Background: Giant cell tumor of bone (GCTB) rarely affects elderly individuals, and its clinical characteristics in this population remain insufficiently defined. This study aimed to investigate epidemiologic features and age-related differences in the surgical management of GCTB using a nationwide registry. Methods: Patients with histologically confirmed benign GCTB recorded in the Japanese Bone and Soft Tissue Tumor (BSTT) Registry between 2006 and 2019 were analyzed. Clinical characteristics, treatment patterns, and postoperative outcomes were compared among peak-incidence (20–45 years), middle-aged (46–64 years), and elderly (≥65 years) groups. Results: Among 1,978 eligible cases, 173 patients (8.7%) were aged 65 years or older. Surgical intervention decreased with increasing age and was lowest in the elderly group (88%, 80%, and 75%, respectively; p < 0.001). After 2014, the proportion of elderly patients undergoing surgery declined significantly from 85% to 66% (p = 0.005). When surgery was performed, elderly patients more frequently underwent marginal or wide resection, whereas intralesional curettage predominated in younger adults. Conclusions: This nationwide registry analysis demonstrates age-related differences in the surgical management of GCTB. Although the proportion of patients undergoing surgery decreased after 2014, causal relationships with denosumab approval cannot be established in this registry-based study. Reduced use of surgery did not necessarily imply less extensive surgical management among patients who underwent surgery. These findings support individualized, age-sensitive treatment strategies.
Background: Obesity is strongly associated with an increased risk of hiatal hernia (HH) and gastroesophageal reflux disease (GERD). The impact of laparoscopic sleeve gastrectomy (LSG) on GERD remains controversial. Objective: To evaluate the effect of concomitant hiatal hernia repair (HHR) during LSG on postoperative GERD symptoms. Methods: A retrospective study was conducted on 106 morbidly obese patients who underwent LSG between March 2021 and December 2024. Patients were divided into two groups: LSG with HHR (Group A, n=45) and LSG alone (Group B, n=61). GERD symptoms were assessed pre- and postoperatively using a standardized questionnaire over a follow-up period of at least one year. Results: All procedures were completed laparoscopically without conversion. Operative time was significantly longer in Group A (83.22 ± 13.18 min vs 51.8 ± 10.13 min, p < 0.001). GERD improvement was significantly higher in Group A (90.4%) compared to Group B ( p =0.04). De novo GERD occurred in 7% of patients in Group A versus 20.4% in Group B (not statistically significant). No significant differences were observed in weight loss outcomes or postoperative complications. Conclusion: Concomitant HHR during LSG is a safe and effective approach that not only significantly improves GERD symptoms but also reduces the incidence of de-novo reflux.
Background: Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic condition causing persistent bladder-related pain, pressure, or discomfort, significantly impairing quality of life. Cystectomy is a last-resort treatment for severe, refractory cases, but data on outcomes, particularly from specific regions, remain limited. Materials and Methods: This retrospective cohort study analyzed 16 Azerbaijani IC/BPS patients who underwent supratrigonal or total cystectomy between 2014 and 2024. Clinical, radiological, and surgical data were collected, with symptom severity assessed preoperatively and three months postoperatively using the interstitial cystitis symptom index (ICSI), interstitial cystitis problem index (ICPI), and visual analog scale (VAS) for pain. Results: The median age was 57 years, with 75% female. Median symptom duration was 8 years (range: 3-12), anesthetic bladder capacity was 75 mL (range: 40-140), and all patients had Hunner lesions. Surgical interventions included supratrigonal cystectomy with ileal augmentation (12.5%) and simple cystectomy with Bricker ileal conduit diversion (87.5%). Median ICSI scores reduced from 17 (range: 15–19) to 6 (range: 4–8), ICPI from 13 (range: 12–16) to 5 (range: 4–9), and VAS pain scores from 9 (range: 8–10) to 4 (range: 3–5) at the third postoperative month (all p < 0.001). No perioperative complications or in-hospital mortalities occurred, with a median hospital stay of 7 days (range: 6-11). Conclusions: Cystectomy provided substantial symptomatic relief and improved quality-of-life indices in patients with severe, refractory IC/BPS. These findings underscore its role as an effective but complex treatment option for carefully selected patients.
