World J Surg [JOURNAL]
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200 papers
Advancing Minimally Invasive Surgical Education in Low- and Middle-Income Countries: How I Learned Laparoscopy.
Ngam BN, Snell MJ, Kim GJ
World J Surg · 2026 Apr · PMID 41775670 · Publisher ↗
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How Is Colorectal Cancer Care Impacted by Global Crisis in Contrasting Healthcare Systems?-A Descriptive Study From Scotland and Switzerland During the COVID-19 Pandemic.
Wiesler B, Worni M, Studer P … +21 more , Gass JM, Metzger J, Hartel M, Nebiker C, Rosenberg R, Galli R, Eisner L, Andreou C, Zingg U, Stimpfle D, Viehl CT, Müller A, Müller B, Denhaerynck K, Hall P, Gallagher C, Karunaratne P, Lilley C, Zuber M, Paterson H, von Strauss Und Torney M
World J Surg · 2026 Apr · PMID 41772236 · Full text
BACKGROUND: Healthcare across Europe was affected by COVID-19 pandemic lockdowns. How different national healthcare systems coped with this impact remains unclear. Healthcare in Switzerland differs significantly from tha...
BACKGROUND: Healthcare across Europe was affected by COVID-19 pandemic lockdowns. How different national healthcare systems coped with this impact remains unclear. Healthcare in Switzerland differs significantly from that in Scotland, for example, in terms of centralization. The aim of this study was to assess the impact of the COVID-19 pandemic on the diagnosis and surgical treatment of colorectal cancer (CRC) in contrasting healthcare systems. PATIENTS AND METHODS: This retrospective cohort study was conducted in south-east Scotland and in the extended north-west of Switzerland from January 1st, 2019 to February 28th, 2023. All patients diagnosed with CRC were included. The primary outcomes were the time from CRC diagnosis to treatment and the UICC stage at diagnosis, assessed prior to, during, and following the period of lockdown. The lockdown in Scotland lasted from March 2020 to October 2020 and in Switzerland from March 2020 to April 2020. RESULTS: A total of 6745 patients were included (4127 from Scotland and 2618 from Switzerland). Median time from diagnosis to treatment remained unaltered during the lockdown period in both countries. However, after the lockdown, the median time from diagnosis to treatment increased from 59 to 76 days in Scotland. The median number of patients who were diagnosed per annual quarter declined from 177 (IQR: 171-190) to 152 (IQR: 150-154), and the median number of who received treatment from declined from 256 (IQR: 253-259) to 203 (IQR: 186-218) during lockdown in Scotland. In multivariable logistic regression, the odds of being diagnosed with UICC stage IV increased by 42% for patients diagnosed during lockdown (95%-CI: 12%-81%). In Switzerland, the time from diagnosis to treatment increased slightly after the pandemic. However, the other effects described above were not observed in Switzerland. CONCLUSIONS: This descriptive study demonstrated that the impact of the pandemic on colorectal cancer care was less pronounced in Switzerland, but considerable in Scotland. Because separate subgroup analyses were conducted, direct comparisons cannot be made between Scotland and Switzerland. TRIAL REGISTRATION: This trial is registered on clinicaltrials.gov as part of the EvaCol study (NCT04550156).
Adaptation of Enhanced Recovery After Surgery Protocol for Elective Gastrointestinal and Hepatopancreaticobiliary Surgeries for Tertiary Hospitals in Ethiopia: A Modified Delphi Study.
Shale WT, Sahilemariam AT, Nureta TH … +5 more , Moges TG, Keno EK, Demissie WR, Parker RK, Pilkington M
World J Surg · 2026 Apr · PMID 41771822 · Full text
BACKGROUND: Patients in low- and middle-income countries (LMICs) lack access to safe and affordable surgical and anesthetic care. Standardized evidence-based perioperative care recommendations and instruments to assess g...
BACKGROUND: Patients in low- and middle-income countries (LMICs) lack access to safe and affordable surgical and anesthetic care. Standardized evidence-based perioperative care recommendations and instruments to assess guideline compliance and results are needed. Enhanced recovery after surgery (ERAS) protocols are already in use and have evidence supporting its efficacy. Although ERAS programs have been beneficial in various fields of surgery, they are not widely used in developing countries compared to developed countries. Difference in dietary patterns, living standards, healthcare innovations, and sociodemographic indexes may preclude the direct adoption of existing protocols. The aim of this study is to adapt the ERAS protocol for gastrointestinal (GI) and hepatopancreaticobiliary (HPB) elective surgeries in a way that is feasible, sustainable, and effective for Ethiopian tertiary hospitals. METHODS: A modified Delphi process was used to devise an ERAS protocol for perioperative care of patients who undergo elective gastrointestinal and hepatopancreaticobiliary surgery from preexisting guidelines to fit the Ethiopian context. Thirty-two panelists were invited from target disciplines to participate in the Delphi after being sampled using purposive and snowballing sampling techniques. Two rounds were conducted until a consensus of 80% was reached on different components of the protocol. Data are presented in aggregate after deidentification. RESULTS: Thirty-two experts completed round one and 24/32 completed round two after which mature consensus was achieved. There are eight preoperative recommendations, seven intraoperative recommendations, and six postoperative recommendations that have been adapted from existing guidelines and six novel components. These guidelines were deemed appropriate for 7 types of surgical procedures. CONCLUSIONS: This adapted protocol consisting of 27 recommendations represents a critical step toward implementing standardized resource-appropriate ERAS pathways for GI and HPB surgeries in Ethiopia.
