The American Surgeon[JOURNAL]
Sun
200 papers
A Retrospective Study on the Use of Robotic Surgery in Rural Areas Compared to Urban Centers.
Bruna S, Reyes J, Antar S … +3 more , Halloum M, Helmer SD, Vincent K
Am Surg · 2026 Mar · PMID 41800919 · Publisher ↗
BackgroundRobotic surgery may lend several advantages to the rural surgeon such as improved visualization, ergonomics, mobility, and decreased conversions to open. This study evaluated the growth of robotic surgery acros...
BackgroundRobotic surgery may lend several advantages to the rural surgeon such as improved visualization, ergonomics, mobility, and decreased conversions to open. This study evaluated the growth of robotic surgery across the state of Kansas in regard to urban vs rural use.MethodsA retrospective review of surgical cases performed on da Vinci robotic systems from 2018 to 2022 throughout the state of Kansas. The information is grouped together based on the Rural Urban Commuting Codes (RUCA) for the location of procedure. The cases were divided by type (general surgery, cardiothoracic, urology, and gynecology).ResultsGeneral surgery was the fastest growing procedure type over the 5-year span increasing in proportion from 45.7% to 64.2%. This was followed by gynecology initially at 36.4% to 24.5%. Urology ranged from 16.6% to 9.5% and thoracic remained at 1% for the 5-year span. RUCA 1 facilities maintained a steady growth of cases per robot over the 5-year span initially at 225 cases per robot and increasing to 375 cases per robot. RUCA 4 centers illustrated a slower growth initially down trending the first 2 years then showing steady growth ending around 250 cases per robot. RUCA 7 centers had the fastest growth curve starting at 175 cases per robot and increasing to 360 cases per robot finishing just behind RUCA 1 centers.DiscussionThe robot may be an effective tool in a rural facility to generate caseload, revenue, recruit physicians, and provide health equity.
Identifying Perforated Appendicitis Preoperatively: A Rule-In Risk Stratification Model.
Akpinar E, Gök E
Am Surg · 2026 Aug · PMID 41793376 · Publisher ↗
BackgroundAccurately predicting perforated appendicitis (PA) preoperatively remains challenging.MethodsWe retrospectively studied appendectomy patients with histopathologically confirmed acute appendicitis (2022-2023) to...
BackgroundAccurately predicting perforated appendicitis (PA) preoperatively remains challenging.MethodsWe retrospectively studied appendectomy patients with histopathologically confirmed acute appendicitis (2022-2023) to identify predictors of perforation. The primary outcome was histopathologically confirmed perforated appendicitis. Bayesian univariate analysis and Bayesian logistic regression were performed to estimate risk probabilities, with frequentist analyses conducted for confirmation. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC), sensitivity, and specificity.ResultsOf 770 patients with histologically confirmed appendicitis, 155 (20%) had PA. Bayesian univariate analysis demonstrated decisive evidence (BF > 100) for several predictors, with C-reactive protein (CRP) (BF = 251 079), age (BF = 828), and lymphocyte percentage (BF = 352) showing the strongest associations. Multivariate Bayesian modeling identified a parsimonious three-variable model comprising CRP, age, and lymphocyte percentage. This model demonstrated good discrimination (AUC 0.78) with high specificity (95.4%) and modest sensitivity (29%). Frequentist analyses confirmed these findings.ConclusionA predictive model incorporating CRP, age, and lymphocyte percentage provides a highly specific tool for ruling in perforated appendicitis. This approach may aid in prioritizing surgical urgency and optimizing perioperative management. Prospective validation is warranted.
Evaluating Adenocarcinoma-Based Surgical Paradigms in Gastric Neuroendocrine Tumors: A Comparative Outcomes Analysis.
Inbar-Weissman T, Kanani F, Osher E … +6 more , Geva R, Orbach L, Sagie B, Wolf I, Lahat G, Lessing Y
Am Surg · 2026 Aug · PMID 41793232 · Publisher ↗
BackgroundGastric neuroendocrine tumors (gNETs) are rare malignancies with distinct biological behavior compared with gastric adenocarcinoma. Data directly comparing surgical and oncologic outcomes, including lymph node...
