The American Surgeon[JOURNAL]
Sun
200 papers
Great Debates: Surgeons Should Have a Mandatory Retirement Age.
Alvarez E, Sadoma B, Sheets N … +1 more , Collins JC
Am Surg · 2026 Jun · PMID 42307613 · Publisher ↗
The question of whether to implement a mandatory retirement age for surgeons sits at the intersection of patient safety, professional dignity, and anti-discrimination law. One position cites age-related cognitive decline...
The question of whether to implement a mandatory retirement age for surgeons sits at the intersection of patient safety, professional dignity, and anti-discrimination law. One position cites age-related cognitive decline and the systemic failure of self-regulation, advocating for a uniform age limit as a necessary public safeguard modeled after other high-risk professions. The opposing position argues that chronological age is a poor and discriminatory proxy for individual competence, emphasizing research that identifies maintained technical skill and procedural volume as the primary determinants of surgical outcomes. Evidence demonstrates that while older surgeons may have higher mortality rates for certain procedures, these associations are often explained by lower procedural volume rather than age itself. A mandatory retirement age protects patients but removes experienced surgeons arbitrarily, whereas competency-based assessment offers a fairer, more nuanced approach. This discourse ultimately challenges the surgical field to reconcile patient protection with equity and retention of clinical expertise.
Factors and Outcomes Associated With Cardiac Complications Among Patients Undergoing Elective Major Abdominal Surgery.
Gao Z, Coaston TN, Leung P … +5 more , Balian J, Porter G, Tillou A, Sanaiha Y, Benharash P
Am Surg · 2026 Jun · PMID 42307097 · Publisher ↗
BackgroundAmong patients undergoing major abdominal surgery (MAS), ∼3% develop cardiac complications (CC) and face poorer prognosis. This study aimed to characterize outcomes and identify factors associated with CC follo...
BackgroundAmong patients undergoing major abdominal surgery (MAS), ∼3% develop cardiac complications (CC) and face poorer prognosis. This study aimed to characterize outcomes and identify factors associated with CC following MAS.MethodsAll elective adult (>17) hospitalizations for MAS (colectomy, esophagectomy, gastrectomy, hepatectomy, nephrectomy, pancreatectomy, splenectomy) were identified in the 2016-2022 National Inpatient Sample, using survey weights to generate nationally representative estimates. The primary outcome of interest was the development of CC (acute myocardial infarction (AMI) and cardiac arrest). We also evaluated patient and institutional factors associated with failure-to-rescue (FTR) following CC. Risk-adjusted analyses with multivariable regressions were used to characterize factors associated with the development of CC. Subgroup analyses were conducted for isolated AMI and cardiac arrest.ResultsOf an estimated 904 270 patients, 1.8% developed CC. Compared to others, CC were older (71 vs 62 years), less commonly female (36.5 vs 52.1%, < 0.001), and had a higher burden of comorbidities (Elixhauser: 5 vs 3). Following risk-adjustment, older age (adjusted odds ratio (AOR) 1.02, 95% confidence interval (CI) 1.02-1.03) and higher burden of comorbidity (AOR 1.62, 95% CI: 1.59-1.66) were independently associated with CC ( < 0.05). Greater annual institution PCI and MAS caseloads were independently associated with a reduced risk of CC ( < 0.001). Furthermore, CC was associated with greater mortality (AOR 10.53, 95% CI: 8.90-12.46), respiratory complications (AOR 3.53, 95% CI: 3.18-3.91), and higher costs (β +$8,500, 95% CI: 7400-9700). On subgroup analysis, cardiac arrest revealed markedly higher mortality risk (AOR 6.86) than AMI alone (AOR 1.28).DiscussionIn summary, CC was associated with inferior outcomes and higher resource utilization. Furthermore, we found patient and hospital factors to be independently linked with CC risk. These findings highlight an association between institutional MAS and PCI volume and reduced CC risk, warranting further investigation into the role of center-level factors in perioperative cardiac outcomes.
Managing Pyogenic Soft-Tissue Infections in People Living With HIV in a Resource-Limited Setting: Field Lessons and a Pragmatic Algorithm From South Sudan.
Mišánik M, Smolár M, Musová D … +4 more , Slezák M, Cmarková K, Vasiľová B, Miklušica J
Am Surg · 2026 Jun · PMID 42300153 · Publisher ↗
Severe pyogenic soft-tissue infections (SSTI) are a frequent cause of morbidity among people living with HIV (PLHIV) in resource-limited hospitals. Drawing on five months of frontline work in a district surgical unit in...
