Annali italiani di chirurgia最新文献

{"title":"Albumin-Bilirubin and Severity as Key Factors of Recovery in Patients With PA-HSOS Undergoing Transjugular Intrahepatic Portosystemic Shunt.","authors":"Jianji Dai, Xiaoxian Yang, Xiaogang Hu, Yi Deng, Jun Lu, Jiamin Wang, Gang Li, Jianghao Hong","doi":"10.62713/aic.4033","DOIUrl":"10.62713/aic.4033","url":null,"abstract":"<p><strong>Aim: </strong>To evaluate the safety and efficacy of transjugular intrahepatic portosystemic shunt (TIPS) in the management of pyrrolizidine alkaloid-related hepatic sinusoidal obstruction syndrome (PA-HSOS) and to identify key factors influencing the recovery of liver imaging manifestation after TIPS procedure in PA-HSOS patients.</p><p><strong>Methods: </strong>A retrospective review was conducted of 30 PA-HSOS patients who received TIPS at Jinhua Municipal Central Hospital between 1 January 2018, and 30 September 2021, following failure of anticoagulation-based comprehensive treatments. Baseline characteristics and follow-up data were collected, including clinical manifestations, laboratory test results, computed tomography (CT) radiological manifestations of the liver, hepatic venous pressure gradient (HVPG), survival, and complications. Laboratory tests before and after TIPS were compared, and multiple linear regression was used to analyze factors associated with the recovery time of liver CT radiological manifestations.</p><p><strong>Results: </strong>TIPS was successfully performed in all 30 patients, with no procedure-related adverse events. All patients survived the follow-up period. The portal pressure gradient (PPG) significantly reduced from 22.65 ± 6.36 mmHg to 9.40 ± 3.38 mmHg (<i>p</i> < 0.001). The median time to complete ascites remission was 52 days (range: 29-161 days). The median recovery time for liver CT radiological manifestations was 196.5 days (range: 165-229 days). Disease severity and albumin-bilirubin (ALBI) grade were significant factors influencing the recovery time of liver CT radiological manifestations (<i>R</i>² = 0.666, <i>p</i> = 0.007). Patients with ALBI grade 2 had a significantly shorter recovery time of liver CT radiological manifestations compared to those with ALBI grade 3 (170.44 ± 50.56 days <i>vs</i> 224.83 ± 46.67 days, <i>p</i> = 0.006). Similarly, patients with severe or very severe disease had longer recovery times than those with mild or moderate diseases (218.25 ± 41.60 days <i>vs</i> 162.43 ± 55.11 days, <i>p</i> = 0.004).</p><p><strong>Conclusions: </strong>TIPS is a safe and effective treatment for PA-HSOS. Disease severity and ALBI grade are key factors in estimating the recovery time of liver CT radiological manifestations in patients with PA-HSOS.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 8","pages":"1018-1027"},"PeriodicalIF":0.9,"publicationDate":"2025-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144871053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medial-to-lateral vs. Lateral-to-medial: Determining the Optimal Approach in Laparoscopic Right Hemicolectomy-A Cohort Study.","authors":"Hua Chai, Zhiyong Shen, Shuang Jiang, Yanfeng Li, Jingjing Qian","doi":"10.62713/aic.3947","DOIUrl":"10.62713/aic.3947","url":null,"abstract":"<p><strong>Aim: </strong>To check the immediate and distant results of medial-to-lateral (ML) and lateral-to-medial (LM) methods to laparoscopic right hemicolectomy.</p><p><strong>Methods: </strong>The present study is a retrospective cohort analysis of 453 laparoscopic right hemicolectomy procedures performed between 2018 and 2024 at a single Chinese tertiary care hospital, comparing LM and ML techniques. Rates of conversion, complications, lymph node yield, and survival were the main results. Operating room conditions and recovery measures served as secondary outcomes. Kaplan-Meier techniques were utilized for survival analysis, and propensity score matching was employed to reduce bias in selection.</p><p><strong>Results: </strong>Among 453 patients (mean [SD] age, 60 [12] years; 294 men [65%]), 289 (64%) underwent the ML approach. The ML technique exhibited significantly reduced conversion rates (11% vs. 63%; <i>p</i> < 0.001), fewer Grade III-IV complications (4.8% vs. 68%; <i>p</i> < 0.001), and a lower lymph node yield (32.5% vs. 67.5% reaching ≥12 nodes; <i>p</i> = 0.001). Survival outcomes improved with the ML approach: overall survival (hazard ratio [HR], 0.76; 95% confidence interval [CI], 0.62-0.93; <i>p</i> = 0.008) and disease-free survival (HR, 0.71; 95% CI, 0.58-0.87; <i>p</i> = 0.001). Following propensity score matching, the LM method (n = 164) showed higher operative success (70.9% vs. 29.1%; adjusted odds ratio [aOR], 2.14; 95% CI, 1.56-2.94; <i>p</i> < 0.001) and LM showed reduced major complications (9.8% vs. 90.2%; adjusted OR, 0.52; 95% CI, 0.38-0.71; <i>p</i> < 0.001) compared to the ML approach.