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 : 2025-06-01DOI: 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 : 2025-06-01DOI: 10.1016/j.sopen.2025.05.001
Eleanor G.R. Watson BSc (Hons), MD , Tony Y. Zhang BBMed , Hwa Ian Ong MBChB, FRACS , David M. Proud MBBS (Hons), FRACS , Helen M. Mohan PhD, FRCSI
Background
Benign anorectal diseases such as haemorrhoids, perianal abscesses and fistulas are prevalent and disabling conditions that can be difficult to diagnose and treat.
This review aims to evaluate current education for training doctors around these diseases to inform the revision and development of surgical curricula.
Materials and methods
A literature search was conducted in MEDLINE, Embase and Google Scholar and data from included articles were charted in a semi-structured table. Quantitative outcomes were presented using simple descriptive statistics. Qualitative data were analysed using a reflexive thematic analysis framework.
Results
Ten studies were included. Most education was centred around haemorrhoids and delivered in the format of lectures and simulations. Harnessing the benefits of both on-demand and in-person content was key to optimising education delivery. In simulation studies, low-fidelity models were generally sufficient to meet educational objectives. There was universal agreement that the purpose of education was to supplement or prepare for clinical exposure, rather than to replace or ‘bridge gaps’ in experience. Education was found to be most useful and relevant when delivered to junior surgical or non-surgical cohorts.
Conclusions
This review elucidates gaps in current literature on benign anorectal disease education and provides recommendations for the development and implementation of future education for surgical trainees. There is a need for education that addresses a broader range of anorectal conditions and has a greater focus on the retention and clinical translation of acquired knowledge and skills. Interventions should be designed to enhance clinical exposure and maintain relevance throughout training progression.
{"title":"Surgical trainee education in benign anorectal disease: a scoping review","authors":"Eleanor G.R. Watson BSc (Hons), MD , Tony Y. Zhang BBMed , Hwa Ian Ong MBChB, FRACS , David M. Proud MBBS (Hons), FRACS , Helen M. Mohan PhD, FRCSI","doi":"10.1016/j.sopen.2025.05.001","DOIUrl":"10.1016/j.sopen.2025.05.001","url":null,"abstract":"<div><h3>Background</h3><div>Benign anorectal diseases such as haemorrhoids, perianal abscesses and fistulas are prevalent and disabling conditions that can be difficult to diagnose and treat.</div><div>This review aims to evaluate current education for training doctors around these diseases to inform the revision and development of surgical curricula.</div></div><div><h3>Materials and methods</h3><div>A literature search was conducted in MEDLINE, Embase and Google Scholar and data from included articles were charted in a semi-structured table. Quantitative outcomes were presented using simple descriptive statistics. Qualitative data were analysed using a reflexive thematic analysis framework.</div></div><div><h3>Results</h3><div>Ten studies were included. Most education was centred around haemorrhoids and delivered in the format of lectures and simulations. Harnessing the benefits of both on-demand and in-person content was key to optimising education delivery. In simulation studies, low-fidelity models were generally sufficient to meet educational objectives. There was universal agreement that the purpose of education was to supplement or prepare for clinical exposure, rather than to replace or ‘bridge gaps’ in experience. Education was found to be most useful and relevant when delivered to junior surgical or non-surgical cohorts.</div></div><div><h3>Conclusions</h3><div>This review elucidates gaps in current literature on benign anorectal disease education and provides recommendations for the development and implementation of future education for surgical trainees. There is a need for education that addresses a broader range of anorectal conditions and has a greater focus on the retention and clinical translation of acquired knowledge and skills. Interventions should be designed to enhance clinical exposure and maintain relevance throughout training progression.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"26 ","pages":"Pages 119-127"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144194650","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}
Esophageal cancer remains a major cause of cancer-related mortality worldwide, and esophagectomy is a primary curative treatment for localized disease. However, recurrent laryngeal nerve (RLN) injury is a common and impactful complication that can impair vocal cord function, increase aspiration risk, and hinder postoperative recovery. To quantify its prevalence and explore contributing factors, we conducted a systematic review and meta-analysis including 24 studies and 6015 patients. The overall pooled prevalence of RLN injury was 18.36 % (95 % CI, 11.50 %–28.00 %), with substantial heterogeneity (I2 = 95.8 %). Subgroup analysis revealed a lower pooled prevalence in robot-assisted minimally invasive esophagectomy (RAMIE) at 13.39 % (95 % CI, 9.28 %–18.95 %) compared to 21.89 % (95 % CI, 12.92 %–34.62 %) in minimally invasive esophagectomy (MIE). Among surgical techniques, the McKeown approach had the highest RLN injury prevalence (26.32 %; 95 % CI, 15.59 %–40.85 %), whereas the Ivor Lewis approach demonstrated a notably lower rate (5.77 %; 95 % CI, 1.00 %–100.00 %). RLN injury was more frequent in studies from low-volume or early-learning curve centers, while high-volume single-center RAMIE cohorts showed both lower prevalence and reduced heterogeneity. Sensitivity analyses supported the robustness of these findings, and publication bias assessment indicated only minor asymmetry (LFK index −1.81). These results highlight the clinical importance of RLN injury and support the role of robotic-assisted techniques, surgical experience, and intraoperative neuromonitoring in mitigating risk. Standardized definitions and procedural training are essential to improving outcomes and reducing the burden of this complication.
