Pub Date : 2025-12-01DOI: 10.1016/j.soda.2025.100240
Maroon Tohmeh , Marc Haber , Adel Abou-Mrad
Bariatric surgery is an effective treatment for morbid obesity, but procedures like sleeve gastrectomy may lead to complications, including gastroesophageal reflux disease (GERD), esophageal motility disorders, and hiatal hernia. These complications can be particularly challenging in patients requiring long-term pancreatic surveillance, such as those with intraductal papillary mucinous neoplasms (IPMN), where preserving gastric continuity is essential for endoscopic access. This report presents a case of a 64-year old woman with a history of laparoscopic sleeve gastrectomy who developed severe GERD, dysphagia, and postprandial chest pain. Diagnostic workup revealed a large hiatal hernia, gastric sleeve stenosis, and a proximal esophageal diverticulum. Given the complexity of her altered anatomy and need for continued IPMN surveillance, a robotic surgical approach was employed. The patient underwent successful robotic hiatal hernia repair with resection of an 8 cm intrathoracic esophageal diverticulum. Postoperative recovery was uneventful, and she remained symptom-free at 1-year follow-up. This case highlights the value of a robotic approach in managing complex post-bariatric complications while preserving access for essential diagnostic surveillance.
{"title":"Robotic management of a complicated sleeve gastroplasty in a patient with a pancreatic intraductal papillary mucinous tumor (with video)","authors":"Maroon Tohmeh , Marc Haber , Adel Abou-Mrad","doi":"10.1016/j.soda.2025.100240","DOIUrl":"10.1016/j.soda.2025.100240","url":null,"abstract":"<div><div>Bariatric surgery is an effective treatment for morbid obesity, but procedures like sleeve gastrectomy may lead to complications, including gastroesophageal reflux disease (GERD), esophageal motility disorders, and hiatal hernia. These complications can be particularly challenging in patients requiring long-term pancreatic surveillance, such as those with intraductal papillary mucinous neoplasms (IPMN), where preserving gastric continuity is essential for endoscopic access. This report presents a case of a 64-year old woman with a history of laparoscopic sleeve gastrectomy who developed severe GERD, dysphagia, and postprandial chest pain. Diagnostic workup revealed a large hiatal hernia, gastric sleeve stenosis, and a proximal esophageal diverticulum. Given the complexity of her altered anatomy and need for continued IPMN surveillance, a robotic surgical approach was employed. The patient underwent successful robotic hiatal hernia repair with resection of an 8 cm intrathoracic esophageal diverticulum. Postoperative recovery was uneventful, and she remained symptom-free at 1-year follow-up. This case highlights the value of a robotic approach in managing complex post-bariatric complications while preserving access for essential diagnostic surveillance.</div></div>","PeriodicalId":101190,"journal":{"name":"Surgery Open Digestive Advance","volume":"20 ","pages":"Article 100240"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145693543","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}
Pub Date : 2025-12-01DOI: 10.1016/j.soda.2025.100241
Anaïs Prelot-Claudon , Antoine Mathivet , Pr Martin M Bertrand
{"title":"Surgical management of jejuno-jejunal intussuception 7 years after Roux-en-Y gastric bypass (with video)","authors":"Anaïs Prelot-Claudon , Antoine Mathivet , Pr Martin M Bertrand","doi":"10.1016/j.soda.2025.100241","DOIUrl":"10.1016/j.soda.2025.100241","url":null,"abstract":"","PeriodicalId":101190,"journal":{"name":"Surgery Open Digestive Advance","volume":"20 ","pages":"Article 100241"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145624674","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}
Pub Date : 2025-06-01DOI: 10.1016/j.soda.2025.100213
Michael Jose Abílio de Almeida , Gustavo Serafim Rodrigues , Leonardo Antônio Pinto , Erick Guilherme Stoppa , Mariana Pirani Rocha Machado , Loyane Almeida Gama , Guilherme Augusto Soares , Rozemeire Garcia Marques , Madileine Francely Américo , José Ricardo de Arruda Miranda
Background
Sleeve gastrectomy (SG) is a bariatric procedure resulting in long-term weight loss, but detailed studies on gastric contractility and gastrointestinal transit in the same subject are absent. This study aimed to evaluate the effects of SG on gastrointestinal motility in rats using alternating current biosusceptometry (ACB).
