World Journal of Surgery最新文献

Introduction: Rectus diastasis of parity is the separation of the abdominal muscles that can occur after childbearing. We hypothesized that a subpopulation of women with rectus diastasis also present with back pain and/or urinary incontinence, a condition referred to as symptomatic established rectus diastasis, and this results in impaired health-related quality of life. This study identified the prevalence of symptomatic established rectus diastasis in primiparous women and measured their health-related quality of life.

Methods: Gravid nulliparous women over 18 years old were consecutively recruited from December 2021 to August 2022 and followed prospectively. Inter-rectus distances were measured with ultrasound in early pregnancy, and 6-week, 6-month, and 12-month postpartum. Patient reported outcome measures included the Oswestry Disability Index (ODI) for back pain, International Consultation on Incontinence Questionnaires Urinary Incontinence Short Form (ICIQ-UI SF) for urinary incontinence, and the 36-item short form (SF-36) for health-related quality of life.

Results: Two-hundred and thirteen women were recruited, of which 192 underwent ultrasound measurement in early pregnancy, 130 at 6-week postpartum, 120 at 6-month, and 109 at 12-month. There was a significant increase in mean inter-rectus distance over the study period (p < 0.001). The proportion of women with rectus diastasis at 12-month postpartum (> 30 mm) was 30.3% and compared to those without they had worse back pain (p = 0.014) but no difference in urinary incontinence (p > 0.05). Women with symptomatic established rectus diastasis at 12-month postpartum (rectus diastasis and back pain (ODI > 0)), made up 25% of the cohort and had significantly worse health-related quality of life than those without (p < 0.05). Predictive factors for symptomatic established rectus diastasis included increased total fetal birthweight (OR 3), lower maternal BMI (OR 1.2), and gestational diabetes (OR 6.7).

Conclusion: This study of gravid nulliparous women from early pregnancy until 12-month postpartum identified rectus diastasis in 30.3% and symptomatic established rectus diastasis in 25%. Women with symptomatic established rectus diastasis had significantly worse health-related quality of life.

Background: ROME IV diagnostic criteria describe functional gallbladder disorder as biliary pain in the absence of gallstones, supported by a low ejection fraction on gallbladder scintigraphy. However, clinicians have noticed histopathological analysis of gallbladders to intermittently reveal cholelithiasis. Our study aims to quantify this and to reduce misdiagnosis rates of functional gallbladder disorders.

Methods: We performed a single-center retrospective cohort study at St John of God Midland Hospital in Western Australia, Perth on 484 consecutive patients undergoing hepatobiliary iminodiacetic acid (HIDA) scan between November 1, 2015 and April 1, 2024.

Results: 5.6% (27/484) of patients had functional gallbladder disorder (FGBD) diagnosed preoperatively by ROME IV underwent cholecystectomy at our center. Of this, 18.5% (5/27) were noted to have histopathological cholelithiasis despite preoperative imaging suggesting otherwise. Of the 22 patients with true gallbladder dysfunction, 70% (7/10) had resolution of symptoms after cholecystectomy, with remaining 30% (3/10) experiencing persisting symptoms and referred on for further medical workup. 5 had private follow-up and 7 did not attend follow-up appointments. Ultrasonography had a sensitivity at 64% and specificity of 88% for identifying cholelithiasis, with a negative predictive value of 81.48%.

Conclusion: Functional gallbladder disorders remain a rare but not insignificant contributor to patients with undifferentiated abdominal pain. In the setting of microlithiasis, 1 in 5 patients will have gallstones missed on preoperative imaging. These emphases the importance of considering functional aspects of biliary pain in the absence of structural pathologies and being aware of the limitations of imaging to reduce the morbidity false negatives can confer.

Background: The effect of topical intraoperative corticosteroid application on voice quality in thyroid surgery with preserved RLN remains unclear. This randomized controlled trial aimed to evaluate the efficacy and safety of this intervention.

