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        <title>Frontiers in Surgery | New and Recent Articles</title>
        <link>https://www.frontiersin.org/journals/surgery</link>
        <description>RSS Feed for Frontiers in Surgery | New and Recent Articles</description>
        <language>en-us</language>
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        <pubDate>2026-08-21T14:19:39.512+00:00</pubDate>
        <ttl>60</ttl>
        <item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1868923</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1868923</link>
        <title><![CDATA[Preoperative neutrophil-to-lymphocyte ratio is associated with amputation level progression in patients with diabetic foot]]></title>
        <pubdate>2026-08-21T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Ismail Tugay Yagci</author><author>Ebru Alanbay Yagci</author><author>Ali Baran Budak</author><author>Osman Tugrul Eren</author>
        <description><![CDATA[BackgroundAmputation-level progression after below-knee amputation (BKA) is associated with functional and psychological burden in diabetic foot disease. We evaluated the association between preoperative neutrophil-to-lymphocyte ratio (NLR) and short-term progression from BKA to above-knee amputation (AKA).MethodsThis single-center retrospective cohort included 105 consecutive adults undergoing primary transtibial BKA for diabetic foot complications. The primary outcome was conversion from the index BKA to AKA within 3 months. Demographic, clinical, laboratory, disease severity, perioperative, and 12-Item Short Form Health Survey Version 1 (SF-12v1) data were obtained from medical records. A parsimonious multivariable logistic regression model including age, Wound, Ischemia, and foot Infection (WIfI) stage, Wagner grade, C-reactive protein (CRP), serum albumin, and NLR evaluated the adjusted association between NLR and amputation-level progression. Sensitivity analyses examined NLR estimate stability across alternative specifications. Receiver operating characteristic analysis explored the apparent discriminative ability of NLR.ResultsWithin 3 months, 53 of 105 patients (50.5%) progressed from BKA to AKA. Median preoperative NLR was higher among patients with progression than among those maintaining the initial BKA level [10.42 (interquartile range: 5.68–13.03) vs. 5.47 (3.24–9.04), p < 0.001]. Patients with progression also had higher neutrophil and lower lymphocyte counts (both p = 0.006). In the primary model, each one-unit increase in NLR was associated with 29% higher odds of progression (adjusted odds ratio: 1.29, 95% confidence interval: 1.14–1.47, p < 0.001). The association remained significant after excluding WIfI stage, CRP, Wagner grade, or both CRP and Wagner grade. Exploratory ROC analysis yielded an apparent area under the curve of 0.73. Postoperative SF-12v1 mental component scores, assessed approximately 3 weeks after BKA and before AKA conversion, were lower among patients with progression (p < 0.001).ConclusionsPreoperative NLR was associated with early amputation-level progression after adjustment for available covariates. NLR may provide adjunctive information regarding systemic inflammatory burden but should not be interpreted as a validated standalone predictor or clinical decision threshold. These hypothesis-generating findings require confirmation in larger prospective multicenter cohorts with comprehensive vascular data and internal and external validation.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1866869</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1866869</link>
        <title><![CDATA[The effects of allostatic load on patients undergoing surgery: a systematic review]]></title>
        <pubdate>2026-08-21T00:00:00Z</pubdate>
        <category>Systematic Review</category>
        <author>Whitaker Reid</author><author>Nidhi Rhea Udyavar</author>
        <description><![CDATA[IntroductionAllostatic load (AL) is a measure of physiologic adaptation to repetitive environmental stressors and is associated with poor health outcomes and chronic conditions, ranging from cardiovascular disease and type 2 diabetes to malignancy. Given the acute rise in physiologic stress that accompanies surgically induced trauma, AL has the potential to affect surgical outcomes, particularly for the invasive, complex, lengthy procedures common in surgical oncology. The aims of this study were to systemically review existing literature surrounding AL and surgery, and to contextualize these findings accordingly.MethodsA systematic review was conducted in May 2024 via PubMed, Embase, Cochrane, Web of Science, and PsycINFO to identify existing literature on AL and surgery. Study quality and sources of bias were assessed via the Mixed Methods Appraisal Tool. Data from original studies were extracted and compiled, and a similar process was repeated for related review