Pub Date : 2025-06-01Epub Date: 2025-04-17DOI: 10.1016/j.sopen.2025.04.004
Melvin Joy , Wen Ling Choong , ChangShi Tang , Marta Madurska , Benjie Tang , Brian Ip
Objectives
To evaluate the effectiveness of a training course to improve surgical trainees' confidence in specialty training national selection (STNS) for higher surgical training in surgery. It was also the aim to identify weak areas in the current two-year core surgical training programme in the United Kingdom.
Methods
A prospective observational study was conducted. Delegates were asked to complete evaluation forms to track their perceived confidence levels of success in STNS at different timeframes, measured by a visual analogue scale.
Setting
The 2-day interview preparation course was designed with a maximum delegate number of ten per course in Surgical Skills Centre, Ninewells Hospital, University of Dundee, UK.
Participants
Twenty-seven delegates provided feedback of their perceived confidence levels of success at STNS higher surgical training in general and vascular surgery.
Results
Delegate self-reported confidence increased significantly for all domains except Patient Communication (6.12 ± (1.75) vs 7.10 ± (1.69), P = 0.063). A lower confidence was reported by UK graduates and first-time applicants in the technical and teaching domain (6.03 ± 2.04 vs 7.24 ± 1.92, p = 0.007). 23 (85 %) of the participants were successful in the STNS post course.
Conclusions
Peer-delivered teaching, practice and feedback as a structured interview practice course can significantly improve applicants' overall confidence levels in preparing for STNS and a high success rate at STNS. Patient communication skills training and education should be enhanced in the training programme. A lower confidence was reported by UK graduates and first-time applicants in the technical and teaching domain.
目的评价一门培训课程对提高外科学员对高等外科培训专业培训国家选拔班（STNS）信心的效果。这也是为了确定目前在英国为期两年的核心外科培训计划的薄弱环节。方法采用前瞻性观察研究。代表们被要求完成评估表格，以跟踪他们在不同时间框架内对STNS成功的感知信心水平，以视觉模拟量表衡量。为期两天的面试准备课程在英国邓迪大学Ninewells医院外科技能中心进行，每门课程的代表人数最多为10人。参与者27名代表反馈了他们在STNS普通外科和血管外科高等外科培训中成功的信心水平。结果代表自我报告的信心在除患者沟通外的所有领域均显著增加（6.12±（1.75）vs 7.10±（1.69），P = 0.063）。在技术和教学领域，英国毕业生和首次申请者的信心较低（6.03±2.04 vs 7.24±1.92,p = 0.007）。23名（85%）参与者成功完成了STNS后课程。结论speer教学、实践和反馈作为一门结构化的面试实践课程，可以显著提高申请人准备STNS的整体信心水平，提高STNS的成功率。应在培训方案中加强对患者沟通技巧的培训和教育。在技术和教学领域，英国毕业生和首次申请者的信心较低。
{"title":"Development of an interview practice course for improving overall confidence in specialty training national selection in vascular and general surgery","authors":"Melvin Joy , Wen Ling Choong , ChangShi Tang , Marta Madurska , Benjie Tang , Brian Ip","doi":"10.1016/j.sopen.2025.04.004","DOIUrl":"10.1016/j.sopen.2025.04.004","url":null,"abstract":"<div><h3>Objectives</h3><div>To evaluate the effectiveness of a training course to improve surgical trainees' confidence in specialty training national selection (STNS) for higher surgical training in surgery. It was also the aim to identify weak areas in the current two-year core surgical training programme in the United Kingdom.</div></div><div><h3>Methods</h3><div>A prospective observational study was conducted. Delegates were asked to complete evaluation forms to track their perceived confidence levels of success in STNS at different timeframes, measured by a visual analogue scale.</div></div><div><h3>Setting</h3><div>The 2-day interview preparation course was designed with a maximum delegate number of ten per course in Surgical Skills Centre, Ninewells Hospital, University of Dundee, UK.</div></div><div><h3>Participants</h3><div>Twenty-seven delegates provided feedback of their perceived confidence levels of success at STNS higher surgical training in general and vascular surgery.</div></div><div><h3>Results</h3><div>Delegate self-reported confidence increased significantly for all domains except Patient Communication (6.12 ± (1.75) vs 7.10 ± (1.69), P = 0.063). A lower confidence was reported by UK graduates and first-time applicants in the technical and teaching domain (6.03 ± 2.04 vs 7.24 ± 1.92, p = 0.007). 23 (85 %) of the participants were successful in the STNS post course.</div></div><div><h3>Conclusions</h3><div>Peer-delivered teaching, practice and feedback as a structured interview practice course can significantly improve applicants' overall confidence levels in preparing for STNS and a high success rate at STNS. Patient communication skills training and education should be enhanced in the training programme. A lower confidence was reported by UK graduates and first-time applicants in the technical and teaching domain.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"26 ","pages":"Pages 6-11"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143855203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-01Epub Date: 2025-05-10DOI: 10.1016/j.sopen.2025.04.011
Oh Jin Kwon , Esteban Aguayo , Kevin Tabibian , Jeffrey Balian , Arjun Chaturvedi , Dariush Yalzadeh , Joseph Hadaya , Yas Sanaiha , Peyman Benharash
Background
Despite the increasing use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) as advanced circulatory support for acute cardiac and circulatory failure, its high morbidity and mortality have necessitated the identification of risk factors. The prevalence of chronic kidney disease (CKD) in VA-ECMO patients remains unclear, and its relationship with outcomes is not well established.
