BMC Surgery最新文献

{"title":"Comparative effectiveness of total thyroidectomy versus hemithyroidectomy for low-risk differentiated thyroid cancer: a multicenter retrospective cohort study with propensity score matching.","authors":"Zhen Ma, Ihab E Ali, Vivian George Vincent Fernandez, Wei Wang, Jinqiang Pan, Jingliang Gu, Ziyi Zhai","doi":"10.1186/s12893-026-04028-2","DOIUrl":"10.1186/s12893-026-04028-2","url":null,"abstract":"<p><strong>Background: </strong>The optimal surgical approach for patients with low-risk differentiated thyroid cancer (DTC) remains controversial. Current evidence comparing long-term outcomes between total thyroidectomy and hemithyroidectomy is limited by short follow-up and a lack of comprehensive patient-reported outcomes.</p><p><strong>Objective: </strong>To compare the effectiveness of total thyroidectomy versus hemithyroidectomy in patients with low-risk DTC, evaluating oncologic outcomes, complications, thyroid function, quality of life, and healthcare costs.</p><p><strong>Methods: </strong>We conducted a multicenter retrospective cohort study of 800 patients with low-risk DTC treated at three tertiary centers between 2014 and 2021, with follow-up through 2023. Propensity score matching (1:1) was performed using age, sex, tumor size, histology, and BRAF V600E status. Patients were analyzed according to the operation actually performed (as-treated analysis). Primary outcomes were overall survival and recurrence-free survival. Secondary outcomes included complications, thyroid function, quality of life (HADS, SCL-90), and healthcare costs. Analyses included Kaplan-Meier survival analysis with log-rank tests and Cox proportional-hazards regression, with Bonferroni correction for the two primary endpoints.</p><p><strong>Results: </strong>After propensity score matching, 400 patients were included in each group (median follow-up 7.2 years, IQR 5.1-8.9). The 8-year overall survival rates were 97.2% (95% CI 95.6-98.8%) for total thyroidectomy versus 96.1% (95% CI 94.2-97.9%) for hemithyroidectomy (HR 0.79, 95% CI 0.44-1.42, p = 0.43). The 8-year recurrence-free survival rates were 96.8% versus 94.2% (HR 1.48, 95% CI 0.73-2.98, p = 0.28). Hemithyroidectomy was associated with a significantly lower rate of permanent hypoparathyroidism (2.0% vs 8.0%, p < 0.001, NNH = 17). Total thyroidectomy entailed a universal requirement for lifelong levothyroxine (100% vs 15% requiring replacement in the hemithyroidectomy group); among hemithyroidectomy patients not requiring replacement, subclinical hypothyroidism was common. At one year, fewer hemithyroidectomy patients reported clinically significant anxiety/depression (18% vs 25%, p = 0.018). Mean total 8-year healthcare costs were lower with hemithyroidectomy (¥28,247 vs ¥55,439, p < 0.001).</p><p><strong>Conclusions: </strong>For appropriately selected patients with low-risk DTC, hemithyroidectomy provides oncologic outcomes comparable to total thyroidectomy while offering advantages in complications, thyroid-function preservation, quality of life, and healthcare costs. Treatment decisions should be individualized through shared decision-making. These findings support consideration of de-escalated surgery but require validation in prospective randomized trials.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"26 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Asymmetric cement distribution in the coronal plane increases the risk of prosthetic loosening following total knee arthroplasty: an in-silico study.","authors":"Jun Han, Zhong Zhou, Wenqiang Xu, Han Wang, Lijunpeng Jia, Yong Ma, Jingchi Li","doi":"10.1186/s12893-026-04066-w","DOIUrl":"10.1186/s12893-026-04066-w","url":null,"abstract":"<p><strong>Background: </strong>Total knee arthroplasty (TKA) is the standard treatment for end-stage knee osteoarthritis (KOA). Aseptic loosening of the tibial component is a common complication following TKA. Previous studies have indicated that reduced cement volume and thinner cement mantles can lead to stress concentration in the cancellous bone beneath the tibial plateau, which serves as an etiological basis for prosthetic loosening. Our preliminary study has shown that variations in cement distribution can alter the local biomechanical environment. Asymmetric cement distribution is a frequently observed clinical phenomenon; however, no study has yet investigated its impact on the risk of prosthetic loosening.