U-shaped sacral fractures are rare and often difficult to diagnose primarily due to the difficulty in obtaining adequate imaging and the severe associated injuries. These fractures are highly unstable and frequently c...U-shaped sacral fractures are rare and often difficult to diagnose primarily due to the difficulty in obtaining adequate imaging and the severe associated injuries. These fractures are highly unstable and frequently cause neurological deficits. The majority of surgeons have limited experience in management of U-shaped sacral fractures. No standard treatment protocol for U-shaped sacral fractures has been available till now. This study aimed to examine the management of U-shaped sacral fractures and the early outcomes. Clinical data of 15 consecutive patients with U-shaped sacral fracture who were admitted to our trauma center between 2009 and 2014 were retrospectively analyzed. Demographics, fracture classification, mechanism of injury and operative treatment and deformity angle were assessed. All the patients were treated with lumbopelvic fixation or （and） sacral decompression. EQ-5d score was applied to evaluate the patients＇ quality of life. Of the 15 consecutive patients with U-shaped sacral fracture, the mean age was 28.8 years （range： 15-55 years） at the time of injury. There were 6 females and 9 males. The mean follow- up time was 22.7 months （range： 9-47 months） and mean full weight-bearing time was 9.9 weeks （range： 8-14 weeks）. Ten patients received lumbopelvic fixation and sacral decompression, one lombosacral fixation, and 4 merely sacral decompression due to delayed diagnosis or surgery. The post-operation deformity angle （mean 27.87°, and range： 8°-90°） of the sacrum was smaller than that pre-operation （mean 35.67; range： 15-90） with no significance difference noted. At the latest follow-up, all patients obtained neurological recovery with different extents. Visual analogue score （VAS） was reduced from preoperative 7.07 （range： 5-9） to postoperetive 1.93 （range： 1-3）. All patients could walk without any aid after treatment. Eight patients were able to care for themselves and undertook some daily activities. Five patients had returned to work full time. In conclusion, lumbopelvic fixation is an effective method for stabilization of U-shaped sacral fractures with fewer complications developed. Effective reduction and firm fixation are the prerequisite of early mobilization and neurological recovery. Sacral decompression effectively promotes neurological recovery even in patients with old U-shaped sacral fractures.展开更多
BACKGROUND This study reports the clinical presentation of intraparenchymal hemorrhage as a rare complication after surgical decompression of an intracranial epencephalon arachnoid cyst(IEAC)at the posterior cranial f...BACKGROUND This study reports the clinical presentation of intraparenchymal hemorrhage as a rare complication after surgical decompression of an intracranial epencephalon arachnoid cyst(IEAC)at the posterior cranial fossa.CASE SUMMARY The clinical information of a patient with an IEAC was reported,and the related literature was reviewed.A female patient with nausea presented to our hospital.Computed tomography demonstrated an IEAC located at the posterior cranial fossa,which was large and required surgical intervention.After operation,postoperative intraparenchymal hemorrhage was detected.She had a good recovery with conservative treatment 1 mo later.CONCLUSION Though postoperative intraparenchymal hemorrhage is rare after surgical decompression of an IEAC,more attention should be paid to such a complication.展开更多
Numerous studies have shown that topical application of mitomycin C after surgical decompression effectively reduces scar adhesion. However, the underlying mechanisms remain unclear. In this study, we investigated the...Numerous studies have shown that topical application of mitomycin C after surgical decompression effectively reduces scar adhesion. However, the underlying mechanisms remain unclear. In this study, we investigated the effect of mitomycin C on the proliferation and apoptosis of human epidural scar fibroblasts. Human epidural scar fibroblasts were treated with various concentrations of mitomycin C （1, 5, 10, 20, 40 μg/mL） for 12, 24 and 48 hours. Mitomycin C suppressed the growth of these cells in a dose- and time-dependent manner. Mitomycin C upregulated the expression levels of Fas, DR4, DR5, cleaved caspase-8/9, Bax, Bim and cleaved caspase-3 proteins, and it downregulated Bcl-2 and Bcl-xL expression. In addition, inhibitors of caspase-8 and caspase-9 （Z-IETD-FMK and Z-LEHD-FMK, respectively） did not fully inhibit mitomycin C-induced apoptosis. Furthermore, mitomycin C induced endoplasmic reticulum stress by increasing the expression of glucose-regulated protein 78, CAAT/enhancer-binding protein homologous protein （CHOP） and caspase 4 in a dose-dependent manner. Salubrinal significantly inhibited the mitomycin C-induced cell viability loss and apoptosis, and these effects were accompanied by a reduction in CHOP expression. Our results support the hypothesis that mitomycin C induces human epidural scar fibroblast apoptosis, at least in part, via the endoplasmic reticulum stress pathway.展开更多
<strong>Objectives:</strong> Central cord syndrome has been reported to occur with particular frequency among older persons with cervical spondylosis who sustain hyperextension neck injury. This study aims...<strong>Objectives:</strong> Central cord syndrome has been reported to occur with particular frequency among older persons with cervical spondylosis who sustain hyperextension neck injury. This study aims to determine the efficacy of early surgical decompression (within 24 hours) of traumatic central cord syndrome patients in comparison with conservative management for central cord syndrome to determine a line of management to these cases. <strong>Methods: </strong>60 patients suffering from acute traumatic central cord syndrome with various neurological deficits were divided into 2 groups, group A (conservatively managed) and group B (surgically managed). Patients in group B were operated upon within 24 hr. of trauma by posterior decompression. Clinical assessment of each patient on admission, discharge and 3 months follow-ups was done using the ASIA Impairment Scale, FIM, Ashworth scale, bladder function, and neuropathic pain symptoms. <strong>Results:</strong> Data collected from both groups showed, group A (the conservative group) consisted of 22 male (73.3%) and 8 female subjects (26.6%) with a mean age of 57.5 years while in group B (surgical group) the sample consisted of 20 male (66.6%) and 10 female subjects (33.3%) with a mean age of 58.6 years. There was an improvement in our study—according to ASIA and FIM scales—in 8 patients of 30 (26.6%) in the conservative group. In the surgical group, improvement in 16 patients (53.3%). <strong>Conclusions:</strong> Early surgical decompression with laminectomy and duroplasty can be considered a reliable modality in the management of traumatic CCS and can effectively reduce the secondary injury of the spinal cord and consequent deterioration with less hospital stay.展开更多
1.Introduction Due to the continuous progress in surgical methodologies and the swift evolution of surgical tools,minimally invasive procedures have emerged as the dominant approach in urologic oncology surgeries.Nota...1.Introduction Due to the continuous progress in surgical methodologies and the swift evolution of surgical tools,minimally invasive procedures have emerged as the dominant approach in urologic oncology surgeries.Notably,robot-assisted surgery(RAS)has led to its extensive adoption in the surgical management of urinary system tumors due to its enhanced maneuverability,precision in suturing,and anastomotic capabilities.展开更多
