BACKGROUND: An estimated 140 million additional surgical procedures are required annually, yet access to safe, timely, and affordable surgical care remains limited, particularly in low- and middle-income countries, where...BACKGROUND: An estimated 140 million additional surgical procedures are required annually, yet access to safe, timely, and affordable surgical care remains limited, particularly in low- and middle-income countries, where the poorest 2.2 billion people receive only 3.5% of procedures. In sub-Saharan Africa, the burden of trauma, burns, and congenital malformations far exceeds available capacity, yet evidence on plastic reconstructive surgery (PRS) remains fragmented and poorly quantified. This scoping review mapped the current state of PRS evidence, disease burden, and barriers to care in the region. METHODS: We conducted comprehensive search of PubMed, Embase, and Web of Science, Bioline International, and AJOL (Oct 21, 2024) supplemented by gray-literature screening. Studies addressing PRS-relevant pathologies, surgical capacity, or barriers to care in sub-Saharan Africa (excluding South Africa) were included without date or language restriction. Data were charted in Covidence and synthesized descriptively. RESULTS: Of 11,780 records, 353 met inclusion criteria. Trauma (43.6%) and burns (40.2%) dominated reconstructive workload, with congenital anomalies reported in 33.4% of studies. Most research originated from Nigeria, Uganda, and Tanzania and was concentrated in tertiary hospitals. Workforce shortages, inadequate infrastructure, and financial barriers were the most frequent obstacles. Skin grafting and wound management comprised over one-third of reported procedures. PRS interventions were highly cost-effective, with estimates as low as US$33 per DALY averted. CONCLUSIONS: Reconstructive surgery in sub-Saharan Africa remains critically under-researched and under-resourced. Addressing inequities requires locally adapted assessment tools, workforce expansion, and integration of PRS into national surgical plans.
BACKGROUND: Low- and middle-income countries (LMICs) account for 90% of all deaths from injury globally, yet health systems remain poorly equipped to manage the escalating trauma burden. PURPOSE: This study describes the...BACKGROUND: Low- and middle-income countries (LMICs) account for 90% of all deaths from injury globally, yet health systems remain poorly equipped to manage the escalating trauma burden. PURPOSE: This study describes the prevalence, causes, and surgical management of extremity fractures at Malawi's two high-volume tertiary hospitals. METHODS: A prospective cross-sectional observational study collected injury mechanism and injury type as well as operative data on all patients undergoing surgical management of upper and lower extremity fractures at Queen Elizabeth Central Hospital (QECH) and Lilongwe Institute of Orthopedics and Neurosurgery (LION) Trust Hospital between January 2023 and March 2025. Descriptive statistics characterized study data, and ordered logistic regression evaluated factors associated with injury severity. RESULTS: Details were recorded for 5674 patients and operations, comprising 79% males. Motorcycle collisions accounted for 35% of injuries, followed by falls (18%) and pedestrian-related road traffic collisions (15%). One quarter of patients presented with open fractures, with higher proportions at QECH than at LION (30% vs. 22%, p = 0.001). The median time from admission to surgery was 7 days (interquartile range 1-18). Consultants performed 80% of surgeries at LION but only 16% at QECH (p < 0.001). CONCLUSIONS: This study highlights a critical and escalating operative trauma burden in Malawi, driven largely by road traffic injuries, particularly motorcycle taxis. The high prevalence of open fractures, surgical delays, and workforce disparities underscore the urgent need for coordinated health system reforms, including strengthening surgical infrastructure, expanding specialist training, and implementing evidence-based road safety interventions. LEVEL OF EVIDENCE: Level IV, Prognostic Study.
