Frontiers in Surgery最新文献

Purpose: Sacrococcygeal pilonidal disease (SPD) is a global concern, notably in Southeast Europe and the Middle East. Unroofing curettage (UC), which provides faster recovery, better cosmetic appearance, and lower recurrence rates in the primary cases, was evaluated with the results of recurrent disease.

Methods: This retrospective study included 74 patients with recurrent disease who were over 16 years of age, experienced recurrence after at least one surgical attempt, and underwent unroofing curettage between 2007 and 2019. Operation time, return to work duration, and recurrence rates were assessed.

Results: Mean age of patients was 29.8 ± 10.6 years, and 61 (82.4%) were male. Previous procedures included excision + flap reconstruction, excision + primary closure, and local excision + lay open. Mean operation time for unroofing curettage was 22 ± 5.3 min. Mean durations for return to work and recovery were 5.9 ± 3 days, and 6.5 ± 2.6 weeks, respectively. Mean follow-up duration was 81.6 ± 49 months. Recurrence was only observed in 1 (1.3%) patient. Unroofing curettage showed a mean recurrence-free period of 156.9 months (95% CI [, 152.9-160.9 months).

Conclusion: Unroofing curettage stands out as a low-recurrence approach, likely to persist as a treatment method, especially for a selected group with recurrence.

Objective: To study the anatomic characteristics of gastric peritoneum fascia space and provide a safe surgical approach for laparoscopic radical gastrectomy.

Method: The morphological characteristics of perigastric fascia and fascial space and the course of important blood vessels were observed and studied in 2 fresh adult cadavers, 5 formalin immersed cadavers and 56 patients undergoing total gastrectomy. The hemoglobin, albumin, prealbumin, total protein, operation time, intraoperative blood loss, number of lymph node dissection and the incidence of complications before and after laparoscopic total gastrectomy with different approaches were statistically analyzed.

Results: Through dissecting the cadaver, it is found that the space of the posterior gastric fascia space is suitable for laparotomy and laparoscopic surgery. The space between the prepancreatic fascia and the posterior gastric fascia is located in a plane, and the posterior gastric fascial space is connected with the gastrosplenic space and hepatogastric space. Through three different plane approaches, all can enter the space without blood vessels and nerves, so as to achieve complete gastrectomy. Statistical analysis of patients undergoing total gastrectomy with different approaches showed that there was no significant difference in operation time, intraoperative blood loss, number of lymph node dissection and postoperative complications among the three approaches (P > 0.05). There was no significant difference in postoperative hemoglobin, albumin, prealbumin and total protein (P > 0.05).

Conclusions: The space of the posterior gastric fascia space is suitable for laparotomy and laparoscopic surgery.the application of the anatomical study of perigastric fascial space in laparoscopic radical resection of gastric cancer not only accords with the tumor-free principle of radical resection of tumor, improves the safety of operation, but also reduces the occurrence of complications such as bleeding and important organ injury.

Aim: This study examines the impact of different surgical assistants on robot-assisted Ivor Lewis esophagectomy. It aims to establish a foundation for refining surgical practices and improving patient outcomes.

Methods: The study included patients aged 18-75 with resectable esophageal squamous cell carcinoma, treated at Ruijin Hospital's Department of Thoracic Surgery (May 2015-November 2023). The robot-assisted Ivor Lewis esophagectomy (RAILE) was executed on a cohort of 97 patients, led by a highly experienced thoracic surgeon and assisted by three additional thoracic surgeons. Postoperative complications, including anastomotic leakage, pulmonary and cardiac events, as well as hemorrhages, were assessed using the Clavien-Dindo classification. The da Vinci Surgical System was used, and statistical analysis was performed using SPSS 20.0, with P = 0.05 as the significance threshold.

Results: Of the 97 patients, 50 were in Group A, 23 in Group B, and 24 in Group C. No major differences were found in anastomotic leakage, pneumonia, pneumothorax, severe cardiac complications, chylothorax, and vocal cord paralysis. Assistant C recorded a higher frequency of pleural effusion (45.8%) vs. Assistants A (16.0%) and B (21.7%). The duration of hospital stay was similar across groups, with median durations of 10 days for A, 8 days for B, and 10 days for C.

Conclusion: The study found no significant overall impact of different surgical assistants on postoperative complications in robot-assisted Ivor Lewis esophagectomy. However, pleural effusion rates varied, possibly due to surgical procedure and patient's condition and may be relevant to the assistant's procedure. Future research should involve larger, more varied samples to further validate and refine these findings.

