Pub Date : 2026-01-12DOI: 10.1016/j.surg.2025.110048
Samuel A. Younan MD , Andrea Fa MD , Phillip J. Williams MD, MSc , Danish Ali MD , Marissa C. Kuo MD , Aimal Khan MD , Fei Ye PhD, MSPH , Rebecca Irlmeier MS , Bradley M. Dennis MD , Alexander T. Hawkins MD, MPH
Background
Although primary anastomosis (with or without proximal diversion) offers improved morbidity and higher reversal rates compared with Hartmann procedure, little is known about real-world factors influencing surgical decision making in acute diverticulitis.
Methods
We conducted a mixed methods survey of surgeons treating diverticulitis, recruited through national colorectal and acute care/trauma surgical organizations. Surgeons were surveyed on their decision-making process, patient considerations, personal experience, and practice structure using a web-based survey. The primary outcome was percentage of primary anastomoses performed for diverticulitis in the past year.
Results
We recorded 439 survey responses; 233 (53%) were colorectal surgeons and 99 (23%) acute care surgeons. The median (interquartile range) number of primary anastomoses and Hartmann procedures performed for acute diverticulitis in the past year was 3.0 (1.0, 5.0) and 4.0 (2.0, 6.0), respectively, per surgeon. Roughly a third of surgeons reported performing primary anastomosis a majority (58.3%–100%) of the time. High anticipated surgical difficulty and hemodynamic instability were considered the most important situational and patient factors when deciding to perform a Hartmann procedure over a primary anastomosis. On multivariable analysis, acute care surgical specialty (odds ratio 0.41, 95% confidence interval 0.26–0.65; P < .001) was associated with a lower percentage of primary anastomoses performed.
Conclusions
In this national survey, only one-third of surgeons performed primary anastomosis most of the time for diverticulitis. Patient acuity, high anticipated surgical difficulty, and the presence of proper operative assistance are some of the most important factors surgeons consider when deciding between a Hartmann procedure and primary anastomosis.
{"title":"Surgeon perspective on the treatment of acute diverticulitis: A survey-based analysis","authors":"Samuel A. Younan MD , Andrea Fa MD , Phillip J. Williams MD, MSc , Danish Ali MD , Marissa C. Kuo MD , Aimal Khan MD , Fei Ye PhD, MSPH , Rebecca Irlmeier MS , Bradley M. Dennis MD , Alexander T. Hawkins MD, MPH","doi":"10.1016/j.surg.2025.110048","DOIUrl":"10.1016/j.surg.2025.110048","url":null,"abstract":"<div><h3>Background</h3><div>Although primary anastomosis (with or without proximal diversion) offers improved morbidity and higher reversal rates compared with Hartmann procedure, little is known about real-world factors influencing surgical decision making in acute diverticulitis.</div></div><div><h3>Methods</h3><div>We conducted a mixed methods survey of surgeons treating diverticulitis, recruited through national colorectal and acute care/trauma surgical organizations. Surgeons were surveyed on their decision-making process, patient considerations, personal experience, and practice structure using a web-based survey. The primary outcome was percentage of primary anastomoses performed for diverticulitis in the past year.</div></div><div><h3>Results</h3><div>We recorded 439 survey responses; 233 (53%) were colorectal surgeons and 99 (23%) acute care surgeons. The median (interquartile range) number of primary anastomoses and Hartmann procedures performed for acute diverticulitis in the past year was 3.0 (1.0, 5.0) and 4.0 (2.0, 6.0), respectively, per surgeon. Roughly a third of surgeons reported performing primary anastomosis a majority (58.3%–100%) of the time. High anticipated surgical difficulty and hemodynamic instability were considered the most important situational and patient factors when deciding to perform a Hartmann procedure over a primary anastomosis. On multivariable analysis, acute care surgical specialty (odds ratio 0.41, 95% confidence interval 0.26–0.65; <em>P</em> < .001) was associated with a lower percentage of primary anastomoses performed.