Surgery Today最新文献

Purpose: The Tokyo Guidelines of 2018 recommend performing an intraoperative bile culture for acute cholecystitis. However, their clinical significance remains unclear. We evaluated the impact of performing a bile culture on the perioperative outcomes.

Methods: We retrospectively analyzed 344 patients who underwent cholecystectomy for acute cholecystitis between 2015 and 2024. The patients were classified into a culture group (n = 248) and a non-culture group (n = 96). The inverse probability of treatment weighting was applied to adjust for baseline differences. The perioperative outcomes were compared and the influence of performing a bile culture on antibiotic management was assessed.

Results: The culture group had more Grade II/III tumors (p < 0.05). After adjustment, drain placement was more frequent (73.2% vs. 58.9%; p = 0.01). No significant differences were observed in the operative time (100 vs. 87 min, p = 0.10), gallbladder perforation (32.9% vs. 30.0%, p = 0.85), hospital stay (5 vs. 4 days, p = 0.30), or complications (24.0% vs. 18.0%, p = 0.273). In the culture group, 71.8% of the patients completed antibiotics before the culture results. Therapy was changed in only 2.0% of the patients.

Conclusions: Although a bile culture is often performed in severe cases, it rarely influences the antibiotic strategy or improves the outcomes. Therefore, performing a routine intraoperative bile culture, as recommended by the Tokyo Guidelines 2018, may have limited utility.

Purpose: This study aimed to identify the risk factors for 30-day mortality following neonatal surgery for major thoracic and abdominal conditions.

Methods: We conducted a retrospective cohort study of neonates who underwent major noncardiac abdominal or thoracic surgery in a tertiary pediatric surgery center in Tunisia between April 2015 and March 2025.

Results: A total of 361 neonates underwent major abdominal or thoracic surgeries during the study period. The male-to-female ratio was 1.3:1. The most common surgical conditions were esophageal atresia (n = 105), duodenal atresia (n = 42), and anorectal malformation (n = 39). A total of 85 neonates (23.5%) died within 30 days of surgery. According to a multivariate logistic regression analysis, five variables were independently associated with 30-day mortality.

Conclusion: This study demonstrated that an outborn status, prematurity, congenital heart disease, low 5-minute Apgar score, and prolonged operative time predict 30-day mortality after major neonatal surgery. These factors could serve as valuable tools for identifying patients at increased risk and enhancing the quality of their management.

Purpose: To evaluate the clinical characteristics and short-term outcomes of minimally invasive surgery (MIS) for right-sided colon cancer with superior mesenteric artery rotation (SMAR) when the SMA is found, intraoperatively, to run anterior to the superior mesenteric vein (SMV) in the ileocolic root area.

Methods: The subjects of this retrospective analysis were patients with right-sided colon cancer, who underwent MIS with D3 lymph node dissection between 2018 and 2024. We compared the clinical characteristics and short-term outcomes of MIS in patients with and those without SMAR. The findings of SMAR were defined on preoperative computed tomography as ct-SMAR.

Results: Among the 523 patients included in this analysis, there were 513 (98.1%) without SMAR and 10 (1.9%) with SMAR. It was identified that 60.0% of the patients with SMAR had cecum cancer vs.25.1% of those without SMAR. The sensitivity and specificity of the findings of ct-SMAR were 80.0% and 97.5%, respectively. Both operative time (183 min vs. 231 min, p = 0.004) and blood loss (0 mL vs. 27 mL, p = 0.012) were significantly higher in the patients with SMAR.

Conclusion: The vascular course in patients with SMAR differs from the usual pattern and this may increase the risk of unexpected vascular injury, potentially leading to intraoperative bleeding and prolonged operative time.

Purpose: Portal hypertension (PoH) after liver transplantation is a severe complication that results in graft loss. We investigated the characteristics and evaluated the treatment outcomes of PoH after living donor liver transplantation (LDLT).

Methods: This single-center, retrospective cohort study included 325 LDLT recipients.

Results: Of the subjects, 37 (11.4%) had a PoH. The 10- and 20-year graft survival rates were significantly lower in patients with PoH than in those without PoH (69.1% vs. 90.8% and 42.1% vs. 84.7%, respectively; p < 0.0001). The types of PoH were pre-hepatic, hepatic, and post-hepatic in 16, 13, and 8 patients, respectively. Interventional radiology was performed for PoH in all post-hepatic PoH patients and in 62.5% of pre-hepatic PoH patients. Notably, 46.2% of the patients with hepatic PoH required re-transplantation. The 10-year graft survival rate was significantly worse in patients with hepatic PoH than in those with pre- and post-hepatic PoH (46.2% vs. 86.7% and 75.0%, respectively; P < 0.05). Post-transplant PoH was an independent predictor of graft loss after LDLT (hazard ratio, 5.73; 95% confidence interval: 2.43-13.55, P < 0.0005).

Conclusions: Post-transplant PoH negatively affected the graft survival in LDLT recipients. Pre-hepatic, hepatic, and post-hepatic PoH cases had different characteristics, requiring different treatments. Therefore, an appropriate diagnosis and treatment are important.