Surgery in practice and science最新文献_第6页

Reversal of Hartmann’s procedure: The impact of timing – a single-tertiary-center experience 哈特曼程序的逆转：时间的影响-单一三中心的经验

IF 0.6 Q4 SURGERY

Surgery in practice and science

Pub Date : 2025-06-15 DOI: 10.1016/j.sipas.2025.100292

Sascha Vaghiri , Maria Chara Stylianidi , Laura Engelmann , Eslam Elmaghraby , Levent Dizdar , Wolfram Trudo Knoefel , Hermann Kessler , Dimitrios Prassas

Introduction

The optimal timing for Hartmann’s reversal remains a topic of ongoing debate. This study aimed to assess postoperative outcomes in patients undergoing early versus late Hartmann’s reversal at a tertiary academic center in Germany.

Methods

A single-center retrospective cohort study was conducted, including all patients who underwent Hartmann’s reversal between January 2008 and July 2020. Patients were stratified into early (ER) and late (LR) reversal groups using a median cut-off value of 159 days. Operative outcomes including major morbidity and overall postoperative complications were compared between both groups. Factors associated with major postoperative morbidity were detected using uni- and multivariate regression models.

Results

A total of 133 patients classified into the ER (n = 67, 50.38%) and LR (n = 66, 49.62%) groups were analyzed. There were no significant differences in overall morbidity (ER 56.72% versus LR 39.39%, p = 0.057) and major morbidity rates (Clavien-Dindo ≥ IIIa) (ER 28.36% versus LR 21.21%, p = 0.423) between both groups. On multivariate analysis, smoking (p = 0.006), chronic renal disease (p = 0.003) and anastomotic configuration (p = 0.003) were identified as significant factors contributing to major morbidity after Hartmann’s reversal.

Conclusion

Hartmann’s reversal is still associated with an increased risk of postoperative complications. However, timing of Hartmann’s reversal does not seem to influence postoperative morbidity. Of note, patient-related modifiable factors as well as the anastomotic configuration are important determinants of major complication occurrence.

哈特曼逆转的最佳时机仍然是一个持续争论的话题。本研究旨在评估德国某高等学术中心早期和晚期哈特曼逆转患者的术后结果。方法采用单中心回顾性队列研究，纳入2008年1月至2020年7月期间接受哈特曼逆转的所有患者。采用159天的中位临界值将患者分为早期（ER）和晚期（LR）逆转组。比较两组的手术结果，包括主要发病率和术后总并发症。使用单因素和多因素回归模型检测与主要术后发病率相关的因素。结果133例患者分为ER组（n = 67, 50.38%）和LR组（n = 66, 49.62%）。两组总发病率（ER为56.72%，LR为39.39%,p = 0.057）和主要发病率（Clavien-Dindo≥IIIa）（ER为28.36%，LR为21.21%,p = 0.423）差异无统计学意义。在多因素分析中，吸烟（p = 0.006）、慢性肾脏疾病（p = 0.003）和吻合口形态（p = 0.003）被确定为Hartmann逆转后主要发病率的重要因素。结论hartmann反转仍与术后并发症风险增加有关。然而，Hartmann逆转的时机似乎并不影响术后发病率。值得注意的是，患者相关的可改变因素以及吻合口结构是主要并发症发生的重要决定因素。

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引用次数: 0

Artificial intelligence in surgical care for low- and middle-income countries: Challenges, opportunities, and the path forward 低收入和中等收入国家外科护理中的人工智能：挑战、机遇和前进道路

IF 0.6 Q4 SURGERY

Surgery in practice and science

Pub Date : 2025-06-06 DOI: 10.1016/j.sipas.2025.100290

William Nkenguye

The application of Artificial Intelligence (AI) and Machine Learning (ML) in surgical care has significantly advanced healthcare delivery in high-income countries (HICs), yet remains underutilized in lower- and middle-income countries (LMICs). With a growing burden of surgical diseases, limited surgical expertise, and constrained healthcare resources, AI and ML offer transformative potential in optimizing surgical workflows, improving patient outcomes, and expanding access to specialized care. This manuscript explores the current status, challenges, and future prospects of AI and ML in surgical care for LMICs, emphasizing the critical need for investment, capacity building, and policy development to bridge the healthcare gap.

人工智能（AI）和机器学习（ML）在外科护理中的应用显著提高了高收入国家（HICs）的医疗保健服务水平，但在中低收入国家（LMICs）仍未得到充分利用。随着外科疾病负担的增加、外科专业知识的有限和医疗保健资源的限制，人工智能和机器学习在优化外科工作流程、改善患者预后和扩大专业护理机会方面提供了变革性潜力。本文探讨了人工智能和机器学习在中低收入国家外科护理中的现状、挑战和未来前景，强调了对投资、能力建设和政策制定的迫切需要，以弥合医疗保健差距。

引用次数: 0

Synchronous adenocarcinoma of the transverse colon and gastroesophageal junction: a case report 横结肠胃食管交界处同步腺癌1例

IF 0.6 Q4 SURGERY

Surgery in practice and science

Pub Date : 2025-06-04 DOI: 10.1016/j.sipas.2025.100289

Adam Avas , Astrid Schümatschek , Julia Mühlhäusser , Martin Bolli , Markus Gass , Francesco Mongelli

Introduction

Esophageal cancer is a malignancy with a rapidly increasing incidence in recent decades. The presence of a second synchronous tumor poses challenges when a curative approach is offered.

