Journal Description
Surgeries
Surgeries
is an international, peer-reviewed, open access journal on findings and developments in surgery published quarterly online by MDPI. The Academy of Surgical Research is affiliated with Surgeries and its members receive discounts on the article processing charges.
- Open Access— free for readers, with article processing charges (APC) paid by authors or their institutions.
- High Visibility: indexed within ESCI (Web of Science), Scopus, and other databases.
- Rapid Publication: manuscripts are peer-reviewed and a first decision is provided to authors approximately 19.5 days after submission; acceptance to publication is undertaken in 4.6 days (median values for papers published in this journal in the first half of 2024).
- Recognition of Reviewers: APC discount vouchers, optional signed peer review, and reviewer names published annually in the journal.
Latest Articles
Prevention of Postoperative Pancreatic Fistula: Systematic Review and Meta-Analysis
Surgeries 2024, 5(3), 875-895; https://doi.org/10.3390/surgeries5030071 - 16 Sep 2024
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Background: After pancreatic surgery, the development of postoperative pancreatic fistula (POPF) is a serious concern. POPF involves the leakage of pancreatic fluids from the surgical site, which can lead to complications and even death. Preventing POPF is essential for enhancing patient recovery and
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Background: After pancreatic surgery, the development of postoperative pancreatic fistula (POPF) is a serious concern. POPF involves the leakage of pancreatic fluids from the surgical site, which can lead to complications and even death. Preventing POPF is essential for enhancing patient recovery and lessening the impact on healthcare resources. This systematic review and meta-analysis evaluated medical methods and surgical techniques to prevent POPF. Methods: This study was registered under the International Prospective Register of Systematic Reviews (PROSPERO) with the registration number CRD42024500938. An electronic search was conducted through the PubMed, Google Scholar, Web of Science, and ScienceDirect databases for all relevant articles published in English from 2018 to 2023. The following search terms were used: ((Whipple procedure OR Pancreaticojejunal OR Pancreaticogastrostomy) AND (Prevention of postoperative pancreatic fistula) AND (Prevention OR Octreotide OR Sealant agent OR Stent OR Postoperative drain)). Results: Of 260 papers, 28 articles extracted through the database search were considered suitable for the systematic review. The included studies investigated a variety of surgical approaches for pancreatic resection. Pancreaticoduodenectomy (PD) was the most prevalent intervention. The incidence rates for POPF varied widely across the studies, ranging from as low as 11.6% to as high as 100%. The incidence rate of clinically relevant POPF (CR-POPF) ranged from 11.7% to 33.3%. The length of postoperative hospital stays also varied significantly. Discussion: Postoperative pancreatic fistula (POPF) affects 13–41% of patients post-pancreatic surgery. Despite its high incidence, mortality rates are low. Postoperative hospital stay varies, with higher rates in older patients and overweight individuals. Advancements in surgical techniques and perioperative management have reduced mortality rates to <5%. Conclusions: This study provides insights into the outcomes of pancreatectomy, including the incidence of POPF, postoperative hospital stays, and mortality rate. The findings suggest that the incidence of POPF is similar to that suggested in the literature and is influenced by various factors.
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Open AccessCase Report
Indolent Adenocarcinoma In Situ Mistaken as Aggressive during Lung Cancer Screening Program: To Heal or to Harm?
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Riccardo Orlandi, Giovanni Mattioni, Luigi Rolli and Ugo Pastorino
Surgeries 2024, 5(3), 867-874; https://doi.org/10.3390/surgeries5030070 - 16 Sep 2024
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Background: Low-dose computed tomography-based lung cancer screening (LCS) has demonstrated efficacy in reducing lung cancer mortality. However, concerns about overdiagnosis and overtreatment hinder global LCS implementation. Methods: Here, we report the unique case of a slow-growing 1 cm pure ground-glass opacity (GGO) of
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Background: Low-dose computed tomography-based lung cancer screening (LCS) has demonstrated efficacy in reducing lung cancer mortality. However, concerns about overdiagnosis and overtreatment hinder global LCS implementation. Methods: Here, we report the unique case of a slow-growing 1 cm pure ground-glass opacity (GGO) of the lung, known for 15 years, which unexpectedly developed into a 5 cm mixed GGO within 1 year, with an increased solid component and FDG-PET uptake. Results: The patient, asymptomatic, underwent right upper lobectomy and lymphadenectomy, even complicated with postoperative chylothorax, later revealing to be affected by only an unchanged adenocarcinoma in situ (AIS). Conclusions: This case serves as a reminder of the potential behavior of pre-invasive lesions, which can mimic invasive neoplasia and may lead to overtreatment, and underscores the challenge of distinguishing indolent lesions from potentially aggressive malignancies in LCS, highlighting the need for the ongoing refinement of LCS protocols to mitigate this risk.
