BMC Surgery[JOURNAL]
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200 papers
Does spacer type influence bone lysis and clinical outcomes? A comparative analysis in two-stage revision for periprosthetic knee infection.
Ünyılmaz C, Çopuroğlu C, Özcan M … +1 more , Güner O
BMC Surg · 2026 May · PMID 42216057 · Full text
BACKGROUND: Periprosthetic joint infection (PJI) following total knee arthroplasty remains a serious complication associated with substantial morbidity and complex surgical management. Two-stage revision arthroplasty is...
BACKGROUND: Periprosthetic joint infection (PJI) following total knee arthroplasty remains a serious complication associated with substantial morbidity and complex surgical management. Two-stage revision arthroplasty is widely accepted as the gold standard treatment, in which an antibiotic-loaded cement spacer is used during the interim period to maintain joint space and deliver local antimicrobial therapy. While previous studies have compared static and articulating spacers, limited data are available regarding the impact of handmade versus prefabricated spacers on radiological bone loss and functional outcomes. METHODS: This retrospective observational study included 23 patients who underwent two-stage revision surgery for knee PJI between 2011 and 2024. PJI was diagnosed according to the 2018 International Consensus Meeting (ICM) criteria. Patients were divided into two groups based on spacer type: handmade static vancomycin-loaded spacers (n = 14) and prefabricated articulating gentamicin-loaded spacers (n = 9). Clinical outcomes (reinfection, complications), functional outcomes (range of motion [ROM], WOMAC score, ambulation status), and radiological parameters (bone lysis, joint space gap measurements, and AORI classification) were compared between groups. Statistical analyses were performed using nonparametric tests, with significance set at p < 0.05. RESULTS: Reinfection rates were higher in the handmade spacer group (28.6%) compared with the prefabricated group (11.1%), although the difference was not statistically significant. Radiological analysis suggested greater femoral and tibial bone lysis in the handmade spacer group, reflected by significantly higher AORI scores (femoral p = 0.005; tibial p = 0.002). Functional outcomes favored the prefabricated spacer group, with significantly improved postoperative ROM (p = 0.007) and WOMAC scores (p = 0.038). Independent ambulation was achieved more frequently in the prefabricated spacer group (77.8% vs. 21.4%, p = 0.019). Complication rates, including spacer failure and salvage procedures, were also higher in the handmade spacer group. CONCLUSION: In this retrospective cohort, the clinical pathway involving prefabricated articulating gentamicin-loaded spacers was associated with less radiological bone loss and improved functional outcomes compared with handmade static vancomycin-loaded spacers during two-stage revision for knee PJI. However, given the limited sample size and retrospective design, these findings should be interpreted cautiously and require confirmation in larger prospective studies.
Adherence to the WHO surgical safety checklist at Tibebe Ghion Specialized Hospital, Ethiopia: a prospective observational study.
Debas SA, Taye MM, Desta YT … +4 more , Demsse AA, Tesema MD, Tegegne NS, Zegeye ST
BMC Surg · 2026 May · PMID 42215939 · Full text
BACKGROUND: The WHO Surgical Safety Checklist (SSC) is a globally recognized 19-item tool designed to improve team communication and reduce perioperative complications and mortality. Despite its proven efficacy in promot...
BACKGROUND: The WHO Surgical Safety Checklist (SSC) is a globally recognized 19-item tool designed to improve team communication and reduce perioperative complications and mortality. Despite its proven efficacy in promoting safety by helping clinicians adhere to evidence-based best practice, its global compliance varies. Consequently, this study aims to assess the adherence to the WHO surgical safety checklist at Tibebe Ghione Specialized Hospital, Bahir Dar, Ethiopia. METHODOLOGY: Following ethical approval, a hospital-based prospective observational study was conducted on 213 surgeries performed at Tibebe Ghion Specialized Hospital from November- December, 2025. All patients who underwent elective surgery under anesthesia at TGSH during the study period were included. The WHO Surgical Safety Checklist was transformed into a structured Yes/No observational instrument and implemented through direct observation and chart review using a Kobo Toolbox-based questionnaire. Compliance with the three checklist phases (Sign In, Time Out, and Sign Out) was analyzed using the IBM SPSS Statistics for Windows, Version 26.0. RESULTS: A total of 213 surgical procedures were assessed using the Surgical Safety Checklist. The overall performance level across all checklist standards was 92.2%. The highest compliance was during the Sign-In and Time-Out phases, ranging from 89.7% to 99.5%. The lowest adherence was during the Sign Out phase, with adherence for specimen labeling, equipment problem reporting, and recovery management discussion was 75.1%, 76.5%, and 77.0%, respectively. CONCLUSION AND RECOMMENDATION: Overall compliance with the WHO Surgical Safety Checklist was high, particularly during the Sign-In and Time-Out phases. Critical safety practices, including patient verification, anesthesia checks, team communication, and timely antibiotic administration, were consistently performed. In contrast, adherence during the Sign Out phase was comparatively lower, especially for postoperative planning, specimen labeling, and equipment-related checks. These findings highlight the need for targeted interventions to improve Sign Out compliance and further strengthen overall surgical safety and quality of care.
Timing of TEVAR in grade III blunt traumatic aortic injury: a 12-year single-center retrospective study.
Qin Q, Wang LC, Li QM … +4 more , Li M, He H, Li X, Shu C
BMC Surg · 2026 May · PMID 42210262 · Full text
BACKGROUND: This study aimed to summarize a 12-year single-center experience with Grade III blunt thoracic aortic injury (BTAI) and to evaluate the outcomes of early versus delayed thoracic endovascular aortic repair (TE...
