Background: While radiotherapy (RT) and chemotherapy (CT) significantly improve breast cancer outcomes, they may affect breast reconstruction by causing vascular damage and delayed wound healing. This retrospective study evaluates how preoperative RT, CT, or the combination of both impacts intraoperative and postoperative outcomes in immediate or delayed deep inferior epigastric perforator (DIEP) flap breast reconstructions. Methods: We conducted a single-center review of all patients undergoing autologous DIEP flap reconstruction after mastectomy between 2018 and 2024. Patients were divided into four groups: RT only, CT only, a combination of RT and CT, and a control group with no preoperative therapies. Intraoperative and postoperative outcomes were then compared among these groups, with statistical significance defined as p < 0.05. Results: We included 114 patients representing 141 DIEP-flap breast reconstructions. Flap survival rate was 98.5%. In the univariate analysis, total microvascular recipient site complications were significantly higher in the RT + CT group (14.0%, p = 0.021). Donor-site complication rates differed significantly among the four groups (p = 0.025), with the highest rate observed in the RT + CT group (44.7%). In the logistic regression analysis, ischemia time was found as an independent risk factor for total recipient site complications, but not for microvascular complications (OR = 1.019, 95%-CI = 1.004–1.035, p = 0.014). Conclusions: Combined RT + CT significantly increased microsurgical complications. Ischemia time correlated with higher odds of total recipient site complications. Individualized patient management and diminished ischemia time are likely to improve flap survival.

Introduction: The cyst of the canal of Nuck is a rare cause of inguino-labial swelling in adult women, arising from an obliteration failure of the processus vaginalis during embryological development. Its rarity often leads to misdiagnosis and improper treatment. This article highlights its diagnosis and surgical management. Case presentation: A 21-year-old woman presented with a two-month history of symptomatic swelling in the right inguino-labial region, after consulting multiple doctors. Various investigations including abdominal ultrasonography, computed tomography, and Magnetic Resonance Imaging revealed multiloculated cystic lesion with thin walls, without communication to the peritoneal cavity. During surgery, an encysted sack was discovered at the external inguinal ring, with no associated hernia. The cyst was ligated high and excised along with the round ligament. The anatomical defect was repaired without using prosthetic mesh. The patient had an uneventful post-operative recovery at six-months follow-up. Discussion: The encysted hydrocele (Type 1) is the most common among the three types of canal of Nuck hydroceles. This rare entity should be considered in the differential diagnosis of groin masses, even in adult women. Ultrasonography is often used initially, while Magnetic Resonance Imaging is reserved for complex cases. Surgical intervention is essential for both diagnosis and treatment, with dissection extending up to the deep inguinal ring to address any associated hernias. The choice between open or laparoscopic procedures depends on the nature of the defect. Conclusion: Surgery remains the sole standard therapeutic approach for the management of the cyst of the canal of Nuck. Highlights:

Introduction and importance: Meckel’s diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract, yet acute lower gastrointestinal bleeding as a presentation in adults remains uncommon and diagnostically challenging. This case highlights the importance of early surgical decision-making in this setting. Presentation of case: A 20-year-old male with no medical history presented with 2 days of hematochezia. Hemoglobin levels declined over 72 hours. The patient developed hemodynamic instability and episodes of syncope, which were managed on the surgical ward without vasopressor support. Upper and lower endoscopies were unremarkable. Contrast-enhanced computed tomography (CT) identified a blind-ending ileal structure consistent with MD. Laparoscopic exploration confirmed a 7 × 2 cm MD located 140 cm from the ileocecal valve. A 10-cm ileal segment was resected, and a hand-sewn anastomosis was performed. Histopathology confirmed ectopic gastric fundic-type mucosa without ulceration. The postoperative course was complicated by a transient paralytic ileus (Clavien-Dindo grade II), which was managed conservatively, with discharge on day 6. Clinical discussion: MD should be considered in young adults with unexplained hematochezia when standard endoscopy is negative. CT imaging is key in identifying MD. Segmental bowel resection is preferred when ectopic mucosa is suspected. While technetium-99 m pertechnetate scanning may be considered in stable patients with suspected MD, its sensitivity in adults is lower than in children. Conclusion: Surgical resection remains the definitive treatment for symptomatic cases. Prophylactic excision of incidentally discovered MD may be considered in selected patients with risk factors for complications, though this decision should be individualized and weighed against surgical risks.

Introduction: Complete mesocolic excision (CME) with central vascular ligation (CVL) has been proposed as an oncologically superior surgical technique for right-sided colon cancer, mirroring the impact of total mesorectal excision (TME) in rectal cancer. While promising results have been reported, evidence from routine clinical practice, particularly within Swiss healthcare settings, remains limited. This study aims to evaluate the surgical and oncological outcomes of CME compared with standard right hemicolectomy (non-CME) over a 10-year period. Methods and analysis: This is a retrospective cohort study of adult patients who underwent right hemicolectomy, either CME or non-CME, for histologically confirmed adenocarcinoma of the right colon or right third of the transverse colon at a tertiary centre, between 2010 and 2020. Patients with concomitant malignancies or distant metastases will be excluded. The primary outcome is 3-year and 5-year disease-free survival. Secondary outcomes include number of harvested lymph nodes, 3-year and 5-year overall survival, and 30-day morbidity. Ethics and dissemination: This study was approved by the relevant Ethics Committee (CER-VD 2025-00503). All patients provided general consent for secondary use of anonymised data. Results will be submitted to a peer-reviewed journal and presented at national and international conferences.

Introduction and importance: Idiopathic segmental infarction of the greater omentum (ISIGO) is a rare cause of acute abdominal pain and often mimics appendicitis and cholecystitis. Contrast-enhanced computed tomography (CT) is the most reliable imaging modality and can support conservative management in stable patients. However, conservative treatment may fail and require surgery. Presentation of case: A 55-year-old overweight man presented with 1 week of right-sided abdominal pain with recent worsening despite outpatient medical therapy. He was hemodynamically stable but had right upper quadrant tenderness and localized guarding. Laboratory testing showed an elevated C-reactive protein level with a normal leukocyte count and normal liver biochemistry results. CT demonstrated inflammatory fat stranding of the right greater omentum with a hyperdense rim, consistent with right-sided omental infarction. Given the persistent symptoms and CT findings, diagnostic laparoscopy was performed, which confirmed ischemic omentum with hemorrhagic peritoneal fluid. Laparoscopic segmental omentectomy was completed without complications. Histopathology confirmed omental infarction. The patient was discharged on postoperative day 1 and remained asymptomatic at the 6-week follow-up. Clinical discussion: ISIGO remains under-recognized, with evidence limited to isolated case reports and small series. CT typically shows fat stranding with a hyperdense rim, although overlap exists with other causes of focal fat inflammation. Recent literature supports conservative management in stable patients, reserving surgery for cases of diagnostic uncertainty or failure of symptomatic treatment. Conclusion: ISIGO should be included in the differential diagnosis of acute abdominal pain. CT enables diagnosis, and laparoscopy is a reasonable option when symptoms persist despite pain management, or when diagnostic uncertainty remains.