articles.ResultsA total of 10 original research studies explored the relationship between AL and surgical topics. Eight of these studies attempted to quantify AL as either a numerical composite index or via single or multiple representative biomarkers. AL emerged as (1) a specific predictor of surgical outcomes and (2) an explanatory mechanism for racial and socioeconomic disparities in surgical populations, as AL is known to be increased in socially disadvantaged individuals. Four of 10 included studies explored surgical oncology populations exclusively.DiscussionAL appears to impact surgical care and demonstrates the potential to not only predict postoperative outcomes (i.e., postoperative complications) but also identify high-risk surgical patients. This relationship appears to be most well-defined in surgical oncology relative to any other surgical specialty. By illuminating the connections between AL and surgery, targeted interventions aimed at reducing AL may be implemented to mitigate postoperative complications and improve the quality of surgical care. Future work in this area should include prospective studies examining preoperative AL, specific postoperative outcomes, and the impact of personalized AL-centered interventions on adverse perioperative outcomes.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1941903</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1941903</link>
        <title><![CDATA[Embolizing the middle meningeal artery to treat chronic subdural hematoma: a systematic review and meta-analysis]]></title>
        <pubdate>2026-08-21T00:00:00Z</pubdate>
        <category>Systematic Review</category>
        <author>Kuijia Duan</author><author>Rongmei Xia</author><author>Jibo Lv</author>
        <description><![CDATA[BackgroundComparative studies on the middle meningeal artery (MMA) embolization versus conventional management (CM) to treat chronic subdural hematoma (CSDH) yield inconsistent findings.ObjectiveThis systematic review sought to meta-analyze studies comparing MMA embolization versus CM for treating CSDH.MethodsTerms including “hematoma”, “subdural”, “chronic”, “meningeal arteries”, “embolization”, and “therapeutic” were applied to search PubMed, Embase, the Cochrane Library, and Web of Science databases from their inception to July 11, 2025. After independent reading, screening, and evaluation by two researchers, data were analyzed and processed using RevMan v5.4.ResultsInitially, 1,883 articles were retrieved. After eliminating 692 duplicates and excluding 1,087 articles that are conference abstracts, letters, or have ineligible research objectives, interventions, or outcomes, 104 articles were identified as potentially eligible. These articles were subsequently screened according to the eligibility criteria, and 20 studies were ultimately included. According to the meta-analysis, in the 20 studies involving 255,057 patients, 181,993 (71.4%) and 73,064 (28.6%) patients received MMA embolization and CM, respectively. MMA embolization performed better than CM in terms of treatment failure (relative risk [RR] = 0.40 [0.18–0.87], P = 0.007), recurrence rate (RR = 0.43 [0.32–0.57], P = 0.15), and complication rate (RR = 0.91 [0.77–1.08], P = 0.06). No difference was observed between the two groups for mortality (RR = 0.72 [0.55–0.94], P = 0.94), treatment failure rate (RR = 0.40 [0.18–0.87], P = 0.007), surgical salvage rate (RR = 0.59 [0.22–1.56], P = 0.29), rehospitalization (RR = 0.66 [0.41–1.06], P = 0.24), and improvement rate (RR = 1.05 [0.79–1.41], P = 0.43).ConclusionMMA embolization may lower the failure rate of treatment and cut the demand for surgical salvage without elevating the risk. Therefore, MMA embolization may be considered in the management of CSDH.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/myprospero, PROSPERO CRD420251090976.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1853819</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1853819</link>
        <title><![CDATA[Trends in urolithiasis mortality in the United States, 1999–2024: a Joinpoint regression analysis of age, sex, race, and regional disparities]]></title>
        <pubdate>2026-08-21T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Li-Li Xu</author><author>Chu-xuan Lin</author><author>Xin-yi Lin</author><author>Qin-ying Zhou</author><author>Nai-fen Xu</author><author>Ding-qin Zheng</author><author>Ran Xu</author>
