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Impact of an ERAS-Based Surgical Care Bundle Implementation for Preventing Anastomotic Leakage in Minimally Invasive Low Anterior Resection for Rectal Cancer: A Retrospective Cohort Study. 基于erass的手术护理包实施对预防直肠癌微创前低位切除术吻合口漏的影响:一项回顾性队列研究。
IF 2.5 3区 医学 Q2 SURGERY Pub Date : 2026-01-23 DOI: 10.1002/wjs.70242
Koji Tamura, Takaaki Fujimoto, Jinghui Zhang, Kinuko Nagayoshi, Yusuke Mizuuchi, Kohei Horioka, Naoki Ikenaga, Kohei Nakata, Kenoki Ohuchida, Masafumi Nakamura

Background: Anastomotic leakage (AL) remains a severe complication after low anterior resection (LAR) for rectal cancer, despite advances in minimally invasive (MI) techniques. This study aimed to evaluate the impact of a surgery-focused care bundle, implemented on an enhanced recovery after surgery (ERAS)-based perioperative protocol, on preventing AL and improving postoperative outcomes in patients with MI-LAR.

Methods: In this retrospective historically controlled cohort study, a total of 306 patients who underwent MI-LAR between 2011 and 2024 were included. A late-phase cohort (n = 81) receiving the care bundle with an ERAS-based protocol (from September 2019) was compared with a historical early-phase cohort (n = 225). The surgery-focused care bundle included robot surgery, preoperative oral antibiotics, indocyanine green blood flow evaluation, diverting stoma, transanal drainage tubes, and anastomotic reinforcement. Our institutional ERAS protocol was developed in accordance with the ERAS Society guidelines. Propensity score matching (PSM) was used to adjust for baseline differences between cohorts.

Results: The AL rate significantly decreased from 14.7% (33/225) to 2.5% (2/81) after bundle implementation (p < 0.01). Post-PSM, AL rates remained significantly lower in the late-phase cohort (18.0% vs. 1.3% and p < 0.001). Severe complications (Clavien-Dindo grade ≥ 3) and surgical site infections (SSIs) were also significantly reduced, and no reoperations were required in the late-phase cohort. Multivariate analysis identified lack of care bundle (odds ratio [OR]: 6.36, 95% confidence interval [CI]: 1.42-28.4, and p = 0.01) and male sex (OR: 3.05, 95% CI: 1.24-7.52, and p = 0.01) as significant risk factors for AL.

Conclusions: Implementation of a surgery-focused care bundle, integrated within an ERAS-based perioperative framework, significantly reduced AL, severe complications, and SSIs after MI-LAR, suggesting potential long-term benefits by improving short-term postoperative outcomes.

背景:尽管微创(MI)技术有所进步,吻合口漏(AL)仍然是直肠癌低位前切除术(LAR)后的一个严重并发症。本研究旨在评估以手术为中心的护理包的影响,实施基于手术后恢复(ERAS)的围手术期方案,预防AL和改善MI-LAR患者的术后预后。方法:在这项回顾性历史对照队列研究中,共纳入2011年至2024年间接受MI-LAR治疗的306例患者。将接受基于erass方案的护理包的晚期队列(n = 81)(从2019年9月开始)与历史早期队列(n = 225)进行比较。以手术为重点的护理包包括机器人手术、术前口服抗生素、吲哚菁绿血流评估、转移造口、经肛门引流管和吻合口加固。我们的机构ERAS协议是根据ERAS协会的指导方针制定的。使用倾向评分匹配(PSM)来调整队列之间的基线差异。结果:实施捆绑包后,AL率从14.7%(33/225)显著下降至2.5%(2/81)。(p)结论:实施以手术为重点的护理捆绑包,结合基于erass的围手术期框架,显著减少了MI-LAR后的AL、严重并发症和ssi,表明通过改善短期术后结果可能带来长期益处。
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引用次数: 0
Response to the Letter to the Editor. 对给编辑的信的回应。
IF 2.5 3区 医学 Q2 SURGERY Pub Date : 2026-01-23 DOI: 10.1002/wjs.70238
Yuman Fong, Dennis Fowler, Jordana Bernard
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引用次数: 0
The Invisible Barriers to Sustainable Surgical Practice. 可持续外科实践的无形障碍。
IF 2.5 3区 医学 Q2 SURGERY Pub Date : 2026-01-23 DOI: 10.1002/wjs.70244
Mina Sarofim
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引用次数: 0
When Everything Must Go Right: Textbook Outcome as an Aspirational Measure of Surgical Quality. 当一切都必须顺利:教科书结果作为外科手术质量的理想衡量标准。
IF 2.5 3区 医学 Q2 SURGERY Pub Date : 2026-01-21 DOI: 10.1002/wjs.70240
Dhananjaya Sharma
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引用次数: 0
Effect of Bariatric Surgery on Osteoarthritis-Related Pain and Function: A Systematic Review and Meta-Analysis. 减肥手术对骨关节炎相关疼痛和功能的影响:系统回顾和荟萃分析。
IF 2.5 3区 医学 Q2 SURGERY Pub Date : 2026-01-21 DOI: 10.1002/wjs.70236
Mohammed Mana Mohammed Alqahtani, António Raposo, Abdullah Mohammed Saeed Alshalaan, Saeed Mohammed Saad Asiri, Jaber Salman Yazeed Alfaifi, Saleh Mohammed Saleh Alqahtani, Rawan Asad Salameh Shawabkeh, Afnan Ali Saeed Abonukhaa, Sara Ahmed Elmahadi Ahmed, Maha Hassan Ali Asiri, Mohammad Abdullah Saeed Almastoor, Ariana Saraiva, Ashwag Saleh Alsharidah, Ibrahim Yahya Al Yasin, Najim Z Alshahrani