BACKGROUND: This study aimed to summarize a 12-year single-center experience with Grade III blunt thoracic aortic injury (BTAI) and to evaluate the outcomes of early versus delayed thoracic endovascular aortic repair (TEVAR) in the context of real-world clinical decision-making, with the goal of providing further insight into how optimal surgical timing may be individualized based on patient presentation and clinical stability. METHODS: A retrospective analysis was conducted on 53 patients with Grade III BTAI treated between August 2011 and January 2024. Based on clinical condition, patients were categorized into early TEVAR (< 24 h) and delayed TEVAR (> 24 h) groups. Perioperative and follow-up outcomes were assessed. RESULTS: Among the 53 patients, 16 underwent early TEVAR and 37 underwent delayed TEVAR. The median age was 54.00 (IQR 37.00-59.50) years, and 77.4% were male. Motor vehicle collisions were the leading cause of injury (60.4%). Common associated injuries included fractures (94.3%), pulmonary injuries (62.3%), and cranial injuries (41.5%). The early TEVAR group had significantly higher Injury Severity Score (ISS), a higher proportion of shock index > 1, and higher rates of emergency surgery (all p < 0.01). There were no significant differences in perioperative mortality or endoleak rates between the two groups. No patients experienced paraplegia, cardiovascular events, or renal impairment. Aortic-related length of stay was shorter in the early TEVAR group (p < 0.001), which also had a higher rate of post-TEVAR surgery for associated injuries (p = 0.006). During follow-up, no significant differences were observed in all-cause mortality or aortic-related reintervention rates between groups. No aortic-related deaths occurred in either group. CONCLUSION: Delayed TEVAR may be safe and feasible in selected patients with Grade III BTAI, but retrospective design limits direct comparison with early intervention. Treatment decisions and timing of TEVAR should be individualized.
Efficacy of tranexamic acid for prevention of heterotopic ossification after orthopedic surgery: a systematic review and meta-analysis.
Wang X, Guo D, Xu X … +3 more , Wang Z, Lv B, Lou Y
BMC Surg · 2026 May · PMID 42210213 · Full text
BACKGROUND: To systematically evaluate the effect of tranexamic acid (TXA) on the incidence of heterotopic ossification (HO) following orthopedic surgery. METHODS: A Systematic review and Meta-analysis was carried out ac...
BACKGROUND: To systematically evaluate the effect of tranexamic acid (TXA) on the incidence of heterotopic ossification (HO) following orthopedic surgery. METHODS: A Systematic review and Meta-analysis was carried out according to PRISMA guidelines. PubMed, Embase, Web of Science, and Cochrane Central Register of Controlled Trials were searched from inception date to October 15, 2025. Randomized controlled trials (RCTs) and observational studies comparing TXA with control (placebo or no TXA) in patients undergoing orthopaedic surgery who reported rates of HO were included. Data were pooled using a random-effects model, and subgroup and sensitivity analyses were performed. RESULTS: Six studies involving 1456 patients (TXA = 778, Control = 678) were included. All included studies reported HO outcomes. When stratified by study design, pooled analysis of randomized controlled trials (RCTs) showed no significant reduction in HO incidence with TXA (OR = 0.92, 95% CI 0.11-7.77; I = 55.3%). In contrast, observational studies demonstrated a significant association between TXA use and reduced HO incidence (OR = 0.59, 95% CI 0.45-0.77; I = 0%). Safety outcomes were reported in only one study. No statistically significant differences were observed between the TXA and control groups in the incidence of deep vein thrombosis, pulmonary embolism, or wound infection. CONCLUSIONS: Current evidence does not demonstrate a statistically significant reduction in heterotopic ossification with tranexamic acid based on randomized data. Although observational studies suggest a potential association, this finding may be influenced by confounding and should be interpreted with caution.
Location and risk factors of postoperative deep venous thrombosis in patients with tibial plateau fracture: a retrospective single-center study.
Tang ZD, Wang MY, Wang HP … +4 more , Song XZ, Liu SJ, Lan YP, Li TY
BMC Surg · 2026 May · PMID 42210200 · Full text
BACKGROUND: Deep vein thrombosis (DVT) is a common postoperative complication in patients with tibial plateau fractures. The aim of this study is to determine the incidence and risk factors of postoperative DVT in patien...
BACKGROUND: Deep vein thrombosis (DVT) is a common postoperative complication in patients with tibial plateau fractures. The aim of this study is to determine the incidence and risk factors of postoperative DVT in patients with tibial plateau fractures. METHODS: We conducted a retrospective study from January 1, 2023, to December 31, 2025. The primary endpoints of this study were the prone site and risk factors of DVT. Univariate analysis and multivariate Logistic regression analysis were used to analyze the related factors, and the receiver operating characteristic (ROC) curve was drawn to evaluate its predictive value. RESULTS: Among 890 patients, 207 (23.25%) had postoperative DVT, including 186 cases of distal thrombosis, 4 cases of proximal thrombosis, and 17 cases of mixed thrombosis, all detected DVT events were asymptomatic in the results section.Univariate analysis showed that there were significant differences in age, injury factors, fracture type, preoperative waiting time, operation time, incision length, intraoperative blood loss, preoperative hemoglobin (Hb), preoperative D-dimer, postoperative Hb, postoperative hematocrit (HCT), postoperative fibrinogen (FIB) and postoperative D-dimer levels between the two groups (P < 0.05). Multivariate logistic regression analysis showed that preoperative and postoperative D-dimer levels were independent predictive markers of postoperative DVT in patients with tibial plateau fractures. The area under the curve (AUC) of preoperative D-dimer was 0.928(95%CI = 0.910 ~ 0.946, cut-off value: 2397.0 ng/mL), and the AUC of postoperative D-dimer was 0.922(95%CI = 0.904 ~ 0.940, cut-off value: 2009.5 ng/mL), and the combined prediction efficiency of the two was higher (AUC = 0.960,95%CI = 0.948 ~ 0.971). CONCLUSION: Postoperative DVT in patients with tibial plateau fracture is mostly distal thrombosis. D-dimer level in the 24 h before surgery and D-dimer level in the 24 h after surgery are independent risk factors for postoperative DVT.
Impact of enhanced recovery after surgery protocol on elderly patients undergoing laparoscopic hepatectomy for hepatocellular carcinoma: a retrospective propensity score matched analysis.