Background: Reliable methods for survival risk stratification in gastric cancer (GC) remain limited. We evaluated the prognostic utility of preoperative red cell distribution width (RDW) and the RDW-to-albumin ratio (RAR) in patients undergoing curative surgery for GC. Materials and Methods: Clinicopathological data from 214 consecutive patients who underwent R0 resection for GC were retrospectively analyzed. The prognostic significance of RDW and RAR was assessed using time-dependent receiver operating characteristic (ROC) curves and Cox proportional hazards regression. Optimal cutoff values were determined with X-tile software. Results: Time-dependent ROC analyses demonstrated that RAR consistently yielded higher areas under the curve than RDW for predicting relapse-free survival (RFS), indicating superior discriminatory capacity. In univariate Cox analyses, both RDW and RAR were significantly associated with overall survival (OS) and RFS. Multivariate analyses confirmed that elevated RDW independently predicted poorer OS (hazard ratio [HR] 1.85, 95% confidence interval [CI] 1.11–3.08, P = 0.019) and RFS (HR 1.67, 95% CI 1.03–2.71, P = 0.039). Similarly, elevated RAR independently predicted worse OS (HR 1.77, 95% CI 1.06–2.94, P = 0.029) and RFS (HR 1.76, 95% CI 1.07–2.89, P = 0.025). Conclusions: Preoperative RAR, together with RDW, serves as an independent prognostic marker for long-term outcomes in patients with resectable GC. These easily available markers may represent more reliable and practical tools for mortality risk stratification for GC in clinical practice.
Background: Type 2 diabetes mellitus (T2DM) is strongly associated with peripheral artery disease (PAD), which often presents with distal arterial involvement. The Global Limb Anatomic Staging System (GLASS) standardizes infrainguinal anatomical assessment and assists revascularization planning; however, evidence linking patient characteristics with GLASS-based anatomical complexity remains limited. This study described arterial anatomical patterns according to GLASS criteria and evaluated associations of age and diabetes duration with lesion distribution and GLASS stage in patients with T2DM and PAD. Materials and Methods: A retrospective cohort study was conducted at Dr. Cipto Mangunkusumo National General Hospital, Jakarta. Adult patients with T2DM and PAD who underwent lower-extremity computed tomography angiography (CTA) between August 2024 and August 2025 were included using consecutive sampling. Arterial lesions were classified into femoropopliteal and infrapopliteal segments and staged using GLASS. Age and diabetes duration were independent variables, while sex, HbA1c, hypertension, and dyslipidemia were confounders. Multinomial logistic regression analyses were performed. Results: Seventy patients were analyzed (mean age 65.4 years). Femoropopliteal disease was generally mild, whereas infrapopliteal lesions were more severe. Most limbs were classified as GLASS Stage II. Older age and longer diabetes duration were significantly associated with more severe infrapopliteal disease and higher GLASS stage in bivariate analysis, but not after adjustment. Conclusion: PAD in patients with T2DM predominantly affects distal arterial segments and is commonly of intermediate anatomical complexity. Age and diabetes duration show anatomical associations, particularly infrapopliteal involvement. GLASS provides a useful framework for anatomical assessment and risk stratification.
Acute kidney injury (AKI) is a frequent complication after major surgery, associated with prolonged hospitalization, increased morbidity, and higher healthcare costs. Preoperative renal optimization has been proposed as a preventive strategy; however, the effectiveness of such interventions remains uncertain. This systematic review evaluated randomized controlled trials (RCTs) assessing preoperative interventions aimed at improving renal outcomes in adult patients undergoing major surgery. A comprehensive search was conducted in MEDLINE, Embase, and LILACS, and risk of bias was assessed using the Cochrane RoB 2 tool. Five RCTs met the inclusion criteria, encompassing pharmacologic strategies, nutritional interventions, and perioperative management approaches. Only one study, evaluating a hypocaloric, protein-restricted diet in living kidney donors, demonstrated a significant improvement in early renal outcomes in transplant recipients. In contrast, most trials did not show significant differences in AKI incidence, need for renal replacement therapy, or mortality. Four of the five studies were judged to present “some concerns” regarding risk of bias, while one was classified as low risk. Overall, the available evidence is limited and heterogeneous, precluding definitive recommendations for routine implementation of preoperative renal optimization strategies. Further large, well-designed clinical trials are needed to clarify the role of targeted preoperative interventions in AKI prevention. Systematic review registration: PROSPERO CRD420251161803
Hemorrhoidal disease, characterized by the swelling and inflammation of anal and rectal veins, is one of the most common gastrointestinal disorders worldwide. Prolapsed edematous hemorrhoids, a severe form of this condition, involve the painful protrusion of swollen hemorrhoidal tissue, often associated with edema, bleeding, and complications such as thrombosis. These cases can significantly affect patients' quality of life, necessitating effective and minimally invasive treatment options. Traditional therapies, including conservative measures and surgical interventions, are often associated with complications and high recurrence rates. Recent advancements have led to increased interest in hyaluronic acid (HA), a naturally occurring glycosaminoglycan, for its therapeutic potential in managing prolapsed edematous hemorrhoids. HA plays a critical role in tissue hydration, inflammation regulation, and wound healing. Its hydrophilic properties help to reduce edema, promote tissue regeneration, and alleviate the symptoms associated with hemorrhoidal disease. This review explores the current literature on the application of hyaluronic acid in the treatment of prolapsed edematous hemorrhoids. It examines the mechanisms through which HA exerts its effects, such as reducing inflammation and enhancing tissue hydration. Clinical evidence supporting its efficacy and safety is discussed, along with comparisons to traditional treatment modalities, such as rubber band ligation and sclerotherapy. The review also identifies gaps in current research and highlights areas requiring further investigation to optimize HA-based therapies for hemorrhoid management. In conclusion, hyaluronic acid offers a promising, non-invasive treatment option for prolapsed edematous hemorrhoids, with the potential to improve patient outcomes and reduce the need for invasive interventions.
