Handlebar syndrome has a low incidence and its presentation can be quite different making the diagnosis sometimes challenging. We present a rare case of the handlebar syndrome in which the handlebar of a bike injures the common femoral artery with an atypical clinical presentation. A written informed consent was obtained from the patient, and the study was approved by the Ethics Committee Research UZ/KU Leuven with the corresponding reference number S70224. The case is a unique late presentation of the handlebar syndrome with only mild symptoms during high-intensity exercise, with normal arterial pulsations and a murmur in the groin. The patient was initially conservatively treated. Although symptoms decreased, there was still a loss of power during maximal intense efforts, and the ankle-brachial index dropped on the bike with a duplex showing low-grade stenosis in the common femoral artery. We performed femoral endarterectomy using a bovine patch. Postoperatively, the patient was symptom-free during intense exercise. Diagnosis could be missed in the absence of early symptoms, posing a risk in children with respect to limb growth and length. Treatment is patient- and lesion-tailored, and mostly performed by open surgery, although conservative management has also been described.
Ostomy rods are used to prevent stoma-related morbidity. However, their effectiveness remains questionable, and to date, no standard technique has been recommended. We sought to identify the most suitable method by comparing skin bridge- and conventional rod-supported loop enterostomies. In accordance with PRISMA guidelines, a systematic literature search was conducted in PubMed (MEDLINE), the Cochrane Central Register of Controlled Trials, and Google Scholar databases for all comparative studies evaluating skin bridges and conventional ostomy rods. Odds ratios (ORs) and standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated for outcomes of both methods. Risk of bias and certainty of evidence were assessed using ROBINS-I and GRADE, respectively. The study protocol was registered in PROSPERO (ID: 420251028945). A total of four eligible studies encompassing 323 patients were included (skin bridge: n = 155, control: n = 168). Loop ileostomies with a skin bridge were associated with significantly lower rates of peristomal dermatitis (OR = 0.13; 95% CI [0.06-0.29]; p < 0.00001, I2 = 0%) and mucocutaneous separation (OR = 0.12; 95% CI [0.05-0.29]; p < 0.00001, I2 = 0%) compared with conventional ostomy rods. Other analyzed outcomes, including parastomal hernia, ostomy prolapse, ostomy retraction, ostomy stenosis, and surgical site infection, did not differ significantly between the two groups. Skin bridges appear to reduce the number of ostomy wafers replaced per week and overall ostomy-related costs. Loop ileostomy creation with a skin bridge appears to be a safe and feasible method for preventing early ostomy-related morbidity.
Background. The work of the anatomist surgeon Joseph Maclise has been forgotten by history. His contributions are unknown to younger generations. This study aims to analyze his legacy, focusing on the surgical anatomy of hernias. Results. This is the first study to analyze Maclise's work from a surgical, rather than an artistic, perspective, focusing on the pathology of hernias. His life was marked by a lack of academic and/or institutional recognition. He was forgotten by the Royal College of Surgeons a decade before his death. He collaborated with Morton on his treatise on surgical anatomy. His work was fundamental to the training of surgeons for at least three decades and served as a bridge between two continents. In the field of hernias, he simplifies knowledge for surgeons, shows each type of hernia in anterior and posterior approaches, and describes the region as a single space where all hernias appear. Conclusion. Maclise was an exemplary Victorian surgeon who cultivated many fields of practice (surgical anatomy, comparative anatomy and naturalism, experimental anatomy and physiology, embryology, art and painting), committed to the advancement of science in his time. His surgical anatomy of hernias facilitated the visual understanding of this pathology for surgeons of several generations.
