Introduction: Parastomal hernia is one of the most common late complications after stoma formation and may significantly impair quality of life, stoma care, appliance fit, and daily functioning. Despite numerous operative techniques, no universally accepted gold standard has been established, particularly for complex and recurrent parastomal hernias.Aim: The aim of this narrative review was to summarize current evidence on epidemiology, risk factors, prevention, classification, and surgical treatment of parastomal hernia, with particular emphasis on the Hybrid Parastomal Endoscopic Repair (HyPER) technique.Materials and methods: A narrative literature review was performed using PubMed/MEDLINE, Scopus, Google Scholar, and reference lists of relevant articles. Publications addressing parastomal hernia prevention, classification, operative techniques, recurrence, complications, quality of life, stoma function, and appliance-related outcomes were analyzed. Particular attention was given to randomized trials, cohort studies, case series, systematic reviews, meta-analyses, guidelines, and expert reviews, mainly from the last 20 years.Results: Conventional techniques, including local repair, stoma relocation, keyhole, Sugarbaker, sandwich, retromuscular, Pauli-type have specific advantages and limitations. Their interpretation is limited by heterogeneous study design, inconsistent recurrence definitions, variable follow-up, and insufficient use of standardized classification. HyPER combines laparoscopic adhesiolysis and mesh reinforcement with open peristomal reconstruction, including hernia sac excision, fascial narrowing, stoma revision or relocation, bowel loop shortening, and soft-tissue remodeling.Conclusions: Parastomal hernia repair should be evaluated not only by recurrence, but also by functional outcomes and quality of life. HyPER may represent an important evolution toward comprehensive anatomical and functional reconstruction, particularly in complex and recurrent cases. Further multicenter comparative studies are needed.
Introduction: The spleen is particularly vulnerable due to its fragile capsule and rich blood supply, making it the second most commonly injured solid organ. Moreover, because of its immune role and development of minimally invasive surgery procedures, management of blunt splenic injuries (BSI) has evolved from routine splenectomy towards individualized strategy comprising three main modalities: surgery (open or laparoscopic), endovascular embolization (SAE) and nonoperative management (NOM).Aim: This paper aims to summarize the current state of knowledge and the experiences of different medical centers on this subject, with a focus on areas that remain unclear and require further investigation.Materials and methods: This literature review included studies from PubMed and Google Scholar published from 2020 to 2025, focusing on the treatment of blunt splenic injuries. The keywords used included: blunt splenic injury, splenic trauma, non-operative management, splenic artery embolization, splenectomy, laparoscopic splenectomy and spleen vaccination.Results: NOM is considered the preferred approach in the treatment of patients with BSI. It is especially recommended for hemodynamically stable patients with low-grade splenic injuries. SAE is commonly used in stable patients with moderate- to high-grade injuries, whereas its effectiveness in unstable patients remains inconsistent compared with operative management. Splenectomy continues to be mainly reserved for hemodynamically unstable patients, especially those with high-grade splenic damage.Conclusions: The initial clinical assessment of patients with BSI plays a crucial role in guiding further management. Hemodynamic stability is the primary factor influencing treatment decisions. Importantly, existing management approaches for BSI demonstrate inconsistencies in clinical practice, highlighting the need for well-defined and standardized criteria.
Introduction: Pancreaticopleural fistula (PPF) is a rare complication of pancreatic duct disruption that commonly presents with recurrent pleural effusions and respiratory symptoms, often delaying recognition of its pancreatic origin.Aim: This narrative review evaluated the diagnosis and endoscopic management of PPF, with a focus on transpapillary bridging, disconnected pancreatic duct syndrome (DPDS), and anatomy-based treatment escalation.Materials and Methods: PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar were searched through 2026 for studies on PPF, pancreatic duct disruption, endoscopic retrograde cholangiopancreatography (ERCP), pancreatic duct stenting, endoscopic ultrasound (EUS)-guided drainage, and DPDS. Eligible studies, case series, reviews, guidelines, and technical reports were synthesized narratively.Results: Markedly elevated pleural fluid amylase levels support the diagnosis, while magnetic resonance cholangiopancreatography, computed tomography, ERCP, and EUS delineate ductal anatomy. ERCP with transpapillary pancreatic duct stenting is preferred when a partial disruption can be bridged. Complete disruption, downstream obstruction, or DPDS reduces treatment success and may require EUS-guided transmural drainage, long-term internal stenting, EUS-guided pancreatic duct drainage, radiological intervention, or surgery.Discussion: Management should focus on pancreatic source control rather than repeated pleural drainage. Endoscopic success depends mainly on restoring ductal continuity or establishing durable internal drainage.Conclusions: An anatomy-driven, stepwise approach may improve treatment selection, avoid futile interventions, and reserve surgery for refractory or anatomically unsuitable cases.Relevance of the Study to the Development of the Field: This review provides a practical, endoscopy-focused algorithm that integrates ductal bridging and early recognition of DPDS into multidisciplinary decision-making.
