Langenbeck's Archives of Surgery最新文献

Purpose: The indication for surgical treatment of rectus diastasis (RD) without a coexisting hernia remains controversial. Although guidelines exist, the lack of robust data allows only weak recommendations. This study aimed to provide comprehensive nationwide data on the surgical management of RD without hernia.

Methods: This retrospective observational multicenter study analyzed anonymous data from the German nationwide hospital discharge dataset (2010-2023). Patients with coexisting hernia or under 18 years were excluded. The primary endpoint was the annual number of RD surgeries without hernia. Secondary endpoints included trends over 13 years, patient demographics, mesh use, and early postoperative complications.

Results: A total of 2,768 cases were identified (mean age 46.2 ± 13.2 years; 76.2% female). The annual case number ranged from 120 to 253, with no consistent trend. A mesh was used in 28.0% (n = 775), while 72.0% underwent reconstruction without documented mesh. Data on surgical approach (open vs. minimally invasive) were not available. The overall early complication rate was 6.9%, with bleeding and wound infections most common. Male patients had significantly higher complication rates. Major limitations include potential coding bias, underreporting, and missing data on surgical technique.

Conclusion: This is the first real-world big data analysis of RD repair without hernia in Germany. On average, 198 procedures are performed annually with a low complication rate. The findings support surgical treatment in selected symptomatic cases and emphasize the need for standardized coding and prospective registry data.

Background and objectives: In canonical knowledge, long-segment intraspinal schwannomas (SCHs) require laminectomies at all involved levels for complete exposure. To evaluate a minimally invasive, limited-exposure strategy for gross total resection (GTR) of multi-level intraspinal SCHs.

Methods: A retrospective analysis was conducted on 11 patients with intraspinal SCHs involving ≥ 3 vertebral segments who underwent laminectomy confined to critical vertebrae, achieving gross total resection without full exposure of all involved levels. The surgical approach involved focused laminectomy targeting critical vertebrae, intracapsular decompression, and meticulous microsurgical dissection. Follow-up included clinical assessments and MRI evaluations at 3 months and 1-year post-surgery.

Results: The cohort comprised 4 females and 7 males, with a median age of 50 years. Lesions were predominantly located in the cervical spine. Ten cases exhibited cystic lesions, while one presented a fully solid tumor. The average surgical time was 119 ± 15.6 minutes. Laminectomy was performed within 2 levels (6 cases) or 1 level (5 cases). All patients achieved complete symptom resolution at discharge, with no perioperative complications. During a mean follow-up of 23.5 ± 13.0 months, no cases of postoperative spinal instability or tumor recurrence were identified.

Conclusion: For long-segment intraspinal SCHs, particularly cystic lesions, minimizing the number of laminectomy levels to achieve GTR is technically feasible and clinically safe.

Background and objectives: Esophagojejunal (EJ) leakage is a serious complication following total gastrectomy for gastric cancer. While several nutritional and treatment-related risk factors have been described, the role of Candida esophagitis (CE) in anastomotic failure has not been previously investigated.

Methods: This retrospective cohort study included 268 patients with gastric adenocarcinoma who underwent total gastrectomy with EJ anastomosis. The study was conducted between March 2021 and March 2025 at a tertiary referral center. CE was diagnosed by histopathologic examination of proximal esophageal margins submitted during surgery. Univariable and multivariable logistic regression analyses were performed to determine predictors of EJ leakage. Best subsets variable selection using Akaike's Information Criterion (AIC) and the Bayesian Information Criterion (BIC) guided final model development.

Results: Among the 268 patients, 48 (17.9%) developed EJ leakage. Multivariable analysis identified CE (OR: 2.19, p = 0.043), hypoalbuminemia (< 3.5 g/dL) (OR: 3.08, p = 0.007), BMI ≥ 25 kg/m² (OR: 3.68, p = 0.004), and administration of neoadjuvant therapy (OR: 2.34, p = 0.024) as independent predictors of EJ leakage. Additional analyses of diagnostic timing indicated that CE detected only on permanent histology (delayed treatment) was associated with higher odds of leak (adj OR 3.62; 95%CI: 1.42-9.23; p = 0.007), whereas CE detected on intraoperative frozen section was not.

