Slipping rib syndrome (SRS) is a disorder that occurs when one or more of the eighth through tenth ribs become abnormally mobile. SRS is a poorly understood condition leading to a significant delay in diagnosis and therapeutic management. History and a physical exam are usually sufficient for a diagnosis of SRS. The utility of dynamic ultrasounds has also been studied as a useful diagnostic tool. Multiple surgical techniques for SRS have been described within the literature. Cartilage rib excision (CRE) has been the most common technique utilized. However, the literature has shown a high rate of recurrence and associated risks with the procedure. More recently, minimally invasive rib fixation and costal cartilage excision with vertical rib plating have been shown as successful and safe alternative techniques. This may be an effective, alternative approach to CRE in adult and pediatric populations with SRS.

Background: Pancreatic enucleation is a parenchymal-sparing procedure used for highly select patients with pancreatic neoplasms. We aim to utilize a multi-institutional health research network platform (TriNetX) and a single, high-volume center to assess complications and identify risk factors associated with post-operative pancreatic fistulas (POPF) after pancreatic enucleation. Methods: A two-tiered retrospective study was conducted. We identified 423 patients from TriNetX, and 34 patients from a single-institution IRB-approved database who underwent pancreatic enucleation between 2004–2025 and 2012–2023, respectively. Univariate and multivariate analyses were performed to determine risk factors associated with post-operative complications and occurrence of POPFs. Results: In the TriNetX cohort, 128 (30.3%) experienced postoperative complications after pancreatic enucleation. On univariate analysis, hyperlipidemia (HLD) (OR = 2.37), gastroesophageal reflux disease (GERD) (OR = 3.87), acute pancreatitis (OR = 8.28), chronic pancreatitis (OR = 4.76), nicotine dependence (OR = 2.36), ascites (OR = 6.49), deep vein thrombosis (DVT), pulmonary embolism (PE), and thrombophlebitis (OR = 2.95), and body mass index (BMI) ≥ 25 (OR = 1.56) were identified as significant risk factors. On multivariate analysis, acute pancreatitis (HR = 1.64), chronic pancreatitis (HR = 1.78), ascites (HR = 2.96), DVT, PE and thrombophlebitis (HR = 1.74) remained significant. In our single-institution enucleation cohort, 8 patients had a POPF (23.5%). The measured distance from the neoplasm to the main pancreatic duct (MPD) was significantly shorter in patients who developed POPF (2.8 vs 6.5 mm, P < 0.05). ROC analysis determined that shorter distance from the MPD was predictive of POPF occurrence (AUC = 0.79, p < 0.005). Increased estimated blood loss was also associated with POPF (p < 0.01). Conclusion: Our study identifies clinicopathologic risk factors associated with post-operative complications and POPF after pancreatic enucleation. The distance from the neoplasm to the MPD appears to be a key component of decision-making in the development of POPF.

Background: Diagnostic, therapeutic and surgical techniques for slipping rib syndrome (SRS) are evolving to improve clinical outcomes and recurrence. Our objective was to evaluate current practice patterns in SRS diagnosis and treatment among surgeons nationally. Methods: An electronic survey was nationally distributed to surgeons who were identified as slipped rib repair providers to assess trends in diagnosis and treatment. Descriptive analyses were performed. Results: Twenty-four surgeons responded to the survey (45.3%). Almost half identified as thoracic surgeons (47.6%, n=10); 23.8% identified as pediatric surgeons (n=5), 23.8% as trauma/acute care surgeons (n=5), and 4.8% as general surgeons (n=1). Patient history (54.2%, n=13) and physical exam (70.8%, n=17) were reported as most important diagnostic factors. Of surgeons who utilized preoperative and intraoperative pain regimens, rib blocks with lidocaine were the most common (92.9%, n=13). Suturing of ribs/cartilage was identified as the most integral step in the slipped rib repair operation (70.8%, n=17), followed by excision of rib cartilage (66.7%, n=16), use of a biodegradable plate (54.2%, n=13) and utilizing excised rib cartilage as a spacer (29.2%, n=7). Trauma or inciting event was reported as a positive prognostic factor for post-operative pain relief (82.6%, n=19). Connective tissue disorder (58.3%, n=14) and hypermobility disorder (45.8%, n=11) were identified as the two most common factors associated with recurrence. Conclusions: This national survey of surgeons demonstrates high variability in management and expected outcomes related to diagnosis and treatment for SRS. Further research is needed to identify optimal patient selection and operative approach and long-term clinical outcomes.