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European Surgical Research. Europaische Chirurgische Forschung. Recherches Chirurgicales Europeennes[JOURNAL]
European Surgical Research. Europaische Chirurgische Forschung. Recherches Chirurgicales Europeennes[JOURNAL]
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200 papers
Comparison of Vascular Endothelial Growth Factor-C Expression with Lymph Node Metastasis Status and Survival in Gastric Cancer.
Turan UF, Dinc T, Kayilioglu I … +2 more , Yilmaz-Ciftci A, Coskun F
Eur Surg Res · 2025 Sep · PMID 40999806 · Publisher ↗
INTRODUCTION: Lymph node metastasis is crucial in determining prognosis and treatment for gastric cancer. Vascular Endothelial Growth Factor-C (VEGF-C), known for its role in lymphangiogenesis, has been linked to metasta...
INTRODUCTION: Lymph node metastasis is crucial in determining prognosis and treatment for gastric cancer. Vascular Endothelial Growth Factor-C (VEGF-C), known for its role in lymphangiogenesis, has been linked to metastasis in various cancers. This study investigates the correlation between VEGF-C expression, lymph node metastasis, and overall survival in gastric cancer patients. METHODS: This retrospective cohort study included 109 patients who underwent gastrectomy and D2 lymphadenectomy for gastric adenocarcinoma between 2011 and 2019. VEGF-C expression was evaluated via immunohistochemistry. Clinical data, including demographics, tumor characteristics, lymph node involvement, and survival outcomes, were analyzed. Cox regression identified factors affecting mortality. RESULTS: VEGF-C expression was categorized as absent, low, or high. Although no significant association was found between VEGF-C expression and lymphatic metastasis, lymphatic invasion was more frequent (87.9%) in patients with high VEGF-C expression. VEGF-C was significantly associated with perineural invasion and the development of distant metastasis during follow-up, highlighting its potential role in tumor progression beyond lymphatic dissemination. Cox regression identified T3/T4 tumors, metastasis during follow-up, and lack of adjuvant radiotherapy as independent prognostic factors for overall survival. CONCLUSION: While VEGF-C was not directly linked to lymph node metastasis, its strong association with perineural invasion and subsequent metastasis highlights its potential prognostic value in identifying aggressive tumor behavior. Further studies are needed to clarify its prognostic significance in gastric cancer.
Characterisation of an ischaemia-reperfusion model for the formation of a stage II pressure injury in diabetic mice.
Huang G, Li J, Qin S … +9 more , Chen X, Liao S, Liu Y, Guo Q, Zeng S, Chen W, Ouyang Q, Long D, Gong F
Eur Surg Res · 2025 Aug · PMID 40931484 · Publisher ↗
INTRODUCTION: Pressure injuries (PIs) in patients with diabetes mellitus (DM) still impacts patients' health and places a heavy burden on healthcare systems. Stage I and stage II PIs are particularly prevalent among indi...
INTRODUCTION: Pressure injuries (PIs) in patients with diabetes mellitus (DM) still impacts patients' health and places a heavy burden on healthcare systems. Stage I and stage II PIs are particularly prevalent among individuals with diabetes. Without timely and appropriate interventions, these injuries can progress to more severe stages, requiring prolonged recovery periods. Thus, the development of preclinical animal models that can mimic stage I or II pressure injuries in diabetic patients is urgently needed to understand the mechanisms of injury formation and healing. METHODS: In this study, magnets were used to compress the dorsal sides of mice for 2 hours (h), 4 h, 8 h, or 16 h according to the ischaemia-reperfusion principle, and the changes in compressed skin in diabetic (db/db) and nondiabetic (WT) mice were compared at different ischaemia exposure times and cycle times. RESULTS: After 2 h of ischemia, there was no significant injury in WT and db/db mice. On the third day following 4 h of ischemia, both db/db and WT mice exhibited characteristics resembling human stage II pressure injuries, with damage primarily confined to the epidermis and upper dermis. Ischemia durations of 8 and 16 h resulted in more severe full-thickness skin defects, including exposed subcutaneous adipose tissue and inward contraction of wound margins. After ischaemia (I) for 4 h and reperfusion (R) for 24 h, the morphology of fibroblasts in the compressed skin area of db/db mice changed, and the expression of TGF-β1 decreased significantly compared with those in WT mice. On day 5, epidermal-dermal separation and pronounced infiltration of inflammatory cells were evident in both groups. On day 10, db/db mice exhibited delayed wound closure, as well as impaired regeneration of the panniculus carnosus and dermis, with significantly decreased mRNA levels of VEGF and HSP90. CONCLUSION: Ischaemia lasting 4 h is the appropriate duration for generating stage II pressure injuries in diabetic mice, which may be applicable to generate a reproducible model of stage II pressure injury caused by ischaemia-reperfusion injury. This model offers a valuable experimental tool for in-depth investigation of the pathogenesis of diabetic pressure injuries and for the development of novel therapeutic strategies.
