BMC Surgery最新文献

{"title":"Cumulative sum analysis for evaluating learning curve of endoscopic lateral neck dissection.","authors":"Zhen-Xin Chen, Xin-Ran Zhao, Jie-Min Deng, Ying Cao, Jing-Bao Chen, Feng-Shun Pang, Zhan-Hong Lin, Xiao-Bo Zhang, Bo Xu, You Qin","doi":"10.1186/s12893-024-02666-y","DOIUrl":"10.1186/s12893-024-02666-y","url":null,"abstract":"<p><strong>Objectives: </strong>Endoscopic lateral neck dissection (LND) can be a scarless procedure if a surgeon has performed a sufficient number of operations to become skilled at the techniques involved. Here, we examine the learning curve for a surgeon who performed 53 endoscopic LND procedures via chest approach.</p><p><strong>Methods: </strong>Surgical outcomes for 53 patients with papillary thyroid carcinoma who underwent endoscopic LND via chest approach between February 2017 and November 2022 were retrospectively reviewed. The surgeon's learning curve was evaluated using a cumulative sum graphic model (CUSUM).</p><p><strong>Results: </strong>A CUSUM analysis was applied to 53 patients (10 males, 43 females) with a mean age of 41.4 y who underwent endoscopic LND via chest approach. The best model for the curve was determined to be a third-order polynomial equation as follows: CUSUM_OT = - 0.007×patient number³-0.666×patient number² + 55.721×patient number - 72.964. This equation has a high R² value of 0.929. The peak operative time (OT) occurred at the 30th case. Consequently, the learning curve model was divided into two phases: phase 1 (1-30 cases) and phase 2 (31-53 cases). OT (307.9 ± 63.8 min vs. 232.4 ± 44.2 min, respectively; p < 0.001), blood loss (50 mL vs. 20 mL, respectively; p = 0.001), and complications (43.3% vs. 13.0%, respectively; p = 0.038) decreased significantly in phase 2 compared to phase 1.</p><p><strong>Conclusions: </strong>The learning curve of endoscopic LND via chest approach was found to involve 30 cases. With greater experience, the surgery was completed with shorter OT and fewer complications. This approach may be an alternative for patients who desire cosmesis. Furthermore, the present data and experience insights regarding endoscopic LND via chest approach may help other surgeons to pass the learning phase more safely.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"24 1","pages":"375"},"PeriodicalIF":1.6,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11590531/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142733954","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":"Influence of the ligation sequence of the inferior mesenteric artery and vein on circulating tumor cells in laparoscopic rectal cancer surgery: a prospective pilot study.","authors":"Tao Pan, Chang-Bo Nie, Chao Liu, Hai Hu","doi":"10.1186/s12893-024-02645-3","DOIUrl":"10.1186/s12893-024-02645-3","url":null,"abstract":"<p><strong>Background: </strong>There is no regulation in the current guidelines on the sequence of ligation of the inferior mesenteric artery and vein during rectal cancer surgery owing to a lack of sufficient evidence. Circulating tumor cells (CTCs) in peripheral blood can be used as potential indicators for predicting prognosis in colorectal cancer patients. This study aims to explore the feasibility of different ligation sequences for the inferior mesenteric vessels and their potential influence on CTCs.</p><p><strong>Methods: </strong>This pilot study involved 29 stage I-III rectal adenocarcinoma patients undergoing laparoscopic surgery. Patients were allocated into two groups based on the sequence of vascular ligation: vein-first (V-first) and artery-first (A-first). The primary objective was to assess the impact of the ligation sequence on peripheral blood CTC levels pre- and post-operatively. Secondary outcomes included intraoperative complications, surgical duration, blood loss, and number of lymph nodes harvested, and postoperative complications. The study was approved by the ethics committee of our hospital (SCCHEC-02-2024-102), and all patients provided informed consent.</p><p><strong>Results: </strong>No significant differences were found between the two groups regarding surgical duration, blood loss, lymph nodes harvested, or postoperative complications. A reduction in CTCs postoperatively was observed in 36% of patients in the V-first group, in comparison to 20% in the A-first group.