BACKGROUND: Robot-assisted pancreaticoduodenectomy (PD) has emerged as a surgical technique for an operation known for high postoperative morbidities. However, its impact on intraoperative and oncologic endpoints, and po...BACKGROUND: Robot-assisted pancreaticoduodenectomy (PD) has emerged as a surgical technique for an operation known for high postoperative morbidities. However, its impact on intraoperative and oncologic endpoints, and postoperative outcomes across higher body mass index (BMI) groups is not well established. METHODS: We conducted a retrospective analysis of 116 patients undergoing robot-assisted PD between 2018 and 2023, categorized by BMI into underweight/normal, overweight, and obese groups. Intraoperative (operative time, estimated blood loss), oncologic (lymph node yield, positive nodes), and postoperative (length of stay, composite adverse events) outcomes were compared using multivariate regression analysis. RESULTS: Among 116 patients undergoing robot-assisted PD, 31.9% were underweight/normal, 45.7% overweight, and 22.1% were obese. Operative time (obese: 321.88 ± 77.87 min; overweight: 311.45 ± 71.21 min; normal: 304.16 ± 67.80 min; p = 0.63) and estimated blood loss (obese: 94.81 ± 81.57 mL; overweight: 115.00 ± 161.53 mL; normal: 104.3 ± 101.1 mL; p = 0.80) were similar across BMI groups. Lymph node yield did not significantly differ (obese: 24.81 ± 9.07; overweight: 21.83 ± 5.90; normal: 20.97 ± 5.06; p = 0.06). However, obese patients experienced a significantly higher rate of composite adverse events (CAE) (42.31%) than overweight (13.21%) and normal BMI groups (18.92%; p = 0.01). In the multivariable analysis, obesity was associated with increased odds of CAE (OR 3.50, 95% CI: 1.01-2.16). However, operative time, blood loss, lymph node yields, and length of stay did not have significant association with BMI. CONCLUSION: Higher BMI was not associated with worse intraoperative and oncologic surgical quality with robot-assisted PD. However, obese patients were more likely to experience postoperative complications after robot-assisted PDs.
BACKGROUND: Axillary management in early breast cancer (EBC) is increasingly moving toward surgical de-escalation. While sentinel lymph node biopsy (SLNB) has reduced morbidity compared with axillary lymph node dissectio...BACKGROUND: Axillary management in early breast cancer (EBC) is increasingly moving toward surgical de-escalation. While sentinel lymph node biopsy (SLNB) has reduced morbidity compared with axillary lymph node dissection, it still carries risks and may be unnecessary in selected patients with very low nodal risk. An accurate estimate of the risk of sentinel lymph node (SLN) metastasis may support risk-adapted omission strategies. This study aimed to validate existing prediction models, develop a cohort-derived model, and evaluate whether ensemble modeling improves the prediction of SLN macrometastasis in clinically node-negative (cN0) EBCs. METHODS: We conducted a retrospective cohort study of 1080 women with cN0 EBCs treated at a tertiary center between 2012 and 2020. Existing prediction tools (Memorial Sloan Kettering Cancer Center Nomogram (MSKCCN) and MD Anderson Cancer Center Nomogram (MDACCN) were externally validated. A cohort-derived generalized linear model (GLM) was developed using prespecified clinicopathological predictors. Two ensemble approaches combining model predictions were also evaluated. Model performance was assessed using discrimination (area under the receiver operating characteristic curve, AUC), calibration, and Brier score. Threshold-based clinical performance was evaluated at predicted risk cut-offs of ≤ 5% and ≥ 15%. RESULTS: Among 1080 patients, 187 (17.3%) had nodal macrometastases. The MDACCN achieved an AUC of 0.78 (95% CI 0.74-0.82). The cohort-derived GLM demonstrated improved discrimination with an AUC of 0.83 (95% CI 0.71-0.93) and a Brier score of 0.108. A logistic ensemble model achieved an AUC of 0.82 (95% CI 0.69-0.93) and the lowest Brier score (0.103). At a ≤ 5% predicted risk threshold, the GLM classified 24% of patients as low risk (observed macrometastasis rate 3.8%), while the ensemble classified 37% as low risk (observed rate 2.5%) with a false-negative rate of 5.6%. CONCLUSIONS: Prediction models using routinely available clinicopathological variables can identify a subgroup of patients with a very low risk of SLN macrometastasis. Ensemble modeling modestly improved classification performance and identified a larger low-risk group. Risk-adapted prediction tools may support selective axillary de-escalation in cN0 EBCs.
