Search Results (50)

Background: Infantile hypertrophic pyloric stenosis represents one of the most prevalent gastrointestinal disorders in infants. It presents with severe persistent vomiting and electrolyte imbalance. Pyloromyotomy is the gold standard approach in the management of pyloric stenosis. The laparoscopic approach provides a reliable and safe alternative to the open technique. We aimed to compare the surgical outcomes of both approaches and determine which approach is superior to the other. Methods: We searched for relevant articles by searching Scopus, Web of Science, PubMed, and the Cochrane Library until January 2025. The Cochrane risk of bias tool was utilized to assess the quality of the clinical trials, whereas the ROBINS-I tool was used in the observational studies. Our primary outcomes were operation time, length of hospital stay, time needed for full feeding, incidence of incomplete pyloromyotomy, mucosal perforation, wound infection, postoperative vomiting, postoperative incisional hernia, postoperative seroma or hematoma formation, need for reoperation, and rate of conversion to P in the laparoscopic group. Results: We included 12 eligible articles that compared laparoscopic pyloromyotomy with open pyloromyotomy in infants with hypertrophic pyloric stenosis. Our analysis revealed comparable results for both procedures in terms of operation time (p = 0.83), hospitalization duration (p = 0.06), mucosal perforation (p = 0.49), postoperative complications such as vomiting (p = 0.10), incisional hernia (p = 0.60), seroma (p = 0.52), and reoperation rates (p = 0.17). Patients who underwent LP achieved full feeding in less time (p = 0.007) and had fewer wound infections (p = 0.01) compared to OP. However, the incidence of incomplete pyloromyotomy was lower in the OP group than in the LP group (p = 0.03). Conclusions: Both open and laparoscopic pyloromyotomy are effective for treating hypertrophic pyloric stenosis. The laparoscopic approach offers the advantages of a faster return to full feeding and lower wound infection rates but increases the risk of incomplete pyloromyotomy compared to the open technique. Surgeon preference and experience play crucial roles in surgical outcomes, provided that there is a thorough understanding of the benefits and limitations of both techniques. Full article

Background/Objectives: Surgical site infections (SSIs) following pancreaticoduodenectomy contribute to significant morbidity and healthcare costs. Negative pressure wound therapy (NPWT) has emerged as a potential preventive intervention; however, evidence regarding its efficacy in pancreatic surgery remains limited. This systematic review and meta-analysis aimed to evaluate the efficacy of NPWT compared to conventional dressings in preventing SSI following pancreaticoduodenectomy. Methods: PubMed, Scopus, BASE, Cochrane CENTRAL, and ClinicalTrials.gov were systematically searched from their inception to 2 April 2025. Randomized clinical trials and observational studies comparing NPWT with conventional dressings in patients undergoing pancreaticoduodenectomy were included. Two independent reviewers extracted the data and assessed the methodological quality. Random-effects meta-analysis was performed to calculate the pooled relative risks (RRs) with 95% CIs. The primary outcome was the incidence of SSI. The secondary outcomes included pancreatic fistula, seroma formation, incisional hernia, and readmission rates. Results: Nine studies (three randomized clinical trials and six observational studies) comprising 1247 patients were included. NPWT was associated with a significant reduction in SSI compared with conventional dressings (RR, 0.61; 95% CI, 0.41–0.90). Subgroup analysis revealed varying effects by study design: retrospective cohort studies showed a nonsignificant trend toward SSI reduction (RR, 0.53; 95% CI, 0.19–1.48), randomized clinical trials demonstrated a nonsignificant trend favoring NPWT (RR, 0.67; 95% CI, 0.37–1.23), and the single prospective cohort study showed significant SSI reduction (RR, 0.48; 95% CI, 0.28–0.84). No significant differences were observed in pancreatic fistula rates between the NPWT and conventional dressing groups. Prophylactic NPWT application, longer duration (≥5 days), and higher negative pressure settings (−125 mmHg) appeared more effective than therapeutic application, shorter duration, and lower-pressure settings, respectively. Conclusions: This systematic review and meta-analysis suggests that NPWT is associated with a reduced SSI risk following pancreaticoduodenectomy. The greatest benefit may be achieved with prophylactic application in high-risk patients, longer therapy duration, and higher negative pressure settings. These findings support the consideration of NPWT as part of SSI prevention strategies in pancreatic surgery, particularly for patients with identified risk factors. Full article

