World Journal of Surgery最新文献

Background: Laparoscopic surgery has gradually gained acceptance for abdominal surgical emergencies; however, limited reports exist on laparoscopic surgery for strangulated small bowel obstruction (SSBO). We aimed to demonstrate the efficacy and feasibility of laparoscopic surgery for SSBO.

Methods: In this single-center retrospective study, patients who underwent emergency surgery for SSBO between January 2014 and December 2024 were included and divided into laparoscopy and open groups. Propensity score matching (PSM) was performed to compare the primary outcomes-intraoperative and short-term postoperative outcomes-between the groups. Logistic regression analysis was used to identify the factors associated with the conversion from laparoscopic to open surgery as secondary outcomes.

Results: A total of 123 patients were included in this study, of whom 39 (31.7%) were assigned to the laparoscopy group. After PSM, the overall rate of the Clavien-Dindo grade ≥ II postoperative complications was significantly lower in the laparoscopy than the open group (7.4% vs. 29.6%; p = 0.036). Of the 39 patients in the laparoscopy group, 10 (25.6%) were converted from laparoscopic to open surgery. The number of previous laparotomies (odds ratio: 4.036, 95% confidence interval: 1.189-13.701, and p = 0.025) and a history of gastrointestinal surgery (odds ratio: 6.125, 95% confidence interval: 1.263-29.699, and p = 0.024) were identified as factors significantly associated with conversion from laparoscopic to open surgery in patients with SSBO.

Conclusion: Our study suggests that laparoscopic surgery for SSBO is beneficial for reducing the occurrence of postoperative complications. However, laparoscopic surgery should be performed in patients with a history of multiple laparotomies or gastrointestinal surgery, considering the possibility of conversion to open surgery.

Background: A growing number of emergency general surgery (EGS) admissions comprise of adults age 65 years and older, who are more likely to experience missed or delayed diagnoses, and subsequently worse postoperative outcomes. We aimed to ascertain the perspectives of clinicians on the diagnostic challenges unique to older adults with EGS conditions and strategies to improve feedback.

Methods: In this qualitative study, semi-structured focus groups were conducted with frontline clinicians with experience in providing high volume care to older adult EGS patients to explore diagnostic challenges, tools, and feedback strategies. Questions focused on clinical gaps and approaches, tools, and the mechanisms in place to provide feedback on patient diagnosis and assessment. Focus groups were transcribed and qualitatively analyzed using an inductive approach.

Results: Twenty-two clinicians participated in one of six focus groups. Clinicians reported three key diagnostic challenges: nontextbook presentations, comorbidities, and older-age specific complications. Nondiagnostic factors remained high priorities including functional health status, patient preferences, family involvement, and health related social needs. Practical tools addressing these gaps included the use of multidisciplinary expertise, surgical risk calculators, cognitive assessments, functional health assessments, and protocols guiding goals of care discussions. Participants shared barriers and facilitators for implementation of these tools.

Conclusion: Frontline clinicians identified several high priority considerations unique in EGS for older adults. To address these, context-specific tools and strategies were detailed and inform ongoing work to incorporate feedback and solutions into frontline settings. Future work in quality improvement should incorporate these high priority areas into existing quality improvement frameworks.

Background: PANP has been applied in laparoscopic radical rectal cancer resection, significantly reducing the incidence of genitourinary dysfunction; however, it has not eliminated sexual and urinary dysfunction. Prospective trials focusing on genitourinary function as a primary outcome are rare. To confirm the protective effect on sexual and urinary function in laparoscopic radical resection of rectal cancer with pelvic autonomic nerve preservation (PANP), and explore the risk factor of postoperative sexual dysfunction.

Methods: A prospective, single-center, single-arm trial was conducted on male patients with rectal adenocarcinoma suitable for laparoscopic surgery with PANP at Sun Yat-sen Memorial Hospital, Sun Yat-sen University. Patients with normal genitourinary function were included, and the primary outcome was the change in sexual function 6 months after the operation.

Results: Of 91 patients enrolled, 70 underwent a laparoscopic operation. Six months after the operation, 5 patients were lost to follow-up, and the IIEF-5 and IPSS scores were 22.85 ± 3.66 versus 24.10 ± 1.21 (p = 0.003) and 2.11 ± 2.06 versus 1.89 ± 1.86 (p = 0.018), respectively, compared with preoperative values. Five patients (7.69%) suffered from sexual disorders, and 2 patients (3.08%) developed moderate urinary dysfunction. The majority of the autonomic nerve system was visible and preserved intraoperatively. Quality of TME was complete in 94.29% (66/70) and partially complete in 5.71% (4/70) of patients, respectively. Positive CRM in this study was 2.86% (2/70), and positive distal resection margin was 1.43% (1/70). The mean postoperative hospital stay was 7.80 ± 2.44 days. Surgical procedure, distance of tumor to AV, clinical TNM stage, nCRT, stoma, and completeness of the autonomic nervous system were risk factors of postoperative sexual dysfunction in univariate analysis; however, none of them was an independent risk factor in multivariate analysis.

Conclusions: PANP in laparoscopic radical rectal resection effectively preserves sexual and urinary function without compromising oncological outcomes. It is safe and feasible in high-flow centers and for experienced surgeons.

