BMC Surgery[JOURNAL]
Sun
200 papers
Early graft function after intraoperative assessment-guided selective ligation of segment 5/8 veins in adult right lobe living donor liver transplantation: a retrospective cohort study.
Sonmez Topcu S, Sahin E, Anilir E … +2 more , Dirican A, Ünal B
BMC Surg · 2026 Jul · PMID 42401871 · Full text
BACKGROUND: Reconstruction of segment 5 and/or segment 8 anterior sector veins ≥ 5 mm is widely recommended in adult right lobe living donor liver transplantation (LDLT) to prevent venous congestion. Whether this approac...
BACKGROUND: Reconstruction of segment 5 and/or segment 8 anterior sector veins ≥ 5 mm is widely recommended in adult right lobe living donor liver transplantation (LDLT) to prevent venous congestion. Whether this approach is universally required, or whether selective ligation guided by intraoperative findings is acceptable in lower-risk recipients, remains unresolved. METHODS: This single-centre retrospective cohort study included adult recipients who underwent right lobe LDLT without inclusion of the middle hepatic vein at a high-volume transplant centre (approximately 150 adult LDLTs per year) between November 2021 and May 2025. Eligible patients had intraoperatively measured segment 5 and/or segment 8 veins ≥ 5 mm. Venous management was determined intraoperatively and was not randomized: reconstruction was preferred in recipients judged at higher risk of congestion, and all recipients with graft-to-recipient weight ratio (GRWR) < 0.8 were managed in the reconstruction group. The primary endpoints were postoperative day 7 (POD7) international normalized ratio (INR), total bilirubin, and ascites volume. Multivariable adjustment was prespecified for postoperative ascites only, adjusting for ligation status, MELD score, and GRWR. Prespecified sensitivity analysis restricted to GRWR ≥ 0.8 was performed. Partial Olthoff early allograft dysfunction (EAD) and approximate ILTS-iLDLT small-for-size syndrome (SFSS) were assessed as secondary analyses. RESULTS: A total of 170 recipients were included (16 selective ligation; 154 reconstruction). Baseline variables did not differ statistically, but all 20 recipients with GRWR < 0.8 were in the reconstruction group. POD7 outcomes were comparable: INR 1.24 vs. 1.27 (p = 0.80), bilirubin 1.46 vs. 1.70 mg/dL (p = 0.35), ascites 1100 vs. 1250 mL (p = 0.89). In multivariable analysis (n = 91), selective ligation was not independently associated with ascites (β = 0.202; 95% CI - 0.359 to + 0.764; p = 0.476); MELD was the only significant predictor (p = 0.024). The GRWR ≥ 0.8 sensitivity analysis confirmed these findings. Partial Olthoff EAD was 25.0% vs. 15.7% (p = 0.42); approximate SFSS was 27.3% vs. 24.7% (p = 1.00). Post-hoc power for the ascites comparison was 80% only for Cohen's d ≥ 0.90, far larger than the observed d = 0.02. CONCLUSIONS: In carefully selected recipients with adequate graft volume and favourable intraoperative findings, selective ligation of segment 5 and/or 8 veins ≥ 5 mm was not associated with worse early graft function in this cohort. Given the small ligation group, non-randomized allocation, and substantial missing data, these preliminary results are consistent with the feasibility of selective ligation in a selected lower-risk subgroup but cannot establish its safety, clinical applicability, or equivalence to reconstruction. Prospective, adequately powered, multicentre validation is required before any change in current clinical practice can be considered. CLINICAL TRIAL NUMBER: not applicable.
Wound complications and clinical efficacy of the direct anterior approach versus the posterolateral approach in total hip arthroplasty: a systematic review and meta-analysis of randomized controlled trials.
Fu W, Deng Y, Xu J … +4 more , Chen K, Wang L, He S, Zhang J
BMC Surg · 2026 Jul · PMID 42401861 · Full text
BACKGROUND: The direct anterior approach (DAA) and the posterolateral approach (PLA) are commonly used surgical techniques in total hip arthroplasty (THA). However, whether DAA is associated with different wound complica...
BACKGROUND: The direct anterior approach (DAA) and the posterolateral approach (PLA) are commonly used surgical techniques in total hip arthroplasty (THA). However, whether DAA is associated with different wound complication rates compared with PLA remains controversial. This meta-analysis aimed to compare wound complications and clinical outcomes between DAA and PLA in THA based on randomized controlled trials. METHODS: A comprehensive search was conducted across six major electronic databases: PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), and Chongqing VIP Information (CQVIP). The search strategy encompassed studies indexed from database inception to 31 December 2025. The primary outcomes were wound complications, including incisional infection, hematoma, and delayed wound healing. Predefined eligibility criteria were applied during study screening. The risk of bias of the included studies was assessed using the revised Cochrane Risk of Bias tool for randomized trials (RoB 2). The PLA group was used as the control group. Data were extracted from the included randomized controlled trials (RCTs). A pooled statistical analysis was performed to estimate the rate of wound complications and to compare the clinical effects of DAA and PLA. The meta-analysis was conducted with Review Manager 5.3 and Stata 15. RESULTS: A total of 18 eligible RCTs, comprising 1,485 patients, were included. Compared with PLA, DAA was associated with decreased rates of incisional infection (RR = 0.48, P = 0.03, I = 0%) and a lower overall rate of wound complications (RR = 0.58, P = 0.04, I = 0%). No evidence of a significant difference between groups was observed for hematoma incidence, poor wound healing, or overall surgical complications. Regarding perioperative indicators, DAA demonstrated several advantages. DAA was associated with a shorter incision length (MD = -3.44, P < 0.001, I = 97%), less intraoperative blood loss (MD = -76.74, P < 0.001, I = 97%), and a shorter hospital stay (MD = -2.15, P < 0.001, I = 95%). In terms of functional recovery, DAA demonstrated better early postoperative function. The DAA group had higher HHS at 1 month (MD = 5.87, P < 0.001, I = 15%), 3 months (MD = 5.10, P < 0.001, I = 95%), and 6 months (MD = 2.94, P < 0.001, I = 92%). No significant difference was observed at 12 months. For pain outcomes, DAA was associated with lower VAS scores in the postoperative period, including at 1 day (MD = -0.84, P < 0.001, I = 59%), 3 days (MD = -0.77, P < 0.001, I = 76%), 7 days (MD = -0.85, P < 0.001, I = 88%), 1 month (MD = -0.49, P = 0.002, I = 90%), 3 month (MD = -0.67, P = 0.02, I = 96%), and 6 month (MD = -0.12, P = 0.04, I = 75%). CONCLUSION: Compared with the PLA, the DAA is associated with improved perioperative outcomes following THA. Specifically, the DAA demonstrates a lower incidence of incision infection, fewer overall wound complications, shorter incision length, reduced intraoperative blood loss, and a shorter length of hospital stay. Early postoperative functional outcomes and pain, assessed by HHS and VAS, are also superior with the DAA. However, owing to heterogeneity and limited robustness of certain outcomes, these findings should be interpreted with caution. Further high-quality randomized controlled trials are warranted to confirm these results.
