The British journal of surgery最新文献

{"title":"Incidence of autoimmune disease after hernia surgery with a mesh implant: national retrospective cohort study.","authors":"Maurits J C A M Gielen, Ahmed M Chaoui, Samantha Schoenmakers, Bas Vreugdenhil, Tim Lubbers, Richard P G Ten Broek, Rudi M H Roumen, Nicole D Bouvy, Willem A R Zwaans","doi":"10.1093/bjs/znag025","DOIUrl":"10.1093/bjs/znag025","url":null,"abstract":"<p><strong>Background: </strong>Some patients report experiencing various systemic symptoms after surgical placement of a (polypropylene (PP)) mesh implant, including fatigue, arthritis, and myalgia. As these complaints could resemble systemic symptoms of autoimmune disease (AID), there are concerns that mesh implants could induce such disorders. The aim of this study was to identify the incidence of AID after mesh implantation, compared with controls in whom no mesh was implanted.</p><p><strong>Methods: </strong>In this national retrospective cohort study, approximately 4 million people insured with Dutch health insurer Coöperatie VGZ were screened for operative procedure reimbursements for inguinal and incisional hernia repair, between January 2015 and January 2019. Patients who underwent cholecystectomy were included as controls, as no mesh is implanted during this procedure. Patients were followed from 2 years before surgery to 3 years after surgery. The primary outcome was the difference in the incidence of AID after mesh implantation, compared with surgery without mesh. Propensity score matching for age, sex, and socioeconomic status was performed to reduce selection bias.</p><p><strong>Results: </strong>The cohort included 19 464 inguinal/incisional hernia patients (86.0% male) and 18 259 cholecystectomy patients (31.8% male). After matching, both groups consisted of 1500 patients. The incidence of new AID during follow-up was not statistically different between the two groups (1.1% for the intervention group and 1.5% for the control group; P = 0.520).</p><p><strong>Conclusion: </strong>Based on this cohort study, mesh implants do not increase the medium-term risk of developing AID.</p>","PeriodicalId":520792,"journal":{"name":"The British journal of surgery","volume":"113 5","pages":""},"PeriodicalIF":8.8,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13151888/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147849372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical innovation and technology.","authors":"Jeffrey B Matthews, Jelle P Ruurda, Peter G Vaughan-Shaw, Desmond C Winter, Andrew Beggs, Andrew Yiu, Brian Davidson, Barbara Seeliger, Chen Xin, Daniel Stoyanov, Daphne D Rietbergen, Fijs W B van Leeuwen, Gerlof M Kuiper, Guglielmo N Piozzi, Jianing Qiu, James M Kinross, João Ramalhinho, Jim S Khan, Kurinchi Gurusamy, Kyle Lam, Kai F Chan, Li Zhang, Matthew Boal, Matthew J Clarkson, Matthias N van Oosterom, Nader Francis, Neeraj Lal, Philip W Y Chiu, Tessa Buckle, Yafit Shasha, Israa F E Hussein","doi":"10.1093/bjs/znaf224","DOIUrl":"10.1093/bjs/znaf224","url":null,"abstract":"<p><strong>Background: </strong>The pace of surgical innovation appears ever faster. Innovation is being freed from the design constraints of the opposable digits of a surgeon's hand through the use of programmable binary digits. Surgeons must be the drivers of change and central to the application of innovations. We should collaborate with industry, engineers and scientists to think out of the box but must consider also expense, environmental impact, equity, and ethics. But we should not be blinded by shiny technology: innovation without impact is mere noise. The ultimate considerations are the diagnosis and management of surgical disease, of improving the care of our patients.</p><p><strong>Methods: </strong>Expert surgeons, scientists and engineers across the world were identified and invited to describe areas of innovation within surgery. They were given free rein to review their areas of expertise and to discuss both current and future applications of technology within surgical care.</p><p><strong>Results: </strong>The Commission spans multiple surgical specialties and scientific domains. It reviews translational genomics, including the role of ctDNA, alongside microbiomic and proteomic applications in improving the diagnosis, treatment and monitoring of surgical disease. Applications to enhance surgical procedures are described, from medical micro/nanorobots for minimally invasive interventions, sensory-enriched surgery with visual optimization and molecular image-guidance to intelligent and semiautomated instruments. The expansion and broad influence of artificial intelligence in surgical writing, training and simulation, diagnosis and robotics is widely described. The role of surgical innovation and technology in driving personalized care for benign and malignant surgical disease from genomic profiling to bespoke surgical and non-surgical treatment pathways and surveillance is considered.</p><p><strong>Conclusion: </strong>The future of surgery is poised to become more precise, personalized, and effective. Collaboration with engineers, data scientists, and industry partners not only represents an exciting opportunity for surgeons to participate in team science but is critical to focus innovation goals on optimizing patient care and outcomes.