World J Surg [JOURNAL]
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200 papers
The Effect of Early Mobilization as Part of Enhanced Recovery After Surgery on Postoperative Outcomes After Emergency Abdominal Surgery: A Systematic Review and Meta-Analysis.
Torfadóttir MS, Degett TH, Olsen IH … +4 more , Kjær ML, Jensen J, Gellert-Kristensen DK, Burcharth J
World J Surg · 2026 May · PMID 41903160 · Publisher ↗
BACKGROUND: Early mobilization is considered a key strategy for enhancing recovery after elective surgery, yet its effect after emergency surgery remains unclear. Through this systematic review, we aim to isolate mobiliz...
BACKGROUND: Early mobilization is considered a key strategy for enhancing recovery after elective surgery, yet its effect after emergency surgery remains unclear. Through this systematic review, we aim to isolate mobilization as a postoperative variable in an emergency setting to clarify its role in recovery and support evidence-based clinical guidelines. METHODS: A systematic search was conducted in MEDLINE, Embase, and Cochrane on November 20, 2024, to identify studies on mobilization after emergency abdominal surgery. The review was registered in PROSPERO (CRD42024556789). Eligible studies reported short-term outcomes of postoperative mobilization, including postoperative complications, mortality, length of stay, and postoperative convalescence in adult patients. Studies were excluded if they focused exclusively on elective surgery. Studies were screened independently by two reviewers. Risk of bias was assessed using the ROB-2 for randomized controlled trials (RCTs) and ROBINS-I for observational studies. Meta-analyses used random-effects model, with results expressed as risk ratios, odds ratios or mean differences. Certainty of evidence was evaluated with GRADE. RESULTS: The search yielded 3064 records, of which 19 studies met inclusion criteria (seven RCTs and 12 observational studies), involving 3222 patients. Interventions mainly included early mobilization as part of ERAS protocols. Overall risk of bias was high and certainty of evidence very low. Observational studies showed reduced major complication (OR 0.75 (95% CI [0.61; 0.93])), whereas RCTs found no significant difference. Early mobilization reduced length of stay (RCTs: MD -1.95 days (95% CI [-3.16; -0.75])); Observational: MD -2.84 days (95% CI [-3.84; -1.83]) and time to first diet (RCTs: MD 0.95 days (95% CI [-1.61 to -0.29])); Observational: MD -2.30 days (95% CI [-2.36 to -2.24]). Return of bowel function was earlier (RCTs: MD -0.87 days (95% CI [-1.59; -0.16])); Observational: -0.91 days (95% CI [-1.71; -0.10]). RCTs also reported less postoperative nausea and vomiting (RR 0.46 (95% CI [0.33; 0.65])). CONCLUSION: Postoperative mobilization may reduce major complications, hospital stay and accelerate recovery, primarily as a part of an ERAS protocol. However, certainty of evidence remains very low. Most studies had a serious risk of bias, highlighting the need for high-quality RCTs.
Short-Term Outcomes of Arterial Divestment in Pancreatic Cancer: A Systematic Review and Single Arm Meta-Analysis of Observational Studies.
Peddakota V, Chikkala B, Kottapalli MA … +7 more , Nafady R, Sochorova D, Mittal A, Samra J, Soreide K, Roberts K, Pandanaboyana S
World J Surg · 2026 May · PMID 41903157 · Publisher ↗
BACKGROUND: The present study aimed to review and analyze the impact of arterial divestment during pancreatic surgery on short-term outcomes. METHODS: PubMed, Embase, Web of Science, and the Cochrane Library were searche...
BACKGROUND: The present study aimed to review and analyze the impact of arterial divestment during pancreatic surgery on short-term outcomes. METHODS: PubMed, Embase, Web of Science, and the Cochrane Library were searched. Outcomes of interest included perioperative parameters, resection margins, morbidity, and mortality. Analysis was performed using the meta package in R. RESULTS: Five observational studies comprising 554 patients were included. Two hundred twelve patients had upfront surgery, and 342 patients had neoadjuvant chemotherapy. Four hundred and eighty-two had periarterial dissection and 72 sub adventitial dissection. Operative time varied considerably (median 185-537 min), and intraoperative blood loss ranged between 300 and 900 mL. The pooled prevalence of blood transfusion was 37.6% (95% CI: 32.5%-43.1%; I = 97.7%). Median post-operative stay ranged from 7 to 25 days. R0 resection was achieved in 49.4% (95% CI: 44.9%-53.8%). Complications included post-operative pancreatic fistula (9.2%), delayed gastric emptying (11.2%), post-operative pancreatic hemorrhage (5.8%), chyle leakage (13.9%), reoperation (6.1%), 90-day mortality (3.1%), bile leakage (≤ 2.8%), ischemia (≤ 4.2%), and intractable diarrhea (8%-13%). CONCLUSIONS: Arterial divestment during pancreatic surgery appears to have acceptable morbidity and mortality. However, there is a lack of a unified agreed definition and case selection. A unified reporting, standardization of terminology and relative role compared to arterial resection should be explored in prospective studies.
Exploratory Laparotomy After Routine Cardiac Surgery: Results From 17,000 Patients.