Case presentation

We report a case of a 68-year-old Caucasian male diagnosed with synchronous adenocarcinomas of the transverse colon and the gastroesophageal junction (GEJ), Siewert Type II. The diagnosis followed the presentation of dysphagia and was confirmed through esophagogastroduodenoscopy and colonoscopy. The patient underwent a staging work-up. This has revealed no distant metastases, leading to a decision for curative treatment with multimodal therapy. Neoadjuvant chemotherapy with the FLOT regimen was administered, followed by thoracoabdominal esophagectomy and extended right hemicolectomy. Histopathological and molecular profiling analyses revealed that the tumor of the colon was a metastasis of the GEJ tumor.

Clinical discussion

This case demonstrates the diagnostic and therapeutic challenges posed by rare metastatic pattern of the GEJ. Despite thorough preoperative staging, the metastatic nature of the colonic lesion was only revealed postoperatively in our case. This emphasizes the need for molecular profiling in selected cases to enhance diagnostic accuracy and guide treatment decisions more effectively.

Conclusion

Colonic metastases from esophageal cancer are exceedingly rare, with only a few cases reported. In this case, according to the postoperative staging (M1) a palliative chemotherapy might have been more appropriate. This case highlights the importance of comprehensive diagnostic workups and the need for molecular profiling of synchronous lesions. Molecular diagnostic may be considered as a part of decision-making, as it can significantly impact treatment strategies and outcomes.

食管癌是近几十年来发病率迅速上升的一种恶性肿瘤。当提供治疗方法时，第二同步肿瘤的存在提出了挑战。我们报告一例68岁的白人男性被诊断为横结肠和胃食管交界处（GEJ）的同步腺癌，Siewert II型。在出现吞咽困难后诊断，并通过食管胃十二指肠镜和结肠镜检查证实。病人接受了分期检查。这表明没有远处转移，因此决定采用多模式治疗。给予FLOT方案的新辅助化疗，随后进行胸腹食管切除术和扩大的右半结肠切除术。组织病理学和分子分析表明，结肠肿瘤是GEJ肿瘤的转移灶。本病例展示了罕见的GEJ转移模式所带来的诊断和治疗挑战。尽管术前进行了彻底的分期，但在我们的病例中，结肠病变的转移性仅在术后才被发现。这强调了在选定病例中进行分子谱分析以提高诊断准确性和更有效地指导治疗决策的必要性。结论食管癌结肠转移极为罕见，文献报道较少。在这种情况下，根据术后分期（M1），姑息性化疗可能更合适。该病例强调了综合诊断检查的重要性和同步病变分子谱分析的必要性。分子诊断可以被认为是决策的一部分，因为它可以显著影响治疗策略和结果。

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引用次数: 0

Esophageal cancer surgery in Ethiopia: postoperative mortality and long-term survival 埃塞俄比亚食管癌手术：术后死亡率和长期生存率

IF 0.6 Q4 SURGERY

Surgery in practice and science

Pub Date : 2025-06-03 DOI: 10.1016/j.sipas.2025.100288

Mintesinot Birhanu Senbeta , Sileshi Abiy , Hirbo Samuel , Nigist Birhanu

Introduction

Cancer remains the leading cause of death worldwide, with esophageal cancer being the sixth leading cause of cancer-related deaths. For individuals with esophageal cancer, esophagectomy is the most effective treatment option available and has a high risk of both death and morbidity. Moreover, despite advances in preoperative optimization, surgery, and anesthesia techniques as well as the introduction of neoadjuvant therapy, the mortality and morbidity associated with esophagectomy remain high.

Objective

To assess the survival status and predictors of postoperative survival in patients who underwent esophageal surgery for esophageal malignancies at selected hospitals from to 2018–2023 in Ethiopia, Addis Ababa.

Methods

This was a retrospective cohort study. After acquiring data from the chart review, the data were analyzed using R version 4.3.3. Descriptive statistics for categorical variables were reported as frequencies and percentages. Kaplan-Meier curves and log-rank tests were used to estimate the survival curve and the difference in survival among groups within each covariate. After esophageal surgery, the impact of each covariate on time to death was assessed using the Cox proportional hazard model.

Results

One hundred eighty-three patients who underwent esophageal surgeries for esophageal malignancy at four governmental hospitals in Addis Ababa over 5 years were included. The mean age was 53.8 years. 120 (65.6 %) had a tumor size <3.3 cm, and squamous cell carcinoma accounted for 154 (84.2 %) cases. Epidural analgesia was the most commonly used analgesic technique, 40 (21.9 %). The 30-day mortality was 10.9 %. The overall 1-, 2-, 3-, 4-, and 5-year survival rates were 53 %, 30.6 %, 19.5 %, 19.5 %, and 13 %, respectively. The median survival was 17 months. ASA score of > III (AHR = 2.14, 95 % CI: 1.12–4.12), cervical anastomotic leak (AHR = 3.29, 95 % CI: 1.44–7.52), and sepsis (AHR = 3.70, 95 % CI: 1.46–9.38) were identified as predictors of postoperative mortality in the multivariate Cox regression model.

Conclusion

In Ethiopia, patients who underwent surgery for esophageal cancer had low 5-year survival rates.

