BMC Surgery[JOURNAL]
Sun
200 papers
Clinical efficacy of de-epithelialized flap for reconstruction of pressure ulcers in the buttocks and trochanteric regions.
Liu K, Li X, Zeng S … +1 more , Huang W
BMC Surg · 2026 Jun · PMID 42363214 · Full text
OBJECTIVE: To evaluate the clinical efficacy of the De-Epithelialized Flap technique in the reconstruction of pressure ulcers in the buttocks and trochanteric regions. METHODS: A total of 29 patients with pressure ulcers...
OBJECTIVE: To evaluate the clinical efficacy of the De-Epithelialized Flap technique in the reconstruction of pressure ulcers in the buttocks and trochanteric regions. METHODS: A total of 29 patients with pressure ulcers in the buttocks and trochanteric regions were treated from January 2018 to November 2021, including 16 cases in the sacrococcygeal region, 4 in the intertrochanteric region, and 9 in the ischial tuberosity. Early debridement and drainage were performed to remove necrotic tissue and sinus tracts, followed by repair of the pressure ulcers using the De-Epithelialized Flap. The flap's length in the advancement direction should measure approximately 1.5-2 times the diameter of the defect, with the width slightly exceeding that of the wound. Excess tissue at the recipient site is de-epithelialized and used to fill the dead space. RESULTS: Among the patients, 27 cases achieved primary healing of the skin flaps, while 2 cases experienced delayed wound healing. These wounds were successfully managed with dressing changes and debridement. During a follow-up period of 6-12 months, only 1 case of recurrence at the same site was observed. CONCLUSION: The use of the De-Epithelialized Flap for the repair of pressure ulcers in the buttocks and trochanteric regions offers the benefits of being a simple, safe, and effective procedure with a low recurrence rate. This technique demonstrates promising clinical value and is recommended for broader clinical application.
Prognostic outcomes of pancreaticoduodenectomy with lymph node dissection in pancreatic and periampullary adenocarcinoma; a retrospective cohort study.
Taghipour A, Zarghami SY, Fatemi A … +2 more , Yazdooei Y, Zare F
BMC Surg · 2026 Jun · PMID 42363100 · Full text
BACKGROUND: Pancreaticoduodenectomy (PD) is a key surgical treatment for pancreatic and periampullary malignancies, but morbidity remains a challenge. Lymph node dissection improves outcomes by removing cancerous tissue...
BACKGROUND: Pancreaticoduodenectomy (PD) is a key surgical treatment for pancreatic and periampullary malignancies, but morbidity remains a challenge. Lymph node dissection improves outcomes by removing cancerous tissue and preventing metastasis. This study aims to assess survival rates, recurrence, and other postoperative outcomes. METHODS: A retrospective cohort study was conducted on 390 patients who underwent PD with for pancreatic and periampullary adenocarcinoma between 2019 and 2023 at a single tertiary center. Non-adenocarcinoma histologies were excluded to ensure a homogeneous cohort. Follow-up data were available for 299 patients (76.7%), collected through hospital records and structured telephone interviews. Primary outcomes were overall survival, recurrence, and postoperative morbidity. Statistical analyses included Kaplan-Meier survival estimation, Cox proportional hazards modeling, and recurrence-free survival analysis. Fine-Gray competing risk regression and a prognostic nomogram were used for further risk stratification. RESULTS: Among the 390 patients, the median overall survival was 3.5 years. The 1- and 3-year survival rates were 69.2% and 50.6%, respectively. The 5-year survival estimate (41.0%) should be considered preliminary, as it is based on extrapolation from immature follow-up data; mature 5-year outcomes require extended observation beyond the current study period. Multivariable analysis identified several key predictors of mortality: age ≥ 65 years (HR: 2.55, p < 0.001), pancreatic tumor origin (HR: 1.58, p = 0.009), positive lymph node status (HR: 2.37, p < 0.001), and fewer than 12 nodes removed (HR: 1.53, p = 0.018). Adjuvant chemotherapy reduced the risk of death (HR: 0.68, p = 0.033). Recurrence-free survival demonstrated the steepest decline during the first 36 months postoperatively. CONCLUSION: Lymph node status, chemotherapy, and tumor origin are crucial for predicting survival after PD. Proper lymph node evaluation and adjuvant chemotherapy are essential for improving outcomes.
Ultrasonography-guided single-port transaxillary endoscopic excision for breast fibroadenoma: a retrospective comparative study of technical feasibility and early outcomes.
Wang C, Jiang H, Zhang X … +3 more , Miao X, Zhao F, Dang X
BMC Surg · 2026 Jun · PMID 42351085 · Full text
BACKGROUND: Intraoperative ultrasonography may compensate for the loss of direct palpation during concealed transaxillary endoscopic excision of breast fibroadenoma. This study assessed the feasibility and early outcomes...
