BMC Surgery最新文献

Background: Lung torsion is a rare but serious postoperative complication in thoracic surgery, with traditional management requiring surgical intervention such as video-assisted thoracoscopic surgery or open thoracotomy. Reoperation carries significantly higher mortality rates and prolonged hospitalization compared to routine surgical outcomes. To date, no cases of successful conservative management of postoperative lung torsion have been reported in the literature. This case report presents the first successful conservative management of postoperative lung torsion, challenging the established surgical paradigm and offering new therapeutic possibilities.

Case presentation: A 52-year-old male patient underwent dual-port video-assisted thoracoscopic surgery with right upper lobectomy and right lower lobe superior segmentectomy (RS6) for invasive pulmonary adenocarcinoma. Two hours after chest tube removal on postoperative day 2, the patient developed acute onset of profuse sweating, chest tightness, and dyspnea. Emergency chest radiography revealed complete lung atelectasis, and subsequent multidetector CT imaging combined with flexible bronchoscopy confirmed incomplete torsion of the right middle and lower lobes. A novel multimodal conservative approach was initiated, consisting of selective intrabronchial air insufflation every 48 h, noninvasive positive pressure ventilation (BiPAP), and maintained closed thoracic drainage. On postoperative day 7, three-dimensional imaging demonstrated significant resolution of atelectasis, and the chest tube was successfully removed. Three-month postoperative imaging revealed complete re-expansion of the residual right lung, with sustained expansion confirmed at 2-year follow-up without long-term sequelae.

Conclusions: This case represents the first successful conservative management of postoperative lung torsion using multimodal conservative therapy with excellent long-term outcomes. Conservative management may be considered for carefully selected patients with early-diagnosed incomplete lung torsion who remain hemodynamically stable without tissue infarction. This approach requires intensive monitoring and immediate surgical backup availability. While offering a potential alternative to high-risk reoperation, surgical intervention remains the standard of care, and larger studies are needed to validate this approach and establish treatment protocols.

Background: Liver abscess is a common digestive system disorder primarily caused by bacterial infection. Effective treatment often involves drainage, in which ultrasound technology is commonly used to guide puncture and drainage procedures. However, ultrasound has inherent limitations such as suboptimal visualization of abscess boundaries and adjacent vascular anatomy. Indocyanine green (ICG) fluorescence navigation and three-dimensional (3D) visualization are two intraoperative navigation technologies that, when integrated with ultrasound, overcome these constraints. This synergy improves localization accuracy and abscess size assessment, thereby reducing procedural complexity.

Case description: This article details the case of a 61-year-old male patient hospitalized for a 4-day history of fever of unknown origin, ultimately diagnosed with a pyogenic liver abscess. Preoperative management included standardized antibiotic therapy. The patient subsequently underwent concurrent laparoscopic abscess fenestration and drainage with cholecystectomy. Intraoperative precision localization of the liver abscess was achieved through ultrasound-guided ICG fluorescence imaging integrated with 3D visualization technology, ensuring successful surgical completion. During the 3-month postoperative follow-up, the patient developed no complications.

Conclusion: ICG fluorescence imaging and 3D visualization technologies demonstrate clinical utility in the management of liver abscesses, providing valuable insights for laparoscopic surgical intervention.

Background and objective: The most prevalent complication following total thyroidectomy is hypoparathyroidism. Permanent hypoparathyroidism poses a significant medical burden, necessitating lifelong medication and regular follow-up. Parathyroid transplantation has demonstrated its biological efficacy and is therefore widely utilized in total thyroidectomy procedures. However, the mechanisms and treatment approaches vary considerably, lacking standardized guidelines.

Methods: We conducted a narrative review of relevant literature on PubMed using the keywords "Parathyroid gland, transplantation, autotransplantation, allotransplantation, hypoparathyroidism, total thyroidectomy" to elucidate the surgical management and future prospects for permanent postoperative hypoparathyroidism (PPH).