癌症仍然是全球死亡的主要原因，食道癌是癌症相关死亡的第六大原因。对于食管癌患者，食管癌切除术是最有效的治疗选择，但其死亡率和发病率都很高。此外，尽管术前优化、手术和麻醉技术以及新辅助治疗的引入取得了进展，但与食管切除术相关的死亡率和发病率仍然很高。目的评估2018-2023年埃塞俄比亚亚的斯亚贝巴选定医院食道恶性肿瘤手术患者的生存状况及术后生存预测因素。方法回顾性队列研究。从图表评审中获取数据后，使用R 4.3.3版本对数据进行分析。分类变量的描述性统计以频率和百分比报告。Kaplan-Meier曲线和log-rank检验用于估计每个协变量内组间的生存曲线和生存差异。食道手术后，使用Cox比例风险模型评估每个协变量对死亡时间的影响。结果5年内在亚的斯亚贝巴4家政府医院行食管恶性肿瘤手术的患者183例。平均年龄为53.8岁。肿瘤大小3.3 cm 120例（65.6%），鳞状细胞癌154例（84.2%）。硬膜外镇痛是最常用的镇痛技术，占21.9%。30天死亡率为10.9%。总体1、2、3、4和5年生存率分别为53%、30.6%、19.5%、19.5%和13%。中位生存期为17个月。ASA评分>；在多因素Cox回归模型中，III期（AHR = 2.14, 95% CI: 1.12-4.12）、颈吻合口漏（AHR = 3.29, 95% CI: 1.44-7.52）和脓毒症（AHR = 3.70, 95% CI: 1.46-9.38）被确定为术后死亡率的预测因素。结论在埃塞俄比亚，食管癌手术患者5年生存率较低。

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引用次数: 0

Effects of verapamil on intestinal injury in a rat model of acute mesenteric ischemia 维拉帕米对急性肠系膜缺血大鼠肠道损伤的影响

IF 0.6 Q4 SURGERY

Surgery in practice and science

Pub Date : 2025-06-01 DOI: 10.1016/j.sipas.2025.100286

Silvana N Wilken , Diego V Santos Rodrigues , Colin Price , Julia Jacobs , Jack Nelson , Patrick F Walker , Jonathan J Morrison

Background

Acute mesenteric ischemia (AMI) is a surgical emergency requiring prompt revascularization with resection of unsalvageable bowel. Despite successful revascularization, ongoing organ damage can persist from ischemia-reperfusion injury (IRI) and there is a need for adjunct therapies to ameliorate this ongoing insult.

Materials and methods

Sprague-Dawley rats (n = 36) were divided into five groups: control, heparin (HEP), HEP + verapamil (VER), HEP + valproic acid (VPA), HEP+VER+VPA. The animals were subjected to 45 min of superior mesenteric artery occlusion followed by 4 h of reperfusion. Upon reperfusion, therapies were administered. Plasma samples were collected before occlusion and at end-of-study for intestinal fatty acid binding protein (I-FABP) and pro-inflammatory cytokines. The full length of the small intestine was collected, stained with H&E and scored according to the Park/Chiu score for intestinal ischemia damage.

Results

Twenty-three of 36 rats survived 4 h of reperfusion and there was no difference in survival between the groups. I-FABP levels was significantly lower in HEP+VER vs. control (3.8 ± 1.5 vs. 6.18 ± 1.0ng/ml; p = 0.0040). IL-1beta, IL-6 and TNF-alpha showed the lowest mean values in the HEP+VER group compared to all groups. The histological analysis revealed the lowest score of intestinal damage in the HEP+VER group, however, the difference to control was not significant.

Conclusion

Administering heparin and verapamil at the time of revascularization may mitigate intestinal IRI without causing detrimental systemic effects. Further studies in large animal models and in the setting of local administration are needed to investigate the potential of this approach.

背景：急性肠系膜缺血（AMI）是一种外科急症，需要及时行血运重建并切除无法挽救的肠。尽管成功的血运重建，持续的器官损伤可能持续缺血再灌注损伤（IRI），需要辅助治疗来改善这种持续的损害。材料与方法36只sd大鼠分为5组：对照组、肝素组（HEP）、HEP+维拉帕米组（VER）、HEP+丙戊酸组（VPA）、HEP+VER+VPA。动物进行肠系膜上动脉阻断45分钟，再灌注4小时。再灌注后给予治疗。在闭塞前和研究结束时收集血浆样本，检测肠脂肪酸结合蛋白（I-FABP）和促炎细胞因子。取小肠全长，进行H&；E染色，按照Park/Chiu评分进行肠缺血损伤评分。结果36只大鼠再灌注4 h后存活23只，各组间生存率无差异。HEP+VER组I-FABP水平明显低于对照组(3.8±1.5 vs 6.18±1.0ng/ml；P = 0.0040)。与所有组相比，HEP+VER组il -1 β、IL-6和tnf - α的平均值最低。组织学分析显示，HEP+VER组肠道损伤评分最低，但与对照组差异不显著。结论肝素和维拉帕米在血运重建术时可减轻肠IRI，且对全身无不良影响。需要在大型动物模型和地方管理环境中进行进一步研究，以调查这种方法的潜力。

