Frontiers in Surgery最新文献

Intracranial aneurysms (IAs) are uncommon in children, with an incidence of 1%-5%. However, intracranial dissecting aneurysms (IDA) account for a higher proportion (20%-50%) of all aneurysms in this age group. Pediatric IDAs typically result from vascular wall injury, potentially associated with genetic predisposition, congenital defects, or trauma. These lesions most commonly present with ischemic stroke, while subarachnoid hemorrhage (SAH) is relatively rare. Early symptoms include headache and vomiting, with severe cases potentially leading to neurological deficits. Digital subtraction angiography (DSA) remains the gold standard for diagnosis. Timely diagnosis and intervention are critical for improving prognosis. Treatment options include pharmacological therapy, endovascular intervention, and microsurgical repair. This report details a case of a 14-year-old male diagnosed with a dissecting aneurysm in the communicating segment of the left internal carotid artery (ICA). Emergency endovascular intervention with coil occlusion of the parent artery was performed. Short-term follow-up demonstrated favorable outcomes without new neurological deficits. The clinical characteristics of this condition are briefly reviewed in the context of this case.

This report presents a case of hepatic encephalopathy (HE) induced by a spontaneous splenorenal shunt (SSRS). A 73-year-old male patient was admitted to our medical facility due to loss of consciousness. Laboratory analyses revealed elevated blood ammonia levels and varying degrees of reduction in erythrocyte, leucocyte, and platelet levels. Portal vein imaging utilizing 320-slice CT demonstrated enlargement of the portal and splenic veins, splenomegaly, multiple varicose veins at the splenic hilum, and local protrusion of the left renal vein. An initial diagnosis of HE with SSRS and hypersplenism was established. A multi-disciplinary treatment approach was implemented, incorporating a patient-doctor collaborative decision-making model. Two treatment options were presented to the patient, who opted for surgical intervention over interventional treatment. Subsequently, a combined splenectomy and splenorenal shunt vessel ligation procedure was performed. Postoperatively, the patient's condition exhibited significant improvement compared to his pre-operative state, with no recurrence of HE observed. This article reports a case of recurrent hepatic encephalopathy and severe hypersplenism related to SSRS, which was successfully treated by combined splenectomy and vascular disconnection.

Objective: Bladder neck contracture (BNC) is a challenging postoperative complication of transurethral resection of the prostate (TURP), especially in patients with small-volume prostates (<40 mL) who are at high risk. This retrospective study aimed to evaluate the efficacy and safety of local betamethasone injection in preventing BNC following TURP in this specific population.

Methods: Clinical data of 248 patients with small-volume benign prostatic hyperplasia (BPH) who underwent TURP at Zhuhai People's Hospital from January 2017 to December 2023 were retrospectively analyzed. Patients were divided into two groups: the betamethasone injection group (n = 128) receiving 8 mg betamethasone injected into the submucosal layer of the bladder neck (3, 6, 9, and 12 o'clock positions) during surgery, and the control group (n = 120) undergoing TURP without betamethasone injection. All procedures were performed using standardized bipolar plasma TURP without bladder neck incision. Baseline characteristics, intraoperative parameters, and postoperative outcomes were collected. The primary endpoint was the incidence of BNC within 12 months of follow-up, diagnosed based on clinical symptoms, uroflowmetry (maximal urine flow <10 ml/sec), and cystoscopy. Secondary endpoints included the incidence of other postoperative complications.

Results: The baseline characteristics of the two groups were comparable (all p > 0.05). During the 12-month follow-up, the incidence of BNC in the betamethasone injection group was significantly lower than that in the control group (2.3% vs. 10.8%, p = 0.004). Multivariate logistic regression analysis identified local betamethasone injection as an independent protective factor against BNC (OR = 0.20, 95% CI: 0.06-0.69, p = 0.011), while prostate volume ≤30 mL was an independent risk factor (OR = 3.21, 95% CI: 1.08-9.53, p = 0.036). There were no significant differences in the incidence of other postoperative complications (urinary tract infection, secondary hemorrhage, urethral stricture, urinary incontinence) between the two groups (all p > 0.05).Conclusion: Local injection of betamethasone during TURP significantly reduces the incidence of BNC in patients with small-volume prostates without increasing perioperative complications. This intervention targets the inflammatory and fibrotic mechanisms underlying BNC and serves as a safe and effective adjuvant strategy to optimize surgical outcomes in this high-risk population.

This study introduces a novel "tunnel method" for single-position laparoscopic nephroureterectomy in women with upper urinary tract urothelial carcinoma (UTUC), enabling complete resection of the kidney and entire ureter while preserving the uterine round ligament during dissection of the intramural ureter and bladder cuff excision. By creating a tunnel-like space beneath the round ligament via precise dissection of the uterine broad ligament, this technique avoids round ligament transection, thereby maintaining pelvic anatomical integrity, reducing risks of pelvic organ prolapse, minimizing postoperative adhesions, and preserving reproductive and pelvic function-particularly critical for women of childbearing age or those at risk of prolapse. This innovative approach ensures effective oncological resection while prioritizing female-specific anatomical and functional considerations, providing a more comprehensive and patient-centered treatment option for UTUC.