</div></div><div><h3>Conclusions</h3><div>In this national survey, only one-third of surgeons performed primary anastomosis most of the time for diverticulitis. Patient acuity, high anticipated surgical difficulty, and the presence of proper operative assistance are some of the most important factors surgeons consider when deciding between a Hartmann procedure and primary anastomosis.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"191 ","pages":"Article 110048"},"PeriodicalIF":2.7,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145966671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-10DOI: 10.1016/j.surg.2025.110042
Lia D. Delaney MD, MS , Heather Day MS , Katherine Arnow MS , Robin M. Cisco MD , Dan Eisenberg MD, MS , Manjula Kurella Tamura MD, MPH , Insoo Suh MD , Electron Kebebew MD , Carolyn D. Seib MD, MAS
{"title":"Utilization of thyroid ultrasound and surgery after glucagon-like peptide-1 receptor agonist prescription","authors":"Lia D. Delaney MD, MS , Heather Day MS , Katherine Arnow MS , Robin M. Cisco MD , Dan Eisenberg MD, MS , Manjula Kurella Tamura MD, MPH , Insoo Suh MD , Electron Kebebew MD , Carolyn D. Seib MD, MAS","doi":"10.1016/j.surg.2025.110042","DOIUrl":"10.1016/j.surg.2025.110042","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"Article 110042"},"PeriodicalIF":2.7,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145941431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-09DOI: 10.1016/j.surg.2025.110044
Makena Pook BHSc , Ghadeer Olleik MSc , Maxime Lapointe-Gagner MSc , Shrieda Jain MSc , Francesca Fermi MD , Samin Shirzadi MD , Philip Nguyen-Powanda BSc , Sarah Al Ben Ali MD , Tahereh Najafi Ghezeljeh PhD , Naser Alali MD , Katy Dmowski MSc , Pepa Kaneva MSc , Liane S. Feldman MD , Marylise Boutros MD , Lawrence Lee MD, PhD , Julio F. Fiore Jr. PhD
Background
Opioids are widely prescribed after colorectal surgery but may cause adverse events, misuse, and addiction. Despite growing interest in opioid-free analgesia, the rate and characteristics of patients undergoing colorectal surgery who consume no opioids postdischarge remain uncertain. This study aimed to (1) estimate the rate of patients who consume no opioids postdischarge after colorectal surgery and (2) identify patient and care characteristics associated with opioid-free analgesia.
Methods
This prospective cohort study enrolled adults (aged ≥18 years) undergoing elective colorectal surgery at 2 academic hospitals. Self-reported analgesic consumption was assessed weekly for 1 month postdischarge. Rates of opioid-free analgesia were analyzed descriptively. Predictors were identified using Bayesian model averaging, with higher posterior effect probability reflecting stronger association.
Results
A total of 344 participants were included (mean age: 58 ± 15 years; 54% male; 65% laparoscopic surgery; 31% rectal procedure; median hospital stay: 3 days [interquartile range: 1–5 days]). Discharge prescriptions included nonopioids (92% acetaminophen, 38% nonsteroidal anti-inflammatory drugs, and 2% gabapentinoids) and opioids (92%). At 30 days, 51% used no opioids postdischarge (47% after open surgery, 51% after laparoscopic surgery, 52% after procedures via stoma [ie, loop ostomy reversal]). Opioid-free analgesia was associated with older age (odds ratio: 1.04, posterior effect probability = 100%), fewer opioid pills prescribed (odds ratio: 0.92, posterior effect probability = 100%), no postdischarge cannabis use (odds ratio: 0.09, posterior effect probability = 96%), and high patient activation (ie, confidence for self-managing care; odds ratio: 2.20, posterior effect probability = 67%).
Conclusion
Approximately half of patients undergoing colorectal surgery do not use opioids postdischarge. Older patients, those with higher patient activation, those who did not use cannabis, and those with fewer opioids prescribed were more likely to rely on opioid-free analgesia. Opioid-free postdischarge analgesia may be feasible after colorectal surgery and should be further investigated.