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(This article belongs to the Special Issue Cardiothoracic Surgery)
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Open AccessArticle
Perioperative Analgesia in Crisis Situations: Patient Characteristics in COVID-19 from the PAIN OUT Registry
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María A. Pérez-Herrero, Manuel Carrasco, Berta Velasco, Sara Cocho, Carla del Rey and Hermann Ribera
Surgeries 2024, 5(3), 857-866; https://doi.org/10.3390/surgeries5030069 - 12 Sep 2024
Abstract
Background: To evaluate analgesic practices in perioperative treatment during the SARS-CoV-2 pandemic; recording parameters collected in the PAIN OUT database, and to compare COVID and no-COVID data. Methods: Data were analyzed for 277 patients (87 COVID-19 confirmed diagnosis and 190 non-COVID): years aged,
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Background: To evaluate analgesic practices in perioperative treatment during the SARS-CoV-2 pandemic; recording parameters collected in the PAIN OUT database, and to compare COVID and no-COVID data. Methods: Data were analyzed for 277 patients (87 COVID-19 confirmed diagnosis and 190 non-COVID): years aged, gender, minutes of surgery duration, Likert Scale punctuation, hours in severe pain, minimum and maximum pain intensity, interference with sleep quality, anxiety, need for help, nausea, drowsiness, itching, dizziness, perception of care, pain relief, participation, satisfaction, and information received. Results: Postoperative mortality 1 month after surgery was recorded at 25.3% in COVID-19. Significant differences were found in postoperative pain intensity (p = 0.019), time with severe pain (p < 0.01), lower sleep quality (p < 0.01), and better outcomes in functional items (p < 0.01); there were more side effects and satisfaction with pain relief (p < 0.01) in COVID-patients than with no COVID-19 patients. Conclusions: In conclusion, COVID-19 patients presented greater intensity and duration of severe postoperative pain, greater somnolence, pruritus, and dizziness, lower physical activity limitation, and higher quality index.
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Open AccessArticle
The Association between the Complexity of Nasal Deformities and Surgical Time in Rhinoplasty Patients: A Retrospective Single-Center Study
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Hassan Assiri, Ahmed Naif Alolaywi, Mudafr Mahmoud Alkhedr, Musab Alamri, Mubarak Alanazi, Abdulaziz AlEnazi and Badi AlDosari
Surgeries 2024, 5(3), 848-856; https://doi.org/10.3390/surgeries5030068 - 12 Sep 2024
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Previous reports showed that prolonged operative time increases the risk of surgical site infection rates, prolonged hospital stays, and potentially higher rates of revision surgeries. In the context of rhinoplasty, the type of nasal deformity may complicate the surgical procedure and increase the
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Previous reports showed that prolonged operative time increases the risk of surgical site infection rates, prolonged hospital stays, and potentially higher rates of revision surgeries. In the context of rhinoplasty, the type of nasal deformity may complicate the surgical procedure and increase the operative time. We aimed to investigate the association between the type of nasal deformity and operative time in rhinoplasty patients. This retrospective chart review studies 349 patients who underwent primary and secondary rhinoplasty procedures due to various nasal deformities in King Saud University-Medical City. The primary outcome of the present study was the association between operative time, defined as the time from the initial incision to the completion of skin closure, and the type of nasal deformity. The association between the type of deformity and operative time was assessed using one-way ANOVA and Bonferroni post hoc analysis. There was a statistically significant association between the type of nasal deformity and operative time (p < 0.001). Patients with dorsal, alar base, and tip deformities had significantly longer operative times than patients with isolated dorsal deformities (208.01 ± 57.73 min) (p < 0.001). The analysis also showed that the presence of crooked nose deformities (p < 0.001), an inverted V deformity (p = 0.01), internal nasal valve collapse (p = 0.025), axis deviation (p = 0.003), over-projection, and under-projection significantly increased surgical duration. The complexity of nasal deformities significantly impacts the operative time in rhinoplasty surgeries; more complex deformities that require extensive surgical procedures are associated with a longer operative time. Further research is warranted to corroborate these findings and investigate other potential influencing factors.
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Open AccessReview
Patellar Sleeve Fracture: An Update of Literature
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Giacomo Papotto, Flora Maria Chiara Panvini, Konrad Schütze, Carlos Pankrats, Francesco Costanzo, Giovanni Carlo Salvo, Rocco Ortuso, Saverio Comitini, Antonio Kory, Gianfranco Longo and Marco Ganci
Surgeries 2024, 5(3), 835-847; https://doi.org/10.3390/surgeries5030067 - 9 Sep 2024
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Patellar sleeve fractures, though relatively rare, present unique challenges in diagnosis and management. This review aims to provide a comprehensive overview of the current understanding of patellar sleeve fractures, focusing on their epidemiology, clinical presentation, imaging, and management strategies. Epidemiologically, these fractures are
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Patellar sleeve fractures, though relatively rare, present unique challenges in diagnosis and management. This review aims to provide a comprehensive overview of the current understanding of patellar sleeve fractures, focusing on their epidemiology, clinical presentation, imaging, and management strategies. Epidemiologically, these fractures are uncommon, representing approximately 1% of all fractures in pediatric patients, yet they account for 50% of all patella fractures in this population. They predominantly affect adolescents, with a peak incidence around 12.7 years of age, and are more common in boys, occurring at a ratio of 3 to 5:1. Understanding these demographic patterns is crucial for early recognition and appropriate management. Clinically, patellar sleeve fractures typically present with the sudden onset of severe pain, often associated with explosive activities such as jumping. However, diagnosis can be challenging, particularly in cases with minimal displacement or where alternative muscle groups compensate for the injury. Differential diagnosis is essential, and clinicians should be vigilant for signs such as palpable gaps at the lower pole of the patella and patella alta. Imaging modalities play a vital role in diagnosis, with plain X-rays often revealing no bony damage. Ultrasonography may offer a cost-effective alternative, especially in cases where radiographic findings are inconclusive. Advanced imaging techniques such as MRI can assist in characterizing the extent of the injury and assessing for associated complications. Management strategies encompass a spectrum of approaches, ranging from conservative measures such as immobilization and physical therapy to surgical interventions, including open reduction and internal fixation or arthroscopic surgery. The choice of treatment depends on various factors, including the fracture pattern, displacement, patient age, activity level, and associated injuries. Despite advancements in diagnosis and treatment, the optimal management of patellar sleeve fractures remains a clinical challenge. Further research is warranted to elucidate optimal algorithms for diagnosis and treatment, with the ultimate goal of improving outcomes and reducing the risk of long-term complications associated with this rare but clinically significant knee injury.
