Journal of Investigative Surgery最新文献

Background: This study aimed to identify factors of surgical intervention following medical termination of pregnancy (MTOP) of early pregnancy loss (EPL), using gestational age determined by transvaginal ultrasonography.

Methods: A retrospective study was conducted of women who underwent MTOP for EPL at a single tertiary hospital between 2010 and 2019. The treatment protocol consisted of oral mifepristone (600 mg), followed by oral misoprostol (600 mcg) 48 h later. A transvaginal ultrasound was performed 14-16 days after mifepristone administration to evaluate endometrial morphology. Patients were classified into three groups according to ultrasound-determined gestational age. MTOP failure was defined as the need for surgical evacuation.

Results: Among the 534 patients, 39 (7.3%) required surgical management. Gestational age ≤7+ weeks was not associated with MTOP outcomes. All women exhibiting a linear endometrial midline or homogeneous endometrium appearance achieved complete uterine evacuation (p < 0.001). Multivariate logistic regression identified increased endometrium thickness (adjusted odds ratio [aOR]: 1.43, 95% CI: 1.25-1.62, p < 0.001) and non-clear endometrial-myometrial margin (aOR: 8.88, 95% CI: 3.26-24.15, p < 0.001) as factors associated with MTOPs failure.

Conclusions: Sonographic endometrial assessment approximately two weeks after MTOP provides clinically relevant indicators of treatment success.

The prone position is among the most frequently employed surgical positions in clinical practice. However, it can exert compression on the thoracic and abdominal regions, altering respiratory mechanics, such as a decrease in functional residual capacity, which inevitably results in some degree of ventilatory injury. Consequently, this raises the risk of postoperative pulmonary complications, which may increase patient mortality rates and extend hospital stays. Beyond conventional lung-protective ventilation strategies, certain pharmacological interventions and intraoperative fluid management measures have also been shown to provide lung protection. However, most related studies have focused on the supine position. Since the prone position can affect respiratory mechanics and the circulatory system to some extent, the effects of certain measures when applied in the prone position may differ. This narrative review examines the efficacy and potential implications of current lung-protective measures in the prone position, offering guidance on lung protection for patients undergoing general anesthesia and prone position surgery.

Purpose: To compare therapeutic outcomes of three surgical approaches for acute corneal hydrops (ACH): compression sutures combined with intracameral air injection (CSAI), CSAI followed by deep anterior lamellar keratoplasty (DALK), and penetrating keratoplasty (PKP).

Methods: This study enrolled 26 patients (26 eyes) into three groups: CSAI-only (7 eyes), CSAI+DALK (14 eyes), and PKP (5 eyes). Demographics; best-corrected visual acuity (BCVA), corneal edema area, central corneal thickness (CCT), corneal curvature during the acute phase; resolution time after CSAI; BCVA, corneal curvature, CCT, astigmatism at final follow-up; and complications were collected.

Results: Mean corneal edema resolution time after CSAI was approximately 2 weeks. Postoperative BCVA (logMAR) improved in all groups (p < 0.05): CSAI-only (0.60 ± 0.15), CSAI+DALK (0.34 ± 0.16), PKP (0.15 ± 0.09). Among 17 eyes planned for DALK, Descemet's membrane perforation occurred in 5 eyes. One PKP case had graft rejection, no long-term complications in the other two groups.

Conclusions: CSAI shortens ACH duration but offers limited visual improvement, serving as a phased treatment. DALK after CSAI resolution significantly improves BCVA and reduces graft rejection risk, making CSAI+DALK a preferred balanced approach. PKP provides the greatest BCVA but carries higher rejection risk, reserved for non-suitable cases of other options.

Objective: This study evaluated delayed open aortic repair (OAR) following interventional radiology (IR) in patients with acute type A aortic dissection (ATAAD) and mesenteric malperfusion syndrome (MeMPS), and identified clinical predictors of intestinal ischemia-related organ failure.

Methods: A retrospective analysis was conducted on 693 ATAAD patients (2018-2022). Thirty-seven hemodynamically stable MeMPS patients underwent upfront IR followed by delayed OAR. Controls were 656 ATAAD patients without malperfusion (Non-MPS) in any organ.

