Acta Chirurgica Belgica最新文献

Background: Falciform ligament hernia (FLH) is a highly uncommon type of internal hernia. This internal hernia presents diagnostic difficulties due to its ambiguous clinical symptoms, which can resemble other causes of acute abdominal pain.

Methods: A systematic literature review of cases of falciform ligament hernia was conducted on 5th December 2024 according to PRISMA guidelines and using PubMed and Google Scholar databases.

Results: Among 103 articles, 36 were included in our review. In total 50 patients were reported. The median age at diagnosis was 41 years. Upper abdominal pain and vomiting were the predominant symptoms. Computed Tomography (CT) scan was instrumental in detecting this rare hernia. Despite this, a definitive diagnosis is often established in the surgical setting. The causes of FLH are diverse, including both congenital and acquired elements. Congenital factors (70%) may involve embryological defects or complete failure in the development of the falciform ligament. Acquired causes might stem mainly from previous abdominal procedures (28%) or injuries (2%). The small bowel was responsible for 78% of cases. Emergency laparotomy was performed in 70% of patients, while 28% were managed with laparoscopy.

Conclusion: The treatment for FLH is solely surgical. Laparoscopic methods are preferred, providing faster recovery, enhanced visualization for reducing the hernia, and assessing bowel viability. In cases of severe complications such as bowel ischemia and perforation, open surgery may be necessary. Prompt surgical intervention is crucial to achieve a positive outcome and reduce morbidity.

Background: Klippel-Trenaunay syndrome (KTS) is primarily managed for vascular and soft-tissue abnormalities, while treatment of associated lymphedema remains poorly described. This study outlines our protocol for advanced lower-extremity lymphedema using a combined modified Charles' procedure and vascularized lymph node transfer (VLNT).

Methods: KTS patients with International Society of Lymphology (ISL) stage III lower-limb lymphedema treated between 1999 and 2018 were retrospectively reviewed. All underwent a modified Charles' excisional procedure with Homans techniques and VLNT. Outcomes were assessed at least one year postoperatively, focusing on early complications and postoperative hospital admissions for residual disease or recurrent infections.

Results: Twenty-two patients (14 male, 8 female) with a mean age of 21 years (range, 4-41) were included. Average time since KTS diagnosis was 14 years (range, 3-26). VLNT donor sites included groin (18.2%), supraclavicular (31.8%), and gastroepiploic (50%). Mean hospital stay was 16 days (range, 14-39). Follow-up averaged 38 months (range, 27-45). Three minor complications occurred (one wound dehiscence, one infection, one bleeding), and flap survival was 100%. Annual hospital admissions for soft-tissue infections decreased from a preoperative mean of 3.5 to 1.2 postoperatively. Patients required an average of 3.5 additional procedures (range, 2-8) to remove residual hemangiolymphangioma.

Conclusions: Lymphedema in KTS presents unique challenges and differs markedly from typical primary or secondary lymphedema. Effective management requires meticulous assessment and individualized planning. In this population, functional improvement is the main objective, and extensive debulking procedures combined with physiologic reconstruction may provide meaningful clinical benefit despite limited aesthetic outcomes.

Background: Within the medical industry, operating rooms contribute significantly to greenhouse gas emissions. As a pediatric hospital, we feel highly responsible to reduce the negative impact of healthcare aimed at improving young lives. Therefore, we conducted a pilot study to assess simple waste segregation and recycling strategies aimed at reducing waste and improving sorting and recycling in our operating quarters.

Methods: The study was conducted at Hôpital Universitaire Des Enfants Reine Fabiola (HUDERF)'s operating quarters and consisted of a questionnaire addressing staff opinions and waste measurements before (T = 0) and after (T = 1) a weeklong intervention: a campaign aimed at improving sorting and recycling surgical waste and reducing unnecessary opening of materials.

Results: Participants agreed that a transition towards more sustainable operating quarters will be necessary. At T = 1, 53% of respondents considered measures for sustainable waste management were applied, versus 26% before. Fifty-one surgeries were analyzed at T = 0. The mean weight of waste to incinerate was 1780 gram per hernia/orchidopexy, 940 gram per circumcision, and 2150 gram per central venous catheter (CVC) placement. At T = 1, another 51 surgeries were analyzed. The mean weight of waste to be incinerated was 665 gram per hernia/orchidopexy, 445 gram per circumcision, and 920 gram per CVC placement.

Conclusion: Simple, easy-to-implement measures introduced during a one-week campaign aimed at improved triage and diminished pre-emptive opening of sterile materials led to a > 50% reduction in waste to incinerate.