        <description><![CDATA[BackgroundUrolithiasis is traditionally considered a benign condition with extremely low mortality. However, recent evidence suggests a potential shift in this paradigm. This study aims to analyze urolithiasis mortality trends in the United States from 1999 to 2024, with a focus on demographic and geographic disparities.MethodsDeath certificate data for individuals aged 45 years and older were obtained from the CDC WONDER database. Urolithiasis-related deaths were identified using ICD-10 codes N20–N23. Age-adjusted mortality rates (AAMRs) were calculated, and Joinpoint regression was employed to identify significant changes in mortality trends. Analyses were stratified by census region, sex, race/ethnicity, and age group.ResultFrom 1999 to 2024, the age-adjusted mortality rate for urolithiasis increased from 0.22 to 0.72 per 100,000 population. The rise was modest from 1999 to 2014, with an annual percent change of 1.94%, followed by a sharp acceleration from 2014 to 2024, when the annual percent change reached 8.54%. Substantial disparities were observed. The Northeast had the highest age-adjusted mortality rate at 0.85 per 100,000, while the Midwest experienced the fastest increase, with an average annual percent change of 5.42%. In 2024, the female age-adjusted mortality rate surpassed that of males (0.80 vs. 0.68 per 100,000). Non-Hispanic white people bore the heaviest burden, with an age-adjusted mortality rate of 0.86 per 100,000 and an average annual percent change of 5.71%. Hispanics exhibited a “mortality paradox,” whereas non-Hispanic black people had the lowest rate at 0.36 per 100,000. Mortality increased with age: the highest rate was observed among those aged 85 years and older (5.72 per 100,000), and the fastest increase occurred in the 65–74 years age group, with an average annual percent change of 4.94%.ConclusionUrolithiasis mortality in the United States has increased dramatically since 2014, with persistent disparities observed across region, sex, race, and age. These findings suggest that urolithiasis mortality in the United States has increased substantially since 2014, warranting increased public health attention. However, given the low absolute mortality rates and the inherent limitations of death certificate data, these findings should be interpreted as hypothesis-generating and require confirmation in future studies. Targeted interventions are needed for high-risk groups—including older adults, females, non-Hispanic white people, and individuals with metabolic syndrome—as well as for high-risk regions such as the Midwest and rural areas.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1910839</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1910839</link>
        <title><![CDATA[Association of labor epidural analgesia with early postpartum pelvic floor function in primiparous women undergoing vaginal delivery: a retrospective cohort study]]></title>
        <pubdate>2026-08-21T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Lishan Lin</author><author>Yidan Wang</author><author>Yaping Wang</author><author>Mengjie Yan</author><author>Mingting Wang</author><author>Suoqin Ge</author><author>Junsheng Zhu</author><author>Maohong Gu</author>
        <description><![CDATA[BackgroundThe association between labor epidural analgesia (LEA) and postpartum pelvic floor function remains uncertain. We evaluated whether LEA was associated with pelvic floor outcomes in primiparous women undergoing vaginal delivery.MethodsThis single-center retrospective cohort study included 200 primiparous women with singleton, cephalic vaginal deliveries. Participants were classified according to LEA exposure. Baseline and peripartum characteristics were compared in the overall cohort. Early postpartum pelvic floor outcomes at 6–8 weeks were analyzed in 191 women, and multivariable regression was performed in 175 complete cases. Outcomes included type I and type II pelvic floor surface electromyography, bladder neck mobility, posterior bladder angle during Valsalva, levator hiatus area during Valsalva, urinary incontinence, and pelvic organ prolapse. The multivariable models additionally adjusted for second-stage labor duration and oxytocin use, which were considered potential labor-process variables in the interpretation of the adjusted estimates.ResultsNo statistically significant differences were identified in the measured baseline characteristics between the LEA and non-LEA groups. Compared with non-LEA, LEA was associated with longer first-, second-, and third-stage labor, longer total labor duration, and more frequent oxytocin use. No significant detectable between-group differences were observed in any pelvic floor parameter, urinary incontinence, pelvic organ prolapse, prolapse stage, or levator avulsion. After adjustment for maternal age, pre-pregnancy body mass index, gestational age, neonatal birth weight, second-stage labor duration, and oxytocin use, LEA was not significantly associated with any continuous pelvic floor outcome, urinary incontinence (adjusted odds ratio, 1.305; 95% confidence interval, 0.629–2.710), or pelvic organ prolapse (1.771; 0.717–4.373).ConclusionsLEA was associated with altered labor characteristics, whereas no statistically detectable association with worse pelvic floor outcomes at 6–8 weeks postpartum was observed after adjustment for the measured covariates. Given the observational design, potential residual confounding, and limited precision for infrequent outcomes, modest associations cannot be excluded.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1846295</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1846295</link>
