Major Complications Research Articles

Stereoelectroencephalography (SEEG)-guided insula resections: is it "Reily" worth it?

Stereoelectroencephalography (SEEG) is widely used to characterise epileptic networks and guide resection in paediatric epilepsy surgery programmes. The insula, with its extensive connectivity with temporal and extratemporal structures, has increasingly been seen as a possible surgical target. We report our seizure outcomes after SEEG-guided resection of the insula in a paediatric cohort. From our paediatric epilepsy surgery database of patients aged 0-19 years, we analysed demographic and clinical data of those who underwent SEEG-guided insula cortex resection. In total, 11 children (7 females, 4 males) who underwent SEEG-guided resection were identified. The mean age at first SEEG was 13 years old. Mean age at seizure onset was 4.3 years; seizure frequency ranged from 50/day to 2/week. Four children required 1 SEEG study, 6 children 2 SEEG, and 1 child underwent 3 SEEG recordings. The mean follow-up duration was 2.1 years; at the latest follow-up, three children had Engel I, 2 children Engel III, and 6 children Engel IV. One child classified as an Engel IV outcome for insular surgery had Engel class I after 2 failed insula surgeries, after an occult frontal focal cortical dysplasia was later identified and resected. No major complications were noted. In our paediatric series, one third of the patients undergoing insula cortex surgery after SEEG became seizure free but this may require repeat SEEG implantation, repeat resective surgery and the possibility of changing hypothesis from the insula cortex to nearby foci.

The Predictive Role of Preoperative Malnutrition Assessment in Postoperative Outcomes of Patients Undergoing Surgery Due to Gastrointestinal Cancer: A Cross-Sectional Observational Study

Background: Malnutrition affects patients undergoing surgery for gastrointestinal cancers and contributes to poor postoperative outcomes, including increased complication rates, longer hospital stays, and higher mortality. Despite the availability of several malnutrition screening tools and prognostic scores, their effectiveness in predicting postoperative outcomes remains unclear. This study aimed to compare the predictive accuracy of Patient-Generated Subjective Global Assessment (PG-SGA), Global Leadership Initiative on Malnutrition (GLIM), Geriatric Nutritional Risk Index (GNRI), and Controlling Nutritional Status (CONUT) score for postoperative outcomes in patients undergoing surgery for colorectal, hepato-pancreato-biliary and upper gastrointestinal cancers. Methods: A cross-sectional observational study from March 2022 to October 2023 was conducted in two university surgical departments, after registration on ClinicalTrials database (NCT05795374). Patient characteristics, preoperative nutritional status and postoperative outcomes were analyzed. Results: In total, 480 patients were enrolled. CONUT and GNRI demonstrated high specificity (over 90% and 80%, respectively) for predicting overall complications, major complications, prolonged hospital stay, mortality, and advanced disease stage across all cancer types. Notably, CONUT showed a specificity over 97% and GNRI over 89.7% for colorectal and upper gastrointestinal cancer patients, respectively, despite their lower sensitivity. On the contrary, PG-SGA and GLIM presented better sensitivity (up to 50%), but slightly lower specificity (up to 86.4%). Conclusions: CONUT and GNRI are valuable for ruling out non-at-risk patients for adverse postoperative outcomes, while PG-SGA and GLIM provide better sensitivity. A step-up approach—initial screening with PG-SGA and GLIM, followed by detailed evaluation with CONUT or GNRI— should be validated in future studies across diverse clinical settings.

Antithrombotic but not anticoagulant activity of the thrombin-binding RNA aptamer Apta-1.

