Search Results (121)

Background: Gastrointestinal (GI) symptoms are highly prevalent in people receiving dialysis and contribute to malnutrition and poor quality of life. We examined the prevalence and severity of GI symptoms in Jordanian adults with end-stage kidney disease (ESKD) treated with hemodialysis (HD) or peritoneal dialysis (PD). Methods: In this cross-sectional study, consecutive adults with ESKD receiving maintenance HD at Al-Karak Teaching Hospital or PD at Al-Basheer Hospital were interviewed using the validated Arabic Gastrointestinal Symptom Rating Scale (GSRS). Domain and total scores (range 1–7) were compared between modalities; a GSRS total score ≥3 defined at least mild overall GI symptom burden. Results: Among 168 ESKD participants (mean age 43.4 ± 15.3 years; 116 HD, 52 PD), 92.2% reported at least one GI symptom. The prevalence of GSRS-defined symptoms was greater in PD (94.2%) than HD (91.4%). PD was associated with significantly higher mean scores in all GSRS domains (reflux, abdominal pain, indigestion, diarrhea, constipation) and a higher total GSRS score (3.33 ± 1.36 vs. 2.36 ± 0.71; p < 0.01 for all comparisons). Upper GI bleeding (UGIB) requiring hospitalization after dialysis initiation occurred more often in HD than PD (15.5% vs. 3.8%; OR 4.59; 95% CI 1.03–20.58). Conclusions: This study demonstrated that dialysis patients had a high prevalence of GI symptoms, with an elevated severity in patients on PD. These findings highlight the need for routine structured assessment of GI symptoms and modality-specific management strategies in dialysis units, particularly for patients on PD. Full article

Background/Objectives: A caudal epidural steroid injection (CESI) is a widely used technique for managing low back and lower extremity pain due to its relative ease and safety. However, cephalic spread of the injectate may be limited by the long distance from the sacral hiatus and by increased intra-abdominal pressure caused using conventional abdominal pillows during prone positioning. This study aimed to investigate whether an eleven-bar cushion could facilitate higher cephalic spread of contrast medium during CESI compared to a conventional pillow. Methods: This retrospective study was approved by the Institutional Review Board (IRB number: AJOUIRB-DB-2025-103). Data from 76 patients, who underwent CESI between January 2023 and March 2024, were analyzed. Patients were divided into two groups the eleven-bar group (n = 38) using a pelvic eleven-bar cushion and the pillow group (n = 38) using a conventional pillow. Fluoroscopic images were reviewed to identify the highest vertebral level reached by the injectate and the number of nerve roots visualized. Visual analogue scale (VAS) scores before and one month after the procedure were also assessed. Statistical analyses included Mann–Whitney U tests, linear regression, and Poisson regression. Results: Baseline demographic characteristics were similar between groups. The cephalic spread of contrast medium was significantly higher in the eleven-bar group compared with the pillow group (median level L3/4 vs. L4/5, p = 0.0002). No significant differences were observed in the number of nerve roots reached or in the VAS score improvement between groups. Conclusions: The eleven-bar cushion facilitated greater cephalic spread of contrast medium during CESI compared with a conventional pillow. Although this technique did not affect nerve root distribution or pain reduction outcomes, it may represent a useful positioning strategy to enhance drug delivery to higher lumbar levels during caudal epidural injections. Full article