{"title":"Effects of verapamil on intestinal injury in a rat model of acute mesenteric ischemia","authors":"Silvana N Wilken , Diego V Santos Rodrigues , Colin Price , Julia Jacobs , Jack Nelson , Patrick F Walker , Jonathan J Morrison","doi":"10.1016/j.sipas.2025.100286","DOIUrl":"10.1016/j.sipas.2025.100286","url":null,"abstract":"<div><h3>Background</h3><div>Acute mesenteric ischemia (AMI) is a surgical emergency requiring prompt revascularization with resection of unsalvageable bowel. Despite successful revascularization, ongoing organ damage can persist from ischemia-reperfusion injury (IRI) and there is a need for adjunct therapies to ameliorate this ongoing insult.</div></div><div><h3>Materials and methods</h3><div>Sprague-Dawley rats (<em>n</em> = 36) were divided into five groups: control, heparin (HEP), HEP + verapamil (VER), HEP + valproic acid (VPA), HEP+VER+VPA. The animals were subjected to 45 min of superior mesenteric artery occlusion followed by 4 h of reperfusion. Upon reperfusion, therapies were administered. Plasma samples were collected before occlusion and at end-of-study for intestinal fatty acid binding protein (I-FABP) and pro-inflammatory cytokines. The full length of the small intestine was collected, stained with H&E and scored according to the Park/Chiu score for intestinal ischemia damage.</div></div><div><h3>Results</h3><div>Twenty-three of 36 rats survived 4 h of reperfusion and there was no difference in survival between the groups. I-FABP levels was significantly lower in HEP+VER vs. control (3.8 ± 1.5 vs. 6.18 ± 1.0ng/ml; <em>p</em> = 0.0040). IL-1beta, IL-6 and TNF-alpha showed the lowest mean values in the HEP+VER group compared to all groups. The histological analysis revealed the lowest score of intestinal damage in the HEP+VER group, however, the difference to control was not significant.</div></div><div><h3>Conclusion</h3><div>Administering heparin and verapamil at the time of revascularization may mitigate intestinal IRI without causing detrimental systemic effects. Further studies in large animal models and in the setting of local administration are needed to investigate the potential of this approach.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"21 ","pages":"Article 100286"},"PeriodicalIF":0.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144230178","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}

引用次数: 0

A retrospective analysis of Gastric Cancer Lymph Nodes Based on Groups, Regions, and Stages 基于分组、区域和分期的胃癌淋巴结回顾性分析

IF 0.6 Q4 SURGERY

Surgery in practice and science

Pub Date : 2025-06-01 DOI: 10.1016/j.sipas.2025.100287

Si-kai Song , Jiang Zhu , Hai-min Feng , An-she Ma , Chao-gang Yang

Objective

The consistency between clinical and pathological staging of lymph nodes (LNs) in gastric cancer (GC) remains suboptimal, and there is currently no standardized imaging criterion for diagnosing lymph node metastasis (LNM). This study aimed to elucidate the differences in LNs among various groups, regions, and stages, utilizing imaging and histopathology as the foundational basis.

Methods

We retrospectively analyzed the clinical data of 100 GC patients who underwent surgical treatment at Zhongnan Hospital of Wuhan University between January 2022 and May 2023. Patient characteristics, along with pathological and radiological data of LNs, were collected and compared across different groups, regions, and stages.

Results

Pathologically, 3566 LNs were collected, with a median of 35 (range: 17–72). Radiologically, 2233 LNs were collected, with a median of 22 (range: 3–47). Significant differences were observed in the long-axis diameter (LAD), short-axis diameter (SAD), ratios of long to short axis (RLSA), and product of long and short axis (PLSA) between negative and positive LNs. However, only within group 3 did the RLSA show statistical significance upon grouping analysis. The areas under the curve (AUC) for LAD, SAD, PLSA, and their combination index (CI) in diagnosing LNM were 0.817, 0.817, 0.828, and 0.827, respectively. Diverse groups, regions, and stages exerted a more pronounced influence on LN groups 1–6, while having a comparatively lesser impact on LN groups 7–16.

Conclusion

LAD, SAD, and PLSA exhibited significant diagnostic value for LNM and could serve as diagnostic criteria; however, RLSA demonstrated limited diagnostic utility. The formulation of diagnostic criteria should consider the impact of groups, regions, and stages to enhance sensitivity and specificity.

目的胃癌（GC）淋巴结临床分期与病理分期的一致性尚不理想，目前尚无标准化的淋巴结转移诊断影像学标准。本研究旨在利用影像学和组织病理学作为基础，阐明不同群体、不同区域和不同分期的ln差异。方法回顾性分析2022年1月至2023年5月武汉大学中南医院手术治疗的100例胃癌患者的临床资料。收集不同组、地区和分期的患者特征、病理和放射学资料，并进行比较。结果病理共收集病灶3566例，中位数35例（范围17 ~ 72）。放射学上，收集了2233例LNs，中位数为22（范围：3-47）。阴性LNs与阳性LNs的长轴直径（LAD）、短轴直径（SAD）、长轴与短轴之比（RLSA）、长轴与短轴之积（PLSA）均有显著差异。但分组分析时，RLSA只有在第3组中才有统计学意义。LAD、SAD、PLSA诊断LNM的曲线下面积（AUC）及其联合指数（CI）分别为0.817、0.817、0.828、0.827。不同的群体、地区和阶段对LN 1-6组的影响更为明显，而对LN 7-16组的影响相对较小。结论lad、SAD、PLSA对LNM具有较强的诊断价值，可作为LNM的诊断标准；然而，RLSA的诊断作用有限。诊断标准的制定应考虑群体、地区和分期的影响，以提高敏感性和特异性。

