Surgery in practice and science最新文献

{"title":"Reversal of Hartmann’s procedure: The impact of timing – a single-tertiary-center experience","authors":"Sascha Vaghiri ,&nbsp;Maria Chara Stylianidi ,&nbsp;Laura Engelmann ,&nbsp;Eslam Elmaghraby ,&nbsp;Levent Dizdar ,&nbsp;Wolfram Trudo Knoefel ,&nbsp;Hermann Kessler ,&nbsp;Dimitrios Prassas","doi":"10.1016/j.sipas.2025.100292","DOIUrl":"10.1016/j.sipas.2025.100292","url":null,"abstract":"<div><h3>Introduction</h3><div>The optimal timing for Hartmann’s reversal remains a topic of ongoing debate. This study aimed to assess postoperative outcomes in patients undergoing early versus late Hartmann’s reversal at a tertiary academic center in Germany.</div></div><div><h3>Methods</h3><div>A single-center retrospective cohort study was conducted, including all patients who underwent Hartmann’s reversal between January 2008 and July 2020. Patients were stratified into early (ER) and late (LR) reversal groups using a median cut-off value of 159 days. Operative outcomes including major morbidity and overall postoperative complications were compared between both groups. Factors associated with major postoperative morbidity were detected using uni- and multivariate regression models.</div></div><div><h3>Results</h3><div>A total of 133 patients classified into the ER (n = 67, 50.38%) and LR (n = 66, 49.62%) groups were analyzed. There were no significant differences in overall morbidity (ER 56.72% versus LR 39.39%, p = 0.057) and major morbidity rates (Clavien-Dindo ≥ IIIa) (ER 28.36% versus LR 21.21%, p = 0.423) between both groups. On multivariate analysis, smoking (p = 0.006), chronic renal disease (p = 0.003) and anastomotic configuration (p = 0.003) were identified as significant factors contributing to major morbidity after Hartmann’s reversal.</div></div><div><h3>Conclusion</h3><div>Hartmann’s reversal is still associated with an increased risk of postoperative complications. However, timing of Hartmann’s reversal does not seem to influence postoperative morbidity. Of note, patient-related modifiable factors as well as the anastomotic configuration are important determinants of major complication occurrence.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"22 ","pages":"Article 100292"},"PeriodicalIF":0.6,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144321728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence in surgical care for low- and middle-income countries: Challenges, opportunities, and the path forward","authors":"William Nkenguye","doi":"10.1016/j.sipas.2025.100290","DOIUrl":"10.1016/j.sipas.2025.100290","url":null,"abstract":"<div><div>The application of Artificial Intelligence (AI) and Machine Learning (ML) in surgical care has significantly advanced healthcare delivery in high-income countries (HICs), yet remains underutilized in lower- and middle-income countries (LMICs). With a growing burden of surgical diseases, limited surgical expertise, and constrained healthcare resources, AI and ML offer transformative potential in optimizing surgical workflows, improving patient outcomes, and expanding access to specialized care. This manuscript explores the current status, challenges, and future prospects of AI and ML in surgical care for LMICs, emphasizing the critical need for investment, capacity building, and policy development to bridge the healthcare gap.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"22 ","pages":"Article 100290"},"PeriodicalIF":0.6,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144291439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Synchronous adenocarcinoma of the transverse colon and gastroesophageal junction: a case report","authors":"Adam Avas ,&nbsp;Astrid Schümatschek ,&nbsp;Julia Mühlhäusser ,&nbsp;Martin Bolli ,&nbsp;Markus Gass ,&nbsp;Francesco Mongelli","doi":"10.1016/j.sipas.2025.100289","DOIUrl":"10.1016/j.sipas.2025.100289","url":null,"abstract":"<div><h3>Introduction</h3><div>Esophageal cancer is a malignancy with a rapidly increasing incidence in recent decades. The presence of a second synchronous tumor poses challenges when a curative approach is offered.</div></div><div><h3>Case presentation</h3><div>We report a case of a 68-year-old Caucasian male diagnosed with synchronous adenocarcinomas of the transverse colon and the gastroesophageal junction (GEJ), Siewert Type II. The diagnosis followed the presentation of dysphagia and was confirmed through esophagogastroduodenoscopy and colonoscopy. The patient underwent a staging work-up. This has revealed no distant metastases, leading to a decision for curative treatment with multimodal therapy. Neoadjuvant chemotherapy with the FLOT regimen was administered, followed by thoracoabdominal esophagectomy and extended right hemicolectomy. Histopathological and molecular profiling analyses revealed that the tumor of the colon was a metastasis of the GEJ tumor.