Background/Objectives: Irritable bowel syndrome (IBS) is a highly prevalent gastrointestinal disorder affecting almost 10% of the general population, characterized by recurrent abdominal pain and altered bowel habits. Its pathophysiology is incompletely understood, but it is established that symptoms result from an interplay between several environmental- and patient-related factors. This study aimed to analyze the influence of a widespread shift in lifestyle habits and multidimensional stress on IBS manifestations. Methods: An online survey was administered during the COVID-19 lockdown in 2020 to three groups of people representative of the general population. The survey contained questions regarding socio-demographic data, dietary habits, alcohol, smoking, physical activity, sleeping, working activities, stress level, and the characteristics of gastrointestinal symptoms related to both the pre-pandemic period and the lockdown period. The definition of IBS was based on the Rome IV criteria. Multivariate analyses were used to evaluate the association between environmental variables and the occurrence/resolution of IBS. Results: A total of 2735 participants were enrolled. Among them, 122 patients (46.2%) reported symptoms’ improvement during the observation period, while 118 previously healthy subjects (4.8%) developed IBS symptoms. Reduced general stress (OR = 2.2, 95%CI 1.1–4.6, p = 0.029), increased fiber intake (OR = 2.8, 95%CI 1.6–5.0, p < 0.001), and increased hours of sleep (OR = 2.0, 95%CI 1.1–3.8, p = 0.031) were associated with a high probability of IBS resolution, while increased anxiolytic pill intake (OR = 0.14, 95%CI 0.04–0.46, p = 0.001) showed a low likelihood of IBS resolution. Reduced physical activity (OR = 2.0, 95%CI 1.3–3.2, p = 0.002), increased anti-inflammatory effects (OR = 2.4, 95%CI 1.4–4.1, p = 0.002), anxiolytic pill intake (OR = 3.5, 95%CI 2.1–5.9, p < 0.001), and increased work-related stress (OR = 1.8, 95%CI 1.2–2.8, p = 0.009) were risk factors for IBS symptoms’ occurrence. Reduced alcohol consumption was a protective factor (OR = 0.5, 95%CI 0.3–0.8, p = 0.006). The resolution of IBS did not affect upper gastrointestinal functional symptoms (OR = 0.2, 95%CI 0.1–0.3, p < 0.001). Conclusions: The widespread lifestyle change forced by the pandemic created a protective “Cocoon Effect”, resulting in a beneficial effect in almost half of patients with IBS. Our findings provide large-scale evidence that environmental factors play a pivotal role in the pathophysiology of IBS. Specifically, stress levels, fiber intake, sleep patterns, and alcohol consumption are key modifiable drivers of symptom occurrence and resolution. Full article

Background: This multicenter retrospective study evaluated the long-term outcomes of functional dyspepsia (FD) and factors associated with treatment resistance over a 3-year period after treatment initiation. Methods: A total of 111 patients diagnosed with FD according to the Rome IV criteria and confirmed by upper endoscopy to have no organic disease were retrospectively analyzed. First-line therapy included acid-suppressive drugs, prokinetics, and the Kampo medicine rikkunshito, whereas second-line therapy comprised anxiolytics or antidepressants for refractory cases. Gastrointestinal symptoms, psychological distress, and health-related quality of life were assessed using the Gastrointestinal Symptom Rating Scale (GSRS), Hospital Anxiety and Depression Scale (HADS), and Short Form-8. Symptom improvement was evaluated at 1 and 3 years. Results: The improvement rates at 1 and 3 years were 50.5% and 80.2%, respectively. At baseline, the non-improvement group had significantly higher HADS-Depression and GSRS-Abdominal Pain scores (p < 0.05). Multivariate analysis identified HADS-Depression (odds ratio [OR] = 0.676, p = 0.019) and GSRS-Abdominal Pain (OR = 0.461, p = 0.038) as independent predictors of treatment resistance. Conclusions: The present findings indicate that FD often requires prolonged therapy, and baseline depressive symptoms and abdominal pain predict poor long-term outcomes, emphasizing the need for early psychological assessment and integrated management. Full article

Background and Clinical Significance: Effective postoperative pain management is crucial in patients undergoing extensive thoracoabdominal surgery, such as esophageal reconstruction, where both thoracic and abdominal incisions are involved. In such cases, a single epidural catheter may not provide sufficient analgesic coverage. Dual epidural analgesia (DEA) offers a potential solution, allowing segmental, targeted pain control while minimizing systemic opioid exposure. Case Presentation: A 64-year-old male underwent esophageal reconstruction using a combined thoracoabdominal approach. Two epidural catheters were placed at Th5/6 and Th11/12 levels. Intraoperatively, segmental bupivacaine boluses and multimodal non-opioid intravenous analgesia were administered. Postoperatively, continuous epidural bupivacaine infusion was maintained, supplemented with morphine boluses when the numeric rating scale (NRS) was ≥5. Mean NRS scores were 2 at rest and 5 on movement on postoperative day 1 (POD1); 1 and 4 on POD2; and 3 and 5 on POD3. Total epidural morphine consumption was 36 mg over 340 h, and the 24-h bupivacaine dose was 180 mg (2.77 mg/kg/24 h). No complications were observed. Conclusions: Dual epidural analgesia provided effective, opioid-sparing multimodal pain control in complex thoracoabdominal surgery. This case highlights DEA as a safe and feasible approach when single-catheter coverage is inadequate, supporting enhanced recovery and reduced opioid use after esophageal reconstruction. Full article