BackgroundGastric neuroendocrine tumors (gNETs) are rare malignancies with distinct biological behavior compared with gastric adenocarcinoma. Data directly comparing surgical and oncologic outcomes, including lymph node yield, recurrence pattern, and survival, remain limited.MethodsA retrospective review of 285 gastrectomies (2014-2024) identified 20 gNET and 265 adenocarcinoma cases. After excluding palliative procedures and mixed histology, propensity-score matching (1:2.5; age, sex, BMI, and comorbidities) yielded 18 gNET and 45 adenocarcinoma patients. Outcomes included lymph node harvest, nodal metastasis, lymph node ratio (LNR), recurrence pattern, disease-free survival (DFS), and overall survival (OS).ResultsMedian lymph node yield was lower in gNET than in adenocarcinoma (18 vs 28; = 0.004), and the overall rate of nodal metastasis did not differ between groups (44.4% vs 44.4%; = 1.00), although the nodal metastatic burden was significantly lower in gNET as reflected by a lower median number of positive nodes and lymph node ratio (LNR 0.05 vs 0.17; = 0.008), with no gNET patient exhibiting pN3 disease. DFS was comparable (21.4 vs 18.7 months; = 0.617), whereas OS favored gNET (45.3 vs 27.4 months; = 0.045). Peritoneal recurrence was markedly less frequent in gNET (16.7% vs 81.3%; = 0.003), while hepatic relapse predominated. Perioperative morbidity and 90-day mortality were similar.ConclusionCompared with adenocarcinoma, gastric neuroendocrine tumors show reduced nodal metastatic burden, lower peritoneal dissemination, and improved overall survival. These findings support biology-adapted lymphadenectomy and surveillance for gNET, although validation in larger cohorts is required.
Clinical Features of Postoperative Pancreatic Fistula After Pancreaticoduodenectomy in Patients With a Hard Pancreas: Focused on Estimated Functional Remnant Pancreatic Volume.
Maehira H, Nitta N, Mori H … +9 more , Maekawa T, Sonoda T, Otake R, Tani S, Takebayashi K, Kojima M, Kaida S, Miyake T, Tani M
Am Surg · 2026 Aug · PMID 41790837 · Publisher ↗
BackgroundThis study aimed to evaluate the association between computed tomography (CT) findings and the development of postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD) in patients with a hard p...
BackgroundThis study aimed to evaluate the association between computed tomography (CT) findings and the development of postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD) in patients with a hard pancreas.MethodsThe medical records of 96 patients who underwent PD and had a hard pancreas were retrospectively reviewed. The estimated functional remnant pancreatic volume (eFRPV), which is a composite preoperative CT-derived parameter reflecting both pancreatic volume and attenuation, was evaluated. Additionally, pancreatic attenuation value (PAV), remnant pancreatic volume (RPV), and main pancreatic duct (MPD) were also assessed. Variables, including eFRPV, were compared between patients with and those without POPF after PD.ResultsClinically relevant POPF was observed in seven (7.3%) patients. In the preoperative evaluable factors, only the eFRPV (33.3 HU·mL vs 70.8 HU·mL, = .021) and PAV (32.6 HU vs 40.2 HU, = .013) were associated with clinically relevant POPF. Remnant pancreatic volume and MPD were not significantly different between two groups. The area under the curve (AUC) was 0.764 for eFRPV and 0.783 for PAV. Although the AUCs for eFRPV and PAV were not significantly different ( = .785), eFRPV showed higher specificity at the point corresponding to 100% sensitivity (62.5% vs 38.2%).ConclusionsIn patients with a hard pancreas, POPF following PD can be predicted using eFRPV assessed by preoperative CT.
Intact Fish Skin Grafting in a Patient With Hidradenitis Suppurativa.
Tarar R, Engler C
Am Surg · 2026 Apr · PMID 41786333 · Publisher ↗
Wound management in hidradenitis suppurativa (HS) patients is often challenging due to worsening infections and impaired circulation, which can lead to prolonged hospitalization and poorer quality of life. Traditionally,...
Wound management in hidradenitis suppurativa (HS) patients is often challenging due to worsening infections and impaired circulation, which can lead to prolonged hospitalization and poorer quality of life. Traditionally, autografting-a leading option in skin grafting-exhibits risks, including donor site morbidity. However, xenograft products, such as Kerecis, derived from North Atlantic Cod fish, offer a novel solution for conditions with chronic wounds by promoting natural tissue regeneration. This case report presents a 35-year-old woman with HS who presented with persistent abscesses and fistulas in bilateral axillary regions. Following multiple surgical incisions and drainage procedures, the patient was treated with intact fish skin grafting, which resulted in significant granulation tissue deposition and wound edge approximation. The successful outcome in this case suggests that intact fish skin grafting is a viable option for non-healing wounds, particularly HS wounds, and can be integrated into surgical and wound care practices.
Implementing a Residents as Teachers Program for Interns in Residencies in Community Hospitals.