</p><p><strong>Conclusions: </strong>The ML approach in laparoscopic right hemicolectomy shows superior oncological outcomes and survival pre-matching, while LM excels in operative success and recovery post-matching. ML is preferred when feasible, but further validation is needed.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 8","pages":"1110-1122"},"PeriodicalIF":0.9,"publicationDate":"2025-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144871061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing Clinical Efficacy and Quality of Life Between Transesophageal Echocardiography-Guided and X-Ray Guided Percutaneous Occlusion in Adults With Secundum Atrial Septal Defect.","authors":"Weiwei Ying, Youyou Zhu, Gang Wang","doi":"10.62713/aic.4116","DOIUrl":"10.62713/aic.4116","url":null,"abstract":"<p><strong>Aim: </strong>This study aims to compare the clinical efficacy and quality of life between transesophageal echocardiography (TEE)-guided and X-ray-guided percutaneous closure in adults with secundum atrial septal defect (ASD).</p><p><strong>Methods: </strong>A retrospective cohort study was conducted on 130 adults with secundum ASD who underwent percutaneous closure in our hospital between January 2022 and January 2024. The patients were divided into an observation group (TEE-guided, n = 58) and a control group (X-ray-guided, n = 72). The patients were followed up for 12 months, and their baseline characteristics, operation success rate, ventricular function parameters, postoperative complications and the 36-Item Short Form Health Survey (SF-36) quality of life scores were comparatively analyzed.</p><p><strong>Results: </strong>Compared to the control group, the observation group had shorter procedure times, higher rates of successful primary closure, shorter hospital stays, and lower early residual postoperative diversion rates (<i>p</i> < 0.05). There were no significant differences in baseline right ventricular end-diastolic volume index (RVEDVi), right ventricular end-systolic volume index (RVESVi), right ventricular ejection fraction (RVEF), left ventricular end-diastolic volume index (LVEDVi), left ventricular end-systolic volume index (LVESVi), and left ventricular ejection fraction (LVEF) between the two groups (<i>p</i> > 0.05). However, 3 months after surgery, both groups showed improvement in biventricular function, with the observation group exhibiting better right ventricular functional parameters (RVEDVi, RVESVi, RVEF) than the control group (<i>p</i> < 0.05). Furthermore, the overall complication rate was significantly lower in the observation group than in the control group (<i>p</i> < 0.05). There was no significant difference in pre-procedure SF-36 scores between the two groups (<i>p</i> > 0.05); however, 12 months after surgery, SF-36 scores in all domains increased in both groups, with the observation group scoring higher (<i>p</i> < 0.05).</p><p><strong>Conclusions: </strong>In treating adult secundum ASD, TEE-guided percutaneous ASD closure yields superior clinical outcomes compared to the X-ray-guided method regarding procedural efficiency, reduction of early residual shunts, recovery of right ventricular function, relief of complication, and improvement in quality of life.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 8","pages":"1071-1083"},"PeriodicalIF":0.9,"publicationDate":"2025-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144871057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Machine Learning Models for Predicting In-Hospital Mortality in Burn Patients.","authors":"Samet Şahin, Burak Yavuz, Onur Karaca, Merve Akın, Ali Emre Akgün","doi":"10.62713/aic.3944","DOIUrl":"10.62713/aic.3944","url":null,"abstract":"<p><strong>Aim: </strong>To develop and evaluate predictive models for in-hospital mortality in burn patients using machine learning (ML) techniques.