strong>Conclusion: </strong>This study identified perihilar resection as a risk factor for biliary leakage and trends indicating higher leak rates among patients with advanced comorbidities (ASA III), elevated preoperative bilirubin levels, non-dilated bile ducts, cholangitis or postoperative pancreatic fistula but these associations did not reach statistical significance, likely due to the limited sample size. In the management of anastomotic leakage, conservative and minimally invasive methods are effective; however, most cases required relaparotomy combined with external biliary drainage.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"24 1","pages":"410"},"PeriodicalIF":1.6,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11665246/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878117","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":"Ultrasound guidance in the surgical removal of internal fixators after complete healing of limb fractures.","authors":"Jiachun Li, Lujing Li, Yanqing Hu, Shenghui Huang, Peng Cui, Junming Wan, Tao Shu, Wenfen Liu","doi":"10.1186/s12893-024-02730-7","DOIUrl":"10.1186/s12893-024-02730-7","url":null,"abstract":"<p><strong>Purpose: </strong>The aim of this study was to determine whether ultrasound guidance can reduce the duration, blood loss volume and invasiveness of surgery for internal fixator removal.</p><p><strong>Methods: </strong>The clinical data from 35 adults patients who underwent ultrasound-guided surgical removal of internal fixators after complete healing of limb fractures between June 2019 and April 2023 were retrospectively analysed and compared with those from 34 controls who underwent the procedure without ultrasound guidance. Data concerning the patients' demographic and clinical characteristics and surgical sites were collected. Differences in the patients' demographic and clinical characteristics were compared between the two groups.</p><p><strong>Results: </strong>Sixty-nine patients were enrolled in the study. Thirty-five patients underwent surgical removal of internal fixators with ultrasound guidance, and the average intraoperative blood loss volume was 15.17 ± 18.54 ml, average difference between the incision length and scar length was 4.24 ± 1.38 cm, average operation time was 60.66 ± 24.30 min, and average ultrasound assessment time was 10.00 ± 3.90 min. Thirty-four patients underwent surgical removal of internal fixators without ultrasound guidance, and the average blood loss volume was 46.76 ± 90.74 ml, average difference between the incision length and scar length was 2.68 ± 1.04 cm, and average operation time was 80.15 ± 58.84 min. The difference between the incision length and scar length was significant (P < 0.01), as was the difference in the intraoperative blood loss volume (P < 0.05) between the two groups.</p><p><strong>Conclusion: </strong>Ultrasound is a convenient, noninvasive, radiation-free technique that allows dynamic scanning of multiple sections regardless of patient position. Ultrasound-assisted removal of internal fixators might reduce bleeding and therefore the invasiveness of the procedure. Physicians can use ultrasound for preoperative patient positioning, intraoperative monitoring, and postoperative confirmation of complete removal of internal fixators if necessary.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"24 1","pages":"414"},"PeriodicalIF":1.6,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11665062/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142883518","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 meta-analysis comparing open and minimally invasive cervical tumor surgery wound infection and postoperative complications.","authors":"Ran Song, Mingming Ma, Nana Yang, Chunfang Chen, Huan Wang, Juan Li","doi":"10.1186/s12893-024-02713-8","DOIUrl":"10.1186/s12893-024-02713-8","url":null,"abstract":"<p><p>To evaluate the impact of open surgical care (OSC) compared to minimally invasive surgery (MIS) on the occurrence of wound infection (WI) and overall postoperative aggregate complications (POACs) in female cervical cancer (CC) patients, we conducted this meta-analysis study. A thorough examination of the literature up to March 2024 was conducted, and 1849 related studies were examined. The 44 studies that were selected included 11,631 females who had CC. The odds ratio (ORs) and the estimation using 95% confidence intervals (CIs) were used to calculate the impact of open surgical management and MIS on WI and POACs in females with CC, using dichotomous methodologies and a random or fixed model. When comparing MIS to open surgical care, there was a substantial decrease in WI (OR, 0.19; 95% CI, 0.13-0.29, p < 0.001) and POACs (OR, 0.49; 95% CI, 0.38-0.62, p < 0.001) in females with CC. On the other hand, among female patients with CC, MIS did not differ significantly from open surgical care in pelvic infection and abscess (PI&A) incidence (OR, 0.59; 95% CI, 0.31-1.16, p = 0.13). When compared to OSC, women with CC who underwent MIS experienced considerably fewer WI and POACs; however, there was no discernible difference in PI&A rates. However, given several of the designated examinations for the meta-analysis had relatively small sample sizes, caution must be used while handling its values.