</p><p><strong>Conclusion: </strong>Both A-first and V-first ligation sequences are viable and safe options in laparoscopic rectal cancer surgery. The V-first approach may be more effective in reducing levels of CTCs in peripheral blood. Further randomized studies are warranted to explore these findings comprehensively.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"24 1","pages":"374"},"PeriodicalIF":1.6,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11590328/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142733955","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":"Application of RhBMP-2 in Percutaneous Endoscopic Posterior Lumbar Interbody Fusion.","authors":"Yunsheng Chen, Canhua Xu, Yaohong Wu, Jiangyou Shi, Rongchun Chen","doi":"10.1186/s12893-024-02674-y","DOIUrl":"10.1186/s12893-024-02674-y","url":null,"abstract":"<p><strong>Background: </strong>To investigate the application of recombinant human bone morphogenetic protein-2 (RhBMP-2) in Percutaneous Endoscopic Posterior Lumbar Interbody Fusion (PE-PLIF).</p><p><strong>Materials and methods: </strong>The study randomly included 102 patients with lumbar spondylosis who underwent PE-PLIF at our hospital from April 2020 to August 2022. Following the random number table method, these subjects were graded as a study group of 51 cases and a control group of 51 cases. Posterior pedicle screw fixation treatment with RhBMP-2 or autologous bone was given respectively. The surgical status and perioperative complications, as well as lumbar spine function before surgery and at 1 and 12 months after surgery [Prolo score and Japanese Orthopaedic Association (JOA) score] of patients in the two groups were observed, and the postoperative fusion rate and cage displacement rate at 1 and 12 months after surgery were compared between the two groups. The degree of vertebral body slippage, intervertebral space height, and changes in quality of life were compared between the two groups before and 12 months after surgery.</p><p><strong>Results: </strong>There was no significant difference in hospital stay, surgical time, bleeding volume, and incidence of complications between the two groups (P > 0.05)0.12 months post-operation, the Prolo and JOA scores of both groups largely increased, which were significantly higher in the RhBMP-2 group than the control (P < 0.05). 12 months post-operation, the fusion rate in the RhBMP-2 group was 86.27%, which was significantly higher than that of 54.90% in the control group (P < 0.05). 12 months post-operation, the Cage displacement rate in the RhBMP-2 group was 5.88%, which was lower than that of 21.57% in the control group (P < 0.05). 12 months post-operation, the height of the intervertebral space in both groups largely increased, which was significantly higher in the RhBMP-2 group than in the control (P < 0.05). The degree of vertebral body slippage was significantly reduced in both groups, and the RhBMP-2 group was significantly lower than the control (P < 0.05). The cognitive function, social function, physiological function, and mental health were evidently improved in both groups 12 months post-operation and were significantly higher in the RhBMP-2 group than in the control (P < 0.05).</p><p><strong>Conclusion: </strong>RhBMP-2 material in PE-PLIF could significantly restore lumbar function, promote postoperative fusion, reduce Cage displacement and vertebral slippage, accelerate recovery of lumbar intervertebral space, and improve patient quality of life.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"24 1","pages":"376"},"PeriodicalIF":1.6,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11590271/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142733953","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":"Reappraisal of safety and oncological outcomes of laparoscopic repeat hepatectomy in patients with recurrent hepatocellular carcinoma: it is feasible for the pioneer surgical team.","authors":"Yi Chan Chen, Ruey-Shyang Soong, Po-Hsing Chiang, Shion Wei Chai, Chih-Ying Chien","doi":"10.1186/s12893-024-02676-w","DOIUrl":"10.1186/s12893-024-02676-w","url":null,"abstract":"<p><strong>Background: </strong>Hepatocellular carcinoma (HCC) is prevalent in Taiwan, primarily due to the high incidence of hepatitis B and C infections, with high recurrence rates of 50-70% within five years after initial treatment. Treatment options for recurrent HCC include