Annali italiani di chirurgia最新文献

Aim: This study compared the standard loop electrosurgical excision procedure (LEEP) with an enhanced technique incorporating intraoperative ultrasound guidance and individualized marking for high-risk human papillomavirus (HPV)-associated cervical lesions. The primary focus was on their differential impact on stress injuries incurred during the perioperative period. Furthermore, secondary outcomes included surgical precision, modulation of local immune microenvironment, and clinical endpoints, such as complications, HPV clearance, and recurrence.

Methods: This retrospective cohort study included high-risk HPV-induced cervical intraepithelial neoplasia (CIN) II-III patients (n = 122) who were treated between January 2022 and March 2024. Patients were divided into two groups: an observation group (n = 58), which received intraoperative ultrasound-guided LEEP with individualized marking, and a control group (n = 64), which received conventional LEEP. The outcome measures evaluated were (1) perioperative stress hormones and inflammatory markers, (2) surgical parameters (intraoperative blood loss, margin positivity, and cervical canal adhesion rates), (3) postoperative complications (infection, bleeding, and cervical canal stenosis), and (4) HPV clearance and recurrence rates.

Results: Postoperative stress and the levels of inflammatory markers were significantly reduced in the observation group compared to the conventional group (p < 0.05). However, the observation group demonstrated significant improvement, including reduced intraoperative bleeding, fewer positive margins, and increased HPV clearance rates (p < 0.05). Regarding postoperative complications, the observation group exhibited a significant reduction in acute infection and Cervical canal adhesion rates compared with the control group (p < 0.05). Finally, postoperative Visual Analogue Scale (VAS) and Hospital Anxiety and Depression Scale-anxiety (HADS-A) scores were lower in the observation group than in the control group (p < 0.05).

Conclusions: The use of intraoperative ultrasound-guided LEEP with individualized marking is associated with attenuated perioperative stress responses and a more preserved immune microenvironment. This, in turn, improves HPV clearance rates and diminishes postoperative complication risks.

Aim: Spinal cord injury (SCI), particularly traumatic spinal cord injury (TSCI), is a globally prevalent neurological condition and often causes severe functional and physical disabilities. Neuromuscular electrical stimulation (NMES), when combined with rehabilitation training, has been reported to enhance functional recovery in patients with SCI. However, its specific clinical advantages and safety profile require further validation through robust empirical data. Therefore, this study aims to investigate the synergistic effects of NMES combined with rehabilitation training on improving motor function and reducing muscle atrophy in SCI patients.

Methods: This retrospective study enrolled 856 patients with TSCI. All patients received either surgical intervention or conservative treatment based on injury severity. Among them, 472 patients received NMES combined with rehabilitation training (intervention group), while the remaining 384 patients received rehabilitation training alone (control group). Several parameters, including neurological function score, muscle mass, and quality of life (QoL) were compared pre- and post-interventions to evaluate the rehabilitation outcomes of the two groups.

Results: After treatment, the patients in the intervention group showed higher motor and sensory function scores (American Spinal Injury Association [ASIA] motor and ASIA sensory scores), walking speed on the 10-Meter Walk Test (10MWT), and muscle cross-sectional area (CSA) value than those in the control group (p < 0.05). However, no significant differences were observed between the two groups in Spinal Cord Independence Measure III (SCIM-III) scores, muscle quality index (MQI), and World Health Organization Quality of Life-Brief Version (WHOQOL-BREF) scores (p > 0.05).

Conclusions: Combining NMES with rehabilitation training can enhance motor function recovery, attenuate muscle atrophy, and improve walking ability in individuals with SCI. NMES-augmented rehabilitation offers superior benefits compared to rehabilitation alone.

Aim: This study aims to compare the efficacy of the bilateral triceps approach (BTA) versus the olecranon osteotomy approach (OOA) with orthogonal double plating in managing Arbeitsgemeinschaft für Osteosynthesefragen (AO) Foundation type C3 distal humeral fractures, providing evidence for selecting optimal surgical approaches and fixation methods.

Methods: This retrospective analysis included 31 patients with AO type C3 distal humeral fractures treated at the Department of Orthopaedic Trauma, Orthopaedic Center, the First Hospital of Jilin University between June 2018 and May 2024. All patients underwent open reduction and internal fixation with orthogonal double plates placed dorsally on the radial column and medially on the ulnar column. Based on surgical approach, patients were divided into the BTA group (n = 16) and OOA group (n = 15). The parameters evaluated during this study included injury-to-surgery interval, operative time, intraoperative blood loss, postoperative complications (iatrogenic nerve injury, wound infection, elbow stiffness), and Mayo Elbow Performance Score (MEPS) at 6 and 12 months postoperatively.