Conclusion: CE was associated with increased odds of EJ leakage after adjustment, but causality cannot be inferred from this retrospective study. The finding that delayed CE diagnosis was linked to higher leak risk suggests diagnostic timing may matter. Prospective validation of targeted esophageal assessment and timed antifungal strategies is warranted. Elevated BMI, hypoalbuminemia, and neoadjuvant therapy also contributed to higher odds of EJ leakage.

Background: Peritoneal dialysis catheter (PDC) dysfunction significantly impacts patient survival. While individual risk factors are known, a practical tool that integrates multi-dimensional predictors-including surgical, anatomical, and postoperative parameters-for early risk stratification is lacking. This study evaluates open versus laparoscopic catheterization techniques and aims to develop such a predictive model.

Methods: A retrospective cohort study analyzed 462 end-stage renal disease patients undergoing first PDC implantation (2022-2024). Data included clinical characteristics, surgical method (open/laparoscopic), and dysfunction events. Multivariate COX regression identified independent risk factors, and a nomogram was developed. Model performance was assessed via ROC and calibration curves, with Bootstrap validation.

Results: Among 462 patients (324 modeling, 138 validation) with a median follow-up of 30.7 months, laparoscopic catheterization was associated with a significantly lower risk of dysfunction compared to the open approach (18% vs. 27%; hazard ratio [HR] 2.188, 95% CI 1.263-3.791, p = 0.005). Multivariate analysis identified five independent predictors of catheter dysfunction: history of abdominal surgery (HR 6.924, p < 0.001), open catheterization (HR 2.188, p = 0.005), diabetes (HR 2.373, p = 0.016), albumin < 30 g/L (HR 0.865, p < 0.001), and blood potassium < 4 mmol/L (HR 1.479, p = 0.015). The developed nomogram integrating these predictors showed outstanding discriminative performance, with C-indices of 0.953 (95% CI 0.940-0.967) in the modeling cohort and 0.951 (95% CI 0.929-0.972) in the validation cohort. Time-dependent ROC analysis further confirmed its predictive accuracy, with 1- and 2-year AUCs of 0.957/0.979 and 0.921/0.988 in the modeling and validation sets, respectively. Calibration curves showed close alignment between predicted and observed outcomes across both cohorts. The nomogram provides a clinically useful tool for individualized risk assessment and postoperative management.

Conclusions: Laparoscopic catheterization reduces dysfunction risk. The presented nomogram is unique in its integration of readily available surgical, comorbidity, and nutritional metrics into a single, visual tool. It facilitates early identification of high-risk patients, thereby aiding individualized surgical planning and targeted postoperative monitoring to improve PDC longevity.

Purpose: This study aims to identify UK general surgical trainees' perceptions, attitudes, and perceived barriers to EBM training and assessment so that interventions by general surgery educators to improve integration of EBM are informed by stakeholder data.

Method: A mixed-method survey was developed by adapting the validated McColl and BARRIERS questionnaires, informed by a scoping review and focus group discussions. Ethical approval was obtained (University of Sheffield - 056808). The survey was distributed through social media, surgical society newsletters, and deanery mailing lists, adhering to the CHERRIES checklist.

Results: The survey yielded 101 responses, 53 of which were complete (65% male, 35% female). A quarter of the 53 respondents did not hold higher academic degrees. Most participants (61%) worked in district general hospitals, with the highest response rates from Yorkshire and West Midlands. Attitudes towards EBM were predominantly positive from trainees (50.3%), with most of the respondents indicating their ability to understand and explain EBM terminology. However, they perceived their senior colleagues to be less enthusiastic about EBM (41.5%). Barriers to developing EBM competencies included lack of time, excessive evidence volume, limited access to resources, inadequate critical appraisal skills and limited opportunities for application during clinical practice. Existing postgraduate assessment strategies were deemed adequate for EBM by most of the trainees.

Conclusion: The surveyed UK General surgical trainees exhibit positive attitudes towards EBM but face barriers in its application within their training. One way of addressing this issue is through research informed targeted curricular interventions.

Background/aims: Single-port laparoscopic surgery (SPLS) is a promising alternative to multi-port laparoscopic surgery (MPLS) for emergency appendectomy, with potential advantages in cosmesis and recovery. However, its role remains uncertain, particularly in complex cases. This systematic review and meta-analysis evaluates SPLS's safety, effectiveness, and recent advancements to inform clinical decisions and practice.