Background/Objectives: Hysterectomy is the most common gynecologic surgical procedure. While extensive research has been conducted on the advantages of laparoscopy, the gynecology literature lacks sufficient studies on scar-related outcomes, patient satisfaction, and cosmetic outcomes. In this regard, this study aimed to compare cosmetic outcomes and patient satisfaction between laparotomy and laparoscopic hysterectomy cases performed at our tertiary university hospital center. Methods: Patients who underwent hysterectomy for benign gynecologic reasons were included in the study. The study group consisted of patients who had surgery via the laparoscopic technique, while the control group comprised patients who had laparotomy through a transverse abdominal incision (Pfannenstiel). Postoperative scar areas, scar thickness, color, height, and pain scores were evaluated after the 12th postoperative month. A digital caliper was used to calculate the scar area. Scar satisfaction and general body perceptions were assessed using questionnaires. Results: The mean scar area was significantly lower in the study group (p = 0.003). The physician’s scar assessments revealed no significant differences between the Manchester Scar Scale, POSAS Observer Scale, Vancouver Scar Scale, and SCAR Scale. The mean POSAS Patient Scale score, which assesses patients’ opinions of postoperative scars, was significantly lower in the study group than in the control group. In contrast, the Body Image Questionnaire score was higher (p < 0.01). There were no significant differences between the groups in mean Rosenberg Self-Esteem Scale and Body-Cathexis Scale scores. Conclusions: The patients in the study group were more satisfied with their scars but less satisfied with their body image. Contrary to general expectations, the patients were found to be less satisfied with the visible scar outcomes on the abdominal wall resulting from multi-port surgical procedures. Studies are needed to inform patients about scars before operations, select ports for use during operations, and evaluate the effect of the port-site surgical repair technique on cosmetic outcomes. Full article

Symptomatic uncomplicated diverticular disease (SUDD) is the primary clinical manifestation of diverticular disease (DD). Although gut microbiota (GM) perturbation and dietary habits are considered important factors in the development of the disease, there is currently a lack of data on the potential relationship between diet, GM profile and SUDD. An exploratory retrospective study was conducted in a SUDD cohort of 47 patients to investigate this relationship; a diverticulosis cohort of 19 patients served as the control group. Patients were stratified by their self-reported dietary habits, i.e., Mediterranean diet, predominantly plant-based diet or omnivorous diet. GM was profiled using 16S rRNA amplicon sequencing of fecal swabs. SUDD patients following a Mediterranean or predominantly plant-based diet showed higher alpha diversity and enrichment of known fibre degraders and short-chain fatty acid producers, such as members of the Lachnospiraceae, Ruminococcaceae, Oscillospiraceae and Prevotellaceae families. This suggests that their gut (and whole-body) health is less impaired. In contrast, those following an omnivorous diet showed an increased presence of pro-inflammatory taxa, including the mucus degrader R. torques, which suggests impaired gut barrier function and potential systemic implications. Similar associations between GM profile and dietary habits were found when considering SUDD patients with moderate abdominal pain severity (according to visual analogue scale, VAS) and those scored as DICA 1 according to the endoscopic severity of the disease. However, no such associations or trends were observed in SUDD patients scored as DICA 2, which suggests that diet may be unable to impact GM dysbiosis as SUDD severity increases. Despite the study’s limitations, primarily its retrospective design and related biases, our findings suggest that other GM modulation tools should be employed in more severe cases of SUDD to reverse dysbiosis while alleviating symptoms. Full article

Irritable Bowel Syndrome (IBS) is a complex and multifactorial gastrointestinal disorder characterized by recurrent abdominal pain and altered bowel habits, impacting quality of life. Therapy is mainly based on relieving symptoms with specific drugs, whereas herbal and complementary remedies have gained attention in recent years. This review examines the current knowledge on herbal remedies in IBS management. Several herbal treatments, particularly peppermint oil and Iberogast, have demonstrated efficacy in randomized controlled trials. Preclinical studies have revealed promising anti-inflammatory and antispasmodic effects for herbs, e.g., curcumin, fennel oil, and cannabis derivatives. However, many studies suffer from some limitations, e.g., small sample sizes, short study durations, or methodological weaknesses. There is a lack of large-scale, long-term randomized controlled trials for most herbal remedies, and heterogeneity in study designs makes direct comparisons challenging. Moreover, limited evidence exists regarding herb–drug interactions and long-term safety profiles. Despite these limitations, certain herbal remedies may offer a valuable complementary approach for some IBS patients when used under medical supervision. Future research should focus on larger, well-designed clinical trials to establish efficacy, optimal dosing, and long-term safety, as well as elucidate specific mechanisms of action and identify patient subgroups that may benefit most from specific herbal treatments. Full article