McElveen K
Am Surg · 2026 Apr · PMID 41786332 · Publisher ↗
General surgery residents play a vital role in undergraduate medical education, often serving as primary instructors during clinical rotations and contributing to students' development in communication, professionalism,...
General surgery residents play a vital role in undergraduate medical education, often serving as primary instructors during clinical rotations and contributing to students' development in communication, professionalism, and clinical reasoning. However, most interns begin residency without formal training in teaching strategies, feedback delivery, or student engagement. This lack of preparation can lead to inconsistent instruction and missed opportunities to foster inclusive, supportive learning environments. To address this gap, our medical school developed the Residents as Teachers Program (RATP), a structured, interactive session implemented during intern orientation across seven affiliated hospitals. The session introduces essential instructional skills, including setting expectations, adapting teaching methods across various clinical settings, supporting students who struggle, promoting psychological safety, and delivering effective feedback using Pendleton's model. Interns also learn to write clear, constructive student evaluations grounded in clerkship objectives. Throughout the session, interns participate in case-based discussions, real-time reflection, and small-group activities designed to reinforce key teaching behaviors. These exercises encourage interns to connect their own experiences as students with practical tools they can use as new educators. The RATP is intentionally designed to be scalable and adaptable, making it well-suited for community and rural hospitals, as well as settings without residency programs where formal teaching preparation is limited. By equipping interns with these foundational skills early in their training, the program enhances the educational experience for medical students and fosters a feedback-rich, learner-centered culture in surgical education.
Hepaticojejunostomy to Treat Medically Refractory Bile Reflux After Esophagectomy With Gastric Pull-Up.
Silva TS, Forrester JA, DeSouza M … +2 more , DeMeester SR, Babicky ML
Am Surg · 2026 Apr · PMID 41786331 · Publisher ↗
Gastroesophageal biliary reflux is a common complication after esophagectomy with gastric pull-up. Symptomatic relief focuses on dietary/lifestyle modifications and acid suppression, and possibly bile-binding medications...
Gastroesophageal biliary reflux is a common complication after esophagectomy with gastric pull-up. Symptomatic relief focuses on dietary/lifestyle modifications and acid suppression, and possibly bile-binding medications. Rarely, patients with medically refractory bile reflux may need a surgical intervention. Reoperation in these patients is challenging as injury to the gastroduodenal artery could lead to graft ischemia. To avoid vascular injury, we treated three patients with refractory biliary reflux using a retro-colic Roux-en-Y hepaticojejunostomy. Two patients reported complete resolution of bile reflux symptoms, and the third reported minimal bile reflux after biliary diversion. Follow-up endoscopy in two patients showed improvement of esophagitis, no bile in their grafts, and no recurrent Barrett's esophagus. The Roux-en-Y hepaticojejunostomy, a common and safe operation for biliary diversion, provides the advantage of reducing the risk of conduit vascular injury by avoiding a previous operative field. This surgical strategy provides symptomatic relief and endoscopically confirmed improvement of esophagitis.
Development and Validation of Prognostic Models in Patients With Stage IV Thyroid Cancer Undergoing Surgical Treatment.
Ouyang L, Yang M, Chen J … +4 more , Xu X, Zhang H, Lin J, Wang C
Am Surg · 2026 Apr · PMID 41786330 · Publisher ↗
BackgroundThe low survival rate among patients with advanced thyroid cancer implies a dearth of effective treatment strategies. Research on advanced thyroid cancer has focused on targeted drugs, while neglecting the prog...
BackgroundThe low survival rate among patients with advanced thyroid cancer implies a dearth of effective treatment strategies. Research on advanced thyroid cancer has focused on targeted drugs, while neglecting the prognostic prediction for patients with advanced thyroid cancer who are undergoing surgical treatment. Consequently, further investigation into the prognostic implications of surgery for patients with advanced thyroid cancer is of great significance.MethodsThis study retrieved and screened all stage IV thyroid cancer patients between 2010 and 2020 in the SEER database, and finally included 670 patients in the study. Independent risk factors, which were used to develop a nomogram model predicting prognosis, were screened using univariate and multivariate Cox regression analyses. Furthermore, the log-rank test was used to compare differences in the Kaplan-Meier curves of overall survival (OS) and cancer-specific death (CSS) in different risk factor groups.ResultSurvival analysis was performed based on the OS and TCSS of the surgical and non-surgical groups, and the Kaplan-Meier curves were statistically significant. Cox multivariate analysis showed statistical significance in grade, T stage, surgery, and radiotherapy. When statistically significant variables were incorporated into the construction of the prediction model, the C-index of the training group was 0.857, and the areas under the ROC curve of the modeling group were 0.927, 0.925, and 0.919, respectively. The areas under the ROC curve for the validation group were 0.934, 0.937, and 0.944, respectively. The calibration curves and DCA curves showed excellent prediction effect in the prediction model.ConclusionThe prognostic prediction model established in this study demonstrated higher predictive accuracy.