Yamane T, Kimura Y, Tetsutani M
… +11 more, Yamamura S, Ito A, Tanuma M, Honjoh M, Moriwaki Y, Noma K, Tanabe S, Maeda N, Matsuoka Y, Morita M, Morimatsu H
Esophageal cancer is a highly invasive malignancy necessitating esophagectomy, which is associated with considerable postoperative morbidity and prolonged hospitalization. Enhanced Recovery After Surgery (ERAS) protocols...Esophageal cancer is a highly invasive malignancy necessitating esophagectomy, which is associated with considerable postoperative morbidity and prolonged hospitalization. Enhanced Recovery After Surgery (ERAS) protocols recommend early mobilization to facilitate recovery; however, objectively assessing physical activity during hospitalization remains challenging. Traditional methods, such as the 6-min walk test or patient-reported questionnaires can be burdensome, or may not accurately reflect recovery. Accelerometer-based measurement provides a low-burden, objective approach, but previous studies focused on the immediate postoperative period or long after discharge, leaving the recovery trajectory from surgery to discharge underexplored.
BACKGROUND: Elderly patients with acute appendicitis face high rates of complicated disease, yet the impact of in-hospital timing and the utility of simple biomarkers remain debated. We aimed to assess whether in-hospita...BACKGROUND: Elderly patients with acute appendicitis face high rates of complicated disease, yet the impact of in-hospital timing and the utility of simple biomarkers remain debated. We aimed to assess whether in-hospital timing influences severity and to evaluate the derived neutrophil-to-lymphocyte ratio (dNLR) as a risk-stratification tool. METHODS: A retrospective study of 412 patients (184 aged ≥ 65 years; 228 younger controls) undergoing appendectomy (2010-2019) was conducted. We analyzed Patient Interval (symptom onset to admission) and Hospital Interval (admission to incision). Appendicitis was graded as uncomplicated or complicated (gangrenous/perforated). Multivariable regression and categorical sensitivity analyses (0-6, 6-12, 12-18, > 18 h) were used to identify predictors of severity. RESULTS: Elderly patients had higher rates of complicated appendicitis (29.4% vs. 9.2%) and morbidity (13.0% vs. 1.3%). While night-shift admission increased time to diagnosis, it did not increase complications. Hospital Interval was shorter in the elderly (13.5 vs. 15.4 h) but was not an independent predictor of complications and showed no adverse trend across time categories. In the elderly, dNLR ≥ 4.0 independently predicted complicated disease (AUC 0.65) alongside age, fever, and Patient Interval. Mortality spiked to 8.3% in patients ≥ 85 years, driven by medical complications. CONCLUSIONS: Disease severity in geriatric appendicitis appears to be largely determined prior to admission. Within the limitations of this observational design, short in-hospital delays for optimization or logistical reasons were not associated with increased perforation or morbidity. Furthermore, a dNLR ≥ 4.0 helps identify high-risk patients, suggesting that an "optimize then operate" approach-prioritizing physiological stabilization may be a safe and reasonable strategy for clinically stable elderly patients. TRIAL REGISTRATION: Research Registry (UIN: researchregistry11765).