Intra-abdominal hypertension(IAH)and abdominal compartment syndrome(ACS)play a pivotal role in the pathophysiology of severe acute pancreatitis(SAP)and contribute to new-onset and persistent organ failure.The optimal ...Intra-abdominal hypertension(IAH)and abdominal compartment syndrome(ACS)play a pivotal role in the pathophysiology of severe acute pancreatitis(SAP)and contribute to new-onset and persistent organ failure.The optimal management of ACS involves a multi-disciplinary approach,from its early recognition to measures aiming at an urgent reduction of intra-abdominal pressure(IAP).A targeted literature search from January 1,2000,to November 30,2022,revealed 20 studies and data was analyzed on the type and country of the study,patient demographics,IAP,type and timing of surgical procedure performed,post-operative wound management,and outcomes of patients with ACS.There was no randomized controlled trial published on the topic.Decom-pressive laparotomy is effective in rapidly reducing IAP(standardized mean difference=2.68,95%confidence interval:1.19-1.47,P<0.001;4 studies).The morbidity and complications of an open abdomen after decompressive laparotomy should be weighed against the inadequately treated but,potentially lethal ACS.Disease-specific patient selection and the role of less-invasive decompressive measures,like subcutaneous linea alba fasciotomy or component separation techniques,is lacking in the 2013 consensus management guidelines by the Abdominal Compartment Society on IAH and ACS.This narrative review focuses on the current evidence regarding surgical decompression techniques for managing ACS in patients with SAP.However,there is a lack of high-quality evidence on patient selection,timing,and modality of surgical decompression.Large prospective trials are needed to identify triggers and effective and safe surgical decompression methods in SAP patients with ACS.展开更多
<strong>Aim of the work:</strong> This study aims to assess the value of the surgical management in the improvement of the symptoms & signs of patients with Chiari malformation type 1 and radiological ...<strong>Aim of the work:</strong> This study aims to assess the value of the surgical management in the improvement of the symptoms & signs of patients with Chiari malformation type 1 and radiological follow up in adults.<strong> Patients and methods: </strong>This study included 30 consecutive patients with Chiari malformation type I who were indicated for surgery at neurosurgery department. Data were collected prospectively from the involved patients who were evaluated preoperatively and underwent evaluation by CT scanning of the brain & skull and MRI imaging of the brain and spine. CT and MRI were done as the routine follow up investigations for all patients. We operated through midline suboccipital craniectomy, durotomy in y shaped manner, shrinkage of cerebellar tonsils by bipolar electrocautery, duroplasty by fascia lata graft, watertight closure. <strong>Results: </strong>The assessment from E. J. N. S. (Egyptian Journal of Neurosurgery) vol. 24 no. 2 June 2009 used for evaluating the patients clinically. 18 patients reported good outcome, 6 fair, 6 poor. We evaluated the size of the syrinx if present preoperative in follow up. 15 (50%) patients showed marked reduction (more than or equal to 60%) in size of syrinx, 3 (10%) mild reduction (less than or equal to 30%) in size and 12 (40%) with no change. <strong>Conclusion:</strong> The Chiari type 1 malformation constitutes a controllable malformation with good outcomes. With current microsurgical techniques, the results of the bony decompression and duroplasty became excellent. Before undergoing surgical treatment for CM-I, symptomatic patients and their families should be given clear information about the success of treatment and potential complications.展开更多
Laparoscopic imaging has advanced significantly,with higher resolutions like 4K,and innovative light modes such as narrow band imaging and near-infrared imaging.Recently,yellow enhancement(YE)mode has emerged as a nov...Laparoscopic imaging has advanced significantly,with higher resolutions like 4K,and innovative light modes such as narrow band imaging and near-infrared imaging.Recently,yellow enhancement(YE)mode has emerged as a novel tool that enhances the pale-yellow colour of fat into a fluorescent yellow-green,improving contrast without the need for injected dyes.It can be toggled on and off easily during surgery.YE is still under evaluation,but early experience suggests it helps surgeons differentiate anatomical planes and key intraabdominal structures from surrounding adipose tissue.This is particularly useful in:(1)Dissecting structures surrounded or covered by fat;and(2)operating on patients with obesity,where excess intra-abdominal fat limits visualisation and retraction.By enhancing the visibility of vascular pedicles,ureters,and nerves,YE enables more precise dissections and may reduce the risk of accidental injury.It can also assist less experienced surgeons in identifying important structures,potentially improving efficiency and surgical outcomes.As a training tool,YE may shorten the learning curve,though further study is needed.Overall,YE offers potential benefits in fat-dense surgical fields by improving visualisation,reducing complications,and enhancing patient safety.展开更多
Endoscopic transnasal optic nerve decompression surgery plays a crucial role in minimal invasive treatment of complex traumatic optic neuropathy.However,a major challenge faced during the procedure is the inability to...Endoscopic transnasal optic nerve decompression surgery plays a crucial role in minimal invasive treatment of complex traumatic optic neuropathy.However,a major challenge faced during the procedure is the inability to visualize the optic nerve intraoperatively.To address this issue,an endoscopic image-based augmented reality surgical navigation system is developed in this study.The system aims to virtually fuse the optic nerve onto the endoscopic images,assisting surgeons in determining the optic nerve’s position and reducing surgical risks.First,a calibration algorithm based on a checkerboard grid of immobile points is proposed,building upon existing calibration methods.Additionally,to tackle accuracy issues associated with augmented reality technology,an optical navigation and visual fusion compensation algorithm is proposed to improve the intraoperative tracking accuracy.To evaluate the system’s performance,model experiments were meticulously designed and conducted.The results confirm the accuracy and stability of the proposed system,with an average tracking error of(0.99±0.46)mm.This outcome demonstrates the effectiveness of the proposed algorithm in improving the augmented reality surgical navigation system’s accuracy.Furthermore,the system successfully displays hidden optic nerves and other deep tissues,thus showcasing the promising potential for future applications in orbital and maxillofacial surgery.展开更多
BACKGROUND Balloon-assisted enteroscopy with a specialized overtube has improved the success of endoscopic retrograde cholangiopancreatography(ERCP)in patients with surgically altered anatomy(SAA).However,direct compa...BACKGROUND Balloon-assisted enteroscopy with a specialized overtube has improved the success of endoscopic retrograde cholangiopancreatography(ERCP)in patients with surgically altered anatomy(SAA).However,direct comparative data between double-balloon enteroscopy(DBE)and single-balloon enteroscopy(SBE)remain limited.AIM To compare the ERCP-related outcomes between DBE and SBE in patients with SAA.METHODS We retrospectively reviewed the medical records of 1042 patients with SAA who underwent ERCP.After propensity score matching for age and sex,494 patients were included,with 247 patients in each of the SBE and DBE groups.RESULTS The success rates of intubation,cannulation,completion of intended ERCP,and adverse events were similar between the DBE and SBE groups(94.3%vs 96.4%,P=0.393;89.5%vs 93.5%,P=0.147;88.3%vs 92.7%,P=0.125;10.5%vs 14.6%,P=0.222,respectively).However,the SBE group had significantly longer intubation and procedure times than the DBE group(23.5±22.3 minutes vs 14.1±13.5 minutes,P<0.001;65.2±37.9 minutes vs 31.0±18.5 minutes,P<0.001).Preserved gastric anatomy and Roux-en-Y reconstruction were independently associated with intubation failure(odds ratio=3.18,95%confidence interval:1.30-8.31;odds ratio=8.65,95%confidence interval:1.71-157.60,respectively).CONCLUSION DBE and SBE showed comparable clinical success and safety profiles in ERCP for patients with SAA,although SBE required significantly longer procedure times.DBE could provide procedural efficiency benefits in cases where an extended procedure duration is expected.Furthermore,a preserved gastric anatomy and Roux-en-Y reconstruction were identified as independent risk factors for intubation failure.展开更多
