World Journal of Surgery最新文献

{"title":"The Role of Surgical Techniques in Reducing Postoperative Pain in Abdominal Surgery: Evidence From the PROSPECT Systematic Reviews.","authors":"Stephan Maximilian Freys, Esther Miriam Pogatzki-Zahn, Narinder Rawal, Girish Premji Joshi","doi":"10.1002/wjs.70091","DOIUrl":"https://doi.org/10.1002/wjs.70091","url":null,"abstract":"<p><strong>Introduction: </strong>Inadequate postoperative pain control remains a significant concern as patients continue to experience moderate-to-severe pain after surgery. The influence of surgical techniques has not previously been systematically reviewed.</p><p><strong>Methods: </strong>In this clinical review, data regarding the influence of surgical techniques on postoperative pain after abdominal surgery were extracted and collated from seven published PROSPECT recommendations. The effects of surgical incision and its technique, laparoscopic technique, and local anesthetic infiltration were critically reviewed. The surgical techniques that are recommended and those that are not recommended for the seven procedures are presented.</p><p><strong>Results: </strong>In general, very few studies have assessed the influence of surgical techniques on postoperative pain management. PROSPECT recommends transverse over vertical incision for open colorectal surgery, and cutting diathermy over use of scalpel in appendicectomy, inguinal hernia, and open colorectal surgeries. For laparoscopic cholecystectomy, a three-port (vs. four-port) technique and low-pressure pneumoperitoneum (< 12 mmHg) are recommended to reduce the risk of postoperative shoulder pain.</p><p><strong>Conclusion: </strong>This clinical review demonstrates the important role of surgeons in achieving clinically significant benefits by using appropriate incision techniques, laparoscopic methods, and local anesthetic infiltration. Effective pain relief after surgery can improve recovery and reduce the risk of chronic pain. Our study emphasizes the need for future research in this field.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145058446","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":"Letter to the Editor: Selective Conservatism in Spinal Stab Wounds-Global Relevance and Future Directions.","authors":"James R Burmeister","doi":"10.1002/wjs.70089","DOIUrl":"https://doi.org/10.1002/wjs.70089","url":null,"abstract":"","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145034293","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":"Letter to the Editor: Global Variation in Out-of-Pocket Payments for Cancer Surgery.","authors":"Yaoyu Zhang, Hong Hu, Qin Liu, Bangyi Xiang, Wenjun Meng","doi":"10.1002/wjs.70088","DOIUrl":"https://doi.org/10.1002/wjs.70088","url":null,"abstract":"","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145024262","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":"Re: Tall Cell Variant Histology Predicts Poorer Disease-Free Survival in Papillary Thyroid Carcinoma: A Propensity Matched Cohort Study.","authors":"Sandeep Kumar Parvathareddy, Abdul K Siraj, Khawla S Al-Kuraya","doi":"10.1002/wjs.70086","DOIUrl":"https://doi.org/10.1002/wjs.70086","url":null,"abstract":"","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006700","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":"Current Landscape of Children's Surgery in Africa: A Multicenter Analysis of 16,000 Cases.","authors":"Phillip J Hsu, Madeleine Carroll, Alan Zambeli-Ljepovic, Bolusefe Tijesuni Olatunji-Banire, Pawan Mathew, Jason Axt, Thierno Diallo, Mekonen Eshete, Bertille Ki, Joseph Macharia, George Ngock, Absalat Serawit, Emma Bryce, Doruk Ozgediz, Maija Cheung","doi":"10.1002/wjs.70066","DOIUrl":"https://doi.org/10.1002/wjs.70066","url":null,"abstract":"<p><strong>Background: </strong>Although prior studies have estimated the burden of pediatric surgical disease in low- and middle-income countries (LMICs) through statistical modeling and hospital- or household-based surveys, few large-scale descriptions of procedures and outcomes have been published. We aimed to describe the epidemiology and outcomes of children's surgical care at multiple centers across Africa.</p><p><strong>Methods: </strong>Perioperative clinical data were collected prospectively from 2018 to 2023 at 17 hospitals in 11 African countries using a preexisting tool. Data came from children (age < 18 years) who underwent a surgical procedure in facilities equipped by the NGO Kids Operating Room. Data were stored on REDCap and descriptively analyzed.