Factors Influencing Bile Leakage and Incisional Infection Post Choledocholithotomy: An Analysis Based on 621 Patients.
Gao J, Chen J, Huang X … +3 more , Zheng Y, Wei Y, Shen Y
Eur Surg Res · 2025 Aug · PMID 40931479 · Publisher ↗
PURPOSE: To identify independent risk factors for bile leakage and incisional infection after choledocholithotomy and to explore the potential association between bile leakage and incisional infection. METHODS: A retrosp...
PURPOSE: To identify independent risk factors for bile leakage and incisional infection after choledocholithotomy and to explore the potential association between bile leakage and incisional infection. METHODS: A retrospective study was conducted on 621 patients who underwent laparoscopic or open choledocholithotomy combined with cholecystectomy between January 2017 and October 2024. Clinical data were collected, and univariate analysis followed by binary logistic regression was used to identify independent risk factors for postoperative bile leakage and incisional infection. RESULTS: Bile leakage occurred in 60 patients (9.7%). Multivariate analysis showed that open surgery (OR = 1.672), acute biliary inflammation (OR = 2.469), advanced age (OR = 1.061), continuous suturing (OR = 4.991), prolonged operative time (OR = 1.005), and bile pathogen infection (OR = 2.37) were independent risk factors (all P < 0.05). Among 181 patients who underwent open or converted surgery, 40 (22.1%) developed incisional infections. Independent risk factors for incisional infection included advanced age (OR = 1.055), prolonged operation time (OR = 1.006), elevated postoperative WBC count within 24 hours (OR = 1.149), emergency surgery (OR = 3.745), longer incision length (OR = 1.141), and postoperative bile leakage (OR = 14.027) (all P < 0.05), indicating a strong association between bile leakage and subsequent wound infection. CONCLUSION: Open surgery, acute inflammation, older age, continuous suturing, and intra-biliary infection significantly increase the risk of postoperative bile leakage. Moreover, bile leakage was identified as a strong independent predictor of incisional infection. In addition, prolonged operative time, elevated early postoperative leukocyte count, emergency surgery, and longer incisions were also associated with increased infection risk.
Biological characteristics of Banna miniature inbred pigs.
Cheng W, Yan J, Jamal MA … +6 more , Zhao H, Xu K, Jiao D, Lv M, Zhao HY, Wei HJ
Eur Surg Res · 2025 Aug · PMID 40820515 · Publisher ↗
Banna miniature inbred pigs (BNs) are highly inbred strains derived from Diannan miniature pigs (DNs) through full-sibling or parent‒offspring mating protocols developed in 1980. BNs could be potentially used as organ do...
Banna miniature inbred pigs (BNs) are highly inbred strains derived from Diannan miniature pigs (DNs) through full-sibling or parent‒offspring mating protocols developed in 1980. BNs could be potentially used as organ donors for xenotransplantation, but the biological characteristics of BNs have not yet been systematically reported. In this study, the body growth, organ development, reproductive performance, and blood chemistry of BNs were evaluated and compared with those of Göttingen minipigs (GMs) and other Chinese native mini-pig breeds to provide a fundamental basis for their application. The results revealed that the birth weight of BNs was 0.49±0.12 kg and that the body weight at 6 months of age was less than 30 kg. From 4 months of age, the body weight of BN sows was significantly greater than that of boars (P<0.05), which remained consistent until 10 months of age. The ages of the sexual and body maturity of BNs was 4~5 and 10 months, respectively. The number of live piglets per litter, birth weight, weaning weight, litter weight at birth, and weaning weight were significantly lower than those of DNs (P<0.01). The physiological parameters of BNs, including hematocrit, mean cell volume, hemoglobin concentrations, reticulocyte count, basophils, platelet count, and fibrinogens, and the biochemical parameters, including alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, total protein, albumin, total bilirubin, carbamide, creatinine, triglyceride, total cholesterol, lactate dehydrogenase, glucose, and ion levels, were significantly different from those of GMs. Organ weights and coefficients for different ranges of body weights were obtained. The reference values of the blood physiological and biochemical parameters of BNs were established, and some indices were different from those of GMs and other breeds. This information could be helpful in selecting BNs for preclinical and clinical trials of xenotransplantation, thereby promoting their application in biomedical research.
Retraction Statement.
Eur Surg Res · 2025 · PMID 40602368 · Publisher ↗
Abstract loading — click title to view on PubMed.
Retraction Statement.
Eur Surg Res · 2025 · PMID 40587962 · Publisher ↗
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Advocacy for Adequate Translational Surgery in Large Mammals.
Hubert T
Eur Surg Res · 2025 · PMID 40319891 · Full text
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Pig Models in Translational Surgery.