Influence of Language Barriers on Postoperative Recovery After Hepatobiliary and Pancreatic Surgery: A Retrospective Analysis.
Brodersen F, Hinz J, Friedl S … +7 more , Uzunoglu FG, Heumann A, Ghadban T, Wahib R, Welsch T, Hackert T, Khan-Gökkaya S
World J Surg · 2026 Apr · PMID 41771781 · Full text
BACKGROUND: Understanding health related information is crucial for informed consent and active participation in surgical care. Language barriers between patients and health care professionals pose the risk of misunderst...
BACKGROUND: Understanding health related information is crucial for informed consent and active participation in surgical care. Language barriers between patients and health care professionals pose the risk of misunderstandings and incomplete information exchange. This can significantly impair the quality of health care. Little is known about the impact of language barriers in hepatobiliary and pancreatic surgery and its consequences for postoperative recovery. METHOD: We performed a retrospective study in a University Medical Center in Germany assessing patients from 2020 to 2023 who underwent hepatobiliary or pancreatic surgery. Primarily we investigated whether length of stay (LOS) differed between patients with and without language barrier. Secondary we examined (Enhanced Recovery After Surgery) ERAS-compliance, preoperative education, postoperative mobilization habits, readmission, mortality, occurrence of complications, and certain postoperative complications between both groups. RESULTS: We included 848 patients in our study, 57 (6.5%) patients of whom had a language barrier. The length of stay did not differ significantly between the two groups (12.8 days; (CI 95%: 11.9-13.7) versus 14.4 days; (CI 95%: 11.1-17.7) (p = 0.320). The interpreting service in our cohort was rarely used overall. Patients with language barriers were younger (CI 95%: 46.7-56.7 vs. 59.9-61.9; p = 0.001) and differed in terms of their diagnoses (p = 0.001). We found no differences in ERAS Compliance, complication rate and mortality. Among secondary outcomes, patients with language barriers showed higher rates of specific postoperative complications, including pulmonary embolism (p = 0.026), and paralytic ileus (p = 0.047). Patients without language barriers were more likely to be mobilized on day of surgery (p = 0.009) and received preoperative ERAS-education more frequently (p = 0.035). CONCLUSION: Patients experiencing language barriers constitute a small group. Length of stay did not differ between the two groups. However, with respect to postoperative complications further investigation with larger patient cohorts is needed. Our findings emphasize the need for additional research and development of practical and patient-centered strategies to effectively address language barriers in clinical care.
Trends in Abdominal Aortic Aneurysm Management in France Between 2012 and 2021 From the French Nationwide Database: Treatment Modalities and Outcomes.
Mesnard T, Guery A, Lenne X … +3 more , Patterson BO, Bruandet A, Sobocinski J
World J Surg · 2026 Apr · PMID 41764638 · Publisher ↗
BACKGROUND: This study aimed to analyze recent trends of surgical management and early outcomes in the treatment of abdominal aortic aneurysm (AAA) from the French national Health Data System (SNDS). METHODS: This study...
BACKGROUND: This study aimed to analyze recent trends of surgical management and early outcomes in the treatment of abdominal aortic aneurysm (AAA) from the French national Health Data System (SNDS). METHODS: This study was a retrospective multicenter cohort study based on a national medico-economic database. All ruptured (rAAA) or intact AAA (iAAA) treated between 2012 and 2021 related to a primary procedure code for endovascular aneurysm repair (EVAR) or open aortic surgery (OAR) extracted from the SNDS were included. The modified Elixhauser score was used for grading patient's comorbidities. The primary endpoint was to describe the evolution of practices in France regarding the management of AAA and associated inhospital outcomes. Secondary endpoints included identifying predictors of inhospital mortality, assessing center volume, and analyzing overall survival during follow-up. RESULTS: Overall, 70,088 AAAs were included, comprising 5648 rAAA, 1579 (28%) treated with EVAR and 4069 (72%) with OAR, and 64,440 iAAAs, of which 41,916 (65%) underwent EVAR and 22,524 (35%) OAR. Over the study period, the proportion of EVAR increased significantly, whereas 30-day mortality remained stable, except for rAAA treated with EVAR, where it varied over time. EVAR was associated with lower 30-day mortality compared to OAR for both iAAAs (1.3% vs. 4.1%; p < 0.001) and rAAA (18.7% vs. 35.5%; p < 0.001). For both iAAA and rAAA, significant predictors of inhospital mortality included a higher Elixhauser comorbidity score, and age ≥ 80 years, female sex. Also, OAR was independently associated with higher inhospital mortality (adjusted OR 1.96 for iAAA and 2.22 for rAAA). A graphical association was observed between higher center volume and lower inhospital mortality. The estimated 8-year survival for iAAA was 46% after EVAR and 56% after OAR (log rank p = 0.002). CONCLUSIONS: The proportion of iAAA and rAAA treated with EVAR increased throughout the study period. Increased Elixhauser score, age over 80 years, and female sex are associated with increased postoperative mortality. Higher volume centers have improved postoperative mortality rates.
