Annali Italiani Di Chirurgia[JOURNAL]
Sun
200 papers
Effect of Preoperative Respiratory Training on Perioperative Outcomes in Thoracic Surgery: A Systematic Review and Meta-Analysis.
Zhu Y, Du Y, Zhang M
Ann Ital Chir · 2025 Sep · PMID 40955192 · Publisher ↗
AIM: Postoperative pulmonary complications (PPCs) commonly ensue after thoracic surgery and can impair patients' recovery. This study aimed to evaluate the effectiveness of preoperative respiratory training (PRT) in vari...
AIM: Postoperative pulmonary complications (PPCs) commonly ensue after thoracic surgery and can impair patients' recovery. This study aimed to evaluate the effectiveness of preoperative respiratory training (PRT) in various perioperative outcomes in patients undergoing thoracic surgery, including pulmonary function, exercise capacity, incidence of postoperative complications, and length of hospital stay. METHODS: Randomized controlled trials (RCTs) comparing PRT with routine care, that were published in the period of 1 January 2000 to 30 June 2025, were identified through PubMed, Embase, Web of Science, and Cochrane Library. Pooled analyses were performed using RevMan 5.4.1 to calculate odds ratio (OR) or mean difference (MD) with 95% CI. RESULTS: Nine studies were included in the meta-analysis. The results revealed that PRT significantly reduces PPCs (OR = 0.31, 95% CI: 0.21 to 0.46) and improved the change in six-minute walking distance (6MWD) (MD = 20.50, 95% CI: 11.72 to 29.28). No significant effects were observed on absolute 6MWD, forced expiratory volume in one second (FEV), peak expiratory flow, or length of hospital stay. Sensitivity analysis confirmed result stability, and no substantial publication bias was found. CONCLUSIONS: PRT reduces PPCs and improves postoperative functional recovery in patients undergoing thoracic surgery. Its impact on spirometry-based pulmonary function and length of hospital stay remains uncertain. Further large-scale trials are needed to investigate the effect of integrating perioperative care into routine healthcare, especially for high-risk patients.
Incidental Discovery of Tracheal Diverticulum During Thyroidectomy: A Report of Seven Cases.
He W, Qian L, Xie R … +8 more , Gu J, Xing X, Shen D, Ding M, Xu D, Huang D, Fang J, Fei J
Ann Ital Chir · 2025 Sep · PMID 40955191 · Publisher ↗
AIM: Tracheal diverticulum, an air-filled sac typically located on the right posterolateral aspect of the trachea, has an unclear etiology. This study evaluates the clinical management and outcomes of incidentally detect...
AIM: Tracheal diverticulum, an air-filled sac typically located on the right posterolateral aspect of the trachea, has an unclear etiology. This study evaluates the clinical management and outcomes of incidentally detected tracheal diverticula in patients with papillary thyroid carcinoma, emphasizing the need for preoperative diagnosis and selective treatment. CASE PRESENTATION: Within our multi-center thyroid surgery cohort, seven cases of tracheal diverticula were incidentally discovered during thyroidectomy, with preoperative diagnosis achieved in only a subset of patients. Some tracheal diverticula were surgically excised, allowing for histopathological examination, whereas others were left in situ. All patients recovered without postoperative complications. RESULTS: Histopathological examination of the resected tracheal diverticula confirmed benign pathology. All patients, including those with untreated tracheal diverticula, remained asymptomatic during follow-up, with no tracheal abnormalities or complications observed. High-resolution computed tomography and three-dimensional reconstruction technology proved effective for the preoperative diagnosis of tracheal diverticulum. CONCLUSIONS: Routine surgical treatment is unnecessary for asymptomatic patients, with resection of tracheal diverticulum reserved for symptomatic cases. Diagnostic approaches such as high-resolution computed tomography and three-dimensional reconstruction serve as essential preoperative assessments before thyroidectomy, enabling accurate diagnosis of tracheal diverticulum.
Clinical Application and Technological Advances of Tracheal Intubation in the Lateral Position: A Narrative Review.
Wei H, Zheng X
Ann Ital Chir · 2025 Sep · PMID 40955190 · Publisher ↗
Securing an airway through tracheal intubation is crucial in clinical anesthesia and emergency medicine. However, lateral position surgeries or emergency intubation bring extra challenges, such as tricky airways, acciden...
Securing an airway through tracheal intubation is crucial in clinical anesthesia and emergency medicine. However, lateral position surgeries or emergency intubation bring extra challenges, such as tricky airways, accidental tube displacement, and complications associated with a patient's positional adjustment under anesthesia. Intubating in the lateral position effectively addresses these challenges by matching the individual's posture to the procedural demands. This review systematically examines the technical characteristics, clinical applications, method selection, equipment choice, and current innovations in lateral-position tracheal intubation. It focuses on exploring its strength in complex and specialized cases and analyzing the limitations and potential improvements in current practices. This review aims to provide healthcare professionals with comprehensive theoretical insights and practical guidance, further promoting the application and widespread adoption of tracheal intubation in the lateral position in clinical settings.
Impact of Combining Alfacalcidol With Proximal Femoral Nail Antirotation on Bone Mineral Density, Serum Bone Metabolites, and Inflammatory Markers in Elderly Patients With Osteoporotic Intertrochanteric Fractures.