Methods
Male Wistar rats were fed with a high sugar-fat diet for 12 weeks and randomly assigned to four experimental groups: Control; Control + SG; Obese; and Obese + SG. GI motility measurements were performed using the ACB technique. Mean gastric emptying time (MGET), mean cecum arrival time (MCAT), and frequency gastric contractility were assessed. Moreover, nutritional, lipid profile, and morphometry analysis, were evaluated 30 days after surgery. Data were analyzed by ANOVA followed by post Tukey or Kruskal-Wallis test followed by Dunn's multiple comparisons test.
Results
SG significantly accelerated both MGET and MCAT compared to controls, indicating faster gastric emptying and orocecal transit. Gastric contractility was severely impaired, with reduced dominant frequency and non-stationary, non-sinusoidal waveforms observed post-SG. Morphometric analysis revealed reduced mucosal and muscularis layer thickness and increased leukocyte infiltration, indicating inflammation and tissue remodeling.
Conclusions
The excision of the gastric greater curvature in SG induced persistent dysmotility, accelerating GI transit and impairing gastric contractile function, accompanied by significant morphometric changes. These alterations may have long-term effects, underscoring the importance of extended follow-up in SG studies.
{"title":"Sleeve gastrectomy elicits alterations in gastric motility and morphometry in obese rats","authors":"Michael Jose Abílio de Almeida , Gustavo Serafim Rodrigues , Leonardo Antônio Pinto , Erick Guilherme Stoppa , Mariana Pirani Rocha Machado , Loyane Almeida Gama , Guilherme Augusto Soares , Rozemeire Garcia Marques , Madileine Francely Américo , José Ricardo de Arruda Miranda","doi":"10.1016/j.soda.2025.100213","DOIUrl":"10.1016/j.soda.2025.100213","url":null,"abstract":"<div><h3>Background</h3><div>Sleeve gastrectomy (SG) is a bariatric procedure resulting in long-term weight loss, but detailed studies on gastric contractility and gastrointestinal transit in the same subject are absent. This study aimed to evaluate the effects of SG on gastrointestinal motility in rats using alternating current biosusceptometry (ACB).</div></div><div><h3>Methods</h3><div>Male Wistar rats were fed with a high sugar-fat diet for 12 weeks and randomly assigned to four experimental groups: Control; Control + SG; Obese; and Obese + SG. GI motility measurements were performed using the ACB technique. Mean gastric emptying time (MGET), mean cecum arrival time (MCAT), and frequency gastric contractility were assessed. Moreover, nutritional, lipid profile, and morphometry analysis, were evaluated 30 days after surgery. Data were analyzed by ANOVA followed by post Tukey or Kruskal-Wallis test followed by Dunn's multiple comparisons test.</div></div><div><h3>Results</h3><div>SG significantly accelerated both MGET and MCAT compared to controls, indicating faster gastric emptying and orocecal transit. Gastric contractility was severely impaired, with reduced dominant frequency and non-stationary, non-sinusoidal waveforms observed post-SG. Morphometric analysis revealed reduced mucosal and muscularis layer thickness and increased leukocyte infiltration, indicating inflammation and tissue remodeling.</div></div><div><h3>Conclusions</h3><div>The excision of the gastric greater curvature in SG induced persistent dysmotility, accelerating GI transit and impairing gastric contractile function, accompanied by significant morphometric changes. These alterations may have long-term effects, underscoring the importance of extended follow-up in SG studies.</div></div>","PeriodicalId":101190,"journal":{"name":"Surgery Open Digestive Advance","volume":"18 ","pages":"Article 100213"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144204199","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}
Pub Date : 2025-06-01DOI: 10.1016/j.soda.2025.100234
I.J. Djoko , G. Bwelle , P.V. Mvondo , W. Kengne , C.N. Ngang , A. Essomba
Introduction
Anal fissure is the most common cause of anorectal pain worldwide. Treatment is based on both medical and surgical methods. Surgical management by internal lateral sphincterotomy is the standard treatment, with well-defined indications. There is a high incidence of anal incontinence following this surgery. In order to reduce the occurrence of this complication, we are conducting a study to evaluate a sphincter-sparing surgical technique for the treatment of anal fissures.
