Langenbeck's Archives of Surgery最新文献

Objective: Distal phalangeal fractures are the most common hand injuries, and K-wire fixation is the most frequently used surgical treatment. This study aims to utilize the nail plate shadow on preoperative X-ray images to locate the insertion point for retrograde(from the distal to the proximal direction of the distal phalanx) K-wire fixation of distal phalanges, thereby improving the accuracy of K-wire placement.

Methods: A case-control study was conducted on 60 patients with distal phalangeal fractures from November 2020 to May 2024. Patients in Group A underwent retrograde longitudinal implantation of a single K-wire based on the surgeon's experience. In Group B, preoperative standard anteroposterior and lateral X-rays were used to outline the nail plate shadow, the central axis between the middle and distal phalanges, and measure the distance between the central axis and the nail plate shadow. Intraoperatively, the measured values were used to mark the skin insertion point, through which a single K-wire was inserted retrogradely. The distal interphalangeal (DIP) joint range of motion (ROM), DASH score, VAS score, operation time, intraoperative times of fluoroscopy, and postoperative complications were compared between the two groups.

Results: All cases achieved healing without clinical deformity, and all fractures showed radiological union. In Group A, 2 cases developed superficial infections; in Group B, 1 case had a superficial infection. All 3 infected cases healed after debridement, dressing changes, and oral antibiotic therapy. There were no significant differences in demographic characteristics between the two groups. No statistically significant differences were observed in DASH scores or DIP ROM (P > 0.05). However, significant differences were found in VAS scores, operation time, and times of fluoroscopy (P < 0.05), with Group B performing better than Group A.

Conclusion: Compared with empirically placed retrograde K-wires, using the nail plate shadow on preoperative X-rays to locate the insertion point for distal phalangeal retrograde K-wire fixation improves the accuracy of K-wire placement, avoids repeated insertion, shortens operation time, and reduces radiation exposure for both surgeons and patients.

Background: The global incidence of hepatocellular carcinoma (HCC) is steadily rising, and the disease is associated with poor survival outcomes. As a multicentric cancer with a high recurrence rate, surgical resection alone is often not sufficient for a curative treatment. This study aimed to identify factors that predict its efficacy in patients with HCC classified as borderline resectable according to the BR-HCC Expert Consensus 2023.

Methods: This study retrospectively analyzed 30 patients with borderline resectable HCC who were treated with Lenvatinib as their initial therapy. The study retrospectively examined the predictive factors for the disease control rate (DCR) following Lenvatinib treatment. A secondary objective was to evaluate the impact of the treatment on overall survival and identify cases that showed a significant response.

Results: The presence of a single tumor was found to be the only independent predictive factor for treatment response. The 5-year survival rate for patients in the stable disease (SD) and partial response (PR) groups was 33.3%, which was significantly higher than that of the progressive disease (PD) group. Of the six patients who achieved a PR with Lenvatinib, four had a single tumor with vascular or biliary invasion or extrahepatic metastasis. Similarly, the two patients who underwent radical resection after Lenvatinib treatment also had a single tumor with these characteristics.

Conclusions: The presence of a single tumor may be a crucial factor in the use of Lenvatinib for borderline HCC.

Purpose: Gallstones are the most common cause of acute pancreatitis (AP), which usually necessitate hospitalization. Although cholecystectomy is required to prevent recurrent episodes, no clear guidelines have been established yet regarding the proper timing of cholecystectomy after an AP incidence. The objective was to evaluate the impact of AP on the course of cholecystectomy procedures, both by comparing patients with and without a history of AP and by analyzing the AP subgroup according to timing and severity.

Methods: This retrospective evaluation was performed on patients who had undergone cholecystectomy for various causes in six hospitals in Poland. Patients were divided into the following three groups: patients without AP, patients with a history of AP, and patients with active AP. The analyzed variables included the surgical type and duration, postoperative complications, AP severity, and time elapsed between cholecystectomy and AP treatment completion.

Results: In total, 4183 patients were included in the study, including 3948 without AP, 209 with a history of AP, and 26 with active AP. The most common surgical indications in patients with active AP and history of AP were concomitant cholecystitis (53.85%) and cholelithiasis (82.3%), respectively. The mean complication rates were not significantly different between groups. The surgical type was significantly affected by AP severity. Surgery in the period between 15 and 31 days post-AP attack was associated the highest frequency of minimally invasive surgery and shortest surgical duration, although the differences were not significant.

