Simultaneous bilateral nephrectomy and living donor kidney transplantation (LDKT) is often indicated for autosomal dominant polycystic kidney disease (ADPKD) with end-stage kidney disease (ESKD). Robotic-assisted surgery offers a minimally invasive alternative to open approaches and may reduce perioperative morbidity and length of stay.
Methods
Four adults with ADPKD/ESKD underwent fully robotic-assisted simultaneous bilateral nephrectomy/LDKT (RASBN/LDKT) at a single high-volume transplant center. All procedures used an intra-abdominal approach with a Pfannenstiel incision and GelPort for native kidney extraction and allograft introduction. Clinical, perioperative, and functional outcomes were recorded prospectively and analyzed retrospectively.
Results
Median total operative time was 462.5 min (range, 401-544 min). Median length of stay was 3.5 days (range, 3-5 d). There were no intraoperative or postoperative vascular, urological, or surgical complications, and no conversions or hand assistance were required. All recipients had immediate graft function without delayed graft function (no hemodialysis in the first postoperative week). Kidney allograft function remained stable through 12 mo after transplant.
Conclusions
Robotic-assisted simultaneous bilateral nephrectomy/LDKT is feasible and safe in carefully selected ADPKD/ESKD recipients, providing excellent early clinical outcomes and expanding the role of minimally invasive techniques for complex scenarios.
{"title":"Robotic-Assisted Simultaneous Bilateral Native Nephrectomy and Living Donor Kidney Transplantation","authors":"Rodrigo Vianna MD, PhD , Mahmoud Morsi MD , Armando Salim Munoz-Abraham MD, MBEE , Giselle Guerra MD , Gaetano Ciancio MD, MBA","doi":"10.1016/j.jss.2025.12.015","DOIUrl":"10.1016/j.jss.2025.12.015","url":null,"abstract":"<div><h3>Introduction</h3><div>Simultaneous bilateral nephrectomy and living donor kidney transplantation (LDKT) is often indicated for autosomal dominant polycystic kidney disease (ADPKD) with end-stage kidney disease (ESKD). Robotic-assisted surgery offers a minimally invasive alternative to open approaches and may reduce perioperative morbidity and length of stay.</div></div><div><h3>Methods</h3><div>Four adults with ADPKD/ESKD underwent fully robotic-assisted simultaneous bilateral nephrectomy/LDKT (RASBN/LDKT) at a single high-volume transplant center. All procedures used an intra-abdominal approach with a Pfannenstiel incision and GelPort for native kidney extraction and allograft introduction. Clinical, perioperative, and functional outcomes were recorded prospectively and analyzed retrospectively.</div></div><div><h3>Results</h3><div>Median total operative time was 462.5 min (range, 401-544 min). Median length of stay was 3.5 days (range, 3-5 d). There were no intraoperative or postoperative vascular, urological, or surgical complications, and no conversions or hand assistance were required. All recipients had immediate graft function without delayed graft function (no hemodialysis in the first postoperative week). Kidney allograft function remained stable through 12 mo after transplant.</div></div><div><h3>Conclusions</h3><div>Robotic-assisted simultaneous bilateral nephrectomy/LDKT is feasible and safe in carefully selected ADPKD/ESKD recipients, providing excellent early clinical outcomes and expanding the role of minimally invasive techniques for complex scenarios.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"318 ","pages":"Pages 211-218"},"PeriodicalIF":1.7,"publicationDate":"2026-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978672","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}
Pub Date : 2026-01-17DOI: 10.1016/j.jss.2025.12.025
Kevin T. Mutore MD , Katalina Acevedo BA, MS , Phillip Taboada BS , Munir Buhaya MD, Geli Kane BA, Anthony Froix MD, Thomas Shoultz MD
Introduction
Racial and ethnic minorities remain significantly underrepresented in the health care workforce. Despite ongoing efforts, gains in representation have been limited and the disparity widens across successive stages of medical training. Early interventions are essential to empower underrepresented minority students interested in health care with the tools to navigate the educational path toward health careers. This study evaluated whether a three-session college preparatory course could influence the attitudes and perceived preparedness for college among high school students enrolled in a medical and surgical exposure program.
Methods
Seventy-nine 10th grade students participated in a three-session workshop. Preintervention and postintervention surveys were administered using a modified version of the validated College-Going Self-Efficacy Scale and College Planning Behaviors Scale. Paired presurvey and postsurvey data were analyzed using student's t-tests and Fisher's exact tests, with statistical significance defined as P < 0.05.
Results
Forty-four students (56%) completed both surveys. Postintervention, more students had researched the college application process (P = 0.02), college costs (P < 0.01), and identified someone to answer their college-related questions (P < 0.01). Students also reported increased confidence in choosing a good college (P = 0.01) and belief in their academic ability to finish college (P = 0.02).
Conclusions
This is the first study to assess and improve college planning attitudes and behaviors in high school students participating in a surgery exposure program. This suggests that integrating college preparation into health care exposure programs may better support students' educational advancement. Future work should examine whether these improvements lead to increased college application and matriculation rates.