</p><p><strong>Results: </strong>16,454 procedures were performed, with a higher frequency of procedures performed in younger children than in older children (mean age 4.5 years). Congenital malformations, acquired genitourinary conditions, and acquired gastrointestinal conditions made up the most common diagnoses. We found a mortality rate of 3.7%, with higher mortality in neonates compared to younger children; conditions associated with the greatest mortality included congenital conditions, intestinal perforation, burns, and intussusception. Emergent operations were associated with much higher rates of mortality than elective operations.</p><p><strong>Conclusions: </strong>For the first time at this scale, we have assessed the epidemiology and outcomes of pediatric surgical care in LMICs. Findings were consistent with studies on the burden of disease, with a larger proportion of younger children accessing surgery, comparable mortality to other African studies, and higher mortality than in HICs. Future research and multilevel advocacy are needed to identify gaps in care and to design more effective interventions to reduce global disparities in access to surgical care for children.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006614","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":"Same Day Discharge After Minimally Invasive Heller Myotomy: One Surgeon's Experience.","authors":"Alberto Jarrin Lopez, Cynthia Susai, Jonathan D Svahn","doi":"10.1002/wjs.12695","DOIUrl":"10.1002/wjs.12695","url":null,"abstract":"<p><strong>Background: </strong>Minimally invasive Heller myotomy (MI-HM) with partial fundoplication is a popular treatment for achalasia. Recent advancements in minimally invasive techniques and enhanced recovery after surgery (ERAS) protocols have facilitated same-day discharge (SDD) for various procedures, promoting cost savings and enhanced patient satisfaction. However, limited data exist on the feasibility and safety of performing MI-HM as an ambulatory operation. This study aimed to evaluate the discharge rate occurring on the same day as surgery, postoperative complications, and reasons for delayed discharge in a single-surgeon cohort of MI-HM patients.</p><p><strong>Methods: </strong>A retrospective review was conducted of 157 consecutive MI-HM cases performed by a single surgeon from 2018 to 2024 at an integrated healthcare system. All patients were evaluated preoperatively with high-resolution manometry, endoscopy, and esophagram. Procedures were performed laparoscopically (n = 35) or robotically (n = 122), with all patients receiving Dor fundoplication. SDD was defined as discharge on postoperative day 0. Primary endpoints included SDD rates and reasons for delayed discharge. Secondary endpoints were 30-day emergency department (ED) visits and postoperative complication rates. Data were analyzed descriptively and stratified into quartiles to assess temporal trends in SDD success.</p><p><strong>Results: </strong>Of the 157 patients, 132 (84.1%) were discharged on postoperative day 0, with SDD rates improving from 58% in the first quartile to over 90% in subsequent quartiles. Delayed discharge occurred in 25 patients due to patient preference (36%), surgeon discretion (20%), or emesis/aspiration (20%). The overall complication rate was 2.6%, including three aspiration events and one contained leak (0.6%). No reinterventions or mortalities occurred. Out of the 157 patients, 16 patients (10.2%) presented to the ED within 30 days, and from those 16, 13 (8.28%) had surgically related complaints. From the 132 ambulatory patients, 4 (3.03%) presented within 48 h of discharge. Overall reasons for ED presentation were pain, urinary issues, and a contained leak, which was treated conservatively with antibiotics.</p><p><strong>Conclusions: </strong>This study demonstrates that MI-HM is safe, feasible, and associated with low complication and readmission rates when approached as an ambulatory procedure. Improvements in SDD rates over time reflect enhanced team familiarity and protocol optimization. Given the unique physiological and functional benefits of MI-HM with Dor fundoplication, these findings support its continued use as a treatment for achalasia, with the ambulatory model potentially offering significant cost and resource management benefits. Further studies are warranted to evaluate the generalizability of these findings across diverse healthcare settings.