Iverson KR, Kifle F, Belay E
… +10 more, Ambese TY, Ferreira EB, Fentahun Awedew A, Kifle K, Dula PK, Presser E, Jaraczewski T, Dodgion C, Beyene A, Ethiopian Surgical Outcomes Study (Ethio‐SOS) Investigators
World J Surg
· 2026 May · PMID 41964383
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INTRODUCTION: Globally, over 4.8 billion people lack access to safe, timely, and affordable surgical care, with the burden falling heaviest on low- and middle-income countries. In Ethiopia, where surgical services are ur...INTRODUCTION: Globally, over 4.8 billion people lack access to safe, timely, and affordable surgical care, with the burden falling heaviest on low- and middle-income countries. In Ethiopia, where surgical services are urban-centered and out-of-pocket (OOP) health spending is among the highest globally, financial barriers often deter care-seeking. This study provides the first nationally representative assessment of catastrophic health expenditure (CHE) among surgical patients in Ethiopia to quantify financial risk and inform future equitable health financing reforms. METHOD: This national cross-sectional survey was conducted as part of the Ethio-SOS study, which includes 32 hospitals across Ethiopia. A total of 412 surgical patients were enrolled. Data were collected on direct and indirect costs, sociodemographic characteristics, and surgical indication. CHE was defined as OOP medical expenditure exceeding 10% of annual household expenditure. RESULTS: Of 412 participants (53.6% female, 46.4% male), 103 (25.0%) experienced catastrophic health expenditure (CHE). Key cost drivers included medications (37%), laboratory tests (14%), and surgical fees (14%). Non-medical expenses, such as food, transportation, and caregiver support, accounted for 20% of total spending. Risk factors for CHE included smaller household size (OR = 0.52, p = 0.046), unmarried status (OR = 0.38, p = 0.002), greater distance from the hospital, and trauma-related surgery (OR = 1.95, p = 0.042). Coping mechanisms included borrowing money (16.6%) and selling assets (13.9%). CONCLUSIONS: One in four surgical patients in Ethiopia experiences CHE, with increased vulnerability among unmarried individuals, smaller households, and those undergoing trauma-related procedures. Medication and non-medical costs, such as transportation, remain significant financial burdens. These findings highlight urgent gaps in financial protection and underscore the need for targeted policy reforms, such as improved access to medicine, transportation support, and expanded safety nets, to reduce out-of-pocket surgical costs and promote equitable access to care.
Matsui A, Saito Y, Inoue K
… +4 more, Matsuzu K, Kitagawa W, Sugino K, Ito K
World J Surg
· 2026 May · PMID 41956960
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BACKGROUND: IJV invasion is a rare but significant occurrence in PTC. Although the current staging system categorizes T stages based on organ invasion, the classification for IJV invasion remains unclear. We evaluated th...BACKGROUND: IJV invasion is a rare but significant occurrence in PTC. Although the current staging system categorizes T stages based on organ invasion, the classification for IJV invasion remains unclear. We evaluated the prognostic impact of internal jugular vein (IJV) involvement by extrathyroidal extension (ETE) and extranodal extension (ENE) in papillary thyroid carcinoma (PTC) and investigated the appropriate T-stage classification for ETE to the IJV. METHODS: This retrospective study included PTC patients who underwent surgery between 2005 and 2011 at our hospital. We analyzed patients with IJV resection due to ETE or ENE, dividing them into ETE and ENE groups. We also compared the ETE group's prognoses with those of patients with stage III or IV PTC to evaluate the T4a vs. T4b classification. RESULTS: Among 5482 PTC cases, 17 were in the ETE group and 47 in the ENE group. We compared the ETE group's prognoses with those of the patients with stage III or IV PTC to evaluate the T4a vs. T4b classification. Compared to the ENE patients, the ETE patients had significantly lower 10-year overall survival (40.6% vs. 81.9%; HR 2.77, 95% CI: 0.99-7.67) and disease-specific survival (44.3% vs. 92.6%; HR 6.81, 95% CI: 1.68-27.51). Survival for ETE to the IJV was significantly worse than for stage III PTC but comparable to stage IV. CONCLUSIONS: ETE to the IJV showed a poor prognosis, comparable to stage IV, whereas ENE to the IJV had a favorable prognosis even though we did not exclude the presence of high-risk factors. ETE to the IJV represents an aggressive disease course in PTC, warranting careful consideration in staging and treatment planning.
