Frontiers in Surgery最新文献

Objective: To investigate whether medium-frequency pulse electrical therapy can effectively shorten the duration of postoperative ileus in gynecological patients.

Methods: Clinical data from 126 eligible gynecological surgery patients from January 2024 to June 2024 were analyzed. Patients were grouped based on whether they received medium-frequency pulse electrical therapy and the initiation time of the therapy. Postoperative time to first flatus was compared between groups.

Results: There was no statistically significant difference in the time to first anal exhaust between patients who received medium-frequency pulsed electrotherapy and those who did not (P = 0.36). Similarly, no significant difference was observed based on the timing of initiation of medium-frequency pulsed electrotherapy (P = 0.70).

Conclusion: Medium-frequency pulse electrical therapy shows no significant effect in shortening the duration of postoperative ileus in gynecological patients.

Background: Total hip arthroplasty (THA) reliably restores function and quality of life in patients with end-stage hip disease. Individuals with end-stage renal disease (ESRD) requiring dialysis are vulnerable to perioperative complications due to immune dysfunction, hemodynamic instability, and impaired wound healing. Evidence on risk-adjusted outcomes remains limited.

Methods: A retrospective cohort study was conducted using the Nationwide Inpatient Sample (2016-2022). Dialysis dependence was identified using ICD-10-CM Z99.2. Primary outcomes included in-hospital mortality, length of stay (LOS), and hospital charges; secondary outcomes were major complications. Propensity score matching (10:1 nearest neighbour) balanced baseline demographics and comorbidities. Survey weights were used for national estimates. Post-matching outcomes were compared using risk ratios (RR) with 95% CIs.

Results: Among 1,957,284 THA patients, 2,730 (0.1%) were dialysis dependent. In unmatched analysis, dialysis dependence was associated with substantially increased in-hospital mortality (1.3% vs. 0.03%; crude RR: 31.9, 95% CI: 22.7-44.9). After 10:1 propensity-score matching, dialysis-dependent patients had 62.5% longer LOS (3.9 vs. 2.4 days, p < 0.01), 95.8% higher hospital charges ($98,454 vs. $60,741, p < 0.01), and persistently elevated in-hospital mortality (matched RR: 10.1, 95% CI: 6.3-16.2). Major complications were significantly more frequent.

Conclusion: Dialysis dependence is a strong independent predictor of higher perioperative morbidity, mortality, and cost following THA. Targeted multidisciplinary optimization and enhanced perioperative care pathways are warranted.

Background: Laparoscopic cholecystectomy (LC) is the gold-standard minimally invasive gallbladder removal procedure. Optimal ventilation during LC requires positive end-expiratory pressure (PEEP) and low tidal volumes (TV) to prevent gastric insufflation (GI), which may cause regurgitation and cardiopulmonary complications.

Method: This strictly retrospective observational study analyzed routine collected data from 60 patients undergoing laparoscopic cholecystectomy between January 2022 and December 2023. Patients were categorized into three groups based on anesthesia records of delivered tidal volumes (6, 8, or 10 mL/kg) during facemask ventilation. While group assignment was performed retrospectively, ventilation parameters were standardized per institutional protocol, ensuring consistent clinical delivery. Patients were divided into Group 1 (6 mL/kg), Group 2 (8 mL/kg), and Group 3 (10 mL/kg). Gastric insufflation was assessed via ultrasonography, and respiratory parameters end-tidal carbon dioxide (PetCO₂), end-tidal oxygen (ETO₂), and peak inspiratory pressure (PIP) were recorded.

Result: GI incidence was significantly higher in Group 3 (60%) vs. Group 1 (15%, p = 0.0079) and Group 2 (20%, p = 0.0225). Group 3 showed greater antral area expansion post-ventilation (504.1 ± 109.8 mm² vs. 420.1 ± 47.1 mm², p = 0.001). PetCO₂ and ETO₂ levels differed significantly across groups (p < 0.001).

Conclusion: The study reveals that Group 2's facemask ventilation may improve preoxygenation and minimize gastric insufflation during laparoscopic cholecystectomy anesthesia induction. Further research is needed due to the small sample size, ultrasonography accuracy issues, and a single-center scenario.

Background: Split liver transplantation (SLT) expands the donor pool, but optimal arterial configuration remains debated. We report outcomes of right-sided in situ SLT with systematic celiac trunk preservation with the right graft.

