Annali Italiani Di Chirurgia[JOURNAL]
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200 papers
Comparison of Small-Incision Tension-Free Mesh Repair With Scrotal Drainage and Laparoscopic Transabdominal Preperitoneal Repair for Inguinal Hernia: A Retrospective Cohort Study.
Zhang L, Jin X
Ann Ital Chir · 2026 May · PMID 42304161 · Publisher ↗
AIM: Inguinal hernia repair is among the most common surgical procedures worldwide, and the approach is evolving towards minimally invasive techniques such as laparoscopic transabdominal preperitoneal (TAPP) repair. Howe...
AIM: Inguinal hernia repair is among the most common surgical procedures worldwide, and the approach is evolving towards minimally invasive techniques such as laparoscopic transabdominal preperitoneal (TAPP) repair. However, open tension-free repairs remain essential in specific clinical contexts. This study aimed to compare perioperative outcomes, postoperative recovery, complication rates, and medical costs between small-incision tension-free mesh repair combined with scrotal drainage and laparoscopic TAPP repair, providing evidence-based guidance for surgical selection in diverse practice environments. METHODS: A retrospective cohort study was conducted at Yanbian University Hospital between June 2018 and February 2023. A total of 323 consecutive patients were enrolled. Group A included 107 patients who underwent small-incision tension-free mesh repair combined with scrotal drainage, and Group B included 216 patients who underwent TAPP. Baseline demographics were compared to ensure group equivalence. Intraoperative parameters (blood loss, operative time), postoperative recovery indicators (time to first flatus, ambulation initiation, pain resolution), length of hospital stay, medical costs, complication rates, and recurrence within six months were assessed using appropriate statistical tests ( < 0.05 indicated significance). RESULTS: No significant differences in baseline characteristics were detected between the two groups ( > 0.05). Compared with TAPP (Group B), small-incision tension-free mesh repair with scrotal drainage (Group A) was associated with greater intraoperative blood loss ( < 0.001) but a shorter operative time ( < 0.001). Postoperatively, Group A had longer hospital stays and delayed recovery of gastrointestinal function (time to first flatus), ambulation, and pain resolution (all < 0.001). Total hospitalization costs were significantly lower in Group A than in Group B ( < 0.001). The mean duration of drain placement in Group A was 2.03 ± 0.65 days. Chronic groin pain occurred in 8.4% vs. 4.6% ( > 0.05) of patients, and hernia recurrence rates were 1.9% vs. 1.4% ( > 0.05) for Groups A and B, respectively. Incisional infection was more frequent in Group A (3.7%) than in Group B (0%, < 0.05). CONCLUSIONS: Both small-incision tension-free mesh repair with scrotal drainage and TAPP are safe and effective when performed by experienced surgeons within standardized perioperative protocols. The small-incision approach is particularly suitable for elderly patients and those with comorbidities limiting tolerance to general anaesthesia, as well as for resource-constrained settings. Targeted drain placement effectively prevents postoperative seroma formation but may also increase local tissue trauma, prolong postoperative discomfort, delay mobilization, and increase the risk of superficial wound infection.
Phyllodes Tumors: From National Guidelines to European Evidence and Collaboration.
Bucaro A, Pirrottina CV, Sanchez AM … +4 more , De Lauretis F, Borghesan N, Franceschini G, BEAM study group
Ann Ital Chir · 2026 May · PMID 42304160 · Publisher ↗
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Anorectal Melanoma Management Evolution: A Narrative Review.
Sassun R, Violante T, Brucchi F … +3 more , Sileo A, Cirocchi R, Mari G
Ann Ital Chir · 2026 May · PMID 42304159 · Publisher ↗
Anorectal melanoma (ARM) is one of the rarest and most aggressive subtypes of melanoma, representing less than 1% of all melanomas and 0.1-0.4% of anorectal malignancies. As a mucosal melanoma arising in sun-shielded sit...
Anorectal melanoma (ARM) is one of the rarest and most aggressive subtypes of melanoma, representing less than 1% of all melanomas and 0.1-0.4% of anorectal malignancies. As a mucosal melanoma arising in sun-shielded sites, ARM exhibits distinct molecular features compared with cutaneous melanoma, including low tumor mutational burden, absent ultraviolet signatures, frequent proto-oncogene Receptor Tyrosine Kinase () mutations (15-25%), and lower immunogenicity. These biological differences contribute to its rapid progression, late diagnosis, and poor response to traditional therapies. Patients typically present with nonspecific symptoms such as rectal bleeding, often resulting in advanced disease at diagnosis, with up to 67% harboring regional or distant metastases. Management of ARM has evolved significantly over the past decades. Historically dominated by radical abdominoperineal resection, surgical treatment has shifted toward sphincter-preserving wide local excision when negative margins can be achieved, driven by comparable survival outcomes and superior functional results regarding bowel, urogenital, and psychological quality of life. However, high positive margin rates remain a major limitation of local excision. Systemic therapy has transitioned from largely ineffective cytotoxic chemotherapy to modern immunotherapy. Immune checkpoint inhibitors have become the cornerstone of treatment, while -mutated tumors may benefit from tyrosine kinase inhibitors. Emerging evidence supports neoadjuvant immunotherapy to improve resectability and downstage tumors, with selected matched cohorts reporting 3-year overall survival rates up to 71-75% when combined with abdominoperineal resection. Survival gains have been modest and largely confined to specific subgroups. Key challenges include the absence of a dedicated staging system, high local recurrence rates, limited durability of responses in metastatic disease, and an immunologically "cold" tumor microenvironment. Multidisciplinary team approaches are essential for individualized care. Future progress depends on biomarker-driven trials, integration of novel strategies such as Chimeric Antigen Receptor T-Cell (CAR-T) therapy, and stronger international collaborative research to improve outcomes in this challenging malignancy.
Correlation and Responsiveness of Objective and Subjective Measures in Evaluating Periorbital Swelling After Upper Blepharoplasty: A Retrospective Study Using 3D Stereophotography and Visual Analogue Scale.
