Numerous strategies for perioperative nutrition therapy for patients undergoing pancreaticoduodenectomy (PD) have been proposed. This systematic review aimed to summarize the current relevant published randomized controlled trials (RCTs) evaluating different nutritional interventions via a traditional network meta-analysis (NMA) and component network meta-analysis (cNMA). EMBASE, MEDLINE, the Cochrane Library, and ClinicalTrials.gov were searched to identify the RCTs. The evaluated nutritional interventions comprised standard postoperative enteral nutrition by feeding tube (Postop-SEN), preoperative enteral feeding (Preop-EN), postoperative immunonutrients (Postop-IM), preoperative oral immunonutrient supplement (Preop-IM), and postoperative total parenteral nutrition (TPN). The primary outcomes were general, infectious, and noninfectious complications; postoperative pancreatic fistula (POPF); and delayed gastric emptying (DGE). The secondary outcomes were mortality and length of hospital stay (LOS). The NMA and cNMA were conducted with a frequentist approach. The results are presented as odds ratios (ORs) and 95% confidence intervals (CIs). Two primary outcomes, infectious complications and POPF, were positively influenced by nutritional interventions. Preop-EN plus Postop-SEN (OR 0.11; 95% CI 0.02~0.72), Preop-IM (OR 0.22; 95% CI 0.08~0.62), and Preop-IM plus Postop-IM (OR 0.11; 95% CI 0.03~0.37) were all demonstrated to be associated with a decrease in infectious complications. Postop-TPN (OR 0.37; 95% CI 0.19~0.71) and Preop-IM plus Postop-IM (OR 0.21; 95% CI 0.06~0.77) were clinically beneficial for the prevention of POPF. While enteral feeding and TPN may decrease infectious complications and POPF, respectively, Preop-IM plus Postop-IM may provide the best clinical benefit for patients undergoing PD, as this approach decreases the incidence of both the aforementioned adverse effects.

Background: Concurrent acute cholecystitis and acute cholangitis is a unique clinical situation. We tried to investigate the optimal timing of cholecystectomy after adequate biliary drainage under this condition. Methods: From January 2012 to November 2017, we retrospectively screened all in-hospitalized patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) and then identified patients with concurrent acute cholecystitis and acute cholangitis from the cohort. The selected patients were stratified into two groups: one-stage intervention (OSI) group (intended laparoscopic cholecystectomy at the same hospitalization) vs. two-stage intervention (TSI) group (interval intended laparoscopic cholecystectomy). Interrogated outcomes included recurrent biliary events, length of hospitalization, and surgical outcomes. Results: There were 147 patients ultimately enrolled for analysis (OSI vs. TSI, 96 vs. 51). Regarding surgical outcomes, there was no significant difference between the OSI group and TSI group, including intraoperative blood transfusion (1.0% vs. 2.0%, p = 1.000), conversion to open procedure (3.1% vs. 7.8%, p = 0.236), postoperative complication (6.3% vs. 11.8%, p = 0.342), operation time (118.0 min vs. 125.8 min, p = 0.869), and postoperative days until discharge (3.37 days vs. 4.02 days, p = 0.643). In the RBE analysis, the OSI group presented a significantly lower incidence of overall RBE (5.2% vs. 41.2%, p < 0.001) than the TSI group. Conclusions: Patients with an initial diagnosis of concurrent acute cholecystitis and cholangitis undergoing cholecystectomy after ERCP drainage during the same hospitalization period may receive some benefit in terms of clinical outcomes.

Background: Parathyroidectomy for medically refractory secondary hyperparathyroidism in patients with end-stage renal disease (ESRD) traditionally relies on experience-dependent surgical exploration due to limited preoperative localization capabilities. This study evaluates whether four-dimensional computed tomography (4D CT) provides significant improvements in surgical efficiency with measurable operative benefits. Methods: This retrospective comparative study analyzed 103 patients with ESRD undergoing total or subtotal parathyroidectomy between January 2023 and December 2024. Patients were stratified into two groups: 4D CT-guided focused parathyroidectomy ( n = 45) versus conventional imaging-guided surgery using ultrasound ± SPECT(Single Photon Emission Computed Tomography)/CT ( n = 58). Primary endpoints included operative time and intraoperative frozen section requirements. Secondary endpoints assessed diagnostic accuracy and positive predictive value (PPV) of imaging modalities, with postoperative outcomes evaluated to ensure therapeutic equivalence. Results: The 4D CT group demonstrated significantly shorter operative times compared to conventional imaging (162.51 vs. 188.78 min, P = 0.014), representing a 13.9% reduction in surgical duration. Multiple frozen sections were required in 8.9% of 4D CT patients versus 31.0% of conventional patients ( P = 0.013), demonstrating a 3.5-fold reduction in intraoperative histological confirmation needs. 4D CT showed superior diagnostic accuracy (75% vs. 33.33%) and PPV (93.75% vs. 85.0%) compared to conventional imaging. Multivariate analysis identified 4D CT as the only independent predictor of reduced frozen section requirements (odds ratio: 0.21, 95% confidence interval: [0.06–0.68]; P = 0.009). Postoperative outcomes including biochemical control and complication rates were equivalent between groups, demonstrating that enhanced surgical efficiency did not compromise therapeutic effectiveness. Conclusions: 4D CT significantly enhances surgical efficiency in ESRD patients with medically refractory secondary hyperparathyroidism through improved preoperative localization. These efficiency gains are achieved while maintaining therapeutic effectiveness.