To evaluate the features of carotid web (CW) by ultrasonography.

A total of 66 patients with CW were retrospectively enrolled from January 2018 to June 2019 at Xuanwu Hospital, Capital Medical University. All patients were examined by both ultrasonography and CTA, and were divided into either a<50% stenosis group (54 cases) or a ≥50% stenosis group (12 cases). The ultrasonographic characteristics of CW, including the length, thickness, direction (forward or backward to the flow), acute angle between the web and carotid wall, and thrombus between the web and carotid wall were compared between the two groups. The stenosis degrees of carotid artery were compared between patients with and without ischemic stroke.

Forty-two (42/66, 63.6%) patients were diagnosed with CW by initial CDFI examination, of whom 21 (21/66, 31.8%) were diagnosed with ulcerative plaque and 3 (3/66, 4.5%) were diagnosed with carotid dissection at first but confirmed by second examination. There were no differences in the web length, thickness, direction, or thrombus detected between the two groups (P>0.05). The angle between the web and carotid wall in the<50% stenosis group was significantly smaller than that of the ≥50% stenosis group (median angel 39o vs 73o, P=0.002), and the percentage of patients with an angle≤ 60o in the<50% stenosis group was significantly higher than that of the ≥50% stenosis group (74.1% vs 41.7%, P=0.042). The diameter of the residual carotid artery at CW location in the<50% stenosis group was significantly larger and peak systolic velocity was significantly higher in the<50% stenosis group than in the≥50% stenosis group (P<0.001). The stenosis degrees of carotid artery were not statistically different between patients with and without ischemic stroke (P=0.321).

Ultrasonography can be used to evaluate the characteristics of carotid web in 2D and color mode. When the angle between the CW and carotid wall is large, the carotid artery stenosis ≥ 50% is more likely to happen, but carotid artery stenosis is not the main cause of ischemic stroke.

The aim of the present study was to evaluate the efficiency of sling exercise, therapeuticultrasound, therapeuticultrasound and sling exercise in patients to alleviate pain and improve lumbar function with lumbar disc herniation.

Individuals were selected from a list of patients being followed at the department of Rehabilitation in the third hospital of Hebei Medical University. 30 patients who were diagnosed with lumbar disc herniation were collected, the diagnoses were established upon medical history, physical examination, and results of imaging studies. The patients were randomly divided into three groups: therapeuticultrasound group received 14 sessions of ultrasonic therapy to the lumbar region, Sling exercise group received 14 sessions of sling exercise, and therapeuticultrasound and sling exercise group received therapeuticultrasound and sling exercise therapy 14 sessions of therapeuticultrasound to the lumbar region,7 sessions per week, 2 weeks. The VAS and ODI were compared with the assessment of the patients before and at the end of the therapy.

At the end of treatment, three groups VAS scores (F=3.069, P=0.043) and ODI scores (t=12.676, P<0.001) was lower than that at the beginning of treatment (P<0.05), at the end of treatment the VAS scores (F=59.400, P<0.001) and of the ODI scores (t=12.737, P<0.001) of ultrasonic and sling exercise therapy group was lower than the other group, the difference is significantly.

All three groups could reduce pain and improve lumbar function, and the ultrasonic and sling exercise therapy was most effective for lumbar disc herniation treatment in the three groups.

To analyze the treatment of different types of traumatic cerebral infarction in children, and explore its pathogenesis in combination with literature so as to improve the cure rate and reduce disability rate.

The clinical data of 42 cases of traumatic cerebral infarction in children were retrospectively analyzed in The Hospital of 81^st Group Army PLA from January 2015 to December 2019. The diagnosis of traumatic cerebral infarction in children was made by CT scan and MRI scan. According to different conditions, children with traumatic cerebral infarction were classified, and different treatment strategies were selected. Children with lacunar infarction were treated with calcium antagonists and neurotrophic drugs, supplemented by hyperbaric oxygen and exercise rehabilitation. The children of focal cerebral infarction and complex cerebral infarction treated by junior dehydrant and hormone also included the calcium antagonist and nutritional nerve drugs. The therapeutic regimen perhaps adjusted by the evolution of the disease. The children of extensive cerebral infarction underwent emergency cranial decompression, and was treated by reducing intracranial pressure and preventing complications after operation. The treatment results and recovery were observed.