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":"2374-2379"},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144561332","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":"Surgical Case Cancellations at a Safety Net Hospital: Implications for Patient Care and Resource Management.","authors":"Shivani Srivastava, Sneha Gandhi, Sergio Romero Medina, George Tewfik, Faraz Chaudhury, Nisha Narula","doi":"10.1002/wjs.70007","DOIUrl":"10.1002/wjs.70007","url":null,"abstract":"<p><strong>Introduction: </strong>Surgical cancellations disrupt hospital operations, reduce efficiency, and delay patient care. These cancellations occur for a variety of reasons including hospital-related issues, patient-related challenges, inadequate preoperative workup, or logistical barriers. Although some factors have been well-studied, a complete understanding of cancellations at safety net hospitals, which serve a unique and vulnerable population, is yet to be elucidated.</p><p><strong>Methods: </strong>This is a single institution retrospective study. The electronic health system was queried for patients from 2022 to 2024 who were scheduled for surgery. Details of the cancellation date and reason, urgency of case, surgical service, and location of surgery were captured. Specific reason of cancellation was then divided into broad categories: scheduling, change in treatment, patient, medical professional, facility, and social.</p><p><strong>Results: </strong>There were a total of 34,441 cases scheduled and 5939 canceled procedures. The overall surgical cancellation rate was 17.2%. Cancellations were more frequent in the main operating room (19%) compared to the ambulatory operating room (13%). 86.3% of cases were canceled the same day of surgery. The reasons for cancellation were as follows: scheduling 37.3%, patient-related 35.0%, social 12.6%, change in treatment 8.2%, facility-related 3.6%, and medical professional-related 3.3%. When accounting for total volume in a specialty-specific analysis, pulmonary had the highest proportion of canceled cases, followed by gastroenterology, podiatry, and oral maxillofacial surgery.</p><p><strong>Conclusion: </strong>There is a significant rate of surgical case cancellations, particularly same-day cancellations, in our study at a single institution tertiary care and safety net hospital, predominantly related to scheduling, patient-related, and social factors. Specific interventions and systems improvements are urgently needed to improve assessment of patient-related factors, fix problems with scheduling of cases, and support patients who lack access to care. The added resources for these process improvement interventions that will be required may be offset by the improved efficiency and lower cancellation rate.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":"2493-2500"},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144675952","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":"Risk Factors for Postoperative Complications Following Emergency Abdominal Surgery: A Prospective Pediatric Cohort.","authors":"Mohamed Zouari, Wiem Rhaiem, Manel Belhajmansour, Manar Hbaieb, Salma Kharrat, Najoua Ben Kraiem, Mahdi Ben Dhaou, Riadh Mhiri","doi":"10.1002/wjs.70015","DOIUrl":"10.1002/wjs.70015","url":null,"abstract":"<p><strong>Background: </strong>Postoperative complications remain a significant concern in pediatric emergency abdominal surgery. However, reliable predictors to anticipate these adverse events are lacking in the pediatric population. The aim of this study was to identify risk factors for postoperative complications in children undergoing emergency abdominal surgery.</p><p><strong>Methods: </strong>Following the approval by our institutional ethics committee, we conducted a prospective study from January 1, 2022, to December 31, 2024, in a pediatric surgery department. All children under 14 years of age who underwent emergency abdominal surgery were included.