Search Results (25,433)

Background: Deep infiltrating endometriosis (DIE), particularly when involving the bowel, significantly impairs health-related quality of life (HRQoL) and gastrointestinal function. This study aimed to evaluate the short- and mid-term impact of minimally invasive excision on these parameters in a large multicenter cohort. Methods: A retrospective observational study was conducted on 837 patients treated for endometriosis in two tertiary referral centers between 2018 and 2024. All patients underwent laparoscopic or robotic-assisted excision. Quality of life was assessed preoperatively and at 6 months (VAS: n = 69; SF-36: n = 100; GIQLI: n = 98) and 12 months (VAS: n = 30; SF-36: n = 46; GIQLI: n = 44) postoperatively, using validated patient-reported outcome measures (PROMs): the Visual Analog Scale (VAS) for pain, the Short Form-36 (SF-36) survey, and the Gastrointestinal Quality of Life Index (GIQLI). Results: The study population presented with predominantly advanced disease (Stage III–IV in 83.4% of cases), with 39.7% of patients undergoing segmental bowel resection. Postoperatively, a statistically significant reduction was observed in dysmenorrhea (VAS 7.6 vs. 5.0, p < 0.001) and chronic pelvic pain. The SF-36 scores improved significantly across all eight domains at 6 months, with the most dramatic recovery seen in Role Physical (p < 0.001) and Bodily Pain (p < 0.001). Regarding digestive function, the mean GIQLI score showed a progressive increase, reaching statistical significance at 12 months compared to baseline (112.6 vs. 106.6, p = 0.027), indicating superior long-term functional outcomes. Conclusions: Multidisciplinary minimally invasive surgery for deep infiltrating endometriosis was associated with significant and sustained improvements in quality of life among patients with available follow-up. Gastrointestinal quality of life, as measured by GIQLI, improved significantly at 12 months postoperatively, including in patients who underwent segmental bowel resection. Systematic use of PROMs is essential for accurate patient counseling and outcome monitoring. Full article

Background: Obesity is an independent and major risk factor for cardiovascular diseases. However, the presence of common comorbidities such as diabetes and hypertension makes it difficult to understand the direct impact of obesity on the myocardium. The aim of this study is to evaluate the isolated effects of weight loss achieved after bariatric surgery on left ventricular (LV) geometry and diastolic functions in individuals with the “Metabolically Healthy Obese” (MHO) phenotype. Materials and Methods: The study included 28 patients (Surgical Group) who underwent Laparoscopic Sleeve Gastrectomy (LSG) between January 2022 and December 2025, had a preoperative Body Mass Index (BMI) > 40 kg/m², and had no known cardiovascular or metabolic diseases. The control group consisted of 25 age- and gender-matched metabolically healthy morbidly obese patients who had not undergone surgery. Demographic and echocardiographic data of all participants were analyzed at baseline and at 6 months. Results: Weight Loss: In the surgical group, BMI decreased from 46.21 kg/m² to 37.11 kg/m² at the 6th month, while no significant change was observed in the control group. Cardiac Structure: In the surgical group, Left Ventricular Mass Index was significantly decreased from 51.11 g/m² to 44.57 g/m². Cardiac Function: The E/A ratio, an indicator of diastolic function, increased significantly from 1.19 to 1.34 in the surgical group, indicating notable improvement. No clinically meaningful change in systolic function was detected. Metabolic Parameters: The surgical group exhibited marked improvements in glucose and lipid profiles (decrease in Total Cholesterol, increase in HDL). Conclusions: The study demonstrates that bariatric surgery, independent of metabolic comorbidities, directly provides “reverse remodeling” of cardiac structure and improves function through reduction of adipose tissue and alleviation of hemodynamic load. These results support the effectiveness of surgery in reducing cardiovascular risk and preserving cardiac structure even in morbidly obese patients without comorbidities. Full article