In 42 cases of traumatic cerebral infarction in children, 35 cases (83.3%) were good recovery, 4 cases (9.5%) were moderate disability, 2 cases (4.8%) were severe disability, 1 case (2.4%) died, and no vegetative state. The good recovery rate of lacunar infarction was 100%, that of focal cerebral infarction was 62.5%, that of mixed cerebral infarction was 60%, and that of extensive cerebral infarction was 50%.

It is of great significance to improve the therapeutic effect and prognosis of children with traumatic cerebral infarction to adopt different treatment schemes for different types of cerebral infarction.

To characterize the patients with supratentorial hypertensive intracerebral hemorrhage (ICH) in the Tibetan Plateau over an altitude of 4000 meters.

A total of 68 cases with supratentorial hypertensive ICH were retrospectively included in Ali Regional People’s Hospital from January 2017 to September 2018. The clinical and laboratory data were collected. A simple linear correlation analysis was applied to analyze the correlation between the amount of bleeding and sex, age, nationality, time from onset , systolic blood pressure (SBP), diastolic blood pressure (DBP), hemoglobin (Hb), serum triglyceride (TG), and cholesterol. According to computed tomography (CT) findings, 68 cases were divided into the basal ganglia ICH group (33 cases) and the lobar ICH group (35 cases). The characteristics between two groups were analyzed using t-test or χ² test.

The data of sex, age, nationality, time from onset, SBP, DBP, Hb, TG, and cholesterol of 68 cases on admission did not show any definitive correlation with the hematoma volumes (P＞0.05). The SBP and DBP of patients in the basal ganglia ICH group were significantly higher than that in the lobar ICH group, respectively [(184.9±28.5) mmHg vs (164.6±24.4) mmHg; (113.0±18.1) mmHg vs (103.0±18.4) mmHg] (t=0.499, 0.486; P=0.002, 0.033).

The relevant factors of hematoma volumes in patients with ICH in plateau area were not yet clear. Diastolic and systolic blood pressure of patients in the basal ganglia ICH group was higher than that in those in lobar ICH group.

To compare the efficacy evaluation of electrospun composite biomaterials and a porcine small intestine submucosa mesh for hernia repair.

A randomized, single-blind, controlled multicenter trial was performed in 3 hospitals in Shanghai. Eligible adult patients with primary unilateral reducible groin hernias were randomly assigned (1∶1) to electrospun composite biomaterials (experimental group) or porcine small intestine submucosa (control group) mesh groups. Patients were treated with the tARB technique and assessed at 1,3 and 6 months after the surgery. The primary endpoint was hernia recurrence. The secondary endpoints were postoperative complications including groin pain and operative site infections.

172 patients were assigned to experimental (n=86) and control (n=86) groups. At 6 months follow-up, postoperative complications occurred in 5 patients (5/86, 5.95%) and 2 (2/86, 2.35%) patients in the control and experimental groups, respectively (P>0.05). There was no significant difference in VAS or SVS score between the two groups.

We demonstrate that electrospun composite biomaterial mesh can be used as a ideal choice for inguinal hernia repair. Electrospun composite biomaterial has the characteristics of low recurrence rate, absorbability and long-term comfort.It can be further applied in clinical practice in the future.

Pancreaticoduodenectomy(PD)remains one of the most complicated hepatobiliary operations. The development of minimally invasive surgery for PD has always been an hot spot. Laparoscopic pancreaticoduodenectomy(LPD) has not been widespread carried out due to its difficulty and long learning curve. LPD accounts for 9% of all PD, according to the National Cancer Data base. Compared with laparoscopic surgery, robotic surgery system has significant advantages in the field of minimally invasive PD, including stereotactic amplified vision, filtering hand tremor and simulating the wrist. The article would review the surgical techniques and notes, which could provide clinical reference for other surgeons.

To compare the perioperative and long-term oncological outcomes of natural orifice specimen extraction surgery (NOSES) and conventional laparoscopic-assisted surgery (CLAS) for left-sided colorectal cancer.