Pharmacological intervention of thrombosis is challenging, requiring a fined tune balance between beneficial antithrombotic effect versus risk of major bleeding complications. In this investigation, we elucidated the antithrombotic capacity of the novel 90-mer RNA aptamer Apta-1 and its underlying mechanism of action. We utilized three independent in vivo animal models to establish antithrombotic activity and bleeding risk of Apta-1. Several cellular and molecular techniques were utilized to extensively characterize the effects of Apta-1 on primary and secondary haemostasis. Apta-1 significantly reduced thrombus weight in ferric chloride-induced carotid artery thrombosis. A consistent reduction in thrombus weight was also observed in arteriovenous shunt thrombosis in rats, whereas tail bleeding time was unaffected. Cellular and molecular analyses revealed that Apta-1 interacted with thrombin, resulting in significant inhibition of protease-activated receptor (PAR) signalling in platelets. On the other hand, Apta-1 shortened both thrombin generation and thrombin-induced clotting times. Apta-1 targets the heparin-binding motif exosite II on thrombin leading to significant suppression of platelet PAR1 and PAR4 signalling. Intriguingly, Apta-1 produces substantial antithrombotic activity without anticoagulant or general antiplatelet properties. In fact, we found that Apta-1 accelerates the formation of blood clots and thus supports haemostasis without exhibiting typical anticoagulant properties. We suggest that Apta-1 may be a promising future drug candidate for treatment of thrombosis in diseases/conditions where there are significant risks of serious bleeding complications.

First Experience with the NPseal®: A Novel Mechanically Powered Negative Pressure Dressing Applied to Colorectal Surgery Wounds.

The use of prophylactic closed-incisional negative pressure wound therapy after colorectal procedures has been shown to reduce postoperative wound complications and surgical site infection. We present our experience with a novel, closed-incision, mechanically powered negative pressure (MP-NPD) dressing after colorectal procedures. This was a prospective, single-center, single-arm observational study assessing patient reported and wound healing outcomes of colorectal surgical incisions dressed with a MP-NPD. Consecutive patients, 18years and older, that met inclusion criteria were enrolled between May 2021 and December 2021. Thirty patients were included (13 male/17 female) with a mean age of 62.7 ± 11.8years and mean body mass index of 25.5 ± 4.4kg/m2. The mean incision length covered was 3.0 ± 1.8cm. The median number of manual pinches required to initially activate the dressing with negative pressure within -75 to -125mmHg was 12 (range 7-20). Four dressings were changed (13.3%) after drainage was noted inside the pump; not including these, 88.5% (23/26) of dressings held pressure consistently without any re-pinching during the 72-h period since they were first applied in the operating room. 75.9% of patients reported the dressing was "very comfortable" and none reported the dressing restricted mobility. 79.3% of patients reported the dressing was "very easy" to use. There were no cases of major wound complication or surgical site infection within 30days. The use of MP-NPD appears to be feasible on primarily-closed colorectal incisions. Further randomized controlled study is warranted to ascertain its clinical efficacy.

Diagnostic Value of Endobronchial Ultrasound-Guided Intranodal Forceps Biopsies Combined with Rapid On-Site Evaluation for Mediastinal/Hilar Lymph Node Disease

