BMC Surgery[JOURNAL]
Sun
200 papers
Correction: Surgical decision-making in self-inflicted, non-ballistic penetrating neck injuries: a single-center retrospective study.
Yoshitake H, Uchida K, Nishimura T … +1 more , Mizobata Y
BMC Surg · 2026 Jun · PMID 42243841 · Full text
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The application of mini T-plate and high-strength suture wires in the surgical treatment of posterior cruciate ligament avulsion fractures: a retrospective case series.
Sun C, Wang S, Chen P … +6 more , Lu Y, Han K, Zhang P, He Y, Liang Y, Fang Y
BMC Surg · 2026 Jun · PMID 42243827 · Full text
BACKGROUND: Posterior cruciate ligament (PCL) avulsion fractures at the tibial insertion can cause posterior knee instability and accelerate osteoarthritis. Meyers-McKeever type II/III fractures require surgery. Traditio...
BACKGROUND: Posterior cruciate ligament (PCL) avulsion fractures at the tibial insertion can cause posterior knee instability and accelerate osteoarthritis. Meyers-McKeever type II/III fractures require surgery. Traditional open approaches are traumatic, while arthroscopic techniques are limited by equipment, learning curves, and fixation efficacy. OBJECTIVE: To evaluate the short-term clinical outcomes and feasibility of a combined vertical medial posterior incision approach using a small T-plate and high-strength suture fixation for isolated PCL avulsion fractures. METHODS: We retrospectively reviewed 21 patients with isolated Meyers-McKeever type II/III PCL tibial avulsion fractures treated with posteromedial longitudinal mini-incision fixation using a mini T-plate combined with high-strength suture. Operative parameters, fracture healing, knee ROM, Tegner-Lysholm score, IKDC score, posterior drawer test, and complications were assessed. RESULTS: The mean surgery duration was 81.5 ± 20.9 min, with an average intraoperative blood loss of 33 ± 11 ml. All fractures achieved anatomical reduction, with an average healing time of 10.9 ± 1.6 weeks. At the final follow-up (mean 10.6 ± 5.2 months), knee ROM improved significantly from 76.5°±12.1° preoperatively to 132.2°±4.2° (P < 0.05). Both Tegner-Lysholm scores (from 45.5 ± 9.3 to 95.5 ± 2.8) and IKDC scores (from 35.9 ± 8.9 to 96.8 ± 1.5) showed statistically significant improvements (P < 0.05). The posterior drawer test was negative in all patients, and no infection, implant failure, or gastrocnemius weakness was observed. CONCLUSION: Posteromedial longitudinal mini-incision fixation with a mini T-plate combined with high-strength suture achieved satisfactory clinical outcomes for PCL tibial avulsion fractures. The proposed 5T concept summarizes the main practical advantages of this technique. In this descriptive case series (Level IV evidence), the technique achieved satisfactory short-term clinical outcomes for PCL tibial avulsion fractures, particularly in patients with small or comminuted fragments. Further prospective comparative studies are needed to validate its long-term clinical value.
HYPOChLorous Acid TEsting Studies in elective groin VASCULAR surgery (HYPOCLATES:VASCULAR): protocol for an ambispective cohort study evaluating a standard change to hypochlorous acid lavage in patients undergoing elective groin vascular surgery.
Nadvornik MP, Uhl J, Hoch Al Hessen T … +6 more , Siegel N, Kramer A, Michalski CW, Böckler D, Meisenbacher K, Harnoss JC
BMC Surg · 2026 Jun · PMID 42243808 · Full text
BACKGROUND: Surgical site infections remain a frequent and clinically relevant complication following elective open vascular groin surgery, particularly in procedures involving implantation of alloplastic material. Despi...
BACKGROUND: Surgical site infections remain a frequent and clinically relevant complication following elective open vascular groin surgery, particularly in procedures involving implantation of alloplastic material. Despite routine use in many surgical disciplines, the role of standardized intraoperative wound irrigation in vascular groin surgery is insufficiently defined. Hypochlorous acid is a physiologically occurring antimicrobial agent with broad-spectrum activity and favourable tissue compatibility, making it a promising option for intraoperative wound lavage. However, clinical evidence for its preventive use in elective vascular groin procedures is limited. METHODS: Hypoclates:vascular is a single-centre, ambispective cohort study conducted at Heidelberg University Hospital. Adult patients undergoing elective open vascular groin surgery with arterial exposure are included. A departmental standard change introduced intraoperative wound irrigation with at least 250 ml hypochlorous acid-containing Granudacyn prior to wound closure, with additional irrigation of alloplastic material where applicable. Patients treated before this change form a retrospective control cohort without antiseptic lavage, while those treated thereafter constitute the prospective cohort. The primary outcome is the incidence of surgical site infections classified according to Centers for Disease Control and Prevention criteria. Secondary outcomes include postoperative morbidity, wound-related complications, antibiotic use, length of hospital stay, and overall morbidity assessed by the Comprehensive Complication Index. Multivariable logistic regression will be used to explore associations between hypochlorous acid-based irrigation and infectious outcomes. DISCUSSION: This study provides a pragmatic real-world evaluation of standardized hypochlorous acid-based intraoperative wound irrigation in elective open vascular groin surgery. The results will clarify whether this physiologically compatible antiseptic approach is associated with reduced surgical site infections and postoperative morbidity, thereby informing the design of future randomized trials and evidence-based perioperative standards in vascular surgery. TRIAL REGISTRATION: The study was registered on 25 March 2026 in the German Clinical Trials Register (registration identifier: DRKS00039521) prior to data acquisition.
