Surgical stress triggers catabolic processes and insulin resistance, leading to impaired recovery. Preoperative nutritional support, particularly with high-quality proteins like whey, is hypothesized to mitigate these effects. This meta-analysis evaluates the impact of preoperative oral whey protein supplementation on postoperative metabolic and inflammatory biomarkers. A systematic search of PubMed, Web of Science, Scopus, and Cochrane databases (2000–2024) identified randomized controlled trials (RCTs) comparing preoperative whey protein with standard care/placebo. Primary outcomes included C-reactive protein (CRP), serum albumin, blood glucose, and insulin resistance (HOMA-IR). Meta-analysis was performed using a random-effects model. Subgroup and meta-regression analyses were conducted to explore sources of heterogeneity. Seven RCTs involving surgical patients were included. Pooled results demonstrated that preoperative whey protein significantly reduced postoperative CRP levels (SMD = -0.92; 95
It is still common practice to routinely place prophylactic intraperitoneal drains after abdominal emergency surgery, even though this practice has been abandoned in most elective abdominal interventions. International guidelines recommend against prophylactic drain placement, and the available evidence is inconclusive. We aimed to report the impact of an interventional, de-implementation strategy for prophylactic drain placement after emergency laparotomy/laparoscopy in Copenhagen University Hospital NOH, Denmark. A prospective, single-center study included patients undergoing emergency abdominal surgery through one-year after implementing a no-prophylactic drain strategy compared to a historic cohort. Primary outcome was rate of intraperitoneal drain placement. Secondary outcomes were drain-indications, LOS, and 30-day complications. Overall, 1275 patients were included. Prophylactic drain-placement after emergency abdominal surgery was reduced from 15.7
Coagulase-negative staphylococci (CoNS) are prevalent yet diagnostically challenging pathogens in postoperative intracranial infections. Their distinct clinical presentation compared to other bacterial causes remains poorly characterized. In this single-center retrospective cohort study (2010–2020), we compared adult patients with microbiologically confirmed post-neurosurgical intracranial infection caused solely by CoNS (n = 102) versus other bacterial pathogens (n = 256). We employed stringent criteria to define true CoNS infection. Clinical features, laboratory parameters, and outcomes were compared. Multivariable logistic regression and LASSO analysis were used to identify factors associated with CoNS etiology. The CoNS group exhibited a significantly lower incidence of severe clinical symptoms, including headache (64.7
To compare and analyze the therapeutic effects of paraspinal approach and midline approach in patients undergoing transforaminal lumbar interbody fusion (TLIF) 80 patients with single-segment lumbar disc herniation from April 2023 to Feb 2025 were randomly selected and studied through retrospective analysis. They were randomly divided into two groups: the paraspinal approach group (Group A) and the midline approach group (Group B), with 40 patients in each group. By comparing and analyzing indicators such as patient age, average length of stay, operation time, postoperative skin abrasions, wound infection, wound drainage volume, postoperative pain score, screw insertion angle, and fusion rate between the two groups, the effectiveness of the two surgical methods was evaluated. There were no statistical differences in age and average length of stay between the two groups. The operation time in the paraspinal and midline approach group were 241.20±62.85 minutes and 230.55±38.10 minutes, suggesting a shorter duration in the midline approach group. The postoperative skin abrasions and wound drainage volume were significantly higher in the midline approach group compared to the paraspinal approach group (P<0.05). There were no significant differences in Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) scores between two groups at 3 days and 24 weeks postoperatively. However, at 7 days postoperatively, the VAS and ODI scores in the paraspinal approach group were significantly lower than those in the midline approach group, with statistical differences (P<0.05). Postoperative CT showed that the pedicle screw inclination angles were 61.40±13.27 in the paraspinal approach group and 40.43±8.32 in the midline approach group, with the paraspinal approach group having a greater inclination angle. During the 18 weeks follow-up, there were no significant statistical differences in fusion rates between the two groups (P>0.05). The paraspinal approach results in less surgical trauma, reduced skin abrasions and wound drainage, and has a minor impact on patients during the perioperative period. Additionally, this approach allows for greater screw placement angles, although there is no significant difference in fusion rates ultimately.