Background and Objectives: Thoracic epidural analgesia (TEA) is considered the gold standard for postoperative pain control following major abdominal surgery. Bilateral rectus sheath block (RSB) is a promising alternative regional technique. This study aimed to compare the efficacy of RSB and TEA in managing early postoperative pain and enhancing recovery after open gastrectomy. Materials and Methods: Between October 2021 and December 2024, 70 patients scheduled for elective open gastrectomy were randomized into two groups: Group A (RSB with continuous bupivacaine infusion) and Group B (TEA with 10 mg bupivacaine plus 1 µg/mL fentanyl). Primary outcomes included opioid consumption within 72 h postoperatively and pain intensity measured using the visual analog scale (VAS). Statistical analysis was conducted using the Mann–Whitney U test, Friedman’s ANOVA with Bonferroni correction, and Chi-square or Fisher’s exact test for categorical variables. Results: A total of 64 patients were finally included (30 in RSB, 34 in TEA). VAS scores in the RSB group were significantly lower at 24 and 48 h postoperatively compared to baseline (p < 0.001). Between-group comparisons showed consistently lower pain scores in the RSB group at all measured time points. At 48 h, 94% of patients in the TEA group required rescue analgesia, compared to only 17% in the RSB group. Additionally, the RSB group had a significantly shorter postoperative hospital stay (mean 6 vs. 9 days) and demonstrated earlier return of bowel function. Conclusions: RSB is a safe and effective alternative to TEA for analgesia after open gastrectomy. It significantly lowers pain scores, reduces opioid and rescue medication use, shortens hospital stay, and enhances early recovery. Bilateral rectus sheath block with continuous bupivacaine infusion significantly lowers pain scores, reduces opioid and rescue medication use, shortens hospital stay, and facilitates early recovery. Full article

Relevance of the problem and aim of the work: Ankylosis of the temporomandibular joint (TMJ) affects physical, psychological, and social well-being and quality of life. One of the most frequently used surgical interventions for the treatment of temporomandibular joint ankylosis is interpositional arthroplasty, particularly in cases where joint preservation is feasible, with different autologous fats: dermis fat, buccal fat pad, and full thickness skin-subcutaneous fat. The aim of the work was to evaluate the efficiency of using different autologous fats in temporomandibular joint ankylosis treatment with interposition arthroplasty method. Materials and Methods: This systematic literature review was conducted according to PRISMA guidelines and registered in the PROSPERO database (CRD420251038325). A comprehensive search was performed in PubMed, the Cochrane Library, and ScienceDirect databases using combinations of keywords: (temporomandibular joint disorders OR temporomandibular joint) AND (adipose tissue or autologous) AND (ankylosis OR arthroplasty). Inclusion criteria were clinical studies conducted on human subjects, written in English, that evaluated the use of autologous fat in interpositional arthroplasty for TMJ ankylosis. The main outcome measures included postoperative maximum mouth opening (MMO), pain intensity, and relative fat volume contraction. Risk of bias was assessed using the Cochrane RoB 2 tool for randomized controlled trials and the Newcastle–Ottawa Scale for cohort studies. Most included studies were of moderate to high quality. Results: A total of 20 publications were selected, including a total of 369 patients. In a qualitative analysis, the best results for maximal opening of mouth (MOM) at 3, 6, 12, and more than 12 months were obtained with dermal fat. After 3 months, the MOM was 40.0 ± 2.7 mm, after 6 months—40.80 ± 4.26 mm, after 12 months—41.9 ± 4.0 mm, after more than 12 months—43.5 mm. The lowest pain intensity was observed using dermal fat taken from the iliac crest region. The rate of volumetric fat shrinkage was greater using buccal fat pad than dermis fat. Conclusions: The most commonly used types of autologous fat in interposition arthroplasty in ankylosis are the following: dermal fat from the abdominal region (iliac crest, subumbilical area, groin), buccal fat pad and full-thickness subcutaneous fat. The best results after the surgical treatment of TMJ ankylosis with interposition arthroplasty are obtained using dermis fat. Full article

