Frontiers in Surgery最新文献

Background: Superior labrum anterior and posterior (SLAP) lesions are a common cause of shoulder pain and instability. Developing accurate, non-invasive diagnostic tools is essential to support clinical decision-making for SLAP lesions. This study aimed to establish an automated diagnostic model for SLAP lesions using a 2.5D deep learning framework combined with ensemble learning and to evaluate its clinical utility.

Methods: In this retrospective study, 185 patients who underwent shoulder arthroscopy between January 2019 and September 2025 were included (91 SLAP lesions, 94 controls). Preoperative shoulder magnetic resonance imaging (MRI) data were analysed. Images from three consecutive slices, centred on the maximal region of interest (ROI), were processed using a Wide_ResNet101_2 network pre-trained on ImageNet for deep feature extraction and probability prediction. A decision-level fusion strategy integrated the predicted probabilities from all three layers as input features for three ensemble classifiers: AdaBoost, Random Forest, and XGBoost. Model performance was assessed with accuracy, area under the receiver operating characteristic curve (AUC), sensitivity, specificity, precision, and F1-score. The DeLong test and integrated discrimination improvement (IDI) were used to compare models.

Results: All ensemble models exhibited robust diagnostic performance. On the test set, the XGBoost model achieved the highest AUC (0.754) and sensitivity (0.933), though specificity was moderate (0.538). The Random Forest model yielded an AUC of 0.745, while the AdaBoost model achieved an AUC of 0.731. F1-scores ranged from 0.75 to 0.80. There were no statistically significant differences in AUC among the models. Feature importance analysis highlighted the central MRI slice as most contributory. Model interpretability assessments showed that the network focused predominantly on the biceps-labral complex, which is anatomically consistent with SLAP pathology.

Conclusions: The proposed automated diagnostic model, utilising a 2.5D deep learning and ensemble approach, demonstrated favourable diagnostic performance and clinical applicability for SLAP lesion detection on shoulder MRI. Among the ensemble strategies, the XGBoost model provided the highest sensitivity, rendering it particularly suitable as a clinical decision-support tool. The multi-slice information fusion framework substantially improved diagnostic accuracy, supporting its potential as a novel artificial intelligence solution to assist radiologists in diagnosing shoulder labral injuries.

Carpal tunnel syndrome (CTS) is most commonly idiopathic or associated with wrist strain, while neoplastic compression, a rare etiology, is easily overlooked. This report describes a 50-year-old male patient presenting with numbness in the 1st to 4th fingers of the right hand. Preoperative electromyography confirmed the diagnosis of CTS, but ultrasonography showed no obvious abnormalities. During single-channel endoscopic carpal tunnel release, a protruding mass was identified at the bottom of the carpal tunnel, which was resected and sent for pathological examination. Immunohistochemical and molecular testing results indicated clear cell sarcoma of soft tissue with a maximum diameter of 4 cm. No BRAF gene V600E mutation was detected, but the EWSR1/ATF1 fusion gene was positive. Following tumor resection and multimodal adjuvant therapy, the patient achieved complete relief of numbness and maintained independent daily living activities at the 12-month follow-up, with stable pulmonary disease. This study analyzes the clinical characteristics, diagnosis, and treatment of the case, combined with a literature review. It suggests that neoplastic compression should be suspected in male patients with recurrent CTS, especially when preoperative imaging is negative, and meticulous intraoperative exploration is crucial. Literature analysis shows that wrist tumors are prone to recurrent nerve compression due to anatomical space limitations, and early identification followed by surgical resection is key to improving prognosis.

Study design: Systematic review and update meta-analysis.

Purpose: This systematic review and meta-analysis was conducted to determine the effect of preoperative (neoadjuvant) chemotherapy with 5-fluorouracil (intraperitoneal) on the integrity of colorectal anastomoses in an experimental rat model.