Goutchtat R, Béguier A, Kasal-Hoc N … +5 more , Guerreschi P, Fayoux P, Rancan L, Pattou F, Hubert T
Eur Surg Res · 2025 · PMID 40319887 · Publisher ↗
BACKGROUND: Because rodents are too small to perform surgical procedures on people, large mammals are frequently required for surgical studies. Because of its similar overall anatomy and physiology, the pig has a very hi...
BACKGROUND: Because rodents are too small to perform surgical procedures on people, large mammals are frequently required for surgical studies. Because of its similar overall anatomy and physiology, the pig has a very high translational value and is thus frequently used as the first choice in surgical research. SUMMARY: In cardiovascular treatments, it helped design stents, improve coronary bypass grafting, and perform heart valve xenotransplants. Future efforts will be concentrated on improving the models and, as a result, the trustworthiness of the preclinical findings. Pigs have been used in gastro-intestinal surgery for a variety of purposes, including the development of meshes for abdominal defect repair and the enhancement of surgical methods aimed at compensating functional impairments. A special application has been made in liver regeneration and transplantation procedures, which have promising future prospects, as well as in metabolic surgical research for metabolic illness interventional treatment. Pigs have mostly been used in endocrine surgery to develop pancreatic and islets transplantation for type 1 diabetes therapy, with little research on the other glands. Osteoarticular and neurosurgery are two fields where the pig is increasingly being used: for ethical reasons rather than non-human primate models in neurosurgery, and because this species' rapid growth allows for the testing of the biomechanical properties of orthopedic devices in the context of skeletal growth. In general, the pig has a current and future role in testing novel surgical equipment or bioengineering solutions, establishing new minimally invasive techniques, and training in robotic surgery, regardless of discipline. Finally, pig-to-human organ xenotransplantation poses a significant translational surgical hurdle. If the research has reached a milestone with some alive patients receiving heart or kidney transplants from pigs with various genetic alterations, more evidence is needed to demonstrate the safety and long-term effectiveness of the procedure, as well as to expand it to other organs such as the liver. KEY MESSAGES: In conclusion, the pig model has resulted in significant breakthroughs in surgical research, with future prospects centered mostly on xenotransplantation. The use of the pig in biomedical research will have to deal with rising societal ethical standards.
Sheep Models in Translational Surgery.
Lussier B, Behr L, Borenstein N … +9 more , Brants I, Garabedian C, Ghesquiere L, Le Duc K, Sharma D, Storme L, Touzot-Jourde G, White J, Hubert T
Eur Surg Res · 2025 · PMID 40288355 · Publisher ↗
BACKGROUND: The selection of an animal model is tedious. One must consider several factors; one of these, of utmost importance, is the translational value of the animal model. The sheep, as a translational surgical model...
BACKGROUND: The selection of an animal model is tedious. One must consider several factors; one of these, of utmost importance, is the translational value of the animal model. The sheep, as a translational surgical model, possesses a multiple of advantages that makes it one of the preferred models in several research domains. SUMMARY: Sheep are the state-of-the-art test models for cardiovascular research and safety studies required for approval of cardiovascular implantable devices; the sheep's heart size, cardiac muscle, heart valves, and the mechanical, haemodynamic, and coagulation parameters are very similar to humans. Furthermore, the pregnant sheep/lamb are robust models for studying neonatal adaptation and placental physiology due to its physiological similarities with humans. Its placental structure supports efficient gas exchange, resembling human oxygen transfer mechanisms. The ovine model is mainly used in studies of adaptation at birth, foetal physiology during labour, and congenital diaphragmatic hernia. The sheep model is also used in several orthopaedic preclinical models, mainly in the study of critical bone defects, cancellous bone healing, osteomyelitis, and joint replacement surgeries. It is also a preferred model of bone healing in osteoporosis. Moreover, the sheep has gained popularity as a model of osteoarthritis (OA); it is a validated model of surgically induced OA. Several therapeutic modalities can be evaluated using validated outcome measures such as, kinetics, kinematics, imaging, repeated arthroscopic grading, synovial fluid analysis, and biomarkers. The ovine model, because of its size, is the closest to humans for the evaluation of spinal surgery techniques, devices, and spinal fusion biological enhancers/cancellous graft replacement. Finally, we will outline the different specificities of sheep analgesia and anaesthesia. Challenges encountered in ruminant anaesthesia are mainly in relation with their digestive physiology that creates a high risk of regurgitation during anaesthesia and a hindrance of diaphragm/respiratory movements due to rumen repletion and meteorism. Fasting regimen and management of recovery should encompass strategies that limit the starving sensation and allow for reduced social isolation. Clarification of the interactions between scientific objectives and anaesthesia-analgesia protocols prevents conflicts between the ethics and the purpose of the experiment while allowing for development of model-specific anaesthesia and pain management protocols. KEY MESSAGES: The sheep has become a popular model because of its size, availability, robustness, cost, and ease of handling. Furthermore, as a preclinical model, the same validated objective outcome measures used to measure success in humans can apply to sheep.
Nonhuman Primate Models in Translational Surgery.
