BMC Surgery最新文献

{"title":"Indications and clinical outcomes of percutaneous cholecystostomies in acute cholecystitis: a study from Qatar.","authors":"Mohamed Said Ghali, Syed Muhammad Ali, Khadija Jaffar Siddig Gibreal, Rajvir Singh, Mona S Shehata, Raed M Al-Zoubi, Ahmad Zarour","doi":"10.1186/s12893-025-02765-4","DOIUrl":"10.1186/s12893-025-02765-4","url":null,"abstract":"<p><strong>Introduction: </strong>Acute cholecystitis (AC) is a prevalent condition in emergency departments (EDs). Standard care involves early laparoscopic cholecystectomy; however, in cases of delayed presentation, high surgical risk, or during situations like the COVID-19 pandemic, percutaneous cholecystostomy (PC) serves as an alternative management strategy. This study reports our center's experience with PC in managing AC, providing insights from a unique geographical context.</p><p><strong>Methods: </strong>We conducted a retrospective review of 97 patients undergoing PC operation from June 1, 2016, to January 1, 2021. The data collected included demographic details, indications for PC, clinical outcomes, ICU admissions, overall mortality, and long-term follow-up.</p><p><strong>Results: </strong>The cohort comprised 61.9% male patients with a mean age of 67.2 ± 15.5 years. The primary comorbidity was hypertension (83.5%), and 88.6% had an ASA (American Society of Anesthesiologists) score of ≥ III. The main cause of AC was calculous type, and 15.2% of cases were acalculous cholecystitis. Main Tokyo Guidelines 18 (TG 18) grade was grade II and was found in 56.4% of patients. The readmission rate was 33.1% and overall mortality rate was 34% during follow-up. The native population in Qatar were older and burdened with more co-morbidities. High risk of surgery was the main indication for PC, followed by delayed presentation of AC. Patients with delayed presentations were younger (p = 0.051), had higher albumin levels (p = 0.005), and had lower ICU admission rates (p = 0.002) and mortality (p = 0.014) than those with multiple comorbidities. The overall Mortality rates post-PC were 34%, predominantly attributed to underlying conditions rather than the PC procedure itself. Patients who proceeded to post-PC cholecystectomy were younger, had higher albumin levels, and experienced fewer readmissions (p < 0.05).</p><p><strong>Conclusion: </strong>In high-risk patients or when surgical risk is prohibitive, PC is a viable and effective alternative for AC management. Post-PC cholecystectomy was associated with favorable outcomes, suggesting PC as a bridge to surgery in selected patients. This study highlights the role of PC in a high-risk population within our regional setting.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"100"},"PeriodicalIF":1.6,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11909981/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634788","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":"Clinical efficacy of allograft bone combined with calcium phosphate bone powder in repairing bone defects of benign bone tumors: A retrospective controlled study.","authors":"Qiang Liu, Jianping Zheng, Long Ma, Dawei Chu, Zongqiang Yang, Ningkui Niu, Jiandang Shi","doi":"10.1186/s12893-025-02823-x","DOIUrl":"10.1186/s12893-025-02823-x","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the clinical efficacy of repairing bone defects caused by benign bone tumors using allograft bone combined with calcium phosphate bone powder.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 55 patients (aged 10-61 years, mean 35 ± 13.2) with benign bone tumors treated at our hospital from June 2020 to December 2022. The bone defects in these cases were created after surgical curettage of the tumor lesions, which included common benign tumors such as osteochondroma, giant cell tumor of bone, and enchondroma. Patients were divided into two groups based on bone graft materials: a simple allograft bone group (n = 30) and a combined group using allograft bone with calcium phosphate bone powder (n = 25). Preoperative data, surgical time, intraoperative blood loss, postoperative complications, imaging findings, limb function, and quality of life (KPS scores) were analyzed.</p><p><strong>Results: </strong>All 55 patients were followed for 12-30 months (mean 13.45 ± 5.18). All incisions healed by primary intention without complications such as graft nonunion, fractures, or tumor recurrence. The combined group showed a significantly shorter healing time (t = 4.280, P < 0.05) and higher KPS scores at 6 months postoperatively (X² = 3.646, P < 0.05) compared to the simple group. However, no significant differences were observed between groups in healing rate, residual bone defects, or limb function at 12 months postoperatively (P > 0.05).