Methodology
We conducted a descriptive cross-sectional study with prospective data collection from January to December 2022 on patients with isolated anal fissure at Yaoundé Central Hospital. Patients fulfilling the inclusion criteria were operated on using the vertical internal midline sphincterotomy technique performed by the same surgical team. Anal incontinence was assessed using the Jorge-Wexner score. Results were analyzed using IBM SPSS 20 software.
Results
15 patients fulfilling the inclusion criteria were operated on; the mean age of this population was 33 years. 60% of fissures were acute. The most frequent indication for surgery was failure and/or unavailability of medical treatment. The average operating time was 30 min. There was very little bleeding or pain, and we recorded one case of postoperative soiling with a Joge and Wexner score of 1 which subsided after one week. No other complications were noted. Healing of the fissure took place between 16 and 30 days post-op.
Conclusion
Preliminary results of mid-thickness vertical sphincterotomy show advantages such as very low morbidity, rapid healing, absence of complications. No major episodes of incontinence were observed in the series using the Joge &Wexner scale.
{"title":"Mid-thickness vertical sphincterotomy: A solution for postoperative anal incontinence?","authors":"I.J. Djoko , G. Bwelle , P.V. Mvondo , W. Kengne , C.N. Ngang , A. Essomba","doi":"10.1016/j.soda.2025.100234","DOIUrl":"10.1016/j.soda.2025.100234","url":null,"abstract":"<div><h3>Introduction</h3><div>Anal fissure is the most common cause of anorectal pain worldwide. Treatment is based on both medical and surgical methods. Surgical management by internal lateral sphincterotomy is the standard treatment, with well-defined indications. There is a high incidence of anal incontinence following this surgery. In order to reduce the occurrence of this complication, we are conducting a study to evaluate a sphincter-sparing surgical technique for the treatment of anal fissures.</div></div><div><h3>Methodology</h3><div>We conducted a descriptive cross-sectional study with prospective data collection from January to December 2022 on patients with isolated anal fissure at Yaoundé Central Hospital. Patients fulfilling the inclusion criteria were operated on using the vertical internal midline sphincterotomy technique performed by the same surgical team. Anal incontinence was assessed using the Jorge-Wexner score. Results were analyzed using IBM SPSS 20 software.</div></div><div><h3>Results</h3><div>15 patients fulfilling the inclusion criteria were operated on; the mean age of this population was 33 years. 60% of fissures were acute. The most frequent indication for surgery was failure and/or unavailability of medical treatment. The average operating time was 30 min. There was very little bleeding or pain, and we recorded one case of postoperative soiling with a Joge and Wexner score of 1 which subsided after one week. No other complications were noted. Healing of the fissure took place between 16 and 30 days post-op.</div></div><div><h3>Conclusion</h3><div>Preliminary results of mid-thickness vertical sphincterotomy show advantages such as very low morbidity, rapid healing, absence of complications. No major episodes of incontinence were observed in the series using the Joge &Wexner scale.</div></div>","PeriodicalId":101190,"journal":{"name":"Surgery Open Digestive Advance","volume":"18 ","pages":"Article 100234"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144240144","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}
Pub Date : 2025-06-01DOI: 10.1016/j.soda.2025.100195
Naveena AN Kumar, Akhil Palod, Sameer Ahmed
{"title":"Thoracoscopic radical total mesoesophagectomy and en bloc total mediastinal lymph node dissection in semi prone position (with video)","authors":"Naveena AN Kumar, Akhil Palod, Sameer Ahmed","doi":"10.1016/j.soda.2025.100195","DOIUrl":"10.1016/j.soda.2025.100195","url":null,"abstract":"","PeriodicalId":101190,"journal":{"name":"Surgery Open Digestive Advance","volume":"18 ","pages":"Article 100195"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144279913","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}
Pub Date : 2025-05-27DOI: 10.1016/j.soda.2025.100209
Sophie Laroche , Jérome Danion , Fabiano Perdigao , Thomas Baron , Eric Savier
In 2012, a 42-year-old man underwent a right hepatectomy with replacement of the inferior vena cava using a PolyTetraFluoroEthylene (PTFE) prosthesis for hepatocellular carcinoma on a healthy liver. Seven years later, the patient was treated with antibiotics for recurrent bacterial infections. Preoperative computed tomography scanner revealed a thrombotic prosthesis into the duodenum. Venous blood flow bypassed the prosthesis via the enlarged azygos system. We described our surgical procedure to remove the prosthesis with a video and reviewed 11 published cases. Our recommendation is to systematically interpose an omentum flap between prostheses and surrounding digestive structures whenever possible.
