World Journal of Surgery最新文献

{"title":"Interhospital Transfer Patients With Necrotizing Soft Tissue Infections: An Evaluation of the Role for Pretransport Operation.","authors":"Hans V Strobl, Diane N Haddad, Renee Bicaba, Renee I Tristano, Phillip M Dowzicky, Abid D Khan, Timothy P Plackett, Justin S Hatchimonji","doi":"10.1002/wjs.70546","DOIUrl":"10.1002/wjs.70546","url":null,"abstract":"<p><strong>Background: </strong>Early debridement is the cornerstone of treatment for necrotizing soft tissue infections (NSTI), but patients are frequently transferred for management. We described practice patterns, hypothesizing that pre-transfer NSTI debridement is associated with improved outcomes.</p><p><strong>Methods: </strong>We analyzed data from the Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SID) and State Emergency Department Databases (SEDD) for Massachusetts, Wisconsin, and Colorado in 2022. NSTI patients and the subset undergoing operation before transfer (PRE) were identified. The primary outcome was mortality. We performed multivariable logistic regression adjusting for demographics, weekend transfer, severe sepsis or septic shock, and Charlson comorbidity index (CCI). Secondary outcomes were length of stay (LOS) and hospital charges.</p><p><strong>Results: </strong>We identified 243 transferred NSTI patients. Mean age (SD) was 56.7 (14.5) years, and 74 (30.5%) were female. There were 127 referring and 52 receiving centers, with a wide range of case volume and PRE rates. Seventy-seven (31.7%) patients were PRE; there was no difference in rates of sepsis between these patients and the remainder (41.6% vs. 37.4%, p = 0.531). Mortality with and without pre-transfer operation was 7/77 (9.1%) versus 10/166 (6.0%), with aOR = 1.62 for PRE, (p = 0.38). Pre- and post-transfer median LOS were longer for PRE (4 vs. 0 days at the referring hospital, p < 0.001; 15 vs. 10 days at the receiving hospital, p = 0.01), and PRE had higher median charges before ($66,214.50 vs. $11,227.50, p < 0.001) and after transfer ($161,615 vs. $89,728, p = 0.012).</p><p><strong>Conclusion: </strong>Among transferred NSTI patients, mortality did not differ between PRE and the remainder of the cohort. PRE patients had longer hospital stays and higher healthcare charges, possibly due to worse physiology or more complex wounds.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":"2861-2865"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662498/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148875570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"De-Epithelialization Using Scalpel Versus Monopolar Electrocautery Cutting in Reduction Mammoplasty: A Prospective Comparative Study.","authors":"Khaled E Barakat, Mohamed F Asal, Ahmed A Abdelkader, Doaa K Abuhasan, Anas Bakdalieh, Annaliisa Cordova, Adil Nusair, Ahmed Adham R Elsayed, Marc D Basson","doi":"10.1002/wjs.70574","DOIUrl":"10.1002/wjs.70574","url":null,"abstract":"<p><strong>Background: </strong>Reduction mammoplasty for symptomatic macromastia provides meaningful relief from musculoskeletal pain, postural strain, and functional limitations. A critical step in the procedure is pedicle de-epithelialization, traditionally performed using a scalpel. Although effective, scalpel de-epithelialization can be time-intensive, prompting evaluation of alternative techniques such as monopolar electrocautery. Other sharp techniques include curved-scissor de-epithelialization, en bloc removal, and pedicle deskinning. Monopolar techniques utilize either a conventional blade electrode or a Colorado needle tip. This study compares surgical outcomes between scalpel and monopolar electrocautery de-epithelialization.</p><p><strong>Methods: </strong>A prospective, intra-patient comparative study was conducted at the Department of Surgery, Alexandria Faculty of Medicine, between October 2023 and April 2025. Patients with symptomatic macromastia undergoing bilateral reduction mammoplasty received scalpel de-epithelialization on the right breast and monopolar electrocautery on the left. Follow-up assessments occurred at 1 week, 2 weeks, 1 month, and monthly thereafter for up to 12 months. The primary outcome was de-epithelialization time. Secondary outcomes were intraoperative blood loss and pain both postoperatively and at 6 months. Statistical analyses included paired t-tests, Wilcoxon signed-rank tests, and McNemar's tests.