BMC Surgery[JOURNAL]
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200 papers
Long-term survival in generalized peritonitis: the impact of early critical periods in major emergency abdominal surgery.
Olausson M, Tolver MA, Gögenur I
BMC Surg · 2026 Jun · PMID 42277763 · Full text
BACKGROUND: Generalized peritonitis is a severe intra-abdominal infection associated with high morbidity and mortality in patients undergoing major emergency abdominal surgery. While short-term outcomes are well document...
BACKGROUND: Generalized peritonitis is a severe intra-abdominal infection associated with high morbidity and mortality in patients undergoing major emergency abdominal surgery. While short-term outcomes are well documented, long-term survival and prognostic factors remain less explored. This study investigated four-year survival and conditional survival to assess the impact of generalized peritonitis on long-term outcomes. METHODS: This was a retrospective study based on prospectively collected data from 2017 to 2020, including patients aged ≥ 18 years who underwent major emergency abdominal surgery. All patients were treated within a high-quality, multidisciplinary standardized protocol. The primary outcome was four-year overall survival stratified according to the degree of peritonitis. Secondary outcomes were conditional survival, in which time at risk began on postoperative days 30 and 90 and included only patients alive beyond these time points. Associations between survival and risk factors were assessed using Cox regression analyses. RESULTS: A total of 966 patients were included, of whom 21% (203/966) were found perioperatively to have generalized peritonitis. The four-year overall survival rate was 66% (95% CI: 62.38-69.12%) in patients without generalized peritonitis and 53% (95% CI: 46.52-60.39%) in patients with generalized peritonitis, with the log-rank test showing a significant difference in survival (P = 0.00014). Among patients alive 30 days after surgery, generalized peritonitis was still associated with significantly lower survival (log-rank test, P = 0.028). However, this association was no longer observed among patients surviving beyond 90 days after surgery (log-rank test, P = 0.51). Furthermore, age > 70 years, ASA ≥ 3, intra-abdominal malignancy, and generalized peritonitis were significantly associated with poor survival, whereas among patients surviving beyond 90 days, generalized peritonitis was no longer associated with four-year survival. CONCLUSION: Generalized peritonitis was independently associated with significantly worse four-year overall survival. Although this survival disadvantage remained significant among 30-day survivors, it was no longer observed beyond 90 days postoperatively, suggesting that the prognostic impact of generalized peritonitis is primarily confined to the early postoperative period.
Association between early postoperative posterior displacement of the spinal cord and postoperative C5 nerve root dysfunction after anterior cervical decompression and fusion: a retrospective imaging cohort study using standardized measurements.
Chen H, Liu F, Zhuo S … +3 more , Lin Y, Jiang C, Zhao T
BMC Surg · 2026 Jun · PMID 42277730 · Full text
BACKGROUND: C5 nerve root palsy is a challenging complication following anterior cervical decompression and fusion (ACDF) or anterior cervical corpectomy and fusion (ACCF) with a reported incidence of 1-5% (1). While pos...
BACKGROUND: C5 nerve root palsy is a challenging complication following anterior cervical decompression and fusion (ACDF) or anterior cervical corpectomy and fusion (ACCF) with a reported incidence of 1-5% (1). While posterior displacement of the spinal cord with resultant nerve root tethering is a leading hypothesis, high-quality evidence quantifying early postoperative cord migration and its association with C5 palsy risk, based on standardized imaging, remains scarce. OBJECTIVE: To investigate the association between early postoperative posterior displacement of the spinal cord, measured using a standardized magnetic resonance imaging (MRI) protocol, and the occurrence of symptomatic C5 palsy, and to explore its potential discriminative value with postoperative C5 palsy. METHODS: A retrospective cohort study was conducted. Patients who underwent single- or double-level ACDF/ACCF for cervical spondylotic myelopathy between January 2019 and December 2023 were included. An initial cohort was identified via surgical log review. Patients with eligible pre- and early postoperative (3 days to 6 weeks) MRI were enrolled. The distance from the anterior surface of the spinal cord to the posterior vertebral body line at the C4/5 and C5/6 levels was measured independently and in a blinded manner by two radiologists. The primary outcome was postoperative symptomatic C5 palsy. Multivariable logistic regression was used to identify independent risk factors, and receiver operating characteristic (ROC) curve analysis was performed to explore the discriminative ability. RESULTS: One hundred patients were ultimately included, with a C5 palsy incidence of 10.0% (10/100). The C4/5 posterior migration distance was significantly greater in the C5 palsy group than in the non-palsy group (3.42 ± 0.47 mm vs. 2.04 ± 0.76 mm, P < 0.001). Multivariable analysis showed that, after adjusting for age and preoperative intramedullary high signal, C4/5 posterior migration was an independent risk factor for C5 palsy (adjusted odds ratio [aOR] = 2.89, 95% confidence interval [CI]: 1.35-6.20, P = 0.006). ROC analysis revealed that the C4/5 posterior migration distance predicted C5 palsy with an area under the curve (AUC) of 0.86. The optimal cut-off value was 2.85 mm (sensitivity 80.0%, specificity 84.4%). CONCLUSION: This retrospective exploratory study suggests that greater early postoperative posterior displacement of the spinal cord at the C4/5 level may be associated with an increased risk of symptomatic C5 nerve root palsy following anterior cervical decompression and fusion. Although a migration distance of 2.85 mm demonstrated preliminary discriminative ability in this cohort, the small number of C5 palsy events and the retrospective single-center design substantially limit the robustness and external applicability of the findings. Therefore, the identified threshold should be considered hypothesis-generating and requires validation in larger prospective multicenter studies before clinical application.
Clinical characteristics and prognostic factors of severe intra-abdominal infection due to gastrointestinal perforation: a retrospective cohort study.
Ye Z, Jin-Hua J, Yu-Ting C
BMC Surg · 2026 Jun · PMID 42271371 · Full text
OBJECTIVE: Gastrointestinal perforation is a medical emergency. We aimed to explore clinical characteristics and prognostic factors in patients with severe intra-abdominal infection due to gastrointestinal perforation. M...