Correlations between intraparenchymal cerebral temperature and peripheral temperature monitoring sites during rewarming after deep hypothermic circulatory arrest on cardiopulmonary bypass.
Parmantier D, Erhlich T, Dan P … +17 more , Piccoli J, Phamisith É, Ferraro F, Tavian F, Vignola M, Quiring F, Staehle J, Kaiser O, Falanga A, Marie V, Groubatch-Joineau F, Garnier E, Lovarini F, Liu Y, Grandmougin D, Tran N, Maureira JP
BMC Surg · 2026 Jun · PMID 42243805 · Full text
BACKGROUND: Optimal anatomical sites for temperature monitoring that most closely correlates with cerebral temperature remain debated in cardiac surgery, particularly during cardiopulmonary bypass (CPB) with deep hypothe...
BACKGROUND: Optimal anatomical sites for temperature monitoring that most closely correlates with cerebral temperature remain debated in cardiac surgery, particularly during cardiopulmonary bypass (CPB) with deep hypothermic circulatory arrest (DHCA) and subsequent rewarming. This experimental study aimed to identify the monitoring site best correlated with intracerebral temperature during the rewarming phase and to assess whether some sites may underestimate cerebral rewarming, thereby increasing the risk of undetected hyperthermia. METHODS: The study was conducted in six male Landrace pigs (≈58 kg) undergoing CPB with a 45-min DHCA at 18 °C, followed by a gradual rewarming phase. Temperature was monitored throughout the procedure at seven anatomical sites (jugular, bladder, esophageal, rectal, nasopharyngeal, venous, and arterial) and compared with direct intracerebral temperature measured using a Pt1000 probe inserted into the cerebral parenchyma. Correlation analyses were performed between peripheral and intracerebral temperature measurements. RESULTS: Jugular temperature demonstrated the strongest correlation with intracerebral temperature (r = 0.975), with no statistically significant difference between jugular values and cerebral temperature (p = 0.2189). In contrast, a significant discrepancy was observed between cerebral and esophageal temperatures (p = 0.0247), indicating differences in thermal kinetics during the early rewarming phase. No cases of cerebral hyperthermia were observed. CONCLUSIONS: This study demonstrated that jugular temperature most accurately reflects cerebral temperature during the rewarming phase of CPB following DHCA. Esophageal and nasopharyngeal measurements, although commonly used, may underestimate cerebral temperature during early rewarming, potentially increasing the risk of cerebral hyperthermia. These findings underscore the value of multisite temperature monitoring and highlight the importance of understanding the mechanisms underlying cerebral thermal dynamics.
Continuous extracorporeal chyme reinfusion using the veraflo system in open abdomen with duodenostomy: a case report.
Saed K, Akhavan R, Rodriguez M … +4 more , Young J, Zois A, Bashir H, Hus N
BMC Surg · 2026 Jun · PMID 42243797 · Full text
This case report describes a novel approach to optimizing nutrition in a 47-year-old male who underwent multiple laparotomies following sulfuric acid ingestion. The resulting necrosis necessitated a total gastrectomy and...
This case report describes a novel approach to optimizing nutrition in a 47-year-old male who underwent multiple laparotomies following sulfuric acid ingestion. The resulting necrosis necessitated a total gastrectomy and subtotal jejunal resection, leaving the abdomen open and the bowel in discontinuity. The team utilized the 3 M Veraflo wound vac system to continuously draw digestive contents from the duodenum and infuse them with enteral feed via a Y-connector into the proximal ileum. While specialized chyme reinfusion devices exist, this paper highlights a unique application of the 3 M Veraflo system to circumvent disrupted anatomy and optimize recovery in a critically ill patient.
Development and validation of a nomogram model for predicting bone cement leakage during vertebroplasty.
Ran T, Fan G, Wang Z … +2 more , Yang S, Liu Y
BMC Surg · 2026 Jun · PMID 42243774 · Full text
OBJECTIVE: To develop and validate a nomogram model for predicting the risk of bone cement leakage (BCL) during vertebroplasty, providing a visual tool to assist preoperative risk assessment and clinical decision-making....
OBJECTIVE: To develop and validate a nomogram model for predicting the risk of bone cement leakage (BCL) during vertebroplasty, providing a visual tool to assist preoperative risk assessment and clinical decision-making. METHODS: A retrospective analysis was conducted on patients who underwent vertebroplasty at our hospital between January 2022 and June 2025. Patients were divided into two groups based on the occurrence of BCL. Univariate and multivariate Logistic regression analyses were performed to identify independent risk factors, which were then used to construct a combined predictive model. Based on the regression results, a nomogram was established. The discriminative ability of the model was evaluated using the receiver operating characteristic (ROC) curve. Calibration was assessed using a Bootstrap resampling calibration curve, and clinical utility was examined through decision curve analysis. RESULTS: Univariate analysis indicated significant differences between the two groups in bone mineral density, operative time, surgical type, fracture vertebral segment, presence of multiple fractures, cortical disruption of the vertebra, degree of vertebral compression, bone cement injection volume, cement viscosity during injection, postoperative vertebral height restoration rate, and hypertension (all P < 0.05). Multivariate Logistic regression identified bone mineral density, multiple fractures, vertebral cortical disruption, degree of vertebral compression, and bone cement injection volume as independent predictors of cement leakage. Validation of the nomogram demonstrated good discrimination and excellent calibration. CONCLUSION: The nomogram model exhibits robust predictive performance and clinical applicability. It may offer a visual tool for individualized preoperative risk assessment in vertebroplasty.
