Pub Date : 2026-03-01Epub Date: 2025-08-05DOI: 10.1016/j.sipas.2025.100299
Frank Davis, Oscar Atkinson, Marwan El-Sayed, Abdel Rahman Saad, Riem Johnson
Background
Historically, there have been concerns that reusable gowns may increase post operative infection rate, though more recent literature does not support this. The Sussex Orthopaedic Treatment Centre’s (SOTC) hand unit introduced reusable gowns in hand surgery and evaluated infection rates before and after implementation. Their adoption could provide economic and environmental benefits for the NHS.
Methods
A retrospective analysis compared infection rates in 396 hand surgeries. A two month period of disposable gowns was compared with a two month period of reusable gowns.
Results
Infection rates were 1.58 % (3/190) pre-intervention and 1.94 % (4/206) post-intervention. All cases were managed with oral antibiotics, with no reoperations.
Discussion
This small study shows that our infection rates align with that of current literature that reusable gowns do not increase infection rates. Their environmental benefits support adoption, and addressing misconceptions is key to implementation.
{"title":"Evaluating the impact of reusable gowns on postoperative infection rates in hand surgery","authors":"Frank Davis, Oscar Atkinson, Marwan El-Sayed, Abdel Rahman Saad, Riem Johnson","doi":"10.1016/j.sipas.2025.100299","DOIUrl":"10.1016/j.sipas.2025.100299","url":null,"abstract":"<div><h3>Background</h3><div>Historically, there have been concerns that reusable gowns may increase post operative infection rate, though more recent literature does not support this. The Sussex Orthopaedic Treatment Centre’s (SOTC) hand unit introduced reusable gowns in hand surgery and evaluated infection rates before and after implementation. Their adoption could provide economic and environmental benefits for the NHS.</div></div><div><h3>Methods</h3><div>A retrospective analysis compared infection rates in 396 hand surgeries. A two month period of disposable gowns was compared with a two month period of reusable gowns.</div></div><div><h3>Results</h3><div>Infection rates were 1.58 % (3/190) pre-intervention and 1.94 % (4/206) post-intervention. All cases were managed with oral antibiotics, with no reoperations.</div></div><div><h3>Discussion</h3><div>This small study shows that our infection rates align with that of current literature that reusable gowns do not increase infection rates. Their environmental benefits support adoption, and addressing misconceptions is key to implementation.</div></div><div><h3>Evidence level</h3><div>2b (Retrospective Cohort).</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"24 ","pages":"Article 100299"},"PeriodicalIF":0.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146173542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2026-01-28DOI: 10.1016/j.sipas.2026.100329
Kazuhiro Tada, Yo-ichi Yamashita, Naotaka Inomata, Sota Nakamura, Shun Nakamura, Shohei Yoshiya, Yosuke Kuroda, Kentaro Iwaki, Shoji Hiroshige, Kengo Fukuzawa
Background
Obesity may contribute to pancreatic cancer development via metabolic modulation. The number of obese patients with pancreatic cancer is expected to increase worldwide. Herein, we investigated the effects of obesity on patients with pancreatic head cancer who underwent pancreaticoduodenectomy (PD).
Methods
We reviewed 141 consecutive PDs and compared clinicopathological factors and survival outcomes in obese (O: 29 patients) or non-obese (N: 112 patients) groups. Obesity was defined as a body mass index > 25 kg/m2.
Results
Intraoperative bleeding was higher in the O group than in the N group (450 vs. 280 mL, p < 0.001); however, there were no intergroup differences in operation time, frequencies of Clavien-Dindo grade Ⅲ or higher morbidities, pancreatic fistula grade B or higher, or postoperative hospital stay duration. There were no significant intergroup differences in the radical resection rate, but the O group had more advanced tumor-related factors than the N group, with higher lymphatic invasion (79 vs. 46%, p = 0.002) and lymph node metastasis rates (90 vs. 68%, p = 0.019). There was no intergroup difference in the rate of postoperative adjuvant therapy; however, the recurrence rate tended to be higher (83% vs. 69%, p = 0.136), whereas early recurrence within 6 months was significantly higher (38% vs. 19%, p = 0.02), in the O group than the N group. In addition, the median recurrence-free survival was significantly shorter in the O group than in the N group (7.6 vs. 17.3 months, p = 0.037).
Conclusions
Obesity was associated with early recurrence in patients undergoing PD for pancreatic head cancer.