Purpose: Metabolic bariatric surgery (MBS) remains the cornerstone for sustained weight loss in obesity management. However, suboptimal clinical response or recurrent weight gain remains significant challenges. Obesity management medications (OMMs) are increasingly used post-MBS, yet data on surgeons’ perspectives are limited, especially for glucagon-like peptide-1 receptor agonists (GLP-1 RAs). This study aimed to assess Taiwanese metabolic and bariatric surgeons’ attitudes, prescribing practices, and expectations regarding OMMs use after surgery. Materials and Methods: A 43-item survey was piloted and sent to primary surgeons at hospitals contributing to the annual report of the Taiwan Society for Metabolic and Bariatric Surgery. The practicing members were invited to participate in June 2024. Survey items included demographic information, questions pertaining to the percentage/indication of surgical revision during their practice, and rationales for OMMs after MBS. The consideration for prescribing OMMs and its priority were analyzed concomitantly. OMMs enrolled herein were Saxenda ® , Ozempic ® , Contrave ® , Rybelsus ® , Trulicity ® , and Victoza ® . Results: A total of 20 consultant surgeons participated in the survey (20/31; 64.5%), with 70% reporting experience exceeding 500 MBS cases, and 85% performing revisional bariatric surgery in less than 10% of their annual practice. The primary indication for prescribing OMMs after MBS was salvage therapy for suboptimal clinical response (85%), with 65% initiating treatment between 6 months and 2 years postoperatively. GLP-1 RAs, especially Ozempic ® and Rybelsus ® , were regarded as the most effective agents, although concerns about gastrointestinal side effects and cost were common. Surgeons consistently prioritized cost, adverse event, and efficacy when choosing OMMs, and More than 60% expressed a preference for future medications to have once-weekly or less frequent dosing, oral administration, greater weight loss efficacy, and lower cost. Conclusions: This national survey provides preliminary insight into consistent practices among Taiwanese surgeons in using OMMs after MBS, including indications, timing, and future preferences. Despite the modest sample size, these findings are valuable amid the lack of global consensus. The results highlight pharmacotherapy—especially GLP-1 RAs—as a key adjunct for managing post-surgical weight issues and underscore the need for further research and clear guidelines to support the integration of OMMs into obesity care.
Postoperative delirium (POD) is a common acute neuropsychiatric complication following surgery, especially in older patients. Characterized by fluctuating disturbances in attention, awareness, and cognition, POD typically occurs within days after surgery and can last days to weeks. Its pathophysiology involves neuroinflammation, neurotransmitter imbalances, blood-brain barrier disruption, and oxidative stress. Key risk factors include advanced age, baseline cognitive impairment, comorbidities, surgical complexity, environmental factors and excessive deep anesthesia. Incidence varies by surgical type, with highest rates in cardiac surgery (~23%) and hip fracture repair (30-50%). Prevention strategies encompass nonpharmacological approaches (early mobilization, reorientation, sleep promotion) and pharmacological interventions (optimized anesthesia, dexmedetomidine, melatonin). For established delirium, management focuses on treating underlying causes, supportive care, and judicious use of antipsychotics for severe agitation. Beyond its immediate impact, POD is associated with concerning long-term outcomes: accelerated cognitive decline, increased dementia risk, functional deterioration, and higher mortality. Studies show patients who experience POD have a 40% faster rate of cognitive decline and approximately double the mortality risk within one year compared to non-delirious patients. This relationship with adverse outcomes underscores that POD is not a transient phenomenon; rather, it may be a pivotal event in a patient’s long-term health trajectory. Implementation of evidence-based prevention and management protocols is essential to improve perioperative outcomes in our aging surgical population.
