BMC Surgery[JOURNAL]
Sun
200 papers
Predictive value of the preoperative controlling nutritional status score for anastomotic leakage after radical gastrectomy for gastric cancer and risk stratification based on predicted probability.
Chen R, Li J, Guan S
BMC Surg · 2026 Jun · PMID 42321752 · Full text
BACKGROUND: Anastomotic leakage remains one of the major complications after gastrectomy in patients with gastric cancer and may increase postoperative morbidity and delay recovery. Preoperative nutritional status is clo...
BACKGROUND: Anastomotic leakage remains one of the major complications after gastrectomy in patients with gastric cancer and may increase postoperative morbidity and delay recovery. Preoperative nutritional status is closely associated with anastomotic healing; however, the value of the Controlling Nutritional Status (CONUT) score for predicting clinically relevant anastomotic leakage after gastric cancer surgery requires further clarification. This study aimed to evaluate the predictive value of the preoperative CONUT score for clinically relevant anastomotic leakage after radical gastrectomy and to construct an interpretable risk prediction model and a three-tier risk stratification system based on predicted probability. METHODS: Clinical data from 283 patients who underwent radical gastrectomy from January 2021 to January 2025 were retrospectively analyzed. The CONUT score was calculated from serum albumin, total lymphocyte count, and total cholesterol. The primary endpoint was clinically relevant anastomotic leakage of grade II or higher within 30 postoperative days. Logistic regression was used to identify risk factors. Receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive value of the CONUT score and its components. Internal validation was performed using bootstrap resampling with 1000 repetitions, and exploratory temporal validation was conducted by using patients treated from January 2021 to December 2023 as the modeling cohort and those treated from January 2024 to January 2025 as the temporal validation cohort. RESULTS: Among the 283 patients, 39 (13.8%) developed clinically relevant anastomotic leakage. Multivariable Logistic regression showed that CONUT score (odds ratio [OR] = 1.425, 95% confidence interval [CI]: 1.168-1.739, P < 0.001), diabetes mellitus (OR = 2.486, 95% CI: 1.052-5.876, P = 0.038), total gastrectomy (OR = 2.318, 95% CI: 1.028-5.228, P = 0.043), operative time (OR = 1.008, 95% CI: 1.002-1.014, P = 0.012), and intraoperative blood loss (OR = 1.004, 95% CI: 1.001-1.007, P = 0.018) were independent risk factors for anastomotic leakage. The area under the curve (AUC) of the CONUT score for predicting anastomotic leakage was 0.782 (95% CI: 0.716-0.848). When a CONUT score ≥ 3 was used as a sensitivity-prioritized screening threshold, the sensitivity, specificity, and negative predictive value were 74.4%, 62.3%, and 93.8%, respectively; when a score ≥ 4 was used as a higher-specificity alternative threshold, the sensitivity and specificity were 59.0% and 78.3%, respectively. Compared with serum albumin alone, the AUC of the CONUT score showed a modest increase of 0.058 (DeLong test P = 0.042). The risk prediction model based on five independent risk factors had an apparent concordance index (C-index) of 0.838 (95% CI: 0.779-0.897), a bootstrap-corrected C-index of 0.826, and a C-index of 0.803 (95% CI: 0.701-0.905) in the temporal validation cohort. After three-tier risk stratification based on predicted probability, the incidence of anastomotic leakage increased stepwise in the low-, intermediate-, and high-risk groups (χ² = 56.925, P < 0.001). CONCLUSIONS: The preoperative CONUT score was associated with an increased risk of clinically relevant anastomotic leakage after gastric cancer surgery. A risk prediction model incorporating CONUT score, diabetes mellitus, total gastrectomy, operative time, and intraoperative blood loss may provide a reference for perioperative risk assessment, although multicenter external validation is still required before broader application.
Anatomical structure of pulmonary vessels and bronchi in the right upper lobe based on three-dimensional reconstruction.
Yan W, Wang M, Li Y … +2 more , Xu L, Zhao J
BMC Surg · 2026 Jun · PMID 42321722 · Full text
OBJECTIVE: The aim of this study was to evaluate the anatomical patterns of the right upper lobe pulmonary segments through three dimensional reconstruction and to describe the frequency of observed variant types. METHOD...
OBJECTIVE: The aim of this study was to evaluate the anatomical patterns of the right upper lobe pulmonary segments through three dimensional reconstruction and to describe the frequency of observed variant types. METHODS: Three-dimensional reconstruction of images of the pulmonary structures was performed in 67 patients with ground-glass pulmonary nodules who were due for segmentectomy in our hospital, from August 2021 to June 2025. RESULTS: Incidentally, the reconstructed models were used for the statistical analysis of the anatomical structures in the right upper lobe. In terms of results, the most common anatomical variant of the bronchus right upper lobe was trifurcate (51/67). This was followed by bifurcate (16/67). Bifurcation was the most common configuration (36/67) in the right upper lobe pulmonary artery followed by trifurcation (16/67) and singled branching (8/67). The most frequent configuration of the right upper lobe pulmonary veins was anterior vein + central vein (42/67), followed by anterior vein + posterior vein (7/67) and isolated central vein (7/67). Furthermore, a set of 12 rare variations were also observed, which includes 4 bronchial cases, 2 pulmonary artery cases, and 7 pulmonary vein variations cases. CONCLUSION: The lung has complex anatomical structures with various variations. The surgeon must have a proper knowledge of the segmental anatomy of the area of the operation. The study offers a descriptive reference of anatomical variations that may assist in preoperative planning and intraoperative orientation for right upper lobe segmentectomy.
Rapid recovery vs standard care in laparoscopic appendectomy: a prospective study on patient-reported outcomes.