Background/Objectives: To evaluate the clinical outcomes and prognostic factors of Baerveldt glaucoma implant (BGI) surgery performed as a primary filtering procedure in eyes without prior glaucoma filtering surgery. Methods: This retrospective cohort study included 148 eyes of 148 patients who underwent BGI surgery with a 350-mm² endplate at a single tertiary center. Surgical success was defined using three intraocular pressure (IOP)-based criteria: IOP > 21 mmHg (criterion A), >17 mmHg (criterion B), or >14 mmHg (criterion C), failure to achieve ≥ 20% IOP reduction, need for additional glaucoma surgery, loss of light perception, or persistent hypotony. Kaplan–Meier survival analysis and multivariable Cox proportional hazards regression were used to evaluate surgical outcomes and prognostic factors. Results: The 5-year cumulative probability of surgical success was 70.6%, 49.8%, and 27.6% for criteria A, B, and C, respectively. Mean IOP decreased significantly from 33.5 ± 10.0 mmHg preoperatively to 13.9 ± 4.0 mmHg at 5 years (p < 0.01); number of glaucoma medications decreased from 4.0 ± 1.2 to 1.8 ± 1.9 (p < 0.01). Younger age was associated with a higher risk of surgical failure (criterion A: hazard ratio [HR] 0.97, p < 0.01; criterion B: HR 0.98, p = 0.011; criterion C: HR 0.97, p < 0.01). More previous intraocular surgeries were associated with failure under criterion B (HR 1.30, p = 0.048). Early and late postoperative complications occurred in 34.5% and 14.2% of eyes, respectively; 20.9% required additional postoperative interventions. Conclusions: BGI surgery performed as a primary filtering procedure demonstrated favorable long-term IOP control in eyes without prior glaucoma filtering surgery. Younger age was identified as a consistent risk factor for surgical failure. Full article

Artificial intelligence (AI) is increasingly integrated into emergency general surgery (EGS), where rapid diagnosis, accurate decision-making, and timely intervention are essential for improving patient outcomes. Recent advances in machine learning, deep learning, computer vision, and predictive analytics have enabled AI-assisted systems to support clinicians throughout the perioperative workflow. Current applications include radiologic image interpretation, diagnosis of acute abdominal conditions, surgical workflow recognition, intraoperative anatomical guidance, postoperative complication prediction, and intensive care monitoring. AI technologies may improve diagnostic accuracy, optimize operative planning, enhance surgical safety, and facilitate personalized perioperative management. In minimally invasive surgery, computer vision and real-time data analysis have shown promising results for intraoperative decision support and surgical education. However, important limitations remain, including concerns regarding data quality, algorithm transparency, ethical governance, regulatory approval, and implementation disparities between healthcare systems. In addition, much of the current evidence is derived from retrospective or highly specialized datasets, limiting broad clinical applicability. This narrative review summarizes the current clinical applications of AI in emergency general surgery and discusses emerging technologies, existing challenges, and future perspectives regarding the integration of AI into acute surgical care. Full article

Background and Objectives: Postoperative dysphagia following anterior cervical discectomy and fusion (ACDF) remains a common complication affecting patient quality of life. This study evaluated the safety and clinical efficacy of reprocessed micronized acellular dermal matrix (ADM) compared to conventional gel-type anti-adhesive agents in patients undergoing single-level ACDF. Materials and Methods: This retrospective propensity score-matched study included 108 patients (54 matched pairs) who underwent single-level ACDF between January 2021 and December 2025. The ADM group received CGDerm Matrix™ and the control group received Mediclore™. The primary outcome was postoperative swallowing function assessed by the Swallowing Impairment Score (SIS-6) at 3 months (pre-specified primary time point). Secondary outcomes included VAS, NDI, modified MacNab criteria, adhesion scores, prevertebral soft tissue swelling, and perioperative inflammatory markers. Bonferroni correction was applied for multiple comparisons (adjusted α = 0.0125). Results: The ADM group demonstrated significantly lower SIS-6 scores at 3 months (0.26 ± 0.16 vs. 0.68 ± 0.27, p = 0.01), which remained significant after Bonferroni correction. All other clinical and radiological outcomes were comparable between groups. No device-related complications occurred. Conclusions: ADM application in ACDF surgery appears safe and is associated with improved postoperative swallowing function at 3 months. However, the clinical significance of observed differences requires further investigation. Full article