This retrospective cohort study included patients with left-sided colorectal cancer who underwent NOSES or CLAS between January 2017 and December 2021. Propensity score matching (PSM) was performed at a 1:1 ratio, with 48 patients in each group. Perioperative outcomes, postoperative recovery, complications, pathological outcomes, and long-term oncological outcomes were compared. Disease-free survival (DFS) and overall survival (OS) were analyzed using the Kaplan-Meier method.

NOSES was associated with less intraoperative blood loss and faster postoperative recovery, as well as reduced postoperative pain and improved cosmetic satisfaction. No significant differences were observed in postoperative complications, infection rates, or main pathological outcomes. During a median follow-up of 60 months, recurrence occurred in 3 patients in the NOSES group and 8 in the CLAS group (P=0.109). The 5-year DFS rates were 93.7% and 83.3%, respectively (P=0.114).

NOSES is a feasible alternative to conventional laparoscopic surgery for left-sided colorectal cancer, offering improved postoperative recovery and cosmetic outcomes without an apparent adverse impact on long-term oncological outcomes. However, further validation in prospective, large-scale, multicenter clinical studies is warranted.

To compare the effects of a single vaginal preparation on the day before surgery (1-day group) and daily vaginal preparation on days 3, 2, and 1 before surgery (3-day group) on short-term outcomes of colorectal cancer surgery with transvaginal specimen extraction.

This exploratory retrospective cohort included 125 patients who underwent colorectal cancer surgery with transvaginal specimen extraction at the Cancer Hospital, Chinese Academy of Medical Sciences, from 2020 to 2025 were retrospectively included, comprising 53 patients in the 1-day group and 72 in the 3-day group. Vaginal antisepsis on the day of surgery and perioperative management were identical in the two groups. Preoperative characteristics, intraoperative and pathological indicators, postoperative recovery, and complications within 30 days were compared.

No statistically significant differences were found between the 1-day and 3-day groups in operative time (141.0 vs. 134.5 min, U=1 788.5, P=0.552), lymph-node yield (24.0 vs. 24.0 nodes, U=1 818.0, P=0.654), time to first postoperative flatus (2 vs. 2 days, U=1 898.0, P=0.954), or postoperative hospital stay (6 vs. 6 days, U=1 855.0, P=0.783). Infection-related complications occurred in 5/53 (9.4%) vs. 7/72 (9.7%) patients (P=1.000), early fever in 7/53 (13.2%) vs. 9/72 (12.5%) patients (P=1.000), and vaginal complications in 1/53 (1.9%) vs. 0/72 (0.0%) patients (P=0.424); none of these comparisons showed a statistically significant difference. The absolute risk difference for infection-related complications (1-day minus 3-day group) was −0.29 percentage points (95% CI: −10.76~11.60), and the odds ratio was 0.97 (95% CI: 0.23~3.79).

No statistically significant differences were observed between 1-day and 3-day vaginal preparation in operative measures, pathological quality, postoperative recovery, or short-term infectious outcomes. With standardized surgical procedures and perioperative management, vaginal preparation on the day before surgery may be considered as an option to simplify the preoperative pathway for colorectal cancer surgery with transvaginal specimen extraction.

To compare the perioperative indicators, postoperative recovery, complications and short-term follow-up outcomes between natural orifice specimen extraction surgery (NOSES) type I-A and conventional laparoscopic surgery for low rectal cancer, and to evaluate its short-term clinical benefits and safety.

Clinical data of 114 patients who underwent either of the two surgical procedures for low rectal cancer between January 2025 and June 2026 were retrospectively collected (57 cases in each group). Perioperative indicators, postoperative pathological features, postoperative complications, postoperative numerical rating scale (NRS) pain scores, postoperative low anterior resection syndrome (LARS) scores and short-term recurrence were compared between the two groups.

Compared with the conventional laparoscopic group, the NOSES type I-A group had shorter operation time [(143.98±41.84) min vs. (162.81±36.28) min], lower ileostomy rate (29.8% vs. 49.1%), lower hospitalization cost, lower NRS pain score on postoperative day 1 and lower incidence of poor wound healing (all P＜0.05); however, postoperative hospital stay was longer [12 (8.5, 14) d vs. 9 (8, 13) d, P＜0.05]. There were no significant differences in overall postoperative complications, anastomotic leakage, LARS scores, distal resection margin or short-term recurrence between the two groups (all P＞0.05).