Ge C, Ge C, Zhang Y … +3 more , Yang K, Li K, Huang J
Ann Ital Chir · 2026 May · PMID 42304158 · Publisher ↗
AIM: To compare the correlation between three-dimensional stereophotography (3D-SPG) and visual analogue scale (VAS) in the evaluation of periorbital swelling after upper blepharoplasty, and to provide a basis for postop...
AIM: To compare the correlation between three-dimensional stereophotography (3D-SPG) and visual analogue scale (VAS) in the evaluation of periorbital swelling after upper blepharoplasty, and to provide a basis for postoperative swelling monitoring and recovery evaluation. METHODS: This retrospective study included 39 patients who underwent upper blepharoplasty between December 2024 and April 2025. On postoperative days 1, 7, 14, and 28, 3D-SPG was used to measure objective morphological volume and double-eyelid fold width, while periorbital swelling experienced by the patients was assessed using a visual analogue scale. Changes in objective morphological volume and VAS scores from their baseline levels were calculated. Repeated measures analysis of variance was used to assess changes over time, and Pearson correlation analysis was used to evaluate the correlation between objective morphological volume and VAS scores. Standardized response mean (SRM) was calculated to compare the responsiveness of the two parameters. RESULTS: During the postoperative 28-day period, the double-eyelid fold width, VAS score, and objective morphological volume decreased significantly over time (all < 0.001). There was a significant positive correlation between the objective morphological volume and VAS score in the early postoperative period (d1-d7) (left eye: d1 r = 0.467, = 0.003; d7 r = 0.546, < 0.001; right eye: d1 r = 0.449, = 0.004; d7 r = 0.497, = 0.001). At late postoperative days (d14-d28), the correlation weakened and became not statistically significant (left eye: d14 r = 0.098, = 0.555; d28 r = 0.175, = 0.286; right eye: d14 r = 0.254, = 0.119; d28 r = 0.113, = 0.494). Sensitivity analysis showed that both parameters demonstrated high responsiveness in the early intervals (d1-d7 and d7-d14). However, 3D-SPG maintained consistently higher responsiveness throughout the observation period (SRM = 3.406-5.007), whereas VAS showed a decline in responsiveness in the late interval (d14-d28), potentially due to a floor effect (SRM = 0.902-1.355). CONCLUSIONS: Both 3D-SPG and VAS demonstrate distinct performance characteristics across postoperative stages. 3D-SPG provides objective, quantitative volumetric data, while VAS captures patient-perceived symptoms. These findings suggest that both methods assess different dimensions of postoperative swelling. However, further studies are needed to determine whether their combined use offers additional clinical benefit.
Colonic Continuity After Splenic Flexure Resection: Does the Orientation of the Anastomosis Matter? A Retrospective Cohort Study.
Roufael F, Crippa J, Sassun R … +8 more , Vignati B, Santonocito M, D'Alessandro V, Maggioni D, Ballabio A, Magistro C, Mari G, AIMS Academy Clinical Research Network
Ann Ital Chir · 2026 May · PMID 42304157 · Publisher ↗
AIM: Splenic flexure resection (SFR) is a technically demanding procedure due to the region's complex vascular anatomy and limited colonic mobility. The orientation of the colonic anastomosis-either isoperistaltic or ani...
AIM: Splenic flexure resection (SFR) is a technically demanding procedure due to the region's complex vascular anatomy and limited colonic mobility. The orientation of the colonic anastomosis-either isoperistaltic or anisoperistaltic-represents a critical yet understudied technical factor that may influence operative complexity and postoperative recovery. This study aimed to compare short-term outcomes between these two anastomotic configurations. METHODS: We conducted a retrospective cohort study at a tertiary colorectal center, including consecutive patients who underwent elective SFR for colon cancer between January 2023 and December 2024 (n = 53). Patients were stratified according to the orientation of the side-to-side anastomosis: isoperistaltic (ISO, n = 32) or anisoperistaltic (ANISO, n = 21). Demographic, oncologic, surgical, and postoperative variables were analyzed. Primary endpoints were operative time, gastrointestinal recovery (time to first flatus and first stool), and length of hospital stay. Secondary endpoints included estimated blood loss, conversion rate, 30-day complications, inflammatory markers, analgesic use, costs, and quality of life assessed using the Gastrointestinal Quality of Life Index (GIQLI). RESULTS: Baseline demographics were largely comparable between groups, although patients in the ANISO group were significantly older (71.4 ± 6.0 vs. 67.8 ± 4.4 years; = 0.023) and had a slightly lower body mass index (BMI) (25.4 ± 1.4 vs. 26.5 ± 2.3 kg/m; = 0.049). Operative time was significantly shorter in the ANISO group (126.5 ± 13.8 vs. 154.8 ± 23.4 minutes; < 0.001). Gastrointestinal recovery was faster following anisoperistaltic anastomosis, with earlier first flatus (31.7 ± 8.7 vs. 39.3 ± 10.2 hours; = 0.005), while time to first stool did not differ significantly (51.2 ± 12.5 vs. 55.8 ± 9.0 hours; = 0.159). Length of hospital stay was comparable (5.2 ± 0.8 vs. 5.6 ± 1.3 days; = 0.172). Estimated blood loss was significantly lower in the ANISO group (34.6 ± 17.0 vs. 47.6 ± 13.6 mL; = 0.006). Conversion rate and postoperative complications were comparable between groups ( = 1.000 and = 0.743 respectively). No differences were observed in inflammatory markers, analgesic use, or costs. GIQLI scores at 30 days were similar between groups (126.9 ± 11.0 vs. 123.0 ± 8.1; = 0.166). CONCLUSIONS: Anisoperistaltic anastomosis following splenic flexure resection is safe and effective and is associated with shorter operative time and faster postoperative gastrointestinal recovery without compromising short-term outcomes. The choice of anastomotic orientation may be influenced by intraoperative anatomical conditions and technical factors.
Aortic Repair in Landing Zone 2: From Chimney Technique to Branched Graft.