salvage liver transplantation, trans-arterial chemoembolization, re-hepatectomy, and radiofrequency ablation. Repeat hepatectomy exhibits superior oncological outcomes compared with alternative approaches. Although laparoscopic liver resection has demonstrated safety and feasibility for primary HCC resection, the persistence of intrahepatic recurrence necessitates effective intervention. However, repeat liver resection poses several challenges including adhesions from previous surgeries, limited access to recurrent tumors, altered liver structure post-regeneration, difficulties in obtaining hilar control, and compromised liver reserves. Suggesting a laparoscopic approach for recurrent HCC is typically based on the surgeons' experience and confidence. In this study, we reconfirmed the safety, feasibility and oncological outcome of laparoscopic repeat liver resection and investigated the optimal timing for initiation of this procedure by a pioneering team in minimally invasive liver resection.</p><p><strong>Methods: </strong>We retrospectively reviewed our collective experience of 57 patients with recurrent HCC between January 2009 and December 2021.The patients were followed until June 30, 2024. Among them, 37 underwent laparoscopic approaches and 20 opted for open procedures.</p><p><strong>Results: </strong>Both groups exhibited similar operative times and perioperative outcomes, with significantly reduced hospital stays in the laparoscopic cohort (median: 5 vs. 7, p < 0.001). The median follow-up duration was 41.5 months (range, 2.8 to 112.6 months). Mortality occurred in 22 patients (38.6%) and recurrence occurred in 26 patients (45.6%) The overall survival and disease-free survival after the operation were similar in both groups and comparative to the literatures.</p><p><strong>Conclusion: </strong>Using a stepwise approach, laparoscopic repeat liver resection can be performed safely and effectively with a low incidence of conversion by an experienced surgical team with similar oncological outcomes. The introduction of laparoscopic techniques has also sparked a strategic shift in the surgical approach for recurrent HCC. This treatment option should be offered to patients by an experienced surgical team for minimally invasive liver resections.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"24 1","pages":"373"},"PeriodicalIF":1.6,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11583780/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142693409","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 overweight on patients undergoing laparoscopic pancreaticoduodenectomy: analysis of surgical outcomes in a high-volume center.","authors":"Dechao Li, Shulin Wang, Huating Zhang, Yukun Cao, Qingsen Chu","doi":"10.1186/s12893-024-02671-1","DOIUrl":"10.1186/s12893-024-02671-1","url":null,"abstract":"<p><strong>Background: </strong>The feasibility and safety of laparoscopic pancreaticoduodenectomy (LPD) in overweight patients is still controversial. This study was designed to analyze the impact of overweight on surgical outcomes in patients undergoing LPD.</p><p><strong>Methods: </strong>Data from patients who underwent LPD between January 2018 and July 2022 were analyzed retrospectively. A 1:1 propensity score-matching (PSM) analysis was performed to minimize bias between groups.</p><p><strong>Results: </strong>A total of 432 patients were enrolled, with a normal weight group (n = 241) and an overweight group (n = 191). After matching, 144 patients were enrolled in each group. The results showed that the incidence of clinically relevant postoperative pancreatic fistula (CR-POPF) and delayed gastric emptying (DGE) was significantly higher in the overweight group compared to the normal weight group (P = 0.036). However, there were no significant differences in perioperative mortality (1.4% vs. 2.1%, P = 0.652) and long-term survival outcomes between malignancy patients with different body mass index (BMI) before and after PSM (all P > 0.05).</p><p><strong>Conclusions: </strong>It is safe and feasible for overweight patients to undergo LPD with mortality and long-term survival outcomes comparable to the normal weight group. High-quality prospective randomized controlled trials are still needed.