BACKGROUND: Intraoperative ultrasonography may compensate for the loss of direct palpation during concealed transaxillary endoscopic excision of breast fibroadenoma. This study assessed the feasibility and early outcomes of this ultrasound-guided remote access technique compared with conventional open excision. METHODS: Twenty women with breast fibroadenoma underwent single-port transaxillary endoscopic excision with intraoperative ultrasonographic guidance (n = 10) or conventional open excision (n = 10). Outcomes included operative time, blood loss, incision length, postoperative pain, hospital stay, complications, residual lesion on postoperative ultrasonography, and selected BREAST-Q domains. RESULTS: Endoscopic excision was completed in all patients without conversion. In all endoscopic cases, intraoperative ultrasonography was used to re-identify the target lesion after working-space creation, and repeat ultrasonography confirmed no sonographically visible residual lesion after tumor removal. No residual lesion was detected on postoperative ultrasonography in either group. Compared with open excision, the endoscopic approach showed longer operative time (mean difference [MD], 64.8 min; 95% CI, 42.2 to 87.4; Hedges g = 2.62), higher 24-hour postoperative pain scores (MD, 2.3 points; 95% CI, 1.2 to 3.4; Hedges g = 1.97), and longer institution-specific hospital stay (MD, 2.0 days; 95% CI, 1.0 to 3.0; Hedges g = 1.81). Estimated intraoperative blood loss was lower in the endoscopic group (MD, -10.3 mL; 95% CI, -14.2 to -6.4; Hedges g = -2.44), although the absolute difference was small and should not be interpreted as a major clinical advantage. Incision length and 30-day complication rates showed limited between-group separation. At 3 months, patient-reported psychosocial well-being, breast satisfaction, and scar satisfaction scores were numerically higher in the endoscopic group. CONCLUSION: In this small retrospective proof-of-concept cohort, single-port transaxillary endoscopic excision with intraoperative ultrasonographic guidance was technically feasible in selected patients with breast fibroadenoma and enabled complete excision without sonographically visible residual lesions. However, this concealed-access approach involved longer operative time, higher early postoperative pain, and longer institution-specific hospitalization than conventional open excision. Its potential role should therefore be framed as a selected cosmetic and image-guided surgical option rather than a broadly superior alternative to open excision.
Axillary desmoid-type fibromatosis: a rare clinical presentation, histopathological correlation, and literature review.
Al-Mourgi M, Shams A, Mohammed S
BMC Surg · 2026 Jun · PMID 42337760 · Full text
BACKGROUND: Desmoid tumours are rare soft-tissue tumours arising from mesenchymal tissue and exhibiting local invasiveness, although they don't metastasize. These tumours present variably and follow an unpredictable cour...
BACKGROUND: Desmoid tumours are rare soft-tissue tumours arising from mesenchymal tissue and exhibiting local invasiveness, although they don't metastasize. These tumours present variably and follow an unpredictable course, ranging from asymptomatic to locally aggressive with excruciating symptoms. Surgical intervention is indicated for symptomatic cases, while indolent cases benefit from close surveillance. Recently, the use of systemic approaches to the management of desmoid tumours has increased. These include γ-secretase inhibitors, which have shown encouraging therapeutic results in the treatment of progressive, refractory cases. Nonetheless, due to the disease's rarity, managing DT remains challenging, and updating the field with current knowledge is warranted. Our case presents a rare axillary desmoid tumour, for which surgical resection was chosen and optimized to achieve complete clearance while preserving upper-limb function. CASE PRESENTATION: Herein, we present a rare case of desmoid-type fibromatosis in the right axillary region of a young, otherwise healthy female. Surgical resection of the mass was performed without intra- or postoperative complications, with the aim of preserving upper-limb function and motion. Postoperative follow-up over 18 months showed no clinical or radiological evidence of tumour recurrence, with full preservation of upper-limb function and motion. CONCLUSION: Desmoid tumours of the axilla are clinically challenging, requiring a careful balance between complete resection and functional preservation. Recently, active surveillance has been used as the primary management for desmoid tumour cases and has shown spontaneous regression without the need for intervention. However, our case demonstrates that a surgical approach can still achieve excellent local control and long-term disease-free survival without functional impairment. It also provides live evidence underscoring the valuable role of surgery in managing symptomatic or progressive tumours in complex anatomical locations.
Preoperative topical 5% benzoyl peroxide reduces intraoperative deep cutibacterium acnes contamination in shoulder arthroscopy: a retrospective cohort study.
Jin X, Fan L, Zhou H … +1 more , Yu J
BMC Surg · 2026 Jun · PMID 42337739 · Full text
BACKGROUND: Intraoperative deep contamination with Cutibacterium acnes (C. acnes) from hair follicles and sebaceous glands remains a microbiological risk in shoulder arthroscopy, and routine chlorhexidine-alcohol skin pr...
BACKGROUND: Intraoperative deep contamination with Cutibacterium acnes (C. acnes) from hair follicles and sebaceous glands remains a microbiological risk in shoulder arthroscopy, and routine chlorhexidine-alcohol skin preparation has limited efficacy against this reservoir. OBJECTIVE: To evaluate the association between preoperative topical 5% benzoyl peroxide use and intraoperative deep C. acnes contamination, and to explore skin colonization load. METHODS: A retrospective cohort analysis was performed on patients undergoing shoulder arthroscopy. Deep specimens (synovial fluid, synovium, inner portal cannula wall) were obtained for anaerobic culture. The primary outcome was the patient-level deep contamination rate. Relative risks (RR), adjusted odds ratios (aOR), and incidence rate ratios (IRR) were estimated using multivariable logistic regression, Poisson regression, and non-parametric tests. Sensitivity analyses used a strict positivity definition. RESULTS: The cohort included 162 patients (81 with BPO pretreatment, 81 with standard preparation alone). The BPO group had a lower deep contamination rate (16.05% vs. 34.57%; RR = 0.46, 95%CI 0.26-0.83, p = 0.007), with an adjusted aOR = 0.38 (95%CI 0.18-0.79). The number of positive deep specimens per patient was lower (IRR = 0.44, p = 0.004). Among positive cases, the time to culture positivity was delayed in the BPO group (p = 0.031). Preoperative skin colonization load was lower in the BPO group (p = 0.001). A higher skin score was independently associated with increased risk of deep contamination (aOR = 1.57 per 1-grade increase, 95%CI 1.19-2.07, p = 0.002). Sensitivity analyses showed consistent results. No significant between-group differences were found in short-term infection-related clinical events. CONCLUSION: In this retrospective analysis, preoperative topical 5% benzoyl peroxide was associated with a significant reduction in intraoperative deep C. acnes contamination and bacterial burden during shoulder arthroscopy, supporting the microbiological rationale for a source decolonization strategy. CLINICAL TRIAL REGISTRATION: Not applicable.