The effect of dexamethasone on inflammatory markers of surgical stress: a randomized trial in robotic hysterectomy.
Kaiser K, Karstensen SH, Petersen SR … +6 more , Nielsen KA, Valorenzos AV, Strøm T, Gögenur I, Balsevicius L, Lauszus FF
BMC Surg · 2026 Jun · PMID 42237296 · Full text
BACKGROUND AND AIM: The immunosuppressive action of dexamethasone may help reduce the risk of postoperative complications such as infection, adhesion formation, and delayed wound healing. Dexamethasone may mitigate tissu...
BACKGROUND AND AIM: The immunosuppressive action of dexamethasone may help reduce the risk of postoperative complications such as infection, adhesion formation, and delayed wound healing. Dexamethasone may mitigate tissue damage and hasten recovery by attenuating the inflammatory response, modulating immune cell activity, and reducing the release of pro-inflammatory cytokines. In this first randomized trial of dexamethasone in robotic hysterectomy, we aimed to evaluate its effect on reducing C-reactive protein (CRP) as a proxy marker of surgical stress. METHODS: Women scheduled for robotic-assisted hysterectomy were recruited into a randomized trial comparing a preoperative dose of 24 mg dexamethasone with placebo. Blood tests were obtained, and visual analogue scale scores for pain, postoperative nausea and vomiting, and medication use during admission were recorded at 0, 4, 8, 12, and 24 h postoperatively. RESULTS: Among the 112 included women, postoperative CRP levels were lower in the dexamethasone group at 12 and 24 h. Postoperative nausea and vomiting over time were also reduced in the dexamethasone group (p = 0.039 without adjustment; p = 0.02 with adjustment). Changes in CRP were analyzed using repeated-measures analysis, showing highly significant differences both without and with adjustment for BMI, age, and baseline CRP (both p < 0.001). Overall, the dexamethasone group demonstrated substantially lower CRP levels during the postoperative period. CONCLUSION: Dexamethasone significantly reduced postoperative CRP levels, suggesting a potential role in further reducing surgical stress in robotic-assisted hysterectomy. TRIAL REGISTRATION: European medical agency (EUDRACT no.2021-000874-28). 02.06.2021. CTIS Public Portal (European Medicines Agency) Registry of randomized clinical trials: NCT04762381, "Effect of 24mg Dexamethasone Preoperatively on Surgical Stress, Pain and Recovery in Robotic-assisted Laparoscopic Hysterectomy", 11th March 2022. CLINICALTRIALS: gov.
Femoral insertion osteotomy of the lateral collateral ligament for expanding lateral knee space in meniscus repair.
Wu C, Chen X, Wu Z … +4 more , Chen Z, Yan W, Lian C, Zhang H
BMC Surg · 2026 Jun · PMID 42237287 · Full text
OBJECTIVE: To evaluate the technical feasibility, short-term safety, and clinical outcomes of an incomplete osteotomy at the femoral insertion of the lateral collateral ligament (LCL) for expanding a tight lateral compar...
OBJECTIVE: To evaluate the technical feasibility, short-term safety, and clinical outcomes of an incomplete osteotomy at the femoral insertion of the lateral collateral ligament (LCL) for expanding a tight lateral compartment during arthroscopic lateral meniscus repair. METHODS: A single-institution retrospective case series was conducted in patients with lateral meniscus tears and a tight lateral compartment who underwent LCL femoral insertion osteotomy between January 2020 and December 2022. Osteotomy was performed only when standard exposure maneuvers, including the figure-four position, portal adjustment, and gentle varus stress, failed to provide safe visualization and instrument access. The primary outcome was technical success, defined as adequate arthroscopic exposure and completion of the planned meniscal repair. Secondary outcomes included Lysholm score, International Knee Documentation Committee (IKDC) score, Visual Analog Scale (VAS) score for knee pain, osteotomy healing on computed tomography (CT), meniscal healing on magnetic resonance imaging (MRI), and complications. RESULTS: Twenty-five knees were included and followed for 12 months. Adequate exposure of the lateral meniscus and completion of meniscal repair were achieved in all cases. At 12 months, Lysholm, IKDC, and VAS scores improved significantly compared with preoperative values (all P < 0.001). CT at 3 months showed satisfactory osteotomy healing without displacement in all patients. MRI at 12 months demonstrated meniscal healing in 19 patients (76%); the 6 patients who did not meet MRI healing criteria were asymptomatic and did not require reoperation during follow-up. No infection, neurovascular complication, clinically apparent varus instability, loss of reduction, or serious complication was observed. CONCLUSION: In selected patients with lateral meniscus tears and a tight lateral compartment, arthroscopic repair combined with incomplete osteotomy of the LCL femoral insertion may facilitate exposure and meniscal repair with satisfactory short-term functional recovery. Because this retrospective case series lacked a control group and objective quantification of joint-space widening, the findings should be confirmed in prospective comparative studies with longer follow-up.
Recurrent ophthalmic arteries supplying posterior meningiomas: embryologic background and 3D anatomical visualization.