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"24 1","pages":"372"},"PeriodicalIF":1.6,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11583451/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142693121","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 treatment of posttraumatic spinal cord tethering and syringomyelia: a retrospective cohort investigation of cost, reimbursement, and financial sustainability.","authors":"Phillip Jaszczuk, Denis Bratelj, Crescenzo Capone, Susanne Stalder, Marcel Rudnick, Rajeev K Verma, Tobias Pötzel, Michael Fiechter","doi":"10.1186/s12893-024-02672-0","DOIUrl":"10.1186/s12893-024-02672-0","url":null,"abstract":"<p><strong>Background: </strong>Posttraumatic spinal cord tethering and syringomyelia are considered disabling diseases in patients with spinal cord injury. In symptomatic patients, surgical management can achieve promising clinical outcomes. As the raising economic pressure might jeopardize optimal and thus personalized patient care, we aimed to exemplify expenses of surgical treatment in contrast to reimbursement by the Swiss diagnosis related group (DRG) system.</p><p><strong>Methods: </strong>This retrospective investigation includes 60 patients who underwent surgery for spinal cord tethering and syringomyelia. The duration of surgeries was used to estimate the costs of care in the operating room (OR) considering established bench marks. Coverage of costs was calculated by comparing Swiss DRG reimbursements with the expenses from the investigated cases.</p><p><strong>Results: </strong>The mean duration of surgeries was 251.0 ± 93.5 min while 2.8 ± 1.4 vertebral segments were treated by spinal cord untethering. The mean OR costs (in USD) were $9,401.2±$3,500.2 (range $4,119.5 to $20,223.0). The mean reimbursement and the ratio of OR costs to reimbursement (in USD) were $24,122.5±$7,409.3 (range $17,249.8 to $31,977.1) and 0.41 ± 0.15 (range 0.14 to 0.74) for standard, and $39,106.0±$4,028.6 (range $35,369.1 to $43,376.8) and 0.24 ± 0.08 (range 0.10 to 0.47) for complex cases, respectively. The estimated costs of surgeries were different from reimbursements (p = 0.005).</p><p><strong>Conclusions: </strong>Although the cost of surgical management of patients with posttraumatic spinal cord tethering and syringomyelia are principally covered, it remains questionable if total hospital expenses are sufficiently outweighed by the current reimbursement system. This could potentially limit the availability of best medical care and might endanger personalized patient management.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"24 1","pages":"370"},"PeriodicalIF":1.6,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11577722/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142682219","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":"Modified screw-rod fixation for management of posterior pelvic ring fractures: a retrospective study.","authors":"Junqi Huang, Jiajia Cheng, Bo Shi, Heng Yang, Tao Wang, Dingwei Zhang, Nan Ye, Shitian Tang","doi":"10.1186/s12893-024-02654-2","DOIUrl":"10.1186/s12893-024-02654-2","url":null,"abstract":"<p><strong>Background: </strong>Pelvic fractures are often associated with life-threatening damage and mechanical instability. Surgical therapy is a prior choice. To minimize surgical invasion and risk, bilateral screws combined with curved rod were applied to stabilize posterior pelvic ring. This study was aim to explore the clinical effect of this procedure.</p><p><strong>Methods: </strong>From January 2018 to January 2022, 27 patients with posterior pelvic fracture were included retrospectively. There were 12 males and 15 females with an average age of 56.3 ± 14.2 years. The prognosis of pelvis was evaluated by Matta and Majeed scores. Relevant clinical evaluation indications include the time of fracture healing, limb function and complications.</p><p><strong>Results: </strong>The average follow-up time was 14.2 ± 5.4 month. Matta scoring standard: excellent in 18 cases, good in 7 cases, the good rate was 92.6%. The average healing time was 8.4 months. The standard of Majeed score in 6 months after operation: excellent in 14 cases, good in 10 cases, the good rate was 88.8%. At the last follow-up, the functional recovery of the affected limb was satisfactory. No deep infection occurred after operation. The neurological symptoms of patients with caudal sacral nerve injury were recovered 6 months after operation.