Pilonidal sinus disease (PND) is a chronic condition with a significant disease burden that commonly affects adolescents and young adults. Traditional approaches to treating PND include excision with midline closure, subcutaneous flap reconstruction, or healing by secondary intention. However, high postsurgical morbidity has led to the use of minimally invasive approaches. This study compares the medium- and long-term outcomes after treatment of PND with laser, surgical excision, and sinotomy. An observational, retrospective, nonrandomized study of patients with PND was conducted between April 2022 and December 2024. The interventions included laser treatment, simple excision, and sinotomy. The primary outcome was the cure rate after surgery and the secondary outcome was failure rate. Overall, 207 patients underwent surgery; 112 underwent laser treatment, 90 simple excision, and 5 sinotomy. The patient groups were comparable in baseline characteristics. There were no statistically significant differences in the cure rate or treatment failure among groups (p > 0.05). Complications were similar among groups (p = 0.88). Healing time was shorter with laser therapy and sinotomy than with simple excision (8 and 7 weeks, respectively, vs. 12 weeks, p < 0.05). Time to return to work was shorter in the laser group (3 weeks vs. 10 weeks for simple excision vs. 9 weeks for sinotomy, p < 0.05). This comparative study of the most commonly used techniques in the treatment of PND demonstrates that laser provides much faster and more satisfactory postoperative recovery and return to work.
In this case report, we describe a 74-year-old woman who underwent robotic-assisted transabdominal preperitoneal patchplasty (rTAPP) for the repair of a right-sided inguinal hernia. Preoperative evaluation in the outpatient setting included inguinal ultrasonography and computed tomography (CT). Radiological findings demonstrated a right-sided inguinal hernia containing the tip of the appendix vermiformis within the hernia sac, consistent with an Amyand hernia. On the day of surgery, the hernia was non-reducible. Intraoperative findings revealed a femoral hernia with incarceration of the appendiceal tip. The hernia was reduced, and the hernia sac with the adherent appendix and surrounding peritoneum was resected en bloc. No free intra-abdominal fluid or signs of appendiceal perforation were observed intraoperatively. Robotic-assisted TAPP repair was subsequently performed. The peritoneum was completely reconstructed using a resorbable suture. Following peritoneal closure, robotic-assisted appendectomy was carried out. The postoperative course was uneventful, and the patient was discharged on the second postoperative day. According to follow-up data from the Herniamed Registry, the patient remains asymptomatic without complications to date.
The optimal management strategy for mild acute biliary pancreatitis (ABP) in older adults, particularly in those with contraindications to cholecystectomy, remains uncertain. Early cholecystectomy is the standard strategy to reduce recurrent biliary events, whereas endoscopic sphincterotomy (ES) may be used as a nonoperative biliary intervention in carefully selected patients who are not candidates for definitive surgery. This study evaluated the long-term outcomes associated with ES in older adults with mild ABP. We conducted a retrospective cohort study of patients aged ≥ 70 years admitted with mild ABP between 2010 and 2020. Patients were stratified into two groups based on treatment modality: ERCP with ES versus conservative management. Primary outcomes included recurrence of pancreatitis, overall survival, and ERCP-related morbidity. Secondary outcomes were biliary complications and readmission rates. Statistical analyses included Kaplan–Meier survival curves, multivariable Cox proportional hazards models, and competing-risk analyses. Patients were included on the basis of advanced age and real-world treatment allocation; the cohort was not intended to represent all older adults with ABP who would otherwise be candidates for surgery. A total of 182 patients (median age: 78 years) were included, with 90 undergoing ERCP with ES and 92 managed conservatively. Recurrence rates were similar (ES: 8.9
The growing population of elderly has resulted in a rise in complex abdominal wall hernias, especially among older and more vulnerable individuals. This review aims to summarize the latest evidence regarding the timing, surgical techniques, and perioperative care associated with the repair of complex abdominal wall hernias in geriatric patients. A narrative review of the literature was conducted using structured searches of major databases for publications in English from 2000 to July 2025. Studies addressing age, frailty, comorbidities, surgical technique, and perioperative outcomes in older patients were qualitatively synthesized. Multimorbidity and frailty emerged as key predictors of postoperative risk, particularly among patients with a Charlson Comorbidity Index of ≥ 3, which was associated with higher mortality. Sarcopenia and malnutrition also contributed significantly to adverse outcomes. Elective repair was consistently associated with lower mortality and complication rates compared with emergency surgery. When comorbidities and frailty were optimized, older patients demonstrated outcomes comparable to younger cohorts in propensity-matched analyses. Prehabilitation strategies, including nutritional optimization and risk-factor modification, were associated with improved perioperative outcomes. Permanent synthetic mesh was favored in clean cases, while biologic options were used selectively in contaminated fields. Minimally invasive approaches reduced wound morbidity but require further evaluation in populations with frailty. Chronological age alone should not preclude ventral or incisional hernia repair. Instead, frailty, multimorbidity, and nutritional status are critical determinants of risk. Elective repair following patient optimization is associated with improved safety, while prehabilitation and multidisciplinary care play a central role in reducing complications in older patients.
