Hemorrhoidectomy remains the mainstay treatment for advanced mixed hemorrhoids; however, postoperative pain, delayed wound healing, and complications remain important concerns after surgery. This study aimed to evaluate the efficacy and safety of a modified ultrasonic scalpel hemorrhoidectomy incorporating figure-eight closure. This was a single-center, single-blind, randomized, parallel-controlled trial. A total of 78 patients with grade III–IV mixed hemorrhoids were randomly assigned to undergo either modified ultrasonic scalpel hemorrhoidectomy incorporating figure-eight closure (n = 39) or Milligan–Morgan hemorrhoidectomy (n = 39). The primary outcomes were incision healing time and time to return to normal activities. Secondary outcomes included postoperative pain, complications, anal function, and patient satisfaction. The trial was approved by the institutional ethics committee and registered in the Chinese Clinical Trial Registry (ChiCTR2100047229). The intervention group showed significantly shorter incision healing time (P < 0.05) and faster return to normal activities. The intervention group also demonstrated lower resting pain scores at 8 h after operation and lower defecation pain scores on postoperative days 2, 5, 6, and 7 (P < 0.05). In addition, the incidence of urinary retention and postoperative bleeding scores were lower in the intervention group than in the control group (P < 0.05). However, no significant differences were observed in overall clinical efficacy, postoperative anal function, or patient satisfaction (P > 0.05). Modified ultrasonic scalpel hemorrhoidectomy incorporating figure-eight closure was associated with faster wound healing and earlier recovery compared with Milligan–Morgan hemorrhoidectomy. These findings suggest that this technique may provide short-term postoperative benefits; however, further multicenter studies with larger sample sizes and longer follow-up are required to confirm its long-term efficacy and safety. Chinese Clinical Trial Registry, ChiCTR2100047229. Registered on 11 June 2021.
Minimally invasive esophagectomy (MIE) after neoadjuvant immunochemotherapy is standard for locally advanced esophageal cancer, but anastomotic leakage (AL) remains common and severe. Perfusion of the gastric conduit via the right gastroepiploic artery (RGEA) is critical. We investigated whether the distance from anastomosis to the distal RGEA terminus (anastomotic distance) is associated with AL. This retrospective cohort study included 134 patients with esophageal squamous cell carcinoma undergoing MIE after neoadjuvant immunochemotherapy. Patients were stratified by anastomotic distance using a receiver operating characteristic (ROC)-derived cut‑off (6.1 cm). The primary outcome was AL. Associations were analyzed by logistic regression, restricted cubic spline (RCS), and piecewise regression with subgroup analyses. AL occurred in 21.6
Surgical resection remains a commonly used local treatment option for selected patients with pulmonary metastases. However, reoperation may be technically difficult after prior ipsilateral thoracic surgery or when substantial pleural adhesions are anticipated. Percutaneous cryoablation (CA) is a parenchyma-sparing local treatment option. This study compared short-term perioperative outcomes between CA and thoracoscopic resection; it was not designed to establish oncologic equivalence. We retrospectively analyzed 85 patients with metastatic pulmonary tumors treated at a single tertiary center between June 2022 and September 2024. The patients underwent thoracoscopic pulmonary metastasectomy (n = 70) or percutaneous cryoablation (n = 15). Short-term perioperative parameters, including prosedure time, chest drainage, length of hospital stay, and procedure-related cost, were compared between the groups. Prior ipsilateral pulmonary resection was more frequent in the CA group (66.7
