BMC Surgery[JOURNAL]
Sun
200 papers
Sandwich mesh repair for the treatment of lumbar incisional hernia: a case series.
Orban YA, Baz Y, Hegab YH
BMC Surg · 2026 May · PMID 42163263 · Full text
BACKGROUND: A variety of surgical techniques have been described for the open repair of lumbar incisional hernias. Determining the optimal surgical technique for these hernias remains challenging. This study evaluates th...
BACKGROUND: A variety of surgical techniques have been described for the open repair of lumbar incisional hernias. Determining the optimal surgical technique for these hernias remains challenging. This study evaluates the sandwich mesh technique, preperitoneal mesh, and onlay mesh for the treatment of lumbar incisional hernia. METHODS: This is a prospective study conducted to repair lumbar incisional hernias. We employed the sandwich approach with preperitoneal and onlay mesh reinforcement. Postoperative outcomes, complications, and length of hospital stay were assessed. The primary outcome was recurrence of hernia, and secondary outcomes included wound seroma, surgical site infection, and wound ischemia. RESULTS: Ten patients were involved in this study, six males and four females, with a mean age of 50.5 ± 9.32. The main complaints were abdominal protrusion at a site of previous abdominal operation, both in 100% of cases. Pain was present in four patients. All the patients had previous surgery through a lumbar incision; the most frequent surgery was for ureteric stone (7 patients), while the other cause was for nephrectomy (3 patients). 50% of patients presented with comorbidities, including diabetes mellitus, smoking habits, ischemic heart disease, and hypertension. The operative time was 76.4 ± 11.86 min. The mean hospital stay was four days. Complications were infrequent and manageable, with seroma formation being the most common. No major morbidity was observed. CONCLUSION: The sandwich mesh repair technique represents a potentially feasible surgical option for lumbar incisional hernia repair, demonstrating satisfactory early outcomes and acceptable complication rates. TRIAL REGISTRATION: NCT07196254.
Construction and metabolic efficacy evaluation of sleeve gastrectomy and modified Roux-en-Y gastric bypass in a mouse model with obesity and MASLD.
Wang Z, Li Z, Tian C … +8 more , Yu C, Chen X, Sun Y, Chen W, Wang D, Wang L, Lian D, Zhang N
BMC Surg · 2026 May · PMID 42163259 · Full text
INTRODUCTION: Obesity and related metabolic diseases are major global health challenges. Metabolic and bariatric surgery (MBS) is an effective treatment. Yet exploring its molecular mechanisms remains limite due to the c...
INTRODUCTION: Obesity and related metabolic diseases are major global health challenges. Metabolic and bariatric surgery (MBS) is an effective treatment. Yet exploring its molecular mechanisms remains limite due to the challenge of obtaining postoperative tissue samples. While rat models are more convenient in size and operation, mouse models offer unique advantages such as lower breeding costs and easier genetic modification. However, research on mouse MBS models is still limited because of their small size and surgical complexity, highlighting the need for optimized techniques to advance the field. OBJECTIVE: This study aims to establish a high-fat diet-induced (HFD) obesity combined with metabolic dysfunction-associated steatotic liver disease (MASLD) mouse model, and to evaluate the MBS models assisted by microsurgery, so as to provide a reliable tool for mechanism research. METHODS: Male SPF C57BL/6J mice were randomly assigned to the normal diet (ND) group and the HFD group. The mouse in the HFD group were induced to develop obesity with MASLD through a high-fat diet for 16 weeks. The HFD group was further divided into sham operation group (Sham), sleeve gastrectomy (SG) group, and modified Roux-en-Y gastric bypass (RYGB) group (n = 6). Metabolic efficacy was evaluated by weight, metabolic parameters, and pathological staining analysis at the 4th week post-surgery. RESULTS: Compared with the ND group, the weight of the HFD group increased by 38.25% (P < 0.001), and the liver tissue showed pathological features of MASLD. Compared with the Sham group, the weight of the SG group and the modified RYGB group decreased significantly at 4 weeks after operation (P < 0.05). Compared with the Sham group, the insulin sensitivity of the RYGB group was improved. Hepatic steatosis was significantly reduced in SG and RYGB groups, and serum TG and LDL levels were significantly improved. The postoperative survival rate of SG and Sham mice was 100%, and RYGB was 83.3% (1 case died of anastomotic stenosis). CONCLUSION: The establishment of a modified RYGB and SG mouse model has good reproducibility, safety, and efficacy. This study provides a useful tool for exploring the mechanism of MBS in the treatment of obesity with MASLD.
Radiomics-based prediction model for lymph node metastasis in thyroid microcarcinoma.
Yang Y, Yuan A, Huang C
BMC Surg · 2026 May · PMID 42157214 · Full text
OBJECTIVE: To develop and validate a predictive model for lymph node metastasis (LNM) in thyroid microcarcinoma (TMC) based on clinical, ultrasonographic, and radiomic features, providing a basis for accurate preoperativ...