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Open AccessArticle
Meralgia Paresthetica: Neurolysis or Neurectomy?
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Erika Carrassi, Elisabetta Basso, Lorenzo Maistrello, Giampietro Zanette and Stefano Ferraresi
Surgeries 2024, 5(3), 826-834; https://doi.org/10.3390/surgeries5030066 - 8 Sep 2024
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Meralgia paresthetica is a compressive neuropathy of the lateral femoral cutaneous nerve. Surgery is the gold standard for severe cases. However, no high-quality evidence exists on which strategy is best: decompression or neurectomy. Data of a consecutive series of 52 patients treated for
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Meralgia paresthetica is a compressive neuropathy of the lateral femoral cutaneous nerve. Surgery is the gold standard for severe cases. However, no high-quality evidence exists on which strategy is best: decompression or neurectomy. Data of a consecutive series of 52 patients treated for meralgia paresthetica over 25 years (1997–2022) were retrospectively collected from medical records and telephone interviews. In total, 27 women and 25 men were operated on; 11 patients had iatrogenic meralgia paresthetica. Decompression was performed on 47 patients, and neurectomy in 8 cases (5 primary neurectomies plus 3 failed neurolysis). Out of the patients who underwent decompression, 41 (87.2%) benefited from the treatment; 3 had pain relief, but no benefit on paresthesia; and 3 reported pain persistence. The latter required neurectomy to resolve symptoms. The eight patients who underwent neurectomy experienced symptom relief but had an obvious anesthetic area persisting over years. Complications were rare (3.8%): a groin hematoma in the post-operative course and an inguinal herniation 6 months after surgery. Surgery, be it neurolysis or neurectomy, offers excellent results with low risks. Decompression has been proven to be adequate in almost all patients, avoiding the side effects of neurectomy. The latter should be confined to failed decompression or to iatrogenic meralgia.
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Open AccessArticle
The Effect of Increasing Thread Depth on the Initial Stability of Dental Implants: An In Vitro Study
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Chiara Cucinelli, Miguel Silva Pereira, Tiago Borges, Rui Figueiredo and Bruno Leitão-Almeida
Surgeries 2024, 5(3), 817-825; https://doi.org/10.3390/surgeries5030065 - 7 Sep 2024
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Background: The long-term success of dental implants largely depends on achieving primary stability, previously described as crucial to obtaining osseointegration and immediate loading protocol requirements. Implant thread depths seem to be one of the key factors influencing primary stability, particularly in low-density bone.
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Background: The long-term success of dental implants largely depends on achieving primary stability, previously described as crucial to obtaining osseointegration and immediate loading protocol requirements. Implant thread depths seem to be one of the key factors influencing primary stability, particularly in low-density bone. Insertion torque (IT) and resonance frequency analysis (RFA) are considered the most reliable tests to assess primary stability. The aim of this work was to evaluate how different thread depths of commercially available dental implants affect primary stability in low-density D3 bone. Materials and Methods: An in vitro study was carried out between February 2024 and March 2024. Twenty-four dental implants were divided into four groups (six implants each) according to their thread depths (Group A: 4 mm, Group B: 4.5 mm, Group C: 5 mm, Group D: 5.5 mm) and were inserted in D3-type artificial bone blocks. The main outcome variables were the IT and the Implant Stability Quotient (ISQ) measured in four different areas of the implant (buccal, lingual, mesial, and distal) with an Osstel® ISQ reader. Descriptive and inferential analyses of the data were performed, and the significance value was set at 5%. Results: A total of 24 implants were analyzed. The highest IT values were obtained in Group D, with a mean of 54.03 Ncm (standard deviation (SD) = 8.99), while the lowest measurements were observed in Group A (mean = 25.12; SD: 2.96 N.cm). The mean ISQ values were consistently higher in Group D for each analyzed area, with a mean of 70.13 N.cm (SD = 1.12). Conclusions: Taking into consideration the limitations of this in vitro study, greater thread depths seem to increase the primary stability of dental implants placed in soft bone. Furthermore, a positive correlation was observed between all IT and ISQ values, regardless of the thread depth.