{"title":"Rates and predictors of postdischarge opioid-free analgesia after elective colorectal surgery: A prospective cohort study","authors":"Makena Pook BHSc , Ghadeer Olleik MSc , Maxime Lapointe-Gagner MSc , Shrieda Jain MSc , Francesca Fermi MD , Samin Shirzadi MD , Philip Nguyen-Powanda BSc , Sarah Al Ben Ali MD , Tahereh Najafi Ghezeljeh PhD , Naser Alali MD , Katy Dmowski MSc , Pepa Kaneva MSc , Liane S. Feldman MD , Marylise Boutros MD , Lawrence Lee MD, PhD , Julio F. Fiore Jr. PhD","doi":"10.1016/j.surg.2025.110044","DOIUrl":"10.1016/j.surg.2025.110044","url":null,"abstract":"<div><h3>Background</h3><div>Opioids are widely prescribed after colorectal surgery but may cause adverse events, misuse, and addiction. Despite growing interest in opioid-free analgesia, the rate and characteristics of patients undergoing colorectal surgery who consume no opioids postdischarge remain uncertain. This study aimed to (1) estimate the rate of patients who consume no opioids postdischarge after colorectal surgery and (2) identify patient and care characteristics associated with opioid-free analgesia.</div></div><div><h3>Methods</h3><div>This prospective cohort study enrolled adults (aged ≥18 years) undergoing elective colorectal surgery at 2 academic hospitals. Self-reported analgesic consumption was assessed weekly for 1 month postdischarge. Rates of opioid-free analgesia were analyzed descriptively. Predictors were identified using Bayesian model averaging, with higher posterior effect probability reflecting stronger association.</div></div><div><h3>Results</h3><div>A total of 344 participants were included (mean age: 58 ± 15 years; 54% male; 65% laparoscopic surgery; 31% rectal procedure; median hospital stay: 3 days [interquartile range: 1–5 days]). Discharge prescriptions included nonopioids (92% acetaminophen, 38% nonsteroidal anti-inflammatory drugs, and 2% gabapentinoids) and opioids (92%). At 30 days, 51% used no opioids postdischarge (47% after open surgery, 51% after laparoscopic surgery, 52% after procedures via stoma [ie, loop ostomy reversal]). Opioid-free analgesia was associated with older age (odds ratio: 1.04, posterior effect probability = 100%), fewer opioid pills prescribed (odds ratio: 0.92, posterior effect probability = 100%), no postdischarge cannabis use (odds ratio: 0.09, posterior effect probability = 96%), and high patient activation (ie, confidence for self-managing care; odds ratio: 2.20, posterior effect probability = 67%).</div></div><div><h3>Conclusion</h3><div>Approximately half of patients undergoing colorectal surgery do not use opioids postdischarge. Older patients, those with higher patient activation, those who did not use cannabis, and those with fewer opioids prescribed were more likely to rely on opioid-free analgesia. Opioid-free postdischarge analgesia may be feasible after colorectal surgery and should be further investigated.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"Article 110044"},"PeriodicalIF":2.7,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145941432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-08DOI: 10.1016/j.surg.2025.110043
Bennet S. Cho MD , Nguyen K. Le MD, MS , Troy Coaston BS , Esteban Z. Aguayo MD , Oh Jin Kwon MD , Saad Mallick MD , Giselle Porter BS , Peyman Benharash MD, MS
Background
Redo coronary arterial bypass grafting is a high-risk operation associated with significant morbidities. Although conduit selection remains a critical factor influencing post–coronary arterial bypass grafting outcomes, the trends in vessel utilization in redo operations remain poorly characterized. We used a nationally representative database to examine contemporary trends in conduit selection in redo versus first-time coronary arterial bypass grafting and risk factors of mortality among patients with repeat bypasses.
Methods
Using the 2016–2021 Nationwide Readmissions Database, we identified adult patients undergoing isolated coronary arterial bypass grafting, stratified into First-time and Redo cohorts. The primary outcome was in-hospital mortality; secondary outcomes included perioperative complications, postoperative length of stay, hospitalization costs, nonhome discharge, and 30-day nonelective readmissions. Temporal trends in conduit use (internal mammary artery, radial artery, and saphenous vein) were assessed.
Results
Among 928,925 patients, 5.3% underwent redo coronary arterial bypass grafting. From 2016 to 2021, the use of the internal mammary artery, radial artery, and saphenous vein increased in both cohorts (P < .001). Redo status was associated with higher likelihood of developing complications, longer length of stay (β + 6.2 days), and increased costs (β + $11,100), but lower odds of in-hospital mortality (adjusted odds ratio: 0.75). Internal mammary artery use was independently associated with reduced odds of mortality (adjusted odds ratio: 0.57).
Conclusion
Redo coronary arterial bypass grafting is modestly increasing nationwide and remains associated with greater morbidity and resource use, compared with first-time coronary arterial bypass grafting. Nonetheless, adjusted mortality is lower in redo coronary arterial bypass grafting, potentially reflecting careful patient selection and intensive perioperative care. Arterial conduit use, especially internal mammary artery, may confer survival benefits and warrants further study in the redo setting.
