International journal of surgery最新文献

{"title":"Comment on: \"Comparison on the predictive value of four preoperative nutritional assessment tools for acute kidney injury after major surgery: a retrospective cohort study\".","authors":"Hinpetch Daungsupawong, Viroj Wiwanitkit","doi":"10.1097/JS9.0000000000005140","DOIUrl":"10.1097/JS9.0000000000005140","url":null,"abstract":"","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":"112 7","pages":"13299-13300"},"PeriodicalIF":9.0,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13336585/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on \"Invasive or non-invasive vagus nerve stimulation modulation of brain function and remodeling after stroke: a review\".","authors":"Huihui Zhang, Yanfei Chen, Ying Zheng","doi":"10.1097/JS9.0000000000005076","DOIUrl":"10.1097/JS9.0000000000005076","url":null,"abstract":"","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":"112 6","pages":"12989-12991"},"PeriodicalIF":9.0,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13249344/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148873981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentary on \"Association between urinary heavy metal burden and overactive bladder in adults: evidence from NHANES 2005-2018\".","authors":"Zeming Qiu, Xueyan Xia, Xiancheng Li","doi":"10.1097/JS9.0000000000005147","DOIUrl":"10.1097/JS9.0000000000005147","url":null,"abstract":"","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":"112 7","pages":"13309-13310"},"PeriodicalIF":9.0,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13336594/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Short-term outcomes and risk factors of full-size split liver transplantation: a single-center experience of 113 cases.","authors":"Shengdong Wu, Kai Wang, Jing Huang, Jiongze Fang, Libin Dong, Shuqi Mao, Changjiang Lu, Ke Wang, Wei Jiang, Hongda Zhu, Xiao Xu, Caide Lu","doi":"10.1097/JS9.0000000000005154","DOIUrl":"10.1097/JS9.0000000000005154","url":null,"abstract":"<p><strong>Background: </strong>Full-size split liver transplantation (FSLT) offers an attractive way to expand the donor pool for adult patients. However, the efficacy and safety of FSLT remain under debate.</p><p><strong>Materials and methods: </strong>One hundred and three recipients who underwent FSLT were enrolled, and 124 recipients who received whole-liver transplantation (WLT) were taken as a control group. Clinical data and short-term outcomes within 1 year posttransplantation from 2019 to 2023 were compared between the two groups. Survival rates were calculated using the Kaplan-Meier method and compared by the log-rank test. Meanwhile, propensity-score matching (PSM) using key prognostic factors was conducted and the results were compared. Univariate and multivariate logistic regression analyses were performed to identify risk factors for serious complications in FSLT.</p><p><strong>Results: </strong>Thirty-three (29.2%) and 25 (20.2%) recipients in FSLT and WLT experienced postoperative complications graded ≥ III, with no significant differences (<i>P</i> = 0.106). However, biliary and vascular complications were more frequent in FSLT than in WLT (11.5% vs. 4.0% and 12.4% vs. 1.6%). The 3- and 6-month mortality rates in FSLT did not differ significantly from those in WLT (6.2% and 8.8% vs. 3.2% and 4.8%). The 1-year recipient (OS) and graft survival (GS) rates were 87.6% and 85.8% for FSLT, and 92.7% and 91.9% for WLT, with no significant differences. After PSM, the 1-year OS and GS were 81.3% and 81.3% for FSLT, and 90.6% and 90.6% for WLT (<i>P</i> = 0.081). Multivariate analysis revealed that a graft with steatosis of 5%-10%, a MELD score ≥ 20, sarcopenia, a history of hepatectomy, and an operation time > 420 min were independent risk factors for the incidence of postoperative complications graded ≥ III in FSLT.</p><p><strong>Conclusions: </strong>FSLT remains a challenging procedure. However, the short-term outcomes of FSLT were acceptable compared with those of WLT, encouraging the use of this procedure to increase the donor pool whenever possible.