Hu J, Zhu H, Pan K … +4 more , Zhu J, Zhang Y, Liu Y, Zheng Y
BMC Surg · 2026 May · PMID 42204525 · Full text
BACKGROUND: Elderly patients with hepatocellular carcinoma (HCC) are particularly vulnerable to postoperative complications after liver resection. Evidence on enhanced recovery after surgery (ERAS) specifically in elderl...
BACKGROUND: Elderly patients with hepatocellular carcinoma (HCC) are particularly vulnerable to postoperative complications after liver resection. Evidence on enhanced recovery after surgery (ERAS) specifically in elderly individuals undergoing laparoscopic hepatectomy for HCC remains limited. METHODS: We retrospectively analyzed elderly patients (70-85 years) with pathologically confirmed HCC who underwent elective laparoscopic hepatectomy at a single tertiary center between June 2018 and June 2024. Patients managed with a standardized ERAS pathway were compared with those receiving conventional perioperative care. Propensity score matching (1:1) was performed based on demographic characteristics, comorbidities, liver function, and surgical factors. The primary endpoint was postoperative length of stay (LOS). Secondary endpoints included time to gastrointestinal recovery, postoperative pain scores, complications (Clavien-Dindo classification), rates of pleural effusion, 30-day readmission, and total hospitalization costs. RESULTS: After matching, baseline characteristics were well balanced between the ERAS and conventional care groups. Compared with conventional care, the ERAS group achieved earlier gastrointestinal recovery (shorter time to first flatus and liquid diet) and shorter urinary catheterization. Median postoperative LOS was significantly reduced, and total hospitalization costs were lower in the ERAS group. ERAS patients reported lower pain scores on postoperative days 1 and 3 and experienced fewer overall and pulmonary complications, particularly pleural effusion, without an increase in life-threatening (Clavien-Dindo grade IV-V) complications or 30-day readmissions. CONCLUSIONS: In carefully selected elderly patients undergoing laparoscopic hepatectomy for HCC, implementation of an ERAS protocol appears safe and feasible, and is associated with accelerated recovery, fewer complications, and reduced healthcare costs compared with conventional perioperative care. Prospective multicenter studies are warranted to confirm these findings and to further define the role of ERAS in more vulnerable elderly subgroups.
Improvement of mobility and motivation in patients with elective colorectal resection using tracking devices and utilizing self-awareness (IMPETUS): a randomized controlled trial in a traditional non-ERAS clinical setting.
Zimniak L, Soufiah E, Ha CSR … +2 more , Gretschel S, Paschold M
BMC Surg · 2026 May · PMID 42204518 · Full text
BACKGROUND: Early postoperative mobilization is a cornerstone of modern perioperative care, including in elective colorectal surgery. Here we evaluated the effectiveness of smart wearables for improving patients' mobilit...
BACKGROUND: Early postoperative mobilization is a cornerstone of modern perioperative care, including in elective colorectal surgery. Here we evaluated the effectiveness of smart wearables for improving patients' mobility and motivation during the recovery period after elective colorectal resection. METHODS: This prospective randomized two-armed clinical trial enrolled 62 patients undergoing elective colorectal resection. These patients were randomized into an intervention group that received hourly active reminders to mobilize via a smartwatch, and a control group that received only passive monitoring. All patients were given a wearable device that tracked their daily step counts. The primary end-point was the total number of steps taken within five postoperative days. Secondary end-points included complication rates, length of hospital stay, and subjective motivation, assessed using a structured questionnaire. RESULTS: Compared to the control group, the intervention group achieved significantly higher step counts (p = 0.039), and reported increased motivation for mobilization (p = 0.016). The groups did not significantly differ in overall complication rates or duration of hospital stay. CONCLUSION: Smart wearable devices with hourly active reminder functionalities effectively promoted postoperative mobility and motivation. TRIAL REGISTRATION: German Clinical Trials Register (DRKS), DRKS00039731. Registered 24.03.2026. Retrospectively registered.
Efficacy of uterine artery ascending branch ligation for preventing postpartum hemorrhage in Caesarean section for placenta previa.
Xu L, Yang Y, Zhu Y
BMC Surg · 2026 May · PMID 42204497 · Full text
BACKGROUND: Postpartum hemorrhage (PPH) remains a leading cause of maternal morbidity and mortality globally. This study aimed to assess the efficacy of ascending uterine artery ligation (AUAL) in preventing PPH among pa...
BACKGROUND: Postpartum hemorrhage (PPH) remains a leading cause of maternal morbidity and mortality globally. This study aimed to assess the efficacy of ascending uterine artery ligation (AUAL) in preventing PPH among patients undergoing cesarean section (CS) for placenta previa. METHODS: A retrospective cohort study was conducted at our institution between January 2022 and December 2024, enrolling 103 patients with placenta previa who underwent CS with concurrent AUAL. A matched control group was included, comprising 134 patients with placenta previa who underwent CS with administration of specialized uterotonic agents (without AUAL). All participants in both groups received intraoperative and postoperative oxytocin administration. Demographic characteristics and clinical outcomes were compared between the two groups, including maternal age, gestational age at delivery, parity, total surgical duration, 24-hour postpartum blood loss volume, postoperative hemoglobin concentration, occurrence of puerperal fever, and rate of uterine involution. Postoperative abdominal pain intensity was assessed via the Numerical Rating Scale (NRS). RESULTS: No statistically significant differences were observed between the AUAL group and the control group regarding maternal age, gestational age at delivery, parity, uterine involution rate, or the incidence of puerperal fever (P > 0.05). Notably, the AUAL group had significantly lower total 24-hour postpartum blood loss (495.3 ± 159.9 ml vs. 648.1 ± 246.8 ml, P < 0.001) and a smaller reduction in postoperative hemoglobin (12.8 ± 5.5 g/L vs. 16.8 ± 6.8 g/L, P < 0.001) compared with the control group. However, the AUAL group was associated with a significantly longer operative time (1.9 ± 0.4 h vs. 1.7 ± 0.5 h, P = 0.025) and more severe postoperative abdominal pain. CONCLUSIONS: AUAL serves as an effective intervention to reduce 24‑hour postoperative blood loss in patients undergoing cesarean section for placenta previa. Although it was associated with more severe postoperative abdominal pain, it does not compromise key clinical recovery outcomes.