Aim: This systematic review and meta-analysis aimed to synthesize current evidence on the effect of metabolic and bariatric surgery on osteoarthritis (OA) diagnosis, pain, stiffness, and functional outcomes.

Method: A systematic search was conducted in PubMed/MEDLINE, Scopus, Web of Science, and the Cochrane Library for studies published between January 2000 and July 2025. Eligible studies included adult patients undergoing any form of bariatric surgery who had either a documented diagnosis of OA before and after surgery or a quantitative assessment of OA-related symptoms using validated instruments such as the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Data were pooled using random-effects models, and heterogeneity was assessed using the I2 statistic.

Results: Twelve studies published between 2007 and 2024 met the inclusion criteria, encompassing 12,000 participants across prospective and retrospective cohorts. The pooled odds ratio for OA diagnosis after surgery compared with preoperative status was 0.21 (95% CI: 0.11-0.41), indicating a 79% reduction in OA likelihood. Significant improvements were observed in WOMAC pain, stiffness, and physical function scores at 6 and 12 months postoperatively, with overall pooled mean differences of -20.80 (95% CI: -32.74 to -8.86) and -17.12 (95% CI: -25.28 to -8.96), respectively. Heterogeneity was substantial across studies (I2 > 75%).

Conclusions: Metabolic and bariatric surgery is associated with significant reductions in osteoarthritis diagnosis and improvements in OA-related pain and physical function. These findings suggest that surgical weight loss may provide meaningful benefits for joint health in patients with obesity.

目的:本系统综述和荟萃分析旨在综合代谢和减肥手术对骨关节炎(OA)诊断、疼痛、僵硬和功能结局影响的现有证据。方法:系统检索PubMed/MEDLINE、Scopus、Web of Science和Cochrane Library,检索2000年1月至2025年7月间发表的研究。符合条件的研究包括接受任何形式的减肥手术的成年患者,他们在术前和术后都有OA的诊断记录,或者使用有效的工具(如西安大略和麦克马斯特大学骨关节炎指数(WOMAC))对OA相关症状进行定量评估。采用随机效应模型合并数据,采用I2统计量评估异质性。结果:2007年至2024年间发表的12项研究符合纳入标准,包括前瞻性和回顾性队列的12,000名参与者。与术前相比,术后OA诊断的合并优势比为0.21 (95% CI: 0.11-0.41),表明OA的可能性降低了79%。术后6个月和12个月WOMAC疼痛、僵硬和身体功能评分均有显著改善,总合并平均差异分别为-20.80 (95% CI: -32.74至-8.86)和-17.12 (95% CI: -25.28至-8.96)。各研究间存在显著的异质性(2 ~ 75%)。结论:代谢和减肥手术与骨关节炎诊断的显著减少和oa相关疼痛和身体功能的改善相关。这些发现表明,手术减肥可能为肥胖患者的关节健康提供有意义的益处。
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引用次数: 0
Aberrant Drainage to the Right Upper Pulmonary Vein From the Right Middle or Lower Lung: How Common? 右中肺或下肺右上肺静脉异常引流:常见吗?
IF 2.5 3区 医学 Q2 SURGERY Pub Date : 2026-01-20 DOI: 10.1002/wjs.70188
Yeong Jeong Jeon, Hong Kwan Kim, Yong Soo Choi

