Updates in Surgery最新文献

When the native hepatic artery is unsuitable for use in liver transplantation (LT), an extra-anatomical reconstruction became mandatory. Commonly, this unsuitability is due to the consequences of repeated intra-arterial procedures (such as chemoembolization or radioembolization), congenital arterial hypoplasia, intraoperative arterial dissection, or postoperative arterial thrombosis or rupture. In such conditions, a possible technical solution is extra-anatomical reconstruction directly on the infrarenal aorta or the right common iliac artery. Both of these extra-anatomical reconstructions can benefit from a lateral (sideways) implantation of an interposition arterial graft, which produces an angle that reduces the risk of thrombosis. In this technical article, we describe these two sideways approaches to rescue extra-anatomical arterial reconstruction in LT.

Postoperative chronic inguinal pain is a common postoperative complication after open inguinal hernia repair e.g. ilioinguinal nerve entrapment is a common cause of chronic pain which may adversely affect the patients' life. Triple neurectomy (ilioinguinal, iliohypogastric, and genital branch of genitofemoral) seems to be beneficial in preventing such pain, but it may carry the risk for numbness and hypoesthesia. This is a randomized clinical trial, which took place between January 2024 and January 2025, including all patients who were operated on by open inguinal hernioplasty either with triple neurectomy or with nerve preservation. A questionnaire filled by patients either written or by telephone to assess the severity of pain was obtained three months or more after surgery. Fifty one patients were included in nerve preservation group, while 59 patients were included in neurectomy group. Eleven patients in the nerve preservation group suffered from pain of variable severity. Six, four, and one patients had mild, moderate, and sever pain, respectively. In the neurectomy group only three patients had mild pain. There was a significant difference (p = 0.008) between the two groups. At time of questionnaire, the number of patients suffered from numbness in the nerve preservation group was 7 patients versus 10 patients in the neurectomy group, which was statistically non-significant, p value = 0.641. Prophylactic triple neurectomy provides the advantage of decreasing chronic postoperative pain after open inguinal hernia surgery. While our findings are promising, further studies with larger populations are needed before recommending triple neurectomy as a standard step during inguinal hernioplasty.Clinical trial registrationNCT06327763 registered on Mar 25, 2024.

Parastomal hernia (PSH) is a common complication following stoma formation. Although prophylactic mesh placement initially showed that promise, recent long-term follow-up randomized trials have demonstrated its ineffectiveness. To enhance PSH prevention, modifications in technique are necessary. We introduced a novel laparoscopic method, the laparoscopic extraperitoneal route to colostomy combined with retromuscular prophylactic mesh. This study documents detailed surgical procedures and postoperative outcomes. Up to now, after a median follow-up of 13 (range: 12-16) months, none of the five subjects in our study cohort experienced a PSH or other serious complication. Impressively, all these patients were followed up for over 1 year. In conclusion, the laparoscopic extraperitoneal route to colostomy combined with retromuscular prophylactic mesh appears to be safe and feasible for patients who need permanent sigmoidostomy. The procedure provides a novel option for those patients.

To summarize medical device reports (MDRs) between 2012 and 2022 relating to staplers within the Manufacturer and User Facility Device Experience (MAUDE) database maintained by The Food and Drug Administration (FDA). The MAUDE database was analysed for all MDRs relating to each FDA-approved stapler for the last ten years. Event descriptions were reviewed and characterized into specific event types for all the different manufacturers. All data is de-identified and in compliance with the Health Insurance Portability and Accountability Act (HIPAA). No further data was available in the database. Pooled Relative risk was used to compare data. Overall, 712 reports were retrieved in 10 years. In all, 413/712 (58%) were reported as malfunction of the device while 292/712 (41%) as injury. The most frequently reported adverse events (AEs) were Misfire (111/712: 15.6%), Failure to form staple (92/712: 12.9%), Mechanical jam (76/712: 10.7%) and Failure to fire (72/712: 10.1%). In terms of manufacturer: 401/712 (56%) were Covidien, 172/712 (24%) were Teleflex Medical and 139/712 (19.5%) were Ethicon Instruments. When comparing on disproportional analysis the different manufacturers, Teleflex medical's staplers were safer in terms of failure to fire and failure to form staple and Covidien showed the safest profile for misfire and along with Ethicon for mechanical jam. According to MAUDE database the most frequent complications related to staplers are misfire, failure to form staple, mechanical jam and failure to fire and the reported adverse events vary among the different manufacturers.

Surgical treatment can achieve a cure in stage IA non-small-cell lung cancer (NSCLC). Although invasion of vascular, lymphatic, or perineural structures does not alter TNM staging, such features are sometimes considered when recommending adjuvant therapy. This study aimed to evaluate the impact of these invasion types on overall survival (OS) and disease-free survival (DFS) in stage IA NSCLC patients who did not receive adjuvant treatment. A total of 402 patients with pathological stage T1N0M0 NSCLC who underwent anatomical lung resection between January 2014 and December 2019 were retrospectively analyzed. Final staging was performed according to the 8th edition of the TNM classification. Pathology reports and follow-up data were reviewed. Demographic features, surgical details, postoperative complications, and tumor invasion patterns were examined in relation to OS and DFS using Jamovi (v2.5.3.0). In multivariable analysis, older age (HR 1.03, 95% CI 1.00-1.06, p = 0.05), male sex (HR 1.81, 95% CI 1.10-2.98, p = 0.01), and postoperative complications (HR 1.64, 95% CI 1.12-2.40, p = 0.01) independently predicted lower OS. While individual invasion types were not significantly associated with OS, their co-occurrence predicted poorer OS (HR 4.06, p = 0.05) and DFS (HR 12.74, p = 0.001). In subgroup analyses, lymphatic invasion was linked to reduced OS in male patients (HR 1.46, p = 0.04), while lymphatic and vascular invasion both negatively affected OS in squamous cell carcinoma (HR 1.72 and 1.98, respectively). When all three invasion types were present, prognosis worsened markedly in stage IA NSCLC. Sex- and histology-based risk assessment may help guide postoperative treatment decisions.