Frontiers in Surgery最新文献

Objective: Demonstrate the superiority of percutaneous balloon compression (PBC) in the treatment of primary trigeminal neuralgia (PTN) compared to trigeminal microvascular decompression (MVD).

Methods: Clinical data, including immediate, short-term, and long-term pain relief, complications, duration of the operation, and postoperative hospital stay, were retrospectively analyzed for 114 patients diagnosed with PTN who were treated with either PBC or MVD between January 2018 and December 2021.

Results: There were no statistically significant differences observed in the pain relief rates between the two surgical methods at 24 h postoperatively (MVD: 91.07%, PBC: 96.55%), at 6 months postoperatively (MVD: 87.5%, PBC: 94.8%), at 1 year postoperatively (MVD: 83.90%, PBC: 94.80%), and at 2 years postoperatively (MVD: 78.60%, PBC: 72.40%). However, the incidence of meningitis following MVD was significantly higher than that following PBC (P < 0.005). Additionally, both the duration of the operation and the length of the postoperative hospital stay in the MVD group were longer than those in the PBC group (P < 0.005).

Conclusion: PBC demonstrates efficacy comparable to MVD while offering a simpler procedure, improved safety, and a shorter postoperative hospital stay. Therefore, it may serve as a viable alternative to MVD and could become the preferred surgical approach for treating PTN in the future.

Background: There are few literatures comprehensively analyzed the global research in hip prosthesis joint infections (HPJI). We aim to clarify the global research trends and analysis the top 10 cited articles in the HPJI field.

Methods: We identified the core collection of articles/reviews in the HPJI field from 2001 to 2021 through the Web of Science Core Collection (WOSCC). VOSviewer and online bibliometric tool were used to conduct the visualized and knowledge maps. Annual trends of publications, research hotspots and the top 10 cited articles were analyzed.

Results: A total of 5,477 publications were finally included. Generally, an increasing trend was observed in the number of publications from 2001 to 2021. The authors, journals and institutions with largest number of publications all belong to the USA. Co-occurrence analysis of keywords showed that surgical techniques, risk factors, revision surgery strategy, epidemiology, diagnoses and prevention were the 6 major research directions. Total hip arthroplasty, replacement, outcomes, risk factors and diagnosis were the keywords that occurred most frequently. The top 10 cited articles were all published in Journal Citation Reports (JCR) Q1 journals, providing valuable reference value from the perspectives of clinical guidelines, perioperative management, causes and diagnostic methods of infection, epidemiological investigation, risk factors and prognostic analysis.

Conclusions: The number of publications in HPJI field had been on the rise over the past 20 years, from disease management to prevention. An intensive reading of the top 10 cited articles is beneficial to understand the focus of HPJI research comprehensively.

Background: Rotationplasty, an invasive surgery, serves as an alternative to amputation in pediatric orthopedic oncology. It is currently applied in broader cases (e.g., infection, trauma, or malignant tumors). Winkelmann Type BII rotationplasty is a rare procedure with limited literature. Furthermore, no description of rotationplasties where the femur is attached to the sacroiliac joint has been published to date.

Methods: Between September 2022 and March 2023, three patients underwent Type BII rotationplasty. We used the Clavien-Dindo classification to describe postoperative complications and the musculoskeletal tumor society score (MSTS) for functional result assessments.

Results: One patient suffered from multiple complications during the first 6 months postoperatively, one presented a single complication, and one had no complications after 4 and 3 months postoperatively, respectively. Two patients could walk pain-free with the help of crutches. One patient developed a crack on the femur, which did not require surgical revision. They all achieved satisfactory joint amplitudes of at least 50° in passive hip flexion. Unfortunately, one of the patients suffered from lung metastases.

Conclusions: Winkelmann's Type BII rotationplasty is a reliable alternative to hindquarter amputation. Furthermore, we demonstrated that complete resection of the iliac wing and femur fixation through the sacroiliac joint is feasible.

Background: Prepancreatic postduodenal portal vein (PPPV) is a rare anatomic variant where the portal vein (PV) runs anterior to the pancreas and posterior to the duodenum. Only 20 cases of PPPV, all in adults, have been reported in literature. We report the first case of PPPV in a pediatric patient discovered intraoperatively during total pancreatectomy with islet autotransplantation (TPIAT) and the third known case in which the PPPV could be isolated intraoperatively.

Case: A 10-year-old girl with debilitating acute recurrent pancreatitis requiring daily pain medication was admitted for elective TPIAT operation. Genetic workup for hereditary causes of pancreatitis was negative. Preoperative magnetic resonance cholangiopancreatography did not identify an abnormal course of the PV. During operation, dissection of tissues anteriorly overlying the pancreas revealed the variant PV anatomy. The PV was adherent to the anterior neck of the pancreas and coursed cranially posterior to the duodenum. Although prior reports have described PPPVs as thin-walled and fragile, the morphology and caliber of the PPPV appeared normal in our patient. The pancreas was adherent to and coursed between the PV and the superior mesenteric artery. The pancreas was meticulously dissected off the vessels and resected. The PPPV was successfully isolated and preserved for islet infusion later in the procedure. After isolation, 2/3 of islets were infused into the PV, and the remaining 1/3 were placed within the peritoneum due to persistently elevated portal venous pressures. There were no complications during the case, and the patient recovered as expected after operation.