</p><p><strong>Methods: </strong>A three-dimensional model of the tibial side following total knee arthroplasty was constructed. The model included the tibial cortex, cancellous bone, polyethylene insert, tibial tray, and bone cement. Three model groups were created based on the coronal plane distribution of the cement: symmetric cement distribution, 75% of cement on the tibial side (medial), and 75% of cement on the fibular side (lateral). The model with symmetrical cement distribution achieved cement thickness exceeding 2 mm on both sides. In contrast, in models with asymmetrical cement distribution, the cement thickness on the thinner side fell below this threshold. All models were subjected to a 2100 N compressive load at flexion angles of 0°, 30°, and 60°, under both varus and valgus loading conditions. The differences in compressive stress distribution within the cancellous bone beneath the tibial plateau were analyzed across the models to predict the risk of prosthetic loosening.</p><p><strong>Results: </strong>In models with asymmetric cement distribution, a pronounced stress concentration trend was observed in the cancellous bone on the thinner cement side. Under varus and valgus loading conditions, the load borne by the cancellous bone on the thicker cement side decreased compared to the symmetric distribution model, with the extent of this reduction being smaller than the increase in stress on the thinner cement side. Under axial loading conditions, the peak stress in the asymmetric cement distribution model was consistently higher than that in the symmetric model. A more substantial increase in peak stress was observed when the lateral cement layer was thinner.</p><p><strong>Conclusion: </strong>Asymmetric cement distribution leads to an aggravated trend of compressive stress concentration in the cancellous bone on the side with a thinner cement mantle, where the cement thickness is less than 2 mm, the threshold for prosthesis loosening reported by published studies. This serves as a risk factor for increased aseptic loosening of the prosthesis.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"26 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149221055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond Recurrence: Impact of Surgical Technique on Testicular Microcirculation After Inguinal Hernia Repair.","authors":"Mehmet Emin Gönüllü, Fatih Gürsoy, İbrahim Feyyaz Naldemir, Erman Yekenkurul, Mehmet Fuat Çetin, Sami Dogan","doi":"10.1186/s12893-026-04078-6","DOIUrl":"https://doi.org/10.1186/s12893-026-04078-6","url":null,"abstract":"<p><strong>Background: </strong>The impact of different inguinal hernia repair techniques on testicular perfusion remains a subject of clinical interest. While open and laparoscopic approaches demonstrate comparable outcomes in terms of recurrence and complications, their effects on testicular microcirculation are not fully elucidated.</p><p><strong>Methods: </strong>This retrospective comparative cohort study included 180 male patients who underwent unilateral primary inguinal hernia repair using open Lichtenstein, total extraperitoneal (TEP), or transabdominal preperitoneal (TAPP) techniques between January 2015 and December 2025 at a tertiary referral center. Doppler ultrasonography parameters, including resistive index (RI), peak systolic velocity (PSV), end-diastolic velocity (EDV), and testicular volume, were evaluated preoperatively, at postoperative day 7, and at 1 month. Changes over time and between groups were analyzed using multivariable regression and linear mixed-effects models. Subclinical testicular ischemia was defined based on predefined Doppler criteria.</p><p><strong>Results: </strong>Early postoperative changes in testicular perfusion parameters differed significantly between surgical techniques. At postoperative day 7, RI values were higher and EDV values were lower in the Lichtenstein group compared to TEP and TAPP (p < 0.001 and p = 0.002, respectively). These differences decreased at 1 month but remained statistically significant for RI (p = 0.003). Multivariable analysis demonstrated that surgical technique, operative time, and hernia sac size were independently associated with changes in RI. Subclinical testicular ischemia was more frequent in the Lichtenstein group, while laparoscopic approaches were associated with lower odds (TEP: OR 0.34, p = 0.002; TAPP: OR 0.41, p = 0.006). Longitudinal analysis confirmed a significant time-by-technique interaction for RI (p < 0.001), indicating partial recovery over time.