Scandinavian Journal of Surgery最新文献

{"title":"Preoperative expectations and quality of life after breast reconstruction: Finnish validation of the BREAST-Q Reconstruction Expectations module.","authors":"Charlotta Kuhlefelt, Jussi P Repo, Tiina Jahkola, Susanna Kauhanen, Pauliina Homsy","doi":"10.1177/14574969261428789","DOIUrl":"10.1177/14574969261428789","url":null,"abstract":"<p><strong>Background and aims: </strong>Patient expectations can influence satisfaction and health-related quality of life (HRQL) after breast reconstruction. The aim of this study was to evaluate both patient expectations before breast reconstruction and HRQL after a 1-year follow-up.</p><p><strong>Methods: </strong>A cohort study was performed on patients awaiting delayed breast reconstruction at Helsinki University Hospital in April 2020. The BREAST-Q Reconstruction Expectations module was translated into Finnish following accepted guidelines for preoperative assessment of expectations. One-year outcomes were assessed using the BREAST-Q Reconstruction module. Correlation analyses were performed to evaluate associations between expectations and postoperative HRQL.</p><p><strong>Results: </strong>Of 145 patients approached, 57 patients (39%) participated. Median preoperative age was 54 years (interquartile range (IQR) = 47-63). Expectations for coping were high (median = 100, IQR = 68-100). At 1 year, appearance, shape, and clothing fit were expected to return to near normal (median = 69, IQR = 53-91), and donor site appearance and function were expected to normalize (median = 6, IQR = 5-7). At 1 year, 38 patients (67%) completed follow-up. Median scores (IQR) were psychosocial well-being 62 (48-80), satisfaction with breasts 60 (47-76), physical well-being of the chest 85 (64-92), and physical well-being of the abdomen 72 (62-81), indicating generally favorable outcomes. High expectations for coping were associated with better psychosocial well-being postoperatively. In addition, patients expecting more pain reported lower physical well-being of the chest at 1 year.</p><p><strong>Conclusions: </strong>Breast cancer patients reported high expectations regarding the upcoming breast reconstruction, and the HRQL after a 1-year follow-up reflected attainment of these goals.</p><p><strong>Clinical trial registration: </strong>N/A.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"218-225"},"PeriodicalIF":1.8,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147515820","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":"Management of extracervical recurrence following total parathyroidectomy and autotransplantation for renal hyperparathyroidism.","authors":"Dan Cortes, Sujith Wijerethne, James Lee, Ralph V Yap, Ngiam K Yuan, Rajeev Parameswaran","doi":"10.1177/14574969251363333","DOIUrl":"10.1177/14574969251363333","url":null,"abstract":"<p><strong>Background: </strong>In patients with renal hyperparathyroidism the choice of surgery varies between total parathyroidectomy with autotransplantation (TPTx + AT) and subtotal parathyroidectomy (SPT) with variable outcomes. The present study investigated the risk of extracervical recurrences in patients who underwent total parathyroidectomy with autotransplantation for dialysis patients with renal hyperparathyroidism.</p><p><strong>Methods: </strong>A retrospective cohort analysis of patients who underwent TPTx + AT for renal hyperparathyroidism between the years 2000 and 2023 at a tertiary referral hospital. Patient demographic profiles, biochemical and surgical data, incidence of recurrence and outcomes of intervention were collected.</p><p><strong>Results: </strong>Some 142 (71M:71 F) patients with a mean age of 58.6 ± 11.2 years underwent total parathyroidectomy and autotransplantation during the study period. The mean dialysis vintage was 6.3 ± 3.2 years. Extracervical recurrence was seen in 25 (17.6%) of 142 patients, after a mean follow-up of 9 (±4.2) years, with the common sites of recurrence being the deltoid autotransplant site (73.1%) and the mediastinum (11.5%), while 7.7% of recurrences were biochemical with no localized site. Of the recurrences, 19 of 25 (76%) underwent explant of the deltoid autotransplant, and two in the mediastinum underwent minimally invasive excision (one video assisted thoracic surgery and one robotic excision) of the parathyroid lesion. The median parathyroid hormone level at the time of recurrence was 109.4 pg/ml compared with 17.2 ng/L postexcision or explantation. The only factor predictive for recurrences in the cohort on multivariable analysis was postoperative serum PTH (<i>p</i> = 0.001). Log-rank test showed no statistically significant difference in survival between the two groups (<i>p</i> = 0.355).