Chen O, Hu Y, Xu B … +1 more , Xu W
Ann Ital Chir · 2025 Sep · PMID 40955189 · Publisher ↗
AIM: Proximal femoral nail antirotation (PFNA) fixation remains an effective surgical method in effectively managing intertrochanteric fractures in elderly patients with osteoporosis. While postoperative anti-osteoporoti...
AIM: Proximal femoral nail antirotation (PFNA) fixation remains an effective surgical method in effectively managing intertrochanteric fractures in elderly patients with osteoporosis. While postoperative anti-osteoporotic therapy is essential, only a part of the elderly patients adhere to anti-osteoporosis treatment. Therefore, this study aims to investigate the therapeutic efficacy of combining alfacalcidol (an anti-osteoporotic drug) with PFNA fixation, as well as their effects on serum bone metabolic markers and inflammatory indicators in elderly patients with osteoporotic intertrochanteric fractures. METHODS: This retrospective study recruited 140 elderly patients with osteoporosis intertrochanteric fractures who were treated at Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine, China, between January 2021 and January 2024. Patients were divided into two groups based on their treatment approach: a surgical group (n = 63, who received PFNA with routine postoperative care) and a combined group (n = 77, who received PFNA combined with alfacalcidol). Postoperatively, these patients were followed up for a six-month period. Fracture healing was comprehensively evaluated through functional assessment and X-ray imaging examination. Harris hip scores and bone mineral density (BMD) were assessed before surgery, and then again one month and six months after surgery. Furthermore, serum bone metabolic markers and inflammatory cytokines were evaluated preoperatively and then six months after surgery. RESULTS: The fracture healing time was significantly shorter in the combined group than in the surgical group (p < 0.001). Compared to the surgical group, the Harris scores in the combined group were significantly higher at one and six months postoperatively (p < 0.001, p = 0.003). Additionally, BMD in the combined group was significantly increased at six months postoperatively (p = 0.002). Serum levels of interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), interferon-γ (IFN-γ), β-Crosslaps (β-CTX), and parathyroid hormone (PTH) were significantly lower in the combined group compared to the surgical group after surgery (p < 0.001), whereas 25-hydroxyvitamin D (25-OHD) and procollagen type I C-terminal propeptide (PICP) levels were significantly higher (p < 0.001). In the surgical group, there were 4 cases of screw migration, 2 cases of delayed healing, and 1 case of venous embedding in the lower limbs. There was 1 case of infection, 2 cases of screw migration, 1 case of delayed healing, and 2 cases of venous embedding in lower limbs in the combined group. The incidence of postoperative complications was comparable between the combined group (6/77, 7.79%) and the surgical group (7/63, 11.11%) (p = 0.501). CONCLUSIONS: Alfacalcidol combined with PFNA provides superior therapeutic outcomes for elderly patients with osteoporotic intertrochanteric fractures. This treatment approach effectively reduces postoperative fracture healing time, enhances BMD, and promotes functional recovery of the hip joint. Additionally, it improves bone metabolism and alleviates inflammatory responses, thereby enhancing overall clinical outcomes.
Effect of Restrictive Blood Transfusion Strategy on Perioperative Prognosis in Elderly Orthopedic Surgery Patients With Preoperative Anemia.
Ren W, Yao J
Ann Ital Chir · 2025 Sep · PMID 40955188 · Publisher ↗
AIM: Preoperative anemia remains a common condition in elderly patients undergoing orthopedic surgery, and the choice of transfusion strategy may affect perioperative outcomes. Therefore, this study aims to investigate t...
AIM: Preoperative anemia remains a common condition in elderly patients undergoing orthopedic surgery, and the choice of transfusion strategy may affect perioperative outcomes. Therefore, this study aims to investigate the effect of a restrictive transfusion strategy on perioperative outcomes in this population. METHODS: A retrospective analysis was conducted on 782 preoperatively anemic patients (aged ≥60 years) who underwent hip replacement, knee replacement, or spine surgery at Xuanwu Hospital Capital Medical University, China, between January 2018 and June 2024. Patients were categorized into the restrictive (n = 380) and liberal (n = 402) transfusion strategy groups. Perioperative indicators included estimated blood loss, transfusion volume, length of hospital stay, as well as additional relevant variables. Primary outcomes were 30-day all-cause mortality, transfusion-related adverse reactions, and postoperative infection rates. Secondary outcomes included postoperative hemoglobin levels, readmission rates, reoperation rates, thrombosis, and cardiovascular events. RESULTS: In hip replacement and spine surgery patients, the estimated blood loss was significantly lower in the restrictive transfusion group than in the liberal transfusion group (p < 0.001), while higher in knee replacement patients (p < 0.001). The restrictive transfusion strategy reduced transfusion requirements and shortened hospital stay across all surgical types (p < 0.001). No significant difference in 30-day all-cause mortality was observed between the groups (p > 0.05). However, the restrictive transfusion group had significantly lower rates of transfusion-related adverse reactions (1.3% vs. 5.0%, p < 0.001) and infections (2.6% vs. 6.5%, p = 0.017). Additionally, transfusion strategy was identified as an independent risk factor for transfusion-related adverse reactions [odds ratio (OR) = 3.96, 95% CI: 1.468-10.682, p = 0.007)]. CONCLUSIONS: A restrictive transfusion strategy reduces transfusion volume, minimizes the incidence of transfusion-related adverse reactions and infections. This study supports individualized perioperative anemia management to optimize outcomes in elderly patients.
Impact of Risk Early Warning Management on Postoperative Rehabilitation Quality and Incidence of Delirium in Patients With Unilateral Intertrochanteric Femur Fracture.