背景：肥胖可能通过代谢调节促进胰腺癌的发展。肥胖胰腺癌患者的数量预计将在世界范围内增加。在此，我们研究了肥胖对胰头癌患者行胰十二指肠切除术（PD）的影响。方法回顾了141例连续的pd，比较了肥胖组（29例）和非肥胖组（112例）的临床病理因素和生存结果。肥胖被定义为体重指数为25kg /m2。结果O组术中出血量高于N组（450 vs 280 mL, p < 0.001）；然而，在手术时间、Clavien-Dindo级Ⅲ及以上发病率、B级及以上胰瘘发生率、术后住院时间等方面，组间无差异。组间肿瘤根治率差异无统计学意义，但O组肿瘤相关因素较N组更先进，淋巴浸润率（79比46%，p = 0.002）和淋巴结转移率（90比68%，p = 0.019）更高。术后辅助治疗率组间无差异；然而，O组的复发率更高（83%比69%，p = 0.136）， 6个月内早期复发率明显高于N组（38%比19%，p = 0.02）。此外，O组的中位无复发生存期明显短于N组（7.6个月对17.3个月，p = 0.037）。结论肥胖与胰头癌行PD治疗的早期复发有关。
{"title":"Associations between obesity and lymph node metastasis and early recurrence in pancreatic head cancer: A single-center retrospective cohort study","authors":"Kazuhiro Tada, Yo-ichi Yamashita, Naotaka Inomata, Sota Nakamura, Shun Nakamura, Shohei Yoshiya, Yosuke Kuroda, Kentaro Iwaki, Shoji Hiroshige, Kengo Fukuzawa","doi":"10.1016/j.sipas.2026.100329","DOIUrl":"10.1016/j.sipas.2026.100329","url":null,"abstract":"<div><h3>Background</h3><div>Obesity may contribute to pancreatic cancer development via metabolic modulation. The number of obese patients with pancreatic cancer is expected to increase worldwide. Herein, we investigated the effects of obesity on patients with pancreatic head cancer who underwent pancreaticoduodenectomy (PD).</div></div><div><h3>Methods</h3><div>We reviewed 141 consecutive PDs and compared clinicopathological factors and survival outcomes in obese (O: 29 patients) or non-obese (N: 112 patients) groups. Obesity was defined as a body mass index > 25 kg/m<sup>2</sup>.</div></div><div><h3>Results</h3><div>Intraoperative bleeding was higher in the O group than in the N group (450 vs. 280 mL, <em>p</em> < 0.001); however, there were no intergroup differences in operation time, frequencies of Clavien-Dindo grade Ⅲ or higher morbidities, pancreatic fistula grade B or higher, or postoperative hospital stay duration. There were no significant intergroup differences in the radical resection rate, but the O group had more advanced tumor-related factors than the N group, with higher lymphatic invasion (79 vs. 46%, <em>p</em> = 0.002) and lymph node metastasis rates (90 vs. 68%, <em>p</em> = 0.019). There was no intergroup difference in the rate of postoperative adjuvant therapy; however, the recurrence rate tended to be higher (83% vs. 69%, <em>p</em> = 0.136), whereas early recurrence within 6 months was significantly higher (38% vs. 19%, <em>p</em> = 0.02), in the O group than the N group. In addition, the median recurrence-free survival was significantly shorter in the O group than in the N group (7.6 vs. 17.3 months, <em>p</em> = 0.037).</div></div><div><h3>Conclusions</h3><div>Obesity was associated with early recurrence in patients undergoing PD for pancreatic head cancer.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"24 ","pages":"Article 100329"},"PeriodicalIF":0.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2025-12-19DOI: 10.1016/j.sipas.2025.100324
Shashikanth Vijayaraghavalu
{"title":"From prediction to action—Making emergency laparotomy risk scores clinically usable","authors":"Shashikanth Vijayaraghavalu","doi":"10.1016/j.sipas.2025.100324","DOIUrl":"10.1016/j.sipas.2025.100324","url":null,"abstract":"","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"24 ","pages":"Article 100324"},"PeriodicalIF":0.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Various techniques are used to localise non-palpable breast cancer and identify sentinel lymph nodes (SLN). Seed-based localisations can be expensive, may dislodge and require special intraoperative equipment. We report our experience of using radioguided occult lesion localisation (ROLL) alone and with SLN (SNOLL)
Methods
This is a retrospective review of all patients undergoing breast excision procedures using ROLL between January 2008 and 2018. On the morning of surgery or the day before, patients had 10 MBq Technetium 99 m colloid injected into the centre of the breast lesion under ultrasound guidance with a further 10 MBq injected into the periareolar skin if SLN was planned. Surgery was performed with the aid of a gamma probe to detect the radioisotope signal in the breast and axilla and specimen X-rays of the breast excision specimen were performed with cavity shaves considered if appropriate.
Results
1073 ROLL-guided excisions were performed in 1050 patients: 1043 of these were wide local excisions (WLE), which included 11 level two oncoplastic procedures, with the remaining being excision biopsies. 957 of the WLEs were SNOLL procedures. ROLL was successful in 1065 (99.3 %) procedures. Of the eight ROLL failures, three were due to incorrect lesion localisation and two were due to diffuse ROLL signal. SLN biopsy was successful in 955 (99.8 %) of cases.
Conclusions
SNOLL/ROLL is a reliable, cheap and easy localisation technique where the marker cannot be dislodged during the procedure. Both localisations are performed on the day of surgery using the same equipment for signal detection in the breast and axilla.