Laparoscopic hiatal hernia repair is considered the golden standard. Since its entrance in the mid-'00s, robotic surgery has been available in every modern operating center. The aim of this systematic review and meta-analyses is to compare laparoscopic versus robotic surgical hiatal hernia repair regarding clinically relevant postoperative complications, using the Clavien Dindo score 3. After registration in PROSPERO, a literature review was performed following the PRISMA flow diagram, resulting in eleven studies. Their quality was assessed using the Newcastle-Ottowa scale. Risk of bias was assessed using the ROBINS-I tool. Statistical analysis was performed using Python. The primary outcome was Clavien Dindo score 3, the secondary outcomes were mortality, intraoperative complications, postoperative complications, length of stay and operation time. Eleven studies (182.467 patients in total, 12.056 robotic surgical repairs) were analyzed. The meta-analysis showed no statistically significant result between CD score 3 (OR = 0,68 (95% CI 0,27 - 1,72)). From the investigated secondary outcomes, only intraoperative complications showed a significant difference favoring robotic repair (OR = 0,41 (95% CI 0,22 - 0,76) and p-value = 0,005). Robotic hiatal hernia repair shows less intraoperative complications in comparison to laparoscopic repair. With the current available literature, no difference in Clavien Dindo score 3 is seen. To investigate the full potential of robotic surgery, prospective studies should be performed with surgeons who have passed their learning curve. Subgroup analyses regarding giant hiatal hernia and redo surgery should be performed. A uniform definition of 'giant' hiatal hernia is needed.
Falciform ligament hernia (FLH) is a highly uncommon type of internal hernia. This internal hernia presents diagnostic difficulties due to its ambiguous clinical symptoms, which can resemble other causes of acute abdominal pain. A systematic literature review of cases of falciform ligament hernia was conducted on 5th December 2024 according to PRISMA guidelines and using PubMed and Google Scholar databases. Among 103 articles, 36 were included in our review. In total 50 patients were reported. The median age at diagnosis was 41 years. Upper abdominal pain and vomiting were the predominant symptoms. Computed Tomography (CT) scan was instrumental in detecting this rare hernia. Despite this, a definitive diagnosis is often established in the surgical setting. The causes of FLH are diverse, including both congenital and acquired elements. Congenital factors (70%) may involve embryological defects or complete failure in the development of the falciform ligament. Acquired causes might stem mainly from previous abdominal procedures (28%) or injuries (2%). The small bowel was responsible for 78% of cases. Emergency laparotomy was performed in 70% of patients, while 28% were managed with laparoscopy. The treatment for FLH is solely surgical. Laparoscopic methods are preferred, providing faster recovery, enhanced visualization for reducing the hernia, and assessing bowel viability. In cases of severe complications such as bowel ischemia and perforation, open surgery may be necessary. Prompt surgical intervention is crucial to achieve a positive outcome and reduce morbidity.
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. 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. 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). 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.
Inguinal hernia repair is one of the most commonly performed procedures worldwide. Several different methods for repair exist, where the preferred surgical procedure for a non-complicated unilateral inguinal hernia is still up for debate. Originally described as a tissue repair, the introduction of prostheses have led many surgeons to move away from this type of repairs. However, recently updated guidelines still recommend non-mesh treatment, in a subgroup of patients, with a preference for the Shouldice technique. Therefore, we set out to map the incidence and knowledge about tissue-based repair of a primary inguinal hernia in Belgium. We designed a voluntary, open web-based survey for both surgeons and trainees asking about their knowledge, experience and indication for tissue-based suture repair, using a Google-forms document. The survey included level of experience and surgical preference, practice of tissue-based inguinal repair, indications for tissue-based repair, and technique and knowledge about tissue-based repair. Data was collected between 1st of December 2023 and 31st of January 2024 and analyzed using Microsoft Excel (version 16.77.01). A total of 122 respondents filled out the questionnaire, 47 trainees and 75 surgeons, of which 4 were discarded due to inaccurate data. Only 15 out of 71 surgical respondents still performed a non-mesh based repair in an elective setting, where the Shouldice repair was the preferred technique (n = 12, 80%). Knowledge about tissue-based mesh was rated mainly moderate (43.7%) and a non-mesh based repair was still considered an option when faced with fecal contamination (54.9%). Upon patient's request, 67.7% respondents would convince patients of mesh superiority. Among surgical trainees eighteen respondents (38.3%) had never seen a tissue based repair before and 36.1% respondents said tissue-based repair was not taught in their current or previous hospital(s). Most surgical trainees (48.9%) had basic knowledge and know a single technique. Considering indications for primary tissue repair, 57.4% mentioned a contaminated field as a valid indication. Comparable to the surgeon's response, 66% of surgical trainees would convince the patient of mesh superiority when asked for a pure tissue-based repair. Our survey confirms the declining rate of tissue based repairs, with only 7% of surgical respondents performing sufficient procedures to allow for equivocal result compared to mesh-based repairs. Centralizing these procedures into specific hernia centers might allow for an increased case-load and dedicated training pathways giving trainees and future surgeons proper training.