Background: Infective native aortic aneurysm (INAA) is an uncommon but lethal disorder caused by microbial destruction of the aortic wall. Objective: To summarize current evidence on epidemiology, pathogenesis, clinical presentation, diagnosis, microbiology, and treatment of INAA. Methods: This narrative review synthesizes recent English-language literature and key consensus documents relevant to native aortic infection. Results: INAAs account for approximately 0.6–3% of aortic aneurysms in Western series, with higher proportions in East Asia. Staphylococcus aureus, Streptococcus species, and non-typhoidal Salmonella are the dominant pathogens, although gram-negative bacilli, anaerobes, mycobacteria, and fungi are occasionally encountered. Presentation is often nonspecific, with fever, chest, back, or abdominal pain, and systemic inflammatory response. Contrast-enhanced computed tomography is the first-line imaging test; magnetic resonance imaging and fluorodeoxyglucose positron emission tomography/computed tomography are useful adjuncts when diagnosis or treatment response is uncertain. Management requires prompt broad-spectrum antibiotics followed by prolonged pathogen-directed therapy and definitive aortic exclusion or excision. Open reconstruction offers the most reliable source control, whereas endovascular repair reduces initial operative stress but leaves infected tissue in situ and therefore carries a greater risk of persistent or recurrent infection. Conclusions: Outcomes depend on early recognition, immediate antimicrobial therapy, and timely selection of open, endovascular, or staged hybrid treatment. Because delayed diagnosis remains common and evidence is largely observational, management should be individualized in a multidisciplinary aortic infection team.
Postoperative colovesical fistula (CVF) is a rare but serious complication of colorectal cancer (CRC) surgery that typically results from locally advanced tumors or surgical complications. This review summarizes the current knowledge on postoperative CVF, focusing on its epidemiology, clinical presentation, diagnostic evaluation, surgical management, and outcomes. CVFs predominantly affect older male patients and often arise from either direct bladder tumor invasion or postoperative anastomotic leakage. Patients usually present with urinary symptoms, such as pneumaturia, fecaluria, and recurrent urinary tract infections, making prompt diagnosis essential to prevent serious morbidity. Computed tomography (CT) is the first-line diagnostic modality complemented by magnetic resonance imaging (MRI), colonoscopy, and cystoscopy to characterize fistulas and guide surgical planning. Definitive treatment is surgery, involving resection of the affected bowel segment and repair of the bladder, with a preference for minimally invasive techniques when feasible. Staged procedures and conservative management are reserved for high-risk patients, particularly those with significant comorbidities or uncontrolled infections. Emerging evidence suggests that laparoscopic and robotic approaches are associated with fewer postoperative complications and shorter hospital stays than open surgery. Outcomes after surgical repair are generally favorable, with low fistula recurrence and marked improvement in the patient’s quality of life. Prognosis largely depends on the tumor stage and completeness of oncological resection. Overall, timely, tailored surgical intervention supported by modern imaging and optimized perioperative care yields favorable outcomes, with prolonged survival and improved quality of life in this population.
Background: Obesity is a well-established risk factor for hernia development, recurrence, and adverse perioperative outcomes, posing major challenges in patients undergoing abdominal wall reconstruction (AWR) or complex hernia repair (CHR). Glucagon-like peptide-1 receptor agonists (GLP-1RAs), initially approved for type 2 diabetes, have demonstrated substantial weight-loss benefits and are increasingly used for preoperative optimization. Methods: A systematic search of PubMed, Embase, and the Cochrane Library was conducted for studies published up to June 11, 2025, evaluating GLP-1RA use in obese adults undergoing AWR or CHR. Studies were selected using predefined criteria. Data were charted and synthesized thematically to assess preoperative weight loss, time to surgery, perioperative safety, wound complications, and feasibility. Results: Three observational studies including 65 obese patients undergoing AWR or CHR were identified. GLP-1RA use was associated with a shorter time to surgery (6.3–9.1 months) compared with controls (13.5–14.7 months) and moderate preoperative weight loss (11.3–14.9%). Thirty-day morbidity was lower or comparable in GLP-1RA groups. Reported adverse events were infrequent, non-serious, and manageable. Conclusion: Preoperative GLP-1RA therapy appears promising as a prehabilitation strategy; however, current evidence is limited to small, heterogeneous observational studies with significant risk of bias. These findings should be considered hypothesis-generating rather than practice-changing.
