BMC Surgery最新文献

Backgrounds: We aimed to study the outcomes of mitral valve (MV) reoperations in children with congenital MV diseases and to summarize our treatment experience.

Methods: In this single-center retrospective study, we enrolled 24 patients aged < 18 years who underwent MV reoperation from among 265 patients who underwent MV repair between January 2013 and July 2023. MV reoperations were based on the types of MV disease. Cox regressions were used to analyze the risk factors for death and second MV reoperation.

Results: A total of 5 patients underwent second MV reoperations. 3 patients experienced early death, and 1 experienced late death. The 3- and 5-year survival rates of the entire cohort were 86.6% ± 7.3% and 72.1% ± 14.5%, respectively. Patients who had the double-orifice MV technique applied during MV reoperation were significantly more prone to receive mechanical MV replacement (P < 0.0001). The use of double-orifice MV technique during MV reoperation was identified as an independent risk factor for second MV reoperation (HR = 8.136, 95%CI = 1.099-60.240; P = 0.040).

Conclusions: The reoperation of the MV in children with congenital MV diseases poses a formidable challenge, manifested by a high postoperative mortality rate and re-intervention rate. Patiently and meticulously repair based on the types of MV disease has demonstrated the capacity to enhance and sustain stable valve function and cardiac function in the vast majority of children. The use of the double-orifice MV technique did not achieve ideal therapeutic results in children with complex valve lesions.

Objective: To compare the clinical outcomes of two different surgical approaches for treating localized prostate cancer: extraperitoneal robot-assisted radical prostatectomy (Ep-RARP) and transvesical robot-assisted radical prostatectomy (Tv-RARP).

Methods: This study collected and analyzed data from patients with localized prostate cancer who underwent robot-assisted radical prostatectomy (RARP) within the same surgical team between October 2018 and March 2024. The cohort included two groups: the Ep-RARP group (37 cases) and the Tv-RARP group (29 cases). The primary outcomes analyzed were postoperative drainage time, length of hospital stay, surgical margin status, postoperative complications, urinary continence, and erectile function.

Results: The baseline characteristics of the two groups of patients were consistent (p > 0.05), making them comparable. The Ep-RARP group had a significantly shorter hospital stay (7 days [5.5-8] vs. 9 days [9-10], p < 0.001) and shorter drain retention time (7 days [6-8] vs. 8 days [7-10], p < 0.001). There were no significant differences in intraoperative blood loss, blood transfusion requirements, and surgical complications. The duration of catheterization was similar in both groups (7 days [7-8] vs. 7 days [7-8], p = 0.135), as well as the distribution of Gleason scores, pathological staging (T1, T2), and positive surgical margin rate (p > 0.05). No significant differences were found in immediate postoperative urinary control rates (Tv-RARP: 20 [68.97%] vs. Ep-RARP: 26 [70.27%], p = 0.909), 3-month urinary control rates (Tv-RARP: 27 [93.10%] vs. Ep-RARP: 35 [94.59%], p = 1.000), or 6-month urinary control rates (Tv-RARP: 29 [100%] vs. Ep-RARP: 37 [100.00%], p = 1.000). The biochemical recurrence rate at 6 months was also comparable (Ep-RARP: 1 [2.70%] vs. Tv-RARP: 1 [3.45%], p = 1.000). Postoperative erectile function recovery at 3 and 6 months was similar between the two groups (3 months: Ep-RARP: 14 [37.84%] vs. Tv-RARP: 12 [41.40%], p = 0.804; 6 months: Ep-RARP: 18 [48.64%] vs. Tv-RARP: 17 [58.62%], p = 0.464).

Conclusion: Both extraperitoneal and transvesical robot-assisted radical prostatectomy are feasible approaches for localized prostate cancer, offering comparable oncologic control and functional outcomes. However, the extraperitoneal approach demonstrates advantages in terms of shorter surgery time, drain retention time, and hospital stay.

Background: Intraoperative localization of ground glass opacity (GGO) is a major clinical challenge. We previously introduced a novel method called geometric localization technique (GLT). We aimed to compare GLT and the mostly common used technique-CT guided percutaneous localization technique (CPLT) in terms of the effectiveness, safety and accuracy.