        <title><![CDATA[Graded and threshold effects of body mass index on perioperative outcomes after pancreaticoduodenectomy: a meta-analysis incorporating an institutional cohort]]></title>
        <pubdate>2026-08-21T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Yingyue Pan</author><author>Yi Chen</author><author>Yanyu Qiu</author><author>Ke Zhang</author><author>Xiaodong He</author><author>Naishi Li</author><author>Xianlin Han</author>
        <description><![CDATA[BackgroundThe influence of body mass index (BMI) on perioperative results after pancreaticoduodenectomy (PD) remains controversial. This study aimed to clarify how different BMI strata influence operative complexity, postoperative morbidity, and mortality.MethodsWe performed a meta-analysis and systematic review of 25 studies, including one institutional cohort, evaluating BMI-related perioperative and survival outcomes in patients undergoing PD. The outcomes assessed included operative time, estimated blood loss, postoperative complications, clinically relevant pancreatic fistula, reoperation, perioperative mortality, and overall survival.ResultsBMI ≥25 kg/m2 was linked to prolonged operative time, higher blood loss, and a greater risk of postoperative complications, including clinically relevant pancreatic fistula, delayed gastric emptying, and major complications, without a significant increase in perioperative mortality. In contrast, BMI ≥30 kg/m2 was associated with an increased risk of perioperative mortality. Analyses across BMI categories demonstrated a progressive increase in operative complexity with increasing BMI, whereas perioperative mortality exhibited a threshold pattern, with a marked increase observed primarily at BMI ≥30 kg/m2. No notable relationship was found between BMI and long-term overall survival.ConclusionsOverweight (BMI ≥25 kg/m2) is primarily associated with increased operative complexity and moderate morbidity, whereas obesity (BMI ≥30 kg/m2) represents a threshold associated with perioperative mortality. These findings support BMI-based risk stratification and may inform individualized perioperative management in patients undergoing PD.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1869935</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1869935</link>
        <title><![CDATA[Interpretable machine learning analysis of the impact of tranexamic acid combined with antibiotics on renal function and its risk factors in hip replacement surgeries]]></title>
        <pubdate>2026-08-21T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Lijuan Xu</author><author>Xiaowang Lan</author><author>Yafang Jiang</author><author>Haoyu Wang</author><author>Jiangbao Xu</author><author>Bingsheng Liu</author>
        <description><![CDATA[BackgroundEarly prediction of renal function changes in patients undergoing hip replacement surgery enables timely intervention for acute kidney injury and acute renal failure, which in turn improves treatment outcomes. This study aimed to develop and validate an interpretable machine learning model that uses real-world clinical parameters to predict postoperative renal function changes. The model incorporates tranexamic acid (TXA) and antibiotics as key predictive factors, examines their combined effect on renal function, and identifies associated risk factors.MethodsThis observational study was conducted from January 2022 to June 2024 at Quzhou Affiliated Hospital of Wenzhou Medical University. After data preprocessing, the full dataset was randomly split into a training cohort and an internal validation cohort at a 7:3 ratio. We performed feature selection via support vector machine-recursive feature elimination (SVM-RFE) to identify the most clinically relevant predictive variables. Changes in serum creatinine (Scr) levels were defined as the primary outcome variable. We evaluated the predictive performance of four machine learning models using multiple standard assessment metrics. Feature importance was calculated for each candidate model, and the top-performing model was further interpreted using SHAP and LIME algorithms.ResultsIn both the training and validation cohorts, the LightGBM model outperformed RF, GBDT, and XGBoost in predicting Scr changes. SHAP analysis showed that the top five features contributing to Scr prediction in the LightGBM model were D-dimer difference, C-reactive protein (CRP) level, sodium difference, hemoglobin difference, and antibiotic use. DCA analysis indicated that all these models delivered superior predictive performance compared to traditional methods.ConclusionsThe LightGBM model demonstrated higher AUC values in predicting Scr changes. TXA dosage was not identified as a top predictor of postoperative acute kidney injury in our models; however, antibiotic dosage was correlated with renal function outcomes. Our study identified and validated critical risk factors for postoperative renal impairment, including elevated CRP levels, sodium fluctuations, intraoperative blood loss, and transfusion volume. These findings have significant clinical implications for perioperative management, monitoring protocols, and risk stratification.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1850986</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1850986</link>