BACKGROUND Hepatobiliary surgery is complex and requires a thorough understanding of the liver’s anatomy,biliary system,and vasculature.Traditional imaging methods such as computed tomography(CT)and magnetic resonanc...BACKGROUND Hepatobiliary surgery is complex and requires a thorough understanding of the liver’s anatomy,biliary system,and vasculature.Traditional imaging methods such as computed tomography(CT)and magnetic resonance imaging(MRI),although helpful,fail to provide three-dimensional(3D)relationships of these structures,which are critical for planning and executing complicated surgeries.AIM To explore the use of 3D imaging and virtual surgical planning(VSP)technologies to improve surgical accuracy,reduce complications,and enhance patient recovery in hepatobiliary surgeries.METHODS A comprehensive review of studies published between 2017 and 2024 was conducted through PubMed,Scopus,Google Scholar,and Web of Science.Studies selected focused on 3D imaging and VSP applications in hepatobiliary surgery,assessing surgical precision,complications,and patient outcomes.Thirty studies,including randomized controlled trials,cohort studies,and case reports,were included in the final analysis.RESULTS Various 3D imaging modalities,including multidetector CT,MRI,and 3D rotational angiography,provide high-resolution views of the liver’s vascular and biliary anatomy.VSP allows surgeons to simulate complex surgeries,improving preoperative planning and reducing complications like bleeding and bile leaks.Several studies have demonstrated improved surgical precision,reduced complications,and faster recovery times when 3D imaging and VSP were used in complex surgeries.CONCLUSION 3D imaging and VSP technologies significantly enhance the accuracy and outcomes of hepatobiliary surgeries by providing individualized preoperative planning.While promising,further research,particularly randomized controlled trials,is needed to standardize protocols and evaluate long-term efficacy.展开更多
BACKGROUND Surgical site infections(SSIs)are a significant complication in laparoscopic cholecystectomy(LC),affecting patient outcomes and healthcare costs.AIM To identify risk factors associated with SSIs and evaluat...BACKGROUND Surgical site infections(SSIs)are a significant complication in laparoscopic cholecystectomy(LC),affecting patient outcomes and healthcare costs.AIM To identify risk factors associated with SSIs and evaluate the effectiveness of prophylactic antibiotics in reducing these infections.METHODS A comprehensive retrospective evaluation was conducted on 400 patients who underwent LC from January 2022 to January 2024.Patients were divided into infected(n=36)and non-infected(n=364)groups based on the occurrence of SSIs.Data collected included age,diabetes mellitus status,use of prophylactic antibiotics,and specific surgical complications.Statistical analyses using SPSS(Version 27.0)involved univariate and multivariate logistic regression to determine factors influencing the risk of SSIs.RESULTS The use of prophylactic antibiotics significantly reduced the incidence of SSIs(χ²=68.34,P<0.01).Older age(≥60 years)and comorbidities such as diabetes mellitus were identified as significant risk factors.Surgical complications like insufficient cystic duct stump,gallbladder perforation,and empyema also increased SSI risk.Notably,factors such as intraoperative blood loss and operation time did not significantly impact SSI occurrence.CONCLUSION Prophylactic antibiotics are effective in reducing the risk of SSIs in patients undergoing LC.Age,diabetes mellitus,and certain surgical complications significantly contribute to the risk.Effective management of these risk factors is essential to improve surgical outcomes and reduce the incidence of SSIs.展开更多
Objective:To assess the safety and effectiveness of urological tumor surgeries using the hinotori^(TM)Surgical Robot System(hinotori)in a real-world clinical setting.Methods:All surgeries including robot-assisted radi...Objective:To assess the safety and effectiveness of urological tumor surgeries using the hinotori^(TM)Surgical Robot System(hinotori)in a real-world clinical setting.Methods:All surgeries including robot-assisted radical prostatectomy(RARP),robot-assisted partial nephrectomy(RAPN),robot-assisted radical nephrectomy(RARN),robot-assisted nephroureterectomy(RANU),robot-assisted adrenalectomy(RAA),and robot-assisted radical cystectomy with intracorporeal urinary diversion(RARC+ICUD)for urological tumors with the hinotori and da Vinci surgical system(da Vinci)from January 2022 to September 2023 were enrolled.We evaluated the safety and effectiveness of surgeries using the hinotori compared with those using the da Vinci.Results:Robotic surgeries using the hinotori were performed in a total of 91 cases,comprising 42 cases of RARP,18 cases of RAPN,six cases of RARN,10 cases of RANU,13 cases of RAA,and two cases of RARC+ICUD;no major intraoperative complications were observed in any of the cases using the hinotori;no major postoperative complications occurred in any of the cases;no case experienced an unrecoverable equipment error during surgery.Meanwhile,robotic surgeries using the da Vinci were performed in a total of 277 cases,comprising 126 cases of RARP,94 cases of RAPN,12 cases of RARN,10 cases of RANU,20 cases of RAA,and 15 cases of RARC+ICUD;major intraoperative complications occurred in two cases;major postoperative complications occurred in seven cases;seven cases required transfusion;one case underwent conversion to open surgery;during the study period,no case experienced an unrecoverable equipment error.Surgical outcomes for cases with the hinotori were comparable to those with the da Vinci.Conclusion:This study demonstrated that the hinotori is a safe and feasible tool for robotic surgeries in the field of urology.展开更多
BACKGROUND The management of severe symptomatic aortic stenosis has been revolutionized by transcatheter aortic valve replacement(TAVR),offering a minimally invasive alternative to surgical aortic valve replacement(SA...BACKGROUND The management of severe symptomatic aortic stenosis has been revolutionized by transcatheter aortic valve replacement(TAVR),offering a minimally invasive alternative to surgical aortic valve replacement(SAVR).However,the compara-tive safety and efficacy of these interventions remain subjects of ongoing investigation.AIM To compare the clinical outcomes and safety of TAVR vs SAVR in patients with severe symptomatic aortic stenosis.METHODS A systematic review and meta-analysis were conducted according to PRISMA guidelines.Randomized controlled trials(RCTs)comparing TAVR and SAVR were identified from databases including PubMed,Scopus,and Web of Science up to May 31,2024.Data were extracted on clinical outcomes,including mortality,procedural compli-cations,and post-procedure adverse events.Risk ratios(RRs)with 95%CIs were calculated using a random-effects model.RESULTS A total of 10 RCTs were included.TAVR demonstrated a significantly lower risk of acute kidney injury(RR:0.33;95%CI:0.25–0.44),major bleeding(RR:0.37;95%CI:0.30–0.46),and new-onset atrial fibrillation(RR:0.44;95%CI:0.34–0.57)compared to SAVR.However,TAVR was associated with higher risks of new permanent pacemaker implantation(RR:3.49;95%CI:2.77–4.39),major vascular complications(RR:2.47;95%CI:1.91–3.21),and paraval-vular leaks(RR:4.15;95%CI:3.14–5.48).Mortality at 30 days was comparable(RR:0.95;95%CI:0.78–1.15),but long-term mortality was slightly higher with TAVR in some analyses(RR:1.23;95%CI:1.01–1.49).Rates of stroke(RR:0.97;95%CI:0.81–1.17)and myocardial infarction(RR:0.91;95%CI:0.67–1.24)were similar between the groups.CONCLUSION TAVR offers a less invasive option with significant benefits in reducing acute kidney injury,major bleeding,and new-onset atrial fibrillation,making it particularly advantageous for high-risk surgical candidates.However,higher risks of permanent pacemaker implantation,vascular complications,and paravalvular leaks highlight the need for individualized patient selection and shared decision-making to optimize outcomes.展开更多
The surgical approach for patellar instability usually refers to reconstruction of the medial patellofemoral ligament associated with an osteotomy of the tibial tuberosity or a trochleoplasty when required.The medial ...The surgical approach for patellar instability usually refers to reconstruction of the medial patellofemoral ligament associated with an osteotomy of the tibial tuberosity or a trochleoplasty when required.The medial patellotibial ligament and the medial patellomeniscal ligament are secondary stabilizers of the patella.Despite this,both the medial patellotibial and patellofemoral ligaments aid in patellar rotation and tilt when the knee is flexed beyond 45°.The medial patellotibial ligament plays a particularly important role in the final stages of stretching in extension and between 40 degrees to 90 degrees of flexion.The clinical relevance and surgical indications for medial patellotibial ligament reconstruction associated with medial patellofemoral ligament reconstruction are still controversial.This editorial explores the surgical indications and clinical results for medial patellotibial ligament reconstruction to improve readers’understanding of this technique,especially because reported clinical outcomes have remained sparse.展开更多
