Presser E, Al-Hajj S, Michael M
… +7 more, Moustafa M, Farhat M, El Asmar K, Farran S, Nasrallah A, Shahrour M, Mowafi H
World J Surg
· 2026 Jun · PMID 42012847
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BACKGROUND: The Syrian conflict has displaced over 14 million people since 2011, with Lebanon hosting over 1.5 million Syrian refugees, the highest per capita worldwide. Displaced Syrians living in informal settlements f...BACKGROUND: The Syrian conflict has displaced over 14 million people since 2011, with Lebanon hosting over 1.5 million Syrian refugees, the highest per capita worldwide. Displaced Syrians living in informal settlements face significant unmet surgical needs, yet data on their access to care remains limited. To identify potential surgical conditions among displaced Syrians in Lebanon and assess access to and barriers to surgical care. METHODS: Cross-sectional, cluster-sample survey has been conducted over a period of 9 months (August 2020-April 2021). Household- and individual-level data were collected from informal refugee settlements across three Lebanese governorates. Heads of household (n = 1468) and two individuals per household (n = 2936) were interviewed to assess surgical conditions, care-seeking, barriers to access, and associated functional and psychosocial impacts. RESULTS: Among 2936 respondents from 1468 households, 4192 potential surgical conditions were reported. Wounds (55.2%), followed by deformities (35.8%), and masses (7.1%) were most common. 86.2% sought medical care, of which surgery was recommended in 19.0%. Of those, only 34.8% underwent surgery. Financial burden was the most cited barrier. Impacts included inability to work (20.8%), dependence in daily activities (7.1%), and shame (5.8%). Household mortality over 12 months was 6.4%, equivalent to 32 deaths per 1000 population. Among deceased, surgical needs suggested in reported conditions (e.g., masses, injury, deformities); only 19.6% received surgical care before death. CONCLUSIONS: Displaced Syrians in Lebanon report high unmet surgical needs, with wounds and deformities most common. Financial barriers limited surgical access, contributing to impaired quality of life and increased mortality. The surgical burden among refugees in Lebanon represents a critical public health concern, underscoring the need for equitable access to essential surgical care.
World J Surg
· 2026 Jun · PMID 42012770
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BACKGROUND: Acute cholecystitis is a common surgical emergency. In high-risk patients, percutaneous cholecystostomy (PC) is often used as a temporizing measure before interval cholecystectomy (IC). The optimal timing of...BACKGROUND: Acute cholecystitis is a common surgical emergency. In high-risk patients, percutaneous cholecystostomy (PC) is often used as a temporizing measure before interval cholecystectomy (IC). The optimal timing of IC remains uncertain. This study evaluates outcomes of early versus late IC following PC. METHODS: PubMed, Embase, The Cochrane Library, and Scopus were systematically searched from inception to November 2025 for studies comparing early and late IC after PC. Primary outcomes were perioperative complications. Secondary outcomes included intraoperative duration, blood loss, postoperative length of stay (LOS), and catheter-related complications. Subgroup analyses were performed using 1-month and 8-week interval cut-offs. RESULTS: Twelve retrospective studies comprising 10,328 patients (early n = 8690; late n = 1638) were included. Baseline characteristics were comparable, although BMI was slightly lower in the early IC group (MD -0.26, 95% CI: -0.50, -0.03, p = 0.03). Overall postoperative complications, major perioperative complications, bile duct injury, subtotal cholecystectomy, and mortality were similar between groups. Conversion to open surgery, operative duration, and postoperative LOS were also comparable. Intraoperative blood loss was greater in the early IC group (MD 16.65, 95% CI: 2.24, 31.06, p = 0.02). Early IC was associated with fewer catheter-related complications (RR 0.38, 95% CI: 0.22, 0.66, p = 0.005). Risk ratio analysis suggested increased intra-abdominal abscess in the early IC group; however, risk difference analysis showed only a small absolute increase, indicating limited clinical significance. In subgroup analysis using a 1-month cut-off, early IC was associated with significantly fewer postoperative complications (RR 0.67, 95% CI: 0.56, 0.79, p < 0.00001). CONCLUSION: Early IC may confer clinical benefit in appropriately selected patients, with fewer postoperative and catheter-related complications despite risk of greater intraoperative blood loss. A 1-month threshold may represent a pragmatic definition of late IC. A risk-stratified approach remains essential, and further prospective studies are warranted.
