Surgery in practice and science最新文献

{"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}

{"title":"Assessment of negative appendectomy in acute appendicitis diagnoses","authors":"Francisco Antonio Rodriguez-Garcia ,&nbsp;Carlos Enrique Rodríguez-Sánchez ,&nbsp;Julio Cesar Naranjo-Chávez ,&nbsp;Christian Jorge Torres-Ortiz-Ocampo ,&nbsp;Fabián Rojas-Larios ,&nbsp;Karen Covarrubias-Ramírez ,&nbsp;Eduardo Missael Evangelista-Ruiz ,&nbsp;Quitzia Libertad Torres-Salazar","doi":"10.1016/j.sipas.2025.100281","DOIUrl":"10.1016/j.sipas.2025.100281","url":null,"abstract":"<div><h3>Background</h3><div>A negative appendectomy is a surgery performed due to a clinical suspicion of acute appendicitis, but no evidence of inflammation is identified upon examination. The main reason is the incorrect diagnosis of acute appendicitis, which remains a challenge, especially in developing countries, where the rates are different among populations. This study aims to explore the prevalence of negative appendectomies in a regional hospital and evaluate the diagnostic methods used in clinical practice.</div></div><div><h3>Materials and methods</h3><div>A retrospective analysis was conducted on patients who underwent emergency appendectomy between 2021 and 2022. Negative appendectomy was defined as the absence of histopathological evidence of acute appendicitis postoperatively.</div></div><div><h3>Results</h3><div>Out of 324 patients, 38 were found to have undergone a negative appendectomy, representing a two-year rate of 11.7%. Imaging was performed in 78% of cases, but no significant difference was observed in its use between patients with positive and negative appendectomies. Differential diagnoses showed pathologies such as cysts and intestinal lesions. The Alvarado score was found to be a useful tool when applied with a threshold score of 7. However, variability in clinical presentations such as nausea/vomiting, anorexia, right iliac fossa tenderness and fever highlighted the limitations of relying solely on this metric. The factors associated with negative appendectomy were previous abdominal surgery, Alvarado score &lt;7, abdominal pain, rebound tenderness, leukocytosis and neutrophilia.</div></div><div><h3>Conclusions</h3><div>The prevalence of negative appendectomies at our institution was 11.7%. Despite the widespread use of diagnostic imaging and clinical scoring systems, improvements in diagnostic accuracy are necessary to reduce the rate of unnecessary surgeries.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"21 ","pages":"Article 100281"},"PeriodicalIF":0.6,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143820822","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":"Laparoscopic ventral hernia repair: A surgeon's insights into defect closure","authors":"Muayad Abass Fadhel","doi":"10.1016/j.sipas.2025.100280","DOIUrl":"10.1016/j.sipas.2025.100280","url":null,"abstract":"<div><h3>Introduction</h3><div>Laparoscopic ventral hernia repair (LVHR) is favored over open-repair methods due to reduced pain, shorter hospital stays, and lower recurrence rates. However, whether to close the hernial defect before placing the mesh remains debated. This study compares LVHR outcomes with and without defect closure.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted on 108 patients undergoing LVHR from 2018 to 2022. Group A (49 patients) underwent LVHR without defect closure, and Group B (59 patients) underwent LVHR with defect closure. Data on demographics, operative time, complication rates, postoperative pain, and hernia recurrence were analyzed. Patients were followed for at least 1 year after surgery.</div></div><div><h3>Results</h3><div>Closing the hernial defect significantly reduced seroma formation (P = 0.04) and mesh bulge (P = 0.04). However, it was associated with longer operative times and higher immediate postoperative pain. Group A had shorter operative times and lower initial pain but higher rates of seroma formation (18.4 %) and mesh bulge (6.1 %). Group B had fewer seromas (5.1 %) and no mesh bulges but required longer surgeries and reported higher immediate postoperative pain. No significant differences were observed in hernia recurrence rates, hospital stays, or chronic pain levels. Mesh infections were only noted in the non-closure group (2.0 %).</div></div><div><h3>Conclusions</h3><div>Defect closure during LVHR reduces seroma formation and mesh bulge but increases operative time and immediate postoperative pain. Further randomized controlled trials are necessary to optimize LVHR protocols.