BACKGROUND Minimally invasive esophagectomy(MIE)is a widely accepted treatment for esophageal cancer,yet it is associated with a significant risk of surgical adverse events(SAEs),which can compromise patient recovery ...BACKGROUND Minimally invasive esophagectomy(MIE)is a widely accepted treatment for esophageal cancer,yet it is associated with a significant risk of surgical adverse events(SAEs),which can compromise patient recovery and long-term survival.Accurate preoperative identification of high-risk patients is critical for improving outcomes.AIM To establish and validate a risk prediction and stratification model for the risk of SAEs in patients with MIE.METHODS This retrospective study included 747 patients who underwent MIE at two centers from January 2019 to February 2024.Patients were separated into a train set(n=549)and a validation set(n=198).After screening by least absolute shrinkage and selection operator regression,multivariate logistic regression analyzed clinical and intraoperative variables to identify independent risk factors for SAEs.A risk stratification model was constructed and validated to predict the probability of SAEs.RESULTS SAEs occurred in 10.2%of patients in train set and 13.6%in the validation set.Patients with SAE had significantly higher complication rate and a longer hospital stay after surgery.The key independent risk factors identified included chronic obstructive pulmonary disease,a history of alcohol consumption,low forced expiratory volume in the first second,and low albumin levels.The stratification model has excellent prediction accuracy,with an area under the curve of 0.889 for the training set and an area under the curve of 0.793 for the validation set.CONCLUSION The developed risk stratification model effectively predicts the risk of SAEs in patients undergoing MIE,facilitating targeted preoperative interventions and improving perioperative management.展开更多
BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)is an invasive endoscopic procedure used mainly to treat hepato-pancreato-biliary(HPB)diseases.The need for ERCP has increased with the rising number of H...BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)is an invasive endoscopic procedure used mainly to treat hepato-pancreato-biliary(HPB)diseases.The need for ERCP has increased with the rising number of HPB diseases over the past decade.Thus,due to increased demand,ERCP is performed at more centers.Currently,it is performed by general surgeons,gastroenterology and invasive radiology specialists in the United States and Europe as recommended by the British Society of Gastroenterology(BSG).AIM To present the results of ERCP procedures from fourteen surgical centers in Türkiye.METHODS Fourteen surgical centers performing ERCP were included in the present study.The age,gender,ERCP indication,success status,post-ERCP complications,ERCP reports and the files of 66993 patients who underwent ERCP were collected from the participating centers.The results are discussed according to the targets declared by the BSG,which are volume load per annum,proportion of successful cannulation(>85%),bile duct clearance rate(>75%),stenting rate for strictures(>80%)and complications(<6%).RESULTS A total of 66993 ERCP procedures were performed in the centers included in the study up to August 2024.29250(43.6%)of the procedures were performed urgently,especially for suppurative cholangitis,biliary tract injuries,etc.The remaining 37743(56.4%)cases were performed electively.50.2%of the patients were female and 49.8%were male.The average ages were 56.5 years for women and 55.9 years for men.General anesthesia was used in 84.1%of the patients while sedation was used in 15.9%.The indications were bile duct stone(78.7%),pancreatic tumor(3.9%),papillary tumor(3.3%),cholangiocarcinoma(2.6%),Oddi sphincter dysfunction(2.4%),bile leakage after cholecystectomy(2%),bile leakage after hydatid cyst surgery(1.9%),biliary stricture(1.7%),and other diseases(3.1%).Hyperamylasemia and post-ERCP pancreatitis were the most common complications as observed in 8.1%of the patients.They were usually self-limited and responded to supportive measures.The frequency of the other complications was also consistent with the literature.CONCLUSION There is a huge shortage of ERCP endoscopists worldwide due to insufficient ERCP training and centers especially in developing and underdeveloped countries.As patients requiring ERCP usually present to surgical practitioners,the incorporation of surgeons into this training program is an effective and reliable solution.The BSG recommends the incorporation of surgeons and radiologists in addition to gastroenterology specialists.This study is the first to present the results of ERCP procedures from fourteen surgical centers throughout Türkiye.The results suggest that the surgical centers included were able to achieve the targets set by the BSG.This study demonstrated that the surgical ERCP units in the present work have reached satisfactory results and provided a reliable and successful ERCP service.There are currently no issues regarding the validity and appropriateness of the surgeons performing ERCP.Therefore,ERCP training should be encouraged in surgeons and more surgical ERCP centers should be provided.展开更多
Fluorescence imaging in the second near-infrared window(NIR-II,900-1880 nm)offers high signalto-background ratio(SBR),enhanced definition,and superior tissue penetration,making it ideal for real-time surgical navigati...Fluorescence imaging in the second near-infrared window(NIR-II,900-1880 nm)offers high signalto-background ratio(SBR),enhanced definition,and superior tissue penetration,making it ideal for real-time surgical navigation.However,with single-channel imaging,surgeons must frequently switch between the surgi⁃cal field and the NIR-II images on the monitor.To address this,a coaxial dual-channel imaging system that com⁃bines visible light and 1100 nm longpass(1100LP)fluorescence was developed.The system features a custom⁃ized coaxial dual-channel lens with optimized distortion,achieving precise alignment with an error of less than±0.15 mm.Additionally,the shared focusing mechanism simplifies operation.Using FDA-approved indocya⁃nine green(ICG),the system was successfully applied in dual-channel guided rat lymph node excision,and blood supply assessment of reconstructed human flap.This approach enhances surgical precision,improves opera⁃tional efficiency,and provides a valuable reference for further clinical translation of NIR-II fluorescence imaging.展开更多
BACKGROUND Abdominal aortic aneurysm(AAA)repair often involves significant postoperative pain,traditionally managed with systemic opioids,which can cause undesirable side effects.This case report explores the novel us...BACKGROUND Abdominal aortic aneurysm(AAA)repair often involves significant postoperative pain,traditionally managed with systemic opioids,which can cause undesirable side effects.This case report explores the novel use of a surgically-initiated rectus sheath block with a catheter-over-needle assembly for pain management in AAA repair.CASE SUMMARY A 67-year-old female with hypertension and previous aortic dissection underwent elective open repair of an infrarenal AAA,which had grown from 3.4 cm to 4.3 cm over 14 months.A rectus sheath block was initiated surgically for postoperative pain control.The patient reported low pain scores and did not require systemic intravenous opioids,enabling early ambulation and discharge on postoperative day seven without complications.By preventing complications of systemic opi-oids,the method indicating a promising direction for postoperative pain management in major vascular surgeries.CONCLUSION Surgically-initiated rectus sheath block as a valuable tool for managing postoperative pain in AAA repair.展开更多
