World Journal of Surgery最新文献

{"title":"Letter to the Editor: A 48-Hour Symptom Threshold Predicts Perforated Appendicitis: Development of a Clinical Risk Model.","authors":"Pratik Bhattacharya, Shaadman Umran, Constantine Ezeme, Giordano Perin","doi":"10.1002/wjs.70137","DOIUrl":"https://doi.org/10.1002/wjs.70137","url":null,"abstract":"","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145245544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on \"Prehospital Trauma Quality Improvement: Database-Driven Opportunities for Timely Access\".","authors":"Wilhelm Hansen","doi":"10.1002/wjs.70133","DOIUrl":"https://doi.org/10.1002/wjs.70133","url":null,"abstract":"","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145233669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Disease-Specific Simulator of the Laparoscopic Percutaneous Extraperitoneal Closure (LPEC) Method for Pediatric Inguinal Hernia: A Validation Study With Comparison of Experienced Pediatric Surgeons and Novices.","authors":"Masakazu Murakami, Yumiko Tabata, Yumiko Iwamoto, Masato Ogata, Lynne Takada, Chihiro Kedoin, Yudai Tsuruno, Koshiro Sugita, Keisuke Yano, Shun Onishi, Takafumi Kawano, Satoshi Ieiri","doi":"10.1002/wjs.70119","DOIUrl":"https://doi.org/10.1002/wjs.70119","url":null,"abstract":"<p><strong>Background: </strong>Laparoscopic inguinal hernia repair is the most common procedure in the pediatric field and is one of the first pediatric endoscopic surgical procedures that a trainee should learn. Off-the-job training is important in pediatric surgery to compensate for the lack of experience due to the small number of cases. We developed a disease-specific simulator for laparoscopic percutaneous extraperitoneal closure (LPEC) of inguinal hernia. We compared the results of simulated surgery using this simulator between experts and novices.</p><p><strong>Methods: </strong>The simulator was developed for a 1-year-old infant body size and allowed for training in needle manipulation unique to LPEC. The participants were pediatric surgeons and trainees and were divided into novice and experienced groups. The task involved simulated LPEC operations. The task completion time, three-dimensional characteristics of needle device manipulation evaluated by a magnetic three-dimensional position-measuring device, and accuracy of needle device manipulation evaluated by a checklist were compared. A questionnaire survey was conducted to evaluate the effectiveness of the simulator.</p><p><strong>Results: </strong>There were 35 and 18 participants in the experienced and novice groups, respectively. The experienced group had a significantly shorter task completion time than the novice group (308.1 vs. 695.8 s, p < 0.001), shorter total pass length (37591.1 vs. 102678.1 mm, p = 0.001), slower average velocity (79.2 vs. 136.8 mm/s, p = 0.002), and lower average acceleration than the novice group (8477.9 vs. 17775.5 mm/s², p = 0.005). The experienced group showed significantly better performance in the evaluation using a checklist. In the questionnaire survey, the effectiveness of the simulator was highly evaluated by experienced surgeons.</p><p><strong>Conclusion: </strong>Our simulator could clearly differentiate between novice and experienced surgeons, and the validity of the LPEC simulator was established. The validity of the LPEC simulator was also proven using a questionnaire survey after simulation surgery.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145233671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Outcomes of Different Angioembolization Techniques and Materials for Hemodynamically Unstable Pelvic Fractures: An Overlap Weighted Study.","authors":"Hui Li, Guangbin Huang, Yunfeng Yi, Tao Ai, Yong Fu, Yong Luo, Anyong Yu, Gongliang Du, Xingwen Zhang, Eryue Qiu, Cai Lin, Junyu Jiang, Mao Zhang, Dingyuan Du","doi":"10.1002/wjs.70098","DOIUrl":"https://doi.org/10.1002/wjs.70098","url":null,"abstract":"<p><strong>Background: </strong>Internal iliac artery embolization (IIAE) is a critical hemostatic intervention for controlling hemorrhage in patients with hemodynamically unstable pelvic fractures (HUPF). However, the optimal technique-nonselective versus selective embolization-and the choice of embolic materials remain debated. This study compares the efficacy, safety, and clinical outcomes of nonselective embolization (NSE) and selective embolization (SE) techniques in patients with HUPF. A secondary analysis examined the impact of different embolic materials on patient outcomes.