BMC Surgery[JOURNAL]
Sun
200 papers
The influence of different bariatric surgeries on male sex hormones and semen parameters among infertile obese male patients: an observational study.
Azhary M, Ali MH, AbdELsalam MA … +3 more , Elshal M, Abdelmonim AM, Ahmed EF
BMC Surg · 2026 May · PMID 42177498 · Full text
BACKGROUND: This research examines the impact of bariatric procedures on male sex hormones and semen parameters in infertile men with obesity. Obesity adversely affects male fertility by causing hormonal imbalances and w...
BACKGROUND: This research examines the impact of bariatric procedures on male sex hormones and semen parameters in infertile men with obesity. Obesity adversely affects male fertility by causing hormonal imbalances and worsening semen quality. Metabolic and bariatric surgery (MBS) offers sustained weight loss and potential reversal of these abnormalities. METHODS: This prospective case series included 43 infertile men with severe obesity who underwent sleeve gastrectomy, One-anastomosis gastric bypass (OAGB), or Roux-en-Y gastric bypass. All participants had a BMI ≥ 35 kg/m² and a history of infertility for over one year. Semen analysis and hormonal profiling (FSH, LH, total testosterone, estradiol [E2], and prolactin) were conducted preoperatively and at 3, 6, and 12 months postoperatively. RESULTS: Significant weight loss was observed at all follow-up points (p ≤ 0.003). Improvements were noted in semen motility, progressive motility, vitality, and abnormal forms (all p ≤ 0.003). Serum testosterone levels increased, while estradiol levels decreased significantly (p ≤ 0.003). Changes in FSH, LH, and prolactin were statistically insignificant. CONCLUSIONS: Metabolic and bariatric surgery (MBS) is associated with marked improvements in semen quality and serum testosterone levels, supporting its role as an effective therapeutic strategy for obesity-related male infertility. No pregnancies were recorded during the 12-month follow-up. TRIAL REGISTRATION: Not applicable.
Slow debridement combined with hemi-Masquelet technique for post-traumatic chronic osteomyelitis calcaneal bone defect.
Yang X, Li Y, Liu Y … +3 more , Yang F, Zhou W, Li N
BMC Surg · 2026 May · PMID 42177466 · Full text
BACKGROUND: The treatment of calcaneal osteomyelitis presents considerable challenges to orthopedic surgeons. The objective of this study was to explore an effective approach for the radical treatment of the disease and...
BACKGROUND: The treatment of calcaneal osteomyelitis presents considerable challenges to orthopedic surgeons. The objective of this study was to explore an effective approach for the radical treatment of the disease and to examine a novel bone grafting strategy for better functional recovery. METHODS: Between 2021 and 2025, 9 patients with chronic calcaneal osteomyelitis were treated via slow debridement combined with the Masquelet technique using structural bone grafting. The number of debridement, complications during treatment, and recurrence rates were recorded and analyzed. Postoperative hindfoot function was assessed by using the American Orthopedic Foot and Ankle Society (AOFAS) ankle and hindfoot scoring system. RESULTS: All 9 (100%) patients achieved infection eradication after an average of 1.7 (range, 1-3) debridement. Preoperative infectious symptoms, including sinus tracts, redness and swelling, were generally eliminated. All patients achieved bony healing of the calcaneal defect and could tolerate full weight bearing without pain within one year after surgery. The average AOFAS ankle and hindfoot score was 93 (range, 86-100), and the calcaneal defects of all 9 patients achieved bony healing. CONCLUSIONS: Slow debridement combined with the Masquelet technique using via structural bone grafting is an effective method for treating posttraumatic chronic calcaneal osteomyelitis. The application of this technique can lead to the complete elimination of infection as well as the preservation of hindfoot function in a cost-effective manner for patients with posttraumatic chronic calcaneal osteomyelitis.
The concept of Laparoscopic Intracorporeal Rectus Aponeuroplasty (LIRA) technique in complex abdominal hernias based on size and location.
Morales-Conde S, Tamburi V, Curado Soriano A … +6 more , Naranjo Fernández JR, Domínguez-Muñoz M, Cañizares Jorva I, Castrodá Cópa D, Gómez-Menchero J, Balla A
BMC Surg · 2026 May · PMID 42177464 · Full text
BACKGROUND: The management of complex abdominal wall hernias remains a surgical challenge, particularly in selecting the most appropriate technique. This study reports our experience with the laparoscopic repair of compl...
BACKGROUND: The management of complex abdominal wall hernias remains a surgical challenge, particularly in selecting the most appropriate technique. This study reports our experience with the laparoscopic repair of complex hernias using the laparoscopic intracorporeal rectus aponeuroplasty (LIRA) technique concept and its evolution as LIRA-like, LIRA with transabdominal preperitoneal extension (LIRA-TAPE), and the LIRA-Sugarbaker technique in case of parastomal hernia. METHODS: A retrospective analysis of prospectively collected data was conducted from 2019 to 2025. Hernias were classified according to the European Hernia Society classification. Techniques were selected based on hernia location: LIRA for M1-M4 W3 defects, LIRA-like for L1-L4 W1-W3, LIRA-TAPE for M5 W1-W3, and the LIRA-Sugarbaker for parastomal hernias. Postoperative seroma was classified according to the Morales-Conde classification. RESULTS: Nine patients underwent LIRA. Median defect width was 11 cm (range 10-15 cm) and median operative time was 100 min (range 60-173 min). Seromas occurred in 3 patients (33.3%) (two type I and one type II-a), all managed conservatively. Recurrences did not occur. In the LIRA-like group (11 patients), median defect width was 8 cm (range 1.5-14 cm), and median operative time was 60 min (range 25-110 min). Seromas occurred in 6 patients (54.5%) (one type I, two type II-a and 3 type II-b). One recurrence (9.1%) occurred due to central mesh failure. Seven patients with median defect width measured 10 cm (range 7-18 cm) underwent LIRA-TAPE. Median operative time was 70 min (range 45-110 min). One patient (14.3%) developed ileus and one (14.3%) seroma (type III-a), treated conservatively. Recurrences did not occur. Three patients, with median defect width of 9 cm (range 7-11 cm) underwent LIRA-Sugarbaker technique. Median operative time was 95 min (range 85-110 min). Across all groups, no intraoperative complications or conversions occurred. CONCLUSIONS: In this single-center retrospective study, the LIRA concept for the treatment of complex ventral hernias appears to be a safe and feasible approach, allowing tension-free defect closure with encouraging short-term outcomes.