Autologous pericardial conduit reconstruction of an inadvertently transected left superior pulmonary vein during thoracoscopic surgery: A case report and literature review.
Zhu W, Mo H, Wang K … +1 more , Zheng Y
BMC Surg · 2026 Jun · PMID 42337520 · Full text
BACKGROUND: Major vascular complications during video-assisted thoracoscopic surgery (VATS) are uncommon, and complete transection of a non-target pulmonary vein by an endoscopic stapler is exceedingly rare. When venous...
BACKGROUND: Major vascular complications during video-assisted thoracoscopic surgery (VATS) are uncommon, and complete transection of a non-target pulmonary vein by an endoscopic stapler is exceedingly rare. When venous drainage of a preserved lobe is abruptly interrupted, rapid pulmonary congestion and life-threatening complications may ensue. Optimal management is particularly challenging when direct reconstruction is not technically feasible and additional lung resection is poorly tolerated. CASE PRESENTATION: A 76-year-old man with left lower lobe lung cancer and moderate-to-severe obstructive ventilatory dysfunction underwent thoracoscopic resection, during which the left superior pulmonary vein was inadvertently completely transected. The left upper lobe became progressively congested. Because the proximal stump was only 3-5 mm long and located adjacent to the left atrium, direct reanastomosis was not possible. Additional left upper lobectomy, combined with the planned lower lobe resection, would have effectively amounted to left pneumonectomy. After conversion to thoracotomy, an autologous pericardial patch was fashioned into a tubular conduit and used to reconstruct the transected vein. The planned lobectomy was modified to extended S7 + 8 segmentectomy to preserve pulmonary function. Postoperative imaging showed no obvious residual congestion and satisfactory perfusion of the remaining left lung; however, conduit patency was not directly confirmed radiologically but was inferred from these favorable imaging findings and the absence of clinical signs of venous obstruction. Follow-up CT at approximately 3 months demonstrated significant resolution of pulmonary exudative lesions with no evidence of recurrent venous congestion. CONCLUSIONS: Autologous pericardial conduit reconstruction may provide an effective salvage strategy for inadvertent pulmonary vein transection during VATS when standard repair is not feasible. Combined with parenchymal-sparing resection, this approach may be particularly valuable in patients with limited pulmonary reserve. However, conduit patency in this case was confirmed only indirectly, and long-term durability remains to be established.
Constrained acetabular liner total hip arthroplasty versus conventional hemiarthroplasty for unstable comminuted femoral intertrochanteric fractures in elderly patients with neurological disorders.
Dong M, Liu Y, Wei C
BMC Surg · 2026 Jun · PMID 42337507 · Full text
BACKGROUND: To evaluate whether constrained acetabular liners (CAL) used in total hip arthroplasty (THA) reduce the risk of dislocation and related complications in patients with neuromuscular disorders and unstable comm...
BACKGROUND: To evaluate whether constrained acetabular liners (CAL) used in total hip arthroplasty (THA) reduce the risk of dislocation and related complications in patients with neuromuscular disorders and unstable comminuted femoral intertrochanteric fractures (ITF). METHODS: This retrospective cohort study included patients diagnosed with Evans type III-V ITFs who underwent hemiarthroplasty or THA at our institution from July 2011 to July 2016. Patients were divided into two groups: a hemiarthroplasty group and a CAL group. Radiological data, clinical records, and laboratory test results were meticulously collected. Differences between the two groups were analyzed to support clinical decision-making regarding treatment strategies. RESULTS: Significant differences were observed between the two groups in operation duration (90.50 ± 25.12 vs. 110.10 ± 26.38 min, P = 0.008), intraoperative blood loss (205.12 ± 68.50 vs. 275.58 ± 83.36 mL, P = 0.003) and blood transfusion rate (16.67% vs. 30.87%, P = 0.012). Compared to hemiarthroplasty, CAL was associated with a significantly higher risk of heterotopic ossification (HO) (Odds ratio = 1.198, 95% CI: 1.020-1.850), a higher risk of aseptic loosening (Odds ratio = 1.155, 95% CI: 0.708-1.782), and a lower risk of dislocation (Odds ratio = 0.120, 95% CI: 0.022-0.552). CONCLUSIONS: Among patients with neurological disorders undergoing HA for unilateral unstable comminuted femoral ITF, CAL THA was correlated with a lower postoperative dislocation rate but increased risks of aseptic loosening and HO. Despite reducing dislocation risk, the overall clinical benefits of CAL appeared limited. Additionally, no significant differences in long-term hip function outcomes were observed between CAL and conventional hemiarthroplasty.
Penetrating trauma leading to a transfixing common bile duct injury: case report and surgical management.
Kallel Y, Laaribi A, Kallel MA … +3 more , Beji H, Mighri MM, Touinsi H
BMC Surg · 2026 Jun · PMID 42337502 · Full text
BACKGROUND: Extrahepatic bile duct injuries following penetrating abdominal trauma are rare, occurring in only 1-5% of cases, and are frequently missed during the initial assessment due to nonspecific clinical and imagin...