Ishikawa K, Watanabe N, Kato N … +8 more , Tomoto K, Koseki H, Ishii Y, Tanaka T, Akasaki Y, Ishibashi T, Murayama Y, Watanabe K
BMC Surg · 2026 Jun · PMID 42237166 · Full text
PURPOSE: Recurrent branches of the ophthalmic artery rarely function as feeding arteries to posteriorly located meningiomas. This study describes two such cases and examines the embryologic basis and collateral pathways...
PURPOSE: Recurrent branches of the ophthalmic artery rarely function as feeding arteries to posteriorly located meningiomas. This study describes two such cases and examines the embryologic basis and collateral pathways that enable this atypical supply. The utility of three-dimensional (3D) simulation for delineating skull base vascular relationships is also assessed. METHODS: Two patients with posteriorly located meningiomas supplied by recurrent ophthalmic artery branches underwent detailed angiographic evaluation. The embryogenesis of the superficial recurrent ophthalmic artery (SROA) and deep recurrent ophthalmic artery (DROA) was reviewed based on established developmental models. Contrast-enhanced MRI, rotational angiography, and MRI CISS sequences were fused using GRID software to visualize vascular courses relative to the cerebellar tentorium and cranial nerves. RESULTS: In both tumors, the SROA or DROA continued distally as tentorial arteries and contributed to tumor vascularization. Fusion 3D simulation enabled clear visualization of these recurrent branches, their tentorial trajectories, and their anatomical relationships with the surrounding dura and cranial nerves. These findings demonstrate that persistent embryologic communications between the ophthalmic artery and adjacent ICA dural branches may supply lesions far from the orbit. CONCLUSION: Recurrent ophthalmic artery branches can function as feeding vessels to posterior meningiomas through embryologically derived anastomotic pathways. Integrating 3D simulation into preoperative hemodynamic assessment enhances understanding of such vascular variants and supports safer treatment planning.
Association between intraoperative cerebral desaturation detected by near-infrared spectroscopy and early postoperative cognitive changes in patients undergoing laparoscopic major oncologic surgery: a preliminary exploratory study.
Özkaya Hız H, Kalaycı D, Altınel S … +2 more , Ünver S, Şen Ö
BMC Surg · 2026 Jun · PMID 42237127 · Full text
BACKGROUND: The Trendelenburg position and pneumoperitoneum cause cardiovascular, cerebrovascular, metabolic, and respiratory changes. This preliminary study aimed to evaluate the effects of the Trendelenburg position an...
BACKGROUND: The Trendelenburg position and pneumoperitoneum cause cardiovascular, cerebrovascular, metabolic, and respiratory changes. This preliminary study aimed to evaluate the effects of the Trendelenburg position and pneumoperitoneum on cerebral tissue oxygen saturation (rSO₂) and their association with early postoperative cognitive changes in patients undergoing laparoscopic major abdominal oncological surgery. METHODS: This preliminary exploratory study included 55 patients scheduled for elective laparoscopic major abdominal cancer surgery. Preoperative cognitive status was assessed using the Mini-Mental Test (MMT). Intraoperatively, regional cerebral oxygen saturation (rSO₂) was monitored using near-infrared spectroscopy (NIRS). Cerebral desaturation was defined as a decrease of ≥20% from baseline rSO₂ lasting at least 15 seconds. Hemodynamic parameters, pneumoperitoneum pressure, and Trendelenburg angle were recorded. Hemodynamic parameters and rSO₂ were recorded at 16 predefined time points: baseline (T0), after preoxygenation (T-preox), after induction (T-postind), after CO₂ insufflation (Ti), after Trendelenburg position (Tt), and every 20 minutes intraoperatively. Cognitive function was re-evaluated using the MMT one week postoperatively. Early postoperative cognitive change was defined as either a decrease of 2 or more points in the postoperative day 7 MMT score compared with baseline, or a postoperative MMT score of 23 and below. RESULTS: A significant decrease in rSO₂ was observed after pneumoperitoneum and the Trendelenburg position. Patients were divided into two groups: those with a >20% decrease in rSO₂ (Group 2, n=6) and those without (Group 1, n=47). Group 2 had significantly lower median rSO₂ values at baseline and most intraoperative time points compared to Group 1 (p<0.05), which may be related to underlying cardiac comorbidities. The incidence of early postoperative cognitive changes was 11.3% (6/53 patients). All patients in Group 2 (100%) developed early postoperative cognitive changes, compared to 17% in Group 1 (p=0.002).Postoperative MMT scores were significantly lower in Group 2 (22.6 ± 2.2 vs. 26.1 ± 2.4, p=0.002). A negative correlation was found between postoperative MMT scores and age, ASA score, and comorbidity (p<0.05). CONCLUSIONS: In conclusion, although the Trendelenburg position and pneumoperitoneum are generally expected to increase cerebral oxygenation, this may not be evident in high-risk patients with cardiac compromise. In this specific population, these factors may pose a significant risk for cerebral desaturation and appear associated with early postoperative cognitive changes. Therefore, monitoring rSO₂ using NIRS should be considered a beneficial tool for identifying vulnerable patients and potentially reducing the risk of cognitive decline. TRIAL REGISTRATION: Clinical Trial: NCT04714346.
Analysis of medium-term prognostic factors for laparoscopic radical resection of serosal infiltrating (pT4a) gastric cancer: a retrospective cohort study.