Koterazawa Y, Goto H, Aoki T
… +10 more, Sugita Y, Ikeda T, Harada H, Otowa Y, Urakawa N, Hasegawa H, Kanaji S, Yamashita K, Matsuda T, Kakeji Y
World J Surg
· 2026 May · PMID 41956959
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BACKGROUND: Chronological age is an important indicator of the physical condition; however, it may not fully capture their physiological status. Recently, biological age has gained attention as a more accurate predictor...BACKGROUND: Chronological age is an important indicator of the physical condition; however, it may not fully capture their physiological status. Recently, biological age has gained attention as a more accurate predictor of physical condition. This study aimed to investigate the association between biological age and postoperative outcomes in patients with esophageal squamous cell carcinoma (ESCC). METHODS: This study included 345 patients with ESCC who underwent minimally invasive esophagectomy at Kobe University Hospital. Biological age was estimated using Levine et al.'s model based on data from nine commonly used blood tests. Patients were stratified by biological age: ≥ 75 years and < 75 years. RESULTS: Patients with biological age ≥ 75 years (N = 59) were more likely to be male (p = 0.012) and had lower serum albumin levels (p = 0.0003) and higher creatinine levels (p = 0.0009) than those with biological age < 75 years (N = 286). Regarding postoperative complications, patients aged ≥ 75 years had higher rates of pulmonary complications (p = 0.032) and anastomotic leakage (p = 0.038). No significant differences were observed in overall survival between the ≥ 75 and < 75 age groups, regardless of disease stage. In patients with advanced ESCC, 93% of those with chronological age < 75 years and biological age ≥ 75 years (N = 27) received preoperative chemotherapy. Conversely, only 80% of patients with chronological age ≥ 75 years and biological age < 75 years (N = 20), who had better general condition, received preoperative chemotherapy. CONCLUSIONS: Biological age is associated with postoperative complications. Assessing physical condition using biological age may help determine patients' eligibility for preoperative chemotherapy.
Silva LM, Mohammed SA, Strong PJ
… +5 more, Dietrich A, Watts T, Bisson J, Torkington J, Cornish JA
World J Surg
· 2026 May · PMID 41956955
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BACKGROUND: Emergency laparotomy (EmLap) is a high-risk surgery for acute abdominal conditions. This study uses a retrospective mixed-methods approach to explore quality of life and patient-reported outcomes and experien...BACKGROUND: Emergency laparotomy (EmLap) is a high-risk surgery for acute abdominal conditions. This study uses a retrospective mixed-methods approach to explore quality of life and patient-reported outcomes and experiences (PROMs and PREMs) among EmLap survivors. METHODS: Patients who underwent EmLap from 2016-2019 at a tertiary hospital were surveyed, with demographic and clinical data collected from institutional National Emergency Laparotomy Audit (NELA) databases. Outcomes included QoL (EQ-5D-5L), employment, sexual function, incisional hernias, peri-operative anxiety, body image, and overall patient experience. The themes explored in the questionnaire were developed based on findings from previous studies of EmLap survivorship. Thematic analysis was conducted for qualitative responses, alongside statistical analysis for quantitative data. RESULTS: A total of 725 eligible patients were identified, and 310 responses were returned (42.8% response rate). Mean length of follow up was 33 months (range 6-54 months). Regression analysis confirmed QoL was associated with higher socioeconomic status (coefficient 0.047, p < 0.001), reduced BMI (coefficient -0.009, p < 0.05) and reduced ASA (coefficient -0.070, p < 0.05). Nearly half of respondents were retired at the time of surgery; among those who were employed, 40.5% experienced changes in employment which included earlier retirement. Recovery of sexual function was delayed, with 11.3% of patients reporting they had not resumed sexual activity post-surgery. Incisional hernia was reported by 38.9% of respondents, and 34.0% expressed dissatisfaction with body image. Free-text responses revealed unmet needs for mental health support (22.6%), dietary guidance (10.3%), and physiotherapy (15.8%). CONCLUSION: These findings highlight the physical, psychological, and socioeconomic burden faced by patients after EmLap, and support the need for tailored post-operative support systems to be integrated into post-operative care.
