Acta Chirurgica Belgica最新文献

Background: Fournier gangrene is a rapidly progressive and life-threatening soft-tissue infection originating in the perineal and genital regions, spreading quickly along fascial planes. Early identification of causative pathogens and their antimicrobial susceptibility is essential to guide empirical therapy and improve outcomes.

Methods: This retrospective study was conducted at a tertiary academic medical center. Among 59 surgically treated patients, 30 with complete clinical and microbiological data and available wound cultures were included. Demographic characteristics, microbiological profiles, and antimicrobial susceptibility patterns were analyzed.

Results: The mean age was 59.2 years (range 45-84), and 56.7% were male. Nearly half of the patients were aged 50-59 years (46.7%). Wound cultures revealed monomicrobial growth in 50.0%, polymicrobial in 26.7%, and no growth in 23.3%. Escherichia coli was the leading pathogen (56.3%), followed by Klebsiella pneumoniae (9.4%), while anaerobes were rarely isolated. Resistance rates were 41.4% among Gram-positives and 38.3% among Gram-negatives. Amikacin (100%) and carbapenems (>80%) showed the highest susceptibility, whereas fluoroquinolones and aminopenicillins exhibited resistance exceeding 40%.

Conclusion: E. coli was the predominant organism in Fournier gangrene, accompanied by substantial resistance to commonly used antibiotics. Aminoglycosides and carbapenems remain the most reliable empirical choices. Although most patients presented with low FGSI scores, the presence of resistant isolates highlights the need for region-specific antibiotic stewardship and ongoing surveillance.

Redo cardiac surgery following a prior sternotomy presents significant technical challenges and increased risks due to potential injuries during sternal re-entry, mediastinal adhesions and hemorrhage. Endoscopically assisted coronary artery bypass grafting (CABG) offers a minimally invasive alternative approach, avoiding sternotomy while achieving complete revascularization and reducing operative morbidity. An 86-year-old male with prior CABG in 2011 who presented with recurrent angina due to graft occlusion and a circumflex lesion unsuitable for intervention. Revascularization was performed using thoracoscopic adhesiolysis and internal mammary harvesting, followed by a hand-sewn coronary anastomosis through a limited left thoracotomy under femoral cardiopulmonary bypass. The patient recovered uneventfully and was discharged on postoperative day 6. At one-month follow-up, he remained asymptomatic with preserved ventricular function. Endoscopically assisted coronary bypass grafting is a safe and feasible alternative in selected patients while reducing surgical trauma and allowing rapid recovery.

Introduction: Rectovaginal fistulae resulting from rectal surgery for cancer, especially in the irradiated field, represent a difficult situation for colorectal surgeons. To avoid radical and mutilating solutions and to limit morbidity, several therapeutic approaches have been described, but no consensus has yet been established. Omental and pedicled muscular flaps interpositioned between the rectum and vagina offer good outcomes; nevertheless, the cosmetic result is poor and the short- and long-term morbidity is high, and resection of the previous anastomosis and redo is often required.

Technique: Surgery is represented by usual laparoscopy using five 5 mm ports; the first step consists of the dissection of the rectovaginal space down to the pelvic floor; afterwards, a modified Vertical Rectus Abdominis pedicled flap (m-VRAM) can be easily harvested full laparoscopically and simply interposed in the rectovaginal space. No additional skin or fascial incisions and no repeat anastomosis were needed. No recurrence, stenosis, or other short- or long-term complications were noted.

Conclusion: Our technique is minimally invasive and offers a valid alternative for the treatment of rectovaginal fistulae with low morbidity and no additional incision.

Background: Dextro-transposition of the great arteries is one of the most common cyanotic congenital heart diseases in newborns. Today's first-choice surgery is the arterial switch. This study aims to analyze predictors (<30 postoperative days) of short-term morbidity and mortality after arterial switch at HUDERF and to compare them between simple (without VSD) and complex transpositions (with VSD with/without left/right ventricular outflow tract obstruction or aortic arch anomalies) and between premature and full-term newborns.

Methods: A retrospective single-center cohort study was conducted, reviewing the records of patients with transposition of the great arteries operated at HUDERF between 1997-2023. Patients were divided into simple and complex transpositions, and premature and full-term newborns.

Results: 171 patients were included: 113 simple transpositions and 58 complex. In the early postoperative period, seven (4%) patients died, 89 (52%) had heart failure, and 3 (2%) had myocardial ischemia. 33 (19%) had pulmonary stenosis. Complex morphology was a risk factor for early morbidity and mortality (p = 0.01). Premature newborns had higher morbidity and mortality rates than full-term newborns (12% vs 3%). Early reoperation was performed in 15 patients (9%) and late in 9 (6%). Complex morphology was a risk factor for early (p = 0.0047) and late reoperation (p = 0.048).

Conclusions: Early morbidity, early mortality and reoperation rates were higher in complex transpositions, particularly among premature newborns. Heart failure and pulmonary stenosis were the most common early complications. Heart failure was the main factor associated with early mortality. Pulmonary stenosis was one of the most frequent causes of reoperations.

Background: Cardiac metastasis of hepatocellular carcinoma (HCC) is extremely rare, especially when it presents as isolated metastasis of HCC in the right ventricle without involving the right atrium or inferior vena cava. The cardiac metastasis of HCC may develop insidiously and lack specific clinical manifestations, which hinders early detection of cardiac metastasis. The prognosis for patients with cardiac metastasis of HCC is not satisfactory.