{"title":"Improving College Readiness Through a High School Surgery Exposure Program","authors":"Kevin T. Mutore MD , Katalina Acevedo BA, MS , Phillip Taboada BS , Munir Buhaya MD, Geli Kane BA, Anthony Froix MD, Thomas Shoultz MD","doi":"10.1016/j.jss.2025.12.025","DOIUrl":"10.1016/j.jss.2025.12.025","url":null,"abstract":"<div><h3>Introduction</h3><div>Racial and ethnic minorities remain significantly underrepresented in the health care workforce. Despite ongoing efforts, gains in representation have been limited and the disparity widens across successive stages of medical training. Early interventions are essential to empower underrepresented minority students interested in health care with the tools to navigate the educational path toward health careers. This study evaluated whether a three-session college preparatory course could influence the attitudes and perceived preparedness for college among high school students enrolled in a medical and surgical exposure program.</div></div><div><h3>Methods</h3><div>Seventy-nine 10th grade students participated in a three-session workshop. Preintervention and postintervention surveys were administered using a modified version of the validated College-Going Self-Efficacy Scale and College Planning Behaviors Scale. Paired presurvey and postsurvey data were analyzed using student's <em>t</em>-tests and Fisher's exact tests, with statistical significance defined as <em>P</em> < 0.05.</div></div><div><h3>Results</h3><div>Forty-four students (56%) completed both surveys. Postintervention, more students had researched the college application process (<em>P</em> = 0.02), college costs (<em>P</em> < 0.01), and identified someone to answer their college-related questions (<em>P</em> < 0.01). Students also reported increased confidence in choosing a good college (<em>P</em> = 0.01) and belief in their academic ability to finish college (<em>P</em> = 0.02).</div></div><div><h3>Conclusions</h3><div>This is the first study to assess and improve college planning attitudes and behaviors in high school students participating in a surgery exposure program. This suggests that integrating college preparation into health care exposure programs may better support students' educational advancement. Future work should examine whether these improvements lead to increased college application and matriculation rates.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"318 ","pages":"Pages 200-207"},"PeriodicalIF":1.7,"publicationDate":"2026-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978707","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}
Pub Date : 2026-01-16DOI: 10.1016/j.jss.2025.12.026
Mary Junak MD , Devashish Joshi MD , Victoria R. Rendell MD , Giuseppe V. Toia MD , Charles Patrick Shahan MD, MS
Introduction
Gastric and duodenal perforations are surgical emergencies with high morbidity and mortality. Postoperative leak is a serious complication, yet there are no guidelines for imaging modality or patient selection. This study compared fluoroscopic upper gastrointestinal series (fUGI) and computed tomography (CT) for postoperative leak detection following surgical repair.
Methods
This is a retrospective cohort study of patients who underwent repair of a gastric or duodenal perforation between 2011 and 2023. Surgical interventions, postoperative imaging (UGI vs CT), and clinical outcomes were assessed. Post repair leak was defined by radiographic evidence of contrast extravasation, change in drain character, and/or intraoperative findings. Performance of UGI and CT to identify post repair leak was assessed.
Results
A total of 168 patients were included; 142 underwent open repair and 26 laparoscopic. An omental patch was used in 87.5%, and drains were placed in 81.5%. Postoperative imaging was obtained in 85.7%, most often on postoperative day 5, with 95 fUGI and 49 CT studies. Postoperative leak occurred in 20.2% (34/168). All patients with leaks underwent imaging. For patients with confirmed leaks, fUGI demonstrated a sensitivity of 56.3% and negative predictive value (NPV) of 91.9%, while CT demonstrated a sensitivity of 44.4% and NPV of 75.6%. Discordant imaging results were frequent, and CT contrast protocols were not standardized.
Conclusions
Postoperative imaging after gastric or duodenal perforation repair is common but variable, often performed for surveillance. fUGI demonstrated modestly higher sensitivity and NPV compared with CT, suggesting greater reliability for ruling out early leaks. Both modalities showed limitations, underscoring the need for standardized imaging protocols.
胃和十二指肠穿孔是一种高发病率和死亡率的外科急症。术后渗漏是一种严重的并发症，但对于成像方式或患者选择尚无指导方针。本研究比较了透视上消化道系列（fUGI）和计算机断层扫描（CT）在手术修复后的术后泄漏检测中的应用。方法：这是一项回顾性队列研究，研究对象是2011年至2023年间接受胃或十二指肠穿孔修复术的患者。评估手术干预、术后影像（UGI vs CT）和临床结果。修复后渗漏的定义是通过造影剂外渗、引流特征改变和/或术中发现的影像学证据来确定的。评估UGI和CT识别修复后泄漏的性能。结果共纳入168例患者；142例行开腹修复，26例行腹腔镜修复。87.5%的患者使用网膜贴片，81.5%的患者放置引流管。术后影像学检查占85.7%，多见于术后第5天，fUGI检查95例，CT检查49例。术后发生渗漏的占20.2%（34/168）。所有有渗漏的患者都进行了影像学检查。对于确诊渗漏的患者，fUGI的敏感性为56.3%，阴性预测值（NPV）为91.9%，而CT的敏感性为44.4%，NPV为75.6%。不一致的成像结果是常见的，CT对比方案不标准化。结论胃或十二指肠穿孔修补术后的术后影像学是常见但不稳定的，常用于监测。与CT相比，fUGI显示出更高的灵敏度和NPV，表明排除早期泄漏的可靠性更高。这两种方式都显示出局限性，强调了标准化成像方案的必要性。
{"title":"Performance of Postoperative Imaging for Leak Detection Following Repair of Upper Gastrointestinal Perforation","authors":"Mary Junak MD , Devashish Joshi MD , Victoria R. Rendell MD , Giuseppe V. Toia MD , Charles Patrick Shahan MD, MS","doi":"10.1016/j.jss.2025.12.026","DOIUrl":"10.1016/j.jss.2025.12.026","url":null,"abstract":"<div><h3>Introduction</h3><div>Gastric and duodenal perforations are surgical emergencies with high morbidity and mortality. Postoperative leak is a serious complication, yet there are no guidelines for imaging modality or patient selection. This study compared fluoroscopic upper gastrointestinal series (fUGI) and computed tomography (CT) for postoperative leak detection following surgical repair.</div></div><div><h3>Methods</h3><div>This is a retrospective cohort study of patients who underwent repair of a gastric or duodenal perforation between 2011 and 2023. Surgical interventions, postoperative imaging (UGI vs CT), and clinical outcomes were assessed. Post repair leak was defined by radiographic evidence of contrast extravasation, change in drain character, and/or intraoperative findings. Performance of UGI and CT to identify post repair leak was assessed.