Wang Y, Ding H, Huang X
… +5 more, Guo S, Liu X, Wang X, Xie H, Yang T
World J Surg
· 2026 Jun · PMID 42009562
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OBJECTIVE: To determine the incidence and risk factors associated with postoperative stump complications in diabetic patients who underwent amputation using a nationwide cohort study. METHOD: A retrospective cohort analy...OBJECTIVE: To determine the incidence and risk factors associated with postoperative stump complications in diabetic patients who underwent amputation using a nationwide cohort study. METHOD: A retrospective cohort analysis was conducted using the Nationwide Inpatient Sample (NIS) database from 2010 to 2019. Patients were categorized into two groups based on the presence or absence of stump complications. Patient demographics (age, sex, and race), hospital characteristics (admission type, payer status, bed size, teaching status, location, and region), length of stay (LOS), total hospitalization charges, in-hospital mortality, comorbidities, and perioperative complications were analyzed. Risk factors were identified using multivariate logistic regression analysis, incorporating patient demographics, hospitalization parameters, economic indicators, and comorbidities. RESULTS: A total of 101,015 patients were included, of whom 6547 developed stump complications, yielding an overall incidence of 6.5%. Patients with stump complications had longer hospital stays (7 vs. 5 days, p < 0.0001) and higher total hospitalization charges ($52,248 vs. $40,226, p < 0.0001) than those without complications. Multivariable analysis showed that Black race, Hispanic ethnicity, Native American heritage, larger hospital bed size, greater comorbidity burden, weight loss, peripheral vascular disease, blood transfusion, hemorrhage/hematoma, wound dehiscence/non-healing, and wound infection were independently associated with higher odds of stump complications. CONCLUSION: Several demographic, hospital-level, and clinical factors were associated with postoperative stump complications in diabetic patients undergoing amputation. These findings may help improve perioperative risk stratification and identify patients who warrant closer postoperative monitoring.
Mock C, Hardcastle TC, Gaarder C
… +5 more, Gupta A, Gyedu A, Joshipura M, Steyn E, Essential Trauma Care revision author group
World J Surg
· 2026 Jun · PMID 42008664
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Injury is a major cause of death and disability globally, with the highest burden in low- and middle-income countries (LMICs). Strengthening the organization and planning for trauma care (care of the injured) can improve...Injury is a major cause of death and disability globally, with the highest burden in low- and middle-income countries (LMICs). Strengthening the organization and planning for trauma care (care of the injured) can improve care and lower mortality. In 2004, the International Association for Trauma Surgery and Intensive Care (IATSIC) and the World Health Organization (WHO) co-published the Guidelines for Essential Trauma Care (EsTC). The goals of the Guidelines for EsTC were to promote affordable and achievable standards for trauma care resources that could realistically be achievable at health care facilities anywhere in the world, even in the lowest-income settings. By so doing, IATSIC and WHO hoped to strengthen trauma care services globally, especially in LMICs. Since its publication in 2004, the Guidelines for EsTC have been extensively cited. More importantly, there have been documented, published examples of implementation of the Guidelines in 48 countries worldwide, spanning all economic levels from low-income to high-income countries. The current publication represents the first update and revision of the Guidelines for EsTC. As with the first edition, the current edition contains resource tables listing human resources (skills, training, staffing) and physical resources (equipment and supplies) that should be available at varying health care facilities in all countries, ranging from clinics to first-level hospitals to second-level hospitals to tertiary hospitals. These resource tables cover the breadth of trauma care, including initial management and resuscitation to definitive care of most major injuries. As with the original version, these resource tables are meant to be flexible to allow adjustments as needed to tailor them based on local health care system resources and capabilities. The Guidelines focus on fixed facilities, as other publications address prehospital care.
Zhang D, Brucchi F, Colombo C
… +2 more, Dionigi G, Wan L
World J Surg
· 2026 Jun · PMID 42002891
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BACKGROUND: Transoral endoscopic thyroidectomy via the vestibular approach (TOETVA) provides a scarless alternative to open thyroidectomy but entails specific risks, particularly mental nerve injury. How patients weigh t...BACKGROUND: Transoral endoscopic thyroidectomy via the vestibular approach (TOETVA) provides a scarless alternative to open thyroidectomy but entails specific risks, particularly mental nerve injury. How patients weigh these risks against cervical scarring and wound morbidity from open surgery remains unclear. METHODS: In this prospective cross-sectional study at a high-volume endocrine surgery centre, 68 consecutive TOETVA patients completed pre- and postoperative surveys on informational priorities, risk recall, and satisfaction. To contextualize TOETVA-specific morbidity and the informational trade-offs faced by patients, we prospectively identified a contemporary open thyroidectomy cohort and applied 1:1 nearest-neighbor matching by age, sex, indication, and extent of resection, thereby supporting comparative inferences beyond simple descriptive contrasts. All patients received structured, multimodal counselling with centre-specific numerical risks, and an additional questionnaire assessed how risk information influenced procedure choice and willingness to reconsider preferences under alternative risk scenarios. RESULTS: TOETVA patients rated procedural details, TOETVA-specific risks-particularly mental nerve injury-and general thyroidectomy complications as highly important (≥ 4.7/5), with recall and satisfaction exceeding 90%. In the TOETVA cohort, transient recurrent laryngeal nerve palsy occurred in 7.4% and transient hypocalcaemia in 6.1%, with no permanent events; mental nerve paraesthesia affected 30.9%, persisting at 6 months in 4.4%. Matched open thyroidectomy patients showed comparable transient RLN palsy (5.9%) and hypocalcaemia (6.1%), but had 1.5% permanent RLN palsy, 1.5% permanent hypocalcaemia, no mental nerve injury, and 7.4% cervical wound complications. Overall, 94% of patients considered precise numerical risk estimates essential, and 88% reported that comparative risk information strongly influenced technique choice, with many indicating they would reconsider preferences if rates of persistent mental nerve symptoms or neck-scar morbidity changed. CONCLUSIONS: Patients prioritise quantified, centre-specific risk information and use it to balance the cosmetic benefits of TOETVA against mental nerve morbidity and the wound risks of open surgery, supporting routine integration of audited complication rates into shared decision-making.
