Subtrochanteric femoral fractures (SFF) are challenging to manage due to their complex anatomy and high complication rates. Various surgical techniques, including locking compression plate fixation (LCPF) and intramedullary nailing (IMN), have been used, but there is no consensus on the optimal treatment method. To compare perioperative outcomes, radiological parameters, and functional recovery between LCPF and IMN in patients with SFF. A comprehensive search was conducted on PubMed, Scopus, Cochrane Library, and Google Scholar from inception through March 2025. 5 studies comprising 341 patients (185 LCPF and 156 IMN) met the inclusion criteria. Primary outcomes included intraoperative blood loss, operative time, hip flexion, varus malalignment, time to full weight-bearing, hospital stay, malunion, nonunion, postoperative complications, and Harris Hip Score (HHS). IMN showed significantly lower blood loss (MD: 147.53 mL; p < 0.001), shorter hospital stay (MD: 4.73 days; p < 0.001), and better HHS (MD: -4.49 points; p = 0.02) compared with LCPF. LCPF was associated with shorter operative time (MD: 11.93 minutes; p = 0.03). No significant differences were observed in hip flexion, varus malalignment, nonunion, or overall complication rates. Both LCPF and IMN provide acceptable outcomes in the management of SFF. However, IMN offers significant advantages in reducing intraoperative blood loss, shortening hospital stay, and enhancing early functional recovery. These findings suggest that IMN may be the preferable option, particularly in patients at higher risk for perioperative morbidity. Further large-scale, prospective randomised studies are warranted to validate these conclusions and establish definitive treatment guidelines.

To investigate the efficacy and safety of single-port (SP) robotic nephroureterectomy (NUx) with bladder cuff excision. From September 2021 to August 2024, we reviewed all patients diagnosed with urothelial carcinoma who underwent robot-assisted laparoscopic NUx at our institution since the introduction of the SP robot. A total of 105 patients were included in the study, of whom 52 underwent surgical procedureusing the multi-port (MP) approach, whereas 53 underwent surgery using the SP approach. No statistically significant differences were found in patient characteristics, such as gender, body mass index, or tumor size. In terms of surgical outcomes, no statistically significant differences were found in key metrics, such as console time and estimated blood loss. However, a statistically significant difference was observed in total operative time, with an average difference of 45 minutes (222.25 ± 69.38 minutes in MP, 169.98 ± 49.63 minutes in SP, p = 0.000). The estimated blood loss was lower with the SP robot (144.91 mL ± 108.25 in MP, 96.68 ± 72.95 mL in SP, p = 0.004). During the one-year follow-up, no statistically significant differences in renal function loss or T stage were observed. NUx with bladder cuffing using the SP approach demonstrated feasibility compared with surgery performed using the MP approach. Notably, the ease of access during cuffing contributed significantly to reducing the total operative time.

Hepatic caudate lobe hemangiomas present unique surgical challenges due to the segment's deep location amidst critical vasculature (IVC, portal vein, hepatic veins). The literature on hepatic caudate lobe hemangiomas remains limited, resulting in a lack of comprehensive understanding and standardized treatment protocols for this condition. By comparing the surgical and perioperative outcomes of robotic versus open complete isolated caudate lobectomy for hemangiomas, this study aims to advance our understanding and management of this disease. This single-center study included 83 patients who underwent complete isolated caudate lobe hemangioma resection. Patients were allocated to two groups: the robotic liver resection group (RLR, n = 33) and the open liver resection group (OLR, n = 50). Demographic characteristics and perioperative outcomes were compared between the two cohorts. Additionally, we explored the risk factors for intraoperative bleeding and conducted a subgroup analysis of patients with BMI ≥ 25kg/m2. RLR demonstrated superior outcomes vs OLR: shorter median operative time (median 105.0 vs. 192.5min, p < 0.001), reduced blood loss (50 vs 300mL; p < 0.001), lower transfusion rates (3.0% vs 20.0%; p < 0.05), abbreviated hospital stay (9 vs 16days; p < 0.001), and faster recovery (postoperative stay: 5 vs 8days; p < 0.001). Univariate analysis revealed that increased blood loss was significantly associated with surgical approach, platelet count, POD (postoperative days), operation time, and ALT level. Multivariate analysis confirmed that longer operation time was an independent predictor of increased intraoperative blood loss. High-BMI RLR patients had significantly reduced operative time (105.0 vs 231.0min; p = 0.001), blood loss (30.0 vs 400.0mL; p < 0.001). Robotic isolated caudate lobectomy for hemangioma is feasible and safe, offering significant perioperative advantages over open surgery-including reduced blood loss, shorter hospitalization, and accelerated recovery-even in high-BMI patients. Robotic resection represents a viable surgical option for selected patients with hepatic caudate lobe hemangiomas.

