Surgery最新文献

{"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":"Reply to the Editor regarding \"Neoadjuvant chemotherapy improves overall survival in stage III but not in stage II colon cancer: A propensity score-matched analysis of the National Cancer Database\".","authors":"Nir Horesh, Sameh Hany Emile, Steven Wexner","doi":"10.1016/j.surg.2025.109516","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109516","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109516"},"PeriodicalIF":3.2,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498011","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":"Integrity in academic surgery.","authors":"Ravi S Radhakrishnan, Peter Angelos, Marie Crandall","doi":"10.1016/j.surg.2025.109472","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109472","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109472"},"PeriodicalIF":3.2,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498010","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":"Comment on: \"Timing of parathyroidectomy after kidney transplantation: A cost-effectiveness analysis\".","authors":"Rihai Xiao, Ruohui Huang","doi":"10.1016/j.surg.2025.109521","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109521","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109521"},"PeriodicalIF":3.2,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498009","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":"Evaluating cost savings through equipment shutdown: A practical step toward sustainable surgery.","authors":"Siya Lodhia, Victoria Pegna, Timothy Rockall","doi":"10.1016/j.surg.2025.109484","DOIUrl":"https://doi.org/10.1016/j.surg.2025.109484","url":null,"abstract":"<p><strong>Introduction: </strong>The National Health Service has committed to being net zero by 2040, and one of the most energy-intensive areas of a hospital are operating theaters. Generally, to reduce the carbon footprint of an area, departments have to buy new equipment; however, turning off equipment at the end of the day is a completely free way to help reach this goal. We aimed (1) to understand which pieces of equipment are more energy intensive; (2) to calculate the difference in energy and cost of equipment in use and on standby; (3) to determine the environmental and financial cost of equipment not being turned off at the end of the day; and (4) to determine the environmental and financial cost of equipment not being turned off over the weekend.</p><p><strong>Methods: </strong>Using a power monitor, we calculated the power usage of different pieces of equipment in colorectal theaters. We plugged the monitors into equipment during typical operating lists and recorded \"in-use\" and \"standby\" energy consumption. Out-of-hours and weekends also were monitored.</p><p><strong>Results: </strong>Turning off equipment at the end of the day and at weekends could save the trust £147,053 per year in the theater complex alone. When considering cost savings extrapolated to the entire hospital, just by switching off computers across the hospital there is an additional cost saving of £487,760.</p><p><strong>Conclusion: </strong>Switching off plugs would contribute greatly to energy wastage saved and is simple. In newer builds, these could be turned off centrally. Turning off equipment is a necessity; going forward, it will help with net-zero targets, as well as financial savings for the trust with no risk to patient safety. With a calculated estimated saving of approximately £175 million to the National Health Service nationwide, it should be implemented in all theaters with immediate effect.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109484"},"PeriodicalIF":3.2,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144485801","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}

{"title":"Author's Reply to the Letter regarding our manuscript: \"Impact of biliary drainage method before pancreaticoduodenectomy on short- and long-term outcomes in patients with periampullary carcinoma and obstructive jaundice: A multicenter retrospective analysis\".","authors":"Yusuke Yamamoto, Teiichi Sugiura, Minoru Esaki, Yu Takahashi, Junichi Arita, Masaji Hashimoto, Yoshihiro Sakamoto, Masaru Konishi, Tsuyoshi Sano, Akifumi Notsu, Katsuhiko Uesaka, Kazuaki Shimada","doi":"10.1016/j.surg.2025.109486","DOIUrl":"10.1016/j.surg.2025.109486","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"109486"},"PeriodicalIF":3.2,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144337018","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}