Catheter-related thrombosis in cancer patients with tunnelled non-cuffed centrally inserted central catheters: a retrospective cohort study.
Douchy T, Boecxstaens V, Hompes D … +1 more , Goossens GA
BMC Surg · 2026 Jul · PMID 42401856 · Full text
BACKGROUND: Peripherally inserted central catheters (PICCs) are widely used in oncology but are associated with higher rates of catheter-related thrombosis compared to other central venous access devices. Tunnelled non-c...
BACKGROUND: Peripherally inserted central catheters (PICCs) are widely used in oncology but are associated with higher rates of catheter-related thrombosis compared to other central venous access devices. Tunnelled non-cuffed centrally inserted central catheters (tnc-CICC) may offer a safer alternative in patient at high risk of thrombosis. METHODS: This retrospective cohort study evaluated 193 tnc-CICCs placed in 182 cancer patients at a tertiary oncology unit between January 2021 and December 2022. Primary outcomes is catheter-related thrombosis; secondary outcomes are procedural duration and complication rates. Data were analysed using non-parametric statistical methods. RESULTS: The overall thrombosis rate was 1% (0.18 per 1,000 catheter days), significantly lower than reported PICC-associated thrombosis rates. No major intraoperative complications occurred. The overall complication rate was 19.7%, with catheter malfunction (9.3%), migration (5.2%) and bloodstream infections (4.1%) being the most common. Median procedural time was 34 min, with no significant difference based on operator experience. CONCLUSIONS: Off label use of PICCs as tnc-CICCs seems safe and effective. It provides an alternative to PICCs in oncology patients at high risk of thrombosis, even when placed by operators with low experience levels. These findings support the inclusion of tnc-CICCs in vascular access algorithms for cancer patient at high risk of thrombosis and suggest feasibility for nurse-led insertion programs.
Perioperative factors associated with intraoperative circulatory decompensation during lung transplantation under initial VV-ECMO support: an exploratory single-center study.
Yang H, Hao Y, An S … +5 more , Zhang J, Zhu W, Su K, Liang C, Li J
BMC Surg · 2026 Jul · PMID 42401840 · Full text
BACKGROUND: Intraoperative circulatory decompensation during lung transplantation is a life-threatening event that often necessitates a challenging transition from veno-venous (VV) to veno-arterial (VA) extracorporeal me...
BACKGROUND: Intraoperative circulatory decompensation during lung transplantation is a life-threatening event that often necessitates a challenging transition from veno-venous (VV) to veno-arterial (VA) extracorporeal membrane oxygenation (ECMO). This study evaluated perioperative variables associated with decompensation under an explicitly exploratory observational framework. METHODS: A retrospective analysis was conducted on 97 patients with end-stage lung disease undergoing lung transplantation with initial VV-ECMO support from January 2020 to December 2022. Intraoperative circulatory decompensation was redefined using objective hemodynamic and echocardiographic criteria; VV-to-VA conversion was recorded as a management consequence rather than as a defining criterion. Propensity score matching (PSM) was applied to balance confounding factors, resulting in 75 analyzed patients. Candidate models were revised as exploratory penalized models and internally assessed by repeated fivefold cross-validation and bootstrap optimism correction. RESULTS: In the matched descriptive comparison, pH and lactate remained robustly different after FDR correction, while highest intraoperative PASP, pulmonary valve VMAX, aortic valve VMAX, and heart rate were interpreted as exploratory signals. To reduce temporal bias, we separated a preoperative/peri-induction model from a secondary intraoperative monitoring model. In internal validation, the preoperative/peri-induction model achieved a repeated fivefold cross-validation AUC of 0.803 and a bootstrap optimism-corrected AUC of 0.813, with a Brier score of 0.151. The intraoperative monitoring model, which included highest intraoperative PASP, achieved a repeated fivefold cross-validation AUC of 0.853 and a bootstrap optimism-corrected AUC of 0.865, with a Brier score of 0.121. CONCLUSIONS: Lower preoperative arterial pH, higher lactate, and dynamic intraoperative pulmonary pressure changes were associated with clinically documented circulatory decompensation in this exploratory single-center cohort. These internally assessed findings require external validation before clinical implementation.
Robotic versus laparoscopic surgery in hepatobiliary procedures: a scoping review.
Montoya JC, González Garcés M, Torres MAT … +2 more , Rincón EHH, Barbosa DOS
BMC Surg · 2026 Jul · PMID 42401835 · Full text
BACKGROUND: Robotic platforms have expanded the technical capabilities of minimally invasive hepatobiliary surgery. However, their clinical value compared with laparoscopy remains heterogeneous and appears to vary accord...
BACKGROUND: Robotic platforms have expanded the technical capabilities of minimally invasive hepatobiliary surgery. However, their clinical value compared with laparoscopy remains heterogeneous and appears to vary according to procedural complexity, anatomical constraints, and institutional experience. METHODS: A procedure-stratified scoping review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews and the Joanna Briggs Institute Manual for Evidence Synthesis. PubMed, Scopus, and Web of Science were searched for comparative studies published between 2019 and 2025 evaluating robotic versus laparoscopic hepatobiliary surgery. Evidence was synthesized using a procedure-specific analytical framework to account for heterogeneity in technical complexity and outcome reporting. RESULTS: Seventy studies met inclusion criteria, the majority of which were retrospective. In technically demanding procedures, particularly major hepatectomy and resections of posterosuperior liver segments, robotic surgery was more frequently associated with lower intraoperative blood loss and reduced conversion to open surgery. Operative time was generally longer for robotic procedures across most indications. Overall perioperative morbidity, mortality, and early oncological outcomes were comparable between robotic and laparoscopic approaches. Postoperative recovery outcomes were inconsistently reported and heterogeneous, while procedural costs were consistently higher for robotic surgery. CONCLUSIONS: Robotic hepatobiliary surgery may offer context-dependent advantages in anatomically complex procedures, particularly in settings with appropriate surgical expertise. However, given the predominance of retrospective and heterogeneous evidence, these findings should be interpreted cautiously. Overall, robotic and laparoscopic approaches demonstrate comparable safety and effectiveness across most indications. These findings support a procedure-based and context-sensitive integration of robotic technology rather than universal adoption.