Intraoperative complications during gender-affirming laparoscopic hysterectomy in transgender men receiving testosterone: a case series.
Rokhgireh S, Norouzi S, Derakhshan R … +3 more , Hashemi N, Pourbarghi M, Salehi Z
BMC Surg · 2026 May · PMID 42177449 · Full text
BACKGROUND: Laparoscopic hysterectomy is a core component of gender-affirming care for transgender men. However, long-term testosterone therapy can lead to anatomical and tissue changes that increase the complexity of pe...
BACKGROUND: Laparoscopic hysterectomy is a core component of gender-affirming care for transgender men. However, long-term testosterone therapy can lead to anatomical and tissue changes that increase the complexity of pelvic surgery. OBJECTIVE: To describe the intraoperative complications encountered during gender-affirming laparoscopic hysterectomy in transgender men receiving testosterone therapy and discuss strategies for mitigation. METHODS: This retrospective case series includes four transgender men undergoing total laparoscopic hysterectomy at a tertiary academic center. All patients were nulliparous virgins with ≥ 2.5 years of testosterone therapy. Clinical data, intraoperative events, and management strategies were analyzed. RESULTS: Intraoperative complications included posterior cul-de-sac perforation (n = 1), cervical avulsion requiring conversion to laparotomy (n = 1), bladder dome injury (n = 1), and deep vaginal lacerations (n = 4). Contributing factors were cervical atrophy, stenosis, and limited vaginal elasticity due to long-term testosterone exposure. Multidisciplinary support was required in two cases (urology and vascular surgery). All patients recovered without long-term sequelae, although one expressed dissatisfaction with abdominal scarring. CONCLUSION: Gender-affirming hysterectomy in transgender men presents unique challenges related to testosterone-induced anatomic changes. Preoperative planning, gentle tissue handling, customized instrumentation, and patient counseling are critical to reduce risk and optimize outcomes.
Rare giant cell tumour of the left parieto-occipital skull in an 8-year-old female patient: a case report.
Engidaw EA, Tefera EA, Bekele KM … +3 more , Belayneh EM, Tibebe SB, Seid HA
BMC Surg · 2026 May · PMID 42177430 · Full text
Giant cell tumor (GCT) of bone is a generally benign but locally aggressive neoplasm that most commonly affects the epiphysis of long bones in young adults, while involvement of the cranial bones is exceedingly rare, par...
Giant cell tumor (GCT) of bone is a generally benign but locally aggressive neoplasm that most commonly affects the epiphysis of long bones in young adults, while involvement of the cranial bones is exceedingly rare, particularly in the pediatric population. Calvarial GCTs pose significant diagnostic challenges because their clinical and radiologic features overlap with other lytic skull lesions. We report a rare case of a pediatric giant cell tumor arising from the calvarium that presented with progressive scalp swelling and localized pain. Radiologic evaluation demonstrated an expansile osteolytic lesion involving the skull with cortical destruction. Surgical excision of the lesion was performed with adequate margins, followed by histopathological examination together with clinico-radiological correlation supported the diagnosis of giant cell tumor of bone in the absence of immunohistochemistry and molecular testing. Although immunohistochemistry tests were not available, diagnosis was established based on clinicopathological correlation. The patient had an uneventful postoperative recovery with no evidence of recurrence during follow-up. This case highlights the importance of considering giant cell tumor in the differential diagnosis of pediatric calvarial lesions despite its rarity. Early recognition and complete surgical excision remain critical for optimal outcomes and for preventing local recurrence. Reporting such uncommon presentations contributes to the limited literature on cranial GCTs in children and helps improve diagnostic awareness among clinicians.
Comparative analysis of cold curettage and coblation adenoidectomy: surgical and postoperative outcomes with 0° and 70° endoscopic techniques.
Şeneldir L, Doğan VPA
BMC Surg · 2026 May · PMID 42174589 · Full text
BACKGROUND AND OBJECTIVES: Adenoidectomy is a common pediatric otolaryngologic procedure. While cold curettage remains widely practiced, endoscopic coblation has been developed to enhance precision, minimize intraoperati...