{"title":"National trends in conduit selection for redo coronary arterial bypass grafting","authors":"Bennet S. Cho MD , Nguyen K. Le MD, MS , Troy Coaston BS , Esteban Z. Aguayo MD , Oh Jin Kwon MD , Saad Mallick MD , Giselle Porter BS , Peyman Benharash MD, MS","doi":"10.1016/j.surg.2025.110043","DOIUrl":"10.1016/j.surg.2025.110043","url":null,"abstract":"<div><h3>Background</h3><div>Redo coronary arterial bypass grafting is a high-risk operation associated with significant morbidities. Although conduit selection remains a critical factor influencing post–coronary arterial bypass grafting outcomes, the trends in vessel utilization in redo operations remain poorly characterized. We used a nationally representative database to examine contemporary trends in conduit selection in redo versus first-time coronary arterial bypass grafting and risk factors of mortality among patients with repeat bypasses.</div></div><div><h3>Methods</h3><div>Using the 2016–2021 Nationwide Readmissions Database, we identified adult patients undergoing isolated coronary arterial bypass grafting, stratified into <em>F</em><em>irst-time</em> and <em>R</em><em>edo</em> cohorts. The primary outcome was in-hospital mortality; secondary outcomes included perioperative complications, postoperative length of stay, hospitalization costs, nonhome discharge, and 30-day nonelective readmissions. Temporal trends in conduit use (internal mammary artery, radial artery, and saphenous vein) were assessed.</div></div><div><h3>Results</h3><div>Among 928,925 patients, 5.3% underwent redo coronary arterial bypass grafting. From 2016 to 2021, the use of the internal mammary artery, radial artery, and saphenous vein increased in both cohorts (<em>P</em> < .001). Redo status was associated with higher likelihood of developing complications, longer length of stay (β + 6.2 days), and increased costs (β + $11,100), but lower odds of in-hospital mortality (adjusted odds ratio: 0.75). Internal mammary artery use was independently associated with reduced odds of mortality (adjusted odds ratio: 0.57).</div></div><div><h3>Conclusion</h3><div>Redo coronary arterial bypass grafting is modestly increasing nationwide and remains associated with greater morbidity and resource use, compared with first-time coronary arterial bypass grafting. Nonetheless, adjusted mortality is lower in redo coronary arterial bypass grafting, potentially reflecting careful patient selection and intensive perioperative care. Arterial conduit use, especially internal mammary artery, may confer survival benefits and warrants further study in the redo setting.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"Article 110043"},"PeriodicalIF":2.7,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145941375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Postoperative skin tears are an underrecognized complication following pancreatectomy and often result from the removal of adhesive surgical drapes. Despite a negative impact on recovery, limited strategies are available for their prevention.
Methods
We retrospectively analyzed data for 348 patients who underwent pancreatectomy at our institution from April 2019 to December 2021. In this cohort, 71 patients had received a preoperative sterile coating agent (intervention group), and 277 patients had not (control group). The incidence, severity, and treatment duration of postoperative skin tears were compared between these 2 groups, and univariate and multivariate analyses were performed to identify risk factors. Propensity score matching also was conducted, and receiver operating characteristic curve analysis was used to evaluate operative time thresholds.
Results
Skin tears occurred in 19.0% of patients. The incidence was significantly lower in the intervention group compared with the control group (9.9% vs 21.3%, P = .02). Multivariate and propensity score matching analyses identified a prolonged operative time and absence of coating agent as independent risk factors for tears. Treatment duration was significantly shorter in the intervention group (P = .03). Receiver operating characteristic analysis identified a longer threshold operative time for skin tear occurrence in the intervention group (673 minutes versus 656 minutes in the control group), suggesting improved skin tolerance.
Conclusion
A sterile preoperative coating agent significantly reduces the risk of postoperative skin tears following pancreatectomy and may improve skin tolerance during prolonged procedures. Clinical use of this agent should be considered in high-risk surgical patients.