Our publication Across the CROSS in daily practice challenged the routine use of neoadjuvant chemoradiotherapy (nCRT) for locally advanced esophageal adenocarcinoma, showing a comparable 5-year overall survival after primary surgery. Disease-free survival, however, did show a tendency towards higher recurrence rates in the primary surgery group, although not reaching statistical significance. This current study aims to differentiate recurrence patterns and its final impact on overall survival. This retrospective cohort study with propensity score-matched analysis included all surgically treated patients between 2000 and 2018 with locally advanced adenocarcinoma (cT1/2N+ or cT3/4N0/+). Exclusion criteria of the CROSS trial were applied. Patients were matched on age, Charlson comorbidity score, clinical tumor length, and lymph node status. Primary end point was time to recurrence. One hundred and forty-nine propensity score-matched cases were defined in each group. Primary surgery resulted in more recurrences (73.2% vs. 57.0%, p = 0.003). However, nCRT resulted in a shorter time to overall recurrence (6.3 vs. 11.5 months, p = 0.004) and locoregional recurrence (6.3 vs. 13.6 months, p = 0.005). Additionally, overall survival after diagnosis of recurrence was significantly shorter for nCRT than for primary surgery (6.9 vs. 9.6 months, p = 0.03). Our propensity score-matched results indicate that both overall and locoregional recurrences occur significantly earlier in nCRT patients and overall survival after recurrence is significantly shorter after nCRT. These findings might explain the comparable 5-year overall and disease-free survival of both groups.Abbreviations: CROSS: trial chemoradiotherapy for oesophageal cancer followed by surgery study; CT scan: computed tomography scan; HR: hazard ratio; nCRT: neoadjuvant chemoradiotherapy.
Retroperitoneal hemorrhage is a life-threatening entity that can result from a range of etiologies. Rupture of an abdominal aortic aneurysm (AAA) is the most common vascular emergency associated with high morbidity and mortality. However, not all retroperitoneal hemorrhages result from this vascular emergency. Adrenal hemorrhage, though rare, represents an important, often under-recognized and potentially fatal alternative diagnosis. The diagnostic challenge is further compounded when such adrenal pathology occurs in the presence of a concurrent AAA, as overlapping clinical and radiologic features can obscure the true source of bleeding. This coexistence can lead to misdiagnosis, delays in appropriate treatment, and complex decision-making in the acute care setting. A man in his 70s presented with hemodynamic collapse and right-sided flank pain, initially raising concern for a ruptured abdominal aortic aneurysm (AAA). Imaging revealed both an infrarenal AAA and a large retroperitoneal mass consistent with a hemorrhaging adrenal lesion. Due to diagnostic uncertainty and persistent hemodynamic instability, the patient underwent emergency endovascular aortic repair (EVAR) followed by selective arterial embolization of the adrenal lesion. Postoperative recovery was favorable, with resolution of hemodynamic instability and planned delayed adrenalectomy. This case report illustrates the diagnostic complexity and clinical challenge posed by simultaneous adrenal hemorrhage and AAA. Adrenal tumors can cause life-threatening retroperitoneal hemorrhage. Timely recognition via high-resolution imaging and a flexible interventional approach tailored to the evolving clinical picture are key to successful management. Clinicians should remain vigilant for alternative bleeding sources, even in the context of known vascular disease.
