Surgery最新文献

{"title":"The role of kidney-preserving surgery in renal trauma: A nationwide analysis","authors":"Masaki A. Ito BS ,&nbsp;Kyosuke Takahashi MD, PhD ,&nbsp;Madeleine L. Burg MD ,&nbsp;Matthew J. Ashbrook MD, MPH ,&nbsp;Jamal A. Nabhani MD ,&nbsp;Matthew J. Martin MD ,&nbsp;Kenji Inaba MD ,&nbsp;Kazuhide Matsushima MD","doi":"10.1016/j.surg.2025.109505","DOIUrl":"10.1016/j.surg.2025.109505","url":null,"abstract":"<div><h3>Background</h3><div>Although renal trauma is commonly managed nonoperatively, surgical intervention may be necessary in some patients. Within operative management, the rationale for choosing between total nephrectomy and kidney-preserving approaches remains unclear. In this study, we aimed to define the role of kidney-preserving surgery within renal trauma management.</div></div><div><h3>Methods</h3><div>Using the National Trauma Data Bank 2017–2021, we retrospectively evaluated clinical characteristics and outcomes of patients who underwent total nephrectomy or kidney-preserving surgery. We performed logistic regression for the use of kidney-preserving surgery and to assess the risk of hospital complications between the 2 cohorts.</div></div><div><h3>Results</h3><div>Of 52,212 patients with renal injury, 1,756 (3.4%) and 794 (1.5%) underwent total nephrectomy and kidney-preserving surgery, respectively. Patients with penetrating injuries were more likely to undergo kidney-preserving surgery (odds ratio, 3.18; 95% confidence interval. 2.34–4.31, <em>P</em> &lt; .001). Total nephrectomy was preferred for patients with admission systolic blood pressure &lt;90 mm Hg (odds ratio, 0.61; 95% confidence interval, 0.47–0.79, <em>P</em> &lt; .001), Glasgow Coma Scale &lt;9 (odds ratio, 0.51; 95% confidence interval, 0.37–0.70, <em>P</em> &lt; .001), or high-grade renal injuries (odds ratio, 0.41; 95% confidence interval, 0.33–0.52, <em>P</em> &lt; .001). Kidney-preserving surgery was associated with a greater risk for postoperative urine leakage procedures (odds ratio, 1.40; 95% confidence interval, 1.06–1.85, <em>P</em> = .019) but a lower probability of requiring hemodialysis (odds ratio, 0.32; 95% confidence interval, 0.14–0.72, <em>P</em> = .006) or developing acute kidney injury (odds ratio, 0.49; 95% confidence interval, 0.32–0.76, <em>P</em> = .001).</div></div><div><h3>Conclusion</h3><div>Kidney-preserving surgery is preferred for stable patients with penetrating trauma and lower-grade injuries. It carries a greater risk of requiring procedures for urine leakage but a decreased risk for acute kidney injury and the need for hemodialysis when compared to total nephrectomy.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"185 ","pages":"Article 109505"},"PeriodicalIF":3.2,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144365590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgeon as advocate: A widening lane","authors":"Chelsea Dorsey MD ,&nbsp;Simi Ogunnowo BA ,&nbsp;Anthony Douglas MD ,&nbsp;Selwyn Rogers MD ,&nbsp;Jeffrey B. Matthews MD","doi":"10.1016/j.surg.2025.109515","DOIUrl":"10.1016/j.surg.2025.109515","url":null,"abstract":"<div><div>Surgeons have traditionally engaged in advocacy focused on the practice of surgery, addressing issues like payment reform and regulatory policies. However, rising societal challenges and global shifts have underscored the need for surgeons to expand their advocacy scope beyond the operating room. Surgeon-advocates are uniquely positioned to leverage their expertise to influence public discourse, inform key stakeholders, and champion solutions to pressing social issues. A contemporary approach to surgical care necessitates integrating advocacy to address the whole patient within their social context. Despite increased interest among medical students and trainees, advocacy is rarely recognized as a viable career pathway, limiting systematic support and incentive structures. Introducing mentorship programs, dedicated curricula, and advocacy tracks during surgical training could attract motivated individuals to the profession while equipping them to influence policy and societal change. Emphasizing advocacy not as indoctrination but as skill-building empowers surgeons to widen their lanes responsibly. Failure to integrate advocacy into surgical career development risks missing a pivotal opportunity to advance equitable care, inspire transformative impact, and ensure surgeons' voices in critical policymaking processes. Recognizing the importance of advocacy in the surgical field is essential—not for staying in a predetermined lane, but for effectively addressing the complex societal and multidisciplinary challenges of our era.