Background: Anatomical variations in pulmonary vein (PV) drainage are critical considerations during right upper or middle lobectomy, as unrecognized aberrant veins can increase surgical risks. Although such variations have been described in anatomical and radiologic studies, surgically verified data under a standardized thoracoscopic approach remain limited. This study investigates the prevalence and patterns of aberrant venous drainage from the right middle lobe (RML) and right lower lobe (RLL) into the right upper pulmonary vein (RUPV).

Methods: A total of 213 patients undergoing right upper or middle lobectomy between March 2019 and April 2021 were reviewed from the prospectively collected database. Intraoperative findings documented aberrant venous drainage patterns, including accessory veins and segmental vein variations. We performed video-assisted thoracoscopic surgery (VATS) using a fissure-first, hilum-last to visualize the PV anatomy.

Results: Aberrant venous drainage was observed in 60 patients (28%). Variant drainage from the RML to the RUPV was present in 44 patients (20.7%), whereas drainage from the RLL to the RUPV was found in 22 patients (10.3%). The most common pattern involved accessory veins from the RML draining into various branches of the RUPV, noted in 49 patients (61% of cases with aberrant veins). Accessory veins from the RLL were identified in 20 patients (25%). Superior segmental veins of the RLL drained into the RUPV instead of the right inferior pulmonary vein in 3 patients (1.4%). These frequencies are broadly comparable to those reported in previous anatomical and radiologic series.

Conclusion: Aberrant venous drainage from the RML and RLL to the RUPV is relatively common and largely consistent with prior anatomical and radiologic descriptions. These findings, based on surgically verified mapping under a standardized VATS approach, confirm and refine existing knowledge and underscore the need for meticulous intraoperative assessment and careful review of preoperative imaging to avoid vascular complications. Future studies should explore multi-institutional data and long-term outcomes to further optimize surgical strategies.

背景:在右上叶或中叶切除术中,肺静脉(PV)引流的解剖变异是需要考虑的关键因素,因为未被识别的异常静脉会增加手术风险。尽管解剖和放射学研究已经描述了这种变异,但标准化胸腔镜入路下的手术验证数据仍然有限。本研究探讨了右中肺叶(RML)和右下肺叶(RLL)进入右上肺静脉(RUPV)的异常静脉引流的患病率和模式。方法:从前瞻性收集的数据库中回顾2019年3月至2021年4月期间接受右上叶或中叶切除术的213例患者。术中发现异常静脉引流模式,包括副静脉和节段静脉变异。我们进行了视频辅助胸腔镜手术(VATS),采用裂隙先,门后的方法来观察PV解剖结构。结果:60例(28%)患者出现异常静脉引流。44例(20.7%)患者出现从RML到RUPV的不同引流,而22例(10.3%)患者发现从RLL到RUPV的引流。最常见的模式是RML的副静脉流入RUPV的各个分支,在49例患者中发现(61%的病例有异常静脉)。在20例(25%)患者中发现了RLL的副静脉。3例(1.4%)患者RLL上节段静脉引流至RUPV,而不是右下肺静脉。这些频率与先前解剖和放射学系列报道的频率大致相当。结论:从RML和RLL到RUPV的异常静脉引流相对常见,并且与先前的解剖和放射学描述基本一致。这些发现基于标准化VATS方法下手术验证的制图,证实并完善了现有知识,强调了术中细致评估和术前影像学检查的必要性,以避免血管并发症。未来的研究应探索多机构数据和长期结果,以进一步优化手术策略。
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引用次数: 0
Transition From Epidural to Paravertebral Analgesia After Minimally Invasive Ivor Lewis Esophagectomy. 微创Ivor Lewis食管切除术后硬膜外镇痛到椎旁镇痛的过渡。
IF 2.5 3区 医学 Q2 SURGERY Pub Date : 2026-01-20 DOI: 10.1002/wjs.70218
Linda Riks, Frank de Wit, Jan Willem T Dekker, Louise C Urlings-Strop, Stijn van Esser

Background: Paravertebral analgesia may be a safe and adequate alternative to epidural analgesia during and after minimally invasive Ivor Lewis esophagectomy and may be associated with a lower incidence of post-thoracotomy pain syndrome, side effects, and complications. The aim of this study is to monitor the transition from epidural to paravertebral analgesia after minimally invasive Ivor Lewis esophagectomy and to compare both techniques through the transition period.