Severe pyogenic soft-tissue infections (SSTI) are a frequent cause of morbidity among people living with HIV (PLHIV) in resource-limited hospitals. Drawing on five months of frontline work in a district surgical unit in South Sudan, this field report distills practical lessons into a simple, resource-adapted algorithm for triage, source control, antibiotics, and wound care. Core steps include bedside sepsis screening with qSOFA, prompt empiric antibiotics aligned with the WHO EML/AWaRe approach, and decisive operative debridement without waiting for advanced diagnostics when necrotizing infection is suspected, followed by planned re-look procedures. Low-cost wound-care options (eg, diluted hypochlorite/povidone-iodine transitioning to saline gauze) and loss-to-follow-up-aware discharge practices are emphasized. The aim is to standardize care and shorten time to debridement in district-level services rather than report outcomes. Keywords: pyogenic soft-tissue infection; HIV; resource-limited settings; necrotizing fasciitis.
Where Are We Now? An Update on Colectomies for Diverticulitis in the Wake of the COVID-19 Pandemic.
Gallant B, Hu A, Hwang H … +7 more , Oldewurtel K, Crawford A, Maykel J, Peponis T, Sturrock P, Alavi K, Aulet T
Am Surg · 2026 Jun · PMID 42299493 · Publisher ↗
BackgroundThe COVID-19 pandemic strained hospital systems and post-pandemic data on colectomy trends for diverticulitis are limited. We aimed to describe trends in colonic resections in patients with diverticulitis befor...
BackgroundThe COVID-19 pandemic strained hospital systems and post-pandemic data on colectomy trends for diverticulitis are limited. We aimed to describe trends in colonic resections in patients with diverticulitis before, during, and after the pandemic.MethodsThis retrospective cohort study queried the American College of Surgeons NSQIP database, analyzing patients who underwent a colectomy for diverticulitis during quarters 2-4 (April 1-December 31) in 2018 ("pre-COVID"), 2020 ("during COVID"), and 2022 ("post-COVID"). The primary study outcome was emergency case rates during the 3 time periods. Secondary outcomes included trends in patient comorbidities, severity of presenting illness, 30-day postoperative complications, and disposition status.ResultsA total of 21,642 patients were studied (7163 pre-COVID, 6254 during COVID, and 8225 post-COVID). Emergency cases of diverticulitis increased to 21% during the COVID period but remained at 17% and 18% during the pre-COVID and post-COVID periods, respectively ( < 0.001). Similarly, end colostomy creation rates rose to 20% during COVID and returned to baseline levels (18%) after the pandemic ( < 0.001). Hospital length of stay and 30-day mortality increased during the COVID period and remained slightly elevated post-COVID.ConclusionsThe COVID-19 pandemic was associated with a temporary increase in emergency colectomies and end colostomy creations for diverticulitis, with operative urgency returning to pre-pandemic levels in the post-COVID period. Short-term postoperative outcomes also shifted modestly during and after the pandemic. These findings offer a national perspective on trends in the surgical management of diverticulitis during and after the pandemic and may help guide surgical practice during future health care disruptions.
Percutaneous Endoscopic Pharyngostomy (PEP) Tube Placement for Gastrointestinal Diversion: A PEP in Your Palliative Step.
Bissell JNR, Hayton R, Mukherjee K
Am Surg · 2026 Jun · PMID 42287130 · Publisher ↗
BackgroundNeed for chronic gastrointestinal diversion (GID) due to advanced malignancy or prolonged gastrointestinal discontinuity can pose a challenge for patients in which gastrostomy tube placement is not a feasible o...
