Annali Italiani Di Chirurgia[JOURNAL]
Sun
200 papers
Predictive Value of Early Postoperative CT Imaging Parameters for Major Complications Following Thoracoscopic Segmentectomy.
Jiang W, Zhang M, Zhang D
Ann Ital Chir · 2026 Jun · PMID 42304141 · Publisher ↗
AIM: This study aimed to systematically evaluate the independent predictive value and diagnostic performance of quantitative indices derived from early postoperative computed tomography (CT) imaging for predicting major...
AIM: This study aimed to systematically evaluate the independent predictive value and diagnostic performance of quantitative indices derived from early postoperative computed tomography (CT) imaging for predicting major complications (Clavien-Dindo grade ≥II) within 30 days after pulmonary segmentectomy. METHODS: A total of 231 patients who underwent Video-Assisted Thoracoscopic Surgery (VATS) segmentectomy were retrospectively enrolled. On CT images obtained within 2-3 days postoperatively, the depth of pleural effusion, pneumothorax rate, lung re-expansion ratio, and maximum subcutaneous air thickness were measured. The primary outcome was the occurrence of Clavien-Dindo grade ≥II complications within 30 days. Univariate and multivariate logistic regression analyses were performed, and predictive performance was evaluated using the area under the curve (AUC). RESULTS: Major complications occurred in 42 patients (18.2%). Multivariate analysis identified depth of pleural effusion (odds ratio [OR] = 1.213, 95% confidence interval [CI]: 1.107-1.329, < 0.001), pneumothorax rate (OR = 1.201, 95% CI: 1.081-1.333, < 0.001), lung re-expansion ratio (OR = 0.872, 95% CI: 0.809-0.940, < 0.001), and maximum subcutaneous air thickness (OR = 1.438, 95% CI: 1.248-1.656, < 0.001) as independent predictors. Receiver operating characteristic (ROC) analysis demonstrated that maximum subcutaneous air thickness had the highest predictive performance (AUC = 0.850), followed by pneumothorax rate (AUC = 0.831), lung re-expansion ratio (AUC = 0.785), and depth of pleural effusion (AUC = 0.783). CONCLUSIONS: Quantitative indices derived from early postoperative CT scans may serve as reliable imaging biomarkers for predicting major complications after pulmonary segmentectomy, thereby facilitating early identification of high-risk patients and guiding individualized postoperative management.
Bioprinting Techniques for Creating Patient-specific Implants in Treating Craniofacial Disorders-A Systematic Review.
Mathew VB, Shamsuddin S, Sainudeen S … +6 more , Khalil AA, Marrapodi MM, Uzunçıbuk H, Russo D, Cicciù M, Minervini G
Ann Ital Chir · 2026 Apr · PMID 42136182 · Publisher ↗
AIM: Craniofacial disorders are complex and debilitating conditions that require personalized treatment approaches. Various technologies in the field of bioprinting have developed into promising methods for the productio...
AIM: Craniofacial disorders are complex and debilitating conditions that require personalized treatment approaches. Various technologies in the field of bioprinting have developed into promising methods for the production of patient-specific implants for the aforementioned disorders. This review evaluates the ability of the bioprinting methods used to produce patient-specific implants for improved patient outcomes. METHODS: A comprehensive search strategy was designed to gather pertinent research from databases of PubMed, Scopus, Web of science, Cochrane Library, Embase, ProQuest and Science Direct, published till July 2024. The search approach was developed by mixing Boolean operators, Medical Subject Heading (MeSH) terms, and free-form terms to guarantee an exhaustive and accurate search. RESULTS: After a thorough screening process for duplicates and compliance with eligibility criteria, seven studies met our exacting inclusion criteria, out of the initial 312 studies. The collective findings of the studies demonstrated the efficacy and feasibility of bioprinting techniques in creating patient-specific implants for craniofacial disorders. The studies were grouped into three categories based on their similarities and dissimilarities, highlighting the high success rates and low complication rates of bioprinting techniques in craniofacial reconstruction, the feasibility and effectiveness of bioprinting techniques in specific craniofacial applications, and the use of custom-made implants as a successful treatment option. Majority (five out of seven) reporting a 100% success rate, minor complication rates averaging less than 5%, and patient satisfaction rates over 90% across a range of craniofacial applications, the reviewed studies collectively showed the excellent efficacy of bioprinting techniques. CONCLUSIONS: The synthesised evidence from the seven studies included for the review concluded that bioprinting methods were efficient in producing custom or individual specific implants for craniofacial disabilities. Though the results are promising, multicentric, prospective studies are needed to validate long term outcomes.
De-Escalating Thyroid Cancer Surgery: Insights and Unresolved Questions From the 2025 ATA Guidelines.
Medas F, Canu GL, Cappellacci F … +4 more , Lanzolla G, Corrias S, Boi F, Calò PG
Ann Ital Chir · 2026 Apr · PMID 42136181 · Publisher ↗
Abstract loading — click title to view on PubMed.
Association Between Preoperative Systemic Inflammatory Indices and Visual Outcomes After Cataract Surgery.
Xu G, Zhang Y, Yuan Y … +4 more , Zeng L, Wang X, Pan X, Ye P
Ann Ital Chir · 2026 May · PMID 42136180 · Publisher ↗
AIM: To evaluate the association between preoperative systemic inflammatory indices (systemic immune-inflammation index [SII], systemic inflammation response index [SIRI], and aggregate index of systemic inflammation [AI...