Power A, Parekh A, Jessula S
… +2 more, Rezende-Neto J, Moore LJ
World J Surg
· 2026 May · PMID 41952331
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BACKGROUND: Noncompressible torso hemorrhage is a leading cause of preventable death. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is used to control hemorrhage but full aortic occlusion is limited b...BACKGROUND: Noncompressible torso hemorrhage is a leading cause of preventable death. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is used to control hemorrhage but full aortic occlusion is limited by distal ischemia. Partial REBOA (pREBOA) allows some distal perfusion to prolong occlusion, but precise balloon titration is difficult with standard devices. The COBRA-OS 4 French (Fr) aortic occlusion catheter was evaluated in vitro and in vivo for partial REBOA. METHODS: Bench-top (in vitro) and porcine (in vivo) models were used. The titration window of the device was evaluated in a non-hemorrhage porcine model and in a pulsatile aortic model. The ability of the device to maintain a targeted distal aortic pressure (20 mmHg) for an extended period (3 h) was tested in a porcine model of hemorrhagic shock (40% blood volume), with a corresponding in vitro experiment using a pulsatile aortic model. RESULTS: The COBRA-OS demonstrated a 3-4 mL linear titration window with 1-1.5 mL deflation volume to reach a target distal aortic pressure of 20 mm Hg in vitro and in vivo. During 3 h of prolonged partial REBOA, the device maintained a stable distal target with a set-and-forget strategy (21 +/- 2 mmHg in vitro and 22 +/-7 mmHg in vivo). CONCLUSIONS: The COBRA-OS 4 Fr device enabled precise, stable partial aortic occlusion in this preclinical model. This is the first demonstration of a 4 Fr REBOA catheter achieving prolonged, controlled partial occlusion in a large-animal hemorrhagic shock model, supporting the feasibility of this device for pREBOA. LEVEL OF EVIDENCE: Basic Science, Animal study.
World J Surg
· 2026 May · PMID 41952330
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Isolation of the right anterior Glissonean pedicle (RAG) during minimally invasive liver surgery (MILS) remains challenging due to its deep intrahepatic location. Although cystic plate cholecystectomy has been proposed t...Isolation of the right anterior Glissonean pedicle (RAG) during minimally invasive liver surgery (MILS) remains challenging due to its deep intrahepatic location. Although cystic plate cholecystectomy has been proposed to facilitate RAG identification based on the anatomical importance of the posterior extremity, quantitative clinical evidence remains limited. Therefore, this study evaluated the posterior extremity of the cystic plate as a specific landmark to assess the feasibility of this approach and document its spatial relationship with the RAG. We retrospectively analyzed 57 patients who underwent laparoscopic or robotic anatomical liver resection with successful RAG isolation. Two approaches were utilized: (1) cystic plate cholecystectomy and (2) posterior extremity traction. The intraoperative spatial relationship between the RAG and the posterior extremity of the cystic plate was classified and analyzed using surgical video documentation. Laparoscopic and robotic approaches were performed in 80.7% and 19.3% of cases, respectively. The RAG was located beneath the posterior extremity in 42 patients (73.7%), to the right in 14 patients (24.6%), and to the left in one patient (1.8%). In all cases, successful RAG isolation was intraoperatively confirmed using demarcation lines or indocyanine green (ICG) negative staining. The posterior extremity of the cystic plate serves as a useful anatomical landmark for RAG isolation during MILS. By quantitatively defining its spatial relationship with the RAG, this study offers a practical guide that may facilitate safe and reproducible RAG isolation.