Study DesignRetrospective multicenter cohort study.ObjectivesSpine surgery for multiple myeloma (MM) is associated with an increased intraoperative blood loss. Therefore, this study aims to examine prognostic factors for higher intraoperative blood loss in spine surgery for patients with MM.MethodsIn total, 158 adult patients with MM undergoing spine surgery between May 2001 and December 2021 were included. The main outcome for intraoperative blood loss was the Bleeding Index (BI), next to the visually estimated blood loss (EBL). Two separate multivariable generalized linear models (GLMs) were utilized to assess the associations between the predictors and these two outcomes.ResultsThe average BI was 4.4 and average EBL was 750mL. Compared to corpectomy with stabilization, other types of surgery (decompression with stabilization, sole decompression, sole stabilization) were associated with a lower expected BI, ranging from a 26.5% to 39% decrease. A cervical location of surgery was associated with a 40.3% reduction of expected BI compared to a lumbar location (P = 0.006). Lower platelet count (P = 0.003) and longer duration of surgery (P < 0.001) were associated with a higher expected BI. For EBL, ECOG score, surgery type, and duration of surgery were found as independent predictors.ConclusionsThis study identified lower platelet count, type of surgery, location of operated spinal levels, and a longer duration of surgery as independent predictors of higher intraoperative BI in MBD-related spine surgery. These outcomes can be relevant for preoperative screening, shared decision making, and perioperative blood transfusion deliberation or planning.

Despite laparoscopic resection's established role in gastric gastrointestinal stromal tumor (GIST) management, its application for esophagogastric junction (EGJ) tumors involving the Z-line remains technically challenging and insufficiently studied. This study compares feasibility, safety, and oncologic outcomes of laparoscopic versus open resection for EGJ-GIST. A retrospective cohort analysis included 45 patients undergoing EGJ-GIST resection (24 laparoscopic, 21 open). Perioperative metrics and survival outcomes were evaluated, with clinicopathological parameters systematically compared. Groups had similar baseline characteristics. Laparoscopic surgery showed superior intraoperative outcomes, including reduced median blood loss (47.5 vs 85.0mL, p < 0.001). Postoperatively, laparoscopic patients experienced faster gastrointestinal recovery (first flatus: 2 vs 3days, p = 0.004), earlier dietary advancement (liquid: 3 vs 4days, p = 0.003; solid: 4 vs 5days, p < 0.001), and shorter hospitalization (6 vs 8days, p = 0.002). Complication rates trended lower with laparoscopy (8.3% vs 23.8%, p = 0.306). Over 68-month median follow-up, recurrence occurred in 5 patients (laparoscopic:3; open:2). Five-year disease-free survival (DFS) (86.3% vs 87.7%) and overall survival (OS) (92.9% vs 93.3%) were comparable, with no intergroup differences in Kaplan-Meier analysis (DFS: p = 0.644; OS: p = 0.506). Multivariate analysis confirmed surgical approach did not independently affect prognosis. Laparoscopic resection for EGJ-GIST offers significant perioperative benefits-reduced blood loss, faster recovery, and fewer complications-while demonstrating comparable descriptive long-term survival rates to open surgery. These findings advocate prioritizing minimally invasive techniques in surgically selected cases.