Methods
A retrospective analysis was conducted on patients (≥18 years) undergoing VA-ECMO using the 2019–2021 Nationwide Readmissions Database. Patients were stratified into non-CKD, CKD 1–2, and CKD 3–5 based on renal disease severity. Those with end-stage renal disease requiring dialysis or prior renal transplant were excluded. The primary outcome was in-hospital mortality, while perioperative complications were secondarily assessed. Multivariable regression models were employed to assess the associations between CKD severity and outcomes across VA-ECMO indications.
Results
Of an estimated 15,432 included for analysis, 11.7 % had CKD, with 84.7 % categorized as CKD 3–5. Following risk adjustment, CKD 3–5 was independently associated with increased odds of in-hospital mortality (AOR 1.32, 95%CI 1.10–1.59) and overall complications (AOR 1.72, 95%CI 1.09–2.72) compared to non-CKD. Additionally, both CKD 1–2 and CKD 3–5 were linked to increased risks of cardiac and acute renal failure complications. When assessed across VA-ECMO indications, CKD 3–5 was associated with the highest risk-adjusted mortality when used for postcardiotomy shock, cardiogenic shock, and mixed cardiopulmonary support.
Conclusions
Advanced CKD is independently associated with increased mortality and perioperative complications in VA-ECMO patients, highlighting the association between preexisting renal dysfunction and adverse outcomes.
{"title":"National Outcomes of Venoarterial Extracorporeal Life Support in Patients with Chronic Kidney Disease","authors":"Oh Jin Kwon , Esteban Aguayo , Kevin Tabibian , Jeffrey Balian , Arjun Chaturvedi , Dariush Yalzadeh , Joseph Hadaya , Yas Sanaiha , Peyman Benharash","doi":"10.1016/j.sopen.2025.04.011","DOIUrl":"10.1016/j.sopen.2025.04.011","url":null,"abstract":"<div><h3>Background</h3><div>Despite the increasing use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) as advanced circulatory support for acute cardiac and circulatory failure, its high morbidity and mortality have necessitated the identification of risk factors. The prevalence of chronic kidney disease (CKD) in VA-ECMO patients remains unclear, and its relationship with outcomes is not well established.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted on patients (≥18 years) undergoing VA-ECMO using the 2019–2021 Nationwide Readmissions Database. Patients were stratified into <em>non-CKD</em>, <em>CKD 1–2</em>, and <em>CKD 3–5</em> based on renal disease severity. Those with end-stage renal disease requiring dialysis or prior renal transplant were excluded. The primary outcome was in-hospital mortality, while perioperative complications were secondarily assessed. Multivariable regression models were employed to assess the associations between CKD severity and outcomes across VA-ECMO indications.</div></div><div><h3>Results</h3><div>Of an estimated 15,432 included for analysis, 11.7 % had CKD, with 84.7 % categorized as <em>CKD 3–5</em>. Following risk adjustment, <em>CKD 3–5</em> was independently associated with increased odds of in-hospital mortality (AOR 1.32, 95%CI 1.10–1.59) and overall complications (AOR 1.72, 95%CI 1.09–2.72) compared to <em>non-CKD</em>. Additionally, both <em>CKD 1–2</em> and <em>CKD 3–5</em> were linked to increased risks of cardiac and acute renal failure complications. When assessed across VA-ECMO indications, <em>CKD 3–5</em> was associated with the highest risk-adjusted mortality when used for postcardiotomy shock, cardiogenic shock, and mixed cardiopulmonary support.</div></div><div><h3>Conclusions</h3><div>Advanced CKD is independently associated with increased mortality and perioperative complications in VA-ECMO patients, highlighting the association between preexisting renal dysfunction and adverse outcomes.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"26 ","pages":"Pages 87-93"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144070059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-01Epub Date: 2025-05-10DOI: 10.1016/j.sopen.2025.04.012
Daniel Soroudi , Daniel S. Rouhani , Alap Patel , Ryan Sadjadi , Reta Behnam-Hanona , Nicholas C. Oleck , Israel Falade , Merisa Piper , Scott L. Hansen
Background
Artificial intelligence (AI) has significantly influenced various medical fields, including plastic surgery. Large language model (LLM) chatbots such as ChatGPT and text-to-image tools like Dall-E and GPT-4o are gaining broader adoption. This study explores the capabilities and limitations of these tools in hand surgery, focusing on their application in patient and medical education.