Soylu LÍ, Vestergaard M, Malik T
… +2 more, Burcharth J, Kokotovic D
World J Surg
· 2026 May · PMID 41952241
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BACKGROUND: Readmissions following emergency laparotomy are frequent, and mainly a result of late-onset postoperative complications, worsening of pre-existing comorbidities, and non-compliance with care instructions. Thi...BACKGROUND: Readmissions following emergency laparotomy are frequent, and mainly a result of late-onset postoperative complications, worsening of pre-existing comorbidities, and non-compliance with care instructions. This review aimed to describe current evidence on readmission after emergency laparotomy. METHODS: A systematic search was performed in MEDLINE, Embase, and the Cochrane Library. Studies were included if they reported readmission incidence following non-trauma emergency laparotomy for perforated viscera, intestinal obstruction, mesenteric ischemia, or intraabdominal bleeding in adults. Bias was assessed with The JBI Checklist for Prevalence Studies, and certainty of the evidence was assessed using GRADE. The primary outcomes were all-cause hospital readmission and emergency department utilization within 30-, 90-, and 180 days. Secondary outcomes were risk factors and leading causes for readmission. RESULTS: In total, 78,387 patients (10 studies) were included. Three studies reported on emergency department utilization, and the remaining reported on hospital readmission. The pooled 30-day hospital readmission rate for 1907 patients was 17% (95% confidence interval (CI) = 16-19%; prediction interval (PI) = 15-20%), and the pooled 30-day emergency department utilization for 2004 patients was 28% (95% CI = 18-40%; PI = 12-53%). Two studies reported discharge disposition as an independent risk factor of hospital utilization. The leading causes of hospital utilization were wound-related, abdominal complaints, dehydration and infections. CONCLUSIONS: The cumulative incidence of 30-day hospital readmission following emergency laparotomy was 16%-19%. These high readmission rates raise global concern, as they may strain hospital resources and compromise quality of care for all patients in need of urgent care.
Cueva-Ramírez JE, Valdez R, Tejada R
… +2 more, Gonzalez-Alcaide G, Ramos-Rincon JM
World J Surg
· 2026 May · PMID 41931542
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BACKGROUND: Severe burns represent a major public health burden in middle-income countries. This study describes the epidemiological profile and identifies independent prognostic factors for in-hospital mortality in pati...BACKGROUND: Severe burns represent a major public health burden in middle-income countries. This study describes the epidemiological profile and identifies independent prognostic factors for in-hospital mortality in patients with severe burns treated at the national referral center of the Dominican Republic over a 32-year period. METHODS: A retrospective cohort study was conducted including 5941 adult patients with severe burns admitted between 1993 and 2024. Epidemiological, clinical, and outcome data were analyzed. Independent predictors of mortality were identified using multivariable logistic regression. RESULTS: The cohort was predominantly male (73.5%) with a median age of 34 years. The most common etiology was flame burns (58.2%). The median total body surface area (TBSA) burned was 25%. The overall mortality rate was 28.2%, remaining stable across four eight-year periods. In the adjusted analysis, the strongest independent predictors of mortality were TBSA ≥ 40% (adjusted odds ratio [aOR] 12.00), age ≥ 65 years (aOR 6.18), the presence of a full-thickness (third-degree) component (aOR 2.69), and female sex (aOR 1.23). CONCLUSION: Mortality from severe burns remains high and stable over time, driven predominantly by burn extent, depth, and patient age. These findings underscore the critical need to strengthen prehospital care systems and target prevention strategies toward domestic flame and scald risks in similar settings.
World J Surg
· 2026 May · PMID 41931541
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AIMS: To synthesize evidence on the demographic and prognostic profile of surgically treated intrathyroidal thymic carcinoma (ITC). METHODS: A PRISMA-compliant systematic review and meta-analysis was conducted. Due to th...AIMS: To synthesize evidence on the demographic and prognostic profile of surgically treated intrathyroidal thymic carcinoma (ITC). METHODS: A PRISMA-compliant systematic review and meta-analysis was conducted. Due to the rarity of the disease, all patients with surgically treated ITC were combined from individual case reports to create a cohort of patients which was subsequently pooled with other eligible case series. Single-arm meta-analysis was used to synthesize a demographic profile and Kaplan-Meier statistics were used for survival analyses. RESULTS: Analysis of 55 articles (154 patients) showed that patients with ITC are likely to be symptomatic (95.2%, 95% CI 91.1-99.2) with neck mass (72.2%, 62.2-82.1) as the most common symptom with no laterality preferences (left:right, 46.4%:53.6%). Overall survival (OS) at 15 years was 96.0% (mean OS time:19.7 years; median OS time 18 years). Recurrence-free survival (RFS) at 15 years was 77.9% (mean RFS time:13.4 years; median RFS time: 17 years). RFS was not affected by symptomatic status (HR: 0.0001, p = 0.96), tumor size (HR; 1.044, p = 0.113), lymph node metastasis (HR: 1.909, p = 0.307), extrathyroidal extension (HR: 0.769, tumor p = 0.688), surgery plus radiotherapy (HR: 0.434, p = 0.207), surgery plus chemoradiotherapy (HR: 0.0001, p = 0.959), subtotal thyroidectomy (HR: 0.821, p = 0.854), lobectomy (HR: 0.366, p = 0.140), lymph node dissection (HR: 1.088, p = 0.888). CONCLUSIONS: Surgically treated ITC may have excellent long-term prognosis which seems to be not affected by the extent of resection or use of adjuvant therapy; however, this could be type 2 error; hence more robust evidence is required for definitive conclusions.
