Updates in Surgery最新文献

Despite increasing numbers of women entering surgical training, gender disparities in surgical careers persist. Female surgeons remain underrepresented in leadership roles and face challenges related to family responsibilities. This study investigates gender-specific differences in surgical careers, family planning, caregiving responsibilities, and perceived institutional support in Germany. A nationwide cross-sectional survey was conducted among 432 board-certified surgeons and residents from various surgical specialties in Germany. A 68-item questionnaire assessed demographics, career stage, family planning, childcare responsibilities, work models, and perceived career barriers. Analyses included descriptive statistics, chi-square tests, t-tests, and regression models adjusted for age and institutional background. Female surgeons were significantly more likely to work part-time (OR 12.03, 95% CI 4.19-50.87), interrupt training due to parental leave, and experience prolonged specialization (OR 1.74, 95% CI 1.03-2.96). Nearly half (46.2%) postponed childbearing for career reasons (OR 4.72, 95% CI 2.34-10.23), and 82.5% reported negative career impacts from motherhood (OR 11.22, 95% CI 4.77-30.0). Women also reported greater domestic burdens, physical (OR 2.32, 95% CI 1.32-4.17) and emotional exhaustion (OR 2.61, 95% CI 1.39-5.20). Reassignment to non-surgical duties during pregnancy occurred in 46.4% (n = 44). Structural and cultural barriers constrain gender equity in surgery. Family responsibilities disproportionately affect female surgeons' careers, contributing to slower advancement and increased burnout. Reforms such as flexible work models, accessible childcare, transparent promotion pathways, and mentorship are critical for fostering equal opportunity and retaining female talent for surgical leadership.

Endoscopic treatment is the standard treatment for biliary strictures after liver transplantation (LT), but the specific strategies and different success patterns have not been clearly defined in terms of their impact on survival. The aim of this study was to investigate the predictors of successful endoscopic treatment and the impact of different patterns of success on patient survival outcomes. A total of 93 patients with accurately diagnosed biliary strictures who subsequently underwent endoscopic retrograde cholangiopancreatography (ERCP) were retrospectively enrolled. The primary endpoint was standard of care success and final treatment success, while secondary endpoint was overall survival. Non-anastomotic strictures (NAS) and anastomotic strictures (AS) were diagnosed in 57 and 36 patients, respectively, based on imaging before the last ERCP procedure. Definitive treatment success was achieved significantly more often in patients with AS (P = 0.018), while there was no significant difference in standard treatment success between AS and NAS (P = 0.900). Both treatment success patterns showed a better overall survival benefit in the overall and NAS groups (P < 0.05), and in the AS group, the survival curve showed a long-term benefit for both treatment success patterns, despite no statistical difference. In addition, balloon dilatation with stenting increased final treatment success in the overall groups. ERCP is a safe and effective therapeutic option for patients with NAS and AS, with both successful treatment patterns improving long-term survival. Balloon dilatation with stenting can increase the treatment success of ERCP in both types of biliary strictures.

Objective: Chronic anal fissures (CAF) is a common cause of severe anorectal pain in adults causing poor quality of life. In case of failure of conservative treatments, lateral internal sphincterotomy (LIS) is an effective cure. We aimed to analyse the outcomes of LIS in a consecutive patients' series operated in a high volume Surgical Coloproctology Unit.

Methods: A retrospective cohort study was conducted on 422 patients with CAF undergoing surgical treatment between January 2015 and December 2019 at our Surgical Coloproctology Unit. Patients over the age of 18, not responding or recurring after a standard course of nifedipine ointment were included. Score of anal pain, bleeding, incontinence score, bowel habit was recorded before the operation and at 10th day and two months after treatment. After a mean follow-up of 48.7 months same data were recorded by a phone call on 362 patients available.

Results: Surgical treatment resulted in sharp and fast improvement of anal pain. Male patients, those complaining of constipation and those younger than 35 yr showed less improvement at short term. Postoperative complications included 3 cases of early postoperative bleeding, 3 abscesses at surgical wound and persisting postoperative bleeding in 28 cases (median 4 days). A mild, transient, faecal incontinence was reported at first post-operative visit in females compared to males and in patients older than 50 yrs. compared to younger (p < 0.001). At two months follow up visit 97.5% of patients reported absence of pain, normal continence and thus patients' satisfaction was very high. Nine patients (8 males) complained of persisting post-operative pain and had the fissure unhealed at two months follow up. At long term follow-up no patient complained of recurrent symptoms of anal fissure, continence was normal in all.

