Frontiers in Surgery最新文献

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.

Background: Robotic Radical Prostatectomy has become the dominant surgical approach for localized prostate cancer, offering offers many advantages in postoperative recovery and quality of life. Despite these advances, the standard duration of urethral catheterization- typically 7 days- has remained largely unchanged.

Objective: To systematically evaluate the feasibility and safety of early urethral catheter removal after robotic radical prostatectomy and to identify the optimal timing for catheter removal.

Methods: A systematic review was conducted according to PRISMA guidelines. PubMed, Web of Science, Cochrane Library, Google Scholar and Scopus databases were searched from inception to August 2025. Case reports, non robotic studies and non English publications were excluded Study quality was assessed using the Newcastle-Ottawa Scale for non randomized studies and the Jadad scale for randomized controlled trials.

Results: Thirteen studies involving 4.055 patients met inclusion criteria, including three randomized controlled trials. Early catheter removal was variably defined, most commonly between 1 and 4 post operative days. Across studies early removal was not associated with increased rates of anastomotic leakage, urethral stricture or bladder neck contracture. Continence recovery seams to be occur earlier with early removal although higher short term urinary retention rates were reported. Overall complications and readmission rates were low. Study quality was acceptable despite the limited evidence from high quality randomized studies.

Conclusions: Early catheter removal after robotic radical prostatectomy appears both safe and feasible in appropriate selected patients and may accelerate continence recovery without compromising long-term outcomes. Catheter removal on postoperative days 3-4 appears to offer the most favora.

Background: Surgical fixation for Schatzker IV tibial plateau fractures presents a clinical dilemma: achieving robust stability while avoiding impingement on the pes anserinus tendons. This study evaluated the biomechanical profile of a novel hockey-stick locking plate (NHLP), which is anatomically contoured to address this challenge by being placed anteriorly.

Methods: A finite element model of a standardized Schatzker IV fracture was created. Three fixation methods were simulated: the novel hockey-stick locking plate (NHLP), the traditional T-shaped locking plate (TTLP), and the double reconstruction locking plates (DRLP). The models were subjected to four loading conditions: three physiological loads, a low axial load (500 N), a moderate combined load (1,500 N axial compression plus 150 N anterior shear force), and a high axial load (2,500 N) and a fourth "worst-case" load scenario combining a 1,700 N axial force, a 200 N anterior shear force, and a 10° varus tilt. Key biomechanical metrics, including implant stress, construct stability, fragment displacement, fracture interface mechanics and fatigue safety factor, were analyzed.

Results: Under physiological loading, the NHLP construct demonstrated the lowest peak von Mises stress on the implant. At the high axial load of 2,500 N, the peak stress on the NHLP (159.8 MPa) was 15% lower than that on the TTLP (188.1 MPa) and 35% lower than that on the DRLP (245.5 MPa). In the "worst-case" scenario, all constructs exhibited high safety factors. In terms of stability, the NHLP provided displacement comparable to that of the TTLP, and both were substantially more stable than the DRLP construct, which exhibited the largest displacement under high load. Paradoxically, the DRLP construct consistently resulted in the highest degree of implant stress and the least stability. At the fracture interface, the NHLP maintained a stable environment across all loads, with key metrics remaining within a range conducive to bone healing.

Conclusion: This finite element analysis demonstrated that the NHLP provides fracture stability while reducing peak implant stress under physiological loading. These findings support the biomechanical feasibility of its pes anserinus-sparing design, providing a strong rationale for further investigation.

Ganglioneuroma is defined as a rare, benign neurogenic tumor. This paper reports a case of pelvic retroperitoneal ganglioneuroma in a 12-year-old girl and reviews the relevant literature. The patient was found to have a pelvic retroperitoneal mass incidentally during a health check-up and had no significant clinical symptoms. Gynecological ultrasound revealed a hypoechoic mass posterior to the uterus, measuring approximately 63 × 52 mm, with clear boundaries. No obvious abnormalities were observed in the uterus and adnexa. Pelvic CT showed a well-defined, low-density mass measuring 59 mm × 55 mm with mild enhancement at the posterior margin, the adjacent coccygeal bone showed discontinuity and was closely related to the mass, the rectum was displaced anteriorly with clear demarcation from the mass, and no enlarged lymph nodes or effusion were found in the pelvis. The tumor was successfully and completely resected via laparoscopy, and pathological examination confirmed the diagnosis of ganglioneuroma. The standard surgical methods and approaches for retroperitoneal ganglioneuroma have not yet been established. The successful diagnosis and treatment of this case highlight the importance of accurate preoperative assessment and appropriate surgical planning. The literature review summarizes the clinical manifestations, diagnostic methods, and therapeutic strategies of ganglioneuroma, aiming to provide references for clinicians.