INTRODUCTION: Laparoscopic colorectal surgery (LCS) is a valuable method of colorectal cancer treatment and an integral component of residency training programs in general surgery. Real participation of residents in LCS, their outcomes, and proficiency thresholds in basic laparoscopy procedures for performing high-quality LCS remain unclear. AIM: This study aimed to comprehensively assess the outcomes of LCS performed by supervised general surgery residents and evaluate their prior laparoscopic experience.MATERIAL AND METHODS: A retrospective single-center analysis included elective LCS for colorectal cancer performed by colorectal surgeons and supervised residents. The quality measures and outcomes were compared between the groups with the propensity score matching analysis (PSM) and an assessment of the resident's previous experience in laparoscopic techniques.RESULTS: The analysis included 412 elective LCS: 42 performed by residents (Group 1), and 370 by experts (Group 2). The patient groups were equal in demographics and cancer staging. Procedures performed by residents were significantly longer (154 vs. 125 minutes; p<0.05). There was no significant difference regarding surgical complications and mortality. PSM analysis confirmed prolonger time (154 vs 136 minutes, p<0.05) and indicated a higher number of resected lymph nodes in residents’ group (16 vs 13; p<0.05). The resident had performed over 80 laparoscopic procedures for other indications and had assisted in an average of 24 LCSs.CONCLUSIONS: Elective LCS procedures performed by residents under supervision are both safe and effective, ensuring high-quality indicators of oncological care. Introducing LCS training in the early years of residency may enable proficiency to be achieved at an earlier stage of a physician’s career.
Introduction: Necrotising fasciitis (NF) is a rare surgical emergency characterized by spreading necrosis of subcutaneous tissue and fascial planes that is associated with significant systemic toxicity. The aggressive nature of this disease process correlates with its high morbidity and mortality rates. Aim: The aim of this study was to review the profile of patients treated for NF of the breast, as documented in the recent literature. Materials and methods: In September 2025, a thorough literature search was carried out using the keywords and terms “breast necrotizing fasciitis”, “breast tissue necrosis”, and “necrotizing soft tissue infection of the breast” across electronic databases, including PubMed, Medline (OVID), Embase, PsycINFO, Scopus, and Web of Science. The study's five-year period was set between 2020 and 2025, and only English-language literature was taken into consideration. Results: A total of 43 cases reported in 34 case reports were included in the review. Cases ranged in age from 19 to 83 years (median 47.5 years; IQR: 35–60 years), and there were 42 (97.5%) females. Breast pain and discoloration were the presenting complaints in 42 (97.7%) cases. NF in 24 (55.8%) cases was secondary in nature, and more than half (51.2%) were hemodynamically unstable upon presentation. The median delay in seeking medical care after the onset of symptoms was 7 days (IQR: 4–10 days). Aggressive surgical management, including wide debridement and various modifications of mastectomy, was undertaken in 42 cases (97%). The survival rate was about 91%. Conclusions: NF of the breast is a rare surgical emergency that often gets misdiagnosed, leading to adverse outcomes. A high level of suspicion on the part of the physicians can help with prompt diagnosis, the identification of related risk factors, and implementation of appropriate treatment. The cornerstones of management include aggressive surgical removal of necrotic tissue, dedicated supportive care, and careful wound care.