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted using data from burn patients admitted to Ankara Bilkent City Hospital Burn Treatment Center between 2015 and 2020. Key variables including age, gender, total body surface area burned, burn depth, burn type, inhalation injury, inflammatory markers and inflammatory indexes were collected. Seven ML models-Logistic Regression, Random Forest, Support Vector Machine, Decision Tree, K-Nearest Neighbors, Naive Bayes, and Gradient Boosting-were trained and evaluated.</p><p><strong>Results: </strong>The cohort included 218 patients (mean age 42.5 ± 18.5 years; 69.7% male, 30.3% female), with an in-hospital mortality rate of 18.8% (n = 41). Logistic Regression had the best performance (accuracy: 88.6%, Receiver Operating Characteristic (ROC)-Area Under Curve (AUC): 0.906), while Random Forest achieved the highest accuracy (90.9%) and recall (97.2%). K-Nearest Neighbors excelled in recall (99.0%), Gradient Boosting balanced precision and recall (91.6% each, ROC-AUC: 0.744), and Support Vector Machine showed moderate results (accuracy: 84.0%, ROC-AUC: 0.864).</p><p><strong>Conclusions: </strong>ML models, particularly Logistic Regression and Random Forest, demonstrated strong predictive capabilities for mortality in burn patients. This study supports the potential for ML in burn care, offering a data-driven approach for personalized prognosis and clinical decision-making. Further multicenter validation is recommended.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 8","pages":"1039-1046"},"PeriodicalIF":0.9,"publicationDate":"2025-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144871060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Efficacy of Traditional Surgery Versus Minimally Invasive Surgery in Non-Lactation Mastitis Patients: A Retrospective Data Analysis.","authors":"Shenbao Hu, Yajie Wang, Wei Liu, Yifei Fan, Xiaofeng Luo, Hong Huo, Yue Wu","doi":"10.62713/aic.4092","DOIUrl":"10.62713/aic.4092","url":null,"abstract":"<p><strong>Aim: </strong>This study comparatively analyzes the clinical efficacy and safety of traditional open surgery and minimally invasive approach for non-lactation mastitis using a retrospective cohort analysis. By assessing the impact of these surgical approaches on postoperative inflammatory indicators, recurrence rates, and recovery outcomes, the study intends to offer a scientific basis for optimizing clinical management strategies.</p><p><strong>Methods: </strong>This study included 109 patients diagnosed with non-lactation mastitis who were treated at Jingmen Central Hospital between January 2018 and December 2023. The study cohort included 61 patients who received traditional surgery and 48 who underwent minimally invasive surgery. Diagnosis was confirmed via preoperative pathological examination, and all patients were followed for 12 months post-surgery. Collected data included patient demographics, surgical parameters (e.g., operation duration, length of hospital stay, and complication rates), inflammatory marker levels (Neutrophil Count [NC] and C-reactive Protein [CRP]), and recurrence rates. Inflammatory markers were evaluated on postoperative days 7 and 30. Multivariate logistic regression analysis was employed to identify independent predictors of postoperative recurrence.</p><p><strong>Results: </strong>The minimally invasive surgery group demonstrated apparent clinical advantages over the traditional surgery group. The levels of NC and CRP were significantly lower in the minimally invasive surgery group on both postoperative day 7 (<i>p</i> < 0.001) and day 30 (<i>p</i> < 0.001). Furthermore, the minimally invasive group had a significantly lower recurrence rate (8.3%) compared to 32.8% in the traditional surgery group (<i>p</i> < 0.01). Additionally, patients in the minimally invasive group experienced shorter hospital stays (4.3 ± 1.2 days vs. 7.8 ± 2.4 days, <i>p</i> < 0.01) and a lower incidence of complications (4.17% vs. 16.39%, <i>p</i> < 0.05). Multivariate logistic regression analysis identified minimally invasive surgery as an independent protective factor against recurrence (Exponentiated Beta (Exp(β)) = 0.24, 95% Confidence Interval (CI): 0.069-0.832, <i>p</i> = 0.024).</p><p><strong>Conclusions: </strong>Minimally invasive surgery offers significant advantages over traditional open surgery in managing non-lactation mastitis. It effectively reduces postoperative inflammatory marker levels and recurrence rates, shortens hospital stays, and lowers the incidence of complications, underscoring its role as a promising therapeutic modality for this condition.