</div></div><div><h3>Results</h3><div>A total of 168 patients were included; 142 underwent open repair and 26 laparoscopic. An omental patch was used in 87.5%, and drains were placed in 81.5%. Postoperative imaging was obtained in 85.7%, most often on postoperative day 5, with 95 fUGI and 49 CT studies. Postoperative leak occurred in 20.2% (34/168). All patients with leaks underwent imaging. For patients with confirmed leaks, fUGI demonstrated a sensitivity of 56.3% and negative predictive value (NPV) of 91.9%, while CT demonstrated a sensitivity of 44.4% and NPV of 75.6%. Discordant imaging results were frequent, and CT contrast protocols were not standardized.</div></div><div><h3>Conclusions</h3><div>Postoperative imaging after gastric or duodenal perforation repair is common but variable, often performed for surveillance. fUGI demonstrated modestly higher sensitivity and NPV compared with CT, suggesting greater reliability for ruling out early leaks. Both modalities showed limitations, underscoring the need for standardized imaging protocols.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"318 ","pages":"Pages 188-192"},"PeriodicalIF":1.7,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978708","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}
Pub Date : 2026-01-14DOI: 10.1016/j.jss.2025.12.019
Fan Liu MD, Tao Kuang MD, Chao Chen MD, Guangyu Liu MD
Introduction
Inguinal hernia is a common surgical condition with a low rate of self-healing. This study aimed to analyze the associations of hernia sac size, serum indicators, and postoperative complications following laparoscopic inguinal hernia surgery.
Methods
Eighty-one patients with inguinal hernia who underwent laparoscopic surgery from January 2021 to July 2024 were enrolled and followed up at 2 weeks, 1 month, 3 months, and 6 months after surgery. Based on the presence or absence of postoperative complications, the patients were divided into a complication group (n = 30) and a noncomplication group (n = 51). The complication group was subdivided according to the type of complication into a seroma group/a nonseroma group, an incision infection group/a nonincision infection group, and a chronic pain group/a nonchronic pain group.
Results
The postoperative follow-up showed that 30 of the 81 patients had complications, with an incidence rate of 37.04%. Multivariate ridge regression analysis identified hernia sac size, body mass index, and age as significant positive predictors of postoperative complications, whereas serum Na+ level was inversely associated (P < 0.05). The combined ridge regression model had an area under the curve of 0.93 (95% confidence interval: 0.86-0.98), with a sensitivity of 91% and specificity of 88%, indicating good discriminatory ability. Subgroup analyses further demonstrated consistent predictive capacity for seroma, incision infection, and chronic pain.
Conclusions
Hernia sac size, body mass index, age, and serum Na+ are independently associated with postoperative complications following laparoscopic inguinal hernia repair. A combined predictive model incorporating these factors allows early risk stratification, which may guide targeted perioperative management.
{"title":"Associations of Hernia Sac Size, Serum Indicators, and Postoperative Complications After Laparoscopic Inguinal Hernia Repair","authors":"Fan Liu MD, Tao Kuang MD, Chao Chen MD, Guangyu Liu MD","doi":"10.1016/j.jss.2025.12.019","DOIUrl":"10.1016/j.jss.2025.12.019","url":null,"abstract":"<div><h3>Introduction</h3><div>Inguinal hernia is a common surgical condition with a low rate of self-healing. This study aimed to analyze the associations of hernia sac size, serum indicators, and postoperative complications following laparoscopic inguinal hernia surgery.</div></div><div><h3>Methods</h3><div>Eighty-one patients with inguinal hernia who underwent laparoscopic surgery from January 2021 to July 2024 were enrolled and followed up at 2 weeks, 1 month, 3 months, and 6 months after surgery. Based on the presence or absence of postoperative complications, the patients were divided into a complication group (<em>n</em> = 30) and a noncomplication group (<em>n</em> = 51). The complication group was subdivided according to the type of complication into a seroma group/a nonseroma group, an incision infection group/a nonincision infection group, and a chronic pain group/a nonchronic pain group.</div></div><div><h3>Results</h3><div>The postoperative follow-up showed that 30 of the 81 patients had complications, with an incidence rate of 37.04%. Multivariate ridge regression analysis identified hernia sac size, body mass index, and age as significant positive predictors of postoperative complications, whereas serum Na<sup>+</sup> level was inversely associated (<em>P</em> < 0.05). The combined ridge regression model had an area under the curve of 0.93 (95% confidence interval: 0.86-0.98), with a sensitivity of 91% and specificity of 88%, indicating good discriminatory ability. Subgroup analyses further demonstrated consistent predictive capacity for seroma, incision infection, and chronic pain.</div></div><div><h3>Conclusions</h3><div>Hernia sac size, body mass index, age, and serum Na<sup>+</sup> are independently associated with postoperative complications following laparoscopic inguinal hernia repair. A combined predictive model incorporating these factors allows early risk stratification, which may guide targeted perioperative management.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"318 ","pages":"Pages 180-187"},"PeriodicalIF":1.7,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978674","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}
Pub Date : 2026-01-14DOI: 10.1016/j.jss.2025.11.071
Hongke Wu MD, MS, MPH , Ye Liu MD, MPH, DrPH
Introduction
Spatial analysis helps to understand geographic influences on surgical outcomes, healthcare access, and resource allocation.