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"24 1","pages":"413"},"PeriodicalIF":1.6,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11665136/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878093","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":"Geriatric nutritional risk index as a predictor of major postoperative complications in emergency femoral hernia patients.","authors":"Qiuyue Ma, Xiaoli Liu, Chen Liang, Huiqi Yang, Jie Chen, Yingmo Shen","doi":"10.1186/s12893-024-02727-2","DOIUrl":"10.1186/s12893-024-02727-2","url":null,"abstract":"<p><strong>Background: </strong>To evaluate the prognostic values of GNRI for major postoperative complications in emergency femoral hernia patients.</p><p><strong>Methods: </strong>In this cross-sectional study, we enrolled 105 emergency femoral hernia patients. GNRI was calculated using preoperative body weight, height, and serum albumin. The primary outcome was a composite of major postoperative complications. Univariable and multivariable logistic regression analyses were used to examine the association between GNRI and major complications. The ability of GNRI in detecting major complications was assessed by area under the curve (AUC).</p><p><strong>Results: </strong>The prevalence of low, moderate, and severe nutritional risk was 18.1%, 25.7%, and 10.5%. Five patients (4.8%) had major postoperative complications. Higher GNRI was associated with lower risk of major complications after adjusting for age and sex (aOR = 0.90, 95% CI: 0.81-1.00, P = 0.044). The AUC for GNRI identifying major complications was 0.812 (95% CI: 0.640-0.984, P = 0.019), and the optimal cut-point value was 90.96 (sensitivity: 80.0%; specificity: 72.0%).</p><p><strong>Conclusions: </strong>GNRI is significantly associated with major postoperative complications. It is a simple and useful prognostic tool for femoral hernia patients in emergency settings.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"24 1","pages":"412"},"PeriodicalIF":1.6,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11664821/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878103","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 urinary dysfunction following lateral lymph node dissection for rectal cancer via minimally invasive surgery.","authors":"Makoto Takahashi, Kazuhiro Sakamoto, Hisashi Ro, Saki Kochi, Miyuki Toake, Hiromitsu Takahashi, Takahiro Irie, Hirotaka Momose, Kota Amemiya, Yuki Tsuchiya, Ryoichi Tsukamoto, Kumpei Honjo, Masaya Kawai, Shun Ishiyama, Kiichi Sugimoto, Yutaka Kojima","doi":"10.1186/s12893-024-02697-5","DOIUrl":"10.1186/s12893-024-02697-5","url":null,"abstract":"<p><strong>Background: </strong>Lateral lymph node dissection (LLND) for locally advanced rectal cancer (LARC) is performed widely since it reduces local recurrence. However, there are some disadvantages to LLND, including technical difficulties and association with postoperative urinary dysfunction. Procedures for LARC have also become more minimally invasive: laparoscopic surgery (LS) has become more common, and use of robot-assisted LS (RALS) is increasing. The purpose of this study is to assess differences in postoperative urinary dysfunction after LLND for LARC between LS and RALS, and to identify risk factors for postoperative urinary dysfunction.</p><p><strong>Methods: </strong>The subjects were 100 patients with LARC (≥ cT3) with the inferior border of the tumor reaching the peritoneal reflection who underwent LS or RALS with LLND between 2009 and 2023 at Juntendo University Hospital. After LLND, the urinary catheter was usually removed on or before postoperative day 5. The duration of urinary catheterization (DUC) was used to evaluate postoperative urinary dysfunction. The standard (S) and long-term (L) groups were defined as cases with urinary catheter removal at ≤ 5 and > 5 days, respectively. DUC was examined for LS vs. RALS and clinicopathological factors were identified that adversely affect DUC.</p><p><strong>Results: </strong>Of the 100 subjects, 72 underwent LS and 28 received RALS. LLND was bilateral in 65 cases and unilateral in 35 cases. The median DUC was 5 days, with 74 cases in group S and 26 in group L. The most frequent postoperative complication (Clavien-Dindo Grade 2 or higher) was urinary dysfunction, followed by ileus and surgical site infection (SSI), and none differed by procedure (LS vs. RALS). Univariate analysis showed significant differences in LLND laterality (p = 0.02) and SSI (p = 0.04) between groups S and L. In multivariate analysis, bilateral LLND (p < 0.01, HR 7.37) and SSI (p = 0.01, HR 15.36) were independent factors that worsened DUC.