Methods: Between January 2023 and June 2024, 134 patients scheduled for thyroid surgery were screened for eligibility. Patients who developed loss of signal (LOS) during surgery or who had postoperative impaired vocal cord motility on laryngoscopy were not included in the final analysis. Fourteen patients were excluded (six for previous thyroid/parathyroid surgery, four for preoperative vocal cord paralysis, and four for corticosteroid allergy), leaving 120 patients who were randomized equally to receive either topical intraoperative corticosteroids (n = 60) or standard treatment (n = 60). Baseline demographic and clinical data were comparable between the groups. Dynamic function of the larynx was monitored intraoperatively using electromyography (EMG), and vocal outcomes were assessed 1 week postoperatively using the Voice Handicap Index (VHI) and voice-related quality of life (V-RQOL). Laryngeal findings and adverse events were also recorded.

Results: No EMG signal was recognized in any patient. The EMG amplitudes and latencies of the vagus nerve (V1 and V2) did not differ significantly between the groups. EMG signal changes between V1 and V2 were observed in 16% of RLNs in the control group and in 18% in the corticosteroid group, but these were not associated with clinically significant decreases in amplitude or increases in latency. Postoperatively, the corticosteroid group had significantly lower (better) mean VHI scores (12.4 ± 3.2 vs. 19.6 ± 4.7; p < 0.01) and higher V-RQOL scores (88.3 ± 6.1 vs. 77.5 ± 8.8; p = 0.02) than the control group. The subgroup analysis of patients with EMG changes showed similar trends. Vocal fold edema occurred in 2 patients in the corticosteroid group and 5 in the control group, with complete resolution of stroboscopic abnormalities in all patients after 4 weeks. No local or systemic complications related to the use of corticosteroids were observed, and the postoperative courses were uneventful in both groups.

Conclusions: Topical intraoperative use of corticosteroids in thyroid surgery with preserved RLN is safe and associated with improved early postoperative voice outcomes. No significant adverse events were observed, and RLN function was preserved in all cases. Further studies are needed to assess the long-term clinical relevance of these results.

Introduction: Initiatives in workforce training and education have emerged as a key strategy to address the critical shortage of skilled surgical providers in low and middle-income countries (LMICs). Nonetheless, the scope and distribution of these initiatives remain poorly characterized within the global surgery literature. This bibliometric review identifies the most highly cited studies on international surgical workforce development to clarify current trends, synthesize areas of consensus, and highlight persistent gaps that limit sustainable capacity building.

Methods: A bibliometric analysis was conducted using Web of Science to identify the top 50 publications related to global initiatives in surgical workforce development. We employed a comprehensive search strategy to analyze citation trends, authorship patterns, geographic distribution, and institutional collaborations. The most frequently cited articles, journals, and research topics were also assessed to measure the scholarly impact of surgical workforce development efforts. We also examined the duration, training approaches, and stated objectives of each initiative to clarify the major themes represented in the literature.

Results: A total of 50 publications were identified from 2000 to 2025. All publications were published within the last 10 years, reflecting a growing academic interest in global surgical education. Plastic surgery, neurosurgery, and multispecialty training programs were the most frequently represented domains, with notable emphasis on reconstructive procedures, microsurgical training, and cleft care. Authorship trends revealed a predominance of contributors from high-income countries, highlighting an imbalance in knowledge production and a need to elevate LMIC-led research. Although many initiatives were categorized as "ongoing," nearly 25% spanned less than 1 year, indicating an opportunity for improvement in the continuity and sustainability of workforce impact. Across studies, there was a clear consensus that long-term training partnerships and locally led educational models offered the most durable impact, yet few publications evaluated outcomes beyond the program period.

Conclusion: This bibliometric study offers insight into global surgical training programs, highlighting increasing research output, international collaboration, and concentrated efforts within select specialties. Findings point to an urgent need to strengthen long-term program sustainability, expand LMIC authorship leadership, and develop standardized metrics to assess educational and clinical outcomes. Advancing global surgical efforts will require establishing best practices for surgical mentorship and sustainable training models as well as promoting equitable research partnerships and enhancing LMIC representation.

Background: Aim of this study is to evaluate the prognostic role of nodal parameter in early stage pathologically patients with N0 who underwent lobectomy and lymphadenectomy.

