BMC Surgery最新文献

Background: Incisional hernia is the most common long-term complication following abdominal surgery, resulting in considerable morbidity and the need for reoperation. The effectiveness of the small-bite fascial closure technique in reducing incisional hernia rates has been demonstrated; however, outside of elective settings, evidence is scarce regarding mixed elective and emergency populations. This prospective observational cohort study aimed to evaluate factors associated with incisional hernia at 12 months and to assess the association between closure technique and hernia formation.

Methods: We prospectively enrolled consecutive adults undergoing midline laparotomy from May 2021 to June 2023. Patient information including intraoperative parameters, such as the closure technique employed, that is, small-bite versus conventional, incision and suture length, and the suture-to-wound length ratio were recorded. Occurrence of incisional hernia was confirmed clinically and ultrasonographically after 12 months. Secondary outcomes included early wound complications and hospital stay duration. Independent predictors were identified using univariate and multivariate logistic regression analyses.

Results: Of the 231 patients enrolled, 217 completed 12-month follow-up (76 small-bite, 141 conventional). Incisional hernia developed in 3 patients (3.9%) with small-bite and 31 (22.0%) with conventional closure (p = 0.001). Early wound complications occurred in 16.6% overall and were significantly less frequent with small-bite closure (8.6% vs. 20.9%, p = 0.018). In the multivariate model, emergency surgery (OR = 5.74, p = 0.011), comorbidities (OR = 6.03, p = 0.001), and early wound complications (OR = 16.59, p < 0.001) were independent predictors for incisional hernia, whereas the protective effect of small-bite technique was not significant (OR = 0.47, p = 0.325). The small-bite technique independently diminished the risk of postoperative early wound complications by 74% (adjusted OR = 0.26, p = 0.045).

Conclusions: The major independent predictors for incisional hernia development were emergency surgery, comorbidity, and early wound complications. The small-bite closure technique significantly reduced the occurrence of early wound complications and demonstrated a favorable but not statistically significant effect regarding hernia prevention.

Trial registration: ClinicalTrials.gov NCT07340918 (Retrospectively registered).

Background: Proximal gastrectomy (PG) for proximal gastric cancer (PGC) is associated with complications such as gastroesophageal reflux. The double-flap technique (DFT) has been proposed as an effective anti-reflux reconstruction method. This systematic review aims to compare the safety and short-term outcomes of DFT versus other reconstruction methods for proximal gastrectomy.

Methods: The present meta-analysis was conducted, following PRISMA guidelines. Studies comparing DFT with other reconstruction methods for proximal gastric cancer were included. Outcomes assessed included surgical parameters (operative time and intraoperative blood loss), postoperative reflux incidence (subjective reflux symptoms, objective evaluation using endoscopy and proton pump inhibitor (PPI) intake), and other short-term postoperative indicators (postoperative complications and length of postoperative hospital stay). Data were extracted from PubMed, Web of Science, EMBASE, and the Cochrane Library through June 1st, 2025. Risk of bias was assessed using the Newcastle-Ottawa Scale. We performed meta-analyses using Review Manager 5.4, presenting mean differences (MD) and odds ratios (OR) with 95% confidence intervals (CI).

Results: A total of 11 retrospective studies were included in this meta-analysis. Qualitative analysis showed DFT had anastomotic leakage, stricture, and pancreatic fistula rates of 1.4%, 5.9%, and 1.8%, respectively. Postoperatively, 17.4% of patients took PPIs, and 3.4% reported subjective reflux symptoms. One year after surgery, during follow-up endoscopy, 5.1% of patients were found to have gastroesophageal reflux (Los Angeles classification grade B or higher). Meta-analysis results showed that the DFT group had significantly longer operative times but reduced intraoperative blood loss compared to the esophagojejunostomy (EJ) groups. Postoperative complication rates, including anastomotic leakage and stricture, were similar across the double tract reconstruction (DTR) group and other esophagogastrostomy (EG) groups. While no significant differences were found in reflux symptoms or esophagitis at the 1-year follow-up, DFT was associated with significantly reduced PPI usage, especially compared to the EG group.

Conclusions: DFT is a safe and effective method for reconstructing the digestive tract following PG, offering a balance between surgical complexity and favorable short-term outcomes. Although it does not fully eliminate reflux, its reduced PPI dependency and acceptable complication profile make it a promising option. Further large-scale randomized trials are needed to confirm these findings.