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"185 ","pages":"Article 109515"},"PeriodicalIF":3.2,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144365620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing the pathway and timing for ileostomy reversal in rectal cancer: A retrospective cohort study","authors":"Megan E. Boyer MD ,&nbsp;Totadri Dhimal MD ,&nbsp;Bailey K. Hilty Chu MD ,&nbsp;Anthony Loria MD, MSCI ,&nbsp;Xueya Cai PhD ,&nbsp;Shan Gao MS ,&nbsp;Marie L. Jacobs MD ,&nbsp;Yue Li PhD ,&nbsp;Paula Cupertino PhD ,&nbsp;Fergal J. Fleming MD, MPH","doi":"10.1016/j.surg.2025.109507","DOIUrl":"10.1016/j.surg.2025.109507","url":null,"abstract":"<div><h3>Background</h3><div>Surgery for locally advanced rectal cancer often requires temporary fecal diversion, which significantly impacts quality of life and can lead to unintended morbidity. Patients typically are counseled that reversal is planned for 3 months postoperatively, but the actual time to reversal and factors that may delay closure are poorly understood. We aimed to evaluate time from diversion to ostomy reversal, with secondary outcomes including patient- and systems-level factors influencing this timeline.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included patients with stage I-III rectal cancer who underwent low anterior resection with diverting loop ileostomy between 2011 and 2022 at a tertiary center. Median time to reversal and intervals to prereversal events were determined. A stepwise Cox proportional hazards model was used to identify factors associated with prolonged time to reversal, whereas Kaplan-Meier methods were applied to estimate median time to reversal for subgroups.</div></div><div><h3>Results</h3><div>Among 133 patients, 79.0% (<em>n</em> = 105) had their stomas reversed after a median of 5.5 months. Delays were observed in time to follow-up appointments, endoscopic evaluations, and gastrografin enemas. Prolonged time to closure was associated with receipt of adjuvant therapy (hazard ratio, 0.50; 95% confidence interval, 0.29–0.85), ASA status ≥3 (hazard ratio, 0.59; 95% confidence interval, 0.39–0.90), Clavien-Dindo complications ≥3 (hazard ratio, 0.32; 95% confidence interval, 0.11–0.91), persistent anastomotic disruption (hazard ratio, 0.36; 95% confidence interval, 0.15–0.85), and more follow-up appointment cancellations (hazard ratio, 0.35; 95% confidence interval, 0.18–0.68).</div></div><div><h3>Conclusion</h3><div>Stoma reversal often exceeds the anticipated 3-month timeline as the result of patient risk factors and anastomotic evaluation protocols. Identifying these barriers is essential to develop standardized, timely, and patient-centered reversal metrics.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"185 ","pages":"Article 109507"},"PeriodicalIF":3.2,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144365592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical wisdom as phronesis: An evidence-based hypothesis about “understanding… the great gray that exists in the field”","authors":"Jonathan D. D'Angelo PhD, MAEd ,&nbsp;David A. Cook MD, MHPE ,&nbsp;McKenna L. Schimmel MD ,&nbsp;Nikhil Kapur BS ,&nbsp;Ellen Mi BS ,&nbsp;Mariela Rivera MD ,&nbsp;Anne-Lise D. D'Angelo MD, MSEd","doi":"10.1016/j.surg.2025.109509","DOIUrl":"10.1016/j.surg.2025.109509","url":null,"abstract":"<div><h3>Background</h3><div>Surgeons make vital decisions in the face of uncertainty, yet, the development of surgical wisdom necessary to make these choices prudently remains understudied and undefined. On the basis of previous commentary, we asked whether phronesis, the ability to combine epistemic knowledge and technical skill and choose the best action from many possible right actions, provides a useful conceptual framework to explicate the notion of surgical wisdom.</div></div><div><h3>Methods</h3><div>We conducted a thematic analysis. One-hour in-depth semistructured interviews were conducted with a convenience sample of faculty surgeons from 2 hospitals. Participants described experiences observing, acting with, and teaching surgical wisdom. We interpreted our findings through our proposed lens of phronesis. We applied deductive and inductive thematic coding, with deductive codes based on previously established definitions and components of phronesis and inductive codes aimed to capture additional aspects of surgical wisdom. Authors read interview transcripts, applied codes, synthesized findings into main themes and subthemes by group consensus.