Ascoli Marchetti A, Oddi FM, Turriziani V … +5 more , Caruso C, Battistini M, Fresilli M, Fazzini S, Martelli E
Ann Ital Chir · 2026 Jun · PMID 42304156 · Publisher ↗
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Primary Clivus Bone Lesions.
Silva VTGD, Nepomuceno TB, Silva RPDS … +3 more , Martucci C, Figueiredo EG, Paiva WS
Ann Ital Chir · 2026 Jun · PMID 42304155 · Publisher ↗
AIM: To address the diagnostic and therapeutic challenges posed by primary clival bone lesions, specifically chordoma, chondrosarcoma, giant cell tumor, and benign notochordal cell tumor, by providing a comprehensive rev...
AIM: To address the diagnostic and therapeutic challenges posed by primary clival bone lesions, specifically chordoma, chondrosarcoma, giant cell tumor, and benign notochordal cell tumor, by providing a comprehensive review of their clinical, radiological, and biological characteristics. METHODS: A systematic review was performed using the Cochrane Library, Scielo, and Medline databases. The search incorporated MeSH terms such as "chordomas", "chondrosarcoma", "giant cell tumor of bone", and "bone neoplasms". From 2630 initial results, 33 studies were selected and categorized by tumor type, histology, clinical presentation, imaging findings, diagnosis, treatment, and prognostic factors. RESULTS: Despite extensive literature on individual aspects of these tumors, comprehensive reviews encompassing all four primary clival lesions are scarce. These tumors exhibit overlapping radiological features and complex anatomical locations, each with distinct biological behavior. The systematic review highlights the importance of differentiating among these lesions to inform diagnosis and management, as well as the current limitations in evidence-based treatment strategies due to the rarity and complexity of these entities. CONCLUSIONS: Understanding the key characteristics of primary clival bone lesions is essential for clinicians and neurosurgeons to select optimal diagnostic and therapeutic approaches, ultimately aiming to improve patient outcomes.
Diagnostic Efficacy of I-SPECT/CT in Detecting Postoperative Residual and Recurrent Lesions in Patients With Differentiated Thyroid Cancer: A Meta-Analysis.
Liu W, Lin R, Chen Y … +2 more , Gao Q, Zhong J
Ann Ital Chir · 2026 Jun · PMID 42304154 · Publisher ↗
AIM: Single-photon emission computed tomography/computed tomography (SPECT/CT) technology is a promising imaging tool for the detection of postoperative residual and recurrent lesions in differentiated thyroid cancer (DT...
AIM: Single-photon emission computed tomography/computed tomography (SPECT/CT) technology is a promising imaging tool for the detection of postoperative residual and recurrent lesions in differentiated thyroid cancer (DTC). However, existing studies presented mixed results, and the overall diagnostic efficacy of this technology remains unclear. Therefore, this meta-analysis was conducted to systematically evaluate the diagnostic value of I-SPECT/CT for identifying residual or recurrent disease in patients with DTC. METHODS: A systematic literature search was conducted across PubMed, Web of Science, EMBASE, and Cochrane Library from inception to 4 December 2025. The search strategy incorporated relevant keywords and MeSH terms, such as "differentiated thyroid cancer", "thyroidectomy", "SPECT", "SPECT/CT", "SPECT-CT", "metastasis", "recurrence", and "residual". Study selection, data extraction, and risk-of-bias assessment were performed independently by two investigators. The overall diagnostic performance was assessed by calculating the pooled sensitivity (SENS), specificity (SPEC), and summary receiver operating characteristic (SROC) curve. Sensitivity analyses were performed by excluding individual studies to assess the robustness and stability of the pooled results. Subgroup analysis was used to determine the source of heterogeneity. RESULTS: Six studies involving 800 patients were included. Pooled analysis showed that lesion-level I-SPECT/CT had a pooled SENS of 0.59 (0.33-0.81) and a pooled SPEC of 0.92 (0.85-0.96). The pooled diagnostic odds ratio (DOR) was 18 (3-91), and the area under the curve (AUC) was 0.92. Based on patient-level I-SPECT/CT, the pooled SENS was 0.89 (0.63-0.98), the pooled SPEC was 0.95 (0.70-0.99), and the DOR was 166 (7-4126). The AUC of the SROC curve was 0.97. The overall diagnostic accuracy of I-SPECT/CT was confirmed, regardless of whether it was conducted at the patient or lesion level. To avoid potential patient overlap, we excluded an earlier study for a sensitivity analysis. The results after exclusion remained within reasonable limits, supporting the robustness of the main findings. Subgroup analyses indicated that patient type may be a potential source of heterogeneity in the non-threshold effect. No publication bias was statistically suggested through Deeks' funnel plot. CONCLUSIONS: I-SPECT/CT demonstrates efficacy for the targeted detection of postoperative residual and recurrent lesions in DTC, showing high diagnostic accuracy. However, existing evidence is subject to high heterogeneity, and clinical application should be carefully interpreted in combination with the specific characteristics of patients. Future higher-quality studies conducted using unified standards are needed to further verify its clinical value.
Multimodal Imaging-Guided and Intraoperatively Verified Resection of Mediastinal Ectopic Parathyroid Adenomas: A Five-Case Series.
Yılmaz M, Barçin M, Zerey C … +3 more , Süleymanoğlu M, Benli S, Berkeşoğlu M
Ann Ital Chir · 2026 Jun · PMID 42304153 · Publisher ↗
AIM: To present the diagnostic approach, surgical management, and early outcomes of patients with mediastinal ectopic parathyroid adenoma (MEPA) causing primary hyperparathyroidism. CASE PRESENTATION: Between January 201...