AIM: To evaluate the association between preoperative systemic inflammatory indices (systemic immune-inflammation index [SII], systemic inflammation response index [SIRI], and aggregate index of systemic inflammation [AISI]) and poor visual outcomes following cataract surgery. METHODS: This retrospective study included 240 patients who underwent cataract surgery between April 2022 and June 2025. SII, SIRI, and AISI were calculated from complete blood counts obtained within 7 days preoperatively. Poor visual outcome at 4 weeks postoperatively was analyzed using multivariable logistic regression and restricted cubic spline models, with adjustment for potential confounders. RESULTS: The mean age was 69 years, and 67.1% of participants were female. SII demonstrated a nonlinear association with poor postoperative visual outcomes ( for nonlinearity = 0.029), with increased odds observed at SII values of 500-1000 and at extremely low levels. Compared with the lowest tertile, the highest SII tertile was associated with a significantly increased risk (adjusted odds ratio [OR] 2.790, 95% confidence interval [CI] 1.209-6.615; = 0.018). After adjustment for sex, body mass index (BMI), and intraocular pressure, SIRI (tertile 3 vs. tertile 1: OR 2.019, 95% CI 1.035-3.997; = 0.041) and AISI (tertile 2 vs. tertile 1: OR 1.977, 95% CI 1.017-3.898; = 0.046) were also associated with poor visual outcomes. In multivariable analyses, SII and AISI remained independently associated with poor postoperative vision (OR 2.790, 95% CI 1.209-6.615; = 0.018; OR 2.104, 95% CI 1.016-4.432; = 0.047). CONCLUSIONS: Preoperative SII, SIRI, and AISI were significantly associated with worse short-term visual outcomes after cataract surgery. These indices, particularly SII and AISI, may provide clinically useful information for perioperative risk stratification. Further prospective validation studies and investigation of targeted anti-inflammatory strategies are warranted.
Emergency Laparoscopic Surgery: A Call to Action.
Yiasemidou M
Ann Ital Chir · 2026 May · PMID 42136179 · Publisher ↗
Abstract loading — click title to view on PubMed.
Abdominal Hematoma After IPOM Repair of an Incisional Hernia Mimicking a Recurrence: A Case Report on the Role of Diagnostic Laparoscopy.
Rizza V, Barbonetti A, Ciarrocchi A … +1 more , Pietroletti R
Ann Ital Chir · 2026 May · PMID 42136178 · Publisher ↗
AIM: Incisional hernia (IH) and especially postoperative recurrences of IH persist as a common and extremely costly problem to treat and manage. In case of suspected recurrence, radiological studies are frequently mislea...
AIM: Incisional hernia (IH) and especially postoperative recurrences of IH persist as a common and extremely costly problem to treat and manage. In case of suspected recurrence, radiological studies are frequently misleading and/or inconclusive. With our case report, we aim to define the diagnostic and therapeutic role of a diagnostic laparoscopic approach. CASE PRESENTATION: We report a case of a pseudo-recurrence of a ventral IH in a patient who had undergone IH Intraperitoneal Onlay Mesh (IPOM) repair. Recurrent IH was suspected due to the occurrence of an abdominal bulge and the findings of the abdominal wall Computed Tomography (CT) scan. CT showed an abdominal wall mass over the fascia containing a fluid-air level at the site of the mesh, highly suggestive of recurrent IH with bowel loop entrapment. At diagnostic laparoscopy, the prosthesis was shown to be well-positioned and no recurrent IH was detected. Conversely, a subcutaneous encapsulated hematoma was identified at the abdominal incision over the bulge. RESULTS: The patient experienced a fast and smooth postoperative recovery and was discharged symptom-free in good general conditions. CONCLUSIONS: In cases of suspected recurrent IH and in the presence of inconclusive imaging studies, diagnostic laparoscopy can play an important role, ensuring a minimally invasive approach and avoiding overtreatment.
Indications, Technical Advantages, and Debatable Aspects of Laparoscopic Appendectomy: A Comprehensive Review.
Basile G, Vacante M, Evola FR … +4 more , Romano L, Barchitta M, Musumeci G, Evola G
Ann Ital Chir · 2026 May · PMID 42136177 · Publisher ↗
Laparoscopic appendectomy has emerged as the preferred surgical approach for treating acute appendicitis, one of the most common abdominal emergencies. This review explores the key indications, technical benefits and ong...
Laparoscopic appendectomy has emerged as the preferred surgical approach for treating acute appendicitis, one of the most common abdominal emergencies. This review explores the key indications, technical benefits and ongoing controversies surrounding laparoscopic appendectomy. While diagnosing acute appendicitis is typically straightforward, atypical presentations due to variable appendix locations can complicate management. Advances in imaging and scoring systems have improved diagnostic accuracy, yet timely surgical intervention remains crucial. Compared to open appendectomy, laparoscopic appendectomy offers several advantages, including reduced postoperative pain, a shorter hospital stay, quicker recovery and better cosmetic outcomes. However, concerns persist regarding intra-abdominal abscess formation, operative time, and cost effectiveness, particularly in complicated or atypical cases. Additionally, debates continue on whether to remove a macroscopically normal appendix and the appropriateness of laparoscopic appendectomy in certain patient populations. This review synthesizes the current evidence to clarify the evolving role of laparoscopic appendectomy in managing both routine and complex cases of acute appendicitis.
Present Status of Discharge Readiness and Its Influencing Factors in Individuals Receiving Surgery for Pancreatic Cancer: A Cross-Sectional Study.
Chen J, Shi X, Bian L … +1 more , Li H
Ann Ital Chir · 2026 May · PMID 42136176 · Publisher ↗
AIM: To ascertain the present status of readiness for hospital discharge (RHD) in individuals after pancreatic cancer (PC) surgery and clarify its influencing factors, providing a reference for formulating an interventio...