Aims/Background Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is the standard method for sampling mediastinal/hilar lymph node disease. However, the smaller samples obtained via needle aspiration have a lower diagnostic rate for benign compared to malignant diseases. The low diagnostic rates have been reported to be improved through using endobronchial ultrasound-guided intranodal forceps biopsy (EBUS-IFB), but the implementation of IFB presents technical challenges, as described with variable results in certain studies. The main objective of this study was to investigate the diagnostic value and safety of EBUS-IFB for mediastinal/hilar lymph node disease. Methods A retrospective analysis was conducted on 150 patients with mediastinal/hilar lymph node disease at Tianjin Medical University General Hospital. EBUS-TBNA was performed using a rigid bronchoscope on the same lymph node of each patient under general anesthesia, with rapid on-site evaluation (ROSE) conducted to determine the presence of pathological tissue. Following this, a tunnel was established, and a 1.5 mm biopsy forceps was employed for EBUS-IFB. Subsequently, diagnostic rates and safety of the methods used were determined. Results EBUS-IFB + EBUS-TBNA (the combined strategy) exhibited the highest diagnostic rates, with the addition of bronchial mucosa biopsy/transbronchial lung biopsy/neoplasm biopsy contributing to a successful diagnostic rate of 97.2% (139/143). The combined strategy (90.2%) and EBUS-IFB alone (88.1%) contributed to successful diagnosis for all diseases, with rates significantly higher than that of EBUS-TBNA (60.1%) (p < 0.001). The diagnostic rates for malignant disease detected with the combined strategy (97.4%) and EBUS-IFB alone (93.6%) were significantly higher than that with EBUS-TBNA alone (71.8%) (p < 0.001). Both the diagnostic rates for sarcoidosis detected with the combined strategy and EBUS-IFB alone were 87.8%, which was significantly higher than that with EBUS-TBNA alone (46.9%) (p < 0.001). The procedures implemented did not engender major complications. Conclusion Routine EBUS-TBNA followed by ROSE to acquire pathological tissue, followed by tunnel formation and EBUS-IFB, can enhance the overall diagnostic rate for mediastinal/hilar lymph node lesions. This approach is particularly valuable for diagnosing malignant diseases and sarcoidosis. EBUS-IFB serves as a safe and feasible complement to EBUS-TBNA, despite the fact that the procedure was extended in duration.

Outcomes of Intraoperative Radiotherapy for Locally Advanced Adenocarcinoma of the Esophagogastric Junction After Neoadjuvant Therapy: A Single-Arm, Phase 1 Trial Fromthe Chinese National Cancer Center.

The role of intraoperative radiotherapy (IORT) for adenocarcinoma of the esophagogastric junction (AEG) remains uncertain. Therefore, a prospective phase 1 trial was conducted to assess the safety and feasibility of IORT for locally advanced AEG. The study enrolled patients with AEG at stages II-IVA from January 2019 to September 2019. Eligible patients received esophagectomy and a single fraction of electron beam radiotherapy. The primary endpoint of the study was a safety profile for IORT. Additionally, survival outcomes and the locoregional recurrence rate (LRR) were compared between the non-IORT and IORT cohorts using propensity score-matching. For 15 (93.8 %) of the 16 patients in the study, R0 resection was successfully achieved, with only one patient undergoing R1 resection. A total postoperative complication morbidity rate of 43.8 % (7/16) was observed, with major complications (Clavien-Dindo classification ≥3) in 12.5 % of the cases (2/16). Total treatment-related adverse events were reported for seven patients (43.8 %, 7/16). After matching, a lower LRR was observed in the IORT group than in the non-IORT group (0 % [0/12] vs 33.3 % [4/12]; p = 0.028). However, the two groups did not differ significantly in 3-year progression-free survival (PFS: IORT [50.9 %] vs non-IORT [53.4 %]; p = 0.93) or 3-year overall survival (OS: IORT [58.3 %] vs IORT [72.9 %]; p = 0.23). The current study demonstrated favorable feasibility and safety of IORT for locally advanced AEG. Although IORT is beneficial for improving local control, it may not prolong PFS or OS for patients with locally advanced AEG. A phase 2 trial is warranted for further validation of these outcomes.

Utility of Surgical Apgar Score in Predicting Post-operative Complications After Whipple Procedure in Pancreatic Cancer Patients

