BMC Surgery[JOURNAL]
Sun
200 papers
A selective strategy for celiac trunk non-reconstruction in visceral debranching hybrid surgery for abdominal aortic aneurysm: a case report.
Geng D, Miao Y
BMC Surg · 2026 Jul · PMID 42387477 · Full text
OBJECTIVE: To explore the feasibility and clinical value of a novel strategy involving selective non-reconstruction of the celiac trunk based on pancreaticoduodenal arterial arch collateralization during visceral zone de...
OBJECTIVE: To explore the feasibility and clinical value of a novel strategy involving selective non-reconstruction of the celiac trunk based on pancreaticoduodenal arterial arch collateralization during visceral zone debranching hybrid surgery for abdominal aortic aneurysm (AAA). METHODS: We report a case of a 68-year-old male patient with a 52 mm paravisceral AAA (infradiaphragmatic, without thoracic involvement) involving the origins of the visceral arteries. Preoperative CTA demonstrated well-developed pancreaticoduodenal arterial arch collateralization. An innovative strategy was adopted: only the superior mesenteric artery and bilateral renal arteries were revascularized, with selective non-reconstruction of the celiac trunk. The hybrid surgical procedure is described in detail including patient positioning, incision, graft type, operative time, blood loss, EVAR landing zone, and access site. The technical advantages of this strategy and the postoperative imaging validation results were analysed. RESULTS: In this case, classic four-vessel revascularization was simplified to a three-vessel procedure, reducing surgical difficulty and avoiding dissection posterior to the pancreas as well as pancreas-related complications. Total operative time was 275 min, estimated blood loss was 450 mL, and no intraoperative transfusion was required. Postoperative CTA revealed satisfactory perfusion of the celiac trunk system, homogeneous enhancement of the liver parenchyma and splenic parenchyma (no evidence of splenic infarction), robust retrograde filling of the pancreaticoduodenal arterial arch and gastroduodenal artery, absence of endoleak, and patency of the bypass grafts. Postoperative endoscopic examination showed normal gastric mucosa, and serum amylase/lipase levels remained within normal limits. The patient had no postprandial symptoms, and bowel function returned on postoperative day 2. CONCLUSION: Selective non-reconstruction of the celiac trunk via pancreaticoduodenal arterial arch collateralization represents an innovative strategy for visceral zone debranching in hybrid surgery for AAA. This strategy simplifies the procedure and reduces surgical trauma through a "subtraction" approach while ensuring adequate visceral perfusion. The strategy reduces surgical risk by avoiding pancreas-related complications, shortening operative time, and reducing warm hepatic ischemia time. Postoperative CTA serves as a core tool for validating the efficacy of collateral compensation. Long-term imaging surveillance is essential to monitor for late complications including pancreaticoduodenal arch aneurysm formation and Type II endoleak.
To explore or not: machine learning models for intraoperative decision on testicular exploration in infants under 3 months with incarcerated inguinal hernia.
Fu Y, Liu G, Tang Z … +5 more , Zhou J, Qiu S, Ge X, Song X, Kang Q
BMC Surg · 2026 Jul · PMID 42387474 · Full text
PURPOSE: To develop a machine learning (ML) model for preoperative prediction of testicular necrosis risk in male infants under 3 months with incarcerated inguinal hernia (IIH), addressing the limitations of current asse...
PURPOSE: To develop a machine learning (ML) model for preoperative prediction of testicular necrosis risk in male infants under 3 months with incarcerated inguinal hernia (IIH), addressing the limitations of current assessment methods. METHODS: We retrospectively analyzed 288 male infants under 3 months with IIH who underwent emergency surgery. Key preoperative variables (testicular blood flow, echotexture, incarceration duration, procalcitonin, neutrophil-to-lymphocyte ratio) were used to train ten ML models. Performance was evaluated using ROC AUC, PR AUC, accuracy, precision, recall, and F1-score. SHAP analysis assessed interpretability. RESULTS: The Gradient Boosting model performed best, achieving a ROC AUC of 0.940 and a recall of 0.889. SHAP identified absent testicular blood flow, heterogeneous echotexture, prolonged incarceration, and elevated procalcitonin and neutrophil-to-lymphocyte ratio as top predictors. CONCLUSION: This ML model predicts testicular necrosis risk preoperatively. By integrating color Doppler ultrasound, serological markers, and clinical data, it offers an interpretable tool to guide selective testicular exploration, potentially optimizing outcomes. However, given the single-center retrospective nature of this study, external validation in multi-center prospective cohorts is required before clinical implementation.
Handmade loop ligation versus Hem-o-lok clip closure for appendiceal stump management in laparoscopic appendectomy: a propensity score-matched study with direct material cost analysis.
Çakcak A, Erkent M, Kamilova S … +4 more , Badalov R, Şafak A, Gojayev A, Yıldırım S
BMC Surg · 2026 Jul · PMID 42387467 · Full text
BACKGROUND: Laparoscopic appendectomy is widely accepted as the standard surgical treatment for acute appendicitis. Several methods have been described for appendiceal stump closure, including handmade loop ligation and...