AIM: To ascertain the present status of readiness for hospital discharge (RHD) in individuals after pancreatic cancer (PC) surgery and clarify its influencing factors, providing a reference for formulating an intervention program for RHD in these patients. METHODS: The current cross-sectional research employed a convenience sampling method. The study selected patients who underwent PC resection at a tertiary hospital from January 2024 to July 2024. Data were collected using general demographic questionnaires, the Readiness for Hospital Discharge Scale (RHDS), the Quality of Discharge Teaching Scale (QDTS), the Social Support Rating Scale (SSRS), and the Chinese version of the simplified Connor-Davidson Resilience Scale-10 (CD-RISC10). The data were analysed using descriptive statistics and multivariate linear regression. The influencing factors of RHD were then elucidated. RESULTS: 122 PC patients receiving surgery were enrolled, with a mean postoperative RHDS score of (90.84 ± 13.80). The RHDS score of expected support was the highest, followed by adaptability and personal status. Multivariate linear regression analysis revealed that gender, discharge with tubes, social support, discharge guidance quality, and psychological resilience were independent influencing factors for RHD ( < 0.05). CONCLUSIONS: Healthcare professionals should pay particular attention to female patients, those discharged with tubes, those with weak social support, and those with low psychological resilience. During hospitalization, diversified health education methods should be employed to enhance the content that patients receive, improve guidance skills, and ultimately increase RHD, thereby improving the patients' quality of life.
Efficacy and Safety of Small-Caliber Disposable Digital Cholangioscope-Assisted Endoscopic Retrograde Appendicitis Therapy in Acute Uncomplicated Appendicitis.
Tang W, Huang M, Yang Q … +2 more , Yu G, Lei J
Ann Ital Chir · 2026 May · PMID 42136175 · Publisher ↗
AIM: To compare perioperative outcomes and short-term safety of endoscopic retrograde appendicitis therapy (ERAT) assisted by a single-use small-caliber digital cholangioscope (digital cholangioscope) and laparoscopic ap...
AIM: To compare perioperative outcomes and short-term safety of endoscopic retrograde appendicitis therapy (ERAT) assisted by a single-use small-caliber digital cholangioscope (digital cholangioscope) and laparoscopic appendectomy (LA) in patients with acute uncomplicated appendicitis. This study utilized a direct-vision technique in which a digital cholangioscope was advanced over a guidewire through the colonoscope working channel into the appendiceal lumen, enabling intraluminal evaluation and intervention under direct visualization. METHODS: A total of 60 patients with acute uncomplicated appendicitis treated at Hangzhou Ninth Hospital between January 2023 and December 2024 were retrospectively included and allocated, based on the actual treatment received, to an ERAT group (n = 32) or an LA group (n = 28). In the ERAT group, a digital cholangioscope was advanced over a guidewire through the colonoscope working channel into the appendiceal lumen, and intraluminal evaluation and treatment were performed under direct vision. Perioperative outcomes, inflammatory and pain-related parameters within 48 h postoperatively, and in-hospital complications were compared between the groups. Continuous perioperative outcomes were analyzed using multivariable linear regression, adjusted for prespecified covariates, whereas in-hospital complications were compared using a two-sided Fisher's exact test. RESULTS: Compared with the LA group, the ERAT group demonstrated shorter operative time, reduced intraoperative blood loss, shorter postoperative bed rest, and a shorter length of hospital stay (all < 0.001). Total in-hospital costs were significantly higher in the ERAT group than in the LA group ( < 0.001). At 48 hours postoperatively, levels of inflammatory markers (interleukin-6 [IL-6], tumor necrosis factor-α [TNF-α], C-reactive protein [CRP], and procalcitonin [PCT]) and pain-related mediators (dopamine [DA], substance P [SP], 5-hydroxytryptamine [5-HT], and prostaglandin E2 [PGE]) were significantly lower in the ERAT group than in the LA group (all < 0.05). A lower crude in-hospital complication rate was observed in the ERAT group than in the LA group (two-sided Fisher's exact < 0.05). CONCLUSIONS: In this single-center retrospective cohort study of patients with acute uncomplicated appendicitis, digital cholangioscope-assisted ERAT was associated with improved perioperative recovery and reduced short-term inflammatory and pain responses compared with LA, without evidence of an increased in-hospital complication rate. These findings suggest that ERAT may represent a feasible appendiceal-preserving minimally invasive treatment option. However, given the retrospective, non-randomized design, the results should be interpreted cautiously as associative rather than causal.
Effect of Arthroscopic Rotator Cuff Repair Combined With Different Long Head of the Biceps Tendon Fixation Techniques on Postoperative Clinical Outcomes and Shoulder Function.
Guan J, Chen Y, Ye J … +3 more , Hu G, Ma H, Zhu L
Ann Ital Chir · 2026 May · PMID 42136174 · Publisher ↗
AIM: Rotator cuff tears and long head of the biceps tendon (LHBT) injuries are primary causes of shoulder pain. During rotator cuff repair, concurrent LHBT injuries are frequently identified. Surgical management of LHBT...