</p><p><strong>Conclusion: </strong>Surgical technique is associated with transient alterations in testicular perfusion following inguinal hernia repair. Open Lichtenstein repair demonstrated more pronounced early microvascular changes, whereas laparoscopic techniques exhibited a more stable perfusion profile. These findings highlight the importance of surgical technique and intraoperative handling in preserving testicular microcirculation.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"26 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Workflow-oriented learning curve analysis of laparoscopic distal pancreatectomy: step-specific associations of operative maturation.","authors":"Kun Su, Renchao Zou, Xiawei Yang, Tao Wu, Jie Huang","doi":"10.1186/s12893-026-04063-z","DOIUrl":"10.1186/s12893-026-04063-z","url":null,"abstract":"<p><strong>Background: </strong>The learning curve of laparoscopic distal pancreatectomy (LDP) has traditionally been assessed using global operative indicators such as operative time and blood loss. However, little is known about how technical performance evolves during individual operative steps. This study aimed to perform a workflow-oriented learning curve analysis of LDP using cumulative sum (CUSUM) methodology and step-specific operative assessment.</p><p><strong>Methods: </strong>We retrospectively analyzed 58 consecutive patients who underwent LDP between January 2023 and December 2025 at a high-volume pancreatic center. Operative workflow was divided into predefined operative steps according to anatomical landmarks. CUSUM analysis based on operative time was used to identify the transition from the initial phases to the proficiency phase.</p><p><strong>Results: </strong>CUSUM analysis identified a transition point at approximately Case 29. Mean operative time decreased from 77 ± 13 min in the early phase to 54 ± 14 min in the late phase (P < 0.001). The steepest reductions occurred during pancreatic mobilization (31 ± 10 vs. 17 ± 6 min, P < 0.001) and splenic vessel dissection (24 ± 9 vs. 12 ± 4 min, P < 0.001). Estimated blood loss also declined significantly (39 ± 18 vs. 21 ± 11 mL, P = 0.002), while postoperative pancreatic fistula rates and overall complication rates remained comparable between phases.</p><p><strong>Conclusions: </strong>In this cohort, reductions in operative time during LDP were concentrated in anatomically complex dissection steps rather than uniform acceleration of the entire procedure. Step-specific analysis describes temporal patterns that characterize technical change during minimally invasive pancreatic surgery.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"26 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patterns of small bowel volvulus in North - Eastern Ethiopia.","authors":"Yohannes Teshome Kassie, Fikru Tadelle Mengesha, Meron Tadesse Awoke, Redwan Yimer Assen, Atalel Fantahun Awedew, Assefa Sisay Ayenew, Setegn Abebaw Abera","doi":"10.1186/s12893-026-04062-0","DOIUrl":"10.1186/s12893-026-04062-0","url":null,"abstract":"<p><strong>Background: </strong>Small bowel volvulus (SBV) is a condition where the small bowel loops coil around the axis of their own mesentery, which can lead to mechanical intestinal obstruction. It contributes a significant number of patients at surgical emergency with small bowel obstruction (SBO), especially in developing countries. The main objective of this study was to assess the clinical and epidemiological status of SBV in North-Eastern Ethiopia.</p><p><strong>Method: </strong>The study was conducted at Dessie Comprehensive and Specialized Hospital, Dessie, Ethiopia. The study period was in November 2023. A hospital-based retrospective cross-sectional study design was used, and data were collected with a standardized structured checklist. Data were collected from medical records of adult patients with a discharge diagnosis of small bowel obstruction over a four (4)-year period from September 1, 2019, to August 31, 2023. Cross-tabulation analysis was done for factors that contributed to the mortality and morbidity of SBV.