BACKGROUND: Laparoscopic appendectomy is widely accepted as the standard surgical treatment for acute appendicitis. Several methods have been described for appendiceal stump closure, including handmade loop ligation and Hem-o-lok clip closure. Although Hem-o-lok clips are technically simple, their use increases direct material cost. The aim of this study was to compare perioperative outcomes, postoperative complications, and direct material costs between handmade loop ligation and Hem-o-lok clip closure during laparoscopic appendectomy. METHODS: This retrospective cohort study included adult patients who underwent laparoscopic appendectomy for acute appendicitis at a tertiary academic center. Patients were grouped according to appendiceal stump closure method. Propensity scores were estimated using age, sex, ASA class, previous abdominal surgery, preoperative white blood cell count, appendix diameter, periappendiceal fluid, and cecal edema. Histopathologic type was not included in the propensity model because it was unavailable at the time of intraoperative treatment allocation. BMI and preoperative temperature were excluded because of substantial missingness. One-to-one matching was performed using a caliper of 0.2 standard deviations of the logit of the propensity score, with exact matching for sex, ASA class, and cecal edema. Balance was evaluated using standardized mean differences. Direct material cost was calculated using institutional unit prices. RESULTS: The raw dataset included 695 patients, comprising 652 patients in the handmade loop group and 43 in the Hem-o-lok group. BMI and preoperative temperature were missing in 609 (87.6%) and 614 (88.3%) patients, respectively. After the matching procedure, 35 well-defined pairs were obtained (n = 70). Operation time, length of hospital stay, time to first flatus, conversion to open surgery, postoperative complications, major complications, intra-abdominal abscess, and 30-day readmission did not differ significantly between groups. Drain placement was more frequent in the handmade loop group [6/35 (17.1%) vs. 0/35 (0.0%), p = 0.025; risk difference 17.1%, 95% CI 3.7 to 32.7]. Direct material cost per patient was 75 TL for handmade loop ligation and 570 TL for Hem-o-lok closure, corresponding to a 495 TL per-patient cost difference. CONCLUSION: After propensity score matching, handmade loop ligation and Hem-o-lok clip closure showed no statistically significant differences in most short-term perioperative and postoperative outcomes, although drain placement was higher in the handmade loop group. Handmade loop ligation was associated with substantially lower direct material cost. Because of the retrospective design, small matched sample, residual imbalance in some covariates, and limited power for rare complications, these findings should be interpreted cautiously and should not be considered proof of equivalence.
Ultrasound-guided rectus sheath blocks after midline laparotomy: an exploratory observational comparative implementation study comparing the analgesic effect between liposomal bupivacaine and continuous ropivacaine.
Vereen MS, Dirckx M, Koopsen R … +5 more , Koutstaal K, Simoncelli T, Stolker RJ, Hoeks SE, Harms F
BMC Surg · 2026 Jul · PMID 42387465 · Full text
BACKGROUND: Open abdominal surgery can cause significant postoperative pain, requiring optimal management to facilitate recovery. The use of epidural analgesia has declined, resulting in the increased use of locoregional...
BACKGROUND: Open abdominal surgery can cause significant postoperative pain, requiring optimal management to facilitate recovery. The use of epidural analgesia has declined, resulting in the increased use of locoregional analgesic techniques as part of a multimodal regime. METHODS: This exploratory observational comparative implementation study aimed to evaluate the postoperative opioid consumption and analgesic outcome following the clinical implementation of liposomal bupivacaine in ultrasound-guided rectus sheath blocks, compared to a historical cohort receiving continuous ropivacaine after midline laparotomy. Opioid consumption and pain scores in the first 72 h postoperatively were respectively the primary and secondary outcomes. RESULTS: Twenty-two patients were included in each group. A total of 35 patients had opioid consumption noted for the first 72 h. Mean opioid consumption was significantly higher in the liposomal bupivacaine group, with mean difference of 46.4 mg morphine milligrams equivalents (95% CI [11.1 mg, 81.7 mg]). Mean pain scores in both groups were low during the first 72 postoperative hours. CONCLUSIONS: Although ultrasound-guided rectus sheath blocks with LB were associated with higher opioid consumption up to 72 h postoperatively after midline laparotomy compared to continuous rectus sheath blocks with ropivacaine, both groups exhibited low opioid consumption as well as similarly low pain scores.
Preoperative CT and inflammatory index-based risk scores for predicting short-term recurrence following resection of pancreatic ductal adenocarcinoma.
Mansouri-Tehrani MM, Zamani F, Iraji H … +3 more , Safarnezhad Tameshkel F, Mansouri Tehrani MM, Ghasemi M
BMC Surg · 2026 Jul · PMID 42387459 · Full text
BACKGROUND: Pancreatic ductal adenocarcinoma (PDAC) carries a poor prognosis, with nearly half of resected patients relapsing within one year. Current National Comprehensive Cancer Network (NCCN) and American Joint Commi...
BACKGROUND: Pancreatic ductal adenocarcinoma (PDAC) carries a poor prognosis, with nearly half of resected patients relapsing within one year. Current National Comprehensive Cancer Network (NCCN) and American Joint Committee on Cancer (AJCC) staging systems inadequately reflect tumor biology. This study aimed to develop and validate preoperative risk scores integrating computed tomography (CT) features and systemic inflammatory markers to predict 12-month recurrence. METHODS: In this two-center retrospective cohort, consecutive patients with histologically confirmed resectable/borderline PDAC who underwent pancreaticoduodenectomy (2017-2024) were included. Standardized preoperative multiphase CT and laboratory data within 28 days before surgery were reviewed. Quantitative and qualitative CT parameters and inflammatory indices were analyzed using multiple imputation and pathway-specific logistic regression for up-front surgery (US) and neoadjuvant therapy (NT) groups. Model performance was evaluated by discrimination, calibration, and decision-curve analysis. RESULTS: Of 544 resections, 133 met eligibility (US = 81; NT = 52). Final models retained tumor size, necrosis, fat stranding, and the C-reactive protein-to-albumin ratio (CAR) and neutrophil-to-lymphocyte ratio (NLR) for US, and tumor size, hepatic-artery contact ≥ 90°, CAR, NLR, and carcinoembryonic antigen (CEA) for NT. Development area under the curve (AUC) values were 0.84 (US) and 0.81 (NT), and test AUCs were 0.82 and 0.78, respectively, outperforming AJCC 8ᵗʰ staging (ΔAUC + 0.19 and + 0.20). CONCLUSIONS: Compact, pathway-specific preoperative scores combining CT descriptors and inflammatory indices improved prediction of early recurrence compared with AJCC staging, supporting their potential use for individualized surgical and perioperative decision-making.
Reconstruction of the Achilles tendon using LARS artificial ligament in bilateral xanthoma: a case report and literature review.
