Frontiers in Surgery最新文献

Background: At present, consensus on the management of female stress urinary incontinence (SUI) after pelvic radiotherapy is lacking. We aim to assess the clinical effects of mid-urethral sling (MUS) for the treatment of SUI after pelvic radiotherapy in women.

Methods: We conducted a retrospective review of the clinical database of female with SUI after pelvic radiotherapy from June 2015 to February 2022. The clinical efficacy was evaluated by International Consultation on Incontinence Questionnaire-Short Form (ICI-Q-SF) questionnaire, maximum flow rate (Qmax) and postvoid residual (PVR) urine. All patients were reviewed postoperatively in an outpatient clinic.

Results: We identified 26 patients with mean age of 59.35 ± 7.32 years. All the patients who suffered from SUI had a history of gynaecological malignancies and received pelvic radiotherapy. 21 patients (80.77%, 95% CI: 0.621-0.915) were considered to have successfully improved after surgery, the ICI-Q-SF scores were lower than the pre-operative at 2 weeks, 6 months and 1 year postoperatively (P < 0.01). After 1-year follow-up, none of the patients had mesh erosion.

Conclusion: SUI following radiotherapy for the treatment of pelvic malignancy can be challenging to manage. MUS is a highly effective and safe option for the treatment of SUI after radiotherapy, additionally, that proper sling tension is the key to the success of the procedure.

The use of the gastrocnemius muscle flap has become an excellent choice for coverage of Knee Defects. However, the surgical management of gastrocnemius muscle flap in the injuries of the popliteal artery remains a challenging therapeutic problem. The purpose of this manuscript is to present a case of a successful knee gastrocnemius flap in a patient with popliteal artery injuries. In 2024, a 46-year-old woman with a tibia fracture and popliteal artery injury went to the emergency department of Namazi Hospital. In the first step, the external fixator of the tibia bone was performed to fix the fracture. Then, popliteal artery anastomosis was performed. After two weeks, all internal implants were removed due to abscess. Four weeks later, the patient's skin developed necrosis and was repaired using medial hemi gastrocnemius Muscle flaps. We present a case of the successful use of medial hemi gastrocnemius Muscle flaps for Coverage of knee defects in the injuries of the popliteal artery.

Background: Multiple myeloma (MM) is a hematological malignancy characterized by bone marrow infiltration and osteolytic tumor formation. Despite advancements in the treatment of this disease, MM remains incurable and often leads to complications, such as multiple myeloma bone disease (MMBD). Surgical intervention is frequently necessary to manage symptoms associated with bone disease, including pain and fractures.

Methods: A retrospective review was conducted on 135 patients diagnosed with MMBD who had undergone surgery, compared to 190 patients diagnosed with MM who had not undergone surgery and served as controls. Surgical interventions were performed based on typical clinical presentations of myeloma-related bone disease, as indicated by imaging results. Patients who had only undergone percutaneous kyphoplasty or vertebroplasty (PKP/PVP) were excluded from this study.

Results: Among patients who underwent surgery, the spine was the most common site of bone metastasis, accounting for 50% of cases. The number of operations (overall survival [OS], p = 0.82; progression-free survival [PS], p = 0.41) and the order of surgery and chemotherapy treatment (OS, p = 0.85; PS, p = 0.83) did not significantly impact the outcomes. Further, MM patients with surgery exhibited a significant prognostic difference compared to those without surgery (OS, p < 0.0001). The International Staging System (ISS) stage serves as a prognostic factor for MMBD who have undergone surgery, with higher ISS stages indicating worse prognoses.

Conclusions: These results indicate that surgery and chemotherapy together improved patient survival rates compared to chemotherapy alone, thereby facilitating patients' acceptance of systemic chemotherapy. Furthermore, the appropriate timing of surgery contributes to the positive prognoses of patients with MMBD.

Purpose: This study aims to investigate how aspirin influences lumbar degeneration by analyzing the effect of aspirin on patients with low back pain (LBP) and concurrent atherosclerosis.

Methods: Using 1:1 nearest neighbor matching based on propensity score matching (PSM), 73 patients who regularly took aspirin were assigned to the aspirin group, while another 73 patients who did not take aspirin formed the control group. Radiographs were used to measure lumbar lordosis (LL) and intervertebral height index (IHI). Subcutaneous fat tissue thickness (SFTT), paravertebral muscle fat infiltration area (%FIA), cartilage endplate (CEP) Modic changes, and modified Pfirrmann grading scores were performed based on lumbar MRI.

Results: After PSM analysis, confounders between the aspirin and control groups were balanced. A total of 73 pairs of patients were analyzed in this study. The aspirin group showed lower SFTT(L1/2) and a reduced incidence of CEP Modic changes, compared to the control group (both P < 0.05). Additionally, the %FIA and Pfirrmann scores were lower in the aspirin group, particularly in the upper lumbar spine (both P < 0.05). No significant differences were observed in LL and IHI between the aspirin and control groups.

Conclusion: In summary, conservative treatment with aspirin protects against upper lumbar spine degeneration, although its effect on the lower lumbar spine is less pronounced.