OBJECTIVE: Gastrointestinal perforation is a medical emergency. We aimed to explore clinical characteristics and prognostic factors in patients with severe intra-abdominal infection due to gastrointestinal perforation. METHODS: In this retrospective cohort study, we reviewed patients diagnosed with severe intra-abdominal infection due to gastrointestinal perforation between January 2020 and January 2025. Demographics, clinical information, laboratory test results, management approach, 28-day mortality, and 180-day survival rate were recorded. Through regression probability analysis, multivariate logistic regression, Kaplan-Meier survival analysis, and Cox regression, we systematically analyzed patient clinical characteristics and determined the variables impacting their prognosis. RESULTS: A total of 108 eligible patients were included, with a 28-day mortality rate of 24.1% and a 180-day survival rate of 59.3%. Smoking history, diabetes, cardiovascular disease, rheumatic immune disease, malignant tumors, presence of elevated procalcitonin, the Acute Physiology and Chronic Health Evaluation II score, Mannheim Peritonitis Index score, low serum albumin and low prealbumin, infection from the stomach and duodenum, and fungal infection were independent risk factors while empirical use of antifungal drugs was associated with reduced 28-day mortality (all p < 0.05). Diabetes (p = 0.047), malignant tumors (p = 0.016), initial serum albumin level below 30 g/L, prealbumin level below 300 mg/L, infection source control time exceeding 12 h (p < 0.001), and enteral nutrition initiation time exceeding 6 days (p = 0.001) were independent risk factors for 180-day survival status. Compared with patients whose infection originated from the jejunum, ileum, cecum, or colon, infection from the stomach and duodenum was an independent risk factor for 180-day survival status. CONCLUSION: Patients with severe intra-abdominal infection due to gastrointestinal perforation had poor prognosis. Multiple variables were identified to be associated with 28-day mortality and 180-day survival. Early infection source control, appropriate enteral nutrition initiation could improve prognosis.Early and timely empirical antifungal treatment in addition to other necessary interventions might be considered in these patients.
Peritoneal drainage versus primary laparotomy in premature newborns with intestinal perforation: a retrospective cohort study evaluating an etiology-driven surgical approach.
Shalaby MM, Negm AR, Mahran IA … +2 more , Shehata M, Awad M
BMC Surg · 2026 Jun · PMID 42271313 · Full text
BACKGROUND: The surgical management of intestinal perforation in extremely low birth weight (ELBW) infants, stemming from necrotizing enterocolitis (NEC) or spontaneous intestinal perforation (SIP), is a subject of endur...
BACKGROUND: The surgical management of intestinal perforation in extremely low birth weight (ELBW) infants, stemming from necrotizing enterocolitis (NEC) or spontaneous intestinal perforation (SIP), is a subject of enduring debate. The comparative effectiveness of initial bedside peritoneal drainage (PD) versus formal primary laparotomy (PL) on mortality and major morbidity is not fully resolved. OBJECTIVE: To compare 90-day mortality and comprehensive morbidity outcomes between PD-first and PL-first strategies in a homogeneous cohort of preterm infants with intestinal perforation, with rigorous subgroup analysis based on disease etiology (NEC vs. SIP). METHODS: A single-center retrospective cohort study (2010-2023) included infants with gestational age < 32 weeks and/or birth weight < 1500 g undergoing surgery for pneumoperitoneum. Propensity score matching (PSM) with comprehensive illness severity covariates was used to balance baseline characteristics. Primary outcome was 90-day all-cause mortality, with secondary analysis of attributable versus non-attributable deaths. Secondary outcomes included short-term surgical morbidity, nutritional independence, long-term gastrointestinal outcomes, and incidence of short-bowel syndrome (SBS). Sensitivity analyses addressed temporal bias and confounding by non-GI comorbidities. RESULTS: Of 126 eligible infants, 66 underwent PD-first and 60 PL-first. After PSM with 15 covariates (n = 94), overall mortality was comparable (PD: 34.0% vs. PL: 36.2%, p = 0.81; p-for-interaction between treatment and etiology = 0.02). In the SIP cohort (n = 41), PD was associated with significantly lower mortality (15.8% vs. 45.5%, p = 0.03; adjusted HR 0.32, 95% CI 0.11-0.91) and fewer major surgical complications (21.1% vs. 54.5%, p = 0.03). Among 14 SIP patients managed definitively with PD alone, median 24-month follow-up revealed no cases of intestinal obstruction or stricture. In the NEC cohort (n = 53), PL was associated with a non-significant trend towards lower mortality (38.5% vs. 55.6%, p = 0.24) but a significantly higher rate of surgical complications (57.7% vs. 29.6%, p = 0.04). Time to full enteral feeds was shorter in the PD group overall (median 42 vs. 55 days, p = 0.02), a finding that persisted after excluding patients with non-GI comorbidities. Sensitivity analyses restricted to 2015-2023 confirmed main findings. CONCLUSION: The observed association between initial surgical strategy and survival is contingent upon underlying etiology. PD appears advantageous for SIP, was associated with lower mortality and morbidity with acceptable long-term outcomes. For NEC, PL may offer a survival trend advantage despite higher immediate surgical morbidity, likely due to definitive source control. These findings strongly advocate for an etiology-driven surgical decision-making paradigm.
The rebirth of pancreas transplantation: an innovative, fully robotic, reproducible surgical technique.
Abreu P, Kadri H, Zaragoza S … +11 more , Guerra G, Ortigosa-Goggins M, Nguyen MC, Khan AS, Eltemamy M, Riella J, Figueiro J, Vianna R, Broering D, Boggi U, Spaggiari M
BMC Surg · 2026 Jun · PMID 42271309 · Full text
BACKGROUND: Pancreas transplantation remains the only definitive therapy for restoring endogenous insulin secretion and physiologic glycemic control in patients with insulin-dependent diabetes mellitus. Utilization in th...