OBJECTIVE: To develop and validate a predictive model for lymph node metastasis (LNM) in thyroid microcarcinoma (TMC) based on clinical, ultrasonographic, and radiomic features, providing a basis for accurate preoperative risk assessment and individualized surgical planning. METHODS: A total of 426 TMC patients treated at our institution from June 2022 to December 2024 were retrospectively enrolled and randomly divided into a training set (n = 300) and a validation set (n = 126) at a 7:3 ratio. Demographic characteristics (age, gender), preoperative clinical and ultrasonographic features (tumor size measured by ultrasound, multifocality assessed by ultrasound, capsular invasion on ultrasound, etc.), ultrasound features (lymph node size, sphericity, etc.), laboratory indicators (preoperative TSH level), and radiomic parameters (3D tumor volume, surface area, etc.) were collected. In the training set, univariate analysis was performed to screen LNM-associated factors, followed by LASSO regression for variable selection. Multivariate logistic regression was used to identify independent predictors. Random forest (RF), K-nearest neighbors (KNN), and gradient boosting (GB) models were constructed. The model performance was evaluated using the area under the receiver operating characteristic curve (AUC), calibration curves, and decision curve analysis (DCA) in the training and internal validation sets. RESULTS: No significant differences in baseline characteristics were observed between the training and validation sets (P > 0.05). Univariate analysis revealed that tumor size, lymph node size, TSH level, central lymph node metastasis, 3D tumor volume, and sphericity were associated with LNM (P < 0.05). Multivariate logistic regression identified tumor size, lymph node size, TSH level, central lymph node metastasis, and 3D tumor volume as independent risk factors for LNM (P < 0.05), while sphericity was an independent protective factor (P < 0.05). The RF model exhibited superior performance (training AUC: 0.838, internal validation AUC: 0.815) compared to KNN (0.815, 0.792) and GB (0.787, 0.763), demonstrating good calibration and stable clinical net benefit. CONCLUSION: The RF model constructed using multidimensional features effectively predicts LNM in TMC, with TSH level, tumor size, and sphericity as key predictors, demonstrating high clinical utility.
Hidden blood loss estimation using perioperative hemoglobin drop: agreement with the Sehat formula.
Ramadanov N, Heinz M, Prill R … +2 more , Fuchs D, Becker R
BMC Surg · 2026 May · PMID 42157204 · Full text
BACKGROUND: Perioperative hemoglobin drop is widely used as a surrogate marker for blood loss and transfusion risk across surgical disciplines. However, its agreement with dilution-based estimates of hidden blood loss re...
BACKGROUND: Perioperative hemoglobin drop is widely used as a surrogate marker for blood loss and transfusion risk across surgical disciplines. However, its agreement with dilution-based estimates of hidden blood loss remains insufficiently validated. As both approaches represent indirect estimators rather than a reference standard, this study evaluates agreement rather than validation. METHODS: This retrospective registry-based study included 828 patients undergoing elective primary total hip arthroplasty between 2016 and 2023. Hemoglobin drop was defined as the difference between preoperative hemoglobin and the lowest postoperative value within 48 h. Hidden blood loss was calculated using the Gross-Sehat method with blood volume estimation according to Nadler. Agreement between hemoglobin drop and hidden blood loss was assessed using Bland-Altman analysis and intraclass correlation coefficients. Discriminative performance for identifying patients with high hidden blood loss (upper quartile) was evaluated using receiver operating characteristic analysis. RESULTS: Mean perioperative hemoglobin drop was 33.5 ± 12.3 g/L. Mean hidden blood loss was 854.9 mL, accounting for the majority of total blood loss. Agreement between hemoglobin drop and hidden blood loss was limited, with wide limits of agreement on Bland-Altman analysis. Although a positive association was observed, substantial interindividual variability persisted, particularly at higher blood loss levels. Hemoglobin drop demonstrated only moderate discriminative performance for identifying patients with high hidden blood loss. CONCLUSION: Perioperative hemoglobin drop shows only moderate agreement with dilution-based estimates of hidden blood loss and cannot reliably replace formal blood loss calculations at the individual patient level. These findings have implications for perioperative blood management and caution against reliance on hemoglobin change alone for blood loss assessment. LEVEL OF EVIDENCE (LOE): Level III - retrospective cohort study / registry-based observational study.
A simplified strategy for chest wall reconstruction: locoregional flaps as a reliable alternative in resource-limited settings.
Yang T, Liu Z, Wang S … +7 more , Wen T, Zhang G, Zhang B, Huang S, Zhou X, Li J, Shi Y
BMC Surg · 2026 May · PMID 42157186 · Full text
BACKGROUND: The reconstruction of complex chest wall defects resulting from advanced breast cancer poses a significant challenge in facilities lacking microsurgical expertise. This study aims to present a simplified, rel...
BACKGROUND: The reconstruction of complex chest wall defects resulting from advanced breast cancer poses a significant challenge in facilities lacking microsurgical expertise. This study aims to present a simplified, reliable, and easily reproducible locoregional flap strategy for these scenarios. METHODS: A retrospective analysis was conducted on four female patients who underwent immediate chest wall reconstruction following resection for locally advanced breast cancer between 2020 and 2022. A standardized protocol employing regional flaps, selected based on defect size and location, was used. Core principles included meticulous preservation of the blood supply, tension-free closure, and adequate drainage. RESULTS: The chest wall defects ranged from 8 × 8 cm to 26.3 × 21.5 cm. The flaps used included lateral thoracic and pedicled abdominal flaps. All flaps survived completely (4/4). One patient with a massive defect experienced minor superficial skin compromise (approx. 3 cm) at the distal flap edge, which healed with conservative management. All defects were successfully addressed in a single stage, resulting in high patient satisfaction with the chest wall contour. CONCLUSION: This simplified locoregional flap strategy, which does not require microvascular anastomosis, is feasible strategy and has a short learning curve. Despite the limited number of cases, it is particularly suitable for promotion in primary hospitals or resource-limited settings, offering a practical solution for reconstructing complex chest wall defects in advanced breast cancer patients.
Perceived ergonomic and psychological experiences with powered circular staplers among female gastrointestinal surgeons: an exploratory cross-sectional survey in Japan.
Hasegawa F, Sato T, Enjoji M
BMC Surg · 2026 May · PMID 42157152 · Full text
BACKGROUND: Conventional surgical instruments are often designed based on assumptions regarding hand size and grip strength that may not reflect the physical characteristics of all surgeons. Circular staplers require sub...