Background: Cesarean sections have become increasingly prevalent in both developed and developing nations. Nevertheless, postoperative complications, including surgical site infections (SSIs), remain a substantial con...Background: Cesarean sections have become increasingly prevalent in both developed and developing nations. Nevertheless, postoperative complications, including surgical site infections (SSIs), remain a substantial concern that contributes to heightened morbidity and mortality. This study is designed to evaluate the frequency and key determining factors associated with surgical site infections following cesarean section procedures in a tertiary care hospital in Bangladesh. Materials and Methods: This observational cross-sectional study, conducted at the Gynecology Department of Dhaka Medical College Hospital, involved 100 patients aged 15 - 45 who had cesarean deliveries. Data was collected during hospitalization and post-discharge and analyzed to determine the prevalence and relationship between socio-demographic characteristics and surgical site infection. Results: Among the study participants, 14% developed surgical site infections following cesarean operations. More than half of these patients were under the age of 25, with a mean age of 24.45 ± 4.44 years. Surgical site infections were more prevalent in individuals over 30 years old (P-value Conclusion: Post-cesarean surgical site infections are notably prevalent among the participants in this study. Several risk factors have been identified, including age, body mass index (BMI), socioeconomic status, anemia, preterm delivery, personal hygiene practices, regular menstrual cycles, and adherence to antenatal check-ups. The implementation of an effective awareness program, coupled with updated antibiotic protocols, is crucial for significantly reducing the incidence of these infections.展开更多
文摘U-shaped sacral fractures are rare and often difficult to diagnose primarily due to the difficulty in obtaining adequate imaging and the severe associated injuries. These fractures are highly unstable and frequently cause neurological deficits. The majority of surgeons have limited experience in management of U-shaped sacral fractures. No standard treatment protocol for U-shaped sacral fractures has been available till now. This study aimed to examine the management of U-shaped sacral fractures and the early outcomes. Clinical data of 15 consecutive patients with U-shaped sacral fracture who were admitted to our trauma center between 2009 and 2014 were retrospectively analyzed. Demographics, fracture classification, mechanism of injury and operative treatment and deformity angle were assessed. All the patients were treated with lumbopelvic fixation or （and） sacral decompression. EQ-5d score was applied to evaluate the patients＇ quality of life. Of the 15 consecutive patients with U-shaped sacral fracture, the mean age was 28.8 years （range： 15-55 years） at the time of injury. There were 6 females and 9 males. The mean follow- up time was 22.7 months （range： 9-47 months） and mean full weight-bearing time was 9.9 weeks （range： 8-14 weeks）. Ten patients received lumbopelvic fixation and sacral decompression, one lombosacral fixation, and 4 merely sacral decompression due to delayed diagnosis or surgery. The post-operation deformity angle （mean 27.87°, and range： 8°-90°） of the sacrum was smaller than that pre-operation （mean 35.67; range： 15-90） with no significance difference noted. At the latest follow-up, all patients obtained neurological recovery with different extents. Visual analogue score （VAS） was reduced from preoperative 7.07 （range： 5-9） to postoperetive 1.93 （range： 1-3）. All patients could walk without any aid after treatment. Eight patients were able to care for themselves and undertook some daily activities. Five patients had returned to work full time. In conclusion, lumbopelvic fixation is an effective method for stabilization of U-shaped sacral fractures with fewer complications developed. Effective reduction and firm fixation are the prerequisite of early mobilization and neurological recovery. Sacral decompression effectively promotes neurological recovery even in patients with old U-shaped sacral fractures.
基金The Science and Technology Program of Nantong Health Committee,No.MA2019003 and No.KEY03.
文摘BACKGROUND This study reports the clinical presentation of intraparenchymal hemorrhage as a rare complication after surgical decompression of an intracranial epencephalon arachnoid cyst(IEAC)at the posterior cranial fossa.CASE SUMMARY The clinical information of a patient with an IEAC was reported,and the related literature was reviewed.A female patient with nausea presented to our hospital.Computed tomography demonstrated an IEAC located at the posterior cranial fossa,which was large and required surgical intervention.After operation,postoperative intraparenchymal hemorrhage was detected.She had a good recovery with conservative treatment 1 mo later.CONCLUSION Though postoperative intraparenchymal hemorrhage is rare after surgical decompression of an IEAC,more attention should be paid to such a complication.
基金supported by the National Natural Science Foundation of China,No.81401791,81371968,81672152
文摘Numerous studies have shown that topical application of mitomycin C after surgical decompression effectively reduces scar adhesion. However, the underlying mechanisms remain unclear. In this study, we investigated the effect of mitomycin C on the proliferation and apoptosis of human epidural scar fibroblasts. Human epidural scar fibroblasts were treated with various concentrations of mitomycin C （1, 5, 10, 20, 40 μg/mL） for 12, 24 and 48 hours. Mitomycin C suppressed the growth of these cells in a dose- and time-dependent manner. Mitomycin C upregulated the expression levels of Fas, DR4, DR5, cleaved caspase-8/9, Bax, Bim and cleaved caspase-3 proteins, and it downregulated Bcl-2 and Bcl-xL expression. In addition, inhibitors of caspase-8 and caspase-9 （Z-IETD-FMK and Z-LEHD-FMK, respectively） did not fully inhibit mitomycin C-induced apoptosis. Furthermore, mitomycin C induced endoplasmic reticulum stress by increasing the expression of glucose-regulated protein 78, CAAT/enhancer-binding protein homologous protein （CHOP） and caspase 4 in a dose-dependent manner. Salubrinal significantly inhibited the mitomycin C-induced cell viability loss and apoptosis, and these effects were accompanied by a reduction in CHOP expression. Our results support the hypothesis that mitomycin C induces human epidural scar fibroblast apoptosis, at least in part, via the endoplasmic reticulum stress pathway.
文摘<strong>Objectives:</strong> Central cord syndrome has been reported to occur with particular frequency among older persons with cervical spondylosis who sustain hyperextension neck injury. This study aims to determine the efficacy of early surgical decompression (within 24 hours) of traumatic central cord syndrome patients in comparison with conservative management for central cord syndrome to determine a line of management to these cases. <strong>Methods: </strong>60 patients suffering from acute traumatic central cord syndrome with various neurological deficits were divided into 2 groups, group A (conservatively managed) and group B (surgically managed). Patients in group B were operated upon within 24 hr. of trauma by posterior decompression. Clinical assessment of each patient on admission, discharge and 3 months follow-ups was done using the ASIA Impairment Scale, FIM, Ashworth scale, bladder function, and neuropathic pain symptoms. <strong>Results:</strong> Data collected from both groups showed, group A (the conservative group) consisted of 22 male (73.3%) and 8 female subjects (26.6%) with a mean age of 57.5 years while in group B (surgical group) the sample consisted of 20 male (66.6%) and 10 female subjects (33.3%) with a mean age of 58.6 years. There was an improvement in our study—according to ASIA and FIM scales—in 8 patients of 30 (26.6%) in the conservative group. In the surgical group, improvement in 16 patients (53.3%). <strong>Conclusions:</strong> Early surgical decompression with laminectomy and duroplasty can be considered a reliable modality in the management of traumatic CCS and can effectively reduce the secondary injury of the spinal cord and consequent deterioration with less hospital stay.
基金supported by grants from the National Natural Science Foundation of China(No.82172741 to Ye D)Shanghai Municipal Health Bureau(No.2020CXJQ03 to Ye D)Xuhui District Hospital Local Cooperation Project(No.23XHYD-14 to Ye D).
文摘1.Introduction Due to the continuous progress in surgical methodologies and the swift evolution of surgical tools,minimally invasive procedures have emerged as the dominant approach in urologic oncology surgeries.Notably,robot-assisted surgery(RAS)has led to its extensive adoption in the surgical management of urinary system tumors due to its enhanced maneuverability,precision in suturing,and anastomotic capabilities.