BACKGROUND: Extrahepatic bile duct injuries following penetrating abdominal trauma are rare, occurring in only 1-5% of cases, and are frequently missed during the initial assessment due to nonspecific clinical and imaging findings. We report a rare transfixing injury of the common bile duct caused by a stab wound, highlighting the diagnostic challenges and surgical decision-making required to prevent severe biliary complications. CASE PRESENTATION: A 35-year-old male presented two hours after a stab wound to the right hypochondrium. He was hemodynamically stable, with leukocytosis and mild anemia. A CT scan revealed a 4-cm laceration of hepatic segment IVb with moderate intra-abdominal fluid. Initial conservative management was attempted, but six hours later, he developed fever, tachycardia, and peritoneal irritation, prompting diagnostic laparoscopy. Bilious fluid was observed, and a transfixing liver laceration was identified. Conversion to laparotomy revealed a transfixing injury of the supraduodenal segment of the common bile duct. The posterior defect was repaired via the anterior defect after controlled longitudinal enlargement, a 12 Fr T-tube was placed, and a subhepatic drain was positioned. Postoperative course was uneventful. T-tube cholangiograms performed on postoperative day 8 and 60 days later showed no leakage or stricture. At 1-year follow-up, the patient remained asymptomatic. CONCLUSIONS: Early diagnostic suspicion and timely surgical exploration are essential in penetrating upper abdominal trauma to prevent missed bile duct injuries. Primary repair with T-tube drainage may represent a safe and effective option in selected patients when tissue viability and injury characteristics are favorable.
Basilic vein transposition to enhance arteriovenous fistula venous outflow: a single-center technical note.
Li X, Wu D, Song X … +5 more , Yang B, Liu Q, You C, Shu Y, Jin L
BMC Surg · 2026 Jun · PMID 42337498 · Full text
OBJECTIVE: To describe the technical feasibility and early clinical outcomes of basilic vein to fistula outflow vein transposition as an autogenous salvage option for malfunctioning forearm arteriovenous fistulas (AVFs)...
OBJECTIVE: To describe the technical feasibility and early clinical outcomes of basilic vein to fistula outflow vein transposition as an autogenous salvage option for malfunctioning forearm arteriovenous fistulas (AVFs) with venous outflow obstruction at the elbow level and a patent basilic vein. METHODS: This single-center retrospective technical note reviewed nine patients who underwent basilic vein to fistula outflow vein transposition between December 2023 and March 2026. Clinical indications, reasons for selecting surgical transposition over further endovascular treatment, operative details, time to postoperative dialysis use, complications, reinterventions, and individual access outcomes were summarized descriptively. RESULTS: The mean age was 67.8 ± 7.2 years; seven patients were male. Hypertension was present in all patients and diabetes mellitus in two patients. The main clinical triggers for intervention were venous hypertension during hemodialysis, thrombotic occlusion of the cephalic outflow vein, and inadequate dialysis blood flow. The mean preoperative basilic vein diameter was 2.0 ± 0.28 mm. After reconstruction, all patients had restoration of a normal access thrill and resolution of abnormal fistula pulsatility, while intradialytic venous hypertension improved compared with the preoperative status. All AVFs were successfully used for hemodialysis within 48 h after surgery. Two patients had wound hemorrhage that resolved after bedside management. During follow-up, five patients required reintervention for restenosis, including PTA and open thrombectomy. No early thrombosis, hematoma, nerve injury, wound infection, clinically significant steal syndrome, or access abandonment occurred during the available follow-up. CONCLUSION: In patients with a functioning forearm AVF, preserved arterial inflow, elbow-level venous outflow obstruction, and a suitable basilic vein, basilic vein-to-fistula outflow vein transposition may represent a practical autogenous salvage option. These findings should be interpreted as preliminary technical experience.
Kidney transplantation - colour doppler and contrast-enhanced ultrasound in the early postoperative assessment of delayed graft function: retrospective results and pilot prospective findings.
Zanchetta M, Morabito M, Ripamonti M … +9 more , Liepa L, Iori V, Adani GL, Coppola A, Fontana F, Inversini D, K. T.-CEUS Workgroup , Carcano G, Ietto G
BMC Surg · 2026 Jun · PMID 42337475 · Full text
INTRODUCTION: Delayed graft function (DGF) remains a relevant early complication after kidney transplantation (KT), and reliable non-invasive imaging markers may improve postoperative graft assessment. MATERIALS AND METH...
INTRODUCTION: Delayed graft function (DGF) remains a relevant early complication after kidney transplantation (KT), and reliable non-invasive imaging markers may improve postoperative graft assessment. MATERIALS AND METHODS: We retrospectively evaluated 381 KT recipients who underwent colour Doppler (CD) ultrasound (US) on postoperative day (POD) 1 and before discharge between January 2013 and February 2022. Resistive index (RI) measurements were analyzed in relation to DGF, defined as the need for at least one dialysis session within the first postoperative week. A prospective pilot subgroup of 25 recipients transplanted between February 2021 and February 2022 also underwent contrast-enhanced US (CEUS) between POD 1 and 3, with analysis of wash-in slope (WIS), time to peak (TTP), peak intensity (PI), and area under the curve (AUC). RESULTS: In the retrospective cohort, 71 (18.6%) developed DGF. Higher RI values on POD 1 and before discharge were significantly associated with DGF. In the CEUS pilot subgroup, 7 patients (28.0%) developed DGF. Among CEUS-derived parameters, AUC was significantly associated with DGF, with lower values in patients who developed DGF and a valuable ROC AUC of 0.794. CONCLUSIONS: These findings support a role for early postoperative CD in graft function assessment and suggest that CEUS-derived AUC may provide valuable complementary information in the early evaluation of grafts for DGF. However, the CEUS results are exploratory and require validation in larger prospective studies.
Endoscopic sinus surgery combined with nasal corticosteroids and surgery alone for chronic rhinosinusitis with nasal polyps: a meta-analysis.
Chen Y, Zhang X
BMC Surg · 2026 Jun · PMID 42337457 · Full text
OBJECTIVE: The purpose of this meta-analysis was to assess whether the outcomes of endoscopic sinus surgery in chronic rhinosinusitis with nasal polyps could be improved by adjunctive corticosteroid therapy. METHODS: Thi...