Peng M, Wen C, Wei Y … +4 more , Zhang W, Liu Z, Zhang Y, Li S
Ann Ital Chir · 2025 Sep · PMID 40955187 · Publisher ↗
AIM: This study aims to assess the impact of risk early warning management on postoperative rehabilitation outcomes in patients with unilateral intertrochanteric femur fracture (UIFF), and to investigate the effect on th...
AIM: This study aims to assess the impact of risk early warning management on postoperative rehabilitation outcomes in patients with unilateral intertrochanteric femur fracture (UIFF), and to investigate the effect on the incidence of postoperative delirium. METHODS: This study included 284 patients with unilateral femoral intertrochanteric fracture admitted between January 2023 and December 2023. The patients received internal fixation with proximal femoral nail (PFN). Patients were divided into two groups: the experimental group (n = 142), which received risk early warning management, and the control group (n = 142), which received routine perioperative management. The coagulation function and self-care ability were evaluated in both groups before (before surgery) and after intervention (10 days after surgery). Furthermore, postoperative complication rate, hip rehabilitation quality, and satisfaction levels were comparatively analyzed between the two study groups. RESULTS: Higher fibrinogen (FBG) and lower D-dimer (D-D) were found in the experimental group compared to the control group (p < 0.05). Furthermore, the experimental group showed a significantly lower incidence of delirium, as well as improved hip rehabilitation quality and self-care ability compared to the control group (p < 0.05). Additionally, the overall satisfaction levels were substantially higher in the experimental group of patients than those observed in the control group (p < 0.05). CONCLUSIONS: Risk early warning management can enhance the coagulation function and reduce the risk of postoperative delirium in patients with UIFF. These findings will provide a more reliable safety package for the future surgical treatment of UIFF.
An Interpretable Deep Learning Framework for Preoperative Classification of Lung Adenocarcinoma on CT Scans: Advancing Surgical Decision Support.
Shi Q, Liao Y, Li J … +1 more , Huang H
Ann Ital Chir · 2025 Sep · PMID 40955186 · Publisher ↗
AIM: Lung adenocarcinoma remains a leading cause of cancer-related mortality, and the diagnostic performance of computed tomography (CT) is limited when dependent solely on human interpretation. This study aimed to devel...
AIM: Lung adenocarcinoma remains a leading cause of cancer-related mortality, and the diagnostic performance of computed tomography (CT) is limited when dependent solely on human interpretation. This study aimed to develop and evaluate an interpretable deep learning framework using an attention-enhanced Squeeze-and-Excitation Residual Network (SE-ResNet) to improve automated classification of lung adenocarcinoma from thoracic CT images. Furthermore, Gradient-weighted Class Activation Mapping (Grad-CAM) was applied to enhance model interpretability and assist in the visual localization of tumor regions. METHODS: A total of 3800 chest CT axial slices were collected from 380 subjects (190 patients with lung adenocarcinoma and 190 controls, with 10 slices extracted from each case). This dataset was used to train and evaluate the baseline ResNet50 model as well as the proposed SE-ResNet50 model. Performance was compared using accuracy, Area Under the Curve (AUC), precision, recall, and F1-score. Grad-CAM visualizations were generated to assess the alignment between the model's attention and radiologically confirmed tumor locations. RESULTS: The SE-ResNet model achieved a classification accuracy of 94% and an AUC of 0.941, significantly outperforming the baseline ResNet50, which had an 85% accuracy and an AUC of 0.854. Grad-CAM heatmaps produced from the SE-ResNet demonstrated superior localization of tumor-relevant regions, confirming the enhanced focus provided by the attention mechanism. CONCLUSIONS: The proposed SE-ResNet framework delivers high accuracy and interpretability in classifying lung adenocarcinoma from CT images. It shows considerable potential as a decision-support tool to assist radiologists in diagnosis and may serve as a valuable clinical tool with further validation.
Analysis of the Influencing Factors of Postoperative Lymphedema of Breast Cancer and the Influence of Axillary Reverse Mapping on Edema and Postoperative Quality of Life.
Zeng H, Wang X, Xiao Y … +2 more , Xie S, Zhuang C
Ann Ital Chir · 2025 Sep · PMID 40955185 · Publisher ↗
AIM: Postoperative lymphedema was a common and debilitating complication following breast cancer surgery, which significantly affects quality of life. This study analyzes the risk factors associated with lymphedema and e...
AIM: Postoperative lymphedema was a common and debilitating complication following breast cancer surgery, which significantly affects quality of life. This study analyzes the risk factors associated with lymphedema and evaluates the effectiveness of axillary reverse mapping (ARM) in reducing its incidence and improving quality of life. METHODS: For this retrospective cohort study, 232 breast cancer patients who underwent axillary dissection between January 2022 and January 2023 were recruited. Patients were classified into the lymphedema group (n = 54) and the control group (n = 178) based on edema occurrence. Influencing factors such as body mass index, surgical techniques, and adjuvant therapies were analyzed. To assess ARM's impact on lymphedema and quality of life, patients were also divided into a mapping group (n =133) and the control group (n = 99). Lymphedema stages were evaluated according to the International Lymphatic Society consensus, and quality of life was assessed using the Quality of Working Life Questionnaire for Cancer Survivors (QWLQ-CS), Breast Cancer Survivors Resilience Scale (BCRS), and Strategies Used by People to Promote Health (SUPPH) scale. RESULTS: The results showed that chemotherapy (odds ratios [OR]: 4.063; p < 0.001) and radiotherapy (OR: 3.358; p < 0.001) were significant risk factors for lymphedema. ARM was associated with a reduced risk of lymphedema (OR: 0.322, p = 0.004). A higher proportion of patients in the mapping group were classified as having Stage 0 lymphedema (86.46%) compared to the control group (63.67%). For the mapping group, the QWLQ-CS was 71.04 ± 12.31 (p = 0.041), BCRS was 23.89 ± 6.32 (p = 0.003), and SUPPH was 85.65 ± 12.57 (p = 0.001), which were significantly higher than the control group. CONCLUSIONS: Postoperative lymphedema risk in breast cancer patients is influenced by chemotherapy and radiotherapy, with ARM proving beneficial in reducing incidence and enhancing postoperative quality of life.