Mönttinen T, Kalliomäki ML, Laukkarinen J … +1 more , Ukkonen M
BMC Surg · 2026 Jun · PMID 42321685 · Full text
BACKGROUND: Laparoscopic appendectomy for uncomplicated acute appendicitis traditionally requires postoperative hospitalization. Rapid recovery and same-day discharge protocols have been increasingly adopted, yet evidenc...
BACKGROUND: Laparoscopic appendectomy for uncomplicated acute appendicitis traditionally requires postoperative hospitalization. Rapid recovery and same-day discharge protocols have been increasingly adopted, yet evidence regarding patient-reported outcomes is limited. This study aimed to compare a rapid recovery program with standard postoperative care, focusing on patient satisfaction, pain experience, and postoperative functional interference with daily activities. METHODS: In this prospective, non-randomized observational study with sequential group allocation, 96 consecutive adults undergoing laparoscopic appendectomy for uncomplicated acute appendicitis at a single tertiary hospital were enrolled. Patients were allocated sequentially into standard care (n = 62, enrolled first) or a rapid recovery program (n = 34, enrolled in a subsequent phase). Outcomes included length of hospital stay, postoperative pain intensity (NRS 0-10), pain interference with daily activities, sleep quality, and overall satisfaction, assessed via structured telephone interviews conducted 3-5 days post-discharge. RESULTS: Baseline demographics and comorbidities were comparable between groups. Median hospital stay was significantly shorter in the rapid recovery group compared with standard care (12 vs. 18 h, p < 0.001). All patients reported high overall satisfaction with care and pain management. Patients in the rapid recovery group reported lower worst pain (p = 0.049) and least pain (p = 0.006), while median pain was slightly higher (p = 0.004). Pain outcomes showed a mixed pattern that does not support a definitive conclusion regarding superiority of pain management in either group. Sleep disturbance due to pain was less common in the rapid recovery group (18% vs. 42%, p = 0.022). Nearly all patients expressed confidence in the rapid recovery protocol and would recommend it to others. CONCLUSION: Rapid recovery following laparoscopic appendectomy is feasible, well accepted, with high patient satisfaction and a modest reduction in hospital stay. TRIAL REGISTRATION: ISRCTN registered.
Technical feasibility of hand-meshed autologous dermal grafts in immediate prepectoral breast reconstruction: a preliminary case series.
Mahmoodzadeh H, Hakimian SMR
BMC Surg · 2026 Jun · PMID 42321680 · Full text
BACKGROUND: Prepectoral breast reconstruction offers reduced morbidity and improved aesthetic outcomes compared to traditional approaches. However, access to cost-effective and biologically compatible tissue for implant...
BACKGROUND: Prepectoral breast reconstruction offers reduced morbidity and improved aesthetic outcomes compared to traditional approaches. However, access to cost-effective and biologically compatible tissue for implant support remains limited. This case series explores the use of hand-meshed autologous dermal grafts harvested from patients as a readily available and cost-effective alternative for implant coverage. METHODS: Breasts underwent immediate prepectoral implant-based reconstruction using hand-meshed autologous dermal grafts, harvested from the lower abdomen, the ipsilateral breast, or the contralateral breast, in a prepectoral breast reconstruction technique referred to as harvested corium-covered implant (HACCIM). Data regarding clinical, surgical, and short-term minor and major complications were recorded and analyzed. RESULTS: Sixteen patients (21 breasts) underwent prepectoral implant-based reconstruction with autologous hand-meshed dermal grafts. The mean duration of dermal graft preparation and donor site repair was 36 min. Minor complications occurred in 10 breasts as superficial mastectomy skin flap wound events, with 4 also showing small wound dehiscence; all were managed conservatively. Major complications occurred in 2 of 21 cases: one involving a large radiation-induced skin ulcer following early postoperative radiotherapy (initiated 4 weeks after surgery), which resulted in implant exposure and eventual loss; and another involving implant loss in a patient who had received radiotherapy 18 months before reconstruction. CONCLUSION: This case series suggests the technical feasibility of hand-meshed free dermal autograft in immediate prepectoral implant-based breast reconstruction. However, minor superficial mastectomy skin flap wound events were common, indicating a clinically relevant complication burden. Implant loss was also observed in two patients with recent pre- or postoperative radiotherapy exposure. Given the small sample size, these findings remain descriptive, and larger prospective studies are needed to further evaluate the safety, complication profile, and long-term outcomes of this approach.
Impact of intraoperative parathyroid identification and accidental removal on post-thyroidectomy hypocalcemia: a single-center 15-year experience.
Brugués A, Eschlböck S, Siegenthaler E … +5 more , Taha-Mehlitz S, Sortino R, Delko T, Droeser R, Posabella A
BMC Surg · 2026 Jun · PMID 42316352 · Full text
INTRODUCTION: Post-thyroidectomy hypocalcemia remains a common and clinically significant complication. Despite advances in surgical technique and perioperative care, rates of transient and persistent hypocalcemia remain...