Bakker J, Buchholz T, de la Garza MA … +2 more , Virgilio T, Hubert T
Eur Surg Res · 2025 · PMID 40267893 · Publisher ↗
BACKGROUND: Nonhuman primates (NHPs) play a unique role in translational science by bridging the gap between basic and clinical investigations and are often seen as a last step before clinical application. They are widel...
BACKGROUND: Nonhuman primates (NHPs) play a unique role in translational science by bridging the gap between basic and clinical investigations and are often seen as a last step before clinical application. They are widely utilized in biomedical research due to their anatomical and physiological similarities to humans. Examples of commonly used species include the genera Macaca (macaques), Papio (baboons), Aotus (owl monkeys), Callithrix (marmosets), Saimiri (squirrel monkeys), and Chlorocebus (vervet monkeys). SUMMARY: NHP models have played an instrumental role in the development of surgical techniques, each being balanced with a unique set of advantages and shortcomings. With the appropriate selection of species and anatomy, animal models can be used to provide insight into the pathophysiology of diseases, to confirm the feasibility of new surgery technologies, to assess the potential efficacy of new surgical techniques for specific clinical outcomes, and to establish reasonable safety of new techniques for specified clinical use. Robotics have augmented surgical precision for microinjections and a brain-spine robotic interface used in gait restoration, illustrating the translational potential of NHP models in human neurological research. Recent studies highlight protocols for procedures such as tubectomy and spinal cord access with minimal postoperative risk, expanding surgical possibilities. KEY MESSAGES: This review provides an overview of the recent advancements made in surgery in NHP models and the translation of these techniques to the clinical setting. Surgical refinements not only enhance animal welfare but also improve the quality of experimental outcomes. The integration of robotics, imaging, and personalized approaches signifies a transformative shift in NHP surgical models, encouraging collaboration among veterinary and research staff for continuous progress.
The Utilisation, Application, and Quality of Videos of Clinical Interventions in Peer-Reviewed Literature: A Scoping Review.
Robb HD, Fadel MG, Das B … +8 more , Alghazawi LOK, Ariarasa O, Arif A, Alizadeh A, Arain Z, Fehervari M, Ashrafian H, SPRINT (Standards for Presenting and Reporting clinical InterveNtions Televisually)
Eur Surg Res · 2025 · PMID 40112783 · Publisher ↗
BACKGROUND: Videos of clinical interventions (VoCIs) demonstrating surgical and interventional procedures have become a mainstay in clinical practice and peer-reviewed academic literature. Despite the widespread availabi...
BACKGROUND: Videos of clinical interventions (VoCIs) demonstrating surgical and interventional procedures have become a mainstay in clinical practice and peer-reviewed academic literature. Despite the widespread availability of VoCI in the literature, there remain no established guidelines regarding the reporting of VoCI. We undertook a scoping review to investigate the current utilisation, application, and quality in VoCI reporting. SUMMARY: A comprehensive literature search of Medline, Embase, Emcare, and CINAHL databases was performed to retrieve articles presenting VoCI, from January 2020 to December 2023. A customised data extraction tool assessed video characteristics (e.g., case presentation, outcomes), utility (e.g., target audience, reproducibility of procedure), and quality (subjective and objective). A total of 624 VoCIs were included (mean length 06:06), with over 62 h of VoCI reviewed. The most common VoCI perspectives were endoscopic (n = 153; 25%) and laparoscopic (n = 140; 22%). The clinical background and outcomes were described in 480 (76.9%) and 403 cases (64.6%), respectively, with disclosures (n = 23; 3.8%) rarely presented. VoCI primarily targeted trainees (n = 547; 87.7%) with most videos providing technical guidance (n = 394; 63.1%). In total, 248 videos (40%) were rated as medium or low quality on subjective assessment. KEY MESSAGES: There are significant heterogeneity and notably poor-quality control in VoCI reporting in peer-reviewed literature resulting in the omission of critical procedural steps and suboptimal visual quality. VoCI reporting guidelines are therefore urgently required to provide a set of minimum items that should be reported by clinicians when uploading VoCI.
Comparison of the C-REX LapAid and Circular Stapled Colorectal Anastomoses in an Experimental Model.
Vilhjalmsson DT, Grönberg A, Syk I … +1 more , Thorlacius HT
Eur Surg Res · 2025 · PMID 39933492 · Full text
INTRODUCTION: The rate of colorectal anastomotic leakage has remained unchanged for the last decades. The limitations of current anastomotic methods have generated an interest in alternative anastomotic techniques, such...