Wang C, Wang J, Wu C … +2 more , Zou J, Shi Z
BMC Surg · 2026 Jul · PMID 42387456 · Full text
BACKGROUND: Achilles tendon xanthoma (ATX) is a rare benign lesion characterized by lipid deposition within the tendon and is often associated with hyperlipidemia and genetic diseases. Surgery is challenging due to the r...
BACKGROUND: Achilles tendon xanthoma (ATX) is a rare benign lesion characterized by lipid deposition within the tendon and is often associated with hyperlipidemia and genetic diseases. Surgery is challenging due to the risk of recurrence and its impact on patients' quality of life. Reconstruction using a synthetic ligament has not been previously reported for this condition. CASE PRESENTATION: A 35-year-old female patient presented with a progressive mass in both heels over 4 years, accompanied by limited ankle dorsiflexion (5°-10°), a Visual Analogue Scale (VAS) score of 6, and an American Orthopaedic Foot and Ankle Society (AOFAS) score of 51. Laboratory evaluation after 6 months of atorvastatin therapy (20 mg/day) revealed persistent hypertriglyceridemia (3.45 mmol/L) and borderline hypercholesterolemia (total cholesterol 5.77 mmol/L, low-density lipoprotein 3.93 mmol/L). Magnetic resonance imaging showed diffuse thickening of both Achilles tendons. After thorough discussion and informed consent, the patient underwent total xanthoma excision combined with Achilles tendon reconstruction using a LARS artificial ligament. At the 2-year follow-up, the patient reported no pain or swelling, achieved a VAS score of 0 and an AOFAS score of 90, and demonstrated full recovery of muscle strength and joint motion without clinical or radiological signs of recurrence or foreign body reaction. CONCLUSIONS: Total excision combined with Achilles tendon reconstruction using a LARS artificial ligament might offer a potential alternative for patients with Achilles tendon xanthoma who have high functional demands, considering its avoidance of donor site morbidity, early postoperative recovery, and sufficient biomechanical strength.
Efficacy of 3D-printed bone graft container in the treatment of tibial plateau fractures and postoperative rehabilitation prediction model.
Zhao X, Cao L, Qian J … +3 more , Ge J, Xu Z, Sheng X
BMC Surg · 2026 Jul · PMID 42387454 · Full text
BACKGROUND: Accurate bone grafting is critical for tibial plateau fracture management, yet conventional empirical methods frequently result in imprecise graft volumes and suboptimal outcomes. METHODS: A total of 210 pati...
BACKGROUND: Accurate bone grafting is critical for tibial plateau fracture management, yet conventional empirical methods frequently result in imprecise graft volumes and suboptimal outcomes. METHODS: A total of 210 patients with tibial plateau fractures (Schatzker type III) admitted to Zhangjiagang First People's Hospital from June 2023 to June 2025 were enrolled in this study. According to the intraoperative bone grafting method, patients were divided into 3D-BGC (3D-printed Bone Graft Container) group (57 cases) and Empirical group (153 cases). The 3D-BGC serves as a non-implantable external volumetric tool: bone graft material is pre-packed inside the container, then transferred into the bone defect, while the container itself is discarded. A comprehensive scoring method was used to evaluate rehabilitation outcomes, and patients were divided into good rehabilitation group and poor rehabilitation group based on the median of comprehensive scores. Univariate analysis and LASSO regression were used to screen predictive variables, multivariate Logistic regression was used to analyze the influencing factors of rehabilitation, and a nomogram prediction model was established with internal validation. RESULTS: Among 210 patients, 103 cases (49.05%) achieved good rehabilitation and 107 cases (50.95%) had poor rehabilitation. The good rehabilitation rate in the 3D-BGC group was 92.98% (53/57), significantly higher than that in the Empirical group (32.68%, 50/153, P < 0.001). Logistic regression analysis showed that bone grafting method, time to first weight-bearing, and range of motion at 1 week postoperatively were independent influencing factors for postoperative rehabilitation of tibial plateau fractures (P < 0.05). The receiver operating characteristic (ROC) curve showed that the area under the curve (AUC) of the nomogram model for predicting good rehabilitation was 0.848 (95%CI: 0.796, 0.900). The Hosmer-Lemeshow goodness-of-fit test showed χ²=6.159, P = 0.630, and the calibration curve indicated good consistency of the model. The decision curve showed that the model had positive net benefit within the threshold probability range of 0.44-0.93. CONCLUSION: The 3D-BGC was significantly associated with better postoperative rehabilitation. The nomogram provides reliable guidance for individualized rehabilitation risk stratification. TRIAL REGISTRATION: This study is a retrospective observational study; prospective registration was not applicable. The study was approved by the Institutional Review Board of Zhangjiagang Hospital Affiliated to Soochow University (Approval No. ZJGYYLL-2023-05-038).
Bridging present and future: a case report of CT-Guided "Chimney" Commando for prosthetic sustainability in the transcatheter age.
Mehriddin S, Ye Y, Shen J … +1 more , Shi J
BMC Surg · 2026 Jul · PMID 42387453 · Full text
BACKGROUND: Re-operative double-valve replacement in patients with small annuli and concomitant left ventricular outflow tract (LVOT) obstruction represents a significant surgical challenge. The classic Commando procedur...