背景：术后皮肤撕裂是胰腺切除术后未被充分认识的并发症，通常是由于移除手术黏附膜所致。尽管对恢复有负面影响，但可用于预防的战略有限。方法回顾性分析2019年4月至2021年12月在我院行胰腺切除术的348例患者的资料。在本队列中，71例患者术前使用了无菌包衣剂（干预组），277例患者未使用无菌包衣剂（对照组）。比较两组患者术后皮肤撕裂的发生率、严重程度和治疗时间，并进行单因素和多因素分析，以确定危险因素。同时进行倾向评分匹配，并采用受试者工作特征曲线分析评估手术时间阈值。结果19.0%的患者出现皮肤撕裂。干预组的发生率明显低于对照组（9.9% vs 21.3%, P = 0.02）。多变量分析和倾向评分匹配分析表明，手术时间延长和缺乏包衣剂是导致撕裂的独立危险因素。干预组治疗时间明显缩短（P = 0.03）。受试者操作特征分析发现，干预组皮肤撕裂发生的阈值手术时间较长（673分钟，对照组为656分钟），表明皮肤耐受性得到改善。结论术前无菌包衣剂可显著降低胰腺切除术后皮肤撕裂的风险，并可提高长时间手术过程中皮肤的耐受性。临床应考虑高危外科患者使用本品。
{"title":"Effect of a preoperative coating agent on postoperative skin tears in pancreatectomy","authors":"Masahiko Kubo MD, PhD , Eri Iwai RN , Hirofumi Akita MD, PhD , Kunihito Gotoh MD, PhD , Yasunari Fukuda MD, PhD , Hisateru Komatsu MD, PhD , Kei Yamamoto MD, PhD , Ryota Mori MD , Masatoshi Kitakaze MD, PhD , Norihiro Matsuura MD, PhD , Yasunori Masuike MD, PhD , Takahito Sugase MD, PhD , Yuki Ushimaru MD, PhD , Masaaki Mio MD, PhD , Yoshitomo Yanagimoto MD, PhD , Takashi Kanemura MD, PhD , Toshinori Sueda MD, PhD , Yoshinori Kagawa MD, PhD , Kazuyoshi Yamamoto MD, PhD , Junichi Nishimura MD, PhD , Shogo Kobayashi MD, PhD","doi":"10.1016/j.surg.2025.110039","DOIUrl":"10.1016/j.surg.2025.110039","url":null,"abstract":"<div><h3>Background</h3><div>Postoperative skin tears are an underrecognized complication following pancreatectomy and often result from the removal of adhesive surgical drapes. Despite a negative impact on recovery, limited strategies are available for their prevention.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed data for 348 patients who underwent pancreatectomy at our institution from April 2019 to December 2021. In this cohort, 71 patients had received a preoperative sterile coating agent (intervention group), and 277 patients had not (control group). The incidence, severity, and treatment duration of postoperative skin tears were compared between these 2 groups, and univariate and multivariate analyses were performed to identify risk factors. Propensity score matching also was conducted, and receiver operating characteristic curve analysis was used to evaluate operative time thresholds.</div></div><div><h3>Results</h3><div>Skin tears occurred in 19.0% of patients. The incidence was significantly lower in the intervention group compared with the control group (9.9% vs 21.3%, <em>P</em> = .02). Multivariate and propensity score matching analyses identified a prolonged operative time and absence of coating agent as independent risk factors for tears. Treatment duration was significantly shorter in the intervention group (<em>P</em> = .03). Receiver operating characteristic analysis identified a longer threshold operative time for skin tear occurrence in the intervention group (673 minutes versus 656 minutes in the control group), suggesting improved skin tolerance.</div></div><div><h3>Conclusion</h3><div>A sterile preoperative coating agent significantly reduces the risk of postoperative skin tears following pancreatectomy and may improve skin tolerance during prolonged procedures. Clinical use of this agent should be considered in high-risk surgical patients.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"Article 110039"},"PeriodicalIF":2.7,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145908847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-08DOI: 10.1016/j.surg.2025.110035
Belkacem Acidi, Eric Vibert
{"title":"In Reply: Remnant liver ischemia and recurrence risk after hepatectomy.","authors":"Belkacem Acidi, Eric Vibert","doi":"10.1016/j.surg.2025.110035","DOIUrl":"https://doi.org/10.1016/j.surg.2025.110035","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110035"},"PeriodicalIF":2.7,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145946389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-08DOI: 10.1016/j.surg.2025.110041
Joaquín M. Munoz-Rodriguez MD, PhD, FACS , Laura Román García de León MD , Álvaro Robin Valle De Lersundi MD, PhD , Luis A. Blazquez-Hernando MD, PhD , Manuel Medina Pedrique MD , Celia Fidalgo Martínez MD , Marcello De Luca MD , José Luis Lucena de la Poza MD, PhD , Miguel A. Garcia-Urena MD, PhD, FACS , Javier Lopez-Monclus MD, PhD, FACS
Background
Minimally invasive options for incisional hernia repair have expanded, yet data on preperitoneal enhanced-view totally extraperitoneal approaches for incisional hernias are limited. We aimed to evaluate safety, feasibility, and early outcomes of the preperitoneal enhanced-view totally extraperitoneal approach via cranial, caudal, and midline access in midline and lateral incisional hernias.
Methods
We performed a multicenter retrospective cohort study across 2 university hospitals (January 2024–June 2025). Patients with midline or lateral incisional hernias undergoing a preperitoneal enhanced-view totally extraperitoneal approach were included; primary hernias and loss-of-domain cases were excluded. Perioperative management was standardized. The primary end point was recurrence; secondary end points included surgical site occurrences, surgical site occurrences requiring procedural intervention, mesh infection, bulging, chronic pain, operative time, and length of stay.