Delivery of Surgical Care by Local Actors in Chronic Conflict Settings: The Example of Bor State Hospital, South Sudan.
Matiop MP, Ratnayake AS, Wijekoon AL … +1 more , Wild HB
World J Surg · 2026 Apr · PMID 41761433 · Full text
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Different Knots, Same Outcome: Evaluating the Role of Surgical Technique on Biliary Anastomotic Strictures After Liver Transplantation.
Alwis SM, Torode R, Fink MA … +5 more , Furtado R, Lee E, Starkey G, Jones R, Perini MV
World J Surg · 2026 Apr · PMID 41760577 · Full text
BACKGROUND: Biliary anastomotic strictures (BAS) after liver transplant (LT) are a significant contributor to post-transplant morbidity. Although surgical technique has been proposed as a risk factor, accurate evaluation...
BACKGROUND: Biliary anastomotic strictures (BAS) after liver transplant (LT) are a significant contributor to post-transplant morbidity. Although surgical technique has been proposed as a risk factor, accurate evaluation of technique has been limited by inherent bias in conventional definitions for BAS. This study aimed to evaluate the incidence of clinically significant BAS (csBAS) with absorbable suture material and variable anastomotic suture technique in patients undergoing LT with duct-to-duct (DD) anastomosis. METHODS: A retrospective medical record review was conducted of adult patients undergoing LT at a single center between January 1st, 2000 and December 31st, 2023. Suture technique included continuous or interrupted alone, or a combined technique (continuous to posterior wall, interrupted anteriorly), while suture material was either absorbable or non-absorbable suture. Primary endpoint was the incidence of csBAS using a previously introduced surrogate marker, extended biliary dilatation programs (EBDP). Secondary endpoints included time to csBAS, incidence of bile leak, intervention rates with csBAS, and graft failure. Univariable and multivariable analyses were performed to identify independent associations with csBAS. Graft survival with csBAS was assessed using a Kaplan-Meier curve. RESULTS: A total of 842 patients underwent 864 LTs with DD anastomosis, of which 123 LTs (14.2%) developed csBAS. The mean age and follow up time were 53.3 ± 11.3 years and 7.0 ± 5.0 years, respectively. Year of transplant (p < 0.01), donor age (p = 0.01), suture material (p = 0.05) and suture technique (p = 0.01) were associated with csBAS on univariable analysis. On multivariable analysis, only donor age (adjusted OR 1.01, 95% CI 1.00-1.03, p = 0.03) was found to be independently associated, while absorbable suture material, suture technique and year of transplant were not associated. No difference was seen in bile leaks or graft failure with absorbable suture material nor anastomotic technique. No significant association was observed with time to csBAS, nor between csBAS and graft failure. CONCLUSION: Variable suture technique and suture material during DD reconstruction are associated with comparable outcomes following LT.
The Price of a Whipple: Predicting Hospital Charges Using Preoperative Patient Characteristics.
Bonthu SSR, Mukharjee S, Kong J … +3 more , Malo J, Osman H, Jeyarajah DR
World J Surg · 2026 Apr · PMID 41741389 · Full text
BACKGROUND: Whipple's pancreaticoduodenectomy (PD) is a highly complex hepato-pancreato-biliary (HPB) procedure associated with substantial morbidity and cost. Although postoperative complications are known to increase h...