INTRODUCTION: Post-thyroidectomy hypocalcemia remains a common and clinically significant complication. Despite advances in surgical technique and perioperative care, rates of transient and persistent hypocalcemia remain substantial, with reported transient rates up to 50% and persistent rates up to 4%. This study evaluates the impact of intraoperative parathyroid gland identification and accidental removal on postoperative hypocalcemia in a Swiss hospital. METHODS: We conducted a retrospective analysis of 615 adult patients undergoing thyroid surgery at the University Hospital of Basel between 2007 and 2022. 322 patients (52.3%) who received total thyroidectomy were selected for statistical analysis. Data on demographics, intraoperative nerve monitoring, number of parathyroid glands visually identified, histological confirmation of gland removal and use of autotransplantation were collected. Postoperative hypocalcemia was categorized as temporary (< 6 months) or persistent (> 6 months). Statistical analyses included chi-squared tests, Wilcoxon rank-sum tests, and logistic regression to assess associations between gland identification/removal and hypocalcemia, with significance set at p < 0.05. RESULTS: Among 288 patients who underwent total thyroidectomy with intraoperative identification of parathyroid glands, 43% (n = 124) developed temporary hypocalcemia and 0.9% (n = 3) experienced persistent hypocalcemia. Surgeons identified a median of 2.54 parathyroid glands intraoperatively, with no significant association emerging between the number of glands identified and temporary hypocalcemia (p = 0.594). Histological evidence of inadvertent gland removal occurred in 18.6% of cases and correlated with a non-significantly higher rate of temporary hypocalcemia (47.3% vs. 40.5%, p = 0.402). Parathyroid autotransplantation had a significantly higher rate of postoperative hypocalcemia compared with those without autotransplantation (61.0% vs. 38.6%; OR 2.48, 95% CI 1.26-4.87; p = 0.007). CONCLUSION: Our findings suggest that intraoperative visual identification of parathyroid glands alone may not be sufficient to reliably predict postoperative hypocalcemia, highlighting the multifactorial nature of postoperative calcium disturbances. Accidental gland removal increases temporary hypocalcemia but lacks statistical significance. Autotransplantation, while useful for preserving long-term function, may initially exacerbate transient hypocalcemia. Meticulous surgical techniques and preservation of gland vascularity remain paramount to minimize hypocalcemia risk. Future prospective studies should evaluate the role of novel intraoperative identification technologies in reducing these complications.
Negative-pressure wound therapy versus conventional dressings following stoma reversal: a GRADE-based systematic review and meta-analysis of randomized controlled trials with predefined subgroup analyses by closure technique.
Mirza W, Khan ME, Iqbal H … +4 more , Khan A, Khan HM, Moeen-Ud-Din MB, Hadhoud AM
BMC Surg · 2026 Jun · PMID 42316134 · Full text
BACKGROUND: Surgical site infection (SSI) after stoma reversal remains common (15-40%), prolonging hospitalization and potentially delaying adjuvant therapy. Prophylactic negative-pressure wound therapy (NPWT) is increas...
BACKGROUND: Surgical site infection (SSI) after stoma reversal remains common (15-40%), prolonging hospitalization and potentially delaying adjuvant therapy. Prophylactic negative-pressure wound therapy (NPWT) is increasingly used for closed incisions; however, its efficacy with different skin-closure techniques remains unclear. We conducted a systematic review and meta-analysis of randomized controlled trials comparing NPWT with conventional non-pressure dressings after stoma reversal, with prespecified subgroup analyses by skin-closure technique and certainty of evidence appraised using GRADE. METHODS: The review protocol was registered in the PROSPERO International Prospective Register of Systematic Reviews (CRD420251182767). We searched MEDLINE, Embase, Scopus, Web of Science, CENTRAL, ClinicalTrials.gov, and WHO ICTRP without language restrictions. Eligible randomized controlled trials enrolled adults undergoing elective ileostomy or colostomy reversal and compared negative-pressure wound therapy (NPWT) with conventional (non-pressure) dressings with a specified skin-closure technique (purse-string or primary). The primary outcome was incisional surgical site infection within 30-42 days of surgery. Secondary outcomes included length of stay, time to complete wound healing, operative duration, and estimated blood loss. Two reviewers independently screened the studies, extracted data, and assessed the risk of bias using RoB 2. Random-effects meta-analyses were conducted with sensitivity analyses and pre-specified subgroup comparisons based on closure techniques. The certainty of evidence was appraised using GRADE. RESULTS: Seven randomized trials (n = 429) met the inclusion criteria (NPWT, n = 220; conventional dressings, n = 209). The primary pooled analysis showed no significant reduction in incisional SSI with NPWT versus conventional dressings (RR 0.42, 95% CI 0.14-1.30; I²=46%). By closure technique, the effects were larger with primary closure (RR 0.20, 95% CI 0.06-0.67; I²=0%) than with purse-string closure (RR 0.68, 95% CI 0.14-3.35; I²=48%), although the interaction was not statistically significant (P = 0.23). The risk of bias was generally rated as "some concerns," primarily due to open-label care, and heterogeneity was low after the sensitivity analysis. Prespecified leave-one-out analyses identified influential studies for SSI, length of stay, and wound healing; however, these findings were interpreted as exploratory influence diagnostics and did not replace the primary pooled analyses. CONCLUSIONS: In this primary pooled analysis, prophylactic NPWT did not significantly reduce incisional surgical site infection after stoma reversal, although the effect favored NPWT. Exploratory sensitivity and subgroup analyses suggested possible benefits in selected contexts, although these findings should not supersede the nonsignificant primary pooled analyses. Larger, standardized randomized trials are needed to clarify which closure techniques and patient groups derive the greatest benefit.
Prognostic value of hematological markers for anastomotic leakage diagnosed after postoperative day 5 following laparoscopic surgery for colorectal cancer.
Wen Z, Wen Z, Zhou R … +6 more , Liu X, Luo J, Fan S, Peng J, Zhang Y, Wang X
BMC Surg · 2026 Jun · PMID 42316131 · Full text
BACKGROUND: Anastomotic leakage (AL) is a common complication following colorectal cancer surgery, yet accurate and unified diagnostic criteria remain lacking. METHODS: This retrospective study included 360 patients who...