Al-Qudimat AR, Zarour A, Al-Taweel R
… +2 more, Al-Awadat AI, Bawadi H
World J Surg
· 2026 May · PMID 41928721
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BACKGROUND: Incisional hernia is the most common postoperative complication of abdominal wall surgery that significantly increases morbidity. We aimed to evaluate recurrence rates and perioperative outcomes associated wi...BACKGROUND: Incisional hernia is the most common postoperative complication of abdominal wall surgery that significantly increases morbidity. We aimed to evaluate recurrence rates and perioperative outcomes associated with Laparoscopic and open repair for Incisional hernia recurrence. METHODS: A comprehensive and systematic literature search was conducted across PubMed, Embase, CINAHL Ultimate, Medline, Scopus, and the Cochrane Controlled Trials Register. Studies published between July 2013, and November 2024 were screened for inclusion. The data extracted included recurrence rates, surgical complications, bowel injury, and outcomes. Pooled risk ratios (RR) were calculated to compare the outcomes of Laparoscopic repair and Open repair. Statistical analysis was performed using STATA V17 using a random-effects model. RESULTS: A total of 15 randomized controlled trials (RCTs), encompassing 1502 patients from nine countries, met the eligibility criteria. The analysis revealed no significant difference in recurrence rates between LR and OR. However, LR was associated with a significantly lower likelihood of wound drainage (RR = 0.07, 95% CI: 0.04-0.15) and a reduced risk of postoperative infection (RR = 0.31, 95% CI: 0.17-0.55) compared to OR. Conversely, the risk of bowel injury (RR = 2.80, 95% CI: 1.15-6.80, p = 0.02), indicating that patients undergoing LR were nearly three times more likely to experience bowel injury than those undergoing OR. CONCLUSION: Laparoscopic repair of incisional hernias offers several advantages over open repair, including lower rates of wound infection. However, it is associated with a higher risk of bowel injury, necessitating careful patient selection and surgical expertise.
World J Surg
· 2026 May · PMID 41925643
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BACKGROUND: NCRT is a standard preoperative treatment for locally advanced RC with variable efficacy. This prospective cohort study explored HIF-1α and PD-L1 expression in RC and their impact on NCRT efficacy to provide...BACKGROUND: NCRT is a standard preoperative treatment for locally advanced RC with variable efficacy. This prospective cohort study explored HIF-1α and PD-L1 expression in RC and their impact on NCRT efficacy to provide a theoretical basis for effective predictive indicators. METHODS: Patients with locally advanced rectal cancer (n = 128) (cT3/T4-N0 or cTany-N1/N2) were prospectively enrolled. General clinical data were collected. Preoperative tumor and adjacent non-tumor tissues were obtained via pre-treatment biopsy, and HIF-1α/PD-L1 expression was detected by qRT-PCR. All patients underwent radical surgery after NCRT, with efficacy evaluated by pTRG. ROC analysis assessed the predictive value of HIF-1α/PD-L1 for NCRT response. Logistic regression analyzed HIF-1α/PD-L1 independent association with NCRT efficacy. The 5-year follow-up recorded survival/recurrence; Kaplan-Meier analyzed DFS/OS, and COX regression explored the independent correlation between HIF-1α/PD-L1 mRNA levels and post-NCRT DFS/OS. RESULTS: HIF-1α and PD-L1 were highly expressed in tumor tissues, with higher levels in NCRT-insensitive patients. Combined HIF-1α and PD-L1 showed better AUC for predicting NCRT insensitivity than either alone (AUC = 0.706, sensitivity = 63.24%, specificity = 73.33%). For each 1-unit increase in HIF-1α and PD-L1, the risk of recurrence in patients increased by 1.567-fold (p = 0.001, HR = 1.567, 95% CI = 1.216-2.018), and the risk of death increased by 1.725-fold (p = 0.000, HR = 1.725, 95% CI = 1.354-2.200). CONCLUSION: HIF-1α and PD-L1 expression can serve as reliable indicators for predicting NCRT efficacy and poor prognosis in RC patients.