AbstractAn intraoperative 10-point Surgical Apgar Score, based on estimated blood loss, lowest mean arterial pressure, and lowest heart rate, was developed and validated for predicting postoperative complications in patients undergoing vascular and general surgeries. We sought to estimate the ability of this metric to predict major postoperative complications in patients with pancreatic cancer undergoing the Whipple procedure. This is a prospective, observational, single-centre study involving adult patients undergoing the Whipple procedure, at a major tertiary cancer centre. All eligible patients undergoing Whipple surgery in our institute between March 2018 and October 2021 were included in the study. Demographic data, clinicopathological characteristics, comorbidities, intraoperative variables, and postoperative complications were analyzed. The surgical score was calculated from intraoperative blood loss, lowest heart rate, and lowest mean arterial pressure. All the patients were followed up till 30 days postoperatively. Descriptive statistics and univariate and multivariate analyses were used as appropriate. The occurrence of major postoperative complications represented the primary outcome. A total of 253 patients were analyzed. The mean duration of surgery was 436 min. On statistical analyses, the occurrence of major postoperative complications was significantly associated with SAS ≤ 4 (OR = 8.00, 95% CI = 3.78–16.93, p = 0.000), use of intraoperative vasopressor (OR = 2.247, 95% CI = 1.312–3.846, p = 0.003), and body mass index (BMI) (OR = 1.074, 95% CI = 1.010–1.142, p = 0.022). However, we did not find any significant association between other demographic variables like age, comorbidities, duration of surgery, and preoperative s. albumin with the occurrence of postoperative complications. Lower SAS (≤ 4) is the most powerful predictor of postoperative complications in pancreatic cancer patients undergoing Whipple surgery. The score provides a simple and immediate means of measuring and communicating patient outcomes, using data routinely available in any setting.

Size Does Matter: Mastectomy Flap Thickness as an Independent Decisional Factor for the Peri-Prosthetic Device Choice in Prepectoral Breast Reconstruction

Background. In alloplastic breast reconstruction, the choice of implant positioning and the selection of periprosthetic devices is a critical and challenging decision. Surgeons must navigate between various biologic and synthetic meshes, including acellular dermal matrices (ADM). This study aimed to propose a simple selection tool for periprosthetic devices in prepectoral breast reconstruction. Methods. Patients scheduled for mastectomy followed by implant-based breast reconstruction between September 2019 and December 2023 were included. Preoperative risk assessments were performed using the Pre-Bra Score, and only those deemed suitable for prepectoral implant placement were selected. Mastectomy flap thickness was used as an independent criterion, and only cases with flap thicknesses less than 1 cm were included. Results. A total of 70 cases with an average flap thickness of 0.7 cm (range, 0.4–0.9 cm), as measured by preoperative contrast-enhanced spectral mammography (CESM), underwent prepectoral reconstruction with ADM covering the implant. Of these, 25 patients (35%) received direct-to-implant reconstruction, while 45 (65%) underwent two-stage reconstruction with a temporary tissue expander. Postoperative complications were recorded during a minimum follow-up period of 6 months. Over an average follow-up duration of 17.5 months (range 6–36 months), no major complications were observed. Minor complications occurred in seven patients: infection (1.28%), seroma (3.85%), and superficial skin necrosis (1.28%). Additionally, 21 patients (30%) experienced rippling, and secondary lipofilling was scheduled. Conclusions. The incidence of rippling was reduced by 40% through ADM in this patient subgroup, reducing the need for secondary aesthetic refinements.

Ultrasound-Guided vs Non-Ultrasound-Guided Angio-Seal Vascular Hemosasis After Endovascular Treatment for Peripheral Artery Disease: An Observational Study.

Ultrasound visualization of vascular closure devices during endovascular access closure leads to a significant decrease in overall and major post interventional access site complications. This non-invasive and often readily available imaging technique could therefore lead to an important decrease in morbidity and subsequent overall health care costs when added to the standard intervention protocol. With the increasing use of endovascular techniques to treat peripheral artery disease, the addition of ultrasound-techniques in closure of endovascular access sites could potentially have a large clinical impact, both on patient outcomes as well as financial outcomes.