BACKGROUND: Whipple's pancreaticoduodenectomy (PD) is a highly complex hepato-pancreato-biliary (HPB) procedure associated with substantial morbidity and cost. Although postoperative complications are known to increase healthcare expenditures, few studies have explored the association between preoperative factors and healthcare costs. This study evaluated the predictive value of baseline patient characteristics and preoperative laboratory tests in estimating index admission charges for Whipple's PD. METHODS: A retrospective review of 375 patients who underwent open PD (2018-2023) at a high-volume, non-university tertiary care center was conducted. Preoperative demographics, comorbidities, laboratory values, and index admission hospital charges were analyzed. Univariate logistic regression identified significant predictors of charges, and the Kruskal-Wallis test was used to assess the relationship between cumulative preoperative indicators and charges. RESULTS: Six preoperative laboratory values were significantly associated with increased charges: white blood cell count, hemoglobin, serum albumin, platelet count, prothrombin time, and hemoglobin A1c. A significant association was found between the cumulative preoperative indicators and hospital charges (p = 0.001). Patients with three or more unfavorable preoperative indicators incurred significantly higher charges compared to those with fewer than three indicators (p < 0.001). CONCLUSION: Preoperative laboratory tests, many of which are modifiable, are significant predictors of hospital charges in patients undergoing PD. A higher cumulative burden of adverse preoperative indicators is associated with higher financial charges. These findings support the use of preoperative risk stratification and optimization to enhance value-based care, guide resource allocation, and mitigate financial toxicity in high-risk surgical patients.
Clinical and Inflammatory Predictors of False-Negative Ultrasound in Children With Suspected Appendicitis: A Prospective Cohort Study.
Zouari M, Belhajmansour M, Hbaieb M … +4 more , Jarboui O, Tounsi MK, Dhaou MB, Mhiri R
World J Surg · 2026 Apr · PMID 41731339 · Publisher ↗
BACKGROUND: Ultrasound (US) is the first-line imaging test for suspected pediatric acute appendicitis (AA), yet false-negative examinations remain a concern and may delay diagnosis. Clinical and inflammatory factors may...
BACKGROUND: Ultrasound (US) is the first-line imaging test for suspected pediatric acute appendicitis (AA), yet false-negative examinations remain a concern and may delay diagnosis. Clinical and inflammatory factors may influence this risk but have not been well defined. The aim of this study was to identify predictors of false-negative US in children with suspected AA. METHOD: We conducted a prospective cohort study from 1 January 2022 to 31 October 2025 including children presenting with suspected AA whose initial abdominal US was negative. Multivariable logistic regression identified independent predictors of false-negative US. RESULTS: Among 1174 children evaluated, 610 had a negative US and were included in the analysis. Of these, 54 were ultimately diagnosed with AA (false-negative US). The median age was 10 years and males accounted for 51.3% of the cohort. On univariable analysis, male sex, symptom duration > 48 h, Pre-hospital antibiotic administration, admission temperature > 38°C, Alvarado score ≥ 5, white blood cell count > 10 × 10/L, and C-reactive protein (CRP) ≥ 10 mg/L were significantly associated with false-negative findings. In multivariable analysis, three factors remained independently predictive: Alvarado score ≥ 5 (OR 10.53; 95% CI 4.49-24.70; p < 0.001), symptom duration > 48 h (OR 4.54; 95% CI 2.18-9.45; p < 0.001), and CRP ≥ 10 mg/L (OR 2.25; 95% CI 1.03-4.92; p = 0.042). CONCLUSION: False-negative US occurred in 8.9% of children with suspected AA. Higher Alvarado scores, prolonged symptoms, and elevated CRP were independently associated with missed AA despite negative imaging.
Does When We Operate Matter? Revisiting Surgical Timing in Pancreatic Trauma.
Kang SC, Kuo YC, Tee YS … +4 more , Liao CH, Hsieh CH, Fu CY, Bokhari F
World J Surg · 2026 Apr · PMID 41731329 · Publisher ↗
PURPOSE: Pancreatic injuries are rare but are associated with high morbidity and mortality, particularly when diagnosis or treatment is delayed. However, the optimal timing for surgical intervention remains unclear. This...
PURPOSE: Pancreatic injuries are rare but are associated with high morbidity and mortality, particularly when diagnosis or treatment is delayed. However, the optimal timing for surgical intervention remains unclear. This study aimed to assess the impact of surgical timing on outcomes of hemodynamically stable patients with blunt pancreatic trauma using data from the Trauma Quality Improvement Program (TQIP). METHODS: This retrospective study analyzed TQIP data (2017-2019) for hemodynamically stable patients with blunt pancreatic injuries who underwent pancreatic surgery. Outcomes including mortality, complications, hospital length of stay (LOS), intensive care unit (ICU) LOS, and ventilator days were evaluated based on the time (in hours) from emergency department (ED) arrival to surgery. Patients were categorized into two groups based on surgical timing: within 48 h or beyond 48 h of ED arrival. Multivariate logistic regression was performed to identify independent predictors of complications. RESULTS: Among the 703 patients included in the study, a longer interval from ED arrival to surgery was linearly associated with increased hospital LOS, ICU LOS, and duration of mechanical ventilation. Multivariable analysis revealed that delayed surgery (> 48 h) was an independent predictor of complications (Odds Ratio = 3.831; p = 0.002). Interestingly, mortality rates did not differ significantly between the early and delayed intervention groups. Furthermore, a subgroup analysis of patients treated within the initial 48-h window showed that the precise timing of surgery within this period did not significantly impact complication rates (p = 0.256). CONCLUSIONS: Pancreatic surgery delayed beyond 48 h significantly increases the risk of complications and prolongs hospitalization. When performed within this time frame, additional delay appears to have minimal impact, allowing time for thorough evaluation and surgical planning.
