Summary Background Boerhaave’s syndrome (BS) is a rare but often fatal condition with high mortality rates despite intensive treatment. Data are scarce. We herein report a single-center experience with BS. The aim of this study was to investigate and point out the role of endoluminal vacuum therapy (EVT) in BS. Methods Between June 2011 and April 2024, all patients with BS in our tertiary referral center with a unit specialized in surgical endoscopy were analyzed regarding age, gender, delay of diagnosis, treatment technique, and outcome. Results During the study period, 12 consecutive patients (9 male) were treated for BS. The median age was 64.8 years. Five patients were treated with EVT only, four with surgery and simultaneous EVT, and three by surgery only. After implementation of EVT, all patients were treated with either EVT only or surgery with simultaneous EVT. Intensive care unit stay was significantly shorter in patients treated with EVT only. The 30-day mortality was 25% (3 patients). No long-term complications occurred. Conclusion This investigation led to our current strategy of applying only EVT in patients in a stable condition and no CT signs of vast pleural content. Otherwise, surgery plus EVT is performed.

Summary Purpose Inguinal hernia repair is one of the most common surgeries worldwide, with synthetic mesh as the standard of care. With interest in the potential of mesh weight to impact long-term outcomes, we compared short- and long-term safety and effectiveness outcomes of inguinal hernia repair using comparable heavy- and lightweight mesh. Methods A registry-based retrospective observational study of patients undergoing elective open and laparo-/endoscopic inguinal hernia repair with heavy- (3DMax™ Mesh; Davol Inc., subsidiary of C.R. Bard, Inc., BD) and lightweight (3DMax™ Light Mesh Davol Inc., subsidiary of C.R. Bard, Inc., BD) mesh was performed using data collected prospectively from the Herniamed registry. Perioperative, postoperative, and 1‑year clinical outcomes (complications and recurrences) were reported and compared between groups in unadjusted analyses. Results Of the hernia operations performed at more than 800 centers in the registry, 2420 patients with 3DMax™ Mesh and 9033 with 3DMax™ Light Mesh met the inclusion criteria. Most procedures were performed laparoscopically. There were no significant differences between these comparable heavy- and lightweight meshes in terms of interoperative complications, general complications, postoperative complications, or complication-related reoperations in the unadjusted analyses. Furthermore, there was no significant difference between mesh weights in terms of recurrence, trocar hernia, secondary hemorrhage, seroma, and infection at 1‑year follow-up. While heavyweight mesh was associated with significantly higher pain at rest (p = 0.014) and pain upon exertion (p = 0.035) at 1 year versus lightweight mesh, this could not be shown for pain requiring treatment at 1 year. Conclusion Postoperative complications and 1‑year outcomes did not significantly differ between inguinal hernia repair performed with heavy- and lightweight meshes in unadjusted analyses. These outcomes demonstrate the safety and performance of such mesh for inguinal hernia repair regardless of mesh weight, although additional studies with longer follow-up periods and multivariable analyses adjusting for confounders are needed.

Summary Background Complications in colorectal surgery inevitably occur. Especially emergency surgery is associated with worse outcomes and connected with higher failure to rescue. The aim of this study was to assess surgical and nonsurgical complications and their management in colorectal surgery. Methods This study comprises a retrospective data collection among patients undergoing colorectal surgery between 2020 and 2022 at the Kepler University Hospital in Austria. Emergency and elective right-sided hemicolectomy, left-sided hemicolectomy, and rectal resection were included. Results A total of 407 patients (male 49.8%; mean age 63 years) were included. Of these, 127 patients (31.2%) underwent right-sided hemicolectomy, 181 patients (44.5%) left-sided hemicolectomy, and 99 patients (24.3%) rectal resection; 62 patients (15.2%) had emergency index surgery, and they showed significantly higher morbidity than patients undergoing elective surgery (P < 0.001). Surgical complications occurred in 59 patients (14.5%), nonsurgical complications in 68 patients (16.7%). The reoperation rate was 16.1% after emergency and 8.7% after elective surgery (P = 0.059). Conclusion This study highlights complications in three common colorectal procedures. Surgical complications showed the highest morbidity and mortality rates in patients undergoing right-sided hemicolectomy. Nonsurgical complications demonstrated the highest morbidity in the right-sided hemicolectomy group, while mortality was most pronounced in patients undergoing rectal resection. While innovations have improved colorectal complication management, enhanced preoperative optimization in emergency settings is essential. Patient stratification considering surgical morbidity and quality of life is crucial for further outcome improvements.

Summary Background The accuracy of the physiological and operative severity score for the enumeration of mortality adjusted for esophagogastric surgery (O-POSSUM score) is controversial. Therefore, the aim of this study was to validate and evaluate the O‑POSSUM score with regard to its predictive power for mortality and morbidity after esophagectomy. Methods Data of 71 patients who underwent Ivor Lewis esophagectomy between 2010 and 2022 in our surgical department were analyzed retrospectively. The predicted mortality was compared with the actual mortality by binary logistic regression, and the morbidity was examined for a correlation between the Clavien–Dindo classification and the O‑POSSUM score. Results The observed mortality was 14 times higher than the predicted mortality. Thus, the O‑POSSUM score underpredicted mortality for the patient population. The area under the receiver operating characteristic curve was 0.358 (95% confidence interval 0.055 to 0.660; p = 0.291). Conclusion The O‑POSSUM score failed to identify the deceased patients. There is a very slightly positive but statistically nonsignificant correlation between the Clavien–Dindo grade and the O‑POSSUM score. The O‑POSSUM score was not found to be a reliable tool for prediction of morbidity and mortality in this study. The score should be modified or, alternatively, a new score could be invented.

Summary Background Malnutrition is a potentially preventable risk factor for surgery. This systematic review examines nutritional management strategies aiming to enhance surgical outcomes. Methods A systematic search was conducted in PubMed for English-language studies published between July 1, 2004, and July 1, 2024, involving adult surgical patients. Study selection focused on four key themes: (1) nutritional screening and assessment, (2) preoperative nutritional therapy, (3) nutritional support in critically ill surgical patients, and (4) postoperative nutritional rehabilitation. Studies in non-surgical cohorts, letters, and case reports were excluded. Reference lists of relevant studies were manually screened for additional sources. Results Of 2763 studies identified, 251 met the inclusion criteria and 85 were added after manual screening, contributing to a total of 341 papers for the review. The prevalence of malnutrition varied widely by procedure, with the highest rates observed in pancreatic and esophagogastric operations. Preoperative malnutrition was strongly associated with increased postoperative complications, infections, prolonged hospital stay, and higher mortality. The Malnutrition Universal Screening Tool (MUST) was effective in identifying at-risk patients. Preoperative nutritional interventions, including dietitian-led counseling, oral supplementation, and enteral or parenteral nutrition, may reduce complications and improve outcomes. Critically ill patients benefited from structured enteral and parenteral strategies. Early postoperative nutrition within enhanced recovery after surgery (ERAS) protocols are linked to less complications and shorter hospital stay. Conclusion Malnutrition significantly impacts surgical outcomes, necessitating early identification and intervention. Standardized management is key to improving recovery and reducing complications. Future research should focus on refining diagnostic tools, assessing nutritional requirements, optimizing perioperative nutritional strategies, and establishing long-term nutritional follow-up guidelines for surgical patients.