</p>","PeriodicalId":520792,"journal":{"name":"The British journal of surgery","volume":"113 5","pages":""},"PeriodicalIF":8.8,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13182719/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147978563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mirizzi syndrome.","authors":"Haoyang Huang, Tao Wu, Jie Huang","doi":"10.1093/bjs/znag051","DOIUrl":"10.1093/bjs/znag051","url":null,"abstract":"","PeriodicalId":520792,"journal":{"name":"The British journal of surgery","volume":" ","pages":""},"PeriodicalIF":8.8,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147937251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative management of anticoagulation.","authors":"Aditya Narain, Alex James","doi":"10.1093/bjs/znag049","DOIUrl":"10.1093/bjs/znag049","url":null,"abstract":"","PeriodicalId":520792,"journal":{"name":"The British journal of surgery","volume":" ","pages":""},"PeriodicalIF":8.8,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147731182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What a mesh: a call for better science and regulatory oversight.","authors":"Andrew W Kirkpatrick, Phillip M Millar, Christopher J Doig","doi":"10.1093/bjs/znag042","DOIUrl":"10.1093/bjs/znag042","url":null,"abstract":"","PeriodicalId":520792,"journal":{"name":"The British journal of surgery","volume":"113 5","pages":""},"PeriodicalIF":8.8,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13151922/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147849341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and molecular landscape of surgically resected early onset pancreatic cancer.","authors":"Stephan B Dreyer, Adam Bryce, Fieke Froeling, Shannon Jackson, Leonor Santana, Euan J Dickson, Maria Coats, Colin McKay, David Holroyd, Andrew V Biankin, Nigel B Jamieson, David K Chang","doi":"10.1093/bjs/znag032","DOIUrl":"10.1093/bjs/znag032","url":null,"abstract":"<p><strong>Background: </strong>The increase in incidence of early-onset pancreatic cancer (EOPC) is of concern and poorly understood. The aim of this study was to investigate the clinical outcomes of surgically resected patients with EOPC and the potential molecular heterogeneity between EOPC and late age-onset disease.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted, with clinical, pathological, and survival outcome data obtained from two large independent prospective cohorts curated by the Australian Pancreatic Genome Initiative (APGI) and the West of Scotland Pancreatic Unit (Glasgow Royal Infirmary) between 1997 and 2022. Patients were categorized into two age groups (<50 and ≥50 years) at time of diagnosis. Clinicopathological features and survival outcomes, in addition to gene expression and tumour microenvironment data, were compared between groups.</p><p><strong>Results: </strong>In total, 851 patients were identified, of whom 68 (8%) were aged <50 years. EOPC was associated with significantly earlier recurrence after surgery (median disease-free survival (DFS) 10.9 versus 14.2 months; P = 0.011) and there was no statistically significant difference in disease-specific survival (median 19.9 versus 23.8 months; P = 0.117). There were no differences in validated clinicopathological variables to account for the shorter DFS in the EOPC group. Despite an increased proportion of patients with EOPC receiving adjuvant chemotherapy (P = 0.032), DFS was significantly worse (DFS 12.6 versus 16.0 months; P = 0.022). EOPC demonstrated enrichment of genes associated with more aggressive molecular pathology and the squamous (basal-like) molecular subtype of pancreatic ductal adenocarcinoma, including S100A2 (P < 0.001) and TP63 (P = 0.044), and down-regulation of GATA6 (P = 0.016).</p><p><strong>Conclusion: </strong>EOPC is associated with a shorter time to recurrence and more aggressive, adverse molecular pathology.</p>","PeriodicalId":520792,"journal":{"name":"The British journal of surgery","volume":"113 5","pages":""},"PeriodicalIF":8.8,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13151028/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147849345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical technology and innovation: reality mirroring fiction.","authors":"Peter G Vaughan-Shaw","doi":"10.1093/bjs/znaf225","DOIUrl":"https://doi.org/10.1093/bjs/znaf225","url":null,"abstract":"","PeriodicalId":520792,"journal":{"name":"The British journal of surgery","volume":"113 5","pages":""},"PeriodicalIF":8.8,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147978627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nationwide outcomes of endovascular thoracoabdominal aortic aneurysm repair.","authors":"Harry H Y Yu, Giuseppe Asciutto, Nuno V Dias, Anders Wanhainen, Angelos Karelis, Björn Sonesson, Kevin Mani","doi":"10.1093/bjs/znag035","DOIUrl":"10.1093/bjs/znag035","url":null,"abstract":"<p><strong>Background: </strong>Complex endovascular repair has emerged as a minimally invasive alternative for thoracoabdominal aortic aneurysms (TAAAs). The aim of this study was to assess the short- and mid-term outcomes of endovascular TAAA repair in Sweden.