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Open AccessSystematic Review
Nail–Plate Constructs for Treating Distal Femur Fractures: A Systematic Review of Biomechanical Studies
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Omkar S. Anaspure, Shiv Patel, Anthony N. Baumann, Albert T. Anastasio, Christian Pean and Malcolm R. DeBaun
Surgeries 2024, 5(3), 799-816; https://doi.org/10.3390/surgeries5030064 - 6 Sep 2024
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The biomechanical efficacy of nail–plate constructs (NPCs) used in the treatment of traumatic distal femur fractures (DFFs) remains understudied compared to traditional approaches. This systematic review examines the biomechanical efficacy of NPCs compared to alternative approaches for the surgical fixation of DFFs to
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The biomechanical efficacy of nail–plate constructs (NPCs) used in the treatment of traumatic distal femur fractures (DFFs) remains understudied compared to traditional approaches. This systematic review examines the biomechanical efficacy of NPCs compared to alternative approaches for the surgical fixation of DFFs to guide surgical decision-making and improve patient outcomes. This systematic review searched the PubMed, CINAHL, MEDLINE, Web of Science, and SPORT Discus databases from inception until 24 January 2024. Inclusion criteria were biomechanical studies that involved nail–plate combination constructs for DFFs. Six observational studies were included. Of the included studies, five studies utilized synthetic bone models in testing, and one study used both synthetic and cadaveric bone models. All studies found NPCs to have significantly higher axial and torsional stiffness and resistance to loading than distal lateral femoral locking plate (DLFLP) constructs. The 11 mm NPCs were significantly stiffer than the 9 mm NPCs under torsional and axial loading. Only one of two studies found NPCs to have greater axial stiffness than dual-plate (DP) constructs. NPCs and DP constructs had greater torsional and axial stiffness than the plate-only or DP with medial distal tibial plate constructs. NPCs had less displacement and torque than the plate- or nail-only constructs under axial and torsional loads. NPCs demonstrate superior axial and torsional stiffness and resistance to mechanical loads compared to DLFLP. The varying performance between 11 mm and 9 mm NPCs suggests that construct diameter plays a role in mechanical stability. NPCs and DP constructs performed better than plate-only constructs. Future research should explore the impact of varying nail diameters and plate configurations on stability, as well as the clinical efficacy of NPCs across different patient populations, particularly those with varying bone densities, to better understand their performance in real-world scenarios.
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Open AccessArticle
Comparative Analysis of the Six-Strand Hamstring and Peroneus Longus in Sports Medicine and Rehabilitation
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Ondar Artysh Vyacheslavovich, Nikonova Alina Vladimirovna, Dzhunusov Bekzhan, Khaizhok Konstantin Ivanovich, Evgeniy Goncharov, Oleg Koval, Eduard Bezuglov, Manuel De Jesus Encarnacion Ramirez and Nicola Montemurro
Surgeries 2024, 5(3), 778-798; https://doi.org/10.3390/surgeries5030063 - 6 Sep 2024
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The anterior cruciate ligament (ACL) is crucial for knee stability and is often injured in sports, leading to significant issues like degenerative changes and meniscal tears. ACL tears are prevalent in high-school sports injuries, accounting for 50% of knee injuries in the U.S.
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The anterior cruciate ligament (ACL) is crucial for knee stability and is often injured in sports, leading to significant issues like degenerative changes and meniscal tears. ACL tears are prevalent in high-school sports injuries, accounting for 50% of knee injuries in the U.S. Surgical reconstruction, often involving bone-patellar tendon-bone (BPTB) or hamstring autografts, is common, with varying success rates and complications. Emerging alternatives like the peroneus longus tendon show promise but require further comparative studies. This prospective and multicentric study included 110 patients who underwent ACL reconstruction from 2020 to 2022. Fifty-five patients received hamstring tendon autografts (Group H) and fifty-five received peroneus longus tendon autografts (Group P). Surgeries were performed by experienced surgeons using standardized techniques. Patients were evaluated using clinical tests and functional scores including the Lysholm Knee Questionnaire and IKDC-2000 at various postoperative intervals up to 24 months. Data were analyzed using SPSS with a significance level set at p < 0.05. Group H showed superior knee function preoperatively and at 24 months postoperatively compared to Group P. Group H had higher Lysholm and IKDC scores consistently throughout the study period. The anterior drawer and Lachman’s tests indicated better knee stability for Group H. Complications were comparable between groups, with specific issues related to donor site morbidity and muscle weakness observed in each. The six-strand hamstring tendon autograft (Group H) demonstrated superior functional outcomes and knee stability compared to the peroneus longus tendon autograft (Group P) for ACL reconstruction. Despite some donor site morbidity, the hamstring tendon showed better long-term recovery and fewer complications. Future studies should explore larger, multicentric cohorts and integrate regenerative medicine techniques to further enhance ACL reconstruction outcomes.
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Open AccessEditorial
Balancing Innovation and Proven Techniques in Oral and Maxillofacial Surgery
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Karolina Walczyńska-Dragon and Maciej Chęciński
Surgeries 2024, 5(3), 774-777; https://doi.org/10.3390/surgeries5030062 - 5 Sep 2024
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The field of oral and maxillofacial surgery is continuously evolving, with ongoing advancements in surgical techniques, materials, and pharmacological approaches that enhance patient outcomes [...]