Peripheral nerve cavernous hemangioma refers to cavernous vascular malformations occurring on peripheral nerves outside the cranial and spinal nerves. It is a rare non-neoplastic condition. We report a case of a 53-year-old female patient who presented with a painless mass in the right mid-lower neck and a foreign body sensation in the pharynx for five months. Preoperative ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI) revealed a well-delineated lesion with minimal blood flow signals, heterogeneous enhancement on contrast-enhanced CT and T1-weighted imaging, and high signal intensity on T2-weighted imaging. The patient underwent complete surgical excision of the lesion. Intraoperatively, the lesion was found to be located between the epineurium and perineurium of the vagus nerve and was completely enucleated. Postoperative histopathological and immunohistochemical analyses confirmed the diagnosis of cavernous hemangioma. The patient recovered without complications and exhibited no hoarseness or other neurological deficits postoperatively. No signs of lesion recurrence were observed during a 28-month follow-up. This case suggests that when managing tumors of the cervical vagus nerve, vascular lesions should be included in the differential diagnosis, although such instances are relatively rare.

Background: Robotic right colectomy (RRC) with complete mesocolic excision (CME) and central vascular ligation (CVL) has become a standard oncologic approach for right-sided colon cancer. However, evidence regarding hand-sewn intracorporeal anastomosis (ICA) and its associated learning curve remains limited.

Methods: This single-center retrospective study analyzes a series of consecutive patients with histologically confirmed right-sided colon adenocarcinoma who underwent fully robotic RRC with CME, CVL, and hand-sewn ICA. Perioperative outcomes, pathological results, and the learning curves of three colorectal surgeons were evaluated using cumulative sum (CUSUM) and risk-adjusted CUSUM (RA-CUSUM) methods.

Results: Overall, 71 patients were treated by RRC from April 2021 through December 2024. All surgical procedures were completed robotically. The median operative time was 165 min (Q1-Q3: 147-192). Major complications (Clavien-Dindo ≥ IIIb) occurred in 9.9% of cases, with an anastomotic leak rate of 5.6%. Mean lymph-node yield was 29.6 ± 11.2, and R0 resection was achieved in 98.6%. The CUSUM learning curves for the three surgeons revealed a comparable trend, starting with a rise during the learning phase and followed by a decline reflecting increased efficiency. The learning curve plateau was reached after approximately 16 cases for each surgeon.

Conclusion: RRC with CME, CVL, and hand-sewn ICA is feasible, safe, and oncologically effective. Proficiency is typically achieved after 15-20 cases, supporting its role as a reproducible and teachable procedure in structured robotic colorectal programs.

Peritoneal metastases (PM) from colorectal cancer (CRC) represent a unique clinical challenge with distinct biological behavior and therapeutic implications. Although PM has traditionally been associated with poor prognosis, recent advances in diagnostics, surgical techniques, and intraperitoneal therapies have offered selected patients opportunities for prolonged survival and, in some cases, long-term disease-free status. This review discusses the pathophysiology, risk factors, diagnostic strategies, and treatment options for CRC patients with PM. The peritoneum is the second most common site of CRC metastasis after the liver, with synchronous and metachronous PM occurring at similar rates. Risk factors include right-sided colon tumors, BRAF mutations, and mucinous histology. Diagnosis relies on imaging modalities such as CT, MRI, PET/CT, and laparoscopy, although sensitivity remains limited for small-volume disease. The peritoneal carcinomatosis index (PCI) is a critical prognostic and therapeutic decision-making tool. Cytoreductive surgery (CRS) with or without hyperthermic intraperitoneal chemotherapy (HIPEC) has been shown to improve survival, particularly in well-selected patients with limited PCI and resectable disease. While the role of HIPEC remains debated following the PRODIGE 7 trial, alternative approaches such as pressurized intraperitoneal aerosol chemotherapy (PIPAC) are emerging. Systemic chemotherapy remains foundational, but response in PM can differ from parenchymal metastases due to the peritoneal-plasma barrier. Overall, outcomes are most favorable when patients are managed in specialized centers by multidisciplinary teams offering individualized, biomarker-informed treatment strategies. Ongoing research into molecular predictors and innovative drug delivery methods is critical to further improving prognosis for this complex patient population.