This prospective study aimed to evaluate the clinical and radiological outcomes of lever-up laminoplasty (LLP) using innovative hinged titanium plates for treating multilevel cervical spondylotic myelopathy (CSM).Ten patients diagnosed with multilevel CSM underwent LLP between June and October 2022 were enrolled. Intraoperative parameters, including operative time, blood loss, transfusion volume, and complications, were systematically recorded. Postoperative imaging evaluated spinal cord decompression by measuring the midsagittal diameter, transverse area, and osseous canal volume. Clinical outcomes were evaluated using the Japanese Orthopaedic Association (JOA) score, and axial symptoms (AS) assessed with the the Visual Analogue Scale (VAS).All procedures were successfully performed, with follow-up periods ranging from 12 to 15 months. Postoperative imaging confirmed complete neural decompression in the treated segments, without any signs of cervical instability. Significant increases in the mid-sagittal diameter (C3-C7) and cross-sectional area of the spinal canal were observed compared to preoperative values (P < 0.01). The osseous spinal canal volume increased by an average of 61.82% ± 18.50%. Both the JOA and VAS scores demonstrated significant improvements at the final follow-up (P< 0.01). One patient experienced transient C5 nerve root palsy, which was resolved with conservative treatment. No other complications or significant AS were reported.LLP using hinged titanium plates is a safe and effective surgical approach for the treatment of multilevel CSM. The technique achieves significant spinal canal expansion and a reduced incidence of postoperative AS, offering a promising alternative to conventional laminoplasty methods. Nevertheless, additional comparative research with extended follow-up is essential to confirm its long-term benefits and comparative advantages over conventional surgery.

Total knee arthroplasty and distal femoral replacement in young patients with bony neoplasm: complications, survival and patient-reported outcomes.

Background Nasal vestibular cyst is a common disease in otolaryngology. Traditional surgery via the labiogingival groove approach is invasive, while the rapid development of endoscopic minimally invasive technology may be significant for the improvement of nasal vestibular cyst surgery. Objectives To compare the clinical efficacy of endoscopic uncapping surgery and traditional sublabial approach resection in treating nasal vestibular cysts, providing evidence for clinical practice selection. Methods A retrospective analysis was performed on 47 patients with nasal vestibular cysts admitted to the Department of Otorhinolaryngology-Head and Neck Surgery from March 2019 to October 2024. They were divided into an endoscopic group (24 cases, undergoing endoscopic uncapping surgery) and a control group (23 cases, receiving traditional sublabial resection). Surgical indicators (operation time, intraoperative blood loss), postoperative recovery indicators (facial compression need, VAS scores at 24/48h, hospital stay), complication incidence, and cyst recurrence during follow-up were compared. Results The endoscopic group showed significantly shorter operation time [(20.13 ± 3.15) vs (59.13 ± 13.45) min], less intraoperative blood loss [(5.34 ± 0.67) vs (15.64 ± 2.63) ml], no need for facial compression (vs all controls needing it), lower VAS scores (24h: 2.13 ± 0.52 vs 4.87 ± 0.76; 48h: 1.56 ± 0.41 vs 3.92 ± 0.63), shorter hospital stay [(1.25 ± 0.31) vs (3.76 ± 0.84) days], and lower complication incidence (4.17% vs 13.04%) (all p < 0.05). No recurrence was found in either group during 12-month follow-up. Conclusion Endoscopic uncapping surgery for nasal vestibular cysts has advantages of short operation time, less bleeding, mild postoperative pain, rapid recovery, few complications, and low recurrence rate, with significant clinical effect worthy of wide promotion.

Objective To evaluate the technical feasibility, safety, and clinical outcomes of bronchial sleeve anastomosis in a pediatric case series encompassing two main etiologies (trauma and tumor). Methods A retrospective analysis was conducted on 8 pediatric patients who underwent bronchial sleeve resection at our center between May 2018 and May 2025. Preoperative diagnosis was confirmed by computed tomography, magnetic resonance imaging, and bronchoscopy. Collected data included demographic characteristics, surgical parameters, pathological results, perioperative outcomes, and follow-up information. Results All eight procedures were successfully completed without perioperative mortality. The mean operative time was 306.88 ± 127.31 min, with mean intraoperative blood loss of 51.25 ± 23.57 mL. The mean duration of mechanical ventilation was 16.06 ± 12.57 h, chest tube drainage was maintained for 234.86 ± 91.04 h, and the mean postoperative hospital stay was 25.00 ± 8.45 days. The median follow-up period was 2.7 years (range: 0.6–7.1 years). Perioperative complications included two cases of mild anastomotic stenosis, both successfully managed with bronchoscopic cryotherapy, and one case of chylothorax that resolved with conservative drainage. The trauma group required significantly longer postoperative mechanical ventilation compared to the tumor group ( P &amp;lt; 0.05). At the last follow-up, all patients were alive with patent airways, recovered pulmonary function, and had resumed normal activities. No tumor recurrence was observed in the oncology patients. Conclusion Bronchial sleeve resection represents a safe, feasible, and effective lung-preserving procedure in carefully selected pediatric patients. This technique allows complete lesion removal while maximizing pulmonary function preservation and promoting long-term quality of life, establishing it as a preferred surgical option for children with severe airway trauma or bronchial tumors.