Methods
Utilizing Google Trends data, common search terms were identified and queried on ChatGPT-4.5 and ChatGPT-3.5 from the following categories: “Hand Anatomy”, “Hand Fracture”, “Hand Joint Injury”, “Hand Tumor”, and “Hand Dislocation”. Responses were graded on a 1–5 scale for accuracy and evaluated using the Flesch-Kincaid Grade Level, Patient Education Materials Assessment Tool (PEMAT), and DISCERN instrument. GPT 4o, DALL-E 3, and DALL-E 2 illustrated visual representations of selected ChatGPT responses in each category, which were further evaluated.
Results
ChatGPT-4.5 achieved a DISCERN overall score of 3.80 ± 0.23. Its responses averaged 91.67 ± 0.29 for PEMAT understandability and 54.67 ± 0.55 for actionability. Accuracy was 4.47 ± 0.52, with a Flesch-Kincaid Grade Level of 9.26 ± 1.04. ChatGPT-4.5 consistently outperformed ChatGPT-3.5 across all evaluation metrics. For text-to-image generation, GPT-4o produced more accurate visuals compared to DALL-E 3 and DALL-E 2.
Conclusions
This study highlights the strengths and limitations of ChatGPT-4.5 and GPT-4o in hand surgery education. While combining accurate text generation with image creation shows promise, these AI tools still need further refinement before widespread clinical adoption.
{"title":"Dall-E in hand surgery: Exploring the utility of ChatGPT image generation","authors":"Daniel Soroudi , Daniel S. Rouhani , Alap Patel , Ryan Sadjadi , Reta Behnam-Hanona , Nicholas C. Oleck , Israel Falade , Merisa Piper , Scott L. Hansen","doi":"10.1016/j.sopen.2025.04.012","DOIUrl":"10.1016/j.sopen.2025.04.012","url":null,"abstract":"<div><h3>Background</h3><div>Artificial intelligence (AI) has significantly influenced various medical fields, including plastic surgery. Large language model (LLM) chatbots such as ChatGPT and text-to-image tools like Dall-E and GPT-4o are gaining broader adoption. This study explores the capabilities and limitations of these tools in hand surgery, focusing on their application in patient and medical education.</div></div><div><h3>Methods</h3><div>Utilizing Google Trends data, common search terms were identified and queried on ChatGPT-4.5 and ChatGPT-3.5 from the following categories: “Hand Anatomy”, “Hand Fracture”, “Hand Joint Injury”, “Hand Tumor”, and “Hand Dislocation”. Responses were graded on a 1–5 scale for accuracy and evaluated using the Flesch-Kincaid Grade Level, Patient Education Materials Assessment Tool (PEMAT), and DISCERN instrument. GPT 4o, DALL-E 3, and DALL-E 2 illustrated visual representations of selected ChatGPT responses in each category, which were further evaluated.</div></div><div><h3>Results</h3><div>ChatGPT-4.5 achieved a DISCERN overall score of 3.80 ± 0.23. Its responses averaged 91.67 ± 0.29 for PEMAT understandability and 54.67 ± 0.55 for actionability. Accuracy was 4.47 ± 0.52, with a Flesch-Kincaid Grade Level of 9.26 ± 1.04. ChatGPT-4.5 consistently outperformed ChatGPT-3.5 across all evaluation metrics. For text-to-image generation, GPT-4o produced more accurate visuals compared to DALL-E 3 and DALL-E 2.</div></div><div><h3>Conclusions</h3><div>This study highlights the strengths and limitations of ChatGPT-4.5 and GPT-4o in hand surgery education. While combining accurate text generation with image creation shows promise, these AI tools still need further refinement before widespread clinical adoption.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"26 ","pages":"Pages 64-78"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144070057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A biliary microbiome comprising flora within normal gallbladders was recently uncovered through analyses targeting the bacterial 16S ribosomal RNA (16S rRNA) gene, despite the gallbladder previously being regarded as a sterile environment. In the present study, we subjected bile samples from patients with acute cholecystitis to gene analysis targeting bacterial flora.
Methods
We targeted patients diagnosed as having Grade I or Grade II acute cholecystitis (in accordance with the Tokyo Guidelines 2018 established by the Japanese Society of Hepato-Biliary-Pancreatic Surgery) who underwent laparoscopic cholecystectomy within 24 h of diagnosis at Juntendo University Urayasu Hospital between July 2021 and January 2024 for evaluation. We drew bile sample from the gallbladder of each patient to confirm the presence of biliary bacterial flora, using both standard bacteriology (culture test) and 16S rRNA gene sequence.