</p><p><strong>Methods: </strong>This multicenter retrospective study included patients aged 16 and older with HUPF who underwent IIAE. Patients were categorized into NSE or SE groups. Key outcomes included 24-h red blood cell (RBC) transfusion volume, duration of angioembolization (AE), complications, mortality, and infection rates. Propensity score overlap weighting (PSOW) was used for comparisons, with validation via propensity score matching (PSM). Subgroup analyses also employed PSOW to assess outcomes based on embolic materials.</p><p><strong>Results: </strong>A total of 296 patients with HUPF met the inclusion criteria, with 214 undergoing NSE and 82 receiving SE. After PSOW, near-perfect comparability between the two groups was achieved (SMDs = 0). The NSE group had significantly lower 24-h RBC transfusion volumes (2.00 vs. 4.00 units, MD, -2 units; 95% CI, -2.0 to 0; and p = 0.018) and shorter AE duration (65 vs. 80 min, MD, -15 min; 95% CI, -20 to -5.16; and p < 0.001). NSE group also required less 24-h plasma transfusion. Although the NSE group showed higher rates of deep vein thrombosis and urinary tract infection in PSOW analysis, subsequent PSM analysis revealed no significant differences between groups. Similarly, both groups showed comparable rates of other complications, hospital costs, and mortality rates. Subgroup analysis showed that the gelatin sponge (GS) group had higher 24-h RBC transfusion volumes and longer AE durations, though these were not statistically significant. Notably, the GS group had significantly higher rates of pulmonary infections and incision/pin tract infections.</p><p><strong>Conclusion: </strong>Nonselective embolization appeared to be associated with reduced RBC transfusion needs and provide faster hemorrhage control, though this did not translate to a survival benefit. The evidence regarding NSE's effect on specific complication risks was inconclusive. Subgroup analysis showed coils were associated with fewer complications than GS. Further prospective studies are needed to clarify the optimal technique and materials.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145226006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"I Don't Wear Men's Cloths, I Wear My Own\": How Mary Edwards Walker Pioneered Trauma Surgery as the First Female Trauma Surgeon.","authors":"SaeRam Oh, Alvin Singh, Caitlin A Fitzgerald, Jill R Streams","doi":"10.1002/wjs.70085","DOIUrl":"https://doi.org/10.1002/wjs.70085","url":null,"abstract":"","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145226064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Robotic and Laparoscopic Liver Resection Within One Couinaud Segment: A Propensity Score-Based Analysis.","authors":"Awang Danzeng, Baima Deji, Zhen-Hua Yang, Xue-Wei Jiang, Ling Guo, Xin Luo, Bi-Xiang Zhang, Bin-Hao Zhang","doi":"10.1002/wjs.70121","DOIUrl":"https://doi.org/10.1002/wjs.70121","url":null,"abstract":"<p><strong>Background: </strong>Minimally invasive liver resection (MILR), including laparoscopic (LLR) and robot-assisted (RLR) approaches, is being increasingly utilized for hepatic tumors, though comparative evidence for hepatectomy within one liver segment remains limited.</p><p><strong>Methods: </strong>From January 2015 to December 2024, 2290 patients underwent MILR for hepatic tumors at our institution. After excluding combined resections (other than cholecystectomy), resections involving more than one Couinaud segment, multiple tumors in different segments, and incomplete data, 718 single-segment cases (LLR, n = 630; RLR, n = 88) were analyzed. Propensity score matching (PSM) at 1:1 and 1:3 ratios was performed to balance baseline covariates.</p><p><strong>Results: </strong>Before matching, RLR had longer operative time (226.5 vs. 197.0 min; p = 0.027) and greater blood loss (150 vs. 100 mL; p = 0.037) than LLR, but less frequent Pringle maneuver use (53.4% vs. 64.8%; p = 0.038). After 1:1 and 1:3 propensity score matching, operative time, blood loss, conversion, transfusion, and R0 resection were comparable, whereas Pringle use remained lower with RLR (51.2% vs. 66.7%, p = 0.041; 51.2% vs. 64.3%, p = 0.035). Postoperatively, length of stay was longer after RLR in the unmatched cohort (8.0 vs. 7.0 days; p = 0.006), but not after matching (both 7.0 days). Major complications, including post-hepatectomy liver failure, hemorrhage, and bile leakage, were similar; no perioperative deaths occurred. Subgroup analyses showed shorter length of stay with RLR in advanced IWATE cases (RR, 0.79; 95% CI, 0.64-0.97; p = 0.022) and caudate resections (RR, 0.65; 95% CI, 0.46-0.90; p = 0.010), and shorter operative time in advanced IWATE cases (RR, 0.85; 95% CI, 0.74-0.99; p = 0.039), with significant interaction across IWATE levels (p = 0.047).