Introduction: Traumatic abdominal wall hernias (TAWHs) are rare injuries, most often resulting from blunt trauma in motor vehicle accidents. Their diverse, uncommon, and often acute nature makes treatment planning challenging, with no consensus on the optimal approach, including the timing and type of surgery, and the role, selection, and fixation techniques of mesh. Aim: The aim of this systematic review was to synthesize the recent literature on traumatic abdominal wall hernias in adults, including their epidemiology, diagnosis, associated injuries, and management, with particular emphasis on the timing and type of repair and the use of mesh. Material and methods: We conducted a systematic review of the recent literature on TAWHs, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic search of the PubMed database was conducted to identify studies published between 2014 and the first half of 2024. All English-language studies documenting TAWH in adult patients were included. Results: In the literature review, 70 articles describing 721 cases were included. The main limitation was that most articles were case reports or case series. The results confirmed substantial variability in treatment selection. Conclusions: Traumatic abdominal wall hernias are rare, heterogeneous, and clinically significant conditions with no established treatment algorithm. More research is needed to help guide surgeons in the management of such hernias.
Introduction: Liver resection remains one of the fundamental treatment modalities for both malignant and benign hepatic diseases; however, it is still associated with a significant risk of intraoperative bleeding. Reducing blood loss and the need for transfusion is crucial for perioperative outcomes and long-term prognosis. The Coolingbis system, which utilizes a cooled monopolar radiofrequency electrode, represents a novel method of achieving hemostasis during hepatic parenchymal transection. Aim: The aim of this study was to evaluate the impact of the Coolingbis system on intraoperative blood loss, the need for blood product transfusions, and the perioperative course in patients undergoing liver resection. Materials and Methods: A retrospective analysis was conducted on 58 patients who underwent surgery for liver lesions between 2022 and 2024. The Coolingbis system was used in 25 patients, while conventional hemostatic techniques were applied in 33 patients. Intraoperative blood loss, operative time, transfusion rate, length of hospital stay, postoperative complications, and mortality were analyzed. Statistical analysis was performed using the Kruskal–Wallis test, the chi-square test, and Fisher’s exact test. Results: Intraoperative blood loss was significantly lower in the Coolingbis group compared with the conventional techniques group (338.0 450.1 mL vs 607.6 752.5 mL; p = 0.0062). Blood product transfusions were less frequent in the Coolingbis group (12.0% vs 24.2%; p = 0.0410). No significant differences were observed between the groups in terms of operative time or length of hospital stay. The rate of postoperative complications was lower in the Coolingbis group; however, the difference did not reach statistical significance. Age, sex, and BMI had no significant impact on intraoperative blood loss. Conclusions: The use of the Coolingbis system in liver resections is associated with a significant reduction in intraoperative blood loss and transfusion requirements, without an increased risk of complications. This technique may represent a valuable adjunct to conventional hemostatic methods in liver surgery.
Introduction: Low grade appendiceal mucinous neoplasm (LAMN) is a rare appendiceal tumor with indolent histology but clinically relevant risk of peritoneal dissemination and pseudomyxoma peritonei, creating uncertainty in surgical extent and follow-up.Aim: To synthesize evidence on surgical decision making in LAMN, including right hemicolectomy indications, TNM interpretation, perforation management, imaging limitations, CRS/HIPEC (Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy) selection, and surveillance.Materials: A targeted narrative review was conducted using biomedical sources (2000–2026), supplemented by manual reference screening and citation tracking of key guidelines, consensus statements, and cohort studies. Evidence from pathology/staging, imaging, operative strategy, intraperitoneal treatment, and surveillance was narratively synthesized into clinical decision frameworks.Results: Contemporary evidence supports de-escalation for most localized LAMN. Routine right hemicolectomy is usually overtreatment in non-perforated pTis/pT3 disease after complete appendectomy and is not routinely indicated in selected perforated cases with acellular mucin. LAMN staging differs from adenocarcinoma, including absence of T1/T2 categories and prognostic distinction between M1a and M1b disease. Perforation increases recurrence risk and supports risk-adapted surveillance, but does not alone mandate right hemicolectomy.Discussion: The evidence base remains predominantly retrospective and surveillance protocols are heterogeneous, limiting standardization.Conclusions: Risk stratified, evidence based algorithms can reduce overtreatment while preserving oncologic safety in LAMN.Significance of the study: This review integrates staging, operative strategy, and surveillance into a practical framework for standardized LAMN management and future multicenter research planning.