Methods: In a randomized controlled trial, patients who were diagnosed with pulmonary GGO and underwent wedge resection were randomized into GLT group (localized using GLT method) and CPLT group (localized using CPLT method). Baseline data, localization related data, successful localization rate, complications, operation related data and pathological results of patients were prospectively collected. Statistical analysis was performed between the two groups.

Results: A total of 455 patients in our hospital were enrolled in this study from 2022-7-6 to 2024-2-22, including 228 patients in the GLT group and 227 patients in the CPLT group. There were significant differences in terms of the successful localization rate (99.6% vs. 94.3%, χ2 = 10.667, P = 0.001), the rate of sufficient resection margin (99.6% vs. 87.2%, χ2 = 28.110, P < 0.001), and incidence of localization-related complications (0 vs. 17.6%, χ2 = 114.251, P < 0.001) between GLT group and CPLT group. In the GLT group, the distance between GGO and marked visceral pleural point was 3.9 ± 3.1 mm. In the CPLT group, the distance from punctured pleural point to GGO and the distance from anchor to GGO were 18.3 ± 11.4 mm and 4.1 ± 3.5 mm, respectively. In CPLT, one dislocation and thirteen dislodgement occurred. In multivariate regression analysis, only the localization technique was independently correlated with the successful localization rate (OR = 13.105; 95% CI: 1.688, 101.713; P = 0.014). Gender (OR = 0.239; 95% CI: 0.099, 0.579; P = 0.002), nodule size (OR = 0.864; 95% CI: 0.758, 0.984; P = 0.028), depth of nodules (OR = 0.908; 95% CI: 0.861, 0.957; P < 0.001) and the localization technique (OR = 40.809; 95% CI: 5.357, 310.855; P < 0.001) were independent variables in determining the rate of sufficient resection margin.

Conclusions: Compared with CPLT, GLT has at least comparable outcomes in terms of effectiveness and accuracy; good safety profile was the advantage of GLT.

Trial registration: ChiCTR2200060527 (  https://www.chictr.org.cn ), 2022/6/4, prospectively registered.

Objective: To comprehensively evaluate and compare surgical outcomes of obese patients versus non-obese patients for surgical complications and postoperative prognosis due to epithelial ovarian cancer (EOC).

Methods: Studies were obtained from database search systems of Medline (PubMed) and Embase. Data were analyzed by the meta-analysis method and the random-effect or fixed-effect model. The heterogeneity between the studies was evaluated by I2 index and the data were analyzed using STATA version 15.1 and Review Manager version 5.4.

Results: 14 studies with 4858 cases of proven epithelial ovarian cancer who underwent extensive surgery were included. Obesity may be a risk factor of the low surgical complex score (RR1.08, 95% CI 1.01-1.15, p = 0.05), but had no manifesting difference in the surgical complications score compared non-obesity group (RR 0.50, 95% CI 0.07-3.79, p = 0.501 and RR 0.60, 95% CI 0.22-1.63, p = 0.316). Obesity EOC patients who undergone surgery tended to be correlated with surgical complications, such as wound infection (RR 2.71, 95% CI 1.59-4.61, p = 0.000), intestinal complications (RR 2.09, 95% CI 1.00-4.35, p = 0.000), and 30-readmission rate (RR 1.84, 95% CI 1.16-2.93, p = 0.000). Obese patients were more likely to have shorter prognosis free survival (PFS) (SMD 0.62-year, 95% CI-0.13 to 0.15), but the results did not discover a significant difference in overall survival (OS)between obesity and non-obesity. (SMD 0.01-year, 95% CI-0.13 to 0.15) CONCLUSIONS: Obesity affects the difficulty of ovarian cancer surgery, and a negative relationship between obesity and surgical complications is observed. Obesity is a potential risk factor for prognosis of EOC patients. Attention is played on determining what kind of case should be benefit most from this surgery to minimize the rates of operative complications and postoperative mortality.

Prospero registration number: CRD 42,023,434,781.

Objective: The aim of this study is to evaluate the effectiveness of Six Sigma management in standardizing surgical hand disinfection practices among medical personnel.