Understanding Improvements in Disparities in Breast Cancer Care in Memphis, Tennessee: A Comparison of Two Time Cohorts.
Cripe L, Moten AS, Hendrix A … +1 more , Fleming M
Am Surg · 2026 Apr · PMID 41786329 · Publisher ↗
IntroductionBetween 2005 and 2009, Black women in Memphis had the highest breast cancer mortality rate in the United States as compared to their White counterparts. This study assesses current breast cancer outcomes for...
IntroductionBetween 2005 and 2009, Black women in Memphis had the highest breast cancer mortality rate in the United States as compared to their White counterparts. This study assesses current breast cancer outcomes for Black women in Memphis with hopes of finding improvement.MethodsPatients with breast cancer were identified in the tumor registry of a large health care system in Memphis, TN. Patients were stratified by race. Associations between race, clinical characteristics, and treatments were determined using chi-square tests. Associations between race, recurrence, and mortality were determined using logistic regression. The study sample was divided into period 1 (2002-2012) and period 2 (2013-2020) for comparison.ResultsIn period 2, 36.5% of Black women and 48.8% of White women presented with stage 1 disease ( < 0.001). 11.4% less Black women were diagnosed with stage 2-4 disease in period 2 as compared to period 1. Treatment regimens are stratified per race in Table 1. In both periods, the median time to surgery (TTS) was higher for Black vs White women with stages 0-3 disease. In period 2, Black women were 42% more likely to experience recurrence and 36% more likely to die when compared to White women vs findings in period 1 of 100% and 50%, respectively ( < 0.05).ConclusionAlbeit improved over the past decade, there continues to be significant racial disparity in breast cancer treatment in Memphis. Our next steps will be to evaluate specific social and medical interventions currently existing while identifying areas for improvement.
A Nomogram to Predict Non-Sentinel Axillary Lymph Node Metastases in Breast Cancer Patients With Negative or Positive Sentinel Lymph Node Results.
Fan S, Yong Shen, Hu Y … +4 more , Xiao T, Xu L, Xie X, Gu X
Am Surg · 2026 Apr · PMID 41786328 · Publisher ↗
PurposePostoperative radiation therapy has been recommended as a replacement for axillary lymph node dissection (ALND) in patients with early-stage breast cancer who have one or two sentinel lymph node (SLN) metastases....
PurposePostoperative radiation therapy has been recommended as a replacement for axillary lymph node dissection (ALND) in patients with early-stage breast cancer who have one or two sentinel lymph node (SLN) metastases. This study aimed to develop a predictive model to assess the risk of intraoperative non-SLN metastases based on preoperative parameters.Materials and MethodsA retrospective analysis was conducted on 580 patients diagnosed with invasive breast cancer who underwent traditional ALND between January 2011 and June 2023 and were intraoperatively identified as SLN positive. The primary outcome of the study was non-SLN metastasis status. A nomogram prediction model was constructed to predict ipsilateral non-SLN metastases, and the optimal threshold value for SLN positivity rate was determined. Subgroup analysis was performed on hormone receptor (HR)-positive breast cancer cases to further refine the prediction model.ResultsThe optimal threshold for the SLN positivity rate in breast cancer eradication procedures was identified as 35.42%. Multivariate analysis of the entire cohort, as well as the HR-positive subgroup, revealed that histopathological grade, clinical T stage, clinical N stage, and a higher SLN positivity rate were significant risk factors for non-SLN metastases. The area under the receiver operating characteristic curve (AUC) of the nomogram prediction model was 0.809 for the entire cohort and 0.805 for the HR-positive subgroup, indicating robust calibration.ConclusionThe nomogram model developed in this study provides clinicians with a more accurate tool for predicting non-SLN metastases, potentially reducing unnecessary ALND procedures.
The Impact of Trauma Survivor Rounds on the HCAHPS Surveys.
Nie J, Grigorian A, Victor R … +5 more , Giafaglione B, Burruss S, Aryan N, Kuza C, Nahmias J
Am Surg · 2026 Apr · PMID 41786327 · Publisher ↗
IntroductionA component of trauma-informed care (TIC) is providing opportunities for patients to share their stories and access healing resources. We introduced a "Trauma Survivor Rounds" (TSR) initiative to provide trau...