AbstractPurposePostoperative pancreatic fistula (POPF) remains the major source of morbidity after distal pancreatectomy (DP) for pancreatic neuroendocrine tumours (pNETs). While intraoperative risk factors are well established, the clinical relevance of discrepancies between preoperative computed tomography (CT), intraoperative, and histopathologic measurements remains unclear. This study aimed to assess the agreement between radiologic and intraoperative measurements and to explore their relationship with postoperative outcomes after DP for pNETs.MethodsThis retrospective single-centre study included 76 patients who underwent open distal pancreatectomy for histologically confirmed pNETs between 2017 and 2022. Tumour size and main pancreatic duct diameter were assessed on preoperative contrast-enhanced CT, intraoperatively, and histopathologically. Postoperative complications were graded according to the Clavien–Dindo classification, and POPF was defined according to the 2016 ISGPS criteria. The Fistula Risk Score (FRS) was calculated retrospectively. Agreement between CT, intraoperative, and histopathologic measurements was analysed using Bland–Altman plots and Spearman correlation.ResultsMedian patient age was 58 years, and 52.6% were female. Overall morbidity was 53.9%, clinically relevant POPF occurred in 19.7% of patients, and major complications (Clavien–Dindo ≥ III) were observed in 21.1%. Soft pancreatic texture (p < 0.001) and intraoperative blood loss > 700 mL (p = 0.02) were significantly associated with clinically relevant POPF and severe morbidity. FRS correlated with complication grade (τ = 0.38, p < 0.01) and hospital stay (r = 0.73, p < 0.01). CT significantly underestimated tumour size compared with intraoperative and histopathologic measurements (median bias = –0.3 cm; p = 0.01), whereas concordance between CT and intraoperative pancreatic duct diameter was weak (ρ = 0.28, p = 0.08). Neither CT-based tumour size nor duct diameter was associated with clinically relevant POPF or overall postoperative complications.ConclusionPreoperative CT underestimates tumour size and shows limited agreement with intraoperative assessment of the pancreatic duct in pNET distal pancreatectomy. In contrast, intraoperative findings, particularly pancreatic texture and blood loss, appear to be more clinically relevant in assessing the risk of postoperative complications.
Introduction: Bariatric surgery is the most effective treatment for obesity, yet obesity increases the risk of perioperative complications, including surgical site infections. Although bariatric procedures are classified as clean or clean-contaminated, current guidelines recommend antibiotic prophylaxis for all such operations, despite the lack of clear clinical evidence supporting this approach.Aim: To assess the effect of antibiotic prophylaxis on Incidence of Surgical Site infection (SSI) rate, and other postoperative outcomes after bariatric procedures.Materials and methods: A systematic search used the terms “Bariatric Surgery” and “Antibiotic Prophylaxis,” with added queries for SG, RYGB, OAGB, SADI, SASI, and AGB. Eligible designs included randomized trials, and observational studies that reported clinical outcomes such as SSI, wound complications, morbidity, or mortality. Reports without original clinical data were excluded. Data were analyzed separately for clean procedures (SG, AGB) and clean-contaminated procedures (RYGB, SADI, SASI). Results: Eight studies met criteria. Three studies directly compared prophylaxis with no prophylaxis across clean and clean-contaminated operations and found no significant reduction in SSI. In clean procedures, available evidence consistently indicated no justification for routine antibiotic use. In clean-contaminated procedures results were underpowered. Isolated studies suggested a modest benefit in selected subgroups, yet none reached statistical significance. Vancomycin was associated with increased infection risk. Ertapenem lowered infection rates compared with ceftriaxone in open gastric bypass. Alternative prophylaxis with levofloxacin and metronidazole after sleeve gastrectomy was linked to less weight loss, and clindamycin after gastric bypass to a higher rate of hypertension remission.Discussion: Current evidence does not support routine perioperative antibiotic prophylaxis in all bariatric surgery procedures. For clean operations such as SG, prophylaxis appears unnecessary. In clean-contaminated procedures, selective use may be justified for high-risk patients until adequately powered prospective trials are available. When used, prophylaxis should be weight-adjusted, timed appropriately, and repeated intraoperatively when indicated.Conclusions: Beyond infection prevention, some evidence suggests that antibiotic choice may influence non-infectious outcomes, including postoperative weight loss and hypertension remission. Future studies are needed to evaluate both infectious and metabolic endpoints to develop evidence-based, antibiotic prophylaxis strategies in bariatric surgery.
