Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery最新文献

{"title":"Management, evolution and risk factors of bile leaks after subtotal cholecystectomies: a cohort study in Quito, Equador.","authors":"María de Los Ángeles Cela-Sosa, Lizeth Cristina Logacho-Carrera, Walter Iván Díaz-Chamba, Diego Antonio Mena-Noroña, Byron Arturo Montenegro-Muñoz, Franklin Gonzalo Ruales-Rosero, Erika Karina Quishpe-Narváez","doi":"10.1590/0102-672020260000033e1962","DOIUrl":"https://doi.org/10.1590/0102-672020260000033e1962","url":null,"abstract":"<p><strong>Background: </strong>Laparoscopic subtotal cholecystectomy is indicated for severe cholecystitis; however, it may lead to complications, including postoperative bile fistulas.</p><p><strong>Aims: </strong>To evaluate the management, evolution, and risk factors associated with bile fistulas after laparoscopic subtotal cholecystectomy in a hospital in Quito from January 2019 to June 2022.</p><p><strong>Methods: </strong>A cross-sectional analytical study with a quantitative approach was conducted. A retrospective review of medical records of patients who underwent laparoscopic subtotal cholecystectomy (n=256) was performed. The dependent variable was the occurrence of bile fistulas, while independent variables included sociodemographic data (age, sex) and clinical factors such as comorbidities, nutritional status, cholecystitis severity (Parkland classification), surgical planning, type of cholecystectomy, anesthetic risk (American Society of Anesthesiologists; ASA I-IV), surgical time, intraoperative complications, time of fistula onset, evolution, and postoperative complications.</p><p><strong>Results: </strong>The incidence of postoperative fistulas was 12.9% (n=33). Management strategies included drainage (69.7%) and endoscopic retrograde cholangiopancreatography (ERCP) (30.3%). Spontaneous closure occurred in 60.6%, while 30.3% required therapeutic ERCP and 9.1% needed reoperation. Significant risk factors included surgical time >105 minutes (relative risk [RR]: 2.06; 95% confidence interval [CI] 1.04-4.08), type A cholecystectomy (RR 2.19; 95%CI 1.05-4.57), and choledocholithiasis (RR 2.5; 95%CI 1.34-4.67). Logistic regression confirmed surgical time (odds ratio [OR]: 2.6; 95%CI 1.2-5.8) and choledocholithiasis (OR 3.3; 95%CI 1.4-3.9) as significant predictors (p<0.05).</p><p><strong>Conclusions: </strong>The incidence of postoperative fistulas observed was comparable to previous reports in the literature, highlighting the importance of early identification and appropriate management.</p><p><strong>Central message: </strong>Type B subtotal cholecystectomies were associated with bile leaks, as were the presence or history of choledocholithiasis and prolonged surgical times, exceeding 105 minutes. Bile leaks were not related to whether a prior ERCP or sphincterotomy were performed, nor to the presence of biliary stents.</p><p><strong>Perspectives: </strong>There is currently no standardization regarding the optimal timing for ERCP for bile leaks or the amount of bile leakage that should prompt the procedure. A standardized prospective study could help establish evidence-based management criteria.</p>","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"39 ","pages":"e1962"},"PeriodicalIF":1.8,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13480961/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148802173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic ultrasound-guided radiofrequency ablation in the treatment of pancreatic ductal adenocarcinoma: when science tries to increases hope.","authors":"José Celso Ardengh, Rafael Kemp, José Sebastião Dos Santos","doi":"10.1590/0102-672020260000032e1961","DOIUrl":"https://doi.org/10.1590/0102-672020260000032e1961","url":null,"abstract":"<p><p>Pancreatic ductal adenocarcinoma (PDAC) is the most common form of pancreatic cancer and remains the most lethal malignancy of the digestive system. Despite recent advances, surgical treatment remains the only potentially curative option. Most patients are diagnosed with locally advanced or disseminated disease, and chemotherapy is the only indicated treatment. Pancreatic resection rates in centers that do not perform vascular resection are around 15-20% of diagnosed cases, while in specialized centers with vascular expertise, they may reach 30-45%. Ablative therapies have been investigated as local alternatives for unresectable tumors. Radiofrequency ablation (RFA) has proven efficacy in the treatment of hepatic neoplasms, and has recently been explored in PDAC. Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) represents a minimally invasive alternative for thermal ablation of pancreatic tumors. Early experience suggests that may serve as a palliative modality for pain or obstruction control, and to facilitate chemotherapy. However, this treatment is considered experimental and requires procedural standardization. Careful patient selection is essential, prioritizing cases without metastatic spread, with tumors accessible by EUS and without extensive vascular invasion. Endoscopic ultrasound-guided radiofrequency ablation should not replace surgery in resectable pancreatic ductal adenocarcinoma. The endoscopic ultrasound-guided radiofrequency ablation should be considered as a palliative option within multidisciplinary protocols. Endoscopic ultrasound-guided radiofrequency ablation is an isolated palliative modality, and considered an option to treat the pancreatic ductal adenocarcinoma.</p>","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"39 ","pages":"e1961"},"PeriodicalIF":1.8,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13480962/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148802115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevention, surveillance, and early detection of hepatocellular carcinoma - a Brazilian multidisciplinary consensus.","authors":"Felipe José Fernández Coimbra, André Luís de Godoy, Paulo Henrique de Sousa Fernandes, Heládio Feitosa E Castro Neto, Rodrigo Nascimento Pinheiro, Ilka de Fátima Santana Ferreira Boin, Wellington Andraus, Francisco Tustumi, Paulo Cezar Galvão do Amaral, Carlos Eduardo Brandão-Mello, Alexcia Camila Braun, Maria Ignez Braghiroli, Luis César Bredt, Carla Caparroz, Flair José Carrilho, Guilherme Moura Cunha, Alessandro Landskron Diniz, Daniel Neves Forte, José Huygens Parente Garcia, Tércio Genzini, Mauro Monteiro Correia, Cássio Virgílio Cavalcante de Oliveira, Antonio Nocchi Kalil, Agnaldo Soares Lima, Guilherme Lopes Pinheiro Martins, Cristina Melo Rocha, Marcos Roberto de Menezes, Joaquim Maurício da Motta-Leal-Filho, Munir Murad Júnior, Renata D'Alpino Peixoto, Rafael Soares Nunes Pinheiro, Marcelo Bruno de Rezende, Héber Salvador de Castro Ribeiro, Mario Rino Martins, Duilio Reis da Rocha Filho, Arthur Accioly Rosa, Luiz Arnaldo Szutan, Orlando Jorge Martins Torres, Luiz Augusto Carneiro D'Albuquerque, Ângelo Alves de Mattos, Anelisa Kruschewsky Coutinho, Paulo Herman, Alexandre Ferreira Oliveira","doi":"10.1590/0102-672020260000018e1947","DOIUrl":"10.1590/0102-672020260000018e1947","url":null,"abstract":"<p><strong>Background: </strong>Hepatocellular carcinoma is a major cause of cancer-related mortality and represents a growing public health challenge.</p><p><strong>Aims: </strong>To develop multidisciplinary evidence-based recommendations for the prevention and early detection of hepatocellular carcinoma.</p><p><strong>Methods: </strong>This consensus was coordinated by the Brazilian Society of Surgical Oncology, with the participation of 13 additional national societies. A steering committee defined the key clinical questions addressing prevention, surveillance, and early detection strategies. Recommendation statements were informed by a comprehensive, non-systematic review of the literature conducted using PubMed, Scopus, and the Cochrane Library.</p><p><strong>Results: </strong>Eighteen recommendations reached consensus, covering three main domains: 1. Primary prevention, including HBV vaccination, timely antiviral therapy for viral hepatitis, and lifestyle interventions for metabolic dysfunction. 2. Secondary prevention, outlining risk-based surveillance strategies for patients with advanced fibrosis or cirrhosis due to hepatitis B virus, hepatitis C virus, or metabolic dysfunction-associated steatotic liver disease. 3. Operational standards for surveillance, emphasizing ultrasound as the cornerstone of monitoring, the importance of structured reporting, management of small nodules, and the selective use of cross-sectional imaging.</p><p><strong>Conclusions: </strong>These multidisciplinary recommendations provide practical, adaptable guidance for the prevention, surveillance, and early detection of hepatocellular carcinoma. This guidance document aims to reduce the burden of hepatocellular carcinoma and support better clinical outcomes across diverse healthcare settings.