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. 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. 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. 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. Key findingsPatients with hepatocellular carcinoma (HCC) who have experienced multiple recurrences and undergone repeated radiofrequency ablation (RFA) therapy should be vigilant about extrahepatic metastases, including cardiac metastasis, especially when intrahepatic recurrence has been ruled out and alpha-fetoprotein (AFP) levels continue to rise.What is known, and what is new?Cardiac metastasis of hepatocellular carcinoma is rare, and such metastases most commonly involve the right atrium or inferior vena cava.Patients with hepatocellular carcinoma who have undergone comprehensive treatment, especially those who have experienced multiple recurrences and undergone RFA therapy, may be a potential population at risk for cardiac metastasis of hepatocellular carcinoma. When AFP levels increase while no tumor lesions are found in the liver, attention should also be paid to organs with potential for rare metastasis during follow-up examinations.What is the implication, and what should change now?Based on the multiple recurrences within the liver and the multiple RFA treatments administered after the surgery for this HCC case, thermal ablation is suspected as a key factor in promoting the dissemination of tumor cells to the heart, which warrants further investigation into potential molecular mechanism changes. Cardiac metastasis is difficult to detect, but it necessitates reasonable suspicion and rigorous examination. In terms of treatment, an individualized multimodal approach is advisable.
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.
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Lungs are the second most frequent site of colorectal cancer metastases. Complete resection of isolated lung metastases is recommended in the current guidelines because of the high long-term survival rate and low morbidity-mortality. The aim of this study is to determine prognostic factors for lung metastasectomy in order to better select patients who will benefit from surgical resection. This single-center retrospective study is based on the medical data of patients operated for resection of colorectal lung metastases between 2004 and 2023. A total of 109 patients were selected, and four had to be excluded. The univariate analysis revealed factors influencing the survival: primary cancers that were metastatic at diagnosis, high preoperative CEA rate, the number and size of metastases, hilar lymph node involvement, invasion of the resection margins and poorly differentiated histological grade. A multivariate analysis including only the pre-operative factors was performed: CEA (p < 0.001), the size (p = 0.003) and number (p = 0.038) of metastases and the metastatic stage of the primary cancer at diagnosis (p = 0.052). The 5-year survival rate in this study is 55%. Survival can be evaluated by four preoperative factors: CEA rate, size and number of metastases and metastatic status of the primary cancer. These factors can be combined to form a survival score, each factor being worth one point. Patients with a score of 0 have a 5-year survival of around 90%, while patients with a score of 3 have a 5-year survival of around 10%. This score could be used to select patients eligible for surgery.
Hashimoto's thyroiditis (HT) is the most common autoimmune thyroid disorder, while papillary thyroid carcinoma (PTC) is the most prevalent thyroid malignancy. The association between HT and PTC remains debated, with some studies suggesting a protective effect of HT against aggressive PTC features. This study explores the relationship between HT and PTC in a single-center cohort, focusing on clinicopathological and prognostic factors. This retrospective study included adult patients who underwent thyroid surgery between 2009 and 2017. Patients were divided into two groups: those with concurrent PTC and HT (Group 1, n = 68) and those with PTC alone (Group 2, n = 329). Demographic, laboratory, and pathological data were compared using appropriate statistical analyses. A significant association between HT and PTC was observed (χ2=5.3; p = 0.021; OR: 1.682). Group 1 patients were more often female and significantly younger. TSH levels were higher in Group 1 (p < 0.001), and follow-up duration was longer (p = 0.023). Although the mean tumor diameter was smaller in the HT group, the difference was not statistically significant. No significant differences were found regarding multifocality, capsular invasion, or lymphovascular invasion. The presence of HT appears to be significantly associated with the occurrence of PTC and may be linked to a less aggressive clinical profile, as suggested by younger age and higher TSH levels. The longer follow-up duration observed in HT patients may reflect more vigilant surveillance due to underlying autoimmune pathology. However, the retrospective and single-center design limits generalizability. Prospective, multicenter studies with larger cohorts are warranted to confirm these findings.
