Recent advances in the development of biomaterials have given rise to new options for surgery. New-generation medical devices can control chemical breakdown and resorption, prevent post-operative adhesion, and stimulate tissue regeneration. For the fabrication of medical devices, numerous biomaterials can be employed, including non-degradable biomaterials (silicone, polypropylene, expanded polytetrafluoroethylene) or biodegradable polymers, including implants and three-dimensional scaffolds for tissue engineering, which require particular physicochemical and biological properties. Based on the combination of new generation technologies and cell-based therapies, the biocompatible and bioactive properties of some of these medical products can lead to progress in the repair of injured or harmed tissue and in tissue regeneration. An important aspect in the use of these prosthetic devices is the associated infection risk, due to the medical complications and socio-economic impact. This paper provides the latest achievements in the field of antimicrobial surgical meshes for hernia repair and discusses the perspectives in the development of these innovative biomaterials.

Hepatocellular carcinoma is the most common liver malignancy and is among the top five most common cancers. Despite the progress of surgery and chemotherapy, the results are often disappointing, in part due to chemoresistance. This type of tumor has special characteristics that allow the improvement of diagnostic and treatment techniques used in clinical practice, by combining nanotechnology. This article presents a brief review of the literature focused on nano-conditioned diagnostic methods, targeted therapy, and therapeutic implications for the pathology of hepatocellular carcinoma. Within each subdomain, several modern technologies with significant impact were highlighted: serological, imaging, or histopathological diagnosis; intraoperative detection; carrier-type nano-conditioned therapy, thermal ablation, and gene therapy. The prospects offered by nanomedicine will strengthen the hope of more efficient diagnoses and therapies in the future.

Perineal hernia is a rare complication of rectal surgery. Different types of surgical approach have been described, but none of them have proven their superiority. Although there are many methods of closing the defect, we selected two cases to present from a series of five cases, in which the perineal hernia was successfully resolved surgically using only the perineal approach. The reconstruction of the perineal floor and closure of the defect were performed using a synthetic polypropylene mesh. The significance of this Technical Note article lies in the fact that we describe, step by step, a surgical technique for perineal hernia using just a perineal approach.

Background: Pancreatic and hepatobiliary tumors continue to rank among the deadliest cancers worldwide. Due to a low response rate to treatment, these tumors continue to have a high death rate, a poor prognosis and survival rate, and an overall poor patient outcome. The multimodal strategy used in current treatment includes systemic therapy, radiation therapy, and surgery. However, surgery remains the only treatment with curative intent. Preoperative biliary drainage has a direct impact on the perioperative prognosis of patients with obstructive jaundice and significantly compromised liver function due to hepato-bilio-pancreatic malignancies. Our study’s goal was to determine the safest and most efficient preoperative biliary drainage technique by conducting a systematic review and meta-analysis of resectable periampullary cancers. Methods: Our approach consisted of searching PubMed, BMC Medicine, and Scopus databases using keywords with a result of 1104 articles from 2010 to 2023. The remaining 24 articles that met our inclusion criteria were subjected to meta-analysis using R Commander 4.3.2. Results: Endoscopic retrograde biliary drainage (ERBD) demonstrated a higher rate of postprocedural pancreatitis (RR = 2.22, p < 0.01), intra-abdominal abscess (RR = 1.64, p < 0.01), and delayed gastric emptying (DGE) (RR = 2.07, p < 0.01) than percutaneous transhepatic biliary drainage (PTBD) or endoscopic nasobiliary drainage (ENBD). Plastic stent (PS) had higher rates of catheter occlusion (RR = 2.20, p < 0.01) and POPF (RR = 1.66, p < 0.01) compared to self-expandable metallic stent (SEMS), which could explain a longer hospital stay (MD = 2.41 days, p < 0.01). However, PS had lower rates of grade 1–2 complications (RR = 0.79, p = 0.017) and wound infection rates (RR = 0.66, p = 0.017) than self-expandable metallic stent (SEMS). Conclusions: The choice of a preoperative drainage method can influence postprocedural and postoperative complications rates. ERBD appears to be associated with higher procedure-related and postoperative complication rates and may be linked to a prolonged hospital stay compared to ENBD or PTBD. Moreover, the type of stent placed through ERBD procedure had an important impact on prognosis, as PS had a higher rate of catheter occlusion and POPF, with a prolonged hospital stay compared to SEMS, while mild complications and wound infections were less common in PS group.