</div></div><div><h3>Results</h3><div>Thirty-one surgeons participated. Surgeon participant comments provided empirical support for understanding surgical wisdom as phronesis, a capacity distinct from medical knowledge and technical skill that allows one to understand and competently make choices in situations characterized by competing values, ill-defined rules, and unique circumstances. Comments supported previously proposed functions of phronesis (constitutive, integrative, blueprint, emotional regulative). Novel themes emerged related to the building blocks necessary for the development of surgical wisdom: variety of experience, failure, openness to change/growth mindset, and challenging situations.</div></div><div><h3>Conclusion</h3><div>Phronetic knowledge and its associated functions and building blocks provide new concepts to help refine, restructure, and reconceptualize how surgeons view their developmental trajectory and the path to surgical wisdom. This research offers a vision of practice that can help redefine professional goals and our understanding of success as a surgeon.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"185 ","pages":"Article 109509"},"PeriodicalIF":3.2,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144365503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A qualitative needs assessment of Lima's prehospital emergency trauma system: Identifying challenges and opportunities for improvement","authors":"Jaclyn A. VanDerWal MD ,&nbsp;Allison Dentice BA ,&nbsp;Gabriela Zavala-Wong MD ,&nbsp;Melina Chavarria BS ,&nbsp;Carolina E. Morales BS ,&nbsp;Anika Agrawal BA ,&nbsp;Morgan Blaser BS ,&nbsp;Sophia Pittman BS ,&nbsp;Lacey N. LaGrone MD ,&nbsp;Gerardo Arredondo-Manrique MD ,&nbsp;Jenner Rusman Betalleluz Pallardel MD ,&nbsp;Gianni Aragon-Graneros MD ,&nbsp;Manuel Rodríguez-Castro MD ,&nbsp;Giuliano Borda-Luque MD, FACS ,&nbsp;Astrid Castro-Dolorier MD ,&nbsp;Alfredo Allagual MD ,&nbsp;Eduardo Huamán-Egoávil MD ,&nbsp;Katherine R. Iverson MD","doi":"10.1016/j.surg.2025.109519","DOIUrl":"10.1016/j.surg.2025.109519","url":null,"abstract":"<div><h3>Background</h3><div>In Peru, a middle-income country experiencing rapid urbanization, the prehospital system faces numerous challenges, particularly in the efficient and effective care of patients with trauma. This study aimed to examine stakeholder perspectives to identify system challenges and opportunities for improvement in Lima's prehospital emergency care system.</div></div><div><h3>Methods</h3><div>Semistructured qualitative interviews were conducted with 49 providers from 4 urban hospitals and multiple prehospital agencies in Lima. Participants included physicians, trainees, volunteer firefighters, and emergency service personnel. Interviews were conducted in Spanish, audio-recorded, transcribed, translated to English, and analyzed using thematic analysis.</div></div><div><h3>Results</h3><div>Four major themes emerged: System Structure and Organization, Communication and Coordination, Sociocultural Context, and System Improvement Needs. Key challenges included fragmented emergency response services, limited hospital and prehospital capacity, poor communication between agencies, frequent mis-triage, and lack of standardized prehospital training. Prehospital-specific challenges included absence of formal paramedic recognition, procedural limitations for volunteer providers, and inadequate oversight. Participants identified priority interventions including strategic resource allocation, unified emergency communications, standardized hospital notification protocols, formal provider training frameworks, and public education campaigns.</div></div><div><h3>Conclusion</h3><div>Lima's prehospital system faces interconnected challenges requiring a phased approach to improvement. Short-term interventions should focus on prehospital trauma training implementation, whereas long-term efforts may address structural issues of dispatch and system unification. These findings provide a foundation for designing and implementing targeted interventions within Lima's rapidly urbanizing setting and also may be applicable in other similar middle-income settings.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"185 ","pages":"Article 109519"},"PeriodicalIF":3.2,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144365504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Carcinoma sequence inferred from increasing age at choledochal cyst excision","authors":"Derek A. Riffert MD ,&nbsp;Heidi Chen PhD ,&nbsp;James L. Rogers BS ,&nbsp;James F. Bathon BS ,&nbsp;Muhammad B. Mirza MD ,&nbsp;Kamran Idrees MD, MSCI, MMHC, FACS ,&nbsp;Caitlin E. Hughes MD ,&nbsp;Hernan Correa MD ,&nbsp;Dai H. Chung MD, MBA, FACS ,&nbsp;Harold N. Lovvorn III MD, FACS","doi":"10.1016/j.surg.2025.109510","DOIUrl":"10.1016/j.surg.2025.109510","url":null,"abstract":"<div><h3>Background</h3><div>Choledochal cysts pose risk for biliary carcinoma, although age-related progression of biliary epithelial transformation remains uncharacterized. This study aimed to elucidate the carcinoma sequence within choledochal cysts across all patient ages to inform cancer risk and screening.