文摘Intra-abdominal hypertension(IAH)and abdominal compartment syndrome(ACS)play a pivotal role in the pathophysiology of severe acute pancreatitis(SAP)and contribute to new-onset and persistent organ failure.The optimal management of ACS involves a multi-disciplinary approach,from its early recognition to measures aiming at an urgent reduction of intra-abdominal pressure(IAP).A targeted literature search from January 1,2000,to November 30,2022,revealed 20 studies and data was analyzed on the type and country of the study,patient demographics,IAP,type and timing of surgical procedure performed,post-operative wound management,and outcomes of patients with ACS.There was no randomized controlled trial published on the topic.Decom-pressive laparotomy is effective in rapidly reducing IAP(standardized mean difference=2.68,95%confidence interval:1.19-1.47,P<0.001;4 studies).The morbidity and complications of an open abdomen after decompressive laparotomy should be weighed against the inadequately treated but,potentially lethal ACS.Disease-specific patient selection and the role of less-invasive decompressive measures,like subcutaneous linea alba fasciotomy or component separation techniques,is lacking in the 2013 consensus management guidelines by the Abdominal Compartment Society on IAH and ACS.This narrative review focuses on the current evidence regarding surgical decompression techniques for managing ACS in patients with SAP.However,there is a lack of high-quality evidence on patient selection,timing,and modality of surgical decompression.Large prospective trials are needed to identify triggers and effective and safe surgical decompression methods in SAP patients with ACS.
文摘<strong>Aim of the work:</strong> This study aims to assess the value of the surgical management in the improvement of the symptoms & signs of patients with Chiari malformation type 1 and radiological follow up in adults.<strong> Patients and methods: </strong>This study included 30 consecutive patients with Chiari malformation type I who were indicated for surgery at neurosurgery department. Data were collected prospectively from the involved patients who were evaluated preoperatively and underwent evaluation by CT scanning of the brain & skull and MRI imaging of the brain and spine. CT and MRI were done as the routine follow up investigations for all patients. We operated through midline suboccipital craniectomy, durotomy in y shaped manner, shrinkage of cerebellar tonsils by bipolar electrocautery, duroplasty by fascia lata graft, watertight closure. <strong>Results: </strong>The assessment from E. J. N. S. (Egyptian Journal of Neurosurgery) vol. 24 no. 2 June 2009 used for evaluating the patients clinically. 18 patients reported good outcome, 6 fair, 6 poor. We evaluated the size of the syrinx if present preoperative in follow up. 15 (50%) patients showed marked reduction (more than or equal to 60%) in size of syrinx, 3 (10%) mild reduction (less than or equal to 30%) in size and 12 (40%) with no change. <strong>Conclusion:</strong> The Chiari type 1 malformation constitutes a controllable malformation with good outcomes. With current microsurgical techniques, the results of the bony decompression and duroplasty became excellent. Before undergoing surgical treatment for CM-I, symptomatic patients and their families should be given clear information about the success of treatment and potential complications.
文摘Laparoscopic imaging has advanced significantly,with higher resolutions like 4K,and innovative light modes such as narrow band imaging and near-infrared imaging.Recently,yellow enhancement(YE)mode has emerged as a novel tool that enhances the pale-yellow colour of fat into a fluorescent yellow-green,improving contrast without the need for injected dyes.It can be toggled on and off easily during surgery.YE is still under evaluation,but early experience suggests it helps surgeons differentiate anatomical planes and key intraabdominal structures from surrounding adipose tissue.This is particularly useful in:(1)Dissecting structures surrounded or covered by fat;and(2)operating on patients with obesity,where excess intra-abdominal fat limits visualisation and retraction.By enhancing the visibility of vascular pedicles,ureters,and nerves,YE enables more precise dissections and may reduce the risk of accidental injury.It can also assist less experienced surgeons in identifying important structures,potentially improving efficiency and surgical outcomes.As a training tool,YE may shorten the learning curve,though further study is needed.Overall,YE offers potential benefits in fat-dense surgical fields by improving visualisation,reducing complications,and enhancing patient safety.
基金the National Natural Science Foundation of China(Nos.82330063 and M-0019)the Interdisciplinary Program of Shanghai Jiao Tong University(Nos.YG2022QN056,YG2023ZD19,and YG2023ZD15)+2 种基金the Cross Disciplinary Research Fund of Shanghai Ninth People’s Hospital,Shanghai Jiao Tong University School of Medicine(No.JYJC202115)the Translation Clinical R&D Project of Medical Robot of Shanghai Ninth People’s Hospital,Shanghai Jiao Tong University School of Medicine(No.IMR-NPH202002)the Shanghai Key Clinical Specialty,Shanghai Eye Disease Research Center(No.2022ZZ01003)。
文摘Endoscopic transnasal optic nerve decompression surgery plays a crucial role in minimal invasive treatment of complex traumatic optic neuropathy.However,a major challenge faced during the procedure is the inability to visualize the optic nerve intraoperatively.To address this issue,an endoscopic image-based augmented reality surgical navigation system is developed in this study.The system aims to virtually fuse the optic nerve onto the endoscopic images,assisting surgeons in determining the optic nerve’s position and reducing surgical risks.First,a calibration algorithm based on a checkerboard grid of immobile points is proposed,building upon existing calibration methods.Additionally,to tackle accuracy issues associated with augmented reality technology,an optical navigation and visual fusion compensation algorithm is proposed to improve the intraoperative tracking accuracy.To evaluate the system’s performance,model experiments were meticulously designed and conducted.The results confirm the accuracy and stability of the proposed system,with an average tracking error of(0.99±0.46)mm.This outcome demonstrates the effectiveness of the proposed algorithm in improving the augmented reality surgical navigation system’s accuracy.Furthermore,the system successfully displays hidden optic nerves and other deep tissues,thus showcasing the promising potential for future applications in orbital and maxillofacial surgery.
基金Supported by National Research Foundation of Korea,No.RS-2022-NRO71822Hallym University Medical Center Research Fund(Mighty Hallym,4.0).
文摘BACKGROUND Balloon-assisted enteroscopy with a specialized overtube has improved the success of endoscopic retrograde cholangiopancreatography(ERCP)in patients with surgically altered anatomy(SAA).However,direct comparative data between double-balloon enteroscopy(DBE)and single-balloon enteroscopy(SBE)remain limited.AIM To compare the ERCP-related outcomes between DBE and SBE in patients with SAA.METHODS We retrospectively reviewed the medical records of 1042 patients with SAA who underwent ERCP.After propensity score matching for age and sex,494 patients were included,with 247 patients in each of the SBE and DBE groups.RESULTS The success rates of intubation,cannulation,completion of intended ERCP,and adverse events were similar between the DBE and SBE groups(94.3%vs 96.4%,P=0.393;89.5%vs 93.5%,P=0.147;88.3%vs 92.7%,P=0.125;10.5%vs 14.6%,P=0.222,respectively).However,the SBE group had significantly longer intubation and procedure times than the DBE group(23.5±22.3 minutes vs 14.1±13.5 minutes,P<0.001;65.2±37.9 minutes vs 31.0±18.5 minutes,P<0.001).Preserved gastric anatomy and Roux-en-Y reconstruction were independently associated with intubation failure(odds ratio=3.18,95%confidence interval:1.30-8.31;odds ratio=8.65,95%confidence interval:1.71-157.60,respectively).CONCLUSION DBE and SBE showed comparable clinical success and safety profiles in ERCP for patients with SAA,although SBE required significantly longer procedure times.DBE could provide procedural efficiency benefits in cases where an extended procedure duration is expected.Furthermore,a preserved gastric anatomy and Roux-en-Y reconstruction were identified as independent risk factors for intubation failure.