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(This article belongs to the Special Issue Oral and Maxillofacial Surgery: Balance Between Innovative and Proven Procedures, Drugs and Materials)
Open AccessReview
Brain Tumor Reporting and Data System (BT-RADS) for the Surveillance of Adult-Type Diffuse Gliomas after Surgery
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Marco Parillo and Carlo Cosimo Quattrocchi
Surgeries 2024, 5(3), 764-773; https://doi.org/10.3390/surgeries5030061 - 5 Sep 2024
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Glioblastoma is the most frequent form of adult-type diffuse gliomas, and it carries a very poor prognosis. Magnetic resonance imaging (MRI) is an indispensable tool for diagnosing and monitoring brain tumors, potentially influencing choices like repeat surgery, biopsy, or alternative management strategies. However,
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Glioblastoma is the most frequent form of adult-type diffuse gliomas, and it carries a very poor prognosis. Magnetic resonance imaging (MRI) is an indispensable tool for diagnosing and monitoring brain tumors, potentially influencing choices like repeat surgery, biopsy, or alternative management strategies. However, interpreting post-surgical MRI for gliomas can be particularly demanding, especially in differentiating between tumor progression and treatment effects. Recently, a novel score specifically designed for classifying and reporting post-treatment brain tumors on MRI was proposed by a team of neuroradiologists, neurosurgeons, and neuro-oncologists: the Brain Tumor Reporting and Data System (BT-RADS). This review examines the current body of evidence regarding the use of BT-RADS in monitoring adult-type diffuse gliomas following surgery. This classification has demonstrated a number of benefits in terms of prognostic value, treatment decisions, reliability, and the quality of radiology reports. On the other hand, despite the promising diagnostic value in identifying recurrent glioblastoma, there is still some uncertainty in defining the presence or absence of tumor recurrence in the intermediate category 3. In such a category, incorporating advanced techniques such as perfusion-weighted imaging and diffusion-weighted imaging may improve the stratification of patients, avoiding repeat surgery on false positive findings.
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Open AccessCase Report
A Case Report of Radiation-Induced Morphea Treated with Completion Mastectomy and Delayed Closure
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Niharika Singh, Zaina Naeem, Duc Bui and Anastasia Bakoulis
Surgeries 2024, 5(3), 758-763; https://doi.org/10.3390/surgeries5030060 - 2 Sep 2024
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Radiation-induced morphea (RIM) is a progressive and irreversible scleroderma encountered after breast radiation therapy. This condition is often underdiagnosed, with confounding differentials including post-radiation fibrosis, infection, inflammatory breast cancer, and cancer recurrence, amongst others. Treatment paradigms differ, and early diagnosis of RIM is
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Radiation-induced morphea (RIM) is a progressive and irreversible scleroderma encountered after breast radiation therapy. This condition is often underdiagnosed, with confounding differentials including post-radiation fibrosis, infection, inflammatory breast cancer, and cancer recurrence, amongst others. Treatment paradigms differ, and early diagnosis of RIM is essential in preventing further fibrosis and improving quality of life. First-line therapy includes immunosuppressive therapy; surgical management is infrequently described in the literature. Here, we report one of the few reports of completion mastectomy for RIM with postoperative outcomes described. This is a case of a patient who was treated with completion mastectomy with delayed wound closure after developing debilitating RIM status post right breast lumpectomy with radiation for invasive ductal carcinoma.
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Open AccessArticle
Prognostic Nomogram for Predicting Survival, Clinicopathological Analysis, and Racial Disparities in Uterine Carcinosarcoma: A Retrospective Population-Based Study
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Asad Ullah, Lily Rubin, Alexa Rakusin, Abdul Qahar Khan Yasinzai, Abdullah Chandasir, Amir Humza Sohail, Asif Iqbal, Abdul Waheed, Roona Khan, Luis Brandi, Bisma Tareen, Aman Goyal, Abu Baker Sheikh, Agha Wali, Thomas Paterniti and Mark Reedy
Surgeries 2024, 5(3), 743-757; https://doi.org/10.3390/surgeries5030059 - 20 Aug 2024
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Introduction: Uterine carcinosarcoma is an aggressive gynecologic malignancy that accounts for 5% of all gynecological malignancies. There is a disproportion in its incidence and mortality among different races. This study describes demographic and clinicopathological factors and racial disparities affecting the survival of
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Introduction: Uterine carcinosarcoma is an aggressive gynecologic malignancy that accounts for 5% of all gynecological malignancies. There is a disproportion in its incidence and mortality among different races. This study describes demographic and clinicopathological factors and racial disparities affecting the survival of patients with uterine carcinosarcoma. Methods: Data on uterine carcinosarcoma patients were obtained from the Surveillance, Epidemiology, and End Results (SEER) database from 2000 to 2020. Results: Of the 11,338 patients identified, the median age at diagnosis was 68 years, and the five-year cause-specific survival (CSS) rate was 38.7%. for all races. Compared with Asian patients (39.5%, 95% CI, 36.0–43.4%), Hispanic patients (39.4%, 95% CI, 36.5–42.5%), and White patients (37.9%, 95% CI, 36.7–39.2%), Black patients accounted for 21% of the patients and had a significantly lower 5-year CSS (95% CI, 27.2–31.2%). The CSS rates were 84.4% (95% CI, 83.3–85.6%) for localized tumors, 68.5% (95% CI, 66.9–70.1%) for regional tumors, and 39.0% (95% CI, 36.9–41.2%) for distant tumors. Multimodal treatment involving chemotherapy, surgery, and radiation improved the overall one- and five-year survival rates by 88.2% (95% CI, 87.0–89.5%) and 52.8% (95% CI, 50.7–55.1%), respectively, across all disease stages. Multivariate analysis identified age >60 years, Black race, tumor size >4 cm, and distant metastases as independent risk factors for mortality (p < 0.0001). Conclusions: This large database study presents the most up-to-date epidemiological information regarding cases of uterine carcinosarcoma. The findings suggest that a combination of surgery, chemotherapy, and radiation may be most efficacious in treating this malignancy, especially in patients with distant disease.