Background: Current guidelines recommend preserving at least one of the bilateral pelvic flows in patients with aortoiliac aneurysms. The sandwich parallel graft, using commercially available devices, provides a viable option for patients who fall outside the instructions for use of iliac branch devices. However, gutter endoleak remains a significant challenge.

Case report: A 78-year-old woman with an incidentally discovered small AAA and bilateral CIAAs experienced aneurysmal growth to 42 mm for the abdominal aortic aneurysm (AAA) and 41 mm and 33 mm for the right and left common iliac artery aneurysms (CIAAs), respectively. Morphologic assessment of the aortoiliac aneurysm revealed the nearly 90-degree angles of the bilateral iliac bifurcations and the tortuous path of the internal iliac arteries. The iliac branch device was considered relatively contraindicated and ineligible; therefore, to preserve pelvic blood flow, the decision was made to employ the sandwich parallel graft technique in the left iliac arteries. Following the placement of the sandwich graft within the iliac limb, standard procedures were carried out. However, completion angiography revealed a type IA endoleak and a significant gutter endoleak in the left CIAA extending to the AAA sac. Despite the extension of overlapping zone, the gutter endoleak persisted after a 10 min waiting period. Therefore, we then advanced an 014 wire and a microcatheter to selectively access the gutter endoleak and performed embolization using multiple detachable coils. The final angiography showed complete resolution of the gutter endoleak and computed tomography angiography 1-month postoperatively confirmed the absence of any endoleaks.

Conclusion: This case report highlights that targeted embolization is a feasible and effective treatment for significant gutter endoleak following the sandwich parallel graft technique.

Background: The cornerstone of low anterior resection syndrome (LARS) treatment is self-management, which requires patient engagement. Colorectal surgeons and nurses may use patient-generated health data (PGHD) to help guide patients in their use of self-management strategies for LARS. However, the perspectives of LARS experts on the use of PGHD remain largely unexplored. The objective of this study was to explore the perspectives and experiences of LARS experts regarding the use of PGHD in the management of LARS.

Methods: We utilized purposive snowball sampling to identify international LARS experts, including surgeons, nurses, and LARS researchers with knowledge and expertise in LARS. We conducted individual semi-structured interviews with these experts between August 2022 and February 2024. We performed thematic analysis using the framework method to identify domains and associated themes.

Results: Our sample included 16 LARS experts from five countries. Thematic analysis identified four domains and associated themes. The domains included: data collection practices, data review practices, perceived usefulness, and future directions. Within the data collection practices domain, we found that most experts asked LARS patients to collect some form of PGHD, including bowel diaries, patient-reported outcome measures, or both. Within the data review practices domain, we found that both surgeons and nurses reviewed PGHD. Most participants described finding it difficult to interpret the data and identified time constraints, legibility, and completeness as the most common barriers to reviewing data in clinic. In terms of perceived usefulness, data collection was felt to help clinicians understand symptoms and their impact and assist patients with self-management. The future directions domain revealed that most experts felt that a clinical tool in the form of an online app or website to support data collection and enhance data visualization would be useful. Finally, some participants saw promise in leveraging PGHD to inform the creation of automated treatment algorithms for LARS management.

Conclusions: This study highlights many gaps in the processes of patient-generated LARS data collection and review. A clinical tool including various data collection templates and data visualization prototypes could help to address these gaps. Future research will focus on incorporating the patient perspective.

Background: The main goals of surgery for fistula-in-ano are to completely resolve the condition and maintain optimal anal function. Effective management of the internal opening during and proper postoperative drainage of the intersphincter plane are crucial for achieving successful outcomes. This study evaluated the clinical efficacy of a novel sphincter-sparing technique for treating high transsphincteric anal fistula (HTAF).

Methods: This prospective study included 55 patients with HTAF who underwent closed trans-intersphincteric fistulotomy (CTiF) between July 2021 and April 2022 at our institution. Preoperative anorectal magnetic resonance imaging was performed for all patients. The primary outcome measures assessed the rate of fistula healing while the secondary outcome measures evaluated healing time, Cleveland Clinic Florida fecal incontinence score (CCF-FIS), 11-point visual analog scale (VAS) pain score and postoperative complications.

Results: We included 55 patients with HTAF in this study. During a mean follow-up period of 9.3 months, CTiF achieved a healing rate of 90.91% (50/55). The mean time to recovery was 7.09 ± 1.94 weeks. Four (7.27%) patients developed postoperative urinary retention. At the 6-month follow-up, the CCF-FIS and VAS score were 0 [(0,0) range, 0-3] and 0 [(0,1); range, 0-4], respectively. Two patients with recurrent HTAF recovered after treatment with a transanal opening of intersphincteric space procedure, and three recovered after seton placement.

Conclusions: CTiF is a promising and effective sphincter-sparing technique for treating HTAF. To confirm long-term outcomes, larger sample size prospective randomized controlled trials are required.

[This retracts the article DOI: 10.3389/fsurg.2022.871321.].