Results
Of the 29 samples, 15 yielded cultures positive for bacterial flora, and gene analysis revealed the presence of bacterial biliary flora in all 14 samples that had tested negative in standard bacteriology. Considering the bacterial flora of a normal gallbladder without lesions as “normal flora,” bacteria other than normal flora—Propionibacterium spp., Coprococcus spp., Prevotella spp., Sediminibacterium spp., and Collinesella spp.—were detected in 25 of the 29 cases (86 %).
Conclusions
Bacteria not detected in non-inflammatory gallbladders such as Propiobacterium spp., Coprococcus spp., Prevotella spp., Sediminibacterium spp., and Collinesella spp. may play a role in the mechanism underlying development of acute cholecystitis.
{"title":"Searching for bacteria within acute cholecystitis using next-generation sequencers","authors":"Tomohiro Otsuka , Yoichi Ishizaki , Jiro Yoshimoto , Kenji Takamori , Shin Watanabe","doi":"10.1016/j.sopen.2025.05.006","DOIUrl":"10.1016/j.sopen.2025.05.006","url":null,"abstract":"<div><h3>Introduction</h3><div>A biliary microbiome comprising flora within normal gallbladders was recently uncovered through analyses targeting the bacterial 16S ribosomal RNA (16S rRNA) gene, despite the gallbladder previously being regarded as a sterile environment. In the present study, we subjected bile samples from patients with acute cholecystitis to gene analysis targeting bacterial flora.</div></div><div><h3>Methods</h3><div>We targeted patients diagnosed as having Grade I or Grade II acute cholecystitis (in accordance with the Tokyo Guidelines 2018 established by the Japanese Society of Hepato-Biliary-Pancreatic Surgery) who underwent laparoscopic cholecystectomy within 24 h of diagnosis at Juntendo University Urayasu Hospital between July 2021 and January 2024 for evaluation. We drew bile sample from the gallbladder of each patient to confirm the presence of biliary bacterial flora, using both standard bacteriology (culture test) and 16S rRNA gene sequence.</div></div><div><h3>Results</h3><div>Of the 29 samples, 15 yielded cultures positive for bacterial flora, and gene analysis revealed the presence of bacterial biliary flora in all 14 samples that had tested negative in standard bacteriology. Considering the bacterial flora of a normal gallbladder without lesions as “normal flora,” bacteria other than normal flora—<em>Propionibacterium</em> spp., <em>Coprococcus</em> spp., <em>Prevotella</em> spp., <em>Sediminibacterium</em> spp., and <em>Collinesella</em> spp.—were detected in 25 of the 29 cases (86 %).</div></div><div><h3>Conclusions</h3><div>Bacteria not detected in non-inflammatory gallbladders such as <em>Propiobacterium</em> spp., <em>Coprococcus</em> spp., <em>Prevotella</em> spp., <em>Sediminibacterium</em> spp., and <em>Collinesella</em> spp. may play a role in the mechanism underlying development of acute cholecystitis.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"26 ","pages":"Pages 113-118"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144147269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-01Epub Date: 2025-05-21DOI: 10.1016/j.sopen.2025.05.005
Dariya Jaeger , Eric Hinrichs , Ralf Schoppe , Gebhard Reiss , Georg Feigl , Benno Mann
Objective
Pancreaticoduodenectomy (PD) is one of the most complex procedures in abdominal surgery. Nowadays, it is very difficult for novice surgeons to learn the procedure of PD on living patients. New concepts are needed to improve the surgical training of PD, comparable to education in the operating room.
Method
We investigated the feasibility of performing PD on a soft embalmed human cadaver using the Dodge preservation technique, considering all operative steps. Surgery was performed by a certified expert. The settings corresponded to the conditions of the operating room with the original surgical instruments and sutures. Upon completion of the PD, feedback in the form of a comprehensive questionnaire was obtained from the expert by evaluating all relevant operational steps in terms of realism using a 5 point Likert scale.
Results
PD was performed successfully by the expert. The results showed very good feasibility for PD on the used Dodge embalmed cadaver (DeC). The expert confirmed a realistic surgical performance similar to real-life conditions, with good color contrast, clearly visible tissue layers for a layered preparation, and a great result for the reconstruction part of the anastomoses.
Conclusions
New educational methods are needed to improve surgical training of PD. Hands-on training of PD performed on DeC enables a realistic surgical experience and offers a promising educational method for training in pancreatic surgery.