Turner M, Brown JA, Yoon P … +14 more , Yoon M, Liu Z, Feng Z, Rivosecchi R, Murray H, Zhu J, Thoma F, Serna-Gallegos D, Kaczorowski D, Bonatti J, Chu D, Hasan I, Ogami T, Sultan I
World J Surg · 2026 May · PMID 41888059 · Full text
OBJECTIVE: This study sought to elucidate the incidence and risk factors for exploratory laparotomy ("exlap") after cardiac surgery, its associated perioperative complications, and its impact on long-term survival. METHO...
OBJECTIVE: This study sought to elucidate the incidence and risk factors for exploratory laparotomy ("exlap") after cardiac surgery, its associated perioperative complications, and its impact on long-term survival. METHODS: This was an observational study of consecutive STS index cardiac operations between 2010-2022, excluding circulatory arrest, transplant, and multivalvular cases. The cohort was dichotomized by the incidence of exlap in the postoperative period. RESULTS: A total of 17,362 patients were included, of which 77 (0.5%) underwent an exlap. Postoperatively, the exlap group required more intra-aortic balloon pumps (IABP), vasopressors, and rescue therapy (i.e., methylene blue or hydroxocobalamin) than the no-exlap group. The exlap group had higher operative mortality, stroke, prolonged ventilation, sepsis, dialysis, mediastinal re-exploration, and pRBC transfusions. On multivariable logistic regression, total number of postoperative pressors, use of rescue therapy, preoperative IABP, white race, chronic dialysis use, and history of cerebrovascular accident were associated with the need for postoperative exlap. On multivariable logistic regression, exlap was an independent risk factor for operative mortality (OR 3.67, 95% CI: 1.95-6.88, p < 0.001). Among patients surviving to discharge, Kaplan-Meier survival estimates were lower in the exlap group compared to the no-exlap group (p < 0.001), with 5-year survival being 58.9% (42.6-74.2) in the exlap group versus 84.4% (83.8-85.0) in the no-exlap group. CONCLUSIONS: Exploratory laparotomy is rare after open-heart surgery, and it was performed for gastrointestinal complications that occurred in the context of other severe postoperative complications. Several factors were associated with the need for exlap, including increasing age, pre-existing renal and vascular disease, and pre- and post-operative shock.
Diagnostic Decision-Making in Intermediate-Risk Pediatric Appendicitis: A Prospective Cohort Study.
Zouari M, Belhajmansour M, Hbaieb M … +4 more , Issaoui A, Jarboui O, Dhaou MB, Mhiri R
World J Surg · 2026 May · PMID 41888057 · Publisher ↗
BACKGROUND: Diagnosing acute appendicitis in children with intermediate Pediatric Appendicitis Score (PAS) values remains a major clinical challenge. In this diagnostic gray zone, clinical findings, laboratory markers, a...
BACKGROUND: Diagnosing acute appendicitis in children with intermediate Pediatric Appendicitis Score (PAS) values remains a major clinical challenge. In this diagnostic gray zone, clinical findings, laboratory markers, and imaging often provide conflicting information, leading to uncertainty and variable management strategies. The aim of this study was to identify predictive factors of true appendicitis in children presenting with suspected appendicitis and intermediate PAS scores. METHODS: We conducted a prospective observational study including children aged 2-14 years presenting with suspected appendicitis and a PAS of 4-6 at a tertiary referral center between January 2022 and October 2025. RESULTS: Among 559 included children, 289 (51.7%) had true appendicitis. The mean age was 9.4 ± 2.5 years, and males accounted for 58.1% of the cohort. On multivariable analysis, positive ultrasound was the strongest independent predictor of appendicitis (OR 55.1; 95% CI 29.4-103.2; p < 0.001), followed by localized right lower quadrant tenderness (OR 2.98; p = 0.003), white blood cell count > 15 × 10/L (OR 2.53; p = 0.003), and male sex (OR 1.99; p = 0.015). Ultrasound demonstrated excellent diagnostic performance, with a sensitivity of 94%, a negative predictive value of 93%, and an overall accuracy of 88%. CONCLUSION: In children with intermediate PAS scores, ultrasound plays a central role in diagnostic decision-making. Its strong rule-out value allows meaningful risk reclassification, supporting safe observation while guiding timely surgical intervention when positive.
Determinants of Compliance to Enhanced Recovery Protocol After Emergency Laparotomy.
Ceresoli M, Fumagalli C, Biloslavo A … +16 more , La Greca A, Carlucci M, Pesenti G, Occhionorelli S, Bisagni P, Feo C, Tartaglia D, Parini D, Runfola M, Somigli R, Visconti D, Mariani D, Cassini D, Mingoli A, Braga M, Study Collaborative Group
World J Surg · 2026 May · PMID 41882802 · Full text
BACKGROUND: Enhanced recovery protocols (ERP) are comprehensive, evidence-based approaches aimed at accelerating patient recovery and improving surgical results; increasing evidence exists about their adoption in emergen...