INTRODUCTION: The rate of colorectal anastomotic leakage has remained unchanged for the last decades. The limitations of current anastomotic methods have generated an interest in alternative anastomotic techniques, such as compression anastomosis. The aim of this experimental study was to evaluate the early mechanical strength in left colonic anastomoses, comparing C-REX LapAid and circular stapled anastomotic methods. METHODS: A total of 48 pigs underwent open sigmoid resection with end-to-end colorectal anastomoses 15 cm above the anal verge, where 21 anastomoses were constructed with traditional circular staplers and 27 with the C-REX LapAid device. Bursting pressure was measured at different time intervals postoperatively through an attached anal plug while the upper limit of the bowel segment was closed with a bowel clamp. Early histological changes were assessed 6-24 h after the anastomotic formation with vascular CD31 and collagen Masson Trichrom staining. RESULTS: All animals recovered uneventfully after the surgical procedure. The circular stapled anastomoses exhibited a median bursting pressure of 36 mbar (28-64) at 1 h, 45 mbar (43-69) at 6 h, and 145 mbar (85-185) 12 h after surgery. In comparison, the C-REX LapAid anastomoses demonstrated a median bursting pressure of 195 mbar (180-240) at 1 h, 192 mbar (180-220) at 6 h, and 180 mbar (160-180) 12 h after surgery, representing a 2-5-fold higher median bursting pressure in the early anastomotic healing phase. Early microscopic architecture showed little evidence of vascular and collagen formation. CONCLUSION: The novel C-REX LapAid device demonstrated significantly higher bursting pressure values in the early phase of the anastomotic healing process compared to the circular stapled method. A clinical study to further verify the benefits of C-REX LapAid is warranted. INTRODUCTION: The rate of colorectal anastomotic leakage has remained unchanged for the last decades. The limitations of current anastomotic methods have generated an interest in alternative anastomotic techniques, such as compression anastomosis. The aim of this experimental study was to evaluate the early mechanical strength in left colonic anastomoses, comparing C-REX LapAid and circular stapled anastomotic methods. METHODS: A total of 48 pigs underwent open sigmoid resection with end-to-end colorectal anastomoses 15 cm above the anal verge, where 21 anastomoses were constructed with traditional circular staplers and 27 with the C-REX LapAid device. Bursting pressure was measured at different time intervals postoperatively through an attached anal plug while the upper limit of the bowel segment was closed with a bowel clamp. Early histological changes were assessed 6-24 h after the anastomotic formation with vascular CD31 and collagen Masson Trichrom staining. RESULTS: All animals recovered uneventfully after the surgical procedure. The circular stapled anastomoses exhibited a median bursting pressure of 36 mbar (28-64) at 1 h, 45 mbar (43-69) at 6 h, and 145 mbar (85-185) 12 h after surgery. In comparison, the C-REX LapAid anastomoses demonstrated a median bursting pressure of 195 mbar (180-240) at 1 h, 192 mbar (180-220) at 6 h, and 180 mbar (160-180) 12 h after surgery, representing a 2-5-fold higher median bursting pressure in the early anastomotic healing phase. Early microscopic architecture showed little evidence of vascular and collagen formation. CONCLUSION: The novel C-REX LapAid device demonstrated significantly higher bursting pressure values in the early phase of the anastomotic healing process compared to the circular stapled method. A clinical study to further verify the benefits of C-REX LapAid is warranted.
Appendicolith as a Sign of Complicated Appendicitis: A Myth or Reality? A Retrospective Study.
Nikkolo C, Muuli M, Kirsimägi Ü … +1 more , Lepner U
Eur Surg Res · 2025 · PMID 39907993 · Publisher ↗
INTRODUCTION: Appendicolith can be incidentally detected on abdominal computer tomography (CT) without any signs of appendicitis. However, it has also been found to be a risk factor for failure of nonoperative management...
INTRODUCTION: Appendicolith can be incidentally detected on abdominal computer tomography (CT) without any signs of appendicitis. However, it has also been found to be a risk factor for failure of nonoperative management in acute appendicitis. The present retrospective study aimed to evaluate whether appendicolith predicts complicated appendicitis in patients with any appendicitis. METHODS: A retrospective chart review was conducted for patients undergoing appendectomy from January 2016 to December 2018. Appendicolith was considered to be present when it was described in a CT scan. RESULTS: Of the 267 patients, appendicolith was found in 120 cases, while there were no in 147 cases in preoperative CT scans. In the case of complicated appendicitis (gangrenous or gangrenous perforated appendicitis), appendicolith was visible in CT scans in 57.7% of the patients. Of the patients with uncomplicated appendicitis, 38.3% had appendicolith in CT scan (p = 0.002). In univariate logistic regression analysis, based on the finding of the histological specimen, appendicolith was associated with complicated appendicitis (OR: 2.12; 95% CI: 1.28-3.51; p = 0.004). When adjusting for sex, age group (age ≤50 vs. >50 years), and duration of symptoms (≤24 vs. >24 h), the odds ratio was 3.52 (95% CI: 1.88-6.58; p < 0.001). CONCLUSION: Our study found that appendicolith can be considered an independent risk factor for complicated appendicitis. Therefore, in the presence of appendicolith, surgical treatment should probably be preferred over nonsurgical treatment in acute appendicitis.