Results
We analyzed 60 incisional hernia repairs (58.3% men; age 65.1 ± 12.2 years; body mass index 28.7 ± 4.2 kg/m2; obesity 35%). Defects were midline in 81.7% and lateral in 18.3%; most were European Hernia Society W2 classification. Access was cranial in 76.7%, midline 13.3%, and caudal in 10.0%. Three procedures required intraoperative conversion to enhanced-view totally extraperitoneal approach due to peritoneal fragility; no conversions to open surgery occurred. Fascial closure was achieved in all cases; a tailored preperitoneal mesh (mean area 544.6 ± 272 cm2) was placed without fixation. Mean operative time was 163 ± 66 minutes; length of stay was 1.28 ± 0.7 days. Surgical site occurrence rate was 6.6% (2 superficial hematomas, 2 asymptomatic seromas), with no surgical site infections or surgical site occurrences requiring procedural interventions. At 8.12 ± 3.92 months' follow-up, there were no recurrences, mesh infections, chronic seromas, or chronic pain.
Conclusions
The preperitoneal enhanced-view totally extraperitoneal approach appears to be a feasible and safe minimally invasive option for midline and lateral incisional hernia repair, enabling broad anatomic applicability with low short-term morbidity and no early recurrences. Prospective studies with long-term follow-up are needed to validate its long-term efficacy.
{"title":"Preperitoneal enhanced-view totally extraperitoneal (PeTEP) technique in midline and lateral incisional hernia repair: Early multicenter outcomes","authors":"Joaquín M. Munoz-Rodriguez MD, PhD, FACS , Laura Román García de León MD , Álvaro Robin Valle De Lersundi MD, PhD , Luis A. Blazquez-Hernando MD, PhD , Manuel Medina Pedrique MD , Celia Fidalgo Martínez MD , Marcello De Luca MD , José Luis Lucena de la Poza MD, PhD , Miguel A. Garcia-Urena MD, PhD, FACS , Javier Lopez-Monclus MD, PhD, FACS","doi":"10.1016/j.surg.2025.110041","DOIUrl":"10.1016/j.surg.2025.110041","url":null,"abstract":"<div><h3>Background</h3><div>Minimally invasive options for incisional hernia repair have expanded, yet data on preperitoneal enhanced-view totally extraperitoneal approaches for incisional hernias are limited. We aimed to evaluate safety, feasibility, and early outcomes of the preperitoneal enhanced-view totally extraperitoneal approach via cranial, caudal, and midline access in midline and lateral incisional hernias.</div></div><div><h3>Methods</h3><div>We performed a multicenter retrospective cohort study across 2 university hospitals (January 2024–June 2025). Patients with midline or lateral incisional hernias undergoing a preperitoneal enhanced-view totally extraperitoneal approach were included; primary hernias and loss-of-domain cases were excluded. Perioperative management was standardized. The primary end point was recurrence; secondary end points included surgical site occurrences, surgical site occurrences requiring procedural intervention, mesh infection, bulging, chronic pain, operative time, and length of stay.</div></div><div><h3>Results</h3><div>We analyzed 60 incisional hernia repairs (58.3% men; age 65.1 ± 12.2 years; body mass index 28.7 ± 4.2 kg/m<sup>2</sup>; obesity 35%). Defects were midline in 81.7% and lateral in 18.3%; most were European Hernia Society W2 classification. Access was cranial in 76.7%, midline 13.3%, and caudal in 10.0%. Three procedures required intraoperative conversion to enhanced-view totally extraperitoneal approach due to peritoneal fragility; no conversions to open surgery occurred. Fascial closure was achieved in all cases; a tailored preperitoneal mesh (mean area 544.6 ± 272 cm<sup>2</sup>) was placed without fixation. Mean operative time was 163 ± 66 minutes; length of stay was 1.28 ± 0.7 days. Surgical site occurrence rate was 6.6% (2 superficial hematomas, 2 asymptomatic seromas), with no surgical site infections or surgical site occurrences requiring procedural interventions. At 8.12 ± 3.92 months' follow-up, there were no recurrences, mesh infections, chronic seromas, or chronic pain.</div></div><div><h3>Conclusions</h3><div>The preperitoneal enhanced-view totally extraperitoneal approach appears to be a feasible and safe minimally invasive option for midline and lateral incisional hernia repair, enabling broad anatomic applicability with low short-term morbidity and no early recurrences. Prospective studies with long-term follow-up are needed to validate its long-term efficacy.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"Article 110041"},"PeriodicalIF":2.7,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145941430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-08DOI: 10.1016/j.surg.2025.110036
Xiaoli Liu MD, Qiuyue Ma PhD, Haiyun Li BS, Minxian Zhao BS, Yingmo Shen MD, Huiqi Yang MD
Background
Laparoscopic tension-free repair has become the standard surgical treatment for hiatal hernia because of its favorable clinical outcomes. However, the associated hospitalization costs vary considerably, driven by both patient complexity and technical factors. This study aimed to analyze the drivers and composition of hospitalization costs in patients undergoing laparoscopic tension-free hiatal hernia repair using a quantile regression approach.