Beyond Obstruction: Evaluating Self-Expandable Metallic Stents (SEMSs) vs. Emergency Surgery for Challenging pT4 Obstructive Colon Cancer: Multicentre Retrospective Study

Background/Objectives: Colon cancer presents as an obstruction in almost 30% of patients. Self-expandable metallic stents emerged as an alternative to emergency surgery, despite early controversies around their use. Improved techniques led to stent incorporation in clinical guidelines. Our objective is to compare colectomies performed after the insertion of self-expandable metallic stents versus emergency surgeries in pT4 obstructive left colon cancer, analysing postoperative and oncological outcomes. Methods: This is an observational retrospective multicentre study involving 50 hospitals and analysing data from patients with pT4 obstructive tumours treated for curative intent between 2015 and 2017. Patients with left-sided obstructive colon cancer were included, with exclusion criteria being palliative surgery or incomplete resection. Primary outcomes were local, peritoneal, and systemic recurrence rates, overall survival (OS), and disease-free survival (DFS). Secondary outcomes were postoperative complications and the rate of surgeries without major complications. Results: In total, 196 patients were analysed, 128 undergoing emergency surgery and 68 receiving colonic stents. Stents more frequently allowed for minimally invasive surgeries: 33.8% vs. 4.7% (p < 0.01). The stent group showed fewer major complications (Clavien–Dindo ≥ 3) at 4.5% vs. 22.4% (p < 0.01), fewer infectious complications at 13.2% vs. 23.1% (p = 0.1), and fewer organ-space infections at 3.3% vs. 15.9% (p = 0.03). No significant differences in recurrence rates, 29.4% vs. 28.1% (p = 0.8); disease-free survival, 44.5 vs. 44.3 months (p = 0.5); or overall survival, 50.5 vs. 47.6 months (p = 0.4), were found between groups. Conclusions: Self-expandable metallic stents are a safe alternative for pT4 obstructive left colon cancer, improving postoperative outcomes without compromising short- and medium-term oncological results. Consideration of experienced clinicians and potential referral to centres with advanced stenting capabilities may enhance patient care.

Complications of Caroli's Disease: Two Case Reports and a Literature Review

Caroli's disease is a rare congenital disorder of the bile ducts, characterized by intrahepatic segmental dilatation. It can remain asymptomatic for many years. Imaging, especially hepatobiliary MRI, plays a central role in diagnosis, identifying pathognomonic signs (Dot-sign, cyst communication with bile ducts), and monitoring complications. Treatment primarily involves surgery, ranging from partial resection to liver transplantation for diffuse forms. This article presents two cases: one involving an association with cholangiocarcinoma and another complicated by intrahepatic stones and cholangitis. These cases highlight the major complications, diagnostic approaches, and therapeutic strategies for this rare condition.

High Success Rate in Sealing Distal Coronary Artery Perforations Using Absorbable Gelatin Sponge

AbstractCoronary artery perforation (CAP) is a major complication of percutaneous coronary intervention (PCI). The management of CAP can be challenging, requiring tailored approaches based on specific clinical scenarios. We are reporting outcome data on six patients who experienced distal CAP during PCI and were 100% successfully treated using absorbable gelatin sponge embolization without procedural or immediate postprocedural complications.

Hands-On Robotic Microsurgery: Robotic-Assisted Free Flap Reconstruction of the Upper Extremity