BACKGROUND: Anastomotic leakage (AL) is a common complication following colorectal cancer surgery, yet accurate and unified diagnostic criteria remain lacking. METHODS: This retrospective study included 360 patients who underwent laparoscopic colorectal resection with one-stage anastomosis at the First Affiliated Hospital of Kunming Medical University between October 2019 to December 2023. Hematocrit-to-albumin difference (HCT-ALB), neutrophil-to-albumin ratio (NAR), and neutrophil-to-lymphocyte ratio (NLR) on postoperative days (POD) 1, 3, and 5 were compared between patients with and without AL. This study specifically aimed to evaluate the predictive performance of these markers for AL occurring after POD 5. RESULTS: Compared to the non-AL group, the AL group exhibited significantly higher HCT-ALB, NAR, and NLR values on POD 3 and 5 (P < 0.05), except for NLR on POD 1. Multivariate analysis identified rectal tumor location, HCT-ALB and NLR on POD 3, and NAR and NLR on POD 5 as associated factors of AL, while preoperative ALB, HCT-ALB on POD1 and POD5, and NAR on POD1 and POD3 showed weaker associations (P > 0.05). The best predictors were NAR on POD 5 (AUC = 0.910, cut-off = 2.09) and NLR on POD 5 (AUC = 0.885, cut-off = 7.19). Due to the exploratory nature of this study and the potential for collinearity between these inflammatory markers, these results should be interpreted with caution. CONCLUSION: Tumor location (rectum), HCT-ALB and NLR on POD 3, and NAR and NLR on POD 5 may serve as reliable indicators for AL, thus enabling early identification and timely intervention to improve postoperative outcomes after colorectal surgery.
CTA-guided preoperative perforator selection for knee soft tissue reconstruction.
Yang X, Cai T, Dai X … +6 more , Zhou M, Tian X, Shi Y, Xu Y, Xia S, He X
BMC Surg · 2026 Jun · PMID 42316126 · Full text
BACKGROUND: Perforator flaps represent an effective and versatile option for the reconstruction of soft tissue defects around the knee. However, interindividual variability in perforator origin, course, and pedicle chara...
BACKGROUND: Perforator flaps represent an effective and versatile option for the reconstruction of soft tissue defects around the knee. However, interindividual variability in perforator origin, course, and pedicle characteristics often complicates flap selection and increases intraoperative uncertainty. This study aimed to evaluate the role of computed tomography angiography (CTA) in guiding perforator selection and supporting individualized preoperative planning for knee soft tissue reconstruction. METHODS: Between August 2014 and March 2024, we retrospectively evaluated 16 patients who underwent 17 flap procedures after preoperative CTA for reconstruction of soft tissue defects around the knee. The location, course, and length of candidate perforators were evaluated using the Picture Archiving and Communication System (PACS). Based on comparative preoperative assessment, the most suitable perforator was selected for flap design. RESULTS: Seventeen flaps were harvested in 16 patients, including 16 CTA-selected perforator-based flaps and one random-pattern local flap selected after CTA showed no suitable perforator. All 16 CTA-selected target perforators were identified intraoperatively as anticipated, yielding a target-perforator identification discrepancy rate of 0/16. Complete skin-paddle survival was achieved in 15 of 16 CTA-selected perforator-based flaps and in 16 of 17 flaps overall. One CTA-selected perforator flap developed partial distal necrosis and healed conservatively; no total flap loss occurred. The random-pattern local flap survived completely without complications. CONCLUSION: CTA provided a practical decision-support method for preoperative assessment of perforator anatomy around the knee. In this proof-of-concept retrospective Level IV case series, the structured CTA-guided workflow was feasible and showed qualitative concordance with intraoperative findings, supporting individualized flap planning according to defect characteristics and perforator anatomy. Because no Doppler-only, non-CTA, or historical control group was included, these findings demonstrate feasibility and anatomical concordance rather than measurable clinical superiority over other mapping modalities.
Surgical management and immunohistochemical diagnosis of giant retroperitoneal tumors with spindle cell histology: a five-case case series.
Azhary M, Ali MH, Elansary AO … +4 more , Abd Elmonim AM, Elkordy MA, Shafik A, Elshal M
BMC Surg · 2026 Jun · PMID 42316111 · Full text
BACKGROUND: Giant retroperitoneal tumors are rare and pose significant surgical challenges due to delayed presentation, massive size, and complex anatomical relationships. Although these tumors encompass biologically het...
BACKGROUND: Giant retroperitoneal tumors are rare and pose significant surgical challenges due to delayed presentation, massive size, and complex anatomical relationships. Although these tumors encompass biologically heterogeneous entities, many share common surgical features that complicate operative management, particularly in cases with predominant spindle cell histology. METHODS: We retrospectively reviewed five cases of giant retroperitoneal tumors with spindle cell histology managed surgically at our institution. Data collected included clinical presentation, preoperative imaging, operative strategy, extent of resection, histopathological and immunohistochemical findings, and short-term postoperative outcomes. RESULTS: The cohort included five patients with retroperitoneal tumors ranging from 10 to 40 cm in maximum dimension. Histopathological diagnoses comprised gastrointestinal stromal tumor, desmoid-type fibromatosis, and liposarcoma subtypes. All patients underwent open surgical resection, with multivisceral dissection performed when required to achieve complete macroscopic tumor removal. No major perioperative complications occurred. All patients experienced significant symptomatic improvement following surgery. During a median follow-up of six months, no early local recurrence was detected. CONCLUSION: Surgical resection of giant retroperitoneal tumors is feasible and can be performed safely with acceptable short-term outcomes when guided by careful preoperative planning and individualized operative strategy. Given the heterogeneity of tumor subtypes and limited follow-up, this case series should be interpreted as a demonstration of surgical feasibility and perioperative safety rather than oncologic efficacy. Tumor size and anatomical complexity remain the primary determinants of surgical approach in extreme retroperitoneal disease.
Comparative efficacy of total en-bloc spondylectomy and separation surgery followed by stereotactic body radiotherapy for isolated spinal metastases in lung cancer patients: a retrospective study.
Zhu Z, Yuan H, Shen Z … +3 more , Liu H, Li B, Xu W
BMC Surg · 2026 Jun · PMID 42316097 · Full text
OBJECTIVE: To compare the clinical efficacy between total en bloc spondylectomy (TES) and separation surgery combined with stereotactic body radiotherapy (SSRS) in patients with isolated spinal metastases secondary to NS...