Methods: Retrospective Multicentre analysis of 36 consecutive adult recipients of right-sided split grafts (2015-2025) with celiac trunk preservation. Primary outcomes included vascular complications, patient/graft survival, and comparison with published benchmarks.

Results: Recipients (mean age 54.0 ± 12.6 years, 53% male) underwent SLT for HCV (30.6%), NASH (19.4%), and other etiologies. Major vascular complications occurred in 12/36 (33%) of cases, though life-threatening events remained uncommon: HAT 2.8%, postoperative PVT 5.6%, arterial stenosis 5.6%. Biliary complications occurred in 25% (ischemic 8.3%, technical 17%). Patient survival was 86% at 1 year and 81% at 3 years. Reoperation rate was 47%, primarily for biliary complications (17%) and intra-abdominal abscess (14%). Retransplantation rate was 11%.

Conclusion: Right-sided SLT with celiac trunk preservation achieves excellent vascular outcomes, with both HAT (2.8%) and PVT (5.6%) rates meeting international benchmarks. These results strongly support this configuration as the preferred technical approach for in situ split liver transplantation.

Introduction: Secondary lymphedema is a chronic swelling of the extremities caused by physical disruption of the lymphatic system, leading to impaired lymph drainage. It frequently develops in cancer patients after surgical removal of lymph nodes and vessels during tumor resection, when reconnection of lymphatic pathways fails. Current clinical therapies are mainly palliative or conservative, with limited therapeutic effects. Therefore, an animal model that closely mimics the chronic and severe characteristics of secondary lymphedema in patients is required to enable mechanistic and therapeutic research.

Methods: To establish a long-term secondary lymphedema model in the mouse hindlimb, a combination of surgical, radiological, and mechanical interventions was designed. A novel surgical procedure termed the folding suture technique was developed to disrupt both the superficial and deep lymphatic networks. Controlled radiation exposure was applied postoperatively to inhibit early-stage lymphangiogenesis, while hindlimb immobilization was introduced to suppress lymphatic pumping and enhance edema formation.

Results: The newly developed model showed a significant and persistent increase in hindlimb paw thickness, with edema sustained for over six weeks. Immunofluorescence analysis demonstrated a markedly reduced number and diameter of regenerated lymphatic vessels compared to previously established models. Functional lymphography using fluorescein isothiocyanate (FITC)-dextran and live indocyanine green (ICG) imaging confirmed diminished lymphangiogenesis and impaired lymphatic flow. Further evaluation using the leg dermal backflow (LDB) staging system-commonly applied in clinical assessment-showed consistently higher severity scores, indicating a robust and irreversible secondary lymphedema phenotype.

Discussion: This study demonstrates that the newly established mouse hindlimb lymphedema model successfully replicates the chronic, severe, and irreversible nature of clinical secondary lymphedema. The combination of the folding suture technique, radiation-induced inhibition of lymphangiogenesis, and immobilization effectively induces and maintains the pathology. This model provides a reliable preclinical platform for in-depth investigation of secondary lymphedema pathophysiology and for the development and validation of novel therapeutic strategies.

Introduction: Robot-assisted laparoscopic pyeloplasty (RALP) is the most common robotic procedure performed in children. The aim was to evaluate the LC of a pediatric urologist experienced in open and laparoscopic surgery, using CUSUM analysis of both operative times and outcomes, to provide a more comprehensive understanding of the learning process.

Methods: This single-centre prospective study included children who underwent RALP for ureteropelvic junction obstruction (UPJO) between February 2021 and October 2024. Demographic, operative and postoperative data were collected. The parameters assessed through CUSUM analysis were total operative time (TOT), plotted using three different reference means; console operative time (COT); and a composite parameter (CP) combining TOT, urological complications, and success.

Results: Twenty-two patients were included. Median age at surgery was 2.1 years, and mean weight 17.1 kg. Mean TOT was 158.1 min, and mean COT was 109.2 min. Median follow-up was 8.8 months. CUSUM-TOT and CUSUM-COT curves, based on the operating surgeon's mean values, identified three phases: introductory (4 cases), proficiency (6 cases), and mastery (12 cases). In contrast, the CUSUM-CP curve revealed only two phases: an introductory phase of 17 patients and a proficiency phase of 5.