Zhu G, Qu J, Liu C … +3 more , Zhou S, Chen Y, Liu Y
BMC Surg · 2026 Jun · PMID 42231343 · Full text
OBJECTIVE: To investigate the clinicopathological characteristics and factors influencing medium-term prognosis in patients with gastric cancer and serosal invasion (pT4a) following laparoscopic radical gastrectomy. METH...
OBJECTIVE: To investigate the clinicopathological characteristics and factors influencing medium-term prognosis in patients with gastric cancer and serosal invasion (pT4a) following laparoscopic radical gastrectomy. METHODS: In this retrospective study, 461 patients with pT4a gastric cancer who underwent laparoscopic D2 radical gastrectomy at The First Affiliated Hospital of Shandong Second Medical University (October 2019-December 2024) were analyzed. Survival was assessed by the Kaplan-Meier method; prognostic factors were identified using univariate and multivariate Cox regression. RESULTS: Poorly differentiated/undifferentiated adenocarcinoma comprised 76.8% of cases, and 63.8% were of the diffuse Lauren type. Median tumor diameter was 5.5 cm (58.2% >5 cm). Lymphovascular and perineural invasion were present in 88.7% and 92.4% of patients, respectively; tumor deposits were found in 10.7%. Overall lymph node metastasis rate was 84.8% (pN3a: 25.2%, pN3b: 19.5%). With a median follow-up of 26.0 months, median overall survival (OS) was 49.0 months and median disease-free survival (DFS) was 37.0 months. Multivariate analysis identified independent adverse prognostic factors for OS: age (HR = 1.03, 95% CI 1.01-1.04, P = 0.001), elevated CA19-9 (HR = 1.58, 95% CI 1.15-2.17, P = 0.004), tumor deposits (HR = 1.40, 95% CI 1.01-1.94, P = 0.045), Lauren classification (HR = 1.32, 95% CI 1.04-1.68, P = 0.022), total gastrectomy (vs. partial/subtotal; HR = 1.81, 95% CI 1.35-2.43, P < 0.001), and advanced pN stage (HR = 1.54, 95% CI 1.26-1.88, P < 0.001). For DFS, independent predictors were age, elevated CA19-9, tumor deposits, total gastrectomy, and pN stage (all P < 0.05). CONCLUSION: In this study cohort, patients with pT4a gastric cancer who underwent laparoscopic D2 radical resection achieved medium-term survival outcomes that are broadly comparable to those reported in historical open surgery cohorts. Age, elevated CA19-9, tumor deposits, Lauren classification(diffuse type), total gastrectomy, and advanced pN stage are independent adverse prognostic factors.
Association between chorda tympani manipulation time and early taste disturbance after primary stapes surgery.
Güzel B, Baki A, Bayram İ … +2 more , Ayata Y, Yiğit Ö
BMC Surg · 2026 Jun · PMID 42231341 · Full text
OBJECTIVE: The aim of this study was to investigate the association between intraoperative chorda tympani nerve (CTN) manipulation time and early postoperative taste disturbance after primary stapes surgery. METHODS: Thi...
OBJECTIVE: The aim of this study was to investigate the association between intraoperative chorda tympani nerve (CTN) manipulation time and early postoperative taste disturbance after primary stapes surgery. METHODS: This retrospective study included 56 patients who underwent primary stapes surgery. CTN manipulation time was measured objectively using archived surgical video recordings. Early postoperative subjective taste symptoms were assessed at postoperative week 1 using a patient-reported ordinal scale. Patients were grouped according to manipulation duration, and taste outcomes were compared. Receiver operating characteristic (ROC) analysis was performed to determine the discriminative ability of manipulation time and identify an optimal cutoff value. In addition, logistic regression analysis was performed to evaluate the association between CTN manipulation time as a continuous variable and the risk of postoperative taste disturbance. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. RESULTS: Postoperative taste disturbance occurred in a total of 13 patients (23.2%), including 3 patients (10.7%) in the short manipulation group and 10 patients (35.7%) in the long manipulation group (Fisher's exact test p = 0.041; OR = 4.63). Postoperative taste scores were significantly lower in the long manipulation group, with median scores of 3 (IQR: 2-3) versus 3 (IQR: 3-3) in the short manipulation group (p = 0.021). ROC analysis demonstrated high discriminative performance (AUC = 0.93; 95% CI: 0.80-1.00); however, given the limited number of outcome events, these findings should be interpreted as exploratory and hypothesis-generating. When CTN manipulation time was analyzed as a continuous variable, univariable logistic regression analysis demonstrated that longer manipulation time was significantly associated with an increased risk of postoperative taste disturbance (OR = 1.06 per second increase, 95% CI: 1.02-1.11, p = 0.008). CONCLUSION: Prolonged CTN manipulation time may be associated with an increased risk of subjective early postoperative taste disturbance after primary stapes surgery and may reflect underlying surgical complexity and intraoperative conditions rather than a direct causal mechanism. However, given the potential influence of perioperative confounders, these findings should not be interpreted as indicating a direct causal relationship.
Iatrogenic thoracic inlet narrowing during growing rod distraction causing critical tracheal stenosis: a case report and management implications.