Robotic vs. laparoscopic resection for rectal cancer with neoadjuvant chemoradiotherapy: perioperative outcomes and survival.
Zhang W, Peng J, Situ Y … +9 more , Wang W, Wang R, Wu X, Lu Z, Li Y, Tang J, Lin J, Ding P, Pan Z
BMC Surg · 2026 Jul · PMID 42401820 · Full text
BACKGROUND: Although the safety and effectiveness of robot-assisted surgery for rectal cancer have been demonstrated, its peri-operative safety and long-term survival benefit in patients who have received neoadjuvant che...
BACKGROUND: Although the safety and effectiveness of robot-assisted surgery for rectal cancer have been demonstrated, its peri-operative safety and long-term survival benefit in patients who have received neoadjuvant chemoradiotherapy (NCRT) remain unclear. METHOD: A retrospective cohort of 463 consecutive rectal-cancer patients who underwent either robot-assisted anterior resection or laparoscopic anterior resection after NCRT at Sun Yat-sen University Cancer Center from June 2016 to August 2023 was analyzed. Propensity-score matching (PSM) was applied to balance baseline variables that could affect surgical outcomes and survival. Peri-operative parameters, complication rates, and pathological findings were compared, and 5-year overall survival (OS) and disease-free survival (DFS) were calculated. RESULT: A total of 121 patients undergoing robotic-assisted surgery and 342 patients undergoing laparoscopic surgery were included in the study. Operative time was longer in the robot-assisted group both before and after matching. Before matching, the robot-assisted group showed a lower rate of ileostomy (65.3% vs 76.6%, P = 0.021), an advantage that disappeared after PSM (65.3% vs 75.2%, P = 0.063). In the matched cohort, the 5-year DFS was 89.8% for robot-assisted versus 82.3% for laparoscopic (P = 0.130), whereas the 5-year OS was higher in the robot-assisted group than in the laparoscopic group (96.8% vs 86.8%; P = 0.019). In the primary preoperative covariate-adjusted Cox model after PSM, the association between robot-assisted surgery and OS was attenuated and did not reach conventional statistical significance (HR = 0.231, 95% CI 0.052-1.015; P = 0.052). CONCLUSIONS: Robot-assisted and laparoscopic surgery showed comparable perioperative outcomes and DFS after NCRT for rectal cancer. Although an apparent OS difference was observed in the matched cohort, this finding was attenuated in the primary preoperative covariate-adjusted Cox model and should be interpreted cautiously given the potential for residual confounding.
A prospective observational cohort study comparing perioperative outcomes, complications, and quality of life between surgical procedures for female stress urinary incontinence.
Jiang J, Wang T, Deng Q … +1 more , Zhang Y
BMC Surg · 2026 Jul · PMID 42399922 · Full text
OBJECTIVE: To compare perioperative outcomes, complications, and quality of life between tension-free vaginal tape obturator (TVT-O) and retropubic tension-free vaginal tape exact (TVT-E) procedures for female severe str...
OBJECTIVE: To compare perioperative outcomes, complications, and quality of life between tension-free vaginal tape obturator (TVT-O) and retropubic tension-free vaginal tape exact (TVT-E) procedures for female severe stress urinary incontinence (SUI). METHODS: This prospective cohort study enrolled women undergoing surgery for severe stress urinary incontinence (December 2023-February 2025). Patients were grouped by procedure (TVT-O vs. TVT-E). We compared perioperative data, complications, quality-of-life scores (ICI-Q-SF, IIQ-7, PISQ-12 at 6 and 12 months), and 12-month objective cure rates. Kaplan-Meier curves assessed cumulative recurrence. RESULTS: Of 120 patients enrolled (TVT-O: 66; TVT-E: 54), baseline characteristics were comparable (P > 0.05). Operative time was significantly shorter in the TVT-O group (P < 0.001), with no significant differences in blood loss, catheterization time, or hospital stay. Complication rates were similar (TVT-O: 21.21% vs. TVT-E: 18.52%, P = 0.710), including specific complications like groin pain. Both groups showed significant postoperative quality-of-life improvements (P < 0.001), but between-group differences were not significant. At 12 months, objective cure rates and cumulative recurrence-free survival were comparable between groups. CONCLUSION: Both TVT-O and TVT-E are safe and effective for severe SUI, significantly improving quality of life. TVT-O offers shorter operative time with equivalent efficacy and complication rates to TVT-E.
Tranexamic acid as an alternative to epinephrine in WALANT carpal tunnel release: a randomized clinical trial.
Kamimura L, Castano-Betancourt MC, de Castro MC … +4 more , Almeida Bastos C, Isper C, Galdeano EA, Hirata HH
BMC Surg · 2026 Jul · PMID 42399912 · Full text
BACKGROUND: Carpal tunnel release can be performed using the WALANT (Wide-Awake Local Anesthesia No Tourniquet) technique, in which epinephrine is commonly used to improve intraoperative hemostasis. However, concerns reg...
BACKGROUND: Carpal tunnel release can be performed using the WALANT (Wide-Awake Local Anesthesia No Tourniquet) technique, in which epinephrine is commonly used to improve intraoperative hemostasis. However, concerns regarding vasoconstrictor-related complications persist. This study aimed to compare tranexamic acid (TA) with epinephrine for bleeding control during WALANT carpal tunnel release. METHODS: A prospective randomized study including 53 patients with carpal tunnel syndrome was conducted. Patients were randomized to WALANT with epinephrine (n = 27) or tranexamic acid (n = 26). Surgical time, intraoperative hemostasis, patient satisfaction, and postoperative complications were recorded. Clinical outcomes were assessed using specific clinical tests and the Boston Carpal Tunnel Questionnaire preoperatively and at 30 days. RESULTS: No severe bleeding or ischemic complications were observed in either group. One infection occurred in the epinephrine group requiring surgical debridement. Greater difficulty in achieving intraoperative hemostasis was observed in the TA group, resulting in longer surgical times (29.3 ± 10.5 min vs. 21.4 ± 6.9 min; P < 0.001). Patient satisfaction and functional outcomes were high and comparable between groups. CONCLUSION: Carpal tunnel release performed using the WALANT technique with either epinephrine or tranexamic acid was associated with similar short-term functional improvement and patient satisfaction. No major complications were observed in either group. However, the use of tranexamic acid was associated with greater difficulty in achieving intraoperative hemostasis and longer surgical times. TRIAL REGISTRATION: The trial protocol is available in the trial registry at Brazilian Clinical Trials Registry (ReBec) under registration number RBR2njtg49, date of registration 11/07/2025 (retrospectively registered). https://ensaiosclinicos.gov.br/rg/RBR2njtg49.