Background/Objectives: Probiotic interventions can alleviate gastrointestinal (GI) discomfort, but evidence comparing multi-strain combinations at different doses remains limited. We evaluated whether formulation potency influences clinical and microbiome outcomes. Methods: In a 4-week, randomized, double-blind trial, 100 eligible adults received one of two higher-dose multi-strain probiotic formulations at different dosages (Wec120B vs Wec300B). Weekly Gastrointestinal Symptom Rating Scale (GSRS) scores tracked symptom trajectories. Gut microbiota composition and diversity were profiled by 16S rRNA gene sequencing. Biomarkers included lipopolysaccharide (LPS), fecal calprotectin (FC), and immunoglobulin A (IgA). Results: Results indicated that the Wec120B group showed more significant improvement in abdominal pain during the early phase of intervention, while the Wec300B group was more effective in relieving reflux symptoms. In terms of biomarkers, Wec120B was more effective in reducing lipopolysaccharide (LPS) levels, whereas Wec300B showed a greater increase in immunoglobulin A (IgA) and a more pronounced reduction in fecal calprotectin (FC) levels. Both formulations significantly increased the abundance of beneficial genera such as Bifidobacterium, Blautia, [Eubacterium]_hallii_group, and Anaerostipes, while suppressing the growth of potential pathogens including Prevotella and Escherichia-Shigella. Conclusions: These findings suggest that both compound probiotic products can significantly improve GI symptoms and modulate gut microbiota structure, with Wec300B showing a superior performance in microbial regulation, likely due to its higher dosage of probiotics. This study provides reference evidence for the rational application of probiotic products in gut health management. Full article

Background: Autoimmune cholestatic liver diseases (AICLDs), including primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC), are characterized by progressive biliary injury and cholestasis, leading to an impaired quantity/quality of life. Pruritus affects 20–70% of patients and is often refractory to current treatments. Ileal bile acid transporter (IBAT) inhibitors reduce bile acid reabsorption and may alleviate cholestatic pruritus. This systematic review and meta-analysis evaluates their efficacy and safety in adults with AICLD. Methods: Following PRISMA guidelines, we systematically searched PubMed, Embase, and Cochrane-CENTRAL for studies assessing IBAT inhibitors in adult AICLD patients with pruritus for ≥12 weeks. The primary outcome was the change in the 5-D Pruritus Scale. Secondary outcomes included sleep quality, serum bile acids, liver biochemistry, and safety. Heterogeneity was assessed using Cochrane Q and I² statistics. Results: Three studies (n = 180) met inclusion criteria, including two RCTs and one single-arm study. Patients (78% female; 85% PBC; 77% linerixibat) showed a significant pruritus reduction (MD = −4.93, 95%CI [−6.26, −3.59], p < 0.0001), accompanied by improved sleep quality (MD = −8.12, 95%CI [−13.54, −2.70], p = 0.0033). Serum bile acids, FGF19, and autotaxin decreased significantly, with increased C4 levels. AST and GGT declined, while ALP, ALT, and bilirubin remained stable. Adverse events occurred in 89.7%, mainly diarrhea (22.7%), nausea (12.2%), and abdominal pain (18.2%); serious events were rare (2.2%). Conclusions: IBAT inhibitors significantly reduce pruritus and improve sleep in AICLD, with a favorable safety profile. These findings support their potential as a novel therapeutic option for cholestatic pruritus in adults with AICLD. Full article

Background/Objectives: General anesthesia is the most widely used anesthesia technique for major abdominal surgery, but it may have a longer recovery time, high cost, and environmental impact. In addition, general anesthesia may be contraindicated in some frail patients. Our study aims to evaluate the feasibility and safety of performing colorectal surgery with a minimally invasive technique in frail patients under spinal anesthesia. Methods: From June 2021 to January 2022, 39 consecutive frail patients, undergoing elective laparoscopic colorectal oncological resection surgery under neuraxial anesthesia at the Colorectal Surgery Unit of the Fondazione Policlinico Campus Bio-Medico in Rome, were selected. A retrospective analysis prospectively maintained database of these patients was performed. Results: In all 36 patients, the surgery was successfully completed under spinal anesthesia and laparoscopic technique. Some patients experienced mild abdominal pain between I and II POD (Post Operative Day) (Visual Analogue Scale between 3 and 5) and were treated with oral analgesics as needed. No patients experienced episodes of vomiting or nausea after surgery with gas channeling in I POD. The average hospital stay was about 4 days (range 3–7). No patient required ICU (Intensive Care Unit) admission, and 30-day mortality was 0. Conclusions: Our preliminary data show that performing major surgery with a minimally invasive technique under spinal anesthesia can be feasible and safe, if performed by experienced operators, and can be a viable alternative for the treatment of frail and/or high-risk patients. Full article