BACKGROUND: Re-operative double-valve replacement in patients with small annuli and concomitant left ventricular outflow tract (LVOT) obstruction represents a significant surgical challenge. The classic Commando procedure entails high risk in re-operative settings with dense fibrosis. The "Chimney" Commando technique provides a modular alternative for anatomical reconstruction. This case emphasizes the role of computed tomography angiography (CTA) with digital twin simulation in preoperative planning and explores the concept of "prosthetic sustainability" as a proposed extension of lifetime valve management, aiming to address the immediate pathology while preserving anatomical feasibility for potential future transcatheter interventions. CASE PRESENTATION: A 65-year-old woman with a four-decade cardiac surgical history presented with severe prosthetic valve dysfunction due to pannus overgrowth. Preoperative planning with virtual valve implantation predicted catastrophic neo-LVOT obstruction with conventional surgery, contraindicating standard approaches. A CT-guided "Chimney" Commando procedure was performed, involving the construction of a valved conduit to enlarge the annuli and reconfigure the LVOT. The patient recovered uneventfully. Postoperative imaging demonstrated a patent outflow tract, and subsequent simulation suggested that the reconstructed anatomy may be favorable for potential future valve-in-valve procedures. CONCLUSIONS: This case illustrates the feasibility of a CTA-guided "Chimney" Commando strategy in a high-risk, anatomically complex re-operative double-valve setting. By integrating virtual simulation with an LVOT-oriented reconstruction, this approach successfully mitigated the immediate risk of obstruction and may help preserve the anatomical substrate for future transcatheter valve-in-valve interventions.
Efficacy of prophylactic ursodeoxycholic acid in preventing gallstone formation after metabolic bariatric surgery: an updated systematic review and meta-analysis of randomized controlled trials.
Alrubaiaan A, Altunaib F, AlMutairi SA … +2 more , AlFadhly N, AlKandari AF
BMC Surg · 2026 Jun · PMID 42380928 · Full text
BACKGROUND: Rapid weight loss following Metabolic bariatric surgery (MBS) is associated with an increased risk of developing de novo gallstone formation. We aimed to evaluate the efficacy of prophylactic ursodeoxycholic...
BACKGROUND: Rapid weight loss following Metabolic bariatric surgery (MBS) is associated with an increased risk of developing de novo gallstone formation. We aimed to evaluate the efficacy of prophylactic ursodeoxycholic acid (UDCA) in preventing gallstone formation and reducing gallstone-related outcomes after MBS. METHODS: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) following the PRISMA guidelines through PubMed/MEDLINE, Cochrane, Embase, Scopus, Google Scholar, and clinicaltrials.gov. The primary outcome was gallstone formation at 12-24 months, while symptomatic gallstones and cholecystectomy incidence were secondary outcomes. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using random-effects models. Subgroup analysis was conducted according to UDCA dose, duration of administration, and the type of operation. Meta-regression was performed to assess the effect of age and baseline BMI on gallstone formation. I and Cochrane Q p-value were used to assess the heterogeneity of the studies. RESULTS: Ten RCTs, including 3,575 participants, were included. Prophylactic UDCA reduced the incidence of gallstone formation by 67% at 12-24 months, and 73% at 6 months, while symptomatic gallstones were reduced by 70%. No statistically significant difference was found in the cholecystectomy rates. Subgroup analysis showed that UDCA doses of 500-600 mg daily administered for 6-12 months were effective, with no significant differences in gallstone formation between surgical procedures. Meta-regression analysis showed a slight increase in gallstone risk with age and a slight decrease with higher BMI, although neither relationship reached statistical significance. CONCLUSIONS: Prophylactic UDCA may be an effective preventive measure for gallstone formation in MBS patients, however additional studies are needed to assess its effect on cholecystectomy. TRIAL REGISTRATION: The systematic review was registered in PROSPERO under registration number CRD420251004594.
Surgical management and clinical reflections on acute type A intramural hematoma with a focal intimal tear in an adult with double aortic arch: a case report.
Zhu D, Zhou J, Wan C … +2 more , Ren X, Wei W
BMC Surg · 2026 Jun · PMID 42380909 · Full text
BACKGROUND: Double aortic arch (DAA) is a rare congenital aortic arch anomaly that is usually identified in infancy because of symptoms related to a vascular ring. Acute type A intramural hematoma (IMH) with a focal inti...
BACKGROUND: Double aortic arch (DAA) is a rare congenital aortic arch anomaly that is usually identified in infancy because of symptoms related to a vascular ring. Acute type A intramural hematoma (IMH) with a focal intimal tear in an adult with DAA is extremely rare, and no consensus has been established regarding emergency management. CASE PRESENTATION: Seventy-three year-old woman presented with burning pain in the throat and suprasternal notch and was initially suspected of having acute coronary syndrome. Computed tomography angiography (CTA) of the whole aorta and supra-aortic vessels demonstrated a double aortic arch, with the right common carotid artery and right subclavian artery originating from the right arch and the left common carotid artery and left subclavian artery originating from the left arch. After preoperative evaluation, emergency surgery was performed through a median sternotomy. Intraoperatively, a focal intimal tear approximately 2 cm in length was identified in the ascending aorta. Given the complex branching anatomy of the double aortic arch, right femoral artery cannulation was used to establish cardiopulmonary bypass in order to minimize invasive manipulation of the arch. Resection of the diseased ascending aorta and graft replacement were performed, and the potential false lumen at the aortic root was obliterated using the adventitial inversion technique. The prosthetic graft was wrapped with bovine pericardium, and the double aortic arch was not addressed during the same operation. The patient experienced recurrent perioperative hypoxemia and was extubated 17 h after surgery following respiratory support, lung-protective management, and anti-inflammatory treatment. She was discharged on postoperative day 12. Approximately 1 month later, she was readmitted with chest pain, and CTA revealed a newly developed dissection in the proximal right aortic arch. The family declined reoperation, and the patient was subsequently lost to follow-up. CONCLUSIONS: In patients with DAA complicated by acute type A IMH with a focal intimal tear, limited ascending aortic replacement in the emergency setting may reduce surgical trauma; however, it may leave a high-risk residual arch segment and increase the risk of clamp-related injury or insufficient resection margins. Perioperative airway compression caused by the vascular ring should be assessed using imaging, and one-stage or staged reconstruction should be planned according to the patient's condition. Strict postoperative blood pressure control and close follow-up are essential to reduce the risk of recurrence.
Efficacy and safety of traditional open surgery versus radiofrequency ablation for great saphenous varicose veins: a retrospective comparative study.