{"title":"Radioguided occult lesion localisation for wide local excision, excision biopsies and in combination with radioisotope sentinel lymph node localisation (SNOLL) – 10 year experience of a single centre","authors":"Bahar Mirshekar-Syahkal, Haifa Alotaibi, Sendhil Rajan, Mathew Gray, David Newman, Maged Hussien","doi":"10.1016/j.sipas.2025.100326","DOIUrl":"10.1016/j.sipas.2025.100326","url":null,"abstract":"<div><h3>Background</h3><div>Various techniques are used to localise non-palpable breast cancer and identify sentinel lymph nodes (SLN). Seed-based localisations can be expensive, may dislodge and require special intraoperative equipment. We report our experience of using radioguided occult lesion localisation (ROLL) alone and with SLN (SNOLL)</div></div><div><h3>Methods</h3><div>This is a retrospective review of all patients undergoing breast excision procedures using ROLL between January 2008 and 2018. On the morning of surgery or the day before, patients had 10 MBq Technetium 99 m colloid injected into the centre of the breast lesion under ultrasound guidance with a further 10 MBq injected into the periareolar skin if SLN was planned. Surgery was performed with the aid of a gamma probe to detect the radioisotope signal in the breast and axilla and specimen X-rays of the breast excision specimen were performed with cavity shaves considered if appropriate.</div></div><div><h3>Results</h3><div>1073 ROLL-guided excisions were performed in 1050 patients: 1043 of these were wide local excisions (WLE), which included 11 level two oncoplastic procedures, with the remaining being excision biopsies. 957 of the WLEs were SNOLL procedures. ROLL was successful in 1065 (99.3 %) procedures. Of the eight ROLL failures, three were due to incorrect lesion localisation and two were due to diffuse ROLL signal. SLN biopsy was successful in 955 (99.8 %) of cases.</div></div><div><h3>Conclusions</h3><div>SNOLL/ROLL is a reliable, cheap and easy localisation technique where the marker cannot be dislodged during the procedure. Both localisations are performed on the day of surgery using the same equipment for signal detection in the breast and axilla.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"24 ","pages":"Article 100326"},"PeriodicalIF":0.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-09-20DOI: 10.1016/j.sipas.2025.100309
Ibrahim Nagmeldin Hassan , Mohamed Ibrahim , Siddig Yaqub , Muhsin Ibrahim , Haythem Abdalla , Ghada Aljaili , Wafa Osman , Nagmeldin Abuassa
Background
Informed consent is a cornerstone of ethical surgical practice, yet significant challenges persist in ensuring patients' comprehension, particularly in low-resource settings. Cultural norms, literacy barriers, and limited institutional support often hinder truly informed decision-making.
Methods
A hospital-based cross-sectional study was conducted from September to December 2024 at a rural surgical center in Omdurman, Sudan. A total of 422 adult patients undergoing elective surgery were interviewed postoperatively using a validated, culturally adapted questionnaire. Descriptive and inferential statistics were applied to assess patient demographics, perceptions of the informed consent process, and associated barriers.
Results
The mean age of participants was 42.0 ± 14.3 years, with a near-equal gender distribution. Only 17.1% of patients signed their own surgical consent forms, with 80.6% of these self-signers being male. Among those whose consent was signed by relatives (82.9%), females were overrepresented (56.6%). While 91.5% recognized the importance of informed consent, only 33.6% understood its medico-legal significance. Consent explanations were predominantly delivered by residents or house officers (62.1%), and just 20.1% of patients felt that the discussion influenced their surgical decision. Self-signers were more likely to recall discussion of surgical complications (75.0% vs. 51.4%; p < 0.001), less likely to recall expected benefits (61.1% vs. 78.9%; p = 0.001), and showed no significant difference for consequences if surgery was not performed (80.6% vs. 82.9%; p = 1.0). Overall satisfaction with the consent process was high (87.7%), though this did not correlate with comprehension. Educational status significantly influenced autonomy, with illiterate participants disproportionately less likely to sign their own forms and more likely to cite language barriers and lack of information (p < 0.05).
Conclusion
Despite high reported satisfaction, substantial deficiencies exist in patients’ comprehension and autonomy in the informed consent process in Sudan. Gender disparities, literacy limitations, and systemic reliance on junior staff compromise the ethical validity of consent. Interventions tailored to cultural and educational contexts—such as provider training, simplified materials, and patient-centered communication—are urgently needed to enhance informed surgical decision-making in low-resource environments.