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":"112 7","pages":"13154-13167"},"PeriodicalIF":9.0,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13336613/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changing concepts in perihilar cholangiocarcinoma resections and surgery.","authors":"Eduardo Fernandes, Shintaro Yagi, Kaichiro Kato, Orlando Torres, Mario De Bellis, Hugo Pinto Marques, Andrea Ruzzenente","doi":"10.1097/JS9.0000000000005091","DOIUrl":"10.1097/JS9.0000000000005091","url":null,"abstract":"<p><p>Perihilar cholangiocarcinoma (PHCC) is a malignant tumor arising from bile ducts at the hilar area. It was first described by Altemeyer <i>et al</i> in 1957 in Cincinnati and later in 1965 by Gerald Klatskin at Yale University. The surgical management with R0 resection represents the only potentially curative treatment for PHCC patients. The ideal surgical treatment represents a challenge for liver surgeons across the globe, and expertise in vascular reconstruction and transplantation is required. The anatomy of the liver hilum is a complex area where the proximity of portal vein bifurcation and hepatic artery branches, especially the right hepatic artery, gets an intimal relation with the bile duct confluence area. This explains frequent vascular involvement in such tumors. The modern surgical approaches in PHCC involve several topics of discussion and controversies among hepatobiliary surgeons. Some key points will be discussed in this comprehensive discussion.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":"112 6","pages":"12579-12587"},"PeriodicalIF":9.0,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13249319/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148873980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Human acellular dermal matrix for middle hepatic vein reconstruction in living donor liver transplantation: a prospective feasibility and safety study.","authors":"Gwang-Sik Chun, Min-Kyung Yeo, Seok-Hwan Kim, Hyuk-Soo Eun, Sun-Jong Han, In-Sang Song","doi":"10.1097/JS9.0000000000005143","DOIUrl":"10.1097/JS9.0000000000005143","url":null,"abstract":"<p><strong>Background: </strong>During living donor liver transplantation (LDLT), middle hepatic vein (MHV) reconstruction requires a conduit that preserves early venous outflow while avoiding late device-related complications typical of synthetic grafts. We evaluated human acellular dermal matrix (ADM) as an off-the-shelf biological conduit.</p><p><strong>Methods: </strong>In a prospective single-center cohort (2022-2025), adults undergoing LDLT with MHV reconstruction using ADM (<i>n</i> = 40) were followed. Outcomes were benchmarked against historical controls using Hemashield (<i>n</i> = 40) or polytetrafluoroethylene (PTFE; <i>n</i> = 20). Primary endpoints were early-phase patency (≤6 months) and major structural complications. Two blinded radiologists independently reviewed serial Doppler ultrasonography and contrast-enhanced computed tomography with consensus adjudication. Patency was estimated by Kaplan-Meier and compared with the log-rank test.</p><p><strong>Results: </strong>ADM achieved excellent early patency [95.0% (83.5-98.6) at 3 months; 85.0% (70.9-92.9) at 6 months]. At 18 months, patency was 62.5% for ADM versus 50.0% (PTFE) and 47.5% (Hemashield) (log-rank <i>P</i> = 0.785). No ADM graft required re-intervention, and no graft infection or duodenal invasion occurred (0/40 vs 2/60 [3.3%] in synthetic cohorts). Baseline characteristics were comparable. Case review showed that several ADM occlusions were associated with large bilomas, where secondary infection rather than intrinsic graft failure likely triggered thrombosis.</p><p><strong>Conclusions: </strong>ADM is a feasible and safe biological conduit for MHV reconstruction, delivering robust patency throughout the critical period of graft regeneration while avoiding catastrophic complications observed with synthetic materials. These hypothesis-generating results support a randomized trial and introduce the concept of ADM as a temporary biological scaffold. Given its excellent early patency and safety profile, ADM should be considered a valuable addition to the surgical armamentarium with potential to redefine success in venous reconstruction.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":"112 7","pages":"13116-13123"},"PeriodicalIF":9.0,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13336604/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Omitting axillary dissection in breast cancer patients with one to two positive sentinel nodes undergoing mastectomy: a retrospective and prospective cohort study with a target trial emulation.","authors":"Haitong Xie, Xin Wang, Xianlin Gu, Chihua Wu, Wanying Guo, Rui Li, Binxu Qiu, Zhihao Zhang, Peng Gao, Xiangyue Meng, Liang Du, Shengchun Liu, Michael Gnant, Jie Chen","doi":"10.1097/JS9.0000000000004708","DOIUrl":"10.1097/JS9.0000000000004708","url":null,"abstract":"<p><strong>Background: </strong>Previous trials have demonstrated the safety of omitting axillary lymph node dissection (ALND) in cT1-3, cN0 breast cancer patients with one to two sentinel lymph node (SLN) involvement undergoing breast-conserving surgery (BCS). However, their applicability to mastectomy patients - who do not routinely receive chest wall irradiation - remains unclear. This study aimed to evaluate whether omitting ALND is noninferior to completion of ALND among patients undergoing mastectomy.