{"title":"Migration of an inferior vena cava prosthesis into the duodenum (with video)","authors":"Sophie Laroche , Jérome Danion , Fabiano Perdigao , Thomas Baron , Eric Savier","doi":"10.1016/j.soda.2025.100209","DOIUrl":"10.1016/j.soda.2025.100209","url":null,"abstract":"<div><div>In 2012, a 42-year-old man underwent a right hepatectomy with replacement of the inferior vena cava using a PolyTetraFluoroEthylene (PTFE) prosthesis for hepatocellular carcinoma on a healthy liver. Seven years later, the patient was treated with antibiotics for recurrent bacterial infections. Preoperative computed tomography scanner revealed a thrombotic prosthesis into the duodenum. Venous blood flow bypassed the prosthesis <em>via</em> the enlarged azygos system. We described our surgical procedure to remove the prosthesis with a video and reviewed 11 published cases. Our recommendation is to systematically interpose an omentum flap between prostheses and surrounding digestive structures whenever possible.</div></div>","PeriodicalId":101190,"journal":{"name":"Surgery Open Digestive Advance","volume":"18 ","pages":"Article 100209"},"PeriodicalIF":0.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144138133","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}
Pub Date : 2025-05-27DOI: 10.1016/j.soda.2025.100222
Mohammad Mashiur Rahman , Israt Jahan , Akash Saha , Abidur Rahman , Mohammad Emrul Hasan Khan
Introduction
Curative resection for gallbladder carcinoma is extremely rare, as it presents in a very advanced stage. Staging laparoscopy may improve resectability and prevent unnecessary exploration of the abdomen. The purpose of this cross-sectional comparative study was to evaluate the necessity of staging laparoscopy in patients with carcinoma gallbladder in South-Asian setting.
Materials and methods
With clinically diagnosed gallbladder carcinoma, forty-four patients were included in the present study in the Department of Hepatobiliary, Pancreatic, and Liver transplant surgery at a specialized center of South East Asia, from July 2019 to June 2020. Patients were divided equally into two groups: Group I: staging laparoscopy done, and Group II: staging laparoscopy not done. Demographic, clinical, biochemical, various imaging, and peroperative data were collected from patients’ medical records. All these data were compared between two groups.
Results
Demography, clinical, biochemical, and imaging data were similar in both groups. The resectability rate was significantly (P < 0.027) higher in group I (84.6 %) than in group II (45.5 %). Moreover, unnecessary laparotomy was avoided in 36.36 % of cases in group I.
Conclusion
Staging laparoscopy can increase resectability and avoid unnecessary laparotomy; thus, nonsurgical therapy can be initiated early for inoperable cases and improve patient compliance.
{"title":"Assessing resectability of carcinoma gallbladder using staging laparoscopy: A cross-sectional comparative study in the South Asian context","authors":"Mohammad Mashiur Rahman , Israt Jahan , Akash Saha , Abidur Rahman , Mohammad Emrul Hasan Khan","doi":"10.1016/j.soda.2025.100222","DOIUrl":"10.1016/j.soda.2025.100222","url":null,"abstract":"<div><h3>Introduction</h3><div>Curative resection for gallbladder carcinoma is extremely rare, as it presents in a very advanced stage. Staging laparoscopy may improve resectability and prevent unnecessary exploration of the abdomen. The purpose of this cross-sectional comparative study was to evaluate the necessity of staging laparoscopy in patients with carcinoma gallbladder in South-Asian setting.</div></div><div><h3>Materials and methods</h3><div>With clinically diagnosed gallbladder carcinoma, forty-four patients were included in the present study in the Department of Hepatobiliary, Pancreatic, and Liver transplant surgery at a specialized center of South East Asia, from July 2019 to June 2020. Patients were divided equally into two groups: Group I: staging laparoscopy done, and Group II: staging laparoscopy not done. Demographic, clinical, biochemical, various imaging, and peroperative data were collected from patients’ medical records. All these data were compared between two groups.</div></div><div><h3>Results</h3><div>Demography, clinical, biochemical, and imaging data were similar in both groups. The resectability rate was significantly (<em>P</em> < 0.027) higher in group I (84.6 %) than in group II (45.5 %). Moreover, unnecessary laparotomy was avoided in 36.36 % of cases in group I.</div></div><div><h3>Conclusion</h3><div>Staging laparoscopy can increase resectability and avoid unnecessary laparotomy; thus, nonsurgical therapy can be initiated early for inoperable cases and improve patient compliance.</div></div>","PeriodicalId":101190,"journal":{"name":"Surgery Open Digestive Advance","volume":"19 ","pages":"Article 100222"},"PeriodicalIF":0.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144138264","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}
Pub Date : 2025-05-26DOI: 10.1016/j.soda.2025.100211
M. Yadollahi , S. Hamedani
Background
The liver is the most commonly afflicted organ in abdominal trauma, manageable conservatively or operatively. However, debate persists over case selection for operative management. We aimed to evaluate our experience with liver trauma management and provide insights for improved case management.