BACKGROUND: Enhanced recovery protocols (ERP) are comprehensive, evidence-based approaches aimed at accelerating patient recovery and improving surgical results; increasing evidence exists about their adoption in emergency laparotomy. The study aimed to evaluate the compliance to the proposed postoperative pathway and the determinants of late recovery. METHODS: This is a multicenter observational prospective study involving 13 Italian centers. Inclusion criteria targeted adults undergoing emergency surgery for intestinal occlusion or perforation. The primary end point was the early recovery rate (discontinuation of intravenous fluids and the initiation of oral intake on postoperative day three) and its determinants. The secondary end point were reasons for uncompliance to postoperative ERP items. RESULTS: Between March 2023 and March 2024, 760 patients were recruited and analyzed, 60.2 with intestinal obstruction and 39.8 with intra-abdominal infections. Recovery was achieved by 53.7% of patients on postoperative Day 3. Among determinants, clinical frailty and ASA status negatively correlated with recovery whereas the absence of surgical drains, anesthetic depth monitoring and intraoperative goal-directed fluid therapy positively correlated with recovery. An analysis of the reasons for noncompliance with postoperative items revealed that aside from postoperative complications, the most frequently cited reason was protocol deviation for clinical decision, accounting for approximately 10%-15% of noncompliance for each item. CONCLUSIONS: This study showed that half of the patients reached the recovery goal on postoperative Day 3 and that early recovery after surgery is influenced both by intrinsic patient factors and by adherence to ERP strategies. Future research should prioritize strategies to improve ERP adherence and postoperative compliance.
Reply to the Letter to the Editor: Impact of an ERAS-Based Surgical Care Bundle Implementation for Preventing Anastomotic Leakage in Minimally Invasive Low Anterior Resection for Rectal Cancer: A Retrospective Cohort Study.
Tamura K, Fujimoto T, Mizuuchi Y
World J Surg · 2026 May · PMID 41882747 · Publisher ↗
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Effect of Preoperative Transarterial Embolization on Surgical Blood Loss in Thyroidectomy for Large Graves' Disease.
Chi SY, Chou SE, Chou FF … +3 more , Wu YJ, Lin WC, Chan YC
World J Surg · 2026 May · PMID 41882510 · Publisher ↗
BACKGROUND: Thyroidectomy for Graves' disease (GD) is associated with an increased risk of intraoperative bleeding, particularly in patients with enlarged and hypervascular thyroid glands. This retrospective cohort study...
BACKGROUND: Thyroidectomy for Graves' disease (GD) is associated with an increased risk of intraoperative bleeding, particularly in patients with enlarged and hypervascular thyroid glands. This retrospective cohort study evaluated factors associated with intraoperative blood loss and examined the association between preoperative transarterial embolization (TAE) and surgical outcomes. MATERIALS AND METHODS: A total of 199 patients with GD who underwent thyroidectomy between 2015 and 2024 were analyzed and stratified by excised thyroid weight (< 100 g, 100-200 g, and > 200 g). Preoperative TAE was selectively performed in patients with large goiters beginning in 2021. RESULTS: Multivariate regression analysis identified thyroid weight (95% confidence interval [CI] 0.58-1.30, p < 0.001), operative time (95% CI 0.04-1.05, p = 0.035), and duration from disease onset to surgery (95% CI 2.50-17.72, p = 0.010) as independent predictors of increased blood loss. In patients with thyroid glands weighing > 200 g, TAE was associated with significantly lower intraoperative blood loss compared with historical controls (median 95 vs. 350 mL, p = 0.012), without an increase in postoperative complications. No significant benefit was observed in patients with glands weighing 100-200 g. CONCLUSION: Larger thyroid gland size is associated with increased intraoperative blood loss for GD, and selective preoperative TAE may reduce bleeding in patients with markedly enlarged glands.
From Guidelines to Clicklists: GPT-5-Generated ERAS Checklists Improve Guideline Coverage for Bariatric and Gastrointestinal Cancer Surgery-A STROBE-Compatible Cross-Sectional Evaluation.
Çalışkan YK, Başak F, Erdem O … +1 more , Kudaş İ
World J Surg · 2026 May · PMID 41873099 · Publisher ↗
BACKGROUND: Enhanced Recovery After Surgery (ERAS) pathways improve outcomes after bariatric and gastrointestinal (GI) cancer surgery, yet real-world adherence remains inconsistent. Digital tools and checklists can suppo...