BACKGROUND: Pancreas transplantation remains the only definitive therapy for restoring endogenous insulin secretion and physiologic glycemic control in patients with insulin-dependent diabetes mellitus. Utilization in the United States has declined, however, in part due to morbidity associated with open simultaneous pancreas-kidney transplantation (SPKT), secondary to the incision or bowel manipulation, and procedural concentration within high-volume centers. The dissemination of robotic kidney transplantation has demonstrated the feasibility of minimally invasive transplant surgery and provides a platform to reconsider pancreas transplantation using standardized robotic principles. METHODS: We describe a reproducible technique for robotic pancreas transplantation (RPT), applicable to SPKT, pancreas-after-kidney transplantation, and pancreas-transplant-alone. Patient selection follows established criteria with multidisciplinary evaluation and preoperative vascular imaging. The operative workflow includes back-table vascular construction, limited iliac vessel dissection, extraperitoneal graft placement in a head-down orientation on the left iliac fossa, tension-free portal vein anastomosis to the external iliac vein, arterial anastomosis to the external iliac artery, controlled reperfusion, and side-to-side duodeno-ileostomy. Port placement mirrors robotic kidney transplantation to promote procedural standardization. RESULTS: Early experiences from high-volume centers demonstrate technical feasibility of RPT. Published series report successful implementation without routine need for hand assistance, and institutional experience supports reproducibility. Data remain limited, however, and are not powered to assess comparative outcomes or cost-effectiveness. CONCLUSIONS: A standardized approach to RPT is technically feasible and may reduce the surgical burden associated with open SPKT. While larger multicenter studies are required to define safety, graft outcomes, and economic impact, dissemination of a reproducible operative framework represents an essential first step toward broader adoption.
Development and validation of a preoperative nomogram for predicting postoperative high drainage output after robot-assisted Roux-en-Y hepaticojejunostomy for children with choledochal cysts: based on cyst diameter, age, and other indicators.
Zhang J, You T, Qin X … +7 more , Liang C, Zhu Z, Liu X, Ji S, He X, Duan X, Yan X
BMC Surg · 2026 Jun · PMID 42265711 · Full text
BACKGROUND: Robot-assisted Roux-en-Y hepaticojejunostomy (RYHJ) is the standard treatment for choledochal cysts (CDC). Routine abdominal drainage is typically placed, but no reliable preoperative tool exists to identify...
BACKGROUND: Robot-assisted Roux-en-Y hepaticojejunostomy (RYHJ) is the standard treatment for choledochal cysts (CDC). Routine abdominal drainage is typically placed, but no reliable preoperative tool exists to identify patients at risk of high drainage output (≥ 2 mL·kg⁻·d⁻), limiting early drain removal or selective omission under close monitoring. This study aimed to develop and validate an intuitive preoperative nomogram using readily available clinical indicators (e.g., cyst diameter, age) to predict high-drainage risk after robot-assisted RYHJ and support individualized drainage management. METHODS: This single-center retrospective cohort study enrolled 129 children with CDC who underwent da Vinci robot-assisted RYHJ. Based on weight-adjusted daily drain output, patients were divided into low-drainage (< 2 mL·kg⁻·d⁻, n = 30) and high-drainage (≥ 2 mL·kg⁻·d⁻, n = 99) groups. Potential predictors were identified via univariate and multivariate logistic regression and incorporated into a nomogram. Model performance was assessed using the area under the receiver operating characteristic curve (AUC) and calibration plots. RESULTS: Multivariate analysis identified younger age as an independent predictor of high drainage output (OR = 0.983, 95% CI: 0.972-0.994), and larger cyst diameter as a potential predictor showing a trend toward association (OR = 1.321, 95% CI: 0.979-1.783). The final nomogram, incorporating cyst diameter, age, body mass index (BMI), hemoglobin (HGB), and globulin (GLB), showed good discrimination (AUC = 0.753) and calibration. The optimal risk threshold was 79.88%, yielding a specificity of 75.9%, and, using an optimal threshold, identifies low-risk patients suitable for early drain removal protocols to guide individualized drainage management. CONCLUSION: We have developed and validated a nomogram model based on "cyst diameter + age" (supplemented by BMI, HGB, and GLB) that enables noninvasive, precise assessment of high-drainage risk following robot-assisted RYHJ. Notably, the model identifies a low-risk subset-older children with smaller cysts-for whom early drain removal (e.g., within 24-48 h) is safe, and in whom selective drain omission could be prospectively evaluated under rigorous monitoring. This risk-stratified approach has the potential to reduce drain-related complications and optimize ERAS pathways following robot-assisted RYHJ. As this is an internal validation only, external validation in independent cohorts is warranted before clinical implementation.
Cholecystectomy versus conservative management for patients with uncomplicated symptomatic gallstones and cholecystitis: an updated systematic review and meta-analysis.
Gad MM, Ayad Q, Elgamal MM … +4 more , Moubarak ES, Ziada AF, Beddor A, Abusalah MA
BMC Surg · 2026 Jun · PMID 42265664 · Full text
BACKGROUND: Gallstone disease affects 10-25% of the population, with higher prevalence in women over 40 years of age. Laparoscopic cholecystectomy is the standard treatment for symptomatic or complicated cases. However,...
BACKGROUND: Gallstone disease affects 10-25% of the population, with higher prevalence in women over 40 years of age. Laparoscopic cholecystectomy is the standard treatment for symptomatic or complicated cases. However, it is costly, can cause adverse effects, and can result in post-cholecystectomy syndrome. Conservative management remains an option, especially for high surgical risk patients. The optimal management of uncomplicated gallstones remains controversial. This updated systematic review and meta-analysis incorporates recently published randomized controlled trials (RCTs) comparing the safety and efficacy of cholecystectomy with conservative treatment in symptomatic uncomplicated gallstones and mild acute cholecystitis. METHODS: This systematic review and meta-analysis followed PRISMA guidelines. We searched PubMed, Scopus, Web of Science, and Cochrane Central for RCTs comparing cholecystectomy versus conservative management in adults with uncomplicated gallstones or mild acute cholecystitis. Primary outcomes were biliary colic and overall gallstone-related complications, while secondary outcomes included mortality and surgery-related complications. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using fixed or random effect models based on heterogeneity. Risk of bias was assessed using the Cochrane risk of bias 2.0 (RoB-2) tool, and the certainty of evidence was evaluated using the GRADE approach. RESULTS: Four RCTs, involving a total of 677 patients, were included. Their quality ranged from moderate to high when assessed by the ROB-2 tool. Cholecystectomy was found to decrease both biliary colic (RR = 0.43, 95% CI [0.24 to 0.78], P = 0.006) and overall gallstone complications (RR = 0.40, 95% CI [0.23 to 0.69], P = 0.0009). However, conservative management was associated with fewer overall surgical complications (RR = 0.40, 95% CI [0.23 to 0.69], P = 0.0009) and the proportion of patients who underwent surgery. Largely because many patients avoided or deferred operative intervention during follow-up. There was no significant difference in mortality, acute cholecystitis, acute pancreatitis, or common bile duct stones between the two groups. CONCLUSION: Our findings suggest that cholecystectomy provides better biliary pain control. However, conservative management may be considered in selected patients due to its lower surgical complication rate and comparable major clinical outcomes. Additional large RCTs are needed to confirm these findings. TRIAL REGISTRATION: The PROSPERO database has the study protocol recorded with ID CRD420250651103.
