Search Results (257)

Post-craniotomy pain is common yet often sub-optimally managed because systemic opioids can obscure postoperative neurologic examinations. The superficial cervical plexus block (SCPB) has, therefore, emerged as a targeted regional anesthesia option for occipital craniotomies. The SCPB targets the C2–C4 nerves to anesthetize the occipital scalp region, covering the lesser occipital nerve territory that lies within typical posterior scalp incisions. Clinical evidence shows the block is effective in reducing acute postoperative pain after occipital craniotomy and diminishes opioid requirements. Studies have demonstrated successful and long-lasting analgesia, reductions in 24-h opioid consumption, and a lower incidence of severe pain. Moreover, the technique exhibits a low complication rate and is safer than a deep cervical plexus block because the injection remains superficial and avoids critical vascular and neural structures. When delivered under ultrasound guidance, major adverse events are exceedingly rare. By reducing opioid use, the SCPB can help reduce postoperative complications, allowing earlier neurological assessments and fewer opioid-related side effects. Incorporation of the SCPB into multimodal analgesia regimens can, therefore, accelerate postoperative recovery by providing regionally focused, opioid-sparing pain control without clinically significant sedation. Overall, current data support the SCPB as a dependable, well-tolerated, and clinically practical approach for managing post-craniotomy pain in patients undergoing occipital approaches. In this narrative review, we will discuss the mechanism of action and anatomy, the clinical application, safety and tolerability, patient outcomes, and emerging future directions of the superficial cervical plexus block and how it mitigates post-occipital craniotomy pain. Full article

Background and Objectives: Postoperative pancreatic fistula and post-hepatectomy liver failure remain significant complications after HPB surgery; however, superficial surgical site infection (SSI) is the most frequent wound-related complication. Closed-incision negative-pressure wound therapy (ciNPWT) has been proposed to reduce superficial contamination, yet no liver-focused quantitative synthesis exists. We aimed to evaluate the effectiveness and safety of prophylactic ciNPWT after hepatopancreatobiliary (HPB) surgery. Methods: MEDLINE, Embase, and PubMed were searched from inception to 30 April 2025. Randomized and comparative observational studies that compared ciNPWT with conventional dressings after elective liver transplantation, hepatectomy, pancreatoduodenectomy, and liver resections were eligible. Two reviewers independently screened, extracted data, and assessed risk of bias (RoB-2/ROBINS-I). A random-effects Mantel–Haenszel model generated pooled risk ratios (RRs) for superficial SSI; secondary outcomes were reported descriptively. Results: Twelve studies (seven RCTs, five cohorts) encompassing 15,212 patients (3561 ciNPWT; 11,651 control) met the inclusion criteria. Device application lasted three to seven days in all trials. The pooled analysis demonstrated a 29% relative reduction in superficial SSI with ciNPWT (RR 0.71, 95% CI 0.63–0.79; p < 0.001) with negligible heterogeneity (I² 0%). Absolute risk reduction ranged from 0% to 13%, correlating positively with the baseline control-group SSI rate. Deep/organ-space SSI (RR 0.93, 95% CI 0.79–1.09) and 90-day mortality (RR 0.94, 95% CI 0.69–1.28) were unaffected. Seven studies documented a 1- to 3-day shorter median length of stay; only two reached statistical significance. Device-related adverse events were rare (one seroma, no skin necrosis). Conclusions: Prophylactic ciNPWT safely reduces superficial SSI after high-risk HPB surgery, with the greatest absolute benefit when baseline SSI risk exceeds ≈10%. Its influence on deep infection and mortality is negligible. Full article