</p><p><strong>Methods: </strong>We emulated a target multicenter, nonblinded, noninferiority trial to compare sentinel lymph node biopsy only (SLNB only) and SLNB plus ALND using combined prospective and retrospective cohorts. Eligible patients had cT1-3, cN0 breast cancer with one to two SLN metastases. The primary endpoint was 5-year recurrence-free survival (RFS). Noninferiority was defined as a hazard ratio (HR) of less than 1.54 comparing the SLNB-only group to the ALND group. This study was prospectively registered with Chictr.org.cn.</p><p><strong>Results: </strong>Among 1090 included patients, 438 (40.2%) received SLNB only and 652 (59.8%) received ALND. After a median follow-up of 4.74 years, 88 patients experienced recurrence or died. The estimated 5-year RFS was 91.5% (95% CI, 89.1-93.9) in the SLNB only group and 91.8% (95% CI, 88.7-95.1) in the ALND group (HR = 0.83; 95% CI, 0.51-1.33; P_{noninferiority} = 0.005). Primary findings were consistent across subgroups and sensitivity analyses.</p><p><strong>Conclusion: </strong>Results of this targeted trial revealed that ALND can be omitted in patients undergoing mastectomy with clinically node-negative, cT1-3 invasive breast cancer who had one to two SLN metastases. These findings further inform the de-escalation of axillary surgery in breast cancer management.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":"112 4","pages":"11000-11012"},"PeriodicalIF":9.0,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13105511/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An artificial intelligence-based navigation system for enhancing anatomical recognition and safety during laparoscopic cholecystectomy: a pilot study.","authors":"Keita Sonoda, Yuta Abe, Yutaka Nakano, Masashi Takeuchi, Yosuke Uematsu, Tasuku Furube, Minoru Kitago, Yasushi Hasegawa, Shutaro Hori, Masayuki Tanaka, Hirofumi Kawakubo, Yuko Kitagawa","doi":"10.1097/JS9.0000000000005086","DOIUrl":"10.1097/JS9.0000000000005086","url":null,"abstract":"<p><strong>Background: </strong>Failure to incise ventral to the Rouvière's sulcus and maintain the dissection plane on the gallbladder (GB) surface predisposes patients to bile duct injuries (BDIs), particularly during trainee-performed laparoscopic cholecystectomy (LC). No existing artificial intelligence (AI) tools offer Tokyo Guidelines 2018 (TG 2018)-anchored real-time guidance. We developed and externally validated an AI navigation system that highlights the alert zone (AZ) - the hepatoduodenal-ligament tissues lying below an imaginary line from the roof of the Rouvière's sulcus to the base of segment 4 and the infundibulum-cystic duct junction - and GB surface specified in the TG 2018.</p><p><strong>Materials and methods: </strong>Seventy-three LC videos (January 2022-March 2024) were used to train the DeepLab v3 + segmentation model. The AZ and GB surface were manually annotated. The performance was tested on 10 independent videos (100 frames) with an intersection-over-union (IoU) metric. A two-arm pilot usability study randomized 10 fifth- or sixth-year postgraduate surgeons to answer video-based safety questions with or without AI assistance (20 tasks each).</p><p><strong>Results: </strong>The AI achieved a mean IoU of 0.703 (AZ) and 0.735 (GB) compared to the developer ground truth and 0.706 (AZ) and 0.730 (GB) compared to the external ground truth. With AI navigation, the correct selection of a safe incision point increased from 58% to 90%, and contour recognition of the GB surface increased from 70% to 92% (both <i>P</i> < 0.05).</p><p><strong>Conclusion: </strong>The AI navigation system based on the TG 2018 reliably delineated critical landmarks and markedly improved intraoperative trainee decision-making. Prospective real-time trials should determine whether this technology reduces BDIs.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":"112 6","pages":"12720-12727"},"PeriodicalIF":9.0,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13249260/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148873818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of a deep-learning model to detect free air on abdominal computed tomography for surgical decision support.","authors":"Sangwook Kim, Sin Hye Park, Joonghyup Lee, Hayemin Lee, Dong Jin Kim","doi":"10.1097/JS9.0000000000005385","DOIUrl":"10.1097/JS9.0000000000005385","url":null,"abstract":"<p><strong>Background: </strong>Free air (FA) in the abdominal cavity is a critical finding requiring prompt surgical intervention. We developed an AI-based segmentation model, Free Air-Net (FA-NET), to detect FA in abdominal computed tomography (CT) scans and further refined it with negative training to create FA-NET-NT, aiming to reduce false positives.