BJS Open最新文献

{"title":"Splenic hilum nodal involvement in resected left-sided pancreatic cancer: meta-analysis.","authors":"Caro L Bruna, Charlotte E Baggerman van Houweninge, Faridi S Jamaludin, Guiseppe Malleo, Mohammad Abu Hilal, Marc G Besselink, Jony van Hilst","doi":"10.1093/bjsopen/zrag153","DOIUrl":"10.1093/bjsopen/zrag153","url":null,"abstract":"<p><strong>Background: </strong>Splenectomy is standard of care during left pancreatectomy for pancreatic ductal adenocarcinoma (PDAC) to obtain adequate lymphadenectomy. However, evidence supporting this approach is lacking. Splenic preservation would reduce short-term morbidity and is essential for emerging oncological adjunctive therapies, including immunotherapy and personalized cancer vaccines. This study reviewed the incidence of splenic hilum nodal involvement (SHNI) in left-sided PDAC.</p><p><strong>Methods: </strong>A systematic review of the PubMed, Embase, and Cochrane databases was performed, identifying studies published from inception to July 2026. Outcomes of interest were the rate of SHNI (station 10), overall survival, and the rate of splenic artery nodal involvement (SANI; station 11). Meta-analyses were conducted using random-effects models. Subgroup analyses for SHNI were performed per tumour localization (pancreatic neck, body, tail).</p><p><strong>Results: </strong>Among 2776 screened studies, 22 with 2260 patients undergoing left pancreatectomy for PDAC were included. The pooled prevalence of SHNI was 3.7% (95% confidence interval (c.i.) 2.2% to 6.2%); 1.1% for pancreatic body PDAC (95% c.i. 0.3% to 4.3%) and 9.7% for pancreatic tail PDAC (95% c.i. 3.5% to 24.0%). SHNI was not significantly associated with survival (pooled hazard ratio 2.05; 95% c.i. 0.89% to 4.72; P = 0.072). The pooled prevalence of SANI was 39.1% (95% c.i. 25.1% to 55.1%).</p><p><strong>Conclusion: </strong>In patients undergoing left pancreatectomy for PDAC, the presence of SHNI is rare, particularly in pancreatic body cancer (1.1%). These findings suggest that the relevance of routine splenectomy remains unclear, especially for pancreatic body PDAC. However, because the quality of current evidence is low, further investigation in prospective studies is required.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"10 5","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13563183/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outpatient non-operative treatment of uncomplicated acute appendicitis: meta-analysis.","authors":"Mauro Podda, Adolfo Pisanu, Fausto Catena, Marco Ceresoli","doi":"10.1093/bjsopen/zrag138","DOIUrl":"10.1093/bjsopen/zrag138","url":null,"abstract":"","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"10 5","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13560070/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148918348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Familial adenomatous polyposis-associated desmoid disease: comprehensive review.","authors":"Benjamin Zare, Susan Clark, Palma Dileo, David Liska, Andrew Latchford","doi":"10.1093/bjsopen/zrag089","DOIUrl":"10.1093/bjsopen/zrag089","url":null,"abstract":"<p><strong>Background: </strong>Familial adenomatous polyposis (FAP)-associated desmoid disease is a rare but important manifestation of FAP and remains a major cause of morbidity and mortality. In contrast to sporadic desmoids, which most commonly occur in the abdominal wall or extra-abdominal sites, approximately 70% of FAP-associated desmoids arise intra-abdominally, usually within the small bowel mesentery. These lesions can cause bowel and ureteric obstruction, sepsis, intestinal failure, and death. This review summarizes current evidence regarding the pathogenesis, risk factors, diagnosis, surveillance, and management of FAP-associated desmoid disease, and identifies key evidence gaps.</p><p><strong>Methods: </strong>A literature search was performed in accordance with PRISMA methodology using Medline, Embase, PROSPERO, Cochrane, Campbell, and Joanna Briggs Institute databases. Original research studies, reviews, and guidelines relating to desmoid disease, FAP-associated desmoid disease, and FAP published up to August 2025 were eligible. Data were extracted and synthesized narratively by topic.