文摘BACKGROUND Hepatobiliary surgery is complex and requires a thorough understanding of the liver’s anatomy,biliary system,and vasculature.Traditional imaging methods such as computed tomography(CT)and magnetic resonance imaging(MRI),although helpful,fail to provide three-dimensional(3D)relationships of these structures,which are critical for planning and executing complicated surgeries.AIM To explore the use of 3D imaging and virtual surgical planning(VSP)technologies to improve surgical accuracy,reduce complications,and enhance patient recovery in hepatobiliary surgeries.METHODS A comprehensive review of studies published between 2017 and 2024 was conducted through PubMed,Scopus,Google Scholar,and Web of Science.Studies selected focused on 3D imaging and VSP applications in hepatobiliary surgery,assessing surgical precision,complications,and patient outcomes.Thirty studies,including randomized controlled trials,cohort studies,and case reports,were included in the final analysis.RESULTS Various 3D imaging modalities,including multidetector CT,MRI,and 3D rotational angiography,provide high-resolution views of the liver’s vascular and biliary anatomy.VSP allows surgeons to simulate complex surgeries,improving preoperative planning and reducing complications like bleeding and bile leaks.Several studies have demonstrated improved surgical precision,reduced complications,and faster recovery times when 3D imaging and VSP were used in complex surgeries.CONCLUSION 3D imaging and VSP technologies significantly enhance the accuracy and outcomes of hepatobiliary surgeries by providing individualized preoperative planning.While promising,further research,particularly randomized controlled trials,is needed to standardize protocols and evaluate long-term efficacy.
文摘BACKGROUND Surgical site infections(SSIs)are a significant complication in laparoscopic cholecystectomy(LC),affecting patient outcomes and healthcare costs.AIM To identify risk factors associated with SSIs and evaluate the effectiveness of prophylactic antibiotics in reducing these infections.METHODS A comprehensive retrospective evaluation was conducted on 400 patients who underwent LC from January 2022 to January 2024.Patients were divided into infected(n=36)and non-infected(n=364)groups based on the occurrence of SSIs.Data collected included age,diabetes mellitus status,use of prophylactic antibiotics,and specific surgical complications.Statistical analyses using SPSS(Version 27.0)involved univariate and multivariate logistic regression to determine factors influencing the risk of SSIs.RESULTS The use of prophylactic antibiotics significantly reduced the incidence of SSIs(χ²=68.34,P<0.01).Older age(≥60 years)and comorbidities such as diabetes mellitus were identified as significant risk factors.Surgical complications like insufficient cystic duct stump,gallbladder perforation,and empyema also increased SSI risk.Notably,factors such as intraoperative blood loss and operation time did not significantly impact SSI occurrence.CONCLUSION Prophylactic antibiotics are effective in reducing the risk of SSIs in patients undergoing LC.Age,diabetes mellitus,and certain surgical complications significantly contribute to the risk.Effective management of these risk factors is essential to improve surgical outcomes and reduce the incidence of SSIs.
文摘Objective:To assess the safety and effectiveness of urological tumor surgeries using the hinotori^(TM)Surgical Robot System(hinotori)in a real-world clinical setting.Methods:All surgeries including robot-assisted radical prostatectomy(RARP),robot-assisted partial nephrectomy(RAPN),robot-assisted radical nephrectomy(RARN),robot-assisted nephroureterectomy(RANU),robot-assisted adrenalectomy(RAA),and robot-assisted radical cystectomy with intracorporeal urinary diversion(RARC+ICUD)for urological tumors with the hinotori and da Vinci surgical system(da Vinci)from January 2022 to September 2023 were enrolled.We evaluated the safety and effectiveness of surgeries using the hinotori compared with those using the da Vinci.Results:Robotic surgeries using the hinotori were performed in a total of 91 cases,comprising 42 cases of RARP,18 cases of RAPN,six cases of RARN,10 cases of RANU,13 cases of RAA,and two cases of RARC+ICUD;no major intraoperative complications were observed in any of the cases using the hinotori;no major postoperative complications occurred in any of the cases;no case experienced an unrecoverable equipment error during surgery.Meanwhile,robotic surgeries using the da Vinci were performed in a total of 277 cases,comprising 126 cases of RARP,94 cases of RAPN,12 cases of RARN,10 cases of RANU,20 cases of RAA,and 15 cases of RARC+ICUD;major intraoperative complications occurred in two cases;major postoperative complications occurred in seven cases;seven cases required transfusion;one case underwent conversion to open surgery;during the study period,no case experienced an unrecoverable equipment error.Surgical outcomes for cases with the hinotori were comparable to those with the da Vinci.Conclusion:This study demonstrated that the hinotori is a safe and feasible tool for robotic surgeries in the field of urology.
文摘BACKGROUND The management of severe symptomatic aortic stenosis has been revolutionized by transcatheter aortic valve replacement(TAVR),offering a minimally invasive alternative to surgical aortic valve replacement(SAVR).However,the compara-tive safety and efficacy of these interventions remain subjects of ongoing investigation.AIM To compare the clinical outcomes and safety of TAVR vs SAVR in patients with severe symptomatic aortic stenosis.METHODS A systematic review and meta-analysis were conducted according to PRISMA guidelines.Randomized controlled trials(RCTs)comparing TAVR and SAVR were identified from databases including PubMed,Scopus,and Web of Science up to May 31,2024.Data were extracted on clinical outcomes,including mortality,procedural compli-cations,and post-procedure adverse events.Risk ratios(RRs)with 95%CIs were calculated using a random-effects model.RESULTS A total of 10 RCTs were included.TAVR demonstrated a significantly lower risk of acute kidney injury(RR:0.33;95%CI:0.25–0.44),major bleeding(RR:0.37;95%CI:0.30–0.46),and new-onset atrial fibrillation(RR:0.44;95%CI:0.34–0.57)compared to SAVR.However,TAVR was associated with higher risks of new permanent pacemaker implantation(RR:3.49;95%CI:2.77–4.39),major vascular complications(RR:2.47;95%CI:1.91–3.21),and paraval-vular leaks(RR:4.15;95%CI:3.14–5.48).Mortality at 30 days was comparable(RR:0.95;95%CI:0.78–1.15),but long-term mortality was slightly higher with TAVR in some analyses(RR:1.23;95%CI:1.01–1.49).Rates of stroke(RR:0.97;95%CI:0.81–1.17)and myocardial infarction(RR:0.91;95%CI:0.67–1.24)were similar between the groups.CONCLUSION TAVR offers a less invasive option with significant benefits in reducing acute kidney injury,major bleeding,and new-onset atrial fibrillation,making it particularly advantageous for high-risk surgical candidates.However,higher risks of permanent pacemaker implantation,vascular complications,and paravalvular leaks highlight the need for individualized patient selection and shared decision-making to optimize outcomes.
文摘The surgical approach for patellar instability usually refers to reconstruction of the medial patellofemoral ligament associated with an osteotomy of the tibial tuberosity or a trochleoplasty when required.The medial patellotibial ligament and the medial patellomeniscal ligament are secondary stabilizers of the patella.Despite this,both the medial patellotibial and patellofemoral ligaments aid in patellar rotation and tilt when the knee is flexed beyond 45°.The medial patellotibial ligament plays a particularly important role in the final stages of stretching in extension and between 40 degrees to 90 degrees of flexion.The clinical relevance and surgical indications for medial patellotibial ligament reconstruction associated with medial patellofemoral ligament reconstruction are still controversial.This editorial explores the surgical indications and clinical results for medial patellotibial ligament reconstruction to improve readers’understanding of this technique,especially because reported clinical outcomes have remained sparse.