The superficial circumflex iliac artery perforator (SCIP) flap is a widely accepted workhorse flap for covering defects. Although the success rate of SCIP flaps is currently high, flap failure occurs occasionally due to venous congestion. Venous re-anastomosis is the ideal rescue method but is sometimes limited by poor venule condition. The "chemical leech" technique could relieve venous congestion without venous re-anastomosis. However, owing to insufficient offloading, this technique is less effective in free flaps than in fasciocutaneous flaps, especially large-volume flaps. In this case report, we modified the "chemical leech" technique by adding a venous catheter. Congested blood was drained in a 2-way manner, both through a venous catheter and the skin incisions. On the first day, congested blood was mainly drained through the catheter. Intermittent heparin irrigation was required to maintain the blood flow. On days 2 and 3, as the microcirculation improved, the flow regulator was turned down to reduce blood loss. Blood loss through the catheter decreased dramatically from day 4 onward. This was probably due to thrombosis in and around the catheter. Another pathway through the skin still worked until the establishment of microcirculation, which occurred on day 8. Compared to previous "chemical leech" therapy, the modified "chemical leech" therapy was more reliable and could help drain the congested blood on venule level in addition to capillary level, making the blood drainage more efficient.

Background: Malignant ureteral obstruction (MUO) has the potential to result in a range of outcomes, including varying degrees of hydronephrosis and renal impairment. Allium covered metal stents have provided a new, highly effective treatment option for MUO. Our objective was to evaluate the safety and efficacy of the Allium covered metallic stent for the treatment of malignant ureteral obstruction.

Methods: Clinical data of 29 patients who underwent endoscopic insertion of an Allium ureteral stent between October 2019 and August 2021 at Yongchuan Hospital, affiliated with Chongqing Medical University, were analyzed retrospectively. At one, three, six and 12 months after insertion, serum creatinine was measured, the width of the renal pelvis was rechecked under ultrasound guidance, and the position and shape of the stent were checked by abdominal x-ray. Data on long-term stent patency, incidence of complications, changes in renal function and hydronephrosis grade were collected and analyzed. Ureteral stent symptom questionnaire (USSQ) was administered preoperatively and after six months in 22 patients with previous stent history.

Results: Allium covered metal stents (n = 33) were implanted successfully in 29 patients who were followed for three to 22 months, with 32/33 stents remaining patent. Serum creatinine levels decreased in 17 patients (p < 0.001), and hydronephrosis decreased in 24 patients. Clavien-Dindo grade I complications were observed in seven patients, Clavien-Dindo II in one patient, whereas stent displacement and stent encrustation occurred in one patient each (Clavien-Dindo III-IV). USSQ scores had significantly improved six months after stent insertion (p < 0.001).

Conclusions: Allium ureteral stents are a safe and effective treatment option for malignant ureteral obstruction, with good long-term patency, helping to preserve renal function and improve quality of life.

Background: Rectal cancer (RC) commonly affects older patients. Total Neoadjuvant Therapy (TNT) has been introduced to improve local and systemic control of RC. The aim was to present real-world data of older patients receiving TNT followed by surgery after a frailty assessment and verify feasibility and safety of this approach.

Methods: This was a single-center retrospective study which enrolled all patients ≥70 years of age with RC who underwent TNT followed by surgery between November 2017 and April 2022. Data regarding cancer characteristics, neoadjuvant chemoradiotherapy (CRT), and toxicity were recorded. All patients underwent surgery 12-16 weeks after the end of therapy. Intra- and postoperative outcomes were recorded. Pre- and postoperative functional evaluation was carried out.

Results: Fifteen patients were enrolled. Mean age was 74 (70-81) years. Mean distance of the tumor from the anal verge was 5.2 cm. Fourteen patients had positive nodes (93.3%), 11 (73.3%) showed involvement of the circumferential margin (CRM+) and 10 (66.6%) had extramural vascular invasion (EMVI+). Ten patients (66.6%) received mFOLFOX-6 and 5 CAPOX (33.3%) followed by CRT. After CRT, positive nodes were reported in 4 cases (26.6%), CRM+ in 4 (26.6%), and EMVI+ in 1 (6.6%). Transanal total mesorectal excision (taTME) was performed in all cases. Median operative time was 280 min (110-420). Median length of stay was 4 days (3-29). One Clavien-Dindo grade 4 complication, no readmissions, and no variations in pre- and postoperative functional status within 30 days from surgery were reported. No positive distal or CRMs were detected. Three pathologic complete responses were reported (20%).