AIM: To present the diagnostic approach, surgical management, and early outcomes of patients with mediastinal ectopic parathyroid adenoma (MEPA) causing primary hyperparathyroidism. CASE PRESENTATION: Between January 2015 and January 2025, patients with mediastinal ectopic parathyroid adenoma identified among 458 patients who underwent surgery for a solitary parathyroid adenoma were retrospectively reviewed, and five cases were identified (1%; n = 5). Diagnostic evaluation included cervical ultrasonography, technetium-99m sestamibi single-photon emission computed tomography/computed tomography (SPECT/CT), and CT. The surgical strategy was individualized according to lesion location and proximity to major vascular structures. Intraoperative confirmation was achieved using radioguided surgery, frozen section analysis, and intraoperative parathyroid hormone (ioPTH) monitoring. Patients were followed for one year with serial serum calcium and parathyroid hormone (PTH) measurements. RESULTS: The median age was 62 years (range, 40-70 years), and three patients were female. Bone pain and fatigue were the most common presenting symptoms, whereas one patient was asymptomatic. Preoperative albumin-corrected serum calcium levels ranged from 11.24 to 13.43 mg/dL, and PTH levels ranged from 161 to 1493 pg/mL. Lesion size ranged from 8 × 8 mm to 35 × 22 mm, and four lesions were located in the anterior mediastinum. Four patients underwent J-shaped partial median sternotomy, and one underwent a transcervical approach. The 10-minute ioPTH decline ranged from 48.3% to 85.5%. No major surgical complications occurred. All patients remained normocalcemic and clinically stable at the 1-year follow-up. CONCLUSIONS: In patients with MEPA, the combined use of functional and anatomical imaging, supported by multiple intraoperative confirmation modalities, may facilitate curative resection with low morbidity through an individualized surgical strategy.
Accessory Soleus Muscle and Persistent Posterior Ankle Pain: Report of Three Cases.
Pogliacomi F, Battaglia S, Quattrini F … +2 more , Ceccarelli F, Calderazzi F
Ann Ital Chir · 2026 Jun · PMID 42304152 · Publisher ↗
AIM: Posterior ankle pain is a nonspecific symptom that can result from various pathologies. Rare accessory muscle variants, including the accessory soleus muscle, may cause overlapping clinical conditions due to mass ef...
AIM: Posterior ankle pain is a nonspecific symptom that can result from various pathologies. Rare accessory muscle variants, including the accessory soleus muscle, may cause overlapping clinical conditions due to mass effect, dynamic impingement, chronic compartment syndrome, or tibial nerve compression. Limited familiarity with this anatomical variant often leads to diagnostic delay, misdiagnosis, or inappropriate treatment. The authors report three cases of chronic posterior ankle pain in athletes caused by the accessory soleus muscle with the aim to highlight the importance of considering the accessory soleus muscle (ASM) as a possible cause of this symptomatology. The diagnostic and therapeutic management, and clinical-functional outcomes are analysed. CASE PRESENTATION: All patients reported posterior ankle pain for more than one year, exacerbated by sports activity and forced plantar flexion, with relief at rest. Magnetic Resonance Imaging (MRI) or Computed Tomography (CT) demonstrated the presence of ectopic muscle tissue compatible with an accessory soleus muscle. Clinical data, imaging findings, treatment modalities, and clinical-functional outcomes were retrospectively collected for each case. Preoperative, one year postoperative, and final follow-up assessments included the Visual Analog Scale (VAS) for pain evaluation, 17-Item Italian Foot Function Index (17-IFFI), and the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score validated in Italian. All patients underwent surgical excision of the accessory soleus muscle through a posteromedial approach. RESULTS: Surgical excision was the definitive treatment for each patient, resulting in pain relief, clinical and functional improvement, and return to sports activity. No complications or recurrences were observed. CONCLUSIONS: The accessory soleus muscle is a potential cause of chronic posterior ankle pain and must be considered in the differential diagnosis to avoid diagnostic delays or misdiagnosis. Surgical excision has represented the effective and definitive treatment of the three reported cases.
The Impact of Preoperative Blood Glucose Control on Corneal Recovery and Visual Function After Phacoemulsification in Diabetic Cataract Patients.
Ye Q, Lin X, Lu Z … +3 more , Guo Q, Tong Y, Liang X
Ann Ital Chir · 2026 Jun · PMID 42304151 · Publisher ↗
AIM: Diabetic patients are at an increased risk for cataract and may experience delayed postoperative recovery due to diabetes-related ocular tissue vulnerability. However, the impact of preoperative glycemic control on...
AIM: Diabetic patients are at an increased risk for cataract and may experience delayed postoperative recovery due to diabetes-related ocular tissue vulnerability. However, the impact of preoperative glycemic control on early surgical outcomes and quality of life remains to be fully elucidated. This study aimed to investigate the effects of preoperative fasting blood glucose (FBG) control on postoperative corneal recovery, visual function, and vision-related quality of life in type 2 diabetic patients undergoing phacoemulsification. METHODS: In this retrospective analysis, 197 cataract patients with type 2 diabetes who underwent phacoemulsification between March 2023 and March 2025 were included. Based on their preoperative FBG levels, they were divided into a well-controlled group (FBG <6.1 mmol/L, = 83) and a poorly controlled group (FBG ≥6.1 mmol/L, = 114). National Eye Institute Visual Function Questionnaire-25 (NEI-VFQ-25), mean corneal astigmatism, corneal edema recovery, and best corrected visual acuity (BCVA) were compared between the two groups. RESULTS: Postoperatively, the well-controlled group had significantly higher total scores and scores on all dimensions of the NEI-VFQ-25 scale than the poorly controlled group (all < 0.05). Regarding corneal recovery, the group with better control showed greater changes in mean corneal astigmatism on postoperative days 7 and 30 ( < 0.001). The corneal transparency ratio was higher on postoperative day 7 ( = 0.006), while there was no significant difference between the two groups on postoperative day 30. On postoperative day 7, the logarithm of the minimum angle of resolution (logMAR) BCVA of the well-controlled group was also significantly better than that of the poorly controlled group ( < 0.001). By postoperative day 30, the differences in corneal transparency and BCVA between the two groups became non-significant ( > 0.05). CONCLUSIONS: Good preoperative glycemic control in diabetic patients undergoing phacoemulsification is associated with faster early corneal edema resolution, better early visual recovery, and clinically meaningful improvements in vision-related quality of life. These findings underscore the importance of enhanced perioperative glycemic management to optimize short-term surgical outcomes and health-related quality of life in this population.
Impact of Individualized Positioning Care on Cardiac Function Recovery and Comfort in Patients After Heart Valve Surgery.