AIM: Rotator cuff tears and long head of the biceps tendon (LHBT) injuries are primary causes of shoulder pain. During rotator cuff repair, concurrent LHBT injuries are frequently identified. Surgical management of LHBT injuries can effectively relieve pain and improve shoulder function. Two commonly used surgical approaches for LHBT repair are interference screw compression fixation and suture anchor ligation fixation. However, no definitive conclusion has been reached regarding which technique yields superior clinical outcomes. This study compared the efficacy of arthroscopic rotator cuff repair combined with different LHBT fixation techniques in treating repairable rotator cuff tears with LHBT injuries and evaluated their impact on shoulder joint function. METHODS: This retrospective study analyzed clinical data from 112 patients with rotator cuff tears and LHBT injuries who underwent arthroscopic rotator cuff repair at the Department of Orthopedics of Xiaoshan Affiliated Hospital of Wenzhou Medical University. Patients were allocated into two groups based on the LHBT fixation method: interference screw tenodesis group (n = 54) and suture anchor tenodesis group (n = 58). Functional outcomes were evaluated using the Constant-Murley shoulder function score, University of California at Los Angeles (UCLA) shoulder score, and visual analogue scale (VAS) at preoperative baseline and at 3, 6, and 12 months postoperatively. The incidence of postoperative complications was also compared between the two groups. RESULTS: In both the interference screw tenodesis group and the suture anchor tenodesis group, VAS scores at all postoperative time points were significantly lower than preoperative values, while Constant-Murley and UCLA scores were significantly higher than baseline (all < 0.008). Both groups showed a progressive improvement over time (scores at 6 and 12 months were significantly better than at 3 months, and scores at 12 months were better than at 6 months; all < 0.008). Between-group comparisons showed that VAS scores in the suture anchor tenodesis group at 3, 6, and 12 months post-operatively were significantly lower than those in the interference screw tenodesis group ( < 0.05). Additionally, the Constant-Murley scores and UCLA scores in the suture anchor tenodesis group at 3 and 6 months were significantly higher than those in the interference screw tenodesis group ( < 0.05). No statistically significant differences in Constant-Murley or UCLA scores were observed between the two groups at baseline or at 12 months postoperatively. The incidence of postoperative complications was slightly lower in the suture anchor tenodesis group compared with the interference screw tenodesis group; however, the difference did not reach statistical significance ( > 0.05). CONCLUSIONS: For proximal LHBT injuries, both interference screw compression fixation and suture anchor ligation under shoulder arthroscopy can effectively restore LHBT continuity, relieve shoulder pain, and improve functional outcomes. Suture anchor ligation demonstrates superior efficacy in pain relief, particularly during early postoperative recovery. However, in terms of long-term functional improvement at 12 months, both techniques yield comparable results. Moreover, suture anchor fixation is associated with a relatively lower, although not statistically significant, rate of postoperative complications.
Comparison of Clinical Efficacy of Early Versus Delayed Laparoscopic Cholecystectomy Following Ultrasound-Guided Percutaneous Transhepatic Gallbladder Drainage.
Liu R, Zhang G, Zhou P … +1 more , Xia S
Ann Ital Chir · 2026 May · PMID 42136173 · Publisher ↗
AIM: To investigate the clinical value of early (≤7 days) versus delayed (>6 weeks) laparoscopic cholecystectomy (LC) after ultrasound-guided percutaneous transhepatic gallbladder drainage (PTGBD) in high-risk acute chol...
AIM: To investigate the clinical value of early (≤7 days) versus delayed (>6 weeks) laparoscopic cholecystectomy (LC) after ultrasound-guided percutaneous transhepatic gallbladder drainage (PTGBD) in high-risk acute cholecystitis (AC), with PTGBD serving as a bridging intervention. METHODS: A retrospective analysis was performed on 110 high-risk AC patients admitted between August 2021 and January 2025. Patients were divided into an early LC group (52 cases) and a delayed LC group (58 cases). Surgical indicators, inflammatory response control, hospitalization duration, treatment costs, quality of life, and postoperative complications were compared between the two groups. RESULTS: The early LC group demonstrated significantly superior outcomes in operative time (22.51 ± 4.32 vs. 65.28 ± 15.12 minutes, < 0.001), intraoperative blood loss (12.16 ± 2.13 vs. 52.47 ± 6.11 mL, < 0.001), length of hospital stay (7.12 ± 0.58 vs. 10.11 ± 1.62 days, < 0.001), and total treatment costs (2.36 ± 0.32 vs. 3.80 ± 0.52 ten thousand yuan, < 0.001, 1 dollar = 6.91 yuan). The incidence of moderate to severe adhesions was significantly lower in the early LC group (28.85% vs. 56.90%, = 0.003). However, the delayed LC group exhibited lower postoperative C-reactive protein levels (12.45 ± 2.23 vs. 15.32 ± 2.78 mg/L, < 0.001) and procalcitonin levels (0.25 ± 0.06 vs. 0.38 ± 0.05 ng/mL, < 0.001), as well as significantly higher quality-of-life scores at 3 months postoperatively (all < 0.001). No statistically significant differences were observed in complication rates (9.62% vs. 15.52%) or conversion-to-laparotomy rates (3.85% vs. 10.34%) between groups ( > 0.05). CONCLUSIONS: Early LC following PTGBD effectively shortens overall treatment duration, reduces healthcare costs, and lowers surgical complexity. However, careful consideration should be given to the potential influence of residual inflammation on long-term quality of life. Further multi-center prospective studies are warranted to validate long-term safety and to optimize individualized treatment strategies.
Clinical Factors Affecting Postoperative Antihypertensive Efficacy in Patients With Adrenal Tumors Complicated by Hypertension: A Retrospective Study.
Tian Y, Yang Q, Ye P … +2 more , Zhu T, Chen X
Ann Ital Chir · 2026 May · PMID 42136172 · Publisher ↗
AIM: Clinically, patients with adrenal tumors are prone to secondary hypertension. This study aimed to identify key factors influencing the antihypertensive effect of surgery by retrospectively analyzing clinical data fr...