{"title":"Prevalence of recurrent nerve injury among esophageal cancer patients undergoing esophagectomy: A systematic review and meta-analysis","authors":"Prakasini Satapathy , Abhay M. Gaidhane , Nasir Vadia , Soumya V. Menon , Kattela Chennakesavulu , Rajashree Panigrahi , Ganesh Bushi , Mahendra Singh , Sanjit Sah , Awakash Turkar , S. Govinda Rao , Khang Wen Goh , Muhammed Shabil","doi":"10.1016/j.sopen.2025.05.009","DOIUrl":"10.1016/j.sopen.2025.05.009","url":null,"abstract":"<div><h3>Background</h3><div>Esophageal cancer remains a major cause of cancer-related mortality worldwide, and esophagectomy is a primary curative treatment for localized disease. However, recurrent laryngeal nerve (RLN) injury is a common and impactful complication that can impair vocal cord function, increase aspiration risk, and hinder postoperative recovery. To quantify its prevalence and explore contributing factors, we conducted a systematic review and meta-analysis including 24 studies and 6015 patients. The overall pooled prevalence of RLN injury was 18.36 % (95 % CI, 11.50 %–28.00 %), with substantial heterogeneity (I<sup>2</sup> = 95.8 %). Subgroup analysis revealed a lower pooled prevalence in robot-assisted minimally invasive esophagectomy (RAMIE) at 13.39 % (95 % CI, 9.28 %–18.95 %) compared to 21.89 % (95 % CI, 12.92 %–34.62 %) in minimally invasive esophagectomy (MIE). Among surgical techniques, the McKeown approach had the highest RLN injury prevalence (26.32 %; 95 % CI, 15.59 %–40.85 %), whereas the Ivor Lewis approach demonstrated a notably lower rate (5.77 %; 95 % CI, 1.00 %–100.00 %). RLN injury was more frequent in studies from low-volume or early-learning curve centers, while high-volume single-center RAMIE cohorts showed both lower prevalence and reduced heterogeneity. Sensitivity analyses supported the robustness of these findings, and publication bias assessment indicated only minor asymmetry (LFK index −1.81). These results highlight the clinical importance of RLN injury and support the role of robotic-assisted techniques, surgical experience, and intraoperative neuromonitoring in mitigating risk. Standardized definitions and procedural training are essential to improving outcomes and reducing the burden of this complication.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"27 ","pages":"Pages 68-80"},"PeriodicalIF":1.4,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144633375","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 : 2025-05-30DOI: 10.1016/j.sopen.2025.05.010
Yang-Tao Chen , Zhao-Chu Wang, Ya-Meng Xie, Xun Wang, Xu-Xiong Wu, Yang Li, Rong Shi, Jing Wang
Transanal Opening of Intersphincteric Space (TROPIS) has emerged as a promising surgical approach for anal fistula management over recent years. This meta-analysis comprehensively evaluates the comparative efficacy and safety of TROPIS versus conventional treatments through systematic analysis of 24 clinical studies involving 2813 patients. Through systematic searches across 7 major biomedical databases (including PubMed, EMBASE, and Chinese repositories) from inception to March 2024, we identified comparative studies assessing TROPIS against six established interventions: incision-thread-drawing, seton placement, LIFT, EAFR, fistulotomy, and incision-suture techniques. Pooled analysis demonstrated TROPIS achieved superior clinical outcomes, with a 3.15-fold higher total efficacy rate (95 % CI 1.22–8.13, p = 0.02) and 64 % lower complication risk compared to conventional methods (OR 0.28, 95 % CI 0.18–0.42, p < 0.00001). Sensitivity analyses confirmed result stability across study designs, while publication bias assessment via funnel plots and Egger's test revealed no significant distortion. Importantly, TROPIS maintained its advantage across various complication subtypes including incontinence (OR 0.31), infection (OR 0.27), and recurrence (OR 0.19). These findings establish TROPIS as a clinically superior alternative that significantly improves therapeutic outcomes while reducing procedure-related risks, suggesting its potential to become the new reference standard in anal fistula management. The consistent results across diverse patient populations and comparator procedures underscore the robustness of this evidence synthesis.