Acute postoperative abdominal wall failure with recurrent evisceration is a rare but severe complication following emergency laparotomy. Progressive lateral wall contracture and loss of medial compliance may render repeated primary closures ineffective. We describe the salvage management of a frail 66-year-old male with three episodes of recurrent postoperative evisceration after emergency laparotomy for an incarcerated inguinal hernia with ischemic small bowel. Bilateral transversus abdominis release (TAR) combined with retromuscular polypropylene mesh placement was performed, along with intraoperative botulinum toxin A (BTA) injection into the lateral abdominal wall. Transversus abdominis release restored medial compliance and allowed for anatomical midline reconstruction with wide retromuscular mesh overlap. Intraoperative BTA was used as a protective adjunct to decrease lateral muscle tension during early healing—not to facilitate closure. The patient’s postoperative course was uneventful with regard to abdominal wall integrity. At 6‑month follow-up, there was no recurrence, bulging, or chronic pain. This case highlights the technical viability of combining anatomical reconstruction with functional modulation as a salvage strategy in highly selected patients with acute abdominal wall failure when repeated primary closure is unlikely to succeed and preoperative chemical component separation is not feasible. This observation is hypothesis generating only and should not be generalized beyond similar exceptional cases.
This study aimed to systematically evaluate the operative and perioperative outcomes of transperitoneal laparoscopic adrenalectomy (TLA) and retroperitoneal laparoscopic adrenalectomy (RLA) for the treatment of adrenal tumors, aiming to clearly identify the advantages and disadvantages of each surgical approach. Databases, including PubMed, the Cochrane Library, Embase, Web of Science, and Scopus, were searched from their establishment to June 2025 for randomized controlled trials (RCTs) comparing the operative and perioperative outcomes of TLA and RLA. Meta-analysis was performed according to the PRISMA guidelines. Data on operative time, intraoperative blood loss, time to postoperative oral intake, time to postoperative ambulation, postoperative hospital stay, complication rate, conversion to open surgery rate, and postoperative pain score were extracted. Two reviewers independently screened the literature, extracted the data, and assessed the risk of bias. Meta-analysis was performed using RevMan 5.4 (The Nordic Cochrane Centre, Copenhagen, Denmark) and Stata 18 (StataCorp LP, College Station, TX, USA). Five studies were included, involving a total of 306 patients (143 in the TLA group and 163 in the RLA group). The results showed that compared with RLA, TLA had a longer time to postoperative oral intake (MD = 9.60, 95
Thyroid paraganglioma (TPGL) is an exceptionally rare neuroendocrine tumor, with fewer than 75 cases reported. Its clinical and imaging features often resemble those of medullary thyroid cancer, making diagnosis challenging. Accurate identification is essential for appropriate surgical management and genetic counselling. A 63-year-old woman with atrial fibrillation was incidentally found to have a right thyroid nodule in carotid ultrasound. High-resolution ultrasonography showed a solid, hypoechoic EU-TIRADS 4 lesion; fine-needle aspiration was inconclusive. The patient underwent right lobectomy with isthmectomy. Histology revealed a well-circumscribed intrathyroidal mass composed of epithelioid cells in a nested (zellballen) pattern and delicate vascular stroma. Immunohistochemistry was positive for synaptophysin, neuron-specific enolase, CD56, and S‑100, but negative for TTF‑1, calcitonin, parathyroid hormone (PTH), and cytokeratin, confirming thyroid paraganglioma. Thyroid paraganglioma usually arises from inferior laryngeal paraganglia and is often discovered incidentally. Its features overlap with those of other thyroid neoplasms, requiring immunohistochemical confirmation to avoid misdiagnosis. Functional catecholamine secretion is rare and was absent in this case. About 25