Continuous extradural infusions (CEIs) provide sustained analgesia, avoiding fluctuations seen with bolus administrations. An extradural catheter was placed in a cat with severe abdominal trauma following a vehicular accident. To provide sustained pain relief, a CEI of 0.5% ropivacaine at 0.18 mg/kg/h or 0.036 mL/kg/h was initiated, resulting in improved analgesia, as shown by lower scores on both the Feline Grimace Scale (FGS) and the Glasgow Composite Measure Pain Scale-Feline (CMPS-Feline). During treatment, the cat developed hypersalivation, which persisted after catheter removal at 72 h. Eventually, the cat’s condition deteriorated, with signs of sepsis leading to euthanasia due to a poor prognosis. Potential contributors to the cat’s decline included systemic infection, local anaesthetic systemic toxicity, or opioid-related effects. This report describes the placement of an extradural catheter in a cat, highlighting the potential of CEI in feline pain management while emphasising the need for further research on its pharmacokinetics and safety. Full article

Background: Abdominal wall endometriosis (AWE) is a rare but debilitating condition, often occurring in surgical scars after Caesarean sections. It is characterized by cyclic pain and a palpable mass, significantly impacting patients’ quality of life. Traditional treatments, including hormonal therapy and surgery, have limitations, prompting interest in minimally invasive techniques such as cryoablation. This study evaluates the efficacy and safety of percutaneous image-guided single-probe cryoablation using liquid nitrogen for symptomatic AWE. Purpose: To evaluate the effectiveness and safety of percutaneous image-guided single-probe cryoablation using liquid nitrogen in treating symptomatic AWE lesions, with a primary objective to assess pain relief using the Visual Analog Scale (VAS). Materials and Methods: This retrospective, single-center study included 14 patients (23 lesions) treated with percutaneous cryoablation between September 2022 and April 2025. Clinical, imaging (MRI and ultrasound), and procedural data were analyzed. Pain scores (VAS scale) were assessed before treatment and at 3-month follow-up. Hydro- and/or carbo-dissection were used to protect adjacent structures. Response to treatment was evaluated with MRI and clinical follow-up. Statistical analysis was performed using median, range, and percentage calculations, with comparisons made using the Mann–Whitney test. Results: A total of 23 AWE lesions were treated in 14 patients (mean age: 39.6 years). The median lesion volume was 3546 mm³, with a range from 331 mm³ (8 × 4.6 × 9 mm) to 45,448 mm³ (46 × 26 × 38 mm). Most of the lesions were located in the muscle (69.6%, n = 16), while 17.4% (n = 4) involved both muscle and subcutaneous tissue, and 13.0% (n = 3) were purely subcutaneous. Among the 23 treated lesions, 8.7% (n = 2) appeared as purely hemorrhagic, 13.0% (n = 3) as fibrotic, and 78.3% (n = 18) were classified as mixed, based on imaging characteristics. Procedures were performed under general anesthesia in 65% of cases and under sedation in 35%. Hydrodissection was used in 48% of lesions, carbo-dissection in 4%, and combined hydro–carbo-dissection in 26%. A single 13G cryoprobe was used in 83% of cases, and a 10G probe in 17%. The median ablation time was 15 min (range: 6–28 min), and the median total procedure time was 93 min (range: 22–240 min). Pain scores significantly decreased from a median of 8/10 (range: 6–10) before treatment to 0/10 (range: 0–2) at follow-up (p < 0.0001). MRI follow-up confirmed complete coverage of the ablation zone and disappearance of hemorrhagic inclusions in all cases. Two patients (14%) required re-treatment, both with satisfactory outcomes. No peri- or post-procedural complications were observed, and no visible scars were noted. Conclusions: Percutaneous cryoablation using a single probe with liquid nitrogen is a safe and effective treatment for AWE, offering significant pain relief, minimal morbidity, and excellent cosmetic outcomes. It should be considered as part of multidisciplinary care. Further prospective studies with longer follow-up are warranted to confirm these findings. Full article