Methods and Materials
In this retrospective cross-sectional study, all patients with traumatic liver injury over a five-year period were evaluated. Imaging studies were reassessed by radiologists to calculate the Injury Severity Score (ISS). Treatment trends and comparisons between operatively and non-operatively managed patients were analyzed.
Results
A total of 209 patients (mean age 34.72 ± 16.1 years, 79.4 % male) included 45.9 % (n = 96) managed non-operatively and 54.1 % (n = 113) operatively, with 23.9 % (n = 50) mortality. AAST Grade V injuries occurred in 1.9 % (n = 4); 48.3 % (n = 101) had ISS ≥25. AAST predicted operative need (P = 0.037) but not mortality (P = 0.217); ISS predicted mortality (P = 0.041) but not operative management (P = 0.432). Operative predictors included penetrating trauma (aOR=5.12, P = 0.011), transfusion (aOR=1.58, P < 0.001), volume resuscitation (aOR=1.89, P < 0.001), catecholamine use (aOR=2.97, P = 0.017), and AAST IV/V (aOR=4.25, P = 0.006). Mortality correlated with age, lower Glasgow Coma Scale (GCS), and transfusion needs.
Conclusion
ISS excels in mortality prediction, while AAST and resuscitation markers guide operative decisions. Integrating these enhances trauma care precision.
背景：肝脏是腹部创伤中最常见的受累器官，可采用保守或手术治疗。然而，关于手术治疗病例选择的争论仍然存在。我们的目的是评估我们在肝外伤管理方面的经验，并为改进病例管理提供见解。方法和材料在这项回顾性横断面研究中，对所有5年内的外伤性肝损伤患者进行了评估。影像学检查由放射科医生重新评估，以计算损伤严重程度评分（ISS）。分析了手术和非手术治疗患者的治疗趋势和比较。结果209例患者（平均年龄34.72±16.1岁，男性79.4%），其中非手术治疗占45.9% (n = 96)，手术治疗占54.1% (n = 113)，病死率23.9% （n = 50）。AAST V级损伤发生率为1.9% (n = 4)；48.3% （n = 101）的ISS≥25。AAST预测手术需求（P = 0.037），但不能预测死亡率（P = 0.217）；ISS预测死亡率（P = 0.041），但不能预测手术管理（P = 0.432）。手术预测因素包括穿透性创伤（aOR=5.12, P = 0.011）、输血(aOR=1.58, P <；0.001)，容积复苏(aOR=1.89, P <；0.001)、儿茶酚胺使用（aOR=2.97, P = 0.017）和AAST IV/V （aOR=4.25, P = 0.006）。死亡率与年龄、较低的格拉斯哥昏迷评分（GCS）和输血需求相关。结论iss在预测死亡率方面具有优势，而AAST和复苏指标可指导手术决策。整合这些可以提高创伤护理的准确性。
{"title":"Patterns of traumatic liver injury and mortality: A five-year study at shahid rajaei hospital (2018–2023)","authors":"M. Yadollahi , S. Hamedani","doi":"10.1016/j.soda.2025.100211","DOIUrl":"10.1016/j.soda.2025.100211","url":null,"abstract":"<div><h3>Background</h3><div>The liver is the most commonly afflicted organ in abdominal trauma, manageable conservatively or operatively. However, debate persists over case selection for operative management. We aimed to evaluate our experience with liver trauma management and provide insights for improved case management.</div></div><div><h3>Methods and Materials</h3><div>In this retrospective cross-sectional study, all patients with traumatic liver injury over a five-year period were evaluated. Imaging studies were reassessed by radiologists to calculate the Injury Severity Score (ISS). Treatment trends and comparisons between operatively and non-operatively managed patients were analyzed.