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"21 ","pages":"Article 100280"},"PeriodicalIF":0.6,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143681404","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":"An Australian regional hospital's oesophagectomy experience: A 10-year case series from Tasmania","authors":"Renishka Sellayah,&nbsp;Girish Pande","doi":"10.1016/j.sipas.2025.100279","DOIUrl":"10.1016/j.sipas.2025.100279","url":null,"abstract":"<div><h3>Introduction</h3><div>Oesophagectomy is recommended as part of curative treatment for oesophageal cancer but is associated with substantial morbidity. Centralization has been recommended to improve outcomes, but this has not been widely applied in Australia. This study aimed to audit a regional hospital's experience over ten years and compare it to outcomes from national and international centres to support the view that oesophagectomy can be performed safely in select regional centres in Australia.</div></div><div><h3>Methods</h3><div>Patients undergoing oesophagectomy at a single regional hospital in North-East Tasmania, Australia between January 2014 and December 2023 were retrospectively identified. Preoperative patient and tumour characteristics, and outcomes (mortality, anastomotic leak, length of stay, respiratory complications, long-term complications and survival) were compared to other centres.</div></div><div><h3>Results</h3><div>65 patients were identified. 53 % were male, mean age was 65.2 years, 29.2 % had respiratory disease and 18.5 % were current smokers. The anastomotic leak rate was 7.7 %. 25 % developed pneumonia postoperatively. Average ICU length of stay was 4.6 days, median acute inpatient length of stay was 15 days. There was one in-hospital mortality and one 30-day mortality. 2 patients (3 %) required diaphragmatic hernia repair; 12 patients (18.5 %) required endoscopic dilatation of anastomotic strictures. The 5-year survival rate was 66 %. Our results compare favourably to published rates of anastomotic leak (10–15 %), inpatient stay (15 days), pneumonia (20–30 %), 30-day mortality (1–4 %) and anastomotic stricture (20 %).</div></div><div><h3>Conclusions</h3><div>Oesophagectomies can be safely performed in regional centres in Australia that routinely undertake a higher volume of cases per year, provided services required to manage complications are readily available.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"21 ","pages":"Article 100279"},"PeriodicalIF":0.6,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143747608","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":"Surgical site infection reduction bundle in stoma closure: A retrospective cohort study","authors":"Kentaro Goto ,&nbsp;Ryo Matsusue ,&nbsp;Kanako Degawa ,&nbsp;Akimori Miki ,&nbsp;Hiroki Nakanishi ,&nbsp;Hiroaki Hata ,&nbsp;Masato Narita ,&nbsp;Takashi Yamaguchi","doi":"10.1016/j.sipas.2025.100277","DOIUrl":"10.1016/j.sipas.2025.100277","url":null,"abstract":"<div><h3>Introduction</h3><div>Advances in minimally invasive surgeries and pre-operative treatments allow the preservation of anal function through lower anastomosis in patients with rectal cancer, often necessitating temporary diverting stomas owing to the risk of anastomotic leakage. Stoma closure is associated with a high rate of surgical site infections (SSIs). Various measures, including purse-string skin sutures and negative-pressure wound therapy, have been implemented, and some guidelines recommend purse-string skin sutures as the standard method of stoma closure. However, at our institution, we used linear skin closure with an SSI reduction bundle. This study describes our stoma closure method and retrospectively analyses surgical outcomes.</div></div><div><h3>Materials and Methods</h3><div>This retrospective study included patients aged ≥ 20 years who underwent loop stoma closure using linear skin sutures at our institution between January 2006 and March 2021. Our protocol emphasises the following: (1) pre-operative oral anti-microbials, (2) a surgical technique that distinctly separates clean and contaminated regions, and (3) wound closure to eliminate dead space. We evaluated the surgical outcomes, including the incidence of SSIs and other post-operative complications.</div></div><div><h3>Results</h3><div>Ninety-two patients (53 men, 39 women; mean age, 59.4 years) underwent loop stoma closure. SSIs occurred in two patients (2.2%). No risk factors for SSIs were identified.</div></div><div><h3>Conclusion</h3><div>In our department, the incidence of SSIs after linear skin closure of stomas was low. Adherence to proper infection prevention practices can effectively mitigate SSIs, even with linear skin closure.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"20 ","pages":"Article 100277"},"PeriodicalIF":0.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520618","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":"Simultaneous radical cystectomy and nephroureterectomy: A case series","authors":"Gavin G. Calpin ,&nbsp;Steven M. Anderson ,&nbsp;Mark Broe ,&nbsp;Ijaz Cheema ,&nbsp;Niall F. Davis ,&nbsp;Dilly Little","doi":"10.1016/j.sipas.2025.100276","DOIUrl":"10.1016/j.sipas.2025.100276","url":null,"abstract":"<div><h3>Introduction</h3><div>Simultaneous radical cystectomy and nephroureterectomy (RCNU) is a complex procedure. Although performed infrequently, RCNU may be indicated in certain cases of multifocal high grade urothelial carcinoma (UC) or muscle-invasive bladder cancer (MIBC) with an obstructed and atrophic kidney. The aim of this study was to review the indications, operative approach and outcomes for patients undergoing RCNU in our institution.