Zhang Y, Wang Y, Hou Y … +1 more , Ning Y
Ann Ital Chir · 2026 Jun · PMID 42304150 · Publisher ↗
AIM: Postoperative recovery after heart valve surgery is an important topic in the realm of nursing care. This study aimed to evaluate the effect of individualized positioning care on cardiac function recovery and comfor...
AIM: Postoperative recovery after heart valve surgery is an important topic in the realm of nursing care. This study aimed to evaluate the effect of individualized positioning care on cardiac function recovery and comfort in patients after heart valve surgery. METHODS: A single-center, retrospective cohort study was conducted, continuously enrolling patients who underwent heart valve surgery at Affiliated Hospital of Xuzhou Medical University from June 2022 to June 2025. A total of 150 patients were included. The patients were divided into a control group (conventional positioning care, = 76) and an experimental group (individualized positioning care, = 74) according to the nursing method received. The primary outcome measures were changes in cardiac function indicators, such as left ventricular ejection fraction (LVEF) and N-terminal pro-brain natriuretic peptide (NT-proBNP) before and after nursing, as well as postoperative comfort scores measured using the Visual Analog Scale for Comfort (VAS-Comfort). Secondary outcomes included postoperative pain scores (Numeric Rating Scale [NRS]), sleep quality (Richards-Campbell Sleep Questionnaire [RCSQ]), pulmonary complications, pressure ulcer incidence, intensive care unit (ICU) length of stay, and postoperative hospital days. Group comparisons were performed using -test, Mann-Whitney test, Chi-square test, or Fisher's exact test. Postoperative NT-proBNP was analyzed using analysis of covariance (ANCOVA), adjusting for baseline levels. RESULTS: Baseline characteristics were balanced and comparable between the two groups (all > 0.05). Compared to the control group receiving conventional care, the experimental group receiving individualized positioning care showed more significant improvement in cardiac function: the change in LVEF (ΔLVEF) was significantly higher in the experimental group (0.85 ± 3.98% vs. -3.15 ± 4.20%, < 0.001); NT-proBNP levels on postoperative day 7 were significantly lower in the experimental group (median: 685.00 pg/mL vs. 1003.50 pg/mL, < 0.001), and the difference remained statistically significant after adjusting for preoperative values ( = 12.13, < 0.001). The VAS-Comfort score at 72 h postoperatively was significantly higher in the experimental group ( < 0.001). For secondary outcomes, the experimental group had significantly lower NRS pain scores at 72 h postoperatively ( < 0.001), significantly higher RCSQ sleep scores (69.26 ± 9.87 vs. 59.86 ± 12.02, < 0.001), a lower incidence of pulmonary complications (9.46% vs. 23.68%, = 0.019), and significantly shorter ICU stay and postoperative hospital days (both < 0.001). There were no statistically significant differences between the two groups in the incidence of pressure ulcers or adverse events ( > 0.05). CONCLUSIONS: Individualized positioning care can significantly promote cardiac function recovery, enhance comfort, and improve clinical outcomes in patients after heart valve surgery without increasing safety risks.
Alleviating Effects of Perioperative Psychological Intervention and Distraction Therapy on Discomfort in Patients Undergoing Combined Minimally Invasive Treatment for Lower Limb Varicose Veins.
Wang Y, Zhuang Z
Ann Ital Chir · 2026 Jun · PMID 42304149 · Publisher ↗
AIM: To investigate the alleviating effects of perioperative psychological intervention combined with distraction therapy on discomfort in patients undergoing combined minimally invasive treatment for lower limb varicose...
AIM: To investigate the alleviating effects of perioperative psychological intervention combined with distraction therapy on discomfort in patients undergoing combined minimally invasive treatment for lower limb varicose veins. METHODS: In this retrospective study, 150 patients with lower limb varicose veins who underwent combined minimally invasive treatment at The Affiliated Hospital of Xuzhou Medical University from January 2023 to June 2024 were included. The patients were divided into an observation group (73 cases) and a control group (77 cases) according to the type of perioperative nursing treatments received. Both groups of patients received routine intravenous analgesics during the procedure. The control group received routine intraoperative care, while the observation group underwent perioperative psychological intervention and distraction therapy on the basis of routine care. The Visual Analog Scale (VAS) pain scores were compared between the two groups at key procedural time points, including great saphenous vein trunk closure, local vein excision, and sclerosant injection. The Self-Rating Anxiety Scale (SAS) scores at multiple time points, heart rate, blood pressure fluctuations, and postoperative patient satisfaction were evaluated and compared. RESULTS: The VAS scores at each time point in the observation group were significantly lower than those in the control group ( < 0.001). The SAS scores at the pre- and post-operatively were significantly lower in the observation group than in the control group ( < 0.05). The heart rate, systolic blood pressure, and diastolic blood pressure fluctuation during the surgery were smaller in the observation group than in the control group ( < 0.001). The patient satisfaction rate in the observation group significantly exceeded that in the control group (97.26% vs 83.12%, < 0.05). CONCLUSIONS: Perioperative psychological intervention combined with distraction therapy provides a potential strategy to alleviate preoperative anticipatory anxiety in patients with lower limb varicose veins undergoing combined minimally invasive treatment. By employing various intraoperative methods to divert patients' attention from pain, this approach may further alleviate overall discomfort. These findings suggest that this strategy is associated with favorable outcomes and may warrant further investigation for clinical application.
Clinical Application of Surgical Methods Based on Different Lung Segments and Pathological Subtypes in the Treatment of T1b Lung Adenocarcinoma.
Zhai Z, Zhu Y, Lan G … +7 more , Huang L, Gao Y, Chen P, Min Y, Chen H, Li X, Ye Y
Ann Ital Chir · 2026 Jun · PMID 42304148 · Publisher ↗
AIM: This study aimed to explore the clinical application of surgical methods based on different lung segments and pathological subtypes in the treatment of T1b lung adenocarcinoma. METHODS: A total of 207 patients with...