BackgroundNeed for chronic gastrointestinal diversion (GID) due to advanced malignancy or prolonged gastrointestinal discontinuity can pose a challenge for patients in which gastrostomy tube placement is not a feasible option. Nasogastric (NG) tubes carry a risk of multiple complications and can impact quality of life. Need for long-term GID can increase length of stay, delay discharge to post-acute care, and result in readmissions. We discuss the procedural steps to percutaneous endoscopic pharyngostomy (PEP) tube placement utilizing common endoscopic, ultrasound imaging, and percutaneous access skills.MethodsWe conducted a single-center retrospective review of 10 patients who required long-term GID and underwent PEP performed by acute care surgeons between May 2019 and August 2025.ResultsPatients ranged from ages 39 to 81. Nine patients required palliation due to malignant obstruction from advanced malignancy. One patient required decompression of an esophageal pouch after gastrectomy for ischemia without reconstruction. Three dislodged tubes were replaced, resulting in a total of 13 operations performed. Complications included the dislodgement of five PEP tubes, ranging from post-op day 12 to 42. Nine of the patients were discharged home with an average discharge of 3.4 days post-op. Three patients were lost to follow-up, but all three were discharged to home hospice as per the patient's preoperative goals of care.DiscussionPercutaneous endoscopic pharyngostomy is a useful skill for acute care surgeons to provide access for GID in selected patients. Challenges include a high dislodgement rate requiring reintervention.
Different Surgical Strategies in Colorectal Cancer Patients With Synchronous Liver Metastasis: A Meta-Analysis.
Azmy HM, Shafik AA, Ahmed AH … +2 more , Saweeres CE, El Refaie O
Am Surg · 2026 Jun · PMID 42284317 · Publisher ↗
This systematic review aimed to evaluate and compare the short- and long-term outcomes of different treatment strategies for patients with colorectal adenocarcinoma presenting with synchronous liver metastases. A compreh...
This systematic review aimed to evaluate and compare the short- and long-term outcomes of different treatment strategies for patients with colorectal adenocarcinoma presenting with synchronous liver metastases. A comprehensive literature search was conducted in PubMed (MEDLINE), Cochrane Central Register of Controlled Trials (CENTRAL), Embase, Ovid, and ScienceDirect to identify relevant studies assessing surgical sequencing strategies in patients without extrahepatic disease. Data were extracted and analyzed using Review Manager software. Pooled dichotomous outcomes were expressed as odds ratios (ORs) with 95% confidence intervals (CIs), while continuous outcomes were reported as mean differences (MDs) with corresponding 95% CIs. Three treatment strategies were evaluated: the classical "colon-first" approach, the "liver-first" approach, and the simultaneous resection approach. Overall survival (OS) at 1, 3, and 5 years was the primary outcome. The pooled results demonstrated no statistically significant differences in survival outcomes among the three strategies. When compared with the colon-first approach, simultaneous resection showed comparable 1-year (90.1% vs 87.9%), 3-year (66.5% vs 56.2%), and 5-year survival rates (48% vs 40.7%). Similarly, comparisons between colon-first and liver-first approaches revealed no significant differences in 1-, 3-, or 5-year overall survival. These findings indicate that no single surgical sequencing strategy confers a clear survival advantage. Accordingly, treatment decisions should be individualized, taking into account patient characteristics, hepatic tumor burden, primary tumor features, and institutional expertise within a multidisciplinary framework. Further high-quality randomized controlled trials are needed to better define optimal management strategies for this complex and heterogeneous patient population.
Transportation Access as a Structural Determinant of Firearm Violence.
Altman J, Campbell A, Smith E … +8 more , Persons E, Tatum D, Fleckman JM, Theall KP, Harrell K, Zhang J, Duchesne J, Taghavi S
Am Surg · 2026 Jun · PMID 42284064 · Publisher ↗
BackgroundTransportation access, a recently recognized key social determinant of health, has an understudied relationship to gun violence. We hypothesized that poor transportation access would be associated with increase...
BackgroundTransportation access, a recently recognized key social determinant of health, has an understudied relationship to gun violence. We hypothesized that poor transportation access would be associated with increased firearm violence.MethodsThis cross-sectional analysis examined indices of transportation access using University of Minnesota Access Across America (UMAAA) data, which assigns separate rankings based on transit, auto, biking, and walking access scores. Violent firearm injuries and deaths were obtained from the Gun Violence Archive (GVA). Data for educational attainment, income, employment, and housing characteristics came from the US Census's American Community Survey. Data was aggregated from 2019 to 2021 by the 56 largest metropolitan statistical areas (MSA) in the US. Negative binomial Poisson regression models (univariate and multivariate) were used to examine the association between transportation indices and violent firearm injuries and deaths.ResultsNegative Binomial Poisson regression analysis found that lowered overall transit and auto access scores were associated with slightly lower risk of violent firearm injury and death. This relationship persisted even when adjusted for Gini and ICE. Poverty, unemployment, Gini, and the percentage of persons without a vehicle were directly associated and had higher effects compared to AAA score.DiscussionThis study does not support a strong protective effect of transportation access on firearm violence rates, instead suggesting a relatively small, inverse relationship. These findings underscore the complex nature of urban violence, which is influenced by multiple socioeconomic and community factors. Further studies are needed to determine how injury preventive strategies can target important determinants of firearm injury.