</p><p><strong>Conclusions: </strong>There was no difference in urinary dysfunction after LLND between LS and RALS. Bilateral LLND and SSI were risk factors for lengthening DUC. Compared to bilateral LLND, unilateral LLND can reduce urinary dysfunction; therefore, selective LLND, which is overwhelmingly unilateral LLND, and prevention of perioperative SSI may be important for maintenance of urinary function.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"24 1","pages":"416"},"PeriodicalIF":1.6,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11664852/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142883514","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 effectiveness of different flap-raising techniques for mastectomy in reducing the rate of complications: a network meta-analysis.","authors":"Saburi Oyewale, Azeezat Ariwoola, Idris Oyewale","doi":"10.1186/s12893-024-02723-6","DOIUrl":"10.1186/s12893-024-02723-6","url":null,"abstract":"<p><strong>Background: </strong>Seroma has been associated with some energy devices used in raising flaps during modified radical mastectomy. Perhaps, its occurrence might be reduced by determining the most effective technique for raising the flap. Hence, the wide array of energy devices available for mastectomy warrants a network meta-analysis for comparison to determine the most suitable for rseducing complications.</p><p><strong>Methods: </strong>Searches were conducted on Google Scholar and PubMed for randomized controlled trials that compared the various energy devices (argon-cautery, diathermy, plasma blade, LigaSure, and harmonic scalpel) to traditional scalpel/scissors in mastectomy procedures. This review was registered with a PROSPERO number: CRD42023456510. The primary outcome was seroma formation, while the secondary outcomes included flap necrosis, drain effluent, and blood loss.</p><p><strong>Results: </strong>Thirty-three studies were used for this network meta-analysis. Using sharp dissections (scissors or scalpel) for raising flaps in mastectomy reduced seroma formation [Odds ratio (OR): 0.375 (Credible interval (CrI): 0.244, 0.575)], Argon cautery decreased blood loss [Mean difference (MD): -304 (CrI: -698, 90.5)] but harmonic scalpel reduced the rate of flap necrosis [OR: 0.379 (CrI: 0.177, 0.791)] and the volume of drain effluent [MD: -383 (CrI: -704, -62.9)].</p><p><strong>Conclusion: </strong>Using scissors or scalpels for mastectomy was associated with a reduction in the rate of seroma. In addition, the volume of drain effluent was reduced using a Harmonic scalpel compared to other energy devices. Aside from a reduction in flap necrosis rate, blood loss, and the volume of drain effluent; energy devices for raising flaps in mastectomy were not entirely superior to scalpels or scissors.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"24 1","pages":"415"},"PeriodicalIF":1.6,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11665085/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142883516","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":"Fracture classification and coronal plane position of bolt may affect the prognosis after femoral neck system (FNS) surgery for femoral neck fractures.","authors":"Cong Zhang, Haisen Hong, Zhenqi Ding, Zhangxin Chen, Zhenhua Zheng, Haihong Zhang, Guofeng Huang","doi":"10.1186/s12893-024-02692-w","DOIUrl":"10.1186/s12893-024-02692-w","url":null,"abstract":"<p><strong>Purpose: </strong>This study aims to investigate the risk factors for postoperative complications following Femoral Neck System (FNS) fixation in young patients with femoral neck fractures (FNFs).</p><p><strong>Methods: </strong>We retrospective analyzed 133 patients with FNFs who underwent FNS fixation between May 2021 and October 2023. Potential risk factors that may affect the results included age, gender, body mass index (BMI), Pauwels classification, Garden classification, fracture anatomical classification, reduction method, reduction quality, coronal plane position of the FNS bolt. Postoperative complication data, including femoral head necrosis, nonunion, shortening of the femoral neck, fracture displacement, and screw cut-out, were collected. Multivariate logistic regression analysis was used to analyze different influencing factors.</p><p><strong>Results: </strong>A total of 133 FNFs patients were divided into a healing group (108 patients) and a failure group (25 patients). 