Neoplastic precursor lesions of gallbladder cancer include non-mass-forming flat dysplasia/biliary intraepithelial neoplasia and mass-forming intracholecystic papillary neoplasm, whereas isolated metaplasia is a non-neoplastic mucosal alteration. This study evaluated the associations of preoperative inflammatory–nutritional indices and imaging-derived gallbladder wall thickness with neoplastic precursor lesions. This retrospective single-center cohort included 180 patients who underwent cholecystectomy. The primary endpoint was low- or high-grade flat dysplasia/biliary intraepithelial neoplasia or intracholecystic papillary neoplasm; isolated metaplasia was reported separately. Apparent discrimination was evaluated using receiver operating characteristic analysis. Because only 10 primary outcome events were available, four separate age-adjusted parsimonious logistic regression models were fitted using log₂-transformed C-reactive protein, log₂-transformed systemic immune-inflammation index, imaging-derived gallbladder wall thickness, or log₂-transformed C-reactive protein–albumin–lymphocyte index. C-reactive protein and the composite index were compared using DeLong’s method. Restricted-cohort analyses addressed acute inflammatory presentations, and model discrimination and calibration were internally evaluated using 2,000 bootstrap resamples. Neoplastic precursor lesions were identified in 10 patients (5.6
Clinically relevant anastomotic leakage after rectal cancer surgery is multifactorial, and baseline vascular status may contribute to anastomotic perfusion risk. This study evaluated the associations of patient-level vascular comorbidity, preoperative CT/CTA-derived vascular status, and intraoperative left colic artery (LCA) management with clinically relevant anastomotic leakage after anterior resection-based surgery for rectal cancer. This single-center retrospective cohort study included adults who underwent elective anterior resection-based surgery for rectal cancer with primary colorectal or coloanal anastomosis between October 2018 and February 2026. Preoperative contrast-enhanced CT or CT angiography was reviewed for superior and inferior mesenteric artery stenosis and aorto-mesenteric atherosclerotic/calcification burden. An exploratory CT/CTA-derived vascular burden indicator was defined from these imaging features. The primary outcome was clinically relevant anastomotic leakage within 30 days. Associations were evaluated using logistic regression with a prespecified parsimonious model. Among 194 patients, clinically relevant anastomotic leakage occurred in 28 patients (14.4
To investigate surgical outcomes and prognostic factors in elderly patients (≥ 60 years) with valvular heart disease (VHD) undergoing surgery, and to provide evidence for optimizing clinical decision-making. A retrospective analysis was conducted on 347 elderly VHD patients who underwent valve surgery across three Chinese centers from December 2021 to June 2025. Baseline characteristics, comorbidities, preoperative cardiac function, surgical details, complications, and follow-up data were collected. Cumulative survival was estimated using Kaplan–Meier method, with subgroup comparisons by log-rank test. Independent prognostic factors were identified using multivariable Cox regression. Among 347 patients (53.9
Laparoscopic cholecystectomy (LC) following endoscopic retrograde cholangiopancreatography (ERCP) is commonly performed in patients with concomitant gallbladder and common bile duct stones. However, the impact of ERCP-related factors on the technical difficulty and outcomes of LC remains unclear. This study aimed to evaluate the association between prior ERCP exposure and subsequent LC outcomes and to investigate the role of ERCP-related procedural factors. Patients who underwent LC were retrospectively divided into ERCP and non-ERCP groups. To minimize baseline differences, propensity score matching (PSM) (1:1) was performed based on age, sex and ASA score. Following matching, perioperative outcomes were compared between groups to evaluate the impact of prior ERCP. Subgroup analyses within the ERCP cohort were performed according to ERCP-related variables, including indication, ERCP-LC interval, number of ERCP procedures, stone extraction and biliary stenting. A total of 426 patients were included in the study. Following PSM, the rate of laparoscopic subtotal cholecystectomy (LSC) was significantly higher in patients with prior ERCP compared with controls (p = 0.003), whereas conversion to open surgery was similar between groups (p = 0.996). Within the ERCP cohort, patients who underwent ≥ 3 ERCP procedures or received ≥ 2 biliary stents had significantly higher rates of LSC (p = 0.004 and p = 0.008, respectively). Multiple stone extraction was associated with longer operative time in subgroup analyses. In multivariable analysis, ≥ 3 preoperative ERCP procedures were associated with LSC (OR 15.98, 95