Zope M, Mdala S, Phiri W
… +9 more, Tembo B, Mpata S, Yuggu B, Nzira B, Mapurisa A, McAtee CL, Nuchtern JG, Nandi B, Gutnik L
World J Surg
· 2026 Jun · PMID 42376983
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BACKGROUND: Pediatric operative volumes in Malawi have increased over the past decade due to an increase in the pediatric surgical workforce and improved infrastructure. Despite growth in surgical capacity, limited data...BACKGROUND: Pediatric operative volumes in Malawi have increased over the past decade due to an increase in the pediatric surgical workforce and improved infrastructure. Despite growth in surgical capacity, limited data exist regarding post-operative outcomes for common surgical diseases in low-resource settings. METHODS: Guardians of patients < 18 years old undergoing general surgery operations at Kamuzu Central Hospital (KCH) were recruited. Two telephone call attempts 30-day after the operation were made to administer a follow-up questionnaire and an Acceptability of Intervention Measure (AIM) score. Guardians were then purposively sampled for semi-structured interviews to assess participant experiences in the telephone follow-up protocol. Feasibility of telehealth follow up, defined here as reachability and acceptability, and guardian perceived factors affecting reachability were analyzed. RESULTS: Of 327 families approached for recruitment, 309 (94.5%) had access to a phone. After accounting for clinical events, 292 were eligible for a 30-day phone call. The majority of patients were male (70.6%) and the median age was 2 years old (IQR: 0.02-14). Overall, 69.2% (n = 202) were reached via phone call. Participants with secondary phones had increased odds of reachability (OR = 2.0, p = 0.04) compared to those with only a primary phone. The mean AIM score of the reached group was 18.3 (SD: 2.6). Among the interviewees-phone ownership, cellular network access, phone charge, and community influence were identified as key factors affecting participation in telephone follow-up. CONCLUSIONS: Post-operative follow-up via phone call is feasible in Malawi as evidenced by high patient reachability and acceptability. The results of this pilot study support scaling up implementation of telehealth follow-up in Malawi and utilizing the resulting post-operative metrics to guide quality improvement of surgical care.
Habtemariam A, Cyuzuzo MM, Derichs SW
… +13 more, Umutoni A, Muhawenimana A, Gadisa A, Mithi V, Tenna M, Nkusi EA, Mukundwa PN, Alayande BT, Bekele A, Nsazimana S, Nkeshimana M, Roy N, Bucyibaruta G
World J Surg
· 2026 Jun · PMID 42365604
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BACKGROUND: Access to safe, timely, and affordable surgical care remains a challenge in low- and middle-income countries (LMICs), where deficits in infrastructure and workforce are most acute at the district hospital lev...BACKGROUND: Access to safe, timely, and affordable surgical care remains a challenge in low- and middle-income countries (LMICs), where deficits in infrastructure and workforce are most acute at the district hospital level. From 2018 to 2024, Rwanda implemented its first National Surgical, Obstetric, and Anesthesia Plan (NSOAP) and prioritized decentralized surgical care. We aimed to conduct a post-implementation national assessment of surgical infrastructure, workforce, and service delivery at Rwanda's district and level 2 teaching (L2TH) hospitals. METHODS: We conducted a nationwide cross-sectional survey of 43 hospitals, comprising all 34 district hospitals, and 9 L2TH in Rwanda from May-June 2025, using the WHO Situational Analysis Tool for Emergency and Essential Surgical Care (SAT-EESC). Five domain-specific informants per facility provided infrastructure, workforce, and service delivery data, complemented by facility walk-throughs and a review of operating room registers. In addition to descriptive data analysis, we compared rural and urban hospitals and mapped workforce distribution. RESULTS: All facilities had at least one functional operating room. Most facilities reported continuous electricity and running water, and oxygen cylinders were available at all times in 90.7% of facilities. Blood banks and oxygen concentrators were the least consistently available, reported as available at all times in 32.6% and 58.1% of facilities, respectively. The median facility-level surgeon, anesthesiologist, and obstetrician density was 0.71 per 100,000 population, and 14 hospitals had no specialist SAO cadre. Non-specialist cadres were widely available, with a median non-specialist surgical workforce density of 6.76 per 100,000 population. No statistically significant urban-rural workforce differences were observed, although rural facilities were significantly farther from next-level referral facilities. CONCLUSION: Rwanda's district and level 2 teaching hospitals demonstrate high infrastructure readiness. However, gaps persist in the distribution of the specialist workforce, diagnostics, and advanced surgical care capacity. The findings also highlight the importance of non-specialist cadres in sustaining district-level surgical service delivery.