IntroductionA component of trauma-informed care (TIC) is providing opportunities for patients to share their stories and access healing resources. We introduced a "Trauma Survivor Rounds" (TSR) initiative to provide trauma patients an opportunity to discuss and receive individualized assistance. We evaluated whether they reported improved Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey scores, hypothesizing increased hospital recommendation rates following TSR implementation.MethodsA single-center retrospective (2021-2023) analysis of admitted trauma patients with HCAHPS survey responses was conducted. The HCAHPS survey measures patient experience, satisfaction, and health care quality. Pre-TSR (1/1/2021-12/31/2021) (PRE) and post-TSR (1/1/2022-12/31/2023) (POST) cohorts were compared. In TSR, a medical student discussed trauma and assisted patients obtain resources. The primary outcome was whether patients recommended the hospital on the HCAHPS survey.ResultsOf 348 patients, 133 (38.2%) were in the POST cohort. Hospital recommendation rates were statistically similar: "definitely yes" (POST: 82.9% vs PRE: 78.3%), "probably yes" (POST: 15.4% vs PRE: 14.0%), "probably no" (POST: 1.7% vs PRE: 4.3%), and "definitely no" (POST: 0% vs PRE: 3.4%) ( = 0.12). No significant difference was found in the overall hospital ratings. Notably, more POST patients reported receiving help "as soon as wanted" (61.4% vs 54.7%, < 0.001).ConclusionsImplementation of a TIC-based TSR program showed no statistically significant difference in hospital recommendations or ratings; however, it was associated with more patients reporting receiving help "as soon as wanted." Larger sample size studies are needed to determine whether this approach improves HCAHPS scores or other quality metrics.
Enhancing Patient Understanding Through Video-Assisted Consent for Laparoscopic Cholecystectomy: A Randomized Controlled Trial.
Acar A, Canbak T, Erdem O … +2 more , Başak F, Karaman KO
Am Surg · 2026 Apr · PMID 41786326 · Publisher ↗
BackgroundInformed consent is a cornerstone of ethical and legal medical practice, ensuring patients understand treatment benefits, risks, and alternatives. Patients often forget key details, potentially compromising dec...
BackgroundInformed consent is a cornerstone of ethical and legal medical practice, ensuring patients understand treatment benefits, risks, and alternatives. Patients often forget key details, potentially compromising decision-making. This study evaluates whether incorporating an informative video into the standard consent process enhances patient comprehension, retention, and satisfaction for laparoscopic cholecystectomy.MethodsThis single-center, parallel-group, superiority randomized controlled trial was conducted in a hospital setting in Turkey. It included 264 patients, evenly divided. The control group underwent standard verbal consent; the video-consent group received an informative video additionally. Both groups completed an 8-question knowledge test and the 32-point Client Satisfaction Questionnaire (CSQ-8) post-consent. Scores were compared statistically. Harms were assessed via patient self-report of adverse events or discomfort related to the consent process or video.ResultsThe video-consent group achieved significantly higher scores in the surgery and complications categories ( = 0.032 and = 0.048). Significant differences were found for Questions 5 and 7 ( = 0.021 and = 0.043). Satisfaction scores were higher in the video-consent group ( = 0.044), and satisfaction correlated with comprehension scores ( < 0.001). Older age negatively correlated with comprehension ( = 0.041), and secondary-educated patients in the video-consent group scored significantly higher ( = 0.039).ConclusionIncorporating video into the consent process improves patient comprehension and satisfaction, particularly for surgery and complications. Video-assisted consent is a valuable adjunct to traditional methods, enhancing patient understanding and engagement. Further studies are needed to explore its broader applicability.
Elective Colectomy Versus Observation Following Initial Nonoperative Success in Hinchey Ib/II Diverticulitis: A Systematic Review and Meta-Analysis.
Akbarpoor F, Delgado LM, Aakef K … +9 more , Mokhtar J, Masiero BB, Alshehhi DA, Aakef A, de Oliveira HM, Rowaiaee R, Khokar MA, Pompeu BF, Formiga FB
Am Surg · 2026 Aug · PMID 41783915 · Publisher ↗
Introduction/PurposeDiverticulitis with abscess (Hinchey Ib or II) is often initially managed nonoperatively with antibiotics and/or percutaneous drainage (PCD). For patients who respond successfully to this approach, it...