Surgical outcomes of cubital tunnel syndrome with acute symptom exacerbation caused by elbow ganglion cysts: a retrospective case series of 32 patients.
Guo XC, Zhang H, Wang J … +5 more , Hao JK, Ren J, Shi XC, Cong R, Xian H
BMC Surg · 2026 Jul · PMID 42399881 · Full text
BACKGROUND: Cubital tunnel syndrome (CuTS) caused by elbow ganglion cysts, characterized by abrupt onset or sudden exacerbation of ulnar nerve symptoms, is a rare condition with few reported cases. The current study aims...
BACKGROUND: Cubital tunnel syndrome (CuTS) caused by elbow ganglion cysts, characterized by abrupt onset or sudden exacerbation of ulnar nerve symptoms, is a rare condition with few reported cases. The current study aims to retrospectively assess the surgical treatment outcomes of patients with CuTS with acute symptom exacerbation caused by ganglion cysts from elbow joint. METHODS: From January 2023 to June 2024, patients diagnosed with CuTS with acute symptom exacerbation who were admitted to our hospital and followed up. Routine X-ray was performed to evaluate the degeneration of the elbow joint. Ultrasound test was used to evaluate the morphology of the ulnar nerve and ganglion cysts, especially in the elbow joint. Sensory deficit assessment of little finger according to British Medical Research Council Sensory Function Assessment Standards (BMRCS) and motor function assessment according to Medical Research Council (MRC) Scale for interosseous muscles strength were introduced. Surgical interventions including anterior subcutaneous transposition of the ulnar nerve and ganglion cyst resection were performed. Visual analogue scale (VAS) score was used to evaluate the pain of the patients. All the above parameters were collected and analyzed at the time points of pre-operation and final follow-up. RESULTS: A total of 32 patients was followed up with a mean age of 54.94 years, including 6 females and 26 males with 10 left and 22 right limbs affected. The period of follow-up ranges from 6 to 22 months (11.6 ± 5.4 months) post-operation. The X-ray indicated that 30 patients had osteoarthritis of the elbow joint. The symptom duration ranges from 0.5 to 24 months (6.0 ± 5.5 months). There were 4 cases of intraneural cysts and 28 cases of extraneural cysts according to ultrasound findings. In terms of sensory recovery, 18 cases (56.25%) achieved ≥ S3 + recovery, and of muscle strength recovery, 19 cases (59.375%) achieved ≥ M4 recovery post-operation. The parameters of sensory and muscle strength recovery above showed significant improvement (P = 0.0000038, and 0.0001318). The patients got significant pain relief after surgery according to the VAS scale with 16 cases (50%) experiencing complete disappearance of pain (P = 0.0000017). CONCLUSIONS: For CuTS caused by elbow ganglion cysts presenting with abrupt onset or sudden exacerbation of symptoms, accurate diagnosis and surgical treatment was associated with improvement in pain and neurological parameters, though complete functional recovery is not guaranteed. In addition, distinguishing between intraneural and extraneural cysts may be informative for postoperative surveillance and individualized follow-up planning.
Long-term outcomes after surgical repair of anomalous origin of one pulmonary artery from the aorta in infants younger than 6 months.
Zhu Y, Cai Y, Ye M … +4 more , Chen G, Shen X, Zhang H, Mi Y
BMC Surg · 2026 Jul · PMID 42399869 · Full text
BACKGROUND: This study aimed to summarize the clinical characteristics and long-term surgical outcomes of infants younger than 6 months with anomalous origin of one pulmonary artery from the aorta (AOPA) and to identify...
BACKGROUND: This study aimed to summarize the clinical characteristics and long-term surgical outcomes of infants younger than 6 months with anomalous origin of one pulmonary artery from the aorta (AOPA) and to identify factors associated with reoperation. METHODS: Infants younger than 6 months who underwent surgical repair for AOPA between January 2013 and December 2020 were retrospectively included. Long-term follow-up data were analyzed. Patients were stratified according to reoperation status and use of patch reconstruction during the primary operation, and preoperative, intraoperative, and postoperative variables were compared. RESULTS: Fifteen infants were enrolled, including 14 with anomalous origin of the right pulmonary artery and 1 with anomalous origin of the left pulmonary artery. All survived to hospital discharge. The median follow-up time was 65 months (IQR 39-97 months). During follow-up, reimplanted pulmonary artery branches remained smaller than normal. Five patients (33.3%) required reintervention. Patients in the reoperation group had lower preoperative pulmonary artery z scores. In the patch-repaired group, abnormal pulmonary artery branches had lower z scores and higher flow velocities at first discharge. Patients operated on at ≤ 1 month of age had a higher risk of reoperation and demonstrated smaller pulmonary artery z scores and faster flow velocities at first discharge. CONCLUSIONS: Surgical repair of AOPA in early infancy yields favorable outcomes. Younger age at surgery and smaller branch pulmonary arteries are associated with an increased risk of reoperation.
Diagnostic performance of RIPASA versus modified Alvarado score in acute appendicitis: a prospective diagnostic accuracy study from a tertiary centre in India.
Singh H, Yadav RK, Khan F … +3 more , Agarwal G, Gupta S, Garg V
BMC Surg · 2026 Jul · PMID 42399848 · Full text
PURPOSE: Acute appendicitis is a common surgical emergency. Clinical scores assist risk stratification where routine advanced imaging is impractical. The Alvarado score's performance in Asian populations is debated. The...