Operating Together: Challenges and Solutions for Sustaining Impactful Global Health Partnerships From 18 years of the RCSI/COSECSA Surgical Training Collaboration.
O'Flynn E, Fualal JO, Magee D … +8 more , Mulwafu W, Brocato L, Bekele A, Geraghty J, Philipo GS, Borgstein E, Puyana JC, Chikoya L
World J Surg · 2026 Apr · PMID 41725554 · Full text
BACKGROUND: International support for surgery and healthcare in low-resource settings is primarily channeled through partnerships. To be truly impactful, such partnerships must endure long enough to mature, however longe...
BACKGROUND: International support for surgery and healthcare in low-resource settings is primarily channeled through partnerships. To be truly impactful, such partnerships must endure long enough to mature, however longevity appears to be rare. Analysis of the challenges faced by successful long-term partnerships and how they were overcome may offer useful lessons for newer and aspiring global health partnerships. METHODS: The surgical training collaboration between the Royal College of Surgeons in Ireland and the College of Surgeons of East, Central, and Southern Africa has continued for 18 years and has delivered significant benefits for both partner institutions. Challenges faced by the collaboration and solutions to these challenges were elicited from key stakeholders in each college through an inductive approach. RESULTS: Challenges and solutions reported were grouped under four domains: power, operational capacity, changing needs, and maximizing impact. A set of governance structures are proposed to mitigate power disparities between partners and between individuals. Leveraging nonclinical staff members to support development of back-office systems increases local operational capacity to effectively engage in partnership activities. Constant change is a challenge for partnerships, which must both be accepted and planned for. The impact of work done through partnerships can be multiplied by expanding the collaboration to other comparable or synergistic institutions and making resources available open access. CONCLUSIONS: The RCSI/COSECSA collaboration program demonstrates that, over time, global health partnerships can play a transformational role in improving health outcomes in low-resource settings, while also benefitting high-income partners. Analysis of the development of the collaboration offers practical strategies for the development of other global health partnerships.
Invited Commentary on: Operating Together: Challenges and Solutions for Sustaining Impactful Global Health Partnerships From 18 Years of the RCSI/COSECSA Surgical Training Collaboration.
Sanfey H
World J Surg · 2026 Apr · PMID 41724701 · Publisher ↗
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Management of Burn Injuries in Brazil by Total Body Surface Area Affected.
Melo PHM, Neno JOG, Mesquita CF … +4 more , Salomão SL, Kratky L, Mooney DP, Camargo CP
World J Surg · 2026 Apr · PMID 41724685 · Full text
INTRODUCTION: Major Burns are life-threatening injuries that cause approximately 2500 deaths per year in Brazil. The Brazilian healthcare system has 80 hospitals with Burn Care Units (BCUs). However, non specialized hosp...
INTRODUCTION: Major Burns are life-threatening injuries that cause approximately 2500 deaths per year in Brazil. The Brazilian healthcare system has 80 hospitals with Burn Care Units (BCUs). However, non specialized hospitals also manage major burn injuries. The aim of this study was to evaluate differences in burn management and outcomes between BCUs and hospitals without BCUs. METHODS: Patients with an ICD-10 code for a burn injury were identified in a Brazilian discharge database (DATASUS) from 2015 to 2023, were categorized by total body surface area (TBSA). Hospitalizations were compared based on whether they occurred in a BCU or not, adjusting for TBSA, age, and sex. RESULTS: From 2015 to 2023, there were 22,627 burn injury hospitalizations in Brazil. Of these, 14,187 (62.71%) were treated in Burn Care Units (BCUs), 6553 (28.96%) in non-BCU hospitals with plastic surgery services, and 1887 (8.34%) in non-BCU hospitals without plastic surgery. Mean TBSA was highest in non-BCUs with plastic surgery (42.0%) compared to BCUs (35.2%) and non-BCUs without plastic surgery (34.4%; p < 0.001). Mortality occurred in 9.87% of hospitalizations at BCUs, 7.78% at non-BCUs with plastic surgery, and 4.45% at non-BCUs without plastic surgery. After adjusting for TBSA, age, and sex, non-BCU facilities showed lower odds of mortality (non-BCU with plastic surgery: aOR 0.49, 95% CI 0.44-0.56; non-BCU without plastic surgery: aOR 0.36, 95% CI 0.28-0.47; both p < 0.001). Transfers to other facilities occurred in 1.28% (182/14,187) of BCUs, 16.26% of non-BCUs with plastic surgery, and 29.61% (559/1887) of non-BCUs without plastic surgery. Surgical management rates were highest in BCUs, intermediate in non-BCUs with plastic surgery, and lowest in non-BCUs without plastic surgery. CONCLUSION: Hospitalizations in BCUs were associated with lower transfer rates and higher rates of surgical intervention. However, BCUs also reported higher mortality rates, suggesting that they likely provided care to the most severely injured burn patients until their final outcomes, whether recovery or death. Despite non-BCUs with plastic surgery treating burns with higher mean TBSA, BCUs had higher mortality, suggesting that BCUs receive patients with unmeasured risk factors beyond TBSA and serve as referral centers for the most complex cases.