Key content and findings: Preservation of the parathyroid gland blood supply and prevention of inadvertent parathyroid removal during thyroid surgery, performed by a skilled surgeon, are crucial for preventing PPH. Parathyroid autotransplantation (PAT) during thyroidectomy significantly reduces the occurrence of PPH. For established PPH, alternative techniques include transplantation of autologous cryopreserved parathyroid tissue (PT) and parathyroid allotransplantation.

Conclusions: Current management of PPH primarily encompass high-dose vitamin D and calcium supplementation, parathyroid hormone (PTH) replacement therapy, and autologous or allogeneic transplantation of parathyroid. Ongoing research is expanding the therapeutic landscape to include novel approaches such as stem cell-derived therapies and recombinant human PTH (rhPTH) replacement.

Breast reconstruction surgery can result in various complications, some of which lead to medical litigation or formal mediation. However, systematic comparison of these medicolegal cases with evidence-based preventive strategies from randomized controlled trials remains unexplored. This study employed a novel methodology comparing complications resulting in litigation/mediation with contemporary randomized controlled trial (RCT) evidence. A mixed-methods approach was utilized, combining systematic review of RCTs (PubMed, 2020-2024) following modified PRISMA guidelines with comprehensive analysis of medical litigation and mediation databases. Narrative synthesis compared complication patterns between medicolegal cases and preventive interventions evaluated in RCTs. Nineteen RCTs and seven medicolegal cases (5 litigations, 2 mediations) were analyzed. All cases involved complications for which preventive strategies have been evaluated in recent RCTs. In implant-based reconstruction, tissue necrosis leading to implant loss (3/5 cases, 60%) occurred despite RCT evidence showing 50% reduction with indocyanine green assessment and 37% reduction with prostaglandin E1 (34.3% to 21.6%, p < 0.001). Both autologous reconstruction cases developed abdominal hernias, contrasting with 1-3% rates using synthetic mesh versus 38% with biological materials (p < 0.001). None of these cases documented use of such strategies. Informed consent violations were identified in 86% of cases. Total awards (compensation plus consolation money) ranged from $0-34,509, granted in 86% (6/7) of cases. These findings suggest a gap between available evidence and documented clinical practice in complications severe enough to prompt litigation or formal mediation. The preventive strategies identified in this analysis-including indocyanine green perfusion assessment, prostaglandin E1 administration, and selective synthetic mesh reinforcement-represent potential opportunities for reducing catastrophic complications and medicolegal risk, though implementation must be individualized based on patient-specific factors, risks, costs, and resource availability.

Background: Deep vein thrombosis (DVT) remains a major postoperative complication despite routine prophylaxis. This audit investigated an unexpected rise in DVT incidence in a tertiary surgical ward in Cairo, Egypt.

Methods: A six-month retrospective audit (December 2024-June 2025) included 212 adult patients undergoing general surgical procedures. All received enoxaparin prophylaxis. Clinically suspected DVTs were identified using Wells Score criteria and confirmed by duplex Doppler ultrasonography. Cold chain integrity of enoxaparin storage was reviewed in collaboration with pharmacy and biomedical engineering teams. Descriptive and comparative analyses were performed.

Results: Eighteen patients (8.5%) were clinically suspected to have DVT within 30 days postoperatively; 14 cases (6.6%) were confirmed by Doppler. Nine occurred during index admission and five during follow-up. Eleven of 14 confirmed cases (78.6%) were temporally linked to a malfunctioning ward refrigerator with storage temperatures exceeding 25 °C. Patients with DVT were more likely to have undergone emergency surgery and less likely to have received mechanical prophylaxis, although these differences were not statistically significant. No major bleeding events were systematically recorded. Patients with DVT were more likely to have undergone emergency surgery and less likely to have received mechanical prophylaxis, although these differences were not statistically significant. By contrast, exposure to enoxaparin from the malfunctioning refrigerator was significantly associated with postoperative DVT (p = 0.002).

Conclusion: Cold chain failure was strongly associated with prophylaxis failure and is the most plausible contributor, though definitive pharmacological degradation was not confirmed. Infrastructure monitoring and mechanical prophylaxis adherence are essential to effective thromboprophylaxis. A prospective re-audit is scheduled following corrective measures.