</p><p><strong>Conclusions: </strong>RLR and LLR yielded comparable perioperative outcomes in single-segment liver resections. Nonetheless, RLR was associated with reduced reliance on vascular inflow occlusion and conferred selective advantages in anatomically complex or high-difficulty cases.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145225989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Novel Two-Trocar Transumbilical Laparoscopic Appendectomy: Lower Cost and No Visible Scars.","authors":"Ashley Stoeckel, David P Mooney","doi":"10.1002/wjs.70033","DOIUrl":"10.1002/wjs.70033","url":null,"abstract":"<p><p>Children in high-resource countries enjoy the short- and long-term benefits of the laparoscopic approach when appendectomy is necessary. Children in resource-limited settings may not have the same opportunity, in part due to cost restraints related to the expense of the laparoscopic equipment required. This study describes a novel approach for the laparoscopic appendectomy which is lower in cost than the standard three trocar approach and could be utilized in lower resource areas. This novel two-trocar transumbilical appendectomy is a low-cost option, quicker, and has a comparable length of stay and complication profile than the standard three-trocar appendectomy, while requiring no specialized equipment and leaving no visible scar.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":"2803-2806"},"PeriodicalIF":2.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144859692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhanced Recovery After Surgery Versus Conventional Care in Patients After Urgent Laparotomy: A Prospective Cohort Study.","authors":"Kirollos Samir F Messiha, Tarek M Sehsah, Osama H Abd-Raboh, Hamdy Abdelhay Mohamed, Mohamed Saad Aboul-Enein","doi":"10.1002/wjs.70042","DOIUrl":"10.1002/wjs.70042","url":null,"abstract":"<p><strong>Background: </strong>Enhanced recovery after surgery (ERAS) protocols, though extensively accepted in prearranged procedures, remain underutilized in emergency settings such as emergency laparotomy (EL), which carries morbidity and mortality rates. This study evaluated the feasibility, safety, and clinical performance of ERAS protocols versus conventional care in participants requiring emergency laparotomy.</p><p><strong>Methods: </strong>This prospective cohort study involved 72 individuals with abdominal pathology requiring EL. The participants in this study were equally categorized into two cohorts (n = 36): Group I, designated as the urgent (ERAS) group, and Group II, referred to as the urgent standard care group. Our hospital's general surgery department has two gastrointestinal tract (GIT) units. One uses the ERAS method, whereas the other uses the conventional method. Patients from both units were equally included.</p><p><strong>Results: </strong>The ERAS group demonstrated a markedly quicker improvement reflected in days to first bowel movement (p = 0.005), first resumption of fluids (p < 0.001), initiation of a soft diet (p < 0.001), and transition to a solid diet (p < 0.001). Pain relief was markedly better in the ERAS group, with an average pain score of 3.14 ± 1.02 compared to 4.0 ± 1.47 in the standard care group (p = 0.012). Average inpatient stay in the ERAS group was (4.64 ± 1.23) days, whereas it was (8.96 ± 1.87) days in the standard care group (p > 0.001). Additionally, there was a meaningful decrease in the incidence of postoperative paralytic ileus in the ERAS group (p = 0.035). No meaningful differences between the cohorts were observed in mortality rates, readmission, or reoperation rates.</p><p><strong>Conclusions: </strong>ERAS protocols demonstrate significant clinical benefits in EL patients, substantially reducing inpatient stay and postoperative complications while maintaining safety profiles.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":"2699-2705"},"PeriodicalIF":2.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144971650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Autologous Graft for Venous Vascular Reconstruction in Hepatopancreatobiliary Surgery: A Single Center Experience.","authors":"Taiga Fujii, Atsushi Takahashi, Mamiko Miyashita, Shoichi Irie, Yoshinori Takeda, Hirofumi Ichida, Ryuji Yoshioka, Yoshihiro Mise, Yoshihito Kotera, Akio Saiura","doi":"10.1002/wjs.70083","DOIUrl":"10.1002/wjs.70083","url":null,"abstract":"<p><strong>Background: </strong>Achieving R0 resection in hepatopancreatobiliary (HBP) surgery frequently necessitates venous resection and reconstruction. Autologous grafts offer a promising solution, particularly in complex resections where infection risk or graft availability limit the use of synthetic or donor grafts. However, clinical data on the outcomes of autologous venous grafts remain limited. This study aimed to evaluate the safety and feasibility of autologous grafts in venous reconstruction during HBP surgery.