知情同意是外科伦理实践的基石，但在确保患者理解方面仍然存在重大挑战，特别是在资源匮乏的环境中。文化规范、识字障碍和有限的制度支持往往阻碍真正知情的决策。方法于2024年9月至12月在苏丹恩图曼的一家农村外科中心进行以医院为基础的横断面研究。共有422名接受择期手术的成年患者在术后接受了一份经过验证的、适应文化的问卷调查。描述性和推断性统计应用于评估患者人口统计学，知情同意过程的看法，以及相关的障碍。结果参与者的平均年龄为42.0±14.3岁，性别分布基本相等。只有17.1%的患者自己签署了手术同意书，其中80.6%的患者是男性。在亲属签署同意书的患者中（82.9%），女性比例过高（56.6%）。虽然91.5%的人认识到知情同意的重要性，但只有33.6%的人了解其医学-法律意义。同意解释主要由住院医生或住院医生（62.1%）提供，只有20.1%的患者认为讨论影响了他们的手术决定。自签名者更有可能回忆起手术并发症的讨论（75.0% vs. 51.4%; p < 0.001），不太可能回忆起预期的益处（61.1% vs. 78.9%; p = 0.001），如果不进行手术，其后果没有显着差异（80.6% vs. 82.9%; p = 1.0）。对同意过程的总体满意度很高（87.7%），尽管这与理解程度无关。教育程度显著影响自主性，不识字的参与者不太可能在自己的表格上签名，更有可能提到语言障碍和缺乏信息（p < 0.05）。结论尽管报告的满意度很高，但苏丹患者在知情同意过程中的理解和自主权存在实质性缺陷。性别差异、读写能力的限制以及对初级员工的系统性依赖损害了同意的道德有效性。在资源匮乏的环境中，迫切需要针对文化和教育背景的干预措施，如提供者培训、简化材料和以患者为中心的沟通，以提高知情的手术决策。
{"title":"Perceptions, practices, and barriers in surgical informed consent: A cross-sectional study from Sudan","authors":"Ibrahim Nagmeldin Hassan , Mohamed Ibrahim , Siddig Yaqub , Muhsin Ibrahim , Haythem Abdalla , Ghada Aljaili , Wafa Osman , Nagmeldin Abuassa","doi":"10.1016/j.sipas.2025.100309","DOIUrl":"10.1016/j.sipas.2025.100309","url":null,"abstract":"<div><h3>Background</h3><div>Informed consent is a cornerstone of ethical surgical practice, yet significant challenges persist in ensuring patients' comprehension, particularly in low-resource settings. Cultural norms, literacy barriers, and limited institutional support often hinder truly informed decision-making.</div></div><div><h3>Methods</h3><div>A hospital-based cross-sectional study was conducted from September to December 2024 at a rural surgical center in Omdurman, Sudan. A total of 422 adult patients undergoing elective surgery were interviewed postoperatively using a validated, culturally adapted questionnaire. Descriptive and inferential statistics were applied to assess patient demographics, perceptions of the informed consent process, and associated barriers.</div></div><div><h3>Results</h3><div>The mean age of participants was 42.0 ± 14.3 years, with a near-equal gender distribution. Only 17.1% of patients signed their own surgical consent forms, with 80.6% of these self-signers being male. Among those whose consent was signed by relatives (82.9%), females were overrepresented (56.6%). While 91.5% recognized the importance of informed consent, only 33.6% understood its medico-legal significance. Consent explanations were predominantly delivered by residents or house officers (62.1%), and just 20.1% of patients felt that the discussion influenced their surgical decision. Self-signers were more likely to recall discussion of surgical complications (75.0% vs. 51.4%; <em>p</em> < 0.001), less likely to recall expected benefits (61.1% vs. 78.9%; <em>p</em> = 0.001), and showed no significant difference for consequences if surgery was not performed (80.6% vs. 82.9%; <em>p</em> = 1.0). Overall satisfaction with the consent process was high (87.7%), though this did not correlate with comprehension. Educational status significantly influenced autonomy, with illiterate participants disproportionately less likely to sign their own forms and more likely to cite language barriers and lack of information (<em>p</em> < 0.05).</div></div><div><h3>Conclusion</h3><div>Despite high reported satisfaction, substantial deficiencies exist in patients’ comprehension and autonomy in the informed consent process in Sudan. Gender disparities, literacy limitations, and systemic reliance on junior staff compromise the ethical validity of consent. Interventions tailored to cultural and educational contexts—such as provider training, simplified materials, and patient-centered communication—are urgently needed to enhance informed surgical decision-making in low-resource environments.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"23 ","pages":"Article 100309"},"PeriodicalIF":0.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145159829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Approximately one-quarter of necrotizing enterocolitis (NEC) cases require surgical resection due to bowel perforation, necrosis, or failure to respond to conservative management. In such cases, the optimal method for restoring intestinal continuity remains debatable. Stoma is traditionally favored over primary anastomosis for its perceived safety, particularly in unstable infants, but it is associated with complications such as fluid and electrolyte imbalances, impaired growth, and the need for a second surgery. This study aims to systematically review and analyze the evidence comparing stoma versus primary anastomosis in neonates undergoing surgery for NEC.
Methods
We searched PubMed, Web of Science (WOS), the Cochrane Library, and Scopus for studies comparing the outcomes of stoma versus primary anastomosis in neonates with NEC. The primary outcomes included overall postoperative complications, intestinal perforation, stricture, mortality, wound infection, time to full enteral nutrition, time to end parenteral nutrition, and length of hospital stay. The meta-analysis was conducted using Review Manager (RevMan) version 5.4.
Results
Eighteen studies were included in the meta-analysis. Primary anastomosis was associated with lower mortality risk: (risk ratios (RR) = 0.61; 95 % confidence interval (CI): 0.42:0.88). No significant differences were observed between groups in overall complications, wound infection, duration of hospital stay, duration of parenteral nutrition, the need for a second operation (excluding stoma closure), strictures, and perforations.
Conclusion
Primary anastomosis for neonates with NEC is associated with lower mortality and comparable complication rates compared to stoma formation in selected cases.