</p><p><strong>Materials and methods: </strong>FA-NET-NT was developed using a retrospective dataset from a single institution (<i>n</i> = 162). To evaluate its generalizability, the model was validated through both a temporal internal cohort (<i>n</i> = 215) and an independent external cohort from a different hospital (<i>n</i> = 237), which included various CT manufacturers and protocols. The model evaluation was threefold: (1) the Dice score coefficient, (2) image-wise, and (3) patient-wise sensitivity and specificity using representative CT segments (segments 4 through 8, out of 20 equally divided sections of the total axial series). If the model detected at least two images having FA among the representative images, the patient was regarded as having FA.</p><p><strong>Results: </strong>Both models achieved high Dice scores (0.87). FA-NET-NT improved specificity (96%) while maintaining high sensitivity (85%) in image-wise analysis. In patient-wise analysis, FA-NET-NT achieved 95-96% sensitivity for ulcer perforation and 82-92% specificity for non-FA conditions (cholecystitis, pancreatitis, and appendicitis). Specificity for ileus remained moderate (62%). In the external validation, the model demonstrated a patient-wise sensitivity of 95% for ulcer perforation. High specificity was maintained against differential diagnoses, including appendicitis (88%), pancreatitis (88%), cholecystitis (82%), and ileus (80%). Most false-positive findings were attributable to physiological bowel gas mimicking FA.</p><p><strong>Conclusion: </strong>FA-NET-NT is a robust decision-support tool for detecting FA, with its generalizability confirmed through multi-institutional validation. To provide definitive evidence of its clinical superiority, further prospective multi-center trials are necessary in emergency settings.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":"112 7","pages":"13207-13216"},"PeriodicalIF":9.0,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13336583/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deciphering the association between uric acid and kidney stones: insights into the mediating roles of BMI and serum iron: a cross-sectional study based on NHANES 2007-2018.","authors":"Ken Li, Chu Ann Chai, Yi Quan Tan, Wei Zhu, Guohua Zeng","doi":"10.1097/JS9.0000000000005126","DOIUrl":"10.1097/JS9.0000000000005126","url":null,"abstract":"<p><strong>Background: </strong>The relationship between serum uric acid (UA) levels and the prevalence and recurrence of kidney stone (KS) remains unclear. This study aims to investigate the association between UA levels and the risk of KS in a large sample of U.S. adults.</p><p><strong>Methods: </strong>We analyzed the relationship between UA levels and the prevalence of KS among 24 039 U.S. adults from the 2007-2018 National Health and Nutrition Examination Survey. Multivariable logistic regression models were employed to assess the impact of UA on KS prevalence, while restricted cubic splines were used to explore potential nonlinear associations. Mediation analysis was conducted to examine the potential influence of body mass index (BMI) and serum iron on this relationship. Subgroup analyses were also performed to account for demographic differences.</p><p><strong>Results: </strong>Higher serum UA levels were significantly associated with an increased prevalence of KS (OR = 1.001, 95% CI: 1.000-1.002, <i>P</i> < 0.001). This association remained significant after adjustment for covariates such as age, sex, and race, whereas UA levels were not related to KS recurrence. Mediation analysis showed partial effects of serum iron (2.7%) and BMI (20.0%) on the UA-KS relationship.</p><p><strong>Conclusion: </strong>Elevated UA levels are statistically associated with an increased prevalence of KS in U.S. adults but are not linked to recurrence. Serum iron and BMI may partially mediate this relationship. These findings underscore the potential role of UA as a target for KS prevention and offer insights into the underlying biological mechanisms.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":"112 7","pages":"13020-13033"},"PeriodicalIF":9.0,"publicationDate":"2026-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13336615/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}