</p><p><strong>Results: </strong>Sixty patients undergoing bilateral reduction mammoplasty were included. Monopolar electrocautery demonstrated a significantly shorter mean de-epithelialization time compared to the scalpel (5.07 ± 0.88 minutes vs. 10.87 ± 1.93 minutes; p < 0.001). Intraoperative blood loss was also significantly lower with monopolar electrocautery (139.1 ± 20.64 mL vs. 176.7 ± 16.06 mL; p < 0.001). At 6 months, BREAST-Q breast pain scores were modestly lower with the monopolar technique (p = 0.046). Rates of postoperative complications and patient satisfaction were comparable between techniques.</p><p><strong>Conclusions: </strong>Monopolar electrocautery significantly reduced de-epithelialization time, the primary outcome of this study. It was also associated with lower intraoperative blood loss. Although modestly lower breast pain scores were observed at 6 months, the difference was small, and its clinical importance remains uncertain. The study was not powered to evaluate postoperative complication rates.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":"2809-2816"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662503/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148978151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correlation Between Anastomotic Leakage and the Anastomotic Position of the Gastric Conduit After Esophagectomy Using ICG Fluorescence Imaging Stratification.","authors":"Yamato Ninomiya, Kazuo Koyanagi, Rie Nakashima, Kohei Tajima, Kohei Kanamori, Mika Ogimi, Yoshiaki Shoji, Akihito Kazuno, Miho Yamamoto, Masaki Mori","doi":"10.1002/wjs.70552","DOIUrl":"10.1002/wjs.70552","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to clarify the correlation between anastomotic leakage and anastomotic position after esophagectomy for esophageal cancer, stratified by gastric conduit blood flow assessed using indocyanine green (ICG) fluorescence imaging.</p><p><strong>Methods: </strong>A total of 136 patients who underwent esophagectomy with retrosternal gastric conduit reconstruction were included. After creating the gastric conduit, three points were identified: point A (anastomotic site), point B (terminal end of the gastroepiploic artery stained with ICG), and point C (terminal end of the gastric conduit wall stained with ICG). Anastomotic position was defined by the relative location of point A between points B and C, and blood flow speed before reconstruction (pre-speed) was quantified using ICG fluorescence imaging. Associations of anastomotic position and pre-speed with anastomotic leakage were evaluated.</p><p><strong>Results: </strong>Anastomotic leakage occurred in 22 patients (16.2%). Mean distance BA (point B to A) was 2.05 cm in the leakage group and 0.15 cm in the non-leakage group (p = 0.018). Mean distance AC (point A to C) was 4.00 cm in the leakage group and 5.89 cm in the non-leakage group (p = 0.016). Logistic regression revealed that BA > -0.50 cm and pre-speed < 2.19 cm/s were independent risk factors for anastomotic leakage (odds ratio 4.67, p = 0.046, and odds ratio 56.16, p < 0.001, respectively). Among patients with delayed blood flow, the anastomotic leakage rate was significantly lower in the proximal group than in the distal group (p = 0.034).</p><p><strong>Conclusions: </strong>ICG fluorescence imaging provides useful information for determining an appropriate anastomotic position. Performing the anastomosis at a more proximal site within the gastric conduit may reduce the risk of anastomotic leakage.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":"2987-2995"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662494/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148866570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Lumbar Vein Preservation on Postoperative Renal Function Following Left Renal Vein Graft Harvesting in Pancreatic Surgery.","authors":"Takeshi Kano, Akira Maki, Shun Goto, Yasuhiro Nunokawa, Haruka Machida, Shinichi Matsudaira, Masaki Yamamoto, Rihito Nagata, Yoichi Miyata, Akifumi Kimura, Riki Ninomiya, Taizen Urahashi, Yoshifumi Beck, Masaya Miyazaki, Nobuyuki Takemura","doi":"10.1002/wjs.70530","DOIUrl":"10.1002/wjs.70530","url":null,"abstract":"<p><strong>Background: </strong>Left renal vein (LtRV) graft harvesting for portal vein (PV) reconstruction during pancreatic surgery is considered to have limited impact on renal function due to the development of collateral venous pathways. However, it was hypothesized that failure to preserve the lumbar vein (LuV), a tributary of the LtRV, may cause renal dysfunction, as the LuV has direct communications with the azygos venous system and may serve as an effective collateral venous pathway. The association between preservation of LtRV tributaries and renal function was investigated.