Introduction: Global obesity is increasing, affecting ~2.5 billion overweight and 1 billion obese adults (WHO, 2022). It is associated with metabolic syndrome, type 2 diabetes, cardiovascular disease, sleep disorders, and depression, forming bidirectional interactions that worsen health outcomes. Bariatric surgery is currently the most effective long-term intervention for sustained weight loss and comorbidity remission. Aim: This study evaluated associations between obesity, metabolic dysfunction, sleep disorders, and depressive symptoms, and assessed the effects of bariatric surgery on sleep quality, insomnia severity, daytime functioning, eating behavior, and mood within six months postoperatively. Material and methods: Four hundred and nineteen patients qualified for bariatric surgery were enrolled; 91 completed preand ≥6-month postoperative assessments. Participants completed validated questionnaires, including the Athens Insomnia Scale, Beck Depression Inventory (BDI) Night Eating Diagnostic Questionnaire, Difficulties in Emotion Regulation Scale, and Body Perception Questionnaire. Analyses were performed in RStudio with p < 0.05. Results: Significant postoperative weight and BMI reduction was observed. Sleep quality improved, with fewer sleep initiation difficulties, nocturnal awakenings, and snoring, as well as better sleep consolidation. Daytime sleepiness decreased, and eating patterns became more structured, including regular meals, increased breakfast intake, and reduced night eating. Depressive symptoms significantly decreased (BDI 12.19 to 8.02; p < 0.01), indicating clinically meaningful improvement in mood. Conclusions: Bariatric surgery provides multidimensional benefits beyond weight loss, improving sleep, metabolic regulation, dietary behavior, and psychological well-being. The findings highlight the interdependence of obesity, sleep disturbances, and depression, and support integrated, multidisciplinary management approaches.
Introduction: Sleeve gastrectomy (SG) has become the most frequently performed bariatric procedure worldwide. Despite its widespread adoption, early complications such as staple-line bleeding and leaks remain clinically significant. This study aimed to assess the relationship between surgical experience and key outcomes, including staple-line leaks, bleeding, and operative time. Material and methods: A retrospective analysis of 3,200 consecutive SG performed between 2013 and 2025 was conducted. Patients were divided into four chronological groups of 800 cases each. Baseline demographics, operative time, hospital stay, and 30-day complications (bleeding, leaks, mortality) were compared.Results: Over the 12-year period, operative efficiency improved markedly, with median operative time decreasing from 60 min (50–75) in Group 1 to 30 min (30–40) in Group 4 (p < 0.001). Hospital stay shortened from 3 to 2 days (p < 0.001). Major complications declined from 5.4% to 1.8% (p < 0.001), with staple-line leaks eliminated entirely (from 2.0% to 0%, p < 0.001). Bleeding incidence fell initially but increased slightly in Group 4 (from 3.0% to 1.4%, p = 0.026). Mortality remained low.Conclusions: Progressive surgical experience and adoption of modern technology improved safety and efficiency in SG, reducing major complications and operative duration. These findings underscore the value of performing metabolic bariatric surgery in high-volume, experienced centers and illustrate the combined effect of learning curve and technological advancement.
<p><strong>Introduction:</strong> Diabetic foot infection (DFI) is a major complication of diabetes associated with high rates of amputation, recurrence, and healthcare utilization. The prognostic interaction between clinical and microbiological markers remains unclear.</p><p><strong>Aim:</strong> The present analysis aimed to characterize clinical, inflammatory, and microbiological predictors of course and resource use in surgically managed DFI.</p><p><strong>Material and methods:</strong> We retrospectively analyzed 121 hospitalizations of 86 patients treated surgically for DFI (2021-2025). Clinical, laboratory, and microbiological variables were assessed in relation to amputation, reamputation, rehospitalization, length of stay (LOS), and mortality.</p><p><strong>Results:</strong> Amputation was performed in 72/121 episodes (59.5%), including 57 minor and 15 major procedures. Reamputation occurred in 13/72 cases (18.1%). Rehospitalization was recorded in 42/86 patients (48.8%). Median LOS was 13 days (IQR 8-21). A total of 227 isolates were obtained, with <em>Enterococcus faecalis</em> (38 isolates, 16.7%) and <em>Staphylococcus aureus</em> (28 isolates, 12.3%) being the most frequent. Polymicrobial infections were present in 75/121 episodes (63%). Neuro-ischemic ulcer phenotype independently predicted reamputation (aOR 3.72; p = 0.036). <em>Staphylococcaceae</em> increased the likelihood of rehospitalization (aOR 3.32; p = 0.014). NLR &gt;5 prolonged LOS by 42%, and <em>Enterococcus</em> spp. by 51%. Repeat hospitalizations showed enrichment of ESBL <em>Klebsiella pneumoniae</em> (5 cases) and HLAR E. faecalis (9 cases).</p><p><strong>Conclusions: </strong>Ulcer phenotype and systemic inflammatory response were the strongest predictors of adverse outcomes. Microbiology contributed selective yet clinically meaningful prognostic information, particularly regarding <em>Staphylococcaceae</em> and <em>Enterococcus</em> spp.</p>.