AIM: This study aimed to explore the clinical application of surgical methods based on different lung segments and pathological subtypes in the treatment of T1b lung adenocarcinoma. METHODS: A total of 207 patients with T1b lung adenocarcinoma admitted to the hospital between December 2019 and December 2022 were included in a retrospective analysis. According to the different surgical treatment strategies, all patients were divided into two groups: control group (n = 117) and experimental group (n = 90). The surgical methods for the control group were based on consolidation-to-tumour ratio (CTR), and the experimental group were according to lung segments and pathological subtypes. All patients were followed up for three years. Kaplan-Meier curve and Cox proportional hazard analysis were adopted to analyze the 3-year overall survival (OS) and recurrence-free survival (RFS) of two groups. RESULTS: Compared with the control group, the proportion of lobectomy, lymph node management strategy, total nodes retrieved, number of stations, blood loss and operation time in the experimental group were decreased ( < 0.05), and the forced expiratory volume in 1 second (FEV) after surgery was increased. During the 3-year follow-up, there were 15 cases of recurrence (12.82%) and 6 cases of death (5.13%) in the control group; there were 9 cases of recurrence (10.00%) and 4 cases of death (4.44%) in the experimental group. There was no significant difference in recurrence or mortality between the two groups ( > 0.05). Kaplan-Meier curves showed no significant differences in 3-year disease-free survival (DFS) rate or 3-year overall survival (OS) rate between the two groups ( = 0.456, 0.623). Cox univariate analysis showed that the risk factors affected RFS were micropapillary pathological subtype (hazard ratio (HR) = 4.125, 95% confidence interval (CI) = 1.241-13.709, = 0.021) and middle and lower lobes (HR = 2.633, 95% CI = 1.092-6.350, = 0.031). CONCLUSIONS: For T1b lung adenocarcinoma, incorporating tumor location and pathological subtype into surgical decisions may be beneficial to patient outcomes. This study may provide a reference for personalized treatment of small-sized lung cancer.
The Value of Perioperative Serum Indexes in Predicting the Risk of Intercostal Neuralgia After PVP in Postmenopausal Patients With Osteoporotic Vertebral Compression Fractures.
Chen H, Sun G
Ann Ital Chir · 2026 Jun · PMID 42304147 · Publisher ↗
AIM: Intercostal neuralgia is a clinically relevant complication after percutaneous vertebroplasty (PVP) in postmenopausal patients with osteoporotic vertebral compression fracture (OVCF), and its risk remains difficult...
AIM: Intercostal neuralgia is a clinically relevant complication after percutaneous vertebroplasty (PVP) in postmenopausal patients with osteoporotic vertebral compression fracture (OVCF), and its risk remains difficult to predict using conventional approaches. Perioperative serum markers are generally used as indicators of metabolic and nutritional status; however, their systematic association with the risk of post-PVP intercostal neuralgia has not been well established. This study aims to evaluate the predictive value of perioperative serological indicators and clinical factors for intercostal neuralgia after PVP in postmenopausal OVCF patients, to provide a reference for clinical risk stratification and individualized intervention. METHODS: A total of 122 postmenopausal OVCF patients who underwent PVP from December 2023 to June 2025 were enrolled in this single-center retrospective cohort study. According to the occurrence of postoperative intercostal neuralgia, patients were divided into the intercostal neuralgia group (52 cases) and the non-intercostal neuralgia group (70 cases). Serum indexes were collected preoperatively and on postoperative day 1. Preoperative indicators included 25-hydroxyvitamin D (25(OH)D), alkaline phosphatase (ALP), serum calcium (Ca), and serum phosphorus (P). Postoperative indicators collected on postoperative day 1 included albumin (Alb) and fasting blood glucose (Glu). Univariate and multivariate logistic regression analyses were performed to identify independent predictors, and a combined predictive model was constructed. Model discrimination was assessed using the receiver operating characteristic (ROC) curve, while calibration was evaluated using a bootstrap method for assessing the model's predictive consistency. RESULTS: Multivariate logistic regression analysis showed that elevated postoperative Glu (odds ratio [OR] = 2.25, 95% confidence interval [CI]: 1.22-4.15) was an independent risk factor for postoperative intercostal neuralgia, while higher levels of postoperative albumin (OR = 0.90, 95% CI: 0.84-0.96), preoperative 25(OH)D (OR = 0.91, 95% CI: 0.85-0.98), and bone mineral density (BMD) T-score (OR = 0.18, 95% CI: 0.05-0.59) were protective factors. Fracture location (lower thoracic) was also independently associated with neuralgia risk (OR = 0.28, 95% CI: 0.11-0.73). The area under the receiver operating characteristic curve (AUC) of the combined predictive model constructed with these five indicators was 0.82 (95% CI: 0.75-0.89). The calibration curve demonstrated good agreement between predicted and observed risk (mean absolute error = 0.048), indicating satisfactory model discrimination and calibration. CONCLUSIONS: BMD T-score, fracture location, postoperative Glu, postoperative Alb, and 25(OH)D can be used as independent predictors to predict intercostal neuralgia after PVP in postmenopausal OVCF patients. The combined model integrating BMD T-score, fracture location, postoperative Glu, postoperative Alb, and preoperative 25(OH)D demonstrates good predictive performance and may facilitate early risk stratification and individualized perioperative management of postoperative neuralgia.
Incidence and Risk Factors of Postoperative Acute Kidney Injury in Colorectal Cancer Patients With Metabolic Syndrome: A Retrospective Cohort Study.
Zha Q, Xiong K, Wei M … +1 more , Chen Y
Ann Ital Chir · 2026 Jun · PMID 42304146 · Publisher ↗
AIM: Postoperative acute kidney injury (AKI) is a serious complication commonly occurring after colorectal cancer surgery, primarily associated with prolonged hospitalization and poor prognosis. Metabolic syndrome (MetS)...