Background: Bullying, undermining behavior, and harassment (BUBH) persist as ongoing concerns in healthcare, particularly within stressful environments. This study aims to explore the prevalence and characteristics of BUBH among Belgian general surgery residents.

Methods: A cross-sectional survey was distributed online using an anonymous link through newsletters and social media channels of the Belgian Association of Surgical Trainees. The survey comprised 54 questions including: A) demographic; B) instances of BUBH, adapted from the validated Leymann Inventory of Psychological Terror and the Negative Acts Questionnaire; C) reporting, perpetrators, and management of BUBH derived from the survey developed by Rouleaux Club (United Kingdom).

Results: Fifty-six surgical residents, aged 24 to 40 years, participated. Of them, 18 (32%) were junior, 26 (56%) senior, and seven (12%) were enrolled in a research trajectory. Most respondents were Caucasian (82%), female (61%), heterosexual (93%), and without disability (98%). BUBH was experienced by 38 (68%) residents, while 44 (79%) witnessed BUBH towards their colleagues. Main perpetrators were consultants (n = 40/132; 30%) and nursing staff (n = 28/132; 21%). Reported behaviors included an unmanageable workload (n = 53; 95%), ignored opinions, (n = 52; 93%) and working below competence (n = 51; 91%). BUBH primarily occurred in operating rooms (39%), hospital wards (34%), or emergency rooms (11%).

Conclusion: This is the first national study examining BUBH during surgical training in Belgium. Results highlight how BUBH is often misidentified and underreported. Proactive measures, educational programs, and support networks are essential to effectively address and mitigate these issues.

Background: Hashimoto's thyroiditis (HT) is the most common autoimmune thyroid disorder, while papillary thyroid carcinoma (PTC) is the most prevalent thyroid malignancy. The association between HT and PTC remains debated, with some studies suggesting a protective effect of HT against aggressive PTC features. This study explores the relationship between HT and PTC in a single-center cohort, focusing on clinicopathological and prognostic factors.

Methods: This retrospective study included adult patients who underwent thyroid surgery between 2009 and 2017. Patients were divided into two groups: those with concurrent PTC and HT (Group 1, n = 68) and those with PTC alone (Group 2, n = 329). Demographic, laboratory, and pathological data were compared using appropriate statistical analyses.

Results: A significant association between HT and PTC was observed (χ²=5.3; p = 0.021; OR: 1.682). Group 1 patients were more often female and significantly younger. TSH levels were higher in Group 1 (p < 0.001), and follow-up duration was longer (p = 0.023). Although the mean tumor diameter was smaller in the HT group, the difference was not statistically significant. No significant differences were found regarding multifocality, capsular invasion, or lymphovascular invasion.

Conclusion: The presence of HT appears to be significantly associated with the occurrence of PTC and may be linked to a less aggressive clinical profile, as suggested by younger age and higher TSH levels. The longer follow-up duration observed in HT patients may reflect more vigilant surveillance due to underlying autoimmune pathology. However, the retrospective and single-center design limits generalizability. Prospective, multicenter studies with larger cohorts are warranted to confirm these findings.

Background: Handlebar syndrome has a low incidence and its presentation can be quite different making the diagnosis sometimes challenging.

Methods: We present a rare case of the handlebar syndrome in which the handlebar of a bike injures the common femoral artery with an atypical clinical presentation. A written informed consent was obtained from the patient, and the study was approved by the Ethics Committee Research UZ/KU Leuven with the corresponding reference number S70224.

Results: The case is a unique late presentation of the handlebar syndrome with only mild symptoms during high-intensity exercise, with normal arterial pulsations and a murmur in the groin. The patient was initially conservatively treated. Although symptoms decreased, there was still a loss of power during maximal intense efforts, and the ankle-brachial index dropped on the bike with a duplex showing low-grade stenosis in the common femoral artery. We performed femoral endarterectomy using a bovine patch. Postoperatively, the patient was symptom-free during intense exercise.

Conclusion: Diagnosis could be missed in the absence of early symptoms, posing a risk in children with respect to limb growth and length. Treatment is patient- and lesion-tailored, and mostly performed by open surgery, although conservative management has also been described.

Background: Several biomarkers are known to predict long-term complications after non-cardiac surgery, including major adverse cardiovascular events (MACE), myocardial infarction, and death. Carotid endarterectomy (CEA), a low to medium-risk procedure for carotid stenosis, aims to prevent stroke. Glycated hemoglobin (HbA1c) may hold prognostic value for MACE. This study evaluates the role of HbA1c in predicting all-cause mortality and MACE in patients undergoing CEA.