{"title":"A retrospective analysis of Gastric Cancer Lymph Nodes Based on Groups, Regions, and Stages","authors":"Si-kai Song , Jiang Zhu , Hai-min Feng , An-she Ma , Chao-gang Yang","doi":"10.1016/j.sipas.2025.100287","DOIUrl":"10.1016/j.sipas.2025.100287","url":null,"abstract":"<div><h3>Objective</h3><div>The consistency between clinical and pathological staging of lymph nodes (LNs) in gastric cancer (GC) remains suboptimal, and there is currently no standardized imaging criterion for diagnosing lymph node metastasis (LNM). This study aimed to elucidate the differences in LNs among various groups, regions, and stages, utilizing imaging and histopathology as the foundational basis.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed the clinical data of 100 GC patients who underwent surgical treatment at Zhongnan Hospital of Wuhan University between January 2022 and May 2023. Patient characteristics, along with pathological and radiological data of LNs, were collected and compared across different groups, regions, and stages.</div></div><div><h3>Results</h3><div>Pathologically, 3566 LNs were collected, with a median of 35 (range: 17–72). Radiologically, 2233 LNs were collected, with a median of 22 (range: 3–47). Significant differences were observed in the long-axis diameter (LAD), short-axis diameter (SAD), ratios of long to short axis (RLSA), and product of long and short axis (PLSA) between negative and positive LNs. However, only within group 3 did the RLSA show statistical significance upon grouping analysis. The areas under the curve (AUC) for LAD, SAD, PLSA, and their combination index (CI) in diagnosing LNM were 0.817, 0.817, 0.828, and 0.827, respectively. Diverse groups, regions, and stages exerted a more pronounced influence on LN groups 1–6, while having a comparatively lesser impact on LN groups 7–16.</div></div><div><h3>Conclusion</h3><div>LAD, SAD, and PLSA exhibited significant diagnostic value for LNM and could serve as diagnostic criteria; however, RLSA demonstrated limited diagnostic utility. The formulation of diagnostic criteria should consider the impact of groups, regions, and stages to enhance sensitivity and specificity.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"21 ","pages":"Article 100287"},"PeriodicalIF":0.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144204838","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}

引用次数: 0

Ventral hernia repair with T-line hernia mesh: A multi-institutional experience 用t线疝补片修补腹疝：一个多机构的经验

IF 0.6 Q4 SURGERY

Surgery in practice and science

Pub Date : 2025-05-12 DOI: 10.1016/j.sipas.2025.100285

Emmanuel O. Emovon III , Anna Malysz Oyola , Luis Arias-Espinosa , Hani I. Naga , Angela S. Volk , William Hope , Flavio Malcher , Jamie P. Levine , Hobart W. Harris , Jin Yoo , Ash Patel

Introduction

Ventral hernia repair (VHR) is a common procedure complicated by high hernia recurrence rates exceeding 30 % over ten years. The T-Line® Hernia Mesh is a synthetic, polypropylene mesh featuring mesh extensions designed to prevent anchor point failure by evenly distributing tension to reduce ventral hernia recurrences. This study evaluates the outcomes of the T-Line® mesh in VHR with 1–3 year follow-up.

Methods

This study is a multi-institutional retrospective cohort study on patients who underwent VHR with T-Line® mesh between October 2020 and December 2022. Patient demographics, surgical details, and postoperative outcomes were collected. Patient-reported outcomes were assessed using HerQLes and ACHQC surveys.

Results

Fifty-seven patients underwent VHR with the T-Line® mesh with a median age of sixty years and BMI of 30.8 kg/m². The median follow-up was 454 days with a range of 365 to 1192 days. The median defect area was 97.0 cm² and mesh area was 300 cm². Seventeen patients (29.8 %) underwent hernia repair with panniculectomy. Postoperatively, seven patients (12.3 %) presented to the emergency department within 30 days, with five patients (8.8 %) requiring readmission. Eight patients (14.0 %) experienced complications within thirty days, with the majority being surgical site infections (n = 7, 12.3 %). Of the five patients that reported feeling a slight bulge at their previous hernia site, upon clinical evaluation two patients had a recurrence (one recurrence was caused by the suture tearing through the underlying laparotomy repair while the mesh remained anchored intact above the repair, and the second recurrence was caused by inadequate mesh fixation at the caudal border of the mesh), while no patients reported using pain medication for abdominal wall discomfort.

Conclusions

The T-Line® Hernia Mesh demonstrated safety and effectiveness in ventral hernia repair, with low recurrences and postoperative complications rates over a 1–3-year period, suggesting it is a valuable tool for complex hernia repairs.