Sun Y, Hu M, Huang S … +1 more , Pan H
BMC Surg · 2026 Jun · PMID 42374381 · Full text
BACKGROUND: This study aims to compare the clinical efficacy and safety of traditional open surgery and radiofrequency ablation in the treatment of great saphenous varicose veins. METHODS: A total of 177 patients with gr...
BACKGROUND: This study aims to compare the clinical efficacy and safety of traditional open surgery and radiofrequency ablation in the treatment of great saphenous varicose veins. METHODS: A total of 177 patients with great saphenous varicose veins admitted to our hospital between January 2023 and December 2024 were retrospectively selected. According to the treatment methods, they were divided into the traditional open surgery group (TG, n = 85) and the radiofrequency ablation group (RG, n = 92). The surgical-related indicators, postoperative pain severity, quality of life score, incidence of complications, clinical efficacy, and postoperative recovery were compared between the two groups. RESULTS: The RG exhibited shorter operative time, reduced intraoperative blood loss, smaller incision length, and shorter hospital stay compared with the TG (P < 0.05). The RG showed lower VAS pain scores at each time point after surgery than the TG (P < 0.05). At 1, 3, and 6 months after surgery, the AVVQ quality of life scores of the RG were lower than those of the TG (P < 0.05). The RG exhibited lower overall incidence of complications than the TG (P < 0.05). There was no statistically significant difference in the postoperative venous closure rate and recurrence rate between the two groups (P > 0.05). The RG exhibited shorter postoperative ambulation time, wound healing time, and compression stocking wearing time compared with the TG (P < 0.05). Bed charges, nursing fees, and medication costs were lower in the RG (P < 0.05). CONCLUSION: Radiofrequency ablation for great saphenous varicose veins is associated with several advantages, including reduced surgical trauma, faster recovery, less pain, and a lower incidence of complications. During the 6-month follow-up period, its clinical efficacy was comparable to that of the traditional open surgery, while showing potential advantages in cosmetic outcomes. Long-term efficacy requires further follow-up studies.
Etiologies, outcomes, and predictors of postoperative complications in the surgical management of extrahepatic biliary obstruction: a study at Tikur Anbesa specialized hospital, Ethiopia.
Hassen TJ, Abubeker Z
BMC Surg · 2026 Jun · PMID 42374348 · Full text
BACKGROUND: Obstructive jaundice has contributed a sizable burden of global mortality, morbidity, economic cost, and hospitalization worldwide cause by benign and malignant conditions. OBJECTIVE: To assess the etiologica...
BACKGROUND: Obstructive jaundice has contributed a sizable burden of global mortality, morbidity, economic cost, and hospitalization worldwide cause by benign and malignant conditions. OBJECTIVE: To assess the etiological pattern, predictors for postoperative complications, and short-term outcomes among patients undergoing surgical intervention for EHBO at Tikur Anbesa Specialized Hospital, Addis Ababa, Ethiopia, 2024. METHODS: A hospital-based retrospective cohort study was conducted to evaluate the etiological patterns, outcomes, and predictors of complications following surgical intervention for extrahepatic biliary obstruction (EHBO). The study included 122 EHBO patients who were consecutively enrolled during the study period. Normality of continuous variables was assessed using the Shapiro-Wilk test; normally distributed data were expressed as means with standard deviations, whereas skewed variables were reported as medians with interquartile ranges. Univariate and multivariate binary logistic regression analyses were performed to identify predictors of 30-day postoperative complications. Results are reported as adjusted odds ratios (AOR) with 95% confidence intervals (CI), and a p-value < 0.05 was considered statistically significant. RESULTS: Among 122 patients undergoing surgical intervention for EHBO, the mean age was 51.8 years (SD 13.2), with a slight male predominance (53.3%). Most patients had good performance status (ECOG 0-1 in 91.8%). Malignant biliary obstruction (MBO) was present in 67 (54.9%), predominantly due to pancreatic cancer (23.0%) and periampullary tumors (18.9%). In MBO patients, mean serum bilirubin decreased from 18.8 mg/dL preoperatively to 1.7 mg/dL at 4 weeks, representing a 90.1% reduction. Curative resection was achieved in 22 (32.8%) patients (Whipple procedure in 19, bile duct excision in 3); the remainder underwent palliative surgery. The 30-day postoperative complication rate was 25.4% (31/122), with mortality of 1.6% (2/122). Surgical site infection was the most frequent complication (19.7%), followed by anastomotic leakage (6.6%). Multivariable analysis identified poorer ECOG status (AOR 6.1, 95% CI 2.0-18.4; p = 0.001) and jaundice duration > 8 weeks (AOR 2.1, 95% CI 1.7-6.3; p = 0.003) as independent predictors of postoperative complications. CONCLUSION: Our findings demonstrate that favorable surgical outcomes for EHBO are achievable even in resource-constrained environments. However, further mitigating postoperative morbidity requires targeted perioperative optimization of high-risk patients, specifically those presenting with prolonged jaundice (> 8 weeks), preoperative cholangitis, poor ECOG performance status, hypoalbuminemia, and malignant biliary obstruction (MBO). Consequently, implementing systematic risk stratification and addressing these key clinical predictors are imperative to minimize complications and optimize patient outcomes. TRIAL REGISTRATION: Not applicable.
Factors influencing postoperative pain catastrophizing in patients with lower limb trauma and development of a nomogram prediction model.
Xie J, Chen Y, Fan J … +2 more , Xu J, Zhang Z
BMC Surg · 2026 Jun · PMID 42374343 · Full text
OBJECTIVE: This study aimed to examine the determinants of postoperative pain catastrophizing among surgical patients with lower limb trauma and to develop a nomogram for individualized risk prediction. METHODS: Data enc...