</div></div><div><h3>Results</h3><div>A total of 209 patients (mean age 34.72 ± 16.1 years, 79.4 % male) included 45.9 % (<em>n</em> = 96) managed non-operatively and 54.1 % (<em>n</em> = 113) operatively, with 23.9 % (<em>n</em> = 50) mortality. AAST Grade V injuries occurred in 1.9 % (<em>n</em> = 4); 48.3 % (<em>n</em> = 101) had ISS ≥25. AAST predicted operative need (<em>P</em> = 0.037) but not mortality (<em>P</em> = 0.217); ISS predicted mortality (<em>P</em> = 0.041) but not operative management (<em>P</em> = 0.432). Operative predictors included penetrating trauma (aOR=5.12, <em>P</em> = 0.011), transfusion (aOR=1.58, <em>P</em> < 0.001), volume resuscitation (aOR=1.89, <em>P</em> < 0.001), catecholamine use (aOR=2.97, <em>P</em> = 0.017), and AAST IV/V (aOR=4.25, <em>P</em> = 0.006). Mortality correlated with age, lower Glasgow Coma Scale (GCS), and transfusion needs.</div></div><div><h3>Conclusion</h3><div>ISS excels in mortality prediction, while AAST and resuscitation markers guide operative decisions. Integrating these enhances trauma care precision.</div></div>","PeriodicalId":101190,"journal":{"name":"Surgery Open Digestive Advance","volume":"19 ","pages":"Article 100211"},"PeriodicalIF":0.0,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144138265","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}
Pub Date : 2025-05-26DOI: 10.1016/j.soda.2025.100212
Guillaume Henry , Catherine Bruant-rodier , Frédéric Bodin
<div><div>Aesthetic enhancement of the abdominal wall is a frequent reason for consulting a plastic surgeon. Abdominoplasty uses a large horizontal scar to remove excess abdominal fat and skin above or below the umbilicus, often resulting from significant weight loss. It can also be used to correct diastasis of the rectus abdominis muscles, which corresponds to the abnormal separation of the two rectus muscles, separated by the linea alba [<span><span>1</span></span>]. Although its exact prevalence is not clearly known, it is a pathology very frequently encountered in plastic surgery, giving a globular and distended look to the abdomen. A classification into four types has been described, based on the distance between the two rectus muscles [<span><span>2</span></span>]. Pregnancy, obesity and diabetes have been cited as risk factors, as they increase intra-abdominal pressure and distend the abdominal wall.</div><div>To achieve the best possible aesthetic result, diastasis must be corrected, ranging from simple suturing of the anterior aponeuroses of the rectus abdominis muscles to more complex aponeurotic plasty procedures or even prostheses.</div><div>In this video, we present the case of a 46-year-old patient with a type D abdominal diastasis, measured at 7 cm, following three pregnancies. This was associated with moderate abdominal skin excess, requiring concomitant skin resection (Fig 1.). We performed a large abdominoplasty with transposition of the umbilicus and cure of diastasis of the rectus abdominis muscles using the technique described by Abrahamson in 1988 [<span><span>3</span></span>] (Fig 2.). This involves creating a new linea alba using an overlap suture between the two anterior aponeuroses of the muscles (Fig 3.). The two lateral parts of the aponeuroses are sutured to this central “beading”, thus reducing the gap between the two muscles (Fig. 4.).