Background and Objectives: Preoperative biliary drainage (PBD) in patients with periampullary neoplasms remains a debated topic, with various techniques available and conflicting evidence regarding their impact on postoperative outcomes. This study aimed to assess, in a high-volume pancreatic surgery center, whether the choice among endoscopic, surgical, or no preoperative biliary drainage influences postprocedural and postoperative complication rates. Materials and Methods: A retrospective cohort study was conducted at the Surgical Department of the “Octavian Fodor” Regional Institute of Gastroenterology and Hepatology in Cluj-Napoca, Romania, between January 2017 and May 2023. A total of 655 patients undergoing pancreaticoduodenectomy or total pancreatectomy for resectable periampullary tumors were divided into three groups: no PBD, endoscopic PBD, and surgical PBD. Clinical, procedural, and postoperative variables were collected and statistically analyzed. Results: Endoscopic drainage was associated with a significantly higher rate of postoperative intra-abdominal abscesses, postoperative pancreatic fistula (POPF), and pancreaticojejunostomy fistula compared to surgical drainage and no PBD. Patients in the endoscopic group also exhibited significantly higher rates of positive bile cultures, particularly with pluribacterial populations. Procedure-related complications, such as pancreatitis and cholangitis, were significantly lower in the surgical drainage group. No significant differences were found among groups regarding postoperative hospital stay, relaparotomy rates, or 90-day mortality. Conclusions: Surgical biliary drainage was associated with lower perioperative morbidity compared to endoscopic drainage. While endoscopic drainage remains the most commonly used approach, surgical drainage may offer a safer alternative in selected patients. Prospective randomized controlled trials are warranted to validate these findings.

Background and Objectives: Pancreaticogastrostomy (PG) and pancreaticojejunostomy (PJ) are the two most frequently employed reconstruction techniques following pancreaticoduodenectomy (PD), yet the optimal method remains debated. The objective of this study was to compare perioperative outcomes of PG versus PJ in patients undergoing PD for resectable periampullary tumors at a high-volume center. Materials and Methods: We conducted a retrospective cohort study including 604 consecutive patients who underwent PD between January 2019 and May 2025. Reconstruction of the pancreatic remnant was achieved by binding PG in 415 patients and duct-to-mucosa PJ in 189 patients. Demographics, intraoperative data, and postoperative outcomes were analyzed using standardized ISGPS/ISGLS definitions. Results: The overall complication rate was similar between groups (43.9% vs. 47.1%; p = 0.481). However, PG was associated with significantly lower rates of postoperative pancreatic fistula (POPF) (12.3% vs. 18.5%; p = 0.042) and postoperative biliary fistula (POBF) (2.9% vs. 6.3%; p = 0.044) compared with PJ. No significant differences were observed in delayed gastric emptying (DGE), postpancreatectomy hemorrhage (PPH), intra-abdominal abscess, relaparotomy, length of postoperative stay, or 90-day mortality. Conclusions: PG was associated with reduced rates of anastomotic fistulas compared with PJ, while other perioperative outcomes were comparable. These findings suggest that PG may be particularly advantageous in patients with a soft pancreatic remnant or nondilated duct, where the risk of fistula is higher, whereas PJ remains appropriate for firm, fibrotic glands with dilated ducts. Tailoring the reconstructive technique to pancreatic texture and ductal anatomy may therefore improve surgical outcomes and reduce postoperative morbidity.