OBJECTIVE: The purpose of this meta-analysis was to assess whether the outcomes of endoscopic sinus surgery in chronic rhinosinusitis with nasal polyps could be improved by adjunctive corticosteroid therapy. METHODS: This meta-analysis was conducted in accordance with the PRISMA statement. We systematically searched PubMed, Web of Science, and CNKI for clinical studies comparing ESS combined with corticosteroid therapy and ESS alone in patients with CRSwNP. RESULTS: Eight clinical studies with an aggregate of 776 patients were included. Meta-analysis revealed: (1) A lower rate of polyp recurrence in the ESS plus corticosteroid therapy group (OR = 0.57, 95% CI: 0.33-0.97, P = 0.04); (2) Better sinonasal quality of life (SNOT-22: SMD = - 1.09, 95% CI: - 1.30 to - 0.89, P < 0.00001); (3) Decrease symptom score (VAS: MD = - 3.80, 95% CI: - 4.53 to - 3.07, P < 0.00001); (4) Better endoscopic outcome (Lund-Kennedy: SMD = - 2.05, 95% CI: - 2.27 to - 1.83, P < 0.00001). Heterogeneity was low (I² = 0%-4%), and funnel plots were generated exploratorily because of the limited number of studies. CONCLUSION: ESS combined with adjunctive corticosteroid therapy was associated with lower recurrence and improved postoperative SNOT-22, VAS, and Lund-Kennedy scores compared with surgery alone in patients with CRSwNP. However, these findings should be interpreted cautiously because endotype-specific effects, corticosteroid delivery methods, surgical extent, and long-term symptomatic recurrence were not consistently reported.
Hugo™ RAS versus da Vinci for robot-assisted radical prostatectomy in localized prostate cancer: a GRADE-assessed systematic review and meta-analysis of prospective comparative studies.
Mirza W, Haider MH, Habib T … +3 more , Ali RN, Moeen-Ud-Din MB, Hadhoud AM
BMC Surg · 2026 Jun · PMID 42332746 · Full text
BACKGROUND: The comparative adoption of the Hugo™ robotic-assisted surgery platform for robot-assisted radical prostatectomy (RARP) is increasing; however, the strength and consistency of prospective head-to-head evidenc...
BACKGROUND: The comparative adoption of the Hugo™ robotic-assisted surgery platform for robot-assisted radical prostatectomy (RARP) is increasing; however, the strength and consistency of prospective head-to-head evidence versus da Vinci remain uncertain. We performed a systematic review and meta-analysis of prospective comparative studies comparing Hugo™ RAS with da Vinci for localized prostate cancer, incorporating sensitivity analyses and GRADE certainty assessments. METHODS: We searched PubMed, Embase, Scopus, Web of Science, CENTRAL, and ClinicalTrials.gov databases from inception to January 2026. Prospective comparative studies enrolling patients with localized prostate cancer undergoing RARP with Hugo™ versus da Vinci were included in this review. Screening and extraction were performed in duplicate with consensus resolution. Random-effects meta-analyses were performed, and risk of bias was assessed using ROBINS I and certainty using GRADE. RESULTS: Three prospective comparative studies comprising 145 Hugo RAS cases and 145 da Vinci cases were included. The primary outcome, intraoperative complications, showed no statistically significant difference between Hugo™ RAS and da Vinci; however, the estimate was imprecise with a wide confidence interval, reflecting limited statistical power and uncertainty around the true effect size (RR 1.95, 95% CI 0.49-7.72; I² 0%). Secondary outcomes also showed no statistically significant differences, including positive surgical margin (RR 1.20, 95% CI 0.49-2.98), operative time (MD - 15.34 min, 95% CI - 41.11 to 10.43), estimated blood loss (MD - 39.09 mL, 95% CI - 143.51 to 65.32; I² 90%), length of stay (MD 0.10 days, 95% CI - 0.02 to 0.22), and catheter duration (MD 0.01 days, 95% CI - 3.97 to 3.99; I² 92%). Leave-one-out sensitivity analysis reduced heterogeneity in blood loss after removing a single study and shifted the pooled estimate toward lower blood loss with Hugo™. The certainty of evidence ranged from moderate to very low, most often downgraded for risk of bias, imprecision, and inconsistency. CONCLUSIONS: In the currently available prospective comparative evidence, Hugo™ RAS showed no statistically significant difference from da Vinci RARP for perioperative safety and early postoperative outcomes in localized prostate cancer. However, the small sample size, sparse events, and wide confidence intervals, particularly for intraoperative complications, preclude conclusions of clinical equivalence or non-inferiority. Larger multicenter prospective comparative studies with standardized outcome definitions and longer oncologic and functional follow-up are required to generate higher-certainty evidence.
Use of microfragmented autologous adipose tissue (LIPOGEMS®) as a sphincter-saving therapy for complex anal fistulas: a single-center retrospective study.
Bustamante-Recuenco C, Sanz-Ongil R, Oliart S … +5 more , Equisoain-Azcona A, García-Quijada J, González-Cavero J, Arenas-Escribano D, Morales FJA
BMC Surg · 2026 Jun · PMID 42332719 · Full text
BACKGROUND: Complex anal fistulas remain a therapeutic challenge due to high recurrence rates and the risk of incontinence associated with conventional treatments. Microfragmented autologous adipose tissue has emerged as...