Sun S, Li S, Liu Z … +4 more , Shi B, Qiu Y, Zhu Z, Mao S
BMC Surg · 2026 Jun · PMID 42226213 · Full text
BACKGROUND: Respiratory complications in pediatric spinal deformities are most commonly attributed to thoracic insufficiency syndrome resulting from reduced thoracic volume and impaired chest wall compliance. Severe airw...
BACKGROUND: Respiratory complications in pediatric spinal deformities are most commonly attributed to thoracic insufficiency syndrome resulting from reduced thoracic volume and impaired chest wall compliance. Severe airway compromise caused by extrinsic tracheal compression is rare and remains under-recognized. Here, we report a rare case of extrinsic tracheal compression caused by progressive upper thoracic hyperlordosis after successive growing-rod interventions. CASE PRESENTATION: A 6-year-old girl with progressive thoracolumbar kyphoscoliosis and compensatory upper thoracic lordosis (straight back) underwent halo-gravity traction and dual growing rod insertion surgery uneventfully, achieving considerable curve correction. In the subsequent first distraction surgery one year later, she developed airway spasm and hypoxemia during anesthetic intubation and encountered substantial difficulty in extubation postoperatively. Subsequent imaging and bronchoscopy showed severe tracheal narrowing at the thoracic inlet due to extrinsic compression. Initial attempts of rod adjustment provided little improvement. After thorough literature review and carefully weighing the pros and cons of various methods, a third posterior spinal procedure with multi-level posterior column osteotomies (PCOs) and kyphotic-contoured rods successfully restored upper thoracic kyphosis, widening the thoracic inlet and trachea. She was successfully extubated on postoperative day two and remained respiratory asymptomatic with stable deformity correction at 1-year follow-up. CONCLUSIONS: This case highlights that the accompanying upper thoracic hyperlordosis (straight back) in pediatric spinal deformity may cause thoracic inlet narrowing and occult asymptomatic airway compression which may become critically aggravated after distraction-based growing rod surgery. Posterior restoration of upper thoracic kyphosis may be an effective and less invasive strategy for relieving tracheal compression in selected cases.
Oblique lumbar interbody fusion with unilateral pedicle screw fixation in a single lateral position for degenerative lumbar diseases.
Zhao Y, Lin W, Li Y … +3 more , Zhong H, Liu J, Lu S
BMC Surg · 2026 Jun · PMID 42219477 · Full text
OBJECTIVE: This study aimed to evaluate the clinical efficacy of oblique lumbar interbody fusion (OLIF) combined with unilateral pedicle screw fixation (OLIF-UPS) performed in a single lateral position for degenerative l...
OBJECTIVE: This study aimed to evaluate the clinical efficacy of oblique lumbar interbody fusion (OLIF) combined with unilateral pedicle screw fixation (OLIF-UPS) performed in a single lateral position for degenerative lumbar diseases. METHODS: Clinical data of patients who underwent OLIF-UPS in a single lateral position were collected retrospectively. During the same period, patients who received OLIF combined with bilateral pedicle screw fixation (OLIF-BPS) requiring intraoperative position change were enrolled as the control group. Perioperative parameters, Visual Analogue Scale (VAS) scores, Oswestry Disability Index (ODI) scores, and the modified MacNab criteria were recorded to assess clinical outcomes. Radiographic parameters, including disc height (DH), lumbar lordosis (LL), cage subsidence rate, and interbody fusion rate, were compared between the two groups. RESULTS: The operative time in the OLIF-UPS group was significantly shorter than that in the OLIF-BPS group (p <0.001), whereas no significant differences were observed in intraoperative blood loss or postoperative hospital stay between the two groups (p >0.05). Postoperatively, VAS scores for back and leg pain and ODI scores were significantly improved in both groups compared with preoperative values (p <0.001), with a further improvement noted at 1 year postoperatively compared with 1 month postoperatively. Postoperative DH and LL were significantly increased in both groups relative to preoperative measurements (p <0.001). A slight reduction in DH and LL was observed at 1 year postoperatively compared with the immediate postoperative period, but this difference was not statistically significant (p >0.05). The interbody fusion rate was 92.2% in the OLIF-UPS group and 93.5% in the OLIF-BPS group. Both groups achieved favorable functional recovery and high patient satisfaction. CONCLUSION: In patients with normal to near-normal bone density (T-score > -2.5), Grade I or no spondylolisthesis, no segmental instability, and BMI <30 kg/m2, single-position OLIF-UPS achieves short-term outcomes comparable to OLIF-BPS while significantly reducing operative time. Given the relatively short follow-up period, further long-term observation is warranted to verify its long-term clinical efficacy.
Letter to the editor regarding the article "Development of a new predictive clinico-biological score for acute appendicitis in the pediatric population".
Arredondo Montero J
BMC Surg · 2026 Jun · PMID 42219471 · Full text
The recently published pediatric appendicitis score demonstrates promising discriminative performance. However, key methodological aspects-including predictor handling, possible predictor redundancy or multicollinearity,...
The recently published pediatric appendicitis score demonstrates promising discriminative performance. However, key methodological aspects-including predictor handling, possible predictor redundancy or multicollinearity, absence of calibration analysis, internal validation, and post hoc cut-off selection-limit interpretability and clinical transportability. In this comment, these methodological aspects are critically and constructively examined to facilitate clearer interpretation and enhance methodological transparency.
Impact of intraoperative hemostatic material placement on intra-abdominal infection control in acute appendicitis: a retrospective cohort study.