Methods: The Six Sigma DMAIC (Define, Measure, Analyze, Improve, Control) framework was utilized to assess and enhance the accuracy and effectiveness of surgical hand disinfection. Factors contributing to low accuracy and a high defect rate in disinfection practices were systematically analyzed. Key issues identified included limited awareness of infection control protocols, insufficient knowledge of proper surgical hand disinfection practices, and inadequate oversight of surgical staff. Interventions based on this analysis included the use of text and video reminders, reinforcement of medical personnel training, implementation of enhanced camera-based monitoring and supervision, and the establishment of a reward-and-penalty evaluation system.

Results: Post-intervention analysis revealed that the accuracy of surgical hand disinfection among medical personnel increased from 42.94 to 82.97%, with surgeons demonstrating the greatest improvement, achieving a 47.70% increase. The overall defect rate decreased substantially, with the most notable reduction observed in incomplete hand coverage with disinfectant, which decreased by 2.75%. Additionally, the average number of bacterial colonies on the hands of medical staff decreased from 4.44 ± 2.51 CFU/cm² to 2.68 ± 0.54 CFU/cm², and the qualification rate improved markedly from 71.67 to 98.33%. All observed improvements were statistically significant.

Conclusion: The application of Six Sigma management effectively enhances the accuracy and quality of surgical hand disinfection, reduces procedural defects, and enhances disinfection outcomes in clean surgical procedures.

Objectives: The aim of this study is to evaluate the utilization of intraoperative colonoscopy (IOC) for determining the integrity of the anastomosis and to establish an IOC scoring system.

Methods: A retrospective cohort study was conducted from January 2021 to June 2024, we analyzed the clinical data of 160 patients registered in a database who underwent laparoscopic left-sided colectomy at Pusan National University Yangsan Hospital. IOC was performed on all patients, and Mucosal color (MC), stapled line bleeding (BL), proximal redundancy (PR), and bowel preparation (BP) were evaluated and scored as variables. Logistic regression analysis was used to evaluate risk factors for anastomotic leakage (AL) and Cohen's kappa was applied to assess the reproducibility of the evaluation.

Results: Of 160 patients, 10 (6.25%) experienced AL. All the IOC variables had kappa values of 0.8 or higher, indicating good agreement. The logistic regression analysis revealed significant differences in the MC 2 (P = 0.017, OR 12.86), PR 2 (P = 0.001, OR 27.64), BP 2 (p = 0.016, OR 10.50) PR 2 score (P = 0.016, OR 10.50) and the sum of the scores (p = 0.001, OR 3.51).

Conclusion: IOC can be performed as a reference procedure to assess the integrity of the anastomosis during left-sided colorectal surgery.

Background: Mediastinal tumors (MTs) develop in various sites within the thoracic cavity, and the robotic surgical approach for MTs varies depending on the tumor location. This study aimed to assess the optimal approach for robotic surgery for MTs.

Methods: From April 2012 to May 2023, 141 cases of MTs removed by robotic surgery were noted. Of these, 130 cases, excluding those with combined lung resection, combined chest wall resection, and biopsy, were investigated for the MT location, surgical approach, operative time, and console time.

Results: Of the participants, 61 were male and 69 were female, with a median age of 60 (16-85) years and a median tumor diameter of 23 (2.5-150) mm. Additionally, 5 upper MTs, 99 anterior MTs, 22 middle MTs, and 4 posterior MTs were observed. The median operative and console time was 146 (38-371) and 76 (14-239) min, respectively. All cases, except for one case of the upper and middle MTs, were operated in the lateral position via a lateral approach. Of the 99 anterior MTs, 87, 9, and 3 were operated via lateral approach, subxiphoid approach, and single incision, respectively. Of the 87 patients who underwent the lateral approach, 78 and 12 underwent surgery in the 30° lateral decubitus position and lateral positions, respectively.

Conclusions: Standardizing the robotic surgery approach for MTs on the basis of tumor location enhances procedural safety and feasibility.

Introduction: Lung collapse can occur for various reasons, especially trauma. Single-port thoracoscopy is a treatment method that has not been discussed in detail. This study aimed to investigate the results of single-port thoracoscopy as a treatment for trauma-induced lung collapse.