Shah SJ, Chamarthi R, Gondwe J
… +1 more, Charles A
World J Surg
· 2026 Jun · PMID 42363585
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BACKGROUND: Thrombocytopenia is a common hematologic abnormality among critically ill patients and may reflect underlying sepsis or multi-organ dysfunction. In low- and middle-income countries (LMICs), constrained transf...BACKGROUND: Thrombocytopenia is a common hematologic abnormality among critically ill patients and may reflect underlying sepsis or multi-organ dysfunction. In low- and middle-income countries (LMICs), constrained transfusion capacity and delayed presentation may amplify its prognostic significance. This study evaluated the association between thrombocytopenia and ICU mortality at a tertiary hospital in Malawi. METHODS: We performed a retrospective analysis of patients admitted to the Kamuzu Central Hospital (KCH) Intensive Care Unit (ICU) in Lilongwe, Malawi, from 2016 to 2018. Platelet count was categorized as ≤ 50,000/μL (severe thrombocytopenia), 50,000-150,000/μL (thrombocytopenia), and ≥ 150,000/μL (normal). Bivariate and multivariable logistic regression analyses were performed to identify predictors of mortality. Bivariate analyses and multivariable logistic regression were used to identify factors associated with mortality. RESULTS: Among 498 patients, 95 (19.1%), 70 (14.1%), and 37 (7.4%) have mild, moderate, and severe thrombocytopenia, respectively. The overall incidence of critical illness thrombocytopenia is 40%. Overall ICU mortality was 51.2% (n = 255), with higher mortality among those with severe thrombocytopenia compared to normal platelet counts (70.3% vs. 50.7%). After adjustment for confounders, severe thrombocytopenia remained independently associated with mortality (OR 2.57, 95% CI 1.18-5.58, p = 0.02). CONCLUSION: Thrombocytopenia, particularly platelet counts ≤ 50,000/μL, is independently associated with increased mortality among critically ill patients in resource-limited ICUs. In contexts with limited transfusion and diagnostic capacity, platelet count may serve as a practical and accessible prognostic marker to identify high-risk patients and guide early intervention.
Hartford L, Maistry N, Brisighelli G
… +1 more, Scribante J
World J Surg
· 2026 Jun · PMID 42347837
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BACKGROUND: Little is known about how patients with anorectal malformations (ARMs), their caregivers and healthcare providers perceive and experience transition from pediatric to adult care (transition of care) in low- a...BACKGROUND: Little is known about how patients with anorectal malformations (ARMs), their caregivers and healthcare providers perceive and experience transition from pediatric to adult care (transition of care) in low- and middle-income countries. This study aimed to explore the perceptions and experiences of young adults, adolescents, their caregivers, and healthcare providers regarding transition of care, as well as their perceptions of an ideal transition of care at the Johannesburg Pediatric Colorectal Clinic. METHODS: A qualitative, exploratory study was conducted employing rich pictures. A workshop was held for each of the four stakeholder groups. Participants were asked to draw a rich picture illustrating their perceptions and experiences of the transition of care, followed by a second picture depicting the ideal transition of care. Data were analyzed using Braun and Clarke's thematic analysis. RESULTS: Four overarching themes were identified: (1) Born to shine-living with ARM as a lifelong condition that shapes, but does not define, identity; (2) Golden gloves-pediatric services as trusted, emotionally safe spaces, contrasted with fear and uncertainty regarding adult care; (3) Growing up, letting go-transition experienced as both developmental progression and relational loss; and (4) Overwhelmed joint passion-system fragmentation, limited adult expertise in congenital colorectal conditions, poor information transfer, and reliance on informal pediatric workarounds. Transition of care was experienced as a fragile, relational and system-level process rather than a discrete transfer event. It was marked by the loss of trusted pediatric relationships, uncertainty regarding adult expertise, and fragmented information transfer. These experiences shaped participants' perceptions of an "ideal transition" as one that is relationally anchored, developmentally appropriate, and coordinated across services. Participants identified feasible, low-resource strategies, including: adolescent-focused clinics, joint pediatric adult consultations to build trust, identifiable adult "champions," and structured information-handover tools. CONCLUSION: Co-designed transition pathways offer a pragmatic opportunity to strengthen lifelong care for patients with ARMs in resource-constrained settings.