Background/Objectives: Robot-assisted microsurgery (RAMS) has been introduced into the field of plastic surgery in recent years. It potentially offers enhanced precision and control compared to traditional methods, which is crucial for complex microvascular tasks in free flap reconstructions. We aim to analyze our experiences with robotic-assisted microsurgery in the field of upper extremity free flap reconstruction. Methods: This prospective study evaluated the efficacy and safety of the Symani Surgical System for free flap reconstructions in 16 patients with upper extremity defects at our institution from February 2023 to March 2024. Operating times were compared to a matched, historical cohort. We collected data on surgical outcomes, operative times, and complication rates, following strict adherence to the Declaration of Helsinki. Results: Our cohort primarily involved male patients (81%) with defects mostly located on the hand (81%). The anterolateral thigh flap was the most commonly used free flap (14/16, 88%). The average operative time was 368 ± 89 min (range: 216–550min). No complete or partial flap losses were observed, but one flap required revision surgery due to arterial thrombosis. Major complications occurred in 13% of the cases. The average anastomosis time was 31 ± 12 min (range: 20–35 min) for arterial end-to-end anastomoses and 33 ± 13min (range: 20–60min) for arterial end-to-side anastomoses. Venous anastomoses required, on average, 20 ± 6min. Operating times were not significantly longer when compared to the historical cohort (p = 0.67). Conclusions: We were able to show comparable outcomes to conventional microsurgery, while requiring more time for the microsurgical anastomoses. The study highlights the need for larger, controlled trials to better understand the benefits and limitations of robotic assistance in microsurgical reconstruction of the upper extremity.

The Impact of Diabetes on Abdominoplasty Outcomes: A Systematic Review and Meta-Analysis.

Abdominoplasty is increasingly sought after by patients for aesthetic rejuvenation or functional improvement. However, no previous study has comprehensively evaluated the impact of diabetes on post-abdominoplasty complications. This systematic review aimed to investigate the impact of diabetes on outcomes following abdominoplasty. A comprehensive literature search was conducted systematically on MEDLINE Ovid, PubMed, Web of Science, and the Cochrane CENTRAL databases from inception to January 2023. The primary outcomes of interest were overall complications. The secondary outcomes included major complications and minor complications. A meta-analysis was performed in accordance with PRISMA guidelines to examine the impact of diabetes on post-abdominoplasty complications. A total of fifteen studies involving 79724 patients, 5483 of whom had diabetes, met our inclusion criteria. Patients with diabetes were more likely to suffer from overall complications (OR = 1.63, 95% CI, 1.12-2.14; P < 0.05), major complications (OR = 1.44, 95% CI, 1.24-1.64; P < 0.05) and minor complications (OR = 1.84, 95% CI, 1.34-2.34; P < 0.05) than non-diabetic patients after abdominoplasty. Furthermore, patients with diabetes had a higher risk of wound-related complications (OR = 2.54, 95% CI, 1.80-3.27; P < 0.05) than non-diabetic patients after abdominoplasty. This study is the first systematic review and meta-analysis to evaluate how diabetes affects abdominoplasty outcomes. It finds that diabetes significantly increases the risk of overall, major, minor, and wound-related complications compared to non-diabetic patients. However, it does not elevate the risk of ischemic complications. Surgeons should inform patients about these risks, and future research should investigate how glycemic control might reduce these complications. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Novel variants impairing Sp1 transcription factor binding in the COL7A1 promoter cause mild cases of recessive dystrophic epidermolysis bullosa.

Recessive dystrophic epidermolysis bullosa (RDEB) is a rare and most often severe genodermatosis characterized by recurrent blistering and erosions of the skin and mucous membranes after minor trauma, leading to major local and systemic complications. RDEB is caused by loss-of-function mutations in COL7A1 encoding type VII collagen (C7), the main component of anchoring fibrils which form attachment structures stabilizing the cutaneous basement membrane zone. Most of the previously reported COL7A1 mutations are located in the coding or intronic regions. We describe 6 patients with localized or intermediate RDEB for whom one recessive pathogenic variant in the coding region and a second variant in the COL7A1 promoter were identified. These substitutions, three of which are novel, are localized in two Sp1 binding sites of the promoter region. DNA pull-down assay showed a drastic reduction of Sp1 binding consistent with a dramatic decrease in COL7A1 transcript and almost undetectable C7 protein levels. Our results reveal that mutations in the COL7A1 promoter on the background of a null allele can underlie localized or intermediate RDEB. They further emphasize the functional importance of Sp1 motifs in the proximal COL7A1 promoter which should be carefully investigated for regulatory mutations in the case of RDEB with only one pathogenic variant identified in the coding or intronic regions.

