Scandinavian Journal of Surgery最新文献

Background: Splenic flexure cancer is relatively uncommon, accounting for less than 5% of all colorectal cancers with challenging surgical treatment because of their unique anatomic location, blood supply, and lymphatic drainage. The aim of this review was to evaluate the current landscape of surgical management of splenic flexure tumors splenic flexure tumors, assessing available evidence and highlighting areas for future research.

Methods: Scoping review of literature up to March 2025, reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines.

Results: Current evidence on the surgical management of splenic flexure tumors relies on analysis of retrospective studies, which are limited by heterogeneity in definitions and significant selection bias. Based on the available evidence, both extended and limited resections appear to result in similar short- and long-term outcomes as well as pathologic outcomes in elective, non-obstructive settings. The certainty of evidence for these outcomes, though, is very low, precluding any safe recommendations for any procedure. Regarding the extent of lymph node dissection, there is no conclusive evidence favoring D3 or central vascular ligation over D2 lymphadenectomy. Minimally invasive surgery is considered safe in experienced hands. Personalized preoperative planning is important due to the highly variable vascular anatomy at the splenic flexure.

Conclusion: Surgical treatment of splenic flexure tumors remains controversial due to the lack of high-quality prospective data. No single approach can currently be recommended for all cases. Until randomized trials provide definitive guidance, individualized surgical strategies that respect embryologic planes, ensure oncological adequacy, and account for anatomic variability should be pursued. Future directions should focus on standardizing definitions, improving pathologic evaluation of mesocolic integrity, and designing randomized trial to avoid selection bias.

Background: In patients with renal hyperparathyroidism the choice of surgery varies between total parathyroidectomy with autotransplantation (TPTx + AT) and subtotal parathyroidectomy (SPT) with variable outcomes. The present study investigated the risk of extracervical recurrences in patients who underwent total parathyroidectomy with autotransplantation for dialysis patients with renal hyperparathyroidism.

Methods: A retrospective cohort analysis of patients who underwent TPTx + AT for renal hyperparathyroidism between the years 2000 and 2023 at a tertiary referral hospital. Patient demographic profiles, biochemical and surgical data, incidence of recurrence and outcomes of intervention were collected.

Results: Some 142 (71M:71 F) patients with a mean age of 58.6 ± 11.2 years underwent total parathyroidectomy and autotransplantation during the study period. The mean dialysis vintage was 6.3 ± 3.2 years. Extracervical recurrence was seen in 25 (17.6%) of 142 patients, after a mean follow-up of 9 (±4.2) years, with the common sites of recurrence being the deltoid autotransplant site (73.1%) and the mediastinum (11.5%), while 7.7% of recurrences were biochemical with no localized site. Of the recurrences, 19 of 25 (76%) underwent explant of the deltoid autotransplant, and two in the mediastinum underwent minimally invasive excision (one video assisted thoracic surgery and one robotic excision) of the parathyroid lesion. The median parathyroid hormone level at the time of recurrence was 109.4 pg/ml compared with 17.2 ng/L postexcision or explantation. The only factor predictive for recurrences in the cohort on multivariable analysis was postoperative serum PTH (p = 0.001). Log-rank test showed no statistically significant difference in survival between the two groups (p = 0.355).

Conclusion: Extracervical recurrences in the autotransplant are not uncommon in the long-term following total parathyroidectomy and autotransplantation for patients with renal hyperparathyroidism. These recurrences need explantation or excision to reduce the PTH burden in patients who cannot avail a renal transplant.

Genital gender-affirming surgery is a crucial yet often overlooked component of gender-affirming care for transgender individuals. Genital gender-affirming surgery is a rapidly evolving field, and it is not uncommon for surgeons - sometimes without prior experience in gender-affirming care - to encounter transgender individuals in clinical practice; hence, it is essential that all healthcare providers possess a foundational understanding of gender-affirming procedures and individual's needs.Research has shown that genital gender-affirming surgery significantly improves the quality of life for transgender individuals by aligning their physical characteristics with their gender identity. It can offer substantial satisfaction, both aesthetically and functionally. For transwomen, genital gender-affirming surgery enables them to wear underwear aligned with their gender identity, facilitates sexual function and the potential for vaginal intercourse. For transmen, it provides a more masculine appearance in the groin area, allows for penetrative intercourse with a reconstructed penis (neophallus), and in some cases enables urination while standing when combined with urethral lengthening.Today, a wide range of surgical options exists for both transwomen and transmen. Thorough preoperative counseling is essential when selecting the most appropriate reconstructive method. Advances in plastic, reconstructive, and microsurgery continue to expand these options, offering greater personalization and improved outcomes. While genital gender-affirming surgery is complex and often irreversible, individuals are generally highly satisfied with the results, particularly when they have realistic expectations prior to surgery.The aim of this narrative review is to provide an overview of genital gender-affirming surgery from a Nordic perspective. In the Nordic countries, gender-affirming care is highly centralized and integrated into publicly funded healthcare systems. The care programs across these countries share many similarities and are largely comparable in structure and approach.

