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Clinical Advances in Abdominal Surgery

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "General Surgery".

Deadline for manuscript submissions: closed (25 April 2026) | Viewed by 12074

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Dr. Juan José Segura-Sampedro

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Guest Editor

General and Digestive Surgery Service, La Paz University Hospital, 28046 Madrid, Spain
Interests: oncologic surgery (cytoreductive surgery and HIPEC); trauma surgery; “balconing” phenomenon
Special Issues, Collections and Topics in MDPI journals

Dr. César P. Ramírez-Plaza

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Guest Editor

Surgical Oncology and Digestive Surgery Department, Hospital Quirón, Málaga, Spain
Interests: HIPEC; surgical oncology; ovarian cancer; peritoneal carcinomatosis; colorectal cancer

Special Issue Information

Dear Colleagues,

Advances in abdominal surgery have significantly transformed the field of medicine, offering new hope and improved outcomes for patients. Minimally invasive techniques, such as laparoscopic and robot-assisted surgery, have revolutionized traditional surgical approaches. These innovative methods are now being applied to a broader range of procedures, including duodenopancreatectomies, abdominal wall repairs, and various aspects of abdominal surgery.

Beyond minimally invasive techniques, new surgical methods are making a profound impact. Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (HIPEC), electrochemotherapy, high-intensity focused ultrasound (HIFU) and others are allowing for the more effective targeting of cancer cells compared to systemic chemotherapy. These advanced techniques have proven particularly beneficial for patients with advanced abdominal cancers, significantly improving survival rates and quality of life.

Overall, these advancements in abdominal surgery not only enhance the efficacy and safety of surgical interventions but also expand the range of conditions that can be successfully treated, offering new hope to patients worldwide.

Dr. Juan José Segura-Sampedro
Dr. César P. Ramírez-Plaza
Guest Editors

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Keywords

abdominal surgery
oncologic surgery
minimal invasive techniques
HIPEC
PIPAC
peritoneal carcinomatosis
liver metastasis

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Published Papers (8 papers)

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Research

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16 pages, 1572 KB

Open AccessArticle

Predictors of Postoperative Complications After Retromuscular Incisional Hernia Repair: A Retrospective Cohort Study

by Daniel Ioan Mihalache, Niculae Iordache, Liviu Vasile, Stelian-Stefaniță Mogoantă, Tiberiu-Ștefăniță Țenea-Cojan, Nicolae-Dragoș Mărgăritescu and Laurențiu Augustus Barbu

J. Clin. Med. 2026, 15(8), 2935; https://doi.org/10.3390/jcm15082935 - 12 Apr 2026

Viewed by 373

Abstract

Background: Incisional hernias are a frequent complication after abdominal surgery and may significantly affect patient outcomes. Retromuscular mesh placement using the Rives–Stoppa technique is widely considered a reliable approach for abdominal wall reconstruction, although postoperative complications remain an important clinical concern. Identifying predictors of adverse outcomes may improve patient selection and perioperative management. Methods: This retrospective cohort study included 1262 patients who underwent retromuscular incisional hernia repair. Demographic characteristics, comorbidities, hernia features, operative data, and postoperative outcomes were analyzed. Univariate and multivariable logistic regression analyses were performed to identify independent predictors of postoperative complications. Model performance was evaluated using receiver operating characteristic analysis. Results: The study included 1262 patients with a mean age of 61.5 ± 12.4 years, with a slight predominance of women (55%). The overall complication rate was 19.5%, with seroma (10.5%), surgical site infection (7.0%), and hematoma (3.5%) being the most common events. Hernia recurrence occurred in 6.0% of patients during follow-up. Multivariable analysis identified obesity (p < 0.001), large defect size (W3) (p < 0.001), diabetes mellitus (p = 0.004), recurrent hernia (p = 0.013), and ASA III–IV status (p = 0.038) as independent predictors of postoperative complications. The predictive model demonstrated moderate discrimination (AUC ≈ 0.73). Conclusions: Retromuscular incisional hernia repair is associated with acceptable morbidity and low recurrence rates. Obesity (OR 2.41), large defect size (W3) (OR 2.12), diabetes mellitus (OR 1.89), recurrent hernia (OR 1.67), and American Society of Anesthesiologists (ASA) classification III–IV status (OR 1.54) were identified as independent predictors of postoperative complications. The predictive model demonstrated moderate discrimination (AUC ≈ 0.73), supporting its potential role in clinical risk stratification and perioperative decision-making. Full article