</div><div>Postoperatively, the patient had to wear an abdominal girdle and refrain from carrying heavy loads for three months. She had no complications. At the end of the video, we present the early postoperative result.</div><div>The Abrahamson technique enables the correction of large diastasis of the rectus abdominis muscles stronger than the simple plication of the anterior aponeuroses and above all without the use of prosthetic reinforcement.</div></div><div><div>L'amélioration esthétique de la paroi abdominale est un motif très fréquent de consultation en chirurgie plastique. L'abdominoplastie permet, par une grande cicatrice horizontale, de retirer l'excès cutanéo-graisseux abdominal sus ou sous-ombilical, souvent secondaire à une perte de poids importante. Elle peut aussi permettre de corriger un diastasis des muscles grands droits de l'abdomen, qui correspond à l'écartement anormal des deux muscles grands droits, séparés par la ligne blanche [<span><span>1</span></span>]. Bien que sa prévalence exacte ne soit pas clairement connue ; il s'agit d'une pathologie très fréquemment
腹壁的美学增强是咨询整形外科医生的一个常见原因。腹部成形术使用一个大的水平疤痕来去除腹部多余的脂肪和脐上下的皮肤，通常导致体重明显减轻。也可用于矫正腹直肌的滑脱，对应于两直肌的异常分离，由白线分隔。虽然它的确切患病率尚不清楚，但它是整形外科中经常遇到的一种病理，使腹部看起来呈球形和膨胀。根据两条直肌之间的距离，将其分为四种类型。怀孕、肥胖和糖尿病被认为是危险因素，因为它们会增加腹内压力，使腹壁膨胀。为了达到最好的美观效果，必须纠正分离，从简单的腹直肌前腱膜缝合到更复杂的腱膜成形术甚至假体。在这段视频中，我们介绍了一位46岁的D型腹部转移患者，在三次怀孕后测量了7厘米。这与中度腹部皮肤过多相关，需要同时切除皮肤（图1）。我们采用Abrahamson在1988年所描述的技术进行了大面积的腹部成形术，包括脐转位和腹直肌移位的治疗（图2）。这包括在两个前腱膜之间使用重叠缝线创建新的白线（图3）。腱膜的两个外侧部分被缝合到这个中央“头”上，从而减少了两个肌肉之间的间隙（图4）。术后，患者必须系腹带，并避免负重3个月。她没有并发症。在视频的最后，我们展示了术后早期的结果。Abrahamson技术能够矫正大面积腹直肌分离，比简单应用前腱膜更有力，最重要的是不需要使用假体加固。L' amsamlioriation esthesamtique de la paroi腹腔est un motif tricents of consultation en chirurgie plastic。L‘腹部整形许可，par one grande cicatlehorizontal, de retirer L’ excres cutan -graisseux abdominal sus ou sous- obilibilical, souvent secondaire, one perde poids important。Elle我们也permettre de趋向联合国脱骱des肌肉资金所有权de l 'abdomen,对应一个l 'ecartement异常的两个肌肉资金所有权,separes par la线布兰奇[1]。请原谅，请原谅，请原谅，请原谅。在手术过程中，由于手术后的可塑性，出现了明显的小球囊和腹部膨胀。一种四分之一的分类- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -多因素因素导致的风险和其他因素导致的风险和其他因素导致的风险和其他因素导致的风险和其他因素导致的风险和其他因素导致的风险和其他因素导致的风险。在获得了可能的调整期后，调整期是强制性的，因为调整期是可能的；“简单缝合法”是指：“简单缝合法”、“简单缝合法”、“大权利肌肉缝合法”、“过程缝合法”、“复合整形法”、“简单缝合法”、“简单缝合法”、“简单缝合法”、“简单缝合法”。6例患者中，有1例患者患有腺样变性，1例患者患有转移性腹部d型变性，体长7cm，体长7cm。它是一种与excents cutanacei -graisseux - abdominal modsamacest - rest， unsamest - unsamest - cutanacei - conitante（图1）有关的现象。Nous avons re（图2）。在肌肉上使用同一缝合线和同一缝合线（图3）。在“波雷莱”中部和东部，“双侧侧”为双侧侧，“双侧侧”为双侧侧，“双侧侧”为双侧侧（图4）。在opsamatoire后，一个病人在dû上做了一个腹部手术，而另一个病人在手术后做了一个腹部手术。Elle n'a pas eu de complicated。Nous prassentons, la fin de la vidsamo, le resamsulta post opsamatire prsamcoce。亚伯拉罕森技术允许对肌肉分散、腹部重要部位的权利进行一次矫正，再加上简单的肩部肩部肩部肩部肩部肩部肩部肩部肩部肩部肩部肩部肩部肩部肩部肩部肩部肩部肩部肩部肩部。
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