BACKGROUND: Complex anal fistulas remain a therapeutic challenge due to high recurrence rates and the risk of incontinence associated with conventional treatments. Microfragmented autologous adipose tissue has emerged as a sphincter-sparing option with potential regenerative and anti-inflammatory properties. This study aimed to evaluate the safety and efficacy of its injection into the fistula tract combined with closure of the internal opening. METHODS: A single-center, retrospective, observational study was conducted between June 2019 and May 2025. All patients with complex anal fistulas treated with microfragmented adipose tissue processed with LIPOGEMS® system were included. Demographic data, fistula characteristics, surgical history, perioperative variables, postoperative morbidity, healing rate, and hospital stay were analyzed. Follow-up visits were performed weekly in the first month, and at 3, 6 and 12 months thereafter. RESULTS: A total of 28 patients with complex fistula were included. Mean patient age was 51.2 years (SD: 15.3), with predominance of males (69.7%). Most fistulas were medium or high transsphincteric (85.7%) and the main location was posterior (57.1%). 75% of patients had undergone previous curative-intent procedures. Median operative time was 71 minutes, and median processed adipose volume was 14 ml. Two postoperative complications were recorded (one abdominal hematoma-CD I and one perianal abscess-CD IIIa). After a median follow-up of 11.2 months, the overall healing rate was 46.4%, higher in primary (57.1%) and posterior fistulas (56.3%). Median hospital stay was one day, and median clinical closure occurred at 2.7 months. CONCLUSIONS: LIPOGEMS® therapy appeared safe, feasible, and associated with encouraging healing outcomes, offering advantages in functional preservation and recovery. Larger prospective studies are needed to confirm these results and refine its role in fistula management.
Proximal femoral bionic nail is associated with lower postoperative complication risk and better early functional recovery in older patients with intertrochanteric fractures: a retrospective cohort study.
Luo X, Ma N, Yang Y … +3 more , Ma H, Lu E, Wang Y
BMC Surg · 2026 Jun · PMID 42332705 · Full text
OBJECTIVE: Proximal femoral bionic nail (PFBN) represents a novel biomechanical design for the internal fixation of intertrochanteric fractures in older adults. However, comparative real-world evidence between PFBN and t...
OBJECTIVE: Proximal femoral bionic nail (PFBN) represents a novel biomechanical design for the internal fixation of intertrochanteric fractures in older adults. However, comparative real-world evidence between PFBN and the conventional proximal femoral nail antirotation (PFNA) remains limited, particularly in the presence of baseline differences in patient frailty and bone quality. METHODS: This retrospective study included 301 older patients with intertrochanteric fractures treated between January 2023 and December 2024. According to the fixation method, 201 patients were assigned to the PFNA group and 100 to the PFBN group. Perioperative outcomes, radiographic parameters, composite medical complications, implant-related mechanical complications, and functional recovery were compared between the two groups. The main outcome measures were radiographic stability, composite medical complications, implant-related mechanical complications, and Harris Hip Score (HHS). Although baseline bone mineral density was significantly lower in the PFNA group than in the PFBN group (P < 0.001), no statistically significant difference was observed in tip-apex distance (TAD), suggesting broadly similar implant positioning. Multivariable logistic regression was used to adjust for potential confounding factors and to assess the association between implant type and composite medical complications. RESULTS: The PFBN group had a statistically longer but clinically small difference in operative time compared with the PFNA group (46.97 ± 11.90 min vs. 44.17 ± 9.42 min, P = 0.041), whereas intraoperative blood loss and length of hospital stay were similar between the two groups. Radiographic follow-up showed that the mean loss of neck-shaft angle was significantly smaller in the PFBN group than in the PFNA group (0.41 ± 0.57° vs. 2.80 ± 2.31°, P < 0.001). During follow-up, implant-related mechanical complications occurred in 3 patients (1.5%) in the PFNA group, all of which were fixation failure events, whereas no implant-related mechanical complication was observed in the PFBN group. Although the crude difference in composite medical complications was not statistically significant, PFBN use was associated with a lower adjusted risk after covariate adjustment (adjusted odds ratio, 0.660; 95% confidence interval, 0.490-0.890; P = 0.006). In addition, HHS at 3 and 6 months was modestly higher in the PFBN group, whereas no significant between-group difference was found at 12 months. CONCLUSION: Compared with PFNA, PFBN was associated with less loss of neck-shaft angle and a lower adjusted risk of composite medical complications, although the crude comparison of composite medical complications was not statistically significant. Early HHS scores were modestly higher in the PFBN group, but functional outcomes were comparable at 12 months. Given the single-center retrospective design and baseline imbalance, these findings should be interpreted cautiously and require confirmation in prospective multicenter studies. TRIAL REGISTRATION: Not applicable. This was a retrospective cohort study and did not prospectively assign participants to interventions.
Impact of surgical approach and anastomosis distance on low anterior resection syndrome.
Harmantepe AT, Canturk AO, Küçük İF … +3 more , Akdeniz Y, Altıntoprak F, Özdemir K
BMC Surg · 2026 Jun · PMID 42332676 · Full text
INTRODUCTION: Low anterior resection syndrome (LARS) is a frequent functional disorder following sphincter-preserving surgery for rectal cancer. This study aimed to assess the impact of surgical approach and anastomosis...
INTRODUCTION: Low anterior resection syndrome (LARS) is a frequent functional disorder following sphincter-preserving surgery for rectal cancer. This study aimed to assess the impact of surgical approach and anastomosis distance on LARS development. METHODS: We retrospectively analyzed 115 patients who underwent low anterior resection without diverting stoma between 2012 and 2024. Patients were stratified using the validated LARS score questionnaire. Surgical approaches (open, laparoscopic, robotic) and clinicopathologic features were compared across LARS severity levels. Statistical analysis included Kruskal-Wallis, Mann-Whitney U, chi-square, and Spearman correlation tests. RESULTS: No significant difference in LARS scores was found among open, laparoscopic, and robotic groups (p=0.130), but open surgery showed higher scores compared to minimally invasive surgery (p=0.045). Anastomosis distance ≤4 cm from the anal verge was strongly associated with higher LARS incidence (p<0.001). Other factors, including age, tumor stage, neoadjuvant therapy, and follow-up duration, were not significantly associated with LARS. The most severe symptoms were urgency and clustering. Symptoms plateaued around 4 years postoperatively. CONCLUSION: LARS remains a common complication after rectal cancer surgery. Minimally invasive surgery and anastomosis distance greater than 4 cm from the anal verge were associated with lower LARS scores. Surgical planning should consider functional outcomes in addition to oncologic safety. TRIAL REGISTRATION: This study does not report the results of a clinical trial.