Comparative Outcomes of Two Non-Crosslinked Porcine Acellular Dermal Matrices in Complex Abdominal Wall Reconstruction: A Randomized Controlled Trial and an Observational Cohort Study.
Elemosho A, Sarac BA, Olson MA … +5 more , Khansa I, Hackenberger PN, Narula V, Eiferman DS, Janis JE
World J Surg · 2026 Apr · PMID 41720620 · Full text
BACKGROUND: Biologic mesh has historically been used for ventral hernia repairs (VHR) in contaminated fields in an off-label fashion due to early evidence suggesting that they may be able to withstand these conditions mo...
BACKGROUND: Biologic mesh has historically been used for ventral hernia repairs (VHR) in contaminated fields in an off-label fashion due to early evidence suggesting that they may be able to withstand these conditions more favorably than synthetic mesh. This study aims to compare outcomes of two non-crosslinked porcine acellular dermal matrices-XenMatrix (Bard, Covington, GA) and Strattice (LifeCell Corporation, Bridgewater, NJ) used in VHR. METHODS: Patients who were undergoing elective open VHR were randomized to receive either XenMatrix or Strattice mesh (randomized controlled trial-RCT cohort). An additional cohort of patients were recruited in a retrospective observational study cohort. Surgical site occurrence (SSO) was the primary outcome evaluated with hernia recurrence being a secondary outcome measure. Simple and multivariate logistic regression analyses were conducted separately for the RCT and observational cohorts. RESULTS: Forty-six patients were randomized into the RCT cohort, and an additional 20 patients were recruited into the observational study cohort. There was no difference in baseline characteristics between the two mesh groups in both the RCT and observational cohorts. In the RCT cohort, the 6-week SSO rate was significantly higher for XenMatrix (36.7%) than Strattice (6.3%) (p = 0.03), and on multivariate analysis, XenMatrix was associated with higher 6-week SSO risk than Strattice [OR: 19.5 (95% CI: 2.3-523.7) and p = 0.02]. However, in the observational cohort, the rate of 6-week SSO was similar for both XenMatrix (50.0%) and Strattice (33.3%) (p = 0.46) as well in the multivariate analysis [OR: 6.6 (95% CI: 0.4-324.6) and p = 0.23]. Finally, random effect meta-analysis of 6-week risk of SSO of both RCT and observational cohort showed that XenMatrix is associated with higher 6-week SSO risk than Strattice [OR: 12.5 (95% CI: 1.8-89.2) and I = 0% p = 0.012]. CONCLUSION: Our study showed that XenMatrix may be associated with higher risk of early SSO compared to Strattice. This underscores the importance of more head-to-head mesh comparison to optimize outcomes following VHR. TRIAL REGISTRATION: NCT02228889 (www. CLINICALTRIALS: gov).
The Feasibility and Safety of Prehospital Whole Blood Administration for Patients in Hemorrhagic Shock in Isolated Regions of Colorado: Assessment of the First 6 Months.
Branney M, Mattox S, Lynch J … +4 more , Branney S, Harwood L, Ryznar R, Balogh ZJ
World J Surg · 2026 Apr · PMID 41720600 · Full text
The aim of this pilot study is to summarize evidence from the implementation of prehospital whole blood programs in rural Colorado with focus on the feasibility and safety of whole blood in rural areas with prolonged tra...
The aim of this pilot study is to summarize evidence from the implementation of prehospital whole blood programs in rural Colorado with focus on the feasibility and safety of whole blood in rural areas with prolonged transport times to definitive care.
Mind the Gap: Reported Versus Observed Surgical Safety Checklist Time-Out Adherence in the Hybrid Operating Room.
Rennie N, Soenens G, Meyns I … +5 more , Legein Z, Vlerick P, Vanpeteghem C, Bruneel B, Van Herzeele I
World J Surg · 2026 Apr · PMID 41714561 · Publisher ↗
BACKGROUND: Endovascular surgery is a high-risk specialty where safety protocols are vital to prevent adverse events. Although WHO Surgical Safety Checklist (SSC) implementation showed significantly reduced overall surgi...
