Search Results (7,171)

Apical pelvic organ prolapse (POP) is characterized by descent of the uterus or post-hysterectomy vaginal vault resulting from failure of level I pelvic support and represents a major contributor to pelvic floor dysfunction and recurrent prolapse surgery. Loss of apical support is frequently associated with anterior and posterior compartment defects, leading to vaginal bulge symptoms, pelvic pressure, urinary and bowel dysfunction, sexual dysfunction, and reduced quality of life. This narrative review summarizes current knowledge on POP, from molecular mechanisms and emerging biomarkers to contemporary surgical management, with particular emphasis on sacrocolpopexy and robotic-assisted approaches. A literature search of PubMed, Scopus, Google Scholar, and Consensus identified peer-reviewed studies published up to February 2026. Evidence demonstrates that POP has a multifactorial and polygenic background involving extracellular matrix remodeling, connective tissue integrity, smooth muscle dysfunction, and altered level of protein expression. Several candidate biomarkers, including single-nucleotide polymorphisms, circulating proteins, metabolites, and imaging-based parameters, show potential for risk prediction and earlier diagnosis, although routine clinical implementation remains limited. Sacrocolpopexy remains the gold standard for apical prolapse repair because of superior anatomical outcomes, low recurrence, and significant quality-of-life improvement. Laparoscopic and robotic-assisted sacrocolpopexy provide comparable efficacy with reduced blood loss, shorter hospitalization, and faster recovery. The objective success rate is usually over 90%. Complications are very rare and typically include mesh erosion in 2–4% of cases and the need for reoperation in 6% of cases. Our own experience shows that, for a group of surgeons, the learning curve for the laparoscopic approach reached a plateau after a total of 30 operations. Robotic platforms may facilitate complex pelvic dissection and shorten the learning curve, although higher procedural costs remain a major limitation. Full article

Introduction: Giant sinus of Valsalva aneurysms (SVA) represent a rare cardiovascular pathology that may remain asymptomatic for an extended period. However, they are associated with a high risk of life-threatening complications, including compression of adjacent structures and aneurysm rupture. Case presentation: We report a clinical case of a 71-year-old female patient with a long-standing history of arterial hypertension and cardiac arrhythmias, in which echocardiography revealed aneurysmal dilatation of the right coronary sinus. Cardiac computed tomography (CT) confirmed the presence of a giant aneurysm of the right sinus of Valsalva measuring 70 × 51 × 49 mm, compressing the outflow tracts of both ventricles (right—up to 7 mm, left—up to 8 mm) and the left inferior pulmonary vein (up to 3 mm), which clinically manifested as dyspnoea, lower-extremity oedema, and rhythm disturbances. The patient successfully underwent complex reconstructive surgery, including aortic root replacement and valve repair. Despite the technical success of the operation, the patient died from pneumonia three months postoperatively. Discussion: This observation underscores the critical role of imaging modalities (echocardiography and CT) in verifying this pathology. The use of multimodal imaging facilitated both a timely diagnosis and a detailed three-dimensional evaluation of the aneurysm’s relationship with adjacent structures. This information, in turn, guided personalised surgical planning. Conclusions: This case highlights the necessity of considering giant SVA in the differential diagnostic workup of patients who present with unexplained symptoms of heart failure. Full article

Surgical intervention in Crohn’s disease remains a significant contributor to patient morbidity, with postoperative complication rates reported between 20% and 50%. These complications include a broad spectrum of adverse outcomes, such as surgical site infections, intra-abdominal abscesses, and anastomotic leakage, all of which can substantially impact recovery, healthcare costs, and long-term prognosis. Although several clinical and perioperative risk factors have been identified, accurate prediction of postoperative outcomes remains challenging, highlighting the need for improved risk stratification strategies. In recent years, the evolution of biological therapies has transformed the management of Crohn’s disease, raising important questions regarding their influence on surgical outcomes and postoperative healing. Consequently, a more nuanced understanding of the interplay between medical and surgical approaches is required to optimize patient care. This systematic review aims to evaluate established and emerging predictive biomarkers associated with postoperative complications in Crohn’s disease surgery. Particular emphasis is placed on inflammatory markers, nutritional parameters, and novel molecular signatures. Furthermore, the review explores the growing role of multiomics approaches—including genomics, proteomics, and metabolomics—as well as the integration of machine learning models to enhance predictive accuracy. By synthesizing current evidence, this study underscores the potential of combining biomarkers with advanced analytical tools to support personalized risk assessment and guide clinical decision-making in Crohn’s disease surgery. Full article

