Joachim S Skovbo,Lasse M Obel,Lytfi Krasniqi,Mads Liisberg,Jes S Lindholt
INTRODUCTIONSupervised Exercise Therapy (SET) is recommended as first-line treatment for intermittent claudication. We hypothesized that oxidative stress from long-term intermittent leg ischaemia is harmful and that revascularization mitigates this risk. The aim of this hypothesis-driven systematic review and meta-analysis was to evaluate the long-term mortality rate and clinical outcomes comparing SET with early revascularization in patients with intermittent claudication.METHODSRCTs comparing SET and early revascularization with >12 months follow-up and reporting mortality rates were included. Medline, Embase, Cochrane Central, ClinicalTrials.gov, and WHO ICTRP were searched using a modified PICO (PICS) framework. Risk-of-bias was assessed using the Cochrane Risk-of-Bias Tool. Meta-analyses applied hazard ratios, incidence rate ratios (IRR), or odds ratios as appropriate. PROSPERO registration: CRD42024536634.RESULTSSome nine cohorts from seven RCTs (1113 patients) were included. Meta-analysis of HR (two cohorts) displayed higher mortality rates with SET compared to early revascularization (HR: 1.83; 95% c.i.: 1.10 to 3.04; P = 0.02). Intention-to-treat IRR analysis (eight cohorts) displayed an IRR of 1.28; 95% c.i.: 0.91 to 1.79; P = 0.16. A worst-case post-hoc sensitivity analysis assuming all losses to follow-up as deaths presented higher mortality rate with SET (IRR: 1.29; 95% c.i.: 1.04 to 1.61; P = 0.02). SET reduced initial revascularizations by 60.3%, but 34.8% crossed over, resulting in over twice the need for subsequent revascularization (OR: 2.30; 95% c.i.: 1.71 to 3.11; P < 0.001). No differences were found for amputation, myocardial infarction, or stroke. Risk-of-bias was deemed high, and certainty of evidence ranged from low to very low.CONCLUSIONEarly revascularization may improve long-term survival compared to SET, although interpretation is limited by risk-of-bias and incomplete data in published studies.
{"title":"Long-term mortality rate after supervised exercise therapy versus early revascularization for intermittent claudication: a systematic review and meta-analysis.","authors":"Joachim S Skovbo,Lasse M Obel,Lytfi Krasniqi,Mads Liisberg,Jes S Lindholt","doi":"10.1093/bjs/znaf294","DOIUrl":"https://doi.org/10.1093/bjs/znaf294","url":null,"abstract":"INTRODUCTIONSupervised Exercise Therapy (SET) is recommended as first-line treatment for intermittent claudication. We hypothesized that oxidative stress from long-term intermittent leg ischaemia is harmful and that revascularization mitigates this risk. The aim of this hypothesis-driven systematic review and meta-analysis was to evaluate the long-term mortality rate and clinical outcomes comparing SET with early revascularization in patients with intermittent claudication.METHODSRCTs comparing SET and early revascularization with >12 months follow-up and reporting mortality rates were included. Medline, Embase, Cochrane Central, ClinicalTrials.gov, and WHO ICTRP were searched using a modified PICO (PICS) framework. Risk-of-bias was assessed using the Cochrane Risk-of-Bias Tool. Meta-analyses applied hazard ratios, incidence rate ratios (IRR), or odds ratios as appropriate. PROSPERO registration: CRD42024536634.RESULTSSome nine cohorts from seven RCTs (1113 patients) were included. Meta-analysis of HR (two cohorts) displayed higher mortality rates with SET compared to early revascularization (HR: 1.83; 95% c.i.: 1.10 to 3.04; P = 0.02). Intention-to-treat IRR analysis (eight cohorts) displayed an IRR of 1.28; 95% c.i.: 0.91 to 1.79; P = 0.16. A worst-case post-hoc sensitivity analysis assuming all losses to follow-up as deaths presented higher mortality rate with SET (IRR: 1.29; 95% c.i.: 1.04 to 1.61; P = 0.02). SET reduced initial revascularizations by 60.3%, but 34.8% crossed over, resulting in over twice the need for subsequent revascularization (OR: 2.30; 95% c.i.: 1.71 to 3.11; P < 0.001). No differences were found for amputation, myocardial infarction, or stroke. Risk-of-bias was deemed high, and certainty of evidence ranged from low to very low.CONCLUSIONEarly revascularization may improve long-term survival compared to SET, although interpretation is limited by risk-of-bias and incomplete data in published studies.","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"23 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145986564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Perioperative management of people with diabetes undergoing surgery.","authors":"Ketan K Dhatariya","doi":"10.1093/bjs/znaf291","DOIUrl":"https://doi.org/10.1093/bjs/znaf291","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"54 