</div></div><div><h3>Methods</h3><div>Patients treated either for choledochal cysts or biliary carcinoma at 1 institution (1988–2023) were analyzed. Choledochal cyst pathology was reviewed for biliary epithelial changes, whereas patients with biliary carcinoma were assessed for history of choledochal cysts. Descriptive statistics and logistic regression of age at epithelial change were performed.</div></div><div><h3>Results</h3><div>Among 130 patients with choledochal cysts, median age at resection was 12 years, female patients predominated (73%), and Asian race was 2.5-fold increased. Patients commonly presented with biliary obstruction, pancreatitis, and type I choledochal cysts. Cyst pathology revealed chronic inflammation (56.1%) and progressive epithelial transformation (6.9%): 3 metaplasia, 1 hyperplasia, 3 dysplasia, and 3 synchronous biliary carcinoma. Logistic regression showed positive association between increasing age at excision and progressive epithelial transformation (<em>P</em> = .038). One 6-year-old patient with choledochal cysts developed metachronous biliary carcinoma at age 37 years. Among 886 nonampullary patients with biliary carcinoma, 8 (0.9%) had choledochal cysts: 7 synchronous and the same metachronous. Resection of choledochal cysts after age 17 years showed increased odds for epithelial transformation (odds ratio, 15.0; <em>P</em> = .0093). Cumulatively, median age (years) increased from premalignant biliary epithelial transformation (34 [16–35]), to biliary carcinoma with choledochal cysts (51 [37–78]), to biliary carcinoma without choledochal cysts (65 [56–72]; <em>P</em> &lt; .001).</div></div><div><h3>Conclusion</h3><div>These data infer sequential epithelial transformation to biliary carcinoma correlating with increasing age at resection of choledochal cysts. Coupled with 1 case of metachronous biliary carcinoma, this study underscores the need to screen patients with previous excision of choledochal cysts for cancer beginning at age 30 years.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"185 ","pages":"Article 109510"},"PeriodicalIF":3.2,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144365591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Do female patients experience worse outcomes than male patients after inguinal hernia repair? An analysis of the Abdominal Core Health Quality Collaborative database","authors":"Amrita Iyer BS ,&nbsp;Sunjay S. Kumar MD ,&nbsp;Martina Rama MD ,&nbsp;Sourav Podder MD ,&nbsp;Li-Ching Huang PhD ,&nbsp;Sami Tannouri MD, FACS ,&nbsp;Talar Tatarian MD, FACS ,&nbsp;Francesco Palazzo MD, FACS","doi":"10.1016/j.surg.2025.109491","DOIUrl":"10.1016/j.surg.2025.109491","url":null,"abstract":"<div><h3>Background</h3><div>Inguinal hernia repair is one of the most common general surgery operations. Some evidence suggests that female patients are at greater risk of chronic postoperative pain and hernia recurrence. We investigated rates of chronic inguinal pain and recurrence after inguinal hernia repair in both male and female patients using the Abdominal Core Health Quality Collaborative database.</div></div><div><h3>Methods</h3><div>The Abdominal Core Health Quality Collaborative database was queried for patients undergoing elective, unilateral inguinal hernia repair who completed 30-day clinical follow-up and baseline and 1-year European Registry for Abdominal Wall Hernias Survey surveys. Both open and minimally invasive cases were included. The primary outcomes of this study were 1-year European Registry for Abdominal Wall Hernias Survey pain, restrictions, and cosmesis scores. The secondary outcome was hernia recurrence.</div></div><div><h3>Results</h3><div>The search identified 1,582 total patients, 1,448 male and 134 female. One-year overall European Registry for Abdominal Wall Hernias Survey and European Registry for Abdominal Wall Hernias Survey pain scores were worse in female patients (<em>P</em> &lt; .01 and <em>P</em> = .02, respectively). On multivariable regression analysis, female sex was associated with worse pain (adjusted effect size, 0.77; 95% confidence interval, 0.17–1.37, <em>P</em> = .01), restriction (adjusted effect size, 1.66; 95% confidence interval, 0.76–2.56, <em>P</em> &lt; .01), and cosmesis scores (adjusted effect size, 0.74;95% confidence interval, 0.18–1.29, <em>P</em> &lt; .01) compared with male sex. Hernia recurrence rates were greater in female patients at 1-year follow-up (adjusted odds ratio, 2.20; 95% confidence interval, 1.10–4.41, <em>P</em> = .03).