World Journal of Surgery最新文献

Cohort study of 777 patients (1238 sides at risk) shows that both oxidized regenerated cellulose and gelatin sponge (topical hemostatic agents) are safe to use in thyroidectomy. Adverse events are nil and the incidence of RLN palsy and permanent hypoparathyroidism are low.

Introduction: Learning laparoscopic surgery in LMICs is hindered by the dearth of technically skilled surgeons. A self-directed, low-cost simulation-based training could bridge this gap. To evaluate the effectiveness of such a program, we assessed the differences in knowledge, laparoscopic skills, and self-ratings between simulation-trained and simulation-naive residents.

Methods: This study involved Cameroonian surgery residents from a program with 3 years of laparoscopic simulation training on the ALL-SAFE platform (Group A) and residents from another training program without simulation exposure (Group B). All participants completed cognitive and psychomotor portions of a novel case-based laparoscopic cholecystectomy module. We used Kruskal-Wallis tests to compare the groups' pre- and post-training test scores, confidence and competence, time to task, and psychomotor skill via checklist and global assessments of submitted videos.

Results: Twenty-six participants, including 14 in Group A and 12 in Group B, completed the module. Both groups reported similar pre-course confidence (p ≥ 0.63) and competence (p ≥ 0.21). They also had similar pretest scores, but Group A's posttest scores were improved (M = 89.29 and p = 0.005) over B's (M = 77.50 and p = 0.28). Group B checklist scores trended slightly lower (p = 0.22) and significantly lower on global assessment (p < 0.001). Group A's mean task completion time was 28.46 (12.00) minutes whereas group B's was 51.83 (16.36); p < 0.001, and d = 1.41. Group B self-ratings were higher than peers' ratings, whereas Group A self-ratings were similar or lower; p = 0.02, and r = 0.35.

Conclusion: Long-term simulation-based training improved cognitive and psychomotor skills, suggesting that a self-directed, low-cost simulation-based training may help learners develop proficiency in laparoscopy.

Objective: Effective postoperative pain control is essential in ambulatory hernia surgery. This pilot randomized controlled trial aimed to evaluate the efficacy, safety, and feasibility of topical EMLA (eutectic mixture of local anesthetics) cream as adjunct postoperative analgesia following open inguinal hernioplasty under local anesthesia.

Methods: A prospective, double-blind, randomized controlled trial was conducted at Hospital Canselor Tuanku Muhriz, UKM, from December 2023 to March 2025. Thirty-six male patients undergoing elective open inguinal hernia repair under local anesthesia were randomized to receive either EMLA (n = 18) or placebo cream (n = 18). The cream was applied topically to the surgical site every 6 h for 48 h. Pain was self-assessed using a numerical rating scale (NRS) after each application. Primary outcomes included pain scores and rescue analgesia use; secondary outcomes included feasibility and adverse events.

Results: Topical application was rated "easy" or "very easy" by all participants, with no adverse events or complications reported. In the EMLA group, pain scores significantly decreased across all post-application time points compared to baseline (p < 0.05), whereas no significant changes were observed in the placebo group. Between-group analysis showed significantly lower pain scores in the EMLA group starting from 6 h postoperatively (p < 0.001). No participants in either group required rescue analgesia.

Conclusion: Topical EMLA cream is a feasible adjunct for postoperative pain control following open inguinal hernia repair under local anesthesia. Although no infections or adverse events occurred in this pilot cohort, the study is underpowered to detect rare complications such as surgical site infection; therefore, safety conclusions should be interpreted with caution. The clinically meaningful reduction of 2-3 points in pain scores supports further validation in larger, adequately powered trials using an inert placebo.

Background: A growing number of emergency general surgery (EGS) admissions comprise of adults age 65 years and older, who are more likely to experience missed or delayed diagnoses, and subsequently worse postoperative outcomes. We aimed to ascertain the perspectives of clinicians on the diagnostic challenges unique to older adults with EGS conditions and strategies to improve feedback.

Methods: In this qualitative study, semi-structured focus groups were conducted with frontline clinicians with experience in providing high volume care to older adult EGS patients to explore diagnostic challenges, tools, and feedback strategies. Questions focused on clinical gaps and approaches, tools, and the mechanisms in place to provide feedback on patient diagnosis and assessment. Focus groups were transcribed and qualitatively analyzed using an inductive approach.

Results: Twenty-two clinicians participated in one of six focus groups. Clinicians reported three key diagnostic challenges: nontextbook presentations, comorbidities, and older-age specific complications. Nondiagnostic factors remained high priorities including functional health status, patient preferences, family involvement, and health related social needs. Practical tools addressing these gaps included the use of multidisciplinary expertise, surgical risk calculators, cognitive assessments, functional health assessments, and protocols guiding goals of care discussions. Participants shared barriers and facilitators for implementation of these tools.

Conclusion: Frontline clinicians identified several high priority considerations unique in EGS for older adults. To address these, context-specific tools and strategies were detailed and inform ongoing work to incorporate feedback and solutions into frontline settings. Future work in quality improvement should incorporate these high priority areas into existing quality improvement frameworks.

Purpose: To evaluate predictive models for complicated acute appendicitis (CAA) and provide insights into their performance, bias, and clinical applicability.

Materials and methods: PubMed, Embase, and Google Scholar were searched up to December 31, 2024. Eligible studies included those with clearly defined predictors and reported model performance metrics. A bivariate random-effects model was applied to pool sensitivity and specificity while estimating the SROC curves. Bias was assessed using the PROBAST tool.

Results: A total of 20 studies focusing on the development and validation of emerging predictive models for complicated AA were included. These models demonstrated pooled sensitivities of 0.840, 0.840, and 0.787, specificities of 0.825, 0.768, and 0.707, and AUCs of 0.897, 0.867, and 0.811 in training, internal validation, and external validation datasets, respectively. PROBAST assessment revealed low risk of bias in participants, predictors, and outcomes across most studies, but a consistently high risk of bias in the analysis domain.

Conclusion: Emerging prediction models for CAA show promising potential but face major challenges in external validation and clinical implementation. Future research should prioritize methodologically robust model development, including prespecified sample size estimation, proper imputation strategies, multivariable predictor selection, and both internal and external validation.

Introduction: This clinical practice guideline from the Explosive Weapons Trauma Care Collective (EXTRACCT) group reviews current best practice for the management of ocular trauma in conflict-affected regions, where explosive weapons are used and healthcare infrastructure is limited.

Methods: An expert literature review of current practice is presented with practical resource-adapted guidelines constructed through expert consensus from ophthalmologists, emergency care providers and allied health professionals with field experience.

Results: The guideline provides recommendations for the assessment, classification and management of major and minor ocular injuries encountered in low-resource settings, particularly during conflict. Guidance is written for frontline healthcare workers who may be addressing such injuries in the absence of specialist ophthalmology expertise and equipment. Dosing of ophthalmic therapeutics is provided.

Conclusion: Actionable context-appropriate strategies to manage ocular trauma caused by explosive weapons can reduce vision loss and improve patient outcomes where specialized ophthalmic care is scarce.

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.