OBJECTIVE: This study aimed to examine the determinants of postoperative pain catastrophizing among surgical patients with lower limb trauma and to develop a nomogram for individualized risk prediction. METHODS: Data encompassing demographic characteristics, Injury Severity Score (ISS), preoperative Numerical Rating Scale (NRS) for pain, Hospital Anxiety and Depression Scale (HADS) scores, and Fear-Avoidance Beliefs Questionnaire (FABQ) scores were collected. The level of pain catastrophizing was measured postoperatively using the Pain Catastrophizing Scale (PCS). The total sample of 320 patients was randomly allocated into a training set (n = 224) and a validation set (n = 96) at a 7:3 ratio. Independent factors identified through logistic regression analysis were utilized to construct a nomogram. The model's predictive performance was assessed via receiver operating characteristic (ROC) analysis, calibration curves, and decision curve analysis (DCA). RESULTS: Educational attainment at college level or above served as a protective factor. In contrast, higher scores on the NRS, ISS, HADS, and FABQ were significant risk factors. The nomogram exhibited robust discriminative ability, with area under the curve (AUC) values of 0.850 (95% CI: 0.797-0.904) in the training set and 0.815 (95% CI: 0.718-0.911) in the validation set. Calibration analysis indicated good fit, and DCA confirmed favorable clinical net benefit across a range of threshold probabilities. CONCLUSION: The incidence of postoperative pain catastrophizing is considerable among patients with lower limb trauma and is influenced by multiple factors including trauma severity, educational level, anxiety/depression, fear-avoidance beliefs, and pain intensity. The constructed nomogram prediction model, based on independent influencing factors, exhibits good discrimination, calibration, and clinical utility, effectively predicting the risk of postoperative pain catastrophizing.
Laser hemorrhoidoplasty versus LigaSure hemorrhoidectomy for grade II-IV hemorrhoidal disease: a systematic review and meta-analysis.
Zamlout A, Kasem MA, Helmy O … +4 more , Allam O, Abdellah AR, Allam K, El-Ayman Y
BMC Surg · 2026 Jun · PMID 42374341 · Full text
BACKGROUND: Many surgical procedures have been developed to treat hemorrhoidal disease. Although conventional excisional techniques are effective, they are also associated with significant postoperative pain and longer r...
BACKGROUND: Many surgical procedures have been developed to treat hemorrhoidal disease. Although conventional excisional techniques are effective, they are also associated with significant postoperative pain and longer recovery times. Consequently, newer techniques have been introduced to address these issues, including laser hemorrhoidoplasty (LHP) and LigaSure hemorrhoidectomy (LigH). This systematic review and meta-analysis aims to compare these two approaches in terms of perioperative outcomes and recurrence. METHODS: A comprehensive search was conducted across PubMed, Scopus, Web of Science, Cochrane Library, ClinicalTrials.gov, and Google Scholar, up to December 2025. We included all eligible studies involving adults with grade II-IV hemorrhoids. Primary outcomes included postoperative pain, time to return to routine activities, and recurrence. Secondary outcomes were operative time, length of hospital stay, and complications. The risk of bias was assessed using the RoB2 and ROBINS-I V2 tools. Meta-analyses were performed with a random-effects model. The certainty of evidence was evaluated using the GRADE approach. RESULTS: Data from 461 patients (213 LHP, 248 LigH) across five studies were analyzed. Patients in the LHP group reported significantly lower pain scores on postoperative day 1 (MD: - 1.61 points; p = 0.025), earlier return to routine activities (MD: -5.75 days; p = 0.0002), shorter operative time (MD: -6.5 min; p = 0.002), and shorter hospital stay (MD: -0.3 days; p < 0.0001) compared to the LigH group. Conversely, LigH demonstrated a significantly lower risk of recurrence (RD: 0.12; 95% CI: [0.05, 0.19]). No significant differences were observed regarding postoperative bleeding, wound infection, urinary retention, or thrombosis. CONCLUSION: LHP yields better perioperative outcomes, including less pain and faster recovery, making it a favorable option for patient comfort. However, LigH has lower recurrence rates. The certainty of evidence is very low. Further high-quality randomized trials are needed to confirm these results.
Application of unilateral biportal endoscopy in lumbar double crush syndrome: a retrospective study and literature-based classification.
Wang W, Yao X, Ding Y … +5 more , Du C, Yang J, Guan L, Hai Y, Pan A
BMC Surg · 2026 Jun · PMID 42374323 · Full text
OBJECTIVE: Double Crush Syndrome (DCS) represents a relatively uncommon peripheral neuropathy caused by compression of the same nerve at two distinct sites. A single lumbar nerve root traverses a long pathway within the...
OBJECTIVE: Double Crush Syndrome (DCS) represents a relatively uncommon peripheral neuropathy caused by compression of the same nerve at two distinct sites. A single lumbar nerve root traverses a long pathway within the spinal structure, making it susceptible to compression at multiple sites. This dual-site entrapment results in dysfunction of a single nerve root and may be easily overlooked in clinical practice, often leading to suboptimal therapeutic outcomes. Considering the limited number of reported cases involving double-site compression of lumbar nerve roots, the present study aimed to report our institutional experience in managing such cases. All patients were treated using a unilateral biportal endoscopic (UBE) technique to achieve decompression at both compression sites. Furthermore, a comprehensive literature review on DCS was conducted, and a preliminary classification framework was proposed based on the patterns of pathology described in previous reports. METHODS: A total of 16 patients diagnosed with DCS were retrospectively analyzed. Demographic data, clinical symptom characteristics, pre- and postoperative imaging, intraoperative details, functional outcome scores, patient satisfaction, and postoperative complications were collected and reviewed. These data were used to evaluate the efficacy and safety of UBE in the treatment of lumbar DCS. In addition, all English-language publications on DCS published after the year 2000 were narratively reviewed. The included studies were categorized according to the anatomical locations and pathological types of compression to establish a new classification system for DCS. RESULTS: Among the 16 patients, 12 had a double crush of the L5 nerve root, and 4 had a double crush of the L4 nerve root. All patients underwent single-stage dual-site decompression using the UBE technique. Postoperative clinical symptom scores improved significantly, and no recurrence of symptoms was observed at 1-year follow-up. The mean endoscopic operative time was 118.4 ± 13.5 min, the mean postoperative bed rest duration was 1.8 ± 0.9 days, and the mean postoperative hospital stay was 4.7 ± 1.5 days. The patients' mean postoperative visual analog scale (VAS) for low back pain and leg pain, as well as their Oswestry Disability Index (ODI), showed a significant decrease compared with preoperative values, with no significant changes observed after the 1-month follow-up. Postoperative imaging confirmed complete decompression in all cases, and no severe complications occurred. Based on the literature review, the newly proposed classification system divided DCS into two major categories comprising five subtypes. CONCLUSION: Single‑stage dual‑site UBE decompression is safe and effective for Type IIc lumbar DCS, providing significant and sustained symptom improvement. The proposed classification is a preliminary working framework to improve recognition and management of DCS. Given the retrospective design, small sample, and lack of specific diagnostic criteria, future prospective controlled studies with larger cohorts are needed to validate these findings.