OBJECTIVE: To compare the clinical efficacy between total en bloc spondylectomy (TES) and separation surgery combined with stereotactic body radiotherapy (SSRS) in patients with isolated spinal metastases secondary to NSCLC. METHODS: A total of 85 NSCLC patients diagnosed with isolated spinal metastases were enrolled in this retrospective analysis. All patients received treatment between June 2018 and April 2022, among whom 25 patients underwent TES and the remaining 60 patients were managed with SSRS. Evaluated endpoints included local tumor control, PFS, OS, postoperative complications, and quality of life assessed via the SOSGOQ scale. RESULTS: TES yielded superior local tumor control and significantly prolonged PFS relative to SSRS. Nevertheless, the TES group presented larger intraoperative blood loss and a higher postoperative complication incidence. Specifically, cerebrospinal fluid leakage occurred in 20% of TES patients and pleural rupture in 12%, whereas both complications only accounted for 3.3% in the SSRS cohort. No significant intergroup difference was observed in OS. CONCLUSION: TES provides superior local tumor control and extended PFS for NSCLC patients with isolated spinal metastases, accompanied by increased intraoperative blood loss and higher complication risks. OS remains comparable between the two therapeutic modalities. Both approaches effectively improve patients' postoperative quality of life. These outcomes highlight the necessity of multidisciplinary collaborative decision-making to individualize and optimize therapeutic strategies for this clinical population.
Correction: Analysis of preoperative nutrition, immunity and inflammation correlation index on the prognosis of upper tract urothelial carcinoma surgical patients: a retrospective single center study.
Ou Y, Zheng Y, Wang D … +2 more , Ren S, Liu Y
BMC Surg · 2026 Jun · PMID 42316095 · Full text
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Early risk stratification of acute postoperative deep vein thrombosis with inflammatory and hemostatic molecular markers in Chinese patients undergoing unicompartmental knee arthroplasty.
Li Z, Lu T, Deng Z … +5 more , Du M, Liu S, Yu B, Xu X, Cao G
BMC Surg · 2026 Jun · PMID 42310660 · Full text
BACKGROUND: Deep vein thrombosis (DVT) is a feared postoperative complication following knee arthroplasty. However, the incidence of acute DVT, associated early risk stratification models, and optimal thromboprophylaxis...
BACKGROUND: Deep vein thrombosis (DVT) is a feared postoperative complication following knee arthroplasty. However, the incidence of acute DVT, associated early risk stratification models, and optimal thromboprophylaxis after unicompartmental knee arthroplasty (UKA) remain unclear. This study aimed to comprehensively evaluate the perioperative dynamics of systemic-inflammatory and hemostatic molecular markers in patients with knee osteoarthritis undergoing UKA and to analyze their association with the occurrence of acute DVT. METHODS: The first multi-center prospective study enrolled consecutive patients undergoing unilateral UKA without routine postoperative pharmacological thromboprophylaxis from three institutions (two for derivation and one for external validation). Systemic-inflammatory and hemostatic molecular markers were measured at admission, 2-hour, 1-day, and 3-day post-UKA. Lower-extremity ultrasound was routinely conducted prior to and at 4-5 days following UKA to detect asymptomatic and symptomatic DVT. Temporal trends in these biomarkers and their relationship with acute DVT were analyzed. A nomogram was then developed to visualize individualized near-term risk stratification of acute postoperative DVT. Finally, a retrospective cohort of UKA-treated patients who received routine thromboprophylaxis was enrolled to evaluate the risk stratification performance of the identified indicators in an anticoagulated population. RESULTS: The derivation cohort included 87 patients (mean age 67.8 ± 6.5 years, 78.2% female), of whom 21 (24.1%) developed acute postoperative DVT (20 asymptomatic and 1 symptomatic). Multivariate Firth's penalized logistic regression identified that higher body mass index (BMI), and elevated postoperative day 3 levels of interleukin (IL)-6, thrombin-antithrombin complex (TAT), and plasmin-α2 plasmin inhibitor complex (PIC) independently associated with an increased risk of acute DVT detected at 4-5 days post-UKA. A nomogram incorporating these four indicators demonstrated good discriminative ability, calibration, and exploratory net benefit. These findings were further validated in an independent external cohort (n = 42; mean age 67.2 ± 7.7 years; 69% female; DVT incidence, 23.8%) and in a separate cohort of 135 patients (mean age 66.4 ± 6.8 years; 77% female; DVT incidence, 20.7%) who received routine thromboprophylaxis. CONCLUSION: A preliminary nomogram incorporating BMI and postoperative day 3 levels of IL-6, TAT, and PIC serves as a promising auxiliary tool for near-term risk stratification of acute DVT detected at 4-5 days following UKA.
Association between completion status and perioperative outcomes of laparoscopic cholecystectomy in elderly patients.
Zhang Y, Jiang X
BMC Surg · 2026 Jun · PMID 42310656 · Full text
OBJECTIVE: To investigate the perioperative outcomes and safety of different completion statuses of laparoscopic cholecystectomy (LC) in elderly patients, providing evidence for surgical risk assessment and perioperative...