{"title":"Pancreaticoduodenectomy on soft-embalmed human cadavers according to Dodge – a pilot feasibility report","authors":"Dariya Jaeger , Eric Hinrichs , Ralf Schoppe , Gebhard Reiss , Georg Feigl , Benno Mann","doi":"10.1016/j.sopen.2025.05.005","DOIUrl":"10.1016/j.sopen.2025.05.005","url":null,"abstract":"<div><h3>Objective</h3><div>Pancreaticoduodenectomy (PD) is one of the most complex procedures in abdominal surgery. Nowadays, it is very difficult for novice surgeons to learn the procedure of PD on living patients. New concepts are needed to improve the surgical training of PD, comparable to education in the operating room.</div></div><div><h3>Method</h3><div>We investigated the feasibility of performing PD on a soft embalmed human cadaver using the Dodge preservation technique, considering all operative steps. Surgery was performed by a certified expert. The settings corresponded to the conditions of the operating room with the original surgical instruments and sutures. Upon completion of the PD, feedback in the form of a comprehensive questionnaire was obtained from the expert by evaluating all relevant operational steps in terms of realism using a 5 point Likert scale.</div></div><div><h3>Results</h3><div>PD was performed successfully by the expert. The results showed very good feasibility for PD on the used Dodge embalmed cadaver (DeC). The expert confirmed a realistic surgical performance similar to real-life conditions, with good color contrast, clearly visible tissue layers for a layered preparation, and a great result for the reconstruction part of the anastomoses.</div></div><div><h3>Conclusions</h3><div>New educational methods are needed to improve surgical training of PD. Hands-on training of PD performed on DeC enables a realistic surgical experience and offers a promising educational method for training in pancreatic surgery.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"26 ","pages":"Pages 107-112"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144124752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Biliary dyskinesia is disorder characterized by reduced gallbladder ejection fraction, which have shown a good response to cholecystectomy. In contrast, hyperkinetic biliary dyskinesia (HBD), as defined by ejection fraction ≥80 %, is an emerging phenomenon, and the role of cholecystectomy is not yet clearly defined. This review investigates the effectiveness of cholecystectomy in alleviating symptoms of HBD.
Material and methods
A comprehensive literature search was conducted to retrieve studies based on predefined inclusion criteria. Data were extracted by two-independent reviewers. A random-effects model was used for meta-analysis. Risk ratios (RR) were calculated to estimate the impact of cholecystectomy on symptom improvement. Heterogeneity was calculated using the I2 statistic and Q-test, with subgroup analyses performed based on study design.
Results
Fourteen studies involving 416 patients with HBD were included. Overall, the pooled RR for symptom relief post-cholecystectomy was 3.72 (95 % CI: 2.57–5.38). A subgroup analysis of retrospective reviews showed an RR of 3.9 (95 % CI: 2.57–5.92). Moderate heterogeneity (I2 = 30.01 %) was observed.
Conclusion
Based on existing evidence, cholecystectomy appeared to be a promising and effective treatment for HBD in select patients.
{"title":"Role of cholecystectomy in hyperkinetic biliary dyskinesia: A systematic review and meta-analysis","authors":"Duyen Quach MD , Kayla Nguyen MD , Gabriella Tavera BS , Rachel Wright MD , Zuhair Ali MD , Mike Liang MD","doi":"10.1016/j.sopen.2025.06.001","DOIUrl":"10.1016/j.sopen.2025.06.001","url":null,"abstract":"<div><h3>Background</h3><div>Biliary dyskinesia is disorder characterized by reduced gallbladder ejection fraction, which have shown a good response to cholecystectomy. In contrast, hyperkinetic biliary dyskinesia (HBD), as defined by ejection fraction ≥80 %, is an emerging phenomenon, and the role of cholecystectomy is not yet clearly defined. This review investigates the effectiveness of cholecystectomy in alleviating symptoms of HBD.</div></div><div><h3>Material and methods</h3><div>A comprehensive literature search was conducted to retrieve studies based on predefined inclusion criteria. Data were extracted by two-independent reviewers. A random-effects model was used for meta-analysis. Risk ratios (RR) were calculated to estimate the impact of cholecystectomy on symptom improvement. Heterogeneity was calculated using the I<sup>2</sup> statistic and Q-test, with subgroup analyses performed based on study design.</div></div><div><h3>Results</h3><div>Fourteen studies involving 416 patients with HBD were included. Overall, the pooled RR for symptom relief post-cholecystectomy was 3.72 (95 % CI: 2.57–5.38). A subgroup analysis of retrospective reviews showed an RR of 3.9 (95 % CI: 2.57–5.92). Moderate heterogeneity (I<sup>2</sup> = 30.01 %) was observed.</div></div><div><h3>Conclusion</h3><div>Based on existing evidence, cholecystectomy appeared to be a promising and effective treatment for HBD in select patients.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"26 ","pages":"Pages 128-134"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144212228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-01Epub Date: 2025-04-18DOI: 10.1016/j.sopen.2025.04.007
Danique J.I. Heuvelings , Mahdi Al-Taher , Joost Calon , Manish Chand , Laurents P.S. Stassen , Tim Lubbers , Kevin P. Wevers , Luigi Boni , Nicole D. Bouvy , Wido Heeman
Introduction
Adequate blood perfusion is widely recognized as a crucial factor for successful healing of an anastomosis and avoid anastomotic leakage. This study aimed to determine if laparoscopic laser speckle contrast imaging, can provide valuable feedback for identifying the state of tissue perfusion. Therefore, we explored the efficacy and feasibility of a new laser speckle contrast imaging system to assess real-time intestinal perfusion.