</p><p><strong>Methods: </strong>We retrospectively reviewed 34 consecutive patients who underwent hepatic vein (HV), inferior vena cava (IVC), or portal vein (PV) reconstruction using autologous grafts between January 2019 and November 2024. Graft materials included peritoneum, saphenous vein, renal vein, and round ligament, selected at the surgeon's discretion. Reconstruction techniques were classified as patch or tubular. The primary outcomes were graft patency, perioperative complications, and graft-related morbidity.</p><p><strong>Results: </strong>Among the 34 patients, HV, IVC, and PV reconstructions were performed in 52.9%, 23.5%, and 23.5%, respectively. The most commonly used grafts were peritoneum (41.1%) and saphenous vein (23.5%). Patch and tubular reconstructions accounted for 58.9% and 41.1% of cases, respectively. Major postoperative complications (≥ Clavien-Dindo grade IIIa) occurred in 20.5% of patients. Graft-related complications, including thrombosis, were observed in 8.8%. The estimated 3-year patency rate was 91.2%. No graft-related mortality was observed.</p><p><strong>Conclusions: </strong>Autologous grafts provide a safe and effective option for venous reconstruction in HBP surgery, offering high patency and low complication rates. These findings support the use of autologous grafts as a flexible and reliable technique in complex HBP cases. Further multicenter studies with larger cohorts and longer follow-up are necessary to validate these outcomes and refine graft selection criteria.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":"2873-2879"},"PeriodicalIF":2.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145024224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does Teamwork Make the Dream Work? A Dual-Surgeon Technique for Endoscopic Bilateral Nipple-Sparing Mastectomy With Immediate Breast Reconstruction.","authors":"Ze Huang, Xiaoyan Fu, Ziteng Liu, Zongyan Li, Yonghai Guo, Zuxiao Chen, Haiyan Li","doi":"10.1002/wjs.70110","DOIUrl":"10.1002/wjs.70110","url":null,"abstract":"<p><strong>Background: </strong>Endoscopic nipple-sparing mastectomy (E-NSM) with immediate breast reconstruction (IBR) represents a key surgical technique in the evolution of minimally invasive breast surgery. For endoscopic bilateral nipple-sparing mastectomy (E-BNSM) with IBR, all surgical steps are typically performed by a single surgeon. Given the complexity of E-BNSM with IBR, we proposed the dual-surgeon (DS) technique as an alternative approach. In this study, the authors compared the surgical outcomes between the single-surgeon and dual-surgeon approaches.</p><p><strong>Methods: </strong>A retrospective review was conducted on all patients who underwent E-BNSM with IBR at a single institution between March 2021 and March 2024. Patients were divided into two cohorts based on the number of surgeons involved during the procedure: a single-surgeon (SS) cohort and a DS cohort. Baseline characteristics and surgical outcomes were analyzed and compared between the two cohorts.</p><p><strong>Results: </strong>A total of 47 patients were included in this study, with 26 undergoing the SS approach and 21 undergoing the DS approach. Baseline characteristics were similar between the two groups. Compared to the SS approach, the DS approach decreased the mean operative time by 36.8 min (p = 0.036). Intraoperative blood loss, postoperative hospital stays, and operation costs were comparable between the two cohorts (p > 0.05). No statistically significant differences were observed in postoperative complications, final pathology results, and oncological outcomes.</p><p><strong>Conclusions: </strong>The DS technique positively influenced outcomes in E-BNSM with IBR, significantly reducing operative time. This innovative technique holds potential clinical utility, warranting further validation through larger-scale studies.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":"2644-2650"},"PeriodicalIF":2.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145126280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}