OBJECTIVE: To investigate the perioperative outcomes and safety of different completion statuses of laparoscopic cholecystectomy (LC) in elderly patients, providing evidence for surgical risk assessment and perioperative management. METHODS: A single-center retrospective study was conducted. Clinical data of elderly patients undergoing LC from January 2023 to December 2024 were collected. Patients were categorized into a difficult laparoscopic cholecystectomy (DLC) group or a successfully completed laparoscopic cholecystectomy (SCLC) group based on intraoperative completion status and technical difficulty. Data on operative parameters, postoperative recovery, postoperative complications, and inflammatory markers [tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), C-reactive protein (CRP)] were analyzed. Independent risk factors for complications were identified via multivariate logistic regression. RESULTS: The SCLC group had significantly shorter operative time, less intraoperative blood loss, and attenuated postoperative rises in TNF-α, IL-6, and CRP compared to the DLC group (all P < 0.05). Recovery was faster in the SCLC group, evidenced by earlier time to first flatus and oral intake, shorter length of hospital stay, and lower Visual Analog Scale (VAS) pain scores (all P < 0.05). The overall complication rate was lower in the LC group (7.50% vs. 30.00%, P < 0.05). American Society of Anesthesiologists (ASA) class III and ≥ 2 comorbidities were independent risk factors for complications (P < 0.05). CONCLUSION: LC is generally safe and feasible for elderly patients. However, completion status and intraoperative difficulty are closely associated with perioperative outcomes. Patients with lower surgical difficulty and successful completion experience faster recovery and lower complication rates.
Small-bore vs. large-bore chest tubes for pneumothorax: a retrospective study.
Li Y, Wen T, Liu Y … +4 more , Tan M, Cao X, Song X, Long X
BMC Surg · 2026 Jun · PMID 42310640 · Full text
OBJECTIVE: To compare the clinical efficacy and safety of small-bore (≤ 14 Fr) versus large-bore (> 14 Fr) chest tubes in the treatment of pneumothorax. METHODS: A retrospective analysis was conducted. Patients were cate...
OBJECTIVE: To compare the clinical efficacy and safety of small-bore (≤ 14 Fr) versus large-bore (> 14 Fr) chest tubes in the treatment of pneumothorax. METHODS: A retrospective analysis was conducted. Patients were categorized into small-bore and large-bore groups based on the initial drainage tube size. Outcomes, including treatment efficacy, drainage duration, lung re-expansion time, hospital stay, complication rates, and analgesic use, were compared between groups. Subgroup analyses were performed based on pneumothorax type as primary and secondary spontaneous pneumothorax. RESULTS: In the overall population of 95 patients (55 large-bore, 40 small-bore), no statistically significant differences were found between the two groups regarding treatment efficacy (90.9% vs. 80.0%, P = 0.063), drainage time, lung re-expansion time, or hospital stay. The large-bore group required a significantly higher equivalent dose of analgesics (P = 0.049). Complication rates were similar between groups. In patients with secondary spontaneous pneumothorax (SSP), the small-bore tube group demonstrated significantly shorter drainage duration and lung re-expansion time compared to the large-bore group (both P = 0.007). CONCLUSION: In this retrospective analysis, small-bore and large-bore chest tubes demonstrated comparable treatment efficacy for pneumothorax management, with no statistically significant difference observed between groups. The large-bore group required a higher equivalent analgesic dosage, although this finding is exploratory given the borderline statistical significance and absence of validated pain assessment instruments. In the SSP subgroup, small-bore tubes were associated with significantly shorter drainage duration and lung re-expansion time, though these findings warrant further prospective validation.
An improved surgical technique for penoscrotal transposition: the penile upward migration method.
Chen H, Li W, Wu Z … +5 more , Yang Q, Wang S, Hu Y, Xu B, Wu Y
BMC Surg · 2026 Jun · PMID 42310633 · Full text
INTRODUCTION: Penoscrotal transposition(PST) is a congenital malformation often associated with hypospadias. Conventional techniques, such as the scrotal M-shaped flap method and buttonhole technique, are limited by sign...
INTRODUCTION: Penoscrotal transposition(PST) is a congenital malformation often associated with hypospadias. Conventional techniques, such as the scrotal M-shaped flap method and buttonhole technique, are limited by significant trauma, compromised blood supply, or unsatisfactory cosmetic outcomes. The "penile upward migration method", derived from the buttonhole technique, has been used clinically since February 2018 in our center to correct PST. It is based on the therapeutic principle of the buttonhole technique. This study aims to evaluate the clinical efficacy and safety of a novel "penile upward migration method" for correcting PST. METHODS: A retrospective case series study was conducted on patients who underwent surgery using the penile upward migration method between January 2018 and June 2023. During the operation, a larger circle is marked around the penile base, while a smaller concentric circle is marked and excised to allow upward penile migration. This technique can be used for isolated PST, residual PST after hypospadias repair, or simultaneous correction of PST and hypospadias. Data on demographics, operative details, complications, and postoperative cosmetic outcomes were collected and analyzed. RESULTS: A total of 35 patients (29 with partial and 6 with complete PST) were included in the study. The mean age was 51.6 months. Thirty-two patients underwent PST correction alone (average operative time: 70.36 ± 9.76 min), while 3 patients underwent simultaneous correction with hypospadias repair (average operative time: 156.67 ± 21.86 min). Postoperative follow-up averaged 13.6 months. Complete correction was achieved in 33 cases. Complications included one case of partial skin necrosis at the penile root and two cases of hypertrophic scarring, all of which resolved with subsequent treatment. Caregivers reported high satisfaction with the postoperative penile and scrotal appearance based on the modified Pediatric Penile Perception Score (PPPS). CONCLUSION: The penile upward migration method is a safe and effective way of correcting PST. This surgical procedure is also simpler than the buttonhole method. It offers advantages of shorter operative time, minimal impact on penile blood supply, and aesthetically pleasing results with hidden scars. However, further comparative studies are warranted.
Can the efficacy of bone wax sealing method in dealing with cerebrospinal fluid leakage during ACDF be alternative to that of dural patch repair method?
Deng XG, Cui W, Sun YL … +3 more , Gu T, Hou W, Shi HG
BMC Surg · 2026 Jun · PMID 42310624 · Full text
OBJECTIVE: Anterior cervical discectomy and fusion (ACDF) is an important treatment for cervical degenerative diseases and trauma. Cerebrospinal fluid (CSF) leakage caused by intraoperative dural injury is a rare but cli...