On the spectrum of complexity for general surgery operations, umbilical hernia repair (UHR) is on the light side. After inguinal hernias, they are the most commonly repaired hernias and, as such, umbilical hernias are an important component of a general surgery practice. Since the time at which WJ Mayo published his seminal technique on the repair of umbilical hernias, multiple strategies for the management of umbilical hernias have emerged ranging from watchful waiting to open repair, as well as minimally invasive approaches. The present perspective maintains that each approach has its merits depending on the patient, surgeon, and institution. However, randomized controlled trials and clinical practice guidelines have favored some approaches over others. Similarly, recommendations have been developed regarding body mass index classification as well as hernia size for mesh placement. Other factors important to UHR are the choice of anesthesia and smoking cessation for elective repair. Though we do not contest well-designed randomized controlled trials (RTCs), or clinical guidelines, we offer our perspective on the care of these common hernias. Full article

Background and Objectives: Incisional hernia is a common complication following cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). This study aimed to identify patient and surgical factors associated with its occurrence. Materials and Methods: We conducted a retrospective analysis of 122 patients undergoing CRS and HIPEC. Logistic regression models were applied to identify predictors of incisional hernia development. Results: Incisional hernia occurred in 23.8% of patients. Hypertension was identified as an independent factor associated with increased risk. Peritoneal Cancer Index (PCI), operative time, and abdominal wall closure technique were not found to be significantly associated with hernia development. Conclusions: Preoperative identification of high-risk patients may support the adoption of targeted preventive strategies, including prophylactic mesh placement and enhanced postoperative surveillance. Full article

Background and Objectives. Umbilical hernia is particularly common among patients with liver cirrhosis, affecting about 20% of this group, compared to 3–8.5% in healthy individuals. This increased prevalence is mainly due to weakened abdominal fascia, elevated intra-abdominal pressure, and malnutrition. The rapid progression of umbilical hernias often leads to complications such as skin necrosis, perforation, and strangulation. Historically, patients with liver cirrhosis and complicated umbilical hernia have faced high morbidity and mortality rates. However, recent advancements in perioperative management, especially in controlling ascites, have improved outcomes in elective treatments. Despite these advancements, managing patients with decompensated liver cirrhosis and complicated umbilical hernia in emergency settings remain a significant surgical challenge. Materials and Methods: We conducted a retrospective review of patients treated for complicated umbilical hernia at the University Medical Centre Ljubljana from 2015 to 2024, using prospectively collected data. This analysis involved implementing hernioplasty combined with incisional negative pressure wound therapy (iNPWT) as part of the surgical protocol. The primary endpoint of our study was the rate of local complications, while the secondary endpoints included the rate of systemic complications and 90-day mortality. Results: We treated 28 consecutive patients with complicated umbilical hernia and liver cirrhosis. Local wound complications were observed in three (10.7%) patients. Systemic complications developed in 10 patients (35.7%). The median duration of hospitalization was 8 days (range: 5–29), and no readmissions were recorded within the 30-day period. Two (7.1%) patients died within 90 days. Conclusions: Our experience indicates that iNPWT, when combined with surgical repair, can be safely utilized, yielding outcomes comparable to elective hernia repairs, even in emergency contexts. Further randomized controlled trials are necessary to validate these findings and optimize treatment protocols. Full article

Background/Objectives: Single-port laparoscopy represents a significant advancement in minimally invasive surgical techniques and is designed to reduce surgical trauma and enhance cosmetic outcomes. However, ongoing debate surrounds its relative benefits and limitations as compared with conventional multi-port laparoscopy. This study systematically reviewed and analyzed comparative outcomes between these two approaches. Methods: We conducted a comprehensive systematic search of major electronic databases from January 2000 to October 2023, following PRISMA guidelines. Only randomized controlled trials comparing single-port laparoscopy with conventional laparoscopy were included. We analyzed operative outcomes, postoperative recovery parameters, complications, and patient-reported measures using random-effects models, with heterogeneity explored through subgroup analyses. Results: Forty-three randomized controlled trials involving 5807 patients were analyzed. Single-port laparoscopy demonstrated longer operative times (weighted mean difference: +10.5 min; 95% CI: 7.83–13.18; p < 0.001), superior cosmetic satisfaction (standardized mean difference: +0.61; 95% CI: 0.39–0.83; p < 0.001), and reduced postoperative pain within 24 h (standardized mean difference: −0.58; 95% CI: −0.95 to −0.21; p = 0.002). The overall complication rates showed no significant differences (risk ratio: 0.94; 95% CI: 0.78–1.14; p = 0.31), though incisional hernia risk increased with single-port laparoscopy (odds ratio: 2.26; 95% CI: 1.23–4.15; p = 0.009). Conclusions: Single-port laparoscopy offers meaningful improvements in cosmetic outcomes and early pain relief, balanced against longer operative times and increased hernia risk. The substantial heterogeneity observed underscores the importance of surgeon experience, appropriate patient selection, and optimal technique selection in determining outcomes. Full article

