Surgery open science最新文献

英文中文

Assessing the impact of comorbidities on surgical outcomes in laparoscopic gastrectomy 评估合并症对腹腔镜胃切除术手术结果的影响

IF 1.7 Q3 SURGERY

Surgery open science

Pub Date : 2026-01-01 DOI: 10.1016/j.sopen.2025.12.003

Saleha Khan , Aleena Zobairi , Ibrahim Kutbi , Nuran Alsobyani , Hamad Aldobashi , Zulaihat Galadima , Ameena Manzoor , Sjaak Pouwels

引用次数: 0

Inflammation and fibrosis at pancreatic resection margin and their role in post-operative pancreatic fistula development after pancreaticoduodenectomy: a pilot study from a single institution 胰腺切除术边缘的炎症和纤维化及其在胰十二指肠切除术后胰瘘发展中的作用：来自单一机构的一项初步研究

IF 1.7 Q3 SURGERY

Surgery open science

Pub Date : 2026-01-01 DOI: 10.1016/j.sopen.2025.12.004

Roberto Cammarata MD , Vincenzo La Vaccara MD, PhD , Alberto Catamerò MD , Chiara Taffon MD , Gianluca Costa MD, PhD , Laura Olivieri MD , Roberto Coppola MD , Damiano Caputo MD

Background/objectives

Postoperative pancreatic fistula (POPF) is a major complication after pancreaticoduodenectomy (PD), with significant impact on outcomes. While the absence of pancreatic fibrosis is a known risk factor, its intraoperative assessment is often subjective. Moreover, the potential protective role of chronic inflammation at the pancreatic resection margin (PRM) has not been fully explored. This study aimed to evaluate the histological presence of fibrosis and chronic lymphomononuclear inflammatory infiltrate (CLII) at the PRM as predictors of POPF and clinically relevant POPF (CR-POPF), and to assess their intraoperative feasibility via frozen sections.

Materials and methods

A retrospective analysis was performed on 141 patients who underwent PD (2014–2022). Intraoperative frozen sections of the PRM were reviewed for fibrosis and CLII using standardized semi-quantitative grading. Univariate and multivariate analyses identified predictors of POPF and CR-POPF.

Results

POPF and CR-POPF occurred in 42.5 % and 22.7 % of patients, respectively. Absence of fibrosis and CLII were independently associated with increased risk of POPF (OR 7.51 and 4.30; p < 0.0001) and CR-POPF (OR 4.43 and 3.40; p = 0.0003 and p = 0.0099). Combined absence of both further elevated risk (OR 5.20 for POPF; OR 4.83 for CR-POPF). In multivariate analysis, absence of fibrosis and CLII and main pancreatic duct <3 mm remained independent predictors.

Conclusion

The absence of fibrosis and CLII at the PRM strongly predicts POPF and CR-POPF. Their intraoperative evaluation via frozen sections is feasible and may support tailored surgical strategies, especially in minimally invasive PD.

背景/目的术后胰瘘（POPF）是胰十二指肠切除术（PD）后的主要并发症，对预后有重要影响。虽然没有胰腺纤维化是一个已知的危险因素，但其术中评估往往是主观的。此外，慢性炎症在胰腺切除边缘（PRM）的潜在保护作用尚未得到充分探讨。本研究旨在评估PRM的组织学纤维化和慢性淋巴单核细胞炎症浸润（CLII）作为POPF和临床相关POPF （CR-POPF）的预测因子，并通过冷冻切片评估其术中可行性。材料与方法对2014-2022年141例PD患者进行回顾性分析。采用标准化的半定量分级对术中PRM冷冻切片进行纤维化和CLII检查。单因素和多因素分析确定了POPF和CR-POPF的预测因子。结果spopf和CR-POPF发生率分别为42.5%和22.7%。无纤维化和CLII与POPF （OR为7.51和4.30;p < 0.0001）和CR-POPF （OR为4.43和3.40;p = 0.0003和p = 0.0099）风险增加独立相关。两者的联合缺失进一步增加了风险（POPF的OR为5.20；CR-POPF的OR为4.83）。在多变量分析中，无纤维化、CLII和主胰管<； 3mm仍然是独立的预测因素。结论PRM无纤维化和CLII可预测POPF和CR-POPF。术中通过冷冻切片进行评估是可行的，可以支持量身定制的手术策略，特别是在微创PD中。