Background: Roux-en-Y gastric bypass (RYGB) is a standard bariatric surgical technique, associated with suboptimal response and recurrent weight gain in 25%-50% of cases. Single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) is a simplification of duodenal switch with promising results. However, a comparison of the two techniques in a randomized clinical trial (RCT) has not yet been reported. This RCT aims to compare SADI-S and RYGB.

Methods: BYPSADIS is a randomized, open-label, multicentre clinical trial comparing SADI-S with RYGB. Patients aged 18-60 years with body mass index (BMI) = 40-50 kg/m² will be recruited in six hospitals. Primary endpoints are as follows: (1) efficacy, measured as percentage of patients with total weight loss (TWL) > 30% at 5 years; and (2) safety, defined as percentage of patients experiencing at least one severe complication either at 90 days postoperatively (Clavien-Dindo >2) or up to 5 years, including severe malnutrition, diarrhea, dumping, hypoglycemia, or need for surgical reintervention. Sample size was calculated for both primary outcomes, needing 432 patients to prove superiority of SADI-S in efficacy and 423 to prove non-inferiority in safety, with statistical power of 0.8, alpha risk of 0.025, assuming 10% loss throughout follow-up. To ensure power for both primary endpoints, 450 subjects will be included, 225 SADI-S and 225 RYGB. Secondary outcomes include metabolic comorbidities, quality of life, digestive symptoms (dumping, bowel habits, and GERD), need of extra supplementations, and alimentary habits. Outcomes will be compared using one-sided 95% confidence interval of proportion difference between groups.

Discussion: To our knowledge, there is only one ongoing RCT comparing SADI-S with RYGB (SADISLEEVE trial, ClinicalTrials.gov identifier NCT03610256), which includes primary and revisional surgeries, without BMI restrictions and with varying limb lengths. The BYPSADIS trial will complement its findings and help to bridge the knowledge gap on whether SADI-S is more effective than RYGB, while offering a similar safety profile.

Trial registration: The study protocol has been approved by the Ethics Committee of the six participating hospitals and has been registered in ClinicalTrials.gov, NCT06789965.

This narrative review provides an in-depth description of gender-affirming breast surgery within the context of publicly funded healthcare systems in the Nordic countries. A comprehensive literature search was conducted in collaboration with two information specialists, focusing on original research, reviews, and clinical guidelines published in English. The prevalence of transgender and non-binary individuals in the Nordic region ranges from 0.04% to 0.6%, depending on the country and study methodology. Gender-affirming treatment, including hormone therapy and surgical interventions such as breast augmentation and mastectomy, plays a critical role in reducing gender dysphoria and improving psychological well-being, with low rates of reported regret. Transfeminine individuals often pursue breast augmentation with implants or autologous fat grafting; procedures tailored to their unique anatomical considerations. These surgeries are associated with improved health-related quality of life and high levels of satisfaction. Surgical planning involves careful consideration of implant type, placement, and incision strategy. Transmasculine individuals commonly undergo chest masculinization, with techniques adapted to breast size, ptosis, skin quality, and individual goals. Both implant-based and mastectomy procedures are generally safe, though complications such as capsular contracture, hematoma, or wound healing disturbances may occur. Although regret is rare, it underscores the need for comprehensive assessment, informed consent, and mental health support throughout the transition process. Breast cancer screening guidelines remain inconsistent, with barriers to access due to legal gender markers and varying levels of provider knowledge While Nordic countries vary in their approaches, all aim to balance medical necessity, individual autonomy, and healthcare equity. Future priorities include refining surgical protocols, expanding research on long-term outcomes, and addressing systemic barriers to ensure inclusive, evidence-based care for all gender-diverse individuals.