Cervical esophagogastric anastomosis using a retrosternal gastric conduit in an adult patient with congenial type A long-gap esophageal atresia after 18 years of gastrostomy: a case report.
Kohmoto M, Yamashita T, Goto S … +9 more , Saito A, Motegi K, Ariyoshi T, Adachi S, Nakayama N, Otsuka K, Watarai Y, Murakami M, Aoki T
BMC Surg · 2026 May · PMID 42192400 · Full text
BACKGROUND: Definitive reconstruction in adulthood after 18 years of gastrostomy dependence for congenital type A long-gap esophageal atresia is extremely rare. We report an adult patient who had been reliant on gastrost...
BACKGROUND: Definitive reconstruction in adulthood after 18 years of gastrostomy dependence for congenital type A long-gap esophageal atresia is extremely rare. We report an adult patient who had been reliant on gastrostomy since birth and regained sustained oral intake following definitive reconstruction, emphasizing the preoperative exclusion of tracheoesophageal fistula (TEF), individualized route selection, and tailored cervical anastomosis. CASE PRESENTATION: An 18-year-old woman with type A LGEA underwent neonatal thoracotomy without definitive repair, followed by gastrostomy. At 2 years of age, cervical esophagostomy was performed for recurrent aspiration. Preoperative computed tomography showed a markedly dilated proximal cervical esophagus with esophagostomy at the left neck and absence of intramediastinal esophagus. No tracheoesophageal fistula (TEF) was identified. Anticipating posterior mediastinal adhesions and difficulty in elevating the gastric conduit through the posterior mediastinum, we planned cervical esophagogastric anastomosis using a gastric conduit via the retrosternal route. An anastomotic leak and left pneumothorax occurred postoperatively but resolved with conservative management. Left recurrent laryngeal nerve palsy occurred without aspiration. She commenced oral intake on postoperative day (POD) 12 and was discharged on POD 21. She maintained stable oral intake, and her body weight increased by 3 kg at 3 months and by 10 kg at the latest follow-up (10 months). CONCLUSION: Durable oral feeding is feasible after long-term gastrostomy in adult patients with type A LGEA when TEF is absent and the reconstruction route and anastomotic technique are individualized for adequate reach and perfusion The retrosternal route represents a viable option when posterior mediastinal adhesions or conduit reach are concerns; candidacy should be determined individually. However, these findings should be interpreted with caution because this report describes a single case, and further studies are needed to clarify the long-term outcomes of delayed reconstruction in adults with long-gap esophageal atresia.
Preoperative imaging strategies to optimize surgical treatment in primary hyperparathyroidism (pHPT).
Fries F, Thaeren J, Greschus S … +9 more , Muschler E, Palmedo H, Loriz HL, Cerasani N, Türler A, Klozoris S, Schmitz U, Kristiansen G, Wilhelm K
BMC Surg · 2026 May · PMID 42192369 · Full text
PURPOSE: Accurate preoperative localization of parathyroid adenomas is essential to enable targeted and minimally invasive surgery in patients with primary hyperparathyroidism (pHPT). A variety of imaging techniques are...
PURPOSE: Accurate preoperative localization of parathyroid adenomas is essential to enable targeted and minimally invasive surgery in patients with primary hyperparathyroidism (pHPT). A variety of imaging techniques are available for this purpose. In routine clinical practice, cervical ultrasound (US) combined with scintigraphy is most commonly used as the initial diagnostic approach. However, the optimal strategy or combination of imaging modalities for reliable localization prior to surgery and its relevance for postoperative outcomes remains a matter of ongoing discussion. The aim of this study was therefore to evaluate the diagnostic performance of different preoperative imaging modalities and their combinations for the detection and localization of parathyroid pathology in a large cohort of patients treated at a specialized thyroid center. This study investigated how well the values reported under controlled study conditions translate to clinical practice and real-world application. METHODS: This retrospective study included 325 patients who underwent minimally invasive parathyroidectomy for primary hyperparathyroidism between January 2015 and December 2023. All patients were evaluated with respect to the preoperative imaging modalities used for localization of the pathological parathyroid gland. In most cases, the standard diagnostic approach consisting of cervical US and scintigraphy was performed initially. When these examinations did not provide conclusive localization, additional imaging techniques were applied, including magnetic resonance imaging (MRI), computed tomography (CT), or 18-fluorocholine PET-CT (18-F PET-CT). In selected cases, invasive selective venous blood sampling (SVS) was also performed. The diagnostic performance of the different imaging modalities was assessed with regard to correct preoperative localization of the adenoma. Furthermore, the influence of factors such as concomitant thyroid disease, previous thyroid or parathyroid surgery, adenoma size and weight, as well as biochemical parameters including calcium and parathyroid hormone levels before, during, and after surgery was analyzed. RESULTS: The primary endpoint of postoperative normalization of parathyroid hormone levels after minimally invasive parathyroidectomy was achieved in 94.2% of patients undergoing surgery. The combination of US and scintigraphy as the primary examination procedures was able to provide clear information regarding the localization of the adenoma in 51% of cases, in all other cases one or more additional imaging procedure had to be performed. On average, three examination modalities (triple localization methods) had to be performed per patient (IQR 2.00 - 3.00), with MRI as the most common supplemented procedure, so that in the end a median of two examinations (IQR 1.00 - 3.00) consistently indicated the correct localization. Related to the individual method, US had the highest over-all sensitivity (69.4%) of the imaging procedures. Scintigraphy and SPECT-CT had a similarly high sensitivity of 58.0% for scintigraphy and 56.4% for SPECT-CT. MRI still achieved a sensitivity of 52.9%, CT 36.6%, 18-fluocholine PET-CT 100% and selective venous blood sampling only 60%. The values in clinical practice and broader real-world application with exception of 18-fluocholine PET-CT were below those reported under controlled study conditions. US, scintigraphy, SPECT-CT and MRI each showed a decrease in the sensitivity of correct preoperative localization in the presence of simultaneous thyroid disease. Selective venous blood sampling showed a drop in sensitivity from 80% without prior surgery to 28.6% with prior thyroid or parathyroid surgery. The mean values of correctly selected parathyroid adenomas suggested that larger and more heavy parathyroid adenomas were more likely to be recognized. It was shown that parathyroid adenomas examined by US, scintigraphy, SPECT-CT and additional MRI had a significantly lower volume (p = 0.004) and weight (p = 0.045) than those examined by US and scintigraphy alone. The possibility of successful preoperative localization did not depend on the specific parathyroid hormone level. In contrast, it was shown that higher preoperative calcium levels do not necessarily correlate with easier imaging detection, but lower calcium levels are more often associated with greater diagnostic effort. In contrast, preoperatively determined parathyroid hormone correlated moderately with adenoma weight (r = 0.44; p < 0.001) and adenoma volume (r = 0.17, p = 0.024), whereas calcium showed only weak, albeit significant, correlations with adenoma weight (r = 0.20; p = 0.005) and volume (r = 0.17; p = 0.024). Without concomitant thyroid disease, the US determined volume correlated very strongly with the histopathologically determined volume with a Spearman correlation coefficient of 0.702 (p <.001). With concomitant thyroid disease, the Spearman correlation coefficient decreased to 0.60 (p <.001), although there was still a strong correlation. CONCLUSION: The findings of this study indicate that the combination of cervical ultrasound and scintigraphy remains an effective first-line imaging strategy for the localization of parathyroid adenomas in the majority of patients undergoing surgery for primary hyperparathyroidism in routine clinical practice. This approach was associated with a high success rate of minimally invasive parathyroidectomy in a specialized thyroid center. Nevertheless, a considerable proportion of patients required additional imaging modalities to achieve reliable preoperative localization, with MRI representing the most frequently used supplementary technique.
