BMC Surgery最新文献

{"title":"Dynamic changes in the aggregate index of systemic inflammation (ΔAISI) predict postoperative complications following ileostomy closure in rectal cancer patients.","authors":"Mesut Yavaş, Selim Keçeoğlu, Ramazan Kozan, Mehmet Akif Türkoğlu, Mustafa Şare","doi":"10.1186/s12893-026-04017-5","DOIUrl":"10.1186/s12893-026-04017-5","url":null,"abstract":"<p><strong>Background: </strong>Ileostomy closure following rectal cancer surgery is generally considered a low-risk procedure; however, postoperative complications remain clinically relevant. Reliable and easily accessible biomarkers for predicting these complications are lacking. This study aimed to evaluate the predictive value of dynamic changes in the aggregate index of systemic inflammation (ΔAISI) for postoperative complications following ileostomy closure.</p><p><strong>Methods: </strong>This retrospective cohort study included 137 patients who underwent curative rectal cancer surgery with diverting ileostomy followed by ileostomy closure between January 2015 and March 2026. Inflammatory and nutritional markers were recorded prior to primary surgery and before ileostomy closure. ΔAISI was calculated as the difference between these two time points. Comparisons were performed using the Mann-Whitney U test and chi-square test. Receiver operating characteristic (ROC) curve analysis and multivariate logistic regression were conducted to evaluate predictive performance.</p><p><strong>Results: </strong>Postoperative complications occurred in 23 patients (16.8%). No significant differences were observed in inflammatory markers measured before primary surgery. In contrast, several inflammatory markers measured prior to ileostomy closure were significantly associated with postoperative complications. Among the evaluated indices, ΔAISI demonstrated good discriminative ability (AUC: 0.755, 95% CI: 0.628-0.882, p < 0.001). In multivariate analysis, high ΔAISI remained an independent predictor of postoperative complications (OR: 4.13, 95% CI: 1.41-12.03, p = 0.009).</p><p><strong>Conclusion: </strong>ΔAISI is a promising and independent predictor of postoperative complications following ileostomy closure in rectal cancer patients. Both pre-closure AISI and ΔAISI demonstrated good predictive performance, whereas AISI measured before primary surgery showed poor discrimination. These findings suggest that inflammatory status immediately before ileostomy closure may serve as a clinically useful biomarker for perioperative risk stratification.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13637127/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148425781","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":"Iatrogenic complications in the removal of humeral intramedullary nails: a systematic review.","authors":"Victor Housset, Geoffroy Nourissat, Pierre-Alban Bouché, Claire Bastard, Quentin Baumann, Jules Descamps","doi":"10.1186/s12893-026-03857-5","DOIUrl":"10.1186/s12893-026-03857-5","url":null,"abstract":"<p><strong>Background: </strong>Intramedullary nailing is a widely recognized technique for the fixation of proximal and diaphyseal humeral fractures. While implant removal is sometimes performed to alleviate symptoms such as impingement or pain, the procedure is not devoid of risks. The aim of this study was to systematically review removal rates after anterograde humeral intramedullary nailing and to assess how removal-specific morbidity is reported, including the frequency and type of explicitly reported adverse events.</p><p><strong>Methods: </strong>This systematic review was conducted in accordance with the PRISMA guidelines. We included studies involving adult patients that reported data on implant removal rates, reasons for removal, and associated complications. The MINORS score was used to assess study quality.</p><p><strong>Results: </strong>A total of 13 studies were included, comprising 545 humeral nailing procedures. Removal rates varied significantly between studies, ranging from 1.8% in modern straight nail series to 38.9% in older curved nail series. The most frequently cited reasons for removal were proximal screw back-out, subacromial impingement, and nonunion. Removal-specific adverse events were explicitly reported in 3/13 studies; within these studies, 3 major events occurred among 12 removals. Across all removals (n = 75), at least 3 major events were confirmed (minimum rate: 4%, 3/75); this figure represents a lower bound, not an estimate, because 10/13 studies did not report removal-specific morbidity. The true incidence of removal-specific morbidity remains unknown, as only three of the thirteen included studies explicitly reported removal-related complications as a predefined study endpoint.