AIM: Clinically, patients with adrenal tumors are prone to secondary hypertension. This study aimed to identify key factors influencing the antihypertensive effect of surgery by retrospectively analyzing clinical data from patients with adrenal tumors complicated by hypertension, to provide a reference for clinical prognosis evaluation, guide individualized treatment planning, and improve treatment success rates. METHODS: A total of 82 patients diagnosed with adrenal tumors by imaging and complicated by hypertension were included, and all underwent laparoscopic adrenal tumor resection. According to the antihypertensive effect at 6 months postoperatively, patients were divided into an effective antihypertensive group and an ineffective antihypertensive group. Clinical data of both groups were collected. Univariate analysis was performed to screen differential variables, and variables with statistical significance were included in a multivariate logistic regression model to identify independent factors affecting the short-term surgical antihypertensive effect. RESULTS: No significant differences were observed between the two groups in age, gender, other general characteristics, or perioperative indicators of laparoscopic surgery (operative time, intraoperative blood loss, postoperative hospital stay, and complication rate) ( > 0.05). Univariate analysis showed significant differences between the two groups in hypertension disease course, tumor pathological type, preoperative systolic blood pressure (SBP) level, preoperative aldosterone/norepinephrine levels, and tumor maximum diameter ( < 0.05). Multivariate logistic regression analysis showed that hypertension duration ≥6 years, non-functional adenoma, and preoperative SBP ≥170 mmHg were independent factors affecting the surgical antihypertensive effect ( < 0.05). CONCLUSIONS: Laparoscopic surgery is an effective treatment for adrenal tumors complicated by hypertension. However, patients with long-term hypertension, non-functional adenoma, and markedly elevated preoperative SBP may experience a poor short-term postoperative antihypertensive effect.
Development of a Continuity of Care Program for Postoperative Enterostomy Patients With Colorectal Cancer Guided by Heider's Balance Theory.
Zhou W, Wang J
Ann Ital Chir · 2026 May · PMID 42136171 · Publisher ↗
AIM: Patients with colorectal cancer undergoing enterostomy often encounter complex physical, psychological, and social challenges after discharge. Effective continuity of care is essential to support postoperative recov...
AIM: Patients with colorectal cancer undergoing enterostomy often encounter complex physical, psychological, and social challenges after discharge. Effective continuity of care is essential to support postoperative recovery and long-term adaptation. However, existing care programs frequently lack a comprehensive and theoretically grounded framework. Guided by Heider's balance theory, this study developed a continuity of care program for postoperative enterostomy patients with colorectal cancer, thereby providing a reference for clinical nursing practice. METHODS: A comprehensive search of domestic and international databases, guideline networks, and professional association websites was conducted to identify publicly available clinical practice guidelines, evidence summaries, and systematic reviews related to postoperative enterostomy care in patients with colorectal cancer. Two reviewers independently performed literature screening, quality appraisal, and data extraction, followed by cross-verification to develop a preliminary program draft. Using Heider's balance theory as the conceptual framework, a preliminary continuity of care program was formulated through evidence synthesis and qualitative analysis, and subsequently refined through a two-round Delphi expert consultation process. RESULTS: A total of 512 records were initially identified, and seven high-quality articles were ultimately included after screening and quality appraisal. A preliminary continuity of care program was developed through evidence synthesis and refined using a two-round Delphi expert consultation. In each round, 20 questionnaires were distributed and all were returned, yielding response rates of 100.0%. Fourteen experts provided comments in the first round, and six provided additional feedback in the second round. The expert authority coefficients were 0.805 and 0.809, respectively, while Kendall's W coefficients were 0.162 and 0.163, both statistically significant. After iterative revision, the final program consisted of 4 first-level indicators, 10 second-level indicators, and 24 third-level indicators. CONCLUSIONS: This study developed a theoretically grounded and expert consensus-based continuity of care program for postoperative enterostomy patients with colorectal cancer. The program may serve as a reference for clinical nursing practice, as well as for feasibility studies and intervention research.
Learning Curve of Landmark-Based TIVAP Placements and Revisions in a Low-Resource Setting.
Yavuz O, Iscan M, Erdogdu E … +2 more , Kertmen M, Yeginsu A
Ann Ital Chir · 2026 May · PMID 42136170 · Publisher ↗
AIM: Totally implantable venous access port (TIVAP) placement is routinely recommended under ultrasound guidance to reduce complications. However, in low-resource settings, the anatomical landmark technique remains widel...
AIM: Totally implantable venous access port (TIVAP) placement is routinely recommended under ultrasound guidance to reduce complications. However, in low-resource settings, the anatomical landmark technique remains widely used. Data evaluating the learning curve of landmark-based TIVAP placement through formal statistical methods are limited. METHODS: This retrospective single-center study analyzed 1285 consecutive TIVAP-related procedures, including port placement, revision, and removal, performed by a single surgeon between June 2022 and September 2025 using the anatomical landmark technique. The cohort comprised 1093 port catheter placements, 98 removals, and 67 revisions. Technical failure was defined as the inability to achieve venous cannulation or to advance the guidewire/catheter into the central venous circulation and was assessed only in procedures requiring venous access (placements and revisions), in which 27 failures occurred. Cumulative sum (CUSUM) analysis was restricted to procedures requiring venous access to evaluate performance based on technical failure rates; port removals were excluded from the failure-based CUSUM framework. Procedures were additionally stratified by technical complexity. The CUSUM inflection point was used to explore a potential transition in procedural performance. RESULTS: Technical success was achieved in 1258 of 1285 TIVAP-related procedures (97.9%). A total of 27 cases resulted in technical failure (failure rate: 2.1%), primarily due to unsuccessful venous cannulation or guidewire advancement. CUSUM analysis identified an inflection point at the 422nd case, indicating a transition from the initial learning phase to a phase of performance stabilization. Among procedures requiring venous access, technical failure rates were significantly higher in Phase 1 (cases 1-422) compared with Phase 2 (cases 423-1187) (5.2% vs. 0.7%, < 0.001). Procedural complexity showed only minimal variation across the series, and technical performance remained stable throughout the study period. No further technical failures were observed during the final 252 consecutive procedures. Pneumothorax occurred in 5 cases (0.39% [5/1285] of all procedures; 0.43% [5/1160] of venous access procedures). CONCLUSIONS: Based on the observed learning curve, procedural stabilization in landmark-based TIVAP placement may require a higher case volume than reported previously for ultrasound-guided approaches. In this single-center, single-operator study, an inflection point at approximately 422 cases was associated with stabilization of procedural performance and a reduction in technical failure rates. These findings suggest that, in low-resource settings where ultrasound guidance is not routinely available, the landmark technique may be performed with an acceptable safety profile under standardized workflows and with adequate training and experience.