Background and Objectives: Surgical site infections (SSIs) remain common after elective colorectal surgery. This systematic review and meta-analysis evaluated whether adding oral antibiotic bowel preparation (OAB) to mechanical bowel preparation (MBP) reduces SSIs compared with MBP alone. Materials and Methods: PubMed, the Cochrane Library, Scopus, and ClinicalTrials.gov were searched for English-language randomized controlled trials published from January 2005 to January 2025. Eligible trials enrolled adults undergoing elective colorectal surgery and compared MBP+OAB versus MBP alone, with standard intravenous prophylaxis in both groups. The primary outcome was overall SSI; secondary outcomes were incisional SSI and organ-space SSI. Risk of bias was assessed with RoB 2, certainty with GRADE, and odds ratios (ORs) were pooled using DerSimonian–Laird random-effects models. The protocol was prespecified but not prospectively registered. Results: Twelve trials including 4073 patients were included (MBP+OAB, n = 2069; MBP, n = 2004). MBP+OAB reduced overall SSI (OR 0.53, 95% CI 0.37–0.75; p < 0.001; I² = 62.5%; 95% prediction interval 0.17–1.66), incisional SSI (OR 0.52, 95% CI 0.34–0.80; p = 0.003; I² = 57.5%), and organ-space SSI (OR 0.63, 95% CI 0.45–0.88; p = 0.007; I² = 8.3%). The effect was preserved in metronidazole-containing regimens (OR 0.46, 95% CI 0.33–0.65), but this subgroup was exploratory. Excluding high-risk-of-bias studies supported the primary result. Publication-bias assessment was underpowered. Overall and organ-space SSI were moderate-certainty outcomes; incisional SSI was low-certainty, and anastomotic leak was very low-certainty. Conclusions: In contemporary elective colorectal surgery when MBP is used, adding preoperative OAB probably reduces SSIs. Findings do not establish whether OAB alone is sufficient or whether MBP is necessary; stewardship-relevant outcomes remain insufficiently reported. Funding was provided by ISCIII grant PI25/01285. Full article

Ovarian cancer (OC) is typically treated with cytoreductive surgery (CRS). Hyperspectral imaging (HSI) is an emerging non-invasive, label-free technique that enables whole-area scanning, making it a promising tool for real-time tumour recognition. However, developing tumour recognition algorithms requires a foundational understanding of spectral variability in normal tissues. This study focusses on the in vivo spectral profiles of key abdominal and pelvic organs encountered during CRS, including the uterus, ovaries, intestines, mesentery, omentum, peritoneum, and fallopian tubes, and evaluates the potential for organ recognition using HSI data. Intraoperative HSI data were from healthy patients. Two machine learning models, a support vector machine (SVM) and a 3D convolutional neural network (3DCNN), were trained to classify the organs based on their spectral signatures. In total, 15 patients were included in the dataset. The 3DCNN slightly outperformed the SVM in terms of the average accuracy (0.889 vs. 0.878), sensitivity (0.648 vs. 0.604), specificity (0.936 vs. 0.930), and Dice Similarity Coefficient (0.595 vs. 0.569). This study demonstrates the feasibility of using HSI for organ differentiation in the clinical setting, although in some cases separability remains a challenge, especially when organs have similar spectra. This is a critical step towards a generalizable in vivo abdominal tumour recognition algorithm, by carefully investigating spectral fingerprints of abdominal tissues. Full article