Thoracoscopic airway reconstruction remains technically demanding because limited exposure and long suture strands can complicate needle handling, suture organization, and tension control. The suture-hiding technique (SHT) temporarily secures one needle-bearing end of a double-armed polypropylene suture within a cylindrical gauze, allowing staged, bidirectional, visibility-guided continuous suturing. We evaluated the technical feasibility and early clinical outcomes of this workflow. This single-center retrospective case series included 22 patients who underwent SHT-assisted thoracoscopic airway reconstruction between July 2020 and December 2025, comprising 20 sleeve lobectomies and 2 tracheal resections. SHT was used selectively according to airway anatomy, anticipated operative exposure, and surgeon judgment. All procedures were performed by one surgeon with prior experience in thoracoscopic sleeve resection and airway reconstruction. Outcomes included technical completion, perioperative and pathological results, airway reconstruction-related adverse events, and follow-up findings. All analyses were descriptive. All 22 planned SHT-assisted reconstructions were completed through biportal video-assisted thoracoscopic surgery without conversion to thoracotomy, use of an alternative reconstruction strategy, additional repair sutures, or residual air leak on intraoperative testing. R0 resection was achieved in all patients; 13 had received neoadjuvant therapy and 5 had pathologically positive lymph nodes. Median airway reconstruction time was 22.5 min (range, 17–33). Postoperative complications occurred in 6 patients (27.3
Moderate-sized distal lower-leg and ankle defects can be reconstructed with local flaps when adjacent donor tissue and vascular territories remain intact. We assessed two anatomy-selected, non-interchangeable options: a broad-pedicle posterior tibial artery perforator-plus fasciocutaneous flap and a distally based sural neurocutaneous flap. This retrospective cohort included 40 adults treated from January 2019 to January 2024 (20 per group). Allocation was anatomy guided rather than randomized. The primary outcome was complete flap survival; secondary outcomes included necrosis, venous congestion, other complications, revision surgery, operative time, protective sensation, ankle motion, ambulation, and follow-up. Welch t tests, Fisher exact tests, and a Pearson chi-square test were used; effect estimates are reported with 95
To compare the early clinical outcomes and radiographic outcomes of unilateral biportal endoscopic transforaminal lumbar interbody fusion (ULIF) versus minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in the treatment of single-level mild to moderate lumbar spondylolisthesis (LS). Clinical data of patients with single-level lumbar spondylolisthesis who underwent ULIF or MIS-TLIF at Shandong Provincial Hospital Affiliated to Shandong First Medical University between January 2018 and August 2025 were retrospectively analyzed, including 33 patients in the ULIF group and 33 patients in the MIS-TLIF group. The baseline characteristics, perioperative parameters and radiographic outcomes were compared between the two groups. All surgeries were successfully completed in all patients. The operative time was significantly longer in the ULIF group than in the MIS-TLIF group (P < 0.05). However, the ULIF group had significantly less intraoperative blood loss, postoperative drainage volume, and shorter postoperative hospital stay compared with the MIS-TLIF group (all P < 0.05). In the early postoperative period, the levels of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were significantly lower in the ULIF group than in the MIS-TLIF group (P < 0.05). Compared with preoperative baseline values, the Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), and Japanese Orthopaedic Association (JOA) scores improved significantly at all postoperative time points in both groups (all P < 0.05). Nevertheless, the VAS scores for low back pain and leg pain at 3 days postoperatively were significantly lower in the ULIF group than in the MIS-TLIF group (P < 0.05). Radiographically, all radiographic parameters improved significantly postoperatively in both groups compared with preoperative values (P < 0.05), with no statistically significant differences observed between the two groups (P > 0.05). The efficacy of ULIF in the treatment of single-level mild to moderate lumbar spondylolisthesis is comparable to that of MIS-TLIF. However, the ULIF group is associated with less intraoperative blood loss, less postoperative drainage, and faster postoperative recovery, albeit with a longer operative time.