</p><p><strong>Results: </strong>Aberrant Wnt/β-catenin signalling resulting from a germline APC pathogenic variant and a somatic second hit underpin the development of FAP-associated desmoid disease. Established risk factors include a distal APC pathogenic variant, positive family history, and previous abdominal surgery. Diagnosis in patients with established FAP is usually clinicoradiological, and routine biopsy is generally unnecessary, except in select circumstances. Active surveillance is now recommended as first-line management for most patients because many lesions remain stable or regress spontaneously. Surgery is primarily reserved for complications, particularly in small bowel mesenteric disease, owing to substantial operative morbidity and a lack of demonstrated survival benefit from complete resection. Systemic therapy is indicated for progressive or symptomatic disease. Tyrosine kinase inhibitors and the γ-secretase inhibitor nirogacestat have demonstrated efficacy in randomized trials, although patients with FAP-associated disease comprise only a small proportion of enrolled patients. Evidence supporting the use of non-steroidal anti-inflammatory drugs and anti-oestrogens remains limited.</p><p><strong>Conclusion: </strong>Important evidence gaps remain regarding optimal imaging strategies, predictors of aggressive disease, clinically meaningful trial endpoints, and FAP-specific treatment algorithms. Dedicated studies in genetically defined FAP cohorts are required to improve risk stratification and management.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"10 5","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13621219/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149073381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Disparities in pathways for anaemia care and recovery among women after major abdominal surgery: secondary analysis of a prospective cohort study in 29 countries.","authors":"Sivesh Kathir Kamarajah, Dharani Hapangama","doi":"10.1093/bjsopen/zrag125","DOIUrl":"10.1093/bjsopen/zrag125","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Anaemia is a common modifiable risk factor in surgery, yet how it is recognized and managed in women across different surgical pathways is unknown. This study aimed to evaluate anaemia prevalence in women and its management across surgical pathways and life stages, examine associations with 30-day outcomes, and estimate the potential benefit of anaemia correction.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A secondary analysis was conducted of a prospective cohort study from 427 hospitals in 29 countries, including women having elective major abdominal surgery. The primary exposure was surgical pathway (gynaecology versus non-gynaecology), used as a pragmatic proxy for pathway design. Preoperative anaemia and perioperative iron therapy were conceptualized as mediators; menopausal status (pre- versus postmenopausal, by age) was a prespecified effect modifier. Coprimary outcomes were 30-day unplanned readmission and days alive and out of the hospital 30 days from surgery (DAOH30). Mixed-effects logistic regression was used with a hospital random intercept for readmission, and quantile regression for DAOH30. A 2000-iteration cluster bootstrap estimated absolute risk reduction and number needed to treat (NNT = 1/absolute risk difference) for counterfactual anaemia correction in key subgroups. Natural-effects models assessed whether recorded perioperative iron therapy partly explained the pathway differences in readmission.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 10 114 women (median age 57.6 years (interquartile range 48.0-69.0)) were included; 3590 (35.5%) were premenopausal and 3214 (31.8%) underwent gynaecological surgery. Preoperative anaemia was present in 29.0% and was more frequent in non-gynaecology than gynaecology (31.9% versus 22.8%). Thirty-day unplanned readmission occurred in 7.2%. In adjusted models, the gynaecology pathway had lower odds of readmission than non-gynaecology (adjusted odds ratio 0.78, 95% confidence interval 0.62 to 0.97), whereas preoperative anaemia was associated with higher readmission (adjusted odds ratio 1.28, 1.06 to 1.56). Lower perioperative iron use in non-gynaecology partly mediated the pathway gap (indirect effect odds ratio 1.06, 1.02 to 1.09; proportion mediated 15.2%). The largest model-based absolute risk difference was observed among women of premenopausal age undergoing non-gynaecological surgery: predicted readmission was 11.8% with anaemia versus 6.4% without anaemia, corresponding to an absolute risk difference of 5.32% and an NNT estimand of 19. Median DAOH30 was 26 days (interquartile range 23-28). Anaemia was associated with fewer days at home, with the largest decrement among those with poorest recovery (10th percentile β -3.0 days, 95% confidence interval -4.0 to -2.0), a smaller reduction at the median (β -1.0 days, -1.3 to -0.72), and no difference at the 90th percentile.