</p><p><strong>Conclusion: </strong>Evidence is limited and heterogeneous across implant generations and fracture patterns; estimates should be interpreted cautiously. The removal of humeral intramedullary nails is associated with iatrogenic risks, difficult extraction, and retained hardware. Routine removal is not supported by the current evidence base; decisions should be individualized to clear indications.</p><p><strong>Prospero registration: </strong>CRD420251265725.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13637307/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148425739","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":"Agreement and discordance between the modified thoracolumbar injury classification and severity score and the thoracolumbar AOSpine injury score in guiding surgical decision-making for thoracolumbar fractures: a comparative study.","authors":"Han Zhang, Junwei Feng, Huibin Luo, Bing Wu, Jiayi Dou, Chen Chen, Binbin Tang, Jiale Zhang, Kaifeng Lin, Fangzhou Sun, Jinzhan Su, Liqiang Dong, Tingyuan Lai, Zhongcheng An, Wangzhe Fan","doi":"10.1186/s12893-026-04033-5","DOIUrl":"10.1186/s12893-026-04033-5","url":null,"abstract":"<p><strong>Purpose: </strong>To compare the agreement and the differences between the modified Thoracolumbar Injury Classification and Severity Score (mTLICS) system and the AO Thoracolumbar Spine Injury Score (TL AOSIS) in guiding surgical decision-making for thoracolumbar fractures.</p><p><strong>Methods: </strong>The clinical and imaging data of 100 patients with thoracolumbar fractures admitted to our hospital between January 2021 and December 2023 were retrospectively analyzed. Two orthopedic surgeons, blinded to the patients' clinical outcomes, independently evaluated the cases using both scoring systems and provided treatment recommendations. Disagreements were resolved by a senior attending surgeon. Agreement between the two systems' treatment categories was quantified by weighted Cohen's κ with 95% confidence intervals from paired 3 × 3 cross-tabulations, and interobserver reliability was assessed before consensus adjudication.</p><p><strong>Results: </strong>The two systems assigned the same treatment category in 86 of 100 patients (86.0%; unweighted κ = 0.773, 95% CI 0.666-0.881; linear-weighted κ = 0.820), with no significant asymmetry (McNemar-Bowker P = 0.160). Agreement was substantial in both the 57 neurologically intact patients (κ = 0.696) and the 43 patients with neurological impairment (κ = 0.619). Surgery was recommended by mTLICS versus TL AOSIS in 24.6% versus 19.2% of neurologically intact patients and in 90.7% versus 81.4% of those with neurological impairment. Interobserver reliability before consensus was substantial to high (linear-weighted κ = 0.88 for mTLICS and 0.75 for TL AOSIS). The two scoring systems showed substantial agreement in treatment recommendations. In burst fractures with intervertebral disc injury, mTLICS tended to assign cases to higher treatment categories than TL AOSIS, although these subgroup differences were not statistically significant.</p><p><strong>Conclusion: </strong>mTLICS and TL AOSIS show substantial concordance as decision-support tools for thoracolumbar fractures. For burst fractures with intervertebral disc involvement, mTLICS tends to recommend surgery more often, reflecting a difference in classification behaviour rather than a demonstrated clinical advantage. Because no outcome data were analysed, whether this tendency improves patient outcomes remains to be determined.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13632313/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148413466","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 intra-abdominal abscess formation after appendectomy: a multicenter retrospective cohort study from Africa.","authors":"Ali Mohamed Arif, Muhammet Ali Aydemir, Tugrul Ozdemir, Abdiwahab Dahir Alasow, Feride İrem Simsek, Orhan Alimoglu","doi":"10.1186/s12893-026-03989-8","DOIUrl":"10.1186/s12893-026-03989-8","url":null,"abstract":"<p><strong>Background: </strong>Postoperative intra-abdominal abscess (IAA) remains a significant cause of morbidity after appendectomy, particularly in low-resource settings where delayed presentation and advanced disease are common. This study aimed to identify factors associated with postoperative IAA formation after appendectomy in an African setting and to evaluate management strategies and outcomes.