NOSES type I-A is safe and feasible for the treatment of low rectal cancer, and can shorten operation time, reduce ileostomy rate and hospitalization cost, alleviate postoperative pain and reduce poor wound healing, without increasing anastomotic leakage, other complications or short-term recurrence. Long-term oncological outcomes warrant further follow-up.

To evaluate the clinical utility of a modified anvil placement technique in laparoscopic resection of low rectal cancer with transanal eversion and specimen extraction without an auxiliary abdominal incision (NOSES type Ⅰ, technique B).

Consecutive patients with low rectal cancer who underwent NOSES type I, procedure B, using either of two anvil placement techniques at the Department of Colorectal and Anal Surgery, the First Affiliated Hospital of Zhengzhou University, between January 2021 and September 2023 were retrospectively identified. Of the 60 patients screened, 4 were excluded because of incomplete data, leaving 56 patients for analysis. Patients were categorized according to the anvil placement technique used into an observation group (modified extracorporeal anvil placement, n=29) and a control group (conventional intracorporeal anvil placement, n=27). In the modified group, the technique previously developed by our team was performed as follows: after total mesorectal excision and adequate mobilization of the proximal sigmoid colon, the rectal stump was everted through the anus, and distal transection was performed under direct vision. The proximal sigmoid colon was then exteriorized transanally, allowing anvil insertion and fixation with a purse-string suture under direct vision. The colon was subsequently returned to the abdominal cavity, and a circular stapled anastomosis was completed. In the conventional group, the anvil was inserted intracorporeally through an incision in the proximal sigmoid stump. Anvil placement time, perioperative outcomes, 30-day complications, pathological outcomes, and oncological follow-up outcomes were compared between groups.

The overall postoperative complication rate was significantly lower in the modified group than in the conventional group [3.4% (1/29) vs. 22.2% (6/27); P=0.048]. Anvil placement time was also significantly shorter in the modified group [4.7 (2.0, 6.0) vs. 8.0 (5.0, 10.0) min; Z=4.89, P＜0.01]. Operative time (157.0 vs. 173.0 min) and intraoperative blood loss (50.0 vs. 50.0 mL) did not differ significantly between groups. No significant differences were observed in time to first flatus, first bowel movement, resumption of oral intake, or ambulation. Lymph node yield, resection margins, and specimen integrity were comparable between groups. At a median follow-up of 42.2 months, the 3-year overall survival rates were 93.1% and 88.9%, and the 3-year disease-free survival rates were 96.6% and 92.6% in the modified and conventional groups, respectively; neither difference was statistically significant.

In selected patients with low rectal cancer undergoing NOSES type Ⅰ technique B, modified extracorporeal anvil placement showed technical convenience and was associated with a shorter anvil placement/fixation time and a lower 30-day postoperative complication rate in this study. Its safety and potential benefits require confirmation in prospective, multicenter studies with larger samples.

Natural orifice specimen extraction surgery (NOSES) enables abdominal wall auxiliary-incision-free resection. Transvaginal natural-orifice specimen extraction surgery (Tv-NOSES) is mainly used in female patients with colorectal cancer, which can overcome the limitations of transanal NOSES in the removal of large volume specimens. The operation is limited by gender, specific complications and insufficient high-level evidence, and the clinical promotion is still controversial. A literature search was conducted to collect domestic and international clinical studies regarding transvaginal natural-orifice specimen extraction surgery (Tv-NOSES) for colorectal cancer published from 2014 to 2026. This narrative review summarizes evidence from the perspectives of technical evolution, key surgical procedural points, indications and contraindications, short-term perioperative efficacy, oncological safety, procedure-specific complications, existing challenges and future research directions.Tv-NOSES confers minimally-invasive benefits in strictly screened female patients with colorectal cancer, which can reduce abdominal incision-related complications, but there are specific risks such as pelvic infection, rectovaginal fistula, and vaginal incision-related injury. Currently, high-quality multicenter randomized controlled trials are lacking, and available evidence is mostly derived from single-center retrospective cohort studies. Clinical practice should strictly comply with relevant guidelines, prioritize oncological radicality, optimize preoperative assessment, and obtain adequate informed consent. Future high-quality clinical investigations with unified outcome measures are warranted to further clarify the genuine benefit-risk profile of Tv-NOSES and facilitate its standardized and individualized application.