BACKGROUND: Conventional surgical instruments are often designed based on assumptions regarding hand size and grip strength that may not reflect the physical characteristics of all surgeons. Circular staplers require substantial manual force during firing and may be associated with perceived ergonomic burden and psychological stress during anastomosis. Powered circular staplers have been introduced to reduce manual effort; however, limited information is available regarding surgeons' subjective experiences with these devices. This exploratory study aimed to examine perceived ergonomic and psychological experiences related to powered circular stapler use among female gastrointestinal surgeons in Japan. METHODS: This small exploratory cross-sectional survey used an anonymous web-based survey conducted between January and March 2021. Female gastrointestinal surgeons in Japan with experience using powered circular staplers were recruited through professional networks using a snowball sampling approach. The survey focused on self-reported perceptions of ergonomic workload, psychological stress during stapler firing, and usability impressions of powered circular staplers. Given the exploratory design and limited sample size, analyses were descriptive only and no inferential statistics were applied. RESULTS: Twenty-five female surgeons responded to the survey. Thirteen respondents (52%) reported that some surgical instruments were too large for their hands, and 20 surgeons (80%) perceived strength limitations with some devices. With conventional manual circular staplers, most participants (24/25, 96%) required both hands to fire the device and reported stress or perceived instability during firing. Among respondents with experience using powered circular staplers, many reported that the devices were easier to handle and less stressful. Sixteen surgeons (64%) reported perceived single-hand operability, and a similar proportion reported perceived improvements in procedural stability. Qualitative comments indicated subjective impressions of reduced physical effort and anxiety. CONCLUSIONS: In this small exploratory survey, powered circular staplers were perceived by female gastrointestinal surgeons as being easier to handle and less stressful to use during anastomosis. These findings reflect self-reported perceptions rather than objective ergonomic or clinical outcomes, and causal relationships cannot be established. These findings are hypothesis-generating and suggest that further studies incorporating objective ergonomic measurements and broader surgeon populations are warranted.
Reoperation rates following breast-conserving surgery in a contemporary cohort.
Lima ADN, Millen EC, Cavalcante FP … +14 more , Zerwes FP, Mattar A, Antonini M, Kraft MBPL, de Alencar AFO, Queiroz Germano A, Torres DP, Goulart Carneiro E, de Lima CFF, Torresan RZ, Brenelli FP, Lichtenfels M, Bines J, Frasson AL
BMC Surg · 2026 May · PMID 42157146 · Full text
BACKGROUND: Breast-conserving surgery (BCS) followed by adjuvant radiotherapy is the standard of care for early-stage breast cancer. However, reoperations after BCS may compromise aesthetic outcomes, increase surgical co...
BACKGROUND: Breast-conserving surgery (BCS) followed by adjuvant radiotherapy is the standard of care for early-stage breast cancer. However, reoperations after BCS may compromise aesthetic outcomes, increase surgical complications, and cause psychological distress. This study aimed to determine the reoperation rate after BCS in a multi-institutional cohort from Brazil and to identify predictive factors associated with reoperation. METHODS: This retrospective multicenter cohort study included female breast cancer patients (AJCC clinical stage 0-III) who underwent BCS followed by adjuvant radiotherapy at six treatment centers in Brazil between January 2016 and December 2022. Logistic regression was used to assess the association between potential risk factors and reoperation. RESULTS: The overall reoperation rate was 5.2%, with a higher rate in the public hospital (9.9%) than in private hospitals (4.8%). Patients had a mean age of 58.2 years, with 70.5% aged over 50; 58.3% were White, and 89.8% were treated in private settings. The most common histological type was invasive ductal carcinoma (67.0%), with AJCC stage I (49.3%) and hormone receptor-positive tumors (54.6%) predominating. Logistic regression showed that ductal carcinoma in situ (DCIS) was significantly associated with an increased risk of reoperation (OR 2.59, 95% CI 1.08-5.76, p = 0.024), whereas the absence of multifocal tumors was associated with a reduced risk (OR 0.37, 95% CI 0.16-0.98, p = 0.031). CONCLUSION: Reoperation after BCS was infrequent in this cohort. DCIS was associated with an increased risk of reoperation, whereas the absence of multifocal disease was associated with a reduced risk. Higher reoperation rates observed in the public hospital should be interpreted with caution given the limited representation of this setting.
Concurrent lumbar degenerative disease is independently associated with chronic post-surgical pain after total knee arthroplasty for knee osteoarthritis: a retrospective study.
Zhang X, Zhu X, Rao D … +5 more , Sha L, Hao L, Jiang S, Zhang Z, Zhang C
BMC Surg · 2026 May · PMID 42157032 · Full text
OBJECTIVE: Chronic post-surgical pain (CPSP) after total knee arthroplasty (TKA) remains a significant clinical challenge. This study aimed to investigate the association between concurrent lumbar degenerative disease (L...
OBJECTIVE: Chronic post-surgical pain (CPSP) after total knee arthroplasty (TKA) remains a significant clinical challenge. This study aimed to investigate the association between concurrent lumbar degenerative disease (LDD) and CPSP after TKA for knee osteoarthritis (KOA). METHODS: A total of 348 KOA patients undergoing first unilateral TKA (June 2023-June 2025) were enrolled and stratified into LDD (n = 167) and non-LDD (n = 181) groups. CPSP incidence, pain severity, and postoperative knee function were compared. Logistic regression models were constructed to identify influencing factors for CPSP after TKA. RESULTS: At 6 months postoperatively, both groups showed significant improvements in knee function, mobility, and pain (all P < 0.05). Compared with the non-LDD group, the LDD group exhibited lower knee society scores, reduced knee range of motion, a shorter 6-minute walk distance, a longer timed up and go test time, higher visual analogue scale (VAS) scores for pain at rest and during activity, a higher rate of non-steroidal anti-inflammatory drug use, and a higher incidence of CPSP (all P < 0.05). Depression/anxiety history, preoperative VAS scores, and LDD were independently associated with CPSP after TKA in patients with KOA (all P < 0.05). Among patients with KOA with concurrent LDD, depression/anxiety history, preoperative VAS scores, and preoperative radicular symptoms were independently associated with CPSP after TKA (all P < 0.05). CONCLUSION: LDD is independently associated with CPSP after TKA. In patients with KOA with concurrent LDD, preoperative radicular symptoms, depression/anxiety history, and intense preoperative pain further increase CPSP risk.