</div></div><div><h3>Conclusion</h3><div>This study demonstrates that quality of life and hernia recurrence are strikingly worse for female patients, despite a greater prevalence of minimally invasive repairs. Identification of these disparities in outcomes is the first step toward achieving health equity in inguinal hernia repair.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"185 ","pages":"Article 109491"},"PeriodicalIF":3.2,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144365502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Randomized controlled trial of primary closure after common bile duct exploration with self-detachable biliary stent placement versus direct primary closure: A new alternative to reduce bile leakage risk","authors":"Huabo Zhou MD,&nbsp;Yijia He BS,&nbsp;Ke Sun PhD","doi":"10.1016/j.surg.2025.109506","DOIUrl":"10.1016/j.surg.2025.109506","url":null,"abstract":"<div><h3>Background</h3><div>Bile leakage is the most common complication after laparoscopic common bile duct exploration. This study explores the clinical efficacy of using a 5-F biliary stent with automatic detachment to prevent bile leakage postbiliary exploration.</div></div><div><h3>Methods</h3><div>This randomized controlled observational study was conducted from January 2023 to January 2025. Patients undergoing primary closure of the common bile duct in our team were randomly divided into 2 groups. The treatment group had biliary stents placed during biliary stone extraction and then primary closure, whereas the control group had direct primary closure after stone extraction. The primary outcome was bile leakage incidence. The secondary outcome measure was the rate of automatic removal of biliary stents, surgical time, postoperative hospital stay, postoperative blood test indicators, and complications.</div></div><div><h3>Results</h3><div>Both groups included 85 patients. Preoperative data such as white blood cell count, aspartate transaminase, alanine aminotransferase, total bilirubin, direct bilirubin, albumin, serum amylase, serum lipase, common bile duct diameter, and stone characteristics were comparable (<em>P</em> &gt; .05). In the treatment group, stent placement took 8 (5–12) minutes. All stents were in place at 72 hours post operatively. The automatic detachment rate at 1 month was 98.93%, with 1 case removed via duodenoscopy. The bile leakage rate (1.17% vs 9.41%), surgical time (103.11 ± 10.16 minutes vs 99.89 ± 9.07 minutes), and postoperative hospital stay (4.56 ± 0.69 days vs 5.09 ± 0.84 days) were significantly different between the groups (<em>P</em> &lt; .05). There were no significant differences in postoperative 48-hour blood indicators (<em>P</em> &gt; .05), but total bilirubin, direct bilirubin, and alanine aminotransferase decreased significantly compared with preoperative levels in both groups.</div></div><div><h3>Conclusion</h3><div>Placing a 5-F biliary stent with automatic detachment during laparoscopic common bile duct exploration for stone extraction and then performing primary closure can effectively reduce bile leakage and postoperative hospital stay. With a short placement time and high automatic detachment rate, this method is simple and worthy of promotion.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"185 ","pages":"Article 109506"},"PeriodicalIF":3.2,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144330375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A classification of laparoscopic central pancreatectomy determined on the basis of anatomical landmarks in 109 patients","authors":"Clément Pastier MD ,&nbsp;Jules Gregory MD, PhD ,&nbsp;Marc-Anthony Chouillard MD ,&nbsp;Béatrice Aussilhou MD ,&nbsp;Vinciane Rebours MD, PhD ,&nbsp;Mickael Lesurtel MD, PhD ,&nbsp;Alain Sauvanet MD, PhD ,&nbsp;Safi Dokmak MD, PhD","doi":"10.1016/j.surg.2025.109442","DOIUrl":"10.1016/j.surg.2025.109442","url":null,"abstract":"<div><h3>Background</h3><div>Laparoscopic central pancreatectomy (LCP) is usually proposed for non-malignant neck-body neoplasms, but it can be proposed for head-neck lesions to avoid pancreaticoduodenectomy or for body-tail lesions to avoid distal pancreatectomy. The aim of this study was to classify CP on the basis of the proximal resection level.