This study investigates the dynamic response mechanisms of discharge capacity in the Han River Estuary to hydrological process changes at the Yangtze–Han River confluence. By constructing a one-dimensional hydrodynamic model for the 265 km Xinglong–Hankou reach, we quantitatively decouple the synergistic effects of riverbed scouring (mean annual incision rate: 0.12 m) and Three Gorges Dam (TGD) operation through four orthogonal scenarios. Key findings reveal: (1) Riverbed incision dominates discharge variation (annual mean contribution >84%), enhancing flood conveyance efficiency with a peak flow increase of 21.3 m³/s during July–September; (2) TGD regulation exhibits spatiotemporal intermittency, contributing 25–36% during impoundment periods (September–October) by reducing Yangtze backwater effects; (3) Nonlinear interactions between drivers reconfigure flow paths—antagonism occurs at low confluence ratios (R < 0.15, e.g., Cd increases to 45 under TGD but decreases to 8 under incision), while synergy at high ratios (R > 0.25) reduces Hanchuan Station flow by 13.84 m³/s; (4) The 180–265 km confluence-proximal zone is identified as a sensitive area, where coupled drivers amplify water surface gradients to −1.41 × 10⁻³ m/km (2.3× upstream) and velocity increments to 0.0027 m/s. The proposed “Natural/Anthropogenic Dual-Stressor Framework” elucidates estuary discharge mechanisms under intensive human interference, providing critical insights for flood control and trans-basin water resource management in tide-free estuaries globally. Full article

Vagal nerve stimulators (VNSs) improve seizure control in up to half of the patients who have them implanted. In non-responding patients, VNS removal may be necessary. Removal is traditionally accomplished through two incisions. We present our experience removing VNSs through a single incision. Background/Objectives: To determine if VNS removal can be safely performed through a single incision. Methods: The medical records of 73 consecutive patients who underwent VNS removal at our institution from 2012 to 2024 were reviewed. Patients were divided into single-incision and two-incision treatment groups. Operative time and surgical complications were compared between groups. Results: A total of 73 patients underwent VNS removal during the study timeframe. Forty-eight VNS removals were accomplished via a single incision, while 25 required both incisions. Time in the operating room was roughly half as long for single-incision removal vs. two-incision removal (29.4 min, range 11–84 vs. 74.2 min, range 33–203); however, single incision was initially attempted in all cases. In two of the incision cases, the neck dissection resulted in an injury to the internal jugular (IJ) vein. In one case, the IJ was repaired and the lead wire removed. In a second case, the IJ could not be repaired, and a segment of lead wire was retained. In a third case, a short length of lead wire was discovered after a single-incision removal and a second procedure was necessary for removal. There were no significant differences in the rates of transient vocal cord weakness, cough, and/or dysphagia between both treatment groups (p = 0.7368), and there were no cases of permanent nerve palsy. Conclusions: VNS removal can be safely accomplished via a single incision in most cases. Successful single-incision procedures may be shorter than the two-incision approach. Attempted VNS removal via a single incision may result in increased incidence of transient hoarseness, dysphagia, and/or cough, but may result in reduced rates of permanent injury or IJ injury. Full article

Inguinal hernia repair is one of the most commonly performed surgical procedures worldwide, with over 20 million cases annually. The evolution of hernia surgery has transitioned from tension-based techniques to tension-free approaches, significantly reducing recurrence rates. This review explores the history, advancements, and current trends in minimally invasive inguinal hernia repair, focusing on laparoscopic techniques such as transabdominal preperitoneal (TAPP), totally extraperitoneal (TEP), single-incision laparoscopic surgery (SILS), and robotic-assisted repair. The importance of prosthetic meshes is emphasized, detailing their mechanical properties, pore size, weight classifications, and biocompatibility. Additionally, various mesh fixation methods—including tacks, sutures, and glues—are analyzed, with a discussion on their impact on postoperative complications such as chronic pain, adhesions, and infection risk. The debate between TAPP and TEP techniques is examined, highlighting the ongoing quest to determine the most effective approach. Emerging advancements, including drug-loaded meshes and dual-layered prosthetics, aim to improve integration and reduce complications. Despite significant progress, no universally superior technique or mesh exists, underscoring the need for individualized surgical approaches. Future research should focus on optimizing materials, refining fixation strategies, and enhancing patient outcomes in minimally invasive hernia repair. Full article