Invasion and metastasis of colorectal cancer are the primary causes of poor prognosis, postoperative recurrence and death in patients. The current intervention methods (such as chemotherapy) are difficult to meet clinical demand due to significant toxic and side effects. Based on holistic concept and differential treatment, traditional Chinese medicine follows different therapeutic principles, including strengthening body resistance and eliminating evil, clearing heat and removing toxicity, invigorating spleen and kidney, activating blood and dissolving stasis, and it demonstrates unique value in inhibiting the invasion and metastasis of colorectal cancer. The pathways of Wnt/β-catenin, phosphatidylinositol-3 kinase/protein kinase B (PI3K/Akt), Janus kinase 2/signal transducer and activator of transcription 3 (JAK2/STAT3), nuclear factor-κB (NF-κB) and vascular endothelial growth factor (VEGF) are core signal networks to regulate invasion and metastasis of colorectal cancer. This article will systematically review the research progress on Chinese medicine compounds and monomer inhibiting colorectal cancer invasion and metastasis by regulating the above-mentioned signaling pathways in recent years, and highlight the integration that overall action mechanism of traditional Chinese medicine is shifting from the traditional single-pathway regulation model to a multi-pathway network so as to provide the basis for TCM prevention and treatment of colorectal cancer.

Colorectal cancer peritoneal metastasis (CRCPM) is often accompanied by ascites, abdominal pain and nutritional decline. Measurable lesions on imaging do not always correspond to the patient’s symptoms; therefore, treatment needs to consider both systemic disease and local intraperitoneal problems. Pressurized intraperitoneal aerosol chemotherapy (PIPAC) delivers aerosolized chemotherapeutic agents into the abdominal cavity under pneumoperitoneum, allowing drug deposition on the peritoneal surface and exposure of superficial lesions. Recent studies suggest that PIPAC may be used for symptom control, repeated biopsy-based assessment of peritoneal disease and conversion treatment in selected patients. However, current evidence mainly comes from early-phase trials, single-arm cohorts and retrospective studies, with considerable heterogeneity in patient selection and combined regimens. This review summarizes studies of PIPAC combined with systemic chemotherapy, targeted therapy and CRS+HIPEC, and discusses the potential role of PIPAC in the multidisciplinary treatment of CRCPM.

To evaluate the clinical efficacy of pedicled myocutaneous flap transfer for pelvic floor reconstruction in the prevention and management of empty pelvis syndrome (EPS) following total pelvic exenteration (TPE).

This retrospective study used a descriptive case-series design. Clinical data were collected from 10 patients who underwent TPE combined with pelvic floor reconstruction using pedicled myocutaneous flaps at the Department of General Surgery, Jiangyin People's Hospital, between December 2023 and July 2026. The primary outcome was the occurrence of EPS-related symptoms following pelvic floor reconstruction. Secondary outcomes included flap survival, pelvic floor wound healing, perioperative complications, and, in patients undergoing staged procedures, the duration of preoperative negative-pressure wound therapy and control of wound infection.

All 10 myocutaneous flaps survived. The median postoperative follow-up was 9.0 months (interquartile range, 1.8 to 22.5 months), during which one patient died of tumor recurrence. No EPS-related symptoms were observed during follow-up, and satisfactory filling of the pelvic dead space was achieved. Primary healing of the pelvic floor surgical wounds was achieved in 3 patients, while delayed healing occurred in 7 patients. Of these 7 patients, 2 developed purulent wound infections that resolved with dressing changes. At the donor sites, primary wound healing was achieved in 8 patients, while delayed healing occurred in 2 patients. No donor-site abscesses or hematomas were observed. Among the 2 patients who underwent vertical rectus abdominis flap transfer, neither developed an abdominal wall hernia, although 1 experienced delayed healing of the abdominal incision.

