World Journal of Surgery最新文献

Background: SPIO is increasingly popular in sentinel lymph node biopsy (SLNBx) because of its non-radioactive nature and logistical advantage. Previous studies have demonstrated non-inferiority of SPIO compared to conventional dual tracer technique in SLNBx for early breast cancers. Brown stain from SPIO raises esthetic concerns in breast conservative treatment (BCT). The aim of this study is to compare the staining outcomes of SPIO to conventional blue dye.

Method: This is a prospective study reporting the predefined secondary analysis of our previously conducted randomized controlled trial (Trial registration number NCT05288686). SPIO arm patients were given subareolar SPIO injections before operation, and control arm patients received blue dye and radioisotope injections. Patients receiving BCT were selected and assessed at follow-ups for skin stains up to 18-month postoperatively.

Results: One hundred and twelve patients and 113 SLNBx were included. Skin stains in both groups gradually decreased with time. SPIO group (61 SLNBx), as compared to control group (52 SLNBx), demonstrated larger incidence and size of skin stains throughout the study period (p < 0.001). The number of sentinel nodes (p = 0.03) and volume of lumpectomies (p = 0.034) were significantly correlated with skin stains at 18-month, that is, patients with more sentinel nodes harvested and larger volume of breast tissue resected have smaller stains by 18-month.

Conclusion: SPIO gives rise to higher incidence and larger skin stains compared to blue dye. Considerations should be given to cosmetic outcomes and shared decision-making be adopted whilst determining the optimal tracers in sentinel lymph node mapping.

Trial registration: The original randomized controlled trial was registered on ClinicalTrials.gov (NCT05288686).

Background: Perioperative morbidity and mortality remain disproportionately high in low- and middle-income countries (LMICs). Quality improvement (QI) has shown effectiveness in improving health outcomes and patient safety across healthcare systems globally and is often a mandatory part of training in high income countries. However, QI education in LMICs remains decentralized and limited in scope. Aiming to address this gap, we designed and delivered perioperative QI education in three LMIC settings. This study aims to summarize methodology and experiences across the three settings and outline the factors leading to success and challenges experienced to inform future QI education efforts in LMICs.

Methods: We designed and implemented a perioperative QI curriculum that included online didactic content, course assessments, and a two to three day in-person course featuring both didactic and QI project development training. Descriptive statistics were reported for course features and participant pre- and post-course survey results. Qualitative course feedback from participants and administrators is summarized in a narrative format.

Results: Five courses were conducted, training a total of 90 participants. Of those who completed pre-course surveys, most participants were nurses (35.5%) or residents (43.6%), and the majority (71.1%) had no prior experience with QI. Self-assessed comfort significantly improved across several domains, including understanding QI concepts, developing aim statements, and designing projects. Qualitatively, participants enjoyed the course's interactive format and recommended future offerings be longer, more frequent, and include expanded content on data analysis and project implementation. Course administrators recommend involving local partners throughout course development, forming structured plans to sustain QI initiatives started as part of the course, and ensuring any pre-course materials use context-specific examples.

Conclusion: Implementation of a perioperative QI curriculum across three LMIC settings was feasible and associated with significant improvements in participant-reported comfort with core QI skills and knowledge. Success was driven by the inclusion of local faculty, interactive project development, and adaptation of course content to local context. Future efforts should focus on building local QI mentorship capacity, integrating QI education into residency training, and developing contextually appropriate resources to support scalable, sustainable QI training in LMICs.

Background: Urinary catheters are frequently used in perioperative care, yet their overuse contributes to iatrogenic complications including catheter-associated urinary tract infections (CAUTIs) and urethral trauma. In response, the Centers for Disease Control and Prevention (CDC) issued guidelines in 2009 to minimize inappropriate perioperative catheter use. This study evaluates national trends in perioperative indwelling urethral catheter utilization across various surgical specialties from 2010 to 2017 using the Nationwide Inpatient Sample database (NIS).

Methods: We conducted a retrospective analysis of elective surgical admissions from the NIS database, including patients ≥ 18 years undergoing surgery with associated ICD codes for urethral catheterization. Proportional catheter utilization was calculated annually per surgical type. Mann-Kendall τ trend tests and locally estimated scatterplot smoothing (LOESS) models assessed temporal trends. Statistical significance was set at p < 0.05.

Results: Over the 8-year period, 81,128,725 procedures involving perioperative catheterization were recorded. Significant reductions in perioperative catheter use occurred in eye (-0.05%, p = 0.013) and urinary system surgical procedures (-0.54%, p = 0.001). Conversely, increases were observed in female reproductive (0.05%, p < 0.001), male reproductive (0.31%, p < 0.001), and respiratory surgical procedures (0.08%, p = 0.015). No significant overall change was found across all surgical categories combined (p = 0.873).

Conclusion: Despite national guidelines, overall perioperative catheter use has not significantly declined. Subspecialty variation suggests that adherence to catheter stewardship may be influenced by procedural norms and surgical specialty-specific practices. Enhanced protocol-driven approaches, particularly nurse-led catheter removal and integration into ERAS pathways, warrant broader implementation.

Background: Propose an innovative surgical method for the treatment of redundant hernias in children.

Methods: All the children with redundant hernias were treated with the suture traction and suspension method to close the internal ring under single-site laparoscopy.

Conclusion: We present an improved and innovative minimally invasive surgical approach for the treatment of redundant hernias in children. This method is not only simple and easy, but also has the advantages of fewer incisions and low trauma, and only one doctor can complete the operation.

Background: Preemptive and preventative methods have been suggested to decrease pain by blocking nociceptive inputs to tissues. Preemptive analgesia has the potential to enhance postoperative recovery in patients undergoing colorectal surgery. This study aimed to evaluate the efficacy and safety of preemptive versus postoperative analgesia in this population.

Methods: We systematically searched PubMed, Scopus, Web of Science, and the Cochrane Library from inception to December 2024, and updated the search in May 2025, to identify randomized controlled trials (RCTs) comparing preemptive analgesia with postoperative analgesia in adult patients undergoing colorectal surgery. The primary outcomes were opioid consumption within 24 h, visual analog scale (VAS) pain score at rest at 24 and 48 h postoperatively. Secondary outcomes included adverse events, length of hospital stay, surgery duration (minutes), and postoperative nausea and vomiting (PONV). The Cochrane Risk of Bias 2.0 tool was used to assess risk of bias, and the strength of evidence was graded using the GRADE approach.

Results: We identified a total of 2739 records. Seven studies involving 625 patients (312 preemptive and 313 postoperative) met the inclusion criteria. Preemptive analgesia decreased VAS scores at 24 h compared to postoperative analgesia (MD -0.45, 95% CI: -0.89 to -0.01, p = 0.04). However, significant heterogeneity was observed among included studies. Additionally, there was no difference between the two groups regarding VAS at 48 h (MD -0.17, 95% CI -0.43 to 0.09, p = 0.21) and opioid consumption at 24 h (MD -21.17, 95% CI 48.18-5.85, p = 0.12).

Conclusion: The findings indicate that preemptive analgesia did not decrease opioid consumption at 24 h; however, it decreased VAS score at 24 h without any difference in VAS at 48 h, length of hospital stay, incidence of PONV, or other adverse events when compared to postoperative analgesia alone in colorectal surgery.

Trial registration: The study is registered in PROSPERO under the registration number CRD420250636020.