The incidence of pancreatic ductal adenocarcinoma (PDAC) is constantly increasing. Surgical resection, in combination with systemic chemotherapy, offers the only option for long-term survival or even cure. However, the high toxicity rates of modern and most-effective chemotherapy protocols limit this treatment option to patients with good performance status (PS). Consequently, the Eastern Cooperative Oncology Group (ECOG) performance score is essential for selecting treatment protocols. In addition, the perioperative complications and survival rates of patients with a reduced PS undergoing surgery for PDAC are unclear. This study aims to evaluate the perioperative morbidity and mortality rates in patients with a reduced PS (ECOG ≥ 2) after resection of PDAC as well as disease-free (DFS) and overall survival (OS). This is a pan-European and African retrospective study conducted at participating centers represented by members of the European–African Hepato-Pancreato-Biliary Association (E-AHPBA). This study will include all consecutive patients with ECOG PS ≥ 2 who underwent pancreatic surgery for PDAC between January 1, 2015, and December 31, 2024. Participating centers enter data via an electronic case report form on REDCap® (Vanderbilt University, Tennessee). The primary outcomes are perioperative morbidity and mortality rates, DFS, and OS. The secondary objectives are related to the type of chemotherapy regimens applied. Impaired PS may negatively affect surgical and oncological treatment algorithms and outcomes. This multicenter study will help to understand how patients with PDAC and ECOG PS ≥ 2 are treated in daily clinical practice throughout Europe and Africa. The results of this large patient cohort analysis are expected to identify the best treatment algorithm for this patient group.
Surgical reduction of a hiatal hernia including re-approximation of the diaphragmatic crura is a crucial component of the operative treatment of gastroesophageal reflux disease. It is one of several components of the restoration of the antireflux barrier to address the underlying alteration. After achievement of the required intraabdominal esophageal segment, tension-free closure of the dilated hiatus is essential for successful and durable repair. This re-approximation of the crural pillars represents an essential part of the surgical procedure and seems to have a greater impact on the compliance of the esophagogastric junction than sphincter augmentation. Therefore, particular attention must be paid to fulfilling the prerequisites for successful hiatal hernia repair.
Adrenocortical carcinomas (ACC) are rare tumors of the adrenal gland. About onethird of patients present with metastatic disease at the time of diagnosis. Surgical removal of the tumor should only be performed when complete resection can be achieved. However, in selected cases, patients may profit from debulking surgery even if complete resection is not possible. Chemotherapy with EDP‑M (etoposide, doxorubicin, cisplatin, mitotane) is considered the standard of care. A 61-year-old female presented with hypertension, peripheral edema, and hirsutism. Diagnostic workup revealed metastatic adrenocortical carcinoma. Debulking surgery was performed. Due to post-surgical complications, no chemotherapy or further treatment—although initially planned—was given, and the patient passed away after 43 days on best supportive care. New therapeutic options in addition to conventional chemotherapy or radiation are required for metastatic ACC. Other treatment options include cytoreductive surgery with hyperthermic intraperitoneal chemotherapy or targeted therapies with immune checkpoint inhibitors, thus necessitating genetic testing. However, additional studies with larger sample sizes are needed to further evaluate these treatment strategies in this tumor entity.