Background: Single-port laparoscopic hepatectomy is a minimally invasive modality for the treatment of benign and malignant liver lesions. Due to the method’s technical challenges, it is suitable for experienced hepatobiliary surgeons and selected groups of patients. The aim of this study was to evaluate the results of a single Slovenian center performing single-port laparoscopic hepatectomy with a literature overview. Methods: A single-center retrospective consecutive case series of the twenty-six patients with liver disease operated with the single-port technique from January 2018 to July 2024 at the Department of Abdominal Surgery at the University Medical Centre, Ljubljana, was performed. Lesions were located in easy-to-treat segments. Operative time, conversion rate, length of hospital stay, and surgical complications were recorded and evaluated. Results: We performed twenty-six single-port laparoscopic liver resections (median age 63.5, range 31 to 79 years). The mean operative time was 92 ± 31 min. None of the cases were converted to multi-port laparoscopic or open surgery. Safe resection margins were obtained in cases of malignant disease. The mean hospital stay was 4 days. The post-operative complication rate involving intervention was 7% (2/26). The incisional hernia rate was 11.5% (3/26). No life-threatening surgical complications or morbidity were noted. Conclusions: Single-port laparoscopic hepatectomy is a safe and feasible technique for the resection of benign and malignant liver lesions in the hands of skilled and well-trained hepatobiliary surgeons. Full article

Background/Objectives: Ventral hernia repair has evolved with the introduction of minimally invasive techniques like l-IPOM and rTA-RM. While robotic surgery offers advantages in precision and ergonomics, its higher costs pose questions regarding its cost-effectiveness compared to laparoscopic approaches. Methods: A retrospective analysis of patients with primary or incisional ventral hernias undergoing either l-IPOM or rTA-RM between February 2022 and October 2023 was conducted. Data on demographics, surgical outcomes, hospital costs, disposable supplies, and robotic system expenses were collected. A one-to-one propensity score matching (PSM) was used to ensure comparability between the groups. Results: After matching, 30 patients were included in each group. The rTA-RM group had longer operative times (93.2 vs. 74.4 min, p = 0.004) but shorter hospital stays (1 day vs. 2 days, p = 0.003) and lower postoperative pain scores (median VAS score 3 vs. 5, p = 0.004). Total costs were comparable between rTA-RM and l-IPOM (EUR 6862 vs. EUR 6575, p = 0.32), with robotic surgery incurring higher capital costs but lower disposable supply costs (EUR 1057 vs. EUR 2006, p < 0.01). Conclusions: Despite the higher per-case cost associated with robotic systems, overall costs for rTA-RM were similar to those for l-IPOM, suggesting that robotic surgery may be cost-competitive due to lower disposable supply expenses and shorter hospital stays. Further research is needed to assess long-term outcomes and broader economic impacts. Full article

Background: Incisional hernias are a frequent complication following ileostomy closure, with rates reaching 24%. Protective ileostomies are commonly performed in colorectal surgery, but their closure presents a significant risk for abdominal wall defects. Identifying risk factors for incisional hernias at the ileostomy site is crucial for improving patient outcomes. Methods: This retrospective study analyzed data from 95 patients who underwent loop ileostomy closure at two Romanian hospitals between 2018 and 2023. Patient demographics, surgical details, and follow-up data were reviewed. Incisional hernias were diagnosed through clinical examination or radiological imaging. Statistical analyses, including univariate and multivariate regression, were performed to identify independent risk factors. Results: The incidence of incisional hernias at the ileostomy site was 13.7% (13/95). Univariate analysis identified BMI (HR 30.08; p = 0.007), previous hernia (HR 7.99; p = 0.059), radiotherapy (HR 299.15; p = 0.029), and chemotherapy (HR 0.004; p = 0.026) as significant factors. Multivariate analysis confirmed BMI > 30 kg/m² (HR 12.27; p = 0.002) and prior hernia (HR 8.14; p = 0.007) as independent risk factors. Conclusions: Obesity and previous hernias significantly increase the risk of incisional hernias following ileostomy closure. Radiological follow-up enhances early detection, and further studies should explore the benefits of prophylactic mesh reinforcement. Optimizing patient selection and surgical technique may reduce postoperative hernia rates, improving long-term outcomes. Full article