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Open AccessArticle
The Use of Male Implants in Thyroplasty Reinterventions for Female Patients: A Case Series Study
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Natsuki Oishi, Sara Orozco-Núñez and Enrique Zapater
Surgeries 2024, 5(3), 738-742; https://doi.org/10.3390/surgeries5030058 - 20 Aug 2024
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Montgomery’s medialization thyroplasty is a laryngeal frame surgery to treat patients with unilateral vocal cord paralysis. This procedure uses a silicone implant in six sizes each for male and female patients. The results of this technique are generally good; however, the results can
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Montgomery’s medialization thyroplasty is a laryngeal frame surgery to treat patients with unilateral vocal cord paralysis. This procedure uses a silicone implant in six sizes each for male and female patients. The results of this technique are generally good; however, the results can be suboptimal in some female patients because of differences in female and male laryngeal anatomy. The angle formed by the thyroid cartilage is greater in women than in men, meaning that the posterior portion of this cartilage is further away from the midline in women. We describe our results using male prostheses to improve suboptimal results in some of our female patients. This study is a retrospective case series study. We included female patients who underwent thyroplasty reintervention from 2014 to 2021 using male Montgomery thyroplasty prostheses. Functional results were studied using maximum phonation time (MPT), the GRBAS scales, and two questionnaires: Voice-Handicap Index 30 and Eating Assessment Tool 10. The functional results for all of these women improved after secondary thyroplasty. In one case, the MPT parameter did not change but patient satisfaction improved. The use of male Montgomery implants in women can be a useful tool to achieve improvement in female thyroplasty failure.
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Open AccessReview
Recurrence Rates of Pilonidal Sinus Disease Are High in Children and Recurrences Occur Exceedingly Early
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Christina Oetzmann von Sochaczewski and Dietrich Doll
Surgeries 2024, 5(3), 726-737; https://doi.org/10.3390/surgeries5030057 - 19 Aug 2024
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Pilonidal sinus disease increasingly affects children and adolescents. While recurrence rates in adults are lower, with a minimum of 2% per year, and are essentially a function of the surgical approach over time, this is totally different in children. Many studies investigating children
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Pilonidal sinus disease increasingly affects children and adolescents. While recurrence rates in adults are lower, with a minimum of 2% per year, and are essentially a function of the surgical approach over time, this is totally different in children. Many studies investigating children and adolescents report much higher recurrence rates. We aimed to gather and concentrate the available data on this matter in our review by searching PubMed, MEDLINE, and Scopus. The crude median recurrence rate of pilonidal sinus disease in children and adolescents was 13% (interquartile range, 7–20%) in our sample of 3599 patients in 42 studies, with a median study size of 52 (interquartile range, 27–96 patients) patients. Time to recurrence was available from eight studies with 1418 patients and its mean or median time to recurrence was usually much less than one year. For both parameters, an association with study size or patient age was not evident. Although treatment algorithms have been developed to adapt treatment to this dire situation, relevant improvements can only be expected if the underlying factors that cause these recurrence dynamics in children, which are substantially different from those in adults, were to be uncovered.
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Open AccessCase Report
C5 Palsy after Cervical Disc Arthroplasty: Two Case Reports and Literature Review
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César Carballo Cuello, Gabriel Flores Milan, Nicolas Baerga, Mark Greenberg, Puya Alikhani and Erik Hayman
Surgeries 2024, 5(3), 719-725; https://doi.org/10.3390/surgeries5030056 - 19 Aug 2024
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Cervical disc arthroplasty (CDA), also known as cervical artificial disc replacement, has become an alternative for the treatment of cervical spondylosis with radicular or myelopathic symptoms. However, there is limited literature regarding its complications and outcomes. We present two cases that developed C5
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Cervical disc arthroplasty (CDA), also known as cervical artificial disc replacement, has become an alternative for the treatment of cervical spondylosis with radicular or myelopathic symptoms. However, there is limited literature regarding its complications and outcomes. We present two cases that developed C5 nerve palsy (C5P) following two-level CDA. Both patients presented with C5P in a delayed fashion with 2/5 and 1/5 deltoid weakness on MMT, respectively. Postoperative imaging did not demonstrate any spinal cord compression and symptoms resolved (5/5 on MMT) with conservative management in both cases. To our knowledge, these represent the first cases of delayed C5P after cervical arthroplasty reported in the literature. We performed a literature review to further enhance our knowledge regarding CDA. By understanding its pathophysiology and response to treatment, these cases can serve as a guide for spine surgeons and improve their future outcomes.