{"title":"Outcomes of primary intestinal anastomosis versus stoma in necrotizing enterocolitis: A systematic review and meta-analysis","authors":"Amani N. Alansari , Salma Mani , Marwa Messaoud , Tariq Altokhais","doi":"10.1016/j.sipas.2025.100319","DOIUrl":"10.1016/j.sipas.2025.100319","url":null,"abstract":"<div><h3>Background</h3><div>Approximately one-quarter of necrotizing enterocolitis (NEC) cases require surgical resection due to bowel perforation, necrosis, or failure to respond to conservative management. In such cases, the optimal method for restoring intestinal continuity remains debatable. Stoma is traditionally favored over primary anastomosis for its perceived safety, particularly in unstable infants, but it is associated with complications such as fluid and electrolyte imbalances, impaired growth, and the need for a second surgery. This study aims to systematically review and analyze the evidence comparing stoma versus primary anastomosis in neonates undergoing surgery for NEC.</div></div><div><h3>Methods</h3><div>We searched PubMed, Web of Science (WOS), the Cochrane Library, and Scopus for studies comparing the outcomes of stoma versus primary anastomosis in neonates with NEC. The primary outcomes included overall postoperative complications, intestinal perforation, stricture, mortality, wound infection, time to full enteral nutrition, time to end parenteral nutrition, and length of hospital stay. The meta-analysis was conducted using Review Manager (RevMan) version 5.4.</div></div><div><h3>Results</h3><div>Eighteen studies were included in the meta-analysis. Primary anastomosis was associated with lower mortality risk: (risk ratios (RR) = 0.61; 95 % confidence interval (CI): 0.42:0.88). No significant differences were observed between groups in overall complications, wound infection, duration of hospital stay, duration of parenteral nutrition, the need for a second operation (excluding stoma closure), strictures, and perforations.</div></div><div><h3>Conclusion</h3><div>Primary anastomosis for neonates with NEC is associated with lower mortality and comparable complication rates compared to stoma formation in selected cases.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"23 ","pages":"Article 100319"},"PeriodicalIF":0.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145579187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-10-26DOI: 10.1016/j.sipas.2025.100318
Muhammad Mohsin Khan , Noman Shah , Bipin Chaurasia
Introduction
This systematic review aimed to synthesize the literature on integrating biophysical principles such as Laplace’s law with patient-specific hemodynamics to create a more precise and mechanistic framework for assessing rupture risk in unruptured intracranial aneurysms.
Methods
This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies published between January 2010 and December 2024 were identified from databases including PubMed, Scopus, Web of Science, IEEE Xplore, and Google Scholar. The Joanna Briggs Institute checklist and Risk of Bias In Non-randomized Studies - of Interventions (ROBINS-I) tool were used to assess study quality and bias.
Results
These studies showed increasing integration of Laplace's law with patient-specific flow simulations and vessel wall modeling. Hemodynamic models frequently revealed that areas with low wall shear stress or high oscillatory shear index overlapped with regions of high mechanical stress. Thin walled blebs small outpouchings on aneurysms were particularly prone to rupture and were often associated with abnormal flow patterns and higher wall tension. The synthesized evidence supports the conceptual validity of an integrative model that spatially correlates high wall tension with adverse hemodynamic patterns.
Conclusion
This review demonstrates that the proposed integration of Laplace’s law with advanced hemodynamic modeling, as evidenced by the literature, holds promise for improving rupture risk prediction. Future research should focus on implementing this combined approach in a clinical cohort to compare its predictive ability against existing models like the PHASES score.
本系统综述旨在综合有关将拉普拉斯定律等生物物理原理与患者特异性血流动力学相结合的文献，以创建一个更精确和更机械的框架来评估未破裂颅内动脉瘤的破裂风险。方法本系统评价遵循系统评价和荟萃分析首选报告项目（PRISMA）指南。2010年1月至2024年12月期间发表的研究从PubMed、Scopus、Web of Science、IEEE explore和b谷歌Scholar等数据库中确定。采用乔安娜布里格斯研究所检查表和非随机干预研究的偏倚风险（ROBINS-I）工具评估研究质量和偏倚。结果这些研究表明拉普拉斯定律与患者特定流动模拟和血管壁建模的结合越来越多。血流动力学模型经常显示低壁剪切应力或高振荡剪切指数区域与高机械应力区域重叠。动脉瘤上的薄壁小泡特别容易破裂，常伴有异常的血流模式和较高的壁张力。综合证据支持高壁张力与不利血流动力学模式在空间上相关的综合模型的概念有效性。结论本综述表明，将拉普拉斯定律与先进的血流动力学建模相结合，如文献所示，有望改善破裂风险预测。未来的研究应侧重于在临床队列中实施这种联合方法，以比较其与现有模型（如分期评分）的预测能力。