</p><p><strong>Conclusion: </strong>Allograft bone combined with calcium phosphate bone powder is superior to allograft bone alone for repairing bone defects following curettage of benign bone tumors, promoting faster healing and better postoperative functional recovery.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"99"},"PeriodicalIF":1.6,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907860/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical long-term outcomes of Hirschsprung Disease in the Democratic Republic of Congo: a case series of 31 patients in a resource-limited setting.","authors":"Fabrice Gulimwentuga Cikomola, Arsene Daniel Nyalundja, Alliance Wani Bisimwa, Bijoux Safi Matabaro, Franck Masumbuko Mukamba, Costa Musilimu Sudi, Paul Budema Munguakonkwa, Leon-Emmanuel Mukengeshayi Mubenga, Kinja Nyamugabo, Désiré Munyali Alumeti, Théophile Kabesha, Marc Miserez, Dieudonné Mushengezi Sengeyi","doi":"10.1186/s12893-024-02684-w","DOIUrl":"10.1186/s12893-024-02684-w","url":null,"abstract":"<p><strong>Background: </strong>Hirschsprung disease (HD) contributes significantly to the burden of disease related to conditions amenable to pediatric surgery within the Democratic Republic of Congo (DRC). However, it has received less clinical attention due to limited resources. We aimed at assessing the long-term follow-up outcomes following an innovate resection approach in South Kivu, eastern DRC.</p><p><strong>Methods: </strong>In this case series, the authors elucidate the admissions for HD spanning from 2016 to 2021 at a Pediatric Surgical Center in the DRC. All patients underwent surgical management. Due to the absence of an extemporaneous biopsy, the resection margin was defined by a formula developed by the authors: 5 cm for patients under 5 years, 5 cm plus 1 cm per age from 6-10 years, and 5 cm plus 0.5 cm per age above 10 years. Post-operative mortality and complication rates were equally computed. Descriptive statistics were calculated for continuous variables. Discharge-to-Follow-up data were visualized using time-to-event curves.</p><p><strong>Results: </strong>Thirty-one patients aged 195 (interquartile range: 18-669) days were included in this study. Thirteen (58.93%) were from mining areas. The patients were surgically managed and follow-up for a year. 6.45% died in the 30-day post-operative period and 19.35% were lost to follow-up. The complaints were recorded from the fourth month following the surgery with most of the patients complained about fecal soiling (58.06%). The overall complaint rate was 80% (95%CI:56.20%-90.69%). The overall rate of incontinence was different compared to those with fecal soiling (p = 0.04). Although lacking statistical significance, the length of stay (LoS) post-surgery predicting an 9% increased incidence of complaints during the follow-up period (adjusted Hazard Ratio: 1.09, 95% CI:0.97-1.23).</p><p><strong>Conclusion: </strong>HD cause avertable morbidity in South Kivu. These data suggest that the long-term outcome in HD can be mitigated through appropriate surgical management during the operative and intervention aimed at optimizing the LoS.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"96"},"PeriodicalIF":1.6,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11899727/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143617806","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 characteristics of surgical site infection with class I incision in neurosurgery.","authors":"Yifei Li, Ling Gao, Shanhong Fan","doi":"10.1186/s12893-025-02825-9","DOIUrl":"10.1186/s12893-025-02825-9","url":null,"abstract":"<p><strong>Objective: </strong>Surgical site infections (SSIs) were recognized to be the most common complication of neurological surgery, with substantial life quality threats to patients and additional cost burdens to healthcare facilities. This study sought to expound the infection characteristics of class I incision and provide clinical indication for the prevention and treatment of SSIs.</p><p><strong>Methods: </strong>A 2-year retrospective analysis was conducted according to patients who performed neurological surgery with class I incision in a tertiary comprehensive hospital in Shaanxi Province, China. Case mix index (CMI)-adjusted and national nosocomial infection surveillance (NNIS) risk index-adjusted SSI rate were utilized for analytical standardization. The SSIs were specifically analyzed according to various departments, surgeons, and surgical classifications.