Frontiers in Surgery最新文献

Gallbladder necrosis after gastrectomy is very rare, and intractable hiccups caused by gallbladder necrosis is even more rare. Its clinical presentations and management strategies have not been described in available literature. This report firstly describes the clinical presentations, cause, management strategies, and treatment outcome of intractable hiccups immediately after gastrectomy. When intractable hiccups occurs after gastrectomy and abdominal computed tomography (CT) indicates gallbladder enlargement, gallbladder necrosis should be considered. After cholecystectomy or ultrasound-guided percutaneous gallbladder drainage, the patients were successfully treated.

The peripheral nervous system has the remarkable capacity for spontaneous regeneration after injury. Despite this inherent capability, clinical outcomes remain poor and are often hallmarked by pathophysiologic neuroma formation and limited neurologic recovery. Inflammation is fundamental for successful regeneration but can propagate pathophysiologic outcomes when aberrantly activated. Although the numerous mechanisms whereby nerve regeneration is derailed into a pathophysiologic state have yet to be established, a growing body of research has elaborated the interplay of neuroimmune interactions in successful nerve regeneration. In this review, we synthesize the current understanding of neuroimmune interactions in traumatic peripheral nerve injury, regeneration, and pathophysiology across three domains: (1) resident immune response; (2) innate immune response; and (3) adaptive immune response. Here, we examine the temporal dynamics of immune cell recruitment, polarization, and functional contributions during Wallerian degeneration and regeneration. We propose potential mechanisms of pathophysiologic regeneration, including failed inflammatory resolution and neuroimmune interactions that sustain maladaptive responses. Finally, we aim to connect these basic science mechanisms to current therapeutic strategies. Specifically, we detail how pharmacologic interventions, cellular therapies, energetic stimulation, and hydrogel or conduir-based approaches may modulate the immune response and shape the microenvironment to improve regenerative outcomes. Collectively, a comprehensive understanding of the bidirectional interactions among neural, immune, and other local cell types within the injury microenvironment is critical for developing strategies to improve nerve regeneration and neurologic outcomes.

Objective: To evaluate the safety and efficacy of enhanced recovery after surgery (ERAS) protocols in laparoscopic biliary reoperations for extrahepatic bile duct stones.

Methods: A total of 60 patients with prior biliary surgery were randomly assigned to either an ERAS group or a control group (n = 30 each). Both groups underwent laparoscopic bile duct exploration. Perioperative outcomes, inflammatory markers (CRP, IL-6), and nutritional indicators (prealbumin) were compared. Functional recovery, quality of life (SF-36), and complications were also assessed.

Results: The ERAS group showed significantly shorter time to first flatus, faster ambulation and oral intake, lower pain scores, shorter hospital stays, and reduced hospitalization costs (P < 0.05). Patient satisfaction at discharge and 3 months postoperatively was significantly higher. SF-36 scores at 4 weeks showed better physical function, vitality, and general health in the ERAS group. CRP and IL-6 levels were lower, and prealbumin levels were higher postoperatively in the ERAS group (P < 0.05). The incidence of complications such as severe nausea and vomiting was lower in the ERAS group.

Conclusions: ERAS is a safe and effective strategy in laparoscopic reoperation for extrahepatic bile duct stones. It significantly improves early recovery, reduces inflammation and costs, enhances patient satisfaction, and supports wider adoption of ERAS in hepatobiliary surgery.

Introduction: Nasal dorsal augmentation is a fundamental step of rhinoplasty. It must provide height, projection, but also respect the aesthetic lines. Grafts made with diced-cartilage are moldable and have the capability to adequately adapt to the patient's anatomy. Many techniques have been described, with or without fascia wrapping.

Objective: We describe two variations of the dorsal augmentation technique, using glued diced cartilage with and without semi-circumferential fascia. The cartilage is chopped, placed in a hemi syringe and covered with glue-tissue. A layer of fascia or perichondrium may be used to smooth the graft. It is still malleable and can be finely adjusted to the nose. We illustrate the technique and present the postoperative results; we used questionnaires to measure patients' and surgeons' satisfaction.

Results: We included thirty-three patients, who underwent rhinoplasty with dorsal augmentation between September 2013 and January 2020. Nineteen were reconstructed with fascia, while fourteen, without. We chose the fascia technique mainly for women. There appeared to be greater satisfaction within the group with fascia, but not significant. Patients tended to be more satisfied if it was a first surgery rather than a revision, and if the origin of the deformity was anatomical, rather than post-traumatic or postoperative; women seemed more satisfied than men. There was no correlation between surgeons' and patients' satisfaction.