Results: The overall in-hospital mortality for MeMPS patients was 43.2% (16/37). 64.9% (24/37) of MeMPS patients survived initial IR and successfully underwent delayed OAR, achieving in-hospital mortality (12.5% vs. 8.2%, p = 0.714) and short-term survival comparable to those of Non-MPS patients. 35.1% (13/37) failed to undergo OAR following IR, primarily due to refractory organ failure (n = 10) or aortic rupture (n = 3). Reduced true lumen at diaphragm (Area Under Curve, AUC = 0.717), elevated fibrin degradation product (FDP) (AUC = 0.838), and D-dimer (AUC = 0.792) performed well in predicting intestinal ischemia-related organ failure.

Conclusions: For high-risk MeMPS patients, salvage IR effectively bridges to central repair with comparable in-hospital mortality and short-term survival to Non-MPS patients. The reduced true lumen at diaphragm, increased D-dimer and FDP are first identified as independent predictors of organ failure.

Introduction: Splenectomy is commonly performed in Wilson's disease patients with hypersplenism secondary to portal hypertension, yet large-scale data on postoperative complications remain scarce.

Methods: A retrospective analysis was conducted on 986 Wilson's disease patients who underwent splenectomy between 2001 and 2019.

Results: The overall postoperative complication rate was 68.7%, with bleeding, fever, and portal vein thrombosis occurring in 29.0%, 44.9%, and 20.5% of cases, respectively. Multivariable analysis identified hypersplenism grade as an independent risk factor for postoperative bleeding, abnormal liver function for postoperative fever, and lower alanine aminotransferase and albumin levels for portal vein thrombosis.

Discussion: These findings suggest that preoperative evaluation of hypersplenism severity, liver function, and key laboratory markers can aid in surgical risk stratification and optimize perioperative management for Wilson's disease patients undergoing splenectomy.

Background: Chest wall invasion is a relatively kind of infrequent direct tumor extension in non-small cell lung cancer (NSCLC) with a poor survival outcome. Risk factors that impact overall survival (OS) and cancer-specific survival (CSS) remain unclear. We aimed to explore prognostic factors and construct predictive nomograms to predict both OS and CSS in NSCLC patients with chest wall invasion.

Methods: We extracted a total of 2091 patients between 2010 and 2015 from the SEER database. The total patients were divided into the training cohort (1463 patients) and the validation cohort (628 patients). Univariate and multivariate Cox regression analyses were applied to distinguish the independent prognostic factors. Two prognostic nomograms for OS and CSS were established. The concordance index (C-index), receiver operating characteristic curves (ROC), calibration curves, and decision curve analysis (DCA) curves were applied to assess the performance of these two nomograms.

Results: After analysis, age, sex, histology, grade, N stage, M stage, surgery, and chemotherapy were identified as independent prognostic factors for OS, meanwhile, age, histology, grade, N stage, M stage, surgery, and chemotherapy for CSS. The C-index for OS in the training and validation cohorts was 0.711 and 0.716, respectively. The C-index for CSS was 0.721 and 0.726, respectively. The ROC curves, calibration curves, DCA curves, and K-M survival curves also exhibited good predictive performance.

Conclusion: Two nomograms provide a useful tool to predict both OS and CSS in NSCLC patients with chest wall invasion.

Background: Combined epidural-general anesthesia (TEA+GA) can enhance postoperative recovery after gastrointestinal surgery. However, in patients receiving preoperative neoadjuvant chemotherapy (NACT), a known risk factor for postoperative complications, it remains unclear whether TEA+GA improves postoperative outcomes.

Methods: This retrospective cohort study included 365 patients with NACT followed by radical resection of gastrointestinal cancer at Zhongshan Hospital between January 2020 and December 2022. TEA was initiated before the induction of GA. The primary outcome was the incidence of any postoperative in-hospital complications. Secondary outcomes included intraoperative sufentanil consumption, hypotension, vasopressor use, extubation time, post-anesthesia care unit stay, postoperative hospital length of stay, and intensive care unit admission. Inverse probability of treatment weighting (IPTW) and overlap weighting (OW) were applied to adjust for baseline differences.