BACKGROUND AND OBJECTIVES: Adenoidectomy is a common pediatric otolaryngologic procedure. While cold curettage remains widely practiced, endoscopic coblation has been developed to enhance precision, minimize intraoperative complications, and reduce residual tissue. This study compared outcomes of conventional cold curettage adenoidectomy and coblation-assisted adenoidectomy in pediatric patients. MATERIALS AND METHODS: This study was designed as a prospective, comparative, non-randomized clinical study. A total of 128 children aged 3-11 years who underwent adenoidectomy were included. The choice of surgical technique was determined by patient (family) preference after explanation of both procedures. Patients were allocated to Group 1 (cold curettage, n = 64) or Group 2 (endoscopic coblation using 0° or 70° endoscopes, n = 64). Evaluated parameters included operative time, intraoperative blood loss, postoperative pain (VAS), halitosis, peripheral tissue injury, and residual adenoid tissue assessed at 1-, 6-, and 12-month follow-up. RESULTS: Groups were comparable in demographics and baseline adenoid grades (p = 0.689). Mean operative time was longer with coblation (26.6 ± 5.3 min) than with cold curettage (20.6 ± 3.8 min; p < 0.001), although procedures with a 70° endoscope were shorter than with a 0° (p = 0.037). Blood loss was significantly lower in the coblation group compared to the cold curettage group (12.4 ± 2.1 mL vs 24.2 ± 3.3 mL; p < 0.001). Postoperative pain scores at 24 and 72 h were also reduced in the coblation group (p < 0.001). Halitosis was more frequent after coblation (75% vs. 31.3%; p = 0.00000173) but resolved spontaneously within one week. Minor peripheral tissue injuries occurred only with cold curettage (n = 4) without sequelae. Residual adenoid tissue was detected in 29.7% of cold curettage cases but in none of the coblation cases (p = 0.00000079). CONCLUSIONS: Endoscopic coblation adenoidectomy demonstrates advantages in reduced blood loss, less postoperative pain, and elimination of residual tissue compared to cold curettage, though it requires longer operative time and carries a higher incidence of transient halitosis. TRIAL REGISTRATION: ClinicalTrials.gov, NCT07417007, 10 February 2026. Retrospectively registered.
Perioperative and short-term oncological outcomes of laparoscopic versus open pancreaticoduodenectomy: an updated systematic review and meta-analysis of randomized controlled trials with GRADE evaluation.
Qutob IA, Soliman A, Shawkat AM … +7 more , Azim AAA, Gad MM, Gamal A, Nada EA, Seliem S, Aldiban W, Assem MY
BMC Surg · 2026 May · PMID 42174581 · Full text
BACKGROUND: Surgical resection through pancreatoduodenectomy (PD) represents the only curative option for periampullary and pancreatic head tumors. Recently, laparoscopic pancreatoduodenectomy (LPD) has emerged as a mini...
BACKGROUND: Surgical resection through pancreatoduodenectomy (PD) represents the only curative option for periampullary and pancreatic head tumors. Recently, laparoscopic pancreatoduodenectomy (LPD) has emerged as a minimally invasive alternative to the open approach (OPD). However, the safety, feasibility, and short-term oncologic adequacy of LPD compared to OPD remain a matter of controversy. This systematic review and meta-analysis aimed to compare perioperative and short-term oncologic outcomes of LPD versus OPD in patients with periampullary and pancreatic head primaries. METHODS: A comprehensive literature search was performed in PubMed, Scopus, and Web of Science databases for RCTs comparing LPD and OPD in adult periampullary tumor patients. Key outcomes analyzed included operative time, blood loss, hospital length of stay, complications, mortality, and lymph node harvest. Risk of bias was assessed using the Cochrane RoB-2 tool, and the certainty of evidence was graded via GRADE. RESULTS: Seven RCTs were included, revealing that LPD is associated with longer operative times (MD~50.90 min) but significantly reduced blood loss (MD-88.83 mL), shorter hospital stays (MD-1.33 days), and fewer transfusions (RR 0.75). No significant differences were observed in 90-day mortality, overall or severe complications, lymph node retrieval, or R0 resection rates. The GRADE rating was high for clinically relevant gastric emptying, and moderate or low certainty for most other outcomes. CONCLUSION: LPD provides statistically significant perioperative advantages without compromising oncological outcomes, suggesting it is a safe and effective alternative to OPD in experienced centers.
Percutaneous laparoscopic harvest and trans-vaginal implantation of autologous rectus fascia in the treatment of severe anterior vaginal prolapse.
Guan Y, Zhang K, Han J … +4 more , Wang Y, Yao Y, Yang J, Yu B
BMC Surg · 2026 May · PMID 42174569 · Full text
OBJECTIVE: To observe the efficacy of percutaneous laparoscopic harvest and trans-vaginal implantation of autologous rectus fascia (ARF) in the treatment of severe anterior vaginal prolapse (SAP). MATERIALS AND METHODS:...
OBJECTIVE: To observe the efficacy of percutaneous laparoscopic harvest and trans-vaginal implantation of autologous rectus fascia (ARF) in the treatment of severe anterior vaginal prolapse (SAP). MATERIALS AND METHODS: All women who underwent percutaneous laparoscopic harvest and trans-vaginal Implantation of ARF to treat SAP between December 2022 to December 2023 at a single center. Major measurements include operation time, blood loss, postoperative hospital stay, Pelvic Floor Distress Inventory-20 (PFDI-20), patient satisfaction, Patient Global Impression of Improvement (PGI-I), Pelvic Organ Prolapse Quantification (POP-Q). All patients were followed up at 3 months, 1 year and 2 years after the surgery. RESULTS: 7 patients underwent pelvic floor repairing surgery using the described technique with an average age of 63.6 years, BMI 24.0 kg/m, and median parity 2. The average preoperative PFDI-20 score was 67.2. The average operation duration was 163.2 min, intraoperative blood loss was 41.4 mL, and postoperative hospital stay was 4.6 days. No severe complications occurred in the perioperative period. No patients had developed recurrence of prolapse by the average 26 months postoperative telephone follow-up. The average PFDI-20 score was 12.8 and 12.2 at 12 and 24 months of follow-up, respectively. Patient satisfaction remained high and the PGI-I outcome remained "significantly improved" in all patients. CONCLUSION: Harvesting ARF by percutaneous laparoscopy is feasible, and trans-vaginal implantation of ARF to treat SAP has good effects, high safety, and high postoperative satisfaction. More data and longer-term follow-up are needed to confirm these findings.
Learning curve for the abdominal procedure in total robot-assisted minimally invasive esophagectomy with simultaneous cervical approach: an initial experience.