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145961495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"A novel retromuscular Sugarbaker technique for parastomal hernia prevention in end colostomy: combination of laparoscopic posterior component separation and extraperitoneal bowel pull-through.","authors":"Jianlin Xiao,Wenjian Meng,Ziqiang Wang","doi":"10.1093/bjs/znaf252","DOIUrl":"https://doi.org/10.1093/bjs/znaf252","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"41 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145961494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Joel Norton,Allison M Janda,Emma Howie,Nicole Pohl,Egide Abahuje,Steven D Harrington,Vitaliy Popov,Tyler M Bauer,Paulo Borges,Gabriela Querejeta Roca,Michael R Mathis,Raymond J Strobel,Austin Airhart,Nicole Pham,Ryan Harari,Jake A Awtry,Francis D Pagani,Roger D Dias,Donald S Likosky,Steven Yule,
BACKGROUNDDeficiencies in non-technical skills (NTS) such as leadership and communication can lead to intraoperative inefficiency and error. However, the relationship between these skills and patient-level outcomes has yet to be synthesized. The aim of this study was to systematically review the evidence examining the relationship between intraoperative NTS and clinical outcomes.METHODSThe PubMed, Embase, CENTRAL, CINAHL, and PsycINFO databases were searched for relevant studies published between inception and 1 November 2024. Eligible studies assessed NTS of operating room personnel, were conducted in non-simulated environments, and reported clinical outcomes. NTS were categorized into five core domains including leadership and communication. Patient-level outcomes comprised eight clinical measures including mortality and postoperative complications.RESULTSOf 6313 screened studies, 21 met the inclusion criteria. Included studies represented 8536 participants performing 251 180 procedures across 13 specialties. Eleven observational studies assessed NTS of surgical personnel via study participants or observers. Ten interventional studies introduced NTS team training initiatives. Twelve of 21 studies (57%) incorporating 247 036 of all procedures (98.4%) reported significant improvements in clinical outcomes. Nine of 11 observational studies (82%) reported significant improvement in clinical outcomes compared with 3 of 10 interventional studies (30%). No studies demonstrated a significant deterioration in clinical outcomes associated with improved NTS.CONCLUSIONPublished evidence shows a significant link between intraoperative NTS and patient-level outcomes. These findings reinforce the value of behavioural assessment in surgery, support evidence-based team training, and underscore the need to embed NTS into regulatory frameworks to improve surgical quality and safety worldwide.
{"title":"Impact of surgical non-technical skills on clinical outcomes: systematic review.","authors":"Joel Norton,Allison M Janda,Emma Howie,Nicole Pohl,Egide Abahuje,Steven D Harrington,Vitaliy Popov,Tyler M Bauer,Paulo Borges,Gabriela Querejeta Roca,Michael R Mathis,Raymond J Strobel,Austin Airhart,Nicole Pham,Ryan Harari,Jake A Awtry,Francis D Pagani,Roger D Dias,Donald S Likosky,Steven Yule, ","doi":"10.1093/bjs/znaf271","DOIUrl":"https://doi.org/10.1093/bjs/znaf271","url":null,"abstract":"BACKGROUNDDeficiencies in non-technical skills (NTS) such as leadership and communication can lead to intraoperative inefficiency and error. However, the relationship between these skills and patient-level outcomes has yet to be synthesized. The aim of this study was to systematically review the evidence examining the relationship between intraoperative NTS and clinical outcomes.METHODSThe PubMed, Embase, CENTRAL, CINAHL, and PsycINFO databases were searched for relevant studies published between inception and 1 November 2024. Eligible studies assessed NTS of operating room personnel, were conducted in non-simulated environments, and reported clinical outcomes. NTS were categorized into five core domains including leadership and communication. Patient-level outcomes comprised eight clinical measures including mortality and postoperative complications.RESULTSOf 6313 screened studies, 21 met the inclusion criteria. Included studies represented 8536 participants performing 251 180 procedures across 13 specialties. Eleven observational studies assessed NTS of surgical personnel via study participants or observers. Ten interventional studies introduced NTS team training initiatives. Twelve of 21 studies (57%) incorporating 247 036 of all procedures (98.4%) reported significant improvements in clinical outcomes. Nine of 11 observational