Early postoperative pain and quality of life with different modalities of mesh fixation in laparoscopic trans-abdominal pre-peritoneal repair of inguinal hernia: a randomized controlled trial.
Aziz AE, Khalil AH, Abdelnasser A … +1 more , Elmonim AMA
BMC Surg · 2026 Jun · PMID 42265662 · Full text
BACKGROUND: Compared with open inguinal hernia repair, laparoscopic approaches, including Transabdominal Preperitoneal (TAPP) and Totally Extraperitoneal (TEP), improve recovery and reduce pain. However, optimal mesh fix...
BACKGROUND: Compared with open inguinal hernia repair, laparoscopic approaches, including Transabdominal Preperitoneal (TAPP) and Totally Extraperitoneal (TEP), improve recovery and reduce pain. However, optimal mesh fixation remains unclear due to limited high-quality comparative evidence. We aimed to evaluate early postoperative pain and quality of life with different mesh fixation modalities (glue, tacks, and sutures) in laparoscopic TAPP inguinal hernia repair. METHODS: A single-center, prospective, randomized controlled trial was conducted on 75 eligible adult patients with primary inguinal hernia scheduled for elective TAPP repair. Patients were randomized in a 1:1:1 ratio to glue (n = 25), suture (n = 25), or tack (n = 25) fixation. Primary outcomes were postoperative pain intensity (visual analogue scale, VAS) and hernia-specific quality of life (Carolinas Comfort Scale, CCS) assessed at postoperative day 1 1, 3, and 6 months. Secondary outcomes included operative time, length of hospital stay, time to return to work, complications, recurrence, and procedural cost. RESULTS: Compared with the glue and suture fixation groups, the tack fixation group had substantially higher pain levels on the first day after the operation and at one month (P < 0.001). Over the 3rd and 6th months, VAS scores were low and comparable across all groups, with no significant differences. The glue group had significantly lower mesh sensation and total CCS scores at all time points compared to the suture and tack groups (P < 0.001). CONCLUSIONS: In the early postoperative period following laparoscopic TAPP inguinal hernia repair, mesh fixation with surgical glue results in superior pain control, better quality of life, and faster return to work compared to sutures and tacks, without increasing early complication rates. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT07401082 (Registered February 6, 2026; retrospectively registered after completion of enrollment).
Surgical decision-making in pediatric intestinal ascariasis: experience from an endemic region.
Najar FA, Raina AW, Jaan S … +3 more , Mufti GN, Baba AA, Bhat NA
BMC Surg · 2026 Jun · PMID 42260494 · Full text
BACKGROUND: Intestinal ascariasis is the leading cause of pediatric intestinal obstruction in endemic regions. This study aimed to analyze the clinical presentation, diagnostic accuracy, and outcomes of conservative and...
BACKGROUND: Intestinal ascariasis is the leading cause of pediatric intestinal obstruction in endemic regions. This study aimed to analyze the clinical presentation, diagnostic accuracy, and outcomes of conservative and surgical management of ascariasis-induced intestinal obstruction in children. METHODS: Children aged 2-16 years who presented with intestinal obstruction between May 2022 and May 2025 were prospectively evaluated. Patients with intestinal ascariasis confirmed as the cause of obstruction were included, whereas those with concomitant adhesions, intussusception, or other etiologies of obstruction were excluded. Data on demographics, management strategies, operative details, complications, and hospital stay were analyzed. RESULTS: Of the 190 children with intestinal obstruction, 120 (63.2%; 95% CI: 56.3-70.0%) were diagnosed with ascariasis-induced obstruction. There was a male predominance (male-to-female ratio 2:1). The mean age at presentation was 5.8 ± 2.3 years, with the highest incidence observed in the 5-8-year age group (54.2%), followed by the 2-4-year age group (37.5%). Initial conservative management was attempted in 80 of the 120 patients, of whom 65 (81.3%; 95% CI: 72.7-89.8%) improved without surgical intervention. Surgical management was required in 55 patients (45.8%; 95% CI: 36.9-54.7%). The procedures performed included manual kneading of worms (36.4%), enterotomy with worm extraction (32.7%), and bowel resection with end-to-end anastomosis (30.9%). Postoperative complications were observed in eight patients (14.5%; 95% CI: 5.4-23.7%), including surgical site infection (7.3%), anastomotic leak (3.6%), and burst abdomen (3.6%). No mortality was observed. The mean length of hospital stay was 4.2 ± 1.5 days for patients managed conservatively and 7.8 ± 1.5 days for those who underwent surgical intervention. Ultrasonography demonstrated a diagnostic accuracy of 96.5% (95% CI: 93.1-99.8%) and PPV of 100% (95% CI: 95.6-100%) among patients who underwent imaging, with characteristic "bull's-eye" and "railway-track" appearances of intraluminal worms. CONCLUSION: Ascariasis remains the predominant cause of pediatric intestinal obstruction in endemic areas, underscoring its persistent public health relevance. Although conservative management is effective in most cases, timely surgical intervention remains essential for patients with complications or failed conservative treatment.
Successful pancreaticoduodenectomy for ampullary carcinoma in a patient with diabetes and stable chronic lymphocytic leukemia: a case report emphasizing multidisciplinary optimization.
Khanabadi B, Eghlimi H, Asghari Z … +1 more , Tabrizi T
BMC Surg · 2026 Jun · PMID 42260465 · Full text
BACKGROUND: Pancreaticoduodenectomy (PD) for ampullary carcinoma carries significant risks, and the presence of hematologic comorbidities adds further complexity. While stable Chronic Lymphocytic Leukemia (CLL) is not a...