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;For women, pathway design, not only patient risk, shapes whethe","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"10 5","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13623008/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149079566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors for idiopathic granulomatous mastitis: scoping review.","authors":"Rute S S Castelhano, Leah Argus, Daniel Ahari, Goonj Johri, Emma MacInnes, Shaneel Shah, Christopher Darlow, Vijay Sharma, Rudresh Shukla, Iain Lyburn, Nisha Sharma, Roisin Bradley, Cliona C Kirwan","doi":"10.1093/bjsopen/zrag137","DOIUrl":"10.1093/bjsopen/zrag137","url":null,"abstract":"<p><strong>Background: </strong>Idiopathic granulomatous mastitis (IGM) is a rare, benign, inflammatory breast condition. The diagnostic challenge can cause delays in diagnosis and treatment. The quality of evidence for the diagnosis and management of IGM is low. A scoping review of existing literature was conducted to determine risk factors for IGM, with the aim of informing clinical suspicion, earlier diagnosis, and treatment of this condition.</p><p><strong>Methods: </strong>A scoping review of the MEDLINE, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) databases (2003-2023) was performed following PRISMA-ScR guidance. Data on demographics, reproductive history, hormonal factors, body mass index (BMI), and smoking were extracted and subjectively compared to appropriate published population demographics of the relevant risk factors.</p><p><strong>Results: </strong>In all, 230 studies involving 13 062 patients were included. Most common countries of publication origin were Turkey (86 papers; 5233 patients), the USA (30 studies; 764 patients), and China (23 papers; 3990 patients), with three papers (25 patients) from the UK. Most common ethnicities reported were Hispanic (36%), Turkish (20%), White (9%), and Middle Eastern (8%). The mean age (34.7 years) was consistent across the literature, except for UK publications (mean age 50 years). High rates of history of pregnancy (> 90%) were reported, except for UK papers (68%); 64-85% of patients had a history of lactation; and the prevalence of hyperprolactinaemia (reported in 18% of papers) was 5% (versus 0.4% in the general population). BMI appears to match age and country-equivalent BMIs, with no association with diabetes. Smoking association is inconclusive.</p><p><strong>Conclusion: </strong>Risk factors for IGM appear centred on reproductive, hormonal, ethnicity, and possibly geographical factors, although the data are limited by inconsistent reporting, small study sizes, and retrospective study designs.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"10 5","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13623002/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149079614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term oncological outcomes after nipple-sparing mastectomy and implant-based immediate breast reconstruction in a population-based cohort of breast cancer patients.","authors":"Helena Sackey, Ira Oikonomou, Yihang Liu, Axel Frisell, Hannah Coudé Adam, Dhirar Ansarei, Martin Halle, Anna L V Johansson, Jana de Boniface","doi":"10.1093/bjsopen/zrag114","DOIUrl":"https://doi.org/10.1093/bjsopen/zrag114","url":null,"abstract":"<p><strong>Background: </strong>Nipple-sparing mastectomy (NSM) offers superior cosmetic and patient-reported outcomes compared with skin-sparing mastectomy (SSM), although its oncological safety remains debated. This study evaluated recurrence and survival after NSM versus SSM in women with breast cancer receiving implant-based immediate breast reconstruction (IBR).</p><p><strong>Methods: </strong>The population-based Stockholm Breast Reconstruction Database, including all women with breast cancer who underwent implant-based IBR in Stockholm from 2005 to 2015, was reviewed. Data were collected from medical chart review and the National Quality Register for Breast Cancer. The primary outcomes were long-term local recurrence (LR) rates and overall survival (OS) after NSM versus SSM. Survival probabilities and hazard ratios (HR) with their 95% confidence interval (c.i.) were estimated with a maximum 12 years of follow-up.</p><p><strong>Results: </strong>Of 1687 patients registered in the database, this analysis included 1594 implant-based IBRs performed in 1537 women with primary breast cancer. Of these, 86.3% (1376 breasts) had SSM and 13.7% had NSM (218 breasts). The median follow-up was 75 months for SSM and 60 months for NSM. The use of NSM increased from 7.6% in 2005-2007 to 26.6% in 2014-2015 (P < 0.001). LR occurred in 50 breasts, 13 after NSM and 37 after SSM, with a 12-year cumulative incidence of 14.1% for NSM and 3.7% for SSM (P = 0.001). Among the 13 LRs after NSM, 4 (30.8%) were localized in or beneath the nipple-areola complex. The unadjusted HR was 3.18 (95% c.i. 1.67 to 6.03) and remained significant in the multivariable analysis (HR 2.08; 95% c.i. 1.01 to 4.28). OS did not differ significantly (HR 0.74; 95% c.i. 0.38 to 1.44).