</div></div><div><h3>Clinical discussion</h3><div>This case demonstrates the diagnostic and therapeutic challenges posed by rare metastatic pattern of the GEJ. Despite thorough preoperative staging, the metastatic nature of the colonic lesion was only revealed postoperatively in our case. This emphasizes the need for molecular profiling in selected cases to enhance diagnostic accuracy and guide treatment decisions more effectively.</div></div><div><h3>Conclusion</h3><div>Colonic metastases from esophageal cancer are exceedingly rare, with only a few cases reported. In this case, according to the postoperative staging (M1) a palliative chemotherapy might have been more appropriate. This case highlights the importance of comprehensive diagnostic workups and the need for molecular profiling of synchronous lesions. Molecular diagnostic may be considered as a part of decision-making, as it can significantly impact treatment strategies and outcomes.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"22 ","pages":"Article 100289"},"PeriodicalIF":0.6,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144263537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Esophageal cancer surgery in Ethiopia: postoperative mortality and long-term survival","authors":"Mintesinot Birhanu Senbeta ,&nbsp;Sileshi Abiy ,&nbsp;Hirbo Samuel ,&nbsp;Nigist Birhanu","doi":"10.1016/j.sipas.2025.100288","DOIUrl":"10.1016/j.sipas.2025.100288","url":null,"abstract":"<div><h3>Introduction</h3><div>Cancer remains the leading cause of death worldwide, with esophageal cancer being the sixth leading cause of cancer-related deaths. For individuals with esophageal cancer, esophagectomy is the most effective treatment option available and has a high risk of both death and morbidity. Moreover, despite advances in preoperative optimization, surgery, and anesthesia techniques as well as the introduction of neoadjuvant therapy, the mortality and morbidity associated with esophagectomy remain high.</div></div><div><h3>Objective</h3><div>To assess the survival status and predictors of postoperative survival in patients who underwent esophageal surgery for esophageal malignancies at selected hospitals from to 2018–2023 in Ethiopia, Addis Ababa.</div></div><div><h3>Methods</h3><div>This was a retrospective cohort study. After acquiring data from the chart review, the data were analyzed using R version 4.3.3. Descriptive statistics for categorical variables were reported as frequencies and percentages. Kaplan-Meier curves and log-rank tests were used to estimate the survival curve and the difference in survival among groups within each covariate. After esophageal surgery, the impact of each covariate on time to death was assessed using the Cox proportional hazard model.</div></div><div><h3>Results</h3><div>One hundred eighty-three patients who underwent esophageal surgeries for esophageal malignancy at four governmental hospitals in Addis Ababa over 5 years were included. The mean age was 53.8 years. 120 (65.6 %) had a tumor size &lt;3.3 cm, and squamous cell carcinoma accounted for 154 (84.2 %) cases. Epidural analgesia was the most commonly used analgesic technique, 40 (21.9 %). The 30-day mortality was 10.9 %. The overall 1-, 2-, 3-, 4-, and 5-year survival rates were 53 %, 30.6 %, 19.5 %, 19.5 %, and 13 %, respectively. The median survival was 17 months. ASA score of &gt; III (AHR = 2.14, 95 % CI: 1.12–4.12), cervical anastomotic leak (AHR = 3.29, 95 % CI: 1.44–7.52), and sepsis (AHR = 3.70, 95 % CI: 1.46–9.38) were identified as predictors of postoperative mortality in the multivariate Cox regression model.</div></div><div><h3>Conclusion</h3><div>In Ethiopia, patients who underwent surgery for esophageal cancer had low 5-year survival rates.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"22 ","pages":"Article 100288"},"PeriodicalIF":0.6,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144253685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A retrospective analysis of Gastric Cancer Lymph Nodes Based on Groups, Regions, and Stages","authors":"Si-kai Song ,&nbsp;Jiang Zhu ,&nbsp;Hai-min Feng ,&nbsp;An-she Ma ,&nbsp;Chao-gang Yang","doi":"10.1016/j.sipas.2025.100287","DOIUrl":"10.1016/j.sipas.2025.100287","url":null,"abstract":"<div><h3>Objective</h3><div>The consistency between clinical and pathological staging of lymph nodes (LNs) in gastric cancer (GC) remains suboptimal, and there is currently no standardized imaging criterion for diagnosing lymph node metastasis (LNM). This study aimed to elucidate the differences in LNs among various groups, regions, and stages, utilizing imaging and histopathology as the foundational basis.