Mammary Paget Disease is Not an Independent Prognostic Factor: A Contemporary SEER Analysis.
Turan B, Sanli AN, Karabulut A … +1 more , Tekcan Sanli DE
Am Surg · 2026 Jun · PMID 42275575 · Publisher ↗
PurposeThis study aimed to provide an updated evaluation of the clinicopathological characteristics and survival outcomes of mammary Paget disease by analyzing pure Paget, Paget + DCIS, and Paget + IDC subgroups within t...
PurposeThis study aimed to provide an updated evaluation of the clinicopathological characteristics and survival outcomes of mammary Paget disease by analyzing pure Paget, Paget + DCIS, and Paget + IDC subgroups within the contemporary SEER cohort, which includes consistent HER2 reporting and reflects the modern systemic therapy era.MethodsCases diagnosed in the SEER database between 2010 and 2021 were analyzed. Clinicopathological parameters were compared across subgroups. Overall survival (OS) and cancer-specific survival (CSS) were evaluated using Kaplan-Meier analyses and multivariable Cox regression models.ResultsPaget-associated subgroups exhibited distinct biological profiles, characterized by lower hormone receptor positivity and markedly higher HER2 positivity compared with IDC. In unadjusted analyses, pure Paget and Paget + IDC groups demonstrated lower survival, whereas Paget + DCIS showed the most favorable outcomes . However, after adjustment for key prognostic determinants, including age, stage, grade, nodal status, and treatment, histological subgroup was not an independent predictor of OS or CSS.ConclusionIn the modern therapeutic era, survival differences across the Paget spectrum appear to reflect the underlying carcinoma's biological and clinical characteristics rather than the presence of Paget disease itself. This study represents the most contemporary, comprehensively adjusted population-level analysis to date and clarifies that, when tumors are matched for stage and subtype, Paget disease does not independently worsen prognosis.
Gallbladder Volvulus Presenting as Acute Cholecystitis: Diagnostic Challenges and the Need for Early Surgical Intervention.
Dai J, Myers R, Zamora J … +1 more , Nussbaum M
Am Surg · 2026 Jun · PMID 42275033 · Publisher ↗
Gallbladder volvulus, or "floating gallbladder," is a rare but serious and potentially life-threatening condition that is frequently overlooked for more common biliary pathologies. Preoperative diagnosis can be challengi...
Gallbladder volvulus, or "floating gallbladder," is a rare but serious and potentially life-threatening condition that is frequently overlooked for more common biliary pathologies. Preoperative diagnosis can be challenging given a similar clinical presentation to the more common acute cholecystitis, and a high index of suspicion for gallbladder volvulus is required for prompt diagnosis. Unlike cholecystitis, patients with gallbladder volvulus cannot and should not be managed nonoperatively, and failure of conservative therapy in suspected cholecystitis should prompt consideration for an unconventional diagnosis such as torsion. Timely surgical treatment avoids the complications and morbidity of delayed cholecystectomy and leads to overall improved patient outcomes. We report a case of gallbladder volvulus in an elderly patient presenting with signs and symptoms mimicking acute cholecystitis. The patient was admitted for laparoscopy and intraoperatively found to have twisting of the cystic pedicle causing gallbladder ischemia. Given the increased incidence of gallbladder volvulus in the geriatric population, the more liberal use of alternative imaging modalities such as magnetic resonance cholangiopancreatography (MRCP) may be warranted moving forward. Importantly, early surgical intervention is key to successful management of gallbladder volvulus.
A Retrospective Evaluation of Psychiatric Recommendations Using the Injured Trauma Survivor Screen.
McNeil LG, Ching JA, Ramos YL … +1 more , McNickle AG
Am Surg · 2026 Jun · PMID 42266084 · Publisher ↗
BackgroundTrauma patients are at high risk of developing psychiatric disorders such as Post-Traumatic Stress Disorder (PTSD) and depression. The Injured Trauma Survivor Screen (ITSS) is a validated tool designed to ident...