Introduction: Postoperative pancreatic fistula (POPF) is the leading cause of mortality and morbidity following pancreaticoduodenectomy (PD). Comprehensive perioperative risk analyses from African tertiary centers remain scarce. Aim: To identify independent perioperative predictors of clinically relevant POPF (CR-POPF) and to validate the Callery Fistula Risk Score (FRS) in an Upper Egyptian cohort. Material and methods: A retrospective cohort of 112 consecutive PD patients operated on at Minia University Hospital between January 2018 and October 2025 was analyzed. All procedures were carried out by a dedicated hepatopancreaticobiliary (HPB) team of three consultant surgeons at a dedicated Liver and GIT Hospital serving the Upper Egyptian referral population. CR-POPF was defined per 2016 ISGPS criteria (Grades B/C). Univariate and multivariate logistic regression identified independent predictors; the Callery FRS was calculated post-hoc for all patients. Results: CR-POPF occurred in 23.2% (26/112). Multivariate analysis identified six independent predictors: BMI ≥25 kilograms/ m (OR 6.24), soft pancreatic texture (OR 5.12), duct diameter ≤3 millimeters (OR 4.85), periampullary pathology (OR 3.47), operative time above 360 minutes (OR 3.64), and blood loss >800 milliliters (OR 2.89). CR-POPF nearly doubled hospital stay (28.4 vs. 15.3 days; p 1500 units per liter achieved AUROC of 0.93, sensitivity of 88.5%, specificity of 87.2%, PPV of 71.8%, and NPV of 95.9%. Discussion: The identified predictors align with the Callery FRS framework while highlighting BMI as an underappreciated independent risk factor in this population. Early drain amylase surpasses all preoperative scoring tools in postoperative risk stratification. Conclusions: Six perioperative predictors define a high-risk PD phenotype validated against the Callery FRS (AUROC 0.88). A POD 1 drain amylase level >1500 U/L yielded an AUROC of 0.93, enabling early clinical intervention before the fistula declares itself clinically. Significance: This study represents the first comprehensive perioperative POPF risk analysis from Upper Egypt and the first post-hoc validation of the Callery FRS in an African cohort. It provides both regional evidence and an actionable POD 1 drain-amylase threshold (>1500 U/L) that outperforms every preoperative score in this setting, offering a pragmatic early-warning marker for fast-track postoperative intervention.
Introduction: Decompressive craniectomy (DC) is an established life-saving procedure for patients with refractory intracranial hypertension. After stabilization, cranioplasty (CP) is performed to restore cranial integrity, improve cerebral hemodynamics, and protect the brain. However, CP is associated with considerable complication rates, and the optimal timing of reconstruction remains controversial. Aim: To evaluate the impact of cranioplasty timing on postoperative complications and functional outcomes following decompressive craniectomy, and to identify independent predictors of adverse events after reconstruction. Materials and methods: We conducted a retrospective single-center cohort study including 184 adult patients who underwent cranioplasty after decompressive craniectomy between January 2017 and December 2024. Patients were categorized according to the interval between DC and CP into early (≤3 months), intermediate (3–6 months), and delayed (>6 months) groups. Demographic, clinical, and surgical variables were analyzed, including age, sex, indication for DC, Charlson Comorbidity Index (CCI), cranial defect size, implant material, and ventriculoperitoneal shunt dependency. The primary outcome was the occurrence of postoperative complications. Secondary outcomes included surgical site infection, postoperative hematoma, hydrocephalus requiring CSF diversion, seizures, bone flap resorption, and reoperation. Functional outcome was assessed using the modified Rankin Scale (mRS) at six months. Kaplan–Meier analysis was used to evaluate complication-free survival, and multivariable Cox proportional hazards regression was performed to identify independent predictors of complications. Results: The cohort consisted of 184 patients with a mean age of 52.4 16.8 years; 64% were male. The most common indication for decompressive craniectomy was traumatic brain injury (55%), followed by ischemic stroke (42%) and intracerebral hemorrhage (2%). Early cranioplasty was performed in 37% of patients, intermediate in 34%, and delayed in 29%, with a median interval of 121 days between DC and CP. Autologous bone flap reimplantation was used in 86% of cases, whereas 14% received patient-specific synthetic implants. The overall postoperative complication rate was 26.6%. The most frequent complications were surgical site infection (13.0%), postoperative hematoma (8.2%), hydrocephalus (1.6%), and implant-related complications (3.8%). Complication rates did not significantly differ among timing groups (early 28%, intermediate 25%, delayed 26%; p = 0.61). Kaplan–Meier analysis demonstrated similar complication-free survival across groups (p = 0.64). Multivariate analysis identified higher comorbidity burden (CCI ≥4) as an independent predictor of postoperative complications (HR 2.1; 95% CI 1.2–3.7; p = 0.02), whereas timing of cranioplasty, cranial defect size, and implant material were not significant predictors. Conclusions: Cranioplasty after decompressive craniectomy is generally safe, with complication rates comparable to those reported in the literature. In this cohort, the timing of cranioplasty did not independently influence postoperative complication rates. Instead, patient-related factors, particularly comorbidity burden, played a more significant role in determining outcomes. These findings support an individualized approach to cranioplasty timing based on patient condition and clinical factors rather than rigid temporal thresholds.