Coates T, Bak M, Rajagopalan A
… +4 more, Pesevski F, Ravi A, Croagh D, Ooi G
World J Surg
· 2026 Jun · PMID 42324710
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BACKGROUND: As obesity becomes more common, understanding its risks in routine operations is increasingly important. This study assessed the impact of obesity on intraoperative complications during elective laparoscopic...BACKGROUND: As obesity becomes more common, understanding its risks in routine operations is increasingly important. This study assessed the impact of obesity on intraoperative complications during elective laparoscopic cholecystectomy. METHODS: Retrospective data on elective laparoscopic cholecystectomies across a single metropolitan health network were collected from July 2021-June 2023. Patients were stratified into WHO-defined obesity classes. Intraoperative complication (measured by ClassIntra classification), intraoperative and postoperative outcomes were compared. RESULTS: There were 713 patients included. Intraoperative complications graded as ClassIntra 1 and 2 were 11.0% and 6.1% for non-overweight patients and rose to 35.3% and 13.2% respectively for class III obesity (p < 0.001). Increasing obesity class was independently associated with higher intraoperative complication severity, with a 2.59-fold increase in the odds of a more severe complication category per class increase (p < 0.001). Obesity was associated with increased operative duration (p = 0.006) but did not increase the risk of postoperative morbidity (p = 0.88). CONCLUSION: Obesity significantly increases the risks of intraoperative complications in patients undergoing elective cholecystectomy, as measured by the ClassIntra classification, and contributes to increased operative duration. Despite this, postoperative morbidity remains low with no significant difference in length of stay, complications or readmissions across obesity classes.
Ismail MI, Sivananthan J, Baseri R
… +3 more, Azmi N, Ali ZM, Alwi RI
World J Surg
· 2026 Jun · PMID 42316846
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INTRODUCTION: Trauma remains a major cause of mortality worldwide, particularly in low- and middle-income countries. Organized trauma systems and dedicated trauma services have been associated with improved outcomes; how...INTRODUCTION: Trauma remains a major cause of mortality worldwide, particularly in low- and middle-income countries. Organized trauma systems and dedicated trauma services have been associated with improved outcomes; however, data from Southeast Asia remain limited. This study evaluated the impact of establishing a dedicated Trauma Surgery Unit (TSU) at a Malaysian tertiary referral center. METHODS: A single-center observational study was conducted at Hospital Tuanku Ja'afar Seremban, Malaysia, comparing trauma patients managed before TSU establishment (April-June 2024) and after implementation (July 2024-December 2025). Outcomes included epidemiology, operative workload, solid organ injury management, and mortality. Trauma system interventions introduced during the study included a trauma registry, structured Trauma Team Activation (TTA) criteria, institutional trauma protocols, and a Massive Transfusion Protocol (MTP). Statistical analyses were performed using Chi-square, Fisher's exact, and Student's t-tests. RESULTS: A total of 1038 trauma patients were included (128 pre-unit; 910 post-unit). Blunt trauma accounted for 97.0% of injuries, with road traffic crashes comprising 90.7%. Major trauma (ISS > 15) represented 53.7% of admissions. Following TSU establishment, overall mortality decreased from 17.2% to 7.6% (p < 0.001), while mortality among major trauma patients decreased from 24.4% to 13.8% (p < 0.001). A total of 114 operative procedures were performed, including 67 laparotomies, with a non-therapeutic laparotomy rate of 4.5%. Among 197 blunt solid organ injuries, non-operative management was successful in 94.3% of cases. CONCLUSION: Lower overall and major trauma mortality rates were observed following the establishment of a dedicated Trauma Surgery Unit and implementation of structured trauma system initiatives. While causality cannot be inferred from this observational study, the findings support continued development and evaluation of organized trauma services in Malaysia and other middle-income healthcare settings.
