BMC Surgery最新文献

{"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}

{"title":"The effect of depression comorbid with alcohol use disorder on postoperative morbidity of patients undergoing resection of upper gastrointestinal and pancreatic tumors: a study based on a national inpatient sample.","authors":"Zhifen Xie, Huping Gong, Cailing Mei, Yan Zhong, Jing Wang, Li Xiao","doi":"10.1186/s12893-026-03995-w","DOIUrl":"10.1186/s12893-026-03995-w","url":null,"abstract":"<p><strong>Background: </strong>Patients undergoing resection of upper gastrointestinal and pancreatic tumors are at considerable risk for postoperative morbidity. The co-occurrence of alcohol use disorder (AUD) and depression may synergistically impair recovery. This study aimed to investigate the effect of depression comorbid with alcohol use disorder (Dep-AUD) on postoperative morbidity of patients undergoing resection of upper gastrointestinal and pancreatic tumors.</p><p><strong>Methods: </strong>Data from the National Inpatient Sample (2010-2019) were analyzed. Patients undergoing resection of upper gastrointestinal and pancreatic tumors were identified using ICD codes, and divided into Dep-AUD, Non-Dep-AUD, depression, and AUD groups. Multivariable logistic regression was used to investigate the effect of Dep-AUD, Non-Dep-AUD, depression, and AUD on postoperative morbidity.</p><p><strong>Results: </strong>Among 60,783 patients, 637 (1.05%) had Dep-AUD. After covariate adjustment, Dep-AUD was independently associated with increased risks of delirium (aOR 2.27), wound dehiscence (aOR 2.16), and invasive respiratory support (aOR 1.47), alongside the longest median stays and highest costs. A significant supra-additive interaction was observed for wound dehiscence, particularly in esophagectomy and gastrectomy. For other complications like delirium, the elevated risk primarily reflected the additive accumulation of independent effects rather than true biological synergy.</p><p><strong>Conclusion: </strong>Dep-AUD significantly exacerbates postoperative complications - notably wound dehiscence, delirium, and respiratory failure - and increases resource utilization after upper gastrointestinal and pancreatic resections. These procedure-specific findings emphasize the urgent need for systematic preoperative screening and tailored multidisciplinary optimization strategies to mitigate surgical risks in this vulnerable population.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13617730/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148399729","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":"Absent gallbladder discovered during evaluation for biliary pain: case report and literature review.","authors":"Hocine Hamdi, Soumaya Belhoul, Sjaak Pouwels","doi":"10.1186/s12893-026-03996-9","DOIUrl":"10.1186/s12893-026-03996-9","url":null,"abstract":"<p><strong>Introduction: </strong>Gallbladder Agenesis (GA) is a rare congenital anomaly of the biliary tract with reported incidence estimates at 0.03% in general clinical series. Although many patients are asymptomatic, up to half may present with biliary-type symptoms, creating a diagnostic challenge; routine imaging such as ultrasound or Hepatobiliary Iminodiacetic Acid scan (HIDA) may be misleading, and Magnetic Resonance Cholangio-Pancreatography (MRCP) is often required to establish the diagnosis and avoid unnecessary surgery.</p><p><strong>Case presentation: </strong>We report the case of an adult patient presenting with mild biliary-type pain clinically suggestive of gallstone disease. Initial abdominal ultrasonography was inconclusive, failing to clearly visualize the gallbladder and raising suspicion of a contracted or scleroatrophic gallbladder. Further evaluation with Magnetic Resonance Cholangiopancreatography (MRCP) demonstrated complete absence of the gallbladder with compensatory dilation of the common bile duct (CBD), confirming the diagnosis of GA. The patient was managed conservatively with symptomatic treatment and dietary modifications, leading to significant clinical improvement and a significant regression of symptoms.</p><p><strong>Conclusion: </strong>GA is an uncommon but important differential diagnosis in patients presenting with biliary-type pain when the gallbladder is not visualized on ultrasonography. In cases of diagnostic uncertainty, early use of MRCP is crucial to accurately define biliary anatomy and may prevent unnecessary surgical exploration and associated iatrogenic biliary injury. A structured diagnostic approach based on early cross-sectional imaging is essential to reduce diagnostic delay and avoid potentially preventable operative complications.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":"26 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13335320/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148399786","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":"Endoscopic transcervical mediastinal drainage for treating descending necrotizing mediastinitis.","authors":"Jiarui Liao, Han Lei, Long He, Weixiong Chen, Jin Ye, Tianrun Liu, Zhenqing Chen, Wenbin Lei, Wenxiang Gao","doi":"10.1186/s12893-026-04018-4","DOIUrl":"10.1186/s12893-026-04018-4","url":null,"abstract":"<p><strong>Introduction: </strong>Descending necrotizing mediastinitis (DNM) is a severe complication of deep neck infection when the mediastinum is involved. Currently, the optimal surgical treatment for DNM, especially for Endo IIA DNM, has not been defined. We aimed to describe a standardized ETMD procedure emphasizing safe catheter placement into the main mediastinal abscess cavities and to evaluate its association outcomes compared with non-ETMD approaches in patients with DNM.</p><p><strong>Methods: </strong>This multicenter retrospective cohort study included adult patients (≥ 18 years) diagnosed with descending necrotizing mediastinitis (DNM) secondary to deep neck infection between 2008 and 2024. Patients who received incomplete treatment or were unable to undergo surgery were excluded. Clinical, laboratory, and imaging data were collected. Surgical management was classified as endoscopic transcervical mediastinal drainage (ETMD) or non-ETMD. The primary outcome was the requirement for secondary drainage. Secondary outcomes included hospital stay, drainage duration, and major complications. Statistical analyses were performed using t-tests, Mann-Whitney U tests, chi-square tests, and multivariable models where appropriate. Multivariable regression and supplementary inverse probability of treatment weighting (IPTW) analyses were performed to adjust for potential confounding.</p><p><strong>Results: </strong>Among 95 patients enrolled, 49 received ETMD. The secondary drainage rate was significantly lower in patients who received ETMD (10.2% vs. 43.5%; risk difference, -33.3%; 95% CI, -49.9% to -16.6%; P < 0.001). After IPTW adjustment, ETMD remained associated with a lower risk of secondary drainage (OR = 0.184; 95% CI, 0.050-0.677; P = 0.013). In the exploratory Endo IIA subgroup analysis, ETMD reduced secondary drainage rate and shortened selected perioperative recovery measures.</p><p><strong>Conclusion: </strong>In this multicentre retrospective cohort, ETMD reduced the requirement for secondary drainage in patients with DNM, particularly in the exploratory Endo IIA subgroup analysis. These findings suggest that ETMD may be a potential minimally invasive approach for selected patients, but further prospective studies are needed to validate its role.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":49229,"journal":{"name":"BMC Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13617925/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148399736","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}