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 8","pages":"1064-1070"},"PeriodicalIF":0.9,"publicationDate":"2025-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144871064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chondrosarcoma of the Petrous Apex and Posterior Fossa: A Case Report and Literature Overview of a Combined Approach to Resection.","authors":"Amed Natour, Edinson Najera, Robert DeDio, Aber Mukherjee, Hitam Hagog Natour, Walter Jean, Ravi Samy","doi":"10.62713/aic.3646","DOIUrl":"10.62713/aic.3646","url":null,"abstract":"<p><strong>Aim: </strong>In this study, we aimed to provide our initial experience with a novel combined approach resection of chondrosarcomas of the skull base and petrous apex (ChPA) and posterior cranial fossa by employing middle cranial fossa and retrosigmoid (RS) approaches with an augmented reality and virtual reality (AR/VR) system.</p><p><strong>Case presentation: </strong>A 66-year-old female patient was referred to our department owing to the growth of a left petrous apex lesion noted in computed tomography (CT) and magnetic resonance imaging (MRI) scans 10 years earlier. Her symptoms included headache, imbalance, and left-sided hearing loss. The lesion was resected via a combined extended middle cranial fossa (xMCF) and RS approach, gross total resection (GTR) and preservation of hearing and facial nerve function. The tumor was World Health Organization (WHO) Grade II, extending from the left petrous apex (PA) to the posterior fossa, cerebellopontine angle (CPA), and internal auditory canal (IAC). We also performed a systematic literature review of chondrosarcomas involving the skull base.</p><p><strong>Results: </strong>The patient tolerated the procedure well and was discharged without complications or neurological deficits on postoperative day 6 with normal facial nerve function and stable hearing as observed prior to surgery.</p><p><strong>Conclusions: </strong>Preoperative planning for the surgical approach must be carefully evaluated and individualized for each patient while considering the experience of the surgical team. GTR remains the preferred treatment for ChPA, preferably via an approach capable of preserving the facial nerve and hearing function. The xMCF approach, along with the RS approach for petrous apex lesions extending to the posterior cranial fossa/CPA with reconstruction of the skull base, appears to be a safe approach.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 8","pages":"999-1006"},"PeriodicalIF":0.9,"publicationDate":"2025-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144871056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Body Mass Index on Safety and Efficacy of Endoscopic Radical Thyroidectomy via Gasless Unilateral Axillary Approach for Thyroid Cancer Patients.","authors":"Haiwei Guo, Jiajie Xu, Chuanming Zheng, Wenjie Xia, Tianwei Zhan","doi":"10.62713/aic.4134","DOIUrl":"10.62713/aic.4134","url":null,"abstract":"<p><strong>Aim: </strong>To evaluate the safety and efficacy of endoscopic radical thyroidectomy via the gasless unilateral axillary approach (GUAA) for thyroid cancer patients across different body mass index (BMI) categories.</p><p><strong>Methods: </strong>A total of 333 patients with papillary thyroid carcinoma who underwent GUAA unilateral thyroidectomy and central lymph node dissection between June 2021 and February 2023 were retrospectively analyzed. The patients had been followed up for at least longer than 1 year. Patients were stratified into four groups based on their BMI: Group 1 (control group, 18.5 ≤ BMI < 24), Group 2 (BMI <18.5), Group 3 (24 ≤ BMI < 28), and Group 4 (BMI ≥28). The Group 3 and 4 defined as high BMI group while Group 1 defined as low BMI. The surgical-related indicators, operative time, numbness in the supraclavicular area, and rates of complication incidence between the four groups were compared.</p><p><strong>Results: </strong>There were no significant differences among the groups in terms of age, sex, tumor location (left or right), number of central lymph node dissections, central lymph node metastasis rates, total drainage volume, or postoperative hospital stay (<i>p</i> > 0.05). However, patients with higher BMI experienced significantly longer operative time compared to the control group (128.14 ± 38.69 min [Group 3], 142.17 ± 37.92 min [Group 4] vs. 114.33 ± 38.79 min [Group 1], <i>p</i> < 0.05). The incidence of complications-including recurrent laryngeal nerve (RLN) palsy, incision infection, and postoperative bleeding-did not differ significantly among groups. However, patients with low BMI (Group 1) had a significantly higher incidence of supraclavicular numbness compared to the Group 2 (56.25% vs. 8.04%, <i>p</i> < 0.05).