腹疝修补术（VHR）是一种常见的手术，十年来疝复发率超过30%。T-Line®疝补片是一种合成聚丙烯补片，具有补片扩展功能，旨在通过均匀分布张力来防止锚点失效，以减少腹侧疝复发。本研究通过1-3年随访评估T-Line®补片治疗VHR的效果。方法本研究是一项多机构回顾性队列研究，研究对象是2020年10月至2022年12月期间使用T-Line®补片进行VHR的患者。收集患者人口统计资料、手术细节和术后结果。采用HerQLes和ACHQC调查评估患者报告的结果。结果57例患者采用T-Line®补片行VHR，中位年龄60岁，BMI为30.8 kg/m2。中位随访为454天，范围为365天至1192天。中位缺损面积97.0 cm2，网状面积300 cm2。17例（29.8%）患者行疝修补术合并胰管切除术。术后，7例（12.3%）患者在30天内到急诊科就诊，5例（8.8%）患者需要再次入院。8例患者（14.0%）在30天内出现并发症，其中大多数为手术部位感染（n = 7, 12.3%）。5例患者报告在先前的疝部位有轻微隆起感，经临床评估，2例患者复发（1例复发是由于缝线在剖腹修补术中撕裂，而补片在修补术上方锚固完好，2例复发是由于补片尾缘固定不充分引起的），而没有患者报告使用止痛药治疗腹壁不适。结论T-Line®疝补片在腹侧疝修补中具有安全性和有效性，在1 - 3年期间复发率低，术后并发症发生率低，是一种有价值的复杂疝修补工具。

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引用次数: 0

Chemo-radiotherapy after neoadjuvant chemotherapy and radical hysterectomy in women with stage IB-IIB cervical cancer: Do we need to change the therapeutic approach? A cohort study IB-IIB期宫颈癌新辅助化疗和根治性子宫切除术后的放化疗：我们需要改变治疗方法吗？队列研究

IF 0.6 Q4 SURGERY

Surgery in practice and science

Pub Date : 2025-04-28 DOI: 10.1016/j.sipas.2025.100284

Somayeh Nikfar , Azam Sadat Mousavi , Setareh Akhavan , Shahrzad Sheikhhasani , Amir Almasi-Hashiani , Ramin Parvizrad , Narges Zamani

Background

Chemoradiotherapy is recommended as the standard treatment for advanced cervical cancer, and neoadjuvant chemotherapy (NACT) can be beneficial for patients on long radiotherapy waiting lists. This study aimed to evaluate the need for chemoradiotherapy after NACT and radical hysterectomy in women with stage IB-IIB cervical cancer.

Methods

This was a retrospective, cohort study. All patients in the gynecologic oncology clinic of Imam Khomeini Hospital, Tehran, Iran, who were diagnosed with stage IB-IIB cervical cancer and treated with NACT and radical hysterectomy between 2010 and 2020, were included in this study. The records of all the patients who met the inclusion criteria were evaluated during the study period. Outcomes of interest and progression-free survival (PFS) were also assessed.

Results

In this study, the clinical files of 613 patients with cervical cancer were studied, and among them, 63 patients (10.2%) underwent NACT. Eighteen patients (33.3%) did not require another treatment modality after chemotherapy and radical hysterectomy, while 66.7% (36 cases) of patients required chemoradiotherapy after NACT and radical hysterectomy, and recurrence was observed in 11.6% (5 cases) of patients. The 1-, 5- and 10-year PFS rate was 97.6% (95% CI: 84.2–99.6), 89.5% (95% CI: 74.4–95.9) and 89.5% (95% CI: 74.4–95.9), respectively.

Conclusions

It can be concluded that a significant percentage of patients who are candidates for NACT followed by radical hysterectomy would require another modality of treatment, which is chemoradiotherapy; therefore, it is recommended that by conducting prospective studies, in addition to investigating this issue, the choice of the first method of patient treatment in these stages should be reconsidered so that patients do not suffer from two treatments and related complications, and undergo chemoradiotherapy from the beginning.

化疗被推荐为晚期宫颈癌的标准治疗方法，而新辅助化疗（NACT）对于等待放射治疗的患者可能是有益的。本研究旨在评估IB-IIB期宫颈癌患者行NACT和根治性子宫切除术后放化疗的必要性。方法回顾性队列研究。本研究纳入2010年至2020年间在伊朗德黑兰伊玛目霍梅尼医院妇科肿瘤门诊诊断为IB-IIB期宫颈癌并接受NACT和根治性子宫切除术的所有患者。在研究期间对所有符合纳入标准的患者的记录进行评估。对感兴趣的结局和无进展生存期（PFS）也进行了评估。结果本研究对613例宫颈癌患者的临床资料进行了分析，其中63例（10.2%）接受了NACT治疗。18例（33.3%）患者在化疗+根治性子宫切除术后不需要其他治疗方式，而66.7%（36例）患者在NACT +根治性子宫切除术后需要放化疗，11.6%（5例）患者出现复发。1年、5年和10年PFS率分别为97.6% （95% CI: 84.2-99.6）、89.5% （95% CI: 74.4-95.9）和89.5% （95% CI: 74.4-95.9）。结论NACT合并根治性子宫切除术的患者中，有相当比例的患者需要另一种治疗方式，即放化疗；因此，我们建议通过前瞻性研究，在研究这一问题的同时，重新考虑患者在这几个阶段的第一种治疗方法的选择，避免患者出现两种治疗及相关并发症，从一开始就进行放化疗。

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引用次数: 0

Risk factors and outcomes for early returns to the operating room following abdominal wall hernia repairs 腹壁疝修补术后早期返回手术室的危险因素和结果

IF 0.6 Q4 SURGERY

Surgery in practice and science

Pub Date : 2025-04-18 DOI: 10.1016/j.sipas.2025.100283

Saran Kunaprayoon, Cole Brown, Venu Bangla, Tomer Lagziel, I. Michael Leitman

Background

Risks of re-operation in ventral hernias in non-American populations and recurrence have been studied extensively. However, data on early risk factors for reoperation in North America are still lacking. The most recent NSQIP study, analyzing risk factors for reoperation of ventral hernias was extracted from 2005–2008 data. Since then, there have been major advances in ventral hernia repair techniques. Here, we identify risk factors and indications for re-operation within 30 days.