Materials and methods
This commentary reviews spatial methods, including Kernel Density Estimation, indicators of spatial autocorrelation, spatial autoregression models, and Bayesian spatial modeling.
Results
Kernel Density Estimation and Local Moran's Index effectively identify geographic clusters of surgical complications. Spatial autoregression models quantify direct and indirect (spillover) effects, and Bayesian approaches provide stable estimates, especially for small-area studies. Despite these advantages, careful consideration of methodological challenges and limitations is crucial for accurate interpretation and application of spatial analytical findings in surgical research.
Conclusions
Spatial analysis provides powerful tools for examining geographic disparities in surgical care, but thoughtful application and interpretation are essential to ensure valid and actionable insights.
{"title":"Spatial Analysis in Surgical Research","authors":"Hongke Wu MD, MS, MPH , Ye Liu MD, MPH, DrPH","doi":"10.1016/j.jss.2025.11.071","DOIUrl":"10.1016/j.jss.2025.11.071","url":null,"abstract":"<div><h3>Introduction</h3><div>Spatial analysis helps to understand geographic influences on surgical outcomes, healthcare access, and resource allocation.</div></div><div><h3>Materials and methods</h3><div>This commentary reviews spatial methods, including Kernel Density Estimation, indicators of spatial autocorrelation, spatial autoregression models, and Bayesian spatial modeling.</div></div><div><h3>Results</h3><div>Kernel Density Estimation and Local Moran's Index effectively identify geographic clusters of surgical complications. Spatial autoregression models quantify direct and indirect (spillover) effects, and Bayesian approaches provide stable estimates, especially for small-area studies. Despite these advantages, careful consideration of methodological challenges and limitations is crucial for accurate interpretation and application of spatial analytical findings in surgical research.</div></div><div><h3>Conclusions</h3><div>Spatial analysis provides powerful tools for examining geographic disparities in surgical care, but thoughtful application and interpretation are essential to ensure valid and actionable insights.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"318 ","pages":"Pages 193-199"},"PeriodicalIF":1.7,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978671","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}
Cholangiocarcinoma (CCA) is associated with a high incidence of recurrence and patients occasionally develop pulmonary metastases. Systemic chemotherapy is the first-line treatment for unresectable or recurrent CCA. However, we have occasionally encountered cases of favorable prognosis following pulmonary resection for CCA metastases.
Materials and methods
Data from patients undergoing surgery for CCA between 2012 and 2021 were obtained from a prospectively maintained database. We retrospectively reviewed patients with pulmonary metastases from CCA, including those who underwent pulmonary resection and those who did not. Additionally, we described a representative case of repeated pulmonary resection with long-term survival.
Results
Among 122 patients who underwent surgery for CCA with curative intent, 64 patients (52.5%) experienced recurrence, including 14 patients (11.5%) who developed pulmonary metastases. Of these, five underwent pulmonary resection, including 1 who received two resections. None of the patients experienced postoperative complications. With a median follow-up of 2.6 y, three patients remained alive without recurrence. A representative case achieved long-term survival after repeated pulmonary resections. The 5-y overall survival rates were significantly better in patients who underwent pulmonary resection than in those who did not (75.0% versus 0%, P = 0.011).
Conclusions
Pulmonary resection may represent a feasible treatment option for carefully selected patients with pulmonary metastases from CCA.