The knowledge-perception nexus: socio-linguistic disparities in surgical informed consent among patients at Ethiopian tertiary hospitals.
Tolera BD, Altaye EA, Gebretensaye TG
BMC Surg · 2026 May · PMID 42192352 · Full text
BACKGROUND: Surgical informed consent (SIC), the ethical bedrock of patient autonomy is undermined by profound sociodemographic disparities in resource-limited settings. This study aimed to evaluate the knowledge-percept...
BACKGROUND: Surgical informed consent (SIC), the ethical bedrock of patient autonomy is undermined by profound sociodemographic disparities in resource-limited settings. This study aimed to evaluate the knowledge-perception nexus and sociolinguistic determinants of SIC comprehension among surgical patients in Ethiopian tertiary hospitals. METHODS: This institution-based cross-sectional study was conducted among 412 surgical patients in Addis Ababa tertiary hospitals between March 8 to April 30, 2023. The validated interviewer-administered questionnaire was used to assess knowledge and perceptions. Descriptive statistics were used to summarize participant characteristics, and multivariable logistic regression identified predictors (P < 0.05). RESULTS: Only 52.2% demonstrated adequate SIC knowledge; 57.8% had positive perceptions. strongest knowledge predictors were higher education (AOR = 5.21, 95% CI: 3.12-8.68), prior surgery (AOR = 4.58, 95% CI: 2.87-7.32), male sex (AOR = 2.28, 95% CI: 1.52-3.42), and native-language proficiency (AOR = 1.83, 95% CI: 1.09-3.07). Favorable perception associated with urban residence (AOR = 3.99, 95% CI: 2.34-6.80) and marriage (AOR = 1.79, 95% CI: 1.16-2.78). Adequate knowledge independently predicted positive perception (AOR = 1.64, 95% CI: 1.02-2.62), explaining 68% of perception variance. CONCLUSION: Surgical patients in Ethiopia demonstrated inadequate knowledge and perceptions of informed consent, influenced by gender, education, residence, and language barriers. The association between knowledge and perception highlights the need for culturally appropriate interventions, including teach-back methods and shared decision-making to improve informed consent practices and surgical care outcomes in resource-limited settings.
A Clinical nomogram for predicting chronic postsurgical pain in patients undergoing video-assisted thoracoscopic surgery.
Weinian W, Yongjun L
BMC Surg · 2026 May · PMID 42192350 · Full text
OBJECTIVE: To develop and internally validate a clinical nomogram for predicting chronic postsurgical pain (CPSP) in patients undergoing video-assisted thoracoscopic surgery (VATS), with the aim of facilitating early ide...
OBJECTIVE: To develop and internally validate a clinical nomogram for predicting chronic postsurgical pain (CPSP) in patients undergoing video-assisted thoracoscopic surgery (VATS), with the aim of facilitating early identification of high-risk patients and personalized perioperative management. METHODS: This retrospective case-control study enrolled 500 patients who underwent VATS between January 2022 and June 2024. Based on the presence of pain at 3 months postoperatively, patients were categorized into CPSP (n = 92) and non-CPSP (n = 408) groups. Perioperative variables including demographics, surgical details, and daily pain scores (visual analog scale, VAS) assessed at rest, during coughing, and during shoulder abduction on postoperative days 1 through 6 were collected. Univariate analysis, LASSO regression, and multivariate logistic regression were used to identify independent predictors. A nomogram was constructed and validated in a split cohort (70% training, 30% validation) using discrimination (area under the curve, AUC), calibration (Hosmer-Lemeshow test), and decision curve analysis. RESULTS: Multivariate analysis identified higher postoperative shoulder abduction pain (OR = 2.012, 95% CI: 1.601-2.528), scar length (OR = 1.285, 95% CI: 1.101-1.500), and preoperative anxiety (OR = 3.245, 95% CI: 1.502-7.012) as independent risk factors for CPSP, while the use of intercostal sutures was a protective factor (OR = 0.221, 95% CI: 0.088-0.557). The nomogram incorporating these four predictors demonstrated excellent discrimination (training set AUC = 0.852, 95% CI: 0.805-0.899; validation set AUC = 0.837, 95% CI: 0.758-0.916) and good calibration (P > 0.05). Decision curve analysis confirmed its clinical utility across a wide threshold probability range. CONCLUSION: A practical nomogram integrating postoperative shoulder abduction pain, scar length, preoperative anxiety, and intercostal suture use effectively predicts CPSP risk after VATS. This tool may assist clinicians in risk stratification, optimization of analgesic strategies, and implementation of targeted interventions to potentially reduce the incidence of CPSP.
