BMC Surgery最新文献

Background: Wrist ganglion cysts (GCs) are the most common soft-tissue masses of the hand and wrist. Although surgical excision is considered the most effective treatment, recurrence remains a clinical concern. Anatomical and demographic predictors of postoperative recurrence are not well established.

Methods: We included 347 patients who underwent surgical excision of wrist GCs between 2015 and 2023, with a minimum follow-up of 24 months. Clinical data (age, sex, side, hand dominance) and magnetic resonance imaging (MRI)-based topographic features (volume, surface area, wall thickness, location, longest and shortest diameters, aspect ratio, and distance to the adjacent joint) were recorded retrospectively. The primary outcome was cyst recurrence at a minimum follow-up of 24 months, defined as clinically or radiologically confirmed return of the cyst. Statistical analyses included chi-square tests, t-tests or Mann-Whitney U tests, and univariable and multivariable logistic regression analyses. All analyses were performed in the Python (Google Colab) environment using the pandas, NumPy, SciPy, and statsmodels libraries.

Results: The overall recurrence rate at a minimum follow-up of 24 months was 8.6% (30 of 347). Dominant-hand involvement was significantly associated with recurrence (χ² p = 0.006). In age-adjusted logistic regression, dominant-hand involvement increased the risk (OR = 6.51; 95% CI, 1.87-22.63; p = 0.003). Cyst distance to the adjacent joint was significantly shorter in recurrent cases (mean 7.6 mm vs. 8.1 mm; t-test p = 0.001, Mann-Whitney U p = 0.021). Based on age-adjusted logistic regression, each additional millimeter of cyst-to-joint distance conferred a 41% relative reduction in recurrence risk (OR = 0.59; 95% CI, 0.39-0.90; p = 0.013).

Conclusions: MRI-based evaluation of cyst-to-joint distance and consideration of dominant-hand involvement may help identify patients at increased risk of recurrence after surgical excision of wrist GCs. Incorporating these factors into preoperative planning may optimize surgical strategy, guide follow-up, and improve patient counseling.

Background: Biliary complications (BCs) remain a frequent and clinically important cause of morbidity after living donor liver transplantation (LDLT), with adverse effects on graft function and long-term survival. However, evidence from Central Asia remains scarce.

Aim: To evaluate the incidence, risk factors, and survival impact of BCs in adult LDLT recipients at a Central Asian centre.

Methods: This retrospective observational cohort study included 205 adult recipients who underwent living donor liver transplantation between 2011 and 2024. Biliary complications were defined based on combined clinical, biochemical, and radiological criteria. Patients were stratified according to biliary anatomy and reconstruction technique. Risk factors for biliary complications were evaluated using logistic regression analysis. Overall survival was assessed using the Kaplan-Meier method and compared between groups using the log-rank test.

Results: BCs developed in 50 patients (24.4%). Biliary strictures occurred in 27 patients (54.0%), bile leakage in 15 (30.0%), and combined lesions in 8 (16.0%). Multivariate analysis identified male sex (odds ratio [OR] 2.11, 95% confidence interval [CI] 1.01-4.39; p = 0.045) and multiple bile ducts (OR 2.92, 95% CI 1.33-6.39; p = 0.008) as independent predictors of BCs. Prolonged cold ischaemia time was significant on univariate analysis but not after adjustment. Overall survival at 1, 3, and 5 years in the entire cohort was 85.7%, 81.0%, and 78.0%, respectively. Patients with BCs demonstrated reduced long-term survival compared with the overall transplant cohort, with survival rates of 93.3%, 78.3%, and 73.3% at the corresponding time points.

Conclusion: In this Central Asian LDLT cohort, multiple bile ducts and male sex were independent risk factors for biliary complications, which were associated with poorer long-term survival. Careful preoperative biliary evaluation, preservation of ductal blood supply, and tailored reconstruction techniques are critical to reducing biliary morbidity and improving outcomes following LDLT.