Nishi M, Wada Y, Takasu C
… +5 more, Tokunaga T, Nakao T, Kashihara H, Yoshimoto T, Shimada M
World J Surg
· 2026 Jun · PMID 41989150
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AIM: Conversion surgery (CS) for unresectable advanced gastric cancer (GC; clinical stage IVb) has increased in recent years owing to advances in drug therapy. However, little is known about CS following combination trea...AIM: Conversion surgery (CS) for unresectable advanced gastric cancer (GC; clinical stage IVb) has increased in recent years owing to advances in drug therapy. However, little is known about CS following combination treatment with immune checkpoint inhibitors (ICIs) and chemotherapy. METHODS: We conducted a retrospective cohort study of patients initially unresectable metastatic GC. We treated 36 patients with initially unresectable metastatic GC. Thirty-four patients received combination treatment with ICIs and chemotherapy, 11 of whom underwent CS. We evaluated their short-term and long-term surgical outcomes. RESULTS: Among patients who underwent CS, six were male and five female, and the median (interquartile range) age was 71 (47-75) years. All patients started first-line therapy with S-1 plus oxaliplatin combined with nivolumab, and two patients underwent surgery after second-line treatment with ramucirumab and nanoparticle albumin-bound paclitaxel. There were four open, two laparoscopic, and five robotic surgeries. The median operative time was 348 (321-354) minutes, blood loss was 16 (10-30) mL, and number of retrieved lymph nodes was 38 (27-44); there were no cases of conversion to laparotomy. R0 resection was achieved in all patients. And postoperative pathology was complete response; three patients, ypStage I; four patients, II; three patient, III; zero patient IV; one patient. ICI and chemotherapy efficacy was Grade 1 in four patients, Grade 2 in two patients, and Grade 3 in five patients. Overall 2-year survival was 90.0% for those who underwent CS. CONCLUSION: CS following combination treatment with ICI and chemotherapy may be promising for initially unresectable metastatic GC.
World J Surg
· 2026 Jun · PMID 41989135
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PURPOSE: There is limited data surrounding inguinal hernias repairs (IHR) and associated outcomes in the Republic of Ireland. Minimally invasive approaches offer shorter recovery times and lower risk of chronic pain at t...PURPOSE: There is limited data surrounding inguinal hernias repairs (IHR) and associated outcomes in the Republic of Ireland. Minimally invasive approaches offer shorter recovery times and lower risk of chronic pain at the expense of steeper learning curves which may limit widespread adoption. This study aims to qualify the current landscape in IHR in the Republic of Ireland (ROI), and to examine peri-operative outcomes. METHODS: All IHRs performed in the ROI between January 2017 and September 2024 were identified retrospectively from the National Quality Assurance and Improvement System (NQAIS) database. Anonymized patient characteristics and quality indices were extracted for analysis. RESULTS: A total of 20,845 IHR, 72% open an 28% laparoscopic, were performed across 39 public hospitals. Patients undergoing open IHR were significantly older (3.89, p < 0.001), had a significantly longer length of stay (LOS) (0.227, p < 0.001) and were more likely to be readmitted within 7 (χ [1, N = 20,845] = 4.24, p = 0.039) and 30 days (χ [1, N = 20,845] = 4.08, p = 0.043). LOS in low volume centers was significantly longer than high volume centers (0.361, p < 0.001). Patients in high volume centers were less likely to have an emergency admission in 1 year (χ [1, N = 20,845] = 114, p < 0.001). Regression analysis demonstrated that older patients (Estimate 0.0127, OR 1.013, p < 0.001), emergency repairs (Estimate 0.5615, OR 1.753, p < 0.001) and higher ASA grades (Estimate 0.4672, OR 1.596, p < 0.001) to be independently associated with having an open as opposed to laparoscopic IHR. CONCLUSION: Despite advances in laparoscopy, open IHR remain the predominant treatment approach in the ROI. Older, more co-morbid patients and those undergoing emergency repairs are far more likely to have an open IHR.