BackgroundTrauma patients are at high risk of developing psychiatric disorders such as Post-Traumatic Stress Disorder (PTSD) and depression. The Injured Trauma Survivor Screen (ITSS) is a validated tool designed to identify trauma patients at risk, facilitating early psychiatric intervention. However, there is limited information on the types of psychiatric recommendations given following positive screenings. This study compares the frequency of positive ITSS and treatment recommendations between blunt and penetrating trauma at a Level 1 urban center.MethodsWe conducted a retrospective chart review of trauma patients ( = 727) screened with the ITSS between August 2023-July 2024. Data was extracted including demographics, trauma mechanism, ITSS screen result (positive/negative), positive result (PTSD, depression, or both), personal psychiatric history, and psychiatric recommendations following positive screenings (psychotherapy, medications, inpatient psychiatric transfer, or no intervention) Descriptive statistics were used to analyze the frequency of each recommendation and compare blunt and penetrating mechanisms.ResultsOf the 727 patients screened, 46% screened positive for either PTSD or depression. Among those who screened positive, 65% were seen by psychiatry. The most common recommendations were psychotherapy (64%) and pharmacotherapy (50%). Penetrating trauma had more positive screens (69%), but no difference in psychiatry consultations or recommendations.DiscussionThis study highlights the current practices in psychiatric recommendations for trauma survivors and underscores the importance of early identification using tools like ITSS. Patients with penetrating trauma or those screening positive for PTSD may represent a unique subset that has specific needs for follow-up.
Unmasking Hyperammonemia: Psychomotor Slowing as a Diagnostic Trigger During PEG and Enteral Nutrition.
Zhao X, Shen Y, Zhan Q
Am Surg · 2026 Jun · PMID 42266008 · Publisher ↗
A 63-year-old woman developed severe hyperammonemia and psychomotor slowing following percutaneous endoscopic gastrostomy (PEG) and continuous enteral nutrition (EEN) for anxiety-related feeding difficulties. Despite nor...
A 63-year-old woman developed severe hyperammonemia and psychomotor slowing following percutaneous endoscopic gastrostomy (PEG) and continuous enteral nutrition (EEN) for anxiety-related feeding difficulties. Despite normal neuroimaging, her plasma ammonia levels peaked at 117.6 μmol/L. Immediate management via PEG removal and transition to a semi-liquid oral diet successfully normalized ammonia levels and restored cognitive function. This case highlights that PEG-associated EEN, potentially combined with specific formula deficiencies or metabolic vulnerabilities, can precipitate hyperammonemia. Surgeons and gastroenterologists should recognize unexplained psychomotor slowing as a critical diagnostic trigger for hyperammonemia in patients on long-term enteral feeding to ensure prompt intervention.
Coated Polypropylene Mesh Is Not an Independent Predictor of Wound Morbidity in Open Abdominal Wall Reconstruction.
Kerr SW, Walker VL, Hinton LR … +4 more , Scarola GT, Ayuso SA, Augenstein VA, Heniford BT
Am Surg · 2026 Jun · PMID 42265908 · Publisher ↗
BackgroundBarrier-coated meshes were developed to minimize adhesion formation between the PM and adjacent viscera. However, prior data has shown an increased infectious risk associated with rapidly absorbable coated PM v...
BackgroundBarrier-coated meshes were developed to minimize adhesion formation between the PM and adjacent viscera. However, prior data has shown an increased infectious risk associated with rapidly absorbable coated PM vs uncoated PM in open preperitoneal AWR (OPPAWR). This study evaluated differences in wound and mesh infection rates between coated and uncoated PM in patients undergoing OPPAWR.Materials and MethodsA prospectively maintained, tertiary hernia center database was queried for patients undergoing OPPAWR with PM in CDC class 1/2 wounds. Using 1:1 propensity-score matching (PSM), coated and uncoated groups were matched on factors known to influence outcomes. Multivariable regression models determined independent predictors of wound and infectious complications.ResultsOf 1450 patients with coated and uncoated PM, 382 pairs were well-matched. Propensity-score matching covariates were similar (all 0.05). The coated group had higher rates of wound infection (6.3% vs 3.1%), postoperative IV antibiotics (8.6% vs 4.7%), percutaneous drain placement (6.8% vs 3.1%), and mesh infection (2.4% vs 0.0%) (all < 0.05), but no significant difference in composite wound complications (20.4% vs 16.5%; = 0.162). Multivariable regression showed panniculectomy (OR: 1.87, 95% CI: 1.25-2.82; = 0.003) and BMI (OR: 1.05, 95% CI: 1.02-1.08; = 0.002) were independent predictors of wound complications, but coated mesh was not (OR: 0.78, 95% CI: 0.53-1.15; = 0.211). In the infectious model regression, panniculectomy remained an independent predictor (OR: 2.01, 95% CI: 1.24-3.25; = 0.005), while coated mesh again was not (OR: 0.65, 95% CI: 0.41-1.04; = 0.074).DiscussionIn the largest reported cohort, following complex OPPAWR, multivariable regression demonstrated that coated PM did not independently predict wound or infectious complications.