Conclusion: The choice of surgical technique is made on a case-by-case basis, adapting to the patient's anatomy. We describe two techniques that are relatively simple, easily applicable and at the same time, provide regular and smooth grafts.

Introduction: Three-pedicle haemorrhoidectomy (Milligan-Morgan) has traditionally raised concerns in outpatient settings due to postoperative pain and complications. Since 2015, we have performed this procedure on an outpatient basis. This study aimed to assess patients' views on such care.

Methods: We retrospectively included patients who underwent outpatient haemorrhoidectomy at our centre in 2020. A satisfaction questionnaire was sent. The primary outcome was the proportion of patients reporting good or excellent satisfaction. Secondary outcomes included hospital admissions, postoperative complications, and predictors of dissatisfaction. Ethics approval was obtained.

Results: Among 392 patients, 292 underwent outpatient surgery (74%); 176 (60%) completed the questionnaire. Mean age was 52 ± 12 years; 64% were male. Good or excellent satisfaction was reported by 84% of respondents. Postoperatively, 9% required hospital admission, 48% contacted the hospital (nurse 52%, physician 48%) and 23% had unscheduled visits (clinic 65%, emergency department 35%). Complications occurred in 28% of cases, including discomfort, nausea, bleeding, urinary retention, and faecal impaction. Dissatisfaction was associated with poor preoperative explanations (surgeon p < 0.0001, anaesthetist p = 0.0005), complications (p = 0.0002), phone calls (p = 0.0016), and unscheduled visits (p = 0.0016). Multivariate analysis confirmed poor explanations by the surgeon (OR 0.08; p < 0.001) as an independent predictor. When asked, 79% said they would choose outpatient care again. Negative responses were independently associated with female sex (OR 0.33; p = 0.011), poor explanations (OR 0.11; p = 0.009) and unscheduled visits (OR 3.93; p = 0.02).

Conclusions: Outpatient haemorrhoidectomy is acceptable to the majority of patients. However, thorough information and appropriate organisation are essential. As a result, 95% of these procedures are now performed on an outpatient basis at our centre.

Aim: Surgical site infection (SSI) is the most common hospital-acquired infection in neurosurgery. SSI after craniocerebral surgeries may cause serious harm to the prognosis of patients. Six Sigma management is a new type of management approach, and it reduces possible errors to the minimum by designing and monitoring processes, thereby achieving the highest level of quality and efficiency. However, the role of Six Sigma management in reducing SSI in patients with craniocerebral surgeries is not clear. Our study aimed to explore the effect of Six Sigma management in controlling surgical site infections in neurosurgery patients.

Methods: This was a retrospective study. A total of 546 patients who underwent craniocerebral surgeries and were admitted to Taihe County People's Hospital from January 2021 to December 2021 were selected as the control group. A total of 550 patients who underwent craniocerebral surgeries and were admitted to Taihe County People's Hospital from January 2022 to December 2022 were selected as the study group. The control group adopted routine infection prevention and control methods. The study group adopted Six Sigma management methods. The incidence rate of SSIs, detection rate of pathogenic bacteria, hospital stay, nursing quality, quality of life and nursing satisfaction were compared in both groups.

Results: Compared with the control group, the study group had lower incidence rate of SSIs, lower detection rate of pathogenic bacteria, shorter hospital stay, higher nursing quality scores, higher quality of life scores and better nursing satisfaction (P < 0.05 and P < 0.01).

Conclusions: Six Sigma management can diminish the incidence rate of SSIs, diminish the detection rate of pathogenic bacteria, shorten the hospital stay, promote the nursing quality, promote the quality of life and enhance the nursing satisfaction of patients with craniocerebral surgeries.

Severe cervical kyphosis concurrent with neurofibromatosis type 1 (NF-1) and large intraspinal tumors presents a dual challenge of oncological control and biomechanical reconstruction. We report a rare case of a 14-year-old male with NF-1 secondary to C1-C6 cervical spondylolisthesis, cervical retroversion, retrolisthesis of the C3 vertebral body (less than 1/2 of the vertebral diameter), C2 dislocation, atlantoaxial rotational dislocation, and a large intradural tumor, which caused acute spinal cord compression and neurofunctional deficits. An integrated surgical strategy combining microsurgical tumor resection with 3D-printed corrective fusion was implemented. Intraoperatively, gross total resection (GTR) of the tumor was achieved, followed by precise pedicle screw fixation assisted by patient-specific 3D-printed guides. This comprehensive approach prevented further neurological damage, and the patient achieved satisfactory clinical outcomes postoperatively. NF-1 is an autosomal dominant genetic disorder with an incidence of 1/3,000-1/4,000, characterized by diverse manifestations including skin abnormalities, neurological tumors, and musculoskeletal abnormalities. Approximately 50% of cases arise from de novo mutations.