Conclusion: Our case highlights the first reported case of PPPV in a pediatric patient and one of the three instances wherein it could be safely isolated intraoperatively. Recognition of such anatomic variations is crucial for the safety of operations such as TPIAT that include extensive vascular dissection in chronically scarred operative fields.

Background: Human brucellosis is the most common bacterial zoonosis worldwide, with brucella spondylitis (BS) being one of its most severe forms, potentially leading to spinal deformity or paralysis. This study aims to provide a comprehensive overview of the current status and research trends in the BS field using bibliometric methods.

Methods: Publications on BS from January 1, 1980, to March 24, 2024, were retrieved from the Web of Science database. We used Biblioshiny, VOSviewer, Scimago Graphica, CiteSpace, and Microsoft Office Excel Professional Plus 2016 to analyze publication frequency, geographic distribution, institutional affiliations, international collaborations, authorship, journal sources, keyword usage, trends, and cited references.

Results: Between January 1, 1980, and March 24, 2024, 197 publications on BS were analyzed. Turkey emerged as the leading contributor, with 62 publications, accounting for 31.47%. Weibin Sheng was the most prolific author, contributing 7 papers (3.55%). Xinjiang Medical University was the leading institution with 13 documents (6.60%). Medicine and Rheumatology International each published 6 papers (3.05%). CiteSpace analysis highlighted "spinal brucellosis," "spondylitis," "complications," "diagnosis," and "involvement" as the core research areas in BS. Keyword clustering analysis identified 11 primary clusters representing the main research directions. Analysis of abstracts and keyword trends revealed that post-2020, emerging research frontiers include "instrumentation," "management," and "debridement."

Conclusion: There has been significant progress in BS research, with a steady increase in publications. Current research focuses on diagnosis and complications, while future studies may explore management and instrumentation. Increased collaboration among countries and researchers is recommended.

Objective: This study aimed to explore the risk factors of hypokalemia after radical resection of esophageal cancer (EC) and establish a nomogram risk prediction model to evaluate hypokalemia risk after esophagectomy. Thus, this study provides a reference for the clinical development of intervention measures.

Methods: Clinical data of EC patients who underwent radical surgery from January 2020 to November 2022 in the First Affiliated Hospital of Guangxi Medical University were retrospectively collected. The relevant variables were screened using multivariate logistic regression analysis with IBM SPSS 25.0 and R 4.2.0 software, and a nomogram for predicting hypokalemia risk was established. The established nomogram was evaluated by receiver operating characteristic (ROC), calibration, and decision curves. The model was also internally validated by 1000 bootstrap resampling methods.

Results: After radical EC resection, the incidence rate of hypokalemia in 213 patients was 19.2% (41/213). The hemoglobin levels, total serum protein, serum albumin, calcium ion concentration, direct bilirubin, prothrombin time (PT), and activated partial thromboplastin time (APTT) were related (p < 0.05). The multivariate logistic analysis showed that the white blood cell count, serum albumin level, direct bilirubin, and operation time were risk factors for hypokalemia after radical EC resection (p < 0.05). The area under the ROC curve (AUC) was 0.764, demonstrating the good discriminative ability of the established nomogram for hypokalemia prediction. The calibration curve showed a good fit between the predicted and actual observed probabilities. The model maintained a high C-index in the internal validation (C-index = 0.758), supporting that the nomogram can be widely used for hypokalemia prediction.

Conclusion: The prediction model for hypokalemia risk with individualized scores based on the patient's white blood cell count, serum albumin level, direct bilirubin, and operation time can screen out high-risk patients who might develop hypokalemia. It is of certain reference value for clinicians to screen and follow up with patients with emphasis and to formulate preoperative and postoperative intervention strategies.

Background: Currently, there is no clear standard for the surgical options for Evans-Jensen Type IV intertrochanteric femur fractures in elderly patients over 65 years old. This study aims to retrospectively analyze and compare the early postoperative limb function and quality of life of patients treated with total hip arthroplasty (THA) and proximal femoral nail antirotation (PFNA) for this type of fracture. We hypothesize that there is no significant difference in complications and postoperative recovery between the two surgical methods.

Methods: A retrospective analysis was conducted on patients over 65 years old with Evans-Jensen Type IV intertrochanteric femur fractures who were treated between 2020 and 2023. The patients were divided into two groups based on the treatment method: the PFNA group (20 cases) and the THA group (20 cases). General patient information, operative time, intraoperative blood loss, time to postoperative mobilization, time to weight-bearing on the affected limb, Harris hip scores at 1, 3, and 6 months postoperatively, excellent and good rates, SF-36 scores, and postoperative complications were recorded.