</p><p><strong>Findings: </strong>6046 surgical cases were finally included in our study. The majority of the American Society of Aneshesiologists (ASA) score and NNIS risk index of surgeries were allocated in level 2 and score 1. Our study found 121 SSI cases, with the crude infection rate of 2.00%. 95.04% were organ/space infection. The most of the infection were found in the surgeries with score 1 (68.60%) of the NNIS risk index. The main surgical classification was resection of space occupying lesions (61.96%). The highest crude and NNIS risk index adjusted infection were individually found in hybrid operation (11.67%) and endoscopy-assisted resection of space occupying lesions (13.33%). 21 of 54 surgeons were found to have SSIs. We found the main pathogenic bacteria was Staphylococcus epidermidis (22.81%), and the commonly prophylactic used antibiotics was Cefazolin (51.95%).</p><p><strong>Conclusion: </strong>Our study found the main infection was among surgeries with score 1 of NNIS risk index and the surgical classification of endoscopy-assisted resection of space occupying lesions. We indicated specific attention should be paid to the surgeon and surgical classification with highest infection rate to control and prevent SSIs.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"97"},"PeriodicalIF":1.6,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11900087/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143617807","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":"Comparison of laparoscopic versus robot-assisted sugery for rectal cancer after neo-adjuvant therapy: a large volume single center experience.","authors":"Heyuan Zhu, Jingyu Zou, Hongfeng Pan, Ying Huang, Pan Chi","doi":"10.1186/s12893-025-02764-5","DOIUrl":"10.1186/s12893-025-02764-5","url":null,"abstract":"<p><strong>Purpose: </strong>This study aims to assess the short- and long-term outcomes of rectal cancer patients undergoing robotic versus laparoscopic surgery after receiving neo-adjuvant therapy. There is a lack of clarity on this topic, necessitating a comprehensive comparison.</p><p><strong>Method: </strong>Between January 2017 and December 2021, consecutive patients who underwent laparoscopic and robotic rectal resection at a major public medical center were enrolled. All participants received neo-adjuvant chemoradiotherapy (nCRT) before surgery. The primary objective of this study was to assess the sphincter preservation rate and the rate of conversion to open surgery, using propensity score matching (PSM) analysis. Secondary endpoints included 5-year disease-free survival (DFS), 5-year overall survival (OS), short-term postoperative complications, long-term oncological prognosis, and the occurrence of low anterior resection syndrome (LARS).</p><p><strong>Result: </strong>A total of 575 patients diagnosed with rectal cancer participated in the cohort study, with 183 individuals undergoing robotic surgery and 392 undergoing laparoscopic surgery. Patients in the robotic group tended to be younger and had higher ypT, cT, and cN stages, lower tumor locations, and higher rates of extramural vascular invasion (EMVI) and circumferential resection margin (CRM) positivity. PSM resulted in 183 patients in the robotic group and 187 in the laparoscopic group. We found a higher sphincter preservation rate in robotic group compared with laparoscopic group (92.9% vs. 86.1%, P = 0.033), with no significant difference in conversion to open surgery(P > 0.05). The robotic group had a higher incidence of postoperative chylous ascites (4.9% vs. 1.1%, P = 0.029) and potentially lower sepsis occurrence (0% vs. 1.6%, P = 0.085). No significant differences were observed in long-term oncological prognosis or 5-year survival rates (P > 0.05). The median survival time for each group was 34 months. Subgroup analysis of 76 rectal cancer patients who underwent intersphincteric resection (ISR) surgery indicated that those who selected robotic surgery had higher cN and cT stages. Furthermore, no statistically significant differences were observed in short-term and long-term clinical outcomes, LARS, OS time, and DFS time between the two surgical modalities. The primary outcomes of interest, specifically the rate of sphincter preservation and the rate of conversion to open laparotomy, showed no significant differences.