</p><p><strong>Conclusion: </strong>Extracervical recurrences in the autotransplant are not uncommon in the long-term following total parathyroidectomy and autotransplantation for patients with renal hyperparathyroidism. These recurrences need explantation or excision to reduce the PTH burden in patients who cannot avail a renal transplant.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"97-105"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145318848","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":"GallRiks registry: Twenty years of improving the safety and quality of gallstone surgery and ERCP in Sweden.","authors":"Gabriel Sandblom, My Blohm, Carl Johan Drott, Lars Enochsson, Ioannis Gkekas, Erik Haraldsson, Linda Lundgren, Gunnar Persson, Lise-Lott Prebner, Stefan Redéen, Peder Rogmark, Eva-Lena Syrén, Johanna Österberg, Greger Olsson","doi":"10.1177/14574969251387506","DOIUrl":"10.1177/14574969251387506","url":null,"abstract":"<p><p>Gallstone disease is common in the Western world, and approximately 15,000 cholecystectomies and 9000 endoscopic retrograde cholangiopancreatographies (ERCPs) are performed each year in Sweden. While being safe, the high frequency of these procedures has a significant cumulative impact on health in the community, exceeding those of many complex procedures for malignant conditions. Compliance with established guidelines for gallstone disease management varies and the strength of supporting evidence remains inconsistent. The Swedish National Register for Gallstone Surgery and ERCP (GallRiks) was launched in May 2005 to monitor outcomes nationwide, to enhance quality of care, and to facilitate population-based research. Continuous feedback to participating units has contributed to improvement in patient care. Since its introduction, laparoscopic procedures have become more prevalent than open cholecystectomies, antibiotic prophylaxis is used more selectively, and the proportion of procedures performed on a day-case basis has increased: all of this despite unchanged healthcare resources. Register-based studies have highlighted the benefits of intraoperative cholangiography, the advantages of centralizing care to high-volume surgeons, endoscopists and units, as well as the impact of surgeon gender on outcomes. Now in its 20th year, GallRiks remains a cornerstone of quality assurance in Swedish gallstone surgery. Research based on register data continues to improve gallstone disease management and shape clinical guidelines and healthcare practice.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"131-133"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145453476","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":"Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal malignancies: How, to whom, and is centralization needed?","authors":"Ebbe B Thorgersen, Vegar J Dagenborg, Johannes K Schultz","doi":"10.1177/14574969261418796","DOIUrl":"10.1177/14574969261418796","url":null,"abstract":"","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"129-130"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146144597","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":"Gender-affirming healthcare in the Nordic countries: An overview.","authors":"Isak Gran, Cecilia Dhejne, Antti Mikkola, Martin Sollie, Pehr Sommar, Rikke Holmgaard, Kaisu Ojala, Hannes Sigurjonsson, Louise Frisén, Jenny Löfgren, Helena Sackey","doi":"10.1177/14574969251371862","DOIUrl":"10.1177/14574969251371862","url":null,"abstract":"<p><p>This narrative review examines gender-affirming healthcare in the Nordic countries, highlighting historical developments, legal frameworks, epidemiological trends, and current clinical practices. Transgender healthcare dates back to the early 20th century and gained international attention in the early 1950s following one of the first widely publicized gender-affirming surgeries performed in Denmark. Since then, care models have evolved, supported by policy, research, and clinical practice across Europe and North America.All Nordic countries, Denmark, Finland, Iceland, Norway, and Sweden, provide publicly funded gender-affirming healthcare, although service structures differ. Legal gender recognition has shifted toward self-identification in Denmark, Finland, Iceland, Norway, and from July 2025, also Sweden by removing medical or psychiatric prerequisites.In