</p><p><strong>Result: </strong>A total of 162 patients with small bowel volvulus were included in the study, accounting for about 37.2% of patients with small bowel obstruction, with an average annual occurrence rate of about 40.5 patients. The mean age of patients was 47 years. The majority of them (93.8%) were males. The common seasons at presentation were September-November and March-May. All participants had abdominal pain and vomiting, but 98.1% and 88.3% had abdominal distension and constipation, respectively. 52.5% of patients with SBV presented within 24 h of symptom onset, and 61.1% had normal complete blood count results, whereas 38.9% had leukocytosis. The majority (77.1%) were managed with derotation and retrograde milking, whereas 7.4% were managed with resection and anastomosis, and 11.1% underwent band release and derotation. Primary small bowel volvulus was seen in 85.2% of patients, and the remaining 14.8% had secondary small bowel volvulus.</p><p><strong>Conclusion: </strong>The prevalence of SBV among patients with SBO was 37.2%, with 85.2% being primary and the remaining 14.8% being secondary types. The average annual occurrence rate was about 40.5 patients per year, with a mean age of 47 years.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13673918/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148551047","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":"C-Reactive protein and the CALLY index for predicting complicated appendicitis: a retrospective cohort study of 5,428 patients.","authors":"Mahmut Ozan Aydin, Erkan Somuncu, Cenk Ozkan, Zeynep Betul Yildiz, Kubilay Ozgur Oztutuncu, Ozgur Gangal, Beyhan Kilic, Serhan Yilmaz, Emre Bozdag","doi":"10.1186/s12893-026-04072-y","DOIUrl":"10.1186/s12893-026-04072-y","url":null,"abstract":"<p><strong>Background: </strong>Distinguishing complicated from uncomplicated appendicitis before surgery remains a critical yet unresolved clinical challenge. Delayed recognition of complicated appendicitis, particularly in cases of perforation or abscess formation, is associated with increased morbidity and mortality. Although various laboratory markers and inflammatory indices have been proposed as markers associated with disease severity, their relative diagnostic performance remains unclear. This study aimed to evaluate and compare the discriminatory performance of conventional laboratory parameters, leukocyte-derived indices, and composite biomarkers for complicated appendicitis.</p><p><strong>Methods: </strong>In this retrospective single-center cohort study, 5,428 patients who underwent emergency appendectomy between 2015 and 2025 were included. Patients were classified as uncomplicated or complicated appendicitis based on intraoperative findings. Preoperative laboratory parameters, including C-reactive protein, white blood cell count, total bilirubin, leukocyte-derived indices, and composite biomarkers such as the C-reactive protein-albumin-lymphocyte (CALLY) index and the hemoglobin-albumin-lymphocyte-platelet (HALP) index, were analyzed. Receiver operating characteristic analysis was used to assess diagnostic performance, and optimal cut-off values were determined using the Youden index. Multivariate logistic regression was performed to identify variables independently associated with complicated appendicitis.</p><p><strong>Results: </strong>Of the 5,428 patients, 707 (13.1%) had complicated appendicitis. C-reactive protein demonstrated the highest diagnostic accuracy (AUC: 0.781) and demonstrated the strongest independent association (OR: 5.29). Total bilirubin was also independently associated with complicated appendicitis (OR: 1.21). Leukocyte-derived indices showed limited discriminatory ability, with only the systemic immune-inflammation index remaining significant in multivariate analysis. The CALLY index demonstrated relatively strong discriminatory performance (AUC: 0.747), with lower values associated with increased disease severity.</p><p><strong>Conclusions: </strong>C-reactive protein remains the most robust laboratory marker for identifying complicated appendicitis. Composite biomarkers such as the CALLY index may provide additional value in risk stratification. These findings support the use of routinely available laboratory parameters in clinical risk assessment, although prospective validation is warranted.