</p><p><strong>Methods: </strong>A multicenter retrospective cohort study was conducted across three tertiary hospitals in Mogadishu, Somalia. All patients who underwent appendectomy between January 2024 and July 2025 were screened for eligibility. Demographic, clinical, intraoperative, and postoperative variables were collected from medical records. The primary outcome was the development of an intra-abdominal abscess within 30 days after appendectomy. Patients with and without postoperative IAA were compared.</p><p><strong>Results: </strong>Ninety-two patients were included, of whom 19 patients (20.7%) developed postoperative IAA. Delayed presentation beyond 48 h was significantly more frequent in the abscess group than in the non-abscess group (94.7% vs. 30.1%, p < 0.001). Perforated appendicitis and the presence of an appendicolith were strongly associated with IAA formation. Operative duration longer than 60 min and drain placement were also more common among patients with IAA. These patients experienced longer hospital stays and higher rates of wound infection and sepsis. Most postoperative IAA were managed successfully with antibiotics alone in selected cases (13/19, 68.4%).</p><p><strong>Conclusion: </strong>Postoperative IAA formation after appendectomy in this low-resource setting was strongly associated with delayed presentation and advanced disease severity. Improving early access to surgical care and optimizing perioperative management may reduce postoperative morbidity.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13637299/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148425795","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 anastomotic reinforcement suture in laparoscopic anterior resection for middle-low rectal cancer: a propensity-score-matched cohort study.","authors":"Binbin Zheng, Zunqi Hu, Dejun Yang, Weijun Wang, Qiang Sun","doi":"10.1186/s12893-026-03984-z","DOIUrl":"10.1186/s12893-026-03984-z","url":null,"abstract":"<p><strong>Background: </strong>Anastomotic leakage (AL) remains the most consequential complication limiting the outcome of laparoscopic anterior resection (LAR) for middle-low rectal cancer. We compared the efficacy of laparoscopic anastomotic reinforcement suture (LARS), transanal drainage tube (TDT) placement, diverting ileostomy and no prophylactic measure in reducing AL after LAR.</p><p><strong>Methods: </strong>Consecutive patients undergoing laparoscopic LAR for rectal cancer at our institution between January 2020 and January 2025 were retrospectively reviewed. According to the prophylactic measure used, patients were assigned to Group A (LARS), Group B (TDT), Group C (diverting ileostomy) or Group D (no prophylaxis). Propensity scores for this four-arm allocation were estimated by multinomial logistic regression on 16 baseline covariates, and sequential 1:1:1:1 nearest-neighbour matching on the logit of the propensity score was performed (caliper 0.20 × SD of the logit, without replacement); covariate balance was assessed by standardised mean differences (SMD < 0.10). Baseline characteristics, intra-operative variables and postoperative complications were compared before and after matching.</p><p><strong>Results: </strong>After matching, 320 patients (80 per group) were included. Overall, 32 patients (10.0%) developed AL, with incidences of 2.5%, 13.8%, 8.8% and 15.0% in Groups A, B, C and D, respectively (P < 0.05). Left colic artery preservation and neoadjuvant chemotherapy were not associated with AL (P > 0.05). Anastomotic bleeding occurred in 0, 2, 2 and 4 patients, respectively (P > 0.05). No reoperation was required in Group A or C, whereas 5 (6.3%) and 8 (10.0%) patients in Groups B and D, respectively, underwent reoperation for grade C AL with severe symptoms (P < 0.05). Stoma-related complications occurred in 16/80 patients (20.0%) in Group C and were absent in the other three groups.