25 patients (18.79%) had postoperative complications, including 8 cases of femoral head necrosis, 3 cases of nonunion, 3 cases of significant shortening of the femoral neck, and 7 cases of fracture displacement, 4 cases of screw cut-out; the remaining patients' fractures all healed. There were no statistical differences between the two groups in age (P = 0.746), gender (P = 0.992), BMI (P = 0.361), Pauwels classification (P = 0.231), fracture anatomical classification (P = 0.459), reduction method (P = 0.383). Garden classification significantly influenced postoperative complications, with the proportion of Garden type IV being significantly higher in the failure group than in the healing group (64% vs. 39.8%, P = 0.01). Multivariate logistic regression analysis showed that coronal position of the FNS bolt and reduction quality were risk factors for postoperative complications. Subgroup analysis using logistic regression showed a positive correlation between coronal plane position of the FNS bolt and reduction quality with the occurrence of postoperative complications, with FNS positioned in the upper 1/3 and negative support being significant risk factors (P < 0.01; P < 0.01).</p><p><strong>Conclusions: </strong>FNS is an effective method for treating FNFs in young adults, but there is still a certain risk of failure. The Garden classification is an important evaluation indicator for postoperative complications, with a higher failure rate observed in type IV fractures. Coronal plane position of the FNS bolt and reduction quality are significant risk factors for failure after FNS surgery for FNFs.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"24 1","pages":"411"},"PeriodicalIF":1.6,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11664875/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878099","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":"Laparoscopic-assisted versus ultrasound-guided transversus abdominis plane block for laparoscopic cholecystectomy: a systematic review and meta-analysis.","authors":"Sundus Abdul Ghani, Hassan Ul Hussain, Maryam Abdul Wahid, Neha Majeed, Sheeba Burney, Areesha Tanveer, Muhammad Sohaib Asghar","doi":"10.1186/s12893-024-02706-7","DOIUrl":"10.1186/s12893-024-02706-7","url":null,"abstract":"<p><strong>Background: </strong>Laparoscopic-assisted (LTAP) and ultrasound-guided (UTAP) transversus abdominis plane (TAP) blocks are widely used for postoperative analgesia in laparoscopic cholecystectomy (LC), yet their comparative effectiveness remains unclear. The aim of this meta-analysis was to systematically evaluate and compare postoperative outcomes of LTAP and UTAP in LC.</p><p><strong>Materials and methodology: </strong>A comprehensive literature search of five electronic databases was conducted from the inception of the paper till 2 June 2024 following PRISMA guidelines. Eligibility criteria included: (a) randomized controlled trials (RCTs); (b) adult patients (≥ 18 years) undergoing elective LC; (c) intervention group undergoing LTAP; (d) control group receiving UTAP; (e) outcomes: postoperative pain intensity using VAS score; time to first analgesic need; postoperative morphine consumption; postoperative nausea vomiting (PONV); time to first bowel evacuation; time to first flatus. Mendeley Desktop 1.19.8 was used for article retrieval and for the removal of duplicates. Risk of bias was assessed using the Cochrane Risk of Bias Tool, and statistical analysis was performed using Review Manager, applying a random-effects model. Forest plots represented combined effects of Risk Ratios (RRs) for dichotomous outcomes and weighted mean differences (WMDs) for continuous outcomes with a 95% confidence interval (CI). P-value ≤ 0.05 was considered statistically significant and Higgin's I² test was employed to assess heterogeneity.</p><p><strong>Results: </strong>Seven RCTs in total involving 603 patients were included in the analysis, with 236 patients in the LTAP group and 232 in the UTAP group. No statistically significant differences observed between LTAP and UTAP in postoperative pain intensity at 6, 12, and 24 h, time to first analgesic need, postoperative morphine consumption, PONV, time to first stools, and time to first flatus, initially. Sensitivity analysis revealed a significant reduction in 6-hour postoperative pain in the LTAP group (WMD = 0.39; 95% CI = 0.10,0.67; P = 0.008; I² = 0%), but no significant differences were found in later time points (12 h: WMD = 0.12; 95% CI = -0.17,0.40; P = 0.42; I² = 0%; 24 h: WMD = -0.04; 95% CI = -0.26, 0.18; P = 0.73; I² = 5%) or in other outcomes. Moderate levels of heterogeneity and an overall low risk of bias in quality assessment were observed among the studies.</p><p><strong>Conclusion: </strong>Our meta-analysis indicated no clear advantage of LTAP over UTAP in managing postoperative pain and related outcomes in LC. Although LTAP may offer logistical benefits by reducing the need for equipment and personnel, further large-scale RCTs focusing on procedure-specific outcomes are needed to establish definitive conclusions.