{"title":"Integrating Laplace's law with patient-specific hemodynamics to predict rupture risk in unruptured intracranial aneurysms: A systematic review of a biophysical and computational framework","authors":"Muhammad Mohsin Khan , Noman Shah , Bipin Chaurasia","doi":"10.1016/j.sipas.2025.100318","DOIUrl":"10.1016/j.sipas.2025.100318","url":null,"abstract":"<div><h3>Introduction</h3><div>This systematic review aimed to synthesize the literature on integrating biophysical principles such as Laplace’s law with patient-specific hemodynamics to create a more precise and mechanistic framework for assessing rupture risk in unruptured intracranial aneurysms.</div></div><div><h3>Methods</h3><div>This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies published between January 2010 and December 2024 were identified from databases including PubMed, Scopus, Web of Science, IEEE Xplore, and Google Scholar. The Joanna Briggs Institute checklist and Risk of Bias In Non-randomized Studies - of Interventions (ROBINS-I) tool were used to assess study quality and bias.</div></div><div><h3>Results</h3><div>These studies showed increasing integration of Laplace's law with patient-specific flow simulations and vessel wall modeling. Hemodynamic models frequently revealed that areas with low wall shear stress or high oscillatory shear index overlapped with regions of high mechanical stress. Thin walled blebs small outpouchings on aneurysms were particularly prone to rupture and were often associated with abnormal flow patterns and higher wall tension. The synthesized evidence supports the conceptual validity of an integrative model that spatially correlates high wall tension with adverse hemodynamic patterns.</div></div><div><h3>Conclusion</h3><div>This review demonstrates that the proposed integration of Laplace’s law with advanced hemodynamic modeling, as evidenced by the literature, holds promise for improving rupture risk prediction. Future research should focus on implementing this combined approach in a clinical cohort to compare its predictive ability against existing models like the PHASES score.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"23 ","pages":"Article 100318"},"PeriodicalIF":0.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145466405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-11-29DOI: 10.1016/j.sipas.2025.100321
Jennette Hansen, Niaman Nazir, George Zorn III
Introduction
Red blood cell (RBC) transfusion in cardiac surgery is associated with adverse outcomes and increased costs. Traditional predictors such as hemoglobin and BMI offer limited physiologic insight. This study evaluates RBC mass, a calculated measure of total red cell volume, as a preoperative predictor of transfusion in adult cardiac surgery patients undergoing cardiopulmonary bypass (CPB).
Materials and Methods
This retrospective observational study included 463 adult patients undergoing elective cardiac surgery with CPB at a single academic center in 2024. Exclusion criteria included procedures with inherently high transfusion risk (e.g., redo sternotomy, LVAD implantation, circulatory arrest, and “bring-backs”). RBC mass was calculated using estimated blood volume (sex-adjusted mL/kg) and hematocrit. Patients were categorized into three RBC mass groups: 1–2 L, 2–3 L, and >3 L. Multivariable logistic regression was used to assess the association between RBC mass and transfusion, adjusting for sex, age, BMI, and bypass time.
Results
Of the 463 patients, 102 (22 %) received RBC transfusions. Transfused patients had significantly lower RBC mass (mean 1.95 L) versus non-transfused (2.58 L, p < 0.001). Patients in the 1–2 L group accounted for 54.9 % of transfusions despite representing only 25.5 % of the cohort. These patients had 18.7 times the odds of transfusion compared to those with >3 L RBC mass. Female sex, older age, lower BMI, and longer CPB time were also associated with increased transfusion risk.
Discussion
RBC mass proved a more physiologically integrated and predictive metric for transfusion risk than hemoglobin or BMI alone. It may be especially useful in identifying at-risk female patients and those with normal hemoglobin but limited oxygen-carrying reserve.
Conclusions
Preoperative RBC mass is a strong independent predictor of transfusion in cardiac surgery. Its incorporation into preoperative planning may improve patient optimization and reduce unnecessary transfusions.
心脏手术中输血红细胞（RBC）与不良后果和费用增加有关。血红蛋白和BMI等传统的预测指标提供的生理学信息有限。本研究评估了红细胞质量（红细胞总体积的计算指标）作为成人心脏手术患者体外循环（CPB）术前输血的预测指标。材料与方法本回顾性观察性研究纳入了2024年在同一学术中心接受选择性CPB心脏手术的463例成人患者。排除标准包括具有高输血风险的手术（例如，重做胸骨切开术、左心室辅助装置植入、循环停止和“恢复”）。红细胞质量计算使用估计血容量（性别调整mL/kg）和红细胞压积。将患者分为3个红细胞质量组：1-2 L、2-3 L和3 L。采用多变量logistic回归评估红细胞质量与输血之间的关系，调整性别、年龄、BMI和旁路时间。结果463例患者中，102例（22%）接受了红细胞输注。输血患者的红细胞质量（平均1.95 L）明显低于未输血患者（2.58 L, p < 0.001）。1-2 L组患者占54.9%的输血量，尽管仅占队列的25.5%。这些患者输血的几率是3l红细胞肿块患者的18.7倍。女性、年龄较大、较低的BMI和较长的CPB时间也与输血风险增加有关。与单独的血红蛋白或BMI相比，rbc质量被证明是一个更综合的生理指标和预测输血风险的指标。它在鉴别高危女性患者和血红蛋白正常但携氧储备有限的患者时可能特别有用。结论术前RBC肿块是心脏手术输血的独立预测指标。将其纳入术前计划可改善患者优化并减少不必要的输血。