Conclusion: Inflammation is the most common associated cause of surgery during the course of active AP. Surgery at 15-31 days post-AP attack was associated with a higher frequency of minimally invasive surgery and shorter operative duration, although these differences did not reach statistical significance. Our findings therefore suggest, but do not confirm, that this may represent a favorable time window, which warrants further evaluation in prospective studies.

Objective: To evaluate the effect of bupivacaine liposome transversus abdominis plane (TAP) block on laparoscopic colorectal cancer resection patients for clinical practice.

Methods: This randomized controlled trial involved 60 patients (aged 57-84 years, weighing 41-84 kg, mean BMI 21.9 kg/m², ASA Class I/II) undergoing laparoscopic colorectal cancer resection with TAP block. Patients were divided into bupivacaine (Bup) and bupivacaine liposome (Bup + Lip) groups, each with 30 patients. Primary outcomes were postoperative visual analog scale (VAS) scores and sufentanil use. Secondary outcomes included recovery room stay, time to initiate oral intake, 72-h recovery quality, pain control satisfaction, and adverse event incidence.

Results: The study included 28 patients in Bup group and 27 patients in Bup + Lip group in the modiffed intention-to-treat (mITT) population. Compared to the Bup group, the Bup + Lip group had significantly lower VAS scores for both rest and movement at 12, 24, 48, and 72 h postoperatively (P < 0.05), reduced total sufentanil use (P < 0.05), shorter time to initiate oral intake (P < 0.05), and improved 72-h recovery quality (P < 0.05) and pain control satisfaction (P < 0.05). The Bup + Lip group also had a significantly lower incidence of adverse events within 72 h postoperatively (P < 0.05).

Conclusion: Bupivacaine liposome TAP block significantly improves postoperative pain control, reduces recovery time, and enhances recovery quality and patient satisfaction with low adverse event incidence in laparoscopic colorectal cancer resection patients. It is an effective postoperative analgesic strategy recommended for clinical application.

Purpose: Despite medical progress and laparoscopic cholecystectomy being standard for Grade II-III acute calculous cholecystitis in ASA II patients, optimal management, especially the timing of cholecystectomy (early vs. delayed) considering morbidity, risk-benefit, and cost, is still debated. While percutaneous cholecystostomy is definitive for ASA III/IV patients, its role as a bridge to cholecystectomy and the ideal interval in ASA II medically refractory cases remain unclear.

Methods: This retrospective study assessed the impact of initial percutaneous cholecystostomy on the timing, duration, and type of subsequent elective cholecystectomy in ASA Class II patients with Tokyo Grade II-III acute calculous cholecystitis. Percutaneous cholecystostomy was performed in patients with moderate cholecystitis unresponsive to conservative management and in those with severe cholecystitis presenting with negative predictive factors indicating a high risk of conservative treatment failure and perioperative complications. In both groups, the procedure served as a bridging intervention to stabilize patients before definitive surgery. The primary aim was to evaluate the effects of this strategy on surgical timing, complexity, and overall treatment outcomes.

Results: Of the 176 patients initially admitted with acute cholecystitis, 97 met the inclusion criteria, comprising those with Tokyo Grade II-III disease and classified as ASA II. Among patients who underwent laparoscopic cholecystectomy more than eight weeks after percutaneous cholecystostomy, 77% experienced prolonged operative durations, defined as procedures exceeding 60 min. Delayed surgical intervention in this specific cohort was consistently associated with a marked increase in both intraoperative complexity and technical difficulty during the laparoscopic cholecystectomy.

Conclusions: The liberal use of percutaneous cholecystostomy in patients with Tokyo Grade II-III acute calculous cholecystitis is not recommended. When percutaneous cholecystostomy is necessary as a bridging intervention prior to definitive surgical management, early laparoscopic cholecystectomy should remain the preferred approach in the majority of ASA II cases. Percutaneous cholecystostomy should be reserved for patients who are unresponsive to conservative treatment or present with contraindications to immediate surgery.

Objective: To evaluate the safety and efficacy of self-expanding metal stents (SEMS) for managing hepatic venous outflow obstruction (HVOO) following ex vivo liver resection and autotransplantation (ELRA).