Background: Excessive opioid prescribing after colorectal surgery can lead to adverse events and contribute to the opioid crisis. Understanding international prescribing patterns is essential for guiding practice and future research. The Analgesia After Colorectal Surgery (ACORE) survey aimed to characterize international opioid prescribing practices after elective colorectal resection.

Method: This international cross-sectional survey followed established methodological guidelines. Eligible participants were colorectal, gastrointestinal, and general surgeons, as well as surgery trainees. Recruitment followed snowball sampling via international surgical societies' mailing lists, social media, and personal networks. The primary outcome of interest was post-discharge opioid prescribing after open and MIS elective colorectal resection. Secondary outcomes included prescription quantity in morphine milligram equivalents (MMEs). Data were analyzed using descriptive statistics and logistic regression with Bayesian model averaging.

Results: Among 817 participants, 88% were surgeons, 12% were trainees, 62% practiced in academic hospitals, and 67% had over 5 years in practice. Overall, 57% of the participants reported prescribing opioids at discharge (55% after open and 54% after minimally invasive procedures). Opioids were commonly prescribed by surgeons practicing in Australia and New Zealand (100%), Northern America (92%), Northern Europe (68%), and South-eastern Asia (71%). In contrast, they were less frequently prescribed in Eastern Europe (11%), Eastern Asia (22%), Latin America and the Caribbean (26%), Southern Europe (19%), and Northern Africa (0%). The median quantity of opioids prescribed at discharge varied widely (30-200 MMEs). In regression analysis accounting for surgeon and practice characteristics, region of practice was the only factor independently associated with opioid prescribing.

Conclusion: The extensive global variation in opioid prescribing underscores clinical equipoise and challenges the assumption that post-discharge opioids are universally necessary for patients undergoing colorectal resection.

Background: Patients with non-small cell lung cancer (NSCLC) are a heterogeneous group with varied patterns of disease. The skip mediastinal lymph node metastasis is quite frequent and a prognostic factor for patients with N2 lung cancer. The aim of this study is to assess the clinical significance and prognostic value of a new N2 descriptor based on skip N2 disease and ninth edition N2 classification.

Methods: A retrospective review of 533 patients with stage pN2 NSCLC was undertaken. Patients were finally classified into three categories (skip N2a, skip N2b/nonskip N2a, and nonskip N2b). The clinic characteristics, survival outcomes, and metastasis pattern were analyzed among groups.

Results: Significant prognostic differences were found between patients of subdivided N2 descriptor (skip N2a vs. skip N2b/nonskip N2a and p < 0.001 for both OS and DFS and skip N2b/nonskip N2a vs. nonskip N2b, p = 0.037 for OS and p = 0.029 for DFS). Better prognostic value in predicting survival, including a smaller Akaike Information Criterion value and a higher Harrell C-index, was observed for the new N2 descriptor relative to the ninth edition N2 classification. Skip patients had better survival outcomes and different lymph node metastasis pattern compared with nonskip patients.

Conclusions: When compared to the ninth N2 classification, the new N2 descriptor could be a more reliable and accurate prognostic determinant, which is worth considering in the revision of the current tumor, node, and metastasis (TNM) staging system.

Background: Postoperative morbidity remains a significant concern following the surgical treatment of pediatric liver hydatid disease, particularly in endemic regions. The aim of this study was to identify independent predictors of postoperative morbidity in pediatric liver hydatid disease in order to improve preoperative risk assessment.

Methods: This retrospective observational study included consecutive pediatric patients who underwent surgical treatment for liver hydatid disease at Hedi Chaker University Hospital, Sfax, Tunisia, between 1 July 2010 and 30 June 2025. Postoperative morbidity was defined as any complication occurring within 30 days after surgery.

Results: A total of 117 children were included. The median age was 8 years, with a nearly equal sex distribution (59 males and 58 females). The median Sun Pediatric Comorbidity Index (SPCI) was 1 [IQR, 0-2]. The mean cyst size was 8 ± 2.4 cm, with right lobe involvement observed in 83 patients (70.9%). Concomitant extrahepatic hydatid disease was identified in 23 children (19.7%). Postoperative complications occurred in 25 patients (21.4%). In multivariate analysis, three factors were independently associated with postoperative morbidity: SPCI ≥ 3 (OR 5.748, 95% CI 1.696-19.482; p = 0.005), cyst size > 8 cm (OR 5.020, 95% CI 1.172-21.513; p = 0.030), and concomitant extrahepatic hydatid disease (OR 6.355, 95% CI 1.710-23.620; p = 0.006).

Conclusion: Postoperative morbidity after pediatric liver hydatid surgery remains frequent. Beyond cyst size, pediatric comorbidity burden and multisite hydatid disease emerge as novel and independent predictors of adverse postoperative outcomes.

This clinical practice guideline from the Explosive Weapons Trauma Care Collective (EXTRACCT) group provides a review of current best practice for management of burn wounds in low-resource conflict settings. The vast majority of burn wounds occur in low-and middle-income countries and yet international consensus guidelines are largely based on highly resource-intensive practices utilized in high-income countries. The guideline provides recommendations for initial evaluation, including airway management and estimation of burn size, resuscitation strategies, wound care, and approaches to definitive surgical management.