BACKGROUND: Pancreaticoduodenectomy (PD) for ampullary carcinoma carries significant risks, and the presence of hematologic comorbidities adds further complexity. While stable Chronic Lymphocytic Leukemia (CLL) is not a contraindication, it complicates perioperative risk stratification and infection control. CASE PRESENTATION: A 66-year-old male with type 2 diabetes mellitus (DM) and stable, untreated Rai Stage I chronic lymphocytic leukemia (CLL) presented with a three-week history of painless obstructive jaundice. Imaging and biopsy confirmed ampullary carcinoma. INTERVENTION: Following multidisciplinary team (MDT) optimization focusing on glycemic control (target 140-180 mg/dL), preoperative biliary drainage, infection prophylaxis, and immunologic surveillance, a pylorus-preserving PD (PPPD) was performed. OUTCOME: The postoperative course was stable with no biochemical leak or clinically relevant postoperative pancreatic fistula (POPF). Histopathology revealed pT2N0 (Stage I) ampullary carcinoma (intestinal-type) with focal lymphovascular invasion (LVI). Interestingly, regional lymph nodes showed CLL infiltration but were negative for metastasis. CONCLUSION: This case shows that structured MDT optimization and adherence to ERAS protocols enabled safe curative-intent PD in this patient with stable CLL and DM.
MANagement of Gallstone disease in the Older patient (MANGO): clinical and quality of life outcomes from a prospective multicentre cohort study.
Fairclough AE, Gavrila AD, Cossins C … +4 more , Toh SKC, Darbyshire AR, Lord A, Wessex Research Collaborative
BMC Surg · 2026 Jun · PMID 42252455 · Full text
BACKGROUND: Gallstones commonly cause emergency surgical admission in older adults and are frequently associated with complications. Although cholecystectomy is recommended in the general population, decision-making is c...
BACKGROUND: Gallstones commonly cause emergency surgical admission in older adults and are frequently associated with complications. Although cholecystectomy is recommended in the general population, decision-making is complicated by increased comorbidity and frailty in older patients. METHODS: Trainee-led prospective multicentre cohort across nine NHS hospitals. Consecutive emergency admissions in patients aged ≥ 70 years with radiologically confirmed gallstone disease were recruited (November 2022-March 2024). Data were collected at baseline, 30-days and 1-year, including Gastrointestinal Quality of Life Index (GIQLI) scores. RESULTS: Of 194 patients, 36 (18.6%) underwent emergency cholecystectomy, with 158 (81.4%) managed non-operatively at initial presentation. The non-operative group had greater comorbidity burden and frailty. All emergency operations were started laparoscopically (one conversion) with no major complications; median length of stay was similar (7 vs 5 days, p = 0.105). Gallstone-related readmission at 1-year was higher after non-operative management (23.0% vs 2.9%, p = 0.024); non-biliary readmissions were similar. One-year mortality was 12.4% vs 0% (p = 0.06). Baseline GIQLI was similar. At 30-days, emergency cholecystectomy was associated with the greatest difference in GIQLI score compared to the non-operative group (p ≤ 0.007). At 1-year, GIQLI remained higher after emergency cholecystectomy (123.8 vs 115.6, p = 0.039). Forty-three patients had undergone interval cholecystectomy by 1-year. CONCLUSION: Emergency cholecystectomy in older patients deemed suitable for surgery is associated with reduced gallstone-related re-admissions at 1-year and higher QoL scores. These findings support consideration of surgery in appropriately selected older patients and further randomised research in this higher risk group.
Early outcomes of transverse perineal support in obstructed defecation syndrome with pathological perineal descent; a prospective cohort study.
Azmy Basiouny HM, Shafik AA, Elbarmelgi MY … +4 more , Refaie O, Tamer M, Alwafa MAA, Abdelaal AM
BMC Surg · 2026 Jun · PMID 42251344 · Full text
BACKGROUND: While current surgical approaches for obstructed defecation syndrome (ODS) primarily target rectocele and rectal intussusception, excessive perineal descent (PD) may contribute to persistent symptoms and subo...
BACKGROUND: While current surgical approaches for obstructed defecation syndrome (ODS) primarily target rectocele and rectal intussusception, excessive perineal descent (PD) may contribute to persistent symptoms and suboptimal surgical outcomes. This study aimed to evaluate early outcomes of transverse perineal support (TPS), a procedure designed to reinforce the perineum, in patients with ODS and pathological PD. PATIENTS AND METHOD: All consecutive patients with ODS and pathological PD were assessed for eligibility. After at least one year of conservative management (dietary fiber, biofeedback, laxatives) that failed to relieve symptoms, twenty-nine patients were evaluated preoperatively using the Cleveland Clinic Constipation Score (CCCS), Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12), perineometry, anorectal manometry, and MRI defecography. All patients underwent TPS procedure and were followed up for a minimum of 6 months. The primary outcome was the change in CCCS at 6 months. RESULTS: Significant postoperative improvements were observed. The CCCS decreased significantly, with a mean difference (Post - Pre) of -5.31 (95% CI: -6.13 to -4.48 ; p < 0.001). Postoperative PISQ-12 scores were significantly higher than preoperative scores, with median (IQR) values of 35 (34-36) and 25 (24-27), respectively (p = 0.003). Intrarectal pressure during push increased from 34.34 ± 6.03 mmHg preoperatively to 41.17 ± 5.85 mmHg postoperatively with a mean difference (Post - Pre) of 6.83 (95% CI: 5.41 to 8.24; p < 0.001). Perineal descent measured by perineometry decreased from 2.29 ± 0.55 cm preoperatively to 1.74 ± 0.51 cm postoperatively with a mean difference of -0.64 cm (95% CI: -0.75 to -0.52; p < 0.001). No mesh-related complications (erosion, chronic pain) were observed. Nine patients (31.03%) reported persistent symptoms. All had rectal intussusception. Compared with patients who improved, these patients were older, had smaller perineal bodies, and greater preoperative perineal descent. CONCLUSIONS: Transverse perineal support procedure may be an effective option for selected patients with ODS and pathological PD. Outcomes were less favorable in patients with rectal intussusception, older age (observed as an association only, not causation) or smaller perineal body dimensions, underscoring the importance of careful patient selection and individualized surgical planning. Given the small sample size and the absence of a control group, these findings should be interpreted with caution as associational rather than causal.