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Open AccessReview
Metastatic Renal-Cell Carcinoma of the Oro-Facial Tissues: A Comprehensive Review of the Literature with a Focus on Clinico–Pathological Findings
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Vanja Granberg, Alessandra Laforgia, Marta Forte, Daniela Di Venere, Gianfranco Favia, Chiara Copelli, Alfonso Manfuso, Giuseppe Ingravallo, Antonio d’Amati and Saverio Capodiferro
Surgeries 2024, 5(3), 694-718; https://doi.org/10.3390/surgeries5030055 - 18 Aug 2024
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Background: Metastatic tumors of the oro-facial tissuesare rare, with an incidence ranging between 1% and 8% of all oral malignant tumors. Generally reported with a peak of incidence in the 5–7th decades but possibly occurring at any age, metastases may represent the first
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Background: Metastatic tumors of the oro-facial tissuesare rare, with an incidence ranging between 1% and 8% of all oral malignant tumors. Generally reported with a peak of incidence in the 5–7th decades but possibly occurring at any age, metastases may represent the first sign of an occult cancer or manifest in patients with an already known history of a primary carcinoma, mostly from the lungs, kidney, prostate, and colon/rectum in males, and the uterus, breast, lung, and ovary in females. In the oro-facial tissues, the most involved sites are the oral mucosa, gingiva/jawbones, tongue, and salivary glands. Methods: A broad and deep literature review with a comprehensive analysis of the existing research on oro-facial metastases from renal-cell carcinoma (RCC) was conducted by searching the most used databases, with attention also paid to the clear-cell histological variant, which is the most frequent one. Results: Among the 156 analyzed studies, 206 cases of oro-facial metastases of renal cancer were found in patients with an average age of 60.9 years (145 males, 70.3%; 61 females, 29.6%). In almost 40% of the cases, metastasis represented the first clinical manifestation of the primary tumor, and 122 were histologically diagnosed as clear-cell renal-cell carcinoma (ccRCC) (59.2%). The tongue was involved in most of the cases (55 cases, 26.7%), followed by the gingiva (39 cases, 18.9%), mandible (35 cases, 16.9%), maxilla (23 cases, 11.1%), parotid gland (22 cases, 10.6%), buccal mucosa (11 cases, 5.3%), lips (7 cases, 3.3%), hard palate (6 cases, 2.8%), soft palate, masticatory space, and submandibular gland (2 cases, 0.9%), and lymph nodes, tonsils, and floor of the mouth (1 case, 0.4%). Among the 122 ccRCCs (84 males, 68.8%; 38 females, 31.1%), with an average age of 60.8 years and representing in 33.6% the first clinical manifestation, the tongue remained the most frequent site (31 cases, 25.4%), followed by the gingiva (21 cases, 17.2%), parotid gland (16 cases, 13.1%), mandibular bone (15 cases, 12.2%), maxillary bone (14 cases, 11.4%), buccal mucosa and lips (6 cases, 4.9%), hard palate (5 cases, 4%), submandibular gland and soft palate (2 cases, 1.6%), and lymph nodes, tonsils, oral floor, and masticatory space (1 case, 0.8%). The clinical presentation in soft tissues was mainly represented by a fast-growing exophytic mass, sometimes accompanied by pain, while in bone, it generally presented as radiolucent lesions with ill-defined borders and cortical erosion. Conclusions: The current comprehensive review collected data from the literature about the incidence, site of occurrence, age, sex, and survival of patients affected by oro-facial metastases from renal-cell carcinoma, with particular attention paid to the cases diagnosed as metastases from clear-cell renal-cell carcinoma, which is the most frequent histological variant. Clinical differential diagnosis is widely discussed to provide clinicians with all the useful information for an early diagnosis despite the effective difficulties in recognizing such rare and easily misdiagnosed lesionsTheir early identification represents a diagnostic challenge, especially when the clinical work-up is limited to the cervico–facial region. Nevertheless, early diagnosis and recently introduced adjuvant therapies may represent the key to better outcomes in such patients. Therefore, general guidelines about the clinical and radiological identification of oro-facial potentially malignant lesions should be part of the cultural background of any dentist.