Early versus delayed weight-bearing after ORIF of isolated AO/OTA 44-B1 lateral malleolar fractures: a retrospective cohort study.
Güzel İ, Saraç H
BMC Surg · 2026 May · PMID 42186020 · Full text
BACKGROUND: The optimal timing of weight-bearing after surgical fixation of isolated lateral malleolar fractures remains debated. Although delayed mobilization is commonly practiced, early weight-bearing has been propose...
BACKGROUND: The optimal timing of weight-bearing after surgical fixation of isolated lateral malleolar fractures remains debated. Although delayed mobilization is commonly practiced, early weight-bearing has been proposed as a strategy to improve functional recovery without increasing complications. This study compared early versus delayed weight-bearing following operative treatment of AO/OTA 44-B1 fractures using a homogeneous fracture cohort. METHODS: This retrospective cohort study included 89 adults who underwent open reduction and internal fixation for isolated lateral malleolar fractures between January 2018 and December 2021. Patients were managed with either early weight-bearing initiated within two weeks postoperatively (n = 37) or delayed weight-bearing after six weeks (n = 52). All patients had a minimum follow-up of 24 months. Outcomes included postoperative complications, radiographic union time, and final functional status using the American Orthopaedic Foot and Ankle Society (AOFAS) score. Statistical analyses included chi-square tests, t-tests, and exploratory logistic regression. RESULTS: Overall complication rates did not differ significantly between the early and delayed groups (3/37 [8.1%] vs. 6/52 [11.5%], p = 0.61). Time to radiographic union was comparable (7.1 ± 1.2 vs. 7.3 ± 1.5 weeks, p = 0.43). Final AOFAS scores were similar between groups (91.8 ± 5.4 vs. 90.9 ± 6.2, p = 0.47). AOFAS ≥ 90 was achieved in 32/37 (86.5%) patients in the early group and 41/52 (78.8%) in the delayed group (p = 0.38). In exploratory multivariate analysis, early weight-bearing was not significantly associated with postoperative complications. CONCLUSION: Early weight-bearing after operative fixation of isolated lateral malleolar fractures was not associated with increased complication rates or delayed union in this retrospective cohort. Functional outcomes were comparable between groups. These findings suggest that early weight-bearing may be considered in appropriately selected patients with stable fixation; however, prospective randomized studies are required to confirm these results.
Spatial posture perception method combined with ball-tip technique improves pedicle screw placement in adult degenerative scoliosis: a dual-center retrospective cohort study.
Xu X, Song L, Wang K … +3 more , Wang F, Zhang Z, Song R
BMC Surg · 2026 May · PMID 42186011 · Full text
BACKGROUND: Freehand pedicle screw placement is challenging in adult degenerative scoliosis owing to vertebral rotation and pedicle deformity. We evaluated whether the SPPM+ball-tip workflow was associated with improved...
BACKGROUND: Freehand pedicle screw placement is challenging in adult degenerative scoliosis owing to vertebral rotation and pedicle deformity. We evaluated whether the SPPM+ball-tip workflow was associated with improved intraoperative performance and screw accuracy versus the freehand approach. METHODS: In this dual-center, retrospective study, 44 adults who underwent posterior thoracolumbar deformity correction (January 2018-January 2024) were assigned to SPPM+ball-tip (n = 22; 320 screws) or freehand (n = 22; 340 screws). The primary outcome was initial pedicle screw placement accuracy on early postoperative CT according to the Gertzbein-Robbins classification. Secondary outcomes included screw insertion time, intraoperative fluoroscopy exposures, blood loss, delayed screw-related mechanical complications, and radiographic correction at 1 week and 1 year. RESULTS: The SPPM+ball-tip workflow was associated with higher accuracy than freehand (Grade A 90.6% [290/320] vs. 70.9% [241/340]; clinically acceptable Grades A-B 96.0% [307/320] vs. 87.1% [296/340]; poor C-E 4.0% vs. 12.9%; all P < 0.001). Mean insertion time was shorter (2.45 ± 1.02 vs. 5.12 ± 1.67 min/screw; P < 0.001), fluoroscopy exposures fewer (4.1 ± 2.2 vs. 11.1 ± 3.3; P < 0.001), and blood loss lower (280.7 ± 102.3 vs. 450.4 ± 118.7 mL; P < 0.001). Screw cut-out occurred in 0 vs. 5 cases (P = 0.044). Cobb angle correction at 1 week and 1 year was comparable between groups (both P > 0.05). CONCLUSION: The SPPM+ball-tip workflow was associated with higher pedicle screw accuracy and greater operative efficiency, while showing lower radiation exposure and lower intraoperative blood loss, without compromising deformity correction. These findings support the SPPM+ball-tip workflow as a potentially practical alternative to freehand placement. However, because the intervention was evaluated as a combined workflow rather than as isolated components, the independent contribution of SPPM itself cannot be determined from the present study. Prospective multicenter studies are warranted.
Early versus delayed laparoscopic cholecystectomy following endoscopic retrograde cholangiopancreatography for concomitant gallstones and common bile duct stones: a retrospective study.
Liu J, Chen H, Liu S … +2 more , Sha Z, Feng Y
BMC Surg · 2026 May · PMID 42186002 · Full text
BACKGROUND: The optimal timing for laparoscopic cholecystectomy (LC) following endoscopic retrograde cholangiopancreatography (ERCP) in patients with both gallbladder and common bile duct stones remains debated. This stu...