</p><p><strong>Conclusions: </strong>In this propensity-score-matched retrospective cohort, LARS was associated with a lower incidence of clinically relevant AL than no prophylactic measure, and with a complication profile comparable to that of diverting ileostomy but without stoma-related morbidity. TDT placement did not confer a measurable reduction in AL. Given the retrospective design and the possibility of residual treatment-allocation bias, these findings warrant confirmation in prospective randomised trials.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13628764/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148406537","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":"Robotic right hemicolectomy with intracorporeal anastomosis versus laparoscopic right hemicolectomy with extracorporeal anastomosis (PRORHEM): protocol for a randomized controlled trial.","authors":"Jeremy Meyer, Emilie Liot, Guillaume Meurette, Christian Toso, Frédéric Ris","doi":"10.1186/s12893-026-03990-1","DOIUrl":"10.1186/s12893-026-03990-1","url":null,"abstract":"<p><strong>Background: </strong>In laparoscopic right hemicolectomy (lapRHC) for colorectal cancer, intra-corporeal anastomosis (ICA) has been associated with faster recovery and lower incidence of incisional hernia (IH) compared with extra-corporeal anastomosis (ECA). However, due to technical constraints, ICA is not widely adopted, and ECA remains the standard approach. Robotic surgery, with enhanced dexterity and suturing capability, facilitates ICA and may therefore improve short-term outcomes and reduce IH incidence.</p><p><strong>Methods: </strong>We designed a monocentric, double-blind randomized controlled trial to compare robotic right hemicolectomy (robRHC) with D2 lymphadenectomy, ICA, and off-midline extraction (fully minimally invasive) versus lapRHC with D2 lymphadenectomy, ECA, and midline extraction (standard of care). The primary endpoint is bowel recovery, assessed by time to first passage of stool. Secondary endpoints include perioperative safety (morbidity, mortality, resection margins, lymph node yield), length of stay, IH incidence, and patient-reported esthetic and quality-of-life outcomes. Based on a hypothesized 1-day reduction in bowel recovery, a total of 70 patients will be randomized.</p><p><strong>Ethics and dissemination: </strong>The trial complies with the Declaration of Helsinki, ICH-GCP, and Swiss regulatory standards. It has been approved by the local ethics committee (CCER 2024 - 00975) and registered in ClinicalTrials.gov (NCT06067620, 09.05.2024).</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13628920/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148413443","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 profile, outcomes and mortality determinants among emergency general surgery patients in a Latin American tertiary hospital: a retrospective registry-based cross-sectional study.","authors":"Juan José Meléndez Lugo, Luis Castro-Blanco, Alexandra Patricia Pineda Hernández, María Del Rosario Espinoza-Mora","doi":"10.1186/s12893-026-03949-2","DOIUrl":"10.1186/s12893-026-03949-2","url":null,"abstract":"<p><strong>Background: </strong>Emergency General Surgery (EGS) patients are clinically complex and frequently underreported, particularly in Latin America, which hampers benchmarking and quality-improvement efforts. We implemented a hospital-based structured data collection system to characterize EGS patients and outcomes in a tertiary university hospital.</p><p><strong>Methods: </strong>We conducted a retrospective cross-sectional study of a prospectively collected database including all patients aged ≥ 13 years who required emergency general surgery between May and November 2020 at a high-complexity public university hospital in Costa Rica, comparable to a US Level I trauma center. Sociodemographic, perioperative, and outcome variables were collected. Descriptive statistics were computed. Univariate analyses and multivariable Firth penalized logistic regression were performed to identify factors independently associated with in-hospital mortality.</p><p><strong>Results: </strong>A total of 575 patients were included; 52.9% were male and the most frequent age group was 18-29 years (23.7%). Most procedures occurred outside ordinary hours (72.2%), and surgical residents were the primary surgeons in 51.1% of cases. Laparoscopy was the initial approach in 67.8%. The most frequent care categories were gastrointestinal emergencies (48.2%), hepatobiliary emergencies (23.7%), and trauma (8.2%). Acute appendicitis (37.4%) and gallbladder and biliary disease (23.3%) were the leading diagnostic groups. Overall in-hospital mortality was 5.6%. In the final complete-case cohort (n = 511), mechanical ventilation, ASA III-IV status, hemodynamic instability, and open abdomen were independently associated with in-hospital mortality.