Methods
Three gradually perfused porcine small bowel loops were created, and five senior surgeons were asked to assess the perfusion differences based on laser speckle contrast images using PerfusiX-Imaging®. Subsequently, the study evaluated the impact of laser speckle contrast imaging on decision-making for anastomosis creation. Afterwards, a questionnaire was completed by all surgeons to assess the usability of the device.
Results
Results demonstrated a high accuracy (100 %) in identifying compromised perfusion and detecting perfusion differences between loops using the imaging system. In case of compromised perfusion, all surgeons recommended against creating an anastomosis based on the visual feedback. The questionnaire revealed that the senior surgeons were satisfied with the perfusion imager, particularly in terms of minimal latency, ease of use and set up, and ability to accurately represent blood flow patterns as these questions showed a (very) strong agreement in 80 %.
Conclusion
Laser speckle contrast imaging can provide valuable real-time feedback on intestinal tissue perfusion during surgery, enabling surgeons to select optimal tissue segments for a well-perfused anastomosis. However, further research is required to validate the efficacy in clinical settings and its potential impact on surgical outcomes in patients.
{"title":"Real-time intestinal perfusion assessment for anastomotic site selection using laser speckle contrast imaging: Verification in a porcine model","authors":"Danique J.I. Heuvelings , Mahdi Al-Taher , Joost Calon , Manish Chand , Laurents P.S. Stassen , Tim Lubbers , Kevin P. Wevers , Luigi Boni , Nicole D. Bouvy , Wido Heeman","doi":"10.1016/j.sopen.2025.04.007","DOIUrl":"10.1016/j.sopen.2025.04.007","url":null,"abstract":"<div><h3>Introduction</h3><div>Adequate blood perfusion is widely recognized as a crucial factor for successful healing of an anastomosis and avoid anastomotic leakage. This study aimed to determine if laparoscopic laser speckle contrast imaging, can provide valuable feedback for identifying the state of tissue perfusion. Therefore, we explored the efficacy and feasibility of a new laser speckle contrast imaging system to assess real-time intestinal perfusion.</div></div><div><h3>Methods</h3><div>Three gradually perfused porcine small bowel loops were created, and five senior surgeons were asked to assess the perfusion differences based on laser speckle contrast images using PerfusiX-Imaging®. Subsequently, the study evaluated the impact of laser speckle contrast imaging on decision-making for anastomosis creation. Afterwards, a questionnaire was completed by all surgeons to assess the usability of the device.</div></div><div><h3>Results</h3><div>Results demonstrated a high accuracy (100 %) in identifying compromised perfusion and detecting perfusion differences between loops using the imaging system. In case of compromised perfusion, all surgeons recommended against creating an anastomosis based on the visual feedback. The questionnaire revealed that the senior surgeons were satisfied with the perfusion imager, particularly in terms of minimal latency, ease of use and set up, and ability to accurately represent blood flow patterns as these questions showed a (very) strong agreement in 80 %.</div></div><div><h3>Conclusion</h3><div>Laser speckle contrast imaging can provide valuable real-time feedback on intestinal tissue perfusion during surgery, enabling surgeons to select optimal tissue segments for a well-perfused anastomosis. However, further research is required to validate the efficacy in clinical settings and its potential impact on surgical outcomes in patients.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"26 ","pages":"Pages 12-17"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143868384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-01Epub Date: 2025-06-02DOI: 10.1016/j.sopen.2025.05.008
Bennet S. Cho MD , Troy N. Coaston BS , Amulya Vadlakonda BS , Sara Sakowitz MPH, MS , Syed Shaheer Ali , Esteban Aguayo MD , Peyman Benharash MD
Background
The association between body mass index (BMI) and outcomes in surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR) is not well understood. This study assessed the nuanced relationship between BMI and clinical outcomes in a nationally representative cohort undergoing aortic valve replacement.