studies (82%) reported significant improvement in clinical outcomes compared with 3 of 10 interventional studies (30%). No studies demonstrated a significant deterioration in clinical outcomes associated with improved NTS.CONCLUSIONPublished evidence shows a significant link between intraoperative NTS and patient-level outcomes. These findings reinforce the value of behavioural assessment in surgery, support evidence-based team training, and underscore the need to embed NTS into regulatory frameworks to improve surgical quality and safety worldwide.","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"9 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145847253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Gordon R Daly,Gavin P Dowling,Sandra Hembrecht,Sorcha O'Grady,Aisling Hegarty,Trudi Roche,Gabriel Orsi,Arielle Pierre,Gavin G Calpin,Colm Neary,Cian M Hehir,Gerard J Hill,Abigail O'Brien,William P Duggan,Matthew G Davey,Ian J B Stephens,Niall D Kennedy,Oisín Brennan,Cathal Hayes,Mohammed Al Azzawi,Ishwarya Balasubramanian,Andrew McGuire,Alexandra M Zaborowski,Ian S Reynolds,Paula Loughlin,Michael Allen,Colm Power,Abeeda Butt,Michael R Boland,Niamh McCawley,John P Burke,William B Robb,Achille Mastrosimone,Mayilone Arumugasamy,Hugo Prins,David Beddy,Michael J Kerin,Deborah A McNamara,David Kearney,Jan Sorensen,Gerard F Curley,Sami Abd El Wahab,Arnold D K Hill
BACKGROUNDTransversus abdominis plane (TAP) block has been shown to be an effective technique in providing postoperative analgesia across a range of intra-abdominal surgeries. Laparoscopic-assisted transversus abdominis plane (LTAP) block is a recent advancement of this technique. The aim of this trial was to evaluate the effectiveness of LTAP block compared with port-site infiltration (PSI) of local anaesthetic in patients undergoing laparoscopic appendicectomy.METHODSA single-blinded RCT was performed across three academic hospitals. Patients were randomized 1 : 1 to receive LTAP block or PSI. The primary outcome was postoperative pain, assessed using a visual analogue scale (VAS). Secondary outcomes were postoperative opioid requirements, length of hospital stay (LOS), time to mobilization, and quality of life (QoL) after hospital discharge.RESULTSIn total, 85 of 87 patients (97.7%) in the LTAP group and 82 of 84 patients (97.6%) in the control (PSI) group were eligible for analysis. The VAS pain scores were statistically significantly lower overall in the LTAP group compared with the control (PSI) group on time-weighted analysis after laparoscopic appendicectomy (-1.7 (95% c.i. -2.06 to -1.34); P < 0.001). The difference-in-difference analysis showed that the mean VAS score for the LTAP group statistically significantly improved at 6 h (-1.63 (95% c.i. -2.55 to -0.70); P = 0.001) and 12 h (-2.06 (95% c.i. -2.92 to -1.20); P < 0.001) with no difference at 24 h (-0.68 (95% c.i. -1.55 to 0.19); P = 0.125). This is in comparison with the PSI group at 6 h (3.72 (95% c.i. 3.27 to 4.17); P < 0.001), 12 h (3.37 (95% c.i. 2.89 to 3.87); P < 0.011), and 24 h (1.57 (95% c.i. 1.13 to 2.01); P < 0.001). There was a significant reduction in oxycodone requirements in the LTAP group (1.2 versus 0.8; P = 0.032).CONCLUSIONLTAP block significantly improved early postoperative analgesia outcomes in patients undergoing laparoscopic appendicectomy and holds promise as part of an effective postoperative analgesic regimen.REGISTRATION NUMBERNCT05427266 (http://www.clinicaltrials.gov).
背景：腹横面阻滞（TAP）已被证明是一种有效的技术，可在一系列腹内手术中提供术后镇痛。腹腔镜辅助腹横面阻滞（LTAP）是该技术的最新进展。本试验的目的是评估LTAP阻滞与端口部位浸润（PSI）局部麻醉在腹腔镜阑尾切除术患者中的有效性。方法采用单盲随机对照试验（RCT）对3所专科医院进行分析。患者以1:1的比例随机接受LTAP阻滞或PSI治疗。主要终点是术后疼痛，使用视觉模拟评分（VAS）进行评估。次要结局是术后阿片类药物需求、住院时间（LOS）、活动时间和出院后生活质量（QoL）。结果LTAP组87例患者中有85例（97.7%）符合分析标准，对照组（PSI） 84例患者中有82例（97.6%）符合分析标准。腹腔镜阑尾切除术后，LTAP组VAS疼痛评分总体上低于对照组（PSI）组(-1.7 (95% ci . -2.06 ~ -1.34)；P < 0.001)。两组间差异分析显示，LTAP组VAS平均评分在6 h时显著改善(-1.63 (95% ci . -2.55 ~ -0.70)；P = 0.001)和12 h (-2.06 (95% c.i。-2.92 - -1.20);P < 0.001)， 24小时无差异(-0.68 (95% ci: -1.55 ~ 0.19)；P = 0.125)。这与PSI组在6小时(3.72 (95% c.i. 3.27至4.17)；P < 0.001)， 12小时（3.37）（95% ci: 2.89 ~ 3.87）；P < 0.011), 24 h (1.57) (95% ci = 1.13 ~ 2.01)；P < 0.001)。LTAP组羟考酮需要量显著降低（1.2 vs 0.8; P = 0.032）。结论ltap阻滞可显著改善腹腔镜阑尾切除术患者术后早期镇痛效果，有望成为有效的术后镇痛方案的一部分。注册号05427266 （http://www.clinicaltrials.gov）。