Anastomotic leakage (AL) remains one of the most serious complications in colorectal surgery, with a substantial impact on morbidity, mortality, and long-term oncological outcomes. Although Hartmann’s procedure has traditionally been considered the standard approach for managing anastomotic failure, its limitations—particularly the high rates of permanent stoma formation and impaired quality of life—have driven the development of less invasive treatment strategies. A comprehensive review of the literature was conducted to evaluate current concepts in the pathophysiology, diagnosis, and management of anastomotic leakage following colorectal surgery, with particular emphasis on minimally invasive and endoluminal treatment modalities. Contemporary evidence indicates a shift toward individualized, minimally invasive management strategies tailored to patient condition and leakage severity. Vacuum-assisted and hybrid endoluminal techniques, including vacuum-assisted closure therapy and VAC stent systems, have emerged as promising alternatives to traditional surgical approaches, demonstrating favorable outcomes in selected patients and a potential reduction in long-term morbidity. This comprehensive review summarizes the current understanding of AL pathophysiology, diagnostic principles, and therapeutic strategies, with a special focus on the evolution of vacuum-assisted and hybrid endoluminal techniques such as the VAC stent. Optimal outcomes appear to depend on appropriate patient selection, early diagnosis, interdisciplinary collaboration between surgical and endoscopic teams, and the development of standardized treatment algorithms. Future efforts should focus on refining selection criteria, integrating multimodal expertise, and implementing perioperative optimization strategies.
The incidence of parastomal hernias after permanent colostomy or ileal conduit creation is high. Nevertheless, prophylactic mesh implantation during primary surgery has not yet become widely established. Combined with the cost pressure (longer operating times, mesh costs) that prevails in most clinics, at least in the Western world, the newly formulated, more conservative recommendation prevents the routine implantation of a prophylactic mesh when creating a permanent colostomy or, if necessary, an ileal conduit, meaning that techniques for surgical treatment of parastomal hernias remain highly relevant. We herein present our modified Sugarbaker technique for stoma lateralization.
Anastomotic stricture (AS) is a significant complication following low anterior resection (LAR) with total mesorectal excision (TME) for rectal cancer and has a relevant impact on patients’ quality of life. This study aimed to identify the independent risk factors associated with benign anastomotic stricture in patients undergoing low anterior resection with total mesorectal excision for rectal cancer using propensity score matching to minimize confounding bias. A retrospective cohort study was conducted at a tertiary care center in Turkey, including 659 patients who underwent LAR with TME for rectal cancer between January 2019 and December 2024. Patients were propensity score matched (1:3) based on age and sex, resulting in 47 patients with AS and 141 without. Data on demographics, preoperative laboratory values, clinical characteristics, surgical techniques, and postoperative outcomes were collected. Anastomotic stricture was diagnosed based on digital rectal examination, colonoscopy, or imaging. Univariate and multivariate logistic regression analyses were performed to identify risk factors, with model performance evaluated using receiver operating characteristic (ROC) curves. The incidence of AS was 7.3
Transversus abdominis release (TAR) is a key technique in complex abdominal wall hernia repair. As extraperitoneal mesh placement with sufficient overlap is feasible in almost every anatomical location, not only large midline defects but also off-midline hernias and those adjacent to osseous abdominal borders can be effectively repaired. Through the introduction of new techniques and instruments (e.g., robotic platforms), TAR can be performed using a minimally invasive approach in many cases. Within this short communication, technical modifications of the original TAR technique, such as posterior rectus sheath release, will be discussed as well.
The role of the robotic platform in liver surgery is still up for debate: “Innovation for the sake of innovation” or an improvement in patient care? This article offers an evidence-based comparison of robotic (RLR) with open (OLR) and laparoscopic (LLR) liver resections for minor, major, and complex surgeries. Recent literature was reviewed and summarized. Statistics were not applied. Benefits for the clinical parameters of length of hospital stay, complication rates, and blood loss are described when comparing RLR with OLR. For the comparison to LLR, the technical superiority translates mainly into a reduced rate of conversion to open surgery. The safety and feasibility of RLR for complex surgeries, including cases with cirrhosis and technically difficult procedures with bile duct reconstruction, have been shown. The higher procedural cost of RLR is in part compensated by the improved clinical outcome and the hereby reduced overall cost. Prospective randomized data are needed to conclusively evaluate the impact of robotics in liver surgery.