(This article belongs to the Special Issue Clinical Advances in Abdominal Surgery)

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18 pages, 601 KB

Open AccessFeature PaperArticle

The Predictive Value of Clinical and Systemic Inflammatory Biomarkers in Emergency Colic Cancer Surgery: A Retrospective Study

by Adrian Marius Silaghi, Crenguta Sorina Serboiu, Dragos Serban, Vlad Denis Constantin, Corneliu Tudor, Ion Motofei, Gebran Hussein, Paul Lorin Stoica, Marina Ionela Nedea, Ana Maria Dascalu and Tudor Mihai Badescu

J. Clin. Med. 2026, 15(4), 1627; https://doi.org/10.3390/jcm15041627 - 20 Feb 2026

Viewed by 561

Abstract

Background/Objectives: Emergency surgery for complicated colon cancer carries high morbidity and mortality, largely driven by systemic inflammation and organ dysfunction. This study aims to investigate the predictive value of preoperative inflammatory biomarkers for postoperative outcomes. Methods: We retrospectively analyzed 219 patients undergoing emergency surgery for complicated colon cancer. Patients were classified as uncomplicated (n = 164) or complicated (Clavien–Dindo ≥ IIIA; n = 55). Preoperative clinical data, comorbidity indices, laboratory values, and inflammatory markers: C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) were assessed. Logistic regression and ROC (Receiver Operating Characteristic) curves analyses identified predictors of Clavien Dindo complications graded as IIIA or higher, anastomotic leak (AL), and in-hospital mortality. Results: Most patients included in the study were males (75.02%), with a mean age of 69.63 (±11.54) years. Patients included in the complicated group had higher comorbidity burden, ASA (American Society of Anesthesiologists) grade, rates of diabetes, organ failure, and systemic inflammatory response. All inflammatory biomarkers were significantly elevated in the complicated group (p < 0.001). CRP (>62.8 mg/dL), NLR (>6.89), and PLR (>334.2) showed good discrimination for Clavien Dindo complications graded as IIIA or higher, with AUC (area under curve) ranging from 0.726 to 0.799. A multivariable model including Charlson Comorbidity Index (CCI), CRP, PLR, and diabetes predicted Clavien–Dindo ≥ IIIA complications with excellent accuracy (AUC 0.870). PLR, creatinine, and diabetes independently predicted AL (AUC 0.834). Mortality (20.5%) was strongly associated with peritonitis, CRP, and NLR (AUC 0.891). Conclusions: Preoperative inflammatory biomarkers, combined with comorbidity and renal function, reliably predict adverse outcomes after emergency colon cancer surgery. Multivariate models may be useful for early risk stratification and support individualized perioperative management. Full article

(This article belongs to the Special Issue Clinical Advances in Abdominal Surgery)

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18 pages, 4371 KB

Open AccessArticle

Evaluation of the Diagnostic and Predictive Significance of Postoperative C-Reactive Protein to Transferrin or Albumin Ratio in Identifying Septic Events Following Major Abdominal Surgery

by Taxiarchis Konstantinos Nikolouzakis, Athanasios Alegakis, Maria Niniraki, Marilena Kampa and Emmanouel Chrysos

