Scandinavian Journal of Surgery最新文献

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.

Background and aims: All Nordic countries have reported a high female admission rate to medical schools over the past decades. A similar female rate is not observed among surgical specialists. The aim of this study was to report the observed female rate in admission to medical school and compare to the female recruitment rate observed in surgical training.

Material and methods: An observational, cross-sectional, nationwide, point-prevalence study (index year 2024) derived from registered medical students (from 2010 to 2025), number of trainees, and certified specialists' statistics of active specialists (defined <70 years of age) in 10 surgical specialties. The national averages of female rate were compared.

Results: The female rate of medical students was 70% (n = 3460 females; n = 1491 males) in Norway in 2024 (with stable rate since 2020 and >60% female rate since 2010). In 2024, there were a total of 9601 doctors in training across 46 medical specialties, with a female rate of 62.7% (n = 6022) of trainees. Among all trainees, some 13.6% (n = 1304) were registered in one of 10 surgical specialties, with 62.7% (n = 817) female rate. Gynecology (n = 324) stands out with >90% of the trainees being female. Excluding gynecology, the female rate of surgeon trainees drops to 53.5% (524 of 980). Even though breast-endocrine and plastic surgery have a high female rate of trainees (>80% and >70%, respectively), they make up for a relatively small actual number of surgical trainees altogether (n = 23 and n = 40, respectively). For 2024, the total number of certified surgeons (n = 3636), with 1409 (38.8%) being female, was lower than the national average for all specialties (48.9%). A considerable number of male surgeons (>30%) are approaching retirement age within the next decade.

Conclusion: Female rate of admission to medical school has been >60% for two decades. Female rate of trainees and specialist surgeons remains lower than the reported national average while improving in general surgery, orthopedics, and gastrointestinal surgery in terms of numbers and rate of females. Research into recruitment, retention and retirement projections is needed.

Background and aims: Gender balance in surgical specialization has received increased focus, as women have traditionally made up a minority in surgical specialties. Little is known about how surgical disciplines are approaching gender equity and balance in general and subspecialty surgery in Norway. The aim of this study was to explore gender distributions across surgical disciplines to investigate gender balance and changes over time.

Material and methods: An observational, cross-national study derived from specialists statistics on board certification in Norway. We investigated gender balance for surgical disciplines for the time period 2008 to 2024. Temporal time trends were investigated for fiscal years 2010, 2015, 2020, and 2024. Statistical analyses were done by the Poisson regression for temporal trends and gender distribution.

Results: For the 10 surgical disciplines investigated, the total number (n) of surgical specialists increased by 33.3% during the period. Numerically, general surgery, gynecology, and orthopedics made up 72% of all surgeon specialists in 2024. The female rate increased from 20.2% to 36.2% across all surgical disciplines. The observed female rate in 2024 was the highest in gynecology (75% women) and the lowest in thoracic surgery (<10% women). Despite a significant increase (with P < 0.001) in the female rate in all specialties, only gynecology and breast-endocrine surgery achieved >50% female rate among specialist surgeons.

Conclusion: Considerable variation in the rate and speed of obtaining gender equity exists across surgical specialties, concerningly in some of the larger surgical specialties. Further investigations should focus on identifying and addressing factors influencing the recruitment and retention of women in surgical specializations.

Background: The prognosis of differentiated thyroid cancer (DTC) is good, and radical surgery has been questioned, especially for small tumors. Size alone cannot, however, predict prognosis. Recurrences occur after several decades, and other risk factors should be included when deciding on an optimal treatment strategy.

Materials and methods: A consecutive series of 231 patients with DTC were treated in 2004-2016 at Borås Hospital in Sweden. Follow-up was performed in 2023, after a mean of 10.7 years (range = 6.5-19.1). Data on type of surgery, adjuvant radioiodine treatment, thyroglobulin levels, deaths, and recurrences were collected. Patients with negative thyroglobulin levels after treatment were compared with those who had measurable thyroglobulin or high levels of anti-thyroglobulin.

Results: In 63/231 patients (27.3%), there was no preoperative suspicion of malignancy, 214 (92.6%) patients underwent total thyroidectomy, and the complication rate was low. There were 181 patients (84.6%) with negative thyroglobulin after treatment, and 33 patients (14.3%) with measurable thyroglobulin and/or anti-thyroglobulin levels. Fifteen patients died from thyroid cancer, and all were in the latter group. Risk factors for recurrence were tumor size, vascular invasion, extra-thyroidal growth, lymph node metastases, and male sex. Multifocality was frequent (32.5%) and patients with bi/multifocal cancers had significantly more lymph node metastases. Ten patients with recurrences had at least two of the identified risk factors.

Conclusion: Total thyroidectomy or hemithyroidectomy in DTC is recommended, preferably including the central lymph node clearance. Total thyroidectomy has the advantage of allowing follow-up with thyroglobulin measurements to detect recurrences in time for treatment.