BACKGROUND: Enhanced Recovery After Surgery (ERAS) pathways improve outcomes after bariatric and gastrointestinal (GI) cancer surgery, yet real-world adherence remains inconsistent. Digital tools and checklists can support implementation, but their maintenance and completeness may be limited. Large language models (LLMs) could rapidly generate structured ERAS checklists; however, their coverage, clarity, and bias profile require systematic evaluation. A practical concern is "bundle inflation," whereby expanding item counts may undermine feasibility even when individual elements are evidence-based. METHODS: We performed a STROBE-compatible cross-sectional observational study (March-June 2025) evaluating AI-generated ERAS checklists against guideline-derived comparators. Using GPT-5, we generated 12 ERAS checklists (6 bariatric; 6 GI cancer: 3 gastrectomy and 3 colorectal). Twelve traditional checklists were curated from ERAS Society guideline items. Three blinded raters (two board-certified surgeons; one clinical informatics specialist) independently scored item coverage (present/absent per guideline item), clarity (5-point Likert), and potential bias/applicability issues using a predefined rubric. Primary outcomes were guideline-item coverage (%) and clarity. Interrater reliability was assessed using Cohen's kappa; group comparisons used two-sided tests with α = 0.05. Coverage was not weighted; all guideline items contributed equally, and "critical" omissions were defined a priori as omissions of items explicitly labeled "strong" or "recommended" in the source guideline documents. RESULTS: AI-generated checklists demonstrated higher mean guideline-item coverage than traditional checklists (97.0% ± 2.1% vs. 89.0% ± 3.2%) and higher clarity scores (4.8 ± 0.2 vs. 4.2 ± 0.3; p = 0.021). Agreement was excellent (κ = 0.92; 95% CI 0.88-0.97). Raters observed no systematic demographic bias; limitations primarily reflected reduced context-specific tailoring (e.g., nutrition pathways for selected subgroups). AI-generated lists contained slightly more discrete items than traditional templates, highlighting the need for an implementability review to prevent overly long bundles from reducing adherence. CONCLUSION: GPT-5-generated ERAS checklists achieved superior guideline coverage and clarity versus traditional checklists in bariatric and GI cancer surgery. Because more items can paradoxically reduce implementation fidelity, AI outputs should be treated as draft "master lists" that require structured local curation (core vs. conditional elements) before deployment. Prospective, workflow-integrated validation is warranted to confirm real-world effectiveness and mitigate context-specific omissions.
18F-Choline PET/CT Localization in a 20-Year Experience of Re-Operative Parathyroidectomy.
Vu AN, Black KA, Shattarah O … +2 more , Preece J, Hubbard JG
World J Surg · 2026 May · PMID 41873061 · Publisher ↗
IMPORTANCE: Reoperative parathyroidectomy is necessary in up to 10% of patients with persistent or recurrent primary hyperparathyroidism. Accurate preoperative localization is critical for surgical success and minimizing...
IMPORTANCE: Reoperative parathyroidectomy is necessary in up to 10% of patients with persistent or recurrent primary hyperparathyroidism. Accurate preoperative localization is critical for surgical success and minimizing complications. Conventional imaging methods often yield inconclusive or false-negative results in this challenging patient population. OBJECTIVE: To evaluate the diagnostic accuracy and clinical utility of 18F-fluorocholine positron emission tomography/computed tomography imaging compared to traditional imaging modalities of neck ultrasonography and Technetium-sestamibi parathyroid scintigraphy in patients undergoing reoperative parathyroidectomy. DESIGN: Retrospective cohort study of patients undergoing reoperative parathyroidectomy over a 20-year period (2005-2025). Localization imaging modalities, operative approaches, intraoperative parathyroid hormone monitoring, and surgical outcomes were analyzed. SETTING: Single tertiary referral center specializing in endocrine surgery with a high-volume parathyroidectomy practice. PARTICIPANTS: 114 consecutive adult patients (aged ≥ 18 years) were included who underwent 124 reoperative parathyroidectomy operations for biochemically confirmed persistent or recurrent primary hyperparathyroidism. Patients were included if there was lithium-associated hyperparathyroidism or multiple endocrine neoplasia type 1 syndrome. MAIN OUTCOMES AND MEASURES: Primary outcome included localization detection rates of imaging modalities performed. Secondary outcomes included type of surgical approach utilized, cause of failure from the primary operation, intraoperative parathyroid hormone monitoring response, biochemical cure rate, and surgical complications. RESULTS: 18F-fluorocholine positron emission tomography/computed tomography demonstrated a detection rate of 95.2%, outperforming 11C-methionine positron emission tomography/computed tomography (63.6%), fludeoxyglucose-positron emission tomography/computed tomography (50.0%), and neck ultrasonography (21.6%). In 90.5% of cases with negative or inconclusive conventional imaging, 18F-fluorocholine positron emission tomography/computed tomography accurately localized pathological parathyroid gland(s). A focused surgical approach (sternotomy or unilateral cervicotomy) was feasible in 87.1% of patients. Appropriate intraoperative parathyroid hormone monitoring decline was associated with a 95.8% biochemical cure rate. Complication rates were low, with vocal cord palsy in 0.8% and long-term hypoparathyroidism requiring calcium supplementation in 2.4%. CONCLUSIONS AND RELEVANCE: 18F-fluorocholine positron emission tomography/computed tomography offers superior localization accuracy and a favorable radiation profile compared to conventional imaging options, supporting its use as a first-line modality in reoperative parathyroidectomy. Its application enables focused surgical interventions with high cure rates and low morbidity.
The Singapore Declaration on Professional Empathy for Surgeons: Rehumanizing Surgical Practice.
Shelat VG
World J Surg · 2026 May · PMID 41866294 · Publisher ↗
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Healthcare Workers' Acceptance and Willingness to Implement a Pragmatic Triple-Component Enhanced Recovery After Surgery Strategy (T-ERAS): A Cross-Sectional Study in Ethiopian Public Hospitals.
Kifle F, Kenna P, Muleye B … +3 more , Desta K, Maswime S, Biccard B
World J Surg · 2026 May · PMID 41866292 · Full text
BACKGROUND: Enhanced recovery after surgery (ERAS) protocols have demonstrated substantial benefits in improving postoperative outcomes. However, in low-resource settings such as Ethiopia, ERAS adoption remains limited,...