</p><p><strong>Conclusion: </strong>NSM was associated with an increased risk of LR compared with SSM, whereas no significant association with OS was observed. Whether these results can be attributed to more residual breast glandular tissue needs to be evaluated in further research.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"10 5","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13660700/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"International expert consensus on managing elective hernia repair in patients with Crohn's disease using the Delphi method.","authors":"Hans Lovén, Frederik Helgstrand, Hans Friis-Andersen, Conrad Ballecer, Frederik Berrevoet, Marja Boermeester, Hanna de la Croix, Christine Gaarder, Ismail Gögenur, Nadia Henriksen, William Hope, Kamal Itani, Lars N Jørgensen, Ferdinand Köckerling, Jan Roland Lambrecht, Marc Miserez, Ulf Petersson, Thomas Pinkney, Benjamin K Poulose, Michael Rosen, Jacob Rosenberg, David L Sanders, Dominic Slade, Björn Törnqvist, Thue Bisgaard","doi":"10.1093/bjsopen/zrag172","DOIUrl":"10.1093/bjsopen/zrag172","url":null,"abstract":"<p><strong>Background: </strong>Patients with Crohn's disease (CD) may be predisposed to mesh-related complications such as impaired wound healing and fistula formation following hernia repair. With limited evidence and no established guidelines for hernia repair in CD, this Delphi study aimed to establish a hernia expert consensus on elective inguinal, incisional, and parastomal hernia repair in patients with CD.</p><p><strong>Methods: </strong>A three-round Delphi process including 21 hernia experts from Europe and the USA was conducted between 24 April and 15 October 2025. The primary outcome of interest was a consensus ≥ 75% among participants. Near consensus was defined as ≥ 70% agreement. Statements were developed from participant comments and questionnaire responses. Experts evaluated statements on timing, surgical approach, and mesh selection (synthetic non-absorbable, synthetic absorbable, biosynthetic, biological, and non-mesh) across different CD subtypes in elective inguinal, incisional, and parastomal hernia repair. Patients were categorized into three CD subtypes, namely abdominal fistulizing Crohn's disease (FCD), isolated perianal FCD, and non-FCD, with each assessed in both active and non-active inflammatory disease states.</p><p><strong>Results: </strong>Consensus or near consensus was achieved for 12 of 20 items (60%) in Round 1, 17 of 33 items (52%) in Round 2, and 13 of 29 items (45%) in Round 3. Overall, 42 of 72 unique items reached consensus (34 items) or near consensus (8 items). It was suggested that elective hernia repair should be avoided in CD patients with active inflammation, regardless of abdominal FCD or non-FCD. In non-active CD, synthetic non-absorbable mesh was suggested for inguinal, incisional, and parastomal hernia repair. Standard mesh placement was recommended for inguinal hernias, whereas retromuscular or preperitoneal mesh placement was recommended for incisional and parastomal hernias. No consensus was reached to avoid elective repair in isolated perianal FCD with active inflammation. The use of non-mesh repair, synthetic absorbable, biological, or biosynthetic mesh was generally not recommended in the elective setting.</p><p><strong>Conclusions: </strong>Consensus was reached that CD with non-active inflammation does not require deviation from standard hernia repair principles provided that the mesh is positioned in extraperitoneal positions. However, patients with CD may have an increased perioperative risk and the surgical management should be guided by shared decision-making.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"10 5","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13675246/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Knowledge, practice, and barriers to opportunistic salpingectomy during non-gynaecological surgery: international survey.","authors":"Jeremy Meyer, Manuela Undurraga, Frédéric Ris, Thibaud Koessler, Intidhar Labidi-Galy","doi":"10.1093/bjsopen/zrag145","DOIUrl":"10.1093/bjsopen/zrag145","url":null,"abstract":"","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"10 5","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13617668/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Smoking, obesity and reoperation after elective open mesh repair of umbilical hernia: nationwide cohort study.","authors":"Jeppe Fredberg, Erling Oma, Frederik Helgstrand, Lars N Jorgensen","doi":"10.1093/bjsopen/zrag136","DOIUrl":"https://doi.org/10.1093/bjsopen/zrag136","url":null,"abstract":"<p><strong>Introduction: </strong>Evidence of the effects of obesity and smoking on complication-related reintervention after elective umbilical hernia mesh repair is limited. This study evaluated the association between these factors and reoperation after mesh repair.