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引用次数: 0

Editorial Board Page 编委会页面

IF 1.7 Q3 SURGERY

Surgery open science

Pub Date : 2026-01-01 DOI: 10.1016/S2589-8450(26)00002-3

引用次数: 0

Association of psychiatric illness with acute outcomes following emergency general surgery 精神疾病与急诊普通外科手术后急性预后的关系

IF 1.7 Q3 SURGERY

Surgery open science

Pub Date : 2025-12-08 DOI: 10.1016/j.sopen.2025.12.001

Giselle Porter BS , Sara Sakowitz MD MBA MPH , Syed Shaheer Ali , Troy Coaston MSCR , Konmal Ali , Amulya Vadlakonda MD , Zihan Gao MHSc , Peyman Benharash MD

Introduction

Prior work has linked severe psychiatric illness (SPI) with greater postoperative mortality and complications following several elective operations. However, this relationship has not been defined in the setting of emergency general surgery (EGS).

Methods

The 2016–2021 United States Nationwide Readmissions Database was used to identify all non-elective adult EGS hospitalizations performed within 48 h of admission. SPI was defined using ICD-10 codes for bipolar disorder and schizophrenia. Patients with severe psychiatric illness comprised the SPI cohort (others: Non-SPI). Multivariable linear and logistic regression models were developed to evaluate the independent association of severe psychiatric illness with in-hospital mortality, perioperative complications, and costs.

Results

Of 2,124,284 EGS patients, 52,130 (2.5 %) were categorized as SPI. On adjusted analysis, SPI was associated with greater odds of in-hospital mortality (Adjusted Odds Ratio [AOR] 1.21; 95 % Confidence Interval [CI]:1.11–1.31), hospitalization costs (+$2304; 95 %CI: +1950, +2658), as well as a 3-fold increase in relative risk of non-home discharge (AOR 3.18, 95 % CI: 3.05–3.31).

Conclusions

Among EGS patients, severe psychiatric illness was linked with inferior clinical and financial outcomes. Improved psychiatric screening and care may allow for early intervention and targeted postoperative care, potentially mitigating complications and costs for these vulnerable patients.

先前的研究已经将严重精神疾病（SPI）与一些选择性手术后更高的术后死亡率和并发症联系起来。然而，在急诊普通外科（EGS）中，这种关系尚未明确。方法使用2016-2021年美国全国再入院数据库来识别入院后48小时内进行的所有非选择性成人EGS住院。SPI使用双相情感障碍和精神分裂症的ICD-10代码进行定义。重度精神疾病患者组成SPI队列（其他：非SPI）。建立了多变量线性和逻辑回归模型来评估严重精神疾病与住院死亡率、围手术期并发症和费用的独立关联。结果2124284例EGS患者中，52130例（2.5%）为SPI。经校正分析，SPI与住院死亡率（校正优势比[AOR] 1.21； 95%可信区间[CI]: 1.11-1.31）、住院费用（+ 2304美元；95% CI: +1950, +2658）以及非家庭出院相对风险增加3倍相关（AOR 3.18, 95% CI: 3.05-3.31）。结论在EGS患者中，严重的精神疾病与较差的临床和财务结果有关。改进的精神病学筛查和护理可能允许早期干预和有针对性的术后护理，潜在地减轻这些弱势患者的并发症和费用。

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引用次数: 0

Isolated right hepatic duct dilation – Type VI of Mirizzi syndrome? 孤立性右肝管扩张- Mirizzi综合征的VI型？

IF 1.7 Q3 SURGERY

Surgery open science

Pub Date : 2025-12-01 DOI: 10.1016/j.sopen.2025.11.006

Longchang Chen , Yan Sun , Quanda Liu

引用次数: 0

Mesenteric inclusion in Crohn's disease surgery: Promising breakthrough or tempest in a teapot? An updated meta-analysis 克罗恩病手术中的肠系膜包涵术：有希望的突破还是茶壶里的风暴？更新后的元分析

IF 1.7 Q3 SURGERY

Surgery open science

Pub Date : 2025-12-01 DOI: 10.1016/j.sopen.2025.10.010

Mohamed Maatouk MD, MS , Mohamed Ben Khalifa MD , Nada Essid MD , Aymen Mabrouk MD , Mariem Nouira MD , Moez Boudokhane MD , Mounir Ben Moussa MD, PhD

Background

Recently, renewed concern has been centered on the role of the mesentery in the development of Crohn's disease (CD). However, there are minimal data supporting the extended mesenteric excision (EME), which may lead to reticence in the adoption of this surgical option. This systematic review and meta-analysis aimed to compare the post-operative outcomes in patients undergoing EME vs limited mesenteric excision (LME) for CD.