The “weekend effect” describes worse outcomes for patients treated on weekends compared with weekdays, but its presence in emergency abdominal surgery remains unclear. This study evaluated the impact of weekend and out-of-hours surgery on clinical outcomes. Methods: This retrospective cohort study included consecutive patients undergoing emergency abdominal surgery at a single institution between April 2022 and March 2024. Patients were categorized by surgery timing: weekends, weekday working hours, and weekday out-of-hours. Three analytical approaches were used to assess timing effects. The primary outcome was in-hospital mortality; secondary outcomes included postoperative length of stay, surgical site infection (SSI), and total hospitalization costs. Statistical analyses included the Mann–Whitney U test, chi-square test, and univariate logistic regression. Results: A total of 125 patients were included, with 60.0
Pancreatic ductal adenocarcinoma (PDAC) frequently recurs within 12 months despite curative-intent resection, indicating biological aggressiveness not fully captured by current staging. This study aimed to develop and validate a Transparent Reporting of a multivariate prediction model for Individual Prognosis or Diagnosis (TRIPOD)-compliant preoperative Early-Recurrence Score (ERS) for ≤ 12-month recurrence. We conducted a retrospective prognostic-model study at a tertiary referral center. Of 213 patients assessed for upfront resection (2018–2022), 127 underwent pancreatectomy, with 68 (53.5
Presacral sinus (PS) is a late sequela of anastomotic leakage that fails to heal following restorative rectal resection. Clinical outcomes following expectant management and subsequent stoma closure remain poorly defined. This single-center case series included patients who developed PS after minimally invasive restorative low anterior resection with defunctioning ileostomy for rectal cancer between 2013 and 2023. PS was defined as a leak-associated presacral cavity persisting beyond 90 days from the index operation; eligibility was anchored on a documented leak with such a cavity, irrespective of when the sinus was first recognized. Patients with concurrent severe anastomotic stricture or rectovaginal fistula requiring surgical intervention were excluded. All patients were initially managed expectantly, with or without adjunctive transanal repair, followed by stoma closure. Long-term clinical and radiological outcomes were evaluated. Of 1,010 patients undergoing minimally invasive restorative rectal resection, 24 (2.4
Choledocholithiasis is commonly managed using either endoscopic retrograde cholangiopancreatography (ERCP) or common bile duct exploration (CBDE). Although both approaches are widely used their comparative efficacy, safety and cost-effectiveness remain debated in the context of contemporary laparoscopic and endoscopic practice. A systematic review and meta-analysis was performed of randomised controlled trials and observational studies comparing ERCP with open or laparoscopic CBDE for the management of choledocholithiasis. PubMed, Embase and Scopus were searched for studies published from January 2013 to 25 March 2026. The primary outcome was procedural success. Secondary outcomes included: retained or recurrent stones, overall complications, severe complications, length of stay and hospitalisation cost. Meta-analysis was performed using pooled risk ratios or mean differences with 95
Afferent loop syndrome (ALS) after pancreaticoduodenectomy (PD) is typically caused by mechanical obstruction. Reverse-orientation small-bowel anastomosis is an exceptionally rare complication of complex bowel reconstruction that causes functional obstruction through retrograde peristalsis despite a structurally patent bowel lumen, thereby closely mimicking ALS and making the diagnosis particularly challenging. We report a rare case highlighting its characteristic radiological findings and diagnostic pitfalls that may facilitate earlier recognition. A 72-year-old man with a history of right hemicolectomy for transverse colon cancer underwent pancreaticoduodenectomy with superior mesenteric vein reconstruction for locally recurrent disease invading the pancreas and mesenteric vessels. Postoperatively, he developed persistent intolerance to oral intake, high-output bilious drainage, and afferent limb dilatation, initially suggesting delayed gastric emptying or ALS. Despite repeated imaging showing a structurally patent bowel without a definite transition point, the diagnosis remained elusive. Dynamic fluoroscopy demonstrated antiperistaltic contrast propulsion, and computed tomography revealed the “reversed jejunal artery sign,” establishing the diagnosis of reverse-orientation small-bowel anastomosis. Revisional surgery restored normal bowel orientation, resulting in complete symptom resolution and recovery of oral intake. Reverse-orientation small bowel anastomosis is a rare but important cause of functional obstruction after PD that may be overlooked because the bowel remains structurally patent. Recognition of the “reversed jejunal artery sign” on computed tomography, antiperistaltic contrast propulsion on fluoroscopy, and the operative circumstances predisposing to loss of bowel orientation may facilitate earlier diagnosis and timely surgical correction.