</p><p><strong>Methods: </strong>This single-center retrospective study reviewed patients who underwent pancreatic surgery with International Study Group of Pancreatic Surgery type 4 circumferential PV reconstruction using vascular grafts during 2015-2026. Renal function was compared between patients who underwent reconstruction using LtRV graft (LtRV graft group) and those who received other types of grafts (non-LtRV graft group). In the LtRV graft group, renal function was further analyzed according to preservation of the LuV (LuV vs. non-LuV groups) and the left adrenal vein (LtAV; LtAV vs. non-LtAV groups).</p><p><strong>Results: </strong>No significant difference in the decline of estimated glomerular filtration rate (eGFR) was observed between the non-LtRV graft group (n = 26) and the LtRV graft group (n = 29). Within the LtRV graft group, 5 and 23 patients were assigned to the non-LuV and LuV groups, respectively. In the non-LuV group, postoperative acute kidney injury occurred significantly more frequently and the median decrease in eGFR of more than 20 mL/min/1.73 m² persisted until 2 months postoperatively. The decline in eGFR and the increase in creatinine on PODs 3, 7, and 28 were significantly greater in the non-LuV group than in the LuV group. Renal scintigraphy demonstrated poorer left renal function in the non-LuV group. No significant difference in renal function was observed between the non-LtAV (n = 10) and LtAV (n = 18) groups.</p><p><strong>Conclusions: </strong>Preservation of the LuV may be important for preventing renal dysfunction after LtRV graft harvesting. Considering the need for early postoperative adjuvant chemotherapy, LtRV grafts should be carefully considered in patients without the LuV and with a preoperative eGFR < 50 mL/min/1.73 m².</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":"3047-3054"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148798712","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":"Clarifying the Surveillance Meaning of Surgical Site Infection After Laparotomy in Kenya.","authors":"Zimin Wang","doi":"10.1002/wjs.70536","DOIUrl":"10.1002/wjs.70536","url":null,"abstract":"","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":"3138-3139"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148726912","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":"Effects of Lymphatic and Venous Invasion Status on Postoperative Prognosis and Metastasis Pattern in Patients With Esophageal Squamous Cell Carcinoma: A Retrospective Cohort Study.","authors":"Nao Kitasaki, Yoichi Hamai, Yuta Ibuki, Naoto Kishi, Manato Ohsawa, Tomoaki Kurokawa, Morihito Okada","doi":"10.1002/wjs.70590","DOIUrl":"https://doi.org/10.1002/wjs.70590","url":null,"abstract":"<p><strong>Background: </strong>Lymphovascular invasion (LVI) is a recognized predictor of poor postoperative outcomes in patients with esophageal squamous cell carcinoma (ESCC). However, only a few studies have evaluated lymphatic invasion (LI) and venous invasion (VI) separately across contemporary perioperative strategies. This study was conducted to evaluate the clinicopathological associations, survival outcomes, and recurrence patterns of LI and VI in patients with ESCC who underwent upfront surgery or neoadjuvant therapy followed by esophagectomy.</p><p><strong>Methods: </strong>We retrospectively analyzed 446 consecutive patients who underwent esophagectomy between January 2003 and March 2022. The patients were categorized into four pathological groups based on their LI and LV status: LI(-)/VI(-), LI(+)/VI(-), LI(-)/VI(+), and LI(+)/VI(+). Overall survival (OS), recurrence-free survival (RFS), and recurrence patterns were evaluated according to LI and VI status in patients who underwent upfront surgery, neoadjuvant chemotherapy (NAC), or neoadjuvant chemoradiotherapy (NACRT) followed by esophagectomy.