Results: All patients achieved bony union and their fractures healed with complete follow-up. No statistically significant differences were observed in gender, age, or injury-to-surgery interval between groups (p > 0.05). Operative time was significantly shorter in the BTA group compared to the OOA group (p < 0.05). Similarly, there were no significant differences between the groups regarding intraoperative blood loss, postoperative complication rates, or excellent/good rates of MEPS at 6 or 12 months (all p > 0.05).

Conclusions: For AO type C3 distal humeral fractures without metaphyseal defects, orthogonal double plating provides rigid fixation enabling early postoperative mobilization. For fractures with intact trochlear articular surfaces (no coronal/horizontal split) where fragments can be directly fixed by distal screws from the plates, the bilateral triceps approach may be prioritized. For severely comminuted trochlear fractures with articular fragmentation (coronal/horizontal split) requiring separate fixation of split fragments with headless compression screws, the olecranon osteotomy approach may provide better exposure.

Aim: Colonic obstruction is a life-threatening condition, requiring emergency surgery (ES) that usually implies laparotomy and stoma construction. Self-expandable metal stents (SEMS) can be used to overcome the occlusion, realizing the so-called "bridge to surgery (BTS)", allowing management of the patient in an elective setting.

Case presentation: We present a case of a 59-year-old man with left colonic obstruction related to stenosing colorectal cancer (CRC) successfully treated with SEMS placement and early laparoscopic definitive surgery. The patient had an excellent course with no stenting or surgery-related complications. Probably young age, no comorbidity and endoscopic expertise played a main role in this favourable outcome, at least in the short term.

Results: Our critical review of the literature published over a period spanning more than two decades, encompassing 41 studies, indicates that SEMS used as a BTS in patients with malignant colorectal obstruction is associated with improved short-term outcomes compared to ES. Specifically, SEMS placement has been shown to reduce postoperative morbidity, lower stoma formation rates, and facilitate preoperative optimization in selected patients. Nevertheless, concerns remain regarding potential adverse oncological outcomes, particularly in terms of local recurrence and disease-free survival. These concerns are compounded by the heterogeneity of available studies, which are predominantly retrospective and underpowered, and by the scarcity of large-scale randomized controlled trials (RCTs). Furthermore, the limited dissemination of technical expertise and institutional experience in SEMS placement continues to restrict its widespread implementation in clinical practice.

Conclusions: The clinical success of SEMS placement as a BTS strategy is contingent upon rigorous patient selection, coordinated multidisciplinary team involvement, and the availability of experienced endoscopists and surgical teams. When these prerequisites are met, SEMS offers an effective means of converting an acute surgical emergency into an elective procedure, thereby mitigating perioperative risk and improving patient-centered outcomes. However, the lack of robust long-term oncological data and the limited penetration of stenting expertise across healthcare institutions remain major impediments to broader adoption. Continued efforts to generate high-quality evidence and promote structured training programs are essential to fully define the role of SEMS in the management of malignant bowel obstruction.

Aim: Managing partial defects of the finger is crucial for both function and aesthetics, especially when bone or tendon is exposed. Permacol Enhanced Layer for Neodermis and Coverage (PELNAC), an artificial dermis, serves as a promising scaffold in surgical procedures, providing wound protection and promoting tissue healing. This study assesses the effectiveness of PELNAC in treating a range of partial finger defects.

Methods: We assessed PELNAC's morphology and microstructure using scanning electron microscopy, characterized its degradation profile over six weeks in simulated body fluid, and confirmed its cytocompatibility with L929 cell cultures. In the clinical setting, 47 patients with 56 partial finger defects (both superficial and deep) were treated using PELNAC alone. Outcome measures included wound closure time, range of motion (ROM), sensory recovery (two-point discrimination), Vancouver Scar Scale (VSS) scores, and patient satisfaction.

Results: Scanning electron microscopy revealed interconnected micropores in PELNAC, with a porosity of 81.3 ± 2.1% and aperture sizes of 40-70 µm (top view) and 60-100 µm (section view). After six weeks in simulated body fluid, PELNAC retained 86.4 ± 1.5% of its weight, and cells proliferated well on its surface. All treated wounds healed without the need for split-thickness skin grafts, with an average closure time of 58.7 ± 12.8 days (range: 30-84 days). Age showed weak positive correlation with healing time (r = 0.152, p < 0.01) and weak negative correlation with two-point discrimination (r = -0.55, p < 0.01). Longer healing times correlated with reduced ROM (r = -0.143, p < 0.01), while higher VSS scores were linked to poorer functional outcomes (r = -0.22, p < 0.01). The average ROM in patients with distal interphalangeal joint (DIPJ) defects was 49° (IQR: 45-56.25°). Sensory recovery averaged 5.95 mm (IQR: 5.175-6.7 mm). The mean VSS score was 2 (IQR: 1-3), indicating minimal scarring. Patient satisfaction was high (functional score: 9 (IQR: 8-9.25)), with no severe complications reported.

