Search Results (80)

Background: Stapled end-to-end anastomosis has a leakage rate close to 10%. Studies indicate that most leaks occur where stapler lines overlap. The single-stapled double purse-string suture technique (SIA) eliminates stapler line overlaps in low anterior resection (LAR) and may thereby decrease leakage rates. Methods: This single-arm, single-center study prospectively and consecutively registered all patients with sigmoid colonic cancer planned for robotic sigmoid resection with primary anastomosis over a two-year period. The primary outcome was time to perform SIA and secondary outcomes were total operative time and short-term complications. Results: The study group consisted of twenty-one patients. The median time to perform SIA was 11.5 min. Two patients (9.5%) experienced 30-day postoperative complications. One patient had ischemic bowels and pneumonia postoperatively and another had an anastomotic leakage grade C. Conclusions: This study has several limitations, including a small sample size, lack of comparator group, and short follow-up period. However, these preliminary results may indicate the SIA technique to be feasible without prolonging the operation substantially. Larger series are, however, evidently needed to evaluate the SIA technique in further detail to elucidate whether the technique is generalizable and safe. Full article

Background/Objectives: Female tubal factor infertility is a major clinical challenge. While surgical repair of the fallopian tubes remains the traditional standard, biological fibrin sealants have been proposed to reduce tissue trauma and improve reproductive outcomes. Methods: We conducted database searches of PubMed/MEDLINE, EMBASE and Google Scholar until 31 August 2025, using the keywords “tubal anastomosis”, “tubal reanastomosis,” “tubal reanastomosis”, “uterine horn anastomosis”, “fibrin glue”, “fibrin sealant”, “biological sealant”, “tissue adhesive”, “rabbit”, “rat” and “sterilization reversal.” Reference lists of retrieved articles have been examined to find studies which tested end-to-end tubal (or small-animal uterine horn) anastomosis through biological adhesives with or without additional components to evaluate patency success, fertility results and adhesion formation. Results: Thirteen studies met the inclusion criteria (eleven animal; two human). Rat and rabbit models demonstrated that fibrin sealants with intraluminal splints and one-to-two anchoring sutures produced results comparable to microsutures for patency (tubal patency rates of 75–100%) and pregnancy success (pregnancy rates of 60–83%) while reducing surgical time and decreasing peritubal adhesions. The success rates of the procedures depended on the anastomosis locations. Isthmic–isthmic anastomosis produced better results than ampullary repairs which tended to fail or develop stenosis. Fibrin sealant-only repairs without splinting were associated with lower patency (almost 60%) despite acceptable histologic healing. Human data showed similar pregnancy rates (intrauterine pregnancy in about 40–50% of women) and tubal patency but no consistent decrease in adhesions. Ectopic pregnancy rates ranged from 9 to 11%. Conclusions: Fibrin sealants are useful adjuncts to microsurgical tubal repair, but they should not replace the basic repair procedures. The effectiveness of this procedure is dependent on three critical factors: precise segment alignment, proper use of splints and stents, and selection of segments with comparable caliber. In a personalized-medicine framework, fibrin-assisted reanastomosis may offer a tailored option for selected women who desire natural pregnancy. Modern standardized research is required to define indications and analyze how the adaptation of fibrin sealants in minimally invasive procedures affect reproductive outcomes, ectopic pregnancy rates, and adhesion development. Full article

Pancreatic ductal adenocarcinoma (PDAC) remains one of the most aggressive malignancies, with overall survival outcomes that have improved only modestly in recent years. Careful preoperative evaluation is essential for defining resectability and planning surgery. Modern imaging modalities, including high-resolution, contrast-enhanced CT, MRI and endoscopic ultrasound, provide a detailed assessment of vascular involvement and allow accurate staging according to various international criteria and consensus statements. In borderline and locally advanced cases, neoadjuvant therapy can aid in downsizing the tumor and increasing the likelihood of achieving negative margin resection (R0), offering long-term survival along with quality of life. When vascular invasion limits resectability, venous resection and reconstruction may permit an R0 resection in patients with borderline resectable disease that is both technically operable and physiologically tolerable for the patient. Arterial resection, however, remains controversial and is rarely justified because of its limited perioperative and survival benefits. Arterial divestment has emerged as an interesting alternative, allowing tumor clearance while avoiding full arterial reconstruction. Vascular reconstructions can be achieved through venorrhapy, end-to-end anastomosis, or segmental replacement using either autologous or synthetic grafts. With the advances in neoadjuvant treatment, the appropriate selection of candidates for vascular resection significantly increases the resectability rate, offering long-term survival along with satisfactory quality of life. In this review, a detailed literature review is performed regarding the best strategies in the diagnosis and surgical management of patients with borderline resectable and locally advanced pancreatic cancer requiring vascular resection. Full article