        <title><![CDATA[Ectopic thyroid tissue implantation associated with hyperthyroidism after endoscopic thyroidectomy: a case report]]></title>
        <pubdate>2026-08-21T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Jianping Huang</author><author>Zhu Yu</author><author>Lv Lv</author>
        <description><![CDATA[BackgroundNeedle track implantation is a rare complication of endoscopic surgery. This appears to be the first reported case of ectopic thyroid tissue implantation in the anterior chest wall following endoscopic thyroidectomy, accompanied by hyperthyroidism.Case descriptionThe patient underwent endoscopic thyroidectomy for a 5 cm left thyroid adenoma. Within one year postoperatively, she noted a chest wall mass extending from the left subclavicular region to the line connecting the left nipple, accompanied by hyperthyroidism. Following treatment with antithyroid drugs, thyroid function was well controlled and the chest wall mass ceased to enlarge. Pathological examination confirmed the left anterior chest wall mass as ectopic thyroid tissue.ConclusionsThis case highlights not only the risk of tissue fragment dissemination following endoscopic thyroidectomy but also indicates that ectopic thyroid tissue, under favorable microenvironmental conditions, can preserve follicular structure and may be involved in metabolic activity.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1890393</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1890393</link>
        <title><![CDATA[Case Report: Hypervascular lipid-rich intrahepatic adrenocortical adenoma in the right posterior liver: a diagnostic challenge for hepatobiliary surgeons]]></title>
        <pubdate>2026-08-20T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Shuqing Wu</author><author>Tong Zhou</author><author>Xingfei Li</author><author>Weihua Zhu</author><author>Jie Gao</author>
        <description><![CDATA[BackgroundIntrahepatic adrenocortical adenoma (IAA) is a rare benign tumor that originates from ectopic adrenocortical tissue or adrenohepatic fusion. Due to its hypervascular enhancement pattern and tendency to occur in the right posterior liver, IAA may closely resemble hepatocellular carcinoma (HCC) on preoperative imaging.Case presentationA 67-year-old woman presented with intermittent right upper quadrant discomfort for 3 months. Despite the absence of viral hepatitis and normal tumor marker levels, contrast-enhanced magnetic resonance (MR) imaging showed a well-circumscribed hypervascular lesion in liver segments VI/VII, with marked arterial phase hyperenhancement, relative portal venous phase hypoenhancement, and hypointensity during the hepatobiliary phase, initially creating an imaging appearance that raised concern for HCC. Contrast-enhanced computed tomography (CT) showed a low-attenuation lesion with a negative attenuation value on unenhanced images (-3 Hounsfield units), indicating lipid-rich content. Because malignancy could not be excluded, a laparoscopic partial hepatectomy was performed. Histopathology demonstrated an adrenocortical neoplasm composed of polygonal cells arranged in nests and cords. Immunohistochemistry was positive for steroidogenic factor-1, inhibin-alpha, and calretinin, whereas hepatocellular markers were negative. The final diagnosis was IAA. The postoperative course was uneventful, and no recurrence or metastasis was observed at 6-month follow-up.ConclusionIAA should be included in the differential diagnosis of hypervascular hepatic lesions adjacent to the right adrenal gland, especially in patients without typical HCC risk factors or tumor marker elevation. Increased awareness of this diagnostic pitfall is crucial for facilitating multidisciplinary assessment and enabling more individualized surgical management.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1900000</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1900000</link>
        <title><![CDATA[Diagnosis and treatment of incarcerated inguinal hernia with "complete reduction": a case report]]></title>
        <pubdate>2026-08-20T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Haron Or Rashid Palash</author><author>Lide Tao</author><author>Muhammad Asad Iqbal</author><author>Anlai Ji</author>