PURPOSE: Acute appendicitis is a common surgical emergency. Clinical scores assist risk stratification where routine advanced imaging is impractical. The Alvarado score's performance in Asian populations is debated. The Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) score was developed for Asian settings. This study prospectively compared RIPASA and the Modified Alvarado Score (MAS) against histopathological examination (HPE) in an Indian tertiary centre. METHODS: Prospective diagnostic accuracy study of 62 patients undergoing appendicectomy for suspected acute appendicitis at S.M.S. Medical College, Jaipur (January-December 2024). Pre-operative demographics, symptoms, signs and laboratory parameters were recorded; RIPASA (cut-off ≥ 7.5) and MAS (cut-off ≥ 7) were calculated. HPE was the reference standard. Outcomes were sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and area under the receiver operating characteristic curve (AUC) with standard error (SE) and 95% confidence interval (CI). AUCs were compared using DeLong's test, and paired sensitivities and specificities using McNemar's test. RESULTS: Participants were predominantly males (71.0%); mean age 30.66 years. HPE confirmed appendicitis in 56/62 (90.3%); negative appendicectomy rate 9.7%. RIPASA ≥ 7.5: sensitivity 94.6%, specificity 66.7%, PPV 96.4%, NPV 57.1%, AUC 0.921 (SE 0.052; 95% CI 0.820-1.000; p = 0.001). MAS ≥ 7: sensitivity 71.4%, specificity 83.3%, PPV 97.6%, NPV 23.8%, AUC 0.821 (SE 0.083; 95% CI 0.659-0.984; p = 0.010). DeLong's test showed superior discrimination for RIPASA (p = 0.030). McNemar's test demonstrated higher sensitivity for RIPASA (p = 0.0009), with no significant difference in specificity (p = 1.000). CONCLUSION: RIPASA demonstrated higher sensitivity and better diagnostic discrimination than MAS in this tertiary surgical cohort, while MAS showed higher specificity. RIPASA may help reduce missed diagnoses in similar high-prevalence emergency settings, although further validation in broader patient populations is warranted.
Minimally invasive surgical strategies for gallbladder stones with concomitant common bile duct stones: a systematic review and network meta-analysis.
Liao Z, Zhu X, Wang Y … +4 more , Pang J, Fu J, Wei J, Yu Y
BMC Surg · 2026 Jul · PMID 42399744 · Full text
BACKGROUND: Approximately 10-20% of patients with gallstones present with concomitant common bile duct stones (CBDS). Although T-tube drainage (TTD) has traditionally been used after bile duct exploration, clinical pract...
BACKGROUND: Approximately 10-20% of patients with gallstones present with concomitant common bile duct stones (CBDS). Although T-tube drainage (TTD) has traditionally been used after bile duct exploration, clinical practice is increasingly shifting toward T-tube-free minimally invasive strategies to enhance postoperative recovery. This study evaluated the effectiveness and safety of these approaches using a network meta-analysis (NMA). METHODS: PubMed, Web of Science, Embase, and the Cochrane Library were searched from inception to October 2025. Randomized controlled trials (RCTs) and cohort studies were analyzed in parallel using separate frequentist NMAs. Interventions included laparoscopic cholecystectomy (LC) + laparoscopic common bile duct exploration (LCBDE) + TTD, LC + LCBDE + primary suture (PS), LC + laparoscopic transcystic common bile duct exploration (LTCBDE), and LC + endoscopic retrograde cholangiopancreatography (ERCP) performed as either a single-stage or two-stage strategy. Treatment effects were expressed as risk ratios (RRs), odds ratios (ORs), and mean differences (MDs), with treatment rankings estimated using the surface under the cumulative ranking curve (SUCRA). RESULTS: Fifty-two studies including 11,327 patients (19 RCTs and 33 cohort studies) were included. Parallel analyses demonstrated generally consistent findings between randomized and observational evidence. In the RCT network, T-tube-free strategies achieved comparable stone clearance and overall safety compared with TTD. LC + LTCBDE showed the highest SUCRA ranking probabilities for operative time (MD - 47.01 min; SUCRA 96.4%) and length of hospital stay (MD - 5.78 days; SUCRA 86.9%). LC + LCBDE + PS was also associated with shorter operative time (MD - 20.02 min; SUCRA 51.8%) and shorter length of hospital stay (MD - 3.03 days; SUCRA 33.8%). Long-term outcomes and postoperative complication rates were generally comparable across strategies. Differences in SUCRA ranking probabilities were observed for postoperative pancreatitis-related outcomes, with LC + ERCP (two-stage) showing a lower ranking probability (SUCRA 15.8%). CONCLUSIONS: T-tube-free minimally invasive strategies achieved stone clearance and overall perioperative safety broadly comparable to those of TTD in patients with gallbladder stones and concomitant common bile duct stones. LC + LTCBDE and LC + LCBDE + PS were associated with shorter operative time and hospital stay in some network comparisons. Overall, treatment selection should remain individualized according to biliary anatomy, stone burden, patient condition, and institutional expertise.
Low excision and high suspension hemorrhoidectomy versus conventional Milligan-Morgan hemorrhoidectomy for mixed hemorrhoids: a 12-month prospective randomized controlled trial.
Shu Y, Deng H, Zhu J … +4 more , Zhang C, Sun P, Wang F, Liu H
BMC Surg · 2026 Jul · PMID 42393699 · Full text
BACKGROUND: Mixed hemorrhoids represent a highly prevalent benign anorectal disorder. Milligan-Morgan hemorrhoidectomy (MM) is the gold-standard treatment but carries substantial risks of severe postoperative pain, delay...
BACKGROUND: Mixed hemorrhoids represent a highly prevalent benign anorectal disorder. Milligan-Morgan hemorrhoidectomy (MM) is the gold-standard treatment but carries substantial risks of severe postoperative pain, delayed recovery, and anal dysfunction due to extensive tissue resection. Low excision and high suspension hemorrhoidectomy (LEHS) is a refined, function-preserving technique, yet high-quality long-term comparative evidence remains limited. This study aimed to assess the efficacy, safety, and anal functional outcomes of LEHS versus MM for grade III-IV mixed hemorrhoids over 12 months. METHODS: This single-center, prospective, randomized, non-inferiority trial enrolled 120 eligible patients between January 2024 and June 2024, randomized 1:1 to LEHS or MM groups with allocation concealment and blinded outcome assessment. Primary outcomes were 12-week clinical effective rate and 12-month hemorrhoid recurrence rate; secondary outcomes included perioperative indicators, pain scores, recovery metrics, complications, anorectal manometry, and patient satisfaction. Statistical analysis was performed via SPSS 26.0 with a -10% non-inferiority margin (P < 0.05). RESULTS: Baseline characteristics were well balanced between groups (all P > 0.05). The 12-week effective rate (96.4% vs. 92.9%) and 12-month recurrence rate (1.8% vs. 5.4%) confirmed LEHS non-inferiority (both P > 0.05). LEHS yielded longer operative time, less blood loss, lower VAS pain scores, faster recovery, fewer complications (14.8% vs. 33.3%, P = 0.027), and more favorable anorectal physiology (all P < 0.001), with higher patient satisfaction. CONCLUSIONS: LEHS is non-inferior to MM in clinical efficacy and long-term recurrence control for grade III-IV mixed hemorrhoids, with superior safety, faster recovery, and better-preserved anal function without excessive hypertonia. It is a reliable, minimally invasive surgical alternative worthy of clinical promotion. TRIAL REGISTRATION: ClinicalTrials.gov, NCT07495046 (Registered: March 2026, retrospectively registered).