{"title":"Laparoscopic-assisted transversus abdominis plane block versus port-site infiltration in appendicectomy: multicentre randomized clinical trial.","authors":"Gordon R Daly,Gavin P Dowling,Sandra Hembrecht,Sorcha O'Grady,Aisling Hegarty,Trudi Roche,Gabriel Orsi,Arielle Pierre,Gavin G Calpin,Colm Neary,Cian M Hehir,Gerard J Hill,Abigail O'Brien,William P Duggan,Matthew G Davey,Ian J B Stephens,Niall D Kennedy,Oisín Brennan,Cathal Hayes,Mohammed Al Azzawi,Ishwarya Balasubramanian,Andrew McGuire,Alexandra M Zaborowski,Ian S Reynolds,Paula Loughlin,Michael Allen,Colm Power,Abeeda Butt,Michael R Boland,Niamh McCawley,John P Burke,William B Robb,Achille Mastrosimone,Mayilone Arumugasamy,Hugo Prins,David Beddy,Michael J Kerin,Deborah A McNamara,David Kearney,Jan Sorensen,Gerard F Curley,Sami Abd El Wahab,Arnold D K Hill","doi":"10.1093/bjs/znaf257","DOIUrl":"https://doi.org/10.1093/bjs/znaf257","url":null,"abstract":"BACKGROUNDTransversus abdominis plane (TAP) block has been shown to be an effective technique in providing postoperative analgesia across a range of intra-abdominal surgeries. Laparoscopic-assisted transversus abdominis plane (LTAP) block is a recent advancement of this technique. The aim of this trial was to evaluate the effectiveness of LTAP block compared with port-site infiltration (PSI) of local anaesthetic in patients undergoing laparoscopic appendicectomy.METHODSA single-blinded RCT was performed across three academic hospitals. Patients were randomized 1 : 1 to receive LTAP block or PSI. The primary outcome was postoperative pain, assessed using a visual analogue scale (VAS). Secondary outcomes were postoperative opioid requirements, length of hospital stay (LOS), time to mobilization, and quality of life (QoL) after hospital discharge.RESULTSIn total, 85 of 87 patients (97.7%) in the LTAP group and 82 of 84 patients (97.6%) in the control (PSI) group were eligible for analysis. The VAS pain scores were statistically significantly lower overall in the LTAP group compared with the control (PSI) group on time-weighted analysis after laparoscopic appendicectomy (-1.7 (95% c.i. -2.06 to -1.34); P < 0.001). The difference-in-difference analysis showed that the mean VAS score for the LTAP group statistically significantly improved at 6 h (-1.63 (95% c.i. -2.55 to -0.70); P = 0.001) and 12 h (-2.06 (95% c.i. -2.92 to -1.20); P < 0.001) with no difference at 24 h (-0.68 (95% c.i. -1.55 to 0.19); P = 0.125). This is in comparison with the PSI group at 6 h (3.72 (95% c.i. 3.27 to 4.17); P < 0.001), 12 h (3.37 (95% c.i. 2.89 to 3.87); P < 0.011), and 24 h (1.57 (95% c.i. 1.13 to 2.01); P < 0.001). There was a significant reduction in oxycodone requirements in the LTAP group (1.2 versus 0.8; P = 0.032).CONCLUSIONLTAP block significantly improved early postoperative analgesia outcomes in patients undergoing laparoscopic appendicectomy and holds promise as part of an effective postoperative analgesic regimen.REGISTRATION NUMBERNCT05427266 (http://www.clinicaltrials.gov).","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"5 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145937838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ignacio Fernandez-Hurtado,Naila Pages-Valle,Maria F Sarubbo,Olga Claramonte-Bellmunt,Santiago Baena-Bradaschia,Jose A Cifuentes-Rodenas,Xavier Serra-Aracil
BACKGROUNDOpen excisional haemorrhoidectomy (OEH) remains the standard treatment for advanced haemorrhoidal disease, offering low recurrence but notable postoperative pain. Transanal haemorrhoidal dearterialization (THD) is an alternative with reduced pain but potentially higher recurrence. The aim of this trial was to compare the 1-year efficacy of both techniques using validated symptom and quality-of-life scores.METHODSA prospective, single-centre, randomized, open-label trial was conducted in patients with grade III haemorrhoids. The primary outcome was the relative change at 12 months in Haemorrhoidal Disease Symptom Score (HDSS) and Short Health Scale adapted for Haemorrhoidal Disease (SHS-HD) from baseline. Additionally, the predefined, pragmatic composite endpoint-the clinical failure rate (CFR), defined as a ≤50% improvement in both HDSS and SHS-HD-was compared. Secondary outcomes included postoperative pain, time to return to work, complications, and reoperation.RESULTSFrom August 2021 to February 2023, 50 patients were randomized (25 OEH patients and 25 THD patients). Three patients were lost to follow-up (2 THD patients and 1 OEH patient). CFR was significantly higher in the THD group (14 of 23 (61%)) versus the OEH group (2 of 24 (8%)) (P <0.001). All eigth reoperations occurred in the THD group (P = 0.001). Both procedures reduced symptom and quality-of-life scores (P = 0.002 and P < 0.001). OEH was associated with greater early postoperative pain and a longer time to return to work (median of 21 versus 14 days; P = 0.010).CONCLUSIONOEH is more effective than THD but is associated with greater early postoperative pain.REGISTRATION NUMBERNCT06420986 (http://www.clinicaltrials.gov).