Methods: We present a 61-year-old male patient diagnosed with BCLC-B stage HCC, who underwent liver tumor resection surgery and, following tumor recurrence, received immunotherapy checkpoint inhibitors and multiple radiofrequency ablation (RFA) treatments. In the third year after surgery, relevant examinations revealed a mass in the patient's right ventricle, ultimately leading to a diagnosis of isolated cardiac metastasis of HCC. In addition, we reviewed the research on cardiac metastasis of HCC over the past decade and summarized the relevant findings.

Results: During follow-up, the patient found a cardiac mass. Based on imaging, isolated cardiac metastasis of HCC was diagnosed, ruling out intrahepatic recurrence and considering alpha-fetoprotein (AFP) persistent rise. Treated with lenvatinib and sintilimab, the patient died of suspected cardiac rupture two weeks later, with no definitive effect observed.

Conclusion: Although cardiac metastasis of HCC is rare, patients who have experienced multiple recurrences and undergone repeated RFA for liver tumors should be wary of extrahepatic metastasis, including heart metastasis, especially when intrahepatic recurrence has been ruled out and AFP levels persistently rise. Treatment should adopt an individualized multimodal approach.

Background: Bladder drainage is systematically used in rectal cancer surgery in male patients, even in the era of enhanced recovery after surgery (ERAS). However, little data is available on risk factors for urinary tract infection (UTI). Identifying the risk factors associated with UTI within 4 days of male rectal cancer surgery in an ERAS program could support more individualized decision-making.

Methods: We used data from the GRECCAR 10 randomized clinical trial, a comparison of outcomes of transurethral catheterization (TUC) or suprapubic catheterization (SPC). 240 patients were randomized, 209 retained in the study (TUC n = 99; SPC n = 109). Univariate and multivariate logistic regression post-hoc study analyses were performed to assess association between potential predictive factors and UTI within 30 days after surgery.

Results: Out of 208 patients (median age 64.5 years), 19 (9.1%) had UTI, 26 (12.5%) had bacteriuria and 145 (69.7%) had pyuria. Univariate analysis identified age ≥ 65 years (OR = 3.08 [1.07-8.89]; p = 0.038), hypertension (OR = 3.65 [1.23-10.84]; p = 0.020) and ASA score ≥ 3 (OR = 4.15 [1.53-11.2]; p = 0.005) as risk factors for UTI until POD4. Multivariate analysis identified ASA score ≥ 3 with a risk of UTI.

Conclusion: Regarding male rectal cancer surgery, our study shows that nearly 1 in 10 patients had UTI within 4 days. An ASA score ≥ 3 is an independent risk factor linked to UTI. Identifying this risk factor for UTI is necessary to advise patients, support a tailored decision-making process, and prevent these complications.

Chest wall chondrosarcoma is a rare malignancy for which no standardized surgical guidelines exist, requiring instead a meticulous multidisciplinary approach. We report the case of an 80-year-old man in excellent general condition who presented with a progressively enlarging right thoracoabdominal mass over a four-year period, initially misdiagnosed as a lipoma. Imaging revealed a 24 cm chondrosarcoma extending from the 7th to the 11th ribs down to the anterior superior iliac spine. En bloc R0 resection was achieved, followed by combined thoracic and abdominal wall reconstruction using synthetic prosthetic material and complex soft-tissue coverage (latissimus dorsi flap, free thigh flap, and advancement abdominoplasty). Postoperative recovery was favorable, with immediate extubation and discharge on postoperative day 42. No recurrence was detected at one year. This case highlights the feasibility of extensive chest wall resection and reconstruction in an elderly patient and emphasizes the critical role of thorough preoperative multidisciplinary planning, in accordance with evidence-based principles, to optimize both oncologic and functional outcomes.

Background: Giant pulmonary hydatid cysts (GHCs), defined as cysts measuring ≥10 cm, pose significant surgical challenges owing to their large size and distortion of the native lung architecture, which often limits the effectiveness of conventional capitonnage. This study evaluates the feasibility and early clinical outcomes of a novel closed-book parenchyma-sparing technique designed to achieve complete residual cavity obliteration while preserving functional lung parenchyma.

Methods: A retrospective analysis was performed on 12 consecutive patients with GHCs who underwent surgery between September 2022 and August 2025. Diagnosis was confirmed by contrast-enhanced computed tomography. The closed-book technique involved controlled cyst evacuation, meticulous bronchial closure, and symmetrical bidirectional intracystic plication. Patients were followed for 15 months to assess postoperative complications, lung re-expansion, and recurrence.

Results: The mean patient age was 33.4 years, with female predominance (75%). Cyst size ranged from 11 to 16 cm (mean 13.5 cm), most commonly involving the right lower lobe and left upper lobe. Four patients presented with ruptured cysts. The technique achieved complete lung re-expansion in all cases. No postoperative air leaks, empyema, atelectasis, surgical site infection, residual cavity, recurrence, or mortality were observed during the 15-month follow-up. One patient developed a transient pleural effusion that resolved spontaneously. The mean hospital stay was 12.9 days.

Conclusion: The closed-book parenchyma-sparing technique is a feasible and promising lung-preserving approach for GHCs. Larger prospective comparative studies are warranted to validate its safety, reproducibility, and long-term effectiveness.Abbreviations: CECT; contrast-enhanced computed tomography; GHCs: giant pulmonary hydatid cysts.