{"title":"Red blood cell mass as a predictor of transfusion risk of packed red blood cells in cardiac surgery patients requiring cardiopulmonary bypass","authors":"Jennette Hansen, Niaman Nazir, George Zorn III","doi":"10.1016/j.sipas.2025.100321","DOIUrl":"10.1016/j.sipas.2025.100321","url":null,"abstract":"<div><h3>Introduction</h3><div>Red blood cell (RBC) transfusion in cardiac surgery is associated with adverse outcomes and increased costs. Traditional predictors such as hemoglobin and BMI offer limited physiologic insight. This study evaluates RBC mass, a calculated measure of total red cell volume, as a preoperative predictor of transfusion in adult cardiac surgery patients undergoing cardiopulmonary bypass (CPB).</div></div><div><h3>Materials and Methods</h3><div>This retrospective observational study included 463 adult patients undergoing elective cardiac surgery with CPB at a single academic center in 2024. Exclusion criteria included procedures with inherently high transfusion risk (e.g., redo sternotomy, LVAD implantation, circulatory arrest, and “bring-backs”). RBC mass was calculated using estimated blood volume (sex-adjusted mL/kg) and hematocrit. Patients were categorized into three RBC mass groups: 1–2 L, 2–3 L, and >3 L. Multivariable logistic regression was used to assess the association between RBC mass and transfusion, adjusting for sex, age, BMI, and bypass time.</div></div><div><h3>Results</h3><div>Of the 463 patients, 102 (22 %) received RBC transfusions. Transfused patients had significantly lower RBC mass (mean 1.95 L) versus non-transfused (2.58 L, <em>p</em> < 0.001). Patients in the 1–2 L group accounted for 54.9 % of transfusions despite representing only 25.5 % of the cohort. These patients had 18.7 times the odds of transfusion compared to those with >3 L RBC mass. Female sex, older age, lower BMI, and longer CPB time were also associated with increased transfusion risk.</div></div><div><h3>Discussion</h3><div>RBC mass proved a more physiologically integrated and predictive metric for transfusion risk than hemoglobin or BMI alone. It may be especially useful in identifying at-risk female patients and those with normal hemoglobin but limited oxygen-carrying reserve.</div></div><div><h3>Conclusions</h3><div>Preoperative RBC mass is a strong independent predictor of transfusion in cardiac surgery. Its incorporation into preoperative planning may improve patient optimization and reduce unnecessary transfusions.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"23 ","pages":"Article 100321"},"PeriodicalIF":0.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145693449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-08-31DOI: 10.1016/j.sipas.2025.100305
Ramiro Fernández-Placencia , Francisco Berrospi , Carlos Luque-Vásquez , Eduarda Bustamante , Néstor Sánchez , Eloy Ruiz , Vanesa Huamán , Eduardo Payet , Juan Celis
Background
Vascular resection and reconstruction during pancreatic surgery has become increasingly common in high-volume centers. However, the impact of intraoperative vascular events and complex venous reconstructions on severe morbidity remains understudied.
Methods
We conducted a retrospective cohort study including 77 patients who underwent pancreatic resection with vascular reconstruction at a high-volume tertiary care center between January 2010 and December 2024. Perioperative factors were evaluated through univariate and multivariate analyses.
Results
Intraoperative events occurred in 25 % of the patients; severe morbidity (≥ IIIb according to the Clavien–Dindo classification) was observed in 31 %, and the mortality rate was 3.9 %. Severe morbidity was significantly influenced by intraoperative events (OR=4.3, 95 % CI 1.3–14.6, p = 0.016) and type 4 venous reconstruction (OR=12.7, 95 % CI 1.5–280, p = 0.037). Despite the increasing proportion of type 3 and type 4 venous reconstructions performed over the years, the rates of severe morbidity have remained stable. A notable improvement in the R0 resection rate for pancreatic ductal adenocarcinoma was observed after 2019, with a significant shift toward more complex venous reconstructions.
Conclusion
Intraoperative events and type 4 venous reconstruction significantly increase the risk of severe morbidity in pancreatic surgery. These findings underscore the importance of surgical planning, expertise in vascular procedures, and multidisciplinary care to improve outcomes.