</p><p><strong>Conclusion: </strong>Robotic surgery for rectal cancer, following preoperative nCRT, demonstrates comparable technical safety and oncological outcomes to laparoscopic surgery. Further comprehensive studies are needed to to confirm the potential advantages of robotic surgical interventions.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"98"},"PeriodicalIF":1.6,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11899483/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143617805","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":"Vascularized fibular epiphyseal transfer for biological reconstruction of bone defects following resection in children with proximal humeral sarcoma.","authors":"Jun Li, Xianzhe Tang, Lu Wang, Tang Liu","doi":"10.1186/s12893-025-02828-6","DOIUrl":"10.1186/s12893-025-02828-6","url":null,"abstract":"<p><strong>Background: </strong>The functional reconstruction of bone defects following resection of proximal humerus tumors in children poses a significant challenge. This study utilized vascularized fibular epiphyseal transfer for proximal humerus reconstruction to evaluate the outcome, complications, and survival rates.</p><p><strong>Methods: </strong>In this study, we conducted a retrospective analysis of 13 pediatric patients who underwent vascularized fibular epiphyseal transfer for biological reconstruction following oncologic resection of the proximal humerus between 2019 and 2021. All patients received adequate preoperative preparation and evaluation, and complications were meticulously recorded. Regular functional follow-ups and imaging evaluations were performed.</p><p><strong>Results: </strong>A total of 13 patients with an average age of 9.8 years were included in this study. The average length of the humerus defect after surgical resection was 13.7 cm (9.4-17.8 cm). Delayed wound healing was observed in 2 patients, and one patient experienced brief common peroneal nerve palsy. There were 3 cases of graft fracture, all of which occurred within 1 year after operation. These cases were successfully managed through the application of draping plaster or brace fixation. The mean follow-up period was 39.8 months (ranging from 19 to 57 months). The mean Musculoskeletal Tumor Society (MSTS) score was 21.5 (18-24). All patients reported no persistent pain.</p><p><strong>Conclusion: </strong>In conclusion, we assert that vascularized fibular epiphyseal transfer provides a reliable and promising option for reconstruction in pediatric patients undergoing proximal humerus tumor resection surgery. Graft fractures were the most prevalent complication, emphasizing the importance of cautionary measures to prevent falls or trauma. However, further validation through increased case numbers and extended follow-up periods is necessary.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"95"},"PeriodicalIF":1.6,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11895305/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605599","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":"Analysis of the efficacy of a prophylactic increasing blood pressure before the end of surgery to reduce postoperative bleeding after gastrectomy: a propensity score-matched analysis.","authors":"Guangxu Zhu, Shengjie Zhou, Qihang Sun, Xuren Lu, Qingshun Zhu, Xin Yin, Lei Yu, Jianjun Qu, Xiaomin Lang","doi":"10.1186/s12893-025-02826-8","DOIUrl":"10.1186/s12893-025-02826-8","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the efficacy of reducing post-gastrectomy hemorrhage by increasing blood pressure at the end of gastric surgery and to evaluate whether this clinical intervention affects the stability of patients' postoperative circulatory system.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 499 patients who underwent radical gastrectomy under general anesthesia at our center between January 2023 and January 2024. After 1:1 propensity score matching, the experimental group comprised 157 patients whose operation cavities were examined after increasing blood pressure before the end of gastrectomy, while the control group included 157 patients whose operation cavities were examined using routine procedures without increasing blood pressure.