Conclusions: The surgical treatment of chronic anal fissure by means of lateral internal sphincterotomy gives excellent results with prompt resolution of anal pain. A standardized approach, surgeon's experience and high volume of cases may represent contributing factors for a good outcome, minimizing complications and recurrence. Normal bowel function contributes to improve and preserve results of surgical treatment.

Nutritional status is a potentially modifiable factor influencing outcomes in retroperitoneal sarcoma (RPS), yet reliable preoperative markers remain underexplored. The prognostic nutritional index (PNI), which combines serum albumin and lymphocyte count, may offer a simple, reproducible tool for risk stratification. We conducted a retrospective cohort study of adult patients undergoing curative-intent resection of primary or recurrent RPS between 2020 and 2024 at a Latin American tertiary center. Patients were stratified by a PNI cutoff of 40, derived via ROC analysis. The primary endpoint was the incidence of major postoperative complications (Clavien-Dindo ≥ III), while secondary endpoints included overall survival (OS) and recurrence-free survival (RFS). Multivariable logistic and Cox regression models were used to assess independent predictors. Among 142 patients, 52.1% had a low PNI (≤ 40). Major complications occurred in 27.6% of patients and were significantly more freq uent in the low-PNI group (37.8% vs. 16.2%, p = 0.006). Low PNI independently predicted significant morbidity (OR 2.72, 95% CI 1.18-6.29, p = 0.018), alongside operative time and intraoperative transfusion. After a median follow-up of 39 months, low PNI was associated with inferior 3-year OS (55% vs. 74%, p = 0.008) and RFS (44% vs. 63%, p = 0.022). On multivariable analysis, low PNI remained a significant predictor of OS (HR 1.98, p = 0.019) and RFS (HR 1.67, p = 0.037). A preoperative PNI ≤ 40 identifies RPS patients at increased risk for significant complications and inferior survival, independent of tumor grade or surgical extent. These findings remained consistent across sensitivity analyses restricted to primary RPS, support the integration of PNI into perioperative risk stratification and nutritional optimization strategies.

Background and aim: Despite laparoscopic resection's established role in gastric gastrointestinal stromal tumor (GIST) management, its application for esophagogastric junction (EGJ) tumors involving the Z-line remains technically challenging and insufficiently studied. This study compares feasibility, safety, and oncologic outcomes of laparoscopic versus open resection for EGJ-GIST.

Methods: A retrospective cohort analysis included 45 patients undergoing EGJ-GIST resection (24 laparoscopic, 21 open). Perioperative metrics and survival outcomes were evaluated, with clinicopathological parameters systematically compared.

Results: Groups had similar baseline characteristics. Laparoscopic surgery showed superior intraoperative outcomes, including reduced median blood loss (47.5 vs 85.0 mL, p < 0.001). Postoperatively, laparoscopic patients experienced faster gastrointestinal recovery (first flatus: 2 vs 3 days, p = 0.004), earlier dietary advancement (liquid: 3 vs 4 days, p = 0.003; solid: 4 vs 5 days, p < 0.001), and shorter hospitalization (6 vs 8 days, p = 0.002). Complication rates trended lower with laparoscopy (8.3% vs 23.8%, p = 0.306). Over 68-month median follow-up, recurrence occurred in 5 patients (laparoscopic:3; open:2). Five-year disease-free survival (DFS) (86.3% vs 87.7%) and overall survival (OS) (92.9% vs 93.3%) were comparable, with no intergroup differences in Kaplan-Meier analysis (DFS: p = 0.644; OS: p = 0.506). Multivariate analysis confirmed surgical approach did not independently affect prognosis.

Conclusions: Laparoscopic resection for EGJ-GIST offers significant perioperative benefits-reduced blood loss, faster recovery, and fewer complications-while demonstrating comparable descriptive long-term survival rates to open surgery. These findings advocate prioritizing minimally invasive techniques in surgically selected cases.