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"26 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149221025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative outcomes of central venous access via open jugular and ultrasound-guided subclavian approaches in low-weight pediatric patients: a study with secondary outcomes.","authors":"Ebrahim Farhadi, Mohsen Rezaee, Saeed Aslanabadi, Davoud Badebarin, Vahid Hamzei","doi":"10.1186/s12893-026-04061-1","DOIUrl":"10.1186/s12893-026-04061-1","url":null,"abstract":"<p><strong>Background: </strong>The necessity of this study stems from the lack of comparative evidence on the outcomes of central venous catheterization via the open internal jugular and ultrasound-guided subclavian approaches in low-weight pediatric patients. Its innovation lies in the simultaneous evaluation of both primary and secondary outcomes of these two techniques in this vulnerable population.</p><p><strong>Methods: </strong>This prospective randomized clinical trial at Mardani Azar Children's Hospital (winter 2022-2023) included 92 pediatric patients under five kilograms weight, randomly assigned to either open internal jugular or ultrasound-guided subclavian vein catheterization (46 per group). Procedural success and major complications-such as pneumothorax, arterial cannulation, ectopic catheter placement, infection, and thrombosis-were evaluated intraoperatively and during a two-weeks follow-up using imaging and clinical assessment.</p><p><strong>Results: </strong>The mean catheter placement time was significantly longer in the jugular group than in the subclavian group (41.19 ± 13.8 vs. 33.15 ± 12.12 min; P = 0.04). No cases of pneumothorax, hemothorax, bleeding, arrhythmia, occlusion, infection, or death occurred in either group. Hematoma developed only in the jugular group (6 vs. 0; P = 0.02), and all cases were associated with a procedure duration greater than 35 min (P = 0.041). In the subclavian group, all failures (n = 4) and upper limb edema (n = 3) occurred exclusively in patients under 2.5 kg, with both outcomes significantly linked to lower body weight (P = 0.03 and P = 0.014, respectively). Other complications showed no significant differences between groups.</p><p><strong>Conclusion: </strong>Both approaches were generally safe, with no major adverse events observed in either group. Ultrasound-guided subclavian access was associated with a shorter procedure time, whereas hematoma occurred only in the jugular group and catheterization failure and upper-limb edema were seen only in low-weight infants in the subclavian group. However, because access site and technique were evaluated together, their independent effects could not be determined. In addition, the findings in infants weighing < 2.5 kg were based on few events and should be considered hypothesis-generating rather than definitive.</p><p><strong>Trial registration: </strong>This clinical trial was registered in the Iranian Registry of Clinical Trials (IRCT) with the code IRCT20230901059317N1(Registration date: 2024-02-16).</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"26 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13673613/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149197459","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":"Defining the learning curve of laparoscopic adrenalectomy: a single-center experience.","authors":"Mohammad Alzoubi, Daoud O Al Aruri, Mohammed A M Aldrini, Omar Awadallah, Farah Ali Obeidat, Mohammad Amjad Bushnaq, Ruba A Al-Qinawi, Rand J AbuZayid, Nidal A Younes, Rami Addasi, Ayman Mismar","doi":"10.1186/s12893-026-03981-2","DOIUrl":"10.1186/s12893-026-03981-2","url":null,"abstract":"<p><strong>Background: </strong>Laparoscopic adrenalectomy has become the standard approach for most benign adrenal lesions. However, the number of cases required for a surgeon to achieve proficiency remains debated, as learning curves vary according to patient characteristics, lesion factors, and surgeon experience. This study aims to evaluate learning curve for laparoscopic adrenalectomy and identified factors influencing operative duration in a single-surgeon experience.