Methods: In this single-center retrospective study, patients undergoing elective minimally invasive Ivor Lewis esophagectomy between January 2016 and November 2023 were included. All patients with paravertebral analgesia since the introduction of paravertebral analgesia in 2020 were included and case-matched with patients receiving epidural analgesia from the period before. Data were obtained from electronic patient files. The primary endpoint was the amount of additional analgesia medication needed and patient pain scores within 4 days postoperatively. Secondary endpoints were postoperative complications, requirement of vasopressor support, analgesia side effects and complications, and the length of ICU stay.

Results: Baseline characteristics were similar for both analgesia groups. The paravertebral patients noted significant higher NRS scores. However, no difference in requirement of rescue analgesia was observed between the paravertebral and epidural analgesia groups. In addition, more patients in the epidural analgesia group reported insufficiency of analgesia. Patients receiving epidural analgesia had a longer ICU stay, were more likely to develop hypotension, and required significantly more vasopressor. Moreover, when vasopressors were needed, the dosage of vasopressors was higher in this group. More obstipation and hypotension were described in the epidural analgesia group. The epidural analgesia group also showed more pulmonary complications, such as pleural fluid, and mediastinitis. No statistical difference was found in (technical) analgesia complications.

Interpretation: From the onset of the transition from epidural to paravertebral analgesia after minimally invasive Ivor Lewis esophagectomy, paravertebral analgesia is as adequate as epidural analgesia but is superior in respect to vasopressor use and concomitant duration of ICU stay.

背景:椎旁镇痛可能是微创Ivor Lewis食管切除术期间和术后硬膜外镇痛的一种安全、充分的替代方法,并且可能与开胸后疼痛综合征、副作用和并发症的发生率较低有关。本研究的目的是监测微创Ivor Lewis食管切除术后硬膜外镇痛到椎旁镇痛的过渡,并在过渡期间比较两种技术。方法:在这项单中心回顾性研究中,纳入了2016年1月至2023年11月期间接受选择性微创Ivor Lewis食管切除术的患者。纳入自2020年引入椎旁镇痛以来的所有椎旁镇痛患者,并与之前接受硬膜外镇痛的患者进行病例匹配。数据来源于电子病历。主要终点是术后4天内需要额外镇痛药物的量和患者疼痛评分。次要终点为术后并发症、血管加压剂支持需求、镇痛副作用及并发症、ICU住院时间。结果:两组镇痛的基线特征相似。椎旁组患者的NRS评分明显较高。脊髓旁镇痛组和硬膜外镇痛组对抢救性镇痛的要求无差异。此外,硬膜外镇痛组更多的患者报告镇痛不足。接受硬膜外镇痛的患者在ICU的停留时间更长,更容易出现低血压,并且需要更多的血管加压剂。此外,当需要血管加压剂时,该组血管加压剂的剂量更高。硬膜外镇痛组出现更多的顽固性和低血压。硬膜外镇痛组也出现更多的肺部并发症,如胸腔积液和纵隔炎。(技术性)镇痛并发症无统计学差异。解释:微创Ivor Lewis食管切除术后,从硬膜外镇痛到椎旁镇痛的过渡开始,椎旁镇痛与硬膜外镇痛一样充分,但在血管加压剂的使用和伴随的ICU住院时间方面更胜一筹。
{"title":"Transition From Epidural to Paravertebral Analgesia After Minimally Invasive Ivor Lewis Esophagectomy.","authors":"Linda Riks, Frank de Wit, Jan Willem T Dekker, Louise C Urlings-Strop, Stijn van Esser","doi":"10.1002/wjs.70218","DOIUrl":"https://doi.org/10.1002/wjs.70218","url":null,"abstract":"<p><strong>Background: </strong>Paravertebral analgesia may be a safe and adequate alternative to epidural analgesia during and after minimally invasive Ivor Lewis esophagectomy and may be associated with a lower incidence of post-thoracotomy pain syndrome, side effects, and complications. The aim of this study is to monitor the transition from epidural to paravertebral analgesia after minimally invasive Ivor Lewis esophagectomy and to compare both techniques through the transition period.</p><p><strong>Methods: </strong>In this single-center retrospective study, patients undergoing elective minimally invasive Ivor Lewis esophagectomy between January 2016 and November 2023 were included. All patients with paravertebral analgesia since the introduction of paravertebral analgesia in 2020 were included and case-matched with patients receiving epidural analgesia from the period before. Data were obtained from electronic patient files. The primary endpoint was the amount of additional analgesia medication needed and patient pain scores within 4 days postoperatively. Secondary endpoints were postoperative complications, requirement of vasopressor support, analgesia side effects and complications, and the length of ICU stay.</p><p><strong>Results: </strong>Baseline characteristics were similar for both analgesia groups. The paravertebral patients noted significant higher NRS scores. However, no difference in requirement of rescue analgesia was observed between the paravertebral and epidural analgesia groups. In addition, more patients in the epidural analgesia group reported insufficiency of analgesia. Patients receiving epidural analgesia had a longer ICU stay, were more likely to develop hypotension, and required significantly more vasopressor. Moreover, when vasopressors were needed, the dosage of vasopressors was higher in this group. More obstipation and hypotension were described in the epidural analgesia group. The epidural analgesia group also showed more pulmonary complications, such as pleural fluid, and mediastinitis. No statistical difference was found in (technical) analgesia complications.</p><p><strong>Interpretation: </strong>From the onset of the transition from epidural to paravertebral analgesia after minimally invasive Ivor Lewis esophagectomy, paravertebral analgesia is as adequate as epidural analgesia but is superior in respect to vasopressor use and concomitant duration of ICU stay.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146012433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Emergency Laparotomy Protocol: A Retrospective Cohort Study of Morbidity and Mortality After the Introduction of a Perioperative Protocol for Emergency Laparotomies. 急诊剖腹手术方案:引入急诊剖腹手术围手术期方案后发病率和死亡率的回顾性队列研究
IF 2.5 3区 医学 Q2 SURGERY Pub Date : 2026-01-14 DOI: 10.1002/wjs.70209
Gustaf Drevin, Jonas Leo, Linn Håwi, Lovisa Strömmer, Karolina Helczynska Hultman