Impact of Nutritional Support Under Comprehensive Nursing on Gastrointestinal Function in Patients With Gastroparesis Syndrome Following Radical Gastrectomy for Gastric Cancer.
Qin Y, Xie C
Ann Ital Chir · 2025 Sep · PMID 40955184 · Publisher ↗
AIM: This study aimed to evaluate the effect of nutritional support intervention, implemented within the framework of comprehensive nursing, on gastrointestinal function and primary symptom indices in patients with gastr...
AIM: This study aimed to evaluate the effect of nutritional support intervention, implemented within the framework of comprehensive nursing, on gastrointestinal function and primary symptom indices in patients with gastroparesis syndrome following radical gastrectomy for gastric cancer. METHODS: Based on existing case records, the clinical data of 225 patients who underwent radical gastrectomy (distal gastrectomy + Billroth II anastomosis) for gastric cancer at our hospital between October 2022 and October 2024 were retrospectively analyzed. After propensity score matching (PSM) at a 1:1 ratio, 160 patients were included in the final analysis and among them, 80 cases in the observation group and 80 cases in the control group. The control group received conventional nursing care, while the observation group received nutritional support intervention within a comprehensive nursing model. Levels of gastrointestinal hormones, severity of gastroparesis symptoms, gastrointestinal function, and nursing satisfaction were compared between the two groups before and after the intervention. RESULTS: Two weeks post-intervention, the levels of motilin (MTL) and gastrin (GAS) in the observation group were significantly lower than in the control group, whereas the pepsinogen I (PG I) level was significantly higher (p < 0.05). Following two weeks of treatment, the observation group demonstrated significantly lower Gastroparesis Cardinal Symptom Index (GCSI) scores than the control group (p < 0.05). Additionally, the observation group had shorter gastric drainage duration, earlier first flatus, quicker resumption of normal eating, and faster symptom resolution compared to the control group (p < 0.05). Nursing satisfaction was significantly higher in the observation group (p < 0.05). CONCLUSIONS: Nutritional support intervention delivered through comprehensive nursing for patients with gastroparesis syndrome after radical gastrectomy for gastric cancer enhances gastric function, modulates gastrointestinal hormone levels, alleviates gastroparesis symptoms, and improves nursing satisfaction.
The Impact of Laser Surgery for Vocal Cord Cysts on Patients' Voice Acoustic Analysis Parameters and Inflammatory Response.
Chen N, Shi Z, Sun X
Ann Ital Chir · 2025 Sep · PMID 40955183 · Publisher ↗
AIM: Vocal cord cyst is a common benign proliferative lesion of the vocal cords, usually resulting from excessive use of the voice, environmental pollution, and inflammatory infections. This study aims to explore the dif...
AIM: Vocal cord cyst is a common benign proliferative lesion of the vocal cords, usually resulting from excessive use of the voice, environmental pollution, and inflammatory infections. This study aims to explore the differences in the effectiveness of carbon dioxide (CO) laser or surgical treatment for vocal cord cyst patients. METHODS: This retrospective study analyzed 81 patients with vocal cord cysts who underwent surgical treatment at Ruijin Hospital, Shanghai Jiao Tong University School of Medicine between July 2021 and July 2024. Among them, 40 patients were treated with CO laser surgery (the laser group), and 41 underwent traditional surgical treatment (the surgery group). The study compared the pre- and post-treatment voice acoustic parameters, aerodynamic parameters, levels of inflammatory factors, stress response indicators, and surgical complications between the two groups. RESULTS: Before surgery, there were no significant differences between the laser group and the surgery group regarding jitter, shimmer, harmonic-to-noise ratio (HNR), maximum phonation time (MPT), mean airflow rate, and subglottic pressure (p > 0.05). However, at 4 weeks post-surgery, the laser group showed lower values for jitter, shimmer, and mean airflow compared to the surgery group (p < 0.05), while the laser group demonstrated a longer MPT compared to the surgery group (p < 0.05). Before surgery, there were no significant differences between the laser and surgery groups regarding the levels of interleukin-6 (IL-6), interleukin-1β (IL-1β), and tumor necrosis factor-α (TNF-α) (p > 0.05). However, at 4 weeks post-surgery, the IL-1β and TNF-α levels in the laser group were lower than those in the surgery group (p < 0.05). Before surgery, there were no significant differences between the laser and surgery groups in Voice Handicap Index (VHI-10) scores and the Grade, Roughness, Breathiness, Asthenia, Strain (GRBAS) scores (p > 0.05). Moreover, the VHI-10 and GRBAS scores were lower in the laser group compared to the surgery group at 4 weeks post-surgery (p < 0.05). Additionally, the complication rates in the laser group were 12.50%, compared to 24.39% in the surgery group, indicating no significant differences (p > 0.05). CONCLUSIONS: Both CO laser and conventional surgery for treating vocal cord cysts show favorable outcomes. However, CO laser surgery offers faster recovery of vocal function and is more effective at reducing the inflammatory response.