Current Basic Research in Normothermic Machine Perfusion.
Hosgood SA, Nicholson ML
Eur Surg Res · 2024 · PMID 39471796 · Publisher ↗
BACKGROUND: Normothermic machine perfusion (NMP) is gradually being introduced into clinical transplantation to improve the quality of organs and increase utilisation. This review details current understanding of the und...
BACKGROUND: Normothermic machine perfusion (NMP) is gradually being introduced into clinical transplantation to improve the quality of organs and increase utilisation. This review details current understanding of the underlying mechanistic effects of NMP in the heart, lung, liver, and kidney. It also considers recent advancements to extend the perfusion interval in these organs and the use of NMP to introduce novel therapeutic interventions, with a focus on organ modulation. SUMMARY: The re-establishment of circulation during NMP leads to the upregulation of inflammatory and immune mediators, similar to an ischaemia-reperfusion injury response. The level of injury is determined by the condition of the organ, but inflammation may also be exacerbated by the passenger leucocytes that emerge from the organ during perfusion. There is evidence that damaged organs can recover and that prolonged NMP may be advantageous. In the liver, successful 7-day NMP has been achieved. The delivery of therapeutic agents to an organ can aid repair and be used to modify the organ to reduce immunogenicity or change the structure of the blood group antigens to create a universal donor blood group organ. KEY MESSAGES: The application of NMP in organ transplantation is a growing area of research and is increasingly being used in the clinic. In the future, NMP may offer the opportunity to change practice. If organs can be preserved for days on an NMP system, transplantation may become an elective rather than an emergency procedure. The ability to introduce therapies during NMP is an effective way to treat an organ and avoid the complexity of treating the recipient.
Fixation of Skin Flaps after Mastectomy Using Running or Interrupted Sutures for Combatting Seroma: A Protocol for a Randomised Controlled Trial (ANNIE).
Spiekerman van Weezelenburg MA, Aldenhoven L, van Kuijk SMJ … +5 more , van Haaren ERM, Janssen A, Vissers YLJ, Beets GL, van Bastelaar J
Eur Surg Res · 2024 · PMID 39462488 · Publisher ↗
INTRODUCTION: Flap fixation significantly reduces the incidence of seroma formation after mastectomy. Previous studies have compared running sutures, interrupted sutures, and tissue glue application with conventional wou...
INTRODUCTION: Flap fixation significantly reduces the incidence of seroma formation after mastectomy. Previous studies have compared running sutures, interrupted sutures, and tissue glue application with conventional wound closure. A recent systematic review with network meta-analysis showed running sutures to be the most optimal technique; however, direct comparisons and high adequate scientific evidence are lacking. This prospective trial aimed to directly compare running sutures with interrupted sutures to determine which technique of flap fixation using sutures is superior. METHODS: This trial will combine a retrospective cohort of patients undergoing flap fixation using interrupted sutures from a previous trial, with a randomised prospective cohort with patients undergoing flap fixation using running sutures or flap fixation using interrupted sutures. This study design was chosen to acquire a sample size with sufficient power and the ability to conduct this study in an acceptable time frame. The primary endpoint is the incidence of complications requiring interventions, including clinically significant seroma, infections and haemorrhagic complications. Secondarily, the length of the procedure and cosmetic results will be compared. CONCLUSIONS: This is the first trial comparing two suturing techniques for flap fixation after mastectomy. Results will be used to optimise flap fixation techniques for these patients to prevent seroma formation.
Treatment of Renal Artery Aneurysm by ex situ Repair and Autotransplantation: A Nationwide Cohort Study.
Fang Y, Kimenai HJAN, de Bruin RWF … +9 more , de Vries DK, Petri BJ, Warlé MC, Tielliu IFJ, van Laanen J, Idu MM, Pol RA, Minnee RC, Dutch Kidney Transplant Study Group
Eur Surg Res · 2024 · PMID 39369696 · Publisher ↗
INTRODUCTION: Renal artery aneurysm (RAA) is a rare vascular disease with a mortality rate of up to 80% upon rupture. This study aimed to investigate the safety and efficacy of ex situ repair and autotransplantation for...
INTRODUCTION: Renal artery aneurysm (RAA) is a rare vascular disease with a mortality rate of up to 80% upon rupture. This study aimed to investigate the safety and efficacy of ex situ repair and autotransplantation for endovascularly untreatable RAA. METHODS: A retrospective nationwide cohort study was conducted in RAA patients undergoing ex situ repair and autotransplantation in the Netherlands. Surgical techniques, postoperative complications, and graft outcomes were assessed. RESULTS: Ex situ repair was performed in 9 patients with 11 RAAs. Eight RAAs were located at the first bifurcation, one on the main trunk, one on the first branch, and one on the second branch. Nephrectomy was performed via laparoscopy (n = 7), robotic-assisted laparoscopy (n = 1), and laparotomy (n = 1). Postoperative complications were recorded in 4 patients, including bowel obstruction, delirium, pneumonia, and hydronephrosis due to double-J dislocation. The median estimated glomerular filtration rate was 83 mL/min/1.73 m2 pretransplant and 88 mL/min/1.73 m2 posttransplant. By an average follow-up of 32 months, 2 patients had died due to lung adenocarcinoma and stroke, while all autotransplanted kidneys had good patency and remained functional. CONCLUSIONS: Ex situ repair and autotransplantation are safe and feasible for endovascularly untreatable RAA cases. Larger cohorts with longer follow-up periods are necessary to further evaluate the role of this surgical approach.