BACKGROUND: Enhanced recovery after surgery (ERAS) protocols have demonstrated substantial benefits in improving postoperative outcomes. However, in low-resource settings such as Ethiopia, ERAS adoption remains limited, necessitating pragmatic context-sensitive implementation approaches. The perspectives of frontline perioperative providers who are central to implementation have rarely been systematically assessed. This study aimed to evaluate acceptance, perceived benefits, implementation challenges, and readiness for sustained adoption of a pragmatic triple enhanced recovery after surgery (T-ERAS) protocol, comprising early oral intake, early ambulation, and early urinary catheter removal, among healthcare workers participating in a multisite ERAS trial in Ethiopia. METHODS: A descriptive cross-sectional survey was conducted among 20 perioperative care providers, including surgeons, obstetricians, anesthetists, and nurses, from five public hospitals involved in the ERAS implementation trial. A structured questionnaire administered via Google Forms captured demographic characteristics, ERAS knowledge and exposure, perceived benefits and challenges, and willingness to adopt ERAS practices. Data were analyzed using descriptive statistics and thematic summaries. RESULTS: Twenty perioperative care providers participated, of whom 13 (65.0%) were male, and 15 (75.0%) were affiliated with tertiary-level public hospitals. Twelve respondents (60.0%) reported being very familiar with ERAS protocols, although only 11 (55.0%) had directly participated in implementation. Sixteen participants (80.0%) believed ERAS improves patient outcomes; however, adherence varied, with 8 (42.1%) reporting rarely applying the protocol. Key implementation challenges included limited resources (85.0%), insufficient staff training (70.0%), resistance to change (50.0%), and inadequate patient education (50.0%). Despite these barriers, 17 participants (85.0%) expressed willingness to adopt ERAS practices permanently, and all (100.0%) were open to further training. The T-ERAS components were viewed favorably, with 15 participants (75.0%) rating each as effective. CONCLUSION: This study demonstrates high awareness and willingness among perioperative professionals in Ethiopian public hospitals to adopt ERAS principles, while highlighting persistent system-level barriers to consistent implementation. Strengthening institutional support, expanding training, and promoting locally led context-sensitive ERAS pathways such as T-ERAS may facilitate sustainable scale-up in low-resource settings.
Endoscope-Assisted Nipple-Sparing Mastectomy With Immediate Implant Reconstruction: A Retrospective Study.
Shao Y, Zhang Y, Kang H … +4 more , Zhou Q, Zhang Z, Yan G, Kan B
World J Surg · 2026 May · PMID 41862426 · Full text
BACKGROUND: Breast cancer surgery increasingly favors nipple-sparing and endoscopic techniques to optimize oncological safety, cosmetic outcomes, and patient satisfaction. We aimed to evaluate and compare the clinical ef...
BACKGROUND: Breast cancer surgery increasingly favors nipple-sparing and endoscopic techniques to optimize oncological safety, cosmetic outcomes, and patient satisfaction. We aimed to evaluate and compare the clinical efficacy and postoperative safety profiles of endoscope-assisted and conventional open approaches for nipple-sparing mastectomy with immediate prosthetic reconstruction in breast carcinoma management. METHODS: This retrospective study evaluated 75 consecutive patients undergoing nipple-sparing mastectomy with concurrent prosthetic reconstruction at a tertiary referral center (Hanzhong Central Hospital) between December 2021 and December 2023. Patients were allocated into two groups based on the surgical modality: endoscope-assisted (n = 35) versus conventional open (n = 40) approaches based primarily on patient preference and secondarily on surgeon selection. In cases of significant comorbidities, conventional open mastectomy (or state type) was performed. RESULTS: We observed significant differences in procedural characteristics between the endoscope-assisted and conventional open surgery cohorts. The endoscopic cohort had a 23.5% prolongation in operative duration, with a 64% reduction in total incision length. No significant differences were observed between the groups in critical clinical outcomes, including intraoperative hemostasis parameters, postoperative drainage volumes, complication profiles, or oncological safety markers. Implant removal was required in one patient in each group. Patient-reported outcome measures showed equivalence in BREAST-Q domains assessing chest wall integrity, psychosocial adaptation, and sexual well-being, along with comparable Harris functional assessment scores. The endoscopic approach yielded superior scar cosmesis as quantified using the SCAR-Q evaluation. CONCLUSIONS: Endoscope-assisted nipple-sparing mastectomy with immediate prosthetic reconstruction is not inferior to conventional open techniques regarding perioperative safety, oncological radicality, and multidimensional patient satisfaction metrics. This approach provides enhanced aesthetic outcomes through minimized cutaneous trauma.
Long-Term Outcomes After Slowly Resorbable P4HB Mesh Implantation: A Multicenter Analysis From European Registry.
van den Berg R, Wieser M, López-Cano M … +8 more , Bueno-Lledó J, Köckerling F, Chatzimavroudis G, Gonella-Pacchiotti C, Stabilini C, Ortega-Deballon P, Romain B, PRS Group (Phasix Research Study Group)
World J Surg · 2026 May · PMID 41862419 · Full text
BACKGROUND: Fully resorbable biosynthetic mesh composed of poly-4-hydroxybutyrate (P4HB), have been designed for incisional hernia (IH) repair, including in contaminated surgical fields. While existing studies have demon...