</p><p><strong>Results: </strong>Of the 446 patients, 121, 197, and 128 underwent NAC, NACRT, and upfront surgery, respectively. Patients in the LI(+)/VI(+) group had the poorest OS and RFS among all the LI/VI groups. Multivariable analysis showed that isolated LI positivity was associated with inferior RFS compared with LI(-)/VI(-) (hazard ratio [HR] 1.55; p = 0.04). Unadjusted Kaplan-Meier comparisons showed no significant difference between isolated LI positivity and isolated VI positivity. Regarding distant metastasis, multiorgan metastasis occurred more frequently in the LI(+)/VI(+) group than in the other LI/VI groups.</p><p><strong>Conclusions: </strong>LI and VI provide distinct and complementary prognostic information for patients with ESCC. VI positivity, especially when it coexists with LI, is associated with worse postoperative survival and a higher risk of distant metastasis. These findings support the use of risk-adapted postoperative strategies for improved clinical outcomes.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115753","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":"Thirty-Day Mortality and Morbidity Outcomes in Abdominal Wall Necrotizing Soft Tissue Infections: The STANMORE Study.","authors":"Vignesh Balasubaramaniam, Geoffrey Yuet Mun Wong, Alessandro Martinino, Varun Sarodaya, Mohamed Abulazayem, Ishaan Wazir, Juan Pablo Scarano Pereira, Claudia Neves Marques, Amira Said, Himanshu Wadhawan, Yitka Graham, Rajesh Kumar Jain, Manel Riera, Ahmed Salah Mahdi, Ahmed Siddique Ammar, Aboelazaiem Mohamed, Ahmad Alfarwan, Ahmet Necati Sanli, Akilimali Aymar, Akram Alkaseek, Almu'atasim Khamees, Amel Ouyahia, Angeliki Kosti, Anjali Dawle, Baila Maqbool, Bassem Abdelhadi, Chetan Parmar, Elif Colak, Ergin Erginoz, Georgios-Ioannis Verras, Haithm G Abd El Hady, Hasan K H Hamdan, Hibad Bileid Bakeer, Hoda Salem Alhadad, Ibrahim Elzayat, Ioannis Gerogiannis, Jonathan Abraham Demma, Khayry Al-Shami, Laila Shalabi, Maximos Frountzas, Matthew Antony Manoj, Merve Tokocin, Michela Campanelli, Mohammad A Omar, Mohammed Akasha Farag Karamelghani, Mounira Rais, Mustafa Ahmad Abu Jayyab, Nigar Allahverdiyeva, Paolo Gentileschi, Rashad Abizade, Sahib Huseynov, Aashna Das, Server Sezgin Uludag, Shabnam S Cyclewala, Serhat Meric, Taryel Omarov, Zoe Rachael Bakewell, Rishi Singhal, Kamal Mahawar","doi":"10.1002/wjs.70558","DOIUrl":"10.1002/wjs.70558","url":null,"abstract":"<p><strong>Background: </strong>Necrotizing soft tissue infection is a rapidly progressive soft tissue infection with a high mortality rate. Limited contemporary data exist on abdominal wall necrotizing soft tissue infections. This study aimed to assess 30-day mortality and morbidity and identify associated clinical factors.</p><p><strong>Methods: </strong>This was a prospective, multinational, multicenter audit of adult patients (≥ 18 years) with abdominal wall necrotizing soft tissue infection presenting between January 1 and June 30, 2022. Data on demographics, comorbidities, clinical features, treatment, and outcomes were collected. Univariate and multivariate regression analysis were performed to identify independent risk factors for morbidity and mortality.</p><p><strong>Results: </strong>A total of 331 patients were included from 63 centers in 27 countries. Thirty-day morbidity and mortality occurred in 200 patients (60.4%), with 47 deaths (14.2%). A LRINEC score ≥ 6 was observed in 134 out of 263 (51.0%) of cases. Common presenting signs were skin changes in 287 out of 327 cases (87.8%), pain out of proportion to clinical findings in 236 out of 311 cases (75.9%), and gas in soft tissue on imaging 210 out of 329 cases (63.8%). The median time to first antibiotics was 2 hours (Range 0-240 hours). The median time to surgery was 6 hours (Range 1-384 hours). In the mortality group, 29 out of 47 (61.7%) had diabetes, 33 out of 47 (70.2%) had hypertension, and 25 out of 47 (53.2%) had obesity. Bowel resection (38.3%, 18 out of 47), stoma formation (44.7%, 21 out of 47) and ICU admission (89.4%, 42 out of 47) were more common in the mortality group (p < 0.05, OR 7.47). On multivariable analysis, polymicrobial infection (OR 1.73 CI 1.01-2.95) and bowel resection (OR 3.10 CI 1.22-7.88) were independently associated with morbidity, while increasing age (OR 1.04 CI 1.01-1.07), elevated creatinine (OR1 CI 1.00-1.01), bowel resection (OR 7.47 CI 2.99-18.62), and longer time to antibiotics (OR 1.02, CI 1.00-1.04) were independently associated with mortality (p < 0.05).</p><p><strong>Conclusion: </strong>Abdominal wall necrotizing soft tissue infection is associated with high early morbidity and mortality. Delays in recognition and treatment remain critical contributors. Risk stratification may assist early identification and management.