Non-operative versus operative management of uncomplicated acute appendicitis: a randomized controlled study in Sierra Leone.
Cummings-John C, Bah AJ, Lebbie A … +1 more , Ogundiran T
BMC Surg · 2026 Jun · PMID 42251306 · Full text
BACKGROUND: Acute appendicitis is the leading cause of acute abdomen in young adults, typically managed by appendectomy. A growing body of evidence supports non-operative management as an alternative for uncomplicated ca...
BACKGROUND: Acute appendicitis is the leading cause of acute abdomen in young adults, typically managed by appendectomy. A growing body of evidence supports non-operative management as an alternative for uncomplicated cases. This study aimed to compare the effectiveness of non-operative management (NOM) versus operative management (OM) for uncomplicated acute appendicitis. METHODS: A prospective, longitudinal, randomized controlled trial was conducted at Connaught Hospital, Sierra Leone. Sixty patients were randomized: 30 to NOM and 30 to OM. NOM patients received intravenous metronidazole and ceftriaxone for 48 h, followed by oral metronidazole and ciprofloxacin for 5 days. OM patients underwent open appendectomy. NOM patients were monitored for symptom resolution or progression; failure required appendectomy. Both groups were followed up on days 7, 10, 30, 60, and 90 post-admissions to assess recurrence, cost of care, and quality of life (QoL). RESULTS: The median age was 26 years (IQR 14-42) for NOM and 27 years (IQR 18-54) for OM. Most patients were males (NOM: 66.7%, OM: 63.3%). Antibiotic treatment was successful in 18 (60%) NOM patients. Failure occurred in 12 (40%) NOM patients, 11 during the index admission, with 1 (3.3%) experiencing recurrence within a week of discharge. Successful NOM resulted in a significantly improved QoL score (5.98), a shorter mean hospital stays (4 days), a lower mean cost of care (NLe 482.29; $49.08), and no catastrophic health expenditure, compared to both OM and failed NOM. Statistically significant differences were observed in favor of successful NOM over surgery (including OM and failed NOM requiring surgery) for the cost of care and time to return to normal activities. CONCLUSION: NOM for uncomplicated acute appendicitis achieved a 60% success rate with a low recurrence rate (3.3%). It is associated with lower costs, reduced risk of catastrophic health expenditure, shorter hospital stays, faster return to normal activities, and improved QoL compared to operative management. TRIAL REGISTRATION: The Pan African Clinical Trials Registry (PACTR). CLINICAL TRIAL NUMBER: PACTR202605655002550. Date of registration:20 April 2026. "Retrospectively registered".
Role of chest wall perforator flaps in reconstruction of upper inner breast defects.
Orabi A
BMC Surg · 2026 Jun · PMID 42251264 · Full text
BACKGROUND: Breast-conserving surgery (BCS) is the standard treatment for early-stage breast cancer; however, defects in the upper inner quadrant (UIQ) remain a significant reconstructive challenge due to paucity of loca...
BACKGROUND: Breast-conserving surgery (BCS) is the standard treatment for early-stage breast cancer; however, defects in the upper inner quadrant (UIQ) remain a significant reconstructive challenge due to paucity of local tissue and heightened cosmetic sensitivity of this quadrant. Chest wall perforator flaps (CWPFs) have emerged as a reliable volume replacement option with minimal donor-site morbidity, yet data focusing specifically on their use in UIQ defects are limited. METHODS: This retrospective study included 20 female patients with UIQ breast tumors who underwent partial breast reconstruction using CWPFs between January 2022 and December 2023. Data regarding patient and tumor characteristics, flap type, operative details, and postoperative complications were collected. Aesthetic outcomes were objectively assessed using BCCT.core software (version 3.1), while patient-reported outcome measures (PROMs) were evaluated at 12 months postoperatively using the BREAST-Q questionnaire. RESULTS: The mean patient age was 40.7 ± 5.0 years. The most commonly used flap was the anterior intercostal artery perforator (AICAP) flap (40%), followed by combined LICAP/LTAP flaps (25%). The mean operative time was 79.0 ± 7.5 min. Postoperative complications occurred in 20% of patients, including seroma (10%), wound infection (5%), and fat necrosis (5%), with no cases of major flap loss or positive surgical margins. According to BCCT assessment, excellent and good cosmetic outcomes were achieved in 95% of patients. PROMs demonstrated favorable outcomes, with mean scores of 73.4 ± 4.7 for physical well-being, 73.8 ± 4.2 for psychological well-being, and 70.1 ± 6.3 for satisfaction with the breast. CONCLUSION: CWPFs were used for reconstruction of UIQ defects following breast-conserving surgery with acceptable postoperative complication rates and favorable cosmetic assessment in this retrospective cohort. These findings describe the surgical and aesthetic outcomes observed in this challenging breast quadrant. Further prospective studies with larger patient populations are needed to better define the role of CWPFs in UIQ reconstruction. TRIAL REGISTRATION: Retrospectively registered after the approval of Baheya Ethical Committee, IRB no. 202,506,300,026.
Influence of posterior malleolar fragment size on clinical function and spatiotemporal gait parameters in trimalleolar ankle fractures.
Aydilek A, Erdem Y
BMC Surg · 2026 Jun · PMID 42249476 · Full text
BACKGROUND: Posterior malleolar fractures accompanying trimalleolar ankle injuries may compromise joint stability and lead to long-term functional impairment. However, the impact of posterior malleolar fragment (PMF) siz...