BACKGROUND: Fully resorbable biosynthetic mesh composed of poly-4-hydroxybutyrate (P4HB), have been designed for incisional hernia (IH) repair, including in contaminated surgical fields. While existing studies have demonstrated its safety and efficacy in the short term, comprehensive long-term data, particularly after complete mesh resorption, remain scarce. METHODS: This multicenter European registry analysis investigates the incidence of short- and long-term complications following IH repair with Phasix (P4HB) or Phasix ST (P4HB with hydrogel barrier; BD, Warwick, RI, USA) mesh. Adult patients from registries in France, Greece, Germany, and Spain were included and stratified using the Ventral Hernia Working Group (VHWG) classification. The primary endpoint was the incidence of long-term mesh-related complications one to five years post-implantation, after mesh resorption. Secondary endpoints included short-term complications and hernia recurrence. RESULTS: A total of 790 patients underwent incisional hernia repair with P4HB mesh, with a median follow-up of 38 months (IQR 36-48). Long-term follow-up beyond 24 months was available in 57% of patients. The majority of complications occur during the first 6 months. Long-term mesh-related morbidity remained low, with mesh infection occurring in 2% of patients and chronic pain in 3%-5%, even after complete mesh resorption. Rates of enterocutaneous fistula and mesh explantation were rare. Long-term complication profiles varied by hernia complexity, comorbidity burden, and mesh position, with higher ASA class associated with increased risk of mesh infection and chronic pain. The overall hernia recurrence rate was 22%, with recurrence increasing after the expected resorption period and stabilizing thereafter. Higher recurrence risk was independently associated with VHWG grade III-IV (HR of 2.55 and 2.49), obesity (HR 1.41), and intraperitoneal mesh placement (HR 2.72). CONCLUSION: P4HB mesh demonstrated a favorable long-term safety profile after complete resorption, with low rates of mesh-related complications, even in high-risk patients. Hernia recurrence remains an important secondary outcome and is strongly influenced by patient risk factors and surgical technique. These findings support a tailored, risk-stratified approach to the use of biosynthetic meshes in IH repair.
Surgical Management of Zollinger-Ellison Syndrome in Multiple Endocrine Neoplasia Type 1 an AFCE and GTE Cohort Study. (Association Francophone de Chirurgie Endocrinienne and Groupe d'étude des Tumeurs Endocrines).
Gaujoux S, Pattou F, Cadiot G … +25 more , Adham M, Bachellier P, Bail JP, Caiazzo R, Carrere N, Chaffanjon P, Deguelte S, Donatini G, Dousset B, Faron M, Gronnier C, Heyd B, Lifante JC, Lubrano J, Meurisse N, Mirallié E, Santucci N, Sauvanet A, Sebag F, Sulpice L, Thebault B, Tuech JJ, Walter T, Binquet C, Goudet P
World J Surg · 2026 May · PMID 41862416 · Full text
OBJECTIVE: To describe surgical indications, procedures and outcomes in patients operated for Zollinger-Ellison syndrome (ZES) in multiple endocrine neoplasia type 1 (MEN1) using a large nationwide cohort. BACKGROUND: Ma...
OBJECTIVE: To describe surgical indications, procedures and outcomes in patients operated for Zollinger-Ellison syndrome (ZES) in multiple endocrine neoplasia type 1 (MEN1) using a large nationwide cohort. BACKGROUND: Management of ZES in MEN1 remains controversial. METHODS: All patients with ZES diagnosed through the MEN1 AFCE/GTE network from 1985 to 2015. RESULTS: Among 233 ZES patients, 66 (28%) were operated for ZES-related gastrinomas. Thirty-three (51%) procedures aimed to remove gastrinomas and associated pancreatic neuroendocrine tumors (pNET(s)) with appropriate resection. Thirty-two procedures (49%) aimed to remove gastrinomas alone (ZES group). Survival was decreased in patients metastatic at ZES diagnosis (p < 0.001). Fifteen-year survival among non-metastatic patients was not significantly better in operated patients (82% vs. 70%, p = 0.2). Perioperative mortality was nil. Metastatic lymph nodes were found in 30/42 lymphadenectomies (71%). The choice between pancreaticoduodenectomy versus duodenal focused surgery in the ZES group was associated with pre-operative detection of adenopathies (p > 0.001), leading to more frequent lymphadenectomies (p < 0.01). Previous pancreatic surgeries (30%) may have influenced the choice of ZES procedures. Gastrin levels were more frequently normalized when the duodenum and the head of pancreas were removed versus more localized duodenal surgeries (p < 0.01). CONCLUSION: The high rate of invaded nodes in lymphadenectomies in MEN1 patients operated for ZES, the absence of operative mortality, and the decreased survival in metastatic patients are indirect arguments for surgery. Pancreaticoduodenectomy may be indicated in young and fit individuals to better control hypergastrinemia and to prevent metastatic progression in the ZES group. Gastrinoma removal is justified when associated with large pNETs.
Mining the Gap: New Opportunities for the WHO Surgical Safety Checklist.