Pediatric laparoscopic splenectomy using a repurposed sterile diathermy pouch as a retrieval bag: preliminary experience.
Zain M
BMC Surg · 2026 May · PMID 42152021 · Full text
INTRODUCTION: Laparoscopic splenectomy is increasingly performed in pediatric patients due to its well-established advantages over open surgery. However, specialized commercial retrieval bags used for specimen extraction...
INTRODUCTION: Laparoscopic splenectomy is increasingly performed in pediatric patients due to its well-established advantages over open surgery. However, specialized commercial retrieval bags used for specimen extraction add to procedural cost and may not be readily available in resource-limited settings. This study evaluated the feasibility and safety of a handmade retrieval pouch fashioned from a sterile diathermy pouch for pediatric laparoscopic splenectomy. METHODS: The study included 25 children aged 3 to 15 years who underwent elective laparoscopic splenectomy for benign hematologic disorders. A retrieval pouch was prepared from a sterile diathermy pouch supplied as part of the disposable sterile towel set. After spleen enclosure, the pouch opening was closed with a running suture and exteriorized through the umbilical incision for controlled in-bag fragmentation and extraction. The primary outcome was successful specimen retrieval without bag failure or conversion. RESULTS: The technique was successfully utilized in all 25 cases with no intraoperative complications. Spleen size ranged from 12 to 22 cm. Mean retrieval time was 36 min, decreasing from 120 min in the first case to 33 min in subsequent cases. Larger spleens (> 16 cm) required longer extraction times (47.0 ± 10.6 vs. 25.0 ± 2.7 min, p < 0.001). Patients experienced rapid recovery (mean hospital stay 1.7 ± 0.8 days) and excellent outcomes, with 92% reporting maximum satisfaction with cosmetic results and no postoperative complications at 3-month follow-up. CONCLUSION: In this preliminary series, use of a retrieval bag fashioned from a repurposed sterile diathermy pouch was feasible and safe for pediatric laparoscopic splenectomy across a broad range of splenic sizes, without additional incisions or retrieval-related complications.
The relationship between postoperative shoulder balance and coronal sacral slanting in adolescent idiopathic scoliosis patients with double structural curves.
Zheng S, Rasool A, Lai Z … +7 more , Li J, Li Q, Wang J, Deng Z, Yang H, Wang L, Song Y
BMC Surg · 2026 May · PMID 42152008 · Full text
BACKGROUND: Adolescent Idiopathic Scoliosis (AIS) is a complex spinal deformity where surgical correction aims to restore both spinal and shoulder balance. Postoperative shoulder imbalance (PSI) is a common complication,...
BACKGROUND: Adolescent Idiopathic Scoliosis (AIS) is a complex spinal deformity where surgical correction aims to restore both spinal and shoulder balance. Postoperative shoulder imbalance (PSI) is a common complication, leading to patient dissatisfaction. While numerous factors contribute to PSI, the role of coronal sacral slanting, particularly in Lenke type 3 and 6 patients, is not well understood. This study investigated the relationship between postoperative shoulder balance and coronal sacral slanting in these patients. METHODS: A retrospective cohort study was conducted on 231 AIS patients (102 males, 129 females) with Lenke type 3 and 6 curves who underwent posterior fusion and had a minimum of 24 months of follow-up. Patients were divided into a postoperative shoulder imbalance (PSI) group (n = 61) and a postoperative shoulder balance (PSB) group (n = 170). They were also subdivided into three groups according to coronal sacral slanting: left-sided (> 3°), non-slanting (0°-3°), and right-sided (> 3°). Radiographic parameters, including clavicle angle (CA), coracoid height difference (CHD), T1 tilt, radiographic shoulder height (RSH), and distal vertebral wedge angle (DWA), were measured at various follow-up intervals. RESULTS: At final follow-up, the PSI group showed significantly worse outcomes in all shoulder parameters (RSH, CA, T1 Tilt, and CHD) and a larger sacral slanting angle compared to the PSB group (P < 0.05). No significant differences were found in main curve correction rates between the two groups. In the sacral slanting subgroups, while preoperative shoulder parameters and main curve correction rates were similar, the postoperative DWA was significantly different among the groups (P < 0.001). The right-side slanting group demonstrated a significant increase in DWA and the largest improvement in RSH, with a mean change of -7.26 mm, suggesting adaptive changes. CONCLUSION: Due to the observational nature of this study, a direct causal relationship cannot be definitively established; however, our findings indicate that right-side sacral slanting is significantly associated with a better long-term recovery of postoperative shoulder balance. This process may be mediated by an adaptive increase in the distal wedge angle. These insights may help surgeons better predict and manage postoperative shoulder imbalance in Lenke type 3 and 6 AIS patients.
A durable solution for challenging multidrug-resistant bone infections: a retrospective study on long-term efficacy of the flow-through fibula osteocutaneous flap in limb reconstruction.
Deng L, Li L, Chen X … +5 more , Li Z, Zhou M, Yu A, Jian C, Xiao W
BMC Surg · 2026 May · PMID 42151948 · Full text
BACKGROUND: Infectious bone and soft tissue defects caused by multidrug-resistant bacteria (MDRB) represent infrequent yet challenging medical conditions. Vascularized fibular grafting constitutes a crucial treatment mod...