Case description: A 14-year-old Han male student with no prior medical history was admitted for a 1-year history of a large right neck mass (15 × 9 cm) and 2 months of progressive generalized weakness. Physical examination revealed multiple café-au-lait macules (>30 mm) and a large cervical mass, consistent with NF-1. Neurological assessment showed decreased muscle strength in all limbs (grade 3), indicating incomplete spinal cord injury. Imaging (MRI/CT) demonstrated an intradural-intramedullary tumor extending through the intervertebral foramen, causing severe spinal cord compression and multiplanar instability (C1-C6).The patient was diagnosed with NF-1, severe cervical kyphosis, and an intraspinal tumor. He underwent posterior decompression, microsurgical GTR of the tumor (confirmed as neurofibroma via intraoperative frozen section), and occipitocervicothoracic fusion assisted by 3D-printed guides. The integrated surgery successfully restored spinal stability and decompressed the spinal cord.

Conclusion: Severe cervical retroversion combined with large NF-1 tumors is rare and technically demanding. A precision-medicine-based model integrating tumor management and digital orthopedic technology is essential for such high-risk cases. Preoperative planning using 3D digital technology enabled precise screw placement, while microsurgical techniques ensured safe and complete tumor resection. This integrated strategy effectively prevented permanent neurological deficits and resulted in satisfactory postoperative outcomes.

Background: Posterior osteotomy is an effective treatment for severe kyphosis; however, postoperative complications, particularly early radiographic proximal junctional kyphosis (PJK), may compromise outcomes. Evidence regarding factors influencing postoperative efficacy and complication risk remains limited.

Objective: To compare the clinical efficacy of long-segment vs. short-segment fixation in posterior osteotomy for kyphosis and identify factors affecting outcomes and complications.

Methods: This retrospective controlled study included 150 patients undergoing posterior thoracolumbar osteotomy with fusion and internal fixation between June 2019 and June 2023. Patients were grouped by fixation length: long-segment (group L, ≥5 segments) and short-segment (group S, ≤4 segments). Propensity score matching balanced baseline characteristics, yielding 50 patients per group. Radiographic parameters (Cobb angle, sagittal vertical axis), perioperative data, and 12-month complications were recorded. Pain and function were assessed using VAS and ODI. Multivariate logistic regression identified independent risk factors for correction loss and early radiographic PJK.

Results: Both groups showed significant postoperative improvement in Cobb angle and sagittal alignment (P < 0.05). Group L achieved a higher correction rate, lower Cobb angle loss, better VAS and ODI scores, and fewer early radiographic PJK and fixation-related complications (all P < 0.05). Group S had shorter operative time and less blood loss (P < 0.05), with no difference in other complications. Short-segment fixation was independent risk factors for correction loss and early radiographic PJK.

Conclusion: When correcting spinal kyphosis via posterior osteotomy, long-segment fixation better maintains correction and reduces complications like early radiographic PJK, while short-segment fixation shortens surgery time but increases risks of correction loss and early radiographic PJK.

Objective: To study the effectiveness of bipolar electrocoagulation cutting technology and traditional ultrasonic scalpel cutting technology in Da Vinci robot-assisted thyroid carcinoma surgery.

Methods: We retrospectively reviewed 154 patients with thyroid carcinoma who had undergone ultrasonic scalper (US, n = 81) or Maryland bipolar electrocoagulation (MB, n = 73) cutting in Da Vinci robotic surgery. The operation time, complications, efficacy and other clinical indicators were compared between the two groups.

Results: The operation time of the MB group was significantly reduced (p < 0.05), and the drainage volume was significantly higher than that of the US group (p < 0.05). The postoperative PTH and serum calcium levels of total thyroidectomy in the MB group were higher than those in the US group (p < 0.05), which were (US: 2.07 ± 1.51, MB: 2.42 ± 1.46) and (US: 2.15 ± 0.14, MB: 2.20 ± 0.13).

Conclusion: Bipolar coagulation cutting technology is more precise. Its application in robotic thyroid surgery can significantly shorten the operation time and protect parathyroid function, which has better clinical application prospects.