Objective: Perform endoscopic surgery for radiculopathy caused by compression fractures and evaluate the results. Methods: A total of 20 patients who underwent biportal endoscopic foraminotomy and unilateral screw fixation using a dynamic rod for radiculopathy secondary to osteoporotic compression fractures were included in this study. All surgeries were performed between July 2021 and January 2025. Patient demographic data, operated level, length of hospital stay, intraoperative blood loss, and operative time were reviewed. Radiological follow-up included assessment of segmental kyphosis, scoliosis, subsidence, and adjacent-level fractures. Complications and pain patterns—separately evaluated for back pain and radiculopathy—were assessed using the visual analog scale (VAS) preoperatively and during follow-up. Only single-level cases were included. Patients with infections, significant stenosis, instability, tumors, prior revision surgery, multilevel pathology, or ambiguous symptoms were excluded. Results: The mean age of the patients was 78.8 years (range, 69–89 years), reflecting an elderly cohort. The mean follow-up period was 13.0 ± 11.9 months (range, 1–41 months). The mean operative time was 164.8 ± 25.7 min, and the mean hospital stay was 10.2 ± 4.6 days (range, 4–25 days). The mean intraoperative blood loss was 126.5 ± 77.6 mL (range, 50–400 mL). One female patient developed postoperative pneumonia, which resolved after appropriate treatment; no other medical complications were observed. Radiculopathy improved significantly immediately after surgery and continued to improve during follow-up. Back pain also improved, but tended to persist to a mild degree. Radiologic evaluation revealed no significant changes in segmental lordosis, and there were no cases of subsidence, scoliosis, or symptomatic screw loosening during the available follow-up period. Conclusions: Biportal endoscopic foraminotomy with unilateral screw fixation may be an effective solution for radiculopathy caused by compression fractures. Full article

Background/Objectives: Evidence on spinal versus general anesthesia in unilateral total knee arthroplasty (TKA) may not extend to one-week-staged bilateral surgery, where older patients receive two anesthetics in a short interval and intra-operative spinal-to-general conversion is common but rarely reported transparently. We compared peri-operative acute kidney injury (AKI) and transfusion between strategies in this setting. Methods: We retrospectively analyzed 207 patients (414 surgeries) undergoing one-week-staged bilateral primary TKA at one center. Co-primary endpoints were creatinine-based AKI (patient level) and packed-red-blood-cell transfusion (surgery level). Because 42 general-anesthesia-classified surgeries had an attempted spinal injection, the primary analysis used the initial anesthetic plan (an intention-to-treat analogue), reclassifying these as spinal, with as-treated classification as a sensitivity analysis; AKI was modeled at the patient level (any general anesthesia versus spinal–spinal) and transfusion per surgery. Results: Median age was 75 years and 82.6% were female; AKI affected 74 of 207 patients (35.7%) and transfusion 185 of 414 surgeries (44.7%). The adjusted any-general-anesthesia versus spinal–spinal estimate was not statistically significant and opposite the spinal-protective hypothesis (adjusted odds ratio 0.49, 95% confidence interval 0.23–1.01, p = 0.054), and no pre-specified sensitivity scenario survived Benjamini–Hochberg correction. Transfusion did not differ between strategies; among secondary endpoints, length of stay, hemoglobin drop, peak C-reactive protein, and intra-operative hypotension likewise showed no significant difference after multiplicity correction. Conclusions: These hypothesis-generating findings do not support changing anesthetic practice; the choice should remain individualized. Approximately 12% of attempted spinal anesthetics converted intra-operatively to general anesthesia—a record-based observation, not a validated failure rate. Full article

