BMC Surgery最新文献

Background: Postoperative pulmonary complications remain a major cause of morbidity after cardiac valve surgery. Although incentive spirometry (Triflow) is routinely used in postoperative care, evidence regarding the additional benefits of combining Triflow with deep breathing and coughing exercises remains limited. This study aimed to evaluate the effects of combined Triflow, deep breathing, and coughing exercises on postoperative pulmonary function in adult patients undergoing mitral valve replacement.

Methods: This randomized controlled, single-blind trial was conducted between May and August 2025 in a private hospital in Istanbul. A total of 60 adult patients undergoing mitral valve replacement were randomly allocated to an experimental group (n = 30) or a control group (n = 30) using simple randomization. The experimental group performed Triflow combined with deep breathing and coughing exercises, while the control group performed Triflow alone.

Results: Postoperative SpO₂ levels were significantly higher in the experimental group at T1 (p = 0.009; 95% CI: 0.46-3.14), T2 (p < 0.001; 95% CI: 1.57-3.43), and T3 (p < 0.001; 95% CI: 2.72-4.54). The FEV₁/FVC ratio increased significantly in the experimental group compared with the control group at discharge (p < 0.001; 95% CI: 4.46-6.41). Respiratory rate was significantly higher in the experimental group at T1 (p < 0.001; 95% CI: 1.68-4.45), T2 (p < 0.001; 95% CI: 3.34-6.26), and T3 (p < 0.001; 95% CI: 5.23-8.37). Hematocrit levels were significantly lower in the experimental group at T1 (p = 0.039; 95% CI: -8.32 to - 0.24), T2 (p = 0.007; 95% CI: -8.29 to - 1.40), and T3 (p = 0.034; 95% CI: -6.54 to - 0.28). Pain scores were significantly lower in the experimental group at T1 (p < 0.001; 95% CI: -2.82 to - 1.71) and T2 (p < 0.001; 95% CI: -1.98 to - 1.08). Time to first mobilization was significantly shorter in the experimental group (p < 0.001; 95% CI: -2.94 to - 1.26). No postoperative pulmonary complications were observed in either group.

Conclusion: The combined application of Triflow, deep breathing, and coughing exercises was associated with significant improvements in postoperative pulmonary function, oxygen saturation, pain reduction, and earlier mobilization compared with Triflow alone in patients undergoing mitral valve replacement. These findings suggest that a structured, combined respiratory exercise protocol may provide additional clinical benefits in the early postoperative period.

Trial registration: ClinicalTrials.gov Identifier NCT06997224 (First registered on 15 May 2025).

Background: Anterior lumbar interbody fusion (ALIF) is an effective treatment for lumbar degenerative diseases, but it usually requires combined posterior fixation. Currently, Currently, there is no high-strength fixation technique for single-position anterior approach. This study aimed to introduce L5 vertebral body screws combined with S1 vertebral body-pedicle screw fixation (BPSF) as a novel single-position anterior fixation technique for ALIF, and to evaluate its clinical and biomechanical outcomes.

Methods: Sixty-three patients with L5/S1 degenerative disease undergoing ALIF were divided into BPSF (n = 22) and posterior pedicle screw fixation (PPSF, n = 41) groups. Clinical outcomes, radiographic parameters, and complications were collected and compared between groups. Biomechanically, an adult lumbar spine model was used to simulate two ALIF fixation configurations under normal and osteoporotic conditions. Each construct was loaded with 500N compression and 10N·m torque to simulate flexion/extension, lateral bending, and axial rotation. Kinematic analyses included ROM, interbody cage stress, and fixation device strain.

Results: The BPSF group showed significantly shorter operative duration (152.5 min (127.5, 173.1) vs. 165.0 min (140.0, 262.5), less intraoperative blood loss (115.0 ± 56.9 ml vs. 160.0 ml (110.0, 222.5) mL), and lower postoperative low back pain scores (1.6 ± 0.8 vs. 2.2 ± 0.7) compared to the PPSF group. And there were no statistically significant differences between the two groups in JOA improvement rate (49.9 ± 14.2% vs. 54.7 ± 18.1%), lumbar lordosis correction (6.9 ± 7.3° vs. 7.6 ± 7.1°), fusion rate (90.9% vs. 92.7%), or complication rate (27.3% vs. 19.5%). Biomechanically, BPSF reduced ROM during flexion (12% reduction) and axial rotation (63% reduction) compared to PPSF, with higher interbody cage stress but lower posterior fixation device stress under most loading conditions.