Early hepatic artery thrombosis (eHAT) after living donor liver transplantation (LDLT) is associated with impaired graft function and reduced patient survival. In living donor liver transplantation (LDLT), the incidence of eHAT is higher compared with deceased donor liver transplantation (DDLT). The main reason is that the hepatic artery of the graft in LDLT is typically smaller in diameter, and the recipient arteries used for anastomosis are often selected from more distal segments, which are likewise of smaller caliber. In the present study we defined eHAT as HAT occurring within the first postoperative week after LDLT, as cases developing during this period may still be amenable to surgical intervention with thrombectomy and reanastomosis. This study aimed to evaluate incidence, management strategies, and patient/graft outcomes of eHAT after LDLT over a 10-year period. All LDLT recipients treated between January 2013 and May 2023 at a single center were retrospectively reviewed (n = 2257). Patients with eHAT within 7 days were identified (n = 64). Six patients were excluded because primary hepatic artery reconstruction could not be completed at the index transplant due to subintimal dissection. The remaining 58 patients were analyzed for demographics, revision strategy, success of revisions, need for re-transplantation, and survival outcomes. Overall incidence of eHAT after LDLT was 2.5
To characterise the visualisation performance, limitations, anatomical findings and safety of routine indocyanine green (ICG) fluorescence cholangiography workflow in a consecutive elective and emergency laparoscopic cholecystectomy cohort. This descriptive study was not designed to establish superiority over white-light surgery or intraoperative cholangiography (IOC). Prospectively collected data were analyzed for consecutive adults undergoing elective or emergency laparoscopic cholecystectomy with intended routine ICG fluorescence cholangiography between August 2022 and January 2026 at a UK district general hospital. The intended protocol was ICG 5 mg intravenously at induction of anaesthesia, with fluorescence imaging using the Stryker 1688 Advanced Imaging Modalities platform. Descriptive statistics, confidence intervals, univariable testing and exploratory multivariable logistic regression were used. A total of 340 patients were included. Median age was 57.5 years (IQR 41–69) and median BMI was 31.23 kg/m² (IQR 27.04–35.21). The CBD was visualised in 297 patients (87.4
Pancreaticojejunostomy (PJ) anastomosis is the “Achilles heel” of the pancreatoduodenectomy (PD). Clinicaly relevant postoperative pancreatic fistula (CR-POPF) remains a significantly morbid complication after pancreatic resection. This retrospective study compares patients who underwent PD utilizing our modified dunking technique for PJ anastomosis to patients who underwent the standard PD technique. The studied outcome was CR-POPF. Patient demographics and clinical characteristics were summarized and compared. The association between surgical technique and CR-POPF was assessed using univariate logistic regression and four multivariable logistic models, each assessing technique while adjusting for gland texture, intraoperative blood loss, receipt of neoadjuvant therapy, or pathology. A supplementary inverse probability of treatment weighting (IPTW) analysis among the subset of patients with complete fistula risk score components was also performed. A total of 208 patients who underwent the modified dunking technique were compared with 159 patients who underwent the standard technique. CR-POPF occurred in 8.2
Although the results of living donor liver transplantation (LDLT) in the elderly have been reported worldwide, there is still a dearth of information on elderly patients in Egypt. The purpose of this study is to investigate the clinical outcomes of LDLT in this growing population group. This was a retrospective study that evaluated all LDLT patients at the Gastrointestinal Surgical Center, Mansoura University, from January 2009 to December 2023. Based on the recipient’s age, two patient cohorts were created: younger (< 60) and elderly (≥ 60). Demographics, liver disease etiology, MELD score, surgical duration, blood loss, and early and late post-transplant outcomes (complications, graft survival, and patient survival) were compared between the two groups. Propensity score matching (PSM) was done to improve the baseline covariates imbalance. Among 967 LDLT operations, 110 patients were classified in the elderly group (≥ 60 years). Hepatocellular carcinoma (HCC) was markedly more prevalent in the elderly group (44.6