World J Surg
· 2026 Mar · PMID 41917719
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BACKGROUND: A major surgery represents a profound psychoneuroendocrine stressor that elicits coordinated inflammatory, immune, and metabolic responses. Although acute stress-related immune dysregulation is well-recognize...BACKGROUND: A major surgery represents a profound psychoneuroendocrine stressor that elicits coordinated inflammatory, immune, and metabolic responses. Although acute stress-related immune dysregulation is well-recognized, whether the magnitude and persistence of perioperative systemic stress phenotypes are associated with immune recovery failure, molecular residual disease (MRD), and long-term clinical outcomes, remains unclear. METHODS: In a prospective longitudinal cohort of 950 patients undergoing curative-intent colorectal cancer surgery, we characterized perioperative systemic stress phenotypes using a multidomain, time-structured Aging Shock Index (ASI). Conceptualized as an integrated perioperative stress-response phenotype rather than a direct measure of biological aging, the ASI was derived from inflammatory, immune surveillance, and immunometabolic biomarkers measured preoperatively and at postoperative days 1, 3, 7, and 30. Clinically significant postoperative complications (Clavien-Dindo grade ≥ II), circulating tumor DNA-defined MRD at postoperative day 30, and disease-free survival (DFS) over 60 months were evaluated. Multivariable regression and Cox proportional hazards models were used to examine associations between ASI and outcomes. RESULTS: Surgery induced marked, time-locked systemic stress responses characterized by inflammatory amplification and delayed immune recovery, as summarized by the ASI. Higher ASI was associated with increased postoperative complications (adjusted odds ratio per SD increase: 1.48, 95% CI 1.31-1.67) and greater MRD positivity at postoperative day 30 (adjusted odds ratio: 1.62, 95% CI 1.34-1.96). Over long-term follow-up, elevated ASI predicted worse DFS (hazard ratio per SD increase: 1.41, 95% CI 1.25-1.59), independent of clinicopathologic factors. These associations were primarily driven by early postoperative stress amplification and impaired resolution rather than baseline biomarker levels. CONCLUSIONS: Perioperative systemic stress phenotypes reflecting sustained psychoneuroendocrine-immune dysregulation are associated with immune recovery failure, molecular residual disease, and adverse long-term outcomes following a major surgery. Quantifying dynamic stress-related biological responses may provide a biologically grounded framework for understanding how acute psychoneuroendocrine stress translates into persistent immune vulnerability and may inform future risk stratification research in perioperative oncology.
George A, Kong V, Kosna S
… +8 more, Ko J, Lee D, He R, Cheung C, Yeung W, Wain H, Bruce J, Clarke D
World J Surg
· 2026 May · PMID 41913369
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BACKGROUND: South Africa experiences exceptionally high levels of interpersonal violence, placing a substantial burden on both the public health and criminal justice systems. Mob assault constitutes a specific subset of...BACKGROUND: South Africa experiences exceptionally high levels of interpersonal violence, placing a substantial burden on both the public health and criminal justice systems. Mob assault constitutes a specific subset of interpersonal violence, characterized by blunt force trauma. This study aims to expand the existing literature by further quantifying the public health burden of mob assaults and comparing injury patterns, clinical outcomes, and healthcare resource utilization between mob-related and non-mob-related assault in a large retrospective trauma cohort. METHODS: This study analyzed 2,622 adult patients with blunt trauma presenting to a tertiary trauma center in South Africa between 2012 and 2022 using a retrospective review design. Patients were categorized into mob assault (MA) and non-mob assault (NMA) groups. Data collected included demographics, injury severity, resource-utilization, and clinical outcomes. RESULTS: Patients in the MA group had significantly worse clinical outcomes and higher Abbreviated Injury Scale (AIS) scores. Compared with the NMA group, the MA group was associated with a statistically significant increase in complications, ICU admissions and mortality. Over the past decade, there has been a notable upward trend in rates of MA. CONCLUSION: Mob assault is a growing public health concern in South Africa, with victims experiencing higher rates of morbidity and mortality than other forms of interpersonal violence. Increased awareness of mob-related injuries and clinical recognition of crush injury patterns may improve early outcomes. However, further research is required to inform targeted prevention strategies and develop effective interventions.