BACKGROUND: The optimal timing for laparoscopic cholecystectomy (LC) following endoscopic retrograde cholangiopancreatography (ERCP) in patients with both gallbladder and common bile duct stones remains debated. This study aimed to evaluate clinical outcomes based on the timing interval of sequential LC performed within two weeks post-ERCP. METHODS: We conducted a retrospective analysis of 241 patients with concomitant cholecystolithiasis and choledocholithiasis who underwent ERCP followed by LC at our institution between January 2018 and December 2023. Patients were stratified into three cohorts based on the ERCP-to-LC interval: Group A (≤ 24 h, n = 78), Group B (24-72 h, n = 83), and Group C (72 h-2 weeks, n = 80). Comparative analyses were performed regarding baseline demographics, perioperative laboratory and imaging data, surgical findings, and postoperative recovery. Logistic regression was employed to determine risk factors associated with delayed surgery (72 h-2 weeks). RESULTS: Compared to Groups A and B, Group C exhibited a significantly prolonged total hospital stay (P < 0.001) and increased overall medical expenses (P < 0.001). Furthermore, Group C demonstrated higher incidences of post-ERCP acute cholecystitis (P = 0.005) and total postoperative adverse events (P = 0.042). Multivariate analysis identified preoperative total bilirubin exceeding three times the upper limit of normal, post-ERCP pancreatitis, and post-ERCP bleeding as independent predictors for delayed LC. CONCLUSION: In the absence of serious complications or high-risk factors, performing LC within 72 h after ERCP is recommended to reduce hospital stay, lower healthcare costs, and minimize complication rates. However, for patients presenting with severe preoperative hyperbilirubinemia or post-ERCP adverse events, a delayed surgical approach following comprehensive individual assessment is recommended.
Efficacy and safety of high-frequency electrosurgery, ultrasonic scalpel, and bipolar electrocoagulation in parathyroidectomy for secondary hyperparathyroidism: a 3-year follow-up retrospective study.
Wang D, Wang Z, Li J … +2 more , Gao Z, Zou S
BMC Surg · 2026 May · PMID 42185852 · Full text
BACKGROUND: This study aimed to evaluate the surgical outcomes of parathyroidectomy (PTX) for secondary hyperparathyroidism (SHPT) in hemodialysis patients, comparing the use of three operative techniques: high-frequency...
BACKGROUND: This study aimed to evaluate the surgical outcomes of parathyroidectomy (PTX) for secondary hyperparathyroidism (SHPT) in hemodialysis patients, comparing the use of three operative techniques: high-frequency electrosurgery (HFE), ultrasonic scalpel (US), and bipolar electrocoagulation (BPE). METHODS: The patients were divided into three groups based on the type of surgical instruments used. Outcomes assessed included surgical efficiency, postoperative complications, recurrence rate, hospitalization costs, biochemical and nutritional parameters over 1 year, and overall survival through March 2025. RESULTS: A total of 171 patients were retrospectively categorized into three groups: HFE (n = 50), US (n = 60), and BPE (n = 61). Compared to group HFE, both the US and BPE groups exhibited significantly shorter durations for drainage tube removal, operative times, and postoperative hospital stays (all p < 0.05). The BPE group also had significantly lower intraoperative blood loss compared to the US and HFE groups (p < 0.05) and incurred the lowest hospitalization costs. The incidence of postoperative complications and recurrence rates did not differ significantly among groups. All groups showed marked reductions in serum calcium, phosphorus, and intact parathyroid hormone levels postoperatively, which stabilized over time with no significant differences between groups. At the 1-year follow-up, patients exhibited significant improvements in anemia-related and nutritional markers compared to baseline. With follow-up extending to March 2025, overall survival did not differ significantly among the three surgical groups (p = 0.987). CONCLUSIONS: PTX effectively corrected SHPT, improved anemia, and enhanced nutritional status in hemodialysis patients. All three surgical techniques, HFE, US, and BPE, were safe and effective, with comparable long-term survival. However, US and BPE offered superior operative efficiency, and BPE represented the most cost-effective option.
Comparative safety and efficacy of gelatin-thrombin matrix sealants versus conventional hemostatic agents in spinal surgery: a systematic review and meta-analysis.
Fang Z, Zhu L, Bao Y … +2 more , Hong Z, Hong H
BMC Surg · 2026 May · PMID 42185846 · Full text
BACKGROUND: Gelatin-thrombin matrix sealants (GTMS), such as Floseal and Surgiflo, are increasingly used to achieve rapid hemostasis in spine surgery, where bleeding control is challenging due to the rich epidural venous...
BACKGROUND: Gelatin-thrombin matrix sealants (GTMS), such as Floseal and Surgiflo, are increasingly used to achieve rapid hemostasis in spine surgery, where bleeding control is challenging due to the rich epidural venous plexus. However, their comparative effectiveness and safety remain unclear. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of GTMS in spine surgery. METHODS: This systematic review and meta-analysis was performed in line with the methodological framework outlined in the PRISMA 2020 statement. A comprehensive literature search was carried out across PubMed, Embase, the Cochrane Library, and Web of Science, covering all eligible studies published up to August 2025. Randomized controlled trials evaluating the use of gelatin-thrombin matrix sealants (GTMS) versus alternative topical hemostatic agents or conventional hemostatic approaches in spine surgery were considered eligible. Pooled estimates were synthesized using a random-effects model and expressed as weighted mean differences (WMDs), standardized mean differences (SMDs), or odds ratios (ORs), together with corresponding 95% confidence intervals (CIs). RESULTS: Seven randomized controlled trials were included. GTMS was associated with a higher 3-min hemostasis success rate than control interventions (OR = 2.50, 95% CI: 1.40-4.45). A borderline reduction in intraoperative blood loss was observed with GTMS (SMD = - 1.05, 95% CI: - 2.11 to 0.00), and GTMS was associated with lower total postoperative drainage volume (WMD = - 16.34 mL, 95% CI: - 24.64 to - 8.04). No significant differences were observed in intraoperative or postoperative transfusion rates, postoperative hemoglobin levels, or postoperative day 1 drainage volume. Adverse events were infrequent and comparable between groups. CONCLUSION: Current randomized evidence suggests that GTMS may improve selected local hemostatic outcomes in spine surgery, particularly early hemostasis. However, the observed reduction in intraoperative blood loss was borderline and accompanied by substantial heterogeneity, and no clear benefit was observed for transfusion requirements, postoperative hemoglobin levels, or perioperative complications. The potential value of GTMS may be more relevant in procedures involving diffuse venous bleeding or technically constrained operative fields. Given the limited number of included trials and the clinical heterogeneity across surgical settings, further well-designed randomized studies are needed to clarify the patient populations and operative scenarios in which GTMS may provide clinically meaningful benefit.