parallel, epidemiological data reveal an increased healthcare utilization, particularly among youth assigned female at birth. Elevated rates of mental health challenges highlight the need for integrated psychosocial support. Clinical care typically follows a multidisciplinary model including psychiatric and medical assessment, hormone therapy, and surgery when indicated. Access to chest and genital surgery requires a formal diagnosis and is with few exceptions restricted to adults. Evidence supports the positive impact of gender-affirming treatment on gender congruence and health-related quality of life. Regret after gender-affirming surgery is rare but does occur, underscoring the importance of individualized care and thorough informed consent.Ongoing challenges include long wait times, unequal access for non-binary individuals, and a growing number of individuals seeking private or cross-border care. Future efforts should focus on expanding public services, strengthening research, and promoting equitable, evidence-based care that reflects the diversity of gender identities.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"5-14"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145030871","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":"Five-year survival outcomes following perioperative hydrocortisone versus pasireotide in patients with high risk of pancreatic fistula: Secondary analysis of the HYPAR randomized clinical trial.","authors":"Timo Tarvainen, Jukka Sirén, Arto Kokkola, Ville Sallinen","doi":"10.1177/14574969251387503","DOIUrl":"10.1177/14574969251387503","url":null,"abstract":"","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"116-118"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145379499","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 practices and perspectives on gender-affirming breast and chest wall surgery in the Nordic region: An overview.","authors":"Isak Gran, Antti Mikkola, Martin Sollie, Rikke Holmgaard, Kaisu Ojala, Hannes Sigurjonsson, Matteo Amoroso, Pehr Sommar, Louise Frisén, Jenny Löfgren, Helena Sackey","doi":"10.1177/14574969251376097","DOIUrl":"10.1177/14574969251376097","url":null,"abstract":"<p><p>This narrative review provides an in-depth description of gender-affirming breast surgery within the context of publicly funded healthcare systems in the Nordic countries. A comprehensive literature search was conducted in collaboration with two information specialists, focusing on original research, reviews, and clinical guidelines published in English. The prevalence of transgender and non-binary individuals in the Nordic region ranges from 0.04% to 0.6%, depending on the country and study methodology. Gender-affirming treatment, including hormone therapy and surgical interventions such as breast augmentation and mastectomy, plays a critical role in reducing gender dysphoria and improving psychological well-being, with low rates of reported regret. Transfeminine individuals often pursue breast augmentation with implants or autologous fat grafting; procedures tailored to their unique anatomical considerations. These surgeries are associated with improved health-related quality of life and high levels of satisfaction. Surgical planning involves careful consideration of implant type, placement, and incision strategy. Transmasculine individuals commonly undergo chest masculinization, with techniques adapted to breast size, ptosis, skin quality, and individual goals. Both implant-based and mastectomy procedures are generally safe, though complications such as capsular contracture, hematoma, or wound healing disturbances may occur. Although regret is rare, it underscores the need for comprehensive assessment, informed consent, and mental health support throughout the transition process. Breast cancer screening guidelines remain inconsistent, with barriers to access due to legal gender markers and varying levels of provider knowledge While Nordic countries vary in their approaches, all aim to balance medical necessity, individual autonomy, and healthcare equity. Future priorities include refining surgical protocols, expanding research on long-term outcomes, and addressing systemic barriers to ensure inclusive, evidence-based care for all gender-diverse individuals.