Primary duct closure after laparoscopic common bile duct exploration in elderly patients with cholecystocholedocholithiasis: a propensity-matched analysis.
Liao Y, Liu F, Yang N
BMC Surg · 2026 Jun · PMID 42374322 · Full text
BACKGROUND: Laparoscopic common bile duct exploration (LCBDE) is a minimally invasive option for treating cholecystocholedocholithiasis. Primary duct closure (PDC) after laparoscopic common bile duct exploration has been...
BACKGROUND: Laparoscopic common bile duct exploration (LCBDE) is a minimally invasive option for treating cholecystocholedocholithiasis. Primary duct closure (PDC) after laparoscopic common bile duct exploration has been shown to be safe. This study aims to evaluate the feasibility and safety of LCBDE + PDC in elderly (≥ 65 years) patients. METHODS: This study included 284 elderly patients who underwent LCBDE(PDC group = 86, T-tube drainage group = 198). We compared the baseline characteristics and perioperative data between the two groups. The Propensity Score Matching (PSM) method was employed to balance the baseline characteristics of the groups and mitigate potential biases. RESULTS: The PDC group showed shorter operative time (105 vs. 130 min, P < 0.001), reduced postoperative hospital stays (7 days vs. 8 days, P < 0.001) and total hospital stays (11.5 days vs. 13 days, P < 0.001), and lower costs (3273.6 USD vs. 3848.4 USD, P < 0.001) compared to the T-tube group. The rates of postoperative bile leakage (4.65% vs. 2.02%, P = 0.25) and severe complications (3.49% vs. 3.54%, P = 1) were comparable between the two groups. After PSM, PDC group maintained advantages in operative time (105 min vs. 130 min, P < 0.001) and costs ( 3310.9 USD vs. 3719.4 USD, P = 0.012). CONCLUSIONS: Our study demonstrates that LCBDE + PDC is a safe and feasible treatment for elderly patients with cholecystocholedocholithiasis.
Traumatic brachial artery reconstruction using an in-wound no-touch superficial vein graft with 20-month imaging follow-up: a case report.
Tian H, Liu Y, Li R
BMC Surg · 2026 Jun · PMID 42374309 · Full text
BACKGROUND: Autologous vein grafting is commonly used for traumatic limb arterial defects when tension-free primary repair is not possible. The no-touch harvest technique has shown structural and patency advantages in co...
BACKGROUND: Autologous vein grafting is commonly used for traumatic limb arterial defects when tension-free primary repair is not possible. The no-touch harvest technique has shown structural and patency advantages in coronary surgery, but its role in traumatic upper-extremity reconstruction remains uncertain. CASE PRESENTATION: A 63-year-old man sustained an open right elbow injury caused by a fan blade, with brachial artery transection, superficial venous injury, lateral antebrachial cutaneous nerve injury, and superficial brachioradialis laceration. After microscopic debridement, the arterial defect between viable ends measured about 5.5 cm. A median cubital vein within the wound was selected as an interposition conduit because an adequate segment remained outside the most severely damaged zone, the wall appeared continuous without visible thrombosis or crush injury, and the caliber matched the brachial artery. The vein was harvested with a limited cuff of surrounding tissue using a no-touch concept, reversed, and anastomosed end-to-end under the microscope. The patient received intraoperative heparin and short-term postoperative low-molecular-weight heparin, but no long-term oral antithrombotic therapy because of individualized bleeding-risk and wound considerations. At 20 months, duplex ultrasonography and computed tomography angiography showed sustained graft patency, preserved distal runoff, and mild ectatic change without hemodynamically significant stenosis, occlusion, or pseudoaneurysm. CONCLUSIONS: This case supports technical feasibility rather than superiority in selected traumatic brachial artery injuries. An in-wound superficial vein may be usable when a structurally intact segment remains available outside the most severely injured zone. The no-touch concept was technically applicable in this setting, but its clinical benefit in peripheral trauma remains unproven.
Analysis of risk factors for perioperative hypothermia in patients undergoing spinal trauma surgery.
Ruimin W, Yaqiu L, Tusentuheti D … +2 more , Sifan Y, Ruitian W
BMC Surg · 2026 Jun · PMID 42374296 · Full text
BACKGROUND: To investigate the independent risk factors for perioperative hypothermia in patients undergoing spinal trauma surgery, and to provide evidence-based support for developing targeted preventive strategies. MET...