Background: Foot degloving injuries are associated with extensive soft-tissue disruption, compromised perfusion, and a high risk of flap necrosis. Hyperbaric oxygen therapy (HBOT) is known to enhance tissue oxygenation and support flap survival; however, its application in pediatric patients may be limited due to poor cooperation, intolerance to chamber-based treatment, and limited accessibility. Case Presentation: A 7-year-old girl presented with a crush injury to the left foot after being run over by a vehicle, resulting in severe soft-tissue damage. Evaluation revealed a dorsal foot degloving injury, a proximal phalanx fracture of the great toe, and dislocations of the fourth proximal interphalangeal and fifth distal interphalangeal joints. Emergency surgery included open reduction, K-wire fixation, debridement, and artificial dermal grafting using Pelnac. On postoperative day 1, the flap showed signs of compromised perfusion. As HBOT was not feasible, topical oxygen therapy using Natrox was applied continuously for 17 days. Serial wound assessments demonstrated gradual improvement in flap viability. Although ischemic changes developed in the toes, necrosis remained superficial and was successfully managed with local debridement and dressings. Residual skin defects with partial necrosis were treated with split-thickness skin grafting, which healed without major complications. The patient resumed ambulation after splint removal. Conclusions: In pediatric patients with compromised flaps in whom HBOT is not feasible, topical oxygen therapy may serve as a practical adjunctive treatment option. Although its independent effect cannot be established in a single case, this report suggests its potential role in flap salvage and in limiting tissue necrosis. Full article

Objective: To evaluate the clinical outcome, safety and efficacy of the APrevent Vocal Implant System (VOIS) in patients with unilateral vocal fold paralysis (UVFP), with particular emphasis on the timing and impact of postoperative saline adjustments. Methods: This retrospective−prospective longitudinal study included 11 patients with chronic UVFP who underwent VOIS medialization thyroplasty (MT) under local anesthesia (n = 2) and general anesthesia (n = 9). Multidimensional voice parameters were analyzed preoperatively and at 1, 3, 6, and 12 months postoperatively. Statistical analyses included the Friedman test for repeated measures and the comparison of outcomes between pre- and each postoperative timepoints was evaluated with the Wilcoxon signed-rank test. Results: Significant and sustained improvements were observed across all multidimensional voice parameters. Mean mVHI-10 decreased from 31.7 ± 4.5 preoperatively to 5.8 ± 5.1 at 12 months, while mean MPT increased from 7.1 ± 3.8 to 14.4 ± 4.5 s (p < 0.05, r > 0.7). Acoustic parameters, including jitter, shimmer, and NHR, demonstrated progressive improvement over 12 months. A high proportion of patients (72.73%) underwent postoperative saline adjustment at a mean interval of 6.23 ± 1.23 months, beyond the early postoperative edema phase, with each adjustment yielding further enhancement in voice outcomes. No major complications, including airway obstruction or hematoma, were observed. Conclusions: VOIS MT is safe and effective, providing sustained improvements in multidimensional voice outcomes. The ability to perform postoperative saline adjustments enables dynamic optimization of glottal closure, reducing the need for revision surgery and addressing evolving laryngeal biomechanics. These findings support VOIS as a flexible, adjustable alternative to static medialization techniques and provide dynamic voice optimization in patients with UVFP. Full article

Cranial cruciate ligament (CrCL) rupture in cats is less common than in dogs, and its optimal treatment remains a subject of debate. This study aimed to evaluate the application of cranial tibial wedge osteotomy (CTWO) as a dynamic stabilization technique in cats with CrCL rupture, describing the technical aspects and clinical outcomes obtained. Five cases with a confirmed diagnosis of CrCL rupture between 2020 and 2024 were included in this study. All patients were treated with CTWO using specific osteosynthesis locking plates designed for use in dogs and a complementary cerclage wire. Radiographic rechecks were performed at 8 and 12 weeks postoperatively, and clinical evaluations were performed 24 h, 8 weeks, 12 weeks, and 6 months postoperatively in every patient. Successful and complete bone healing of the tibial osteotomy was observed in every case. No intraoperative or postoperative complications related to implants or soft tissues were recorded. All cats achieved complete functional recovery without lameness at the last recheck six months after surgery. The technique was performed without significant technical difficulties, providing adequate stability and favorable clinical outcomes in all cases. These preliminary results support the use of CTWO as an effective surgical alternative for the treatment of CrCL rupture in cats. However, further studies with a larger number of cases and a longer follow-up are required to better evaluate its clinical application, outcomes, and influence on osteoarthritis progression in the long term. Full article