Methods: We retrospectively analyzed patients who received SEMS placement for HVOO after ELRA between January 2018 and December 2024. The study analyzed details of vascular invasion, liver resection, vascular reconstruction during ELRA, and the condition before and after stent placement. Complications and short-term and long-term prognoses were also observed.

Results: The study included 10 patients who underwent SEMS placement for HVOO after ELRA. Three patients had preoperative stent placement for Budd-Chiari syndrome. During ELRA, 3 patients underwent left trisegmentectomy, and 7 underwent right trisegmentectomy. Six patients required artificial vascular grafts for inferior vena cava (IVC) reconstruction, and 4 patients underwent partial IVC resection with bovine pericardial patch reconstruction. All patients underwent HV-IVC end-to-side anastomosis after HV widening. Two cases used allogeneic vein reconstruction for hepatic venous outflow. The median time to HVOO after ELRA was 3.0 [IQR 2.0-7.3] months. Three patients experienced left hepatic vein (LHV) obstruction, and 7 experienced right hepatic vein (RHV) obstruction, with a median hepatic venous pressure gradient (HVPG) of 11.8 [IQR 8.8-14.1] mmHg. After stent placement, the HVPG decreased to a median of 2.8 [IQR 2.1-3.1] mmHg. The median follow-up period was 29.5 [IQR 11.3-55.8] months. During follow-up, one patient developed restenosis; other than this, no complications of grade III or higher occurred.

Conclusion: In this single-center cohort, SEMS demonstrated favorable safety and efficacy for HVOO after ELRA, However, larger multicenter studies are required to validate these findings and assess long-term outcomes.

Purpose: The aim of this study is to review the literature and reflect on the importance of sensory perceptions-colors, sounds, odors, taste, and kinetics (tactile and postural)-alongside team behavior and safety culture in the operating room.

Methods: MEDLINE search via PubMed up to March 2025, using both free terms and MeSH related to surgery, sensory perception, safety culture, and situational awareness in the operating room. Only English-language studies were included, with a focus on recent publications. Article selection was based on relevance to the core themes of the review.

Results: The study highlights how visual, auditory, olfactory, and thermal stimuli influence team performance and decision-making in the operation room. Color schemes, alarm sounds, ambient odors, and temperature control all play key roles in enhancing situational awareness and patient safety. Effective posture, communication, and ergonomics further contribute to minimizing errors and promoting a safety-driven culture.

Conclusion: The senses, along with communication and discipline, help the team respond effectively to critical situations. Like in aviation, sensory awareness is central to a strong safety culture.

Aims: Surgical risks are elevated in both patients with cirrhosis and in liver transplant recipients. We aimed to quantify surgical outcomes in comparable patients and procedures.

Methods: This case-control study included liver transplant recipients and cirrhosis patients who underwent small bowel or colorectal surgery. Patients were matched based on Charlson Comorbidity Index (CCI) (± 1), age (± 5 years), and surgical modality. In-hospital mortality, length of hospital stay (LOS), and major morbidity (Dindo-Clavien grade ≥ 3) were used as outcome criteria.

Results: 45 cirrhosis and 45 matched transplant patients were included. Mean age and CCI were 65 years and 6.3, respectively. 38% of all patients underwent emergency surgery. Mortality was significantly higher in the cirrhosis group (38% vs. 11%, p = 0.003). Stratification of cirrhosis patients by MELD revealed no significant difference between patients with MELD ≤ 14 and transplant recipients. However, patients with MELD > 14 exhibited substantially increased mortality (64% vs. 9%, p = 0.07, ns).

Conclusions: Colorectal and small bowel surgery in both cirrhosis and transplant patients carries significant risks. Mortality was significantly higher in cirrhosis patients overall, but data suggests the risk of surgery in cirrhosis patients with MELD scores ≤ 14 might be comparable to transplant patients, while those with MELD scores > 14 are at particular risk. Small sample size and heterogeneity of procedures limit these findings; still, the necessity of surgery in patients with higher MELD should be carefully evaluated, as delaying surgery until after liver transplantation may be safer. WHAT DOES THIS PAPER ADD TO LITERATURE? : This paper contains the largest case-matched comparison of surgery in cirrhosis patients with liver transplant patients. We quantify the risk for small bowel and colorectal surgery in comparable patients for the first time, to assist clinical decision of potentially delaying surgery until after liver transplantation.