Novel laparoscopic optical forceps (OFs), developed and patented by the University of Bari Aldo Moro (EP4119030, Bari, Italy), were designed to enhance safety and efficiency during laparoscopic ovariectomy in dogs by enabling atraumatic ovarian suspension and surgical maneuvers. This study aimed to describe the design, prototyping, sterilization validation, and preliminary clinical evaluation of this instrument. Prototypes were fabricated using ABS-like Pro resin via LSPc 3D printing. EtOx (ethylene oxide) sterilization proved to be the only effective method ensuring both microbiological safety and material integrity after 25 cycles. A randomized clinical trial involving 36 female dogs compared the OFs with conventional extracorporeal suture (ES) suspension using two-port laparoscopic ovariectomy. Surgical performance was assessed via operative times and complication rates. The OF group demonstrated significantly reduced ovariectomy (7.5 ± 1.6 min vs. 23.7 ± 7.6 min, p < 0.01) and overall surgical (14.2 ± 1.7 min vs. 30.4 ± 7.4 min, p < 0.01) times. No intraoperative complications occurred in the OF group, while the ES group exhibited instances of needle breakage, multiple suture attempts, and increased bleeding. The OFs enabled surgical maneuvers and ovarian suspension without requiring additional incisions or complex techniques, offering ergonomic advantages and compatibility with standard optics. These findings support the OFs as a promising tool to simplify and improve minimally invasive ovariectomy in veterinary surgery. Full article

Importance: While minimally invasive esophagectomy is currently accepted as an effective treatment for patients with esophageal cancer, the long-term survival outcomes of single-incision minimally invasive esophagectomy in these patients are still unknown, particularly when compared to those of the more invasive multi-incision minimally invasive esophagectomy. Objective: To determine the long-term oncological outcomes of single-incision minimally invasive esophagectomy in patients with esophageal cancer and to compare these outcomes with those of multi-incision minimally invasive esophagectomy. Design: This was a prospective, randomized, and propensity score-matched study wherein we analyzed patients who underwent treatment from February 2005 to May 2022. Setting: Our study was carried out by a single surgical team in a tertiary medical center. Participants: We analyzed 348 patients with esophageal cancer who underwent single-incision minimally invasive esophagectomy and 469 who underwent multi-incision minimally invasive esophagectomy. Main Outcomes and Measures: We aimed to determine the long-term survival outcomes of single-incision minimally invasive esophagectomy and compare these to those of multi-incision minimally invasive esophagectomy in our study population, and further conducted a propensity score-matching (n = 251 in each arm) study. Results: The disease progression-free (DFS) and overall survival (OS) rates of patients who underwent single-incision minimally invasive esophagectomy (SIMIE) was significantly better than that of those who underwent by multi-incision minimally invasive esophagectomy (MIMIE) (p = 0.024 for OS and p = 0.027 for PFS). This trend of difference was observed in the subsequent propensity-score matching analysis (p = 0.009 and 0.016 for OS and PFS, respectively). Conclusions and Relevance: The single-incision technique applied in minimally invasive esophagectomy to treat esophageal cancer is feasible without compromising the patient’s long-term oncological outcome, as opposed to that applied using multi-incision minimally invasive esophagectomy. Full article

Background: Postoperative wound dehiscence is a major complication following spinal metastasis surgery, particularly in patients who receive preoperative radiotherapy or molecular-targeted therapy; however, preventive strategies remain limited. Objective: In this study, we aimed to identify the risk factors for postoperative wound dehiscence and evaluate the clinical utility of a novel curved skin incision (CSI) technique, designed to avoid irradiated areas, in comparison with the conventional midline incision (MI) technique. Methods: Logistic regression analysis was conducted on 107 patients who underwent MI between 2013 and 2018. Based on the results, we developed the CSI technique. Propensity score matching was performed to compare postoperative wound dehiscence in 29 matched pairs of patients treated with either CSI or MI from 2019 to 2021. Results: Preoperative radiotherapy and molecular-targeted therapy were found to be significant risk factors for wound dehiscence. CSI, which circumvents irradiated skin, was associated with a substantially lower rate of wound dehiscence than MI. Conclusions: The CSI technique offers a simple, reproducible, and effective surgical approach to reduce postoperative wound complications in high-risk patients. Its clinical benefit, especially for those with prior radiotherapy, suggests that it may serve as a valuable addition to standard spinal metastasis surgery. Full article