近年来，经肛门括约肌间隙开放术（TROPIS）已成为肛瘘治疗的一种很有前途的手术方法。本荟萃分析通过对涉及2813例患者的24项临床研究的系统分析，综合评价了TROPIS与常规治疗的比较疗效和安全性。通过对7个主要生物医学数据库（包括PubMed、EMBASE和中文数据库）从成立到2024年3月的系统检索，我们确定了比较研究，评估了TROPIS与六种已建立的干预措施：切口线绘制、seton放置、LIFT、EAFR、瘘切开术和切口缝合技术。合并分析显示，与传统方法相比，TROPIS获得了更好的临床结果，总有效率提高3.15倍（95% CI 1.22-8.13, p = 0.02），并发症风险降低64% (OR 0.28, 95% CI 0.18-0.42, p <；0.00001)。敏感性分析证实了研究设计结果的稳定性，而通过漏斗图和Egger检验进行的发表偏倚评估显示没有显著的失真。重要的是，TROPIS在包括尿失禁（OR 0.31）、感染（OR 0.27）和复发（OR 0.19）在内的各种并发症亚型中保持了优势。这些研究结果表明，TROPIS在临床上是一种优越的选择，可以显著改善治疗结果，同时降低手术相关风险，这表明它有可能成为肛瘘治疗的新参考标准。不同患者群体和比较程序的一致结果强调了这一证据综合的稳健性。
{"title":"Systematic review and meta-analysis of Transanal Opening of Intersphincteric Space (TROPIS) versus conventional treatments for anal fistula","authors":"Yang-Tao Chen , Zhao-Chu Wang, Ya-Meng Xie, Xun Wang, Xu-Xiong Wu, Yang Li, Rong Shi, Jing Wang","doi":"10.1016/j.sopen.2025.05.010","DOIUrl":"10.1016/j.sopen.2025.05.010","url":null,"abstract":"<div><div>Transanal Opening of Intersphincteric Space (TROPIS) has emerged as a promising surgical approach for anal fistula management over recent years. This meta-analysis comprehensively evaluates the comparative efficacy and safety of TROPIS versus conventional treatments through systematic analysis of 24 clinical studies involving 2813 patients. Through systematic searches across 7 major biomedical databases (including PubMed, EMBASE, and Chinese repositories) from inception to March 2024, we identified comparative studies assessing TROPIS against six established interventions: incision-thread-drawing, seton placement, LIFT, EAFR, fistulotomy, and incision-suture techniques. Pooled analysis demonstrated TROPIS achieved superior clinical outcomes, with a 3.15-fold higher total efficacy rate (95 % CI 1.22–8.13, <em>p</em> = 0.02) and 64 % lower complication risk compared to conventional methods (OR 0.28, 95 % CI 0.18–0.42, <em>p</em> < 0.00001). Sensitivity analyses confirmed result stability across study designs, while publication bias assessment via funnel plots and Egger's test revealed no significant distortion. Importantly, TROPIS maintained its advantage across various complication subtypes including incontinence (OR 0.31), infection (OR 0.27), and recurrence (OR 0.19). These findings establish TROPIS as a clinically superior alternative that significantly improves therapeutic outcomes while reducing procedure-related risks, suggesting its potential to become the new reference standard in anal fistula management. The consistent results across diverse patient populations and comparator procedures underscore the robustness of this evidence synthesis.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"27 ","pages":"Pages 15-30"},"PeriodicalIF":1.4,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144314319","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":"2025-05-26","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 : 2025-05-21DOI: 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":"2025-05-21","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}
Pub Date : 2025-05-15DOI: 10.1016/j.sopen.2025.05.003
I. Dantas , I. Jorge , A. Nicolau , M. Vales , C. Coutinho , S. Rodrigues , P. Febra , V.N. Lopes
Objective
The authors sought to evaluate how video-based learning compares to traditional learning method in basic surgical skills.