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Open AccessArticle
Post-Trauma Fetal Care Using Computational Analysis in Prenatal Surgical Guidance
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Atieh Dehghani Ashkezari, Molly Bekbolatova, Jonathan Mayer, Timothy Devine, Kusuma Nio, Rosalyn Chan-Akeley and Milan Toma
Surgeries 2024, 5(3), 682-693; https://doi.org/10.3390/surgeries5030054 - 17 Aug 2024
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The purpose of this research is to explore the biomechanical consequences of maternal injuries on fetal movements. Additionally, the research aims to comprehend the relationship between these injuries and fetal movement within the amniotic sac and to understand the extent to which the
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The purpose of this research is to explore the biomechanical consequences of maternal injuries on fetal movements. Additionally, the research aims to comprehend the relationship between these injuries and fetal movement within the amniotic sac and to understand the extent to which the amniotic fluid can provide protection during severe injuries. The focus is on the potential impact these injuries could have on surgical procedures and preventative strategies. Using advanced computational simulations, the study investigates how various maternal injuries can influence the behavior of amniotic fluid and the subsequent stress exerted on fetal development. The findings suggest that maternal injuries can induce stress, primarily affecting the posterior regions of the fetus and the umbilical cord, depending on the boundary and initial conditions. This stress is associated with fetal displacement within the amniotic sac. While the amniotic fluid provides a certain level of protection, its limitations become apparent during severe injuries. These insights have implications for the field of surgery, particularly fetal procedures. They underscore the need for improved protective measures and the development of personalized obstetric and neonatal care strategies. Moreover, the study highlights the potential of computational simulations in aiding surgeons. These simulations can provide a more accurate understanding of the critical areas to focus on during surgical procedures, thereby enhancing the precision and safety of these operations.
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Open AccessArticle
Can We Trust Them? FAST and DPA in Assessing Unstable Patients Following Blunt Abdominal Trauma
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Rakesh Quinn, Jeremy Hsu and Tony Pang
Surgeries 2024, 5(3), 674-681; https://doi.org/10.3390/surgeries5030053 - 16 Aug 2024
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The diagnosis of intra-abdominal exsanguination in hemodynamically unstable blunt trauma patients is almost universally determined by Focused Assessment with Sonography in Trauma (FAST). However, FAST has been reported to have poor sensitivity and is therefore associated with false-negative examinations. Our institutional practice includes
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The diagnosis of intra-abdominal exsanguination in hemodynamically unstable blunt trauma patients is almost universally determined by Focused Assessment with Sonography in Trauma (FAST). However, FAST has been reported to have poor sensitivity and is therefore associated with false-negative examinations. Our institutional practice includes diagnostic peritoneal aspirate (DPA) following two negative FASTs to address the poor sensitivity. We hypothesized that serial FAST alone would be able to exclude clinically significant abdominal bleeding in an unstable blunt trauma patient. A retrospective cohort study was conducted between 2018 and 2020 at a major tertiary trauma referral hospital, including all blunt trauma patients who were hemodynamically unstable. Two groups were analyzed: 1. “FAST+”: those who had a positive FAST scan and proceeded to a trauma laparotomy, and 2. “DPA”: those who had serial negative FAST scans and proceeded to DPA. Of the 12 patients in the FAST+ group, 92% correctly identified the abdomen as the source of instability. Of the seventeen patients in the DPA group, only two (12%) had positive DPA. Both patients underwent laparotomies, but neither identified an abdominal source of hemodynamic instability. The most common cause of hemodynamic instability in the DPA group was pelvic bleeding from major pelvic ring disruption. The sensitivity and specificity of the serial FAST exam for clinically significant abdominal bleeding were 100% and 94%, respectively. These data suggests that two sequential negative FAST scans are adequate for excluding intra-abdominal bleeding as the source of instability, with further investigation with DPA not identifying any clinically significant sources of intra-abdominal bleeding.
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Open AccessArticle
Postoperative Multimodal Approach to Pain Control in Anterior Cruciate Ligament Autograft Surgery: A Single-Center Series
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Alexey Cheykin, Evgeniy Nikolaevich Goncharov, Oleg Aleksandrovich Koval, Nikolay Goncharov, Eduard Bezuglov, Aleksandr Vetoshkin, Manuel De Jesus Encarnacion Ramirez and Nicola Montemurro
Surgeries 2024, 5(3), 660-673; https://doi.org/10.3390/surgeries5030052 - 15 Aug 2024
Cited by 1
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Background: Anterior cruciate ligament (ACL) injuries are prevalent and represent a significant socioeconomic burden, as ACL injuries account for nearly 60% of all knees joint traumas. The purpose of this study is to emphasize the role of arthroscopic ACL reconstruction and the challenges
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Background: Anterior cruciate ligament (ACL) injuries are prevalent and represent a significant socioeconomic burden, as ACL injuries account for nearly 60% of all knees joint traumas. The purpose of this study is to emphasize the role of arthroscopic ACL reconstruction and the challenges in postoperative pain management. Methods: This study involved 90 patients undergoing ACL reconstruction, categorized into three groups receiving different pain management protocols. The focus was on evaluating the efficacy of multimodal analgesia using lidocaine and magnesium sulfate. The main outcome was pain assessment using the Visual Analog Scale (VAS). Results: Patients receiving fentanyl, lidocaine, and magnesium sulfate (FLM) reported significantly lower pain scores in the postoperative period. Minimal use of additional opioids was observed, suggesting effective pain management with the multimodal analgesia regimen. Conclusions: The study showed that multimodal analgesia, including FLM, effectively manages postoperative pain following ACL reconstruction. This study showed significantly lower pain scores with FLM, highlighting its potential in early postoperative pain relief. Future research should consider long-term outcomes and cost-effectiveness, emphasizing the need for more comprehensive evaluations of multimodal analgesia’s impact.
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