Exploring the Physiological and Demographic Traits of Cutaneous Melanoma in the Romanian Population: A Six-Year Retrospective Cohort Study of 130 Patients.
Vasiu LS, Raducu L, Jecan CR
Ann Ital Chir · 2025 Sep · PMID 40955182 · Publisher ↗
AIM: This study evaluates the demographic and clinicopathological characteristics of patients diagnosed with cutaneous melanoma in the Romanian population. METHODS: This retrospective population-based cohort study analyz...
AIM: This study evaluates the demographic and clinicopathological characteristics of patients diagnosed with cutaneous melanoma in the Romanian population. METHODS: This retrospective population-based cohort study analyzed the histopathological parameters of primary cutaneous melanomas in 130 patients treated at the plastic surgery department of our hospital in Bucharest over a six-year period. RESULTS: The incidence of cutaneous melanoma in the cohort increased by approximately 15.6% annually, with a male predominance and a mean diagnosis age of 59.9 years. The majority (73.1%) of cases were within the 51-80 age group. Superficial spreading melanoma accounted for 52.3% of cases, followed by nodular melanoma at 35.4%. The mean Breslow index was 4.745 mm, and 35.4% of cases were diagnosed at stage T4. Spearman's rank correlation analysis demonstrated that the Breslow index was positively correlated with patient age (rho = 0.327, p < 0.001), indicating that older age is associated with higher Breslow index values. Males presented with higher tumor thickness and were diagnosed later than females, on average by a decade. CONCLUSIONS: Cutaneous melanoma remains a high-risk malignancy with significant morbidity and mortality. Patients in Romania were diagnosed with thicker tumors compared to Western populations, potentially due to limited awareness and insufficient prevention strategies. These findings underscore the urgent need to improve early detection programs and public education on melanoma in Romania.
Timing of Dietary Progression After Mandibular Fracture Repair: The Role of Comorbidities and Their Impact on Postoperative Outcomes.
Cirignaco G, Catarzi L, Monarchi G … +6 more , Petrocelli M, Committeri U, Troise S, Tel A, Vaira LA, Consorti G
Ann Ital Chir · 2025 Aug · PMID 40820635 · Publisher ↗
AIM: This retrospective study evaluated whether the timing of dietary progression after mandibular fracture repair influences postoperative complications (wound dehiscence, infection, and reoperation) and assessed how co...
AIM: This retrospective study evaluated whether the timing of dietary progression after mandibular fracture repair influences postoperative complications (wound dehiscence, infection, and reoperation) and assessed how comorbidities, specifically diabetes and chronic kidney disease (CKD), affect these outcomes. METHODS: A retrospective observational analysis was conducted of 1023 patients who underwent open reduction and internal fixation (ORIF) for mandibular fractures between 2012 and 2023. Patients were categorised into Early (<3 weeks), Standard (3 weeks), and Delayed (>4 weeks) groups according to the interval before the introduction of a solid diet. Postoperative complications were evaluated using multivariate logistic regression models adjusted for diabetes, CKD, and smoking. RESULTS: Early dietary progression was initially associated with higher rates of wound dehiscence (15.2% vs. 9.6% vs. 6.6%) and reoperation (8.2% vs. 2.0% vs. 1.6%) than the Standard and Delayed groups ( < 0.05) in univariate analysis. However, after adjusting for confounders in multivariate analysis, CKD emerged as the strongest independent predictor of wound dehiscence (odds ratio (OR) = 2.77, < 0.001), whereas the impact of early dietary advancement was no longer statistically significant (adjusted OR = 1.08, = 0.58). Multivariate analysis also identified CKD as an independent predictor of both infection and reoperation, with affected patients having an odds ratio of 3.85 for requiring reoperation ( < 0.001), highlighting the impact of systemic metabolic dysfunction on postoperative complications. Diabetes showed a borderline association with wound dehiscence, although it did not reach statistical significance (OR = 1.59, = 0.067). CONCLUSIONS: Although early reintroduction of solid foods initially appeared to increase postoperative complications, CKD was identified as the primary independent predictor of impaired wound healing when adjusting for comorbidities. Progression to a solid diet after approximately three weeks appears generally safe; however, patients with CKD or diabetes may benefit from individualised dietary protocols that minimise mechanical stress on the fracture site. Prospective studies are recommended to validate these findings and refine dietary guidelines, based on individual patient risk profiles.
The Association Between Diverticular Disease of the Colon and Colonic Polyps: A Cross-Sectional Study.
Buyukasik K, Ari A, Aghayeva T … +4 more , Ferlengez E, Degerli MS, Akay O, Guler M
Ann Ital Chir · 2025 Aug · PMID 40820634 · Publisher ↗
AIM: This study aimed to evaluate the relationship between colonic diverticular disease (CD) and colonic polyps (CP) in Turkiye, considering age and gender distribution. METHODS: This retrospective cross-sectional study...