Kidney transplantation significantly improves outcomes in patients with end-stage renal disease; however, postoperative complications remain a substantial concern. This review summarizes the incidence, risk factors, and management strategies for common complications after kidney transplantation. Reported incidence varies widely due to differences in definitions, diagnostic methods, and study designs. Ureteral stenosis occurs in 2.8–18.0% of recipients, vesicoureteral reflux in 0.5–86%, and urinary leakage in 1.1–7.2%. Lymphatic complications, including lymphocele and lymphorrhea, range from 0.6% to 35.2%, with one-third of complications requiring intervention. The incidence of urinary tract infections ranges from 20 to 43%, while asymptomatic bacteriuria is reported in up to 53% of recipients. Surgical site infections have a median incidence of 3.7%, and incisional hernias develop in 2.5–10% of cases, depending on follow-up duration. Vascular complications affect approximately 10% of recipients, with renal artery stenosis and thrombosis being the most prevalent. Neurologic complications, such as femoral nerve palsy and immunosuppression-related neurotoxicity, though less frequent, can impair recovery. Management strategies vary depending on severity, ranging from observation to surgical intervention. Preventive measures—including optimized ureteral stenting protocols, early catheter removal, careful immunosuppression, and appropriate antimicrobial use—play a crucial role in reducing complication risk. Despite advances in transplantation techniques and perioperative care, these complications continue to affect graft survival and patient outcomes. Further research is needed to standardize definitions and establish evidence-based protocols. Full article

Background: Recent studies indicate that minimally invasive surgery is widely accepted as the optimal procedure for colorectal cancer. However, the ideal location of the specimen extraction site remains unclear. This study aimed to compare the conventional periumbilical midline incision with the Pfannenstiel incision for specimen extraction during minimally invasive surgery for rectal cancer. Methods: This retrospective cohort study included 76 patients who underwent minimally invasive surgery (double-stapling technique anastomosis) for rectal cancer between January 2022 and June 2023. The postoperative short- and mid-term outcomes were compared between the periumbilical midline incision and Pfannenstiel incision groups. Results: The patients’ backgrounds were comparable between the two groups. There were no significant differences in the surgical outcomes or short-term postoperative complications. The Pfannenstiel incision demonstrated advantages, including reduced postoperative pain at rest and during movement, and a lower incidence of incisional hernia (p = 0.038). Conclusions: The Pfannenstiel incision is a safe and effective option associated with reduced postoperative pain and a lower risk of incisional hernia. Therefore, it can serve as a useful alternative for specimen extraction during minimally invasive rectal cancer surgery. Full article

Background: Breast cancer is the second most common cancer in women with an improving mortality rate and a growing need for reconstruction following oncologic resection. Advancements in robotic surgery and minimally invasive techniques have offered refinement to traditional open techniques of flap harvest for reconstruction, particularly regarding improved donor site morbidity. Methods: The literature review was based on a PubMed database search using the keyword “Robotic breast reconstruction” in conjunction with the Boolean operators “Flap”, “Latissimus”, and “DIEP” to specify the search. In total, 106 results were generated, which were then manually reviewed and condensed for a comprehensive stance on the current status, technique, variations, and outcomes for robotic breast reconstruction. Results: Robotic technique has been described for the latissimus dorsi (LD) and deep inferior epigastric perforator (DIEP) flaps for breast reconstruction. For LD, robotic flap harvest reduces donor site morbidity, incisional length, and hospital length of stay, with similar complication rates for seroma/hematoma/infection, and longer operative times. Robotic LD procedures have been described in conjunction with single-site nipple-sparing mastectomy and flap elevation leading to a full minimally invasive resection and reconstruction from one lateral incision. Robotic DIEP harvest offers a considerably smaller fascial incision/rectus muscle dissection and has a comparable complication rate to traditional techniques with shorter hospital length of stay, and improved pain, at the expense of longer operating times. Data on hernia/bulge reduction from robotic techniques is limited and not yet available. Conclusions: Robotic breast reconstruction offers great potential for improving breast reconstruction in terms of donor site morbidity, length of incision, hospital length of stay at the cost of longer operating times, and increased technical skill/specialization, but it has yet to be proven on a large scale with long-term outcome data. Multi-center, prospective clinical data and trials are needed to help elucidate the potential for equivalence and superiority of the minimally invasive approach compared to standard open techniques, but the future is promising for robotic surgery in breast cancer and breast reconstruction. Full article