Objective: To explore the effects of multimodal nursing intervention combined with health education on postoperative recovery, pain management, and psychological state in patients undergoing laparoscopic cholecystectomy.

Methods: The clinical data of 100 patients who underwent laparoscopic cholecystectomy in our hospital from January 2023 to December 2024 were retrospectively analyzed. The patients were divided into a control group (CG, n = 50, routine care) and an intervention group (IG, n = 50, multimodal nursing intervention combined with health education) according to the nursing method. The two groups were compared in terms of postoperative recovery indicators, pain scores, psychological state, immune function indicators, incidence of complications, and functional recovery scores.

Results: The IG demonstrated significantly shorter time to first flatus, first defecation, first ambulation, hospital stay, and incision healing than the CG (P < 0.05). VAS scores were significantly lower in the IG at all postoperative time points (P < 0.05). SAS and SDS scores were significantly lower in the IG at discharge (P < 0.05). The IG displayed higher CD4+ level than the CG at discharge (P < 0.05). The IG exhibited significantly lower incidence of abdominal distension and total incidence of postoperative complications than the CG (P < 0.05). The scores of daily activities, self-care ability, pain control, and overall recovery in the IG were significantly higher than those in the CG (P < 0.05).

Conclusion: Multimodal nursing intervention combined with health education can significantly promote postoperative recovery of patients undergoing laparoscopic cholecystectomy, effectively control postoperative pain, improve psychological state and immune function, reduce the incidence of complications, and improve the quality of functional recovery.

Background: This investigation aimed to assess the long-term effectiveness and symptomatic manifestations of the combined therapy of sclerosing foam and endovenous laser ablation (ELA) for treating lower-extremity varicose veins.

Materials and methods: In this study, we examined 2,118 patients (2,324 limbs) diagnosed with varicose veins in one or both lower extremities. These patients were treated at our center between January 2019 and December 2021. All individuals underwent the combined treatment of sclerosing foam and ELA. We closely monitored the occlusion status of the great saphenous vein (GSV) trunk and its tributaries, along with the postoperative therapeutic outcomes and symptomatic presentations. The average follow-up duration was 41.3 months, and data were collected via outpatient appointments and telephone follow-up inquiries.

Results: The success rate of the treatment procedure was 100%. Based on the outcomes of continuous follow-up spanning from 1 to 3 years after the surgery, among the 2,324 legs, 16 legs still required repeated foam sclerotherapy for varicose veins, 2 legs exhibited venous edema, and 11 legs showed skin pigmentation. At one week and one year after the procedure, incomplete closure of the GSV trunk (characterized by patency, blood flow, and reflux) was observed in 1.8% (38 limbs) and 1.1% (23 limbs), respectively. Nineteen patients with local recurrence of varicose veins decided not to undergo further treatment.

Conclusion: The long-term follow-up data demonstrated that the combination of sclerosing foam and endovenous laser was highly efficacious in treating varicose veins. The main postoperative symptoms included the requirement for additional sclerosing foam injections, skin pigmentation, pain and tissue induration.

Introduction: Small bowel obstruction is a common acute abdominal condition in adults, but obstruction caused by midgut malrotation-a congenital anomaly affecting the normal rotation of the intestine during fetal development-is rare. However, among infants and children, midgut malrotation is more frequently observed.

Case presentation: We report the case of a 40-year-old male patient who presented with vomiting, accompanied by cessation of passing flatus and defecation, along with mild abdominal pain. After emergency admission and an enhanced CT scan of the abdomen, a typical mesenteric whirlpool sign was observed, with the cecum and appendix located in the left lower abdomen. The patient underwent emergency surgery and recovered well postoperatively.

Discussion: Midgut malrotation may be asymptomatic in the early stages but is accompanied by an increased risk of intestinal obstruction and intestinal necrosis with an increased angle of torsion, and early surgical intervention is recommended for midgut malrotation in adults.

Conclusion: Midgut malrotation often leads to the development of intestinal obstruction in adults and is a rare cause. Imaging can be well defined, as well as determining the presence of critical conditions such as intestinal necrosis. Surgery is the only effective method of treatment at present, and early surgery after definitive diagnosis is very important.