In patients requiring an ileostomy, the selection of the reconstruction method significantly influences long-term functionality and quality of life. Engaging young patients with the reality of a permanent ileostomy for the remainder of their lives is particularly sensitive and naturally encourages the search for alternative options that may be offered in select cases. Although the end ileostomy and ileal pouch–anal anastomosis (IPAA) continue to be the standard procedures, both possess inherent limitations. When neither approach is feasible, or when these reconstructive techniques have been unsuccessful, having an alternative such as the continent ileostomy (CI) (Kock pouch) proves highly valuable. This review aims to summarize the current indications, contraindications, technical challenges, and outcomes of the Kock pouch to provide surgeons, especially persons with less experience with this procedure, with relevant clinically meaningful information for proper counseling and management of patients. Full article

Aortic coarctation (CoA) is a congenital vascular anomaly characterized by luminal narrowing of the aorta, representing approximately 5–8% of all congenital heart defects, and is frequently associated with a bicuspid aortic valve and additional vascular malformations. The clinical spectrum is broad, ranging from severe neonatal heart failure to asymptomatic systemic hypertension in adulthood, with the severity of presentation directly influencing the timing of diagnosis and therapeutic intervention. Over recent decades, management strategies have transitioned from conventional surgical techniques—such as end-to-end anastomosis, subclavian flap aortoplasty, and patch augmentation—to endovascular modalities including balloon angioplasty and stent implantation, with covered stents now constituting the preferred approach in most cases. Nonetheless, late complications remain clinically significant. Post-coarctation aneurysms (pCoAA), particularly following patch aortoplasty, have been reported in up to 50% of patients and necessitate lifelong imaging surveillance. Re-coarctation persists as a therapeutic challenge, especially in neonates, with recurrence risk influenced by anatomical factors and the initial repair method. Optimal outcomes require an individualized, anatomy-tailored approach that judiciously integrates surgical, endovascular, and hybrid techniques. Lifelong surveillance remains essential to mitigate long-term risks, including systemic hypertension, aneurysm formation, and the need for re-intervention. Full article

Background: The Sandwich technique is a commonly adopted method for reinforcing the dissected aortic wall during acute Type A aortic dissection (ATAAD) repair, using either felt or bovine pericardial strips. However, complications such as anastomotic bleeding, distal anastomotic new entry (DANE) and persistent false lumen (PFL) remain major challenges. This study evaluated and compared the sealing efficacy of felt versus pericardium in a human cadaver model. Methods: ATAAD was simulated in 20 fresh human cadavers. Repairs were performed using the sandwich technique with either felt (n = 10) or pericardium (n = 10), followed by end-to-end prosthetic graft anastomosis. Procedure time was recorded. Following the repair, the aortas were perfused at 160/90 mmHg using a glycerol-water solution to assess fluid leakage (mL), DANE and PFL. Results: Median leakage was significantly lower in the pericardium group (67.5 mL [IQR 40–198.8]) compared to the felt group (315 mL [IQR 285–445], p = 0.002). Procedure times were comparable between groups. DANE occurred in 20% (pericardium) and 30% (felt) of cases, while PFL was observed in 30% of cases in both groups; differences were not statistically significant. Conclusions: The superior sealing properties of pericardium in this study suggest a promising approach for reducing leakage in ATAAD repair. While rates of DANE and PFL were comparable, the advantage of pericardium was confined to leakage reduction. These findings highlight the need for further research to determine whether this experimental benefit translates into improved clinical outcomes. Full article