</p><p><strong>Conclusions: </strong>Endoscopic thyroidectomy via gasless unilateral axillary approach is a safe surgical option for patients with thyroid cancer. High BMI is associated with longer operative time but does not increase complication rates. The average surgical duration for obese patients is approximately 28 minutes longer than that for patients with normal weight. Patients with low BMI require particular attention to the protection of the supraclavicular nerve to reduce the risk of postoperative numbness.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 8","pages":"1103-1109"},"PeriodicalIF":0.9,"publicationDate":"2025-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144871100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of Risk Factors and Model Construction for Recurrence Following Surgery for Primary Retinal Detachment.","authors":"Xinru Jia, Dongwei Yao, Yan Shi, Chengfei Lin","doi":"10.62713/aic.4176","DOIUrl":"10.62713/aic.4176","url":null,"abstract":"<p><strong>Aim: </strong>To investigate the risk factors for recurrent retinal detachment (re-RD) and to develop a predictive model to provide a basis for clinical evaluation.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on clinical data from 432 patients who underwent primary retinal detachment (RD) surgery at our institution between January 2021 and December 2023. Univariate and multivariate logistic regression analyses were used to identify independent risk factors for re-RD. A predictive model was constructed based on significant variables, and its performance was evaluated.</p><p><strong>Results: </strong>Independent risk factors for re-RD included previous ocular surgery, increased axial length, larger retinal tear diameter, and surgical methods (<i>p</i> < 0.05). Younger age was associated with a higher incidence of re-RD, while moderate preoperative best-corrected visual acuity (BCVA, 0.1 ≤ BCVA < 0.5) was associated with a reduced incidence. The predictive model demonstrated satisfactory performance, with an area under the receiver operating characteristic (ROC) curve of 0.789. The calibration curve indicated good agreement between predicted probabilities and observed outcomes.</p><p><strong>Conclusions: </strong>This study identified significant risk factors for re-RD and developed a predictive model with robust clinical relevance. These findings contribute to individualized risk assessment and optimized surgical decision-making in patients undergoing primary RD surgery.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 8","pages":"1047-1056"},"PeriodicalIF":0.9,"publicationDate":"2025-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144871054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Application of a 6Sigma-Based Nursing Intervention to Improve Postoperative Recovery in Patients Undergoing Total Hip Arthroplasty: A Retrospective Study.","authors":"Xing Gu, Jing Guo","doi":"10.62713/aic.4114","DOIUrl":"10.62713/aic.4114","url":null,"abstract":"<p><strong>Aim: </strong>Total hip arthroplasty (THA) is a well-established procedure for treating various hip joint diseases. However, postoperative complications and negative outcomes can affect patient recovery and satisfaction. Conventional perioperative interventions have demonstrated limited effectiveness in addressing these challenges. This study aimed to evaluate the effectiveness of a Six Sigma-based intervention model in patients undergoing THA, with a focus on improving postoperative outcomes, reducing complications, and enhancing patient satisfaction.</p><p><strong>Methods: </strong>A retrospective study was conducted at a single center, including 155 patients who underwent THA between February 2024 to February 2025. Patients were allocated to either a control group (n = 78), which received standard perioperative care, or an experimental group (n = 77), which received Six Sigma-based perioperative care. The intervention included preoperative education, postoperative rehabilitation guidance, and improved communication between healthcare providers and patients. Primary outcomes included postoperative complications, length of hospital stay, pain levels (visual analog scale (VAS)), hip joint function (Harris Hip Score), functional independence measure (FIM), kinesiophobia (Tampa Scale for Kinesiophobia-11 (TSK-11)), and mental health status (self-rating anxiety scale (SAS), self-rating depression scale (SDS)). Patient satisfaction was evaluated using a custom questionnaire.