Frontiers in Surgery最新文献

Postoperative hypopharyngeal fistula is an uncommon yet serious complication of open surgery for Zenker's diverticulum, with an incidence of approximately 1%-4%. It is associated with local infection, malnutrition, deterioration of the patient's general condition, and an increased risk of subsequent esophageal stricture. The most valuable therapeutic approach is based on surgical reintervention with reinforced closure, adequate drainage, antibiotic therapy, and optimization of hemodynamic and nutritional parameters. Other methods may also be used, including digestive diversion or conservative management strategies such as radiologically guided drainage. We report the case of a 54-year-old man with a large symptomatic Zenker diverticulum who underwent open mechanical diverticulectomy. The immediate postoperative course was uneventful, and the patient was discharged on day six; however, four days later he was readmitted with painful cervical swelling and signs of infection. Cervical CT with oral contrast demonstrated an extensive hypopharyngeal fistula. Broad-spectrum antibiotic therapy was initiated, and on the second day of hospitalization the patient underwent surgical re-exploration with primary closure of the defect reinforced by a muscular flap and adequate drainage, followed by enteral nutritional support. The postoperative evolution was favorable, with complete closure of the fistula. During follow-up, an esophageal stenosis developed but was successfully managed by endoscopic dilatation. This case highlights the rarity and the management challenges of hypopharyngeal fistula following Zenker's diverticulectomy. It underscores the importance of early recognition and timely surgical intervention using a reinforced closure technique, which is considered the most reliable approach according to current literature for managing fistulas in the hypopharyngeal region. Coordinated postoperative care with rigorous monitoring remains essential to achieve favorable outcomes, despite the potential for long-term sequelae such as esophageal stricture.

Background: Postoperative seroma is an underrecognized but clinically relevant complication after parotidectomy, leading to repeated aspirations and patient discomfort. Limited evidence exists on its incidence, risk factors, and clinical course.

Methods: We retrospectively reviewed 527 patients who underwent parotidectomy between 2020 and 2025. Demographics, tumor characteristics, surgical details, and postoperative variables were analyzed. Seroma was defined as fluid accumulation requiring aspiration without evidence of salivary fistula. Persistent seroma was defined as requiring multiple aspirations or persisting beyond 14 days after drain removal. Multivariate logistic regression was performed to identify independent predictors, and subgroup analyses were conducted for persistent seroma.

Results: Seroma occurred in 10.6% of patients. Independent risk factors included anterior tumor location (OR 2.21), larger tumor size (OR 1.58 per cm), body mass index ≥25 (OR 1.76), and use of facelift-type incisions (OR 1.92). Among patients with seroma, 33.9% developed persistent seroma, which was associated with larger tumors, higher BMI, greater aspirated volumes, and longer resolution times. Higher drain output prior to removal was also observed in the seroma group, suggesting that current thresholds for drain removal may be insufficient in high-risk patients.

Conclusion: Anterior tumor location, larger tumor size, elevated body mass index, and facelift-type incisions are significant predictors of postoperative seroma after parotidectomy. Risk-adapted strategies, such as individualized drain removal protocols and early use of compression dressings, may reduce seroma-related morbidity.

Introduction: Vertical femoral neck fractures-those with a Pauwels angle >70°-are an especially demanding subset, notorious for their recalcitrance to fixation and high risk of non-union. We propose a previously unrecognized variant of femoral neck fracture in which the fracture plane is vertical (Pauwels ≥ 90°) and lacks any Gotfried-positive cortical contact, a configuration we designate "reverse-obliquity femoral neck fracture" (ROFNF). This report describes two cases of ROFNF and their respective therapeutic strategies.

Case report: The index patient was a 56-year-old woman who sustained a Pauwels-III femoral neck fracture (95°) after slipping while playing table tennis. The second patient, a 45-year-old male, sustained a right femoral neck fracture (Pauwels III, 90°) during an electric vehicle rollover. Lumbar epidural anesthesia was administered supine on a fluoroscopy-compatible table for both cases. Following unsuccessful closed anatomical reduction, an anterior hip approach was utilized for open reduction. Fixation consisted of three 7.3 mm cannulated screws supplemented by a medial buttress plate; radiographs at 8-9 months confirmed uneventful union in both patients.