Objective: Hypoparathyroidism and hypocalcemia are common complications following total thyroidectomy (TT). This study aimed to evaluate the risk of post-total thyroidectomy transient hypoparathyroidism and hypocalcemia through a large single-center retrospective analysis.

Methods: In this retrospective study, consecutive patients underwent total thyroidectomy from May 2021 to September 2022 were included. Postoperative parathyroid hormone (PTH) level and serum calcium levels were evaluated within 24 h. Univariate and multivariate analysis were performed for assessing risk factors for developing transient hypoparathyroidism and hypocalcemia after total thyroidectomy.

Results: A total of 1065 patients undergoing total thyroidectomy who met the inclusion criteria were enrolled in this study. Among the patients, 460 patients (43.2%) developed hypoparathyroidism after surgery, and a total 325 patients (30.5%) developed hypocalcemia. After multivariate analysis, the independent risk factors related to hypoparathyroidism are female (OR = 1.65, p < 0.001), inadvertent parathyroidectomy (OR = 2.26, p = 0.004), non-papillary thyroid microcarcinoma (OR = 1.55, p = 0.003) and capsule invasion (OR = 1.39, p = 0.034). Meanwhile, the independent risk factors related to hypocalcemia are female (OR = 1.94, p < 0.001) and inadvertent parathyroidectomy (OR = 2.01, p = 0.011).

Conclusion: Transient hypoparathyroidism and hypocalcemia are relatively common complications following total thyroidectomy. Female, inadvertent parathyroid gland excision, papillary thyroid microcarcinoma, and capsular invasion were identified as independent risk factors for hypoparathyroidism and hypocalcemia.

Objectives: This retrospective cross-sectional study aimed to investigate the differences and influencing factors between the headache patients who achieved complete remission or significant reduction in headache frequency postoperatively and those whose frequency remained unchanged.

Methods: The study was conducted on 386 patients who underwent bariatric surgery at the four university hospitals between January 2018 and June 2024. Patients were divided two groups as with or without headache and then patients with headache were divided into migraine and tension-type headache groups.

Results: Headache duration, HIT-6 and VAS scores were also significantly reduced after operation. Bariatric surgery was significantly and negatively correlated with headache duration (r=-0.170; p < 0.05), HIT-6 (r=-0.353; p < 0.01) and VAS (r=-0.408; p < 0.01). Bariatric surgery had significant effect on HIT-6 (OR: 7.120; p < 0.01), headache frequency (OR: 13.634; p < 0.01) and VAS (OR: 2.024; p < 0.01). In migraine group; duration, HIT 6 and VAS levels were significantly decreased after operation (p < 0.05). In tension type group; only VAS level was significantly decreased after operation (p < 0.05).

Conclusion: After bariatric surgery, a statistically significant decrease in headache in terms of impact and severity was observed. This situation reveals that bariatric surgery has a direct and significant effect on headache. In patients with a BMI value on the borderline for bariatric surgery, these values ​​can be lowered slightly in case of severe headache.

This case explored the association among posterior circulation hypoperfusion, cryptogenic vertebral artery dissection (CVAD), and idiopathic intractable otalgia. A 67-year-old male patient, afflicted with recurrent right otalgia for over 50 years and misdiagnosed with otitis and trigeminal neuralgia, demonstrated posterior circulation hypoperfusion on cerebral CT perfusion imaging. Conventional vascular tests turned up nothing, yet dynamic contrast-enhanced CT (DCE-CT) disclosed a long-segment CVAD with endothelial flaps within the intracranial vertebral artery, precisely matching the hypoperfused territory. Post endovascular stent repair of the CVAD, the hypoperfusion normalized and the otalgia vanished. At 29 months, the patient remained pain - free without analgesics.This case highlights that CVAD-related posterior circulation hypoperfusion is a critical contributor to cryptogenic intractable otalgia. The evidence supports the efficacy of endovascular therapy as a promising intervention.