Introduction: Elective thyroid surgery continues to be a standard treatment for benign and malignant thyroid diseases when conservative therapy is insufficient. Despite advances in surgical techniques, postoperative complications remain a concern. Aim: This study aimed to analyse postoperative complication rates in patients who underwent elective thyroidectomy, focusing on identifying predisposing and protective factors. Materials and methods: A total of 507 patients underwent elective thyroidectomy after endocrinological evaluation and, when indicated, fine-needle aspiration cytology (FNAC). Intraoperative recurrent laryngeal nerve monitoring was performed, and the resected thyroid specimens were evaluated for volume and histopathology. The postoperative outcomes included surgical complications, parathyroid dysfunction, and calcium level abnormalities. Results: The study cohort consisted of 404 women (79.7%) and 103 men (20.3%), with a mean age of 53.6 13.9 years. The mean thyroid volume was 167.9 170.7 ml, and it was larger in men than in women (209.5 192.2 vs. 157.3 163.4 ml; p = 0.0063). Overall, 400 complications were observed, with hypocalcaemia being the most common one (representing 62.3% of complications) and affecting 249 patients (49.1% of the cohort). Female sex was associated with a 2.7-fold higher risk of postoperative parathyroid dysfunction and a 3-fold higher risk of calcium level abnormalities compared with male patients. No independent predictors of complications were identified, and no mortality occurred. Conclusions: Elective thyroidectomy is safe, with no procedure-related mortality, and hypocalcaemia and parathyroid dysfunction remain the leading complications. Larger prospective studies and meta-analyses should be performed to further evaluate thyroid volume as an independent risk factor and to establish the definitions of calcium abnormalities.
<b>Introduction:</b> Crohn's disease (CD) is a chronic inflammatory bowel disease frequently necessitating surgical intervention, particularly ileocecal resection (ICR), due to complications unresponsive to medical therapy. Postoperative complications remain a significant concern, highlighting the need for reliable preoperative biomarkers to improve risk stratification.<b>Aim:</b> This study aimed to evaluate the utility of selected serologic inflammatory markers in predicting postoperative complications and their severity in CD patients undergoing ICR.<b>Materials and methods:</b> A retrospective analysis was conducted on 110 patients who underwent ICR for CD-related complications between 2015 and 2024. Preoperative blood parameters, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), mean platelet volume (MPV), and C-reactive protein (CRP), were analyzed in relation to postoperative complications classified by Clavien-Dindo grading and the Comprehensive Complication Index (CCI).<b>Results:</b> Postoperative complications occurred in 46 patients (41.8%), with surgical site infection being the most common. Severe complications (Clavien-Dindo grade IV) were observed in 5 patients, with no mortality recorded. While no statistically significant associations were found between Clavien-Dindo grade and white blood cells (WBC), platelets (PLT), NLR, MPV, or CRP levels, CRP demonstrated a significant positive correlation with CCI score (p < 0.05), suggesting its potential as a predictive marker for overall complication burden.<b>Conclusions:</b> Elevated preoperative CRP levels may serve as a useful predictor of postoperative complication severity in CD patients undergoing ICR. Although other markers, such as NLR and MPV, showed trends toward association, statistical significance was not reached. Comprehensive preoperative assessment incorporating inflammatory biomarkers could enhance surgical planning and improve outcomes in this high-risk population.