</p><p><strong>Results: </strong>The incidences of total postoperative bleeding (0% vs. 3.82%, P = 0.013) and early postoperative bleeding (0% vs. 2.55%, P = 0.044) were significantly lower in the experimental group compared to the control group. There were no significant differences between the two groups in delayed bleeding (0% vs. 1.23%, P = 0.156), systolic blood pressure immediately upon returning to the ward (121.02 ± 18.196 vs. 120.34 ± 21.664, P = 0.795), systolic blood pressure 48 h post-surgery (125.04 ± 16.242 vs. 126.23 ± 17.048, P = 0.529), diastolic blood pressure immediately upon returning to the ward (83.83 ± 11.978 vs. 84.75 ± 12.422, P = 0.506), diastolic blood pressure 48 h post-surgery (74.69 ± 9.773 vs. 75.76 ± 10.605, P = 0.353), heart rate immediately upon returning to the ward (74.31 ± 11.610 vs. 75.15 ± 11.660, P = 0.522), or heart rate 48 h post-surgery (80.49 ± 12.267 vs. 79.11 ± 10.969, P = 0.293). Additionally, there were no statistically significant differences between the two groups regarding anastomotic fistula, intestinal obstruction, postoperative pneumonia, reoperation, mortality, combined organ resection, or postoperative hospital stay (P > 0.05).</p><p><strong>Conclusion: </strong>Increasing blood pressure before the end of gastrectomy can effectively reduce the incidence of primary postoperative hemorrhage without affecting the stability of the perioperative circulatory system.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"93"},"PeriodicalIF":1.6,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11892180/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143598310","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 pulmonary infection on thoracoscopic surgery outcomes in children with CPAM: a retrospective study.","authors":"Cui-Xia Yuan, Chun Wu, Zheng-Xia Pan, Yong-Gang Li","doi":"10.1186/s12893-025-02827-7","DOIUrl":"10.1186/s12893-025-02827-7","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary infection is a common clinical complication in children with congenital pulmonary airway malformation (CPAM). Surgical intervention has been proven effective in managing this condition. We aim to evaluate the impact of pulmonary infection on the outcomes of total thoracoscopic procedures in children with CPAM.</p><p><strong>Methods: </strong>This was a single-center retrospective study. CPAM patients who underwent total thoracoscopic surgery at a tertiary care center from January 2013 to December 2023 were divided into three groups based on pulmonary infection status: non-infection (NI), hidden infection (HI), and pulmonary infection (PI). Clinical characteristics and operation-related outcomes were compared among the groups.</p><p><strong>Results: </strong>A total of 154 children with CPAM who underwent thoracoscopic surgery were categorized into three groups based on pulmonary infection: the NI group (27 cases), HI group (56 cases), and PI group (71 cases). The conversion rate to thoracotomy was 14.8%, 23.2%, and 29.2% respectively across the three groups. 116 cases were successfully completed thoracoscopically. There were no significant differences in gender distribution among the three groups (p > 0.05), but statistically significant (p < 0.05) in age and weight. Significant differences emerged in operative time and blood loss (p < 0.05), but no significant variations were found in transfusion requirements, chest tube duration, ventilator use duration, or hospital stay length (p > 0.05). In postoperative pulmonary complications, a statistically significant difference was found regarding pneumothorax incidence among all three groups (p < 0.05), whereas no significant differences (p > 0.05) emerged concerning atelectasis or pneumonia incidences across these cohorts.</p><p><strong>Conclusions: </strong>Pulmonary infection is the most prevalent complication in CPAM and exhibits a high rate of hidden infections, thereby complicating surgical intervention and increasing associated risks. Early thoracoscopic intervention prior to infection manifestation can optimize surgical outcomes and reduce associated complications.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"94"},"PeriodicalIF":1.6,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11892240/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143598311","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":"Efficacy of metronidazole in reducing pain after hemorrhoidectomy: a meta-analysis of randomized controlled trials.","authors":"Hui Dong, Wen-Xing Chen, Yue-Juan Li, Deng-Chao Wang","doi":"10.1186/s12893-025-02819-7","DOIUrl":"10.1186/s12893-025-02819-7","url":null,"abstract":"<p><strong>Objective: </strong>Pain is a significant issue in post-hemorrhoidectomy. Metronidazole is being explored as an adjunctive pain management option. This meta-analysis of randomized controlled trials (RCTs) assesses metronidazole's effectiveness and safety compared to a placebo post-hemorrhoidectomy, aiming to provide evidence-based pain management guidance.