BACKGROUND: Endovascular surgery is a high-risk specialty where safety protocols are vital to prevent adverse events. Although WHO Surgical Safety Checklist (SSC) implementation showed significantly reduced overall surgical morbidity and mortality, more recent studies have shown mixed results. This study aims to observe real-world adherence to the time-out phase of the WHO SSC in a hybrid Operating Room (OR) and to evaluate the Checklist Performance Observation for ImprovemeNT (CheckPOINT) tool. METHODS: This single-center retrospective observational study of prospectively collected data included endovascular procedures performed in a hybrid OR between May 2021 and December 2022. In October 2021, paper SSCs were replaced with electronic SSCs. Procedures were recorded using the OR Black Box (Surgical Safety Technologies Inc., Toronto, Canada). Time-out evaluation of recorded procedures was performed using the CheckPOINT tool. RESULTS: Time-out was initiated in 87.7% (n = 186/212) of all procedures. Average overall reported completion was 95.5% with a median of 15 completed items. Average overall observed completion was 46.8% with a median of seven items completed. Observed adherence was significantly lower than reported adherence for all but one item, "Patient Name". Experienced surgeons were significantly less likely to initiate (p = 0.033) and thoroughly complete (p < 0.001) the checklist. CheckPOINT engagement scored significantly lower than adherence, communication effectiveness, and attitude. CONCLUSIONS: Video-based observation reveals significant discrepancies between observed and reported SSC adherence. These results highlight the need for improved SSC assessment and implementation, and suggest that combining reliable tools with video recording can enable data-driven quality improvement initiatives.
Two-Stage Hepatectomy for Bilobar Colorectal Liver Metastases: Outcomes According to Liver Transplant Selection Criteria.
Addeo P, Canali G, Narita M … +5 more , Marchitelli I, Paul C, De Mathelin P, Faitot F, Bachellier P
World J Surg · 2026 Apr · PMID 41714290 · Publisher ↗
BACKGROUND: Bilobar colorectal liver metastases (CRLMs) are often addressed through a two-stage hepatectomy (TSH) strategy. The outcomes of TSH according to the presence of criteria used for Liver Transplantation (LT) fo...
BACKGROUND: Bilobar colorectal liver metastases (CRLMs) are often addressed through a two-stage hepatectomy (TSH) strategy. The outcomes of TSH according to the presence of criteria used for Liver Transplantation (LT) for unresectable CRLMs has yet to be investigated. METHODS: We conducted a retrospective review of 100 consecutive patients treated with a TSH. Patients were categorized based on the presence of ideal LT criteria, and compared. The selection criteria included: (1) absence of extrahepatic disease, (2) no metastatic lymph nodes in the hepatic pedicle, (3) tumor diameter less than 55 mm, (4) no disease progression before or between the two surgical stages, and (5) preoperative serum carcinoembryonic antigen (CEA) levels below 80 μg/L. RESULTS: Based on the selection criteria, 30 patients filled LT criteria, while 70 patients fell outside these criteria. The median overall survival and the survival rates at 1, 3, and 5 years were significantly higher for patients within the LT criteria, with median overall survival of 57 months, and survival rates of 93%, 71%, and 49%, respectively, compared to 27.2 months, 79%, 41%, and 19% for those outside the criteria (p < 0.001). Characteristics of patients in the two groups were largely similar, except that the transplant-criteria group was younger and had a lower Fong's score. CONCLUSIONS: Patients undergoing TSH for bilobar CRLMs, ideally selected based on strict LT criteria, experienced very favorable long-term survival outcomes. The potential role of LT for bilobar CRLMs addressed through a TSH strategy warrant further investigation in a randomized study.
Transposition of an Aberrant Right Hepatic Artery on the Gastroduodenal Artery During Pancreatoduodenectomy for Cancer: Technique and Outcomes at a Specialized Vascular Pancreatic Surgery Center.
Bachellier P, Addeo P
World J Surg · 2026 Apr · PMID 41711678 · Publisher ↗
An aberrant right hepatic artery (rHA) arising from the superior mesenteric artery (SMA) is present in about 10%-23% of the patients. There has been extensive debate about oncologic significance related to the presence o...