Overview of literature: Emergency surgery in cancer patients undergoing chemotherapy is associated with an increased risk of complications, including anastomotic leakage, and worse survival outcomes. 5FU is widely used in the treatment of GI tumors. The effect of 5FU on anastomotic integrity has been demonstrated previously; this meta-analysis provides a quantitative assessment of this effect.

Methods: A literature search was conducted using PubMed and Google Scholar in MEDLINE up to May 2025. Only experimental studies on rat models were selected, which compared a Control group (no chemotherapy) and a group receiving intraperitoneal 5FU. The following outcomes were extracted: anastomotic bursting pressure, severity of adhesion formation, and hydroxyproline levels.

Results: Six studies were included in the meta-analysis. Statistically significant results demonstrated the superiority of the Control group over the 5FU group in terms of hydroxyproline levels (p < 0.00001). The severity of adhesion formation was higher in the group treated with 5FU (p = 0.59). The anastomotic bursting pressure was higher in the Control group (p = 0.36).

Conclusions: 5FU had a negative impact on the integrity of the anastomotic suture line, as evidenced by lower hydroxyproline levels. Lower bursting pressure and a higher degree of adhesions were found in the 5FU group; however, these results were not statistically significant.

Traditional biliary surgery equated precision with technical mastery, focusing on flawless dissection and minimizing immediate complications. This article describes a fundamental paradigm shift in how surgical precision is defined. We argue that precision is evolving from technical execution to a comprehensive strategy driven by long-term patient outcomes. The analysis begins by examining limitations of the technique-centric approach. It then details the new paradigm's multidimensional aspects, including preoperative planning, intraoperative function preservation, and tailored postoperative care. The discussion addresses key technologies and conceptual innovations enabling this shift, concluding with future directions. Redefining precision is critically important. It guides personalized therapy, optimizes resource allocation, and advances biliary surgery toward improving long-term quality of life.

Aim of the study: To evaluate the use of staged vs. one-stage surgical management for Hirschsprung's disease (HSD) in older children.

Methods: In total, 30 patients were diagnosed with HSD and all cases were confirmed by rectal biopsy. For treatment, rectal irrigation was carried out for two months to achieve colonic decompression; treatment failure occurred in 15 cases due to decompressed colons. In these cases, colostomy or ileostomy were carried out according to the distal or proximal site of the transitional zone to the transverse colon. After two months, eight cases of Laparoscopic Duhamel and seven cases of laparoscopic-aided Swenson were performed.

Results: An anal dilation program was done three weeks after pull-through. Postoperatively, there were three cases of Swenson cases stenosis and two cases of enterocolitis that responded to conservative treatment and one case of fecal incontinence. In Duhamel cases, we had three cases of constipation and three cases of enterocolitis, with no anastomotic leak cases. Four cases of stomal prolapse and skin excoriation occurred.

Conclusion: Both staged and single-staged procedures are safe options for the management of hirshspung's disease in older children.

Objective: To analyze the characteristics and research hotspots of perianal lesions associated with Crohn's disease (CD) based on the currently published literature.

Methods: We conducted a comprehensive search of all relevant literature on "Crohn's disease" and "Perianal" from the inception of PubMed, Web of Science Core Collection and Scopus database up to December 31, 2024. Using the bibliometric analysis software CiteSpace 6.4. R1, we visualized and scientifically interpreted the authors, countries, and keywords of the included studies.

Results: A total of 4,286 papers were retrieved using the subject terms "Crohn's disease" and "Perianal". According to exclusion criteria, 2,134 papers were included in the final analysis. These studies involved 130 researchers, 360 research institutions, and 148 keywords. The analysis revealed that the number of publications on CD with perianal lesions has increased annually since 1979, indicating growing attention to this condition. The United States led in the number of publications, with 452 related papers. The most prolific authors were Ye, Byong Duk and Lightner, Amy L, with 21 published papers each on the topic. The top five keywords were Crohn's disease (357 times), Inflammatory Bowel Disease (202 times), Perianal Fistula (110 times), Ulcerative Colitis (81 times), and Perianal Disease (37 times).