Pancreatic resections remain high-risk surgeries with high morbidity and nonnegligible mortality. Prevention and optimized management of complications are therefore foremost goals of clinical research. While interdisciplinary rescue strategies including radiologic and endoscopic approaches have made relevant advances in the successful management of life-threatening situations, effective preventive measures for complications such as postoperative pancreatic fistula (POPF) and the associated morbidity are lacking. In recent years, ideal outcomes and benchmarks have been defined to better compare surgical results and facilitate quality assurance in pancreatic surgery. This work comprises a narrative review. This review gives an update on the current evidence for preventive strategies and perioperative management of the most relevant complications, including POPF, postpancreatectomy hemorrhage (PPH), postpancreatectomy acute pancreatitis (PPAP), delayed gastric emptying (DGE), chyle leak, and diarrhea after extended resections. Risk stratification tools and standardized algorithm-based postoperative care help to guide risk-adapted surgical procedures and optimize perioperative management, especially in terms of drain policy and diagnostic approaches to detecting complications early and managing them, aiming to reduce severe morbidity and prevent surgery-related deaths.
Boerhaave’s syndrome (BS) is a rare but often fatal condition with high mortality rates despite intensive treatment. Data are scarce. We herein report a single-center experience with BS. The aim of this study was to investigate and point out the role of endoluminal vacuum therapy (EVT) in BS. Between June 2011 and April 2024, all patients with BS in our tertiary referral center with a unit specialized in surgical endoscopy were analyzed regarding age, gender, delay of diagnosis, treatment technique, and outcome. During the study period, 12 consecutive patients (9 male) were treated for BS. The median age was 64.8 years. Five patients were treated with EVT only, four with surgery and simultaneous EVT, and three by surgery only. After implementation of EVT, all patients were treated with either EVT only or surgery with simultaneous EVT. Intensive care unit stay was significantly shorter in patients treated with EVT only. The 30-day mortality was 25
In ventral and incisional hernias a mesh-based open or minimally invasive repair is the base of surgical approach. To minimize complications of the existing open and laparoscopic techniques the endoscopic Mini- or Less-Open Sublay (eMILOS) concept was developed. In 2019 we decided to establish e MILOS as the favourite procedure for umbilical and small ventral hernias combined with rectus diastasis at our hernia center. After successful establishment of this technique we implemented this technique also for small incisional hernias with combined rectus diastasis. Since 2019 243 eMILOS and 72 MILOS procedures in 78 female and 237 male patients were performed at our hernia center. 105 were incisional and 210 ventral hernias with combined rectus diastasis. The average size of the hernias was 4cm, average supraumbilical size of the rectus diastasis was 5cm. In 9 patients a surgical revision was necessary: one because of infection and abscess formation, 4 because of hernia recurrence and 4 because of postoperative bleeding and haematoma. At our hernia center e MILOS is an established and standardized technique with low recurrence and complication rates after repair of incisional and ventral hernias with combined rectus diastasis.
This article provides a step-by-step description of robotic-assisted transabdominal preperitoneal repair (r-TAPP) using the daVinci® system for groin and femoral hernias. The technique integrates contemporary anatomical concepts of the myopectineal orifice to enable safe, structured dissection across three defined preperitoneal zones. Robotic technology enhances visualization and instrument dexterity, facilitating precise management of both direct and indirect hernias, including complex or recurrent cases. A standardized mesh placement strategy ensures comprehensive coverage with minimal fixation. Overall, r-TAPP offers a reproducible, anatomy-based approach associated with low complication rates, favorable postoperative recovery, and reduced chronic pain.
The Lichtenstein tension-free mesh repair remains the most widely applied open technique for primary inguinal hernia repair due to its simplicity, reproducibility, and consistently low recurrence rates. This manuscript provides a structured, contemporary description of the standardized operative method, including patient selection, anesthesia strategies, stepwise dissection, nerve-preserving principles, and evidence-based mesh placement and fixation. Emphasis is placed on precise anatomic exposure, atraumatic cord mobilization, and a tension-free configuration to minimize chronic pain and mesh-related complications. Current evidence and international guidelines continue to support the Lichtenstein repair as the benchmark open approach, demonstrating recurrence and reoperation rates comparable to minimally invasive techniques while maintaining advantages in safety and accessibility across diverse clinical settings.