Lymphatic malformations (LMs) are rare congenital low-flow vascular anomalies that frequently involve the head and neck and may be managed with surgery, laser therapy, sclerotherapy, or multimodal approaches depending on lesion type, size, depth, and relationship with adjacent structures. Ultrasound-guided sclerotherapy with doxycycline is an established treatment option for macrocystic lesions, whereas the practical role of high-frequency superficial ultrasound as a technical adjunct has been less specifically discussed. We report the case of a 32-year-old man presenting with a painless left submandibular swelling of approximately two years’ duration. Magnetic resonance imaging showed a well-encapsulated cystic lesion measuring 56 × 35 mm in the left submandibular region, extending into the internal paralaryngeal space and causing mild compression of the laryngeal wall. Previous fine-needle aspiration cytology had not conclusively established the lymphatic nature of the lesion; therefore, an incisional biopsy was performed and confirmed a macrocystic LM. The patient underwent day-surgery intralesional doxycycline sclerotherapy under real-time high-frequency ultrasound guidance using an 18 MHz hockey-stick transducer. After aspiration of the main cystic compartment through a 25-gauge needle, 100 mg of doxycycline diluted to 10 mg/mL in normal saline was slowly injected under continuous visualization. The procedure was well tolerated under topical local anesthesia, without pain, complications, or adverse effects. A partial clinical reduction was observed after the first session; the treatment was repeated after three months, resulting in apparent complete clinical resolution at one-year follow-up; no post-treatment imaging was available to confirm radiological resolution. This case highlights the potential technical value of high-frequency superficial ultrasonography, particularly for needle positioning, improved delineation of superficial locules, and real-time monitoring of sclerosant distribution. Full article

Background: In locally advanced squamous cell esophageal cancer, concurrent chemoradiotherapy (CRT) is the standard of care, as it especially improves local control and overall survival compared to radiotherapy alone. In contrast, treatment strategies for esophageal adenocarcinoma often parallel those used in gastric cancer, particularly regarding systemic therapy. Objectives: This study aimed to evaluate the clinicopathological factors affecting event-free survival (EFS) and overall survival (OS) following trimodality treatment in patients with non-metastatic esophageal cancer. Methods: A total of 155 patients diagnosed with esophageal cancer between March 2019 and November 2025 were retrospectively analyzed. Response to concurrent chemoradiotherapy was assessed via thoracic magnetic resonance imaging and endoscopic biopsy. Results: Clinicopathological analysis showed that male sex, the presence of lymphovascular invasion, adenocarcinoma histology, poor pathological response and advanced-stage tumors were significantly associated with worse EFS (all p < 0.001). In multivariate analysis, stage IVa disease was identified as an independent predictor of both mortality and relapse, with an approximately five-fold increased risk of death (p = 0.028) and relapse (p = 0.019). Patients with squamous cell carcinoma had a longer median EFS compared to those with adenocarcinoma (18 vs. 8.4 months, respectively). The 3- and 5-year OS rates were 59.2% and 56% in patients with squamous cell carcinoma, compared with 40% and 26% in those with adenocarcinoma, respectively. Conclusions: Survival outcomes were more favorable in patients with squamous cell histology and those diagnosed at an early stage. Active surveillance may be considered in selected patients with a complete clinical response to avoid the perioperative mortality associated with surgery. Full article

Hepatobiliary surgery is a technically complex subspecialty within general surgery, which requires a comprehensive understanding of complex liver and liver tumour anatomy. The current body of literature highlights the use of three-dimensional-printed liver models (3DPLMs) reconstructed from medical imaging datasets may improve clinician comprehension of patient-specific liver anatomy thus creating a useful tool for hepatobiliary surgical planning and clinician training. The purpose of this systematic review was to examine the clinical utility and feasibility of 3DPLMs in hepatobiliary surgical planning and clinical education and investigate whether these applications influence patient outcomes. Studies were retrieved from three electronic databases (ProQuest, PubMed and Scopus) according to predetermined eligibility criteria. In total, 25 eligible articles were identified, including 18 original research articles and seven case reports. An inductive content analysis approach suitable for heterogeneous bodies of literature was used to synthesise key concepts in this review. There are significant case report and descriptive evidence to support the use of 3DPLMs in clinical education, preoperative planning and intraoperative guidance of patient liver and tumour anatomy to improve hepatobiliary surgical decision making. The studies presented display a large variance in cost and times necessary for the production of 3DPLMs, as studies did not include the software, equipment and full expense of materials used. Additionally, studies concentrated on different aspects of the 3DPLMs production process making them not comparable. This review demonstrates the potential value of 3DPLMs in clinical education, preoperative planning and intraoperative guidance in hepatobiliary anatomy and surgery. Future studies, in particular, randomised controlled trials and experimental research are required to investigate the relationship between 3DPLMs and clinical education and surgical planning outcomes. Full article