J. Clin. Med. 2025, 14(12), 4341; https://doi.org/10.3390/jcm14124341 - 18 Jun 2025

Cited by 1 | Viewed by 2117

Abstract

Background/Objectives: Postoperative septic events represent a major paramevter of morbidity and mortality following major abdominal surgery. Early identification and prediction can have a major impact on clinical management, reduction of hospitalization costs, and restriction of irrational use of antibiotics. For this purpose, two novel biomarkers (C-reactive protein to albumin or transferrin ratios, CAR and CTR, respectively) were evaluated. Methods: A combined retrospective and prospective study of 200 patients who underwent elective or emergency open abdominal surgery was performed. Patient demographics, emergency status, type of operation, and white blood cell (WBC) count, serum albumin (ALB), serum transferrin (TRF), and CAR-CTR were evaluated. Multiple-way ANOVA was utilized. Multiparametric and logistic regression analyses were performed for each confounder. Receiver operating characteristic (ROC) curve analysis and corresponding diagrams of sensitivity vs 1-specificity were applied for CAR and CTR in postoperative days 2 and 3. Results: WBC number had no predictive significance in septic event identification (p = 0.461), while postoperative CAR, CTR, ALB, TRF, BMI, and emergency status were significantly correlated (p < 0.001). At postoperative day 2, a CTR of 9.48 and a CAR of 4.14 have 75.9% and 70.4% specificity and 86% and 87.7% sensitivity, respectively. At postoperative day 3, a CTR of 8.89 and a CAR of 4.25 have 74.1% and 79.6% specificity and 87.7% and 86% sensitivity, respectively. Conclusions: Early identification of postoperative septic events may significantly facilitate decreasing postoperative morbidity and mortality. Both CAR and CTR displayed significant predictive ability in identifying patients prone to developing postoperative septic events, highlighting their significance in everyday clinical practice. Full article

(This article belongs to the Special Issue Clinical Advances in Abdominal Surgery)

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12 pages, 993 KB

Open AccessArticle

Rates of Textbook Outcome Achieved in Patients Undergoing Liver and Pancreatic Surgery

by Celia Villodre, Candido F. Alcázar-López, Silvia Carbonell-Morote, Paola Melgar, Mariano Franco-Campello, Juan Jesus Rubio-García and José M. Ramia

J. Clin. Med. 2024, 13(21), 6413; https://doi.org/10.3390/jcm13216413 - 26 Oct 2024

Cited by 3 | Viewed by 1605

Abstract

Backgorund: Textbook outcome (TO) is a composite measure that reflects the most desirable surgical results as a single indicator. The aim of this study was to assess the achievement of TO at a hepatopancreatobiliary (HPB) surgery unit in a Spanish tertiary hospital. Methods: We performed a retrospective observational study of all consecutive patients who underwent HPB surgery over a 4-year period. Morbidity according to the Clavien-Dindo classification at 30 days, hospital stay, risk of morbidity and mortality according to the POSSUM, and mortality and readmissions at 90 days were recorded. TO was considered when a patient presented no major complications (≥IIIA), no mortality, no readmission, and no prolonged length of stay (≤75th). Results: 283 patients were included. Morbidity >IIIA was reported in 21.6%, and 5.7% died; the median postoperative stay was 4 days. TO was achieved in 56.2% of patients. Comparing patients who presented TO with those who did not, significant differences were recorded for the type of procedure and the expected risk of morbidity and mortality calculated according to the POSSUM scale. There were significant differences between patients with major resections (TO rates: major hepatectomy (46.3%) and major pancreatectomy (52.5%)) and those with minor resections (TO rates minor hepatectomy (67.7%) and minor pancreatectomy (40.4%)). Conclusions: TO is a useful management tool for assessing postoperative results. Full article

(This article belongs to the Special Issue Clinical Advances in Abdominal Surgery)

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Review

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30 pages, 13982 KB

Open AccessReview

Liver Xenotransplantation: From Early Primate Trials to the First-in-Human Porcine Bridging Therapies

by Alexandru Grigorie Nastase, Alin Mihai Vasilescu, Ana Maria Trofin, Nicolae Florin Iftimie, Juan José Segura-Sampedro, Ramona Cadar, Iulian Buzincu, Alexandra Davidescu, Anda Lucia Nastase, Oana Georgiana Briceanu, Corina Lupascu-Ursulescu and Cristian Dumitru Lupascu