</p><p><strong>Conclusion: </strong>The results indicated that screw-rod system is a safe technique. Minimally invasive technology reduced frequency of fluoroscopy. It provides a simple and safety method for posterior pelvic fracture.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"24 1","pages":"364"},"PeriodicalIF":1.6,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11577954/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142677539","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":"Long-term outcomes of robot versus video-assisted thymectomy for thymic epithelial tumors: a propensity matched analysis.","authors":"Long-Fei Zhu, Ling-Min Zhang, Chun-Jian Zuo, Bin Jiang, Nian Cheng","doi":"10.1186/s12893-024-02661-3","DOIUrl":"10.1186/s12893-024-02661-3","url":null,"abstract":"<p><strong>Background: </strong>Robot-assisted thoracoscopic surgery (RATS) thymectomy has been increasingly performed for treating thymic epithelial tumors in recent years. However, there are very limited reports on the long-term oncologic outcomes after RATS thymectomy, particularly in comparison to Video-assisted thoracoscopic surgery (VATS). This study aimed to compare the perioperative and long-term oncological outcomes between RATS and VATS.</p><p><strong>Methods: </strong>The study was conducted on 180 consecutive patients undergoing RATS or VATS between July 2016 and December 2019, 85 of whom underwent RATS, and 95 of whom underwent VATS. A 1:1 matched propensity score-matched analysis was performed and the perioperative and long-term oncologic outcomes of the two groups compared.</p><p><strong>Result: </strong>RATS group experienced a shorter operation time (median: 100 min vs. 120 min; P = 0.039) and less blood loss (40.00 ml vs. 50.00 ml, P = 0.011). RATS demonstrated a significantly lower conversion rate to open surgery compared to VATS, with only two patients requiring conversion in the RATS group as opposed to ten patients in the VATS group (3.03% vs. 15.15%, P = 0.030). In the RATS group, the 5-year progression-free survival rate was 87.70%, and the 5-year tumor-related survival rate was 92.31%, demonstrating no statistically significant difference compared to those in the VATS group.</p><p><strong>Conclusion: </strong>Compared with VATS, robotic thymectomy demonstrated excellent perioperative outcomes, and RATS achieved long-term oncologic outcomes comparable to those of VATS. RATS thymectomy could be considered as an effective alternative approach for treating thymic epithelial tumors.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"24 1","pages":"365"},"PeriodicalIF":1.6,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11577881/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142677535","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 required experience of open pancreaticoduodenectomy before becoming a specialist in hepatobiliary and pancreatic surgeons: a multicenter, cohort study of 334 open pancreaticoduodenectomies.","authors":"Tomokazu Fuji, Yuzo Umeda, Kosei Takagi, Masayoshi Hioki, Ryuichi Yoshida, Yoshikatsu Endo, Kazuya Yasui, Daisuke Nobuoka, Toshiharu Mitsuhashi, Toshiyoshi Fujiwara","doi":"10.1186/s12893-024-02677-9","DOIUrl":"10.1186/s12893-024-02677-9","url":null,"abstract":"<p><strong>Background: </strong>Open pancreaticoduodenectomy (OPD) is an essential surgical procedure for expert hepato-biliary-pancreatic (HBP) surgeons. However, there is no standard for how many surgeries must be performed by a surgeon in training before they are considered to have enough experience to ensure surgical safety.</p><p><strong>Methods: </strong>Cumulative Sum (CUSUM) analysis was performed using the surgical data of OPDs performed during the training period of board-certified expert surgeons of the Japanese Society of Hepato-Biliary-Pancreatic Surgery.