Transumbilical single-incision laparoscopic-assisted removal of gastric trichobezoars in children: a technical refinement and feasibility study.
Maher A, Eltayeb AA, Ibrahim H
BMC Surg · 2026 May · PMID 42185791 · Full text
BACKGROUND: Gastric trichobezoars are rare in children and adolescents and are often associated with psychiatric disorders such as trichotillomania and trichophagia. While surgical removal remains the definitive treatmen...
BACKGROUND: Gastric trichobezoars are rare in children and adolescents and are often associated with psychiatric disorders such as trichotillomania and trichophagia. While surgical removal remains the definitive treatment for large bezoars, optimal management must consider not only technical success but also cosmetic outcomes, psychosocial impact, and feasibility in low-resource settings. The aim of the study was to evaluate the safety, feasiblity, and cosmetic of a transumbilical single-incision laparoscopic-assisted technique for gastric trichobezoar removal in children. METHODS: We conducted a retrospective review of pediatric patients who underwent transumbilical single-incision laparoscopic-assisted removal of gastric trichobezoars. Demographic, characteristics, psychiatric comorbidity, clinical presentation, imaging findings, operative details, and postoperative outcomes were analyzed. RESULTS: Five pediatric patients (median age 12 years; range, 9-14 years) were included. Psychiatric comorbidity was present in four of five patients (80%). Complete bezoar removal was achieved in all cases without conversion to open surgery. The median operative time was 120 min (range, 90-150 min). One patient developed a superficial wound infection that resolved with conservative management. The median hospital stay was 3 days (range, 2-4 days). Umbilical scars were well concealed in all patients, with satisfactory early cosmetic outcomes. CONCLUSION: The transumbilical laparoscopic-assisted approach was safe and effective, with concealed scarring and demonstrated feasibility using standard surgical instruments.
Application of indocyanine green fluorescence-guided laparoscopic hepatectomy in patients with liver metastases: a retrospective single‑center study.
Liu L, Shen M, Wang Q … +5 more , Ma P, Yin Y, Liu F, Ren C, Xu Q
BMC Surg · 2026 May · PMID 42178544 · Full text
The present study aimed to investigate the efficacy of indocyanine green (ICG) fluorescence-guided laparoscopic hepatectomy for the treatment of liver metastases. Therefore, data from patients with liver metastases who u...
The present study aimed to investigate the efficacy of indocyanine green (ICG) fluorescence-guided laparoscopic hepatectomy for the treatment of liver metastases. Therefore, data from patients with liver metastases who underwent laparoscopic hepatectomy were retrospectively collected. A total of 69 patients were divided into the ICG group (fluorescence-guided) and conventional group, with 24 well-matched pairs analyzed after propensity score matching. Laparoscopic hepatectomy was successfully performed in all patients.The ICG group had significantly wider surgical margins than the conventional group (1.73 ± 0.57 cm vs. 1.04 ± 0.44 cm; P < 0.001). Pre-matching R0 resection rates were 91.9% (ICG) and 90.6% (conventional), with 100% R0 resection achieved in both groups post-matching. Operative time, intraoperative blood loss and postoperative ALT levels were numerically lower in the ICG group without statistical significance. The rates of overall/severe (Clavien-Dindo ≥IIIa) complications and 6-month recurrence were comparable between the two groups (all P > 0.05). In conclusion, ICG fluorescence-guided laparoscopic hepatectomy is safe and feasible for liver metastases, yielding significantly wider surgical margins. Although perioperative outcomes and 6-month recurrence rates were comparable between groups after matching, the ICG-guided approach achieved significantly wider surgical margins-a finding with potential implications for long-term oncological outcomes that warrant further investigation.
Lower limb compensation mechanisms influencing sagittal balance after lumbar fusion.
Baisamy V, Daher M, Sebaaly A … +5 more , Cresson T, de Guise J, Vazquez C, Shen J, Wang Z
BMC Surg · 2026 May · PMID 42178537 · Full text
BACKGROUND: The adoption of whole-body imaging in routine practice has allowed radiographic analysis of the lower limbs, even in degenerative pathologies. This work aims to characterize the occurrence of knee flexion in...
BACKGROUND: The adoption of whole-body imaging in routine practice has allowed radiographic analysis of the lower limbs, even in degenerative pathologies. This work aims to characterize the occurrence of knee flexion in relation to global and regional sagittal parameters of the spine in lumbar degenerative pathologies. METHODS: This work is a single-center retrospective analysis including patients who underwent lumbar spine fusion for degenerative pathology. All included patients had biplanar whole-body imaging before and after surgery with a minimum of 6 months of follow-up. Exclusion criteria were patients with prior spine surgery and total knee replacement before lumbar spine fusion. Patients were grouped based on preoperative knee flexion threshold (10°) and postoperative changes in knee flexion (ΔKF). RESULTS: Postural parameters of 108 patients (65 M; 43 F) with an average age of 63.02 years were studied. Patients with greater preoperative knee flexion (n = 68) had significantly greater PI-LL mismatch (9.88 +/- 10.48° vs. 0.57 +/- 12.19°) and SVA (5.7 +/- 4.2 cm vs. 2.1 +/- 3.9 cm) than the group with less knee flexion (n = 44). Patients with exacerbated knee flexion postoperatively (n = 57) had significantly greater PI-LL mismatch (p = 0.01) as well as loss of lordosis (p = 0.04) after surgery compared to the group with less flexion (n = 51) without any impact on SVA. CONCLUSION: Knee flexion angle can help quantify lower limb compensation in relation to spinopelvic misalignment in patients operated on for degenerative pathologies. Nevertheless, further work is needed to fully understand the complex interplay of compensation mechanisms in the face of sagittal imbalance and spinopelvic malalignment.
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