Methods

NSQIP ACS data from 2020–2022 were used in our analysis. Additional procedures that posed significant morbidity and mortality were excluded. Risk factors were analyzed with univariate and multivariable models to determine association with re-operation within 30 days. ICD10 codes for re-operation were also analyzed.

Results

Of 56,260 patients, 2.38 % returned to the OR within 30 days. Higher ASA, male gender, surgical site infection (SSI), smoking, ascites, age group > 70, dialysis patients, open surgeries and dehiscence were significantly associated with re-operation whereas outpatient surgery was protective in univariate and multivariable models (p < 0.01). The most common indications for re-operation were surgical site occurrence (SSO) and recurrence of hernia. Mortality was significantly higher in the reoperation group, 3.29 %, compared to those patients that did not require early reoperation (0.36 %, p < 0.01)

Conclusions

Mortality and early reoperation rates have decreased in the past decade in the U.S, which could be attributed to advancement in ventral hernia repair techniques. Our analysis of risk factors for reoperation supports findings in the broader literature. This study also suggests that SSO and recurrence of hernia are leading diagnoses for early reoperation.

背景：非美国人群腹疝再手术的风险和复发已经被广泛研究。然而，关于北美再手术的早期危险因素的数据仍然缺乏。最新的NSQIP研究分析了2005-2008年数据中腹疝再手术的危险因素。从那时起，腹疝修复技术取得了重大进展。在这里，我们确定了30天内再次手术的危险因素和适应症。方法采用2020-2022年snsqip ACS数据进行分析。排除了其他可能造成显著发病率和死亡率的手术。采用单变量和多变量模型分析危险因素，以确定与30天内再次手术的关系。并对ICD10码进行了再操作分析。结果56260例患者中，2.38%的患者在30天内返回手术室。ASA高、男性、手术部位感染（SSI）、吸烟、腹水、年龄；70，透析患者、开放手术和裂开与再次手术显著相关，而门诊手术在单变量和多变量模型中具有保护作用(p <；0.01)。再手术最常见的指征是手术部位发生和疝复发。再手术组的死亡率为3.29%，明显高于不需要早期再手术组(0.36%,p <；（0.01）结论近十年来，美国腹疝修补技术的进步使其死亡率和早期再手术率有所下降。我们对再手术危险因素的分析支持了更广泛文献的发现。本研究还提示，单囊性心动过速和疝复发是早期再手术的主要诊断。

{"title":"Risk factors and outcomes for early returns to the operating room following abdominal wall hernia repairs","authors":"Saran Kunaprayoon, Cole Brown, Venu Bangla, Tomer Lagziel, I. Michael Leitman","doi":"10.1016/j.sipas.2025.100283","DOIUrl":"10.1016/j.sipas.2025.100283","url":null,"abstract":"<div><h3>Background</h3><div>Risks of re-operation in ventral hernias in non-American populations and recurrence have been studied extensively. However, data on early risk factors for reoperation in North America are still lacking. The most recent NSQIP study, analyzing risk factors for reoperation of ventral hernias was extracted from 2005–2008 data. Since then, there have been major advances in ventral hernia repair techniques. Here, we identify risk factors and indications for re-operation within 30 days.</div></div><div><h3>Methods</h3><div>NSQIP ACS data from 2020–2022 were used in our analysis. Additional procedures that posed significant morbidity and mortality were excluded. Risk factors were analyzed with univariate and multivariable models to determine association with re-operation within 30 days. ICD10 codes for re-operation were also analyzed.</div></div><div><h3>Results</h3><div>Of 56,260 patients, 2.38 % returned to the OR within 30 days. Higher ASA, male gender, surgical site infection (SSI), smoking, ascites, age group > 70, dialysis patients, open surgeries and dehiscence were significantly associated with re-operation whereas outpatient surgery was protective in univariate and multivariable models (<em>p</em> < 0.01). The most common indications for re-operation were surgical site occurrence (SSO) and recurrence of hernia. Mortality was significantly higher in the reoperation group, 3.29 %, compared to those patients that did not require early reoperation (0.36 %, <em>p</em> < 0.01)</div></div><div><h3>Conclusions</h3><div>Mortality and early reoperation rates have decreased in the past decade in the U.S, which could be attributed to advancement in ventral hernia repair techniques. Our analysis of risk factors for reoperation supports findings in the broader literature. This study also suggests that SSO and recurrence of hernia are leading diagnoses for early reoperation.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"21 ","pages":"Article 100283"},"PeriodicalIF":0.6,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143886005","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}

引用次数: 0

Improvised chest tube drainage: A practical approach to thoracic emergencies in humanitarian crises 简易胸管引流：人道主义危机中处理胸部紧急情况的实用方法

IF 0.6 Q4 SURGERY

Surgery in practice and science

Pub Date : 2025-04-09 DOI: 10.1016/j.sipas.2025.100282

Alsadig Suliman , Rawan Mohamedosman , Bushra Suliman , Hassan Musa , Siddig Ali , Mohammad Ahmed

Background

Thoracic injuries pose a challenge in conflict zones, where disrupted healthcare infrastructure and supply shortages limit access to conventional chest tube drainage (CTD) systems. This study evaluates the safety and efficacy of an improvised CTD system as a viable alternative in resource-limited settings in Sudan.