</p><p><strong>Results: </strong>Fourteen HBP surgeons participated in this study and performed 334 OPDs during their training period. The median (interquartile range) values for operative time, blood loss, and length of hospital stay were 455 (397-519) minutes, 450 (234--716) ml, and 28 (21-38) days, respectively. CUSUM analysis showed inflection points at 20 surgeries performed for operative time. After 20 procedures, operative time was significantly shorter (461 min vs. 425 min, p = 0.021) and blood loss was significantly lower (470 ml vs. 340 ml, p = 0.038). No significant differences between within 20 and after 21 procedures were found in the complication rate (53% vs. 48%, p = 0.424) and rate of in-hospital deaths (1.5% vs.1.4%. p = 0.945). Up to 20 surgeries, PDAC and another malignant tumor had longer operative time than benign/low malignant diseases (486 min vs. 472 min vs. 429 min, p < 0.001), and higher blood loss (500 ml vs. 502 ml vs. 355 ml, p < 0.001). Mortality rate was higher at PDAC cases (5% vs. 0% vs. 0%, p = 0.01). After the 21 procedures, these outcomes were improved and no differences in by primary disease were observed. Multivariable analysis showed that within 20 surgeries were independent risk factors of longer operative time (HR2.6, p = 0.013) and higher blood loss (HR2.0, p = 0.049).</p><p><strong>Conclusions: </strong>To stabilize the surgical outcome of OPD for malignant disease, at least 20 surgeries should be performed at a certified institution during surgeon training.</p><p><strong>Trial registration: </strong>Clinical trial number: Not applicable.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"24 1","pages":"366"},"PeriodicalIF":1.6,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11577838/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142677544","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":"Acute intestinal obstruction caused by gastrointestinal foreign bodies in children: a comparison of laparoscopically assisted approach and open surgery.","authors":"Min Dong, Wanli Zhang, Lulu Zheng, Jun Sun, Zhibao Lv, Wei Wu","doi":"10.1186/s12893-024-02662-2","DOIUrl":"10.1186/s12893-024-02662-2","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to explore the appropriate surgical treatment method for acute intestinal obstruction caused by gastrointestinal foreign bodies in children through a comparison of clinical characteristics in patients treated via laparoscopically assisted approach and open surgery.</p><p><strong>Methods: </strong>This study retrospectively analyzed 12 children with acute intestinal obstruction caused by gastrointestinal foreign bodies treated at Shanghai Children's Hospital and Huzhou Maternity and Child Care Hospital from June 2019 to June 2024. Basic information, treatment methods, and prognoses of the patients were collected. General data, operation time, postoperative fasting time, postoperative hospital stay, and intraoperative and postoperative complications were compared between the two groups. Categorical data were compared using Fisher's exact test. Normally distributed continuous data were expressed as mean ± standard deviation and analyzed using an independent samples t-test; non-normally distributed data were expressed as M (P25, P75) and analyzed using the non-parametric Mann-Whitney U test.</p><p><strong>Results: </strong>Six cases underwent laparoscopic transumbilical extended incision, successfully extracting the intestines and removing the foreign bodies without converting to open surgery. Compared to Six cases undergoing traditional open surgery during the same period, the postoperative fasting time and postoperative hospital stay in the laparoscopic group were 4 (5 ± 3.65) days and 5.5 (5 ± 7.5) days, respectively, while in the traditional open surgery group, they were 5 (4.25 ± 6) days and 6 (5 ± 8.6) days, respectively; the differences were statistically significant (P < 0.05). The laparoscopic group had significantly shorter operation time and faster postoperative recovery. The acceptance of the laparoscopically assisted approach by the families was significantly higher than that of the open surgery treatment.</p><p><strong>Conclusion: </strong>The method of extracting obstructed intestines and removing foreign bodies via laparoscopic-assisted transumbilical extended incision has advantages over open surgery for treating acute intestinal obstruction caused by gastrointestinal foreign bodies, such as shortening hospital stay and operation time. However, for children with secondary gastrointestinal perforation caused by magnetic foreign bodies, open surgery, due to its broader exploration scope, is more advantageous for detecting occult perforations.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"24 1","pages":"371"},"PeriodicalIF":1.6,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11577814/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142683232","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}