Background: Emergency laparotomy and its perioperative care is associated with high morbidity and mortality. At our institution, 30-day mortality was approximately 12% in 2013-2017. We introduced a perioperative protocol for emergency laparotomies in 2019.

Method: Retrospective cohort of emergency laparotomies 2019-2022. Reoperations, trauma and converted laparoscopies (appendectomy and cholecystectomy) were excluded. Primary outcome was mortality at 30, 90, and 180 days. Secondary outcomes were postoperative complications (Clavien-Dindo; CD) and hospital-based outcomes.

Results: Six hundred eighty-two patients undergoing emergency laparotomy were included. Age was 72 (IQR 23) years and 66.4% (n = 453) were aged ≥ 65 years 56.6% (n = 386) were ASA class III or IV and 6.5% (n = 44) were not living at home at admission. The most frequent surgical findings were bowel obstruction (64.2%; n = 438) and gastrointestinal perforations (n = 134; 19.4%). Stoma creation (29.9%; n = 204), adhesiolysis (28.6%; n = 195), and anastomosis (27.4%; n = 187) were common. Mortality at 30 days was 6.9% (n = 47), 90 days 11.0% (n = 75), and 180 days 12.8% (n = 87). Mortality was higher for patients ≥ 80 years than < 65 years (23.9% vs. 4.4%; p < 0.001). Mortality predictors were admission not from home (p = 0.043), disseminated cancer (p < 0.001), and septic shock (p = 0.003) or systemic inflammatory response syndrome (p = 0.017). CD IIIb-IVb occurred in 81 patients (11.9%). ICU admission was 16.6% (n = 113) and LOS 8 (IQR 7) days.

Conclusions: Mortality and complication rates after the introduction of a perioperative emergency laparotomy protocol were low despite a comorbid aged-patient cohort. Particular focus on the elderly, frail, and septic patients considered for emergency laparotomy is recommended.