BACKGROUND: To investigate the independent risk factors for perioperative hypothermia in patients undergoing spinal trauma surgery, and to provide evidence-based support for developing targeted preventive strategies. METHODS: A retrospective cohort study was conducted, including 222 patients who underwent spinal trauma surgery at a single hospital between January 2022 and December 2024. Patients were divided into a hypothermia group (n = 98) and a non-hypothermia group (n = 124) based on whether perioperative hypothermia (core body temperature < 36.0 °C) occurred. Data on patient demographics, clinical characteristics, surgical parameters, and temperature management measures were collected. Univariate analysis was first performed to compare differences between the groups. Variables with statistical significance in the univariate analysis were then included in a multivariate Logistic regression model (forward stepwise method) to identify independent risk factors. Sensitivity analysis was conducted to test the robustness of the results. RESULTS: Multivariate Logistic regression analysis showed that age ≥ 60 years (OR = 5.00, 95% CI: 2.24-11.16, P < 0.001), BMI ≤ 24 kg/m² (OR = 2.98, 95% CI: 1.36-6.52, P = 0.006), operation time ≥ 4 h (OR = 4.37, 95% CI: 1.58-12.09, P = 0.005), intraoperative blood loss ≥ 200 mL (OR = 3.74, 95% CI: 1.45-9.66, P = 0.007), intraoperative fluid infusion ≥ 3500 mL (OR = 5.64, 95% CI: 1.99-15.98, P < 0.001), and the use of physical warming alone (compared to combined physical and pharmacological warming) (OR = 2.20, 95% CI: 1.05-4.60, P = 0.036) were independently associated with perioperative hypothermia. Sensitivity analysis confirmed the robustness of these associations. CONCLUSION: In this retrospective cohort, advanced age, low BMI, prolonged operation time, significant intraoperative blood loss and fluid infusion, and the use of single‑method physical warming were independently associated with perioperative hypothermia in patients undergoing spinal trauma surgery. These associations do not imply causality due to the observational design and potential residual confounding. Prospective studies, particularly randomized controlled trials where ethically and practically feasible, are needed to confirm causal relationships. Clinicians may use them for risk stratification but should not assume direct protective effects of specific interventions.
From intraoperative visual inspection to postoperative quantification: ICG fluorescence angiography for acute mesenteric ischemia validated by histopathology.
Fan Z, Guo S, Ma T … +4 more , Xiao Y, Zhu R, Zhang P, Wu W
BMC Surg · 2026 Jun · PMID 42374275 · Full text
INTRODUCTION: Acute mesenteric ischemia (AMI) is a rare and life-threatening condition that leads to intestinal necrosis. Accurate assessment of intestinal viability and perfusion is crucial for reducing its high mortali...
INTRODUCTION: Acute mesenteric ischemia (AMI) is a rare and life-threatening condition that leads to intestinal necrosis. Accurate assessment of intestinal viability and perfusion is crucial for reducing its high mortality rate. CASE PRESENTATION: A 65-year-old female patient diagnosed with acute mesenteric ischemia complicated by intestinal necrosis underwent exploratory laparotomy. Under indocyanine green (ICG) imaging guidance, the necrotic bowel segments were resected. Postoperative quantitative analysis and histopathology confirmed intestinal necrosis. DISCUSSION: Due to the lack of specific appearance in the early stages of intestinal wall necrosis caused by acute mesenteric ischemia, relying solely on white light or subjective qualitative ICG fluorescence imaging makes it difficult to precisely define the resection margin. This case innovatively applied quantitative ICG fluorescence analysis, revealing a correspondence between specific perfusion parameters, including T0 and slope, and the histopathological grading of intestinal necrosis. These findings are consistent with trends reported in colorectal surgery, although differences in underlying pathophysiological mechanisms may limit comparability. Therefore, quantitative ICG may provide surgeons with an objective intraoperative decision-making tool. CONCLUSION: This case demonstrates that ICG fluorescence imaging combined with quantitative analysis may provide additional objective information for assessing intestinal viability.
Efficacy and safety of fast-track surgical management for acute orthopedic fractures: a retrospective cohort analysis.
Wang L, Ding L, Liu L
BMC Surg · 2026 Jun · PMID 42366348 · Full text
BACKGROUND: Acute orthopedic fractures pose significant treatment challenges, requiring efficient and effective management to improve patient outcomes. This study compares the efficiency and prognosis of fast-track surgi...
BACKGROUND: Acute orthopedic fractures pose significant treatment challenges, requiring efficient and effective management to improve patient outcomes. This study compares the efficiency and prognosis of fast-track surgical management versus conventional early definitive treatment in managing acute orthopedic fractures. METHODS: This retrospective cohort study included 116 patients with acute orthopedic fractures treated between June 2024 and June 2025. Patients were assigned to either a fast-track surgical management group (fast-track group, n = 60) or a conventional early definitive treatment group (control group, n = 56). The primary outcome was in-hospital mortality. Secondary outcomes included operation time, intraoperative blood loss, transfusion volume, body temperature recovery time, time to first ambulation, length of hospital stay, hospitalization cost, postoperative pain assessed using the Visual Analog Scale (VAS) at 24, 48, and 72 h, fracture healing quality, postoperative complications, and 6-month health-related quality of life evaluated using the 36-Item Short Form Health Survey (SF-36). Logistic regression analyses were performed to identify factors associated with in-hospital mortality. RESULTS: In-hospital mortality was significantly lower in the fast-track group compared with the control group (5.00% vs. 16.07%, P = 0.044). The fast-track group demonstrated significantly shorter operation time, reduced intraoperative blood loss and transfusion requirements, earlier postoperative ambulation, shorter hospitalization duration, and lower total medical costs (all P < 0.05). VAS scores at 24, 48, and 72 h were consistently lower in the fast-track group (all P < 0.05). The overall complication rate was significantly reduced (5.26% vs. 19.15%, P = 0.027). The good healing rate was higher in the fast-track group (P = 0.013). At 6 months, several SF-36 domains, including physical functioning, role physical, vitality, social functioning, and general health, were significantly higher in the fast-track group (all P < 0.05). Multivariable logistic regression analysis demonstrated that fast-track group remained significantly associated with lower in-hospital mortality (OR = 0.352, 95% CI: 0.118-0.947, P = 0.041), whereas higher Injury Severity Score was an independent risk factor (OR = 1.196, 95% CI: 1.031-1.387, P = 0.018). CONCLUSION: Fast-track surgical management was associated with lower in-hospital mortality, enhanced perioperative efficiency, reduced complications, and improved functional recovery compared with conventional early definitive treatment in patients with acute orthopedic fractures.
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