Purpose: To compare perioperative and oncologic outcomes between robotic surgical platforms (Si vs. Xi) in rectal carcinoma.

Methods: A retrospective cohort study of 86 robotic rectal cancer resections (Si: n = 31; Xi: n = 55) were analyzed at Tianjin Medical University Cancer Hospital between November 2019 and June 2024.

Results: Among 86 patients with comparable baseline clinicopathological variables (all p > 0.05), the Xi system showed superior perioperative efficiency: shorter operation (226.7 vs. 282.1 min, p = 0.010), console (p = 0.016) and docking times (p = 0.013), less blood loss (83.8 vs. 155.8 mL, p = 0.005), and a shorter postoperative stay (7.8 vs. 9.7 days, p = 0.016). On multivariable analyses, Xi remained independently associated with a shorter operative time (p = 0.002), reduced blood loss (p = 0.027), and decreased length of stay (p = 0.038). Complication rates, lymph node yield, and short-term oncologic quality indicators (distal resection margin [DRM], circumferential resection margin [CRM], mesorectal integrity) were comparable between two systems (all p > 0.05). In low rectal cancers (≤ 5 cm from the anal verge) with balanced baselines, Xi achieved a higher sphincter preservation rate (90.5% vs. 55.6%, p = 0.049). Survival trends numerically favored Xi (3-year DFS 79.8% vs. 73.0%; OS 92.0% vs. 83.0%), but differences were not significant (DFS: p = 0.54; OS: p = 0.26). On Cox regression, TNM stage independently predicted both DFS (p = 0.041) and OS (p = 0.029). However, the robotic platform (Xi vs. Si) showed no survival advantage (DFS: HR = 1.33, 95% CI 0.53-3.37, p = 0.548; OS: HR = 1.43, 95% CI 0.76-2.67, p = 0.267).

Conclusions: Compared with Si, the Xi platform confers measurable perioperative advantages-shorter operative time, less blood loss, and reduced hospitalization-without compromising short-term oncologic quality or survival. In low rectal tumors, Xi may facilitate sphincter preservation under comparable baselines. Long-term outcomes appear driven primarily by disease stage rather than platform generation.

Introduction: The optimal surgical strategy for synchronous bilateral pulmonary nodules remains unclear. One-stage bilateral resections may offer logistical and clinical advantages, but safety concerns persist regarding bilateral complications.

Methods: We conducted a systematic review and meta-analysis of studies comparing one-stage vs. two-stage pulmonary resections in adult patients with synchronous bilateral nodules. Ten observational studies were included, encompassing 1,015 patients. Continuous outcomes were assessed using mean differences (MDs) and binary outcomes with odds ratios (ORs), applying DerSimonian and Laird random-effects models. Subgroup and meta-regression analyses were performed. Statistical analyses were conducted using R software (v4.4.1).

Results: One-stage resection was associated with significantly reduced operative time (MD -24.36 min; 95% CI -40.59 to -8.13), shorter hospital stay (MD -2.79 days; 95% CI -4.25 to -1.33), and lower direct surgical costs (MD -5,543.73 USD; 95% CI -6,601.05 to -4,486.40). No significant differences were observed in intraoperative blood loss, persistent air leak, or arrhythmia. Subgroup analysis revealed that the type of pulmonary lesion influenced hospital stay, while meta-regression showed no effect of lobectomy rate.

Conclusions: One-stage bilateral resection demonstrates greater efficiency without increased morbidity, supporting its use in experienced centers. These findings suggest that a single-anesthetic approach may facilitate earlier recovery and timely systemic therapy in selected patients.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251048804, identifier: CRD420251048804.

Introduction: Anterior ankle impingement syndrome (AAIS) is a degenerative condition that causes anterior ankle pain and limited dorsiflexion, especially in athletes. It results from either osseous (osteophytes) or soft tissue (synovial hypertrophy, fibrosis) pathology.

Methods: Although conservative treatments offer temporary relief, arthroscopic surgery has become the preferred approach due to its minimally invasive technique and surgical precision.

Results: Current evidence shows 80%-90% success rates, with significant improvements in visual analog scale scores (mean reduction of 4.1 points) and American orthopedic foot & ankle society scores (mean increase of 28 points), along with low complication rates (2%-7%). However, outcomes are closely linked to the severity of pre-existing osteoarthritis, with 93% success in non-arthritic joints compared to 53% in cases with moderate osteoarthritis. Key research limitations include heterogeneous study designs, small sample sizes, and a lack of long-term data (only 18.6% of studies report ≥5-year follow-up).

Discussion: Future research should focus on standardizing outcome measures, assessing the cost-effectiveness of advanced techniques, and establishing evidence-based protocols for patient selection and rehabilitation. These efforts will help optimize surgical decision-making and enhance long-term outcomes for patients with AAIS.