Damage Control Orthopaedics Induced Less Trauma-Induced Coagulopathy than Early Total Care in a Porcine Polytrauma Model.
Mert Ü, Groven RVM, Greven J … +8 more , He Z, Mahmoud MA, van Griensven M, Huber-Lang M, Mollnes TE, Rosado Balmayor E, Horst K, Hildebrand F
Eur Surg Res · 2024 · PMID 39348804 · Publisher ↗
INTRODUCTION: Coagulopathic disorders (CDs) complicate treatment in polytraumatised patients. Against this background, operative strategies for fracture management are controversial in this cohort. This study therefore i...
INTRODUCTION: Coagulopathic disorders (CDs) complicate treatment in polytraumatised patients. Against this background, operative strategies for fracture management are controversial in this cohort. This study therefore investigated the effects of two established operative concepts, early total care (ETC) and damage control orthopaedics (DCO), on CD in a large-animal polytrauma (PT) model. METHODS: Twenty-two animals (Sus scrofa domesticus) sustained PT involving blunt-chest trauma, liver laceration, bilateral femur fracture, and pressure-controlled haemorrhagic shock. After resuscitation, animals were allocated to ETC (n = 8), DCO (n = 8), or served as a non-traumatised control group (CG, n = 6). Animals were ventilated and monitored under ICU standards for 72 h. Blood samples were collected at baseline and post-trauma after 1.5, 2.5, 24, 48, and 72 h. Plasminogen activator inhibitor-1 (PAI-1) and thrombin-antithrombin (TAT) complex concentrations were determined by ELISA. RESULTS: Compared to the CG, ETC and DCO subjects had significantly increased plasma concentrations of PAI-1 after 2.5 h (CG vs. ETC: p = 0.0050, CG vs. DCO: p = 0.0016). Furthermore, the ETC group showed significantly increased plasma PAI-1 concentrations after 24 h compared to the CG and DCO groups (CG vs. ETC: p = 0.0002, DCO vs. ETC: p = 0.0004). During the later clinical course, concentrations of TAT were significantly increased in the ETC group compared to the CG and DCO group after 72 h (CG vs. ETC: p = 0.0290, DCO vs. ETC: p = 0.0322). CONCLUSION: PT is strongly associated with CD in the early post-traumatic course. In comparison to DCO, ETC appeared to be negatively associated with CD. Future studies must investigate this impact, especially in those patients admitted with trauma-induced coagulopathy, to improve outcomes.
Conversion Rates, Causes, and Preoperative Associated Factors in 3,411 Laparoscopic Appendectomies: Insights after Nearly Three Decades of Laparoscopy and an Analysis of the Learning Curve.
Aragone L, Arrechea R, Toffolo M … +2 more , Nardi W, Pirchi D
Eur Surg Res · 2024 · PMID 39236680 · Publisher ↗
INTRODUCTION: Laparoscopic appendectomy is the current gold standard in treating acute appendicitis. Despite the low frequency of conversion to open surgery, it remains necessary in certain cases. Our primary outcome was...
INTRODUCTION: Laparoscopic appendectomy is the current gold standard in treating acute appendicitis. Despite the low frequency of conversion to open surgery, it remains necessary in certain cases. Our primary outcome was to identify the conversion rate of laparoscopic appendectomy to open surgery and how this rate has changed over the learning curve. Second, we aim to determine the causes of conversion, their changes in frequency over time and to identify preoperative factors associated with conversion. METHODS: A retrospective comparative study with prospective case registry was conducted. All patients who underwent laparoscopic appendectomy from January 2000 to December 2023 at a high-volume center were analyzed. The series was divided into six periods, each spanning 4 years. All patients who underwent totally laparoscopic appendectomy and those requiring conversion to open appendectomy were included. RESULTS: A total of 3,411 appendectomies were performed during the study period, with an overall conversion rate of 0.96% (33/3,411). Our analysis showed that after the first three periods (12 years), the conversion rate decreased and reached a plateau of approximately 0.4%. The most common causes of conversion were perforation of the appendix base (9/33), abdominal cavity adhesions (8/33), and pneumoperitoneum intolerance (3/33). Age over 65, American Society of Anesthesiologists (ASA) score III/IV and symptom duration exceeding 24 h were preoperative factors significantly associated with conversion at univariate analysis. However, only age (p 0.0001) and symptoms exceeding 24 h (p 0.01) remained independently associated with conversion after multivariate analysis. CONCLUSION: In experienced centers, conversion from laparoscopic appendectomy to open appendectomy is uncommon, but remains necessary in certain cases. Despite identifying a population with higher association with conversion which should be advised preoperatively, due to the low incidence of conversions once the learning curve is overcome, an initial laparoscopic approach is the preferred choice.