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed the clinical data of 100 GC patients who underwent surgical treatment at Zhongnan Hospital of Wuhan University between January 2022 and May 2023. Patient characteristics, along with pathological and radiological data of LNs, were collected and compared across different groups, regions, and stages.</div></div><div><h3>Results</h3><div>Pathologically, 3566 LNs were collected, with a median of 35 (range: 17–72). Radiologically, 2233 LNs were collected, with a median of 22 (range: 3–47). Significant differences were observed in the long-axis diameter (LAD), short-axis diameter (SAD), ratios of long to short axis (RLSA), and product of long and short axis (PLSA) between negative and positive LNs. However, only within group 3 did the RLSA show statistical significance upon grouping analysis. The areas under the curve (AUC) for LAD, SAD, PLSA, and their combination index (CI) in diagnosing LNM were 0.817, 0.817, 0.828, and 0.827, respectively. Diverse groups, regions, and stages exerted a more pronounced influence on LN groups 1–6, while having a comparatively lesser impact on LN groups 7–16.</div></div><div><h3>Conclusion</h3><div>LAD, SAD, and PLSA exhibited significant diagnostic value for LNM and could serve as diagnostic criteria; however, RLSA demonstrated limited diagnostic utility. The formulation of diagnostic criteria should consider the impact of groups, regions, and stages to enhance sensitivity and specificity.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"21 ","pages":"Article 100287"},"PeriodicalIF":0.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144204838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of verapamil on intestinal injury in a rat model of acute mesenteric ischemia","authors":"Silvana N Wilken ,&nbsp;Diego V Santos Rodrigues ,&nbsp;Colin Price ,&nbsp;Julia Jacobs ,&nbsp;Jack Nelson ,&nbsp;Patrick F Walker ,&nbsp;Jonathan J Morrison","doi":"10.1016/j.sipas.2025.100286","DOIUrl":"10.1016/j.sipas.2025.100286","url":null,"abstract":"<div><h3>Background</h3><div>Acute mesenteric ischemia (AMI) is a surgical emergency requiring prompt revascularization with resection of unsalvageable bowel. Despite successful revascularization, ongoing organ damage can persist from ischemia-reperfusion injury (IRI) and there is a need for adjunct therapies to ameliorate this ongoing insult.</div></div><div><h3>Materials and methods</h3><div>Sprague-Dawley rats (<em>n</em> = 36) were divided into five groups: control, heparin (HEP), HEP + verapamil (VER), HEP + valproic acid (VPA), HEP+VER+VPA. The animals were subjected to 45 min of superior mesenteric artery occlusion followed by 4 h of reperfusion. Upon reperfusion, therapies were administered. Plasma samples were collected before occlusion and at end-of-study for intestinal fatty acid binding protein (I-FABP) and pro-inflammatory cytokines. The full length of the small intestine was collected, stained with H&amp;E and scored according to the Park/Chiu score for intestinal ischemia damage.</div></div><div><h3>Results</h3><div>Twenty-three of 36 rats survived 4 h of reperfusion and there was no difference in survival between the groups. I-FABP levels was significantly lower in HEP+VER vs. control (3.8 ± 1.5 vs. 6.18 ± 1.0ng/ml; <em>p</em> = 0.0040). IL-1beta, IL-6 and TNF-alpha showed the lowest mean values in the HEP+VER group compared to all groups. The histological analysis revealed the lowest score of intestinal damage in the HEP+VER group, however, the difference to control was not significant.</div></div><div><h3>Conclusion</h3><div>Administering heparin and verapamil at the time of revascularization may mitigate intestinal IRI without causing detrimental systemic effects. Further studies in large animal models and in the setting of local administration are needed to investigate the potential of this approach.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"21 ","pages":"Article 100286"},"PeriodicalIF":0.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144230178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ventral hernia repair with T-line hernia mesh: A multi-institutional experience","authors":"Emmanuel O. Emovon III ,&nbsp;Anna Malysz Oyola ,&nbsp;Luis Arias-Espinosa ,&nbsp;Hani I. Naga ,&nbsp;Angela S. Volk ,&nbsp;William Hope ,&nbsp;Flavio Malcher ,&nbsp;Jamie P. Levine ,&nbsp;Hobart W. Harris ,&nbsp;Jin Yoo ,&nbsp;Ash Patel","doi":"10.1016/j.sipas.2025.100285","DOIUrl":"10.1016/j.sipas.2025.100285","url":null,"abstract":"<div><h3>Introduction</h3><div>Ventral hernia repair (VHR) is a common procedure complicated by high hernia recurrence rates exceeding 30 % over ten years. The T-Line® Hernia Mesh is a synthetic, polypropylene mesh featuring mesh extensions designed to prevent anchor point failure by evenly distributing tension to reduce ventral hernia recurrences. This study evaluates the outcomes of the T-Line® mesh in VHR with 1–3 year follow-up.