BACKGROUND: Infectious bone and soft tissue defects caused by multidrug-resistant bacteria (MDRB) represent infrequent yet challenging medical conditions. Vascularized fibular grafting constitutes a crucial treatment modality in limb reconstruction procedures, offering improved recovery by supplying nutrients and structural support, particularly in large defects and compromised vascularity. The present study assessed the long-term outcomes of flow-through fibula osteocutaneous flaps for reconstructing multidrug-resistant infected bone and soft tissue defects. METHODS: Between January 2015 and January 2019, 39 patients with bone and soft tissue defects of the lower leg secondary to multidrug-resistant osteomyelitis were enrolled in this study. The study cohort comprised 23 male and 16 female participants, with a mean age of 45.33 ± 10.93 years. All limbs underwent multiple debridement procedures and were subsequently reconstructed using a flow-through fibula osteocutaneous flap combined with an external locking plate. Clinical and radiological outcomes, including flap survival, bone graft bridging, nonunion, infection recurrence, re-fracture and tibialization of the fibula, were evaluated and recorded over a minimum follow-up period of 5 years (ranging from 5 to 10 years). At the final follow-up, limb function was assessed using the Lower Extremity Functional Scale (LEFS). RESULTS: All the flow-through fibula osteocutaneous flaps survived well. The flow-through flap components measured a mean length of 11.72 ± 2.84 cm (95% CI, 10.83-12.61 cm) and a mean width of 5.69 ± 1.22 cm (95% CI, 5.29-6.09 cm). The median length of the fibula component was 8 cm (IQR: 7-11; 95% CI: 7.0-9.0 cm). Three flaps experienced venous crisis within 48 h postoperatively and ultimately survived following timely exploration, thrombectomy, and venous anastomosis. On the fourth postoperative day, two cases of the flap exhibited venous congestion accompanied by edema, which returned to normal after dressing change. The median length of hospital stay was 17 days (IQR, 16-19; 95% CI, 16.0-18.0 days). Bone graft bridging to the tibia was achieved in all patients, with a mean time of 4.23 ± 0.99 months (95%CI, 3.91-4.55 months). During the 5- to 10-year follow-up period, 32 of the 39 fibular grafts (82.05%) achieved tibialization. Although the remaining 7 grafts (17.95%) had not fully undergone tibialization, they exhibited a progressive trend toward increased thickness. No signs of infection recurrence or refracture were detected. At the final follow-up, all patients were able to walk normally, with a mean Lower Extremity Functional Scale (LEFS) score of 74.26 ± 2.04 (95%CI, 70.14-78.37). CONCLUSION: The flow-through fibula osteocutaneous flap may represent a viable reconstructive option for selected patients with multidrug-resistant infectious bone and soft tissue defects, showing acceptable osseointegration and a low incidence of infection recurrence in this small single-center series. These preliminary observations require validation in larger prospective cohorts.
Selective temporary protective loop ileostomy in complex rectal resection for deep infiltrating endometriosis: a prospective matched cohort study on bowel function, quality of life, and postoperative complications.
Hawezy DJ, Baqer W, Fatah AO … +1 more , Alsaffar MF
BMC Surg · 2026 May · PMID 42151942 · Full text
BACKGROUND: This study aimed to evaluate the impact of temporary protective loop ileostomy (PLI) on postoperative complications, bowel function, and quality of life (QoL) in women undergoing rectal surgery for deep infil...
BACKGROUND: This study aimed to evaluate the impact of temporary protective loop ileostomy (PLI) on postoperative complications, bowel function, and quality of life (QoL) in women undergoing rectal surgery for deep infiltrating endometriosis (DIE) requiring concomitant vaginal and rectal repair. METHODS: In this prospective observational cohort study conducted at Baghdad Teaching Hospital, Medical City, and Kamal Al-Samarrai Hospital (April 2023-April 2024), 230 women underwent colorectal endometriosis surgery. From this population, 42 women with technically feasible colorectal anastomoses were selected; 21 who received a temporary protective loop ileostomy (PLI) were matched 1:1 by age and key risk factors to 21 women without PLI (WPLI). Postoperative outcomes, including the Memorial Sloan Kettering Cancer Center Bowel Function Instrument (MSKCC-BFI score) and QoL (EHP-5 score), were assessed using validated Arabic versions of psychometric instruments at baseline and one year postoperatively. Surgical complications were classified per Clavien-Dindo criteria. RESULTS: Both groups demonstrated significant improvement in pain symptoms, bowel function, and QoL at 12-month follow-up (p < 0.05). Observed differences in postoperative bowel function (MSKCC-BFI: 86.4 ± 4.3 vs. 88.2 ± 4.4; p > 0.05) and EHP-5 scores (28.1 ± 5.3 vs. 31.3 ± 4.3; p > 0.05) should be interpreted as exploratory trends given limited power. Postoperative complication rates (9.5% vs. 14.3%; p = 0.211) suggest a possible pattern. CONCLUSIONS: In women with DIE and technically feasible colorectal anastomoses, selective use of temporary protective loop ileostomy was not associated with significant detriment to bowel function or QoL in this small matched cohort and may be linked to lower rates of severe anastomotic complications. Given the limited sample size and observational design, these findings should be considered preliminary. Larger, adequately powered randomized trials with extended follow-up are warranted to confirm these observations.
A highly feasible simulation model based on nipple-preserving pork portions for practicing superficial mass resection.
Jin P, Weng X, Zhang X … +5 more , Fang T, Geng L, Chen S, Liang T, Hu Q
BMC Surg · 2026 May · PMID 42151933 · Full text
BACKGROUND: Superficial mass resection is a core surgical skill requiring practical training. Existing simulation models, such as silicone pads or virtual reality, are often costly or inaccessible, creating a need for an...
BACKGROUND: Superficial mass resection is a core surgical skill requiring practical training. Existing simulation models, such as silicone pads or virtual reality, are often costly or inaccessible, creating a need for an affordable and feasible alternative for surgical education. METHODS: In this feasibility study, we developed a low-cost, high-fidelity simulation model using a rind-on pork belly with preserved nipples to practice this procedure and evaluated its efficacy in a skill training study involving 56 surgery residents, whose competency was assessed using a procedure-specific rating scale and the Direct Observation of Procedural Skills (DOPS) tool. RESULTS: The pork-based model effectively differentiated competency levels among residents with varying experience. It demonstrated superior fidelity compared to silicone models, without increased operational difficulty, proving particularly suitable for beginners. CONCLUSIONS: This pork-based simulation model is low-cost and easy to prepare, and it represents a high-fidelity training tool, highlighting the possibility of using biological models in hands-on surgical simulation.