Risk factors for post-ERCP pancreatitis: a retrospective analysis of nursing-related factors.
Li Z, Liu L
BMC Surg · 2026 Jun · PMID 42332666 · Full text
BACKGROUND: To investigate the incidence and risk factors of endoscopic retrograde cholangiopancreatography (ERCP) post-ERCP pancreatitis (PEP) from the perspective of nursing practice, and to provide evidence for develo...
BACKGROUND: To investigate the incidence and risk factors of endoscopic retrograde cholangiopancreatography (ERCP) post-ERCP pancreatitis (PEP) from the perspective of nursing practice, and to provide evidence for developing refined prevention and control strategies. METHODS: A single-center retrospective study was conducted on 658 patients who underwent diagnostic or therapeutic ERCP between January 2020 and December 2025. Using a nested case-control design, 45 patients who developed PEP were assigned to the case group, and 180 patients without PEP were matched at a 1:4 ratio as the control group. Baseline characteristics, procedural variables, and perioperative nursing-related factors were collected. Multivariable logistic regression analysis was performed to identify independent risk factors, and a combined prediction model was constructed to evaluate its performance. RESULTS: The overall incidence of PEP was 6.8%, with mild cases accounting for 71.1%. The case group had significantly higher proportions of difficult cannulation and pancreatic duct opacification ≥ 3 times, but significantly lower proportions of receiving comprehensive nursing interventions and cooperation by a dedicated ERCP team. A higher proportion of patients in the case group were assessed as high risk preoperatively. Difficult cannulation (AOR = 6.70, 95% CI: 2.79-16.09, p < 0.001), pancreatic duct opacification ≥ 3 times (AOR = 3.38, 95% CI: 1.40-8.17, p = 0.007), and preoperative high-risk assessment (AOR = 3.98, 95% CI: 1.72-9.20, p = 0.001) were identified as independent risk factors, while comprehensive nursing interventions (AOR = 0.20, 95% CI: 0.09-0.47, p < 0.001) and dedicated ERCP team cooperation (AOR = 0.14, 95% CI: 0.05-0.37, p < 0.001) were protective factors. The combined prediction model showed good discriminative ability (AUC = 0.856) and model fit (Hosmer-Lemeshow test, p = 0.145). CONCLUSIONS: Comprehensive nursing interventions and dedicated ERCP team cooperation were associated with a lower risk of PEP in this retrospective study. These findings suggest that nursing-related factors may play a role in PEP prevention. We therefore recommend integrating nursing assessment and intervention into standardized ERCP management protocols to enhance overall procedural safety.
Psychometric testing of the abdominal surgery impact scale in the Turkish population.
Cihan E, Sayar S, Acar Uysal E
BMC Surg · 2026 Jun · PMID 42323658 · Full text
BACKGROUND: Postsurgery recovery is a multifaceted and dynamic process. Recent reports recommend using condition-specific patient-reported outcome measures to evaluate surgical recovery. This study aimed to examine the p...
BACKGROUND: Postsurgery recovery is a multifaceted and dynamic process. Recent reports recommend using condition-specific patient-reported outcome measures to evaluate surgical recovery. This study aimed to examine the psychometric properties of the Abdominal Surgery Impact Scale (ASIS) in the Turkish population. METHODS: This methodological study included 181 patients who primarily underwent minor or intermediate abdominal procedures. The scale was applied twice: in the early postoperative period and one month postoperatively. Content validity, construct validity, item analysis, internal consistency, and responsiveness were evaluated. RESULTS: Most participants underwent hernia surgery (44.2%) or cholecystectomy (41.4%); only 7.7% had major surgery. Responsiveness analysis showed that mean total ASIS-TR scores increased significantly (p < 0.001) from the early postoperative period (77.71 ± 23.60) to one month postoperatively (116.08 ± 14.50). The ceiling effect of the one-month postoperative scale was 40.3%. Item-total correlations ranged from 0.33 to 0.75. Internal consistency was high (McDonald's ω = 0.91, Cronbach's α = 0.91), with domain ω values ranging from 0.51 for Visceral Function to 0.94 for Psychological Function. The fit indices at the two time points supported construct validity. Early fit index values were as follows: χ/df = 2.08, RMSEA = 0.07, CFI = 0.93, IFI = 0.93, TLI = 0.91, GFI = 0.87. CONCLUSION: The ASIS-TR demonstrated acceptable to high reliability, validity, and responsiveness. However, these findings should be interpreted cautiously given the predominance of minor surgical procedures, the presence of a ceiling effect, and the low reliability of the Visceral Function domain. Future research involving multicentre recruitment should be conducted with patient populations undergoing major gastrointestinal surgeries, and convergent validity and test-retest reliability should be evaluated.
Proximal femoral bionic nail (PFBN) versus InterTAN nail for intertrochanteric femoral fractures in elderly patients: a systematic review and meta-analysis.
Li H, Deng Y, Xu J … +5 more , Xiong X, Li X, Zhao T, Ying Q, Zhang J
BMC Surg · 2026 Jun · PMID 42323636 · Full text
OBJECTIVE: To systematically assess the efficacy and safety of the proximal femoral bionic nail (PFBN) compared with the InterTAN nail in the management of intertrochanteric femoral fractures (IFFs) among elderly individ...