Pedicled myocutaneous flap transfer appears to be a feasible and potentially safe option for pelvic floor reconstruction following TPE. This technique can provide satisfactory filling of the pelvic dead space and may help prevent EPS. However, further studies are needed to confirm its effectiveness in reducing the risk of EPS.

To systematically describe the clinical implementation of four-stage progressive pelvic floor reconstruction following extended pelvic exenteration (EPE), including baseline characteristics, intraoperative parameters, postoperative recovery, and the distribution of complications related to empty pelvis syndrome (EPS). A total of 389 cases from a single center were included, so as to provide comprehensive overview and evidence for standardized pelvic floor reconstruction.

This retrospective descriptive study extracted data from a prospective Chinese pelvic exenteration database. A total of 389 consecutive pelvic tumor patients receiving EPE with en bloc pelvic floor resection at the Second Affiliated Hospital of Naval Medical University from November 2021 to January 2026 were included. Reconstruction was categorized into four stages according to pelvic floor repair, pelvic cavity obliteration, wound management and gastrointestinal reconstruction for radiated patients. Demographics, preoperative baseline, intraoperative indicators, postoperative recovery and complication data were collected. Given its descriptive nature, no intergroup hypothesis tests between four stages were performed.

The four-stage technique was implemented in a stepwise manner: biological mesh reconstruction→greater omental packing→staged negative-pressure wound therapy→prophylactic ileocecal resection for high-risk patients receiving radiotherapy. The median operative duration across the four stages ranged from 520 to 560 min, median blood loss ranged from 740 to 880 ml, and R₀ resection rate ranged from 80.0% to 86.2%. Perineal wound management evolved from primary closure to open staged negative-pressure therapy. The median time to first postoperative flatus across the four stages was 60 to 72 hours, drainage tube indwelling duration was 50 to 80 days, hospital stay was 38 to 75 days, and time to complete healing of the empty pelvis was 62 to 82 days. The proportion of complications with Clavien-Dindo grade<Ⅲ ranged from 52.8% to 68.0%. Perioperative mortality was only observed in the first two stages. In Stage 4 (n=36), no enterocutaneous fistula, perineoenteric fistula, pelvic hemorrhage or flap-related complications were observed (0/36). This finding remains to be validated due to limited sample size; deep pelvic collection, bowel obstruction and severe urological complications still existed.

The four-stage progressive strategy achieves layered optimization of pelvic floor repair, wound management and individualized intervention for radiotherapy-high-risk patients. Reduced severe EPS-associated complications were noted, which is conducive to improving perioperative safety and wound healing quality, and offering clinical reference for precise EPS prevention and enhancedrecovery.

To evaluate the feasibility and efficacy of preperitoneal mesh reinforcement combined with the Lap-re-Do Sugarbaker or Keyhole technique for parastomal hernia repair and stoma reconstruction.

This was a retrospective descriptive study. A retrospective analysis was conducted on the clinical data of 8 patients who underwent tension-free parastomal hernia repair with preperitoneal mesh placement and Lap-re-Do Sugarbaker/Keyhole at West China Hospital, Sichuan University between July 2020 and July 2022. All enrolled patients had concurrent conditions including intra-abdominal contamination, poor stoma construction, and intra-abdominal adhesions. Patient demographics, operative details, and length of hospital stay were analyzed, and postoperative complications were recorded during follow-up.

All patients successfully completed the planned procedure. Operative time ranged from 162 to 620 minutes, with a mean of (454.63±113.38) minutes; Median hernia sac size (length×width) was 8.38 (5.00, 10.00) cm×7.63 (4.00, 8.50) cm; Hernial ring diameter: 7-15 cm (mean 9.50±2.88 cm); Postoperative hospitalization: 7-41 days (mean 18.25±9.06 days). During the 2-year follow-up, no parastomal hernia recurrence was observed. One patient (1/8) required readmission for localized wound infection, which resolved after 20 days of negative-pressure wound therapy and anti-infection treatments.