AIM: This study aimed to evaluate the relationship between colonic diverticular disease (CD) and colonic polyps (CP) in Turkiye, considering age and gender distribution. METHODS: This retrospective cross-sectional study analyzed patients who underwent total colonoscopy between 1 January 2021, and 1 January 2022. Patients with a history of colon resection, inflammatory bowel disease, or prior polypectomy were excluded. The presence of CD and CP was assessed according to age, gender, and colonic localization [right (R), left (L), bilateral (B)]. RESULTS: A total of 452 patients were included, with 248 (54.9%) males and 204 (45.1%) females. The mean age was 57.7 ± 13.0 years. Among them, 235 were in the patient group [CD (+) and/or CP (+)], and 217 were in the control group. The study found a significant association between CD and CP, particularly among older patients, with rates of CD (+) and CP (+) increasing with age ( = 0.001). Interestingly, CD (+) patients had a lower risk of CP compared to CD (-) patients ( = 0.003). Additionally, male patients exhibited significantly higher CP rates than females. CONCLUSIONS: Our findings indicate that CD (+) patients have a significantly lower risk of CP (+) compared to CD (-) patients. These results provide valuable insights into the relationship between CD and CP, which may help guide future research.
Machine Learning Models for Predicting In-Hospital Mortality in Burn Patients.
Şahin S, Yavuz B, Karaca O … +2 more , Akın M, Akgün AE
Ann Ital Chir · 2025 Aug · PMID 40820633 · Publisher ↗
AIM: To develop and evaluate predictive models for in-hospital mortality in burn patients using machine learning (ML) techniques. METHODS: A retrospective cohort study was conducted using data from burn patients admitted...
AIM: To develop and evaluate predictive models for in-hospital mortality in burn patients using machine learning (ML) techniques. METHODS: A retrospective cohort study was conducted using data from burn patients admitted to Ankara Bilkent City Hospital Burn Treatment Center between 2015 and 2020. Key variables including age, gender, total body surface area burned, burn depth, burn type, inhalation injury, inflammatory markers and inflammatory indexes were collected. Seven ML models-Logistic Regression, Random Forest, Support Vector Machine, Decision Tree, K-Nearest Neighbors, Naive Bayes, and Gradient Boosting-were trained and evaluated. RESULTS: The cohort included 218 patients (mean age 42.5 ± 18.5 years; 69.7% male, 30.3% female), with an in-hospital mortality rate of 18.8% (n = 41). Logistic Regression had the best performance (accuracy: 88.6%, Receiver Operating Characteristic (ROC)-Area Under Curve (AUC): 0.906), while Random Forest achieved the highest accuracy (90.9%) and recall (97.2%). K-Nearest Neighbors excelled in recall (99.0%), Gradient Boosting balanced precision and recall (91.6% each, ROC-AUC: 0.744), and Support Vector Machine showed moderate results (accuracy: 84.0%, ROC-AUC: 0.864). CONCLUSIONS: ML models, particularly Logistic Regression and Random Forest, demonstrated strong predictive capabilities for mortality in burn patients. This study supports the potential for ML in burn care, offering a data-driven approach for personalized prognosis and clinical decision-making. Further multicenter validation is recommended.
Medial-to-lateral vs. Lateral-to-medial: Determining the Optimal Approach in Laparoscopic Right Hemicolectomy-A Cohort Study.
Chai H, Shen Z, Jiang S … +2 more , Li Y, Qian J
Ann Ital Chir · 2025 Aug · PMID 40820632 · Publisher ↗
AIM: To check the immediate and distant results of medial-to-lateral (ML) and lateral-to-medial (LM) methods to laparoscopic right hemicolectomy. METHODS: The present study is a retrospective cohort analysis of 453 lapar...
AIM: To check the immediate and distant results of medial-to-lateral (ML) and lateral-to-medial (LM) methods to laparoscopic right hemicolectomy. METHODS: The present study is a retrospective cohort analysis of 453 laparoscopic right hemicolectomy procedures performed between 2018 and 2024 at a single Chinese tertiary care hospital, comparing LM and ML techniques. Rates of conversion, complications, lymph node yield, and survival were the main results. Operating room conditions and recovery measures served as secondary outcomes. Kaplan-Meier techniques were utilized for survival analysis, and propensity score matching was employed to reduce bias in selection. RESULTS: Among 453 patients (mean [SD] age, 60 [12] years; 294 men [65%]), 289 (64%) underwent the ML approach. The ML technique exhibited significantly reduced conversion rates (11% vs. 63%; < 0.001), fewer Grade III-IV complications (4.8% vs. 68%; < 0.001), and a lower lymph node yield (32.5% vs. 67.5% reaching ≥12 nodes; = 0.001). Survival outcomes improved with the ML approach: overall survival (hazard ratio [HR], 0.76; 95% confidence interval [CI], 0.62-0.93; = 0.008) and disease-free survival (HR, 0.71; 95% CI, 0.58-0.87; = 0.001). Following propensity score matching, the LM method (n = 164) showed higher operative success (70.9% vs. 29.1%; adjusted odds ratio [aOR], 2.14; 95% CI, 1.56-2.94; < 0.001) and LM showed reduced major complications (9.8% vs. 90.2%; adjusted OR, 0.52; 95% CI, 0.38-0.71; < 0.001) compared to the ML approach. CONCLUSIONS: The ML approach in laparoscopic right hemicolectomy shows superior oncological outcomes and survival pre-matching, while LM excels in operative success and recovery post-matching. ML is preferred when feasible, but further validation is needed.