Minimally invasive adrenalectomy for Cushing's syndrome and mild autonomous cortisol secretion: a 20-year experience from a tertiary endocrine surgery center.
Karatas I, Koc E, Iscan Y … +8 more , Mutlu U, Hacisahinogullari H, Bagbudar S, Sormaz IC, Aksakal N, Poyanli A, Tunca F, Senyurek Y
BMC Surg · 2026 Jul · PMID 42393675 · Full text
BACKGROUND: Cushing's syndrome is a systemic disorder caused by prolonged exposure to excessive glucocorticoids and is associated with significant morbidity and increased mortality. Minimally invasive adrenalectomy has b...
BACKGROUND: Cushing's syndrome is a systemic disorder caused by prolonged exposure to excessive glucocorticoids and is associated with significant morbidity and increased mortality. Minimally invasive adrenalectomy has become the preferred surgical approach for adrenal tumors due to favorable perioperative outcomes. This study aimed to evaluate the clinical characteristics, surgical outcomes, and histopathological findings of patients who underwent minimally invasive adrenalectomy for overt Cushing's syndrome and mild autonomous cortisol secretion (MACS). METHODS: This retrospective study included 114 consecutive patients who underwent minimally invasive adrenalectomy between January 2006 and December 2025 at our institution. The diagnosis of cortisol excess was established through multidisciplinary evaluation. Hormonal assessment consisted of late-night salivary cortisol measurements, 24-hour urinary free cortisol levels, adrenocorticotrophic hormone (ACTH), and a 1-mg dexamethasone suppression test. Patients with typical clinical features of hypercortisolism and abnormal hormonal findings were classified as having overt Cushing's syndrome, whereas patients without overt Cushingoid features but with a post-dexamethasone suppression test cortisol level > 1.8 µg/dL were classified as having MACS. Demographic characteristics, clinical manifestations, radiological findings, surgical approach, postoperative complications, histopathological and clinical outcomes were analyzed. RESULTS: The mean age of the patients was 47.8 ± 12.4 years, and the female-to-male ratio was 100:14. Adrenalectomy was performed on the right adrenal gland in 43 patients (37.7%), on the left adrenal gland in 62 patients (54.4%), and bilaterally in 9 patients (7.9%). Transabdominal laparoscopic adrenalectomy (TLA) was performed in 111 patients (97.4%), and posterior retroperitoneoscopic adrenalectomy (PRA) was performed in 3 patients (2.6%), with no conversion to open surgery. The mean hospital stay was 4 days. Postoperative complications were rare and mostly minor, with no mortality or major complications. Histopathology revealed adrenocortical adenoma in 76 cases (61.8%), hyperplasia in 39 (31.7%), carcinoma in 3 (2.4%), and other benign lesions in 5 (4.1%). Among patients with available postoperative hormonal follow-up, biochemical remission was achieved in 88.8% of patients, while profound cortisol suppression (< 2 µg/dL) was observed in 75.0% of patients. Adrenalectomy was also associated with significant postoperative improvements in metabolic parameters, particularly LDL cholesterol and triglyceride levels. CONCLUSIONS: Minimally invasive adrenalectomy is a safe and effective treatment option for patients with overt Cushing's syndrome and MACS. The low complication rate and absence of perioperative mortality observed in this study support the role of minimally invasive surgery in appropriately selected patients and highlight the importance of management in experienced, high-volume endocrine surgery centers.
Comparative efficacy of double and triple arthrodesis in adult-acquired flatfoot deformity: a retrospective analysis.
Wang C, Li X, Dong S … +5 more , Ling Z, Tsitsilonis S, Graef F, Alqiq K, Gehlen T
BMC Surg · 2026 Jul · PMID 42393669 · Full text
BACKGROUND: Rigid adult-acquired flatfoot deformity (AAFD) often requires arthrodesis. While triple arthrodesis is standard, double arthrodesis has been proposed as an alternative. However, comparative evidence remains l...
BACKGROUND: Rigid adult-acquired flatfoot deformity (AAFD) often requires arthrodesis. While triple arthrodesis is standard, double arthrodesis has been proposed as an alternative. However, comparative evidence remains limited. This study compared their clinical efficacy, radiographic correction, and plantar pressure distribution. METHODS: Patients who underwent double or triple arthrodesis for rigid AAFD in our department from April 2013 to December 2019 were retrospectively reviewed. Outcomes included AOFAS scores, Foot Function Index (FFI), radiographic parameters (Meary's angle [MA], talonavicular coverage angle [TCA], talus-first metatarsal angle [T1MA]), and plantar pressure measured via wireless insoles. Inter-group and intra-group comparisons were performed. RESULTS: Twenty-two patients were included (12 double, 10 triple arthrodesis). Baseline characteristics were comparable (all P > 0.05). Double arthrodesis had significantly shorter operative time (59.42 ± 6.05 vs. 85.80 ± 6.32 min, P < 0.001). Complication rates (16.67% vs. 10.00%, P = 1.0) and fusion time were similar, with 100% fusion in both groups. Both procedures significantly improved all functional and radiographic parameters (P < 0.05). AOFAS midfoot scores improved from 19.82 ± 6.97 to 73.83 ± 12.56 (double) and 23.80 ± 18.47 to 66.70 ± 16.65 (triple); hindfoot scores from 15.55 ± 11.57 to 68.75 ± 17.50 and 19.00 ± 17.83 to 69.60 ± 9.57; FFI decreased from 59.55 ± 13.77% to 22.58 ± 18.60% and 60.00 ± 16.26% to 33.50 ± 12.98%. Postoperative radiographic improvements included MA (23.53 ± 14.13° to 10.51 ± 6.90° double; 21.79 ± 9.24° to 10.32 ± 7.75° triple), TCA (13.20 ± 7.65° to 4.84 ± 4.72°; 9.80 ± 6.98° to 4.84 ± 4.88°), and T1MA (22.83 ± 12.00° to 11.49 ± 8.39°; 24.66 ± 9.41° to 10.26 ± 5.20°), with no significant inter-group differences. Plantar pressure showed postoperative symmetry between operated and healthy feet in both groups, with inter-group differences only in the lateral plantar region (P = 0.037) and entire sole (P = 0.048) before correction for multiple comparisons; neither remained significant after correction. CONCLUSIONS: In this small cohort, no statistically significant differences were detected between the two procedures in short- to mid-term functional, radiographic, or plantar pressure outcomes, although operative time was shorter for double arthrodesis. Double arthrodesis may be considered a reasonable alternative in appropriately selected patients without significant CCJ involvement. However, these findings are exploratory and require confirmation in larger prospective studies. LEVEL OF EVIDENCE: Level Ⅲ.