Sugase T, Kanemura T, Matsuura N … +16 more , Yamamoto K, Ushimaru Y, Masuike Y, Yanagimoto Y, Yamamoto K, Mori R, Kitakaze M, Kubo M, Fukuda Y, Komatsu H, Miyo M, Sueda T, Kagawa Y, Gotoh K, Kobayashi S, Miyata H
BMC Surg · 2026 May · PMID 42174559 · Full text
BACKGROUND: Robot-assisted minimally invasive esophagectomy (RAMIE) is increasingly being implemented; however, the feasibility and learning process of total RAMIE using robotic approaches for thoracic and abdominal phas...
BACKGROUND: Robot-assisted minimally invasive esophagectomy (RAMIE) is increasingly being implemented; however, the feasibility and learning process of total RAMIE using robotic approaches for thoracic and abdominal phases remain to be fully evaluated, particularly with a dual-docking technique enabling simultaneous cervical and abdominal approaches. METHODS: We retrospectively analyzed 50 consecutive patients who underwent total RAMIE with retrosternal gastric conduit reconstruction and cervical anastomosis at a single institution between September 2024 and August 2025. Cumulative sum (CUSUM) analysis of abdominal operative time was used to assess the learning curve. Perioperative outcomes were compared between the phases. RESULTS: CUSUM analysis identified three phases: phases I (patients 1-6, learning phase), II (7-18, competence phase), and III (19-50, proficiency phase). Median abdominal operative time decreased from 139 min (124-154) in phase I to 104 min (80-137) and 87 min (66-146) in phases II and III, respectively (P < 0.001). Initially, this procedure was applied to cStage I patients without abdominal nodal involvement, and was gradually expanded to advanced disease. The number of harvested abdominal lymph nodes was 15 (6-27) in phases I and II and 17 (6-26) in phase III. Postoperative complications (Clavien-Dindo grade ≥ 2) occurred in 14% of patients, with no abdominal procedure-related morbidity observed. CONCLUSIONS: Procedural proficiency for the abdominal operative procedure was achieved in approximately 18 patients, after which operative efficiency improved without compromising oncologic thoroughness or patient safety. Total RAMIE with a two-team approach can be safely implemented in centers with experience.
Intracardiac migration of a left renal vein stent after endovascular treatment of nutcracker-associated pelvic congestion syndrome: a case report.
Hamouda M, Muehling B
BMC Surg · 2026 May · PMID 42174550 · Full text
BACKGROUND: Left renal vein (LRV) stenting is used in selected patients with symptomatic Nutcracker syndrome (NCS). Stent migration is uncommon but may be serious, particularly in interventions performed primarily for sy...
BACKGROUND: Left renal vein (LRV) stenting is used in selected patients with symptomatic Nutcracker syndrome (NCS). Stent migration is uncommon but may be serious, particularly in interventions performed primarily for symptom relief. We report intracardiac migration after combined treatment of NCS-associated pelvic congestion syndrome (PCS) and use the event to discuss patient selection, treatment sequencing, and consent in pain-driven venous interventions. CASE PRESENTATION: We report a 37-year-old woman with chronic pelvic pain and imaging findings compatible with nutcracker syndrome and associated pelvic congestion syndrome who underwent left renal vein stenting (self-expanding nitinol stent, 14 × 40 mm) with concomitant left ovarian vein coil embolisation. Fourteen days later, she presented with acute dyspnoea and palpitations. Echocardiography revealed a linear foreign body at the tricuspid valve level with severe tricuspid regurgitation, and computed tomography confirmed stent migration from the left renal vein into the right atrium and ventricle. Endovascular snare retrieval failed because of engagement of the stent struts within the tricuspid apparatus, and surgical extraction under cardiopulmonary bypass with tricuspid valve repair was required. Despite technical success of the venous interventions, pelvic pain did not improve durably. CONCLUSIONS: Intracardiac migration after LRV stenting is rare but carries substantial clinical and ethical implications in symptom-directed venous interventions. This case illustrates the importance of a cautious, conservative-first, multidisciplinary approach to chronic pelvic pain, emphasizing careful symptom attribution in NCS-associated PCS. It also suggests that a staged treatment strategy, with reassessment of early stent stability and clinical response before considering embolisation of pelvic collateral pathways, may be considered in selected patients. Possible technical contributors include venous undersizing and limited landing zones; the role of altered flow after collateral embolisation remains speculative.
Robot-assisted versus conventional laparoscopic surgery for endometrial cancer: an updated systematic review and meta-analysis.
Majeed K, Ahmed M, Ali H … +7 more , Kashif A, Murtaza M, Hanif ZM, Sidra F, Batool A, Onesime J, Akilimali A
BMC Surg · 2026 May · PMID 42174518 · Full text
BACKGROUND: Endometrial cancer is commonly treated with minimally invasive staging procedures. Whether robotic assistance improves outcomes compared with conventional laparoscopy remains debatable. Robot-assisted surgery...
BACKGROUND: Endometrial cancer is commonly treated with minimally invasive staging procedures. Whether robotic assistance improves outcomes compared with conventional laparoscopy remains debatable. Robot-assisted surgery (RAS) and conventional laparoscopic surgery (CLS) have been used to manage endometrial cancer. OBJECTIVES: To compare the perioperative and oncologic outcomes of robot-assisted and conventional laparoscopy for endometrial cancer. METHODS: We conducted a meta-analysis of studies comparing robot-assisted and conventional laparoscopic surgeries for endometrial cancer. We searched PubMed, the Cochrane Library, and Google Scholar from inception to April 15, 2025, for comparative studies. Random effects meta-analysis was used to estimate risk ratios or mean differences, and heterogeneity was assessed via the I² statistic. Relevant randomized controlled trials (RCTs) and observational studies were identified. The perioperative outcomes of interest included intraoperative visceral injuries, operation time, estimated blood loss (EBL), blood transfusion, total number of lymph nodes harvested (TLNH), conversion to laparotomy, length of hospital stay, recurrence and overall 3-year and 5-year survival rates. Data were synthesized via random effects models, and heterogeneity was evaluated via I² statistics. RESULTS: Thirty studies (2 RCTs and 28 observational studies) including 10,673 patients were analyzed. RAS was associated with reduced estimated blood loss (MD - 78.36) and a lower rate of conversion to laparotomy (RR 0.35). There were no statistically significant differences between groups in operative time, blood transfusion, total lymph node harvested, length of hospital stay, or recurrence. Three-year and five-year overall survival were not significantly different; however, these estimates were based on a limited number of studies and should be interpreted cautiously. Substantial heterogeneity was observed across several outcomes. CONCLUSION: RALS is associated with reduced blood loss and fewer conversions to laparotomy compared with CLS, while most perioperative and oncologic outcomes remain comparable. Given the predominance of observational evidence, persistent heterogeneity, and limited survival data, these findings should be interpreted with caution, and high-quality randomized trials are needed to better define the comparative effectiveness of these approaches.