BACKGROUND: Posterior malleolar fractures accompanying trimalleolar ankle injuries may compromise joint stability and lead to long-term functional impairment. However, the impact of posterior malleolar fragment (PMF) size on postoperative functional recovery remains unclear. This study aimed to evaluate the association between PMF size and morphology with postoperative clinical outcomes using both functional scoring systems and smartphone-based gait analysis. METHODS: Seventy-two patients who underwent surgical treatment for trimalleolar fractures between 2017 and 2022 and met the inclusion criteria were retrospectively reviewed. Patients were categorized into two groups based on PMF size: <25% and ≥ 25%. Fragment configuration was classified according to the Bartoníček system. Functional outcomes were assessed using AOFAS, FAAM, SF-36, and VAS scores, while gait performance was analyzed through spatiotemporal parameters obtained with the GaitAnalyzer application. Results were compared with an age- and sex-matched control group of 72 healthy individuals. RESULTS: Patients with PMF ≥ 25% demonstrated significantly higher grades of post-traumatic osteoarthritis (p = 0.020). The < 25% group had significantly better SF-36 physical function (p = 0.040) and FAAM-Sport scores (p = 0.023). No significant differences were observed between groups for AOFAS, FAAM-ADL, or VAS scores (p > 0.05). Compared with controls, both patient groups showed pronounced impairments in gait velocity, step time, step length, and cadence (p < 0.001); however, these parameters did not differ significantly between the PMF < 25% and ≥ 25% groups (p > 0.05). In multivariate regression, FAAM-Sport was independently associated with PMF ≥ 25% (β=-15.589; p = 0.022), the presence of joint step-off (β=-21.338; p = 0.002), and male sex (β=+16.448; p = 0.014). Surgical fixation of the posterior fragment was associated with improved FAAM-Sport scores (β=+17.171; p = 0.046). CONCLUSION: A posterior malleolar fragment size ≥ 25% is associated with a higher incidence of post-traumatic osteoarthritis and greater impairment in sport-related functional activities. In contrast, objective spatiotemporal gait parameters appear to be independent of fragment size. Multivariable analysis demonstrates that functional outcomes are influenced not only by fragment size but also by factors such as the presence of articular step-off and the development of post-traumatic osteoarthritis. These findings indicate that postoperative functional recovery following trimalleolar ankle fractures is a multifactorial process.
Plasma albumin and other indicators as risk factors for delayed neurocognitive recovery in elderly patients undergoing orthopedic surgery.
Zhao G, Fu H, Liu F … +2 more , Duan M, Wang T
BMC Surg · 2026 Jun · PMID 42249409 · Full text
BACKGROUND: The risk factors for neurocognitive impairment outcomes vary among different types of surgeries. The risk factors for delayed neurocognitive recovery (DNR) in elderly patients following orthopedic surgery are...
BACKGROUND: The risk factors for neurocognitive impairment outcomes vary among different types of surgeries. The risk factors for delayed neurocognitive recovery (DNR) in elderly patients following orthopedic surgery are unclear. The objective of this study was to identify the risk factors for early postoperative delayed neurocognitive recovery in elderly patients who underwent elective orthopedic surgery. METHODS: The medical data of 166 elderly patients underwent elective orthopedic procedures were analyzed retrospectively. The cognitive scores on the day before the surgery and on the 7th postoperative day were assessed using the MoCA scale, and Z-scores were utilized to account for learning effects. The study population was divided into two groups according to whether DNR occurred by the 7th postoperative day or prior to discharge. Risk factors associated with postoperative DNR in elderly orthopedic patients were determined using logistic regression analysis. RESULTS: There were 166 elderly surgical patients, with an incidence rate of 28.9% DNR. Multivariate logistic regression analysis revealed that a history of drinking (OR = 6.853 [1.825-25.734], P = 0.004), cerebrovascular stenosis (mild: OR = 7.646 [1.432-40.833], P = 0.017; moderate or severe: OR = 5.593 [1.222-25.607], P = 0.027), a preoperative PaO/FiO ratio of < 350 (OR = 2.549 [1.045-6.219], P = 0.040), and postoperative albumin levels of < 35 g/L (OR = 4.214 [1.489-11.923], P = 0.007) were independently associated with DNR on postoperative day 7. Furthermore, plasma albumin levels on postoperative day 1 showed a negative correlation with plasma interleukin 6 levels on postoperative day 3 (r = - 0.251, P = 0.006). CONCLUSION: Early DNR in elderly orthopedic patients appears to be associated with multiple factors, including a history of drinking, cerebrovascular stenosis, a preoperative PaO₂/FiO₂ ratio < 350, and postoperative albumin < 35 g/L.
Treat the patient, not the grade of injury: modern management of solid organ trauma in children.
Özcan Sıkı F, Sarıkaya M, Yağmurlu İ … +5 more , Ünal S, Yiğit FB, Gündüz M, Sekmenli T, Çiftci İ
BMC Surg · 2026 Jun · PMID 42249394 · Full text
BACKGROUND: Trauma remains one of the leading causes of morbidity and mortality in childhood, and intra-abdominal solid organ injuries represent a major clinical challenge in pediatric trauma care. Although multiple inte...
BACKGROUND: Trauma remains one of the leading causes of morbidity and mortality in childhood, and intra-abdominal solid organ injuries represent a major clinical challenge in pediatric trauma care. Although multiple international guidelines define diagnostic, follow-up, and treatment strategies, management decisions may still vary depending on institutional experience, patient characteristics, and imaging findings. This study aimed to evaluate the management process, treatment strategies, and clinical outcomes of pediatric patients followed for posttraumatic intra-abdominal solid organ injuries in a tertiary referral center. METHODS: Pediatric patients aged 0-18 years who were admitted to our hospital between 2014 and 2024 due to blunt or penetrating trauma and diagnosed with intra-abdominal solid organ injuries were retrospectively evaluated. Patients with gastrointestinal perforation and those who died during emergency intervention after trauma were excluded. Demographic characteristics, trauma mechanisms, injured organs, transfusion requirements, and treatment approaches were analyzed to assess current management practices. RESULTS: A total of 1043 pediatric patients were examined. Blunt trauma was present in 97% of the patients, while penetrating trauma was observed in 3%. The most common causes of blunt trauma were falls from heights and traffic accidents. Approximately 76.8% of the patients were male, with a mean age of 9.16 ± 3.4 years. The average hospital stay was 7 ± 2 days. The transfusion requirement was determined to be 8.2%, and the emergency laparotomy rate was 3.4%. Patients with stable vital signs were treated non-operatively. The most commonly injured organs were the spleen, liver, and kidney. CONCLUSIONS: In pediatric patients with solid organ injuries, treatment strategies should primarily be guided by hemodynamic stability and clinical assessment rather than injury grade alone. Conservative management in hemodynamically stable patients effectively reduces surgical intervention rates and supports favorable clinical outcomes. Careful patient selection, structured clinical follow-up, and adherence to guideline-based nonoperative management protocols may further optimize outcomes and minimize unnecessary surgical interventions in pediatric trauma care.