</div></div><div><h3>Method</h3><div>We retrospectively studied all consecutive LCPs performed in our institution from 2011 to 2024. LCP can be associated with vascular procedures (gastroduodenal artery or splenic vessels) and was classified into 3 types according to proximal level of pancreatic resection: head-LCP, neck-LCP, and body-LCP (results in this order). The primary objective of this study was the creation and definition of this new classification for LCP. The secondary objectives were to compare outcomes and textbook outcome (TBO) completion, defined as no clinically relevant postoperative pancreatic fistula, no clinically relevant postpancreatectomy hemorrhage, no bile leaks, no readmission, no mortality, and no severe morbidity within 90 postoperative days.</div></div><div><h3>Results</h3><div>In total, 109 patients underwent LCP with head-LCP, neck-LCP, and body-LCP observed in 20%, 66%, and 14%, respectively. The type was correlated with the distance of the lesion from the gastroduodenal artery (<em>P</em> = .0001). Head and body-LCPs were more frequently associated with vascular procedures (68% vs 17% vs 40%, <em>P</em> = .001) and body-LCP was associated with larger tumor size (millimeters) compared with head and neck-LCPs (17 vs 21 vs 35, <em>P</em> = .07). TBO did not differ significantly (41% vs 58% vs 47%, <em>P</em> = .31) with one patient death (mortality &lt;1%). At median follow-up (22 months), the rate of new-onset exocrine (6%; <em>P</em> = .10) or endocrine (4%; <em>P</em> = .76) pancreatic insufficiencies was similar. On multivariate analysis, only American Society of Anesthesiologists score ≥2 (<em>P</em> = .03) and pancreatic texture (<em>P</em> = .01) were prognostic factors for TBO while LCP type was not.</div></div><div><h3>Conclusion</h3><div>Head and neck-LCPs were more challenging as assessed by the associated vascular procedures without impact on TBO, allowing in some selected patients parenchymal-sparing surgery. Further studies comparing CP with standard pancreatic resections are needed.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"184 ","pages":"Article 109442"},"PeriodicalIF":3.2,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144322252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of near-infrared fluorescence guided colonic interposition for corrosive esophageal stricture","authors":"Eswaravaka Saikrishna MCh ,&nbsp;Vaibhav Kumar Varshney MCh ,&nbsp;Subhash Soni DNB ,&nbsp;B. Selvakumar MCh ,&nbsp;Peeyush Varshney MCh ,&nbsp;Lokesh Agarwal MCh ,&nbsp;Bhavana Katta MS ,&nbsp;Ashish Agarwal DM ,&nbsp;Chhagan Lal Birda DM ,&nbsp;Bikram Choudhury MS","doi":"10.1016/j.surg.2025.109504","DOIUrl":"10.1016/j.surg.2025.109504","url":null,"abstract":"<div><h3>Introduction</h3><div>Colonic interposition is the most commonly performed surgery for high corrosive esophageal or combined esophagogastric strictures. Here, we present the outcomes of colonic interposition using a modified right colonic graft and the utility of indocyanine green–guided fluorescence imaging.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed the medical records of 30 patients with corrosive esophageal strictures who underwent colon interposition surgery between July 2017 and December 2023. The ascending colon, without including the ileocecal valve, and with the transverse colon, which was determined by the ascending branch of the left colic artery in an isoperistaltic fashion, was used in all patients. Vascularity was assessed after clamping the marginal and middle colic arteries using near-infrared fluorescence imaging, and any changes in management based on fluorescence imaging were noted. Short- and long-term outcomes also were analyzed.</div></div><div><h3>Results</h3><div>Among the 30 patients, 20 were male, with a median age of 32 (20–59) years. Only 1 patient (3.3%) had conduit necrosis and underwent re-exploration with necrotic segment removal with esophagostomy. Among the 4 patients who had abdominal anastomotic leaks, 2 were managed conservatively and 2 underwent re-exploration. Twenty-five patients (83.3%) had a median weight gain of 5 (3–25) kg. Five patients (16.6%) had anastomotic stricture, of whom 4 were successfully managed with endoscopic dilatation. The median EuroQol 5-Dimension 5-level health scale score was 90 (70–100).</div></div><div><h3>Conclusion</h3><div>Indocyanine green–guided fluorescence is a useful adjunct during colonic interposition and a modified right colonic graft provides a good quality of life.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"185 ","pages":"Article 109504"},"PeriodicalIF":3.2,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144322810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}