Results: Of the 365 patients, 152 received TEA+GA, while 213 received GA alone. TEA+GA was associated with a significantly higher rate of postoperative complications (23.7% vs. 15.0%, OR [95% CI]: 1.76 (1.05-2.96), p = 0.036) without subgroup difference. This association remained significant after IPTW (24.1% vs 11.7%, OR [95% CI]: 2.39 [1.24-4.59], p = 0.009) and OW (23.3% vs 10.4%; OR [95% CI]: 2.62 [1.36-5.08], p = 0.004) adjustment. The TEA+GA group had a lower dose of intraoperative sufentanil use and shorter extubation times but showed a higher rate of intraoperative hypotension and increased vasopressor requirements.

Conclusions: In patients who underwent NACT followed by gastrointestinal radical surgery, Combined epidural-general anesthesia was associated with an increased incidence of postoperative in-hospital complications.

To evaluate the effectiveness of fecal transplantation (FT) in preventing the development of diversion colitis (DC) and reducing its complications in patients who underwent protective loop ileostomy (PLI) following low anterior resection for rectal cancer. The study was prospectively conducted at Tertiary Hospital. Seventeen patients who underwent PLI were assigned to the FT group (FT+), and 19 patients served as the control group (FT-). In the FT+ group, ileal content was delivered to the efferent loop via a catheter placed during surgery. Both groups were evaluated postoperatively through biopsies taken for histopathological examination. In the FT+ group, significant reductions were observed in parameters specific to DC, such as the severity of inflammation, ulceration, goblet cell loss, and crypt abscesses, compared to the FT- group (p < 0.05). The epithelial structure and crypt organization in the FT+ group were closer to normal. FT is an effective and easily applicable method for preventing DC development and reducing the severity of inflammatory changes in patients undergoing PLI. The technique is low-cost, has high patient compliance, and aligns with methods reported in the literature for DC prevention.

Objective: To investigate the effect of persistent subretinal fluid (SRF) on macular microstructure and visual acuity after surgery for rhegmatogenous retinal detachment (RRD).

Methods: RRD patients diagnosed between January 2020 and March 2023 who underwent successful scleral buckling (SB) surgery with SRF present 3 months post-operation were retrospectively analyzed. Patients were divided into short-term absorption (Group A, n = 40) and delayed absorption groups (Group B, n = 50). Data on best corrected visual acuity (BCVA), retinal nerve fiber layer thickness (RNFL), subfoveal choroidal thickness (SFCT), and vascular densities were collected at various time points.

Results: BCVA and SFCT showed a downward trend over time, with Group A exhibiting higher values than Group B at multiple time points (P < 0.05). RNFL also decreased over time, but Group A consistently had higher measurements. The choriocapillary plexus vessel density (CCP-VD) decreased in Group B while showing fluctuations in Group A, with higher values in Group A at 3 and 6 months post-absorption (P < 0.001).

Conclusion: After SB surgery, foveal RNFL increased while SFCT decreased, with the short-term absorption group displaying more significant improvements. Additionally, vessel densities decreased over time, and the delayed absorption group showed more substantial decreases in CCP-VD.

Articulated laparoscopic instruments such as Artisential^® offer enhanced dexterity compared with conventional tools, but evidence for their use in benign gynecologic surgery remains limited. This multicenter, prospective, non-randomized comparative study evaluated the feasibility and perioperative safety of Artisential^® instruments using contemporaneous controls. Consecutive patients undergoing laparoscopic surgery for benign adnexal disease between December 2022 and August 2024 were enrolled in Korea, Taiwan, and Japan. Patients who consented underwent surgery using Artisential^®, while those who declined were treated with conventional laparoscopic instruments and included as retrospectively collected controls. Propensity score matching was performed based on age, body mass index, history of previous abdominal surgery, and type of surgery. Outcomes included operation time, estimated blood loss, postoperative hospital stay, and Clavien-Dindo-graded complications. A total of 184 patients were analyzed, and 112 matched patients were included after matching. No significant differences were observed between groups in operative outcomes. No conversions or transfusions occurred, and postoperative complications were infrequent and limited to grade I superficial port-site issues. These findings support the feasibility and short-term safety of Artisential^® instruments in benign adnexal surgery, although randomized trials are needed to further evaluate ergonomic and economic benefits.