Methods: A post hoc analysis was conducted using data from a prospective database of patients who underwent CEA under regional anesthesia at a tertiary referral center between January 2014 and December 2023. Patients with HbA1c measured within three months prior to surgery were included and divided into two groups (HbA1c <6.5% vs. ≥6.5%). Kaplan-Meier survival and multivariable Cox regression analyses assessed the impact of HbA1c on outcomes. The primary outcome was the incidence of long-term MACE and all-cause mortality. Secondary outcomes included stroke, acute myocardial infarction (AMI), acute heart failure (AHF), and major adverse limb events (MALE).

Results: A total of 65 patients (mean age 71.4 ± 8.5 years; 81.5% male) were included, with a median follow-up of 30 months. Patients with HbA1c ≥6.5% were significantly younger. Elevated HbA1c was associate with trend toward more stroke risk (log-rank p = 0.045, HR: 3.2 (CI: 0.96-10.7, p = 0.059) HbA1c was an independent predictor of MALE (aHR: 3.387, p = 0.037), while its association with stroke did not reach significance (p = 0.059).

Conclusion: HbA1c appears to be a useful, accessible biomarker for vascular risk stratification in patients undergoing CEA.

Background: Flexible intramedullary nailing is a minimally invasive method used for pediatric tibial shaft fractures stabilization.

Case presentation: A seven-year-old boy sustained a midshaft oblique tibial fracture due to a fall from one meter height and was treated by closed reduction and intramedullary nailing. On the first postoperative day, a swelling of the proximal half of the lower leg occurred and progressed to compartment syndrome. The lower leg was edematous, firm and painful on palpation, and the pain at rest was out of proportion to injury. CT angiography showed a posterior tibial artery pseudoaneurysm and no signs of deep venous thrombosis. He was successfully treated by pseudoaneurysm evacuation and saphenous vein patch repair of the posterior tibial artery. Postoperative course was uneventful.

Conclusion: Vascular complications after flexible intramedullary nailing in children are rare and require early recognition. In this case, treatment by open surgical technique was successful.

Background. The work of the anatomist surgeon Joseph Maclise has been forgotten by history. His contributions are unknown to younger generations. This study aims to analyze his legacy, focusing on the surgical anatomy of hernias. Results. This is the first study to analyze Maclise's work from a surgical, rather than an artistic, perspective, focusing on the pathology of hernias. His life was marked by a lack of academic and/or institutional recognition. He was forgotten by the Royal College of Surgeons a decade before his death. He collaborated with Morton on his treatise on surgical anatomy. His work was fundamental to the training of surgeons for at least three decades and served as a bridge between two continents. In the field of hernias, he simplifies knowledge for surgeons, shows each type of hernia in anterior and posterior approaches, and describes the region as a single space where all hernias appear. Conclusion. Maclise was an exemplary Victorian surgeon who cultivated many fields of practice (surgical anatomy, comparative anatomy and naturalism, experimental anatomy and physiology, embryology, art and painting), committed to the advancement of science in his time. His surgical anatomy of hernias facilitated the visual understanding of this pathology for surgeons of several generations.

Objectives: Lungs are the second most frequent site of colorectal cancer metastases. Complete resection of isolated lung metastases is recommended in the current guidelines because of the high long-term survival rate and low morbidity-mortality. The aim of this study is to determine prognostic factors for lung metastasectomy in order to better select patients who will benefit from surgical resection.

Methods: This single-center retrospective study is based on the medical data of patients operated for resection of colorectal lung metastases between 2004 and 2023.

Results: A total of 109 patients were selected, and four had to be excluded. The univariate analysis revealed factors influencing the survival: primary cancers that were metastatic at diagnosis, high preoperative CEA rate, the number and size of metastases, hilar lymph node involvement, invasion of the resection margins and poorly differentiated histological grade. A multivariate analysis including only the pre-operative factors was performed: CEA (p < 0.001), the size (p = 0.003) and number (p = 0.038) of metastases and the metastatic stage of the primary cancer at diagnosis (p = 0.052).

Conclusions: The 5-year survival rate in this study is 55%. Survival can be evaluated by four preoperative factors: CEA rate, size and number of metastases and metastatic status of the primary cancer. These factors can be combined to form a survival score, each factor being worth one point. Patients with a score of 0 have a 5-year survival of around 90%, while patients with a score of 3 have a 5-year survival of around 10%. This score could be used to select patients eligible for surgery.