Postoperative Outcomes of Thyroid Surgery Following Recent COVID-19 Infection.
Arif Arain H, Caretti R, Gomez Carrillo D … +5 more , Izhar A, Gillis A, Dream S, Lindeman B, Chen H
Am Surg · 2026 Jun · PMID 42265897 · Publisher ↗
IntroductionThe postoperative impact of recent COVID-19 infection on patients undergoing thyroidectomy remains unclear. This study evaluates the 90-day postoperative outcomes in patients with recent COVID-19 compared to...
IntroductionThe postoperative impact of recent COVID-19 infection on patients undergoing thyroidectomy remains unclear. This study evaluates the 90-day postoperative outcomes in patients with recent COVID-19 compared to those without.MethodsA retrospective cohort study was conducted using a large multi-institutional database. Adult patients who underwent total thyroidectomy or thyroid lobectomy were divided into 2 cohorts: those with a documented COVID-19 infection within 7 weeks before surgery and those without. Propensity score matching (1:1) was performed to balance age, sex, race, comorbidities, vaccination status, indications for surgery, and surgical procedure performed. Postoperative complications within 90 days were assessed, including hypocalcemia, dysphonia, recurrent laryngeal nerve (RLN) injury, hematoma, surgical site infection (SSI), venous thromboembolism (VTE), pulmonary embolism (PE), pneumonia, acute myocardial infarction (MI), and cerebral infarction. Risk ratios (RRs) with corresponding 95% confidence intervals (CIs) were calculated.ResultsAfter matching, 581 patients were included in each cohort with similar age (50 vs 49 years) and sex distribution (75.6% vs 74.2% female). COVID-19 vaccination rates were comparable between groups (24.9% vs 27.5%). Thyroidectomy-specific complications were not significantly different. Hypocalcemia occurred in 10.2% of the COVID-19 cohort vs 7.2% (RR: 1.41, CI: 0.96-2.05), RLN injury in 3.3% vs 2.4% (RR: 1.36, CI: 0.69-2.68), and dysphonia in 7.4% vs 4.6% (RR: 1.59, CI: 0.99-2.54). COVID-19-related complications were rare. Pulmonary embolism occurred in 2.6% of COVID-19 patients, while all other events were reported as <10 in each group.ConclusionCOVID-19 infection was not associated with an increased risk of major postoperative complications following thyroidectomy.
The Great Debates: De-Escalation of Standardized Testing in Medical Education (USMLE Pass/Fail, De-Emphasizing Shelf Exams and ABSITE Scores) Has Been a Positive Evolution in Medical Education.
Ha C, Nguyen PD, Steen ST … +1 more , O'Leary MP
Am Surg · 2026 Jun · PMID 42249597 · Publisher ↗
The National Board of Medical Examiners and the American Board of Surgery created a series of examinations including Subject Exams, United States Medical Licensing Examination Steps 1-3, ABS In-Training Exam, and the ABS...
The National Board of Medical Examiners and the American Board of Surgery created a series of examinations including Subject Exams, United States Medical Licensing Examination Steps 1-3, ABS In-Training Exam, and the ABS Qualifying and Certifying Exams originally designed as staged assessments of clinical competence. These exams have evolved beyond licensure requirements into high-stakes screening tools for residency and even surgical fellowship selection. Recent efforts to de-emphasize standardized testing have sparked substantial debate within the medical community. We examine whether standardized tests reflect a true measure of trainee competence and its impact on trainees from low socioeconomic status. We also explored the downstream impact of de-emphasizing standardized testing, shifting selection from objective test scores towards more subjective factors such as research experience, letters of recommendations, and medical school reputation.