Methods: Clinical and pathological characteristics of patients who underwent anatomical lung resection from 1/01/2010 to 31/12/2019 were reviewed and retrospectively analyzed. GGO and part-solid tumors, MIA, AIS, more than 5 cm in size, with nodal and/or distant metastases, or receiving neoadjuvant treatment were excluded. Operatory and pathological report were reviewed to collect data on lymphadenectomy. The primary end-point was disease-free survival (DFS), calculated from surgery to recurrence appearance. Clinical/pathological characteristics and nodal parameters were associate to DFS using Kaplan-Meier curves. The log-rank test was used to assess differences between subgroups. A multivariable model was built using Cox-regression analysis, including variable resulting significant (p value < 0.05), at univariable analysis.

Results: The final analysis was conducted on 487 patients. Most patients presented stage I tumor (82.4%). The mean number of resected nodes (#RN), resected N1 (#RN1) nodes, and resected N2 nodes (#RN2) resulted 9.5 ± 8.0, 3.4 ± 4.3, and 5.9 ± 4.4. The mean number of total resected stations (#RS), N1 resected stations (#RSN1), and N2 resected stations (#RSN2) resulted 2.5 ± 1.6, 1 ± 0.8, and 1.5 ± 1.2, respectively. During a mean follow-up of 43 ± 28 months, a recurrence occurred in 137 (28.1%) patients. At univariable analysis, age < 70 years (p = 0.025), N1 lymphadenectomy (p = 0.019), #RSN1 ≥ 3 (p = 0.001), #RN ≥ 10 (p = 0.019), #RN1 ≥ 3 (p < 0.001), node sampling with more than 3 resected nodes (p = 0.049), at least 3 stations with 3 N1 nodes resected (p = 0.013), at least 3 stations resected with 10 lymphnodes, and 3N1 lymphnodes (p = 0.020) significantly correlated with improved DFS. Multivariable analysis confirmed as independent prognostic factor #RN1 ≥ 3 (p = 0.017; HR 1.782; and 95% CI: 1.107-2.867). Patients with #RN1 ≥ 3 presented a 5-years DFS of 76.3% versus 57.8% of patients with #RN1 < 3 (p = 0.001).

Conclusions: Hilar lymphadenectomy seems to significantly correlate with disease-free survival in patients with pN0NSCLC and should be better defined in lymphadenectomy guidelines.

Background: The use of perioperative bridging therapy remains a topic of debate due to its associated risks and benefits. Therefore, we sought to characterize the association of bridging therapy with thrombotic and bleeding events following a major surgical procedure.

Method: Patients who underwent surgical procedures between 2022 and 2024 were identified using Epic Cosmos database in this retrospective cohort study. Bridging therapy (BT) was defined by the receipt of low molecular weight heparin (LMWH) or unfractionated heparin within 5 days before surgery. Thrombotic and bleeding events within 30-day following surgery were examined using entropy balancing (EB) and multivariable regression models.

Results: Among 36,699 patients (i.e., pneumonectomy: n = 5829, 15.9%, esophagectomy: n = 434, 1.2%, gastrectomy: 4574, 12.5%, pancreatectomy: n = 983, 2.7%, hepatectomy: n = 946, 2.6%, biliary resection: n = 7034, 19.2%, and colectomy: n = 16,899, 46.0%), most were male (n = 19,418, 52.9%) with a mean age of 70 years (standard deviation: ± 13 years); 59.9% (n = 21,831) of patients received bridging therapy before a major surgical procedure. Following surgery, 4.6% (1673) of patients had VTE, 1.7% (n = 625) had CVA, and 12.3% (n = 4532) had bleeding. Following EB weighting, patients who received bridging therapy had 16% lower odds of CVA (OR: 0.84, 95% CI 0.71-0.99) and 12% lower odds of VTE (OR: 0.88, 95% CI 0.80-0.97); there was no difference in incidence of major bleeding events (OR: 0.97, 95% CI 0.91-1.03).

Conclusion: Roughly one in two patients undergoing surgery received bridging therapy. Bridging therapy was associated with reduced risk of thrombotic complications and no increase in major bleeding events.