Methods
Adult (≥18 years) admissions for elective SAVR or TAVR from the 2016–2021 National Inpatient Sample were analyzed. BMI was categorized as underweight (<20), ideal weight (20–30), obesity class I (30–34.9), class II (35–39.9), and class III (≥40). The primary outcome was in-hospital mortality. Secondary outcomes included major adverse events (MAE), a composite of mortality and complications (e.g., stroke, thromboembolic, cardiac, respiratory, infection, renal).
Results
Among 103,000 patients, 61.2 % underwent TAVR. TAVR patients were older (76 vs. 64 years; p < 0.001) and more frequently underweight (3.1 % vs. 1.5 %; p < 0.001) compared to SAVR patients. In TAVR, BMI < 20 was associated with higher mortality (AOR 2.99, 95 % CI 1.16–7.74) and MAE (AOR 1.74, 95 % CI 1.30–2.34) compared to ideal BMI. Obesity did not increase the overall incidence of MAE in patients undergoing TAVR. In SAVR, mortality was not associated with BMI, but underweight (AOR 2.05, 95 % CI 1.33–3.15) and class III obesity (AOR 1.34, 95 % CI 1.09–1.65) were linked to higher MAE risk.
Conclusions
Extremes of BMI results in poorer outcomes in SAVR and TAVR. Underweight patients had increased risks across both approaches, while severe obesity elevated MAE risk in SAVR. These findings underscore the need for tailored perioperative strategies and risk counseling.
背景：身体质量指数（BMI）与外科主动脉瓣置换术（SAVR）和经导管主动脉瓣置换术（TAVR）预后之间的关系尚不清楚。本研究评估了在全国代表性的主动脉瓣置换术队列中BMI与临床结果之间的微妙关系。方法分析2016-2021年全国住院患者样本中因选择性SAVR或TAVR入院的成人（≥18岁）。BMI分为体重过轻（20）、理想体重（20 - 30）、肥胖I级（30-34.9）、II级（35-39.9）和III级（≥40）。主要终点是住院死亡率。次要结局包括主要不良事件（MAE）、死亡率和并发症（如中风、血栓栓塞、心脏、呼吸、感染、肾脏）的组合。结果在103,000例患者中，61.2%的患者接受了TAVR。TAVR患者年龄较大(76岁vs. 64岁；p & lt;0.001)和更频繁的体重不足(3.1% vs. 1.5%；p & lt;0.001)，与SAVR患者相比。在TAVR中，BMI <；与理想BMI相比，20与更高的死亡率（AOR 2.99, 95% CI 1.16-7.74）和MAE （AOR 1.74, 95% CI 1.30-2.34）相关。肥胖并没有增加TAVR患者MAE的总发生率。在SAVR中，死亡率与BMI无关，但体重不足（AOR 2.05, 95% CI 1.33-3.15）和III级肥胖（AOR 1.34, 95% CI 1.09-1.65）与较高的MAE风险相关。结论BMI值越高，SAVR和TAVR的预后越差。体重过轻的患者在两种方法中都增加了风险，而严重肥胖的患者在SAVR中增加了MAE的风险。这些发现强调了量身定制围手术期策略和风险咨询的必要性。
{"title":"Association of body mass index and outcomes in surgical and transcatheter aortic valve replacement","authors":"Bennet S. Cho MD , Troy N. Coaston BS , Amulya Vadlakonda BS , Sara Sakowitz MPH, MS , Syed Shaheer Ali , Esteban Aguayo MD , Peyman Benharash MD","doi":"10.1016/j.sopen.2025.05.008","DOIUrl":"10.1016/j.sopen.2025.05.008","url":null,"abstract":"<div><h3>Background</h3><div>The association between body mass index (BMI) and outcomes in surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR) is not well understood. This study assessed the nuanced relationship between BMI and clinical outcomes in a nationally representative cohort undergoing aortic valve replacement.</div></div><div><h3>Methods</h3><div>Adult (≥18 years) admissions for elective SAVR or TAVR from the 2016–2021 National Inpatient Sample were analyzed. BMI was categorized as underweight (<20), ideal weight (20–30), obesity class I (30–34.9), class II (35–39.9), and class III (≥40). The primary outcome was in-hospital mortality. Secondary outcomes included major adverse events (MAE), a composite of mortality and complications (e.g., stroke, thromboembolic, cardiac, respiratory, infection, renal).</div></div><div><h3>Results</h3><div>Among 103,000 patients, 61.2 % underwent TAVR. TAVR patients were older (76 vs. 64 years; p < 0.001) and more frequently underweight (3.1 % vs. 1.5 %; p < 0.001) compared to SAVR patients. In TAVR, BMI < 20 was associated with higher mortality (AOR 2.99, 95 % CI 1.16–7.74) and MAE (AOR 1.74, 95 % CI 1.30–2.34) compared to ideal BMI. Obesity did not increase the overall incidence of MAE in patients undergoing TAVR. In SAVR, mortality was not associated with BMI, but underweight (AOR 2.05, 95 % CI 1.33–3.15) and class III obesity (AOR 1.34, 95 % CI 1.09–1.65) were linked to higher MAE risk.</div></div><div><h3>Conclusions</h3><div>Extremes of BMI results in poorer outcomes in SAVR and TAVR. Underweight patients had increased risks across both approaches, while severe obesity elevated MAE risk in SAVR. These findings underscore the need for tailored perioperative strategies and risk counseling.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"26 ","pages":"Pages 135-139"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144220839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-01Epub Date: 2025-04-29DOI: 10.1016/j.sopen.2025.04.010
Saad Mallick MD , Sara Sakowitz MS MPH , Syed Shahyan Bakhtiyar MD MBE , Nam Yong Cho BS , Troy Coaston BS , Esteban Aguayo MD , Peyman Benharash MD
Background
Racial health disparities are responsible for ∼$50 billion in excess annual healthcare expenditures, driven in part by unequal access to preventive services. We thus studied cost differences in abdominal aortic aneurysm repair (AAA), coronary artery bypass graft (CABG), and colon resection for malignancy (COL), as the elective status of these procedures suggest greater access to preventive care and screening.