</p><p><strong>Central message: </strong>Prevention and early detection save lives in liver cancer. This Brazilian multidisciplinary consensus integrates the best scientific evidence and the expertise of specialists from across the country to more effectively guide the prevention, identification, and surveillance of hepatocellular carcinoma. By answering key clinical questions and offering practical, easy-to-use recommendations, this document helps physicians and healthcare teams provide better care to people at risk.</p><p><strong>Perspectives: </strong>This consensus provides practical guidance to improve the prevention and early detection of liver cancer in daily clinical care. The recommendations emphasize raising awareness of hepatocellular carcinoma, stimulating the development of broader surveillance programs, promoting earlier diagnosis, and improving outcomes for patients at risk for developing primary liver cancer.</p>","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"39 ","pages":"e1947"},"PeriodicalIF":1.8,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13488426/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148802283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Experimental model of small-for-size syndrome in pigs.","authors":"Paola Sofia Espinoza Alvarez, Jhosimar Alvarez DE Lá Hoz, Daniel Reis Waisberg, Alessandro Rodrigo Belon, Larissa Barbosa Lima, Beatriz de Lima Soares, Ricardo Luis Santamaria Gonzalez, Rubens Macedo Arantes, João Paulo Costa Dos Santos, Pedro Carvalho Cassino, Cinthia Lanchotte Ferreira, Marcia Saldanha Kubrusly, Luciana Severo Brandão, Vinicius Rocha-Santos, Liliana Ducatti, Rafael Soares Pinheiro, Pedro Marin Castro, Rodrigo Bronze de Martino, Luciana Bertocco Haddad, Lucas Souto Nacif, Flavio Henrique Ferreira Galvão, Luiz Augusto Carneiro D'Albuquerque, Wellington Andraus","doi":"10.1590/0102-672020260000012e1941","DOIUrl":"10.1590/0102-672020260000012e1941","url":null,"abstract":"<p><strong>Background: </strong>Small-for-size syndrome (SFSS) is a serious complication after partial liver transplantation or extended hepatectomy. Despite advances, the syndrome remains a complex entity with a multifactorial pathophysiology and a lack of standardized therapeutic approaches.</p><p><strong>Aims: </strong>This study aims to establish a translational model of porcine SFSS, integrating hemodynamic, histopathological, and molecular analyses to quantify the tissue expression of biomarkers to assess liver regeneration.</p><p><strong>Methods: </strong>Ten liver transplants were performed: eight with small (partial) for size (donors underwent a 70% hepatectomy) and two with whole liver. The recipients were followed until death (euthanasia due to severe morbidity) or for five days. Hemodynamic data, laboratory analyses, and liver tissue biopsies were collected. Immunohistochemistry was performed to assess the expression of TNF-α, IL-1β, NF-κB, and VEGF. Gene expression levels of VEGF, IL-6, IL-10, and NF-κB were quantified using reverse transcription polymerase chain reaction.</p><p><strong>Results: </strong>In the partial group, survival rates were 75% in the immediate postoperative period, 25% at 48 hours, and 12.5% at five days. Immunohistochemistry showed a significant increase in TNF-α and NF-κB proteins after reperfusion and at the end of surgery, respectively. Gene expression analysis showed a significant increase in IL-6 and IL-10 at the end of surgery.</p><p><strong>Conclusions: </strong>This study represents a methodological advance by performing the first integrated evaluation of protein and gene expression (TNF-α, IL-6, IL-1, IL-10, VEGF, and NF-κB) correlated with hemodynamic, histopathological, and functional parameters in the small-for-size pig model.</p>","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"39 ","pages":"e1941"},"PeriodicalIF":1.8,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13464761/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148726589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of isthmin-1 immunoreactivity in gastric adenocarcinoma.","authors":"Onur Ağ, Mesut Yur, Serhat Hançer, Mehmet Bugra Bozan, Ibrahim Hanifi Özercan, Tuncay Kuloglu","doi":"10.1590/0102-672020260000013e1942","DOIUrl":"10.1590/0102-672020260000013e1942","url":null,"abstract":"<p><strong>Background: </strong>Isthmin-1, a recently discovered adipokine, was first characterized for its role in early brain development. Subsequent studies have demonstrated that isthmin-1 is involved in a broad range of biological processes, including metabolism, immunity, tumorigenesis, cellular proliferation, endothelial permeability, and organ development.