Effects of Empowerment-Based Health Education Combined With Refined Pain Management on Postoperative Recovery in Patients Undergoing Laparoscopic Partial Hepatectomy.
Chang Y, Qiu Y
Ann Ital Chir · 2026 May · PMID 42136169 · Publisher ↗
AIM: To investigate the impact of empowerment-based health education combined with refined pain management in patients undergoing laparoscopic partial hepatectomy. METHODS: Clinical data from 165 patients who underwent l...
AIM: To investigate the impact of empowerment-based health education combined with refined pain management in patients undergoing laparoscopic partial hepatectomy. METHODS: Clinical data from 165 patients who underwent laparoscopic partial hepatectomy at The First Affiliated Hospital of Soochow University between March 2023 and March 2025 were retrospectively collected and analyzed. Based on documented nursing interventions, patients were assigned to an observation group (85 cases) or a control group (80 cases). The control group received routine nursing care, while the observation group received empowerment-based health education combined with refined pain management. Postoperative clinical indicators, postoperative pain intensity, quality of life, and the incidence of complications were compared between the two groups. RESULTS: The time to first ambulation, time to first flatus, and time to first defecation were significantly shorter in the observation group than in the control group (all < 0.001). Postoperative pain scores at 12 h, 24 h, and 48 h were significantly lower in the observation group compared with the control group (Wald χ = 275.16, < 0.001). At three months after the intervention, scores across all quality-of-life dimensions, including physical, psychological, social function, and material well-being, were significantly higher in the observation group than in the control group ( < 0.001). Additionally, the incidence of postoperative complications was significantly lower in the observation group ( < 0.05). CONCLUSIONS: Empowerment-based health education combined with refined pain management may facilitate early postoperative functional recovery and improve short-term quality of life in patients undergoing laparoscopic partial hepatectomy, while potentially reducing postoperative complications. These outcomes may be related to enhanced patient participation, optimized pain management, and improved adherence to rehabilitation protocols. This integrated nursing model may have potential value for clinical application. However, given the single-center retrospective design and the combined nature of the intervention, causal relationships cannot be established, and further validation through prospective, multicenter randomized controlled trials is warranted.
Factors Influencing Wound Complications After Cesarean Section in Women With Gestational Diabetes Mellitus: Development and Validation of a Prediction Model.
Lu J, Gao C
Ann Ital Chir · 2026 May · PMID 42136168 · Publisher ↗
AIM: To investigate factors influencing wound complications after cesarean section in women with gestational diabetes mellitus (GDM) and to develop a predictive model. METHODS: A retrospective study was conducted, includ...
AIM: To investigate factors influencing wound complications after cesarean section in women with gestational diabetes mellitus (GDM) and to develop a predictive model. METHODS: A retrospective study was conducted, including 600 women with GDM who underwent cesarean delivery at The Maternal and Child Health Care Hospital of Tongxiang between January 2022 and February 2025. Participants were randomly divided into a training set (n = 420) and a validation set (n = 180) at a 7:3 ratio. Clinical variables for model development included age, body mass index (BMI), hypertension status, glycated hemoglobin (HbA1c), albumin level, and time to first postoperative ambulation. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors and establish the predictive model. The discriminative performance of the model was evaluated using the receiver operating characteristic (ROC) curve, while calibration curves and decision curve analysis (DCA) were applied to evaluate calibration and clinical utility, respectively. RESULTS: Wound complications occurred in 108 patients (18%). Multivariate analysis identified concurrent hypertension (odds ratio (OR) = 2.63, 95% CI: 1.30-5.33), elevated BMI (OR = 1.07, 95% CI: 1.01-1.15), increased HbA1c (OR = 1.76, 95% CI: 1.34-2.33), decreased albumin level (OR = 0.84, 95% CI: 0.78-0.91), and delayed time to first ambulation (OR = 1.17, 95% CI: 1.07-1.28) as independent risk factors for wound complications (all < 0.05). The multivariable logistic regression model demonstrated good discrimination, with an area under the curve (AUC) of 0.78 (95% CI: 0.72-0.83) in the training set and 0.78 (95% CI: 0.69-0.87) in the validation set. Calibration and decision curve analyses indicated good agreement and clinical net benefit. CONCLUSIONS: This study developed and internally validated a predictive model incorporating five readily available clinical indicators. The model may assist in identifying women with GDM at increased risk of poor incision outcomes following cesarean section and support risk stratification and early clinical decision-making.
Complete Video-Assisted Thoracoscopic Surgery vs Open Surgery for Rib Fracture: Impacts on Postoperative Inflammation and Foreign Body Sensation.
Qin B, Yang G, Shu D … +3 more , Fang Z, Zhou W, Tang J
Ann Ital Chir · 2026 May · PMID 42136167 · Publisher ↗
AIM: This study aims to compare the effects of complete video-assisted thoracoscopic surgery (VATS) rib fracture (RF) fixation with a conventional open procedure on surgical parameters, inflammatory markers, and postoper...