OBJECTIVE: Anterior cervical discectomy and fusion (ACDF) is an important treatment for cervical degenerative diseases and trauma. Cerebrospinal fluid (CSF) leakage caused by intraoperative dural injury is a rare but clinically significant complication. The current mainstay approach involves dural repair using patches and fibrin glue. The bone wax sealing method is a novel technique for managing intraoperative CSF leakage during ACDF. This study aims to analyse the effectiveness of bone wax sealing in treating intraoperative CSF leakage. METHODS: A retrospective analysis was conducted on consecutive patients who underwent ACDF and were identified as having intraoperative CSF leakage between January 2020 and October 2025. Patients were divided into two groups according to the primary method used to manage the leak: the patch repair group and the bone wax sealing group. In the patch repair group, a dural patch was applied over the dural tear and secured with fibrin glue. In the bone wax sealing group, bone wax was used to completely occlude the anterior interbody space around the interbody cage, thereby physically isolating the prevertebral space from the intervertebral space. Clinical outcomes were assess between the two groups. RESULTS: Among 1,311 ACDF patients, 23 cases (1.75%) experienced intraoperative cerebrospinal fluid (CSF) leakage resulting from iatrogenic dural tear. The maximum diameter of all tears was ≤ 5 mm. Twelve cases were managed with dural patch repair (using dural substitute and fibrin glue), and 11 with bone wax sealing. In the dural patch group, 10 cases achieved successful repair, while 2 required additional lumbar drainage due to persistent leakage. No failures were observed in the bone wax group, and no case developed other postoperative complications. In two groups, no safety-related comorbidities were identified. The cost of the patch and adhesive was ¥3,953, whereas the bone wax costed only ¥18, indicating a significant difference. CONCLUSION: The bone wax sealing method is easy to operate, simple, and highly cost-effective. In appropriately selected cases (small dural tears and complete hemostasis), it may be considered a viable alternative to dural patch repair.
Evaluation of inflammation indices according to the Parkland grading scale in laparoscopic cholecystectomy: can inflammation indices predict operative difficulty? A retrospective cross-sectional study.
Kahraman YS, Soylu VG, Taşkın Ö … +1 more , Demir U
BMC Surg · 2026 Jun · PMID 42310602 · Full text
BACKGROUND: The Parkland Grading Scale (PGS) is a practical intraoperative grading system used to assess operative difficulty during laparoscopic cholecystectomy. This study aimed to investigate the relationship between...
BACKGROUND: The Parkland Grading Scale (PGS) is a practical intraoperative grading system used to assess operative difficulty during laparoscopic cholecystectomy. This study aimed to investigate the relationship between PGS scores and preoperative inflammatory indices and to evaluate whether these indices were associated with operative severity and intraoperative complexity. METHODS: This retrospective cross-sectional study included 1054 patients who underwent elective laparoscopic cholecystectomy for gallstone disease between January 2018 and January 2025. Demographic characteristics, laboratory parameters, inflammatory indices, operative duration, conversion rates, and PGS scores were analyzed. Univariate and multivariate logistic regression analyses were performed to identify variables independently associated with higher PGS severity. Receiver operating characteristic (ROC) curve analysis was used to determine diagnostic performance. RESULTS: According to the PGS classification, 451 patients were classified as PGS 1, 146 as PGS 2, 213 as PGS 3, 164 as PGS 4, and 80 as PGS 5. Operative duration and conversion from laparoscopic to open cholecystectomy increased significantly with increasing PGS scores (p < 0.001). In multivariate logistic regression analysis, type 2 diabetes mellitus (T2DM), CRP/albumin ratio (CAR), neutrophil/lymphocyte ratio (NLR), and inflammatory burden index (IBI) were identified as independent predictors of higher PGS scores (all p < 0.001). ROC analysis demonstrated that IBI had the highest discriminatory performance (AUC: 0.792), followed by NLR (AUC: 0.766) and CAR (AUC: 0.764). CONCLUSIONS: Preoperative inflammatory indices, particularly IBI, NLR, and CAR, were significantly associated with higher PGS scores and increased operative difficulty in laparoscopic cholecystectomy. These markers may help identify patients with increased operative complexity and improve preoperative surgical planning.
Effects of discharge education program on recovery and quality of life after cardiac surgery: a 12 week follow-up single-blind randomized controlled trial.
Kajti E, Selçuk İ, Selçuk ÜN … +2 more , Toköz H, Özbaş A
BMC Surg · 2026 Jun · PMID 42304390 · Full text
AIMS: In the contemporary era of rapid societal and technological advancement, factors such as sedentary lifestyles, environmental pollution, unhealthy dietary habits, consumption of sugar-sweetened beverages, tobacco an...
AIMS: In the contemporary era of rapid societal and technological advancement, factors such as sedentary lifestyles, environmental pollution, unhealthy dietary habits, consumption of sugar-sweetened beverages, tobacco and alcohol use, and the growing prevalence of comorbid conditions associated with these risk factors have contributed to cardiovascular diseases becoming one of the leading causes of mortality worldwide. Among the therapeutic interventions for cardiovascular diseases, open-heart surgery remains one of the principal treatment modalities, as it is associated with superior symptom control, enhanced quality of life, and improved long-term survival outcomes compared with medical management alone. Beside the surgical intervention one of the main components determining the outcomes of the surgery is the patient education therefore this study was conducted to determine the effect of discharge education provided after cardiac surgery on recovery and quality of life. METHODS AND RESULTS: This research was conducted as a randomized pretest-posttest controlled study to determine the effects of discharge education after cardiac surgery on recovery and quality of life. The study was conducted between March 2022 and July 2023, in two Training and Research Hospitals with 70 inpatients. The data of the study were collected face to face and via telephone calls using the 'Patient's Personal Information Form', 'Multidimensional Index of Life Quality-MILQ-TR', 'Quality of Recovery - 40 Questionnaire-QOR-40' and 'Telephone Follow-Up Form'. According to this study's results, the recovery quality level and the quality of life of the patients in the intervention group was significantly higher than the patients in the control group. CONCLUSION: According to the results of the study, which was evaluated at a 95% confidence interval and a significance level below p < 0.05; the quality of recovery and quality of life of the intervention group patients were statistically higher, the complications were fewer, and the level of knowledge was higher. TRIAL REGISTRATION: Trial Registry The Effects of Discharge Education Program on Recovery and Quality of Life After Cardiac Surgery. Unique Identifying Number NCT05631340. Date of Registration 21/11/2022. ( https://clinicaltrials.gov/study/NCT05631340 ).