Conclusion: Current research on CD with perianal lesions is primarily focused on mesenchymal stem cells, intestinal inflammation, and biologic therapies. However, further comprehensive studies are needed to improve the early diagnosis and treatment of CD, particularly when perianal symptoms are the initial manifestation.

Purpose: To compare the pregnancy outcomes of patients with uterine fibroids (UFs) who underwent high-intensity focused ultrasound ablation (HIFU) vs. laparoscopic myomectomy (LM).

Materials and methods: Patients with UFs and fertility undergoing HIFU or LM from January 2020 to June 2023 were included into this retrospective study. The primary outcomes were pregnancy outcomes including the natural pregnancy rate and the median time to pregnancy. Propensity score matching (PSM) was implemented to evaluate the primary outcomes. The secondary outcomes were the risk factors for natural pregnancy among patients with UFs receiving HIFU or LM.

Results: In total, 171 patients were recruited in the HIFU group, while 122 in the LM group. Of them, 60 cases (60/293; 20.5%) achieved pregnancy, including 43 receiving HIFU whereas 17 undergoing LM. After PSM, 75 pairs were acquired. Difference in natural pregnancy rates was not statistically significant between the two groups (HIFU vs. LM: 13.3% vs. 14.7%; p = 0.841). Meanwhile, the interval period of pregnancy was of significant difference between the two groups [HIFU vs. LM: 13.0 (9.5-14.75) months vs. 17.0 (15.0-25.0) months, p = 0.002]. Moreover, as revealed by multivariate logistics regression analysis, age [odds ratio (OR) = 0.899, 95% confidence interval (CI): 0.835-0.969, p = 0.005] and classification of the main fibroids (intramural or submucous vs. subserous: OR = 0.379, 95%CI: 0.158-0.910, p = 0.030) were the independent factors affecting the natural pregnancy among women with UFs who underwent HIFU or LM.

Conclusions: HIFU demonstrated comparable postoperative pregnancy rates to LM and was associated with a shorter median time to pregnancy, suggesting that HIFU may be a potential fertility-sparing treatment for women with UFs. Additionally, age and the classification of main fibroids were identified as the independent factors influencing postoperative pregnancy rates in patients undergoing treatment.

Background: Pertrochanteric fractures are common and challenging for surgeons, especially in unstable conditions. Proximal femoral nails or nails anti-rotation variants are well-established surgical instruments to treat this, but some reports suggest that in unstable situations, hemiarthroplasty provides superior benefits to patients. This study aimed to compare hemiarthroplasty with proximal femoral nails, highlighting the differences to assist surgical decision-making.

Methods: Online databases were searched for eligible studies in accordance with PRISMA guidelines. Results were analyzed across 18 domains, categorized into three branches: function, complication, and perioperative condition and mortality. Effect sizes were calculated, and the heterogeneities thereof were analyzed. We also tested sensitivity, publication biases, and graded certainty of evidence. Finally, comprehensive results were interpreted.

Results: Twenty-seven studies, with a total of 2,517 patients, were included. The hemiarthroplasty performed better than nails in early Harris hip scores, full weight-bearing time, and complication rate related to implants. Proximal femoral nails performed better in terms of surgery duration and superficial infection. No significant differences were observed in final Harris hip scores, general and implant-unrelated complications, mortality, hospital stay, re-operation incidence, bedsores, and deep venous thrombosis. Ambulation time, blood loss, and transfusion incidence showed potential publication bias.

Conclusion: Hemiarthroplasty and proximal femoral nails/nails anti-rotation are effective methods for treating unstable pertrochanteric fractures. No clinically important differences-such as re-operation rates due to implant-related complications-were identified between these two tactics. Surgeons should prioritize internal fixations, barring conditions wherein hemiarthroplasty is essential.