        <description><![CDATA[BackgroundReduction en masse (REM) of an incarcerated inguinal hernia is a rare but serious diagnostic pitfall in which apparently successful reduction masks a persistent closed-loop obstruction within the preperitoneal space. Rather than returning to the peritoneal cavity, the hernia sac and its contents are displaced together as a single unit, so the constricting ring continues to compromise the trapped bowel. The result is an occult internal hernia that carries a high risk of bowel strangulation when diagnosis is delayed, yet the deceptively benign external examination frequently leads clinicians to attribute persistent symptoms to other causes.Case presentationA 70-year-old man presented with small-bowel obstruction 48 hours after forcefully self-reducing a right inguinal hernia. The external bulge had resolved, but obstructive symptoms persisted and progressed. Contrast-enhanced computed tomography (CT) revealed a pathognomonic “preperitoneal hernia-sac sign": a rounded, obstructed jejunal loop adjacent to the inferior epigastric vessels. Diagnostic laparoscopy confirmed REM, with 10 cm of viable but oedematous small bowel trapped within a direct hernia defect. The constriction was released, a serosal tear was oversewn, and the internal ring was closed. Following conservative management of a postoperative pelvic haematoma, a second-stage open tissue repair was performed one week later. The patient recovered well and remained recurrence free at six-month follow-up.ConclusionREM should be suspected in any patient with persistent obstructive symptoms after apparent hernia reduction, particularly when there is a history of forceful self-reduction. High-resolution contrast-enhanced CT demonstrating the “preperitoneal hernia-sac sign” is crucial for early diagnosis. Prompt laparoscopic exploration is both diagnostic and therapeutic, enabling assessment of bowel viability, release of the incarceration, and definitive repair while reducing postoperative morbidity. A staged repair strategy is safe and effective in contaminated or oedematous surgical fields. Greater clinician awareness and the systematic consideration of REM in emergency settings can prevent diagnostic delay and its serious consequences.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1846470</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1846470</link>
        <title><![CDATA[Stapler vs. sleeve circumcision for multiple penile condylomata acuminata: a comparative study]]></title>
        <pubdate>2026-08-20T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Haoran Chen</author><author>Yangfeng Lou</author><author>Longfei Yang</author><author>Peng Zhou</author>
        <description><![CDATA[BackgroundMultiple penile condylomata acuminata (CA) often involve the inner foreskin and frenulum. This retrospective study compared conventional sleeve and disposable circular stapler circumcision, each combined with ablation of visible lesions, in selected patients with multiple penile CA.MethodsConsecutive patients aged 18–55 years with at least 5 visible lesions involving the foreskin and/or frenulum who underwent treatment between January 2020 and December 2024 were screened. Propensity-score matching (1:1 nearest neighbor, caliper 0.05) using prespecified covariates yielded 41 patients per group. Outcomes included operative time, blood loss, complications, baseline and 12-month IIEF-15, cosmetic appearance, patient satisfaction, and 12-month recurrence.ResultsAfter matching, baseline characteristics were well balanced (all standardized mean differences <0.1). Compared with sleeve circumcision, stapler circumcision was associated with shorter operative time (mean difference −14.2 min, 95% CI −16.7 to −11.7), less blood loss (mean difference −7.5 mL, 95% CI −9.2 to −5.8), higher patient- and surgeon-rated cosmetic scores (mean differences 0.7 and 0.8, respectively), and higher patient satisfaction (mean difference 0.7). IIEF-15 scores were similar. Recurrence occurred in 6/41 (14.6%) stapler patients and 8/41 (19.5%) sleeve patients (risk difference −4.9%, 95% CI −21.1% to 11.4%; odds ratio 0.71, 95% CI 0.22 to 2.26). No major complications occurred.ConclusionIn this single-center retrospective matched cohort of carefully selected patients without anatomical contraindications to stapler placement, stapler circumcision was associated with perioperative and patient-reported advantages. The recurrence estimate was imprecise and does not establish equivalence or non-inferiority. These findings are hypothesis-generating and require confirmation in larger prospective studies with longer follow-up.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1961336</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1961336</link>
        <title><![CDATA[Editorial: Biosynthetic resorbable meshes: a New frontier in abdominal wall hernia repair]]></title>
        <pubdate>2026-08-20T00:00:00Z</pubdate>