</p><p><strong>Conclusions: </strong>These findings provide a contemporary description of emergency general surgery patients treated at a Latin American tertiary-care hospital and identify clinical factors associated with in-hospital mortality.</p><p><strong>Trial registration: </strong>NCT05930574.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13628943/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148406617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laparoscopic cholecystectomy using a wireless intelligent endoscopic system versus a conventional wired system: a retrospective study.","authors":"Zhuang Li, Jingpeng Zhang, Wenfei Wang, Minghui Sheng, Feng Bao, Dengqun Sun","doi":"10.1186/s12893-026-04027-3","DOIUrl":"10.1186/s12893-026-04027-3","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the clinical application value of a novel wireless intelligent endoscopic system in laparoscopic cholecystectomy.</p><p><strong>Methods: </strong>A total of 86 patients undergoing cholecystectomy between September and October 2023 were enrolled and randomly allocated to the observation group (wireless group, n = 43) and the control group (traditional wired group, n = 43). We comparatively analyzed technical performance, surgical safety (Critical View of Safety (CVS) achievement rate, complications), operator fatigue (Piper Fatigue Scale), perioperative physiological indicators (liver function, stress hormones, C-reactive protein(CRP)), pain scores (Short-Form McGill Pain Questionnaire(SF-MPQ)), and patient-reported outcomes (quality of recovery (QoR-15), quality of life (GIQLI), and ERAS compliance).</p><p><strong>Results: </strong>All 86 procedures were successfully completed without conversion to open surgery or severe bile duct injury. The wireless system showed no statistical difference in image transmission latency compared to the wired system (P > 0.05), yet its equipment weight was significantly reduced. Preoperative preparation time was significantly shorter in the wireless group (P < 0.001). For surgical safety, the CVS achievement rate was 100% in both cohorts. Operator fatigue scores were significantly lower in the observation group. Furthermore, postoperative CRP levels and SF-MPQ pain scores were significantly lower in the observation group than in the control group (P < 0.01). Patients in the observation group also demonstrated a significant advantage in postoperative QoR-15 and GIQLI scores (P < 0.05), with ERAS compliance exhibiting a positive correlation with recovery quality.</p><p><strong>Conclusion: </strong>The wireless intelligent endoscopic system is safe and feasible for LC, offering a safety profile comparable to traditional wired systems. By improving surgical ergonomics and attenuating postoperative systemic inflammation and pain, the system is positively associated with patients' early quality of recovery, effectively facilitating the implementation of the ERAS paradigm.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13625351/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148406539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A prospective observational study comparing conventional lateral border transfascial mesh fixation versus midline transfascial suturing in laparoscopic intraperitoneal onlay mesh repair for umbilical hernia- a pilot study.","authors":"Vishnu Prakasam N, Tilak Ramu G, Balaji D","doi":"10.1186/s12893-026-04016-6","DOIUrl":"10.1186/s12893-026-04016-6","url":null,"abstract":"<p><strong>Background: </strong>Conventional lateral border transfascial mesh fixation in laparoscopic intraperitoneal onlay mesh (IPOM) repair for umbilical hernia is associated with significant postoperative pain due to nerve entrapment in the lateral abdominal musculature. Midline transfascial suturing, targeting the less-innervated linea alba, may offer improved pain outcomes without compromising mesh stability.