Introduction/PurposeDiverticulitis with abscess (Hinchey Ib or II) is often initially managed nonoperatively with antibiotics and/or percutaneous drainage (PCD). For patients who respond successfully to this approach, it remains controversial whether an elective colectomy (EC) should routinely follow. This systematic review and meta-analysis evaluate and compare the outcomes of two strategies in this population: EC vs continued observation after successful nonoperative management.MethodsWe systematically searched PubMed, Embase, Web of Science, and the Cochrane Library through August 15, 2024, for studies comparing EC to continued observation in patients with Hinchey Ib/II diverticulitis who achieved initial successful nonoperative management. Outcomes assessed included recurrence of diverticulitis. Odds ratios (ORs) with 95% confidence intervals (CIs) were pooled using a random-effects model.ResultsWe included four studies comprising 7236 patients. Among these, 1719 patients (24%) underwent EC following initial successful nonoperative treatment, while 5517 (76%) did not undergo elective surgery. The average patient age was 58.5 years, with a mean follow-up of 3.22 years. The mean time to EC ranged from 2 to 6 months. Elective colectomy was associated with a significantly lower recurrence rate (OR 0.14; 95% CI 0.11-0.17; < .001; I = 0%) but a higher frequency of stoma formation (OR 1.83; 95% CI 1.51-2.23; < .001; I = 0%).ConclusionsIn patients with Hinchey Ib or II diverticulitis who initially underwent successful nonoperative management, subsequent EC was associated with lower odds of recurrence but higher odds of stoma formation.RegistrationPROSPERO CRD42024582759.
Improvements Can be Made in Surgical Waste and Unused Surgical Supplies in Breast Surgery Done at Ambulatory Surgical Centers and Hospitals.
Mehta D, Komenaka M, Keane CA … +4 more , Robinson D, Hsu CH, Davis J, WintonLi LM
Am Surg · 2026 Aug · PMID 41762068 · Publisher ↗
Health care is the second largest producer of waste worldwide. This study was performed to demonstrate that institutional changes can be implemented fairly quickly and improvements can be accomplished. The study was perf...
Health care is the second largest producer of waste worldwide. This study was performed to demonstrate that institutional changes can be implemented fairly quickly and improvements can be accomplished. The study was performed at three hospitals and one ambulatory surgery center (ASC) in Arizona from January 1, 2025 to November 30, 2025. A total of 275 operations were included in the study: 125 consecutive operations at the ASC and 150 operations at the hospitals. All opened disposable items were documented. All reusable surgical equipment were documented. The weight of the waste and laundry bags were recorded for each case. The study included 275 operations. In the initial 150 operations, the surgeons used 18-20% of the instruments in the tray at three hospitals and 14/50 (28%) at ASC. The average weight of the waste produced was 14.1, 14.3, and 15.7 lbs at the hospitals, and 8.03 lbs at ASC. Following the initial 150 operations, more specific trays were requested at one hospital and ASC. The new trays were created within 2 weeks and included only 17 instruments. At the locations with the downsized trays, the surgeons used 14/17 (82%) of the instruments, while there was no change at the other two hospitals. The waste produced at the hospital with the downsized tray decreased by 21%. Waste was significantly greater in hospitals vs ASC. More specific trays with fewer instruments can be created fairly quickly at both hospitals and ASC and result in significantly less waste of resources.
Transjugular Intrahepatic Portosystemic Shunt Before Extrahepatic Abdominal Surgery: A Systematic Review and Novel Application Following Source-Control Laparotomy.
Doran ML, Scarboro DB, Nussbaum MS … +1 more , Gerrish AW
Am Surg · 2026 Aug · PMID 41762061 · Publisher ↗
Patients with cirrhosis undergoing extrahepatic abdominal operations face high morbidity and mortality from portal hypertension. The role of transjugular intrahepatic portosystemic shunts (TIPS) in optimizing surgical ou...
Patients with cirrhosis undergoing extrahepatic abdominal operations face high morbidity and mortality from portal hypertension. The role of transjugular intrahepatic portosystemic shunts (TIPS) in optimizing surgical outcomes remains uncertain, particularly in emergent settings. We present a case and systematic review of studies from 2000-2025 evaluating preoperative, perioperative, and emergent TIPS in patients undergoing extrahepatic abdominal operations. Data on patient characteristics, timing, mortality, complications, and statistical methods were extracted.Fourteen studies were included, encompassing 241 patients who underwent TIPS specifically in the context of non-transplant abdominal operation. Across elective preoperative cohorts, TIPS was mostly performed 2-4 weeks before operation in Child-Pugh A-B patients with MELD <15 which was reported to improve ascites control and operative feasibility, with 80-90% of patients proceeding to the planned operation and 30 to 90-day mortality generally ≤10%, without a clear survival advantage compared with non-TIPS controls. Perioperative and emergent TIPS were reserved for decompensated or high-risk patients, in whom overall mortality remained high but portal decompression reduced bleeding and allowed otherwise prohibitive operations to proceed. This case describes unique TIPS timing, not previously described, after initial colectomy for perforated diverticulitis, enabling reduced bleeding and abdominal closure in the setting of severe portal hypertension. Taken together, available evidence supports TIPS as a feasible adjunct to optimize operative candidacy in carefully selected cirrhotic patients. This highlights a potential role for salvage TIPS in acute care surgery when standard hemostatic techniques fail.