<b>Introduction:</b> Achalasia is a primary esophageal motility disorder of unclear etiology. The development of third-space endoscopy has enabled the advancement of peroral endoscopic myotomy (POEM) as a promising therapeutic alternative. <br><br><b>Aim:</b> To assess the safety profile of the POEM procedure in patients with diverse clinical characteristics. <br><br><b>Material and methods:</b> A retrospective analysis of 484 consecutive POEM procedures performed between 2015 and 2024 at PCZ in Brzeziny (Brzeziny specialized medical center) was conducted. The analysis included demographic data, procedure duration, type of achalasia, as well as intraoperative and early postoperative complications. <br><br><b>Results:</b> Significant complications during or post hospitalization occurred in 26 patients (5.4%), including bleeding, mucosal perforation, pain requiring prolonged treatment, and asymptomatic elevation of inflammatory markers. Two cases of mediastinitis and 7 readmissions were recorded. All complications were successfully managed conservatively. <br><br><b>Conclusions:</b> POEM is characterized by a high safety profile in the treatment of achalasia.
Introduction: Colorectal cancer (CRC) is the second most common cancer worldwide. Much attention has recently been paid to the epigenetic features of CRC. Homologous recombination repair (HRR) is a biochemical pathway that plays a crucial role in maintaining genome integrity through the repair of double-strand breaks (DBS). RAD51 recombinase is widely considered a key enzyme in HRR. Genome-wide single nucleotide polymorphisms (SNPs) are a significant type of genetic variation. Aim: The aim of this study was to assess the association between the occurrence of individual genotypes/alleles of the RAD51 172G/T polymorphism (rs1801321) and the risk of CRC.Materials and methods: The material used for DNA isolation was peripheral blood from patients at the Department of General and Colorectal Surgery, Medical University of Lodz. The study recruited patients (n = 188) with histologically confirmed colorectal cancer. The control group consisted of undiagnosed individuals (n = 200), matched for age and gender, without a family history of cancer among first-degree relatives.Results: No statistically significant association was found between the frequency of the assessed alleles/genotypes and the presence of CRC. The analysis also showed that the 127G/T variant of the RAD51 gene was not statistically significantly associated with the development of colorectal cancer.Discussion: The 127G/T polymorphism of the RAD51 gene appears to be an unpromising marker for colorectal cancer. However, new observations regarding the variant in the distal promoter may open up prospects for future research on molecular markers.Conclusions: The study results indicate no association between the RAD51 172G/T polymorphism and the risk of CRC. Therefore, there is a need for further research in the area of selected polymorphisms in CRC.
<b>Introduction:</b> Full-thickness rectal prolapse (FTRP) is a multifactorial disease that can be treated with different surgicaltechniques. There is still no standard surgical procedure, and the selection of the surgical technique is based on the individualassessment and the experience of the surgeon. The benefits to patients should focus on repair of bowel prolapse, reduction ofconstipation, and an improvement in pelvic floor muscle insufficiency.<b>Aim:</b> Aim of this study was to evaluate clinical and functional outcomes after abdominal surgery for FTRP in a prospective single- -center observational study.<b>Materials and methods:</b> Between 2016 and 2022, a total of 94 consecutive patients (46.2 18.2 years) underwent abdominal surgery due to FTRP using an abdominal approach. They were operated on with ventral mesh rectopexy (VMR) (55 pts.) or resection and suture rectopexy - Frykman-Goldberg procedure (FG) (39 pts.). Before and after the surgery, clinical and functional outcomes were measured. The follow-up period ranged from 1 to 6 years (mean: 26 months).<b>Results:</b> At last follow-up, constipation occurred in 27.6% of VMR and 31.3% of FG patients (p = 0.754; calculated among patients with available postoperative constipation status). The Wexner incontinence score was significantly better in the VMR group (1.0 2.1 <i>vs.</i> 3.6 5.0, p = 0.009). There were no differences in the EQ5D indices between the groups (1.7 2.0 <i>vs.</i> 2.4 2.8, p = 0.257).<b>Conclusions:</b> Both surgical procedures revealed comparable rates of recurrence and complications. While QoL was similarbetween groups, VMR yielded a significantly greater improvement in the Wexner incontinence score.