{"title":"Open excisional haemorrhoidectomy versus transanal haemorrhoidal dearterialization for grade III haemorrhoids: open-label randomized clinical trial.","authors":"Ignacio Fernandez-Hurtado,Naila Pages-Valle,Maria F Sarubbo,Olga Claramonte-Bellmunt,Santiago Baena-Bradaschia,Jose A Cifuentes-Rodenas,Xavier Serra-Aracil","doi":"10.1093/bjs/znaf282","DOIUrl":"https://doi.org/10.1093/bjs/znaf282","url":null,"abstract":"BACKGROUNDOpen excisional haemorrhoidectomy (OEH) remains the standard treatment for advanced haemorrhoidal disease, offering low recurrence but notable postoperative pain. Transanal haemorrhoidal dearterialization (THD) is an alternative with reduced pain but potentially higher recurrence. The aim of this trial was to compare the 1-year efficacy of both techniques using validated symptom and quality-of-life scores.METHODSA prospective, single-centre, randomized, open-label trial was conducted in patients with grade III haemorrhoids. The primary outcome was the relative change at 12 months in Haemorrhoidal Disease Symptom Score (HDSS) and Short Health Scale adapted for Haemorrhoidal Disease (SHS-HD) from baseline. Additionally, the predefined, pragmatic composite endpoint-the clinical failure rate (CFR), defined as a ≤50% improvement in both HDSS and SHS-HD-was compared. Secondary outcomes included postoperative pain, time to return to work, complications, and reoperation.RESULTSFrom August 2021 to February 2023, 50 patients were randomized (25 OEH patients and 25 THD patients). Three patients were lost to follow-up (2 THD patients and 1 OEH patient). CFR was significantly higher in the THD group (14 of 23 (61%)) versus the OEH group (2 of 24 (8%)) (P <0.001). All eigth reoperations occurred in the THD group (P = 0.001). Both procedures reduced symptom and quality-of-life scores (P = 0.002 and P < 0.001). OEH was associated with greater early postoperative pain and a longer time to return to work (median of 21 versus 14 days; P = 0.010).CONCLUSIONOEH is more effective than THD but is associated with greater early postoperative pain.REGISTRATION NUMBERNCT06420986 (http://www.clinicaltrials.gov).","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"42 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145994880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Odd Bjørn Salte,Rolf E Hagen,Marius Svanevik,Morten Wang Fagerland,Hilde Risstad,Jøran Hjelmesæth,Jon A Kristinsson,Rune Sandbu,Tom Mala
OBJECTIVEIdentifying the optimal metabolic bariatric surgery approach for patients with severe obesity with a BMI ≥50 kg/m2 remains challenging. The aim of this long-term follow-up of a randomized clinical trial (RCT) was to compare distal long alimentary limb Roux-en-Y gastric bypass (RYGB) with standard RYGB for 10-year weight loss and nutritional outcomes.METHODSecondary analysis of a 10-year follow-up of an RCT with initially 113 patients (BMI 50-60 kg/m2) randomized to either standard (n = 57, 50 cm biliopancreatic/150 cm alimentary limb) or distal long alimentary limb RYGB (n = 56, 50 cm biliopancreatic/150 cm common limb) from March 2011 to April 2013 at two Norwegian hospitals. The final data collection date was 15 August 2023. The primary focus was weight loss (BMI reduction, %total weight loss) and other secondary outcomes included cardiometabolic risk factors, nutritional status, and health-related quality of life (HRQOL).RESULTSOf 113 patients, 79 (69.9%, mean age 50 (s.d. 8.7) years, 50 (63%) females) patients were available for 10-year follow-up (41 standard RYGB, 38 distal RYGB). The 10-year mortality rate was 3.5% (4/113) and all deaths occurred after distal RYGB. One death may have been associated with the surgery in a patient with previously undiagnosed liver cirrhosis at the time of operation. Mean BMI reduction from baseline was 12.0 kg/m2 (95% c.i., 10.8 to 13.2) after standard RYGB and 14.7 kg/m2 (95% c.i., 13.5 to 15.9) after distal RYGB with a between-group difference of 2.7 kg/m2 (95% c.i., 1.0 to 4.5, P = 0.002). The mean percentage total weight loss from baseline was 23.0% (95% c.i., 20.8 to 25.2) after standard RYGB and 28.2% (95% c.i., 26.0 to 30.5) after distal RYGB, with a between-group difference of 5.3% (95% c.i., 2.1 to 8.4, P = 0.001). The distal RYGB group had higher rates of malnutrition (1/57 standard versus 5/56 distal; P = 0.12), diarrhoea (7/57 standard versus 15/56 distal; P = 0.05), and vitamin D deficiency (24/41 standard versus 32/38 distal; P = 0.01). There were no differences between the groups in the prevalence of type 2 diabetes, hypertension, dyslipidaemia, or metabolic syndrome at 10-year follow-up. Four patients underwent revisional surgery due to malnutrition after distal RYGB. There were no statistically significant differences in HRQOL scores between the groups at 10 years (SF-36 physical 44.2 versus 44.1, mental 50.3 versus 47.3; OWLQOL 63 versus 61; all P > 0.2).CONCLUSIONSDistal long alimentary limb RYGB resulted in greater weight loss after 10 years with a higher risk of malnutrition, diarrhoea, and vitamin D deficiency.TRIAL REGISTRATIONClinicaltrials.gov NCT00821197.