{"title":"Surgical Resection for Pulmonary Metastasis From Cholangiocarcinoma: A Retrospective Case Series","authors":"Yuhi Yoshizaki MD, PhD , Nobuyuki Takemura MD, PhD , Takashi Kokudo MD, PhD , Fuyuki Inagaki MD, PhD , Fuminori Mihara MD , Tatsuo Maeyashiki MD, PhD , Satoshi Nagasaka MD, PhD , Norihiro Kokudo MD, PhD","doi":"10.1016/j.jss.2025.12.006","DOIUrl":"10.1016/j.jss.2025.12.006","url":null,"abstract":"<div><h3>Introduction</h3><div>Cholangiocarcinoma (CCA) is associated with a high incidence of recurrence and patients occasionally develop pulmonary metastases. Systemic chemotherapy is the first-line treatment for unresectable or recurrent CCA. However, we have occasionally encountered cases of favorable prognosis following pulmonary resection for CCA metastases.</div></div><div><h3>Materials and methods</h3><div>Data from patients undergoing surgery for CCA between 2012 and 2021 were obtained from a prospectively maintained database. We retrospectively reviewed patients with pulmonary metastases from CCA, including those who underwent pulmonary resection and those who did not. Additionally, we described a representative case of repeated pulmonary resection with long-term survival.</div></div><div><h3>Results</h3><div>Among 122 patients who underwent surgery for CCA with curative intent, 64 patients (52.5%) experienced recurrence, including 14 patients (11.5%) who developed pulmonary metastases. Of these, five underwent pulmonary resection, including 1 who received two resections. None of the patients experienced postoperative complications. With a median follow-up of 2.6 y, three patients remained alive without recurrence. A representative case achieved long-term survival after repeated pulmonary resections. The 5-y overall survival rates were significantly better in patients who underwent pulmonary resection than in those who did not (75.0% <em>versus</em> 0%, <em>P =</em> 0.011).</div></div><div><h3>Conclusions</h3><div>Pulmonary resection may represent a feasible treatment option for carefully selected patients with pulmonary metastases from CCA.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"318 ","pages":"Pages 171-179"},"PeriodicalIF":1.7,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978670","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}
Pub Date : 2026-01-13DOI: 10.1016/j.jss.2025.12.017
Xiaoli Xie MS , Xiaoyu Zuo PhD , Qiuming He MD , Wei Zhong MS , Liucheng Yang MD
Introduction
Hirschsprung's disease (HSCR) is a complex congenital digestive tract disease affected by multiple genes. Despite the identification of >20 risk loci, no susceptibility variants map to sex chromosomes—a striking gap given the 4- to 6-fold male predominance in short-segment HSCR. This study investigates the contribution of X-chromosomal variation to HSCR pathogenesis.
Methods
We conducted a large case-control study involving a South Chinese population. Four single nucleotide polymorphisms (SNPs) in a disease hotspot region spanning on Xq28 were genotyped through MassARRAY genotyping platform. Association analysis of the selected SNPs with HSCR were performed using PLINK1.9. RNA quantitative analysis, immunohistochemistry staining, and Western blot analysis were performed to observe the expression of the newly identified gene IRAK1 of colon tissues of HSCR patients.
Results
This study included 1470 HSCR patients and 1473 ethnically matched controls. Four SNPs (rs2071128, rs17422, rs1059702, and rs2734647) were identified as associated with HSCR in a male-specific manner, with odds ratios ranging from 1.20 to 1.52. These variants conferred an even higher risk for long-segment HSCR in males, with odds ratios between 1.75 and 2.53. We demonstrated higher expression of the newly identified gene IRAK1 in aganglionic colon samples compared with ganglionic colon tissues, especially in the males (P = 0.00046).
Conclusions
We identified a novel male-specific region Xq28 as associated with HSCR. The differential expression of the newly identified gene IRAK1 in HSCR patients suggests an important role for the HSCR-associated common variants in shaping the male-specific disease.
{"title":"Xq28 Variants as Novel Male-Specific Susceptibility Factors for Hirschsprung Disease","authors":"Xiaoli Xie MS , Xiaoyu Zuo PhD , Qiuming He MD , Wei Zhong MS , Liucheng Yang MD","doi":"10.1016/j.jss.2025.12.017","DOIUrl":"10.1016/j.jss.2025.12.017","url":null,"abstract":"<div><h3>Introduction</h3><div>Hirschsprung's disease (HSCR) is a complex congenital digestive tract disease affected by multiple genes. Despite the identification of >20 risk loci, no susceptibility variants map to sex chromosomes—a striking gap given the 4- to 6-fold male predominance in short-segment HSCR. This study investigates the contribution of X-chromosomal variation to HSCR pathogenesis.</div></div><div><h3>Methods</h3><div>We conducted a large case-control study involving a South Chinese population. Four single nucleotide polymorphisms (SNPs) in a disease hotspot region spanning on Xq28 were genotyped through MassARRAY genotyping platform. Association analysis of the selected SNPs with HSCR were performed using PLINK1.9. RNA quantitative analysis, immunohistochemistry staining, and Western blot analysis were performed to observe the expression of the newly identified gene <em>IRAK1</em> of colon tissues of HSCR patients.</div></div><div><h3>Results</h3><div>This study included 1470 HSCR patients and 1473 ethnically matched controls. Four SNPs (rs2071128, rs17422, rs1059702, and rs2734647) were identified as associated with HSCR in a male-specific manner, with odds ratios ranging from 1.20 to 1.52. These variants conferred an even higher risk for long-segment HSCR in males, with odds ratios between 1.75 and 2.53. We demonstrated higher expression of the newly identified gene <em>IRAK1</em> in aganglionic colon samples compared with ganglionic colon tissues, especially in the males (<em>P</em> = 0.00046).</div></div><div><h3>Conclusions</h3><div>We identified a novel male-specific region Xq28 as associated with HSCR. The differential expression of the newly identified gene <em>IRAK1</em> in HSCR patients suggests an important role for the HSCR-associated common variants in shaping the male-specific disease.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"318 ","pages":"Pages 162-170"},"PeriodicalIF":1.7,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978669","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}
Pub Date : 2026-01-12DOI: 10.1016/j.jss.2025.12.009
Stefanie J. Soelling MD, MPH , Atziri Rubio-Chavez MD , Laura Baird BA , Mary E. Brindle MD , Zara Cooper MD, MSc , Ana-Maria Vranceanu PhD , Christine S. Ritchie MD, MSPH , Christy E. Cauley MD, MPH
Introduction
Patients undergoing colorectal surgery with fecal ostomy experience biopsychosocial challenges during recovery. We aimed (1) to describe clinician's perceived challenges with biopsychosocial recovery after ostomy surgery and (2) to examine current solutions to address patient psychosocial challenges while recovering.