Meta-analysis of the safety and efficacy of flap reconstruction in the treatment of diabetic foot ulcers.
Fang W, Wang X, Lai W … +1 more , Huang Z
BMC Surg · 2026 May · PMID 42151923 · Full text
OBJECTIVE: To systematically evaluate the safety and efficacy of flap reconstruction surgery and the associated influential factors in the treatment of diabetic foot ulcers (DFUs) and to provide an evidence-based basis f...
OBJECTIVE: To systematically evaluate the safety and efficacy of flap reconstruction surgery and the associated influential factors in the treatment of diabetic foot ulcers (DFUs) and to provide an evidence-based basis for clinical flap selection and surgical strategies. METHODS: The PubMed, Embase, Web of Science, and Cochrane Library databases were systematically searched to identify studies on comparative or single-arm flap reconstruction for the treatment of diabetic foot ulcers (DFUs). Eligible study designs included randomized controlled trials (RCTs), cohort studies, and case series published between 1998 and 2025. Two investigators independently screened the literature, extracted relevant data, and assessed the risk of bias using the Cochrane Risk of Bias tool and the Risk Of Bias In Non-randomized Studies-of Interventions (ROBINS-I) tool. Meta-analyses were performed using Review Manager (RevMan) 5.4. The primary and secondary outcome measures included total flap loss, limb loss rate, and flap failure rate. Subgroup analyses were conducted according to flap type and regional differences. RESULTS: A total of 45 studies were included. The results of the meta-analysis showed that patients undergoing flap reconstruction had higher postoperative total flap loss (HR = 5.83; 95% CI 3.65-9.31), limb loss (HR = 11.09; 95% CI 7.22-17.03), and flap failure rate (HR = 10.01; 95% CI 8.31-12.05) compared with reference populations or expected baseline risks. Subgroup analyses revealed that the risk of free flap limb loss was significantly greater than that of non-free flaps (HR = 17.86 vs. 1.94; P = 0.02); the risk of limb loss was greater in Europe (HR = 22.97) and North America (HR = 17.42) than in East Asia (HR = 5.85; P < 0.001), and there was no regional difference in total flap loss (P = 0.67). The results of the sensitivity analysis were robust, with heterogeneity arising mainly from differences in study design and patient characteristics. CONCLUSION: Flap reconstruction remains a viable option for DFU wound closure, but it is associated with elevated risks of postoperative total flap loss and limb loss. Individualized surgical protocols, prioritization of non-free flaps for low- and intermediate-risk patients, and enhanced multidisciplinary collaboration and postoperative management are recommended. More high-quality studies are needed to validate the long-term efficacy of different flap techniques. TRIAL REGISTRATION: Register with PROSPERP, Registration Information: ID: CRD420251075758. Date of first submission to PROSPERO: 25 June 2025. Upload data information: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251075758.
Preoperative glycated hemoglobin predicts postoperative plantar pressure improvement after posterior cervical laminoplasty in patients with cervical spondylotic myelopathy and diabetes mellitus.
Wu Z, Hu Y, Liu Y … +1 more , Sun X
BMC Surg · 2026 May · PMID 42151855 · Full text
BACKGROUND: Diabetes mellitus (DM) may adversely affect neurological recovery after cervical decompression, but its relationship with postoperative plantar pressure restoration in cervical spondylotic myelopathy (CSM) re...
BACKGROUND: Diabetes mellitus (DM) may adversely affect neurological recovery after cervical decompression, but its relationship with postoperative plantar pressure restoration in cervical spondylotic myelopathy (CSM) remains insufficiently defined. OBJECTIVE: To evaluate whether preoperative glycated hemoglobin (HbA1c) is associated with postoperative improvement in plantar pressure distribution after posterior single-door laminoplasty in patients with CSM and DM. METHODS: This retrospective single-center study evaluated diabetic patients with CSM treated with posterior single-door laminoplasty and followed for at least 24 months. Dynamic plantar pressure assessment was performed preoperatively and at final follow-up, with medial foot pressure (MFP) and lateral foot pressure (LFP) used as the primary biomechanical outcomes. Linear and logistic regression analyses were used to examine the association between preoperative HbA1c and plantar pressure recovery after adjustment for selected clinical and radiological variables. Receiver operating characteristic (ROC) analysis was performed as an exploratory assessment of discrimination. RESULTS: Postoperatively, plantar loading shifted toward a more physiological distribution, with reduced MFP and increased LFP. Higher preoperative HbA1c was independently associated with smaller improvements in both ΔMFP2 and ΔLFP2 at 2 years. Radiological parameters, including canal narrowing ratio and modified K-line interval, showed associations with outcome in univariable analyses, but their effects were attenuated after adjustment. HbA1c demonstrated fair discriminatory ability for unfavorable plantar pressure recovery, with AUC values of 0.72 for ΔMFP2 and 0.68 for ΔLFP2. CONCLUSIONS: In diabetic patients with CSM undergoing posterior laminoplasty, poorer preoperative glycemic control was associated with less favorable improvement in plantar pressure distribution at long-term follow-up. HbA1c may be useful as one component of preoperative risk stratification within a laminoplasty cohort, but its discriminatory performance was only fair and should not be interpreted as a stand-alone treatment threshold.
Overcoming the absence of pre-traumatic imaging: a multiplanar three-dimensional virtual reduction workflow for mandibular condylar fractures.