{"title":"Effect of standard versus long alimentary limb distal Roux-en-Y gastric bypass on weight loss and nutritional outcomes at 10 years in patients with BMI 50-60 kg/m2-a secondary analysis of a randomized clinical trial.","authors":"Odd Bjørn Salte,Rolf E Hagen,Marius Svanevik,Morten Wang Fagerland,Hilde Risstad,Jøran Hjelmesæth,Jon A Kristinsson,Rune Sandbu,Tom Mala","doi":"10.1093/bjs/znaf285","DOIUrl":"https://doi.org/10.1093/bjs/znaf285","url":null,"abstract":"OBJECTIVEIdentifying the optimal metabolic bariatric surgery approach for patients with severe obesity with a BMI ≥50 kg/m2 remains challenging. The aim of this long-term follow-up of a randomized clinical trial (RCT) was to compare distal long alimentary limb Roux-en-Y gastric bypass (RYGB) with standard RYGB for 10-year weight loss and nutritional outcomes.METHODSecondary analysis of a 10-year follow-up of an RCT with initially 113 patients (BMI 50-60 kg/m2) randomized to either standard (n = 57, 50 cm biliopancreatic/150 cm alimentary limb) or distal long alimentary limb RYGB (n = 56, 50 cm biliopancreatic/150 cm common limb) from March 2011 to April 2013 at two Norwegian hospitals. The final data collection date was 15 August 2023. The primary focus was weight loss (BMI reduction, %total weight loss) and other secondary outcomes included cardiometabolic risk factors, nutritional status, and health-related quality of life (HRQOL).RESULTSOf 113 patients, 79 (69.9%, mean age 50 (s.d. 8.7) years, 50 (63%) females) patients were available for 10-year follow-up (41 standard RYGB, 38 distal RYGB). The 10-year mortality rate was 3.5% (4/113) and all deaths occurred after distal RYGB. One death may have been associated with the surgery in a patient with previously undiagnosed liver cirrhosis at the time of operation. Mean BMI reduction from baseline was 12.0 kg/m2 (95% c.i., 10.8 to 13.2) after standard RYGB and 14.7 kg/m2 (95% c.i., 13.5 to 15.9) after distal RYGB with a between-group difference of 2.7 kg/m2 (95% c.i., 1.0 to 4.5, P = 0.002). The mean percentage total weight loss from baseline was 23.0% (95% c.i., 20.8 to 25.2) after standard RYGB and 28.2% (95% c.i., 26.0 to 30.5) after distal RYGB, with a between-group difference of 5.3% (95% c.i., 2.1 to 8.4, P = 0.001). The distal RYGB group had higher rates of malnutrition (1/57 standard versus 5/56 distal; P = 0.12), diarrhoea (7/57 standard versus 15/56 distal; P = 0.05), and vitamin D deficiency (24/41 standard versus 32/38 distal; P = 0.01). There were no differences between the groups in the prevalence of type 2 diabetes, hypertension, dyslipidaemia, or metabolic syndrome at 10-year follow-up. Four patients underwent revisional surgery due to malnutrition after distal RYGB. There were no statistically significant differences in HRQOL scores between the groups at 10 years (SF-36 physical 44.2 versus 44.1, mental 50.3 versus 47.3; OWLQOL 63 versus 61; all P > 0.2).CONCLUSIONSDistal long alimentary limb RYGB resulted in greater weight loss after 10 years with a higher risk of malnutrition, diarrhoea, and vitamin D deficiency.TRIAL REGISTRATIONClinicaltrials.gov NCT00821197.","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"29 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145994881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Carmen Rubio-Alarcón,Andrew Georgiadis,Ingrid A Franken,Haoyue Wang,Sietske C M W van Nassau,Suzanna J Schraa,Dave E W van der Kruijssen,Karlijn van Rooijen,Theodora C Linders,Pien Delis-van Diemen,Maartje Alkemade,Anne Bolijn,Marianne Tijssen,Margriet Lemmens,Lana Meiqari,Steven L C Ketelaars,Adria Closa-Mosquera,Miranda M W van Dongen,Mirthe Lanfermeijer,Birgit I Lissenberg-Witte,Linda J W Bosch,Teunise Bisschop-Snetselaar,Bregje C Adriaans,Amy Greer,David Riley,James R White,Christopher Greco,Liam Cox,Jesse Fox,Kaitlin Victor,Catherine Leech,Samuel V Angiuoli,Niels F M Kok,Cornelis J A Punt,Daan van den Broek,Miriam Koopman,Gerrit A Meijer,Victor E Velculescu,Jeanine M L Roodhart,Veerle M H Coupé,Mark Sausen,Geraldine R Vink,Remond J A Fijneman,