Background: Minimally invasive surgery (MIS) for hallux valgus (HAV) correction may benefit from using the medial eminence to enhance lateral capital fragment translation. This study investigates whether osteotomy placement through the medial eminence correlates with improved HAV and forefoot width (FW) correction. A retrospective analysis of 20 patients who underwent MIS bunion correction was performed. Pre- and postoperative radiographs were reviewed to assess hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), sesamoid position, osteotomy location, osteotomy angle, capital fragment shift, and forefoot width. Pearson correlation and multivariable linear regression were used to identify associations. Chart review was performed at the one-year mark for complications (recurrence, infection, non-union, hardware failure). Significant correlations were found between DMAA and HVA (r = 0.883, p < 0.001), DMAA and IMA (r = 0.573, p = 0.008), and HVA and capital fragment shift (r = 0.541, p = 0.014). Osteotomy location and angle were not significantly associated with correction. Multivariable analysis showed DMAA was independently associated with HVA correction (β = 0.679, p < 0.001), and both capital fragment shift and metatarsal head angulation were associated with FW narrowing. Additionally, no patients in this cohort experienced complications. Use of the medial eminence in MIS osteotomy was not associated with improved HAV or FW correction. Angular deformity parameters and lateral fragment shift were more predictive of radiographic outcomes. Full article

Background/Objectives: Adults with single-ventricle physiology (SVP) represent a growing population with complex cardiovascular conditions and an increasing need for noncardiac surgical and interventional procedures. However, perioperative outcomes in this group remain poorly characterized. This study aimed to provide a descriptive characteristic of perioperative management, complications and mortality in adults with SVP undergoing noncardiac surgical and interventional procedures. Methods: We conducted a retrospective cohort study including all adult patients (≥18 years) with SVP who underwent noncardiac surgical and interventional procedures requiring anesthesia or sedation at a tertiary university hospital between 1 January 1995 and 30 November 2023. Demographic data, comorbidities, type of procedure and anesthetic technique were collected. Complications were defined as intraoperative or postoperative adverse events requiring intervention or associated with hemodynamic, respiratory, or cardiovascular instability. Primary outcomes were perioperative complications and all-cause mortality at 24 h, 30 days, and one year, with mortality reported at the patient level. Results: A total of 114 procedures were performed in 67 patients (mean age 32.3 ± 10.8 years). Most procedures were elective (78.9%) and minimally invasive, frequently performed under sedation, with or without local anesthesia (67.5%). Common comorbidities included arrhythmias (46.3%), liver disease (49.3%), and heart failure (17.9%). The overall complication rate was 6.1% (2.6% intraoperative, 3.5% postoperative). Mortality was 1.5% in 24 h, 2.9% in 30 days and 5.9% at one year. Most clinically relevant adverse events occurred in patients with earlier-stage palliation, advanced functional limitation or multiple comorbidities. Conclusions: Perioperative outcomes in adults with SVP undergoing noncardiac surgical and interventional procedures were acceptable when procedures were elective and managed in specialized settings. Risk remains heterogeneous and appears to be influenced by physiological status and stage of palliation. Full article