Trial registration: The protocol was prospectively registered on the PROSPERO website as CRD42025636187 on January 9th, 2025.

Background: Pelvic adhesions are a common consequence of prior abdominal surgery, endometriosis, malignancy, or infection, often leading to infertility, chronic pelvic pain, and surgical complications. Reliable preoperative prediction of these adhesions can guide surgical planning and minimize risks. The sonographic "sliding sign" has shown promise in detecting intra-abdominal adhesions, yet its routine use remains limited. This study aims to evaluate the diagnostic accuracy of both transvaginal and transabdominal ultrasonographic assessments of the sliding sign in predicting intra-abdominal adhesions prior to gynecologic endoscopic surgery.

Methods: This retrospective cohort study included 262 women who underwent gynecologic endoscopic surgery at a tertiary care center in 2024. Patients with body mass index (BMI) > 35 were excluded. Both transabdominal and transvaginal ultrasonographic evaluations of the sliding sign were performed preoperatively by a single experienced physician, while operative outcomes were recorded by a blinded observer. Adhesion status, operative time, hospital stay, and surgical complications were analyzed. Statistical methods included Chi-square, Fisher's Exact test, Mann-Whitney U test, and receiver operating characteristic (ROC) curve analysis.

Results: Intra-abdominal adhesions were confirmed in 56 patients (21.4%). Absence of the sliding sign was significantly associated with the presence of adhesions (p < 0.001). Transvaginal sonography yielded a sensitivity of 77%, specificity of 100%, and area under curve (AUC) of 0.884. Transabdominal sonography demonstrated higher accuracy, with a sensitivity of 96%, specificity of 100%, and AUC of 0.982. The combination of both methods matched the diagnostic performance of transabdominal ultrasound alone. Adhesions were significantly associated with previous abdominal surgery (p < 0.001), endometriosis (p = 0.01), hypotrophic or keloid scars (p < 0.001), obliteration of the Douglas pouch (p < 0.001), longer hospital stay (p = 0.006), and increased rates of hemorrhage (p = 0.003) and bladder injury (p = 0.03).

Conclusion: Preoperative ultrasonographic evaluation of the sliding sign is a highly accurate, non-invasive, and practical tool for predicting intra-abdominal adhesions. Both transabdominal and transvaginal sonography offers superior sensitivity and should be considered in routine preoperative assessments. Integration of this method into standard preoperative protocols may help reduce complications, optimize surgical planning, and improve patient outcomes in gynecologic endoscopic procedures.

Objective: Although numerous studies have assessed the prognostic value of negative lymph nodes (NLN) counts in breast cancer (BC), their findings on survival outcomes have been inconsistent. This study aimed to determine the impact of the number of NLNs removed on overall survival (OS) and recurrence-free survival (RFS) in patients with BC undergoing surgical treatment.

Methods: In this multicenter cohort study, we reviewed medical records of 1,384 patients with histologically confirmed BC who underwent a mastectomy from 2011 to 2022, retrospectively. Patients were stratified into three groups according to the number of NLNs removed: (1) < 10, (2) 10-20, and (3) > 20. The primary endpoints were 5-year OS and RFS. Survival was assessed by Kaplan-Meier analysis using log-rank tests to compare survival curves, and Cox proportional hazards models were used to identify prognostic factors.

Results: At a mean follow-up of 54.6 months, the 5-year OS and RFS were estimated to be 65.5% and 54.2% respectively. Kaplan-Meier curves showed significantly improved survival in patients with ≥ 10 NLNs removed. Multivariate Cox regression demonstrated that the OS rate in patients with the number of NLNs removed > 20 was significantly better than in patients with the number of NLNs removed < 10 (HR: 0.69, 95% CI: 0.56, 0.86, P: 0.001). Also, the OS rate in patients with the number of NLNs removed between 10 and 20 was significantly better than in patients with the number of NLNs removed < 10 (HR: 0.85, 95% CI: 0.75, 0.96, P: 0.001). Additionally, age < 45, higher BMI, comorbidities, advanced tumor/nodal stage, high histologic grade, HER2 status, higher Ki-67, and higher lymph node ratio were independently associated with poorer OS and RFS.

Conclusion: The removal of a greater number of tumor-free lymph nodes was independently associated with improved 5-year OS and RFS in BC patients following surgery.