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. 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. 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%. 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.
Recurrent pyloric stenosis (RPS) is a very rare condition that occurs after an initially successful pyloromyotomy for hypertrophic pyloric stenosis. Over the last decade, the number of reported cases of recurrent pyloric stenosis has increased considerably. Given the rarity of this condition and the paucity of literature on the subject, there is a certain diagnostic difficulty, particularly at ultrasound level, where it is difficult to differentiate a true recurrence of pyloric stenosis from an initial incomplete pyloromyotomy. A systematic literature review was performed to characterize the diagnosis of RPS and to report on all cases previously described in literature. We identified a total of 15 patients (median age of 19 days at first pyloromyotomy; average of 31 days of symptom-free interval before RPS; 66.7% male). Eleven cases fulfilled the 3 Kuckelman criteria for RPS (weight gain, 3 weeks resolution of symptoms, restenosis on imaging). The length of the pylorus on ultrasound appears to increase or remain above 18 mm for RPS, where normally it should decrease immediately after pyloromyotomy. RPS seems to occur more frequently when the first pyloromyotomy is performed at an early age. Hypertrophy of the pyloric muscle is a progressive entity, and if operated upon too early can favor recurrence. The diagnosis of a RPS can be made through the combination of clinical criteria and ultrasound, specifically length measurements of the pylorus. Additional studies need to be performed to confirm our findings and to define strategies to reduce risks for RPS.
Klippel-Trenaunay syndrome (KTS) is primarily managed for vascular and soft-tissue abnormalities, while treatment of associated lymphedema remains poorly described. This study outlines our protocol for advanced lower-extremity lymphedema using a combined modified Charles' procedure and vascularized lymph node transfer (VLNT). KTS patients with International Society of Lymphology (ISL) stage III lower-limb lymphedema treated between 1999 and 2018 were retrospectively reviewed. All underwent a modified Charles' excisional procedure with Homans techniques and VLNT. Outcomes were assessed at least one year postoperatively, focusing on early complications and postoperative hospital admissions for residual disease or recurrent infections. Twenty-two patients (14 male, 8 female) with a mean age of 21 years (range, 4-41) were included. Average time since KTS diagnosis was 14 years (range, 3-26). VLNT donor sites included groin (18.2%), supraclavicular (31.8%), and gastroepiploic (50%). Mean hospital stay was 16 days (range, 14-39). Follow-up averaged 38 months (range, 27-45). Three minor complications occurred (one wound dehiscence, one infection, one bleeding), and flap survival was 100%. Annual hospital admissions for soft-tissue infections decreased from a preoperative mean of 3.5 to 1.2 postoperatively. Patients required an average of 3.5 additional procedures (range, 2-8) to remove residual hemangiolymphangioma. Lymphedema in KTS presents unique challenges and differs markedly from typical primary or secondary lymphedema. Effective management requires meticulous assessment and individualized planning. In this population, functional improvement is the main objective, and extensive debulking procedures combined with physiologic reconstruction may provide meaningful clinical benefit despite limited aesthetic outcomes. Type of Research: Single-center, retrospective, cohort studyTake Home Message: In severe lymphedema of patients diagnosed with KTS, single excisional or physiological surgical treatment is insufficient to fight the totality of pathologic processes at work. A combination of varied techniques that act on different disease's features can achieve significantly better outcomes.