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"24 1","pages":"400"},"PeriodicalIF":1.6,"publicationDate":"2024-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11662483/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142873287","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":"Safety and efficacy of anatomical tunneling technique for precise lung segment resection in complex anatomical settings.","authors":"Kexin Cao, Jian Zhu, Jianan Zheng, Ke Wei, Zhihua Li, Zhijun Chen, Liang Chen, Weibing Wu","doi":"10.1186/s12893-024-02719-2","DOIUrl":"10.1186/s12893-024-02719-2","url":null,"abstract":"<p><strong>Background: </strong>Thoracoscopic segmentectomy is the main surgical method for the treatment of earlylung cancer. With the promotion of technology and increasingly accurate criteria for lung subsegments, lung nodules with complex positions involving intersegmental and multisegments have become technical bottlenecks. This study aimed to verify whether seeking anatomical conditions for creating a fissure by tunneling techniques with precise resection of lung segments could solve this bottleneck problem.</p><p><strong>Methods: </strong>The clinical data of patients with lung nodules ≤ 2 cm located in the complex position in the Department of Thoracic Surgery of Jiangsu Provincial People's Hospital from January 2019 to August 2023 were collected. Date analyzed the characteristics of patients who underwent seeking anatomical conditions for creating a fissure by tunneling techniques with precise resection of lung segments (segment group) at complex setting and compared the surgical outcomes and complications between these lobectomy patients (lobectomy group) at similar locations.</p><p><strong>Results: </strong>A total of 22 patients were included segment group and 47 patients were included lobectomy group. Except for the depth ratio or tumor size or consolidation tumor ratio (CTR), there were no significant differences in the other baseline data between the two groups. All patients in segment group received a satisfactory surgical margin. Compared to the lobectomy group, surgical outcomes were better in segment group (p < 0.05 for postoperative hospital stay and the counts of resected subsegments).</p><p><strong>Conclusion: </strong>Seeking anatomical conditions for creating a fissure by tunneling techniques is a promising technique for performing precise resection of lung segments with a safe resection margin for patients with lung nodules at complex positions involving multiple segments. It can be used as a precise resection of lung segments technique.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"24 1","pages":"409"},"PeriodicalIF":1.6,"publicationDate":"2024-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11662686/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142873299","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":"Topical application of Glauber's salt accelerates the absorption of abdominal fluid after pancreatectomy.","authors":"Jialin Li, Jie Hua, Haiyan Ruan, Hang Xu, Chen Liang, QingCai Meng, Jiang Liu, Bo Zhang, Jin Xu, Si Shi, XianJun Yu, Wei Wang","doi":"10.1186/s12893-024-02696-6","DOIUrl":"10.1186/s12893-024-02696-6","url":null,"abstract":"<p><strong>Background: </strong>Abdominal fluid collection (AFC) is one of the most common complications after pancreatic surgery, yet there are few recommendations on how to manage it. Most cases of AFC only require observation, while others may require more invasive techniques. Unfortunately, there are no drugs that effectively promote the absorption of AFCs. The aim of this study was to evaluate the potential efficacy of Glauber's salt solution for promoting the absorption of AFCs after pancreatectomy.</p><p><strong>Methods: </strong>This study included 196 patients who underwent pancreatomy and had AFCs on at least 2 cross-sectional follow-up CT images between 2020 and 2022. AFCs were defined as effusion with a diameter ≥ 3 cm and located around the pancreatic resection margin. We retrospectively investigated the relationship between Glauber's salt concentration and clinical variables.</p><p><strong>Results: </strong>The rate of clinically significant pancreatic fistula (grades B + C) was significantly higher in the control group (62.8% vs. 40.7%, P = 0.014). The median maximum diameter of the AFC was smaller, and the median time for the AFC to decrease to 30 mm in diameter was shorter in the Glauber's salt group than in the control group (41.9 mm vs. 53.5 mm, P = 0.008; 35.5 d vs. 100 d, P < 0.001). According to the multivariate analysis, percutaneous drainage and the application of Glauber's salt were found to be independent risk factors for AFCs decreasing to less than 30 mm in diameter (HR = 2.338, 95% CI = 1.524-3.585, P < 0.001; HR = 1.853, 95% CI = 1.327-2.589, P < 0.001). Additionally, patients with a maximum postoperative temperature exceeding 38.5 °C exhibited enhanced AFC absorption (hazard ratio (HR) = 1.850, 95% CI = 1.268-2.701; P = 0.001).</p><p><strong>Conclusions: </strong>Topical application of Glauber's salt solution after pancreatic surgery can promote the absorption of AFCs.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"24 1","pages":"398"},"PeriodicalIF":1.6,"publicationDate":"2024-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11662731/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142873301","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}