</p><p><strong>Aims: </strong>This study aimed to evaluate isthmin-1 immunoreactivity in tumor tissues obtained from gastric cancer patients using immunohistochemistry and to assess its usefulness in the diagnosis and histological evaluation of gastric cancer.</p><p><strong>Methods: </strong>The patients were divided into three groups: adenocarcinoma, intestinal metaplasia, and healthy controls. Endoscopic biopsies, obtained according to the Sydney protocol, were examined for the control group and patients diagnosed with intestinal metaplasia. In contrast, surgical resection tissues were used for patients diagnosed with gastric adenocarcinoma.</p><p><strong>Results: </strong>All materials were examined histopathologically. No significant difference in isthmin-1 levels was detected between the control and intestinal metaplasia groups, based on immunohistochemical staining. However, when gastric adenocarcinoma cases were compared with the control and intestinal metaplasia groups, a significant decrease in isthmin-1 immunoreactivity was observed in adenocarcinoma cases. Patients with adenocarcinoma were grouped as well-differentiated, moderately differentiated, and poorly differentiated, and then staged according to the TNM staging system. Histopathological examination revealed no significant differences in the degree of differentiation or TNM stage.</p><p><strong>Conclusions: </strong>We believe that isthmin-1 can be used as a biomarker in the diagnosis of malignant gastric diseases in the future. However, more comprehensive and extensive scientific studies are needed to determine its usefulness in tumor staging or prognosis monitoring.</p>","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"39 ","pages":"e1942"},"PeriodicalIF":1.8,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13464758/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148725485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic value of tumor-infiltrating lymphocytes and their association with clinical and pathological factors in gastric cancer.","authors":"Dhouha Bacha, Ines Mallek, Mohamed Hajri, Amani Benzarti, Farah Loued, Sana Ben-Slama, Lassad Gharbi, Ahlem Lahmar","doi":"10.1590/0102-672020260000019e1948","DOIUrl":"10.1590/0102-672020260000019e1948","url":null,"abstract":"<p><strong>Background: </strong>The prognostic value of tumor-infiltrating lymphocytes has been studied in several cancers, but in gastric cancer, their evaluation by standard hematoxylin-eosin staining remains controversial.</p><p><strong>Aims: </strong>To analyze the prognostic value of tumor-infiltrating lymphocytes in gastric cancer and to investigate the association between tumor-infiltrating lymphocyte levels and a range of clinical and pathological factors in gastric cancer.</p><p><strong>Results: </strong>Forty-four patients were included with a mean age of 62 years, and 77% of the patients were classified as having pathological tumor stage 3 or pathological tumor stage 4. Lymph node metastases were noted in 66% of our patients. At diagnosis, 57% of patients were at an advanced stage (III). Patients with distant metastases were not included in this study. Evaluation of tumor-infiltrating lymphocytes in hematoxylin-eosin staining found that the mean tumor-infiltrating lymphocyte rate was 43 (extremes: 5-90%). 36% of patients had a tumor-infiltrating lymphocyte rate >50%. The overall survival of our patients was 40 months. Patients with tumor-infiltrating lymphocytes >50% had greater survival, without a significant correlation (p=0.275). A tumor-infiltrating lymphocyte rate =50% was correlated with age >50 years (p=0.030), presence of lymph node involvement (p=0.023), and advanced tumor stage (III+IV) (p=0.05). In a multivariate analysis, the presence of lymph node involvement (p=0.045) and advanced tumor stage (III+IV) (p=0.015) were identified as independent factors associated with a low tumor-infiltrating lymphocyte rate =50%.