</p><p><strong>Results: </strong>No significant differences were observed between the two groups regarding demographic characteristics, American Society of Anesthesiologists (ASA) classification, surgery duration, or intraoperative blood loss (<i>p</i> > 0.05). The experimental group experienced significantly shorter hospital stays and earlier postoperative ambulation (<i>p</i> < 0.001). At 8 days postoperatively, the experimental group demonstrated significantly higher Harris and FIM scores, and lower TSK-11 scores compared to the control group. Additionally, the experimental group had significantly higher activities of daily living (ADL) and World Health Organization Quality of Life-BREF (WHOQOL-BREF) scale, and significantly lower SAS and SDS scores (<i>p</i> < 0.05). Pain scores (VAS) at 48 hours postoperatively were significantly lower in the experimental group (<i>p</i> < 0.001). Patient satisfaction was also significantly higher in the experimental group compared to the control group (<i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>The Six Sigma-based perioperative intervention significantly improved clinical outcomes in THA patients by reducing recovery time, enhancing functional recovery, and improving psychological well-being and patient satisfaction. This model represents an effective approach for optimizing perioperative care in patients undergoing THA.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 8","pages":"1057-1063"},"PeriodicalIF":0.9,"publicationDate":"2025-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144871055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sandwich Technique for Iliac Aneurysm Rupture After Treatment of Iatrogenic Type B Aortic Dissection: A Case Report.","authors":"Rocco Cangiano, Marta Ascione, Alessia Di Girolamo, Francesca Miceli, Sabrina Grimaldi, Andrea Molinari, Luca Di Marzo, Wassim Mansour","doi":"10.62713/aic.3955","DOIUrl":"10.62713/aic.3955","url":null,"abstract":"<p><strong>Aim: </strong>Type B iatrogenic acute aortic dissection (IAAD) is a rare complication of diagnostic or interventional cardiac procedures. The STent Assisted Balloon Induced intimaL dISruption and rElamination in aortic dissection repair (STABILISE) technique is being increasingly used for the treatment of complicated aortic dissections. However, hemodynamic changes and the pre-existence of aneurysmal arteries could lead to \"unexpected\" complications.</p><p><strong>Case presentation: </strong>This case report shows how rescue techniques can be employed in response to such challenging handling situations, especially in emergency settings. We describe the case of a patient with bilateral common iliac artery (CIA) aneurysm subjected to coronary angiography followed by iatrogenic type B acute aortic dissection (TBAAD), treated with the STABILISE technique, further complicated with left iliac aneurysm rupture on the 9th postoperative day. During aortic bifurcated endograft deployment, the contralateral gate opened into the false lumen (FL), and it was impossible to re-enter the true lumen (TL).</p><p><strong>Results: </strong>As a rescue solution, an iliac extension was deployed parallel to the main body, using the sandwich technique, extending to the external iliac artery. Before deployment, the left hypogastric artery was embolized with coils. Despite the false lumen of the right iliac aneurysm being perfused by the patent contralateral leg, the ruptured aneurysm was excluded. At a later stage, the right hypogastric artery was embolized with several coils, and the gate was embolized using an Amplatzer™ Vascular Plug.</p><p><strong>Conclusions: </strong>In complex cases, especially with dissections, the unexpected is around the corner. The use of off-the-shelf devices, knowledge of rescue techniques as Parallel Graft Technique (PGT) and experience in applying them can resolve situations that might otherwise be disastrous.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 8","pages":"994-998"},"PeriodicalIF":0.9,"publicationDate":"2025-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144871062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}