Turley N, Brindle ME
World J Surg · 2026 May · PMID 41862415 · Full text
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Approaches to Education and Training on How to Diagnose and Treat Acute Appendicitis in Norway: A Mixed-Method Study.
Skjold-Ødegaard B, Lindeman RJ, Søreide K … +2 more , Ersdal HL, Braut GS
World J Surg · 2026 May · PMID 41862414 · Publisher ↗
BACKGROUND: Clinical practice in diagnosing and treating appendicitis vary, and how this impacts trainees is unclear and not well investigated. The aim of this study was to explore current practice and trainees' percepti...
BACKGROUND: Clinical practice in diagnosing and treating appendicitis vary, and how this impacts trainees is unclear and not well investigated. The aim of this study was to explore current practice and trainees' perception to identify areas for improvement. METHODS: A mixed-method study comprising two parts: One consisted of two time-point surveys to heads of surgical departments (2022 and 2025) and to surgical trainees (2025), and secondly, bi-institutional focus groups were conducted. RESULTS: The survey to heads of departments had a response rate of 92.5% (37/49) in 2022 and 86.1% (31/36) in 2025. It demonstrated variations in hospital size (population base: 11,000-700,0000) and appendectomies performed annually (25-1000). Use of laparoscopic technique increased significantly from 2022 to 2025. The trainee survey had a response rate of 23% (81/345). 69 (85%) of the trainees did not receive a structured competence assessment. 71 (88%) use tools in preparation for surgery, and 42 (55%) used a simulator before their first laparoscopic appendectomy. Assessment by a consultant surgeon and/or a more experienced trainee is considered appropriate for competence assessment, but evaluation board, mandatory course, and number of assists is highlighted. Themes in the focus groups included expression of security, lack of structured assessment, lack of standardized surgical technique, falling motivation for simulation, and lack of satisfactory digital learning tools. Trainees proposed several suggestions for improvement. CONCLUSION: There are variations among the hospitals where training takes place. Trainees express a need for sufficient feedback, regular competency assessment, and quality-assured learning tools.
Neurologic Morbidity and Long-Term Disability After Blunt Traumatic Aortic Injury: A Single-Center Cohort Study.
Mayer-Suess L, Lutz M, Wippel D … +9 more , Moelgg K, Frank F, Kiechl S, Wipper S, Gizewski ER, Knoflach M, Freund M, Loizides A, Enzmann F
World J Surg · 2026 Apr · PMID 41862413 · Full text
Blunt traumatic aortic injury (BTAI) is highly lethal, and contemporary management has shifted from open surgery toward thoracic endovascular aortic repair (TEVAR).
Blunt traumatic aortic injury (BTAI) is highly lethal, and contemporary management has shifted from open surgery toward thoracic endovascular aortic repair (TEVAR).
Trauma Systems in Conflict Zones: A Qualitative Study of Field Operational Requirements in Humanitarian Care.
Markou-Pappas N, Ansaloni L, Ragazzoni L … +2 more , Barone-Adesi F, Lamine H
World J Surg · 2026 Apr · PMID 41840721 · Full text
BACKGROUND: Trauma care is a central component of humanitarian medical response in conflict zones. However, essential operational knowledge-referral pathways, triage practices, logistical coordination, and team leadershi...
BACKGROUND: Trauma care is a central component of humanitarian medical response in conflict zones. However, essential operational knowledge-referral pathways, triage practices, logistical coordination, and team leadership-remains largely undocumented and inconsistently applied. The absence of structured learning mechanisms perpetuates fragmentation and impedes quality improvement across missions. Our study aimed to capture and analyze the field-based experiences of humanitarian health professionals to define practical, system-oriented requirements for effective trauma care in conflict settings. METHODS: We conducted a qualitative, exploratory study grounded in 19 in-depth, semi-structured interviews with experienced humanitarian health professionals. Participants were purposively sampled for their experience across prehospital care, hospital-based trauma response, and humanitarian coordination. Thematic analysis was used to identify structural patterns, operational challenges, and field-informed strategies that shape trauma care delivery in conflict-affected contexts. Reporting of this study adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ). RESULTS: Participants described trauma care in conflict settings as dependent on interlocking requirements of six interdependent domains. Effective coordination was portrayed not as a technical function but as a relational one, built on trust, preparedness, and shared ownership across agencies and communities. Information exchange needed to be ethically governed, technically reliable, and tailored to fragile environments, relying on simplicity, redundancy, and low-tech tools co-developed with local actors. Prehospital care and transport systems were seen as decisive and in need of deliberate design, rooted in safety mapping, role-adapted responder models, and integration with local infrastructure. Workforce competence extended beyond clinical skills to include cross-functional agility, cultural literacy, and ethical resilience. Education and training were considered incomplete unless they prepared staff with conflict-specific competencies, supported by structured, simulation-based training for both expatriate and local staff. Finally, the absence of embedded operational research was viewed as a critical gap, with respondents calling for real-time learning systems that inform both frontline response and long-term planning. CONCLUSION: Trauma care in modern conflict cannot rely on improvisation or technical skill alone. It must be underpinned by ethical, resilient and locally grounded systems. Our study highlights the operational knowledge of field practitioners, offering a foundation for building trauma care systems that are integrated, resilient, locally anchored, and worthy of the people they aim to serve.