Discussion: This study highlights how CUSUM LC analysis in RALP varies depending on both the parameter evaluated and the reference value used. Composite metrics revealed a longer LC than operative time alone, highlighting the influence of postoperative outcomes in assessing surgical competency. These findings emphasize the need for standardized, multidimensional LC assessments in pediatric RALP to better capture the complexity of the learning process.

Objective: To investigate the current status and risk factors of frailty among patients with peripheral artery disease, and to develop a risk prediction model to inform targeted clinical interventions.

Methods: Patients were consecutively recruited for this investigation from August 2024 to May 2025. The study included 499 individuals with peripheral artery disease who were hospitalized in the vascular surgery department of a tertiary hospital in Southwest China. Data were collected using a general information questionnaire, laboratory test results, the Barthel Index, and the Social Support Rating Scale. The Tilburg Frailty Indicator was used to classify patients into a non-frailty group and a frailty group. The dataset was randomly split in a 7:3 ratio into a training set and a validation set. Independent predictors of frailty were identified through univariate and multivariate logistic regression analyses. The risk prediction model was developed using R software. Discrimination of the model was evaluated by plotting receiver operating characteristic (ROC) curves and calculating the area under the curve (AUC), sensitivity, and specificity in both the training and validation sets. Model calibration was assessed using the Hosmer-Lemeshow goodness-of-fit test and calibration curves. Clinical utility was evaluated using decision curve analysis.

Results: Age, hemoglobin level, number of comorbidities, and activities of daily living were identified as independent risk factors for frailty. In the training set, the AUC was 0.771 (95% CI: 0.721-0.821), with a sensitivity of 0.788 and a specificity of 0.808. In the validation set, the AUC was 0.704 (95% CI: 0.620-0.788), with a sensitivity of 0.743 and a specificity of 0.682. The Hosmer-Lemeshow test indicated good calibration in both the training set (χ ² = 7.967, P = 0.435) and the validation set (χ ² = 9.642, P = 0.291). DCA showed that the model provided net clinical benefit within threshold probability ranges of 10%-80% in the training set and 20%-74% in the validation set.

Conclusion: The developed risk prediction model exhibited predictive performance and can assist clinical healthcare providers in identifying populations at high risk of frailty among patients with PAD, thereby providing a reference for developing intervention strategies targeting relevant risk factors.

Background: Despite the global popularity of minimally invasive thread lifts, the absence of standardized protocols has led to significant variations in outcomes. This study establishes China's first expert consensus (T/CAPA 009-2023) on facial thread lift techniques, addressing critical gaps in operator training, material selection, and anatomical precision.

Methods: A multidisciplinary panel analyzed 2,143 PPDO thread procedures (2018-2022) across 35 institutions. The consensus framework integrates: 1) Graded facility/operator requirements (Grade III device management), 2) Anatomical stratification (SMAS, fat layers, ligament anchoring), and 3) Region-specific protocols (upper/mid/lower face, neck) with 14 illustrated surgical designs.

Conclusion: Multicenter data and anatomical studies demonstrate that this consensus framework improves thread lift safety and efficacy, though further RCTs are warranted to confirm long-term outcomes The hierarchical protocol serves as a global benchmark for aesthetic training programs, particularly in Asian facial anatomy.

Background: This retrospective study aimed to compare the efficacy of internal fixation using headless compression screws (HCS) and radial head locking plate (RLP) for comminuted radial head and neck fractures with no more than 3 displaced fragments.

Methods: This retrospective study included 84 patients with radial head and neck fractures treated at Peking University Third Hospital between January 2013 and December 2022, with 38 and 46 patients in the HCS and RLP groups, respectively. The main outcome was the comparison of complications between the two groups. Demographic data, pre-operative time (POT), operation time (OT), and hospital stay time (HST) were also recorded. The Mayo Elbow Performance Score (MEPS), range of movement of the elbow and forearm, and reasons for re-operation were compared between the two groups.

Results: All patients were followed up for an average of 66.4 months (range, 20-135 months). One patient in each group underwent radial head replacement due to non-union, while the remaining patients achieved bone union. There was no statistically significant difference in the clinical outcomes between the two groups (p > 0.0023). Additionally, the re-operation rate due to symptomatic hardware was significantly higher in the RLP group (28.3%) than that in the HCS group (2.6%, p = 0.002).

Conclusion: For internal fixation of comminuted radial head and neck fractures with no more than three displaced fragments, both HCS and RLP achieved good outcomes. However, the RLP increased the incidence of complications and re-operation associated with internal fixation compared to HCS.