Operator radiation burden and periprocedural outcomes in robotic-assisted versus manual percutaneous coronary intervention: a meta-analysis.
Xin Y, Wang L, Han F … +10 more , Chang Q, Li C, Ding C, Xu J, Wang R, Wang Y, Wang K, Dai Y, Shen G, Li F
BMC Surg · 2026 May · PMID 42174487 · Full text
BACKGROUND: Robotic-assisted percutaneous coronary intervention (rPCI) was introduced in part to reduce occupational radiation exposure and improve ergonomics in the catheterization laboratory, while also offering potent...
BACKGROUND: Robotic-assisted percutaneous coronary intervention (rPCI) was introduced in part to reduce occupational radiation exposure and improve ergonomics in the catheterization laboratory, while also offering potential procedural advantages. However, the comparative clinical value of rPCI versus manual PCI (mPCI) remains uncertain. This meta-analysis aimed to evaluate the relative effects of rPCI and mPCI on postprocedural outcomes, healthcare personnel radiation exposure, postprocedural complications, and follow-up outcomes. METHODS: A systematic search was conducted in PubMed, Embase, Web of Science, and the Cochrane Library to identify eligible studies published from January 2014 to January 2026. After rigorous study selection, data extraction, and methodological quality assessment, quantitative synthesis was performed using RevMan 5.4. Odds ratios (ORs) were used for dichotomous outcomes and mean differences (MDs) for continuous outcomes. A random-effects model was applied when heterogeneity was significant (I²>50%); otherwise, a fixed-effects model was used. RESULTS: Compared with mPCI, rPCI was associated with a consistent reduction in operator radiation exposure. Patient- and procedure-related radiation indices, including dose-area product, air kerma, and fluoroscopy time, also tended to favor rPCI. Procedural duration was longer with rPCI, whereas contrast use was comparable between groups. rPCI was also associated with higher clinical success and postprocedural TIMI 3 flow, while technical success and coronary dissection rates were similar between groups. At 12-month follow-up, rPCI showed a trend toward lower rates of major adverse cardiovascular events and all-cause mortality. CONCLUSIONS: The available data support a clear occupational safety advantage of rPCI and suggest favorable periprocedural safety and efficacy profiles, with potential clinical benefits. However, these findings, particularly for patient-level outcomes, should be considered hypothesis-generating rather than conclusive, as they are primarily derived from observational studies with limited sample sizes and require confirmation in larger randomized trials.
Outcomes and evolving surgical trends in inguinal hernia repair following prior urologic surgery: a 15-year single-center retrospective cohort study.
Ryu HS, Cho EH, Kim JS … +3 more , Kwak JM, Kim J, Baek SJ
BMC Surg · 2026 May · PMID 42169067 · Full text
PURPOSE: Previous urologic surgeries, including prostatectomy and cystectomy, are associated with an increased risk of inguinal hernia and may complicate subsequent hernia repair due to adhesions and altered pelvic anato...
PURPOSE: Previous urologic surgeries, including prostatectomy and cystectomy, are associated with an increased risk of inguinal hernia and may complicate subsequent hernia repair due to adhesions and altered pelvic anatomy. However, evidence regarding the optimal surgical approach and outcomes in this population remains limited and inconsistent. This study aimed to investigate the outcomes of inguinal hernia surgery in patients with and without a history of urologic surgery and to examine evolving surgical trends over time. METHODS: This single-center retrospective cohort study included adult male patients (≥ 18 years) who underwent primary inguinal hernia repair between January 2010 and December 2024. Patients were categorized according to a history of prior urologic surgery involving retropubic dissection. The primary outcome was the postoperative complication rate, and the secondary outcomes was hernia recurrence. Multivariate regression analyses were performed to identify factors associated with outcomes. RESULTS: Among 927 patients included in the analysis (826 without and 101 with prior urologic surgery), there were no significant differences in postoperative complication rates between groups (22.8% vs. 24.0%, p = 0.805), nor recurrence rates (1.0% vs. 4.2%, p = 0.186). However, operative time was significantly longer in the urologic group (87.0 vs. 68.4 min, p < 0.001). Multivariable analysis showed that prior urologic surgery was independently associated with longer operative time but not with increased postoperative complications or recurrence. Open repair was more common in the urologic group (51.5%), while the totally extraperitoneal approach (TEP) was rarely used (2.0%). Over time, the transabdominal preperitoneal approach (TAPP) became the predominant approach in this population (46.5%). CONCLUSION: Inguinal hernia repair in patients with a history of urologic surgery is safe and effective, with postoperative outcomes comparable to those in patients without such a history. Despite the increased technical complexity and longer operative times, minimally invasive approaches can be performed reliably in experienced centers.
Outcomes after gastrectomy plus pancreatic resection for gastric cancer invading the pancreas.