Background/Objectives: Despite their low incidence, popliteal artery aneurysms (PAAs) are the most common aneurysms of the peripheral arteries and carry a high risk of limb loss. The optimal treatment, either with open (OR) or endovascular repair (ER), remains debated due to the lack of high-level evidence. Methods: In accordance with STROBE guidelines, we conducted a retrospective observational study with a prospective follow-up. All patients presenting with a PAA who underwent elective OR in the Vascular and Endovascular Surgery Unit of Agostino Gemelli Hospital (Rome, Italy) over the last four years were enrollved. Urgent and endovascular cases were excluded. Clinical examination, Doppler ultrasound (DUS), and contrast-enhanced computed tomography angiography (CTA) were performed preoperatively. Clinical and DUS follow-up was performed at 1, 3, 6, and 12 months postoperatively and annually thereafter. Endpoints were the primary, primary assisted, and secondary patency calculated using a Kaplan–Maier estimate based on the “first event” (arterial stenosis, occlusion, or reintervention) after the procedure. Amputation rate and overall mortality were also assessed. The results were compared with the success and complication rates reported in contemporary endovascular series. Results: Overall, 62 open interventions for popliteal artery aneurysms were performed during the study period; 49 patients (100% male, 70.3 SD ± 8.8 years) were included for a total of 52 PAAs treated electively (median diameter 30.5 mm, range 20–75; 92.3% fusiform). Aneurysm involved P1 segment in 38.5% of cases (20), P2 in 48.1% of cases (25), and P3 in 13.5% of cases (7). Two runoff vessels were present in most patients (37, 71.2%). Surgery consisted of the aneurysm’s exclusion through ligation and autologous vein or prosthetic bypass (25, 48.1%) or aneurysmectomy and interposition graft or end-to-end anastomosis (27, 51.9%). At a mean follow-up of 18 months (SD ± 17.7), the primary, the primary assisted, and the secondary patency were 94.3%, 100%, and 100% respectively. No minor nor major amputations and no deaths were reported. Conclusions: In the endovascular era, our results highlight that regardless the specific characteristics—including age, comorbidities, and aneurysm anatomy—OR provides excellent early and mid-term outcomes with high patency and low complication rate compared with contemporary endovascular series reported in the literature. Full article

Background/Objectives: Conventional imaging modalities are often inadequate for evaluating the proximal extent of anterior obliterative urethral strictures. Magnetic Resonance Imaging (MRI), with its superior soft tissue resolution, provides detailed anatomical insights and significantly contributes to surgical planning in such cases. Methods: Four male patients aged 26–63 years with anterior obliterative urethral strictures were evaluated using MRI in addition to conventional imaging. All MRI scans were performed following a modified Joshi protocol. Clinical data, MRI findings, and surgical outcomes were retrospectively reviewed. Results: MRI successfully delineated stricture length, location, periurethral fibrosis, and proximal urethral status in all cases, correlating well with intraoperative findings. Case 1 showed a 2 cm proximal bulbar obliteration, excised with end-to-end anastomosis. Case 2 had a 2.5 cm distal bulbar stricture, managed similarly. Case 3 revealed multi-segmental strictures, treated with a combination of anastomosis, graft, and Kulkarni urethroplasty. Case 4 demonstrated a rare 9 cm distal penile obliteration with preserved proximal urethra, treated with anastomotic repair. MRI provided critical anatomical detail for surgical decision-making. Conclusions: MRI is a valuable imaging modality for the evaluation of anterior obliterative urethral strictures, particularly when the proximal extent of the stricture cannot be visualized with conventional imaging techniques. In our case series, MRI enabled precise delineation of the stricture length and surrounding anatomical structures, which was critical for selecting the most appropriate surgical approach. Full article

Background and Objectives: Achilles tendon ruptures in middle-aged individuals with systemic comorbidities represent a growing clinical challenge. Revision surgery, indicated in cases of tendon re-rupture, remains technically demanding and lacks standardized treatment protocols. This comprehensive review aimed to summarize current evidence regarding indications, outcomes, and complications associated with the most commonly employed revision techniques and explores the potential of artificial intelligence (AI) in improving management and outcomes. Materials and Methods: A literature review was performed in accordance with PRISMA guidelines. The PubMed, MEDLINE, and Cochrane Central databases were used to search keywords. We included articles (1) reporting indications, outcomes, and/or complications of revision surgery for Achilles tendon rupture; (2) reporting a minimum mean follow-up of >12 months; and (3) written in English. Six studies met the inclusion criteria, with a total of 3250 patients analyzed. A methodological quality assessment using the Modified Newcastle–Ottawa Quality Assessment Scale was performed, and all articles were found to be of high quality. Results: Surgical strategies were stratified based on defect size: <2 cm: end-to-end anastomosis; 2–5 cm: V-Y myotendinous lengthening, often combined with tendon transfer; and >5 cm: fascial turndown flaps, autografts (e.g., semitendinosus), or allografts. Tendon transfers showed satisfactory functional outcomes but varied in complication rates. Allografts offered reduced donor site morbidity. The use of AI and wearable sensors has demonstrated potential in preoperative planning, complication prediction, and real-time rehabilitation monitoring. Conclusions: Achilles tendon revision surgery requires a patient-specific, defect-oriented approach. Combined surgical techniques are often necessary for large or non-viable lesions. The integration of AI represents a promising advancement in enhancing surgical decision-making, optimizing rehabilitation, and improving long-term clinical outcomes. Full article