Qiao H, Wang X, Liu S … +4 more , Li Y, Kang J, Li X, Sun X
BMC Surg · 2026 May · PMID 42218493 · Full text
OBJECTIVE: To evaluate the impact of sodium carboxymethyl cellulose (SCMC)-based absorbable hemostatic gauze on postoperative infectious outcomes in emergency laparoscopic appendectomy (LA) for acute appendicitis. METHOD...
OBJECTIVE: To evaluate the impact of sodium carboxymethyl cellulose (SCMC)-based absorbable hemostatic gauze on postoperative infectious outcomes in emergency laparoscopic appendectomy (LA) for acute appendicitis. METHODS: A retrospective analysis of 184 patients undergoing emergency LA at General Surgery Department of Beijing Fengtai You'anmen Hospital (Collaborative Hospital of Peking University First Hospital Medical Alliance) from January 2024 to March 2025 was conducted. All consecutive patients were included without selection based on disease severity. Patients were divided into two groups: SCMC gauze placement group (n = 55) and non-gauze group (n = 129). Perioperative parameters were compared between groups using descriptive statistics and simple group comparisons (t-test, Mann-Whitney U test, χ² test). RESULTS: Baseline characteristics were well balanced between groups (P > 0.05 for all). No surgical site infections (SSI) or intra-abdominal abscesses were observed in either group during the three-month follow-up period. Key outcomes showed no statistically significant differences (P > 0.05), including: positive rate of intra-abdominal pus culture (97.8% overall); detailed microbial species distribution (e.g., Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae, Enterococcus spp.); inflammatory markers (WBC, CRP, PCT at 24 h/72 h postoperatively); peak WBC and time to peak; peak body temperature and time to peak; and length of stay (LOS). The distribution of disease severity by AAST CT grade was similar between groups, with no significant difference (P = 0.740). All procedures were completed laparoscopically with zero mortality. CONCLUSION: The rational use of SCMC-based absorbable hemostatic gauze during emergency LA appears safe, with no observed association between intraoperative gauze placement and increased postoperative infection risk. Given the non-randomized design and zero event rate, these findings should be interpreted as an observational safety signal, not equivalence or antimicrobial benefit.
Peripheral trigeminal nerve branch lesions: CT and MRI findings in a pathologically confirmed case series.
Wang A, Liu S, Wu H … +1 more , Yuan H
BMC Surg · 2026 May · PMID 42218474 · Full text
PURPOSE: The peripheral branches of the trigeminal nerve (V1, V2, and V3) follow an intricate and tortuous course through various skull base foramina and soft tissue spaces. Due to the rarity of lesions specifically invo...
PURPOSE: The peripheral branches of the trigeminal nerve (V1, V2, and V3) follow an intricate and tortuous course through various skull base foramina and soft tissue spaces. Due to the rarity of lesions specifically involving these distal segments, radiological diagnosis remains a significant challenge. This study aims to summarize the characteristic imaging patterns of diverse pathologically confirmed lesions affecting the peripheral trigeminal branches using CT and MRI. METHODS: We retrospectively reviewed 18 patients (2008-2022) with pathologically proven peripheral trigeminal lesions. The cohort included schwannoma (n = 10), neurofibroma (n = 3), adenoid cystic carcinoma (n = 1), intraneural perineurioma (n = 1), malignant peripheral nerve sheath tumor (n = 1), lymphoid hyperplasia (n = 1), and IgG4-related disease (n = 1). All patients underwent comprehensive multi-planar CT and contrast-enhanced MRI. RESULTS: V1, V2, and V3 divisions were involved in 5, 6, and 5 cases, respectively. We identified three descriptive imaging groupings: Benign Neurogenic Grouping: Characterized by fusiform or nodular thickening with "smooth expansile remodeling" of bony foramina (e.g., foramen rotundum and ovale). Malignant Infiltrative Grouping: Exemplified by adenoid cystic carcinoma, showing aggressive "creeping" spread along neural pathways, often involving the pterygopalatine fossa hub and traversing multiple anatomical compartments. Diffuse/Symmetric Grouping: Observed in intraneural perineurioma and lymphoproliferative disease/IgG4-related disease, manifesting as long-segment, uniform, and often bilateral nerve thickening without focal mass formation. CONCLUSION: Accurate diagnosis of peripheral trigeminal lesions requires a segmental anatomical approach. While MRI is superior for evaluating neural architecture and signal changes, CT provides critical surrogate markers via bone remodeling patterns. Recognizing these descriptive imaging groupings as observed in our series-ranging from indolent remodeling to aggressive perineural spread-is helpful for differentiating rare neural pathologies and guiding clinical management.
Effect of controlled hypotension combined with low-pressure tourniquet on hemoglobin reduction after total knee arthroplasty.
Ji J, Jiang M, Huang L … +5 more , Yang H, Xu W, Zhang Y, Jiang D, Liu L
BMC Surg · 2026 May · PMID 42218438 · Full text
BACKGROUND: Blood loss is common in total knee arthroplasty (TKA). Tourniquet use and controlled hypotension are standard interventions to minimize intraoperative bleeding and avoid transfusions. This study compared the...
