Updates in Surgery最新文献

Colonic stenting for malignant large bowel obstruction (LBO) is established as an effective option for palliation and bridging to more definitive surgery. However, stenting of flexural tumours (hepatic or splenic) is comparatively technically challenging due to colonic angulation and tortuosity. To assess its relative safety and feasibility we have analysed its outcomes against stenting elsewhere in the colon. Retrospective data, including baseline demographics, mortality/morbidity data, and patency rates, were collected on patients diagnosed with malignant LBO at our centre between August 2007 and August 2024. Colonic stenting was performed by advanced endoscopists with fluoroscopic guidance. Malignant flexural and non-flexural stenting outcomes were compared through chi-squared testing and Kaplan-Meier analysis using SPSS. A total of 86 patients underwent colonic stenting, with 13 patients stented in the colonic flexures. Comparison of outcomes between flexural and non-flexural stenting revealed no statistically significant differences. Primary patency at 90 days was higher in the flexure group (69.23%) compared to the non-flexure group (46.15%) (p = 0.195). Kaplan-Meier analysis showed a median primary patency of 164 days (95% CI: 70-258) for flexural stenting and 98 days (95% CI: 13-183) for non-flexural stenting (p = 0.453). No statistically significant difference was found between the two groups in terms of the stent-related complications of migration, re-stenosis and perforation. Flexural colonic stenting for malignant LBO does not appear to be inferior to stenting elsewhere in the colon, highlighting its potential safety and feasibility in experienced hands. Flexural colonic stenting may be considered an option in the management of malignant LBO, for both palliation and bridging.

Lymph node metastasis (LNM) plays a key role in the treatment of patients with early gastric cancer (EGC), especially elderly patients (over 65 years old). The accurate preoperative prediction of LNM is still a challenge, and studies of elderly patients are lacking. The purpose of this study was to develop and validate an effective model based on machine learning to predict the risk of preoperative LNM in elderly patients with EGC. The data of 1578 patients from 2010 to 2020 were extracted from the Surveillance Epidemiology and End Results (SEER) database. Five different machine learning algorithms were applied to construct the models. The external validation data were obtained from 127 elderly patients in our hospital. The area under the receiver operating characteristic curve (AUC), accuracy, sensitivity and specificity of the models were compared and evaluated. A Cox regression model was used to determine the prognostic factors for overall survival (OS) in elderly patients with EGC. Of the 1578 patients included in this study, 165 (10.46%) had LNM. Multivariate logistic regression analysis revealed that differentiation grade, T stage, tumour size were independent predictors of LNM. The performance of the random forest (RF) model was the best, with an AUC of 0.771 in the training cohort, 0.733 in the internal validation cohort and 0.796 in the external test. Multivariate Cox regression analysis confirmed that sex, age, primary site, tumour size, T stage, radiotherapy and RNE were independent prognostic factors for OS in elderly patients with EGC. Based on RF model, clinicians can develop more reasonable treatment plans to improve the prognosis of patients and reduce the burden on the medical system and patients.

Background: Bullfighting-related trauma, common in rural Spain, often results in polytrauma requiring urgent care. This study evaluates the management and outcomes of bullfighting-related trauma at a level I hospital in Medina del Campo, Spain.

Methods: A retrospective study of 154 patients with bullfighting-related trauma from 1998 to 2024 was conducted. Patients were classified by trauma severity using the New Injury Severity Score (NISS): mild (MT), moderate (MoT), moderate-severe (MST), and severe (ST). Demographic data, injury characteristics, surgical procedures, complications, and outcomes were analyzed, with comparisons made using trauma severity scales (RTS, AIS, ISS, NISS).

Results: The cohort had a mean age of 32 years (IQR 23-52), with a male predominance (97%). Open trauma (74.7%) was most common, especially goring (85.1%) to the lower extremities and pelvis. Significant findings included fewer deep goring injuries in MT (77% vs. 100%, p = 0.013) and more lower extremity injuries in MT (65% vs. 44%, p < 0.001). Mortality was higher in the ST group (p < 0.001), with one intraoperative death. Surgical intervention was needed in 92.2% of cases, and the reoperation rate was higher in the ST group (p < 0.001). The NISS scale effectively predicted severity, with MT having a median NISS of 5 (IQR 4-9) compared to 57 in the ST group (p < 0.001).

Conclusion: Bullfighting-related trauma often requires urgent care, and the NISS scale is effective in predicting injury severity. Early surgical intervention improves outcomes. Further multicenter studies are needed to confirm these findings.

Background: Graduate medical education (GME) programmes are integral to healthcare systems, providing clinical manpower through medical residents whose compensation is externally funded in Italy. The financial impact of resident integration on public hospital budgets, particularly amid rising healthcare expenditures, remains poorly quantified.

Methods: We conducted a deterministic 12-month Budget Impact Analysis from the hospital perspective (EUR 2024), comparing an attending-only workforce with a resident-integrated configuration. Inputs included attending full-cost FTE (salary + employer on-costs), resident productivity by setting, supervision shares (translated into effective attending FTE), and departmental workload. Uncertainty was addressed through Monte Carlo probabilistic sensitivity analysis.

Results: This Budget Impact Analysis (hospital perspective; EUR 2024; 12-month horizon) found that integrating Ministry-funded residents reduced annual personnel expenditure by 40-50%. Replacing 40% of attending FTEs produced mean savings of €240,000 (95% CI: €205,000-€275,000). Sensitivity analyses confirmed the robustness of these savings across variations in staffing mix, supervision requirements, and resident productivity rates.