Lumbosacral transitional vertebrae (LSTV) are a common congenital anomaly that often manifests as chronic low back or radicular pain, a condition clinically referred to as Bertolotti syndrome. One specific cause of Bertolotti syndrome is pseudoarticulation of the L5 transverse process with the sacrum or ilium due to LSTV. Although conventional magnetic resonance imaging (MRI) and computed tomography can identify structural changes, they provide limited functional information regarding sites of active arthropathy. Single-photon emission computed tomography (SPECT-CT) enables the localization of metabolically active pseudoarthrotic joints, thereby improving patient selection and surgical planning. We present the case of a 52-year-old woman with Bertolotti syndrome who presented with severe chronic axial back pain and left-sided pain radiating along portions of the L5 and S1 dermatomes. MRI revealed no significant compression of the neural elements but did demonstrate an incidental Tarlov cyst at S1, measuring 5.7 mm × 5.7 mm. SPECT-CT demonstrated localized, abnormal uptake between an anomalous left L5 transverse process and the sacrum. The patient underwent minimally invasive, image-guided removal of the left L5 transverse process, isolating L5 vertebral motion from the iliac crest. She was discharged on postoperative day 1 with significant improvement in her pain and radiculopathy. At 6-week, 3-, and 6-month follow-up, she reported near-complete resolution of presurgical radicular pain, functional restoration, and a return to normal activities. This case highlights the utility of SPECT-CT in evaluating Bertolotti syndrome. Functional imaging enabled precise structural localization of the pain generator, while targeted minimally invasive resection provided durable symptom relief.

Objective: To evaluate the feasibility, technical nuances, and clinical outcomes of using the LVIS stent as a bridging device for the salvage treatment of a malapposed Lattice flow diverter (FD) in a giant posterior circulation aneurysm.

Methods: We present a detailed case report of a patient with a giant aneurysm in the V4 segment of the vertebral artery. Following implantation of a Lattice blood flow diverter and coils, immediate post-procedural angiography revealed incomplete opening and malapposition at the proximal segment of the stent, accompanied by delayed distal flow. After unsuccessful attempts to improve wall apposition via microcatheter massage, a salvage strategy was employed by deploying an LVIS stent within the malapposed FD segment. This approach aimed to enhance overall wall apposition and metal coverage to achieve ultimate aneurysm occlusion.

Results: The salvage procedure was performed successfully. The LVIS stent was accurately deployed within the malapposed segment of the FD. Angiographic assessment after the procedure demonstrated complete wall apposition of the composite stent construct and total occlusion of the aneurysm sac. The patient experienced no new neurological deficits during the perioperative period. Short-term follow-up indicated an excellent clinical outcome, with a modified Rankin Scale score of 0.

Conclusion: Utilizing the LVIS stent as a bridging salvage strategy is a safe and effective technical option for managing malapposed FDs in complex giant posterior circulation aneurysms. This technique effectively enhances stent wall apposition and structural integrity, potentially promoting intra-aneurysmal thrombosis and eventual occlusion. It provides a valuable clinical approach for managing this challenging complication.

Purpose: To investigate the risk factors associated with prolonged postoperative length of stay (PLOS) in patients undergoing primary total hip arthroplasty (THA) via direct anterior approach (DAA) and develop a perioperative dynamic prediction nomogram for optimizing the perioperative management of THA.

Methods: This single-center, retrospective cohort study analyzed the perioperative clinical data of patients who underwent primary THA through DAA by a single surgical team at our institution between September 2022 to September 2024. Patients were divided into two groups based on postoperative hospital stay duration: the normal group (PLOS < 6 days) and the prolonged group (PLOS > 6 days). LASSO regression was used to screen variables, multivariate logistic regression was applied to establish the model and then a nomogram was developed. The area under the curve (AUC) of receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA) were adopted to evaluate the performance and clinical applicability of the model.

Results: This study included a total of 413 patients. Multivariate logistic regression analysis revealed that higher body mass index (BMI), longer operation time, American Society of Anesthesiologists classification (ASA) > II, postoperative extra opioid use, postoperative nausea and vomiting (PONV), postoperative blood transfusion, lower preoperative albumin (ALB) levels, and no prior contralateral THA history were independent risk factors for prolonged postoperative hospital stay in patients undergoing primary DAA-THA (P < 0.05). The AUC of the established predictive model was 0.766, indicating good predictive performance. The calibration curve demonstrated good consistency between actual delayed discharge rates and predicted probabilities. DCA showed that the model provided maximum net benefit when the threshold probability ranged from 2% to 85%.

Conclusions: BMI, operation time, ASA classification, postoperative extra opioid use, PONV, postoperative transfusion, preoperative ALB, and previous contralateral THA history can be used as predictive factors. The LASSO regression-based model for predicting prolonged hospital stay after primary DAA-THA demonstrates accurate predictive performance and strong clinical utility. It can assist clinicians in stratifying patient risk effectively, thereby supporting enhanced recovery protocols.