Methods: This descriptive retrospective cross-sectional study included 100 patients with lung collapse following trauma who were referred to the Madani Hospital. Demographic data, underlying causes and injuries, respiratory and consciousness state, pain level, recurrence rate, hospitalization period, complications, and narcotic and non-narcotic analgesics, re-thoracoscopy, and thoracotomy requirements were evaluated.

Results: The mean age of patients was 38 ± 16 years, and 65% were male. Single port thoracoscopy has suitable therapeutic effects, low complications, less pain, and reduced need for painkillers. Patients with more concomitant injuries, longer duration from trauma to performing thoracoscopy, intubation requirement, bilateral lung involvement, and lower GCS, required re-thoracoscopy, which has been associated with more extended hospitalization, suffering from more pain, need to receive narcotics and thoracotomy, and frequency of narcotic and non-narcotic agents. These results demonstrate the efficacy of the single port thoracoscopy in uncomplicated and initially completely recovered patients, and the re-thoracoscopy requirement and complications are based on the underlying cause and medical circumstances.

Conclusion: Single port thoracoscopy is practical for improving the quality of management of patients with lung collapse following trauma. Future studies should compare different methods.

Purpose: This retrospective study aimed to investigate the effect of mild-to-moderate COVID-19 on the risk of deep vein thrombosis (DVT) in patients with hip fractures. Hip fractures are common in the elderly, and previous research has shown that they accounted for 58.3% of traumatic fractures in older inpatients during the COVID-19 pandemic in China. Meanwhile, the relationship between COVID-19 and DVT is complex. Some studies have reported that the incidence of DVT in critically ill COVID-19 patients can be as high as 46%, and 20% in those with moderate-to-severe cases. However, the impact of mild-to-moderate COVID-19 on DVT risk in hip fracture patients remains unclear.

Methods: Adult patients who underwent surgery for hip fractures between December 8, 2022, and January 9, 2023, were included in the study. All patients were tested for SARS-CoV-2 nucleic acid and were assessed for DVT preoperatively using doppler ultrasonography (DUS). Logistic regression was used to identify risk factors for DVT.

Results: The records of 98 patients with hip fractures, were included in the analysis, of whom 63 were SARS-CoV-2 positive and 35 were SARS-CoV-2 negative. Pre-operative DUS showed that 36/98 patients (37%) had DVT, including 25/63 (40%) patients with COVID-19, and 11/35 (31%) patients without COVID-19. Multivariable logistic regression analysis showed that pre-operative leukocyte count and platelet-to-lymphocyte ratio (PLR) were independent risk factors for DVT, whereas mild-to-moderate COVID-19 was not an independent risk factor for DVT. In patients with hip fractures, COVID-19 did not significantly increase the risk of DVT.

Conclusions: Therefore, in patients with hip fractures, DVT prevention measures should be implemented routinely, regardless of COVID-19 status.

PURPOSE OF REVIEW: Lupus nephritis (LN) is a severe complication of systemic lupus erythematosus (SLE), significantly impacting patient outcomes. Despite advances in immunosuppressive therapies, many patients progress to end-stage renal disease (ESRD), and kidney transplantation becomes essential for improving survival. However, the unique characteristics of autoimmune diseases make the timing of kidney transplantation and post-transplant management challenging. This review evaluates authoritative guidelines and recent studies to identify optimal timing for kidney transplantation and effective pre- and post-transplant management measures for patients with LN. RECENT FINDINGS: Advancements in immunosuppressive therapies, including calcineurin inhibitors, Voclosporin, and biologic agents such as belimumab, have significantly improved LN management. Emerging biomarkers, such as urinary MCP-1 and BAFF, offer promising tools for monitoring LN activity and predicting recurrence risk post-transplantation. Current guidelines emphasize the importance of achieving disease quiescence before transplantation, while new evidence supports the benefits of preemptive transplantation and personalized immunosuppressive regimens in improving patient and graft survival. This review highlights the latest evidence and strategies for optimizing kidney transplantation outcomes in LN patients, focusing on timing, immunosuppression, and disease monitoring.