Methods
We conducted qualitative focus groups evaluating clinician perspectives using a semistructured interview guide. Colorectal surgeons, gastrointestinal psychologists, colorectal surgery nurse practitioners, and ostomy nurses were included.
Results
Five interview sessions were performed including focus groups and individual interviews. Clinicians were 73% female, all White, and with varied experience (2-40 y in practice). All participants reported ostomy-related emotional distress occurs after surgery and impacts patient recovery and adaptation. Participants reported distress was mitigated when the ostomy relieved functional symptoms and in patients with time to cope with needing an ostomy due to chronic diseases. Patients with permanent ostomies were felt to adapt faster. Emotional distress increased dependence on caregivers, prolonged hospital stays, and delayed adaptation to daily life. Ostomy nurses reported they spent significant time addressing patient distress in clinical encounters. Participants reported a lack of training, time, and resources to help manage patients’ emotional distress.
Conclusions
Clinicians treating colorectal surgery patients with ostomy frequently note clinically significant emotional distress. This distress hinders patients’ ability to adapt to life with an ostomy. An ostomy specific distress management intervention is needed to improve biopsychosocial outcomes during surgical recovery and adaptation.
{"title":"Adaptation and Recovery Challenges After Ostomy Surgery: Qualitative Study of Clinician Perspectives","authors":"Stefanie J. Soelling MD, MPH , Atziri Rubio-Chavez MD , Laura Baird BA , Mary E. Brindle MD , Zara Cooper MD, MSc , Ana-Maria Vranceanu PhD , Christine S. Ritchie MD, MSPH , Christy E. Cauley MD, MPH","doi":"10.1016/j.jss.2025.12.009","DOIUrl":"10.1016/j.jss.2025.12.009","url":null,"abstract":"<div><h3>Introduction</h3><div>Patients undergoing colorectal surgery with fecal ostomy experience biopsychosocial challenges during recovery. We aimed (1) to describe clinician's perceived challenges with biopsychosocial recovery after ostomy surgery and (2) to examine current solutions to address patient psychosocial challenges while recovering.</div></div><div><h3>Methods</h3><div>We conducted qualitative focus groups evaluating clinician perspectives using a semistructured interview guide. Colorectal surgeons, gastrointestinal psychologists, colorectal surgery nurse practitioners, and ostomy nurses were included.</div></div><div><h3>Results</h3><div>Five interview sessions were performed including focus groups and individual interviews. Clinicians were 73% female, all White, and with varied experience (2-40 y in practice). All participants reported ostomy-related emotional distress occurs after surgery and impacts patient recovery and adaptation. Participants reported distress was mitigated when the ostomy relieved functional symptoms and in patients with time to cope with needing an ostomy due to chronic diseases. Patients with permanent ostomies were felt to adapt faster. Emotional distress increased dependence on caregivers, prolonged hospital stays, and delayed adaptation to daily life. Ostomy nurses reported they spent significant time addressing patient distress in clinical encounters. Participants reported a lack of training, time, and resources to help manage patients’ emotional distress.</div></div><div><h3>Conclusions</h3><div>Clinicians treating colorectal surgery patients with ostomy frequently note clinically significant emotional distress. This distress hinders patients’ ability to adapt to life with an ostomy. An ostomy specific distress management intervention is needed to improve biopsychosocial outcomes during surgical recovery and adaptation.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"318 ","pages":"Pages 154-161"},"PeriodicalIF":1.7,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145966346","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}
Pub Date : 2026-01-12DOI: 10.1016/j.jss.2025.12.005
Ilse Torres Ruiz MD, Cuneyt Koksoy MD, Zachary S. Pallister MD, Ramyar S. Gilani MD, Joseph L. Mills MD, Jayer Chung MD, MSc
<div><h3>Introduction</h3><div>Chronic limb-threatening ischemia (CLTI) is the most severe form of peripheral arterial disease) and can cause profound psychosocial distress, including depression. Depression in CLTI patients is often underdiagnosed and its impact on clinical outcomes remains unclear. This study aims to quantify the prevalence of depression in CLTI patients and quantify its impact on outcomes.</div></div><div><h3>Methods</h3><div>A single-center, retrospective analysis was conducted from December 2010 to January 2024. Demographics, comorbidities, ischemia metrics, limb-salvage, and survival were collected and analyzed.</div></div><div><h3>Results</h3><div>Over 14 y, 801 CLTI patients (median age, 66.7; interquartile range, 59.3-74.3 y; 62.5% male) underwent 1882 revascularizations. The first episode of revascularization procedures included 697 endovascular, 241 open surgical, and 56 hybrid procedures, while 73 extremities were managed without revascularization. During the follow-up, 288 (36.0%) patients underwent minor amputations and 156 (19.5%) underwent major amputations. A total of 255 (31.8%) patients had a history of depression. Binary logistic regression modeling revealed that age (odds ratio [OR], 0.96, 95% confidence interval [CI], 0.95-0.97), female sex (OR, 2.1; 95% CI, 1.5-2.9), congestive heart failure (OR, 1.6: 95% CI, 1.2-2.2), hypothyroidism (OR, 1.6; 95% CI, 1.2-2.8), and active smoking (OR, 1.6; 95% CI, 1.2-2.2) were independently associated with depression. At a 20-mo follow-up, depressed patients had higher rates