Chang SC, Chen YF, Kou HW … +7 more , Le PH, Chen TH, Kuo CJ, Wang SY, Chou WC, Yeh TS, Hsu JT
BMC Surg · 2026 May · PMID 42169040 · Full text
BACKGROUND: Radical resection is the primary treatment for resectable gastric cancer (GC). However, outcomes remain poor for patients requiring combined gastrectomy and pancreatic resection due to pancreatic invasion. Th...
BACKGROUND: Radical resection is the primary treatment for resectable gastric cancer (GC). However, outcomes remain poor for patients requiring combined gastrectomy and pancreatic resection due to pancreatic invasion. This study compares surgical and survival outcomes between radical (R0) gastrectomy with pancreaticoduodenectomy (PD) versus distal pancreatectomy (DP). METHODS: We retrospectively analyzed 81 patients with pancreatic-invading GC who underwent R0 gastrectomy with pancreatic resection (January 1994-June 2023). Demographics, surgical complications, adjuvant chemotherapy, and survival outcomes were assessed (median follow-up: 13.4 months). RESULTS: Among the cohort, 36 patients underwent gastrectomy with PD, and 45 underwent gastrectomy with DP. The DP group had significantly more total gastrectomies (88.9% vs. 36.1%, p < 0.0001), tumors localized to the upper stomach (p < 0.0001), and a higher metastatic-to-total lymph node ratio (0.30 vs. 0.15, p = 0.024). Postoperative pancreatic fistula occurred less frequently in the DP group (17.8% vs. 61.1%, p < 0.0001), correlating with a shorter median hospital stay (17 vs. 22 days, p = 0.045). Patient age, tumor characteristics, mortality, lymph node retrieval, and adjuvant chemotherapy use were comparable. Two-year disease-free survival (14.5% PD vs. 20.9% DP, p = 0.988) and cancer-specific survival rates (26.8% PD vs. 32.1% DP, p = 0.815) showed no differences. Multivariate analysis identified stage IIIC (reference: IIIA) as an independent prognostic factor for both disease-free survival (adjusted hazard ratio 3.91, p = 0.015) and cancer-specific survival (adjusted hazard ratio 3.12, p = 0.045). CONCLUSIONS: Gastrectomy with PD or DP yields similarly poor outcomes for pancreatic-invading GC. Tumor stage (nodal status) is the dominant prognostic factor.
Clinical efficacy of intervertebral foraminoscopic debridement with catheter drainage for lumbar spinal epidural abscess.
He Y, Yang L, Liu T … +4 more , Long X, Feng X, Xiao Z, Pang Z
BMC Surg · 2026 May · PMID 42169019 · Full text
OBJECTIVES: To evaluate the clinical efficacy of percutaneous transforaminal endoscopic debridement with catheter drainage for the treatment of single-segment lumbar spinal epidural abscess (SEA). METHODS: We retrospecti...
OBJECTIVES: To evaluate the clinical efficacy of percutaneous transforaminal endoscopic debridement with catheter drainage for the treatment of single-segment lumbar spinal epidural abscess (SEA). METHODS: We retrospectively analysed clinical data from 12 patients with nonspecific single-segment spinal epidural abscess who underwent percutaneous transforaminal endoscopy at our hospital between March 2019 and June 2023. Intraoperative lesion tissue was subjected to microbial culture and histopathological examination. Postoperative anti-infection treatment was given based on drug sensitivity and clinical response. Postoperative CT/MRI was performed to evaluate abscess clearance. WBC, CRP, and ESR levels were measured before and after surgery, and the degree of symptom relief was evaluated using the VAS, ODI, and MacNab criteria. Dynamic radiographs were obtained to evaluate spinal stability, and imaging data were reviewed to assess infection recurrence. RESULTS: All patients successfully underwent surgery without postoperative complications. Various indicators improved significantly at 1 week, 1 month, and 3 months after surgery, as well as at the last follow-up, compared with preoperative levels (P < 0.05). Clinical symptoms improved significantly. According to MacNab criteria, the excellent and good rate was 91.7%. Two patients (16.7%) underwent lumbar fusion surgery due to new neurological symptoms in both legs after 3 months. In the remaining patients, infectious symptoms improved, and no recurrence occurred during the follow-up period. CONCLUSIONS: Percutaneous transforaminal endoscopic debridement with catheter drainage is a valuable and minimally invasive surgical approach for the treatment of SEA with preliminary feasibility and safety under certain conditions.
The prognostic nutritional index is an early predictive marker for surgical site infection after spinal fusion surgery: a nested case-control study.
Wang B, Zhang H, Shen S … +4 more , Huang H, Zhou Z, Ma J, Li L
BMC Surg · 2026 May · PMID 42168990 · Full text
OBJECTIVE: This study aimed to evaluate the predictive value of the preoperative prognostic nutritional index (PNI) for surgical site infection (SSI) following spinal fusion surgery and validate its clinical utility as a...