To evaluate clinical and paraclinical parameters at the time of abdominal closure following vacuum-assisted closure (VAC) therapy in patients with secondary peritonitis, and to identify associations to postoperative complications. This retrospective multicenter cohort study included patients with secondary peritonitis from the small intestine, colon, or rectum who underwent emergency laparotomy and VAC therapy at six hospitals in southern Denmark between 2010 and 2019. Clinical status and laboratory values obtained before abdominal closure were recorded. Complications within 30 days were graded using the Clavien-Dindo Classification. The cohort comprised 163 patients divided into two groups: 49 patients with postoperative complications and 114 without. Absence of bowel function (41
There is a constant quest to optimize outcomes of laparoscopic surgery and enhance patient experiences. In this review, we aim to describe the various impacts of dexamethasone in laparoscopic abdominal surgery. A systemic review of randomized controlled trials was performed in accordance with the PRISMA checklist, and the protocol was published in the electronic library (PROSPERO) with a search Accepted manuscript ACCEPTED MANUSCRIPT in Embase, Medline and Cochrane Library. Risk of bias was assessed according to the principles from Rob2. The review includes mainly cholecystectomies (n=26) and, in descending order, major gynecological surgery (n=10), gastric bypass (n=2), fundoplication (n=1), appendectomy (n=1), and inguinal hernia (n=1). The trials were all moderate-good quality providing evidence on postoperative nausea and vomiting while the (often secondary) outcomes on surgical stress markers were classified with a risk of bias from green to yellow according to RoB 2. All 41 studies except for seven reported as primary outcome on postoperative nausea and vomiting. In cholecystectomies, 85
Acute calculous cholecystitis is a common surgical emergency. In health systems with delayed or limited access to radiology-performed ultrasonography, diagnostic delays may increase complications, length of stay, and resource utilization. Surgeon-performed point-of-care ultrasonography may expedite evaluation; however, its diagnostic accuracy when incorporated into structured diagnostic frameworks such as the Tokyo criteria remains uncertain. We conducted a prospective observational diagnostic accuracy study in the emergency department of a second-level referral hospital. Adult patients with clinical suspicion of acute cholecystitis were enrolled during recruitment shifts. All participants underwent standardized clinical evaluation, surgeon-performed point-of-care ultrasonography using a handheld device, and radiology-performed ultrasonography. The reference standard was pragmatic: histopathology for operated patients and structured clinical follow-up for up to 2 months for nonoperated patients. Diagnostic performance (sensitivity, specificity, likelihood ratios, predictive values, and post-test probability) was calculated for surgeon-performed ultrasonography alone, radiology-performed ultrasonography, and the Tokyo criteria using either imaging modality. A total of 170 patients were included (mean age 42.8 years; 78.8
To assess the safety of the “Safe Needle” assistive technique for preventing iatrogenic superficial palmar arch (SPA) injury during single‑portal endoscopic carpal tunnel release (SECTR), and to report secondary clinical outcomes. This single‑center retrospective case series included 100 patients with carpal tunnel syndrome (CTS) who underwent Safe‑Needle‑assisted SECTR from October 2023 to June 2025. The key procedural step was preoperative high‑frequency ultrasound localization of the SPA apex. A sterile 5‑mL syringe needle was percutaneously inserted vertically 1.0 cm proximal to this apex to create a visible and palpable physical barrier as a mechanical stop deep beneath the transverse carpal ligament (TCL). The primary outcome was the incidence of intra‑ or postoperative SPA‑related injury. Secondary outcomes comprised operative time, complication rates, CTS‑6 scores, pillar‑pain Visual Analog Scale (VAS) scores, and patient‑reported satisfaction. Mean follow‑up duration was 13.2 ± 2.8 months. No iatrogenic SPA injuries were observed across the entire cohort (0