AIM: This study aims to compare the effects of complete video-assisted thoracoscopic surgery (VATS) rib fracture (RF) fixation with a conventional open procedure on surgical parameters, inflammatory markers, and postoperative discomfort. METHODS: This multicenter retrospective cohort study enrolled 141 patients with rib fractures, treated at The First People's Hospital of Zunyi, Renhuai People's Hospital, and Sinan People's Hospital between May 2020 and December 2024. Based on the actual procedure performed, as documented in medical charts and operative records, patients were categorized into the VATS group (fully thoracoscopic internal fixation via uniportal or biportal VATS; n = 70) and the open thoracotomy group (open reduction and internal fixation; n = 71). Perioperative variables, complications, and inflammatory biomarkers (white blood cell (WBC) count, neutrophil percentage (NEU%), C-reactive protein (CRP), procalcitonin (PCT), and interleukin-6 (IL-6)) were compared between groups across postoperative 24 h, 72 h, and pre-discharge time points. Furthermore, follow-up outcomes, including implant-related foreign-body sensation and functional status (rib fracture functional scale (RFFS)), were also recorded. Repeated-measures analysis of variance (ANOVA) was used to evaluate time effects and time-by-group interactions, and multivariable logistic regression was performed to identify factors independently associated with an RFFS score ≥80. RESULTS: In both groups, WBC, NEU%, CRP, PCT, and IL-6 peaked at 24 h postoperatively, declined from 72 h onward. Repeated measures ANOVA showed a significant effect of time for all markers (all < 0.001). Compared with the open thoracotomy group, the VATS group had consistently lower WBC, CRP, PCT, and IL-6 levels at 24 h, 72 h, and before discharge, with significant time × group interaction effects for CRP and IL-6 (both < 0.001), indicating a reduced inflammatory burden under a similar overall downward trend. NEU% changed significantly over time but showed no significant between-group or interaction effects ( > 0.05). The incidence of abnormal WBC was high in both groups at 24 h but decreased more rapidly in the VATS group. At 72 h, the proportion of patients with abnormal WBC was significantly lower in the VATS group than in the open thoracotomy group ( = 0.001), whereas more patients in the VATS group achieved normal WBC levels by discharge. No patient in the VATS group required implant removal, whereas 2.94% of patients in the open surgery group underwent implant removal due to pronounced foreign-body sensation. Postoperative hemoglobin levels were higher and electrolyte disturbances less frequent in the VATS group (both < 0.05). Multivariable logistic regression showed that VATS (vs open thoracotomy) remained independently associated with achieving a rib fracture functional scale (RFFS) score ≥80 ( = 0.027). In addition, abnormal WBC status at 24 hours postoperatively showed a borderline association with an RFFS ≥80 ( = 0.049). CONCLUSIONS: Complete thoracoscopic rib fracture fixation significantly reduces surgical trauma, improves recovery, and lowers the incidence of postoperative complications.
Predictive Value of Preoperative Radiographic Indices and Demographic Characteristics for Mandibular Third Molar Extraction Difficulty: A Retrospective Cohort Study.
Xu F, Wu Y
Ann Ital Chir · 2026 May · PMID 42136166 · Publisher ↗
AIM: This study aimed to investigate the predictive value of preoperative radiographic indices, demographic characteristics, and psychological factors for mandibular third molar extraction difficulty, to develop a nomogr...
AIM: This study aimed to investigate the predictive value of preoperative radiographic indices, demographic characteristics, and psychological factors for mandibular third molar extraction difficulty, to develop a nomogram, and to interpret feature contributions using SHapley Additive exPlanations (SHAP) analysis. METHODS: In this retrospective cohort study of 250 patients, demographic characteristics, including age, sex, and body mass index (BMI), together with radiographic indices such as root morphology and psychological factors assessed using the Modified Dental Anxiety Scale (MDAS), were analyzed in relation to surgical difficulty, defined as operative time exceeding 45 minutes. Multivariate logistic regression was used to construct a nomogram, which was validated through receiver operating characteristic (ROC) curves and decision curve analysis (DCA). Feature importance was explored using SHAP analysis, and the association between operative time and perioperative outcomes was assessed. RESULTS: Multivariate logistic regression identified age, root morphology, Winter's angulation, and preoperative dental anxiety (MDAS score) as key predictors of high surgical difficulty ( < 0.05). The resulting nomogram demonstrated excellent discrimination, with an area under the curve (AUC) of 0.91. SHAP analysis illustrated that age and Winter's angulation contribute more to the model's predictions, followed by root morphology. Longer operative time was independently associated with a higher risk of perioperative complications (odds ratio = 1.03, < 0.05) and showed a positive correlation with pain intensity on postoperative day 1 (Spearman's ρ = 0.712, < 0.001). CONCLUSIONS: Bulbous or curved root morphology, advanced age, high dental anxiety, Winter's angulation, and male sex were associated with the difficulty of mandibular third molar extraction. The developed nomogram serves as a precise, clinically interpretable tool for preoperative risk stratification. Integrating psychological evaluation with anatomical assessment facilitates a holistic approach to surgical planning.
Integration of CTA Run-off Score and Systemic Resuscitation Indices to Predict Outcomes in Emergency Lower Extremity Flap Reconstruction: A Retrospective Cohort Study.
Zhao J, Du X, Liu Z … +3 more , Wang R, Liu C, Yu S
Ann Ital Chir · 2026 May · PMID 42136165 · Publisher ↗
AIM: Reconstruction of severe lower extremity trauma with extensive soft tissue defects remains a major microsurgical concern. Unlike elective procedures, emergency reconstruction is plagued by higher rates of necrosis a...