Triadica sebifera, an economically and medicinally valuable tree species native to China, was investigated for its in vitro regeneration potential using leaf explants from nodal cuttings of young stems and sprouts. This study evaluated the effects of basal media, plant growth regulators (PGRs), explant sources, and incision methods on adventitious shoot induction, supplemented by histological analysis. The highest shoot regeneration frequency (98.89%) and maximum shoot number (72) were achieved via direct organogenesis using sucker-derived nodal cuttings cultured on MS medium with 2 mg/L 6- benzyladenine (6-BA), 0.3 mg/L kinetin (KT), and 0.2 mg/L α-naphthaleneacetic acid (NAA). Under identical conditions, branch-derived explants showed lower regeneration (84.44%, 64 shoots). Transverse midvein incision proved most effective, with sucker-derived leaves exhibiting superior regeneration. Shoots elongated completely (100%) on Murashige and Skoog (MS) medium containing 0.3 mg/L 6-BA, 0.03 mg/L NAA, and activated charcoal. Rooting was optimal on MS medium with 0.3 mg/L indole-3-butyric acid (IBA), yielding a 98% acclimatization survival rate. Histological analysis revealed de novo meristem formation from parenchyma cells, confirming direct organogenesis without callus intermediation, further validating the enhanced regenerative capacity of sprout-derived explants. This efficient in vitro regeneration system provides a foundation for large-scale propagation and germplasm conservation of T. sebifera, while offering insights for woody plant regeneration studies. Full article

Background: Regional anesthesia techniques are increasingly used for pain management in minimally invasive cardiac surgery (MICS). We aimed to evaluate whether the combination of interpectoral plane block (IPB) and superficial serratus anterior plane block (SAPB) provides non-inferior postoperative analgesia compared to erector spinae plane block (ESPB) in adult patients undergoing MICS. Methods: In this prospective, single-center, double-blind, randomized, non-inferiority trial, 40 adult patients scheduled for MICS were allocated to receive either ESPB (n = 20) or a combination of IPB + SAPB (n = 20) prior to surgical incision. All patients received standardized anesthesia. Pain was assessed using the Critical-Care Pain Observation Tool (CPOT) during intubation and the Numerical Rating Scale (NRS) at 6–48 h postoperatively, following extubation. The primary outcome was the NRS score at 24 h. A non-inferiority margin of 2 NRS points was pre-specified, and non-inferiority was evaluated using between-group differences with 95% confidence intervals. Opioid consumption was recorded via PCA fentanyl and rescue analgesics, converted to morphine milligram equivalents (MMEs). Secondary outcomes included extubation time and postoperative nausea and vomiting (PONV). Results: Median 24 h NRS was 3.0 (0–5.0) in the ESPB group and 2.5 (0–5.0) in the IPB + SAPB group. The between-group difference remained within the predefined two-point margin (95% CI: −0.8 to 1.2). Opioid consumption (p = 0.394), extubation time, and PONV incidence were comparable (all p > 0.05). No block-related complications occurred. Conclusions: IPB + SAPB was non-inferior to ESPB for postoperative analgesia in MICS. Despite requiring two injections, it remains an effective alternative. Larger trials are needed to confirm these findings. Full article