Background and Objectives: In the current era of solid organ transplantation, the gap between available donors and patients on the waiting list is widening. Worldwide, surgeons are confronted with the challenge of optimizing the utilization of renal grafts, including the presence of multiple renal arteries (MRA), occurring in 20% to 30% of cases. The presence of a lower polar artery (LPA), which provides a significant vascular contribution to both the lower renal parenchyma and the upper urinary tract, constitutes an additional challenge, but its preservation is fundamental for the outcome of the kidney transplant (KT). The end-to-end (E/E) anastomosis with the recipient’s inferior epigastric artery (IEA) has been rarely reported in the literature, with variable results. The aim of this study is to report on technical aspects as well as on short- and long-term outcomes of this reconstruction in KT. Materials and Methods: A retrospective three-centre analysis was conducted on 13 KTs in which the graft’s LPA was anastomosed E/E with the recipient’s IEA. Results: Following an average follow-up period of 84 months, the patient and graft survival rate was 100%. Neither vascular nor urological complications were observed. Conclusions: In the event of KT with LPA, an E/E anastomosis with IEA performed with microsurgical technique is safe and provides excellent long-term results. Full article

Objectives: The aim of this study is to demonstrate the efficacy of the modified technique of radical organ-preserving surgery of invasive cervical cancer (CC) in patients of reproductive age. Methods: This study included 118 patients of reproductive age (34.9 ± 4.8 years) with a morphologically verified diagnosis of invasive CC (T1a-1bNxM0). All patients underwent organ-preserving surgery in the scope of radical trachelectomy. A shape memory mesh implant woven in the form of a stocking from superelastic nickelide titanium thread with subsequent fixation with separate sutures around the perimeter was used to form the uterine closure apparatus and to strengthen the utero-vaginal anastomosis. The mesh implant was made of superelastic thin nickelide titanium threads with a diameter of 60–40 microns on a metal knitting machine. All patients were prospectively followed up for a mean of 120 months. Results: No intraoperative or postoperative complications were revealed when using a shape memory implant made of titanium nickelide during radical trachelectomy to form a locking apparatus and strengthen the anastomosis zone. No cervical stenoses or mesh failures were noted in any case. The 5-year overall and recurrence-free survival rates were 100% and 98%, respectively. Two patients indicated recurrence; it occurred in 3 and 36 months. There were 42 spontaneous pregnancies, and 29 resulted in full-term delivery, whereas 2 and 11 ended in miscarriage and early abortion, respectively. Currently, 18 patients are at different stages of the use of assisted reproductive technologies. Conclusions: The shape memory implant made of titanium nickelide integrates well into the surrounding tissues and successfully imitates the effect of the cervix. The use of this sparing-surgery technique has shown reasonably good results in carrying the pregnancy to term and good reproductive outcomes. Full article

Objectives: The application of fasciocutaneous free flaps for reconstruction of head and neck defects following oncological surgery has increased since the 1970s, coinciding with developments in microvascular techniques. Although reported success rates are between 90% and 99%, flap failure continues to occur, most frequently due to venous congestion. This study examines the rates of re-exploration and flap failure according to the number of venous anastomoses in patients receiving free flap reconstruction after head and neck cancer surgery. Materials and Methods: This retrospective analysis included 163 patients who underwent head and neck reconstruction with free flaps (radial forearm free flap [RFFF] and anterolateral thigh flap [ALTF]) at the University Hospital of Verona between January 2019 and June 2024. Variables examined comprised the type of flap performed, donor and recipient vessels utilized, and number of venous anastomoses, as well as the type (end-to-end [ETE] versus end-to-side [ETS]) and site (internal jugular vein versus external jugular vein) of venous anastomosis. Results: The overall success rate was 93.3%, with no significant difference between single and dual venous anastomosis groups. Prompt re-exploration upon detecting signs of flap failure is critical, as approximately one-third of such failures may be prevented through timely intervention. Conclusions: Single venous end-to-end anastomosis utilizing the internal jugular vein system is typically effective. Further research is warranted to clarify the indications for dual anastomosis involving the external jugular vein system. Full article