Corrigendum to "Local Anesthesia Is Associated With Lower Mortality After Endovascular Repair of Ruptured Abdominal Aortic Aneurysm".
Am Surg · 2026 Jun · PMID 42236686 · Publisher ↗
Abstract loading — click title to view on PubMed.
Law's Praxis-On Becoming Self-Actualized.
Patselas TN
Am Surg · 2026 Jun · PMID 42233629 · Publisher ↗
The 12 Invited Henry L. Laws lecture on Medical Education presented at the 94 Southeastern Surgical Congress Meeting on February 22, 2026 entitled Law's Praxis-On Becoming Self-Actualized by Dr Timothy N. Patselas addres...
The 12 Invited Henry L. Laws lecture on Medical Education presented at the 94 Southeastern Surgical Congress Meeting on February 22, 2026 entitled Law's Praxis-On Becoming Self-Actualized by Dr Timothy N. Patselas addresses how personal and professional qualities of Dr Laws can serve as guideposts to become fuller versions of ourselves. Examples of Dr Laws exceptional attributes are highlighted, followed by correlates from the author's personal and professional experience. Special attention is given to the author's journey with multiple sclerosis, and the impact chronic illness has made on his self-growth. Lastly, the author provides words of encouragement, resilience and hope in both the personal and professional domains.
Inferior Pancreaticoduodenal Artery Aneurysms: Diagnostic Challenges and Management Outcomes-A Systematic Review of 113 Cases.
Horowitz R, Hoffman S, Argaman M … +3 more , Dadaev V, Shakkur W, Kanani F
Am Surg · 2026 Jun · PMID 42228840 · Publisher ↗
BackgroundInferior pancreaticoduodenal artery (IPDA) aneurysms are rare visceral artery aneurysms with high rupture rates and significant mortality. Nonspecific clinical presentation frequently leads to diagnostic delay....
BackgroundInferior pancreaticoduodenal artery (IPDA) aneurysms are rare visceral artery aneurysms with high rupture rates and significant mortality. Nonspecific clinical presentation frequently leads to diagnostic delay. We conducted a systematic review to characterize clinical features, diagnostic pitfalls, treatment modalities, and outcomes.MethodsA systematic review following PRISMA 2020 guidelines was performed. PubMed, Cochrane Library, and Google Scholar were searched from inception through January 2025. Case reports and series describing adult patients with IPDA aneurysms were included. Fisher exact test was used for categorical comparisons. An illustrative fatal index case is presented.Results113 patients from 81 publications were analyzed. Mean age was 60.3 ± 12.0 years with male predominance (62.3%). Rupture occurred in 70.2% of cases. Overall mortality was 9.6% (10/104). Abdominal pain was the most common presentation (71.7%). Diagnostic pitfall was documented in 47.4% of cases. Celiac axis stenosis was identified in 71.7% of patients. Endovascular treatment was associated with numerically lower mortality than open surgery (3.5% vs 14.3%; OR 0.22; 95% CI: 0.04-1.28; = 0.08; non-significant). Retroperitoneal hemorrhage predominated among ruptured cases (58.9%).ConclusionsInferior pancreaticoduodenal artery aneurysms present significant diagnostic challenges due to nonspecific symptoms. High clinical suspicion is warranted in patients with unexplained abdominal pain, particularly those with celiac axis stenosis. A stepwise approach-stabilization, endovascular therapy first, and surgical backup-is endorsed by current guidelines. Multidisciplinary team involvement is essential. Mortality is driven primarily by the systemic consequences of hemorrhagic shock rather than by procedural failure; whether earlier recognition reduces mortality cannot be determined from this data set and warrants prospective study.
Retrospective Analysis Study of Modified Bacon Procedure and Double Stapling Technique in Low Rectal Cancer Surgery.
Tian X, Jiang T, Lei Y … +1 more , Zhang C
Am Surg · 2026 Jun · PMID 42228837 · Publisher ↗
BackgroundSphincter-preserving surgery for low rectal cancer is challenging. The double stapling technique (DST) and modified Bacon procedure are commonly used, but their differences in postoperative functional recovery,...