Background: Uterine fibroids (leiomyomas) are the most common benign tumors in women of reproductive age and represent a significant cause of abnormal uterine bleeding, pelvic pain, infertility, and reduced quality of life. Contemporary management has evolved toward individualized, uterus-sparing approaches, incorporating pharmacological and minimally invasive strategies alongside traditional surgical methods. Methods: This narrative review was conducted based on a comprehensive search of PubMed/MEDLINE, Scopus, and Web of Science databases for studies published between January 2010 and December 2025. The search strategy combined Medical Subject Headings (MeSH) and free-text terms related to uterine fibroids and their management. Eligible studies included clinical trials, systematic reviews, and meta-analyses focusing on pharmacological, minimally invasive, and surgical treatments in adult women. The review was prepared in accordance with the Scale for the Assessment of Narrative Review Articles (SANRA) recommendations to improve methodological transparency and quality of reporting. Results: A total of 97 studies were included in the qualitative synthesis. Minimally invasive techniques, including uterine artery embolization (UAE), radiofrequency ablation (RFA), and high-intensity focused ultrasound (HIFU), demonstrate high efficacy in symptom control and improvement of quality of life, with shorter recovery times and lower complication rates compared to conventional surgery. However, their impact on fertility remains variable and requires careful patient selection. Pharmacological therapies, particularly GnRH analogues and antagonists, effectively reduce bleeding and fibroid volume, although their long-term use is limited by side effects. Conclusions: The management of uterine fibroids should be individualized, taking into account symptom severity, fibroid characteristics, patient age, and reproductive plans. Minimally invasive and pharmacological treatments represent effective alternatives to surgery in appropriately selected patients, while surgical approaches remain essential in advanced or refractory cases. Future research should focus on optimizing personalized treatment strategies and evaluating long-term outcomes, particularly regarding fertility and recurrence. Full article

Background: Postoperative hyperbilirubinemia is a serious complication after cardiac surgery and has been associated with increased perioperative morbidity and mortality. However, data specifically addressing patients undergoing redo valve surgery remain limited. This study aimed to determine the incidence and risk factors of postoperative hyperbilirubinemia after redo valve surgery, and evaluate its association with early postoperative outcomes. Methods: We retrospectively reviewed 259 adult patients who underwent elective redo valve surgery under cardiopulmonary bypass (CPB) between March 2018 and July 2024. Postoperative hyperbilirubinemia was defined as a serum total bilirubin level > 3 mg/dL at any time after surgery. Patients were divided into a hyperbilirubinemia group and a non-hyperbilirubinemia group. Perioperative variables were compared between groups. Univariable and multivariable logistic regression analyses were performed to identify risk factors for postoperative hyperbilirubinemia. Postoperative complications and in-hospital mortality were also compared. Results: Postoperative hyperbilirubinemia occurred in 101 of 259 patients (39.0%). Compared with patients without hyperbilirubinemia, those with hyperbilirubinemia had longer mechanical ventilation and intensive care unit stay, and higher rates of pneumonia, reintubation, tracheostomy, continuous renal replacement therapy, and in-hospital mortality. Univariable logistic regression showed that higher EuroSCORE II, higher preoperative total bilirubin and direct bilirubin levels, lower hemoglobin and platelet count, pulmonary hypertension, anemia, longer operative time, CPB duration, and aortic cross-clamp time, lower nasopharyngeal temperature, greater intraoperative blood loss, larger red blood cell and plasma transfusion volumes, and concomitant surgery on all three valves were associated with postoperative hyperbilirubinemia. Multivariable analysis identified elevated preoperative direct bilirubin, prolonged CPB duration, and more plasma transfusion as independent risk factors. Receiver operating characteristic analysis showed that peak postoperative total bilirubin had moderate prognostic discrimination for in-hospital mortality, with an optimal cut-off value of 3.95 mg/dL (AUC 0.756, sensitivity 66.7%, specificity 80.2%, p = 0.003). Conclusions: Postoperative hyperbilirubinemia is common after redo valve surgery and is associated with worse early postoperative outcomes and higher in-hospital mortality. In this setting, postoperative bilirubin elevation should be interpreted primarily as a prognostic marker of perioperative stress and hepatic vulnerability rather than a direct causal driver of adverse outcomes. Elevated preoperative direct bilirubin, prolonged CPB duration, and greater plasma transfusion were independently associated with the development of postoperative hyperbilirubinemia in this high-risk population. Full article