of major amputation (25.5% <em>versus</em> 16.7%; <em>P</em> = 0.003), lower Kaplan–Meier-estimated amputation-free survival (OR, 49.3; 95% CI, 42.7-55.9 mo <em>versus</em> 70.2, 95% CI, 64.1-76.6 mo; <em>P</em> < 0.001), and lower overall Kaplan–Meier-estimated survival compared to nondepressed patients (OR, 76.9; 95% CI, 65.5-88.5 <em>versus</em> OR, 87.9; 95% CI, 81.9-93.9 mo, <em>P</em> = 0.03). There were no significant differences between depressed and nondepressed patients in baseline symptoms, tissue loss, osteomyelitis, total number of procedures, reintervention rates, and bypass patency. However, depressed patients had higher percentages in Wound, Ischemia, and foot Infection (WIfI) classification ischemia grade I-0 (2.4% <em>versus</em> 4.9%, <em>P</em> < 0.05) and I-2 (11.8% <em>versus</em> 17.9%, <em>P</em> < 0.01), but a lower percentage in grade I-3 (69.7% <em>versus</em> 59.8%, <em>P</em> = 0.001). Depressed patients also had higher percentages in WIfI clinical stage 1 (5.1% <em>versus</em> 9.8%, <em>P</em> < 0.01) and lower in stage 3 (23.2% <em>versus</em> 16.5%, <em>P</em> < 0.05).</div></div><div><h3>Conclusions</h3><div>Depression is prevalent in almost one-third of CLTI patients and is associated with an increased risk of limb-loss. These findings underscore the opportunity for regimented depression screening and integrated psychosocial care in managing CLTI patients
{"title":"Association of Depression With Inferior Amputation-free Survival in Chronic Limb-threatening Ischemia","authors":"Ilse Torres Ruiz MD, Cuneyt Koksoy MD, Zachary S. Pallister MD, Ramyar S. Gilani MD, Joseph L. Mills MD, Jayer Chung MD, MSc","doi":"10.1016/j.jss.2025.12.005","DOIUrl":"10.1016/j.jss.2025.12.005","url":null,"abstract":"<div><h3>Introduction</h3><div>Chronic limb-threatening ischemia (CLTI) is the most severe form of peripheral arterial disease) and can cause profound psychosocial distress, including depression. Depression in CLTI patients is often underdiagnosed and its impact on clinical outcomes remains unclear. This study aims to quantify the prevalence of depression in CLTI patients and quantify its impact on outcomes.</div></div><div><h3>Methods</h3><div>A single-center, retrospective analysis was conducted from December 2010 to January 2024. Demographics, comorbidities, ischemia metrics, limb-salvage, and survival were collected and analyzed.</div></div><div><h3>Results</h3><div>Over 14 y, 801 CLTI patients (median age, 66.7; interquartile range, 59.3-74.3 y; 62.5% male) underwent 1882 revascularizations. The first episode of revascularization procedures included 697 endovascular, 241 open surgical, and 56 hybrid procedures, while 73 extremities were managed without revascularization. During the follow-up, 288 (36.0%) patients underwent minor amputations and 156 (19.5%) underwent major amputations. A total of 255 (31.8%) patients had a history of depression. Binary logistic regression modeling revealed that age (odds ratio [OR], 0.96, 95% confidence interval [CI], 0.95-0.97), female sex (OR, 2.1; 95% CI, 1.5-2.9), congestive heart failure (OR, 1.6: 95% CI, 1.2-2.2), hypothyroidism (OR, 1.6; 95% CI, 1.2-2.8), and active smoking (OR, 1.6; 95% CI, 1.2-2.2) were independently associated with depression. At a 20-mo follow-up, depressed patients had higher rates of major amputation (25.5% <em>versus</em> 16.7%; <em>P</em> = 0.003), lower Kaplan–Meier-estimated amputation-free survival (OR, 49.3; 95% CI, 42.7-55.9 mo <em>versus</em> 70.2, 95% CI, 64.1-76.6 mo; <em>P</em> < 0.001), and lower overall Kaplan–Meier-estimated survival compared to nondepressed patients (OR, 76.9; 95% CI, 65.5-88.5 <em>versus</em> OR, 87.9; 95% CI, 81.9-93.9 mo, <em>P</em> = 0.03). There were no significant differences between depressed and nondepressed patients in baseline symptoms, tissue loss, osteomyelitis, total number of procedures, reintervention rates, and bypass patency. However, depressed patients had higher percentages in Wound, Ischemia, and foot Infection (WIfI) classification ischemia grade I-0 (2.4% <em>versus</em> 4.9%, <em>P</em> < 0.05) and I-2 (11.8% <em>versus</em> 17.9%, <em>P</em> < 0.01), but a lower percentage in grade I-3 (69.7% <em>versus</em> 59.8%, <em>P</em> = 0.001). Depressed patients also had higher percentages in WIfI clinical stage 1 (5.1% <em>versus</em> 9.8%, <em>P</em> < 0.01) and lower in stage 3 (23.2% <em>versus</em> 16.5%, <em>P</em> < 0.05).</div></div><div><h3>Conclusions</h3><div>Depression is prevalent in almost one-third of CLTI patients and is associated with an increased risk of limb-loss. These findings underscore the opportunity for regimented depression screening and integrated psychosocial care in managing CLTI patients","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"318 ","pages":"Pages 146-153"},"PeriodicalIF":1.7,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145966330","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}
Pub Date : 2026-01-09DOI: 10.1016/j.jss.2025.12.018
James L. Galloway MD , Vivi W. Chen MD, MPH , Jennifer Kramer PhD, MPH , Tracey Rosen MSPH , Yongquan Dong MS , Peter A. Richardson PhD , Nader N. Massarweh MD, MPH
Introduction
Manually abstracted variables are considered the gold standard within national surgical quality improvement (QI) programs. However, because of the resources associated with manual data abstraction, opportunities to automate data collection could have numerous benefits for surgical QI. The goal of this study is to describe the accuracy and concordance of Veterans Affairs (VA) Surgical Quality Improvement Program (VASQIP) electronic health record (EHR) variable correlates (derived using EHR data) when compared to manually abstracted VASQIP variables.