The Difference in Surgical Waste and Unused Surgical Supplies in Breast Surgery Done at Ambulatory Surgical Center vs Hospital.
Komenaka M, Mehta D, Robinson D … +4 more , Hsu CH, Keane CA, WintonLi LM, Davis J
Am Surg · 2026 Aug · PMID 41761640 · Publisher ↗
BackgroundThis study was performed to determine the amount of waste produced in breast operations in the ambulatory surgery center (ASC) as well as the hospital setting and where potential improvements could be made.Meth...
BackgroundThis study was performed to determine the amount of waste produced in breast operations in the ambulatory surgery center (ASC) as well as the hospital setting and where potential improvements could be made.MethodsThe study was performed at two hospitals and one ASC in Arizona from January 1, 2025 to September 30, 2025. 60 patients at the ASC and 20 patients were included at each hospital. All the disposable items that were opened were documented. All reusable surgical equipment and instruments were documented. At the conclusion of each case, the weight of the waste bags were recorded.ResultsThe study included 100 patients who had breast conserving operations. The surgeons used 14/70 (20%) and 14/74 (19%) of the instruments at the two hospitals and 14/50 (28%) of the instruments at ASC. A significantly lower percentage of surgical equipment went unused at ASC vs hospitals ( < 0.01). The average weight of the waste produced was 13.8 lbs and 14.0 lbs at the two hospitals, and ASC 7.97 lbs. The amount of waste produced at the ASC was significantly lower ( < 0.01). The costs of the unused items per case at the two hospitals were $183.78 and $252.07, while the cost at the ASC was $52.35.ConclusionEven in small operations, there is significant waste of valuable resources. More specific trays would lessen waste. Waste was greater in hospitals vs the ASC. This may be another cost saving measure of ambulatory surgery center compared to hospital based surgery.
Letter re: Osman Criteria and Timing of Repair After Bile Duct Injury: Methodologic and Reporting Clarifications.
Salgado González A, Garcia Bernal GC
Am Surg · 2026 Jun · PMID 41761623 · Publisher ↗
Abstract loading — click title to view on PubMed.
Treatment Strategies for Management of True Hepatic Artery Aneurysms: A Systematic Review and Meta-Analysis.
Hajibandeh S, Hajibandeh S, Alessandri G … +1 more , de Liguori-Carino N
Am Surg · 2026 Jul · PMID 41757778 · Publisher ↗
AimsTo synthesize evidence on outcomes of treatment strategies for management of primary hepatic artery aneurysms (HAAs).MethodsA PRISMA-compliant systematic review was conducted. Due to rarity of the disease, all report...
AimsTo synthesize evidence on outcomes of treatment strategies for management of primary hepatic artery aneurysms (HAAs).MethodsA PRISMA-compliant systematic review was conducted. Due to rarity of the disease, all reported cases which underwent operative or endovascular intervention for true HAA were pooled from case reports and case series to create a single cohort of patients. Descriptive statistics, logistic regression models, and Kaplan-Meier statistics were used for analyses.Results62 patients from 41 case reports and one case series were included. The mean age was 60.9 and 77% were male; 66% were symptomatic with pain as the most common symptom (76%). The mean diameter and length of aneurysms were 47.4 mm and 55.8 mm, respectively. The anatomy of aneurysm was hostile in 39% and 11% were ruptured at presentation. In terms of treatment, 74% were treated via operative approach and 26% via endovascular approach. Hostile anatomy was the only predictor for selecting operative approach (OR: 8.72, = .031). Technical success was achieved in 98%; postoperative mortality and morbidity occurred in 5% and 16%, respectively. The probabilities of graft patency at 60 months were not different between the operative and endovascular approaches (86% vs 90%, = .961); however, the probability of recurrence-free survival was higher after operative approach (100% vs 85%, = .046).ConclusionsAccepting type 2 error and confounding by indication as the limitations, both operative and endovascular techniques seem to be safe and feasible in management of true HAA. Hostile anatomy may be the main determinant of selecting operative approach over the endovascular approach.