Sandwich Technique for Iliac Aneurysm Rupture After Treatment of Iatrogenic Type B Aortic Dissection: A Case Report.
Cangiano R, Ascione M, Di Girolamo A … +5 more , Miceli F, Grimaldi S, Molinari A, Di Marzo L, Mansour W
Ann Ital Chir · 2025 Aug · PMID 40820631 · Publisher ↗
AIM: Type B iatrogenic acute aortic dissection (IAAD) is a rare complication of diagnostic or interventional cardiac procedures. The STent Assisted Balloon Induced intimaL dISruption and rElamination in aortic dissection...
AIM: Type B iatrogenic acute aortic dissection (IAAD) is a rare complication of diagnostic or interventional cardiac procedures. The STent Assisted Balloon Induced intimaL dISruption and rElamination in aortic dissection repair (STABILISE) technique is being increasingly used for the treatment of complicated aortic dissections. However, hemodynamic changes and the pre-existence of aneurysmal arteries could lead to "unexpected" complications. CASE PRESENTATION: This case report shows how rescue techniques can be employed in response to such challenging handling situations, especially in emergency settings. We describe the case of a patient with bilateral common iliac artery (CIA) aneurysm subjected to coronary angiography followed by iatrogenic type B acute aortic dissection (TBAAD), treated with the STABILISE technique, further complicated with left iliac aneurysm rupture on the 9th postoperative day. During aortic bifurcated endograft deployment, the contralateral gate opened into the false lumen (FL), and it was impossible to re-enter the true lumen (TL). RESULTS: As a rescue solution, an iliac extension was deployed parallel to the main body, using the sandwich technique, extending to the external iliac artery. Before deployment, the left hypogastric artery was embolized with coils. Despite the false lumen of the right iliac aneurysm being perfused by the patent contralateral leg, the ruptured aneurysm was excluded. At a later stage, the right hypogastric artery was embolized with several coils, and the gate was embolized using an Amplatzer™ Vascular Plug. CONCLUSIONS: In complex cases, especially with dissections, the unexpected is around the corner. The use of off-the-shelf devices, knowledge of rescue techniques as Parallel Graft Technique (PGT) and experience in applying them can resolve situations that might otherwise be disastrous.
Chondrosarcoma of the Petrous Apex and Posterior Fossa: A Case Report and Literature Overview of a Combined Approach to Resection.
Natour A, Najera E, DeDio R … +4 more , Mukherjee A, Hagog Natour H, Jean W, Samy R
Ann Ital Chir · 2025 Aug · PMID 40820630 · Publisher ↗
AIM: In this study, we aimed to provide our initial experience with a novel combined approach resection of chondrosarcomas of the skull base and petrous apex (ChPA) and posterior cranial fossa by employing middle cranial...
AIM: In this study, we aimed to provide our initial experience with a novel combined approach resection of chondrosarcomas of the skull base and petrous apex (ChPA) and posterior cranial fossa by employing middle cranial fossa and retrosigmoid (RS) approaches with an augmented reality and virtual reality (AR/VR) system. CASE PRESENTATION: A 66-year-old female patient was referred to our department owing to the growth of a left petrous apex lesion noted in computed tomography (CT) and magnetic resonance imaging (MRI) scans 10 years earlier. Her symptoms included headache, imbalance, and left-sided hearing loss. The lesion was resected via a combined extended middle cranial fossa (xMCF) and RS approach, gross total resection (GTR) and preservation of hearing and facial nerve function. The tumor was World Health Organization (WHO) Grade II, extending from the left petrous apex (PA) to the posterior fossa, cerebellopontine angle (CPA), and internal auditory canal (IAC). We also performed a systematic literature review of chondrosarcomas involving the skull base. RESULTS: The patient tolerated the procedure well and was discharged without complications or neurological deficits on postoperative day 6 with normal facial nerve function and stable hearing as observed prior to surgery. CONCLUSIONS: Preoperative planning for the surgical approach must be carefully evaluated and individualized for each patient while considering the experience of the surgical team. GTR remains the preferred treatment for ChPA, preferably via an approach capable of preserving the facial nerve and hearing function. The xMCF approach, along with the RS approach for petrous apex lesions extending to the posterior cranial fossa/CPA with reconstruction of the skull base, appears to be a safe approach.
Intertwining Coil and Catheter During Brain Arterial-Venous Malformation Embolization: A Case Report of a Rare Complication.
Basile N, Panagrosso M, Capoccia L … +4 more , Cavallo E, Turchino D, Giudice G, Bracale UM
Ann Ital Chir · 2025 Aug · PMID 40820629 · Publisher ↗
Cerebral arteriovenous malformations (AVMs) are rare vascular anomalies associated with a risk of devastating intracerebral hemorrhage. They are often diagnosed following the appearance of seizures, focal neurological si...
Cerebral arteriovenous malformations (AVMs) are rare vascular anomalies associated with a risk of devastating intracerebral hemorrhage. They are often diagnosed following the appearance of seizures, focal neurological signs, or bleeding. In such cases endovascular embolization, which aims to occlude the AVM nidus and reduce risk of hemorrhage, has become a crucial therapeutic approach. Herein, we describe the case of a 62-year-old patient with a history of bleeding caused by cerebral AVM. During urgent endovascular embolization of the patient's AVM, a combination of large-caliber platinum coils and Onyx™ liquid embolic agent was used to achieve hemostasis after catheterizing a primary feeder. However, when the catheter was being pulled back, the proximal part of the coil migrated and became entangled with the catheter, thus remaining partially in the AVM and partially elongated in the access vessel thereby impeding the catheter from being completely removed from the percutaneous access. Surgical access with repair of the axillary artery was necessary to remove the catheter trapped in the coil. The successful outcome of this case demonstrates the importance of early recognition, timely intervention, and multidisciplinary team collaboration in managing AVM complications during neurovascular procedures to optimize patient outcomes.