</div></div><div><h3>Methods</h3><div>This study is a multi-institutional retrospective cohort study on patients who underwent VHR with T-Line® mesh between October 2020 and December 2022. Patient demographics, surgical details, and postoperative outcomes were collected. Patient-reported outcomes were assessed using HerQLes and ACHQC surveys.</div></div><div><h3>Results</h3><div>Fifty-seven patients underwent VHR with the T-Line® mesh with a median age of sixty years and BMI of 30.8 kg/m². The median follow-up was 454 days with a range of 365 to 1192 days. The median defect area was 97.0 cm² and mesh area was 300 cm². Seventeen patients (29.8 %) underwent hernia repair with panniculectomy. Postoperatively, seven patients (12.3 %) presented to the emergency department within 30 days, with five patients (8.8 %) requiring readmission. Eight patients (14.0 %) experienced complications within thirty days, with the majority being surgical site infections (<em>n</em> = 7, 12.3 %). Of the five patients that reported feeling a slight bulge at their previous hernia site, upon clinical evaluation two patients had a recurrence (one recurrence was caused by the suture tearing through the underlying laparotomy repair while the mesh remained anchored intact above the repair, and the second recurrence was caused by inadequate mesh fixation at the caudal border of the mesh), while no patients reported using pain medication for abdominal wall discomfort.</div></div><div><h3>Conclusions</h3><div>The T-Line® Hernia Mesh demonstrated safety and effectiveness in ventral hernia repair, with low recurrences and postoperative complications rates over a 1–3-year period, suggesting it is a valuable tool for complex hernia repairs.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"21 ","pages":"Article 100285"},"PeriodicalIF":0.6,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144115332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chemo-radiotherapy after neoadjuvant chemotherapy and radical hysterectomy in women with stage IB-IIB cervical cancer: Do we need to change the therapeutic approach? A cohort study","authors":"Somayeh Nikfar ,&nbsp;Azam Sadat Mousavi ,&nbsp;Setareh Akhavan ,&nbsp;Shahrzad Sheikhhasani ,&nbsp;Amir Almasi-Hashiani ,&nbsp;Ramin Parvizrad ,&nbsp;Narges Zamani","doi":"10.1016/j.sipas.2025.100284","DOIUrl":"10.1016/j.sipas.2025.100284","url":null,"abstract":"<div><h3>Background</h3><div>Chemoradiotherapy is recommended as the standard treatment for advanced cervical cancer, and neoadjuvant chemotherapy (NACT) can be beneficial for patients on long radiotherapy waiting lists. This study aimed to evaluate the need for chemoradiotherapy after NACT and radical hysterectomy in women with stage IB-IIB cervical cancer.</div></div><div><h3>Methods</h3><div>This was a retrospective, cohort study. All patients in the gynecologic oncology clinic of Imam Khomeini Hospital, Tehran, Iran, who were diagnosed with stage IB-IIB cervical cancer and treated with NACT and radical hysterectomy between 2010 and 2020, were included in this study. The records of all the patients who met the inclusion criteria were evaluated during the study period. Outcomes of interest and progression-free survival (PFS) were also assessed.</div></div><div><h3>Results</h3><div>In this study, the clinical files of 613 patients with cervical cancer were studied, and among them, 63 patients (10.2%) underwent NACT. Eighteen patients (33.3%) did not require another treatment modality after chemotherapy and radical hysterectomy, while 66.7% (36 cases) of patients required chemoradiotherapy after NACT and radical hysterectomy, and recurrence was observed in 11.6% (5 cases) of patients. The 1-, 5- and 10-year PFS rate was 97.6% (95% CI: 84.2–99.6), 89.5% (95% CI: 74.4–95.9) and 89.5% (95% CI: 74.4–95.9), respectively.</div></div><div><h3>Conclusions</h3><div>It can be concluded that a significant percentage of patients who are candidates for NACT followed by radical hysterectomy would require another modality of treatment, which is chemoradiotherapy; therefore, it is recommended that by conducting prospective studies, in addition to investigating this issue, the choice of the first method of patient treatment in these stages should be reconsidered so that patients do not suffer from two treatments and related complications, and undergo chemoradiotherapy from the beginning.