Conclusion: Externally funded residency programmes provide substantial, direct cost savings and support flexible workforce planning in Italian public hospitals. These findings support strategic investment in GME as a driver of economic sustainability and healthcare resource optimisation. Further research should address broader impacts on care quality and workforce stability.

Acute diverticulitis (AD) is a significant socioeconomic burden on healthcare systems, primarily due to elevated rates of hospital admissions and considerable healthcare expenditures. The aim of this systematic review is to update and summarise existing knowledge regarding the viability of conservative management in 2B stage cases (distant free extraluminal air) that remains a crucial condition for surgeons to decide for operative or non-operative management. Patients ages ranging between 52.2 and 60.5 years. Male patients varied from 47 to 73.4%. BMI ranged from 25.7 to 27.1 kg/m², and ASA scores between I and III. Antibiotic regimens varied across studies, including mono-antibiotic or bi-antibiotic therapy (average duration from 7 to 21 days). Percutaneous drainage was used in 3.5 to 27.6%. NOM failure ranged from 2.6 to 31.9%, with corresponding emergency surgery rates between 2.17 and 69%. Mortality was low overall. Follow-up durations ranged from 1 to 71 months. Thirty-day readmission (7.7%) and recurrence (up to 27.8%) were inconsistently reported. The management of AD with distant extraluminal free air remains a complex and challenging topic, however, despite several limits due to the low level of evidence, our review reported that NOM may be feasible in carefully selected, hemodynamically stable individuals, knowing that failure rates can be variable. The ongoing COLD 2B study (ClinicalTrials.Gov ID Number NCT06388538), a multi-center prospective trial, promoted by research Emergency Surgery committee of the Italian Society of Endoscopic Surgery and New Technologies (SICE), was designed to provide high-quality evidence on this complex condition.

To systematically analyze the current status and future trends of artificial intelligence (AI) in gastrointestinal surgery from July 2015 to July 2025 through bibliometrics. Based on the Web of Science Core Collection database, this study retrieved relevant literature from July 13, 2015 to July 13, 2025, and used CiteSpace and VOSviewer software to visualize 1697 articles by country/region, institution, author, journal, fund and keyword. The results show that the number of publications in this field peaked in 2024, with 378 papers and 30,555 cumulative citations. China emerges as the predominant contributor to research output, with 797 papers, 14,075 citations, and an average of 17.66 citations per paper. However, the United States exhibits a higher average citation count per paper, at 26.62, and 6523 total citations. Notably, Tian Jie, with 1921 citations, and Li Jing, with 31 publications, are prominent scholars from China in this domain. Keyword analysis reveals a transition from foundational AI algorithms to clinical precision applications. While China holds a leading position in terms of research output, there is a need for enhancement in research quality. The field is currently experiencing an upward trajectory, with future research likely to focus on advancements in AI-assisted individualized precision medicine.

According to WSES guidelines conservative/non-operative treatment is the first-line therapy for acute complicated diverticulitis (ACD) but failure may represent a challenge in terms of hospitalization, medical costs, morbidities, and mortality. This study aimed to evaluate failure rates following non-operative management of acute complicated diverticulitis and to examine possible predictive factors for failure. We retrospectively analyzed all patients with a diagnosis of diverticulitis consecutively admitted to our Institution from 1 January 2017 to 31 December 2021. Patient demographics, blood inflammatory markers, radiological findings, management, and outcomes were evaluated.A total of 164 patients were included, 34 had uncomplicated diverticulitis and 130 had ACD. Among those with ACD, 18 patients underwent urgent surgery and 112 (WSES 1a n = 54, 1b n = 19, 2a n = 31, 2b n = 8) underwent conservative/nonoperative treatment, consisted of intravenous antibiotics with or without percutaneous drainage. Twenty-three patients (20.5%) failed conservative treatment. Univariate analysis revealed that male sex, obesity (BMI>30), low performance status (ASA > 2), and intra-abdominal abscess greater than 4 cm on CT scan, were significantly associated with conservative treatment failure. Multivariate analysis proved that obesity[OR 2.92; 95%CI 1.104-7.702; p-value 0.046] and intra-abdominal abscess > 4 cm [OR 3.66; 95%CI 1.386-9.672; p-value 0.014], were possible predictive factors of conservative treatment failure.Conservative/non-operative treatment of acute complicated.

Clinically relevant postoperative pancreatic fistula (CR-POPF) is a primary cause of morbidity after distal pancreatectomy (DP). Current stump reinforcement techniques yield inconsistent results. We previously reported promising initial results with a novel Glubran^®2 serosal patching (GSP) technique. This study aims to report outcomes from an expanded series using a standardized GSP methodology. This is a single-center retrospective analysis of 10 consecutive patients who underwent robot-assisted distal pancreatectomy (DP) with standardized GSP for pancreatic stump closure. The primary outcome was the incidence of CR-POPF (Grades B/C) within 90 days, defined according to the International Study Group on Pancreatic Surgery (ISGPS) criteria. Secondary outcomes included overall morbidity and mortality. Ten patients (mean age 71.6 ± 5.4 years; 60% male) were included. The mean operative time was 4.8 ± 1.1 h, and all procedures achieved R0 resection. The mean length of stay was 5.1 ± 2.2 days. The incidence of CR-POPF was 0%. One patient (10%) developed a biochemical leak (formerly Grade A) that resolved without intervention. No major complications (Clavien-Dindo Grade ≥ IIIa) or 90-day mortality occurred. The standardized application of the GSP technique for pancreatic stump closure after robot-assisted DP appears to be a safe and reproducible method. In this small, consecutive series, the technique was associated with a complete absence of clinically relevant pancreatic fistulae; however, these preliminary outcomes must be interpreted with caution. This novel technique shows promise, and its efficacy warrants further investigation in larger, prospective trials.