A Comparative Study on Clinical Features, Surgical Outcomes, and Postoperative Complications in Pituitary Apoplexy vs. Non-Apoplexy Patients.
Li X, Zheng X, Jiang Z … +2 more , Shao D, Li Y
Ann Ital Chir · 2025 Aug · PMID 40820628 · Publisher ↗
AIM: To explore the differences in clinical features between patients with pituitary apoplexy and those without, analyze the risk factors for pituitary apoplexy, evaluate the incidence of postoperative complications betw...
AIM: To explore the differences in clinical features between patients with pituitary apoplexy and those without, analyze the risk factors for pituitary apoplexy, evaluate the incidence of postoperative complications between patients with pituitary apoplexy and those without, and investigate the risk factors for postoperative complications to provide clinical guidance for diagnosis and treatment. METHODS: In this retrospective analysis, clinical data of 108 pituitary tumor patients admitted between January 2020 and July 2024 were collected. The patients were divided into two groups: the pituitary apoplexy group ( = 50) and the pituitary non-apoplexy group ( = 58). Baseline data, surgical outcomes, and postoperative complications were compared between the two groups. Multivariate logistic regression analysis was performed to identify the risk factors for pituitary apoplexy and postoperative complications. RESULTS: Multivariate logistic regression analysis revealed that tumor size (odds ratio [OR] = 1.064, 95% confidence interval [CI]: 1.010-1.120, < 0.05) and hypertension (OR = 5.552, 95% CI: 1.660-18.572, < 0.05) were independent risk factors for pituitary apoplexy. The incidence of postoperative pituitary dysfunction and the average length of hospital stay were higher in the apoplexy group than in the non-apoplexy group ( < 0.05). Multivariate logistic regression analysis showed that tumor size (OR = 1.142, 95% CI: 1.061-1.229, < 0.05) and preoperative hypothyroidism (OR = 12.002, 95% CI: 1.129-127.648, < 0.05) were identified as independent risk factors for postoperative complications in pituitary tumor patients. CONCLUSIONS: The occurrence of pituitary apoplexy is closely related to tumor size and hypertension. Patients with apoplexy face a higher risk of postoperative pituitary dysfunction and experience a longer hospital stay compared to the non-apoplexy patients. Postoperative complications are associated with tumor size and preoperative hypothyroidism.
Albumin-Bilirubin and Severity as Key Factors of Recovery in Patients With PA-HSOS Undergoing Transjugular Intrahepatic Portosystemic Shunt.
Dai J, Yang X, Hu X … +5 more , Deng Y, Lu J, Wang J, Li G, Hong J
Ann Ital Chir · 2025 Aug · PMID 40820627 · Publisher ↗
AIM: To evaluate the safety and efficacy of transjugular intrahepatic portosystemic shunt (TIPS) in the management of pyrrolizidine alkaloid-related hepatic sinusoidal obstruction syndrome (PA-HSOS) and to identify key f...
AIM: To evaluate the safety and efficacy of transjugular intrahepatic portosystemic shunt (TIPS) in the management of pyrrolizidine alkaloid-related hepatic sinusoidal obstruction syndrome (PA-HSOS) and to identify key factors influencing the recovery of liver imaging manifestation after TIPS procedure in PA-HSOS patients. METHODS: A retrospective review was conducted of 30 PA-HSOS patients who received TIPS at Jinhua Municipal Central Hospital between 1 January 2018, and 30 September 2021, following failure of anticoagulation-based comprehensive treatments. Baseline characteristics and follow-up data were collected, including clinical manifestations, laboratory test results, computed tomography (CT) radiological manifestations of the liver, hepatic venous pressure gradient (HVPG), survival, and complications. Laboratory tests before and after TIPS were compared, and multiple linear regression was used to analyze factors associated with the recovery time of liver CT radiological manifestations. RESULTS: TIPS was successfully performed in all 30 patients, with no procedure-related adverse events. All patients survived the follow-up period. The portal pressure gradient (PPG) significantly reduced from 22.65 ± 6.36 mmHg to 9.40 ± 3.38 mmHg ( < 0.001). The median time to complete ascites remission was 52 days (range: 29-161 days). The median recovery time for liver CT radiological manifestations was 196.5 days (range: 165-229 days). Disease severity and albumin-bilirubin (ALBI) grade were significant factors influencing the recovery time of liver CT radiological manifestations ( = 0.666, = 0.007). Patients with ALBI grade 2 had a significantly shorter recovery time of liver CT radiological manifestations compared to those with ALBI grade 3 (170.44 ± 50.56 days 224.83 ± 46.67 days, = 0.006). Similarly, patients with severe or very severe disease had longer recovery times than those with mild or moderate diseases (218.25 ± 41.60 days 162.43 ± 55.11 days, = 0.004). CONCLUSIONS: TIPS is a safe and effective treatment for PA-HSOS. Disease severity and ALBI grade are key factors in estimating the recovery time of liver CT radiological manifestations in patients with PA-HSOS.
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