With strict inclusion criteria, for high-risk patients undergoing tension-free parastomal hernia repair with concomitant abdominal cavity contamination, poor stoma quality, or intra-abdominal adhesions, mesh placement in the preperitoneal space is safe and effective. It can reinforce abdominal wall strength, and may potentially reduce the occurrence of postoperative complications such as infection and intra-abdominal adhesions.

To evaluate the clinical efficacy of totally endoscopic sublay (TES) and intraperitoneal onlay mesh (IPOM) for midline ventral hernia.

A retrospective analysis was conducted on the clinical data of patients diagnosed with midline ventral hernia who underwent either TES (25 cases) or IPOM (26 cases) at Guangzhou Huadu District People's Hospital from November 2018 to May 2025. Operative time, intraoperative blood loss, postoperative pain, hospital stay, complication rates, recurrence rates, total hospitalization costs, and surgical material expenses were compared between the two groups.

The TES group demonstrated significantly lower total hospitalization costs [20 657.06 (19 267.34, 22 103.42) yuan vs 38 853.24 (37 657.86, 45 291.49) yuan, P<0.001] and surgical material expenses [8943.24 (7929.24, 9976.84) yuan vs 27 776.17 (26 270.58, 29 915.35) yuan, P<0.001] compared to the IPOM group. However, there were no significant differences in intraoperative blood loss, postoperative pain, hospital stay, complication rates, operation time or recurrence rates between the two groups (P>0.05).

TES is equally effective as IPOM for midline ventral hernia repair. It has lower total treatment costs and surgical material expenses, making it one of the preferable surgical option for treating midline ventral hernias.

To analyze the preoperative detection of hiatal hernia (HH) and related factors in patients undergoing anti-reflux surgery, and to compare the report-based detection proportions of barium esophagography, upper gastrointestinal endoscopy, and thoracoabdominal computed tomography (CT) among patients with intraoperatively confirmed HH.

This single-center retrospective study included 94 patients who underwent fundoplication with HH repair for gastroesophageal reflux disease (GERD) at Sir Run Run Shaw Hospital Affiliated to Nanjing Medical University, between December 2023 and April 2026. All patients underwent preoperative barium esophagography, upper gastrointestinal endoscopy, and thoracoabdominal CT. Judgment was determined from the original formal clinical reports. HH reported by at least one examination was defined as the preoperative detection group, whereas no HH reported by any examination was defined as the preoperative non-detection group. Firth penalized logistic regression was used to identify factors independently associated with preoperative detection, and Cochran's Q test was used to compare the paired detection proportions of the three examinations. Because only reference-standard-positive surgical cases were included in this study, the detection proportion only reflects the case detection situation within this specific surgical population. Specificity, positive and negative predictive values, and overall diagnostic accuracy could not be estimated.

Among the 94 patients, 31 cases (33.0%) were detected before the operation, while 63 cases (67.0%) were not detected before the operation. The preoperative detection group had a higher median age than the non-detection group [69.0 (58.5, 82.0) years vs 59.0 (55.0, 71.5) years, P=0.026], and a larger hiatal defect area [15.00 (6.00, 16.50) cm² vs 6.00 (4.50, 11.25) cm², P<0.001]. Detection proportion differed significantly between type I and type Ⅱ-Ⅳ HH (P<0.001). Multivariable Firth penalized logistic regression showed higher odds of detection for type Ⅱ-Ⅳ HH than type I HH (OR=8.410, 95% CI: 1.991-48.859; P=0.003). Each 1-cm² increase in hiatal defect area was associated with an 8.4% increase in the odds of detection (OR=1.084, 95% CI: 1.002-1.178; P=0.045). Age, sex, and body mass index were not independently associated with preoperative detection (all P>0.05). Barium esophagography, upper gastrointestinal endoscopy, and thoracoabdominal CT detected HH in 19 (20.2%), 16 (17.0%), and 25 (26.6%) patients, respectively. The overall paired comparison did not reach the statistical significance threshold (Cochran's Q=5.727, P=0.057).

Among the patients who underwent anti-reflux surgery with intraoperatively confirmed HH, HH type and hiatal defect area were independently associated with preoperative detection. Type Ⅰ HH and a smaller hiatal defect area are less likely to be detected before the operation. The overall comparison of the three examinations did not reach the statistical significance threshold.