Methods
A retrospective observational study was conducted among patients who underwent laparoscopic tension-free hiatal hernia repair at Beijing Chao-Yang Hospital, Capital Medical University, between 2020 and 2023. Clinical, demographic, and procedural data were extracted from electronic medical records. The primary outcome was total hospitalization cost; secondary outcomes included cost composition (diagnosis, treatment, nursing, medication, materials, and others) and postoperative recurrence. Quantile regression was used to identify factors associated with total hospitalization costs across the 10th–90th percentiles. Recurrence was examined using multivariable logistic regression.
Results
A total of 197 patients were included. Most were female (60.4%) and aged ≥65 years (54.8%). Material costs represented the largest share of total hospitalization expenses in every year (>58%). In quantile regression, mesh fixation with absorbable sutures versus tackers was associated with lower costs across all quantiles (β = –11,671 to –8,372; all P ≤ .003). Length of stay was positively associated with costs from the 10th to the 70th quantile (β = 623–917; all P ≤ .032). Intensive care unit use increased costs predominantly in the lower-mid quantiles (q10–q40; β = 2,577–4,301). Postoperative recurrence occurred in 9 of 197 patients (4.6%) and had no independent predictors on multivariable analysis.
Conclusion
Hospitalization costs for laparoscopic tension-free hiatal hernia repair were largely driven by material expenditures. Absorbable suture fixation reduced costs across all quantiles without prolonging operative time, whereas longer length of stay increased costs, and intensive care unit use affected mainly the lower-mid range. Early recurrence was uncommon and had no independent predictors, supporting cost-conscious strategies that prioritize judicious fixation, discharge efficiency, and selective critical-care use, to be confirmed in prospective studies with standardized long-term outcomes.
{"title":"Drivers and composition of hospitalization costs in patients undergoing laparoscopic tension-free hiatal hernia repair: A quantile regression study","authors":"Xiaoli Liu MD, Qiuyue Ma PhD, Haiyun Li BS, Minxian Zhao BS, Yingmo Shen MD, Huiqi Yang MD","doi":"10.1016/j.surg.2025.110036","DOIUrl":"10.1016/j.surg.2025.110036","url":null,"abstract":"<div><h3>Background</h3><div>Laparoscopic tension-free repair has become the standard surgical treatment for hiatal hernia because of its favorable clinical outcomes. However, the associated hospitalization costs vary considerably, driven by both patient complexity and technical factors. This study aimed to analyze the drivers and composition of hospitalization costs in patients undergoing laparoscopic tension-free hiatal hernia repair using a quantile regression approach.</div></div><div><h3>Methods</h3><div>A retrospective observational study was conducted among patients who underwent laparoscopic tension-free hiatal hernia repair at Beijing Chao-Yang Hospital, Capital Medical University, between 2020 and 2023. Clinical, demographic, and procedural data were extracted from electronic medical records. The primary outcome was total hospitalization cost; secondary outcomes included cost composition (diagnosis, treatment, nursing, medication, materials, and others) and postoperative recurrence. Quantile regression was used to identify factors associated with total hospitalization costs across the 10th–90th percentiles. Recurrence was examined using multivariable logistic regression.</div></div><div><h3>Results</h3><div>A total of 197 patients were included. Most were female (60.4%) and aged ≥65 years (54.8%). Material costs represented the largest share of total hospitalization expenses in every year (>58%). In quantile regression, mesh fixation with absorbable sutures versus tackers was associated with lower costs across all quantiles (β = –11,671 to –8,372; all <em>P</em> ≤ .003). Length of stay was positively associated with costs from the 10th to the 70th quantile (β = 623–917; all <em>P</em> ≤ .032). Intensive care unit use increased costs predominantly in the lower-mid quantiles (q10–q40; β = 2,577–4,301). Postoperative recurrence occurred in 9 of 197 patients (4.6%) and had no independent predictors on multivariable analysis.</div></div><div><h3>Conclusion</h3><div>Hospitalization costs for laparoscopic tension-free hiatal hernia repair were largely driven by material expenditures. Absorbable suture fixation reduced costs across all quantiles without prolonging operative time, whereas longer length of stay increased costs, and intensive care unit use affected mainly the lower-mid range. Early recurrence was uncommon and had no independent predictors, supporting cost-conscious strategies that prioritize judicious fixation, discharge efficiency, and selective critical-care use, to be confirmed in prospective studies with standardized long-term outcomes.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"192 ","pages":"Article 110036"},"PeriodicalIF":2.7,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145941447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Safety-net hospitals have demonstrated comparable surgical outcomes to non–safety-net hospitals across various populations, highlighting their potential as regional care centers for diagnosis and treatment of time-sensitive conditions. This study evaluated the impact of safety-net status on clinical and financial outcomes following type A aortic dissection repair.