This narrative review examines gender-affirming healthcare in the Nordic countries, highlighting historical developments, legal frameworks, epidemiological trends, and current clinical practices. Transgender healthcare dates back to the early 20th century and gained international attention in the early 1950s following one of the first widely publicized gender-affirming surgeries performed in Denmark. Since then, care models have evolved, supported by policy, research, and clinical practice across Europe and North America.All Nordic countries, Denmark, Finland, Iceland, Norway, and Sweden, provide publicly funded gender-affirming healthcare, although service structures differ. Legal gender recognition has shifted toward self-identification in Denmark, Finland, Iceland, Norway, and from July 2025, also Sweden by removing medical or psychiatric prerequisites.In parallel, epidemiological data reveal an increased healthcare utilization, particularly among youth assigned female at birth. Elevated rates of mental health challenges highlight the need for integrated psychosocial support. Clinical care typically follows a multidisciplinary model including psychiatric and medical assessment, hormone therapy, and surgery when indicated. Access to chest and genital surgery requires a formal diagnosis and is with few exceptions restricted to adults. Evidence supports the positive impact of gender-affirming treatment on gender congruence and health-related quality of life. Regret after gender-affirming surgery is rare but does occur, underscoring the importance of individualized care and thorough informed consent.Ongoing challenges include long wait times, unequal access for non-binary individuals, and a growing number of individuals seeking private or cross-border care. Future efforts should focus on expanding public services, strengthening research, and promoting equitable, evidence-based care that reflects the diversity of gender identities.

Background and aims: Current international guidelines recommend a center volume of at least 20 minimally invasive pancreatic procedures a year to perform laparoscopic left pancreatectomy. Iceland is a small, isolated country that is unavoidably low volume in terms of pancreatic surgery. To ensure good quality of care, there is a long tradition of surgeons training abroad, but this system has not been formally evaluated. The aim of this study was to evaluate the outcomes of laparoscopic and open left pancreatectomy over the last 20 years in Iceland.

Methods: This was a national retrospective cohort study including all patients who underwent left-sided pancreatic resection in Iceland from 2003 to 2022.

Results: A total of 244 patients underwent a pancreatic procedure during the study period. Eighty of these underwent left-sided resections, 41 of whom had a laparoscopic left pancreatectomy (LLP). Resection rates increased over the study period, and a significantly larger proportion of patients underwent LLP in the latter half of the study period. The laparoscopy group had statistically significantly lower rates of splenectomy (<0.001) and blood loss (<0.001) compared with open surgery. The morbidity rate of severe complications (Clavien-Dindo grade IIIa or higher) was 23%. The in-hospital and 90-day mortality rates were 1% and 4%, respectively.

Conclusions: Overall, the operative and postoperative outcomes of left-sided pancreatic resections in a low-volume setting in Iceland were comparable to current reported studies from other Western countries.

Clinical trial registration number: NCT06738914.

Visceral artery aneurysms (VAAs) and pseudoaneurysms are rare but clinically significant vascular pathologies with potentially fatal complications including rupture. VAAs are often asymptomatic and frequently discovered incidentally during imaging performed for unrelated reasons. Their pathophysiology, clinical presentation, and management vary based on the etiology, anatomical location, and patient-specific factors. The prognosis for conservatively managed VAAs is generally favorable, with slow growth rates and low rupture risks. However, pseudoaneurysms, often associated with trauma or pancreatitis, carry a much higher rupture risk and typically require early intervention, regardless of size. Endovascular techniques have progressively replaced open surgery as the preferred treatment approach due to lower complication rates and comparable long-term outcomes. However, current knowledge is biased by the scarcity of high-quality evidence regarding the natural history, rupture risk, and optimal management of VAAs and pseudoaneurysms, largely due to the rarity of these conditions. Consequently, different international societies have provided recommendations with low strength and, in some cases, conflicting indications.

Complicated colonic diverticulitis remains a frequent cause of hospital admissions in Western countries, associated with significant morbidity and health care utilization. Complications include abscess formation, perforation, sepsis, fistulas, and colonic stenosis, which may be present at initial presentation or develop during the disease course. Approximately 10%-20% of hospitalized diverticulitis cases are classified as complicated. Over recent decades, the management of this condition has undergone a paradigm shift-from routine surgical intervention to more individualized, evidence-based strategies emphasizing conservative treatment where appropriate. This review provides a comprehensive, clinically oriented summary of current diagnostic approaches, including the role of cross-sectional imaging, as well as non-operative and operative treatment options. It also outlines recommendations for follow-up, including indications for colonoscopy, and discusses ongoing controversies and future directions in the management of complicated diverticulitis.