Conclusions: TNT followed by TME is feasible and safe in older patients, with good clinical and oncologic outcomes. Patient evaluation is crucial for maximizing cancer care in fit older patients.

Acute onset of colonic obstruction caused by colorectal cancer occurs in approximately 14% of Danish patients with colon cancer(1). Given that colorectal cancer is a common cancer with about 4,500 new cases annually, acute onset will occur in a reasonably large number of patients in Danish emergency departments, and all surgeons should be familiar with the treatment principles. A revised guideline from the Danish Colorectal Cancer Group is currently underway, and this status article reviews the latest knowledge and recommendations.

Background: Thoracoscopic repair is a common surgical procedure to treat esophageal atresia (EA). During thoracoscopic surgery, the single-lung ventilation (SLV) technique is used to collapse one of the lungs to obtain a better surgical view. However, SLV is associated with risks in neonates. This study aimed to assess the perioperative benefits and risks of SLV in neonates who underwent thoracoscopic EA repair.

Methods: This single-center retrospective cohort study included all neonates who underwent thoracoscopic repair of EA at the Children's Hospital of Fudan University between January 1, 2016 and December 31, 2021. Neonates were assigned to SLV (Group S) or dual-lung ventilation (DLV, Group D) groups depending on the technique used intraoperatively. The intraoperative and postoperative information of the two groups were compared.

Results: A total of 70 neonates were included in this study. Twenty-nine neonates were assigned to Group S and forty-one to Group D. No intraoperative adverse events were observed in either group. The surgery time of Group S was significantly shorter than that of Group D (81 ± 23 and 99 ± 29 min, respectively, P = 0.004). In contrast, the anesthetic preparation time of Group S was significantly longer than that of Group D (54 ± 22 and 44 ± 16 min, respectively, P = 0.030). The frequency of postoperative adverse events in Group S was similar to that of Group D (31.03% and 40.54%, respectively, P = 0.453).

Conclusion: SLV was associated with a reduced surgery time for thoracoscopic repair of EA and longer anesthetic preparation time compared to DLV. The SLV was as safe as the DLV with potential advantages in thoracoscopic EA repair.

Background: Over the past few decades, fibular grafts have been widely utilized across 86 countries and regions globally for surgical reconstruction of various anatomical sites, including the mandible, upper extremities, lower extremities, spine, and in phalloplasty procedures. The present study aims to systematically investigate the developmental trajectory of fibular graft and identify research priorities for surgeons.

Methods: A bibliometric analysis was conducted by searching the Web of Science Core Collection on April 12, 2024, for articles published between 2004 and 2023 on fibular grafting, using the query TS = ("graft" OR "transfer" OR "flap") AND TS = ("fibular"). We included full-text English articles and reviews, and exclude documents that were not related to fibular grafting or were non-research-oriented publications. GraphPad Prism, CiteSpace, and VOSviewer analyzed publication trends and co-citation networks, providing insights into fibular grafting research.

Results: A total of 2,884 fibular graft publications were analyzed. Out of 86 countries/regions, the United States and China stood out as the main contributors in terms of publication volume, while England had the highest citation rate per publication. The journals with the most publications and citations were The Journal of Craniofacial Surgery and Plastic and Reconstructive Surgery, respectively. Mark K. Wax had the most publications, while Hidalgo DA had the highest co-citation count. The most frequently occurring keywords were "reconstruction" and "mandibular reconstruction." Co-citation reference clustering revealed a growing preference for vascularized fibular grafts over non-vascularized alternatives. The top 10 co-cited references were exclusively focused on mandibular reconstruction. Keyword bursts analysis showed that over the initial 20-year period, identified keywords fall into three main themes: graft design (e.g., osteoseptocutaneous flap, perforator flap), reconstruction areas (e.g., maxilla, extremity, ankle, spine and phalloplasty), and defect causes (e.g., pseudarthrosis, sarcoma, bone tumor). In particular, fibular grafts in phalloplasty represent an emerging trend among various anatomical reconstruction sites. In the last 5 years, there has been a notable rise in interest in 3D planning, virtual surgical planning, augmented reality, and reconstruction accuracy.

Conclusion: The findings offer an in-depth overview of the landscape of fibular graft research, highlighting key contributors and emerging trends.