Background: Intraoperative periprosthetic femoral fractures (IPFF) represent a concerning and often under-recognized complication in total hip arthroplasty (THA). Although several risk factors have been reported, their association with specific femoral morphology and stem geometry has not been fully addressed. This study aimed to identify the incidence and risk factors for IPFF in THA using cementless tapered stems. Methods: A retrospective review was conducted on 3137 primary THAs (2622 patients) performed with cementless tapered stems at a single institution between February 2011 and August 2018. Femoral morphology was classified according to the Dorr types; A (1425 hips, 45.4%), B (1542, 49.2%), and C (170, 5.4%). Femoral stems were categorized as flat, rectangular, or quadrangular tapered designs. The occurrence of IPFF was identified through surgical records and postoperative radiographs. Multivariate regression analysis was performed to identify independent risk factors for IPFF. The mean age at THA was 55 years (range, 15–96), and 52.9% of the patients were women. Results: The overall incidence of IPFF was 2.2% (69 hips). Non-displaced cracks in the proximal metaphysis (58 hips, 84.1%) were the most common type of fracture. The incidence of IPFF was significantly higher in Dorr type A (3.0%) and type C (4.7%) femurs compared with type B (1.2%) femurs. Multivariate regression revealed that female sex (odds ratio [OR], 1.752; p = 0.032) and Dorr type A (OR, 2.898; p < 0.001) and type C (OR, 4.530; p < 0.001) were significantly associated with IPFF. Additionally, the use of quadrangular tapered stems was associated with a higher risk compared with flat tapered stems (OR, 7.382; p < 0.001). Conclusions: Dorr type A and C femurs, along with female sex and the use of quadrangular tapered stems, were significant risk factors for IPFF. Our findings suggest that preoperative consideration of individual femoral morphology and careful selection of stem design are essential to mitigate the risk of IPFF in THA using cementless tapered stems. Full article

Background and Objectives: Seroma formation is the most common postoperative complication following mastectomy and axillary dissection, negatively affecting wound healing and delaying adjuvant therapy. Despite numerous surgical and pharmacological approaches, no universally effective strategies have been established. This study aimed to comparatively evaluate the effects of porcine dermal collagen (PDC), tranexamic acid (TXA), and thymoquinone (TQ) on seroma formation and tissue repair. Materials and Methods: A randomized controlled experimental study was conducted using 40 female Wistar albino rats that underwent modified radical mastectomy and axillary dissection. All surgical and postoperative procedures were performed in accordance with the institutional animal welfare and ethical guidelines, including postoperative analgesic administration. The animals were divided into four groups: control, PDC, TXA, and TQ (n = 10 each). Seroma volume was measured on postoperative day 14. Histopathological evaluation, immunohistochemical analysis (FGF2, VEGF, TGF-β1, p53), and quantitative real-time PCR were performed to assess tissue remodeling and molecular responses. Results: All treatment groups demonstrated a significant reduction in seroma volume compared to the control group, with the most pronounced decrease observed in the TQ and TXA groups (p < 0.0001), while PDC showed a moderate effect (p < 0.01). Histopathological analysis revealed increased collagen deposition and fibrin formation in the PDC and TQ groups, whereas TXA exhibited a more limited remodeling profile than the others. Immunohistochemical and molecular analyses showed significant upregulation of VEGF across all groups, with broader and more consistent increases in the PDC and TQ groups. TGF-β1 and FGF2 expression demonstrated region-specific increases, particularly in the thoracic tissue. p53 expression remained relatively stable in the TXA group but was elevated in specific regions in the PDC and TQ groups. Importantly, the increased inflammatory infiltration, edema, vascular proliferation, and fibrin deposition observed in the TQ group may reflect not only active tissue remodeling processes but also prolonged inflammatory activation and enhanced fibrotic responses and should therefore be interpreted cautiously. Conclusions: PDC, TXA, and TQ differentially modulate postoperative seroma formation via distinct biological mechanisms. While TXA primarily exerts a targeted anti-seroma effect and PDC enhances extracellular matrix stabilization, TQ is associated with broader angiogenic, inflammatory, and tissue remodeling responses within this preclinical rat model. These findings should be considered exploratory and hypothesis-generating, and additional mechanistic studies and clinical investigations are necessary before definitive therapeutic conclusions can be established regarding the use of TQ in human breast surgery settings. Full article