OBJECTIVE: This study aimed to evaluate the predictive value of the preoperative prognostic nutritional index (PNI) for surgical site infection (SSI) following spinal fusion surgery and validate its clinical utility as a simple screening tool. METHODS: A retrospective nested case-control study was conducted on consecutive patients who underwent spinal fusion surgery between October 2014 and October 2024. A total of 220 patients with SSI (cases) were matched with 440 SSI-free patients (controls) by age, sex, and calendar year. Preoperative PNI was calculated based on serum albumin concentration and total peripheral blood lymphocyte count. Conditional logistic regression models were used to assess the independent association between PNI and SSI, with subgroup analyses stratified by disease category (degenerative diseases or spinal deformity). RESULTS: The proportion of patients with PNI < 50 was significantly higher in cases than in controls (34.5% vs. 22.7%, P = 0.001). Univariate analysis showed that PNI < 50 was associated with an increased SSI risk (OR = 1.794, 95%CI = 1.257-2.562, P = 0.001). After adjusting for confounding factors including diabetes status, estimated blood loss, duration of surgery, drain length, number of surgical levels, surgical region, body mass index, age-adjusted Charlson comorbidity index, and American Society of Anesthesiologists physical status classification, PNI < 50 remained an independent predictor of SSI (OR = 1.568, 95%CI = 1.070-2.298, P = 0.021). Subgroup analysis revealed that the predictive value of PNI was significant in patients with degenerative spinal diseases (OR = 1.814, 95%CI = 1.042-3.156, P = 0.035) but not in those with spinal deformity (P > 0.05). CONCLUSION: Preoperative PNI < 50 is an independent early predictive marker for SSI after spinal fusion surgery, particularly in patients with degenerative spinal diseases. Routine PNI assessment can facilitate preoperative risk stratification and individualized infection prevention strategies, improving surgical outcomes.
Comprehensive use of combined surgical techniques performing liposuction, round-block periareolar de-epithelialization, and complete subcutaneous breast tissue resection approach in grade III gynecomastia: a review of 82 patients.
Soltani H, Nikeghbalian Z, Eskandari A … +5 more , Ahmadinejad M, Dalvand S, Karimi S, Amadeh N, Moradian F
BMC Surg · 2026 May · PMID 42168959 · Full text
BACKGROUND: Gynecomastia is associated with significant psychological and cosmetic concerns. OBJECTIVE: Surgical approaches for gynecomastia that are minimally invasive, associated with few complications, allow for rapid...
BACKGROUND: Gynecomastia is associated with significant psychological and cosmetic concerns. OBJECTIVE: Surgical approaches for gynecomastia that are minimally invasive, associated with few complications, allow for rapid recovery, and result in high patient satisfaction are highly valuable. This study aims to evaluate the aesthetic efficacy and complications of accumulated techniques for treating patients with grade III gynecomastia. METHODS: The preferred strategy includes a combination of enhanced liposuction, round-block de-epithelialization, complete subcutaneous dissection of fibroglandular tissue, and reconstruction methods. Demographic characteristics, complications, satisfaction questionnaires with a 5-point Likert scale, and postoperative quality of life with WHO-QOL-BREF questionnaire were evaluated during follow-up. RESULTS: This study included 82 male patients with gynecomastia grade III (including 3 transgender patients) with a mean age of 30.18 ± 7.60 and the mean BMI of 30.97 ± 3.96. The overall postoperative satisfaction of the patients was 78%. Most patients reported being satisfied or very satisfied with the breast appearance (65.8%), symmetry (75.6%), skin tightness (73.2%), excessive skin resection (64.6%), healing of the incision (62.2%), and contour irregularity (75.6%). Seroma (12.2%), and edema (31.7%) were the most reported postoperative complications which gradually resolved, whereas other complications were insignificant such as bleeding (2.4%), subcutaneous hematoma (3.7%), NAC necrosis (3.7%), and infection (2.4%). No evidence of hemo/pneumothorax, intrathoracic organ damage, and fat embolism, were observed. Regarding scar characteristics, 1.2% had prominent scars and 86.6% had small or hidden scars. Regarding incision characteristics, wound disruption occurred in 8.5% of the cases, whereas 89% of the patients had minimal and good length incisions. CONCLUSION: Enhanced liposuction, round-block periareolar de-epithelialization, and complete subcutaneous breast tissue resection approach in patients with grade III gynecomastia and severe ptosis is a feasible, and safe approach with rapid recovery, hidden scars and acceptable patient satisfaction. TRIAL REGISTRATION: Not applicable. This study is a retrospective observational case series and does not require trial registration.
Modified enhanced pleural fixation: combined intra- and postoperative hypertonic glucose in elderly and high-risk pulmonary bullae patients - a retrospective cohort study.
Chen W, Yang B, Zuo Z … +6 more , Que C, Liu Y, Wang Q, Ma Y, Han S, Gou Y
BMC Surg · 2026 May · PMID 42168958 · Full text
BACKGROUND: Although mechanical pleurectomy effectively prevents recurrent pneumothorax in elderly patients with diffuse emphysematous bullae, it entails substantial surgical trauma and postoperative pain. This study eva...
BACKGROUND: Although mechanical pleurectomy effectively prevents recurrent pneumothorax in elderly patients with diffuse emphysematous bullae, it entails substantial surgical trauma and postoperative pain. This study evaluates an enhanced pleurodesis technique-combining intraoperative hypertonic glucose spraying with three-day postoperative intrapleural perfusion-as a minimally invasive alternative. METHODS: A retrospective analysis included 155 patients who underwent thoracoscopic bullectomy: 72 in the glucose protocol group and 83 in the parietal pleurectomy control group. Following 1:1 propensity score matching, 72 well-balanced matched pairs were obtained. RESULTS: The glucose protocol group exhibited significantly improved perioperative outcomes compared with the parietal pleurectomy control group, including shorter operative duration (65.33 ± 2.43 vs. 84.92 ± 2.35 min), reduced intraoperative blood loss (50.00 ± 3.82 vs. 71.89 ± 4.62 mL), lower postoperative chest tube drainage volume (551.39 ± 27.76 vs. 785.42 ± 57.83 mL), shorter chest tube dwell time (4.42 ± 0.17 vs. 5.32 ± 0.21 days), lower pain scores on postoperative day 3 (0.93 ± 0.07 vs. 1.28 ± 0.06), and shorter length of hospital stay (5.04 ± 0.16 vs. 6.31 ± 0.24 days) (all P < 0.05). No significant differences were observed in postoperative complication rates (18.1% vs. 15.3%) or one-year pneumothorax recurrence rates (4.2% vs. 2.8%) between the two groups (both P > 0.05). CONCLUSION: In this retrospective, propensity-score matched cohort study involving elderly high-risk patients with recurrent diffuse pulmonary bullae, an enhanced pleurodesis protocol-comprising intraoperative hypertonic glucose spray followed by three-day postoperative intrapleural perfusion-was associated with significantly improved perioperative outcomes compared with parietal pleurectomy. No statistically significant difference was detected in 1-year recurrence; however, this finding should not be interpreted as evidence of equivalence or non-inferiority because the recurrence analysis was underpowered and no non-inferiority margin was prespecified. These results indicate that the glucose-based protocol may serve as a viable, less invasive alternative to mechanical pleurectomy in this vulnerable population; however, validation through prospective, randomized controlled trials remains essential to establish causality and generalizability.