Bullying, undermining behavior, and harassment (BUBH) persist as ongoing concerns in healthcare, particularly within stressful environments. This study aims to explore the prevalence and characteristics of BUBH among Belgian general surgery residents. A cross-sectional survey was distributed online using an anonymous link through newsletters and social media channels of the Belgian Association of Surgical Trainees. The survey comprised 54 questions including: A) demographic; B) instances of BUBH, adapted from the validated Leymann Inventory of Psychological Terror and the Negative Acts Questionnaire; C) reporting, perpetrators, and management of BUBH derived from the survey developed by Rouleaux Club (United Kingdom). Fifty-six surgical residents, aged 24 to 40 years, participated. Of them, 18 (32%) were junior, 26 (56%) senior, and seven (12%) were enrolled in a research trajectory. Most respondents were Caucasian (82%), female (61%), heterosexual (93%), and without disability (98%). BUBH was experienced by 38 (68%) residents, while 44 (79%) witnessed BUBH towards their colleagues. Main perpetrators were consultants (n = 40/132; 30%) and nursing staff (n = 28/132; 21%). Reported behaviors included an unmanageable workload (n = 53; 95%), ignored opinions, (n = 52; 93%) and working below competence (n = 51; 91%). BUBH primarily occurred in operating rooms (39%), hospital wards (34%), or emergency rooms (11%). This is the first national study examining BUBH during surgical training in Belgium. Results highlight how BUBH is often misidentified and underreported. Proactive measures, educational programs, and support networks are essential to effectively address and mitigate these issues.
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare T-cell lymphoma increasingly linked to textured breast implants. It typically presents as a late-onset periprosthetic seroma and carries a generally favorable prognosis when diagnosed early. However, its pathogenesis remains incompletely understood, particularly in patients with genetic cancer predispositions. We report a unique case of BIA-ALCL in a 41-year-old woman who underwent bilateral prophylactic mastectomy and subsequent implant-based reconstruction due to a strong family history of breast and ovarian cancer. Ten years post-reconstruction, she presented with progressive unilateral breast swelling. Imaging suggested implant rupture with associated periprosthetic fluid. Cytology and immunohistochemistry confirmed CD30-positive, ALK-negative large T-cell lymphoma. PET-CT and MRI demonstrated disease confined to the implant capsule without lymph node involvement. Surgical management included bilateral en bloc capsulectomy. Histopathological staging revealed pT2N0M0 (Stage IB) disease due to superficial capsular infiltration. No adjuvant therapy was required because of the early intervention. Six-month follow-up imaging was negative for recurrence. This case raises important considerations about cancer risk management in genetically predisposed individuals, especially regarding the safety profile of textured implants. Current evidence suggests a possible oncogenic interaction between hereditary susceptibility and chronic implant-associated inflammation. Clinicians must maintain vigilance for BIA-ALCL even in prophylactic settings, as early diagnosis and complete surgical excision remain key to favorable outcomes.
Within the medical industry, operating rooms contribute significantly to greenhouse gas emissions. As a pediatric hospital, we feel highly responsible to reduce the negative impact of healthcare aimed at improving young lives. Therefore, we conducted a pilot study to assess simple waste segregation and recycling strategies aimed at reducing waste and improving sorting and recycling in our operating quarters. The study was conducted at Hôpital Universitaire Des Enfants Reine Fabiola (HUDERF)'s operating quarters and consisted of a questionnaire addressing staff opinions and waste measurements before (T = 0) and after (T = 1) a weeklong intervention: a campaign aimed at improving sorting and recycling surgical waste and reducing unnecessary opening of materials. Participants agreed that a transition towards more sustainable operating quarters will be necessary. At T = 1, 53% of respondents considered measures for sustainable waste management were applied, versus 26% before. Fifty-one surgeries were analyzed at T = 0. The mean weight of waste to incinerate was 1780 gram per hernia/orchidopexy, 940 gram per circumcision, and 2150 gram per central venous catheter (CVC) placement. At T = 1, another 51 surgeries were analyzed. The mean weight of waste to be incinerated was 665 gram per hernia/orchidopexy, 445 gram per circumcision, and 920 gram per CVC placement. Simple, easy-to-implement measures introduced during a one-week campaign aimed at improved triage and diminished pre-emptive opening of sterile materials led to a > 50% reduction in waste to incinerate.