Conclusion: We were unable to find any prior description of a femoral-neck fracture whose inclination reaches or exceeds 90° while also failing every Gotfried cortical-support criterion. In the two patients presented, closed manipulation could not restore a stable reduction; instead, an anterior approach with open reduction and a screw-plus-medial-buttress construct produced solid union.

Objective: The aim of this study was to describe the surgical technique of endoscopy-assisted anterior cervical discectomy and fusion (ACDF), to evaluate the advantages, efficacy, and safety of this procedure for the treatment of cervical spondylotic myelopathy (CSM).

Methods: The clinical data of patients with CSM treated with endoscopy-assisted ACDF from January 2023 to December 2023 were retrospectively reviewed. And 35 patients, including 13 females and 22 males, were included in this study. Endoscopic assisted ACDF surgery was described step by step in detail, and clinical and imageological assessment were performed before and after operation and follow-up.

Results: All 35 patients underwent endoscopy-assisted ACDF surgery successfully, and were followed up for 12.9 ± 2.1 months (range 9∼18 months). The operation time was 74.4 ± 10.7 min (range 60∼100 min). Postoperative drainage volume was 14.1 ± 5.8 mL (range 5∼25 mL). No complications were observed. There were no complications, aggravation of neurological symptoms after operation, and the JOA score at the last follow-up was significantly improved compared with that before operation (15.7 ± 0.8 vs. 10.3 ± 1.9, P < 0.001). At the last follow-up, the C2-C7 Cobb angle was significantly higher than that before operation (P < 0.001), and Δ Cobb angle was 7.4 ± 2.5˚, and all patients achieved bony fusion.

Conclusions: Endoscopy-assisted ACDF, which combined the uniaxial spinal endoscopy with traditional ACDF, achieved satisfactory short-term clinical efficacy and safety in the treatment of CSM.

Objective: This study aims to evaluate the clinical value of combining 3D printing technology with customized metal plates in the treatment of long-segment femoral shaft comminuted fractures.

Methods: A retrospective study was conducted on 36 patients with long-segment femoral shaft comminuted fractures who were treated at our hospital between September 2020 and September 2023. Patients were divided into two groups: the conventional group (18 patients), treated with limited open reduction and intramedullary nailing, and the 3D printing group (18 patients), which utilized 3D-printed models and customized metal plates for assisted internal fixation. Intraoperative evaluation metrics included surgical time, number of fluoroscopy exposures, and intraoperative blood loss. Postoperative evaluation metrics included the time to weight-bearing initiation, time to full weight-bearing, and fracture healing time. At 3 months post-operation and at the final follow-up, evaluations were conducted on the knee flexion-extension range of motion (ROM), hospital for special surgery (HSS) score, hip flexion-extension ROM, Harris score, visual analogue scale (VAS) score, and the occurrence of complications. At the final follow-up, lateral displacement, angular deformity, shortening deformity, and the modified radiographic union score for tibia (mRUST) score of the fracture site were evaluated.

Results: The 3D printing group had significantly shorter surgical time and fewer fluoroscopy exposures (both P < 0.001), while intraoperative blood loss was higher but not statistically significant (P = 0.252). The 3D printing group also showed faster initiation of partial weight-bearing, full weight-bearing, and fracture healing (P < 0.001, P < 0.001, P = 0.009). At 3 months and final follow-up, the 3D printing group showed significantly better knee flexion-extension ROM, HSS score, hip flexion-extension ROM, and Harris score than the conventional group (all P < 0.001), while VAS scores showed no significant difference (all P > 0.05). At the final follow-up, the 3D printing group demonstrated better results in terms of lateral displacement, angulation deformity, shortening deformity, and mRUST score (all P < 0.001).

Conclusion: Combining 3D printing technology with customized metal plates in treating long-segment femoral shaft comminuted fractures improves surgical efficiency, fracture reduction and healing quality, and promotes functional recovery.