Design
Prospective, randomized and blinded case-control study.
Setting
Faculty of Medicine, University of Porto.
Participants and methods
Fifty medical students were randomized into two groups: traditional learning (in-person course) and video-based learning. Four sutures were taught to both groups: simple interrupted, cruciate mattress, horizontal mattress and vertical mattress sutures.
A first evaluation occurred following the learning sessions, and a retention evaluation was performed two weeks later.
Both groups were compared on performance quality (using a modified Objective Structured Assessment of Technical Skills scale (mOSATS)), time to complete the procedure, and participant satisfaction and self-evaluation (using a Likert-like questionnaire). The frequency and duration of autonomous training by the video-based learning group was documented.
Results
Performance quality was similar in the first evaluation, except for the horizontal [25.88 (SD (Standard Deviation) 3.58) vs 28.28 (SD 3.79), p = 0.04] and vertical mattress sutures [24.14 (SD 3.59) vs 28.44 (SD 3.69), p < 0.01], where the video-based learning group got higher mOSATS scores. In the retention evaluation, the video-based learning group demonstrated higher mOSATS ratings.
The time spent learning with videos was 45 min longer [median in hours: 2:15:30 (IQR (Interquartile Range) 2:17:44)] than the in-person course duration. Overall, the traditional learning group completed sutures faster (p < 0.01).
Conclusion
Video-based learning may be an effective alternative to traditional teaching of basic surgical skills, in performance quality and retention, offering better resource allocation and cost savings.
目的评价基于视频的外科基本技能学习方法与传统学习方法的比较。前瞻性、随机、盲法病例对照研究。波尔图大学医学院。参与者和方法50名医学生随机分为两组：传统学习（面对面课程）和基于视频的学习。两组分别教授四种缝合术：简单间断缝合术、十字缝合术、水平缝合术和垂直缝合术。第一次评估在学习课程之后进行，两周后进行记忆力评估。比较两组的表现质量（使用改进的客观结构化技术技能评估量表（mOSATS））、完成程序的时间、参与者满意度和自我评价（使用李克特式问卷）。记录了视频学习组自主训练的频率和持续时间。结果除水平缝[25.88 （SD (Standard Deviation) 3.58）对28.28 (SD 3.79), p = 0.04]和垂直缝[24.14 （SD 3.59）对28.44 (SD 3.69), p <；0.01]，其中视频学习组获得更高的mOSATS分数。在记忆评估中，视频学习组表现出更高的mOSATS评分。视频学习时间比现场学习时间长45分钟[小时中位数：2:15:30（四分位间距：2:17:44）]。总体而言，传统学习组完成缝合的速度更快(p <；0.01)。结论视频教学可有效替代传统的外科基本技能教学，提高教学效果，提高教学质量，节约教学成本。
{"title":"Video-based learning for basic surgical skills - A randomized trial","authors":"I. Dantas , I. Jorge , A. Nicolau , M. Vales , C. Coutinho , S. Rodrigues , P. Febra , V.N. Lopes","doi":"10.1016/j.sopen.2025.05.003","DOIUrl":"10.1016/j.sopen.2025.05.003","url":null,"abstract":"<div><h3>Objective</h3><div>The authors sought to evaluate how video-based learning compares to traditional learning method in basic surgical skills.</div></div><div><h3>Design</h3><div>Prospective, randomized and blinded case-control study.</div></div><div><h3>Setting</h3><div>Faculty of Medicine, University of Porto.</div></div><div><h3>Participants and methods</h3><div>Fifty medical students were randomized into two groups: traditional learning (in-person course) and video-based learning. Four sutures were taught to both groups: simple interrupted, cruciate mattress, horizontal mattress and vertical mattress sutures.</div><div>A first evaluation occurred following the learning sessions, and a retention evaluation was performed two weeks later.</div><div>Both groups were compared on performance quality (using a modified Objective Structured Assessment of Technical Skills scale (mOSATS)), time to complete the procedure, and participant satisfaction and self-evaluation (using a Likert-like questionnaire). The frequency and duration of autonomous training by the video-based learning group was documented.</div></div><div><h3>Results</h3><div>Performance quality was similar in the first evaluation, except for the horizontal [25.88 (SD (Standard Deviation) 3.58) vs 28.28 (SD 3.79), <em>p</em> = 0.04] and vertical mattress sutures [24.14 (SD 3.59) vs 28.44 (SD 3.69), <em>p</em> < 0.01], where the video-based learning group got higher mOSATS scores. In the retention evaluation, the video-based learning group demonstrated higher mOSATS ratings.