Summary of best evidence for drainage tube management to prevent surgical site infections.
Du Q, Chen C, Wu S … +3 more , Sun F, Bian H, Ni L
BMC Surg · 2026 Jul · PMID 42393661 · Full text
OBJECTIVE: To conduct a narrative evidence synthesis integrating clinical practice guidelines, systematic reviews, meta-analyses, expert consensus, and primary studies to summarize the best available evidence related to...
OBJECTIVE: To conduct a narrative evidence synthesis integrating clinical practice guidelines, systematic reviews, meta-analyses, expert consensus, and primary studies to summarize the best available evidence related to drainage tube management for the prevention of surgical site infections (SSI), and to develop an evidence-based framework for clinical standardized management strategies. METHODS: Utilizing the "6S" evidence model, a systematic search was conducted on various national and international databases and websites up to October 31, 2025, including WHO, CDC, NICE, SHEA/IDSA, APIC, GIN, Medlive Guideline Network, The Cochrane Library, Joanna Briggs Institute (JBI) Evidence Synthesis, PubMed, Web of Science, Embase, CINAHL, ClinicalTrials.gov, CBM, CNKI, VIP, and WanFang. The search aimed to extract relevant evidence regarding the management of drainage tubes to prevent SSI. Two researchers independently performed the literature screening, quality assessment, evidence extraction, and integration of the literature. RESULTS: A total of 21 publications were included, comprising 4 guidelines, 4 expert consensuses and opinions, 2 evidence summaries, 6 systematic reviews, 3 randomized controlled trials, and 2 cohort studies. A total of 40 pieces of best evidence were summarized, covering ten aspects: indications and selection for drainage tube placement, intraoperative principles of drainage tube placement, daily maintenance of drainage tubes, management of drainage tube blockage, infection prevention measures, application of antimicrobial drugs, timing for drainage tube removal, monitoring and assessment of drainage fluid, patient health education, and referral indications. CONCLUSION: The best evidence summary for the management of drainage tubes to prevent SSI provides a preliminary evidence-based reference for the standardized management practice of drainage tubes in clinical settings. Clinicians and nursing staff should integrate specific circumstances and professional judgment to translate evidence into practice, thus providing scientific management and guidance for patients with drainage tubes.
Revised cardiac risk index and adverse outcomes in patients undergoing surgical stabilization of rib fractures.
Wang YH, Liao CA, Kuo LW … +10 more , Chan SY, Chen SA, Tee YS, Cheng CT, Liao CH, Fu CY, Kang SC, Hsieh CH, Scalea TM, Ribeiro MAF
BMC Surg · 2026 Jul · PMID 42393659 · Full text
BACKGROUND: Surgical stabilization of rib fractures (SSRF) is increasingly performed in patients with severe rib fractures or flail chest. It has been shown to reduce ventilator days and pulmonary complications. Neverthe...
BACKGROUND: Surgical stabilization of rib fractures (SSRF) is increasingly performed in patients with severe rib fractures or flail chest. It has been shown to reduce ventilator days and pulmonary complications. Nevertheless, SSRF carries perioperative morbidity, particularly pulmonary and cardiac events, and the optimal preoperative cardiac risk stratification tool for this population has not been established. This study evaluated the association between the Revised Cardiac Risk Index (RCRI) and in-hospital mortality and cardiopulmonary complications in SSRF patients. METHODS: This retrospective cohort study used the ACS-TQIP National Trauma Data Bank (2019-2023) to identify adult patients undergoing SSRF. Patients with AIS ≥ 2 in non-thoracic regions, blunt cardiac injury (AIS ≥ 2), or aortic injury were excluded. Because SSRF is an intrathoracic procedure, each patient carried a minimum RCRI of 1; patients were stratified into RCRI = 1, RCRI = 2, and RCRI ≥ 3. The primary outcomes were in-hospital mortality and a composite of cardiopulmonary complications (myocardial infarction, cardiac arrest, pneumonia, ARDS, deep vein thrombosis, and pulmonary embolism). Modified Poisson regression with robust standard errors estimated adjusted risk ratios (RRs), with RCRI = 1 as the reference and adjustment for demographics, regional and chest AIS, fixation details, and comorbidities. RESULTS: After exclusions, 6,139 patients were analyzed (RCRI = 1, n = 4,678; RCRI = 2, n = 1,208; RCRI ≥ 3, n = 253). Adverse outcomes increased stepwise with higher RCRI in both unadjusted and adjusted analyses. Compared with RCRI = 1, RCRI ≥ 3 was associated with significantly higher adjusted risks of in-hospital mortality (RR 3.34, 95% CI 2.06-5.43, p <0.001) and cardiopulmonary complications (RR 3.42, 95% CI 2.08-5.62; both p < 0.001), as well as myocardial infarction (RR 9.28, 95% CI 2.84-30.34, p < 0.001) and pneumonia (RR 5.85, 95% CI 2.72-12.59, p < 0.001). RCRI = 2 was also associated with increased mortality (RR 2.13, 95% CI 1.50-3.04, p < 0.001) and cardiopulmonary complications (RR 1.72, 95% CI 1.20-2.48, p = 0.003). CONCLUSIONS: RCRI is a simple, readily available bedside tool that independently stratifies the risk of in-hospital mortality and cardiopulmonary complications in patients undergoing SSRF. Incorporating the RCRI into preoperative assessment may help identify high-risk patients and guide perioperative management.
A nomogram for predicting early- and mid-term native liver survival after surgery in patients with type III biliary atresia: a single-center retrospective study.
Li S, Zeng J, Xu X … +10 more , Tao B, Ye Z, Lan M, Zhang H, Luo Y, Liang Z, Zhong Z, Wen L, Guo S, Liu F
BMC Surg · 2026 Jul · PMID 42393638 · Full text
BACKGROUND: Biliary atresia (BA) is a severe obstructive biliary disease. This study aimed to explore the independent risk factors influencing the prognosis of BA in children who underwent Kasai portoenterostomy (KPE) an...