Perioperative alvimopan versus no alvimopan after elective minimally invasive colorectal resection within enhanced recovery pathways: a GRADE-assessed systematic review and meta-analysis.
Saqib M, Mirza W, Salahuddin Z … +8 more , Hakim Z, Anwaar A, Moeen-Ud-Din MB, Javid A, Imtiaz A, Khan HM, Ali RN, Hadhoud AM
BMC Surg · 2026 May · PMID 42168954 · Full text
BACKGROUND: Postoperative ileus remains one of the most frequent barriers to timely recovery after colorectal resection, even in the modern era of minimally invasive surgery and enhanced recovery after surgery. Although...
BACKGROUND: Postoperative ileus remains one of the most frequent barriers to timely recovery after colorectal resection, even in the modern era of minimally invasive surgery and enhanced recovery after surgery. Although alvimopan is designed to counteract opioid-mediated gastrointestinal dysmotility, its incremental benefit in contemporary minimally invasive colorectal surgery remains unclear. Existing studies have reported inconsistent effects on ileus prevention, length of stay, and hospitalization. Therefore, we performed a systematic review and meta-analysis of comparative studies evaluating perioperative alvimopan versus no alvimopan after elective colorectal resection in minimally invasive and enhanced recovery settings. METHODS: This systematic review and meta-analysis was conducted in accordance with the PRISMA 2020 and MOOSE recommendations and was registered in PROSPERO [CRD420261354171]. PubMed/MEDLINE, Embase, Scopus, Web of Science, and Cochrane Library were searched from inception to the final search date. Eighty-eight records were identified, 66 were screened after duplicate removal, nine full texts were assessed, and five comparative studies were included in the analysis. The primary outcome was the incidence of postoperative ileus. The secondary outcomes were length of hospital stay and readmission rate. Random-effects meta-analyses were performed. RESULTS: Five retrospective comparative studies comprising 1,379 patients were included, of whom 698 received alvimopan, and 681 did not. Alvimopan was associated with a borderline reduction in postoperative ileus compared with no alvimopan (23/672 [3.4%] vs. 46/617 [7.5%]; RR 0.43, 95% CI 0.18-0.99), although this finding was not robust in leave-one-out sensitivity analysis after removal of the most influential study. Length of hospital stay numerically favored alvimopan but was not statistically significant in the primary pooled analysis (MD -0.63 days, 95% CI -1.27 to 0.02), and readmission was also not significantly different between groups (21/698 [3.0%] vs. 23/681 [3.4%]; RR 0.89, 95% CI 0.48-1.64). The GRADE certainty of evidence was very low across all outcomes. CONCLUSIONS: In minimally invasive colorectal surgery performed within enhanced recovery pathways, alvimopan may reduce postoperative ileus, but this signal was borderline, sensitivity-dependent, and supported only by very low-certainty retrospective evidence. Current evidence does not support a consistent benefit for length of stay or readmission. Alvimopan should therefore be interpreted as a possible selective adjunct for ileus prevention rather than a routine recovery-enhancing strategy. TRIAL REGISTRATION: PROSPERO registration number [CRD420261354171].
Efficacy of intraoperative topical Sapylin (OK-432) for preventing lymph leakage following inguinal lymph node dissection in melanoma: a retrospective cohort study.
Ning K, Shi G, Xie X … +2 more , Yuan Z, Wu Z
BMC Surg · 2026 May · PMID 42168952 · Full text
OBJECTIVE: To evaluate whether intraoperative topical Sapylin (OK-432) reduces postoperative lymphatic leakage after inguinal lymph node dissection (ILND) in melanoma patients. METHODS: This retrospective study included...
OBJECTIVE: To evaluate whether intraoperative topical Sapylin (OK-432) reduces postoperative lymphatic leakage after inguinal lymph node dissection (ILND) in melanoma patients. METHODS: This retrospective study included 105 melanoma patients who underwent unilateral ILND (2022-2025). The study group (n = 51) received intraoperative topical Sapylin; the control group (n = 54) received saline. Both groups underwent Sartorius muscle flap coverage. Lymphatic leakage incidence, recovery indicators, and complications were compared. Logistic regression was used to identify risk factors. RESULTS: Lymphatic leakage was significantly lower in the Sapylin group (9.8% vs. 25.9%, P = 0.03). Multivariable analysis confirmed age ≥ 60 years as an independent risk factor (OR = 4.93, P = 0.01) and Sapylin use as an independent protective factor (OR = 0.30, P = 0.04). The study group also showed reduced total drainage volume, shorter drain removal time, faster wound healing, and shorter hospital stay (all P < 0.05). No significant between-group differences were observed in fever or surgical site infection. CONCLUSION: Intraoperative topical Sapylin is safe and effective for reducing postoperative lymphatic leakage and accelerating recovery after inguinal lymph node dissection for melanoma. TRIAL REGISTRATION: This trial was registered in the Chinese Clinical Trial Registry (ChiCTR) on September 23, 2025 (Registration Number: ChiCTR2500109640; URL: https://www.chictr.org.cn/showproj.html?proj=287559 ).
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