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":"2886-2896"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148931354","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":"Time Course of Symptom Resolution and Changes in Quality of Life Following Total Thyroidectomy for Graves' Disease: A Prospective Study.","authors":"Ozan Caliskan, Nazlican Mermertas, Mehmet Taner Unlu, Ahmet Faruk Yener, Nurcihan Aygun, Mehmet Uludag","doi":"10.1002/wjs.70572","DOIUrl":"10.1002/wjs.70572","url":null,"abstract":"<p><strong>Background: </strong>Graves' disease (GD) is associated with substantial impairment in health-related quality of life (HRQoL) owing to a broad spectrum of systemic and neuropsychiatric symptoms. Although total thyroidectomy (TT) is an effective definitive treatment, the temporal pattern of postoperative symptom resolution and recovery of HRQoL has not been well characterized. This study aimed to evaluate the time course of symptom resolution and longitudinal changes in HRQoL following TT for GD.</p><p><strong>Methods: </strong>In this prospective observational study, 48 consecutive patients who underwent TT for GD between February 2025 and January 2026 were enrolled. All patients completed at least 6 months of postoperative follow-up. Graves' disease-related symptoms were prospectively assessed before surgery and at scheduled postoperative visits using a standardized symptom assessment form. Time to symptom resolution was analyzed using Kaplan-Meier survival analysis. HRQoL was evaluated preoperatively and at 1 and 6 months postoperatively using the 36-Item Short Form Health Survey (SF-36).</p><p><strong>Results: </strong>The most common preoperative symptoms were irritability (72.9%), palpitations (70.8%), and heat/cold intolerance (70.8%). Kaplan-Meier analysis demonstrated that palpitations, tremor, heat/cold intolerance, diarrhea, and memory impairment resolved most rapidly, with a median time to resolution of 1 week. Anxiety, depression, ocular symptoms, pain, and irritability resolved more gradually, with a median time to resolution of 4 weeks. By the end of the 24-week follow-up, complete resolution was observed in all affected patients with palpitations, tremor, heat/cold intolerance, diarrhea, and pain. Significant improvements were observed across all SF-36 domains over time (all p < 0.005). Improvements in physical functioning, bodily pain, vitality, role limitations due to physical health, and general health were evident early after surgery and continued through 6 months, whereas social functioning improved significantly only at the sixth postoperative month.</p><p><strong>Conclusions: </strong>TT was associated with rapid resolution of the classic manifestations of hyperthyroidism and significant, sustained improvements in both physical and psychosocial aspects of HRQoL. Defining the temporal pattern of postoperative recovery may improve patient counseling, optimize expectation management, and support shared decision-making for patients with GD.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":"2956-2963"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149018095","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":"Long-Term Outcomes of Omniflow II and BioIntegral Xenografts for Open Aortic Reconstruction in Predominantly Infected Settings: A Multicenter Cohort Study.","authors":"Tijmen W Kraai, Eline I Reinders Folmer, Barzi Gareb, David J Liesker, Ben R Saleem, Clark J Zeebregts","doi":"10.1002/wjs.70559","DOIUrl":"10.1002/wjs.70559","url":null,"abstract":"<p><strong>Objective: </strong>Evidence surrounding conduit selection for open in situ aortic reconstruction remains limited particularly for xenograft use in infected settings. We evaluated long-term outcomes after open aortic and aorto-iliac reconstruction using BioIntegral No-React bovine grafts and Omniflow II biosynthetic grafts in patients unsuitable for autologous vein reconstruction.</p><p><strong>Methods: </strong>This multicenter cohort study combined a retrospective Omniflow II cohort from six Dutch hospitals with a prospectively collected BioIntegral registry. Patients undergoing open aortic, aortoiliac, or aortofemoral reconstruction in infected and selected noninfected settings between 2014 and 2021 were included; peripheral bypasses and arteriovenous access procedures were excluded. The primary outcome was graft infection. Secondary outcomes included patency rates (primary, primary-assisted, and secondary), mortality, freedom from major amputation, and 30-day adverse events. Time-to-event outcomes were analyzed using Kaplan-Meier methods and univariate Cox regression.