背景:急诊剖腹手术及其围手术期护理与高发病率和死亡率相关。在我们的机构,2013-2017年的30天死亡率约为12%。2019年,我们推出了紧急剖腹手术的围手术期方案。方法:2019-2022年急诊剖腹手术回顾性队列。排除再手术、外伤和转换腹腔镜(阑尾切除术和胆囊切除术)。主要结局是30,90和180天的死亡率。次要结局是术后并发症(Clavien-Dindo; CD)和基于医院的结局。结果:共纳入682例急诊剖腹手术患者。年龄为72 (IQR 23)岁,66.4% (n = 453)年龄≥65岁,56.6% (n = 386)为ASA III级或IV级,6.5% (n = 44)入院时不在家。最常见的手术表现是肠梗阻(64.2%,n = 438)和胃肠道穿孔(n = 134, 19.4%)。造口(29.9%,n = 204)、粘连溶解(28.6%,n = 195)、吻合(27.4%,n = 187)较为常见。30天死亡率为6.9% (n = 47), 90天死亡率为11.0% (n = 75), 180天死亡率为12.8% (n = 87)。≥80岁的患者死亡率高于< 65岁的患者(23.9% vs. 4.4%; p)结论:尽管存在合并症的老年患者队列,但引入围手术期紧急剖腹手术方案后的死亡率和并发症发生率较低。特别关注老年人,体弱多病和脓毒症患者考虑紧急剖腹手术。
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引用次数: 0
Topical EMLA Cream as Adjunct Analgesia in Postoperative Pain Control for Open Inguinal Hernioplasty Under Local Anesthesia: A Pilot Double-Blind Randomized Controlled Trial. 局部EMLA乳膏作为局部麻醉下开放式腹股沟疝成形术术后疼痛控制的辅助镇痛:一项双盲随机对照试验。
IF 2.5 3区 医学 Q2 SURGERY Pub Date : 2026-01-13 DOI: 10.1002/wjs.70228
Mohd Saufee Al Firdaus Mohd Ismail, Guo Hou Loo, Guhan Muthkumanan, Nik Ritza Kosai

Objective: Effective postoperative pain control is essential in ambulatory hernia surgery. This pilot randomized controlled trial aimed to evaluate the efficacy, safety, and feasibility of topical EMLA (eutectic mixture of local anesthetics) cream as adjunct postoperative analgesia following open inguinal hernioplasty under local anesthesia.

Methods: A prospective, double-blind, randomized controlled trial was conducted at Hospital Canselor Tuanku Muhriz, UKM, from December 2023 to March 2025. Thirty-six male patients undergoing elective open inguinal hernia repair under local anesthesia were randomized to receive either EMLA (n = 18) or placebo cream (n = 18). The cream was applied topically to the surgical site every 6 h for 48 h. Pain was self-assessed using a numerical rating scale (NRS) after each application. Primary outcomes included pain scores and rescue analgesia use; secondary outcomes included feasibility and adverse events.

Results: Topical application was rated "easy" or "very easy" by all participants, with no adverse events or complications reported. In the EMLA group, pain scores significantly decreased across all post-application time points compared to baseline (p < 0.05), whereas no significant changes were observed in the placebo group. Between-group analysis showed significantly lower pain scores in the EMLA group starting from 6 h postoperatively (p < 0.001). No participants in either group required rescue analgesia.

Conclusion: Topical EMLA cream is a feasible adjunct for postoperative pain control following open inguinal hernia repair under local anesthesia. Although no infections or adverse events occurred in this pilot cohort, the study is underpowered to detect rare complications such as surgical site infection; therefore, safety conclusions should be interpreted with caution. The clinically meaningful reduction of 2-3 points in pain scores supports further validation in larger, adequately powered trials using an inert placebo.