</div><div>The time spent learning with videos was 45 min longer [median in hours: 2:15:30 (IQR (Interquartile Range) 2:17:44)] than the in-person course duration. Overall, the traditional learning group completed sutures faster (<em>p</em> < 0.01).</div></div><div><h3>Conclusion</h3><div>Video-based learning may be an effective alternative to traditional teaching of basic surgical skills, in performance quality and retention, offering better resource allocation and cost savings.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"26 ","pages":"Pages 94-106"},"PeriodicalIF":1.4,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144107461","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 : 2025-05-14DOI: 10.1016/j.sopen.2025.05.004
Ko Un Park , Mary Brindle , Heather Neuman , Tasleem J. Padamsee , Sarah Birken
In 2020, the Commission on Cancer (CoC) launched templated synoptic element documentation in operative reports (SORs) as an accreditation standard to standardize and document surgical techniques for key portions of cancer operations. The study team identified multi-level factors influencing implementation of CoC's breast cancer SORs, including variations in surgeons' knowledge about the new SOR standard. One identified facilitator of SOR dissemination was social ties. To better understand mechanisms underlying social ties in disseminating breast SORs, we performed secondary analysis of key informant interviews in this study.
Social ties were identified by characterizing the surgeon's relationship to that program's Cancer Liaison Physician (CLP) or surgeon belonging to a CoC affiliate organization (e.g., Cancer Research Program). The CLP serving as each program's designated physician quality leader was also the central actor receiving information directly from the CoC. We found that both the CLP's direct ties to the CoC, and indirect ties (e.g., personal ties to someone with direct ties to the CoC), facilitated early dissemination of information about SORs. Leveraging interorganizational ties and providing guidance to CLPs about how and when to communicate with providers about new standards may facilitate dissemination.
{"title":"Importance of social ties in dissemination of Commission on Cancer's synoptic operative report","authors":"Ko Un Park , Mary Brindle , Heather Neuman , Tasleem J. Padamsee , Sarah Birken","doi":"10.1016/j.sopen.2025.05.004","DOIUrl":"10.1016/j.sopen.2025.05.004","url":null,"abstract":"<div><div>In 2020, the Commission on Cancer (CoC) launched templated synoptic element documentation in operative reports (SORs) as an accreditation standard to standardize and document surgical techniques for key portions of cancer operations. The study team identified multi-level factors influencing implementation of CoC's breast cancer SORs, including variations in surgeons' knowledge about the new SOR standard. One identified facilitator of SOR dissemination was social ties. To better understand mechanisms underlying social ties in disseminating breast SORs, we performed secondary analysis of key informant interviews in this study.</div><div>Social ties were identified by characterizing the surgeon's relationship to that program's Cancer Liaison Physician (CLP) or surgeon belonging to a CoC affiliate organization (e.g., Cancer Research Program). The CLP serving as each program's designated physician quality leader was also the central actor receiving information directly from the CoC. We found that both the CLP's direct ties to the CoC, and indirect ties (e.g., personal ties to someone with direct ties to the CoC), facilitated early dissemination of information about SORs. Leveraging interorganizational ties and providing guidance to CLPs about how and when to communicate with providers about new standards may facilitate dissemination.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"26 ","pages":"Pages 61-63"},"PeriodicalIF":1.4,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144070060","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 : 2025-05-10DOI: 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":"2025-05-10","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}
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