基金Supported by Joint Funds for the Innovation of Science and Technology,Fujian Province,No.2023Y9187 and No.2021Y9057.
文摘BACKGROUND Minimally invasive esophagectomy(MIE)is a widely accepted treatment for esophageal cancer,yet it is associated with a significant risk of surgical adverse events(SAEs),which can compromise patient recovery and long-term survival.Accurate preoperative identification of high-risk patients is critical for improving outcomes.AIM To establish and validate a risk prediction and stratification model for the risk of SAEs in patients with MIE.METHODS This retrospective study included 747 patients who underwent MIE at two centers from January 2019 to February 2024.Patients were separated into a train set(n=549)and a validation set(n=198).After screening by least absolute shrinkage and selection operator regression,multivariate logistic regression analyzed clinical and intraoperative variables to identify independent risk factors for SAEs.A risk stratification model was constructed and validated to predict the probability of SAEs.RESULTS SAEs occurred in 10.2%of patients in train set and 13.6%in the validation set.Patients with SAE had significantly higher complication rate and a longer hospital stay after surgery.The key independent risk factors identified included chronic obstructive pulmonary disease,a history of alcohol consumption,low forced expiratory volume in the first second,and low albumin levels.The stratification model has excellent prediction accuracy,with an area under the curve of 0.889 for the training set and an area under the curve of 0.793 for the validation set.CONCLUSION The developed risk stratification model effectively predicts the risk of SAEs in patients undergoing MIE,facilitating targeted preoperative interventions and improving perioperative management.
文摘BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)is an invasive endoscopic procedure used mainly to treat hepato-pancreato-biliary(HPB)diseases.The need for ERCP has increased with the rising number of HPB diseases over the past decade.Thus,due to increased demand,ERCP is performed at more centers.Currently,it is performed by general surgeons,gastroenterology and invasive radiology specialists in the United States and Europe as recommended by the British Society of Gastroenterology(BSG).AIM To present the results of ERCP procedures from fourteen surgical centers in Türkiye.METHODS Fourteen surgical centers performing ERCP were included in the present study.The age,gender,ERCP indication,success status,post-ERCP complications,ERCP reports and the files of 66993 patients who underwent ERCP were collected from the participating centers.The results are discussed according to the targets declared by the BSG,which are volume load per annum,proportion of successful cannulation(>85%),bile duct clearance rate(>75%),stenting rate for strictures(>80%)and complications(<6%).RESULTS A total of 66993 ERCP procedures were performed in the centers included in the study up to August 2024.29250(43.6%)of the procedures were performed urgently,especially for suppurative cholangitis,biliary tract injuries,etc.The remaining 37743(56.4%)cases were performed electively.50.2%of the patients were female and 49.8%were male.The average ages were 56.5 years for women and 55.9 years for men.General anesthesia was used in 84.1%of the patients while sedation was used in 15.9%.The indications were bile duct stone(78.7%),pancreatic tumor(3.9%),papillary tumor(3.3%),cholangiocarcinoma(2.6%),Oddi sphincter dysfunction(2.4%),bile leakage after cholecystectomy(2%),bile leakage after hydatid cyst surgery(1.9%),biliary stricture(1.7%),and other diseases(3.1%).Hyperamylasemia and post-ERCP pancreatitis were the most common complications as observed in 8.1%of the patients.They were usually self-limited and responded to supportive measures.The frequency of the other complications was also consistent with the literature.CONCLUSION There is a huge shortage of ERCP endoscopists worldwide due to insufficient ERCP training and centers especially in developing and underdeveloped countries.As patients requiring ERCP usually present to surgical practitioners,the incorporation of surgeons into this training program is an effective and reliable solution.The BSG recommends the incorporation of surgeons and radiologists in addition to gastroenterology specialists.This study is the first to present the results of ERCP procedures from fourteen surgical centers throughout Türkiye.The results suggest that the surgical centers included were able to achieve the targets set by the BSG.This study demonstrated that the surgical ERCP units in the present work have reached satisfactory results and provided a reliable and successful ERCP service.There are currently no issues regarding the validity and appropriateness of the surgeons performing ERCP.Therefore,ERCP training should be encouraged in surgeons and more surgical ERCP centers should be provided.
基金Supported by the National Natural Science Foundation of China(U23A20487)the National Key R&D Program of China(2022YFB3206000)+1 种基金Dr.Li Dak Sum&Yip Yio Chin Development Fund for Regenerative Medicine,Zhejiang Universitythe National Natural Science Foundation of China(61975172).
文摘Fluorescence imaging in the second near-infrared window(NIR-II,900-1880 nm)offers high signalto-background ratio(SBR),enhanced definition,and superior tissue penetration,making it ideal for real-time surgical navigation.However,with single-channel imaging,surgeons must frequently switch between the surgi⁃cal field and the NIR-II images on the monitor.To address this,a coaxial dual-channel imaging system that com⁃bines visible light and 1100 nm longpass(1100LP)fluorescence was developed.The system features a custom⁃ized coaxial dual-channel lens with optimized distortion,achieving precise alignment with an error of less than±0.15 mm.Additionally,the shared focusing mechanism simplifies operation.Using FDA-approved indocya⁃nine green(ICG),the system was successfully applied in dual-channel guided rat lymph node excision,and blood supply assessment of reconstructed human flap.This approach enhances surgical precision,improves opera⁃tional efficiency,and provides a valuable reference for further clinical translation of NIR-II fluorescence imaging.
基金Supported by the Taichung Veterans General Hospital,No.TCVGH-1125401B.
文摘BACKGROUND Abdominal aortic aneurysm(AAA)repair often involves significant postoperative pain,traditionally managed with systemic opioids,which can cause undesirable side effects.This case report explores the novel use of a surgically-initiated rectus sheath block with a catheter-over-needle assembly for pain management in AAA repair.CASE SUMMARY A 67-year-old female with hypertension and previous aortic dissection underwent elective open repair of an infrarenal AAA,which had grown from 3.4 cm to 4.3 cm over 14 months.A rectus sheath block was initiated surgically for postoperative pain control.The patient reported low pain scores and did not require systemic intravenous opioids,enabling early ambulation and discharge on postoperative day seven without complications.By preventing complications of systemic opi-oids,the method indicating a promising direction for postoperative pain management in major vascular surgeries.CONCLUSION Surgically-initiated rectus sheath block as a valuable tool for managing postoperative pain in AAA repair.
文摘Background: Cesarean sections have become increasingly prevalent in both developed and developing nations. Nevertheless, postoperative complications, including surgical site infections (SSIs), remain a substantial concern that contributes to heightened morbidity and mortality. This study is designed to evaluate the frequency and key determining factors associated with surgical site infections following cesarean section procedures in a tertiary care hospital in Bangladesh. Materials and Methods: This observational cross-sectional study, conducted at the Gynecology Department of Dhaka Medical College Hospital, involved 100 patients aged 15 - 45 who had cesarean deliveries. Data was collected during hospitalization and post-discharge and analyzed to determine the prevalence and relationship between socio-demographic characteristics and surgical site infection. Results: Among the study participants, 14% developed surgical site infections following cesarean operations. More than half of these patients were under the age of 25, with a mean age of 24.45 ± 4.44 years. Surgical site infections were more prevalent in individuals over 30 years old (P-value Conclusion: Post-cesarean surgical site infections are notably prevalent among the participants in this study. Several risk factors have been identified, including age, body mass index (BMI), socioeconomic status, anemia, preterm delivery, personal hygiene practices, regular menstrual cycles, and adherence to antenatal check-ups. The implementation of an effective awareness program, coupled with updated antibiotic protocols, is crucial for significantly reducing the incidence of these infections.