World J Surg
· 2026 Jun · PMID 42311108
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BACKGROUND: Minimally invasive breast surgery (MIBS), including endoscopic and robotic-assisted techniques, has demonstrated oncologic safety and favorable cosmetic outcomes in selected patients. However, adoption has be...BACKGROUND: Minimally invasive breast surgery (MIBS), including endoscopic and robotic-assisted techniques, has demonstrated oncologic safety and favorable cosmetic outcomes in selected patients. However, adoption has been uneven globally, particularly in low- and middle-income countries (LMICs), where health-system constraints, training gaps, and resource limitations influence implementation. Understanding surgeons' perspectives and perceived readiness to adopt MIBS is critical for designing context-appropriate adoption pathways. METHODS: We conducted a cross-sectional mixed-methods study among surgeons attending a national MIBS-focused breast surgery meeting in an LMIC. Participants completed an anonymized post-event survey. Outcomes were analyzed using the Kirkpatrick Levels 1-3 framework, assessing perceived relevance (reaction), self-reported understanding and confidence (learning), and intention to adopt or seek further training (behavior). Quantitative data were summarized descriptively, and qualitative responses underwent thematic content analysis. RESULTS: Seventy-seven of 114 eligible surgeons (67.5%) responded; Of which 81.8% were consultants. Prior hands-on MIBS experience was limited (19.5%). Post-meeting, 84.4% reported self-reported improvement in understanding of patient selection and 77.9% increased technical confidence. At the behavioral level, 59.7% expressed increased likelihood of considering MIBS, though an equal proportion preferred further structured training before independent practice. Key perceived barriers included lack of formal training pathways (89.6%), learning-curve concerns (85.7%), equipment costs (85.7%), and limited institutional support (59.7%). CONCLUSIONS: In this exploratory survey of selected cohort of surgeons attending a MIBS-focused academic symposium in an LMIC setting, respondents reported favorable perceptions of minimally invasive breast surgery, improved self-reported understanding, and interest in further structured training. However, these findings should be interpreted cautiously, as they reflect self-reported perceptions and intentions from an engaged group rather than objective evidence of technical readiness, clinical adoption, or broader system-level preparedness.
Habeeb TAAM, Hussain A, Bueno-Lledó J
… +53 more, Giménez ME, Aiolfi A, Abdelsamad A, Chiaretti M, Kryvoruchko IA, Manangi MN, Algalaly NM, Abbas M, Labib MF, Almezaien O, Elkaseer MHM, Abdelkader HRM, Swelam M, Nagaty ME, Alhady MAAAAA, Henish MI, Farag H, Shalamesh MI, Shamy IAME, Fiad AA, Elbelkasi H, Alsaad MIA, Al-Shareef MM, Eissa MA, Elsadek MEA, Ali AKH, Youssef MZ, Mohamed MA, Hamdy A, Khedr AH, Khater AA, Ali HE, Siam M, Elnahas MN, Saqr MA, Ahmed MFI, Mohamed MMM, Elnemr M, Mousa B, Wasefy T, El Teliti AM, Abozaid M, Morsi A, Biomy TA, Atef B, Almeniawy MM, Moussa MS, Hebeishy MH, Metwally H, Bayomi MS, Mostafa A, Saleh AA, Yassin MA
World J Surg
· 2026 Jun · PMID 42311045
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BACKGROUND: Successful surgical management of pilonidal sinus disease (PSD) in young, active patients requires rapid restoration of daily functions, including driving and sexual activity. This study compared patient-repo...BACKGROUND: Successful surgical management of pilonidal sinus disease (PSD) in young, active patients requires rapid restoration of daily functions, including driving and sexual activity. This study compared patient-reported recovery as regards sexual function and driving ability following the KF versus the LF for primary sacrococcygeal PSD. METHODS: This multicenter retrospective cohort study (FLARE study) included employed, sexually active patients who underwent surgery for