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"21 ","pages":"Article 100284"},"PeriodicalIF":0.6,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143899389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors and outcomes for early returns to the operating room following abdominal wall hernia repairs","authors":"Saran Kunaprayoon,&nbsp;Cole Brown,&nbsp;Venu Bangla,&nbsp;Tomer Lagziel,&nbsp;I. Michael Leitman","doi":"10.1016/j.sipas.2025.100283","DOIUrl":"10.1016/j.sipas.2025.100283","url":null,"abstract":"<div><h3>Background</h3><div>Risks of re-operation in ventral hernias in non-American populations and recurrence have been studied extensively. However, data on early risk factors for reoperation in North America are still lacking. The most recent NSQIP study, analyzing risk factors for reoperation of ventral hernias was extracted from 2005–2008 data. Since then, there have been major advances in ventral hernia repair techniques. Here, we identify risk factors and indications for re-operation within 30 days.</div></div><div><h3>Methods</h3><div>NSQIP ACS data from 2020–2022 were used in our analysis. Additional procedures that posed significant morbidity and mortality were excluded. Risk factors were analyzed with univariate and multivariable models to determine association with re-operation within 30 days. ICD10 codes for re-operation were also analyzed.</div></div><div><h3>Results</h3><div>Of 56,260 patients, 2.38 % returned to the OR within 30 days. Higher ASA, male gender, surgical site infection (SSI), smoking, ascites, age group &gt; 70, dialysis patients, open surgeries and dehiscence were significantly associated with re-operation whereas outpatient surgery was protective in univariate and multivariable models (<em>p</em> &lt; 0.01). The most common indications for re-operation were surgical site occurrence (SSO) and recurrence of hernia. Mortality was significantly higher in the reoperation group, 3.29 %, compared to those patients that did not require early reoperation (0.36 %, <em>p</em> &lt; 0.01)</div></div><div><h3>Conclusions</h3><div>Mortality and early reoperation rates have decreased in the past decade in the U.S, which could be attributed to advancement in ventral hernia repair techniques. Our analysis of risk factors for reoperation supports findings in the broader literature. This study also suggests that SSO and recurrence of hernia are leading diagnoses for early reoperation.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"21 ","pages":"Article 100283"},"PeriodicalIF":0.6,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143886005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improvised chest tube drainage: A practical approach to thoracic emergencies in humanitarian crises","authors":"Alsadig Suliman ,&nbsp;Rawan Mohamedosman ,&nbsp;Bushra Suliman ,&nbsp;Hassan Musa ,&nbsp;Siddig Ali ,&nbsp;Mohammad Ahmed","doi":"10.1016/j.sipas.2025.100282","DOIUrl":"10.1016/j.sipas.2025.100282","url":null,"abstract":"<div><h3>Background</h3><div>Thoracic injuries pose a challenge in conflict zones, where disrupted healthcare infrastructure and supply shortages limit access to conventional chest tube drainage (CTD) systems. This study evaluates the safety and efficacy of an improvised CTD system as a viable alternative in resource-limited settings in Sudan.</div></div><div><h3>Methods</h3><div>A prospective, single-center analytical cohort study was conducted at a tertiary hospital in Sudan from June to December 2023. A total of 120 adult patients (aged 18–70 years) requiring CTD for thoracic injuries were included. The improvised CTD system consisted of a radiopaque nasogastric (NG) tube and a repurposed 1.5-liter plastic water bottle as an underwater seal. Clinical outcomes, complications, and patient satisfaction were assessed. Serial imaging at baseline and 24-hour intervals evaluated lung re-expansion and drainage efficacy. Data were analyzed using SPSS, with <em>p</em> &lt; 0.05 considered significant.</div></div><div><h3>Results</h3><div>Lung re-expansion was achieved in 90 % (<em>N</em> = 108) of patients within 72 h. Complications included atelectasis in 15 % (<em>N</em> = 18), subcutaneous emphysema in 20 % (<em>N</em> = 24), and empyema in 12 % (<em>N</em> = 14). Tube repositioning was required in 25 % (<em>N</em> = 30) of cases, and obstruction occurred in 10 % (<em>N</em> = 12). The mean hospital stay was 6.5 days, and mortality was 5 % (<em>N</em> = 6). Smoking status, age, and injury type significantly predicted complications. Patient satisfaction was high, with 85 % (<em>N</em> = 102) rating their experience as satisfactory.</div></div><div><h3>Conclusions</h3><div>The improvised CTD system is a safe, effective, and cost-efficient alternative for managing thoracic emergencies in conflict settings. Its adaptability addresses critical gaps in emergency care, offering a scalable model for humanitarian crises worldwide.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"21 ","pages":"Article 100282"},"PeriodicalIF":0.6,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143855770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}