Background/Objectives: Postoperative pulmonary complications (PPCs) significantly contribute to surgical morbidity, mortality, and healthcare costs, yet their definition remains heterogeneous in clinical literature. We aimed to develop and apply a standardized system for defining and measuring PPCs and their severity among a general, low-risk surgical population. Methods: A retrospective, observational design evaluated data from 95,808 adult patients undergoing elective surgery with general anesthesia between 2015 and 2023 at a large tertiary medical center. PPCs were identified using a curated list of ICD-10 codes based on the StEP-COMPAC consensus and were categorized into mild, moderate, or severe based on the intensity of postoperative oxygen delivery. Multivariable logistic and ordinal regression models were utilized to identify risk factors for the occurrence and clinical severity of PPCs. Results: The overall incidence of PPCs was 7.52% (n = 7206), with mild cases accounting for the majority (5.65%), followed by moderate (1.47%), and severe (0.40%) cases. Key risk factors for PPCs included ASA class 3 or 4, OSA, COPD, increased case duration, and the use of home oxygen devices. Higher mean pre-operative oxygen saturation was identified as a protective factor against PPCs. Conclusions: A feasible and promising framework for standardizing PPC measurement using EHR data and interprofessional collaboration is presented for use in ongoing initiatives aimed at reducing rates of PPCs. Identified risk factors may serve as critical triggers for implementing perioperative strategies to mitigate complications in the general surgical population. Full article

Cardiac surgery induces systemic stress responses that may compromise intestinal homeostasis in animal patients, yet the underlying mechanisms remain poorly understood. This study investigated postoperative intestinal pathophysiology in a porcine model, focusing on the activation of the NF-κB pathway and its impact on intestinal stem cell function. Thirty-two large white pigs (40–50 kg) were randomized into control and model groups; the model group underwent simulated cardiac procedures involving aortotomy and left ventricular outflow tract exposure under standardized anesthesia. Our findings revealed significant NF-κB pathway activation and upregulation of matrix metalloproteinases (MMPs) in the intestine following surgery. Intestinal stem cells isolated from crypts showed downregulated expression of key barrier proteins. Notably, organoids derived from the model group exhibited impaired early proliferative capacity and delayed morphogenesis, despite preserved differentiation potential upon extended culture. This suggests a stress-induced state that favors the maintenance of stemness over commitment to differentiation. These results delineate an NF-κB/MMP-mediated mechanism linking surgical stress to intestinal barrier dysfunction and stem cell dysregulation in this large animal model. Crucially, the study provides insights that may help improve perioperative care and reduce gastrointestinal complications in animal patients undergoing major surgeries, thereby enhancing animal welfare. The identified pathways offer potential targets for developing supportive therapies in veterinary practice. Full article

Mohs Micrographic Surgery (MMS) is considered the most conservative and preserving procedure for removing cutaneous tumors. The major disadvantage of MMS is that tumor involvement in tissue may be underestimated. This may lead to large excisions necessitating complex reconstruction with profound effects on cosmetic results. Some patients refuse complex reconstruction and demand simple closure of post-MMS skin defects. This retrospective cohort study describes our technique of serial Mohs excisions of large non-melanoma skin cancers for patients refusing flaps or skin graft reconstructions. A total of 51 patients who underwent MMS according to the described technique February 2020–May 2021 were included. The mean age was 76.5 (range 63–94) years and 55% were male. More than half of the lesions were on the nose. Mean lesion sizes were 14.25–55 mm depending on location. Most cases required two surgeries and only one needed a third surgery. Postsurgical defects were repaired using primary closure in 90% of cases. Mean follow-up was 31 months (range 6–48) with no evidence of local recurrence. In conclusion, this approach of serial excisions with MMS can be performed safely and achieve better cosmetic outcomes for patients presenting with large skin tumors of the face or other functionally important areas. Full article