</p><p><strong>Method: </strong>We conducted a systematic search of the Cochrane Library, Embase, PubMed, Web of Science, and ClinicalTrials.gov for RCTs comparing metronidazole to placebo after hemorrhoidectomy, covering the period from database inception to July 21, 2024. After screening per inclusion/exclusion criteria, study quality was assessed using Cochrane Handbook's risk of bias tool (version 5.1.0). The meta-analysis was conducted using RevMan 5.3 software, the quality of outcome indicators was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system, and trial sequential analysis (TSA) was employed to verify the adequacy of the sample size.</p><p><strong>Results: </strong>A total of 9 RCTs were included. The meta-analysis results showed that the pain scores on the first day post-operation [MD=-1.07, 95% CI (-1.85, -0.30), P = 0.006], the second day post-operation [MD=-1.72, 95% CI (-2.62, -0.81), P = 0.0002], the seventh day post-operation [MD=-1.73, 95% CI (-2.70, -0.76), P = 0.0005], and the fourteenth day post-operation [MD=-1.80, 95% CI (-2.67, -0.94), P < 0.0001] in the metronidazole group were lower than those in the placebo group. Additionally, the rate of additional analgesia was reduced [RR = 0.48, 95% CI (0.27, 0.84), P = 0.01]. No statistically significant differences were found between the metronidazole and placebo groups in terms of the overall incidence of complications [RR = 0.69, 95% CI (0.41, 1.16), P = 0.16] and time to return to normal activities [MD=-1.69, 95% CI (-6.58, 3.20), P = 0.50]. Sensitivity analysis indicated that the results for pain scores on the first day post-operation were unstable. High heterogeneity was observed in pain scores on the first, second, seventh, and fourteenth days post-operation, as well as in the time to return to normal activities. The TSA indicated that the sample size for the primary outcome measures had achieved the required information size (RIS), supporting the strength and dependability of the meta-analysis findings.</p><p><strong>Conclusion: </strong>Metronidazole may be effective and safe in reducing postoperative pain in patients undergoing hemorrhoidectomy. However, due to the limitations of this study, further verification is needed from future large-sample, multi-center, well-designed high-quality RCTs.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"92"},"PeriodicalIF":1.6,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11889878/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143587833","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":"Clinical progression following acellular dermal matrix use for volume replacement after breast-conserving surgery.","authors":"JinAh Kwon, Jung Hee Byon, Byung Kyun Ko, Jin Sung Kim, Minseo Bang","doi":"10.1186/s12893-025-02821-z","DOIUrl":"10.1186/s12893-025-02821-z","url":null,"abstract":"<p><strong>Background: </strong>The cosmetic outcomes of breast-conserving surgery (BCS) have recently gained increasing attention, and surgeons are exploring the use of the acellular dermal matrix (ADM) as a safe and effective method of breast reconstruction. This study evaluated the clinical progress of patients with breast cancer following the application of sheet-type ADM for breast reconstruction after BCS.</p><p><strong>Methods: </strong>This retrospective study included 137 patients who underwent BCS using ADM at a single center between October 2019 and October 2021. During surgery, sheet-type ADM was folded and inserted into the excised defects. Complications and cancer recurrence were evaluated during surveillance follow-up until December 2023, and maintenance of the inserted ADM was quantitatively compared using volume analysis of the first and last follow-up computed tomography (CT).</p><p><strong>Results: </strong>Of the 137 evaluated patients, 16 (11.6%) had minor complications, and 17 (12.4%) underwent biopsy during the surveillance period. One patient was diagnosed with recurrence. ADM volume was measured in 55 patients. The mean volume reduction between the first and last CT scans was 1.81 ± 2.06 cm³ (a decrease of 17.42 ± 19.82%), which was statistically significant (p < 0.001).</p><p><strong>Conclusions: </strong>The insertion of ADM after BCS is a safe and effective method for addressing volume defects, even though a slight reduction occurs in ADM volume.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"25 1","pages":"91"},"PeriodicalIF":1.6,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11881489/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143568643","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}