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"15-26"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145180090","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":"Gender-affirming surgery in the Nordic countries-advancing equitable, evidence-based care.","authors":"Isak Gran, Antti Mikkola, Helena Sackey, Pehr Sommar","doi":"10.1177/14574969251407221","DOIUrl":"10.1177/14574969251407221","url":null,"abstract":"","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"3-4"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145783493","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":"Androgen deprivation therapy and overall survival after hip fracture surgery in patients with prostate cancer.","authors":"Silja Vuorlaakso, Minna K Laitinen, Heini Huhtala, Antti Kaipia, Jussi Kosola","doi":"10.1177/14574969251387489","DOIUrl":"10.1177/14574969251387489","url":null,"abstract":"<p><strong>Background and aims: </strong>Androgen deprivation therapy (ADT), either by surgical or chemical castration, is the standard treatment for metastatic prostate cancer (PCa). ADT induces osteoporosis and increases the risk of osteoporotic fractures, such as hip fractures. However, the effect of castration on overall survival (OS) after hip fracture is unclear. The aim of this study was to evaluate the association between ADT and OS among PCa patients with surgically treated low-energy hip fractures.</p><p><strong>Methods: </strong>Male patients with surgically treated low-energy hip fractures (ICD-10 codes S72.0, S72.1, and S72.2) were retrospectively identified from the databases of Pirkanmaa Hospital District during the years 2002-2018. Patients with pathological hip fractures were excluded from the analysis. Patients with prior PCa were identified (n = 323) and categorized into three groups according to therapy that affects testosterone levels: no hormonal therapy (n = 94), ADT (n = 212), and nonsteroidal antiandrogen (NSAA) (n = 17) at the time of the fracture. The primary outcome was OS after hip fracture surgery. Postoperative OS was analyzed using the Kaplan-Meier method, and the difference in OS between groups was analyzed using Cox regression in univariable, age-adjusted, and multivariable-adjusted models.</p><p><strong>Results: </strong>Kaplan-Meier survival analysis suggested that patients under ADT had shorter OS after hip fracture surgery (p = 0.006). After adjustment for potential confounders in Cox regression models, no clear association was observed between ADT (hazard ratio (HR) 1.19, 95% confidence interval (CI) 0.90-1.58) or NSAA (HR 1.02 (0.59-1.78)) and OS when compared to patients with PCa not undergoing hormonal therapy. Higher age and comorbidities, rather than ADT, appeared to be associated with poorer OS.</p><p><strong>Conclusions: </strong>In the cohort of patients with PCa, who underwent surgery for low-energy hip fracture, ADT or NSAA utilization was not associated with OS. Wide CIs allow for both modest benefit and potential harm, and the findings should therefore be considered inconclusive.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"73-81"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145423447","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 nationwide comparison of public and private treatment of Achilles tendon rupture in Finland.","authors":"Marjukka Hallinen, Oskari Leino, Inari Laaksonen, Markus Matilainen, Elina Ekman","doi":"10.1177/14574969251363325","DOIUrl":"10.1177/14574969251363325","url":null,"abstract":"<p><strong>Background and aims: </strong>The purpose of this study was to compare the incidence of and treatment methods for Achilles tendon ruptures (ATRs) in public and private healthcare in Finland between 1997 and 2019.</p><p><strong>Methods: </strong>The Finnish National Hospital Discharge Register and the Finnish Register of Primary Health Care Visits were searched to identify all adults diagnosed with ATR in 1997-2019.</p><p><strong>Results: </strong>In the study period, 91% of patients with ATR were treated in the public sector. In public healthcare, the majority of patients were treated nonoperatively (10,997; 40% operative vs 16,303; 60% nonoperative), whereas in the private sector, the majority of the patients were treated operatively (2088; 80% operative vs 514; 20% nonoperative) (P < 0.001).</p><p><strong>Conclusion: </strong>The distribution of public and private treatment for ATRs remained consistent during the follow-up period from 1997 to 2019. In the public sector, treatment methods became significantly more nonoperative during the study period, while no such change was observed in the private sector.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"82-87"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145483439","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}