OBJECTIVE: To systematically assess the efficacy and safety of the proximal femoral bionic nail (PFBN) compared with the InterTAN nail in the management of intertrochanteric femoral fractures (IFFs) among elderly individuals. METHODS: Eligibility criteria (inclusion and exclusion) were established in accordance with the PICOS framework. Relevant clinical studies were systematically retrieved from both Chinese (CNKI, VIP, and Wanfang Data) and English databases (PubMed, Embase, Web of Science, the Cochrane Library) with a search cutoff date of October 31, 2025. The Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tool was employed to appraise methodological quality of the included literature. Meta-analyses of outcome measures, including intraoperative duration, intraoperative haemorrhage, length of hospital stay, postoperative weight-bearing duration, Harris Hip Score (HHS), and internal fixation-related complications, were conducted using RevMan 5.3 and Stata 15 software. RESULTS: Six relevant studies were finally enrolled in the present analysis, consisting of 2 prospective cohort studies and 4 retrospective cohort studies, with a total of 683 participants. Among all cases, 334 patients were allocated to the PFBN group and the remaining 349 cases received InterTAN nail fixation. Meta-analysis outcomes demonstrated no significant inter-group differences in intraoperative blood loss (P = 0.17), postoperative weight-bearing time (P = 0.47) and Harris Hip Score (HHS) (P = 0.11). When compared with the InterTAN nail system, the PFBN group presented a shorter hospital stay (P = 0.04) and a decreased rate of internal fixation-related complications (P = 0.01), whereas the PFBN group had a longer operative time (P = 0.03). Sensitivity analysis further confirmed the good overall stability and reliability of the pooled outcomes in this meta-analysis. CONCLUSION: Based on the limited evidence from current non-randomized studies, PFBN exhibits potential benefits in shortening hospital duration and reducing the risk of internal fixation-related complications among elderly patients with intertrochanteric femoral fractures. Meanwhile, this implant yields equivalent effects to the InterTAN nail with regard to functional recovery. Given the observational design of all included trials and substantial heterogeneity in several outcomes, these findings warrant cautious interpretation.
Analysis of predictive factors and development of a nomogram for complicated acute appendicitis in adults.
Yu J, Li S, Ma Y
BMC Surg · 2026 Jun · PMID 42323591 · Full text
BACKGROUND: The number of patients receiving conservative treatment for acute appendicitis is currently increasing. However, for complicated acute appendicitis (CAA), surgical treatment yields more definitive outcomes, a...
BACKGROUND: The number of patients receiving conservative treatment for acute appendicitis is currently increasing. However, for complicated acute appendicitis (CAA), surgical treatment yields more definitive outcomes, and delayed surgery increases the risk of complications. Therefore, this study aimed to analyze the predictive factors for CAA and establish a nomogram. METHODS: Patients who underwent appendectomy between January 2023 and October 2025 were included. Univariate and multivariate analyses were performed to identify predictive factors and independent predictive factors, respectively. A nomogram prediction model was constructed to visualize these factors. The performance of the prediction model was evaluated via receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA). RESULTS: The incidence of CAA was 25.24%. Analysis revealed six factors as independent predictors associated with CAA in acute appendicitis: age [OR 3.697 (95% CI 1.774-7.704)], body temperature [OR 3.235 (95% CI 1.367-7.656)], neutrophil percentage [OR 2.317 (95% CI 1.123-4.782)], C-reactive protein (CRP) [OR 12.434 (95% CI 5.525-27.982)], appendix diameter [OR 30.731 (95% CI 15.189-62.177)], and appendiceal fecalith [OR 6.968 (95% CI 3.544-13.698)]. A risk prediction model was developed on the basis of these factors and presented as a nomogram. The area under the ROC curve was 0.959, with a sensitivity of 87.3% and specificity of 90.3%. The calibration curve showed a mean absolute error of 0.014, and the DCA indicated favorable clinical net benefit. CONCLUSION: Age, body temperature, neutrophil percentage, CRP level, appendix diameter, and the presence of an appendiceal fecalith are predictive factors for CAA. The established nomogram can effectively predict the risk of CAA.
National survey on management practices for adhesional small bowel obstruction and nasogastric tube use among general surgeons in Australia.
Al-Mashat A, Fareed A, Smith S … +1 more , Gani J
BMC Surg · 2026 Jun · PMID 42323574 · Full text
BACKGROUND: The nasogastric tube (NGT) is recommended routinely by current guidelines in the non-operative management of adhesional small bowel obstruction (ASBO). However, several retrospective studies have reported poo...
BACKGROUND: The nasogastric tube (NGT) is recommended routinely by current guidelines in the non-operative management of adhesional small bowel obstruction (ASBO). However, several retrospective studies have reported poorer outcomes in ASBO patients managed with an NGT. We sought to examine current practices among Australian General Surgeons in managing ASBO and using NGTs, assess the presence of surgical equipoise for a potential randomised controlled trial (RCT), and evaluate interest in multi-centre collaboration. METHODS: In October 2021, we conducted an online survey of all active members of General Surgeons Australia using a REDCap questionnaire distributed via email. The survey included clinical scenarios of small bowel obstruction and questions on demographics, management practices, and clinical reasoning. Descriptive statistics were used to summarise all relevant variables. RESULTS: Of the 893 emails sent, 181 responses were received (20%). Most respondents were from New South Wales (47%) and had subspecialty training (71%). An NGT was used in over 90% of ASBO cases by 42% of respondents. 64% believed NGT use could prevent surgery, and 93% viewed it as having a therapeutic role. Vomiting was the most common indication for insertion, and 69% believed it reduces aspiration risk. Gastrografin was used by 96% of surgeons. 42% expressed willingness to participate in an RCT evaluating NGT use. CONCLUSIONS: There is considerable variation among surgeons in their beliefs regarding its utility. The observed variation in practice patterns and underlying beliefs reflects ongoing clinical uncertainty. Given the exploratory nature of the survey and its response rate, these findings should be interpreted as reflecting practice variability, rather than establishing consensus, and may inform the design of further investigation through a RCT.
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