Methods: A systematic search of PubMed, Embase, and Cochrane Library identified studies comparing SPLS with MPLS in emergency appendectomy. Outcomes included conversion to open surgery, operative time, postoperative complications, length of hospital stay, pain outcomes, and cosmetic satisfaction. Data synthesis followed PRISMA guidelines using a random-effects model.

Results: Eleven studies, including randomized controlled trials and cohort studies, were included. No significant differences were observed in conversion rates (OR 1.78, 95% CI: 0.63-5.03), complication rates (OR 0.96, 95% CI: 0.63-1.46), operative time (mean difference 2.93 min, 95% CI: - 3.17 to 9.02), length of stay (mean difference - 0.23 days, 95% CI: - 0.62 to 0.15), or postoperative pain (mean difference - 0.24, 95% CI: - 0.96 to 0.49). Substantial heterogeneity was present for operative time (I² = 91%), length of stay (I² = 92%), and pain (I² = 80%). Cosmetic satisfaction generally favoured SPLS, although assessment methods varied considerably.

Conclusion: While SPLS appears to be a safe and feasible alternative to MPLS for emergency appendectomy, current evidence does not support definitive equivalence across all outcomes due to significant heterogeneity, small study sizes, and inconsistent measurement tools. Future large-scale randomized trials are necessary to clarify SPLS's role, especially in complex cases and high-risk populations.

Background: Carpal Tunnel Syndrome (CTS) remains a pervasive condition, often resulting in functional impairment and pain. This study examines whether ultrasound guidance enhances the efficacy and safety of corticosteroid injections for CTS compared to traditional injections based on anatomical landmarks.

Methods: This meta-analysis was conducted in accordance with PRISMA guidelines. We performed a systematic search of PubMed, Embase, Web of Science, and the Cochrane Library up to September 19, 2023. Randomized controlled trials (RCTs) comparing ultrasound-guided(US) versus landmark-guided(LM) corticosteroid injections for CTS were included. Data were synthesized using a random-effects model.

Results: Eight RCTs were included in the analysis. US was associated with a significant reduction in BCTQ symptom severity scores (Standardized Mean Difference [SMD] = -0.32, 95% CI -0.44 to -0.20; I²=0%) and functional status scores (SMD = -0.21, 95% CI -0.31 to -0.10; I²=0%). Nerve injury events were rare; while the direction of effect favored US, the evidence was too sparse to permit a reliable pooled estimate.

Conclusions: US corticosteroid injections provide modest, consistent improvements in symptoms and function over landmark techniques. Safety signals directionally favor US, but adverse-event data are sparse and not definitive.

Purpose: This systematic review and meta-analysis aims to compare the recurrence and mortality rates of resection versus non-resection surgery for sigmoid volvulus (SV), a condition requiring a balance between recurrence prevention and mortality minimization.

Methods: A comprehensive search of PubMed, EMBASE, Web of Science, and Cochrane Library identified studies comparing resection and non-resection surgeries for SV. Primary outcomes included recurrence rates, and secondary outcomes included mortality rates. Randomed effects models were used to calculate pooled effect sizes.

Results: A total of 28 nonrandomized studies, comprising 837 resection and 660 non-resection patients, were included. Resection significantly reduced recurrence (RR: 0.12, 95% CI: 0.06-0.24, P < 0.001) with an NNT of 6 (95% CI: 5.7-7.0) but it was associated with increased mortality (RR: 1.69, 95% CI: 1.17-2.44, P = 0.005, NNH = 17 [95% CI: 11.1-33.3]). Subgroup analysis excluding gangrenous sigmoid patients showed resection effectively prevented recurrence (RR: 0.20, 95% CI: 0.08-0.50, P < 0.001, NNT = 9 [95% CI: 6.2-13.7]) with no significant mortality difference (RR: 1.12, 95% CI: 0.53-2.37, P = 0.760). Similar results were observed in sensitivity analyses excluding studies published before 1990, analyses limited to prospective studies, and when comparing resection with specific non-resection procedures.

Conclusions: Resection is effective in preventing SV recurrence, with no significant mortality increase in patients with virable colon, supporting its use in suitable patients. Future research should optimize patient selection and perioperative care.