Background: Surgical site infections (SSIs) remain a serious problem following abdominal surgery due to gynecologic malignancies leading to increased hospitalization, high costs, and delays in adjuvant treatments; thus, SSIs affect overall survival. The aim of the present meta-analysis was to investigate the impact of closed incision–negative pressure wound treatment (ci-NPWT) systems on postoperative surgical site occurrences (SSOs) after gynecologic oncology surgery. Methods: The present meta-analysis was designed using the PRISMA guidelines. A search in several databases was conducted from inception until March 2025. Results: Overall, five studies were included; these studies enrolled 1174 patients in total, where 412 were treated with ci-NPWT systems and 762 were treated with conventional gauze. Patients treated with ci-NPWT systems presented with lower SSI rates (OR 0.40, 95% CI 0.15–1.10, p = 0.08), lower fascial dehiscence rates (OR 0.72, 95% CI 0.21–2.42, p = 0.59), and lower seroma formation rates (OR 0.70, 95% CI 0.25–1.93, p = 0.49), although statistical significance was not reached in all comparisons. On the other hand, patients treated with ci-NPWT systems also presented with higher postoperative hematoma formation rates (OR 1.38, 95% CI 0.32–5.99, p = 0.66), although statistical significance was not reached. Preoperative patient characteristics, operative parameters, and cancer characteristics were similar among the two study groups. Conclusions: The prophylactic use of ci-NPWT systems showed promising results in reducing postoperative SSOs after gynecologic cancer surgery. Nevertheless, prospectively designed studies are needed in the future to reach robust evidence that would enable the wide implementation of such devices in routine clinical practice. Full article

Background: The standard treatment for maxillofacial abscesses is surgical drainage combined with antibiotics, a frequent procedure in maxillofacial surgery departments. However, postoperative complications following this surgery are poorly described in the literature. Identifying their incidence and risk factors could help improve patient outcomes and healthcare planning. Objectives: The primary aim was to identify postoperative complications within 30 days after maxillofacial abscess surgery; the secondary aim was to explore their associated risk factors. Methods: A monocentric retrospective cohort study included patients with maxillofacial abscesses who underwent extraoral incision and drainage under general anesthesia at the Department of Cranio-Maxillofacial and Oral Surgery at a tertiary hospital in Switzerland between January 2012 and August 2023. Postoperative complications within 30 days were recorded and classified according to the validated Dindo–Clavien classification system. Univariable and multivariable logistic regression analyses were conducted to identify risk factors for postoperative complications. Results: A total of 253 participants were analyzed. The overall complication rate was 24.1%, with 15.8% major complications (Dindo–Clavien grade ≥ 3). The most common minor complications (Dindo–Clavien grade < 3) were hypokalemia and lower-extremity edema, with an incidence of 6.4%. The most common major complications were persistent and recurrent abscesses, with an incidence rate of 10.4%. These complications occurred in the early (median range 1–5 days) and delayed (median range 14–15 days) postoperative courses, respectively. Overall, the mortality rate was 0.4%. On multivariable analysis, an American Society of Anesthesiologists (ASA) score > 2 was associated with overall and major postoperative complications (odds ratio [OR], 3.38; 95% CI 1.75–6.51; p < 0.001 and OR, 3.76; 95% CI 1.83–7.72; p < 0.001, respectively). Additionally, female sex (OR, 1.97; 95% CI 1.05–3.70; p = 0.036) and C-reactive protein level > 50 mg/L (OR, 2.25; 95% CI 1.01–4.98; p = 0.046) were associated with overall postoperative complications. Conclusions: This study introduces a novel application of the Dindo–Clavien classification to maxillofacial abscess surgery, providing a standardized framework for assessing postoperative complication severity. Through this approach, we identified ASA score > 2, female sex, and CRP level > 50 mg/L as risk factors for postoperative complications. Our findings highlight the importance of close monitoring during the first five postoperative days to detect early complications, such as persistent abscesses, and recommend standardized outpatient follow-up for at least two weeks to identify delayed complications, like recurrence. Full article