Thyroidectomy carries a significant risk of parathyroid gland injury, with transient hypoparathyroidism occurring in 15–50
This study aimed to evaluate the relationship between preoperative systemic inflammation markers and postoperative complications. This study was conducted as a retrospective, single-center observational study. A total of 674 patients undergoing elective abdominal surgery under general anesthesia were included in the study. Data were collected through patient information forms, preoperative and postoperative laboratory values, and calculation of systemic inflammation markers. Independent samples t-test, Mann-Whitney U test, Pearson chi-square test, Wilcoxon test, Spearman correlation analysis, and multivariable logistic regression were used for data analysis. Data from 674 patients with a mean age of 57.17 ± 16.21 years were analyzed. Clavien-Dindo sınıflandırmasına göre hastaların
Postoperative wound complications are an important cause of morbidity, and routinely available inflammatory markers may assist with early risk assessment. This study evaluated a newly proposed exploratory composite index, the Wound Inflammation–Nutrition Index (WINA), and its change between postoperative day 1 and postoperative day 3 (ΔWINA) in relation to postoperative wound complications. This retrospective observational study included 86 patients who underwent general surgical procedures between January 2020 and December 2025. WINA was calculated by multiplying the C-reactive protein-to-albumin ratio by the neutrophil-to-lymphocyte ratio at postoperative days 1 and 3. ΔWINA was calculated as the POD3 value minus the POD1 value. Logistic regression, receiver operating characteristic analysis, model comparison, bootstrap internal validation, and sensitivity analyses were performed. Postoperative wound complications occurred in 24 patients (27.9
To investigate, in an established rodent model, whether administration of an opioid (buprenorphine) increases the risk of developing an orthopaedic-device related infection (ODRI), and whether prolonged buprenorphine administration interferes with treatment outcome for established ODRI. The primary outcome was infection status; secondary outcomes included bone morphology and implant osseointegration assessed by quantitative microCT. The study comprised two arms. In the “risk study”, 20 rats received proximal tibia implants inoculated with 102 CFU of Staphylococcus epidermidis; 10 were treated with buprenorphine (0,1 mg/kg s.c., once daily for five days), and 10 received saline. Animals were euthanized on day 9. MicroCT scans were performed at surgery and euthanasia. Quantitative bacteriology of bone, soft tissues, and implants was performed post-mortem. In the “interference study”, 24 rats received implants inoculated with 106 CFU of S. epidermidis; 12 were treated with buprenorphine (0,1mg/kg s.c., day 7-18) and 12 received saline. Two buprenorphine-treated animals were excluded because of a deviation from the administration protocol. All animals received cefazolin and rifampin from day 7-21. Longitudinal MicroCT scans were acquired on day 0, 9, 20, and 28. Animals were euthanized on day 28. Three animals per group underwent histopathology; the remainder were assessed by bacteriology. Bacteriological analyses in both arms showed no significant differences between control and treated groups in infection burden or bacterial clearance. In the interference study, persistent infection occurred in 3/12 control animals versus 7/10 buprenorphine-treated animals (p = 0.0836). An exploratory comparison between the two study arms revealed reduced bone formation under high versus moderate contamination (p = 0.0056). No statistically significant effect of buprenorphine on bone morphology was detected under high contamination, whereas under moderate contamination buprenorphine was associated with reduced bone formation. No statistically significant increase in ODRI risk or antibiotic treatment response was detected in the buprenorphine-treated group. A non-significant trend toward higher infection persistence in buprenorphine-treated animals warrants further investigations. High bacterial load reduced bone formation, while buprenorphine did not impair short-term osseointegration or infection-related bone remodeling.