J. Clin. Med. 2026, 15(8), 3144; https://doi.org/10.3390/jcm15083144 - 20 Apr 2026

Viewed by 330

Abstract

Liver transplantation remains the definitive treatment for end-stage liver disease and acute liver failure, yet a critical and persistent shortage of donor organs results in thousands of preventable deaths annually worldwide. Xenotransplantation has emerged as a potential solution to this structural deficit. This narrative review traces the evolution of liver xenotransplantation, from early non-human primate trials in the 1960s through the application of CRISPR/Cas9-driven multi-gene editing platforms in contemporary porcine donors. The immunological barriers that drove the transition from primate to porcine donors are examined, including hyperacute rejection mediated by anti-α-Gal antibodies, coagulation dysregulation and xenograft thrombotic microangiopathy. The genetic engineering strategies underlying current triple-knockout, ten-gene-edited donor pigs are reviewed alongside the preclinical non-human primate evidence establishing biological feasibility. The three pig-to-human liver xenotransplantation studies published between 2025 and 2026 are then analyzed, encompassing heterotopic auxiliary transplantation in a brain-dead decedent, extracorporeal liver cross-circulation and the first auxiliary liver xenotransplantation in a living recipient with a documented 171-day survival. These cases collectively provide preliminary evidence supporting proof-of-concept for porcine hepatic bridging therapy, with current evidence supporting a role for xenogeneic liver support as a temporary bridge to recovery or allotransplantation rather than definitive organ replacement. Xenograft thrombotic microangiopathy is identified as the principal remaining biological barrier, and the substantial translational challenges, including reproducibility, scalability and regulatory readiness that must be resolved before broader clinical application can be considered. Full article

(This article belongs to the Special Issue Clinical Advances in Abdominal Surgery)

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15 pages, 3293 KB

Open AccessReview

Aggressiveness in Well-Differentiated Small Intestinal Neuroendocrine Tumors: A Rare Case and Narrative Literature Review

by Laurențiu Augustus Barbu, Liviu Vasile, Liliana Cercelaru, Valeriu Șurlin, Stelian-Ștefaniță Mogoantă, Gabriel Florin Răzvan Mogoș, Tiberiu Stefăniță Țenea Cojan, Nicolae-Dragoș Mărgăritescu, Marius P. Iordache and Anca Buliman

J. Clin. Med. 2025, 14(16), 5821; https://doi.org/10.3390/jcm14165821 - 18 Aug 2025

Cited by 14 | Viewed by 1236

Abstract

Background: Small intestinal neuroendocrine tumors (SI-NETs) are the most common malignancies of the small bowel. Although typically well differentiated and slow-growing, they may exhibit aggressive behavior, especially when diagnosed at an advanced stage. Objective: To illustrate the diagnostic and therapeutic challenges of advanced SI-NETs through a rare case presentation and a narrative review of recent studies in the literature. Methods: A narrative literature review was conducted using the PubMed database to examine the incidence, risk factors, diagnostic modalities, and treatment strategies for advanced-stage SI-NETs. The search included studies published between January 2010 and June 2025 and focused on human subjects, using keywords such as “small intestinal neuroendocrine tumor”, “metastasis”, “tumor grade”, and “treatment”. Results: We report the case of a 68-year-old man who presented with bowel obstruction. Imaging and surgical exploration revealed a jejunoileal SI-NET with extensive liver and peritoneal metastases, mesenteric fibrosis, and ascites. Histopathology confirmed a well-differentiated grade 2 tumor (Ki-67: 3%) positive for chromogranin A and CD56. Despite a low proliferative index, the tumor demonstrated aggressive clinical behavior. The patient underwent emergency enterectomy with ileostomy and was referred for further evaluation, including somatostatin receptor imaging and consideration for peptide receptor radionuclide therapy (PRRT). Conclusions: This case highlights the potential for aggressive progression in well-differentiated SI-NETs with low Ki-67 indices. Histological grade alone may not predict clinical behavior. Early diagnosis, comprehensive staging, and individualized multidisciplinary management—guided by functional imaging and receptor profiling—are critical to improving outcomes in advanced SI-NETs. Full article

(This article belongs to the Special Issue Clinical Advances in Abdominal Surgery)