Methods

We conducted a systematic search from January 2018 to January 2025 for studies reporting outcomes in patients undergoing EME compared with LME for CD. A pooled meta-analysis was performed. The risk of bias was examined using the ROBINS-I v2 and RoB2 tool.

Results

Nine studies were included in final analysis, comprising two randomized controlled trials, enrolling a total of 4823 patients. Definitions of EME differ, with some studies preserving the ileocolic trunk and others resecting the mesentery with proximal ligation. No significant difference in surgical or endoscopic recurrence was observed between EME and LME. Concerning secondary outcomes, including overall morbidity, intra-abdominal abscess, anastomotic leak and hospital stay, the two groups showed no significant differences.

Conclusions

EME appears as safe as the LME in terms of morbidity, but does not significantly reduce surgical or endoscopic recurrence. Due to the absence of a precise definition of the EME procedure in CD and the need of further high-quality research, the approach of EME still lacks sufficient validation and cannot be broadly recommended for routine clinical practice.

最近，人们重新关注肠系膜在克罗恩病（CD）发展中的作用。然而，支持扩展肠系膜切除（EME）的数据很少，这可能导致对采用这种手术选择的保留。本系统综述和荟萃分析旨在比较EME与有限肠系膜切除（LME）治疗CD患者的术后结果。方法我们从2018年1月至2025年1月对报道EME与LME治疗CD患者结果的研究进行了系统检索。使用ROBINS-I v2和RoB2工具检查偏倚风险。结果纳入9项研究，包括2项随机对照试验，共纳入4823例患者。EME的定义不同，一些研究保留回肠结肠干，而另一些研究切除肠系膜并近端结扎。EME和LME在手术或内镜下复发方面无显著差异。在总体发病率、腹内脓肿、吻合口漏、住院时间等次要结局方面，两组无显著差异。结论在发病率方面，seme与LME一样安全，但没有显著减少手术或内镜下复发。由于缺乏对CD中EME程序的精确定义和进一步高质量研究的需要，EME方法仍然缺乏足够的验证，不能广泛推荐用于常规临床实践。

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引用次数: 0

Editorial Board Page 编委会页面

IF 1.7 Q3 SURGERY

Surgery open science

Pub Date : 2025-12-01 DOI: 10.1016/S2589-8450(25)00103-4

引用次数: 0

Female department chairs and diversity among general surgery applicants and entering residents 女性部门主任和普外科申请者和住院医师的多样性

IF 1.7 Q3 SURGERY

Surgery open science

Pub Date : 2025-12-01 DOI: 10.1016/j.sopen.2025.10.008

Alexander L. Ren MPhil , Jeff Choi MD, MSc , Sherry M. Wren MD

Purpose

Academic surgical department chairs play a critical role in guiding the missions of their departments. One understudied aspect of chairs' influence is their effect on trainee recruitment and diversity. This study explores whether the appointment of female surgical chairs is associated with an increase in the proportion of female and underrepresented-in-medicine applicants and entrants to academic general surgery residency programs.

Method

Academic programs in which a female chair was appointed to replace a male chair were identified. Male-led programs were identified and matched 2:1 to each female-led program based on similar geographic location and time span. Data on applicant and entrant demographics for all included programs was obtained from the Association of American Medical Colleges. A difference-in-difference analysis of applicants and entrants was performed comparing female and underrepresented-in-medicine proportions between the pre-chair appointment and post-appointment years.

Results

No significant changes were found in the proportions of female or underrepresented-in-medicine applicants/entrants following the appointment of a female chair.

Conclusions

Our study found that the appointment of new female chairs is not associated with the gender or racial/ethnic composition of residency applicants/entrants in the immediate post-appointment period. This indicates that increasing diversity among surgical trainees likely relies on the combined efforts of multiple department leaders and faculty members, as well as broader advocacy and outreach efforts in the surgical community.