</p><p><strong>Results: </strong>Forty-four patients were included (BioIntegral n = 21, Omniflow II n = 23). Baseline characteristics were comparable except for a lower body mass index in the Omniflow group (26.8 vs. 23.9 kg/m²; p = 0.046). Thirty-day mortality was 19.0% for BioIntegral and 30.4% for Omniflow II. Infection from infection at 12, 24, and 60 months was 88.2%, 63.7%, and 43.7% for BioIntegral versus 87.1%, 79.1%, and 79.1% for Omniflow II (log-rank p = 0.13). Primary patency at 60 months was 49.9% versus 55.5% (p = 0.48) and secondary patency was 85.7% versus 72.4% (p = 0.24). Overall survival at 60 months was 25.0% versus 47.3% (p = 0.41). Freedom from major amputation at 60 months was 81.8% versus 88.8% (p = 0.59). Graft type was not associated with significant differences in univariate analyses.</p><p><strong>Conclusions: </strong>In open aortic reconstruction performed predominantly for vascular graft or endograft infection, BioIntegral and Omniflow II xenografts showed comparable long-term outcomes without statistically significant differences in patency, mortality or freedom from major amputation. Findings should be interpreted as descriptive given the small sample size and mixed indications. Late graft infections highlight the need for prolonged surveillance after reconstruction.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":"3129-3137"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662509/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148956870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Whole Blood Transfusion With Survival Among Patients Achieving ROSC After Prehospital Traumatic Cardiac Arrest.","authors":"Hui Li, Caitlyn Braschi, Meghan R Lewis, Demetrios Demetriades","doi":"10.1002/wjs.70563","DOIUrl":"10.1002/wjs.70563","url":null,"abstract":"<p><strong>Background: </strong>While whole blood (WB) is increasingly utilized to mitigate trauma-induced coagulopathy, evidence supporting its use in blunt trauma-associated prehospital cardiac arrest (PHCA) remains scarce. We compared the association of WB versus component therapy (CT) with mortality and early resuscitation balance among patients who achieved return of spontaneous circulation (ROSC).</p><p><strong>Methods: </strong>This retrospective cohort study used National Trauma Data Bank data from 2020 through 2024. Adults aged 16 years or older with blunt trauma, documented PHCA, a nonzero initial emergency department systolic blood pressure, survival beyond 1 hour after arrival, and receipt of at least 1 unit of WB or red blood cells within 4 hours were included. Propensity score overlap weighting balanced measured baseline characteristics. A prespecified 2-h landmark sensitivity analysis evaluated robustness among early survivors, and restricted cubic spline interaction models assessed heterogeneity across Injury Severity Score (ISS).</p><p><strong>Results: </strong>Among 3472 patients, 995 (28.7%) received WB. Unadjusted 30-day in-hospital mortality was 69.9% with WB and 72.6% with component therapy; weighted estimated mortality was 69.7% and 72.2%, respectively (hazard ratio, 0.89; 95% CI, 0.81-0.97; p = 0.01). Findings were similar in the 2-h landmark analysis (hazard ratio, 0.88; 95% CI, 0.80-0.98; p = 0.02). At similar total transfusion volumes, WB transfusion delivered greater calculated platelet (mean ratio, 1.40; 95% CI, 1.27-1.55) and plasma equivalents (mean ratio, 1.21; 95% CI, 1.10-1.33); 55.4% of component-therapy recipients received no platelets within 4 hours. The association with lower mortality was more pronounced at higher ISS values (interaction p = 0.006).</p><p><strong>Conclusions: </strong>Among selected early survivors of blunt traumatic PHCA with restored circulation during initial hospital assessment, WB transfusion was associated with lower 30-day in-hospital mortality and greater calculated plasma and platelet delivery than component-only therapy. Residual confounding and survivor selection remain possible, and prospective confirmation is needed.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":"3092-3102"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148875057","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}