</p><p><strong>Methods: </strong>This prospective observational study included 62 patients undergoing laparoscopic IPOM repair for primary umbilical hernia with defect size < 6 cm. Patients were allocated based on surgical unit protocol: 31 underwent midline transfascial suturing (Midline group) and 31 underwent conventional lateral border transfascial fixation (Lateral group). Primary outcomes were postoperative pain assessed by Visual Analogue Scale (VAS) at predetermined intervals (postoperative days 1, 2, 7, 14, and 60), operative time, and length of hospital stay. Secondary outcomes included recurrence, complications, and patient satisfaction using the Patient Satisfaction Questionnaire (PSQ).</p><p><strong>Results: </strong>Baseline demographics including age, gender, body mass index, and defect size were comparable between groups (p > 0.05). The Midline group demonstrated significantly lower VAS scores at all time points: POD1 (2.81 ± 0.64 vs. 4.32 ± 0.60, p = 0.001), POD7 (2.13 ± 0.50 vs. 3.23 ± 0.72, p = 0.001), and POD60 (0.52 ± 0.51 vs. 1.36 ± 0.66, p = 0.001). Hospital stay was significantly shorter in the Midline group (2.48 ± 0.51 vs. 3.48 ± 0.51 days, p = 0.001). Patient satisfaction scores were higher with midline fixation (8.76 ± 0.25 vs. 6.76 ± 0.25, p = 0.001). Operative time was comparable between groups (80.19 ± 12.27 vs. 81.52 ± 10.80 min, p = 0.654). Recurrence rates were similar (9.7% vs. 12.9%, p = 0.688). The Midline group had no complications, while the Lateral group had 16.1% (seroma 9.7%, surgical site infection 6.5%; p = 0.066).</p><p><strong>Conclusion: </strong>Midline transfascial suturing in laparoscopic IPOM repair for umbilical hernia significantly reduces postoperative pain, shortens hospital stay, and improves patient satisfaction compared to conventional lateral border fixation, with comparable operative time and recurrence rates. This technique represents a patient-friendly alternative that should be considered for small-to-medium umbilical hernias.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13629094/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148406651","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":"Outcomes of open Ramstedt's pyoloromyotomy among infantile hypertrophic pyloric stenosis patients at governmental hospitals in Amhara Region, Ethiopia, 2023.","authors":"Yimam Ali, Saleamlak Tigabie, Fekade Demeke Bayou","doi":"10.1186/s12893-026-04026-4","DOIUrl":"10.1186/s12893-026-04026-4","url":null,"abstract":"<p><strong>Background: </strong>Infantile hypertrophic pyloric stenosis is characterized by enlarged pyloric musculature and gastric outlet obstruction. In developing countries, it results in a high rate of malnutrition, dehydration, electrolyte and acid-base imbalance and associated mortality. Ramstedt's pyloromyotomy is the commonest procedure used to treat Infantile hypertrophic pyloric stenosis in Ethiopia, particularly in the study area. However, treatment outcomes of the procedure were not well addressed in Ethiopia, particularly at the study area.</p><p><strong>Objective: </strong>To assess outcomes of open Ramstedt's pyloromyotomy among Infantile hypertrophic pyloric stenosis patients who underwent open Ramstedt's pyloromyotomy at government hospitals in Amhara Region, Ethiopia, 2023.</p><p><strong>Methods: </strong>A facility based cross-sectional study was conducted among 119 Infantile hypertrophic pyloric stenosis patients operated with open Ramstedt's pyloromyotomy at government hospitals. Hospitals were selected by simple random sampling. The data were collected using a data extraction checklist prepared in English language. The data were analyzed using Statistical Package for Social Science (SPSS) version 27. Descriptive statistics was used to describe the characteristics of the study participants.</p><p><strong>Results: </strong>In this study the clinical records of 119 infants were retrieved from three government hospitals. Majority (78.2%) of the study participants were male. All infants had nonbilious vomiting and more than one thirds (34.5%) had malnutrition during admission. The overall proportion of poor outcome was 35.3% (mortality = 0.8% and morbidities = 34.5%). Prolonged preoperative hospital stay, hypokalemia and hypochloremia were the common poor outcome.</p><p><strong>Conclusion: </strong>The mortality rate is significantly decreased, but there were still significant morbidities in this group of patients. High proportion of malnutrition, hypokalemia, and hypochloremia found at the time of admission underscores a critical pattern of delayed healthcare-seeking.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13625360/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148406497","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}