AIM: Reconstruction of severe lower extremity trauma with extensive soft tissue defects remains a major microsurgical concern. Unlike elective procedures, emergency reconstruction is plagued by higher rates of necrosis and failure. Current preoperative assessments predominantly focus on local vascular patency, often neglecting systemic physiological disturbances. This gap in the assessment process highlights the need to incorporate whole-body resuscitation indicators. This study aimed to evaluate the predictive value of combining a modified computed tomography angiography (CTA) Run-off Score with systemic resuscitation indices-specifically Central Venous Oxygen Saturation (ScvO2) and preoperative lactate (Lac_Pre)-for emergency flap prognosis. METHODS: A retrospective cohort study was conducted on 180 patients undergoing emergency free flap transfer for high-energy lower limb trauma between February 1, 2022, and March 31, 2025. Systemic monitoring involved ScvO2 measurement via central venous catheterization and serial lactate analysis. Anatomical assessment included a modified CTA Run-off Score and the measurement of the distance from injury zone to anastomosis site (Dist_Anastomosis). The dataset was divided into the training and validation sets at a 6:4 ratio, which does not represent random clinical allocation. A multivariate logistic regression model was built in the training cohort, with candidate predictors selected based on univariable analyses, collinearity assessment and the clinical relevance supported by previous literature. The model's performance was evaluated through discrimination (Area Under the Curve [AUC]), calibration (calibration curve), and clinical utility (decision curve analysis). For the secondary aesthetic analysis, a total of 163 patients were ultimately included in the 6-month VISIA/Vancouver Scar Scale (VSS)-based analysis after excluding patients with complete flap failure, for whom scar-based assessment was not applicable. RESULTS: Multivariate logistic regression analysis identified three variables independently associated with flap failure: CTA Run-off Score ( 0.001), Dist_Anastomosis (Odds Ratio [OR] 0.76, 0.006), and preoperative lactate (Lac_Pre; OR 1.54, 0.014). The combined prognostic model demonstrated acceptable to good discrimination, with an Area Under the Curve (AUC) of 0.89 (95% Confidence Interval [CI]: 0.82-0.97) in the training set and 0.79 (95% CI: 0.66-0.92) in the validation set. Calibration analysis, assessed via the Brier Score, yielded values of 0.103 for the training set and 0.165 for the validation set, indicating acceptable predictive error and robust model calibration. Secondary analysis revealed that flaps experiencing early adverse events showed significantly higher VISIA-7 Complexion Analysis System-derived "Redness Index" scores at 6 months after surgery ( 0.006). CONCLUSIONS: Integrating anatomical characteristics and perioperative physiological indicators may provide a useful approach for risk stratification in emergency reconstruction. In this internally validated retrospective cohort, preoperative lactate demonstrated a significant association with adverse acute flap outcomes and should be interpreted as a stratification marker rather than a definitive predictor. Further prospective studies with external validation are required to confirm these findings and evaluate functional recovery outcomes.
Influence of Billroth II Combined With Braun Anastomosis on Perioperative Stress Indicators and Pepsinogens in Patients Undergoing Laparoscopic Gastric Cancer Surgery.
Su H, You Y, Wang Y … +4 more , Li B, Zhang B, He C, Zhang Y
Ann Ital Chir · 2026 May · PMID 42136164 · Publisher ↗
AIM: The study aimed to investigate the influence of Billroth II combined with Braun anastomosis on perioperative stress indicators and pepsinogens in patients undergoing laparoscopic gastric cancer surgery. METHODS: Thi...
AIM: The study aimed to investigate the influence of Billroth II combined with Braun anastomosis on perioperative stress indicators and pepsinogens in patients undergoing laparoscopic gastric cancer surgery. METHODS: This study is a single-center retrospective research design. This study included 148 patients who underwent laparoscopic radical distal gastrectomy for gastric cancer between March 2021 and June 2024, with all surgical procedures performed by the same surgical team. According to the digestive tract reconstruction methods, participants were divided into a Billroth II group (n = 63) and a Billroth II+Braun group (n = 85). The short-term efficacy outcomes included perioperative stress indicators, pepsinogen I to pepsinogen II ratio (PGR), Gastrin-17 (G-17), and postoperative complications. Moreover, the long-term efficacy outcomes comprised bile reflux rate, incidence rate of reflux residual gastritis and 1-year survival rate. RESULTS: The C-reactive protein (CRP) showed a gradual increase preoperatively (T0) and at postoperative day 1 (T1) and day 2 (T2) ( = 2.74, = 0.064; = 757.8, < 0.001; = 2.50, = 0.114). However, norepinephrine (NE) and cortisol (COR) initially increased and then declined at these time points ( = 0.90, 0.58, = 0.407, 0.559; = 1628, 466.4, both < 0.001; = 0.83, 0.70, = 0.36, 0.40). Furthermore, no statistical differences in CRP, NE and COR were observed between the Billroth II+Braun group and the Billroth II group at the three time points ( > 0.05). Compared with preoperative levels (T0), PGR increased in both groups, whereas G-17 decreased at postoperative day 30 (T3) ( < 0.01). Additionally, PGR was significantly higher in Billroth II+Braun group ( < 0.001) while there was no statistical difference in G-17 between the two groups at T3 ( = 0.943). Similarly, the anastomotic leakage (Fisher's exact test, = 0.312), anastomotic stenosis (Fisher's exact test, = 1.000), duodenal stump bleeding (Fisher's exact test, = 0.426), duodenal stump leakage (Fisher's exact test, = 0.180), and intestinal obstruction rate (Fisher's exact test, = 0.402) also showed no statistical differences between the two groups. The bile reflux rate was substantially lower in the Billroth II+Braun group ( = 0.005), while no statistical differences were observed in residual food ( = 0.097), reflux residual gastritis (Fisher's exact test, = 0.312) and survival rate (Fisher's exact test, = 0.700) between groups. CONCLUSIONS: This study demonstrates that Billroth II+Braun anastomosis and Billroth II anastomosis are equally safe and effective during radical distal gastrectomy for gastric cancer. There is no significant difference in the influence of two digestive tract reconstruction methods on perioperative stress indicators in this cohort. Additionally, Billroth II+Braun anastomosis can improve PGR level and reduce bile reflux rate.
About
- Frequency
- Sun
- Papers found
- 200
- RSS feed
- Subscribe