BACKGROUND: Biliary atresia (BA) is a severe obstructive biliary disease. This study aimed to explore the independent risk factors influencing the prognosis of BA in children who underwent Kasai portoenterostomy (KPE) and to construct a nomogram for predicting the prognosis. METHODS: The clinical data of patients with type III BA who underwent KPE at Guangzhou Women and Children's Medical Center from June 2016 to May 2024 were retrospectively analyzed. Univariate and multivariate Cox regression analyses were used to screen for independent risk factors. A nomogram was constructed using the screened variables to predict postoperative early- and mid-term native liver survival (NLS). The predictive efficacy of the model was evaluated using the concordance index (C-index), receiver operating characteristic (ROC) curve and area under the curve (AUC), and calibration curves. RESULTS: Two hundred patients with type III BA whose clinical data were available were randomly divided into training and validation cohorts at a ratio of 7:3. Age at surgery, recurrent cholangitis, early bile drainage (EBD), and aspartate aminotransferase (AST) level within 1 month after surgery were identified as independent risk factors (all P < 0.05), and a nomogram was constructed using these factors. The C-index was 0.76 (95% CI: 0.71, 0.80) for the training cohort and 0.69 (95% CI: 0.57, 0.75) for the validation cohort. Excellent discrimination and calibration were observed for both groups. CONCLUSION: The nomogram constructed using variables such as age at surgery, recurrent cholangitis, EBD, and postoperative AST level can accurately predict the probability of NLS after surgery, providing a quantifiable assessment tool for clinical individualized clinical management.
Comparative surgical outcomes of pterional, supraorbital, and endoscopic endonasal approaches for tuberculum sellae meningiomas: a systematic review and network meta-analysis.
Msheik A, Mohamad AE, Sulaiman A … +2 more , Alhajjali A, Ayyad A
BMC Surg · 2026 Jul · PMID 42393610 · Full text
BACKGROUND: The optimal surgical corridor for tuberculum sellae meningiomas (TSMs) remains a subject of ongoing debate. While the pterional (PT) approach is the traditional gold standard, the endoscopic endonasal approac...
BACKGROUND: The optimal surgical corridor for tuberculum sellae meningiomas (TSMs) remains a subject of ongoing debate. While the pterional (PT) approach is the traditional gold standard, the endoscopic endonasal approach (EEA) and supraorbital (SO) keyhole approach have emerged as viable alternatives. OBJECTIVE: To comparatively evaluate the surgical outcomes and complication profiles of the PT, SO, and EEA techniques for the management of TSMs. METHODS: A systematic literature search was conducted across PubMed, Embase, Scopus, Web of Science, and Cochrane databases through March 2026. Frequentist random-effects network meta-analysis was performed to compare gross total resection (GTR), visual improvement, and complications. Treatment rankings were estimated using Surface Under the Cumulative Ranking Curve (SUCRA) scores. RESULTS: Six retrospective comparative studies involving 205 patients were included. Network meta-analysis showed no statistically significant differences between approaches for gross total resection (PT vs. EEA: RR 1.21, 95% CI 0.85-1.73; SO vs. EEA: RR 1.04, 95% CI 0.86-1.24). SUCRA rankings suggested only exploratory numerical patterns, with PT ranking highest for GTR and SO showing a non-significant trend for visual improvement compared with EEA (RR 1.30, 95% CI 0.95-1.76). These rankings were not supported by statistically significant pairwise differences and should be interpreted cautiously because of sparse evidence, retrospective study designs, and wide confidence or prediction intervals. Secondary outcomes, including cerebrospinal fluid leak, diabetes insipidus, and tumor recurrence, were imprecisely estimated and broadly comparable across approaches. CONCLUSION: Available retrospective comparative evidence suggests that pterional, supraorbital, and endoscopic endonasal approaches may provide broadly comparable outcomes for TSMs, but the certainty of evidence is limited. No approach demonstrated statistically significant superiority. Surgical corridor selection should remain individualized according to tumor anatomy, including lateral extension, vascular encasement, and optic canal involvement, as well as institutional expertise and surgeon experience.
Fulminant truncal necrotizing fasciitis of perianal origin with mediastinal extension: a case report.
Li H, Chen C, Wang Z … +5 more , Zhu H, Jian L, Zhou L, Chen S, Li Y
BMC Surg · 2026 Jul · PMID 42387484 · Full text
BACKGROUND: Necrotizing fasciitis (NF) is a rare but life-threatening soft-tissue infection characterized by rapidly progressive necrosis of the fascia and subcutaneous tissue. Early manifestations are often nonspecific,...
BACKGROUND: Necrotizing fasciitis (NF) is a rare but life-threatening soft-tissue infection characterized by rapidly progressive necrosis of the fascia and subcutaneous tissue. Early manifestations are often nonspecific, and delayed diagnosis is associated with substantial mortality. Early recognition and immediate intervention are critical to improving outcomes. CASE PRESENTATION: A 34-year-old man presented with progressive left lower abdominal pain and persistent perianal discomfort 5 days after radical drainage of a perianal abscess combined with internal hemorrhoid ligation. Despite initial treatment with antibiotics, glycemic control, and fluid resuscitation, his condition continued to deteriorate, and he was subsequently transferred to our hospital for definitive treatment. Emergency debridement demonstrated extensive spread of infection from the ischiorectal fossa through the obturator and abdominal fascial planes to the contralateral gluteal region and mediastinal/para-mediastinal fascial planes. Microbiological cultures confirmed type I polymicrobial infection involving Escherichia coli, Enterococcus raffinosus, and Candida albicans. Postoperatively, the patient developed early hypoxemic respiratory failure requiring invasive mechanical ventilation. The lowest documented PaO₂/FiO₂ ratio was 98.6 mmHg, and oxygenation improved after ventilatory optimization, increased PEEP, fluid restriction, and diuretic therapy. He was successfully extubated on postoperative day 3 and subsequently transitioned to high-flow nasal oxygen. Following combined anti-infective therapy, organ support, and nutritional management, the patient recovered and was discharged. CONCLUSIONS: NF can affect any body region, with the perineum, lower limbs, and postoperative wounds being most common. The disease can rapidly progress to systemic infection, sepsis, and multiple organ dysfunction syndrome. Early diagnosis, urgent surgical intervention, and multidisciplinary management are crucial for favorable outcomes.
About
- Frequency
- Sun
- Papers found
- 200
- RSS feed
- Subscribe