BackgroundSphincter-preserving surgery for low rectal cancer is challenging. The double stapling technique (DST) and modified Bacon procedure are commonly used, but their differences in postoperative functional recovery, complication rates, and survival outcomes have not been fully analyzed.MethodsThis retrospective cohort study included 110 patients who underwent low rectal cancer surgery from January 2018 to December 2022. Patients were divided into the modified Bacon procedure group (n = 43) and DST group (n = 67). Perioperative data, postoperative complications, Wexner scores, and three-year disease-free survival(DFS) and overall survival (OS) were collected and analyzed using R software.ResultsThe modified Bacon procedure was associated with lower hospital costs ( = 0.009). Regarding postoperative complications, anastomotic leakage was significantly associated with the DST group (11.9% in the DST group vs 0% in the modified Bacon procedure group, = 0.022), and prophylactic stoma use was significantly associated with a lower frequency in the modified Bacon procedure group (0% in the modified Bacon procedure group vs 19.4% in the DST group, = 0.002). Higher Wexner scores at 3 and 6 months postoperatively were associated with the modified Bacon procedure ( < 0.001), but no significant association between surgical technique and Wexner scores was found at 12 months ( = 0.322). Survival analysis showed no significant association between surgical technique and DFS or OS, with parallel curves between the two groups.ConclusionThe modified Bacon procedure may represent a feasible sphincter-preserving option for low rectal cancer, but its potential role requires further confirmation in prospective studies.
Maximizing Parenchymal Preservation in Anatomical Hepatectomy: A Pathway to Precision Surgery for Hepatocellular Carcinoma.
Kou C, Duan Y, Ji R
Am Surg · 2026 Jun · PMID 42227996 · Publisher ↗
Liver cancer has one of the highest incidence and mortality rates globally, and hepatectomy is the primary treatment for early to intermediate stages of the disease. As the treatment of liver cancer has evolved, traditio...
Liver cancer has one of the highest incidence and mortality rates globally, and hepatectomy is the primary treatment for early to intermediate stages of the disease. As the treatment of liver cancer has evolved, traditional anatomical hepatectomy has not fully met clinical needs, leading to the gradual adoption of Parenchymal-sparing anatomical hepatectomy (limited anatomical hepatectomy) in clinical practice. This technique is tumor-centered and relies on the portal vein territory as a reference for anatomical tumor resection, aiming to maximize the preservation of functional hepatic parenchyma. This article reviews the theoretical foundations and clinical applications of anatomical hepatectomy with preservation of hepatic parenchyma. Its theoretical advantages include the potential to improve oncological control based on anatomical rationale, although robust clinical evidence remains limited, as well as enhancing the operability of recurrent liver cancer, broaden the indications for hepatectomy, decrease the incidence of postoperative liver failure, minimize patient trauma, and promote postoperative recovery. However, it is important to note that this approach is more complex than conventional anatomical hepatectomy, requiring higher standards of medical infrastructure and surgical expertise. Its precise impact on oncological outcomes and surgery-related complications still requires further investigation for validation.
Impacts of Dementia on In-Hospital Outcomes and Discharge Dispositions Following HIP Fracture Surgery in a Rural Appalachian Population.
Fugate C, Martin JC, Collins HW … +4 more , King SA, Devecki K, Roche K, Burns JB
Am Surg · 2026 Jun · PMID 42227071 · Publisher ↗
Hip fracture in the elderly is widely recognized as a sentinel event, yet the trajectory of care following fracture may differ substantially based on cognitive status. This study evaluated whether dementia significantly...
Hip fracture in the elderly is widely recognized as a sentinel event, yet the trajectory of care following fracture may differ substantially based on cognitive status. This study evaluated whether dementia significantly impacts the outcomes of patients with hip fractures at a rural level 1 trauma center and whether dementia patients follow a distinct post fracture care trajectory. A retrospective cohort analysis was performed including 2391 patients aged >65 years admitted with hip fractures from 2017 to 2024. Dementia patients were significantly less likely to be discharged home and more likely to be discharged to hospice. Combined mortality (morgue + hospice) was higher in the dementia group. Advance directive documentation was extremely low in both cohorts. Dementia is associated with worse outcomes following hip fracture, including higher end of life care utilization and reduced likelihood of discharge home. In a rural Appalachian setting where post acute resources are limited, these divergent care trajectories underscore the critical need for early goals of care discussions and may influence operative decision-making for this vulnerable population.
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