Catastrophic pelvic-perineal injuries with traumatic hemipelvectomy following a motorcycle collision: a multidisciplinary reconstruction case report.
Hiep ND, Van Nut L, Vy TTT … +1 more , Tin LD
BMC Surg · 2026 Jun · PMID 42304372 · Full text
BACKGROUND: Catastrophic pelvic and perineal trauma with associated traumatic hemipelvectomy is extremely rare and carries a high mortality risk. These injuries often involve multisystem destruction, including genitourin...
BACKGROUND: Catastrophic pelvic and perineal trauma with associated traumatic hemipelvectomy is extremely rare and carries a high mortality risk. These injuries often involve multisystem destruction, including genitourinary, anorectal, musculoskeletal, and vascular structures, presenting extraordinary challenges for surgical management and reconstruction. Reports of survivors, particularly from resource-limited settings, remain limited. CASE PRESENTATION: A 52-year-old man presented in 2022 with devastating pelvic-perineal trauma following a high-energy motorcycle crash. He received initial first aid at a district hospital before being urgently transferred to our tertiary care center in Vietnam. Upon arrival, he was in profound hemorrhagic shock, with non-palpable pulses and unrecordable blood pressure. Operative findings revealed complete avulsion of the left hemipelvis, severe crush injury of the left lower limb, full-thickness rectal transection, bladder rupture, and complete loss of the external genitalia. He underwent prompt resuscitation, left hemipelvectomy, and fecal and urinary diversion, followed by staged reconstruction. Definitive wound coverage was achieved using a combination of local rotational flap, right profunda artery perforator (PAP) flap, and autologous skin grafting. The patient recovered well and was discharged after 112 days with stable vital signs and functioning urinary and fecal diversion. CONCLUSIONS: This case demonstrates the survivability of catastrophic pelvic-perineal trauma with traumatic hemipelvectomy. It emphasizes the importance of multidisciplinary care, early hemorrhage control and surgical intervention, as well as adaptable reconstruction strategies in low-resource settings. CLINICAL TRIAL NUMBER: Not applicable.
Post-operative pain, nausea, vomiting and optic nerve sheath diameter following total intravenous versus inhalational anesthesia for adults undergoing robotic transabdominal surgery - a systematic review and meta- analysis.
Tahir HN, Butt AI, Rehman M … +6 more , AbdElneam AI, Al-Dhubaibi AM, Rizvi SB, Khan MK, Alotaibi SK, Hakim AHA
BMC Surg · 2026 Jun · PMID 42304358 · Full text
BACKGROUND: The introduction of robotic-assisted abdominal surgery is aimed at reducing the primary and secondary adverse outcomes. Anesthesia in robotic surgery varies from anesthesia for open or laparoscopic surgical p...
BACKGROUND: The introduction of robotic-assisted abdominal surgery is aimed at reducing the primary and secondary adverse outcomes. Anesthesia in robotic surgery varies from anesthesia for open or laparoscopic surgical procedures. The choice of anesthesia influences the perioperative control of pain, nausea, vomiting, and Optic nerve sheath diameter (ONSD). The purpose of this systematic review was to assess outcome variation in patients undergoing transabdominal robot-assisted surgery done under total intravenous anesthesia or inhalational anesthesia. METHODOLOGY: We searched the Cochrane Central Register of Controlled Trials, PubMed, and Google Scholar (January, 2017 to June, 2024). Search terms included "Anesthesia", "Robotics", "prostatectomy", hysterectomy", "nephrectomy", "cholecystectomy" and "cystectomy" with the Boolean operators "AND" and "OR". We searched for randomized controlled trials (RCTs) including adults of both genders aged 18 years and above, who underwent transabdominal robotic-assisted laparoscopic surgery and targeting the consequences related to TIVA or inhalational anesthesia. We reviewed titles and abstracts and proceeded to full-text articles of the eligible studies relevant to inclusion criteria. Mean and standard deviations with 95% CI were calculated. Forest plots were used to present data visually. RESULTS: Six studies (340 patients) were included. We found only one study in which post-operative pain was assessed and results favored intravenous anesthesia in robotic transabdominal surgery. Only two studies reported post-operative nausea and vomiting (PONV). Both studies stated that PONV is reported in few patients in the inhalation anesthesia group. We found evidence suggesting that change in ONSD measurements at 10 min after induction (MD 0.04,95% CI -0.02 to 0.11 p = 0.19) and 40-60 min after Trendelenburg position (MD -0.26, 95% CI -0.34 to 0.17, p = 0.16) are much less in intravenous anesthesia group than in inhalation anesthesia group. Total intravenous anesthesia maintains the ONSD and hence the ICP better than inhalational anesthesia in robotic transabdominal surgery with CO pneumoperitoneum in Trendelenburg positioning requirements. It would be a safer choice than inhalational anesthesia due to fewer adverse events. CONCLUSION: This review concludes that TIVA is a better choice than inhalational anesthesia for transabdominal robotic-assisted surgery in urology, gynecology, and gastroenterology in both male and female patients.
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