Various types of nursing interventions differ in their effectiveness. This systematic review and meta-analysis aimed to evaluate the impact of nursing interventions on postoperative recovery in elderly patients undergoing surgical procedures. A systematic search was conducted in Scopus, PubMed, Web of Science, Embase, and MEDLINE from database inception through May 2026 using predefined search strategies. Studies were selected according to predefined Population, Intervention, Comparison, and Outcome (PICO) criteria. Methodological quality was independently assessed by two reviewers using the Joanna Briggs Institute (JBI) critical appraisal tools appropriate to each study design. Data were extracted and synthesized using both narrative and quantitative approaches. Meta-analysis was performed for postoperative complication outcomes. Postoperative complications were analyzed as dichotomous outcomes, and pooled Risk Ratios (RRs) with 95
As a retrospective feasibility and safety analysis, this study explores the application of robotic pancreatoduodenectomy(RPD) in patients with different PD-ROBOSCORE grades at our center, with a key focus on the safety of RPD for high-difficulty procedures. This study retrospectively analyzed the clinical data of patients who received RPD treatment in Changhai Hospital from 2020 to 2025. According to the PD-ROBOSCORE score, the patients were divided into two groups: high difficulty group and low difficulty group. The perioperative core indicators and postoperative outcomes of the two groups were compared and analyzed, including short-term postoperative complications and overall survival. A retrospective analysis was conducted on 100 RPD patients, classified into low-(score ≤ 12, n = 42) and high-difficulty(score > 12, n = 58) groups. The high-difficulty group was older(64.88 ± 7.73 vs. 59.33 ± 10.81 years, P = 0.003), had higher comorbidity (CCI: 6.00 vs. 4.79, P = 0.011), and more vascular involvement(29.31
Weight loss after bariatric surgery is commonly reported using anthropometric parameters; however, these measures do not distinguish between changes in fat mass, lean tissue, and body water. Bioelectrical impedance analysis (BIA) enables a more detailed assessment of body composition and may provide additional information regarding postoperative physiological adaptations. The present study aimed to evaluate longitudinal changes in BIA-derived body composition over a 24-month follow-up after sleeve gastrectomy (SG) in patients with class III obesity. In addition, exploratory subgroup analyses according to sex and baseline body mass index (BMI) were performed to investigate potential differences in postoperative body composition trajectories. This retrospective observational study included 49 patients who underwent laparoscopic SG at a tertiary bariatric center. Body composition was assessed preoperatively and at regular postoperative follow-up visits using standardized multifrequency BIA. Parameters included body weight, BMI, fat mass, fat-free mass, skeletal muscle mass, total body water, extracellular water-to-total body water ratio (ECW/TBW), phase angle (PhA), visceral adipose tissue estimate, and resting energy expenditure. Longitudinal changes were evaluated throughout the 24-month observation period. Subgroup analyses should be interpreted with caution because of the limited sample size. Substantial reductions in body weight, BMI, fat mass, visceral adipose tissue estimate, fat-free mass, skeletal muscle mass, total body water, and estimated resting energy expenditure were observed during follow-up. The largest changes occurred during the first postoperative year and subsequently stabilized. Phase angle decreased during the early postoperative period before showing partial recovery over time. Exploratory subgroup analyses suggested differences in absolute body composition trajectories between men and women as well as between patients with baseline BMI below and above 50 kg/m²; however, these findings should be interpreted within the context of the observational study design and limited statistical power. Sleeve gastrectomy was associated with marked longitudinal changes in BIA-derived estimates of body composition during the first 24 postoperative months. Besides the expected reduction in fat mass, decreases in fat-free mass and skeletal muscle mass as well as transient changes in phase angle were observed. These findings emphasize the importance of longitudinal body composition assessment following bariatric surgery. Future studies should investigate whether structured nutritional and exercise interventions may further improve postoperative body composition outcomes. Because body composition was assessed exclusively by BIA, the results should be interpreted as impedance-derived estimates rather than direct measurements of individual tissue compartments.
Laparoscopic cholecystectomy (LC) is the gold standard for gallstone disease, but the optimal extraction port (umbilical vs. epigastric) remains debated. This updated systematic review and meta-analysis aimed to evaluate whether port site selection impacts perioperative and postoperative outcomes in LC, specifically comparing their effectiveness regarding pain, operative time, and complications. Following PRISMA 2020, PubMed, Embase, Scopus, Google Scholar, and Cochrane Library were searched to August 2025. Randomized controlled trials comparing umbilical and epigastric extraction in LC were analyzed. The primary outcome was 24-hour postoperative pain (VAS); secondary outcomes included operative time, retrieval time, infection, and hernia. Sixteen RCTs (n = 1415) were included. No significant differences were observed in pain (MD -0.59, 95