Objective: To assess the anatomical and clinical outcomes of a novel, mesh-free cerclage pectopexy technique that uses the round ligament for apical support following total laparoscopic hysterectomy in women with stage II uterine prolapse. Methods: This retrospective observational study included 120 women with stage II uterine prolapse who underwent total laparoscopic hysterectomy followed by laparoscopic non-mesh pectopexy between October 2023 and August 2024. In this procedure, the distal portion of each round ligament was fixed to the pectineal ligament using Ethibond sutures. Multiple plicating stitches were then placed to reinforce the ligament’s tensile strength, creating a biological suspension bridge between the pectineal ligament and the vaginal cuff. All patients were examined preoperatively and at 1, 3, 6, and 12 months postoperatively using the POP-Q system. Anatomical success was defined as an apical stage ≤ I at 12 months. Results: At the twelve-month follow-up, anatomical success was achieved in 95 percent of patients, with six cases of apical recurrence. POP-Q measurements showed significant improvement from baseline, and total vaginal length was preserved. Functional outcomes, including postoperative pain and dyspareunia, were favorable. Early complications were uncommon, and no intraoperative or mesh-related complications occurred. Conclusion: Round-ligament-based non-mesh cerclage pectopexy provides reliable apical support with minimal surgical morbidity following total laparoscopic hysterectomy. This technique appears to provide effective apical support with low surgical morbidity while avoiding synthetic mesh. Preservation of vaginal length and favorable short-term clinical outcomes were observed; however, longer-term comparative studies are required. Future prospective studies combining this procedure with other minimally invasive suspension techniques, such as McCall culdoplasty or uterosacral plication, may broaden its applicability to more advanced prolapse cases. Full article

Background: Acute pain after video-assisted thoracoscopic surgery (VATS) promotes respiratory splinting, impaired cough, and pulmonary complications, and predicts persistent opioid use. Surgeon-administered intercostal nerve block (ICNB) is a simple regional technique, but its independent effect on early pain and opioid requirement in a contemporary uniportal VATS (UVATS) pathway is incompletely defined. Methods: We performed a retrospective cohort study of 456 consecutive patients undergoing UVATS at a single Israeli center between 2017 and 30 May 2025. Patients receiving an intercostal block were compared with those who did not. Baseline covariates were balanced by 1:1 nearest-neighbor propensity-score matching (caliper 0.2 SD of the logit propensity score). The primary endpoints were pain on postoperative day (POD) 1 (visual analog scale, VAS) and postoperative opioid use; secondary endpoints included later pain, analgesic regimen, postoperative pneumonia, and mortality. Results: Matching yielded 159 patients per group (n = 318) with all clinically relevant covariates balanced (standardized mean difference [SMD] < 0.13). Median POD1 VAS was lower with the block (4 [IQR 3–4] vs. 5 [5–7]; p < 0.001), and 76.1% of block patients were opioid-free versus 10.7% who were not (p < 0.001). The effect was concentrated early and attenuated by POD3. In multivariable analysis the block was independently associated with lower POD1 VAS (adjusted β = −1.64, 95% CI −2.00 to −1.29; p < 0.001). Postoperative pneumonia was less frequent in the block group (5.7% vs. 20.1%; p < 0.001). Thirty-day and one-year mortality did not differ significantly. Conclusions: In UVATS, a surgeon-placed intercostal nerve block was associated with lower early postoperative pain that persisted after adjustment for operating surgeon and surgical era, concordant with pooled meta-analytic estimates; associated reductions in opioid use and pneumonia were confounded with surgeon and secular trend and are hypothesis-generating. These single-center, retrospective findings require prospective, protocol-randomized confirmation. Full article

Atlantoaxial dislocation (AAD) or subluxation (AAS) is a potentially life-threatening disorder caused by instability between the atlas and axis. Typical symptoms include neck pain, torticollis, and neurological deficits, but dizziness has rarely been reported in association with AAD/AAS. We describe an adolescent girl who presented with non-spinning dizziness, neck pain, and torticollis after prolonged head flexion and extension. Neurological examination showed rightward torticollis without nystagmus. Cervical spine imaging revealed atlantoaxial rotatory dislocation and fixation, while CT angiography confirmed patency of both vertebral arteries. Conservative management with cervical traction was ineffective, and surgical reduction with C1–C2 fixation and fusion was performed. The patient experienced complete resolution of dizziness and torticollis postoperatively without complications. This image-based report describes a rare case of AAD in which dizziness was the main presenting symptom. This case highlights that cervical instability should be considered in the differential diagnosis of dizziness. Full article