目的：学术外科主任在指导科室任务方面发挥着关键作用。关于主席的影响力，一个未被充分研究的方面是它们对学员招聘和多样性的影响。本研究探讨了女性外科主席的任命是否与女性和代表性不足的医学申请者和进入学术普通外科住院医师项目的比例增加有关。方法确定任命女性主席代替男性主席的学术项目。根据相似的地理位置和时间跨度，确定男性主导的项目，并将其与女性主导的项目进行2:1的匹配。所有纳入项目的申请人和入学者的人口统计数据均来自美国医学院协会。对申请人和进入者进行了差异中差异分析，比较了女性和代表性不足的医学比例在主席任命前和任命后的年份之间。结果在任命女性主席后，女性或代表性不足的医学申请人/进入者的比例没有显着变化。我们的研究发现，在任命后的一段时间内，新的女性主席的任命与住院医师申请人/入职者的性别或种族/民族构成无关。这表明，增加外科培训生的多样性可能依赖于多个部门领导和教职员工的共同努力，以及外科社区更广泛的宣传和推广努力。

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引用次数: 0

Feedback gap and strategies for handling criticism in early surgical career 外科职业生涯早期的反馈差距及处理批评的策略

IF 1.7 Q3 SURGERY

Surgery open science

Pub Date : 2025-12-01 DOI: 10.1016/j.sopen.2025.11.005

Hanne Pedersen , Alexander Tejera , Christopher Mathieu , Britt-Marie Johansson , Magnus Anderberg , Kristine Hagelsteen

Objective

The aim of this study was to explore experiences and challenges in handling feedback and criticism among early career surgeons.

Design

This study is part of a prospective, exploratory, longitudinal study evaluating surgical residents throughout residency. Semi-structured interviews were conducted with medical doctors applying to a locum or residency position in a surgical specialty. Analysis was performed using a cross-sectional thematic analysis.

Setting

Departments in general surgery, urology, and pediatric surgery at seven hospitals in Sweden.

Participants

Contact information to applicants interviewed for a locum or resident position at the included departments were forwarded to the research group. The research group contacted applicants for inclusion and 50 were included.

Results

Four themes were constructed in relation to the participants' management strategies and experiences: 1) reflection and processing of criticism, 2) emotional response to criticism, 3) cautious feedback culture, and 4) navigating criticism in a hierarchical system.

Conclusion

This study revealed barriers to an effective feedback culture in a pool of applicants for a residency or locum position in surgical disciplines. A culture of reluctance to give feedback was a strong and common denominator. A process of filtering feedback could possibly be a method of survival and thriving in the contemporary workplace. Suggestions and initiatives to change the feedback culture are proposed.

目的探讨早期职业外科医生在处理反馈和批评方面的经验和挑战。本研究是一项前瞻性、探索性、纵向研究的一部分，旨在评估外科住院医师在整个住院期间的表现。对申请外科专科实习医师或住院医师职位的医生进行了半结构化访谈。采用横断面专题分析进行分析。设置瑞典七家医院的普通外科、泌尿外科和儿科外科。参与者的联系信息被转发到研究小组，这些申请人在所包括的部门接受了临时或常驻职位的面试。研究小组联系了申请者，最终有50人入选。结果构建了与被试管理策略和经验相关的四个主题：1)对批评的反思与处理，2)对批评的情绪反应，3)谨慎反馈文化，以及4)在等级体系中对批评的导航。结论：本研究揭示了在外科学科的住院医师或临时职位申请者中建立有效反馈文化的障碍。不愿给予反馈的文化是一个强烈而普遍的特征。过滤反馈的过程可能是在当代工作场所生存和发展的一种方法。提出了改变反馈文化的建议和倡议。

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引用次数: 0

Rethinking operative approach metrics in hepatic resection: Toward functional and precision outcomes 肝切除手术入路指标的再思考：功能性和精确性的结果

IF 1.7 Q3 SURGERY

Surgery open science

Pub Date : 2025-12-01 DOI: 10.1016/j.sopen.2025.11.004

Tirayut Veerasatian , Schawanya K. Rattanapitoon , Nav La , Nathkapach K. Rattanapitoon

引用次数: 0

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