Today, endoscopy plays a crucial role not only in the detection of precancerous and malignant colorectal lesions, but also in the treatment of even widespread adenomas and T1 early cancers. In addition to classic polypectomy and endoscopic mucosal resection (EMR) using a snare, in recent years, endoscopic submucosal dissection (ESD) has become increasingly important. Marking, submucosal injection, circumferential incision of the mucosa around the lesion, tunneling, and submucosal dissection using a short diathermic knife facilitate the ‘en bloc’ resection of lesions larger than 3 cm, difficult to resect in one piece using a snare. Lesions with high-grade dysplasia or mucosal carcinoma are other good candidates aside from widespread adenomata with a high risk of recurrence after piecemeal resection. ESD allows R0 resection rates of more than 90% in specialized centers. Lesions of 20 cm have been removed ‘en bloc’ by expert endoscopists. ESD provides an optimal histopathologic yield and has a risk of recurrence as low as 3%. Endoscopic full-thickness resection using a special device (eFTRD) is another addition to the resection armamentarium. It is especially suitable for circumscribed lesions up to 2 cm in the middle and upper rectum. Endoscopic intermuscular dissection (EID) is a recent modification of ESD primarily in the rectum, including the inner, circular muscular layer into the resection specimen. In this way, it allows a histopathologic analysis of the entire submucosa beyond the mucosal and upper submucosal layer such as in ESD. This is especially important for T1 cancers invading the submucosa without any other risk factors of invasion. Full article

A nationwide multicenter follow-up cohort study of hip-replacement arthroplasties performed for nontraumatic osteonecrosis of the femoral head (ONFH) was conducted to clarify factors associated with need for reoperation. We analyzed 7393 arthroplasties including 6284 total hip arthroplasties (THAs), 886 bipolar hemiarthroplasties (BPs), 188 total resurfacing arthroplasties, and 35 hemi-resurfacing arthroplasties (hRSs). The identified risk factors were combined systemic steroid use and excessive alcohol consumption (both ONFH-associated factors), a lateral approach, alumina BPs (aBPs), and hRSs, which were reported previously. The present study performed further analyses separately for THAs and BPs to clarify risk factors in each surgical group. A Cox proportional-hazard model identified the following risk factors: the acetabular-articulating materials of conventional polyethylene (cPE) and metal in the THAs and both ONFH-associated factors, minimum-incision surgery (MIS), and aBPs in the BPs. The risk factors were specific to each surgical group. In the ONFH patients, when performing THA, cPE and metal are not recommended as the acetabular-articulating material. When performing BP, patients with both ONFH-associated factors should be treated carefully, and the employment of MIS and use of aBP are not good strategies. Full article

Background and Objectives: In contrast to the standardization of laparoscopic gastrectomy techniques, the complexity of intracorporeal anastomosis techniques in totally laparoscopic total gastrectomy, the lack of standardization, the positional challenges posed by working in a confined space, and varying complication rates have prevented a consensus on the optimal intracorporeal digestive tract reconstruction method. Selecting an appropriate reconstruction method for esophagojejunostomy is crucial for a successful surgical outcome. This study aims to define a modified anastomotic technique for TLTG and share our experience with this technique. Materials and Methods: A total of 21 patients who underwent TLTG with D2 LND between July 2024 and December 2024 using the sutureless L-shape esophagojejunostomy (SLEJ) technique at the Surgical Oncology Clinic of Gulhane Training and Research Hospital due to gastric cancer were included in the study. In our technique, gastrectomy, lymph node dissection, anastomosis preparation, esophagojejunostomy anastomosis, and enteroenterostomy anastomosis were all performed laparoscopically and intracorporeally. Results: The mean operative time was 180.48 min, with a mean EJ anastomosis duration of 40.24 min. In the standard technique, two Endo GIA™ staplers were used for pyloric and small bowel transection, two for EJ anastomosis, and one for intracorporeal jejunojejunostomy. In only one patient, three staplers were used for anastomosis. Therefore, the average number of staplers was 5.05, with a mean of 2.05 staplers used for anastomosis. The mean hospital stay was 8.19 days, and there were no mortalities. The number of patients with an anastomotic leakage was 1. Since the patient’s general condition remained stable, percutaneous drainage or laparotomy was not planned. The patients’ esophagojejunostomy anastomotic leak was classified as Class 1 and Grade 3a according to the Clavien–Dindo classification. The average size of our widest incision was 3.28 cm, and surgical site infections were developed in two patients. Conclusions: Sutureless L-Shape With Endoscopic Assistance (SLEJ) is an easily applicable, technically simpler, shorter-in-duration, easier-to-learn, and safer intracorporeal EJ anastomosis technique with a low rate of postoperative complications. Full article