Risk and Predictors of Postoperative Mortality in Patients With Obesity Undergoing Trauma Laparotomy: A Systematic Review and Meta-Analysis With Meta-Regression.
Kambal A, Hurt L, Iosifidis M … +2 more , Hajibandeh S, Hajibandeh S
Am Surg · 2026 Aug · PMID 41757535 · Publisher ↗
AimsTo evaluate the effect of obesity on postoperative mortality after trauma laparotomies.MethodsA PRISMA-compliant meta-analysis with meta-regression using random-effects modeling was conducted (last search: August 01,...
AimsTo evaluate the effect of obesity on postoperative mortality after trauma laparotomies.MethodsA PRISMA-compliant meta-analysis with meta-regression using random-effects modeling was conducted (last search: August 01, 2025). All studies comparing the risk of postoperative mortality in adult patients with and without obesity (BMI ≥30) undergoing trauma laparotomies were included. The certainty of evidence was evaluated using GRADE system.ResultsNine studies comprising 19,780 patients were included (obesity group: 6474; no obesity group: 13,306). The obesity and no obesity groups were comparable in terms of male sex (RD: -0.03, 95% CI -0.06, 0.00, = .090), injury severity score (MD: 0.96, 95% CI -0.36, 2.29, = .160), penetrating mechanism of injury (RD: -0.01, 95% CI -0.03, 0.00, = .150), and blunt mechanism of injury (RD: 0.01, 95% CI -0.00, 0.03, = .150). The patients in the obesity group were older (MD: 4.18 years; 95% CI 2.19, 6.18, < .0001). The risk of postoperative mortality was higher in patients with obesity (OR: 1.33, 95% CI 1.09, 1.64. = .006). Injury severity score (coefficient: 0.017, = .004) and blunt mechanism (coefficient: 0.263, = .017) were associated with an increased risk of mortality; penetrating mechanism (coefficient: -0.263, = .017) was associated with a reduced risk of mortality; and age (coefficient: -0.004, = .779) and male sex (coefficient: -0.055, = .908) did not affect the mortality.ConclusionsObesity is associated with increased postoperative mortality in patients undergoing trauma laparotomies (moderate certainty). Injury severity score and blunt mechanism of injury may increase the risk of mortality in obese patients undergoing trauma laparotomies.
Disaggregation of Asian American and Pacific Islander Data Reveals Heterogeneous Outcomes After Neoadjuvant Chemotherapy for Invasive HER2-Positive Breast Cancer.
Yuen S, Sedighim S, Zhu J … +4 more , Bharucha M, McCool K, Narloch K, Yong H
Am Surg · 2026 Feb · PMID 41748560 · Publisher ↗
BackgroundHER2-positive (HER2+) invasive breast cancer is more prevalent among Asian American and Pacific Islander (AAPI) women. We evaluated response to neoadjuvant chemotherapy (NAC) to identify disparities among disag...
BackgroundHER2-positive (HER2+) invasive breast cancer is more prevalent among Asian American and Pacific Islander (AAPI) women. We evaluated response to neoadjuvant chemotherapy (NAC) to identify disparities among disaggregated AAPI subgroups.MethodsWomen with HER2+ breast cancer in the 2018-2020 National Cancer Database who received NAC followed by surgical excision were identified. Patients were categorized as White, AAPI, or Non-White Non-Asian (NWNA), followed by analysis of AAPI subgroups. The primary outcome was pathologic complete response (pCR).ResultsOf 14,110 women, 10,603 (75.1%) were White, 964 (6.8%) AAPI, and 2543 (18.0%) NWNA. Asian American and Pacific Islander patients had the highest overall pCR rate at 43.3% compared with 42.5% in White and 36.1% in NWNA patients ( < .001). Disaggregation revealed heterogeneity: Pacific Islander patients had the lowest pCR rate (35.6%), below both White and NWNA cohorts, while Korean patients had the highest pCR rate (54.6%) (both < .001). Pacific Islander patients were more likely to present with comorbidities, advanced clinical stage, lymphovascular invasion, and experienced the longest time to chemotherapy. Korean patients were least likely to present with advanced disease, nodal involvement, or lymphovascular invasion and had the shortest time to chemotherapy. On multivariable analysis, nodal positivity, lymphovascular invasion, and increasing time to chemotherapy-not race/ethnicity-were independent negative predictors of pCR.DiscussionDisaggregated AAPI data are essential to identify vulnerable subgroups, prioritize timely neoadjuvant therapy, and inform targeted interventions that may reduce disparities in treatment response.
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