The benefit-risk profile of prophylactic capsular tension ring (CTR) implantation during routine cataract surgery in eyes without documented or suspected zonulopathy remains uncertain. This review evaluated its effects in this population. PubMed, EMBASE, CENTRAL, and Web of Science were searched for randomized controlled trials (RCTs) and prospective comparative studies of phacoemulsification with in-the-bag intraocular lens (IOL) implantation with or without a nonsutured CTR. Primary outcomes were postoperative IOL decentration, tilt, and anterior chamber depth (ACD). Secondary outcomes included visual acuity, ocular aberrations, refractive outcomes, and complications. Random-effects meta-analyses were performed, and certainty of evidence was assessed using the GRADE framework. Eighteen studies (1887 eyes) were included. CTR implantation did not significantly affect IOL decentration (MD 0.00 mm; 95
The role of preoperative biliary drainage (PBD) in patients with resectable pancreatic head cancer remains controversial. Although traditionally used to reduce hyperbilirubinemia, increasing evidence suggests an association with higher postoperative morbidity. This study evaluated the impact of preoperative biliary stenting on microbial contamination, postoperative inflammatory response, and clinical outcomes. This retrospective single-center study included 102 patients with preoperative cholestasis and hyperbilirubinemia who underwent pancreatic head resection between March 2017 and January 2024. Patients were divided into a stent group (n = 66) and a no-stent group (n = 36). Intraoperative bile cultures, perioperative parameters, postoperative complications, and serial laboratory values were analyzed. Patients who underwent preoperative stenting showed significantly higher rates of positive intraoperative bile cultures (75.8
Distinguishing between traumatic and non-traumatic rotator cuff tears (RCTs) remains challenging in clinical practice. The coracoacromial ligament (CAL), an important component of the subacromial space, may undergo morphological changes associated with RCT progression. We investigated whether arthroscopically assessed CAL degeneration differed by tear etiology (traumatic or non-traumatic RCT) and whether this association persisted after adjustment for age, tear area, and critical shoulder angle (CSA). We retrospectively included patients who underwent arthroscopic rotator cuff repair at a single center between July 2023 and December 2025. Tears were classified as traumatic or non-traumatic based on the patient’s clinical history and preoperative magnetic resonance imaging findings. CAL degeneration was graded intraoperatively using the Copeland–Levy classification and categorized as mild (grades 0–1) or severe (grades 2–3). Tear etiology, age, CSA, and tear area were compared between the groups, and a forced-entry multivariable logistic regression model was used to identify factors independently associated with severe CAL degeneration. A total of 138 cases were included, comprising 58 with mild and 80 with severe CAL degeneration. Severe CAL degeneration was present in 56 of 80 non-traumatic tears (70.0
Granular cell tumors (GCTs) are uncommon, typically benign neoplasms often linked to a Schwann cell origin, with parotid localization being exceptionally rare. This report details a rare case of a benign granular cell tumor (historically known as Abrikossoff’s tumor) originating in the parotid gland of a 35-year-old woman. The patient presented with a one-year history of a slowly enlarging, painless left pre-tragal mass. Imaging revealed a heterogeneous, poorly defined lesion with calcifications. The patient underwent a total parotidectomy with facial nerve preservation. Histopathological examination revealed tumor cells with abundant granular cytoplasm and absent cytonuclear atypia. Histological analysis confirmed a complete surgical excision with clear, negative margins (R0 resection). The diagnosis was confirmed by immunohistochemistry, which showed strong positivity for S100 protein, SOX10, and CD68, and negativity for DOG1 and mammaglobin. Although complete surgical excision with negative margins remains the primary treatment, long-term recurrence cannot be definitively excluded based on a 6-month follow-up period alone. This case underscores the importance of immunohistochemistry in diagnosing this rare entity and highlights the role of thorough preoperative evaluation to avoid potential overtreatment.
Acute appendicitis is among the most common pediatric surgical emergencies worldwide. Laparoscopic appendectomy (LA) has gained wide acceptance in recent years ; however, its superiority over the traditional open appendectomy (OA) is still a topic of debate, particularly regarding postoperative outcomes and recovery. This systematic review and meta-analysis aimed to compare LA and OA in children with acute appendicitis, focusing on postoperative outcomes, recovery parameters, pain, cosmetic results, and cost-effectiveness to guide evidence-based surgical decision-making. The study followed PRISMA 2020 guidelines and was registered in PROSPERO (CRD42025620445). A comprehensive search was conducted in PubMed, Embase, Science Direct, Scopus, and Google Scholar in November 2024. Randomized controlled trials and observational studies comparing LA and OA in patients aged ≤ 18 years were included. Data were extracted and analyzed using RevMan 5.0, applying fixed- or random-effects models according to heterogeneity. Twenty-five studies involving 166,755 patients (7 RCTs and 18 observational studies) were included. LA significantly reduced surgical site infection (OR = 0.68), intestinal obstruction (OR = 0.24), and reoperation rate (OR = 0.53). It also shortened hospital stay (MD = − 1.16 days) and time to oral intake (MD = − 1.14). No significant differences were found in operative time, intra-abdominal abscess formation, or overall complications. LA offers better postoperative outcomes and faster recovery than OA in pediatric appendicitis, with comparable operative time and abscess risk. These findings support LA as the preferred approach, although further multicenter RCTs are needed for long-term outcome validation.