World J Surg
· 2026 Jun · PMID 41989019
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BACKGROUND: Anal fissure, a common anorectal disorder, usually presents with pain, bleeding, and itching during or after defecation. These fissures can be classified as acute, chronic, or acute on chronic, depending on t...BACKGROUND: Anal fissure, a common anorectal disorder, usually presents with pain, bleeding, and itching during or after defecation. These fissures can be classified as acute, chronic, or acute on chronic, depending on the duration of symptoms (6 weeks or less for acute and more than 6 weeks for chronic). Traditional treatment involves medical interventions to reduce sphincter tone and improve blood flow. Topical calcium channel blockers (CCBs) have shown promising results in conservative management. This study aimed to compare the efficacy and safety of Nifedipine versus Diltiazem ointments in treating anal fissures through a double-blind, randomized controlled trial conducted at a tertiary care centre. METHODS: From August 2022 to November 2023, 110 patients with acute, chronic, or acute-on-chronic anal fissures were randomized into two groups, receiving 1 g of either 0.3% Nifedipine and 2% lidocaine or 2% Diltiazem and 2% lidocaine ointments twice daily for 6 weeks. The primary outcome was assessed using the REALISE score, which measures pain, bleeding, and overall quality of life. Secondary outcomes included perianal irritation and adverse events. RESULTS: Both treatments significantly improved the REALISE scores, with reductions from baseline to 6 weeks indicating effective symptom relief. Nifedipine reduced the score from 17.7 ± 3.9 to 5.3 ± 1.8 (p = 0.0001), while Diltiazem reduced it from 16.3 ± 3.9 to 5.8 ± 2.3 (p = 0.0001). Healing rates were comparable between groups (70.9% for Nifedipine and 67.3% for Diltiazem), and both treatments were well-tolerated with minimal side effects. CONCLUSION: This study confirms that both Nifedipine and Diltiazem are effective first-line treatments for anal fissures, offering viable short-term non-surgical options. Further research with longer follow-up and multicentric studies is needed to evaluate long-term outcomes and treatment combinations. TRIAL REGISTRATION: This study was registered in the Indian Clinical Trials Registry under the code: CTRI/2022/04/042081. Registered on April 22, 2022 (URL: https://ctri.nic.in/Clinicaltrials/rmaindet.php?trialid=66601&EncHid=71722.40664&modid=1&compid=19).
World J Surg
· 2026 Jun · PMID 41968616
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BACKGROUND: The long-term impact of bariatric procedures on gastroesophageal reflux disease (GERD) remains insufficiently characterized. Sleeve gastrectomy (LSG) is technically simpler but may predispose patients to refl...BACKGROUND: The long-term impact of bariatric procedures on gastroesophageal reflux disease (GERD) remains insufficiently characterized. Sleeve gastrectomy (LSG) is technically simpler but may predispose patients to reflux, whereas Roux-en-Y gastric bypass (LRYGB) is recognized for its durable anti-reflux effect. Robust prospective data comparing the procedures beyond 5 years are scarce. This study compared 8-year persistent or new-onset GERD after LSG versus LRYGB using multimodal assessment based on Lyon Consensus 2.0 criteria. METHODS: In this prospective dual-cohort extension of a previous trial (n = 75), 51 patients (LSG = 19; LRYGB = 32) completed 8-year follow-up. Multimodal assessment included a symptom questionnaire, upper endoscopy, contrast radiology, manometry, and 24-h pH monitoring. The primary endpoint was conclusive GERD per Lyon 2.0 classification. RESULTS: Conclusive GERD was present in 94.7% of LSG patients compared with 25.0% following LRYGB (RR = 3.8; 95% CI, 2.06-6.97). Erosive esophagitis (Los Angeles grade ≥ B) was more frequent after LSG (73.7% vs. 18.8%; p < 0.001). Mean acid exposure time was higher after LSG (11.4 ± 6.0% vs. 2.7 ± 5.5%; p < 0.001). Pathological DeMeester scores (> 14.7) occurred in 66.7% of LSG patients versus 19.0% after LRYGB (RR = 3.44; p = 0.002). GERD-related complications, including Barrett's esophagus and conversion to LRYGB, were observed only after LSG. CONCLUSION: At 8-year follow-up, LSG is strongly associated with persistent or de novo GERD, whereas LRYGB maintains a durable protective effect. These findings highlight the relevance of appropriate preoperative evaluation and long-term reflux surveillance when selecting bariatric procedures. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03692455.