primary PSD (July 2017-July 2024). The primary outcome was time to sexual activity resumption; the secondary outcome was time to resumption of driving. Outcomes were assessed at 1 year using a structured Likert-scale questionnaire. Kaplan-Meier curves and Cox regression analyses with adjustment were used. RESULTS: A total of 352 patients were divided into 176 KF and 176 LF. KF patients resumed sexual activity earlier (2.88 ± 0.7 vs. 4.58 ± 1.1 weeks; mean difference -1.7 weeks, 95% CI -1.89 to -1.49, p < 0.001). KF reported significantly less pain, less avoidance, and lower analgesic use during sex. LF reported lower sexual satisfaction (mean 3.94 vs. 2.15; mean difference -1.78, 95% CI -2.02 to -1.53). KF resumed driving earlier (median 9 vs. 19 days; r = 0.7, large effect, p < 0.001) and had longer sitting tolerance (OR 0.3, 95% CI 0.2-0.4, p < 0.001). LF had higher pain while sitting (mean Likert 4 vs. 2; mean difference of -1.94, 95% CI -2.19 to -1.68), higher VAS pain (median 4 vs. 2; r = 0.5), greater need for cushions/analgesics, and more driving-related work/social limitations (all p < 0.001). Time to resume sexual activity and driving was significantly shorter for KF. On multivariable analysis, LF was independently associated with delayed return to sexual activity (adjusted OR 4.02, 95% CI 2.1-7.5, p < 0.001) and delayed return to driving (adjusted OR 2.8, 95% CI 1.5-5.2, p < 0.001). CONCLUSIONS: In this retrospective cohort, KF may be associated with significantly faster return to sexual and driving activity compared with LF. These results underscore the importance of incorporating patient-centered functional outcomes into surgical decision-making for PSD. TRIAL REGISTRATION: Number: NCT07271537.
Abe T, Hosoi T, Higaki E
… +7 more, Nagao T, Inada K, Ozaki K, An B, Yamaguchi J, Komori K, Ito S
World J Surg
· 2026 Jun · PMID 42304712
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BACKGROUND: Anastomotic leakage (AL) remains a major complication after cervical esophagogastric anastomosis. Although indocyanine green (ICG) fluorescence imaging has been used to assess gastric conduit perfusion, its r...BACKGROUND: Anastomotic leakage (AL) remains a major complication after cervical esophagogastric anastomosis. Although indocyanine green (ICG) fluorescence imaging has been used to assess gastric conduit perfusion, its role in structured intraoperative decision-making and the temporal stability of outcomes remain unclear. METHODS: This single-center retrospective study included 507 consecutive patients who underwent esophagectomy with cervical esophagogastric anastomosis using the modified Collard technique under a standardized ICG-guided protocol. Intraoperative ICG imaging was used to identify poorly perfused distal conduit segments for exclusion. Temporal trends were evaluated using moving average and cumulative sum (CUSUM) analyses. RESULTS: Anastomotic leakage occurred in 19 patients (3.75%), including clinically relevant leakage (grade ≥ III) in 13 (2.56%). Reoperation was required in one case, with no leakage-related mortality. ICG assessment prompted additional proximal resection in 49.9% of evaluable patients, reflecting frequent detection of marginal distal perfusion; however, final anastomoses were consistently constructed within adequately perfused zones. Temporal analyses, including CUSUM, demonstrated sustained performance below a stringent 5% target rate throughout the study period. CONCLUSIONS: A standardized ICG-guided intraoperative decision-making strategy for cervical esophagogastric anastomosis using the modified Collard technique was associated with a low (3.75%) and temporally stable anastomotic leakage rate. Rather than serving as a binary perfusion test, ICG imaging functioned as a practical rule-out tool to exclude clearly unsafe conduit segments. When embedded within a structured decision-making framework, this approach enabled consistent implementation and durable reconstructive quality in routine clinical practice.