Hwessa M, Mahmood WU, Lubbad O
… +3 more, Singh KK, Khera G, Sajid MS
World J Surg
· 2026 May · PMID 41913356
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INTRODUCTION: This study compares the outcomes in patients undergoing ventral hernia repair using intraperitoneal underlay mesh (IPUM) without facial defect closure versus intraperitoneal underlay mesh following fascial...INTRODUCTION: This study compares the outcomes in patients undergoing ventral hernia repair using intraperitoneal underlay mesh (IPUM) without facial defect closure versus intraperitoneal underlay mesh following fascial defect closure (IPUM+). METHODS: To search for randomized controlled trials comparing outcomes of patients with ventral hernias who were managed surgically with either IPUM or IPUM+, standard medical databases such as MEDLINE, Embase, PubMed, and Cochrane Library were used, covering studies published up to and including September 2025. The meta-analysis was performed with a random effect model analysis, and all data was analyzed using Review Manager Software 5.4. RESULTS: Five randomized controlled trials (n = 549) were included, involving adult patients who underwent laparoscopic ventral hernia repair with IPUM or IPUM+. The pooled analysis showed no significant difference in hernia recurrence (Risk Ratio [RR]: 0.82, 95% CI: [0.29, 2.27], p = 0.70), seroma formation (RR: 0.78, 95% CI: [0.32, 1.88], p = 0.58), operating times (Standard Mean Difference [SMD]: 0.26, 95% CI [-0.17, 0.69], p = 0.23) and pain scores (SMD: 0.26, 95% CI [-0.17, 0.69], p = 0.23) between the two approaches. CONCLUSION: IPUM and IPUM+ are both associated with similar postoperative morbidities for the treatment of ventral hernia repair.
Balla A, Jaber A, Morales-Conde S
… +1 more, Miserez M
World J Surg
· 2026 May · PMID 41906382
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BACKGROUND: The aim of this scoping review is to report the different items employed in Enhanced Recovery After Surgery (ERAS) protocols for the management of patients who underwent abdominal wall reconstruction (AWR). T...BACKGROUND: The aim of this scoping review is to report the different items employed in Enhanced Recovery After Surgery (ERAS) protocols for the management of patients who underwent abdominal wall reconstruction (AWR). This highlights not only the variability between ERAS protocols, but also the heterogeneity, and in some cases conflicting proposals, of specific items within ERAS categories across the included studies. METHODS: After PROSPERO registration (CRD-42025635207), systematic research was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement. The search was carried out in the PubMed, Embase, and Web of Science databases. Thirty-four articles were fully analyzed, and 23 articles were excluded. One article was included by checking references of related articles. Finally, 12 articles were included. We did not focus on the clinical outcomes of the ERAS protocols, but rather on the specific items included. RESULTS: A total of 140 ERAS items were identified and grouped in categories as follows: preoperative counseling/preparation, optimizing nutrition/diabetes control, thromboprophylaxis, minimizing nausea and vomiting, fluid management, normothermia, drains and tubes management, multimodal analgesia, early mobilization, intestinal recovery and other intra- and postoperative items. This highlights not only the variability between ERAS protocols, but also the heterogeneity, and in some cases conflicting proposals, of specific items within ERAS categories across the included studies. CONCLUSIONS: This scoping review provides a valuable snapshot of current items in ERAS protocols in AWR. Importantly, given the predominantly retrospective design and heterogeneity in protocol items/categories and the limited quality of evidence, no strong item-specific recommendations can currently be formulated. This calls for further research, particularly large-scale, randomized trials or registry data, to better define the optimal categories (and their items) of ERAS protocols for this patient population.