</div></div><div><h3>Methods</h3><div>A single-centre, retrospective review was performed. Cases were identified by reviewing theatre logbooks. Chart reviews were conducted and clinicopathological outcomes were recorded and analysed.</div></div><div><h3>Results</h3><div>Eight patients were identified between 2015–2024. All were male and had a mean age of 66.4 ± 4.7 years. All patients underwent RCNU with ileal conduit formation. The surgical approach for the nephroureterectomy was laparoscopic in four cases and open in the remaining four. The mean post-operative length of stay was 11.6 ± 1.75 days. All patients had high grade UC, seven patients had MIBC at presentation. Only two patients received neoadjuvant chemotherapy, one of whom achieved a complete pathological response. In total, 62.5% (n=5) had T3/4 disease while 50% (n=4) had node positive disease. Two patients had synchronous upper tract urothelial carcinoma (UTUC) on final histology. The remaining cases had chronically obstructed and atrophic kidneys. Incidental primary prostate cancer was found in 62.5% (n=5). The mean follow-up was 31.6 ± 7 months, during which time there were four recurrences with three patients dying from metastatic disease. The mean overall survival was 21.8 ± 11.8 months and the mean disease-free survival was 19.3 ± 12.3 months.</div></div><div><h3>Conclusion</h3><div>The results from this study demonstrate that combined laparoscopic and open RCNU is an effective treatment for both panurothelial cancer and MIBC with severe upper tract dysfunction.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"21 ","pages":"Article 100276"},"PeriodicalIF":0.6,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143548014","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":"Disparities in the expansion of telemedicine in pediatric specialty care through the COVID-19 pandemic and beyond","authors":"Monalisa Attif Hassan,&nbsp;Jeffrey Fine,&nbsp;Kathleen Doyle,&nbsp;Emily Byrd,&nbsp;Minna M. Wieck","doi":"10.1016/j.sipas.2025.100275","DOIUrl":"10.1016/j.sipas.2025.100275","url":null,"abstract":"<div><h3>Introduction</h3><div>The COVID-19 pandemic resulted in the rapid expansion of telemedicine, including in specialties traditionally dependent on physical exams, such as pediatric surgery. Trends in its utilization as in-person visits resumed are not well understood, nor is its effect on mitigating disparities related to social determinants of health (SDOH). We hypothesize that telemedicine utilization increased after the pandemic and has remained higher compared to pre-pandemic levels. Additionally, we hypothesize that increased telemedicine use has contributed to lower no-show rates and more equitable access to care.</div></div><div><h3>Methods</h3><div>A retrospective cohort analysis was conducted of all outpatient visits at a single outpatient pediatric surgery clinic at a quaternary academic center from 01/02/2018 to 10/26/2022. Clinical variables extracted included demographic data, no-show rate (patient did not attend scheduled appointment), and visit type (in person vs telemedicine). Geocoded census data was used to determine SDOH variables such as internet and computer access. A mixed effect logistic regression model was performed to identify which variables were associated with differences in telemedicine usage.</div></div><div><h3>Results</h3><div>6339 encounters for 2735 patients were analyzed. Odds of presenting to a scheduled telemedicine visit compared to an in-person visit was 0.76 (CI 0.63-0.91, p-value &lt; 0.01). The odds of selecting a telemedicine visit decreased by 34 % for Spanish speakers and 63 % for ‘other’ language speakers compared to English speakers (p-value &lt; 0.01). The odds of choosing a telemedicine visit also decreased by 4 % for every one-unit increase in the probability of having access to the internet (p &lt; 0.01). There was no significant difference in the odds of choosing a telemedicine visit for insurance status, age, distance, or probability of having access to a computer.</div></div><div><h3>Discussion</h3><div>Telemedicine continues to be utilized at higher rates compared to pre-pandemic levels, but does not reduce no-show rates, which may reflect limits in its clinical utility. It is used less frequently by non-English speakers, which may contribute to ongoing disparities in access to specialty pediatric care.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"20 ","pages":"Article 100275"},"PeriodicalIF":0.6,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143421258","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}