</p><p><strong>Methods: </strong>This is a retrospective observational cohort study that evaluated 70 consecutive unilateral laparoscopic adrenalectomies performed via the lateral transperitoneal approach. Patient demographics, tumor characteristics, and perioperative variables were collected. Univariate analysis was followed by multivariable linear regression to determine factors associated with operative duration. The learning curve was assessed using moving average smoothing, Cumulative Sum Control Chart, and segmented regression of operative duration against case sequence. A second segmented analysis was performed on the multivariable model incorporating preoperative and intraoperative factors associated with operative duration.</p><p><strong>Results: </strong>The cohort had a mean age of 46 ± 15.8 years, with 71.4% being females. The median surgery duration was 120 min (IQR: 67.5) with a mean of 123 ± 53.7 min. On multivariable analysis, larger tumor size (P = 0.01) and greater intraoperative blood loss (P < 0.001) were independently associated with longer operative durations. Learning curve analysis demonstrated a significant reduction in operative duration (P = 0.01) with a breakpoint at 23 cases. A secondary multivariable model incorporating both preoperative and intraoperative factors identified a later breakpoint at 32.7 cases, reflecting the combined influence of experience and operative conditions.</p><p><strong>Conclusion: </strong>A learning curve was observed, with operative duration improving after approximately 23 cases. A secondary multivariable model identified a later model-based breakpoint at around 33 cases. These findings should be interpreted as cohort-specific estimates and suggest that learning-curve interpretation in laparoscopic adrenalectomy should consider both accumulated experience and operative factors that influence surgical performance.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"26 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13673784/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149208251","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":"Risk factors for delayed gait recovery after primary total hip arthroplasty in patients with crowe type I/II developmental dysplasia of the hip.","authors":"Wei Xin, Cong Wang, Zhipeng Yue, Shu Chen, Yunli Zhu, Peiliang Fu, Qirong Qian","doi":"10.1186/s12893-026-03970-5","DOIUrl":"10.1186/s12893-026-03970-5","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The gait recovery process after total hip arthroplasty (THA) in patients with developmental dysplasia of the hip (DDH) is complex. However, systematic evidence regarding risk factors for delayed early postoperative gait recovery in patients with Crowe type I/II DDH remains limited.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This retrospective study included 283 patients with Crowe type I/II DDH who underwent primary THA at our institution between January 2020 and December 2024. The primary outcome was delayed clinical gait recovery at 3 months after surgery, defined as persistent limping or Trendelenburg gait after full weight-bearing was permitted and/or a Harris Hip Score (HHS) limp subscore &lt; 11; this threshold indicates failure to reach the \"no limp\" score of 11 in the HHS limp subscore. Outcomes were independently adjudicated by two uniformly trained investigators, and inter-rater agreement was assessed using Cohen's kappa (κ). Model 1 included age, bilateral DDH status, American Society of Anesthesiologists (ASA) physical status class II/III, symptom duration, preoperative HHS, preoperative need for a walking aid, preoperative Trendelenburg sign, Crowe classification, preoperative leg length discrepancy (LLD), operative time, and intraoperative blood loss. Model 2 further included postoperative residual LLD, height of the acetabular center of rotation, cup abduction angle, and femoral offset change. The primary analysis was based on multiple imputation by chained equations (MICE; 20 imputations), with sensitivity analyses using the unilateral DDH subgroup, complete cases, alternative outcome definitions, a parsimonious model, an all-prespecified-covariate model, collinearity testing between preoperative and postoperative LLD, and LLD threshold analyses.