</p><p><strong>Methods: </strong>All endovascular TAAA repairs performed during 2018-2023 were identified in the Swedish Vascular (Swedvasc) Registry. Patient characteristics, operative details, and outcomes were analysed. The primary outcome was survival; secondary outcomes included complications and thoracoabdominal aortic life-altering events (TALEs). Predictors of mid-term outcomes were assessed in multivariable analysis.</p><p><strong>Results: </strong>Some 339 patients were treated for TAAAs, which included 476 repairs (366 elective repairs and 110 emergency repairs) across 11 centres (94% concentrated in 5 centres). Elective patients (235 patients; mean diameter 64 mm) had 30-day, 90-day, and 1-year mortality of 2.6%, 3.5%, and 12.4% respectively. Major complications, vascular complications, and TALEs occurred in 16.2%, 9.8%, and 14% respectively. The use of prophylactic spinal drainage declined over time (from 68% to 14%) and the incidence of spinal cord ischaemia declined over time (from 20% to 2.3%). Mean(s.e.) 1-year and 4-year Kaplan-Meier survival estimates were 89.3%(2.1%) and 73.5%(3.7%) respectively. Emergency patients (104 patients; mean diameter 73 mm) had 30-day, 90-day, and 1-year mortality of 12.5%, 17.6%, and 26.9% respectively. Major complications, vascular complications, and TALEs occurred in 20.2%, 12.5%, and 24% respectively. Mean(s.e.) 1-year and 4-year Kaplan-Meier survival estimates were 75.2%(4.3%) and 56.5%(6.2%) respectively. Perioperative myocardial infarction was the strongest predictor of 1-year mortality after both elective and emergency repair.</p><p><strong>Conclusion: </strong>Endovascular TAAA repair in Sweden is associated with significant complication rates, but acceptable mid-term survival. Further research should focus on perioperative refinements, especially with regard to preserving organ function.</p>","PeriodicalId":520792,"journal":{"name":"The British journal of surgery","volume":" ","pages":""},"PeriodicalIF":8.8,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13094540/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147518361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post-hepatectomy liver failure.","authors":"Kjetil Soreide, Anita Balakrishnan, Helena Taflin","doi":"10.1093/bjs/znag004","DOIUrl":"https://doi.org/10.1093/bjs/znag004","url":null,"abstract":"","PeriodicalId":520792,"journal":{"name":"The British journal of surgery","volume":"113 3","pages":""},"PeriodicalIF":8.8,"publicationDate":"2026-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147358742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identifying novel indicators of non-technical skills derived from operative video annotation.","authors":"Lachlan Dick, Connor Boyle, Victoria Ruth Tallentire, Joel Norton, Emma Howie, Douglas S Smink, Richard J E Skipworth, Steven Yule","doi":"10.1093/bjs/znag015","DOIUrl":"10.1093/bjs/znag015","url":null,"abstract":"<p><strong>Background: </strong>Cognitive non-technical skills (NTS), including situation awareness and decision-making, are critical determinants of surgical outcomes. Current NTS assessments depend on expert human observation, which is resource-intensive and difficult to scale. To address this, we investigated whether surgical gestures, derived from annotated video of the surgical field, could serve as objective indicators of cognitive NTS.</p><p><strong>Methods: </strong>A data set of 40 open-source laparoscopic appendicectomy videos was annotated for temporal (for example surgical gestures) and spatial (for example coordinates of actions) indicators of surgical NTS. Using the Non-Technical Skills for Surgeons (NOTSS) tool, 12 expert observers independently assessed decision-making (1-4) and situation awareness (1-4). Multivariable linear regression analysed video-derived indicators predictive of NTS.</p><p><strong>Results: </strong>Across all videos, a total of 10 385 events were annotated, generating 87 374 data points. The mean cognitive NOTSS rating was 5.6 (s.d. 0.8) out of 8, with decision-making and situation awareness highly correlated (r = 0.8, P  <  0.001). The final multivariable model explained 39.6% of the variance in expert cognitive NOTSS ratings, identifying five predictors: dexterity index, events during the final operative phase, coagulating events, dropping actions, and actions targeting the small bowel.</p><p><strong>Conclusion: </strong>This study provides evidence that non-technical skills can be inferred from silent video of the surgical field alone. These findings lay the foundations for scalable, automated tools to evaluate surgeons' cognitive processes offering new avenues to improve surgical training, performance and outcomes.</p>","PeriodicalId":520792,"journal":{"name":"The British journal of surgery","volume":" ","pages":""},"PeriodicalIF":8.8,"publicationDate":"2026-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13036482/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146222753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}