Results: Compared to the PFNA group, the THA group had a longer operative time (86.7 ± 9.6 vs. 51.5 ± 5.3 min, p < 0.001) and more intraoperative blood loss (212.0 ± 35.5 vs. 76.5 ± 16.1 ml, p < 0.001). However, the THA group had an earlier time to first postoperative mobilization (3.1 ± 1.4 vs. 43.3 ± 13.09 days, p < 0.001) and earlier time to full weight-bearing on the affected limb (33.5 ± 3.1 vs. 77.9 ± 12.0 days, p < 0.001). The Harris hip scores and SF-36 scores at 1, 3, and 6 months postoperatively were higher in the THA group (p < 0.05 for all). There was no significant difference in the overall incidence of postoperative complications between the two groups (p = 0.41).

Conclusion: For elderly patients over 65 years old with Evans-Jensen Type IV intertrochanteric femur fractures, especially those with underlying diseases who cannot tolerate prolonged bed rest, hip replacement surgery (THA) may be preferred. Postoperative patients can begin rehabilitation exercises earlier, preventing the exacerbation of internal medical conditions. Early recovery of hip function on the affected side is faster, and the quality of life of patients is higher.

We report a case of a patient with dilated cardiomyopathy who experienced recurrent ventricular tachycardia (VT) and multiple defibrillations following CRT-D implantation. Due to worsening cardiac function, the patient required surgical implantation of a left ventricular assist device (LVAD) as a bridge to heart transplantation. During the procedure, we used the Ensite three-dimensional mapping system to perform activation and substrate mapping of the VT targets, followed by endocardial and epicardial cryoballoon ablation of clinical VT. Subsequently, during LVAD implantation, dual cryoballoon ablation was applied around the surgical incision site to prevent VT associated with the surgical wound and the implanted device. At the 1-year follow-up, the patient had no recurrence of the original clinical VT and no new ventricular arrhythmias were observed.

Aims: This study compared the hemostatic effects and complications of oxidized regenerated cellulose (ORC) and topical TXA in total knee arthroplasty (TKA), thus providing a reference for the use of ORC as an alternative hemostatic agent to TXA in TKA.

Methods: A total of 105 patients were included in this study and randomized into blank control, ORC, and TXA groups. The primary outcomes were total blood loss, hemoglobin drop (Hb drop), transfusion rates, and incidence of thrombosis. The secondary outcomes included operation time, tourniquet duration, coagulation parameters, inflammation markers, and complication rates.

Results: Total blood loss was 1,002.47 ± 308.58 ml and 964.68 ± 273.00 ml in the ORC and TXA groups, respectively, both significantly lower than that in the blank control group (1,168.94 ± 405.04 ml) (P ₁ = 0.043 and P ₂ = 0.014, respectively). Hb Drop was statistically insignificantly different between the ORC (36.03 ± 12.17 g/L) and TXA (34.32 ± 10.19 g/L) groups (P = 0.555). There was no statistically significant difference in transfusion rate, operation time, tourniquet duration, coagulation parameters, inflammation markers, and complication rates among the three groups.

Conclusion: In conclusion, our prospective randomized controlled trial (RCT) highlights that, oxidized regenerated cellulose (ORC) can reduce postoperative invisible blood loss in total knee arthroplasty and achieve a hemostatic effect similar to topical tranexamic acid (TXA). This provides a safe and effective hemostatic option for patients with severe underlying diseases or contraindications to tranexamic acid.

Clinical trial registration: https://www.chictr.org.cn/bin/project/edit?pid=186370, identifier (ChiCTR2200066633).

Introduction: Hemorrhoidal artery embolization, also known as Emborrhoid, has emerged in recent years as a minimally invasive treatment option for patients with recurrent and unresponsive to medical therapies hemorrhoidal bleeding symptoms. We present here an overview of the profile of rectal artery embolization based on the most relevant and recent literature.

Methods: A comprehensive review of literature on Hemorrhoidal artery embolization, was conducted on PubMed-Medline. The most relevant literature was summarized narratively.

Results: Current literature confirms the feasibility, efficacy and safety of rectal artery embolization for bleeding hemorrhoids. To date, the results of nearly 250 patients who have undergone hemorrhoid embolization have been published in several studies. All these authors have reported high immediate technical success, with also high clinical success, ranging from 63% to 94%, without major complications. Because of its beneficial safety profile, rectal artery embolization represents an attractive option for selected patients. In case of recurrence of bleeding it is possible to consider repeating the embolization procedure. Treatment failure may be due to the presence of anatomical variants such as dominant middle rectal arteries, which can be investigated and treated in the second session if necessary.

Conclusion: Rectal artery embolization represents a valuable addition to the therapeutic armamentarium of bleeding hemorrhoidal disease, if patients are selected appropriately.