MicroRNA-216a-5p Alleviates Acute Kidney Injury of Mice via Suppressing FAS Ligand Expression.
Zhou B, Luo R, Sun Y … +1 more , Yang A
Eur Surg Res · 2024 · PMID 39097969 · Publisher ↗
INTRODUCTION: The aim of this present work was to investigate the mechanism of the microRNA (miR)-216a-5p/FASL axis in mice with acute kidney injury (AKI). METHODS: Mice kidney ischemia/reperfusion (I/R) injury was used...
INTRODUCTION: The aim of this present work was to investigate the mechanism of the microRNA (miR)-216a-5p/FASL axis in mice with acute kidney injury (AKI). METHODS: Mice kidney ischemia/reperfusion (I/R) injury was used as AKI models in this study. I/R mice were injected with miR-216a-5p- and FASL-related constructs to investigate potential mechanisms of kidney protection. Kidney function, inflammation, oxidative stress, and kidney cell apoptosis were assessed after 24 h of reperfusion. In vitro, the hypoxia-reoxygenation (H/R) model was used with kidney tubular epithelial cells (TECs) to mimic kidney I/R injury. H/R-treated TECs were transfected with miR-216a-5p- and FASL-related constructs to detect cell viability, inflammation, and oxidative stress. MiR-216a-5p and FASL expression levels in mouse kidney tissues and in H/R-treated TECs were detected. RESULTS: MiR-216a-5p was downregulated and FASL was upregulated in kidney tissues of I/R mice and H/R-treated TECs. Upregulating miR-216a-5p attenuated kidney cell apoptosis and the damage of kidney function, and reduced inflammatory factor levels and oxidative stress response in kidney tissues of I/R mice. Upregulating miR-216a-5p advanced cell viability and reduced inflammatory factor levels and oxidative stress response in H/R-treated TECs. Downregulation of FASL effectively reversed the influences of downregulation of miR-216a-5p on kidney injury in mice and kidney TEC survival. CONCLUSION: Our study reveals that miR-216a-5p reduces I/R-induced pathological kidney damage in AKI via suppressing FASL.
The Role of Enhanced Recovery after Surgery in Pancreaticoduodenectomy: A Systematic Review and Meta-Analysis.
Liotiri D, Diamantis A, Paraskeva I … +4 more , Brotis A, Symeonidis D, Arnaoutoglou E, Zacharoulis D
Eur Surg Res · 2024 · PMID 39008960 · Publisher ↗
INTRODUCTION: This study aimed to compare the safety and short-term outcomes of Enhanced Recovery After Surgery (ERAS) with standard care for patients undergoing pancreatoduodenectomy (PD) based on literature published f...
INTRODUCTION: This study aimed to compare the safety and short-term outcomes of Enhanced Recovery After Surgery (ERAS) with standard care for patients undergoing pancreatoduodenectomy (PD) based on literature published following the first publication of ERAS guidelines for PD. METHODS: Five medical databases were searched for studies that compared ERAS to standard care in adults undergoing PD. Data on postoperative complications, length of hospitalization, readmissions, and time to chemotherapy were analyzed using either a fixed- or random-effects model meta-analysis. Meta-regressions were conducted to investigate the role of operative technique, study origin, and study design. RESULTS: Our analysis included 22 studies involving 4,043 patients. ERAS was associated with fewer complications (relative risk [RR]: 0.83; 0.75-0.91), particularly Clavien-Dindo (CD) grade 1 and 2 complications (RR: 0.82; 0.72-0.92), delayed gastric emptying (RR: 0.69; 0.52-0.93), and postoperative fistula (POPF) (RR: 0.76; 0.66-0.89), and a shorter time to chemotherapy (standardized mean difference [SMD]: -0.68; 95% CI: -0.88 to -0.48). ERAS did not affect the risk for CD grade 3 and 4 complications (RR: 1.00; 0.72-1.38), post-pancreatectomy hemorrhage (RR: 0.88; 0.67-1.14), length of stay (SMD: -0.56; 95% CI: -1.12 to 0.01), readmission (RR: 1.01; 0.84-1.21), and mortality (RR: 0.81; 0.54-1.22). The continent of origin was an effect moderator in the role of ERAS in CD grade 1 and 2 complications (p = 0.047) and POPF (p = 0.02). CONCLUSION: Implementing ERAS principles in PD improves surgical outcomes without compromising safety. ERAS may also accelerate time to chemotherapy, an essential issue for future research.
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