AIM: Postoperative acute kidney injury (AKI) is a serious complication commonly occurring after colorectal cancer surgery, primarily associated with prolonged hospitalization and poor prognosis. Metabolic syndrome (MetS) is accompanied by chronic inflammation, insulin resistance, and subclinical renal dysfunction-factors that could augment susceptibility to AKI in patients under surgical stress. This study aims to investigate the incidence and risk factors of postoperative AKI in colorectal cancer patients with MetS and provide a reference for perioperative risk management. METHODS: In this retrospective cohort study, 209 patients with MetS who underwent radical resection for colorectal cancer at Ezhou Central Hospital from January 2023 to December 2025 were consecutively enrolled. According to whether AKI occurred after surgery, the patients were divided into AKI group ( = 63) and non-AKI group ( = 146). Demographic data, metabolic indicators, inflammatory markers, and surgery-related variables were collected. Univariate and multivariate logistic regression analyses were conducted to identify independent risk factors of AKI, and a predictive model was constructed. The model's performance was evaluated by analyzing the area under the curve (AUC) and the calibration curve. RESULTS: Univariate analysis showed that fasting plasma glucose, 2-hour postprandial blood glucose, systolic blood pressure, diastolic blood pressure, components of metabolic syndrome, preoperative neutrophil-to-lymphocyte ratio (NLR), intraoperative blood loss, hypoalbuminemia, and intraoperative hypotension were significantly associated with AKI ( < 0.05). Multivariate analysis showed that diastolic blood pressure (odds ratio [OR] = 1.071, 95% confidence interval [CI]: 1.033-1.109), preoperative NLR (OR = 2.832, 95% CI: 1.381-5.804), intraoperative blood loss (OR = 1.040, 95% CI: 1.026-1.054), and intraoperative hypotension (OR = 3.499, 95% CI: 1.276-9.592) were independent risk factors for postoperative AKI. The AUC of the predictive model was 0.86, indicating good calibration. CONCLUSIONS: Colorectal cancer patients with MetS are at an increased risk of postoperative AKI. Elevated diastolic blood pressure, a higher preoperative NLR, increased intraoperative blood loss, and episodes of intraoperative hypotension are independent risk factors of AKI. Therefore, optimizing perioperative blood pressure control, assessing the inflammatory status, adopting more delicate surgical techniques, and ensuring vigilant hemodynamic monitoring are essential strategies to reduce the risk of AKI in these patients.
Evaluation of Critical Risk Factors and Development of a Predictive Model for Surgical Site Infection in Type 2 Diabetic Patients Undergoing Oral and Maxillofacial Surgery.
Sun T, Gong J, Zhu W … +1 more , Wu C
Ann Ital Chir · 2026 Jun · PMID 42304145 · Publisher ↗
AIM: This study aims to explore the critical risk factors associated with surgical site infection (SSI) in patients with type 2 diabetes mellitus (T2DM) undergoing oral and maxillofacial surgery, and to develop a predict...
AIM: This study aims to explore the critical risk factors associated with surgical site infection (SSI) in patients with type 2 diabetes mellitus (T2DM) undergoing oral and maxillofacial surgery, and to develop a predictive model to support early risk stratification and guide targeted preventive approaches. METHODS: This retrospective, case-control study enrolled patients with T2DM who underwent oral surgery at Nanjing Stomatological Hospital, Nanjing University between June 2022 and June 2025. A total of 110 patients who developed postoperative SSI were included in the infection group. A total of 110 patients without SSI were selected as the control group, matched 1:1 according to age and sex. Detailed demographic and clinical data, including patient history, perioperative blood glucose control levels, surgical type, oral environment, and antibiotic usage, were collected from both groups. Risk factors associated with SSI were analyzed and compared between groups, and a nomogram prediction model was developed. Internal validation was performed using 5000 bootstrap resamples, and model performance was assessed via the area under the receiver operating characteristic (ROC) curve (AUC) and calibration plots. RESULTS: Among the 110 patients who developed SSI after oral surgery, microbiological assessment identified Gram-negative bacteria as the predominant pathogens (62.73%), with Pseudomonas aeruginosa accounting for 18.18% and Klebsiella pneumoniae for 14.55% of the isolates. This was followed by Gram-positive organisms, which account for 34.55% of the pathogens, predominantly Staphylococcus aureus (10.91%). Multivariable logistic regression analysis showed that a surgical incision classified as Type II or III (vs Type I; Odds Ratio [OR] = 3.789), severe periodontal calculus in the oral environment (Grade III vs Grade I-II; OR = 4.092), poor blood glucose control (vs good; OR = 3.347), and elevated serum C‑reactive protein (CRP) levels (per unit increase; OR = 1.627) were independently associated with postoperative surgical site infection. A nomogram was constructed based on the equation: Logit (P) = 1.402 + 1.332 × (incision type) + 1.409 × (oral environment) + 1.208 × (blood glucose control) + 0.487 × (CRP). The maximum total score on the nomogram was 225 points, corresponding to a 90% predicted probability of postoperative SSI. The Hosmer-Lemeshow test (χ = 2.088, = 0.230 > 0.05) demonstrated no significant difference between the observed and predicted outcomes of the nomogram model. The nomogram demonstrated excellent predictive performance, with an AUC of 0.897 (95% Confidence Interval [CI]: 0.855 to 0.939). CONCLUSIONS: The oral environment, perioperative glycemic control, CRP levels, and surgical incision type are independent risk factors associated with postoperative SSI. Establishing a prediction model based on these factors and implementing targeted interventions can effectively reduce infection in this high-risk cohort.
Clinical Study on Nicotinic Acid for Injection as Adjuvant Therapy to Improve Microcirculatory Perfusion After Digital Replantation.
Yang Y, Zhao Y, Wang X
Ann Ital Chir · 2026 Jun · PMID 42304144 · Publisher ↗
AIM: This study aimed to evaluate the impact of injectable nicotinic acid as adjuvant therapy on microcirculatory perfusion and digit survival rate after digital replantation. METHODS: This single-center retrospective co...