Addressing Systemic Complications of Acute Stroke: A Scientific Statement From the American Heart Association.

Systemic, nonneurological complications are common after ischemic and hemorrhagic strokes, affect different organ systems, and have a major impact on patient outcomes. Despite their obvious implications, this area in stroke management remains inadequately researched, and current literature offers fragmentary guidance for care. The purpose of this scientific statement is to elucidate the major systemic complications of strokes that occur during hospitalization, to synthesize evidence from current literature and existing guidelines, to address gaps in knowledge, and to provide a coherent set of suggestions for clinical care based on interpretation of existing evidence and expert opinion. This document advocates for improved interdisciplinary collaboration, team effort, and effective implementation strategies to reduce the burden of these events in clinical practice. It also calls for further research on strategies for preventing and managing systemic complications after stroke that improve outcomes in stroke survivors.

Single incision laparoscopic totally preperitoneal hernioplasty (SIL-TPP) for bilateral inguinal hernia repair: initial experience

ObjectiveThe aim of this study was to introduce and assess the safety and feasibility of single incision laparoscopic totally preperitoneal hernioplasty (SIL-TPP) for bilateral inguinal hernia repair.MethodForty-two SIL-TPP procedures for bilateral inguinal hernia repair were conducted from June 2018 to July 2022 at the First Affiliated Hospital of Ningbo University using standard laparoscopic instruments and a single-port device. Clinical data such as demographic intraoperative parameters and short-term postoperative outcomes were collected and analysed.ResultsSIL-TPP was successful in 42 bilateral inguinal hernia patients, and no conversion occurred. Of these 42 patients, 38 were males and 4 were females. The average age was 57.4 ± 17 years. The participants’ mean BMI was 22.67 ± 2.19 kg/m2 (range from 18.65 to 28.71 kg/m2). There were 4 types of bilateral hernias. The percentage of patients who underwent surgery before the SIL-TPP procedure in the same region was 21.43% (9/42). The mean operative time was 114 ± 34.24 min (range, 70–215 min). A total of 11 intraoperative complications occurred in 42 bilateral inguinal hernia patients, including unintentional peritoneum tears and hernia sac tears. No major complications occurred in the study. The postoperative complication rate was 2.38% (1/42). One patient experienced intestinal obstruction after the operation that resolved spontaneously without treatment. The surgical time in the SIL-TPP group decreased gradually as the number of operations increased. Moreover, the operation time trend decreased linearly (P < 0.0001, R²=0.42).ConclusionSIL-TPP is a safe and feasible procedure for treating bilateral inguinal hernias. The SIL-TPP procedure requires distinct skills and has specific advantages in treating bilateral hernias. Large-scale randomized controlled studies comparing SIL-TPP with conventional single-port and three-port laparoscopic TEP for bilateral inguinal hernia are needed to confirm these results.

The Role of Helium Plasma-Assisted Liposuction in Lipoabdominoplasty After Weight loss.

Weight loss patients present with major deformities, leading to the rapid development of new body contouring techniques to address their specificities. Abdominal skin laxity is often major due to rapid weight loss and inflammation secondary to bariatric surgeries and is often present in both vertical and horizontal axes. Through this article, the authors wish to demonstrate the use of helium plasma radiofrequency technology for supraumbilical skin tightening following lipoabdominoplasty. A retrospective single-center cohort study was performed, including 100 consecutive patients undergoing HPRF-assisted lipoabdominoplasty. Patient characteristics, intra- and postoperative outcomes and complications were collected. A postoperative Likert scale evaluated patient satisfaction at 6-month follow-up. The mean age was 37, and the median preoperative BMI was 25.3. The median follow-up period was 19.7 months. Among the 100 included patients, no major complication occurred. Minor complications included wound dehiscence (1%), subcutaneous emphysema (2%), hyperpigmentation (8%), seroma (6%), and hematoma (2%). Overall satisfaction was high with 88% of 5/5 evaluations on the Likert scale. HPRF-assisted lipoabdominoplasty stands as a safe and efficient refinement in post-bariatric patients and can be used to avoid vertical scars and decrease scar tension. This technology seems, therefore, valuable to enhance body contouring procedures while minimizing morbidity. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine Ratings, please refer to Table of Contents or online Instructions to Authors www.springer.com/00266 .