BACKGROUND: Blood loss is common in total knee arthroplasty (TKA). Tourniquet use and controlled hypotension are standard interventions to minimize intraoperative bleeding and avoid transfusions. This study compared the effects of conventional tourniquet use versus controlled hypotension combined with a low-pressure tourniquet on postoperative hemoglobin reduction in TKA. METHODS: In this single-center retrospective cohort study, 90 patients undergoing unilateral TKA under general anesthesia were assigned to either the conventional tourniquet group (n = 49) or the controlled hypotension-low-pressure tourniquet group (n = 41). Primary outcomes included postoperative red blood cell (RBC) count, hemoglobin levels, reductions in RBC and hemoglobin, drainage volume, estimated total blood loss, and transfusion rate. Secondary outcomes were intraoperative duration, duration of hospitalization, and incidence of lower extremity deep venous thrombosis (DVT). RESULTS: The controlled hypotension-low-pressure tourniquet group exhibited higher postoperative RBC count and hemoglobin levels. Reductions in RBC, hemoglobin, and cumulative drainage volume were lower, while estimated total blood loss, transfusion requirements, intraoperative duration, and duration of hospitalization were significantly reduced compared with the conventional tourniquet group. DVT incidence was similar between the two groups. CONCLUSION: Controlled hypotension with a low-pressure tourniquet effectively reduced postoperative blood loss without increasing the risk of lower limb DVT.
Surgical management and outcomes of open degloving injuries of the extremities: a retrospective cohort study at a Level II trauma center.
Shurkhay V, Arnold Z, Tamo Achu E … +5 more , Patel U, Schinnerer E, Huo J, Charles M, Liu C
BMC Surg · 2026 May · PMID 42218434 · Full text
BACKGROUND: Open degloving injuries are severe soft-tissue traumas associated with ischemia, infection, and poor functional outcomes. Due to heterogeneous presentations, standardized management protocols remain limited....
BACKGROUND: Open degloving injuries are severe soft-tissue traumas associated with ischemia, infection, and poor functional outcomes. Due to heterogeneous presentations, standardized management protocols remain limited. METHODS: We conducted a retrospective cohort study of 28 consecutive patients with open degloving injuries of the extremities treated at a Level II trauma center between 2020 and 2024. Demographics, injury characteristics, surgical interventions, and outcomes were analyzed using chi-square/Fisher's exact tests and nonparametric methods. RESULTS: Median age was 49 years, and 57.1% were male. Motor vehicle accidents were the most common mechanism (40.7%), with 56.7% involving upper extremities. All but one patient underwent surgical management. Primary debridement was performed in 51.9%, serial debridement in 33.3%, and negative pressure wound therapy in 63.0%. Skin grafting (22.2%) and flap reconstruction (14.8%) were used for definitive closure. Complications occurred in 40.7%, most commonly necrosis (18.5%) and infection (11.1%). Median hospital stay was 7 days. CONCLUSIONS: Early multidisciplinary surgical management is associated with high limb salvage rates and acceptable complication profiles. Prospective multicenter studies are needed to establish standardized treatment algorithms.
Association of preoperative vertebral kyphosis and other factors with cement leakage after percutaneous kyphoplasty: a retrospective cohort study.
Taskala B, Sucu HK, Sevin IE
BMC Surg · 2026 May · PMID 42216160 · Full text
BACKGROUND: Percutaneous kyphoplasty (PKP) is an established treatment modality for painful vertebral compression fractures; however, cement leakage remains its most frequent complication. Although factors such as cortic...
BACKGROUND: Percutaneous kyphoplasty (PKP) is an established treatment modality for painful vertebral compression fractures; however, cement leakage remains its most frequent complication. Although factors such as cortical disruption and fracture type have been widely studied, the influence of preoperative sagittal deformity on leakage risk remains unclear. This study aimed to evaluate the association between preoperative vertebral kyphosis and cement leakage after PKP, with particular attention to CT-based bone quality. METHODS: We retrospectively reviewed patients who underwent PKP for thoracolumbar compression fractures. Bone quality was assessed using CT-derived Hounsfield unit (HU) measurements, and patients were stratified into two groups using a threshold of 114.8 HU: low HU (≤ 114.8) and high HU (> 114.8). Cement leakage was evaluated on routine postoperative CT scans. Radiologic parameters included vertebral kyphosis, segmental kyphosis, Beck index, and posterior wall involvement. To account for multiple procedures within the same patient, we used a generalized linear mixed-effects model (GLMM) with patient ID as a random effect. RESULTS: Cement leakage was detected in 57.4% of procedures (224/390). Leakage patterns included intradiscal leakage in 28.2%, venous leakage in 2.8%, anterior/lateral leakage in 9.5%, spinal canal leakage in 1.8%, and mixed leakage in 15.1%. Despite the relatively high radiographic leakage rate, all leakage events were clinically silent, with no symptomatic neurological deficits or embolic complications observed. In both HU groups, leakage was associated with greater preoperative vertebral kyphosis and a lower Beck index. In the low HU group, each 1° increase in preoperative vertebral kyphosis increased the odds of leakage by 7% (OR 1.07; 95% CI 1.02-1.12; p = 0.009), whereas surgery performed within 3 days was associated with a reduced risk of leakage (OR 0.36; 95% CI 0.14-0.90; p = 0.028). CONCLUSION: Although radiographic cement leakage was common after PKP, clinically significant complications were rare. An increased preoperative vertebral kyphosis may be associated with a higher risk of cement leakage and should be kept in mind during patient assessment. In addition, delayed intervention in patients with poor CT-based bone quality may be associated with an increased leakage risk.
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