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Delayed gait recovery at 3 months occurred in 92 patients (32.5%). Multivariable analysis (Model 1) showed that a positive preoperative Trendelenburg sign (odds ratio [OR] = 2.87, 95% confidence interval [95% CI]: 1.55-5.31), Crowe type II (OR = 2.15, 95% CI: 1.18-3.91), preoperative LLD (per 1-mm increase: OR = 1.14, 95% CI: 1.03-1.26), age (per 1-year increase: OR = 1.03, 95% CI: 1.01-1.05), and symptom duration (per 1-year increase: OR = 1.03, 95% CI: 1.01-1.06) were independent risk factors for delayed gait recovery. The extended model (Model 2) showed that postoperative residual LLD was also independently associated with delayed gait recovery (per 1-mm increase: OR = 1.20, 95% CI: 1.02-1.41), whereas height of the acetabular center of rotation, cup abduction angle, and femoral offset change showed no independent associations. Sensitivity analyses restricted to unilateral DDH and complete-case analyses were consistent with the primary analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In this predominantly female Chinese single-center cohort of patients with Crowe type I/II DDH undergoing primary THA, delayed clinical gait recovery at 3 mon","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13673742/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148550997","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":"Emergency minimally invasive versus open left-sided colonic resection for complicated diverticulitis: a systematic review and meta-analysis.","authors":"Hariruk Yodying, Vichit Viriyaroj, Thammanij Rookkachart, Thana Boonsinsukh, Anuwat Chartkitcharoen, Wannakorn Prapasajchavet, Natchanok Mekrugsakit, Patcharaon Petchkaewkul, Ratchanon Laojanun","doi":"10.1186/s12893-026-04043-3","DOIUrl":"10.1186/s12893-026-04043-3","url":null,"abstract":"<p><strong>Background: </strong>Emergency surgery for complicated diverticulitis carries substantial morbidity and mortality. Whether minimally invasive approaches offer advantages over open surgery in this urgent setting remains uncertain. We synthesized contemporary evidence comparing emergency minimally invasive versus open left-sided colonic resection for complicated diverticulitis.</p><p><strong>Methods: </strong>Following PRISMA 2020 guidelines and a prospectively registered protocol, we searched PubMed, Scopus, Cochrane Library, and ClinicalTrials.gov through July 2025. We included comparative studies of emergency minimally invasive versus open colectomy for complicated diverticulitis (Hinchey II-IV). Random-effects meta-analysis with Hartung-Knapp-Sidik-Jonkman adjustment was performed. Risk of bias was assessed using ROBINS-I at the outcome level, and certainty of evidence was evaluated using GRADE.</p><p><strong>Results: </strong>Six studies encompassing 9,637 patients (1,821 minimally invasive, 7,816 open) met inclusion criteria. Minimally invasive surgery was associated with lower 30-day mortality (4.5% vs. 8.7%; RR 0.48, 95% CI 0.40-0.59; P = 0.0002; I²=0%; low certainty); this estimate derived 86.9% of its weight from one database study and was no longer statistically significant when that study was excluded (RR 0.61, 95% CI 0.35-1.06). Major complications did not differ significantly (15.2% vs. 17.7%; RR 0.63, 95% CI 0.36-1.08; P = 0.10; very low certainty). Length of stay was shorter (MD - 2.55 days, 95% CI - 4.37 to - 0.74; P = 0.02) and incisional surgical site infection rates were lower (RR 0.30, 95% CI 0.12-0.75; P = 0.02), though operative time was longer (MD + 18.27 min, 95% CI 0.89-35.64; P = 0.04). Reoperation rates were similar (RR 0.98, 95% CI 0.78-1.22).</p><p><strong>Conclusions: </strong>Emergency minimally invasive resection was associated with lower 30-day mortality and shorter hospital stay, without conclusive evidence of fewer major complications. The mortality estimate derived most of its statistical weight from one large database study; after excluding that study, the point estimate remained favorable but imprecise. Overall certainty was low to very low, so these findings are hypothesis-generating rather than practice-changing. Minimally invasive resection may be considered in hemodynamically stable, selected patients operated on by surgeons with advanced laparoscopic colorectal expertise, pending prospective validation.</p><p><strong>Systematic review registration: </strong>PROSPERO CRD420251142546.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13673721/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148550994","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}