BMC Surgery最新文献

Background: The anterior interosseous nerve (AIN) end-to-side (ETS) nerve transfer is a relatively recent treatment innovation in managing cubital tunnel syndrome (CuTS). Potential benefits must be balanced against the risks associated with the adoption of an innovative technique, evaluating procedure-specific risks, and considering additional costs in the safe delivery of care. The ETS technique has been proposed as a method of improving intrinsic muscle function in the hand in the setting of ulnar nerve compression at the elbow. The technique is controversial with emerging evidence from retrospective cohort and single-arm interventional studies to support its use. However, there is persisting uncertainty regarding the relative contributions of the decompression, collateral sprouting from intact terminal axons, and neo-innervation from the ETS transfer to any functional recovery. Given this lack of equipoise regarding the efficacy of ETS nerve transfers, a randomised controlled trial is proposed to assess recruitment, protocol compliance, subject retention, and define the sample size for a future multicentre study.

Methods: This randomised controlled trial (RCT) protocol defines a prospective, single centre study of 20 patients randomised to ulnar nerve decompression with or without ETS nerve transfer, with participant blinding to treatment allocation. Anticipated follow up period is up to 24 months.

Discussion: Data from this study will be used to calculate the sample size for a future multicentre RCT evaluating SETs transfer in CuTS. It would also inform on the willingness of clinicians to randomise their patient given the current uncertainty surrounding this technique and the retention rates anticipated. Should the RCT demonstrate significant functional benefits of combining ETS nerve transfer with decompression, it could shift clinical practice toward using this dual approach, especially in patients with moderate or severe ulnar neuropathy. The findings would likely influence treatment algorithms, optimising patient outcomes, and could also spur further studies into ETS applications in peripheral nerve injuries.

Primary trial registry: ISRCTN ID Number: ISRCTN18379703, Date of Registration: 14th May 2024.

Background: Esophagogastrostomy (EG) after proximal gastrectomy (PG) is widely used but often complicated by reflux. Current anti-reflux procedures, such as double-tract and double-flap reconstructions, are effective but technically demanding. We developed a simplified, device-free anti-reflux EG that uses two sutures to approximate the angle of His, the gastric angle, and a neofundus-like contour.

Methods: We retrospectively analyzed 11 consecutive patients with upper-third gastric cancer who underwent laparoscopic PG followed by dual-suture fundoplication between May 2023 and November 2024. Surgical and clinical outcomes included operative time, blood loss, hospital stay, complications (Clavien-Dindo), reflux symptoms, endoscopic findings, and quality of life assessed using the Reflux Disease Questionnaire (RDQ) and the World Health Organization Quality of Life-BREF (WHOQOL-BREF). Continuous variables were summarized as mean ± standard deviation and range. Changes in RDQ and WHOQOL-BREF scores were compared using paired tests (paired t-test or Wilcoxon signed-rank test after normality assessment), with two-sided α = 0.05.

Results: All procedures were successfully completed without intraoperative or postoperative complications (Clavien-Dindo). The mean operative time was 189.9 min and the mean hospital stay was 7.4 days. During a median follow-up of 12 months, no patient required proton pump inhibitors, and no reflux esophagitis of Los Angeles grade B or higher was observed. RDQ scores remained stable, while WHOQOL-BREF scores were higher in the social and environmental domains, suggesting favorable postoperative function and quality of life.

Conclusion: This simplified dual-suture esophagogastrostomy appeared safe and feasible in this cohort and demonstrated reassuring early postoperative outcomes with respect to reflux. Its minimal technical demands and favorable postoperative recovery profile suggest potential suitability for broader clinical application, although larger comparative studies with extended follow-up are needed to clarify long-term outcomes.

Background: Incisional hernia is the most common long-term complication after abdominal surgery, including minimally invasive colorectal procedures. In Japan, fascial closure of small midline incisions is generally performed using interrupted suturing, but high-quality evidence comparing continuous barbed suturing with interrupted suturing is limited. Continuous closure may reduce the risk of incisional hernia; however, robust randomized data in laparoscopic and robot-assisted colorectal surgery are lacking. This study aims to determine whether continuous barbed suturing is superior to conventional interrupted suturing in preventing incisional hernia after minimally invasive colorectal cancer surgery.

Methods: The HIBISCUS trial is a multicenter, prospective, open-label, randomized controlled study comparing continuous barbed suturing with interrupted monofilament suturing for fascial closure of mini-laparotomy incisions. Eligible adults with colorectal cancer undergoing elective laparoscopic or robot-assisted resection will be randomized 1:1 to continuous closure using a barbed absorbable suture (STRATAFIX Symmetric PDS Plus; bite width of 5 mm and stitch spacing of 5 mm) or interrupted closure using a monofilament absorbable suture (PDS Plus; bite width of 8 mm and stitch spacing of 8 mm). Only board-certified surgeons who complete a standardized pre-trial suturing competency assessment will be allowed to participate. The primary endpoint is the incidence of incisional hernia within 18 months after surgery, assessed mainly by scheduled abdominal CT imaging, with clinical examination as complementary. Secondary endpoints include fascial closure time, postoperative wound complications (including surgical site infection (SSI)), postoperative wound pain, and reoperation or readmission. All CT images will be independently reviewed by two blinded specialists. Based on power calculations, 422 patients will be enrolled.

Discussion: This trial will be the first randomized study to directly compare continuous barbed suturing with conventional interrupted suturing for small midline incisions in minimally invasive colorectal surgery. By standardizing suturing parameters and requiring surgeon competency verification, the HIBISCUS trial is designed to yield high-quality evidence on optimal fascial closure technique. The results are expected to influence clinical practice, inform guideline development, and contribute to the global standardization of abdominal wall closure practices.

Trial registration: This study is registered in the Japan Registry of Clinical Trials (jRCT1040250129). Registration date: November 21, 2025.

Background: The "male-female health-survival paradox" describes women's longer lifespan despite a greater burden of non-fatal chronic conditions-a phenomenon rarely examined in surgical settings. This study investigated whether this paradox exists in a national cohort of frail patients undergoing hip replacement and explored its underlying mechanisms. We hypothesized that in this cohort: (1) female patients would be less healthy, presenting with a higher prevalence of frailty, older age, and a higher Charlson Comorbidity Index (CCI); and (2) frail men would experience higher in-hospital mortality.

Methods: A retrospective cohort study was conducted using the US National Inpatient Sample (2005-2014) A frailty-defining diagnosis cluster was employed to identify frail individuals. Sex-based differences in demographics, comorbidities, and in-hospital outcomes (mortality, complications, length of stay, costs) were analyzed using multivariable logistic regression, including interaction terms and sex-stratified models.

Result: Among 29,063 frail patients, 64% were female. Despite being significantly older (median age 81 vs. 77 years, p < 0.001) and having a higher CCI burden, frail women had significantly lower in-hospital mortality than men (3% vs. 5%, p < 0.001). Comorbidity patterns differed markedly: women had higher rates of rheumatoid arthritis, depression, and hypothyroidism, while men had more congestive heart failure, diabetes, and renal failure (all p < 0.001). After adjustment, male sex remained an independent predictor of mortality (Adjusted OR 1.31, 95% CI 1.15-1.49, p < 0.001), primarily driven by significant interactions between male sex and life-threatening conditions such as heart failure and renal failure.

Conclusion: The male-female health-survival paradox is evident in frail patients undergoing hip replacement. These findings highlight the need for sex-tailored preoperative optimization, with particular emphasis on cardiovascular and metabolic risk management in frail male patients.