Comparison of open and minimally invasive radical hysterectomy for cervical cancer: a systematic review and meta-analysis of survival outcomes.
Wu J, Li R, Chen H
BMC Surg · 2026 Jun · PMID 42249382 · Full text
AIM: To systematically evaluate the impact of open versus minimally invasive radical hysterectomy on survival outcomes in cervical cancer patients. METHODS: Relevant literature from the past 10 years was searched in PubM...
AIM: To systematically evaluate the impact of open versus minimally invasive radical hysterectomy on survival outcomes in cervical cancer patients. METHODS: Relevant literature from the past 10 years was searched in PubMed, Web of Science, and Cochrane Library databases. Clinical studies comparing open radical hysterectomy (ORH) and minimally invasive surgery (MIS) were included. Study quality was assessed using the Cochrane Risk of Bias 2.0 tool and the Newcastle-Ottawa Scale. A meta-analysis was performed to compare survival outcomes between ORH and MIS, with subgroup analysis stratified by tumor size (≤ 2 cm vs. > 2 cm). RESULTS: Fifteen clinical studies met the inclusion criteria. All observational studies scored ≥ 7 on the Newcastle-Ottawa Scale. Patients undergoing ORH showed significantly improved 5-year disease-free survival compared with MIS (OR = 1.70 [1.27, 2.27], P < 0.001, I² = 58%). However, no significant difference was observed in overall survival between the two surgical approaches (OR = 1.08 [0.90, 1.15], P > 0.05). Subgroup analysis showed no significant differences in overall survival between ORH and MIS, regardless of tumor size (≤ 2 cm: HR = 1.10 [0.28, 4.31], P = 0.89; >2 cm: HR = 0.82 [0.38, 1.77], P = 0.61). CONCLUSIONS: These findings suggest that open radical hysterectomy is associated with better disease-free survival, whereas overall survival does not differ significantly between the two approaches.
Single aortic sinus repair with double annular sutures in acute type A aortic dissection: a single center case series of seven patients.
Jung H, Lee Y, Bae CM … +4 more , Lee DH, Park SJ, Oh TH, Kim GJ
BMC Surg · 2026 Jun · PMID 42249355 · Full text
BACKGROUND: We evaluated a modified surgical technique designed to preserve and restore the aortic root geometry in patients with acute type A aortic dissection (ATAAD) when the intimal tear is limited to a single corona...
BACKGROUND: We evaluated a modified surgical technique designed to preserve and restore the aortic root geometry in patients with acute type A aortic dissection (ATAAD) when the intimal tear is limited to a single coronary sinus. METHODS: Between January 2015 and December 2021, 160 patients with ATAAD underwent emergency open replacement of the ascending aorta. Most patients (137, 85%) underwent supracoronary ascending aorta replacement. Thirteen patients underwent aorta root replacement with a valved conduit and three underwent valve-sparing aortic root replacement. The remaining seven patients, in whom intimal tears were confined to single coronary sinus, underwent limited root repair using our modified surgical technique: single aortic sinus repair with double annular sutures. RESULTS: Among the seven patients who underwent a single aortic sinus repair, five had coronary sinus dissection, and two had ascending aortic dissection associated with an aneurysmal change of the sinus of Valsalva. The median age at surgery was 59 years (range, 50-74 years). There were no reoperations for postoperative bleeding and no in-hospital mortality. All patients were followed for a median 8 years (range, 3-10 years) postoperatively, and none developed more than mild aortic regurgitation. CONCLUSIONS: Our findings suggest that the modified surgical technique-single aortic sinus repair with double annular sutures-may represent a feasible and effective option for selected patients with ATAAD whom the dissection is limited to a single coronary sinus, and the aortic tissue is relatively fragile.
Early predictors of in-hospital mortality after percutaneous cholecystostomy.
Senol A, Kavak S
BMC Surg · 2026 Jun · PMID 42249338 · Full text
BACKGROUND: Acute cholecystitis is a common cause of emergency surgical admission, particularly among elderly and medically complex patients. Percutaneous cholecystostomy (PC) is frequently used as a minimally invasive t...
BACKGROUND: Acute cholecystitis is a common cause of emergency surgical admission, particularly among elderly and medically complex patients. Percutaneous cholecystostomy (PC) is frequently used as a minimally invasive treatment option for patients considered unsuitable for early cholecystectomy. However, factors associated with in-hospital mortality and the impact of radiologic disease burden after PC remain incompletely characterized. METHODS: We conducted a retrospective single-center cohort study including consecutive adult patients who underwent image-guided PC for acute cholecystitis between January 2022 and December 2025. Clinical, laboratory, procedural, and radiologic variables were analyzed. Factors associated with in-hospital mortality were evaluated using multivariable logistic regression analysis. An exploratory radiologic severity score (RSS) was constructed using predefined imaging findings including pericholecystic fluid, gallbladder perforation, emphysematous cholecystitis, and gallbladder wall thickness ≥ 7 mm. Associations between RSS and inflammatory response following PC were also assessed. RESULTS: A total of 266 patients were included (mean age 64.9 ± 17.1 years; 56.4% male). The overall in-hospital mortality rate was 7.5% (n = 20). Factors independently associated with in-hospital mortality included older age (OR, 2.06 per 10-year increase, 95% CI, 1.25-3.39), malignancy (OR, 9.19, 95% CI, 2.71-31.22), elevated LDH (OR, 1.86 per 100 U/L increase, 95% CI, 1.23-2.81), and higher post-procedural day-3 CRP levels (OR, 2.17 per 50 mg/L increase, 95% CI, 1.32-3.55). The multivariable model demonstrated good discriminative performance in internal validation (cross-validated AUC: 0.895). Higher RSS values were associated with reduced CRP decline following PC (p = 0.041), suggesting slower inflammatory resolution. However, RSS was not significantly associated with mortality or hospital length of stay. CONCLUSION: In this retrospective cohort, in-hospital mortality after percutaneous cholecystostomy was primarily associated with baseline patient vulnerability and persistent early inflammatory response after the intervention. Radiologic disease burden appeared to correlate with inflammatory recovery rather than mortality. Given the retrospective design, limited number of mortality events, and lack of external validation, these findings should be considered exploratory and hypothesis-generating. Prospective multicenter studies are warranted to further validate these observations.
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