Epilepsy surgery in children with operculoinsular epilepsy: Results of a large unicentric cohort.

Epilepsy surgery in the operculoinsular cortex is challenging due to the difficult delineation of the epileptogenic zone and the high risk of postoperative deficits. Pre- and postsurgical data from 30 pediatric patients who underwent operculoinsular cortex surgery at the Motol Epilepsy Center Prague from 2010 to 2022 were analyzed. Focal cortical dysplasia (FCD; n = 15, 50%) was the predominant cause of epilepsy, followed by epilepsy-associated tumors (n = 5, 17%) and tuberous sclerosis complex (n = 2, 7%). In eight patients where FCD was the most likely etiology, the histology was negative. Seven patients (23%) displayed normal magnetic resonance imaging results. Seizures exhibited diverse semiology and propagation patterns (frontal, perisylvian, and temporal). The ictal and interictal electroencephalographic (EEG) findings were mostly extensive. Multimodal imaging and advanced postprocessing were frequently used. Stereo-EEG was used for localizing the epileptogenic zone and eloquent cortex in 23 patients (77%). Oblique electrodes were used as guides for better neurosurgeon orientation. The epileptogenic zone was in the dominant hemisphere in 16 patients. At the 2-year follow-up, 22 patients (73%) were completely seizure-free, and eight (27%) experienced a seizure frequency reduction of >50% (International League Against Epilepsy class 3 and 4). Fourteen patients (47%) underwent antiseizure medication tapering; treatment was completely withdrawn in two (7%). Nineteen patients (63%) remained seizure-free following the definitive outcome assessment (median = 6 years 5 months, range = 2 years to 13 years 5 months postsurgery). Six patients (20%) experienced corona radiata or basal ganglia ischemia; four (13%) improved to mild and one (3%) to moderate hemiparesis. Two patients (7%) operated on in the anterior insula along with frontotemporal resection experienced major complications: pontine ischemia and postoperative brain edema. Epilepsy surgery in the operculoinsular cortex can lead to excellent patient outcomes. A comprehensive diagnostic approach is crucial for surgical success. Rehabilitation brings a great chance for significant recovery of postoperative deficits.

Sportsman's Hernia repair using Nesovic procedure, a 13-year single-center experience.

Sportsman's hernia is very frequent in some sports, particularly in football. This painful syndrome is reported by high-level athletes as well as amateurs. There is no consensus about the management of sportsman's hernia, because of the heterogeneity in anatomoclinic forms. In case of surgical indication, the Nesovic procedure, also named "fasciomyoplasty", is one of the recommended procedures for the abdomino-parietal forms. Our objective was to report our experience with this procedure in terms of short- and mid-term results. All the patients who underwent Nesovic procedure between January 2009 and December 2022 in our center were retrospectively reviewed. 43 patients (98% men; mean age: 29.5 ± 9.2years) were included. 37% of patients were professional athletes. The median time from symptoms' onset to diagnosis was 3months (range = 1-72months). The median time from diagnosis to surgery was 7months (range = 1-58months). Postoperative overall morbidity occurred in six patients (14%), including scrotum swelling (n = 2), hematoma (n = 1), serous collection (n = 1) and acute urinary retention (n = 2). No major complication occurred. At the end of follow-up (median: 1year; range = 1month-11years), 84% of patients recovered their previous sports activity, after a mean delay of 2months. Nesovic procedure is efficient in more than 80% of sports patients without any major morbidity.