目的:有效的术后疼痛控制是门诊疝手术的关键。本随机对照试验旨在评价局部麻醉下局部EMLA(共溶局麻药混合物)乳膏作为开放式腹股沟疝成形术术后辅助镇痛的有效性、安全性和可行性。方法:一项前瞻性、双盲、随机对照试验于2023年12月至2025年3月在UKM的Canselor Tuanku Muhriz医院进行。36例在局麻下行择期开放式腹股沟疝修补术的男性患者被随机分为EMLA组(n = 18)和安慰剂组(n = 18)。乳膏每6小时局部涂抹于手术部位,持续48小时。每次涂抹后使用数值评定量表(NRS)自我评估疼痛。主要结局包括疼痛评分和抢救性镇痛的使用;次要结局包括可行性和不良事件。结果:所有参与者的局部应用评分为“容易”或“非常容易”,无不良事件或并发症报告。在EMLA组中,与基线相比,所有应用后时间点的疼痛评分均显著降低(p)。结论:局部EMLA乳膏是局部麻醉下开放式腹股沟疝修补术后疼痛控制的可行辅助手段。虽然在这个试点队列中没有发生感染或不良事件,但该研究在检测罕见并发症(如手术部位感染)方面的能力不足;因此,安全性结论应谨慎解释。具有临床意义的疼痛评分降低2-3分支持在使用惰性安慰剂的更大规模、充分有力的试验中进一步验证。
{"title":"Topical EMLA Cream as Adjunct Analgesia in Postoperative Pain Control for Open Inguinal Hernioplasty Under Local Anesthesia: A Pilot Double-Blind Randomized Controlled Trial.","authors":"Mohd Saufee Al Firdaus Mohd Ismail, Guo Hou Loo, Guhan Muthkumanan, Nik Ritza Kosai","doi":"10.1002/wjs.70228","DOIUrl":"https://doi.org/10.1002/wjs.70228","url":null,"abstract":"<p><strong>Objective: </strong>Effective postoperative pain control is essential in ambulatory hernia surgery. This pilot randomized controlled trial aimed to evaluate the efficacy, safety, and feasibility of topical EMLA (eutectic mixture of local anesthetics) cream as adjunct postoperative analgesia following open inguinal hernioplasty under local anesthesia.</p><p><strong>Methods: </strong>A prospective, double-blind, randomized controlled trial was conducted at Hospital Canselor Tuanku Muhriz, UKM, from December 2023 to March 2025. Thirty-six male patients undergoing elective open inguinal hernia repair under local anesthesia were randomized to receive either EMLA (n = 18) or placebo cream (n = 18). The cream was applied topically to the surgical site every 6 h for 48 h. Pain was self-assessed using a numerical rating scale (NRS) after each application. Primary outcomes included pain scores and rescue analgesia use; secondary outcomes included feasibility and adverse events.</p><p><strong>Results: </strong>Topical application was rated \"easy\" or \"very easy\" by all participants, with no adverse events or complications reported. In the EMLA group, pain scores significantly decreased across all post-application time points compared to baseline (p < 0.05), whereas no significant changes were observed in the placebo group. Between-group analysis showed significantly lower pain scores in the EMLA group starting from 6 h postoperatively (p < 0.001). No participants in either group required rescue analgesia.</p><p><strong>Conclusion: </strong>Topical EMLA cream is a feasible adjunct for postoperative pain control following open inguinal hernia repair under local anesthesia. Although no infections or adverse events occurred in this pilot cohort, the study is underpowered to detect rare complications such as surgical site infection; therefore, safety conclusions should be interpreted with caution. The clinically meaningful reduction of 2-3 points in pain scores supports further validation in larger, adequately powered trials using an inert placebo.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145967115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Evaluating Single Agent Indocyanine Green as an Alternative to Dual Dye-Tracer Mapping in Sentinel Lymph Node Biopsy for Breast Cancer: A Two-Arm Open-Label Randomized Controlled Trial. 评估单剂吲哚菁绿作为乳腺癌前哨淋巴结活检双染料示踪剂定位的替代方案:一项双臂开放标签随机对照试验
IF 2.5 3区 医学 Q2 SURGERY Pub Date : 2026-01-11 DOI: 10.1002/wjs.70231
Nandury Bhargav Chandra, Suhani Suhani, Mohit Joshi, V Seenu, Ruchi Rathore, Surabhi Vyas, Ankur Goyal, Maroof A Khan, Sandeep Mathur, Rakesh Kumar, Rajinder Parshad

Aim: To compare the sentinel lymph node (SLN) identification proportions using Indocyanine green with the standard radio colloid-blue dye method.

Background: Radioisotope and blue dye are standard agents for performing sentinel lymph node (SLN) biopsy in breast cancer. Limited centers offering nuclear medicine services along with the short half-life of technetium and the hazards associated with radioactive materials contribute to the low acceptability of SLNB.

Methods: This randomized controlled trial conducted between September 2022 and May 2024 compared SLN identification proportions of radioisotope-blue dye [Group A] with Indocyanine Green (ICG) [Group B]. Sample size of 70 (35 in each arm) was calculated. Upfront operable node negative early breast cancer patients were included in the study. Clinico-demographic data, number and type of SLN, and time taken were recorded. Chi-squared/Fisher exact tests were used to compare proportions between two groups. p value of less than 0.05 was considered to represent statistical significance.