An aberrant right hepatic artery (rHA) arising from the superior mesenteric artery (SMA) is present in about 10%-23% of the patients. There has been extensive debate about oncologic significance related to the presence of rHA, during pancreatoduodenectomy (PD) for pancreatic adenocarcinomas, and some authors suggested that rHA should be sacrified to avoid opening of peritumoral planes. Once rHA had been resected, three different surgical strategies have been described: resection without reconstruction, preoperative embolization followed by resection without reconstruction, and resection with arterial reconstruction. In this technical report, we describe our institutional experience with transposition of rHA on the gastroduodenal artery (GDA) after resection of aberrant rHA at our specialized pancreatic vascular surgery unit. This technique, used in 22 consecutive patients, entails direct reimplantation of the rHA into the GDA stump using 8/0 sutures after having trimmed anastomotic ends by spatulation. Technical advantages and drawbacks are presented and discussed. Transposition of an rHA on the GDA represents a valid surgical alternative for arterial reconstruction during PD in specialized vascular pancreatic surgery center.
Incidence, Risk Factors, and Time Trends for Bile Leakage After Cholecystectomy for Gallstone Disease-Results From a Population-Based Cohort Study.
Mirzaei L, Bergenfeldt H, Öberg S … +1 more , Andersson B
World J Surg · 2026 Apr · PMID 41711670 · Full text
BACKGROUND: Bile leakage is a severe complication after cholecystectomy and is associated with an increased risk of morbidity and mortality. The aim of this study was to evaluate the incidence of bile leakage post-cholec...
BACKGROUND: Bile leakage is a severe complication after cholecystectomy and is associated with an increased risk of morbidity and mortality. The aim of this study was to evaluate the incidence of bile leakage post-cholecystectomy and to identify potential risk factors and their association with changes in the incidence of bile leakage over time. METHODS: Demographic and perioperative data of all patients who underwent cholecystectomy in Sweden between 2006 and 2019 were retrieved from the Swedish Registry for Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography (GallRiks). Data on the occurrence of bile leakage within 30 days were recorded and risk factors were identified using uni- and multivariable logistic regression analyses. RESULTS: Bile leakage occurred in 1738 of the 152,413 patients who underwent cholecystectomy, resulting in an overall incidence of 1.14%. The incidence was relatively consistent over the study period. ASA-score II and III, emergent surgery, open cholecystectomy, conversion from laparoscopic to open technique, bleeding requiring intervention, not performing, or incomplete intraoperative cholangiography (IOC) were identified as risk factors for bile leakage. The proportion of ASA II and ASA III patients undergoing cholecystectomy increased over time (p < 0.001). There was also a significant increase in the proportions of emergent cholecystectomies from 27.9% to 43.6% (p < 0.001) and surgery for complicated gallstone disease from 35.4% to 52.5% (p < 0.001) during the study period. CONCLUSION: The incidence of bile leakage was relatively consistent over the study period despite an observed increase in the prevalence of identified risk factors of bile leakage.
Comparison of Perfusion Level of Gastric Tube During Esophagectomy: Indocyanine Green Fluorescence Imaging Versus Doppler Method.
Tane Y, Miyata K, Sugita S … +1 more , Ebata T
World J Surg · 2026 Apr · PMID 41711654 · Publisher ↗
BACKGROUND: Indocyanine green (ICG) fluorescence imaging has gained popularity for preventing anastomotic leakage (AL), which was previously evaluated using the Doppler method. However, no study has directly compared the...
BACKGROUND: Indocyanine green (ICG) fluorescence imaging has gained popularity for preventing anastomotic leakage (AL), which was previously evaluated using the Doppler method. However, no study has directly compared the use of Doppler and ICG fluorescence imaging simultaneously. When introducing ICG fluorescence imaging in our department, we also used the conventional Doppler method to confirm the validity of its results. We hypothesized that the length of the available gastric tube might differ depending on the evaluation method potentially affecting the risk of AL and the choice of surgical technique. This study evaluated the usefulness of ICG fluorescence imaging and tested this hypothesis. METHODS: We retrospectively analyzed the data of 248 patients with esophageal cancer who underwent subtotal esophagectomy with gastric tube reconstruction and cervical anastomosis. After excluding 17 cases, 231 patients were included (Doppler-only group, n = 175; Doppler + ICG group, n = 56). In the Doppler + ICG group, changes in the available gastric tube length were evaluated by directly comparing Doppler-based and ICG-based perfusion assessments. To assess the clinical significance of these changes, surgical outcomes, including anastomotic technique and postoperative complications, were compared with those in the Doppler-only group. RESULTS: In the Doppler + ICG group, the available gastric tube length was extended in 37 cases, unchanged in 15 cases, and shortened in 4, showing that extension was significantly more frequent than other changes (p < 0.001). The anastomosis rate with a circular stapler was significantly higher in the Doppler + ICG group (89%) than in the Doppler-only group (61%; p < 0.001). The incidence of Clavien-Dindo grade IIIa AL was significantly lower in the Doppler + ICG group (3.6%) than in the Doppler-only group (15%; p = 0.03). CONCLUSION: By extending the available gastric tube length, ICG fluorescence imaging was associated with a lower incidence of AL compared with the Doppler method, suggesting it has the potential to improve surgical outcomes and patient safety.
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