</p><p><strong>Conclusions: </strong>Poor prognostic factors for gastric cancer (age >50 years, presence of lymph node involvement, and advanced tumor stage) were associated with a low tumor-infiltrating lymphocyte rate assessed by hematoxylin-eosin staining. However, standardization of tumor-infiltrating lymphocyte assessment is essential to allow comparability between studies and integrate this parameter into routine practice.</p>","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"39 ","pages":"e1948"},"PeriodicalIF":1.8,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13411300/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148727333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Liver transplantation: embracing the future with machine perfusion.","authors":"Henrique de Aguiar Wiederkehr, Michelle C Nguyen, Adyr Moss, Amit Kumar Mathur, Rafael Nuñez-Nateras, Julio Cesar Wiederkehr, Júlio Cezar Uili Coelho","doi":"10.1590/0102-672020260000017e1946","DOIUrl":"10.1590/0102-672020260000017e1946","url":null,"abstract":"<p><p>Despite the annual increase in liver transplants, a persistent disparity between suitable donors and recipients continues to challenge the transplant community. The introduction of machine perfusion emerged as a novel approach to organ preservation. This technique, which utilizes extended criteria donor grafts, is expected to reduce rejection rates and expand the donor pool. Its principle, like that of any ex vivo machine perfusion, is based on the continuous supply of nutrients and oxygen to maintain cellular metabolism while interrupting anaerobic processes. This helps prevent conditions such as ischemia-reperfusion injury, early graft dysfunction, and ischemic cholangiopathy, which can lead to graft loss and the need for retransplantation. There are two main modes of ex vivo machine perfusion: hypothermic and normothermic, differentiated by the operating temperature. Utilizing ex situ perfusion machines presents a promising opportunity to increase liver graft usage and reduce waitlist times. However, it is crucial to evaluate how much this technology would raise the overall cost of transplants. In Brazil, implementing a machine perfusion program may encounter unique challenges not seen in other countries. These challenges include limited access to the healthcare system for high-risk liver transplant candidates, long waiting lists, inadequate support for organ donors, reliance solely on deceased brain-dead donors, since donation after cardiac death is not ethically accepted, and geographical barriers.</p>","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"39 ","pages":"e1946"},"PeriodicalIF":1.8,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13411302/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148724222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of negative pressure wound therapy versus conventional dressings in emergency laparotomy: a systematic review and meta-analysis of randomized controlled trials.","authors":"Francielle de Souza Antonini, Maria Eduarda Caetano Batista de Paiva, Marcílio de Oliveira Filho, Fabricio Inacio de Moraes Nascimento, Rodrigo Ormanes Massoud, Henrique Baggio Pivetta, Leticia Gatti Fonseca, José Victor Gomes Costa, Yekaterina Zelenskaya, Zarpana Akbari, Maria Isabel Lopez Duque, José Eduardo de Aguilar-Nascimento, Gunther Peres Pimenta","doi":"10.1590/0102-672020260000015e1944","DOIUrl":"10.1590/0102-672020260000015e1944","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Surgical site infections represent a significant complication after emergency laparotomy, contributing to increased morbidity, mortality, and healthcare costs. Negative pressure wound therapy (NPWT) may reduce the incidence of surgical site infections; however, evidence from randomized controlled trials remains inconsistent.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aims: &lt;/strong&gt;To present a systematic review and meta-analysis, comparing NPWT with conventional dressings in emergency laparotomies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Systematic searches were conducted according to the Cochrane Handbook and reported according to the PRISMA 2020 guidelines. The PubMed, Embase, and Cochrane CENTRAL databases were searched since their inception, using terms related to emergency laparotomy, NPWT, and conventional dressings. The reference lists of included studies were manually examined to identify additional eligible trials. Only randomized controlled trials that compared NPWT with conventional dressings in emergency abdominal surgeries and that reported surgical site infection rates or other clinical outcomes were included. The primary outcome was the incidence of surgical site infection. Secondary outcomes included wound dehiscence, seroma formation, length of hospital stay, and 30-day mortality.