Conclusions: This study evaluates the clinical and biomechanical effectiveness of PELNAC as a single-stage reconstructive material for partial finger defects. PELNAC facilitates wound healing without secondary skin grafts, preserving joint mobility, promoting sensory recovery, and minimizing scarring. The results highlight PELNAC as a simple, safe, and effective alternative to traditional approaches, reducing donor site morbidity and eliminating the need for multiple surgeries.

Aim: To achieve continuous improvement of thoracic surgery residency program, it is of paramount importance to acknowledge and understand its features. Due to the lack of Italian evidence in literature, the residents' perspective was investigated through a nation-wide survey, focusing on the surgical exposure within Italian residency programs.

Methods: An online anonymous and voluntary survey of 74 items was generated with SurveyMonkey and sent to all thoracic surgery residents in Italy, between the 2nd and the 5th year of residency, selectively investigating surgical exposure and its potential influencing factors.

Results: Among 193 Italian thoracic surgery residents, 103 (53.4%) completed the survey and were included in the analysis. The mean cumulative and monthly number of surgical procedures carried out as first operator were 32.5 ± 44.0 (median 20.0) and 1.97 ± 1.95 (median 1.0), respectively. Independent factors associated to surgical exposure at the multivariable analysis were the administrative workload relative ratio (RR) 0.89, ([95% CI 0.84-0.99], p < 0.001), the perceived idea of free time RR 2.69 ([1.45-4.96], p = 0.003), the year of residency RR 0.34 ([0.17-0.68], p = 0.009), the gender RR 1.46 ([1.07-2.45], p = 0.045), and the number of residents per department RR 0.43 ([0.22-0.85], p = 0.043).

Conclusions: According to the residents' perspective, Italian thoracic surgery residency program is a well-structured educational offer, where surgical exposure overlaps with that offered across Europe. Nonetheless, efforts should be done to address the main criticalities raised to continuously increase the quality of Italian residency programs, aiming at enhancing surgical exposure, as well as promoting fair education.

Aim: This study aimed to identify the risk factors for peristomal moisture-associated skin damage (PMASD) in older patients with enterostomies and to develop a predictive model.

Methods: This is a retrospective study. Data were collected from older patients who underwent enterostomy at The Fifth Affiliated Hospital of Wenzhou Medical University in Lishui between January 2021 and December 2022. With peristomal moisture-associated skin damage as the outcome variable, predictors identified as significant in the univariate analysis were incorporated into a multivariate logistic regression model. The model's goodness-of-fit and discriminative ability were assessed using the Hosmer-Lemeshow test and the area under the receiver operating characteristic (ROC) curve (AUC). To further evaluate the model's stability and predictive performance, an internal validation was conducted using a time-stratified cohort of 68 patients consecutively recruited from the same hospital between January 2023 and December 2023.

Results: The incidence of PMASD was 42.59% in the model development group (n = 162) and 41.18% in the validation group (n = 68). Independent predictors of PMASD included surgical incision in the stoma baseplate area (odds ratio [OR] = 4.80; 95% confidence interval [CI], 1.04-7.51), ileostomy (OR = 3.49; 95% CI, 1.27-7.99), history of radiotherapy (OR = 1.49; 95% CI, 1.05-2.10), lack of preoperative stoma marking (OR = 5.07; 95% CI, 2.50-8.30), and peristomal skin folds (OR = 3.96; 95% CI, 2.53-16.10), while stoma height ≥1.3 cm (OR = 0.11; 95% CI, 0.04-0.29) and continuity of care (OR = 0.60; 95% CI, 0.45-0.80) were protective factors. The model showed good discrimination (area under the receiver operating characteristic curve [AUC] = 0.90; 95% CI, 0.86-0.95) and calibration (Hosmer-Lemeshow p = 0.851) in the model development group and maintained strong performance in the validation group (AUC = 0.91; Hosmer-Lemeshow p = 0.875).

Conclusions: The validated prediction model demonstrated high discrimination (AUC >0.90) and good calibration, providing an effective tool for the early identification of older patients undergoing enterostomy at high risk of PMASD. This model may guide individualized preventive strategies and optimize the continuity of care. Further multicenter prospective studies are needed to confirm the generalizability and clinical utility of our findings.