Methods

A prospective, single-center analytical cohort study was conducted at a tertiary hospital in Sudan from June to December 2023. A total of 120 adult patients (aged 18–70 years) requiring CTD for thoracic injuries were included. The improvised CTD system consisted of a radiopaque nasogastric (NG) tube and a repurposed 1.5-liter plastic water bottle as an underwater seal. Clinical outcomes, complications, and patient satisfaction were assessed. Serial imaging at baseline and 24-hour intervals evaluated lung re-expansion and drainage efficacy. Data were analyzed using SPSS, with p < 0.05 considered significant.

Results

Lung re-expansion was achieved in 90 % (N = 108) of patients within 72 h. Complications included atelectasis in 15 % (N = 18), subcutaneous emphysema in 20 % (N = 24), and empyema in 12 % (N = 14). Tube repositioning was required in 25 % (N = 30) of cases, and obstruction occurred in 10 % (N = 12). The mean hospital stay was 6.5 days, and mortality was 5 % (N = 6). Smoking status, age, and injury type significantly predicted complications. Patient satisfaction was high, with 85 % (N = 102) rating their experience as satisfactory.

Conclusions

The improvised CTD system is a safe, effective, and cost-efficient alternative for managing thoracic emergencies in conflict settings. Its adaptability addresses critical gaps in emergency care, offering a scalable model for humanitarian crises worldwide.

在冲突地区，医疗基础设施中断和供应短缺限制了传统胸管引流（CTD）系统的使用，胸部损伤是一个挑战。本研究评估了临时CTD系统作为苏丹资源有限环境下可行替代方案的安全性和有效性。方法于2023年6月至12月在苏丹某三级医院进行前瞻性、单中心分析队列研究。共纳入120例因胸部损伤需要CTD的成年患者（年龄18-70岁）。这个临时的CTD系统由一个不透射线的鼻胃管和一个1.5升的塑料水瓶组成，作为水下密封。评估临床结果、并发症和患者满意度。基线和24小时间隔连续成像评估肺再扩张和引流效果。数据采用SPSS统计软件进行分析，p <；0.05认为显著。结果90%（108例）的患者在72 h内实现肺部再扩张，并发症包括肺不张15例（18例），皮下肺气肿20例（24例），脓肿12例（14例）。25% （N = 30）的病例需要重新定位输卵管，10% （N = 12）的病例发生梗阻。平均住院时间为6.5天，死亡率为5% （N = 6）。吸烟状况、年龄和损伤类型显著预测并发症。患者满意度高，85% （N = 102）认为他们的经历是满意的。结论简易CTD系统是一种安全、有效、经济的方法，可用于处理冲突环境下的胸部急诊。它的适应性弥补了紧急护理方面的重大空白，为全球人道主义危机提供了一个可扩展的模式。

{"title":"Improvised chest tube drainage: A practical approach to thoracic emergencies in humanitarian crises","authors":"Alsadig Suliman , Rawan Mohamedosman , Bushra Suliman , Hassan Musa , Siddig Ali , Mohammad Ahmed","doi":"10.1016/j.sipas.2025.100282","DOIUrl":"10.1016/j.sipas.2025.100282","url":null,"abstract":"<div><h3>Background</h3><div>Thoracic injuries pose a challenge in conflict zones, where disrupted healthcare infrastructure and supply shortages limit access to conventional chest tube drainage (CTD) systems. This study evaluates the safety and efficacy of an improvised CTD system as a viable alternative in resource-limited settings in Sudan.</div></div><div><h3>Methods</h3><div>A prospective, single-center analytical cohort study was conducted at a tertiary hospital in Sudan from June to December 2023. A total of 120 adult patients (aged 18–70 years) requiring CTD for thoracic injuries were included. The improvised CTD system consisted of a radiopaque nasogastric (NG) tube and a repurposed 1.5-liter plastic water bottle as an underwater seal. Clinical outcomes, complications, and patient satisfaction were assessed. Serial imaging at baseline and 24-hour intervals evaluated lung re-expansion and drainage efficacy. Data were analyzed using SPSS, with <em>p</em> < 0.05 considered significant.</div></div><div><h3>Results</h3><div>Lung re-expansion was achieved in 90 % (<em>N</em> = 108) of patients within 72 h. Complications included atelectasis in 15 % (<em>N</em> = 18), subcutaneous emphysema in 20 % (<em>N</em> = 24), and empyema in 12 % (<em>N</em> = 14). Tube repositioning was required in 25 % (<em>N</em> = 30) of cases, and obstruction occurred in 10 % (<em>N</em> = 12). The mean hospital stay was 6.5 days, and mortality was 5 % (<em>N</em> = 6). Smoking status, age, and injury type significantly predicted complications. Patient satisfaction was high, with 85 % (<em>N</em> = 102) rating their experience as satisfactory.</div></div><div><h3>Conclusions</h3><div>The improvised CTD system is a safe, effective, and cost-efficient alternative for managing thoracic emergencies in conflict settings. Its adaptability addresses critical gaps in emergency care, offering a scalable model for humanitarian crises worldwide.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"21 ","pages":"Article 100282"},"PeriodicalIF":0.6,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143855770","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}

引用次数: 0