Management of PErioperative Anemia in EmeRgency Laparotomy Patients (PEARL Study).
Lakshmanan V, Nantha Kumar DL, Chin C … +5 more , Lukaszewicz AHM, Meggy A, Silva LM, Torkington J, Cornish JA
World J Surg · 2026 Apr · PMID 41840466 · Full text
BACKGROUND/AIM: There has been a drive on improving outcomes after Emergency Laparotomy (EmLap) due to the National Emergency Laparotomy Audit (NELA). This has focused mainly on preoperative and intraoperative management...
BACKGROUND/AIM: There has been a drive on improving outcomes after Emergency Laparotomy (EmLap) due to the National Emergency Laparotomy Audit (NELA). This has focused mainly on preoperative and intraoperative management with less emphasis on other perioperative aspects. We aimed to assess the prevalence of anemia in EmLap patients and its management in a perioperative period, exploring the gaps in anemia care. METHODS: A retrospective cohort study of prospectively maintained database of 1055 EmLap patients (2016-2019) from a UK tertiary center was performed. Data were extracted from the NELA database, POLO study, electronic records (Welsh Clinical Portal). Statistics were performed in SPSS v27. RESULTS: Among 740 patients, 77% underwent open surgery, with mean age of 61.9 years (range 18-98), median age of 65 years, and roughly equal sex distribution (female 54%). The median preoperative NELA risk was 3.6% (IQR 1.1-9.8). Over a quarter of patients (28.6%) were anemic on admission. Anemic patients had significantly longer hospital stays (median 12 days; >/ = 11 days, p = 0.008) and higher stoma formation rates (54.1% moderate anemia vs. 34.3% nonanemic; p = 0.002). Three-quarters of patients (74.2%) were anemic at discharge (median Hb: 108 g/L, range: 74-129 g/L) but only 12% were treated with oral or IV iron or blood transfusion; only 10% had anemia reported in their discharge letters with appropriate follow-up and management plan. CONCLUSIONS: Anemia in patients undergoing emergency laparotomy is significantly under-recognized and inadequately managed at discharge, despite recognized increased morbidity. A structured pathway for continuing anemia treatment and discharge planning is urgently needed to improve outcomes.
Intraperitoneal Local Anesthetic Instillation for Post-Operative Pain Control After Bariatric Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
Ribeiro BDL, Martins IC, Lopes MJS … +9 more , Pereira LER, Cassiano MDS, Matos RFS, Neto JN, Moura ECR, Oliveira CMB, Silva GEB, Filho OPG, Leal PDC
World J Surg · 2026 Apr · PMID 41840461 · Publisher ↗
BACKGROUND: Postoperative pain after bariatric surgery is a significant clinical challenge, with approximately 61.4% of patients reporting persistent pain. Intraperitoneal local anesthetic instillation (IPLA) has been pr...
BACKGROUND: Postoperative pain after bariatric surgery is a significant clinical challenge, with approximately 61.4% of patients reporting persistent pain. Intraperitoneal local anesthetic instillation (IPLA) has been proposed as a strategy to reduce pain and opioid-related adverse effects. However, as its effectiveness in bariatric procedures remains controversial, this meta-analysis was conducted to clarify the role of IPLA in this setting. METHODS: This systematic review and meta-analysis was conducted following PRISMA guidelines and was prospectively registered in PROSPERO. We performed a comprehensive search in Pubmed, Embase, Cochrane Central Register of Controlled Trials, and Web of Science for randomized controlled trials (RCTs) IPLA instillation with a control group in patients undergoing bariatric surgery. The primary outcomes were postoperative pain intensity, need for rescue analgesia, and supplementary opioid consumption. Secondary outcomes included postoperative nausea and vomiting (PONV), nausea, vomiting, and shoulder pain. Data were synthesized using a random-effects model to calculate Risk Ratios (RR) for binary outcomes and Standardized Mean Differences (SMD) and Mean Differences (MD) for continuous outcomes. The methodological quality of the trials was assessed using the Cochrane Risk of Bias 2 (RoB 2) tool. RESULTS: The analysis included 13 randomized controlled trials with a total of 1205 participants, of whom 624 were in the intraperitoneal local anesthetic (IPLA) group and 581 were in the control group. The pooled results showed that IPLA significantly reduced postoperative pain intensity (SMD: -0.96, 95% CI -1.72 to -0.20; p = 0.01) and the need for rescue analgesia (RR: 0.52, 95% CI 0.31-0.89). However, there was no significant difference in postoperative opioid consumption (SMD: -0.56, 95% CI -1.13 to 0.01; p = 0.05). Additionally, no significant effects were found for the incidence of postoperative nausea and vomiting (PONV) or shoulder pain. High heterogeneity was noted in most of the analyses. CONCLUSION: IPLA reduces postoperative pain in bariatric surgery but does not decrease opioid consumption or adverse events. A suggested reduction in rescue analgesia was not robust. Due to high heterogeneity, the findings' clinical applicability is limited, highlighting the need for standardized trials. TRAIL REGISTRATION: PROSPERO protocol CRD420251085223-July 2025.
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