Elayah SA, Zhang R, Chen J … +5 more , Hu W, Huang J, Al-Attab R, Mei X, Long J
BMC Surg · 2026 May · PMID 42144585 · Full text
BACKGROUND: A fundamental challenge in condylar fracture reconstruction with patient-specific implants is the absence of a pre-traumatic baseline, making direct intra-individual comparison impossible. Several virtual red...
BACKGROUND: A fundamental challenge in condylar fracture reconstruction with patient-specific implants is the absence of a pre-traumatic baseline, making direct intra-individual comparison impossible. Several virtual reduction workflows for mandibular condylar fractures have been introduced, but all currently available approaches rely on mirroring the healthy, unaffected condyle as a template for the affected side. However, contralateral mirroring is not feasible in bilateral fractures or cases with contralateral compromise. To address this limitation, the present study introduces a three-dimensional virtual reduction workflow for mandibular condylar fractures in situations where pre-injury imaging data are unavailable or the contralateral side is compromised. METHODS: This study included 45 consecutive patients with unilateral mandibular condylar fractures. Post-traumatic computed tomography data were imported into Mimics Medical software to generate a 3D bone model of the skull. Image segmentation was performed using the default bone threshold. A split mask approach was applied twice: first to separate the mandible from the maxilla and craniofacial bones, and second to isolate the fractured fragment from the residual mandibular portion. Virtual reduction of the fractured fragment was performed directly on the post-traumatic CT scan using the three orthogonal imaging planes, rather than on the 3D model. All linear and angular measurements were obtained from the 3D-reconstructed mid-sagittal slice of the hemimandible using the caliper and angle tools in Slicer software. The Wilcoxon signed-rank test was used to compare paired measurements. RESULTS: The study included 45 patients with unilateral condylar fractures (64.5% male, 35.5% female). Fracture distribution was as follows: 28.9% involved the condylar head, 37.7% the condylar neck, and 33.4% the sub-condylar region. No statistically significant differences were found between the virtually reduced side and the mirrored contralateral control side. The median total ramus height was 61.5 mm versus 61.0 mm, gonial angle was 116.6° versus 116.2°, head-notch angle was 100.7° versus 101.0°, and head-coronoid process distance was 40.8 mm versus 41.0 mm. CONCLUSION: The findings demonstrate that the multiplanar virtual reduction workflow restores ramus symmetry and condylar position. It offers a feasible alternative to pre-traumatic imaging in the management of condylar fractures, as it does not rely on mirroring the contralateral side.
Impact of nutritional status on 30-days postoperative morbidity and mortality in patients undergoing emergency laparotomy for gastrointestinal perforation peritonitis: a prospective observational study.
Jain N, Kumar N, Patel C … +7 more , Singh NP, Prafulla Mahathi RS, Vasudev A, Singh D, Singh SK, Huda F, Basu S
BMC Surg · 2026 May · PMID 42143262 · Full text
BACKGROUND: Malnutrition is an under-assessed risk factor for poor surgical outcomes in emergency settings. Emergency laparotomy (EL) for gastrointestinal perforation peritonitis presents a unique challenge due to its ac...
BACKGROUND: Malnutrition is an under-assessed risk factor for poor surgical outcomes in emergency settings. Emergency laparotomy (EL) for gastrointestinal perforation peritonitis presents a unique challenge due to its acute nature and associated sepsis, which often compromise preoperative nutritional optimization. This study evaluates the impact of preoperative nutritional status on 30-days postoperative morbidity and mortality following EL. METHODS: In this prospective observational study, 105 adult patients undergoing EL for gastrointestinal perforation peritonitis were assessed for nutritional status using CONUT and MUST scores. Postoperative complications were graded using the Clavien-Dindo Classification (CDC). Patients were stratified into high and low risk based on nutritional score thresholds, and complications were grouped as minor (CDC Grades I-II) or major (CDC Grades III-V). RESULTS: A significant proportion of patients were found to be moderate to severely malnourished (66.67% per CONUT, 40% per MUST). Major complications were observed in 38.1% of patients. All recorded deaths occurred in those with moderate to severe malnutrition. Strong correlations were found between higher CONUT/MUST scores and complication severity (ρ = 0.631 and 0.539, respectively; p < 0.001). ROC analysis demonstrated that CONUT had superior predictive ability for 30-day mortality (AUC = 0.949) compared to MUST (AUC = 0.843). Length of hospital stay (LOHS) was also significantly prolonged in patients with high nutritional risk. CONCLUSIONS: Both CONUT and MUST demonstrated good predictive performance, with no statistically significant difference on DeLong comparison. The implementation of nutritional assessment may enable timely interventions, reduce complications, and improve survival outcomes in patients undergoing EL.
Puncture and catheterization of the ascending colon for succus entericus reinfusion in a patient with a high-output single-lumen stoma: a case report.
Lai S, Zhang X, Hu H … +4 more , Jiang K, Zhao X, Zeng H, Ke J
BMC Surg · 2026 May · PMID 42141423 · Full text
BACKGROUND: High-output enterostomy is a common complication following ostomy procedures. In patients with loop ileostomies, the incidence of dehydration can reach 30%, and it represents the most frequent cause of readmi...