Background and Objectives: Incisional hernias are a common and costly complication of surgery, occurring in up to 20% of midline incisions within 3 years of initial operation. Risk factors for incisional hernia include incision site, fascial closure technique, body mass index (BMI), surgical site infections, and gastrointestinal surgery. Limited studies have compared procedural type as a risk factor for hernia formation. The goal of this study was to examine incisional hernia rates among general surgical and gynecologic procedures. Materials and Methods: We queried our Research Data Warehouse for inpatients who had undergone common open abdominal surgeries between January 2012 and December 2022. Patients’ index operations were identified based upon Current Procedural Terminology (CPT) codes and presence of a postoperative incisional hernia was determined by occurrence of an incisional hernia ICD10 diagnosis code more than 2 weeks postoperatively. The main study outcome was time to incisional hernia diagnosis. Results: A total of 4447 patients were identified. Postoperatively, 241 (5.4%) patients were diagnosed with incisional hernias. Hernia rates at 1, 3 and 5 years were 3% (SE 0.003), 6% (0.004) and 8% (0.005), respectively. Patients undergoing exploratory laparotomy (hazard ratio 3.9, p < 0.001), bowel resection (HR 5.5, p < 0.001), and primary hernia repair (HR 13.0, p < 0.001) were found to have significantly increased risk for incisional hernia development compared to those undergoing hysterectomy, following adjustment for comorbid risks, age, sex, and BMI. Conclusions: Exploratory laparotomy, bowel resection, and primary ventral hernia repair are associated with a higher incidence of incisional hernia relative to gynecologic procedures. This relatively unstudied comparison warrants further investigation. Full article

Background/Objectives: An incisional hernia (IH) is a frequent postoperative complication after cytoreductive laparotomic surgery for advanced ovarian cancer (AOC). It occurs in 2–22% of patients in the first two years of follow-up, depending on the series. Although different risk factors have been described for various types of malignancies and surgeries, few studies have analyzed the risk factors for hernia development in ovarian cancer (OC). However, none have examined the role of enhanced recovery after surgery (ERAS) programs. Methods: We performed a retrospective study that included patients with AOC and primary or interval debulking surgery through a median laparotomic approach. This study was conducted in Vall d’Hebron Hospital, Barcelona, Spain, between January 2015 and December 2022. Univariate and multivariate regression analyses were conducted. Results: Of the 156 patients included, 30 (19.2%) presented with an IH. The patients with IHs were smokers in a higher proportion to non-smokers (53.9% vs. 16.1%, p = 0.003) and more frequently presented with wound dehiscence (34.4% vs. 15.0%, p = 0.026). Patients in whom negative pressure wound therapy was applied had a hernia less frequently than those who had not had it (12.5% vs. 26.7%, p = 0.043). Similarly, the incidence of hernia decreased when patients went through an ERAS protocol (10.1% vs. 28.8%, p = 0.008). In the multivariate analysis, smoking was the only independent risk factor (RR 10.84, CI 2.76–42.64), and applying an ERAS protocol was seen to be the sole protective factor (RR 0.22, CI 0.08–0.61) against the development of an IH. Conclusions: The implementation of ERAS is highly recommended due to its numerous benefits, most notably the reduction in hernia incidence. Additionally, the preoperative identification of current smokers provides an opportunity for smoking cessation and targeted respiratory prehabilitation, both of which further contribute to IH reduction. Full article

Objectives: Incisional ventral hernia repair remains a challenging surgery for abdominal wall surgeons. We report the results at 48 months post-surgery regarding open ventral hernia repair (OVHR), analyzing the recurrence rate and incidence of chronic pain. Methods: This was a retrospective, observational study of 111 consecutive patients who underwent OVHR. Between January 2017 and December 2019, patient data were collected from a database and classified by hernia type. Through questionnaires and clinical examinations, the recurrence rate and incidence of chronic pain (measured using the VAS score and a Likert scale) were obtained. Results: In all patients, the hernia repair was performed via an open approach. Long-term follow-up (48 months after surgery) revealed that 20% of patients experienced mild chronic pain alongside the flanks, and the recurrence rate was 5%. Moreover, long-term follow-up revealed the following secondary outcomes: movement limitations in sports were reported in 7% of patients, and movement limitations during long walking were reported in 11% of patients. Conclusions: Our technique for OVHR is a safe procedure with a low rate of recurrence and chronic pain. Our future aim is to organize a prospective study. Full article