Methods
All adult hospitalizations for AAA, CABG, and COL were identified using the 2011–2020 National Inpatient Sample. Generalized linear models were developed to assess cost differences for emergent versus elective surgeries across different racial groups.
Results
Of an estimated 3,069,339 patients, 1,300,717 (42.4%) underwent an emergent operation. The proportion of procedures performed emergently increased from 39.4 in 2011 to 44.5% in 2020 (p < 0.001). After risk adjustment, emergent procedures were associated with a $13,645 (95%CI 13,470-13,820) increment in per-patient hospitalization costs compared with elective, representing a 33% relative difference. The overall adjusted cost difference of emergent surgery was higher for Black ($15,552), Hispanic ($14,525), and Asian/Pacific Islanders ($16,887) patients as compared to White patients ($13,086; all p < 0.001). Emergent surgery was associated with increased adjusted odds of experiencing in-hospital mortality and all major examined postoperative complications, as well as being linked with increased length of stay.
Conclusions
Over a decade, the conversion of only 10% of such procedures to planned elective cases would be associated with $1,774,882,977 in cost savings nationally. With racial minorities experiencing the maximal detriment both clinically and financially, implementing proven strategies can help reduce race-based disparities and annual healthcare expenditures.
{"title":"Race based disparities in clinical and financial outcomes associated with major elective and emergent surgery","authors":"Saad Mallick MD , Sara Sakowitz MS MPH , Syed Shahyan Bakhtiyar MD MBE , Nam Yong Cho BS , Troy Coaston BS , Esteban Aguayo MD , Peyman Benharash MD","doi":"10.1016/j.sopen.2025.04.010","DOIUrl":"10.1016/j.sopen.2025.04.010","url":null,"abstract":"<div><h3>Background</h3><div>Racial health disparities are responsible for ∼$50 billion in excess annual healthcare expenditures, driven in part by unequal access to preventive services. We thus studied cost differences in abdominal aortic aneurysm repair (AAA), coronary artery bypass graft (CABG), and colon resection for malignancy (COL), as the elective status of these procedures suggest greater access to preventive care and screening.</div></div><div><h3>Methods</h3><div>All adult hospitalizations for AAA, CABG, and COL were identified using the 2011–2020 National Inpatient Sample. Generalized linear models were developed to assess cost differences for emergent versus elective surgeries across different racial groups.</div></div><div><h3>Results</h3><div>Of an estimated 3,069,339 patients, 1,300,717 (42.4%) underwent an emergent operation. The proportion of procedures performed emergently increased from 39.4 in 2011 to 44.5% in 2020 (<em>p</em> < 0.001). After risk adjustment, emergent procedures were associated with a $13,645 (95%CI 13,470-13,820) increment in per-patient hospitalization costs compared with elective, representing a 33% relative difference. The overall adjusted cost difference of emergent surgery was higher for Black ($15,552), Hispanic ($14,525), and Asian/Pacific Islanders ($16,887) patients as compared to White patients ($13,086; all <em>p</em> < 0.001). Emergent surgery was associated with increased adjusted odds of experiencing in-hospital mortality and all major examined postoperative complications, as well as being linked with increased length of stay.</div></div><div><h3>Conclusions</h3><div>Over a decade, the conversion of only 10% of such procedures to planned elective cases would be associated with $1,774,882,977 in cost savings nationally. With racial minorities experiencing the maximal detriment both clinically and financially, implementing proven strategies can help reduce race-based disparities and annual healthcare expenditures.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"26 ","pages":"Pages 39-46"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143900356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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