</p><p><strong>Results: </strong>A total of 582 patients were included. The median age was 9 years, and 66.7% were male. Acute appendicitis was the most common surgical condition (n = 515), followed by intussusception (n = 15), ovarian torsion (n = 14), and complicated Meckel's diverticulum (n = 10). Postoperative complications occurred in 12.4% of cases. These complications included surgical site infection (n = 35), adhesive small bowel obstruction (n = 13), postoperative sepsis (n = 8), intra-abdominal abscess (n = 7), respiratory infections (n = 4), urinary tract infections (n = 3), and prolonged postoperative bleeding (n = 2). On multivariate analysis, four independent predictive factors of postoperative complications were identified: symptom duration > 48 h, pediatric comorbidity index ≥ 3, white blood cell count > 15 × 10⁹/l, and operative time > 100 min.</p><p><strong>Conclusion: </strong>Systematic assessment of these risk factors may contribute to early risk stratification, guide postoperative monitoring decisions, and justify the use of more aggressive or prolonged antibiotic therapy in selected high-risk patients.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":"2531-2539"},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144699705","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":"Chronic Lymphocytic Thyroiditis Does Not Worsen Early Surgical Outcomes in Papillary Thyroid Cancer.","authors":"Tanaz M Vaghaiwalla, Jonathan Chang, Victoria DeTrolio, Cima Saghira, Mehmet Akcin, Cheng-Bang Chen, John I Lew","doi":"10.1002/wjs.70012","DOIUrl":"10.1002/wjs.70012","url":null,"abstract":"<p><strong>Background: </strong>Chronic lymphocytic thyroiditis (CLT), an autoimmune thyroid disorder that most commonly causes hypothyroidism in women, may confer a higher surgical risk for patients undergoing thyroidectomy for papillary thyroid carcinoma (PTC). This study evaluates surgical treatment outcomes for patients with a diagnosis of PTC with and without CLT.</p><p><strong>Methods: </strong>A retrospective review of prospectively collected data for patients who underwent thyroidectomy from 2009 to 2020 at a tertiary institution was performed. Patients ≥ 18 years of age were subdivided into 2 groups: patients with CLT and PTC and patients with PTC alone. Sociodemographic factors, tumor characteristics, final histopathology, thyroidectomy-specific outcomes, and postoperative course were evaluated. Chi-squared tests were used for categorical variables and comparisons based on t-tests.</p><p><strong>Results: </strong>Of 1073 patients with PTC, most were women n = 872 (81%), Caucasian n = 933 (87%) with a mean of 48 (± 13) years of age, mean tumor size of 1.8 cm (± 1.3 cm), and low stage disease I/II n = 1049 (98%). Among patients with PTC n = 167 (16%) had a concurrent diagnosis of CLT. When comparing patients with PTC and CLT to PTC alone, there were no significant differences in age, race, or tumor size, respectively. When comparing patients with PTC and CLT to PTC alone, there were no significant differences in permanent recurrent laryngeal nerve injury (1.2% [n = 2] vs. 0.2% [n = 2]), bleeding and/or return to OR (0.6% [n = 1] vs. 0.7% [n = 6]), persistent hypocalcemia (0% [n = 0] vs. 0.33% [n = 3]), wound infection (0.6% [n = 1] vs. 0.4% [n = 4]), and radioactive iodine therapy (35.9% [n = 60] vs. 31.2% [n = 283]). Rates of lymph node positivity (26.9% [n = 45] vs. 30.1% [n = 273]), extrathyroidal extension (14.3% [n = 24] vs. 16.5% [n = 150]), and PTC recurrence (4.19% [n = 7] vs. 4.75% [n = 43]) were similar between groups.</p><p><strong>Conclusion: </strong>Of those undergoing total thyroidectomy for PTC, 16% of patients have concurrent underlying CLT. Underlying CLT is not associated with more aggressive tumor biology, higher rates of surgical complications, or PTC recurrence when performed by high-volume thyroid surgeons.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":"2457-2463"},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12435607/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144733616","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":"Same Day Discharge for Heller Myotomy: Setting Realistic Patient Expectations Is Key.","authors":"Sarah K Thompson","doi":"10.1002/wjs.70047","DOIUrl":"10.1002/wjs.70047","url":null,"abstract":"","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":"2380-2381"},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12435599/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144859694","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}