AIM: This study aimed to evaluate the impact of injectable nicotinic acid as adjuvant therapy on microcirculatory perfusion and digit survival rate after digital replantation. METHODS: This single-center retrospective cohort study included 200 patients who underwent digital replantation. Based on the treatment regimen, patients were divided into two groups: the nicotinic acid group (n = 102) and the control group (n = 98). The primary outcome was the relative perfusion ratio (PU ratio), calculated by normalizing the perfusion value of the replanted digit to that of an intact and uninjured reference digit from the same patient, measured using a laser Doppler flowmeter. Secondary outcomes included the incidence of vascular crisis, digit survival rate, postoperative hospital stay, and adverse reactions. RESULTS: On postoperative day 1, the perfusion ratio did not differ between the two groups. However, on postoperative days 3, 5, and 7, the perfusion ratios in the nicotinic acid group were significantly higher than those in the control group (all < 0.001). In the nicotinic acid group, the total incidence of vascular crisis was significantly lower ( = 0.029), and the digit survival rate was significantly higher ( = 0.030), along with shorter postoperative hospital stay compared with the control group ( < 0.001). Subgroup analysis indicated that the therapeutic benefit of nicotinic acid was particularly pronounced in the subgroup with more severe "crush/avulsion" injuries. The incidence of facial flushing was higher in the nicotinic acid group ( < 0.001). CONCLUSIONS: Adjuvant use of injectable nicotinic acid, in addition to conventional therapy, was associated with improved microcirculatory perfusion, reduced incidence of vascular crisis, and increased digit survival rate. The treatment was generally well tolerated with no serious safety concerns identified. Due to the retrospective and non-randomized nature of this study, these findings should be interpreted as associations rather than definitive treatment effects.
Impact of Evidence-Based Nursing and Health Empowerment on Self-Efficacy and Cognitive Function in Lung Cancer Patients Undergoing Thoracoscopic Surgery.
Shu C, Jin C, Peng J
Ann Ital Chir · 2026 Jun · PMID 42304143 · Publisher ↗
AIM: Given the high incidence of postoperative cognitive decline and reduced self-efficacy in lung cancer patients undergoing radical thoracoscopic surgery, this study aimed to investigate the effect of evidence-based nu...
AIM: Given the high incidence of postoperative cognitive decline and reduced self-efficacy in lung cancer patients undergoing radical thoracoscopic surgery, this study aimed to investigate the effect of evidence-based nursing combined with health empowerment intervention on self-efficacy and cognitive function in this patient population. METHODS: A total of 516 patients who underwent thoracoscopic radical lung cancer surgery between February 2021 and June 2025 in The First People's Hospital of Zunyi were included. The patients were divided into an observation group (232 cases, who received evidence-based nursing combined with health empowerment intervention) and a control group (284 cases, who received conventional nursing). General data of the patients, along with their visual analogue scale (VAS) scores, forced vital capacity (FVC), maximal voluntary ventilation (MVV), forced expiratory volume in 1 second to FVC ratio (FEV1/FVC), General Self-Efficacy Scale (GSES) score, and Mini-Mental State Examination (MMSE) score, were collected. RESULTS: There was no significant difference between the two groups in terms of baseline characteristics ( > 0.05). After the intervention, the observation group achieved significantly greater improvement than the control group in terms of VAS pain scores, pulmonary function indices (FVC, MVV, FEV1/FVC), GSES scores and MMSE scores ( < 0.001). In addition, the total incidence of postoperative adverse reactions was significantly lower in the observation group than in the control group (7.76% vs. 13.73%, = 0.031). CONCLUSIONS: Evidence-based nursing combined with health empowerment intervention significantly relieves postoperative pain, promotes recovery of lung function, enhances self-efficacy and cognitive function, and reduces the incidence of postoperative adverse events.
Risk Factors for Surgical Site Infection After Open Reduction and Internal Fixation in Overweight and Obese Patients With Tibial Plateau Fractures.
Lei Q, Sun X, Ye M … +3 more , Yao Q, Zhu L, Lei Q
Ann Ital Chir · 2026 Jun · PMID 42304142 · Publisher ↗
AIM: Overweight and obese patients present unique pathophysiological characteristics that may increase the risk of surgical site infection (SSI) following orthopedic surgery. However, the specific risk factors for SSI in...
AIM: Overweight and obese patients present unique pathophysiological characteristics that may increase the risk of surgical site infection (SSI) following orthopedic surgery. However, the specific risk factors for SSI in overweight and obese patients with tibial plateau fractures remain unclear. This study aimed to identify the independent risk factors for SSI after open reduction and internal fixation (ORIF) in this high-risk population. METHODS: A total of 300 patients with tibial plateau fractures who underwent ORIF were retrospectively analyzed. Patients were divided into three groups according to body mass index (BMI): control group (BMI <25 kg/m, n = 50), overweight group (25 ≤ BMI < 30 kg/m, n = 194), and obese group (BMI ≥30 kg/m, n = 56). To evaluate the influencing factors of SSI in overweight and obese patients, those with BMI ≥25 kg/m were further classified into an infection group (n = 30) and a non-infection group (n = 220) based on postoperative infection status. All patients were followed for one year to document the occurrence of SSI. Logistic regression analysis was performed to identify the independent factors associated with SSI after ORIF in overweight and obese patients. RESULTS: A total of 31 patients developed postoperative SSI (10.33%), including 8 cases of deep SSI and 23 cases of superficial SSI. There was a significant difference in the incidence of SSI among the three groups ( = 0.042), with the overweight group exhibiting the highest incidence. Among overweight and obese patients, the proportions of open fracture, compartment syndrome, and operation time were significantly higher in the infection group than in the non-infection group ( = 0.022, 0.017, and <0.001, respectively). Multivariate logistic regression analysis showed that open fracture (odds ratio [OR] = 6.012, 95% confidence interval [CI]: 1.393-25.945, = 0.016), compartment syndrome (OR = 3.276, 95% CI: 1.151-9.322, = 0.026), and operation time >178 min (OR = 5.012, 95% CI: 1.907-13.172, = 0.001) were independent risk factors for postoperative SSI after ORIF in overweight and obese patients. CONCLUSIONS: Overweight and obese patients with tibial plateau fractures have a relatively high incidence of SSI. Open fracture, compartment syndrome, and operation time >178 min significantly increase the risks of postoperative SSI after ORIF in overweight and obese patients.
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