A novel partial spleen-preserving distal pancreatectomy procedure: Comparison to the Warshaw technique.

Robotic-assisted radical prostatectomy (RARP) in patients with pre-existing inflatable penile prostheses (IPP) poses technical challenges due to the intrapelvic reservoir. With rising rates of prostate cancer and IPP use, evidence on safely performing RARP in this group is limited. This study assesses the feasibility, safety, and perioperative outcomes of RARP in men with prior IPP. We retrospectively analyzed 32 prostate cancer patients with functional three-piece IPPs who underwent RARP (2016-2024), excluding those with prior pelvic radiation, malleable implants, or incomplete data. Key adaptations included tailored port placement, cold dissection near the reservoir, site-specific retraction without reservoir removal, and intraoperative deflation as needed. Perioperative, functional, and oncologic outcomes were systematically assessed. Median age was 67 years (IQR 61-73). Follow up duration was 24 months from RARP. Median operative time and blood loss were 110 minutes (IQR 98-120) and 100 mL (IQR 50-120), respectively. No intraoperative prosthesis injuries occurred. Clavien-Dindo grade I-II complications were observed in 8 patients (25%). Median time to continence (≤1 pad/day) was 56 days (IQR 46-92). All IPPs remained functional postoperatively without revision. 31 patients were continent at 12 months. Pathologic pT2 disease was present in 16 (50%) patients; positive margins occurred in 4 (12.5%) patients. Biochemical recurrence was noted in 9.4% at 12-month median follow-up. RARP in patients with a pre-existing penile prosthesis reservoir is technically feasible and safe, with no increase in procedure-related or reservoir-specific complications.

Predictors of primary postpartum hemorrhage among middle eastern postpartum women with vaginal delivery: A retrospective matched case-control study.

A collagen/silk fibroin/magnesium hydroxide multifunctional sponge with enhanced mechanical strength, rapid hemostasis, and antibacterial properties for promoting infectious wound healing.

Long-term comparison of non-mesh anchoring vs mini mesh for apical suspension.

Lymphadenectomy through a triple-instrument cervical approach: a technical advance in single-port mediastinoscopic radical esophagectomy for esophageal cancer.

Introduction: Postoperative adhesions are indeed a significant concern following abdominopelvic surgeries. These fibrous bands of tissue can form between abdominal or pelvic organs and tissues, leading to various complications. Postoperative Peritoneal Adhesions (PPAs) barriers are safer and better because they lower the risk of illness and the need for repeated interventions. Various agents and techniques have been studied to prevent PPAs, including activating fibrinolysis, interrupting blood coagulation, inhibiting collagen synthesis, reducing cellular inflammatory responses, and creating a physical barrier between the wound and surrounding tissue or organ. Seprafilm acts as a physical barrier on wounded tissue surfaces, minimising tissue adhesions during wound healing. Aim: To compare the outcomes of patients undergoing abdominopelvic surgery with and without Seprafilm application, in terms of adhesion formation and complication rates. Materials and Methods: The present prospective interventional study was conducted at SRM Medical College Hospital and Research Centre, Chennai, Tamil Nadu, India, from July 2023 to December 2024. In this study, group A, 50 patients underwent surgery with the use of Seprafilm, while group B (50 patients) underwent surgery without the use of Seprafilm. The outcomes measured were: postoperative complications, 20th day adhesions as seen in CT abdomen, postoperative pain, and intraoperative blood loss. Blood loss was estimated using a Gauze Visual Analogue (GVA), and pain was estimated using a visual pain analogue. Results: Among the 100 patients, the mean age was 44 years in group A and 45 years in group B, and among the gender distribution, group A had 21 males and 29 female patients, group B had 23 males and 27 female patients. A total of 42 patients (42%) belonged to the age group of &lt;40 years, of which 22 patients (44%) belonged to group A and 20 patients (40%) belonged to group B. In the present study, 10 patients developed postoperative complications in group A and 22 patients developed postoperative complications in group B (p-value=0.010). A total of 34 patients had developed adhesions, among which 8 (23.5%) patients belonged to group A and 26 (76.5%) belonged to group B (p-value=0.001). Conclusion: In this study, the group that used seprafilm as an adhesion barrier following abdominopelvic surgeries had a significant reduction in the incidence of postoperative adhesions compared to the group in which an adhesion barrier was not used.