Background: Blunt abdominal trauma in pregnancy is a medical emergency with significant maternal-fetal morbidity and mortality. Although rare, intestinal ischemia can occur as a serious abdominal complication following trauma during pregnancy. Case presentation: A 41-year-old woman at 33 weeks and 6 days of gestation was involved in a car accident, as a passenger in the front seat of a vehicle that left the road and overturned. The initial examination revealed severe chest trauma but no immediate signs of abdominal injury. However, the patient’s condition worsened, showing delayed symptoms of gastrointestinal dysfunction, clinical deterioration, and labor onset. Complementary imaging studies did not reveal conclusive findings suggesting complications related to the blunt abdominal trauma. Following a multidisciplinary team’s decision to perform an emergency cesarean section in the maternal-fetal interest, intestinal ischemia secondary to a mesenteric tear was discovered, necessitating intestinal resection and end-to-end anastomosis. Conclusions: Despite being a rare condition often associated with diagnostic delays, in cases of sudden clinical deterioration or maternal hemodynamic instability, immediate multidisciplinary intervention is essential. This approach may allow the early detection of trauma-related complications, reducing potentially preventable deaths and achieving favorable maternal and neonatal outcomes. Full article

Background: Pancreatic Ductal Adenocarcinoma (PDAC) is one of the most common malignancies associated with thrombotic events. While there is research present on various techniques of portal vein reconstruction, there is limited published data on the techniques and/or considerations of reconstruction in the setting of complete portal vein occlusion. We therefore sought to analyze and present our experience of this clinical scenario. Methods: This was a retrospective analysis of a prospectively collected database. All patients who underwent portal vein resection and/or reconstruction during a pancreatic resection were included. Post-operatively, all patients underwent a contrast-enhanced CT scan on post-operative day 1 to assess for any portal vein thrombus. Results: Pancreatic resection with portal vein reconstruction was performed in 183 patients. Complete PV occlusion was seen in 12 patients at the time of surgery. In those patients with an occluded PV, reconstruction options included primary repair with end-end anastomosis (n = 2) or use of an interposition graft (n = 9). Interposition graft conduits included the left renal vein (n = 6), tubularized bovine pericardium (n = 3), and femoral vein (n = 1). Post-operative portal vein thrombus was seen in 4/12 patients. The majority of patients (n = 7) were discharged on therapeutic anticoagulation, 4 were discharged on an antiplatelet, and 1 patient received neither. Conclusions: Based on our series, we would recommend attempting PV reconstruction in these patients with an interposition graft (with autologous left renal vein or bovine pericardium). We believe that with this technique, the post-operative thrombosis risk is similar to PV reconstructions in non-occluded patients. Full article

Background: Iatrogenic nerve injuries (NIs) are an under-recognized complication of urological surgery. Though less common than vascular or organ damage, they may cause lasting sensory and motor deficits, significantly affecting patients’ quality of life. With increasing complexity in pelvic procedures, a consolidated understanding of nerve injuries is essential. Purpose: This review aims to synthesize current knowledge regarding peripheral and autonomic NIs in urological surgery, highlighting mechanisms of injury, associated procedures, preventative strategies, and treatment options. Scope: Focused on common urological interventions such as radical prostatectomy, cystectomy, pelvic lymphadenectomy, and reconstructive techniques, the review explores injuries from positional compression, traction, and intraoperative transection to their surgical management. Key Findings: The review categorizes nerve injuries into crush and transection types and details intraoperative signs and repair techniques. Skeletonization of nerves, avoidance of energy devices near neural structures, and prompt end-to-end anastomosis using 7-0 polypropylene are central to management. Adoption of novel sutureless nerve coaptation devices have also been described with promising outcomes. Early repair offers a better prognosis. New intraoperative technologies like NeuroSAFE during robotic-assisted procedures may enhance nerve preservation. Conclusion: Iatrogenic NIs, although rare, are clinically significant and often preventable. Prompt intraoperative recognition and repair are critical. Further research is warranted to develop standardized preventative protocols and enhance intraoperative nerve monitoring. A multidisciplinary approach, extended across surgical specialties, could improve outcomes and guide timely treatment of nerve injuries. Full article