Methods
This was a national, cross-sectional analysis of VASQIP and VA Corporate Data Warehouse (i.e., EHR) data (2016-2020). EHR-derived VASQIP variable correlates were created from Corporate Data Warehouse and compared to manually abstracted VASQIP variables for the same cases. The primary measure of agreement was Cohen's kappa. Sensitivity, specificity, positive predictive value, and negative predictive value were also calculated for each variable with addition of exact match proportion for lab variables. Strong agreement was considered kappa ≥80%.
Results
Among 533,164 cases across 113 hospitals for 429,163 unique patients, data were evaluated for five variable domains (race and ethnicity, preoperative risk factors, intraoperative factors, labs, and postoperative complications). Kappa for race and ethnicity ranged from 91.1 to 99.5%, with a median of 98.1% (IQR, 95.3-99.5%). Preoperative risk factors ranged from −0.1 to 83.0%, with a median of 28.6% (interquartile range [IQR], 12.7-53.9%). Preoperative labs ranged from 72.2 to 95.9% with a median of 91.9% (IQR, 89.9–93.3%). Intraoperative factors ranged from 0.0 to 99.5%, with a median of 93.9% (IQR, 9.9-97.3%). Postoperative complications ranged from 3.9 to 53.2%, with a median of 15.1% (IQR, 7.1-29.6%).
Conclusions:
Apart from postoperative complications, data collection for many VASQIP variables could potentially be automated using EHR-derived correlates with a high level of accuracy. This could minimize the resources associated with manual data collection and increase the timeliness and robustness of surgical QI programs.
{"title":"Manually Abstracted versus Electronic Health Record Data for Surgical Quality Improvement","authors":"James L. Galloway MD , Vivi W. Chen MD, MPH , Jennifer Kramer PhD, MPH , Tracey Rosen MSPH , Yongquan Dong MS , Peter A. Richardson PhD , Nader N. Massarweh MD, MPH","doi":"10.1016/j.jss.2025.12.018","DOIUrl":"10.1016/j.jss.2025.12.018","url":null,"abstract":"<div><h3>Introduction</h3><div>Manually abstracted variables are considered the gold standard within national surgical quality improvement (QI) programs. However, because of the resources associated with manual data abstraction, opportunities to automate data collection could have numerous benefits for surgical QI. The goal of this study is to describe the accuracy and concordance of Veterans Affairs (VA) Surgical Quality Improvement Program (VASQIP) electronic health record (EHR) variable correlates (derived using EHR data) when compared to manually abstracted VASQIP variables.</div></div><div><h3>Methods</h3><div>This was a national, cross-sectional analysis of VASQIP and VA Corporate Data Warehouse (i.e., EHR) data (2016-2020). EHR-derived VASQIP variable correlates were created from Corporate Data Warehouse and compared to manually abstracted VASQIP variables for the same cases. The primary measure of agreement was Cohen's kappa. Sensitivity, specificity, positive predictive value, and negative predictive value were also calculated for each variable with addition of exact match proportion for lab variables. Strong agreement was considered kappa ≥80%.</div></div><div><h3>Results</h3><div>Among 533,164 cases across 113 hospitals for 429,163 unique patients, data were evaluated for five variable domains (race and ethnicity, preoperative risk factors, intraoperative factors, labs, and postoperative complications). Kappa for race and ethnicity ranged from 91.1 to 99.5%, with a median of 98.1% (IQR, 95.3-99.5%). Preoperative risk factors ranged from −0.1 to 83.0%, with a median of 28.6% (interquartile range [IQR], 12.7-53.9%). Preoperative labs ranged from 72.2 to 95.9% with a median of 91.9% (IQR, 89.9–93.3%). Intraoperative factors ranged from 0.0 to 99.5%, with a median of 93.9% (IQR, 9.9-97.3%). Postoperative complications ranged from 3.9 to 53.2%, with a median of 15.1% (IQR, 7.1-29.6%).</div></div><div><h3>Conclusions:</h3><div>Apart from postoperative complications, data collection for many VASQIP variables could potentially be automated using EHR-derived correlates with a high level of accuracy. This could minimize the resources associated with manual data collection and increase the timeliness and robustness of surgical QI programs.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"318 ","pages":"Pages 136-145"},"PeriodicalIF":1.7,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927330","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}
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