BACKGROUNDCirculating tumour DNA (ctDNA) is a promising biomarker to guide clinical decision-making. The aim of this study was to investigate the prognostic value of postoperative ctDNA in patients with stage III colon cancer who received adjuvant chemotherapy (ACT).METHODSPROVENC3 was a multicentre prospective study of patients who underwent resection of pathological stage III colon cancer. Blood samples were collected at a median of 13 (interquartile range 4-20) days after resection. The presence of minimal residual disease was determined using Labcorp® Plasma Detect™, a novel tumour-informed whole genome sequencing (WGS) ctDNA test. The primary endpoint was 3-year time to recurrence (TTR). ctDNA status was further combined with pathological risk status to investigate the combined prognostic value.RESULTSThe median follow-up of the 209 patients who were included was 40 months. In total, 28 patients (13%) had detectable ctDNA after surgery. Postoperative ctDNA-positive patients had a worse TTR compared with ctDNA-negative patients (HR 6.2 (95% c.i. 3.4 to 11.2); P < 0.001). Of all ctDNA-positive patients, 36% did not develop recurrences during 3-year follow-up. Detectable ctDNA after ACT was associated with worse TTR (HR 7.9 (95% c.i. 3.9 to 15.9); P < 0.001). ctDNA status combined with pathological risk classification resulted in a 3-year recurrence risk that varied from 82% for pathological high-risk (pT4/N2) ctDNA-positive patients to 7% for pathological low-risk (pT1-3 N1) ctDNA-negative patients (HR 28.5 (95% c.i. 10.5 to 77.2); P < 0.001).CONCLUSIONPostoperative ctDNA detection using a tumour-informed WGS test improves prognosis stratification in stage III colon cancer and may help to personalize adjuvant treatment.
{"title":"Circulating tumour DNA in patients with stage III colon cancer: multicentre prospective PROVENC3 study.","authors":"Carmen Rubio-Alarcón,Andrew Georgiadis,Ingrid A Franken,Haoyue Wang,Sietske C M W van Nassau,Suzanna J Schraa,Dave E W van der Kruijssen,Karlijn van Rooijen,Theodora C Linders,Pien Delis-van Diemen,Maartje Alkemade,Anne Bolijn,Marianne Tijssen,Margriet Lemmens,Lana Meiqari,Steven L C Ketelaars,Adria Closa-Mosquera,Miranda M W van Dongen,Mirthe Lanfermeijer,Birgit I Lissenberg-Witte,Linda J W Bosch,Teunise Bisschop-Snetselaar,Bregje C Adriaans,Amy Greer,David Riley,James R White,Christopher Greco,Liam Cox,Jesse Fox,Kaitlin Victor,Catherine Leech,Samuel V Angiuoli,Niels F M Kok,Cornelis J A Punt,Daan van den Broek,Miriam Koopman,Gerrit A Meijer,Victor E Velculescu,Jeanine M L Roodhart,Veerle M H Coupé,Mark Sausen,Geraldine R Vink,Remond J A Fijneman, ","doi":"10.1093/bjs/znaf281","DOIUrl":"https://doi.org/10.1093/bjs/znaf281","url":null,"abstract":"BACKGROUNDCirculating tumour DNA (ctDNA) is a promising biomarker to guide clinical decision-making. The aim of this study was to investigate the prognostic value of postoperative ctDNA in patients with stage III colon cancer who received adjuvant chemotherapy (ACT).METHODSPROVENC3 was a multicentre prospective study of patients who underwent resection of pathological stage III colon cancer. Blood samples were collected at a median of 13 (interquartile range 4-20) days after resection. The presence of minimal residual disease was determined using Labcorp® Plasma Detect™, a novel tumour-informed whole genome sequencing (WGS) ctDNA test. The primary endpoint was 3-year time to recurrence (TTR). ctDNA status was further combined with pathological risk status to investigate the combined prognostic value.RESULTSThe median follow-up of the 209 patients who were included was 40 months. In total, 28 patients (13%) had detectable ctDNA after surgery. Postoperative ctDNA-positive patients had a worse TTR compared with ctDNA-negative patients (HR 6.2 (95% c.i. 3.4 to 11.2); P < 0.001). Of all ctDNA-positive patients, 36% did not develop recurrences during 3-year follow-up. Detectable ctDNA after ACT was associated with worse TTR (HR 7.9 (95% c.i. 3.9 to 15.9); P < 0.001). ctDNA status combined with pathological risk classification resulted in a 3-year recurrence risk that varied from 82% for pathological high-risk (pT4/N2) ctDNA-positive patients to 7% for pathological low-risk (pT1-3 N1) ctDNA-negative patients (HR 28.5 (95% c.i. 10.5 to 77.2); P < 0.001).CONCLUSIONPostoperative ctDNA detection using a tumour-informed WGS test improves prognosis stratification in stage III colon cancer and may help to personalize adjuvant treatment.","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"29 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145937837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BACKGROUNDAortic arch pathologies are complex to treat. Alternatives include open surgery, hybrid surgery (endovascular aortic stent-grafting and open surgical debranching procedures) and total endovascular solutions with branched stent-grafts. Branched stent-grafts are the mainstream approach for endovascular