BACKGROUND: High-output enterostomy is a common complication following ostomy procedures. In patients with loop ileostomies, the incidence of dehydration can reach 30%, and it represents the most frequent cause of readmission after ileostomy surgery, with rates as high as 16.9%. In severe cases, this condition can progress to renal failure (Dis Colon Rectum 55: 175-80, 2021, J Gastrointest Surg 17: 298-303, 2013, Nurs Stand 37: 71-6, 2022). High-output ileostomy (HOI) often imposes dietary restrictions on patients, increasing the risk of malnutrition. Previous studies have demonstrated that ileostomy fluid reinfusion can effectively address dehydration, electrolyte imbalances, renal dysfunction, and malnutrition (Gastroenterol Rep (Oxf) 12: goae100, 2024). However, the primary physiological benefit of reinfusion, particularly into the colon, is rehydration and electrolyte reabsorption, with nutritional improvement likely attributable to concurrent enteral support and intestinal adaptation. CASE PRESENTATION: A 73-year-old female patient underwent ultrasound-guided puncture of the ascending colon for placement of a feeding tube, establishing a route for ileostomy fluid reinfusion. Combined with total enteral nutrition support and distal colon fluid reinfusion, this method was used to manage HOI in a patient with a small bowel single-lumen stoma. CONCLUSIONS: This case demonstrates that ultrasound-guided catheterization of the ascending colon provides a feasible and effective approach for succus entericus reinfusion (SER) in patients with high-output single-lumen ileostomies. The intervention improved hydration, renal function, and nutritional status, facilitating safe stoma reversal. This technique offers a promising alternative for managing high-output stomas when conventional reinfusion pathways are not available.
Risk factors for catheter-related complications after ultrasound-guided percutaneous transhepatic biliary drainage in malignant obstructive jaundice.
Wang J, Chen Y, Gong X
BMC Surg · 2026 May · PMID 42135741 · Full text
OBJECTIVE: To investigate the independent risk factors for catheter-related complications after PTBD in patients with malignant obstructive jaundice, and to construct a risk prediction model to provide evidence for clini...
OBJECTIVE: To investigate the independent risk factors for catheter-related complications after PTBD in patients with malignant obstructive jaundice, and to construct a risk prediction model to provide evidence for clinical prevention and intervention strategies. METHODS: This retrospective study included 337 patients with malignant obstructive jaundice who underwent ultrasound-guided PTBD at our hospital between January 2024 and December 2025. We collected demographic data, preoperative laboratory indices, intraoperative parameters, and postoperative complications. Univariate and multivariate logistic regression analyses identified independent risk factors for postoperative infection and bleeding. Prediction models were constructed and evaluated using receiver operating characteristic (ROC) curve analysis. RESULTS: Among the 337 patients with malignant obstructive jaundice, the incidence of postoperative infection was 7.4%, and the incidence of postoperative bleeding was 9.5%. Multivariate analysis showed that independent risk factors for postoperative infection included ascites, multiple punctures, elevated preoperative neutrophil count, and decreased preoperative hemoglobin levels. Positive HBV DNA status and diuretic use showed unexpected inverse associations. Independent risk factors for postoperative bleeding were decreased preoperative hemoglobin and decreased preoperative prealbumin levels. ROC curve analysis demonstrated that the infection prediction model incorporating the six above-mentioned factors yielded an AUC of 0.825 (95% CI: 0.750-0.900), while the bleeding prediction model combining hemoglobin and prealbumin achieved an AUC of 0.866 (95% CI: 0.810-0.922), indicating good predictive performance for both models. CONCLUSIONS: Ascites, multiple punctures, elevated preoperative neutrophil count, and low preoperative hemoglobin level are independent risk factors for post-PTBD infection, whereas low preoperative hemoglobin and low prealbumin levels are independent risk factors for post-PTBD bleeding. The risk prediction models based on these factors demonstrate good discriminative ability and may help identify high‑risk patients preoperatively, guide targeted preventive strategies, reduce complication rates, and improve the safety of PTBD.
CT-defined body composition is associated with postoperative burst abdomen in patients undergoing laparotomy.
Meyer HJ, Romeo D, Dermendzhiev T … +5 more , Stelzner S, Scheuermann U, Denecke T, Niebisch S, Mehdorn M
BMC Surg · 2026 May · PMID 42135717 · Full text
BACKGROUND: Postoperative abdominal wall dehiscence (AWD) or burst abdomen (BA) is a relevant complication after abdominal surgery that causes additional surgical procedures, prolonged hospital stays and long-term morbid...
BACKGROUND: Postoperative abdominal wall dehiscence (AWD) or burst abdomen (BA) is a relevant complication after abdominal surgery that causes additional surgical procedures, prolonged hospital stays and long-term morbidity. Several underlying risk factors exist and have been described in literature and consist of surgical and medical factors. Recently, CT-derived body composition is of rising interest to provide new prognostic factors in surgical patients. The present study aims to explore the association between CT-defined body composition and postoperative BA. MATERIALS AND METHODS: A database of patients who underwent abdominal surgery and developed post-operative wound infections in our institution between 2015 and 2018, was assembled. The subgroup of patients with BA was compared to a control group without BA. CT-defined body composition was evaluated in L3-level measuring skeletal muscle index (SMI) for sarcopenia assessment, visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT). Clinical risk factors and CT-defined body composition were used to predict the occurrence of postoperative BA using discriminatory and binary logistic regression analyses. RESULTS: A total of 118 patients, 92 (78%) with BA and 26 (22%) without BA were included in the analysis. CT derived body composition parameters for visceral obesity and sarcopenia showed statistically significant differences between the two cohorts. Patients with burst abdomen showed higher VAT (157.6 cm² vs. 84.9 cm², p = 0.001) and a significantly lower SMI (46.9 cm²/m² vs. 53.8 cm²/m², p = 0.016). Consequently, visceral obesity and sarcopenia were significantly more frequent in patients with BA (p = 0.02 and 0.01, respectively). In the multivariable Firth's penalized logistic regression, visceral obesity (OR = 4.87, 95% CI 1.32-21.91 p = 0.02), sarcopenia (OR = 5.94, 95% CI 1.65-26.68 p = 0.006), intestinal resection (OR = 9.33, 95% CI 2.33-55.65 p < 0.001) and length of the surgical wound (OR = 1.12, 95% CI 1.04-1.22 p = 0.001) were independently associated with the occurrence of burst abdomen. CONCLUSION: CT-defined body composition with sarcopenia and visceral obesity are strongly associated with postoperative BA. This analysis should be further acknowledged as a potentially important risk factor in surgical care and could aid in clinical decision making.
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