Giant gallbladder is a rare clinical condition characterized by abnormal gallbladder enlargement, typically defined as a longitudinal diameter exceeding 14 cm or a volume surpassing 1.5 L. The most common pathological etiologies are cholelithiasis and chronic cholecystitis, followed by neoplastic factors, while congenital developmental anomalies and other causes are relatively uncommon. Herein, we report a case of giant gallbladder-induced pyloric obstruction in a patient who presented with nausea and vomiting for two weeks-symptoms that recurred after initial resolution of diabetic ketoacidosis. Abdominal computed tomography (CT) revealed a giant gallbladder with cholelithiasis, and gastroscopy demonstrated an extrinsic compressive bulge in the gastric antrum plus narrowing at the second and third part of duodenum (D2 & D3).The patient was diagnosed with cholelithiasis and chronic cholecystitis leading to giant gallbladder, which caused pyloric obstruction via compression. Management involved initial ultrasound-guided percutaneous gallbladder drainage, followed by laparoscopic cholecystectomy (LC) one week later, and the postoperative course was uneventful. This case highlights that giant gallbladder may present with atypical gastrointestinal symptoms (e.g., isolated nausea and vomiting) and is prone to misdiagnosis, especially in middle-aged and elderly females with comorbidities. Confirmation of the compressive mechanism requires integration of imaging and endoscopic findings; for patients with giant gallbladder complicated by severe adhesions or underlying comorbidities, a two-stage surgical approach (initial decompressive drainage followed by laparoscopic excision) is a safe and effective option.

Aim: To better predict the central lymph node metastasis (CLNM) of patients with isthmic papillary thyroid microcarcinoma (IPTMC) before surgery, we developed a new predictive nomogram based on clinical and ultrasound features and validate its reliability.

Methods: Our study included 160 patients who were hospitalized from January 2016 to December 2024, underwent thyroidectomy with lymph node dissection, and were pathologically diagnosed with IPTMC. These patients were randomly divided into a training group of 112 cases and a validation group of 48 cases. Clinical and ultrasound characteristic data of the patients were collected. Univariate and multivariate logistic regression analyses were conducted on the training group to determine the independent risk factors for CLNM, and a nomogram was established based on these factors to predict the risk of CLNM in patients with IPTMC. The predictive performance of the nomogram was verified using the validation group.

Results: Among the clinical and ultrasound features in the training cohort, we identified four independent risk factors for CLNM: age, tumor size, multifocality, and calcification. A predictive nomogram was developed based on the above four risk factors. The predictive nomogram showed excellent calibration in predicting CLNM, with an area under the curve (AUC) of 0.811 and a concordance index (C-index) of 0.783. The calibration curve of the nomogram was close to the ideal diagonal. In addition, decision curve analysis (DCA) proved that the model had significantly greater net benefits. The validation group verified the reliability of the prediction nomogram.

Conclusions: The nomogram model developed in this study can effectively predict the risk of CLNM in patients with IPTMC before surgery and provide a reference for selecting surgical procedures.

Introduction: Blunt thoracic aortic injury (BTAI) is one of the leading causes of death among trauma patients who sustain high impact thoracic trauma with rapid deceleration. Thoracic endovascular aortic repair (TEVAR) is indicated in high grade injuries and requires a management strategy for the left subclavian artery (LSA). Gore TAG thoracic branch endoprosthesis (TBE) is a newly approved TEVAR device for to maintain LSA patency utilizing a side branch with reported use in acute indications. The anatomic suitability of this device for a population of BTAI patients and optimal inventory for off-the-shelf emergent repairs has not been reported.

Methods: A retrospective analysis of 66 patients admitted to a Level 1 Trauma Center who sustained BTAI between January 2011 and December 2023 and underwent TEVAR was performed. Computed tomography imaging was analyzed on all patients to determine the suitability for repair according to instructions for use (IFU) criteria of the manufacturer.

Results: The distance between the LSA and the injury was less than 2 cm in 59% of patients, representing a possible indication for TBE. The average injury distance in this cohort was 9 mm from the LSA, with 82% of these patients meeting IFU requirements for TBE and 18% requiring standard TEVAR. For patients who met TBE graft requirements, 28 mm, 31 mm, and 34 mm aortic components fit 76% of patients and 10 mm and 12 mm subclavian branches fit 87% of patients. Patients who did not meet IFU requirements for TBE were sized for standard TEVAR with 26 mm, 31 mm, and 34 mm grafts treating 66% of patients.

Conclusions: This study demonstrates key anatomic considerations and models the suitability and optimal TBE inventory drawn from a real-world population of BTAI patients. Despite a vast device catalog for TEVAR, this study demonstrates that carrying three TBE aortic components, two TBE subclavian components, and three standard TEVAR sizes would treat 71% of BTAI patients.