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Eight randomized controlled trials, totaling 1,377 patients (707 in the NPWT group and 670 in the conventional dressing group), were included. NPWT significantly reduced the risk of surgical site infection (risk ratio [RR] 0.43; 95% confidence interval [CI] 0.26-0.73; p=0.002; heterogeneity [I2]=76%) and wound dehiscence (RR 0.32; 95%CI 0.18-0.58; p=0.0002). No significant differences were observed regarding seroma formation (RR 0.59; 95%CI 0.34-1.01; p=0.05), length of hospital stay (mean difference [MD] -0.39 days; 95%CI -1.15- 0.36; p=0.92) or mortality (RR 0.96; 95%CI 0.55-1.68; p=0.88).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This systematic review and meta-analysis of randomized clinical trials suggests that NPWT reduces the incidence of surgical site infection and wound dehiscence after emergency laparotomy, supporting its use in high-risk patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Central message: &lt;/strong&gt;Surgical site infections are a major postoperative complication after emergency laparotomies, contributing substantially to morbidity, mortality, and healthcare costs. Strategies to reduce postoperative complications have increasingly focused on perioperative optimization through evidence-based, multimodal protocols. Retrospective analyses have demonstrated the efficacy of intermittent negative pressure wound therapy in diminishing the incidence of surgical site infections following laparotomy in patients undergoing gynecological and general surgical procedures. Nonetheless, the findings derived from randomized controlled trials have yielded inconsistent results.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Perspectives: &lt;/strong&gt;This original systematic review and met","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"39 ","pages":"e1944"},"PeriodicalIF":1.8,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13379227/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148551656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Helicobacter pylori and Epstein-Barr virus co-infection in gastric cancer patients: a prospective analytical study.","authors":"Anbarasan Sivamoorthy, Sathasivam Sureshkumar, Amaranathan Anandhi, Rahul Dhodapkar, Palanivel Chinnakali, Vikram Kate","doi":"10.1590/0102-672020260000016e1945","DOIUrl":"10.1590/0102-672020260000016e1945","url":null,"abstract":"<p><strong>Background: </strong>Recent evidence suggests that Epstein-Barr virus (EBV) and Helicobacter pylori co-infection increase the prevalence of gastric cancer in the younger age group and are associated with poor prognosis. Identifying the association between these agents has important implications for the management of gastric cancer and also for defining populations at high risk of developing gastric malignancy.</p><p><strong>Aims: </strong>To determine the prevalence of H. pylori and EBV co-infection in patients with gastric cancer.</p><p><strong>Methods: </strong>This is a single-center prospective analytical study. A total of 182 patients were included. The study group (n=91) comprised all consecutive patients of age ≥18 years with gastric cancer. The control group (n=91) included individuals with normal endoscopy findings. Both groups were analyzed for the presence of H. pylori and EBV.</p><p><strong>Results: </strong>The overall prevalence of H. pylori infection in gastric cancer patients was 70.3%, EBV infection was 63.7%, and H. pylori and EBV co-infection was 51.6%. The H. pylori and EBV co-infection in the study and control groups was 51.6% versus 13.1% (p<0.001). The remaining parameters such as smoking, socioeconomic class, dietary habits, prior gastric surgery, tumor location, histological subtype, stage of the tumor, distant metastasis, and lymph node metastasis did not show any significance.</p><p><strong>Conclusions: </strong>There was a significantly higher prevalence of EBV infection and H. pylori and EBV co-infection in patients with gastric cancer. The prognostic and therapeutic role of co-infection requires long-term follow-up and assessment of treatment response.