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16 pages, 2532 KB

Open AccessReview

Fused Ischiorectal Phlegmon with Pre- and Retroperitoneal Extension: Case Report and Narrative Literature Review

by Laurențiu Augustus Barbu, Liviu Vasile, Liliana Cercelaru, Ionică-Daniel Vîlcea, Valeriu Șurlin, Stelian-Stefaniță Mogoantă, Gabriel Florin Răzvan Mogoș, Tiberiu Stefăniță Țenea Cojan and Nicolae-Dragoș Mărgăritescu

J. Clin. Med. 2025, 14(14), 4959; https://doi.org/10.3390/jcm14144959 - 13 Jul 2025

Cited by 6 | Viewed by 1339

Abstract

Background/Objectives: Anorectal and retroperitoneal abscesses, although differing in frequency and presentation, present significant diagnostic and therapeutic challenges, especially when interconnected through complex fascial planes. Rare cases such as horseshoe ischiorectal phlegmons with extraperitoneal spread are particularly difficult to manage due to limited literature and the absence of standardized protocols. This article presents a rare case alongside a narrative review of similar cases, aiming to highlight key diagnostic pitfalls and therapeutic strategies. Methods: We conducted a narrative literature review using PubMed, Embase, Scopus, and Web of Science to identify reports on horseshoe ischiorectal phlegmons with extraperitoneal or retroperitoneal extension. Relevant studies were compared with the present case. Results: We describe a 59-year-old male who presented with severe sepsis, diffuse abdominal pain, and hemodynamic instability. Imaging and surgery revealed extensive necrotizing spread to the anterior abdominal wall, peritoneum, and retroperitoneal space, despite absent local perianal signs. Emergency midline laparotomy, wide debridement, and drainage were performed. Despite intensive care, the patient suffered rapid clinical deterioration and died within six hours postoperatively. Conclusions: This case and literature review highlight how a clinically silent ischiorectal phlegmon can progress to extensive extraperitoneal involvement and fatal sepsis. This underscores the need for early recognition, advanced imaging, and aggressive multidisciplinary management. Further studies are needed to develop evidence-based guidelines for complex anorectal abscesses with deep fascial extension. Full article

(This article belongs to the Special Issue Clinical Advances in Abdominal Surgery)

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15 pages, 3004 KB

Open AccessReview

Mesenteric Cysts as Rare Causes of Acute Abdominal Masses: Diagnostic Challenges and Surgical Insights from a Literature Review

by Laurențiu Augustus Barbu, Nicolae-Dragoș Mărgăritescu, Liliana Cercelaru, Ionică-Daniel Vîlcea, Valeriu Șurlin, Stelian-Stefaniță Mogoantă, Gabriel Florin Răzvan Mogoș, Tiberiu Stefăniță Țenea Cojan and Liviu Vasile

J. Clin. Med. 2025, 14(14), 4888; https://doi.org/10.3390/jcm14144888 - 10 Jul 2025

Cited by 9 | Viewed by 3364

Abstract

Background/Objectives: Abdominal tumors can trigger acute, life-threatening complications, needing urgent care. Though often slow-growing, they may present suddenly with obstruction, bleeding, or organ compression. This article explores diagnostic challenges in such emergencies and presents a rare case of a giant mesenteric cyst. Methods: A PubMed search was conducted to review abdominal tumors in emergencies, focusing on mesenteric cysts. Results: A 37-year-old woman with no significant history presented with two weeks of diffuse abdominal pain and distension. Labs showed mild inflammation and low malignancy risk. Imaging revealed a large cystic mass compressing abdominal organs. Surgery found a 35 × 15 cm cyst from the mesenteric root extending into the pelvis and behind the stomach. Conclusions: Mesenteric cysts are rare with vague symptoms, needing high suspicion for diagnosis. Imaging helps, but large cysts often require surgery. Complete removal prevents recurrence, and bowel resection may be needed if vital structures are involved. Careful planning, teamwork, and follow-up ensure success. Full article

(This article belongs to the Special Issue Clinical Advances in Abdominal Surgery)

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