背景：胰腺手术中血管切除和重建在大容量中心越来越普遍。然而，术中血管事件和复杂静脉重建对严重并发症的影响仍未得到充分研究。方法：我们进行了一项回顾性队列研究，包括2010年1月至2024年12月在一家大容量三级医疗中心接受胰腺切除术和血管重建的77例患者。通过单因素和多因素分析评估围手术期因素。结果术中事件发生率为25%；重度发病（按Clavien-Dindo分级≥IIIb）占31%，死亡率为3.9%。术中事件（OR=4.3, 95% CI 1.3 ~ 14.6, p = 0.016）和4型静脉重建（OR=12.7, 95% CI 1.5 ~ 280, p = 0.037）显著影响重症发病率。尽管近年来进行的3型和4型静脉重建的比例不断增加，但严重发病率保持稳定。2019年之后，胰腺导管腺癌的R0切除率显著提高，并向更复杂的静脉重建方向转变。结论术中事件和4型静脉重建明显增加胰腺手术严重并发症的发生风险。这些发现强调了手术计划、血管手术专业知识和多学科护理对改善预后的重要性。
{"title":"Severe morbidity following pancreatectomy with vascular reconstruction: impact of intraoperative vascular events and grafted venous reconstructions","authors":"Ramiro Fernández-Placencia , Francisco Berrospi , Carlos Luque-Vásquez , Eduarda Bustamante , Néstor Sánchez , Eloy Ruiz , Vanesa Huamán , Eduardo Payet , Juan Celis","doi":"10.1016/j.sipas.2025.100305","DOIUrl":"10.1016/j.sipas.2025.100305","url":null,"abstract":"<div><h3>Background</h3><div>Vascular resection and reconstruction during pancreatic surgery has become increasingly common in high-volume centers. However, the impact of intraoperative vascular events and complex venous reconstructions on severe morbidity remains understudied.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study including 77 patients who underwent pancreatic resection with vascular reconstruction at a high-volume tertiary care center between January 2010 and December 2024. Perioperative factors were evaluated through univariate and multivariate analyses.</div></div><div><h3>Results</h3><div>Intraoperative events occurred in 25 % of the patients; severe morbidity (≥ IIIb according to the Clavien–Dindo classification) was observed in 31 %, and the mortality rate was 3.9 %. Severe morbidity was significantly influenced by intraoperative events (OR=4.3, 95 % CI 1.3–14.6, <em>p</em> = 0.016) and type 4 venous reconstruction (OR=12.7, 95 % CI 1.5–280, <em>p</em> = 0.037). Despite the increasing proportion of type 3 and type 4 venous reconstructions performed over the years, the rates of severe morbidity have remained stable. A notable improvement in the R0 resection rate for pancreatic ductal adenocarcinoma was observed after 2019, with a significant shift toward more complex venous reconstructions.</div></div><div><h3>Conclusion</h3><div>Intraoperative events and type 4 venous reconstruction significantly increase the risk of severe morbidity in pancreatic surgery. These findings underscore the importance of surgical planning, expertise in vascular procedures, and multidisciplinary care to improve outcomes.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"23 ","pages":"Article 100305"},"PeriodicalIF":0.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-10-09DOI: 10.1016/j.sipas.2025.100312
Xin Li, Meng Han, Xiaoliang Wang, Wenjuan Lang, Kai Shi
Background
The association between minimum heart rate (MinHR) within 24 h of ICU admission and 1-month mortality in traumatic brain injury (TBI) patients remains unclear.
Methods
This retrospective cohort study analyzed 2267 TBI patients from the MIMIC-IV v3.1 database. Multivariable Cox regression, restricted cubic spline (RCS) analysis, and subgroup analyses evaluated relationships between 24-hour MinHR and mortality.
Results
The cohort (median age 67 [IQR 51–80] years; 62.6% female) had a median MinHR of 59 [52–68] bpm, with 248 deaths (10.94%). RCS analysis revealed a U-shaped association (P for nonlinear =0.001) with 59 bpm as the inflection point. MinHR ≥59 bpm independently predicted higher mortality after full adjustment (HR=1.84, 95%CI:1.31–2.60; P < 0.001). This association was pronounced in non-hypertensive patients (HR=1.50, 95%CI:1.08–2.08; P = 0.015).
Conclusions
A U-shaped association exists between 24-hour MinHR and 1-month mortality in TBI patients, with 59 bpm as the critical threshold. MinHR ≥59 bpm independently predicts increased mortality. These findings support using 59 bpm as an alert threshold for early intervention.
{"title":"Relationship between minimum heart rate and mortality in ICU patients with traumatic brain injury (TBI): a retrospective analysis based on the MIMIC-IV database","authors":"Xin Li, Meng Han, Xiaoliang Wang, Wenjuan Lang, Kai Shi","doi":"10.1016/j.sipas.2025.100312","DOIUrl":"10.1016/j.sipas.2025.100312","url":null,"abstract":"<div><h3>Background</h3><div>The association between minimum heart rate (MinHR) within 24 h of ICU admission and 1-month mortality in traumatic brain injury (TBI) patients remains unclear.</div></div><div><h3>Methods</h3><div>This retrospective cohort study analyzed 2267 TBI patients from the MIMIC-IV v3.1 database. Multivariable Cox regression, restricted cubic spline (RCS) analysis, and subgroup analyses evaluated relationships between 24-hour MinHR and mortality.</div></div><div><h3>Results</h3><div>The cohort (median age 67 [IQR 51–80] years; 62.6% female) had a median MinHR of 59 [52–68] bpm, with 248 deaths (10.94%). RCS analysis revealed a U-shaped association (P for nonlinear =0.001) with 59 bpm as the inflection point. MinHR ≥59 bpm independently predicted higher mortality after full adjustment (HR=1.84, 95%CI:1.31–2.60; <em>P</em> < 0.001). This association was pronounced in non-hypertensive patients (HR=1.50, 95%CI:1.08–2.08; <em>P</em> = 0.015).</div></div><div><h3>Conclusions</h3><div>A U-shaped association exists between 24-hour MinHR and 1-month mortality in TBI patients, with 59 bpm as the critical threshold. MinHR ≥59 bpm independently predicts increased mortality. These findings support using 59 bpm as an alert threshold for early intervention.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"23 ","pages":"Article 100312"},"PeriodicalIF":0.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145363483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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