Methods
The National Inpatient Sample was queried for years 2017 to 2022 to identify adults with a diagnosis of type A aortic dissection. Safety-net hospitals were defined as institutions in the top quartile for the annual proportion of patients with Medicaid or no insurance. Multivariable regression models were used to assess the association of safety-net status with outcomes of interest including in-hospital mortality, perioperative complications, and resource utilization.
Results
Of an estimated 25,936 patients with type A aortic dissection undergoing aortic interventions, 7,055 (27.2%) were managed at safety-net hospitals. Compared with non–safety-net hospitals, patients at safety-net hospitals had a similar distribution of age, sex, and Elixhauser Comorbidity Index. After excluding patients who did not receive aortic surgical interventions, the proportion of cases transferred into safety-net hospitals increased from 27.5% to 48.1%. Following adequate risk adjustment, safety-net hospitals did not alter the odds of in-hospital mortality (adjusted odds ratio 1.15, 95% confidence interval 0.72–1.83, reference: non–safety-net hospitals). Notably, higher type A aortic dissection center volume was linked with reduced odds of death, independent of safety-net status (adjusted odds ratio 0.94, 95% confidence interval 0.91–0.97).
Conclusions
Our findings suggest that safety-net hospitals yield comparable perioperative outcomes to non–safety-net hospitals in management of type A aortic dissection outcomes. Future studies are warranted to further investigate the impact of safety-net status on long-term outcomes, as well as rates of readmission and reoperation.
{"title":"Surgical repair of type A aortic dissection at safety-net hospitals across the United States","authors":"Dariush Yalzadeh BS , Kevin Tabibian BS , Sara Sakowitz MD , Barzin Badiee BS , Jeffrey Balian BS , Giselle Porter BS , Peter Downey MD , Peyman Benharash MD","doi":"10.1016/j.surg.2025.110040","DOIUrl":"10.1016/j.surg.2025.110040","url":null,"abstract":"<div><h3>Background</h3><div>Safety-net hospitals have demonstrated comparable surgical outcomes to non–safety-net hospitals across various populations, highlighting their potential as regional care centers for diagnosis and treatment of time-sensitive conditions. This study evaluated the impact of safety-net status on clinical and financial outcomes following type A aortic dissection repair.</div></div><div><h3>Methods</h3><div>The National Inpatient Sample was queried for years 2017 to 2022 to identify adults with a diagnosis of type A aortic dissection. Safety-net hospitals were defined as institutions in the top quartile for the annual proportion of patients with Medicaid or no insurance. Multivariable regression models were used to assess the association of safety-net status with outcomes of interest including in-hospital mortality, perioperative complications, and resource utilization.</div></div><div><h3>Results</h3><div>Of an estimated 25,936 patients with type A aortic dissection undergoing aortic interventions, 7,055 (27.2%) were managed at safety-net hospitals. Compared with non–safety-net hospitals, patients at safety-net hospitals had a similar distribution of age, sex, and Elixhauser Comorbidity Index. After excluding patients who did not receive aortic surgical interventions, the proportion of cases transferred into safety-net hospitals increased from 27.5% to 48.1%. Following adequate risk adjustment, safety-net hospitals did not alter the odds of in-hospital mortality (adjusted odds ratio 1.15, 95% confidence interval 0.72–1.83, reference: non–safety-net hospitals). Notably, higher type A aortic dissection center volume was linked with reduced odds of death, independent of safety-net status (adjusted odds ratio 0.94, 95% confidence interval 0.91–0.97).</div></div><div><h3>Conclusions</h3><div>Our findings suggest that safety-net hospitals yield comparable perioperative outcomes to non–safety-net hospitals in management of type A aortic dissection outcomes. Future studies are warranted to further investigate the impact of safety-net status on long-term outcomes, as well as rates of readmission and reoperation.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"191 ","pages":"Article 110040"},"PeriodicalIF":2.7,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145918503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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