</p><p><strong>Central message: </strong>The strongest known environmental risk factor for developing gastric cancer is prolonged colonization with Helicobacter pylori. More than 50% of the world's population harbors H. pylori in the gastric mucosa. Epstein-Barr virus (EBV), which is associated with many hematological malignancies, is now considered to be associated with the development of gastric cancer. Studies have reported that 9% of gastric cancer cases are associated with EBV infection. The association of EBV and H. pylori co-infection in gastric cancer has not been extensively investigated.</p><p><strong>Perspectives: </strong>Epstein-Barr virus (EBV) infection appears to be more prevalent in gastric cancer compared to the normal population. Also, most of the gastric cancer patients have co-infection of both Helicobacter pylori and EBV. The importance of this observation indicates that H. pylori eradication alone does not help in the prevention of gastric cancer. EBV infection, which augments the damage caused by H. pylori, requires a specific targeted therapy. In the future, individuals with a high risk of gastric cancer may benefit from the targeted drug against the EBV-lytic cycle protein, with the aim of preventing reactivation of the virus.</p>","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"39 ","pages":"e1945"},"PeriodicalIF":1.8,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13362985/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148450925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transabdominal preperitoneal videolaparoscopic hernioplasty without mesh fixation.","authors":"Vitor Neves, Gabriela Lyons, Fernando Athayde Madureira","doi":"10.1590/0102-672020260000014e1943","DOIUrl":"10.1590/0102-672020260000014e1943","url":null,"abstract":"<p><strong>Background: </strong>Laparoscopic inguinal hernia repair using the transabdominal preperitoneal (TAPP) technique requires a stapler for mesh fixation, making the method expensive.</p><p><strong>Aims: </strong>To demonstrate the feasibility of videolaparoscopic inguinal hernioplasty (TAPP) without mesh fixation in patients who are not stage 3 according to the European Hernia Society classification.</p><p><strong>Methods: </strong>Forty patients underwent videolaparoscopic inguinal hernioplasty (TAPP) with a polypropylene mesh and without fixation from October 2017 to October 2018. After the procedure, outpatient follow-up appointments were scheduled until the 6th postoperative month. In June 2020, the patients were contacted by phone and a follow-up questionnaire was administered.</p><p><strong>Results: </strong>A total of 52 hernias were operated on, as 25% of patients had bilateral hernias. No patient presented with recurrence or chronic pain. Late in the course of the procedure, 72.5% of patients were contacted, with a mean follow-up of 27.2 months. The incidence of surgical site infection was 12.5%.</p><p><strong>Conclusions: </strong>The inguinal hernia repair by hernioplasty (TAPP) without mesh fixation in grade I and II patients (European Hernia Society) is feasible.</p><p><strong>Central message: </strong>Inguinal hernia repair is the most commonly performed surgical procedure worldwide, with over 20 million operations carried out annually. Laparoscopic procedures are associated with reduced postoperative pain and a shorter recovery time, including a faster return to work. The transabdominal preperitoneal (TAPP) approach is one of the most widely used techniques for laparoscopic inguinal hernia repair and traditionally involves mesh fixation with disposable tackers.</p><p><strong>Perspectives: </strong>Laparoscopic inguinal hernia repair using the TAPP technique without mesh fixation in patients with European Hernia Society grade I and II defects is feasible. The technique showed no recurrences or chronic pain, high quality of life improvement, and a low rate of surgical site infections, supporting its feasibility and safety in selected patients. These findings suggest that, in carefully selected cases, TAPP inguinal hernioplasty without mesh fixation may be considered a safe and cost-effective alternative, particularly in resource-limited settings.</p>","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"39 ","pages":"e1943"},"PeriodicalIF":1.8,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13362984/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148450880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}