Conclusion: BPSF provides safe anterior fixation for ALIF, reducing operative time and early postoperative pain. Its biomechanical stability, especially in rotational resistance, supports it as an alternative to PPSF for L5/S1 fusion.

Background: We compared the short- and long-term results of ArtiSential™-operated patients with a historic group of laparoscopic-operated patients.

Methods: A total of 145 patients were included (37 patients in the ArtiSential group and 108 patients in the Laparoscopic group).

Results: There were significantly more conversions in the Laparoscopic group compared to ArtiSential™ group (15.7% vs. 2.7%; p = 0.043). The procedure duration was significantly shorter in the ArtiSential™ group (240 ± 49 min vs. 277 ± 58 min; p = 0.001). There were no significant differences in postoperative morbidity and mortality between groups (19.4% in the Lap group vs. 10.8% in the ArtiSential™ group). Multivariate analysis identified intraoperative blood loss (Beta 0.335; 95%CI: 21.774-58.616; p < 0.0001), tumor location (Beta - 0.518; 95%CI: -49 - -25.939; p < 0.0001) and the reconstruction with wristed instruments (Beta - 0.312; 95%CI: -52.261- -16.613; p < 0.0001) as significant predictors for duration of the surgery, while wristed instruments (Beta 0.247; 95%CI: 3.296-13.599; p = 0.001) and the UICC stage (Beta 0.375; 95%CI: 3.205-7.517; p < 0.0001) were significant predictors for the number of extracted lymph nodes. Perioperative chemotherapy (OR 3.521; 95%CI: 1.572-7.883; p = 0.002) and the use of wristed instruments (OR 4.018; 95%CI: 1.441-11.205; p = 0.008) were significant predictors for a complete number 10 lymph node station dissection.

Conclusion: Our findings suggest that ArtiSential™ wristed instruments offer key benefits in the challenging proximal anastomosis, allowing safe operations on patients with proximal tumors without increasing morbidity or mortality risk.

Introduction: The Mitrofanoff principal entails creating a continent catheterizable channel, traditionally the appendix. In patients with nonfunctioning kidney, the ureter of this kidney can be an alternative This study aims to compare outcomes of ureter versus appendiceal Mitrofanoff channels (MCs).

Patients and methods: We retrospectively reviewed patients who underwent MC creation between January 2020 and June 2024 for patients with neurogenic bladder, exstrophy-epispadias complex, prune belly syndrome, or posterior urethral valves. Group A included patients who had a ureter as MC (n = 11), while Group B included those with an appendiceal MC (n = 33). Data on demographics, operative details, complications, and continence outcomes were collected and analyzed.

Results: Forty-four patients (Male patients = 24) were included, with a median age of 13.0 years (IQR 9.0-15.0) in Group A and 10.0 years (IQR 7.0-12.0) in Group B (p = 0.002). Myelomeningocele was the most common diagnosis in both groups. Bladder augmentation was performed in 81.8% of patients in each group, predominantly with ileo-cystoplasty. Satisfactory clean intermittent catheterization (CIC) without complications was achieved in 54.4% of Group A and 57.5% of Group B. Stomal stenosis occurred more frequently in Group B (18.2% vs. 9.1%, p = 0.003), while meatal granuloma was more common in Group A (27.3% vs. 9.1%, p = 0.043). Other complications included urine leakage, painful catheterization, catheterization difficulty, and intestinal obstruction, with no significant intergroup differences.

Conclusion: Ureter as an MC offers a valid option for continent urinary diversion, demonstrating comparable continence outcomes as compared to appendiceal MC. The ureter represents a feasible and reliable alternative conduit in patients with a nonfunctioning kidney.