Modified Billroth I versus Roux-en-Y reconstruction after laparoscopic distal gastrectomy: Propensity-matched analysis of perioperative, pathologic, and quality-of-life outcomes in a European cohort.

To assess the safety and efficacy of combined ultrasonography (US) and fluoroscopy-guided percutaneous nephrolithotomy (CG-PCNL) vs pure US-guided endoscopic combined intrarenal surgery (USG-ECIRS) for treating 4-6-cm renal calculi. This prospective randomised trial was conducted in the period May 2022 to April 2025 at the Second Affiliated Hospital of Anhui Medical University and Zhongda Hospital of Southeast University. A total of 114 consecutive patients with 4-6-cm renal calculi were randomly assigned to undergo CG-PCNL or USG-ECIRS, with 57 patients per group. The primary outcomes of the study were the first stone-free rate (SFR) and tract establishment success rate, with secondary outcomes including operating time, haemoglobin drop and complication rate. The study was registered at http://www.chictr.org.cn (ChiCTR2200057865). A total of 106 patients were included in the analysis, with 53 in each group. The two groups had similar baseline characteristics. There was no significant difference in first SFR between the groups (81.1% vs 79.2%; P = 0.872). In patients with S.T.O.N.E. scores >10 or stones involving more than five calyces, SFR was markedly lower in both groups. No intergroup differences were detected in either tract establishment time or initial success rate. The operating time in the CG-PCNL group was significantly longer than that in the USG-ECIRS group (143.2 vs 93.6 min; P < 0.001). Haemoglobin drop was significantly more pronounced in the CG-PCNL group compared to the USG-ECIRS group (14.9 vs 10.3 g/L; P = 0.043). The overall incidence of complications in the CG-PCNL group was significantly higher than that in the USG-ECIRS group (18.9% vs 5.7%; P = 0.038). Use of USG-ECIRS showed comparable efficacy to use of CG-PCNL in the management of 4-6-cm renal calculi, while demonstrating superior safety with fewer complications and less blood loss. However, the SFR declined for both approaches when the S.T.O.N.E. score exceeded 10 or when stones involved more than five calyces.

This study aimed to determine the incidence and risk factors for postoperative pulmonary complications (PPCs) following endoscopic endonasal surgery (ESS). Retrospective review from January 2023 to May 2023. Tertiary academic center. One hundred EES cases, of which 97 met the inclusion criteria. The primary outcome was the incidence of PPC. Univariable and multivariable analyses were used to assess preoperative variables, demographics, and respiratory comorbidities; intraoperative variables of surgery and duration of intubation, endotracheal tube (ETT) size, estimated blood loss (EBL), gastric tube use during surgery; postoperative cerebrospinal fluid (CSF) leak, and length of hospital stay as predictors of PPC. Ninety-seven patients met the inclusion criteria. Twenty-nine developed PPC including increased oxygen requirement (14.4%), pneumonia (9.3%), atelectasis (3.1%), respiratory failure (2.1%), and pulmonary embolism (2.1%). Sixty-four percent were clinically significant PPC. PPC was associated with age ( p < 0.007), longer duration of surgery ( p < 0.001), longer duration of intubation ( p < 0.001), postoperative intubation ( p < 0.001), higher EBL ( p = 0.022), and longer length of hospital stay ( p < 0.001). There was no significant association between PPC and sex ( p = 0.705), body mass index (BMI; p = 0.403), gastric tube presence ( p = 0.778), ETT size ( p = 0.636), and preoperative history of pulmonary disease ( p = 0.403). The incidence of PPC in patients undergoing EES is significant. Targeting perioperative risk factors including age ≥65, duration of intubation, postsurgical intubation status, and intraoperative blood loss should have a meaningful impact on decreasing PPC. The contribution of silent intraoperative aspiration during surgery needs to be investigated further in high-risk patient populations.

Full-endoscopic versus microscopic spinal decompression for lumbar disc herniation: a meta-analysis of 20 cohort studies.