Results: Seventy patients were randomized to either group (35 in Group A and 35 in group B). The clinico-demographics and the tumor characteristics were similar between both the groups. SLN identification rate (IR) was 100% in group A and 97.14% in group B. Median of 3 lymph nodes were identified in Group A and Group B. Median operative time for SLNB was 12 min in both the groups.

Conclusions: Indocyanine green (ICG) fluorescence offers comparable sentinel node identification rate when compared to current standard of radioisotope and blue dye.

Trial registration: This study is registered under Clinical Trials Registry-India (CTRI) vide registration no. CTRI/2022/09/045719.

目的:比较吲哚菁绿与标准放射性胶体蓝染色法对前哨淋巴结(SLN)的鉴别比例。背景:放射性同位素和蓝色染料是乳腺癌前哨淋巴结(SLN)活检的标准试剂。提供核医学服务的中心有限,加上锝的半衰期短以及与放射性物质有关的危害,导致SLNB的可接受性较低。方法:该随机对照试验于2022年9月至2024年5月进行,比较放射性同位素蓝染料[A组]与吲哚菁绿(ICG) [B组]的SLN鉴定比例。计算了70个样本量(每组35个)。研究对象为前期可手术淋巴结阴性的早期乳腺癌患者。记录临床人口学数据、SLN的数量和类型以及所花费的时间。采用卡方/费雪精确检验比较两组间的比例。P值小于0.05为有统计学意义。结果:70例患者随机分为两组(A组35例,B组35例)。两组患者的临床人口学特征和肿瘤特征相似。A组SLN的检出率为100%,b组为97.14%。A组和b组均有3个淋巴结被检出,两组SLNB的中位手术时间均为12 min。结论:与现行标准放射性同位素和蓝色染料相比,吲哚菁绿(ICG)荧光具有相当的前哨淋巴结识别率。试验注册:本研究在印度临床试验注册中心(CTRI)注册。CTRI / 2022/09/045719。
{"title":"Evaluating Single Agent Indocyanine Green as an Alternative to Dual Dye-Tracer Mapping in Sentinel Lymph Node Biopsy for Breast Cancer: A Two-Arm Open-Label Randomized Controlled Trial.","authors":"Nandury Bhargav Chandra, Suhani Suhani, Mohit Joshi, V Seenu, Ruchi Rathore, Surabhi Vyas, Ankur Goyal, Maroof A Khan, Sandeep Mathur, Rakesh Kumar, Rajinder Parshad","doi":"10.1002/wjs.70231","DOIUrl":"https://doi.org/10.1002/wjs.70231","url":null,"abstract":"<p><strong>Aim: </strong>To compare the sentinel lymph node (SLN) identification proportions using Indocyanine green with the standard radio colloid-blue dye method.</p><p><strong>Background: </strong>Radioisotope and blue dye are standard agents for performing sentinel lymph node (SLN) biopsy in breast cancer. Limited centers offering nuclear medicine services along with the short half-life of technetium and the hazards associated with radioactive materials contribute to the low acceptability of SLNB.</p><p><strong>Methods: </strong>This randomized controlled trial conducted between September 2022 and May 2024 compared SLN identification proportions of radioisotope-blue dye [Group A] with Indocyanine Green (ICG) [Group B]. Sample size of 70 (35 in each arm) was calculated. Upfront operable node negative early breast cancer patients were included in the study. Clinico-demographic data, number and type of SLN, and time taken were recorded. Chi-squared/Fisher exact tests were used to compare proportions between two groups. p value of less than 0.05 was considered to represent statistical significance.</p><p><strong>Results: </strong>Seventy patients were randomized to either group (35 in Group A and 35 in group B). The clinico-demographics and the tumor characteristics were similar between both the groups. SLN identification rate (IR) was 100% in group A and 97.14% in group B. Median of 3 lymph nodes were identified in Group A and Group B. Median operative time for SLNB was 12 min in both the groups.</p><p><strong>Conclusions: </strong>Indocyanine green (ICG) fluorescence offers comparable sentinel node identification rate when compared to current standard of radioisotope and blue dye.</p><p><strong>Trial registration: </strong>This study is registered under Clinical Trials Registry-India (CTRI) vide registration no. CTRI/2022/09/045719.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145953197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
World Journal of Surgery
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