</p><p><strong>Methods: </strong>A nationwide cohort of elective open umbilical hernia repairs from 2017 to 2020 was identified from prospective registration in the Danish Hernia Database. Patients were followed until 31 December 2023 through nationwide registries and complete scrutiny of operative notes associated with succeeding reinterventions. Study outcomes were reoperation for any complication, recurrence, or non-recurrence complication with special reference to the repair method. Multivariable analyses included cause-specific hazard models with adjustment for body mass index (BMI), smoking status, sex, age, and hernia size.</p><p><strong>Results: </strong>Of the 2391 patients included in the study, 18.4% were smokers and 34.0% were obese (BMI > 30 kg/m2). The follow-up rate was 99.9% over a median of 4.65 years. Reoperation for any complication was increased in smokers compared with non-smokers (hazard ratio (HR) 1.68; 95% confidence interval (c.i.) 1.05 to 2.69; P = 0.032). Reoperation for non-recurrence complications was more frequent in smokers (HR 2.01; 95% c.i. 1.19 to 3.38; P = 0.009) and obese patients (HR 1.83; 95% c.i. 1.12 to 3.00; P = 0.016). Comparable risks of reoperation for hernia recurrence were found between smokers and non-smokers (HR 0.80; 95% c.i. 0.23 to 2.73; P = 0.721) and between patients with and without obesity (HR 0.73; 95% c.i. 0.26 to 2.09; P = 0.559).</p><p><strong>Conclusion: </strong>Reoperation for any complication after open umbilical hernia mesh repair was more frequent in smokers, whereas no independent association was observed between patients with and without obesity. Smoking and obesity were associated with an increased risk of reoperation for non-recurrence complications, while not affecting reoperation for hernia recurrence.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"10 5","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13660690/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of perioperative calcium and vitamin D supplementation in preventing post-thyroidectomy hypocalcaemia: network meta-analysis of randomized trials.","authors":"Vasileios Gkanis, Dimitrios Papaconstantinou, Sophocles Lanitis, Nikolaos Dafnios, Ioannis Papakonstantinou, Konstantinos Nastos","doi":"10.1093/bjsopen/zrag093","DOIUrl":"10.1093/bjsopen/zrag093","url":null,"abstract":"<p><strong>Background: </strong>Post-thyroidectomy hypocalcaemia is the most common complication after total thyroidectomy. Although perioperative calcium and vitamin D supplementation is widely used, the comparative effectiveness of different prophylactic strategies remains uncertain.</p><p><strong>Methods: </strong>A systematic review and Bayesian network meta-analysis of randomized clinical trials was performed according to PRISMA guidelines. PubMed, Scopus, Web of Science, and the Cochrane Library were searched from inception to 7 May 2026. Adult patients undergoing total or near-total thyroidectomy were included. Three strategies were compared: no routine supplementation, calcium alone, and calcium combined with vitamin D analogues. Primary outcomes were clinical hypocalcaemia, biochemical hypocalcaemia, and need for intravenous calcium supplementation; length of hospital stay was secondary. Random-effects network meta-analysis estimated odds ratios with 95% credible intervals. Risk of bias was assessed using RoB 2. The protocol was registered in PROSPERO (CRD420251068837).</p><p><strong>Results: </strong>Twenty randomized trials including 3669 patients were analysed. Calcium plus vitamin D significantly reduced clinical hypocalcaemia versus no supplementation (odds ratio 0.31, 95% credible interval 0.17 to 0.51) and calcium alone (odds ratio 0.52, 0.25 to 1.04). Combination therapy also reduced biochemical hypocalcaemia compared with no supplementation (odds ratio 0.27, 0.17 to 0.42) and calcium alone (odds ratio 0.44, 0.22 to 0.83), and markedly decreased intravenous calcium requirements (odds ratio 0.15, 0.05 to 0.32). Calcium monotherapy showed no significant benefit. Combination therapy ranked as most effective and was associated with shorter length of hospital stay (mean difference 0.44 days).</p><p><strong>Conclusions: </strong>Perioperative calcium combined with vitamin D is the most effective strategy for preventing post-thyroidectomy hypocalcaemia and reducing intravenous calcium use, supporting routine postoperative implementation despite heterogeneity in supplementation protocols.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"10 4","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13330921/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148381639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}