repair, but they are primarily available only as dedicated custom-made devices. The aim of this study was to evaluate the safety and effectiveness of a non-customized modular aortic arch stent-graft.METHODThis trial was led by the Chinese PLA General Hospital and 16 additional aortic centres in China. All included patients were treated with a non-customized modular inner branched stent-graft (Endonom Medtech, Hangzhou, China). The study endpoints were 30-day death and stroke, technical success, clinical success, early and late complications, reintervention, and death during follow-up. Follow-up via clinical examination and CT angiography scan were scheduled post surgery at 1, 6, and 12 months, and annually thereafter.RESULTSFrom June 2021 to December 2024, a total of 88 patients were enrolled in this study. Technical success rate was 100%. The mean follow-up was 28.6 ± 11.7 months. The overall 30-day mortality rate was 3%, and the 30-day stroke rate was 9%. Overall survival was 91% ± 3%, 86% ± 4%, and 81% ± 4% at 12, 24, and 36 months respectively. A total of 10 patients developed endoleaks, none of which required reintervention.CONCLUSIONModular branched stent-graft repair for aortic arch disease is feasible and with comparative rates of safety with custom made branched endovascular stent-grafts, hybrid techniques and open surgery. Long-term comparative effectiveness studies are required to establish whether it is superior to alternative interventions.
{"title":"Outcomes of endovascular aortic arch repair with an off-the-shelf modular inner branched stent-graft: an IDEAL 2a prospective multicentre trial.","authors":"Wei Guo,Dan Rong,Hongkun Zhang,Leiyang Zhang,Hui Zhuang,Hua Peng,Xuejun Wu,Kunmei Gong,Wei Wang,Zhen Li,Weiguo Fu,Xiaoming Zhang,Mingjin Guo,Guangqi Chang,Xiangchen Dai,Jian Zuo,Yingqiang Guo,Bing Chen,Lei Zhang,Taoran Zhang,Hongpeng Zhang","doi":"10.1093/bjs/znaf279","DOIUrl":"https://doi.org/10.1093/bjs/znaf279","url":null,"abstract":"BACKGROUNDAortic arch pathologies are complex to treat. Alternatives include open surgery, hybrid surgery (endovascular aortic stent-grafting and open surgical debranching procedures) and total endovascular solutions with branched stent-grafts. Branched stent-grafts are the mainstream approach for endovascular repair, but they are primarily available only as dedicated custom-made devices. The aim of this study was to evaluate the safety and effectiveness of a non-customized modular aortic arch stent-graft.METHODThis trial was led by the Chinese PLA General Hospital and 16 additional aortic centres in China. All included patients were treated with a non-customized modular inner branched stent-graft (Endonom Medtech, Hangzhou, China). The study endpoints were 30-day death and stroke, technical success, clinical success, early and late complications, reintervention, and death during follow-up. Follow-up via clinical examination and CT angiography scan were scheduled post surgery at 1, 6, and 12 months, and annually thereafter.RESULTSFrom June 2021 to December 2024, a total of 88 patients were enrolled in this study. Technical success rate was 100%. The mean follow-up was 28.6 ± 11.7 months. The overall 30-day mortality rate was 3%, and the 30-day stroke rate was 9%. Overall survival was 91% ± 3%, 86% ± 4%, and 81% ± 4% at 12, 24, and 36 months respectively. A total of 10 patients developed endoleaks, none of which required reintervention.CONCLUSIONModular branched stent-graft repair for aortic arch disease is feasible and with comparative rates of safety with custom made branched endovascular stent-grafts, hybrid techniques and open surgery. Long-term comparative effectiveness studies are required to establish whether it is superior to alternative interventions.","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"50 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145937821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Thomas Daoulas,Jean-Christophe Courtil,Erik Zanchetta,Hoel Letissier,Muriel Pardon-Labonnelie
{"title":"Reflections on the absence of jointed scissors in Greco-Roman surgery.","authors":"Thomas Daoulas,Jean-Christophe Courtil,Erik Zanchetta,Hoel Letissier,Muriel Pardon-Labonnelie","doi":"10.1093/bjs/znaf266","DOIUrl":"https://doi.org/10.1093/bjs/znaf266","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"74 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145823869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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