        <category>Editorial</category>
        <author>Jose Bueno-Lledo</author><author>Frederik Berrevoet</author><author>John Fischer</author><author>J. Scott Roth</author>
        <description></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1906865</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1906865</link>
        <title><![CDATA[TiRobot-assisted cannulated screw fixation for calcaneal fractures: a meta-analysis of surgical trauma, anatomical restoration, and functional recovery]]></title>
        <pubdate>2026-08-20T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Hong Liu</author><author>Ruoyan Wang</author><author>Guohang Shen</author><author>Yinhai Jiang</author><author>Li Huang</author><author>Junlei Liao</author><author>Jie Zhao</author><author>Yue Zhou</author><author>Yupei Dai</author><author>Chuan You</author>
        <description><![CDATA[BackgroundTiRobot-assisted cannulated screw fixation may improve surgical precision and clinical outcomes in calcaneal fractures. This meta-analysis evaluated its effects on surgical trauma, anatomical restoration, functional recovery, and complications compared with conventional fixation.MethodsPubMed, Embase, Web of Science, Cochrane Library, and CNKI were searched from inception to April 2026. Comparative studies evaluating TiRobot-assisted versus conventional fixation for calcaneal fractures were included. Pooled mean differences (MDs) or odds ratios (ORs) with 95% confidence intervals (CIs) were calculated.ResultsNine studies involving 509 patients were included. Operative time was comparable between groups (MD = −0.75 min). TiRobot-assisted fixation reduced intraoperative blood loss (MD = −28.22 mL) and improved calcaneal anatomical restoration, including calcaneal height (MD = 1.88 mm), Böhler angle (MD = 1.50°), and Gissane angle (MD = 5.00°). Patients treated with TiRobot assistance showed lower postoperative VAS scores (MD = −0.84 points), higher AOFAS ankle–hindfoot scores (MD = 4.21 points), and fewer overall complications (OR = 0.17).ConclusionsTiRobot-assisted cannulated screw fixation provides measurable improvements in surgical trauma, anatomical reconstruction, early pain relief, functional recovery, and postoperative safety compared with conventional fixation. Further multicenter randomized controlled trials with long-term follow-up are required to confirm these findings.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1885436</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1885436</link>
        <title><![CDATA[The lung cancer pathway: seven years of evaluation of multidisciplinary pre-operative management and workflow optimization]]></title>
        <pubdate>2026-08-20T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Adriana Nocera</author><author>Leonardo Petracca-Ciavarella</author><author>Maria Letizia Vita</author><author>Maria Teresa Congedo</author><author>Chiara Scognamiglio</author><author>Claudia Leoni</author><author>Claudia Bellettati</author><author>Alessia Senatore</author><author>Antonio Giulio Napolitano</author><author>Dania Nachira</author><author>Filippo Lococo</author><author>Elisa Meacci</author><author>Stefano Margaritora</author>
        <description><![CDATA[BackgroundMultidisciplinary management is essential in thoracic oncology to optimize diagnostic assessment, treatment planning, and patient selection for surgery. Structured clinical pathways may improve coordination among specialists and reduce delays in the management of patients with suspected or confirmed lung cancer.MethodsWe retrospectively analyzed patients managed within a structured Lung Cancer Pathway (LCP) at Fondazione Policlinico Universitario A. Gemelli IRCCS between January 2018 and December 2024. All patients entering the LCP were included, regardless of final treatment allocation. The pathway involved multidisciplinary assessment including thoracic surgeons, pulmonologists, oncologists, radiologists, pathologists, nuclear medicine specialists, and interventional specialists. The primary endpoints were:<br>-time from LCP initiation to clinical record closure;-time from clinical record closure to surgical intervention.Workflow times were analyzed using median values and interquartile ranges (IQR). Differences between 2018 and 2024 were assessed using the Mann–Whitney U test, while temporal trends across the study period were evaluated using the Kruskal–Wallis test.ResultsA total of 2,691 patients were included. During the study period, the annual number of patients increased progressively, reflecting the expansion of the pathway. The median duration of the LCP significantly decreased from 9 days (IQR 2–23) in 2018 to 1 day (IQR 0–8) in 2024 (p < 0.001). A significant temporal trend was observed across the entire study period (p < 0.001). The median time from LCP closure to surgery was 29 days (IQR 15–43) in 2018 and 35 days (IQR 23–43) in 2024 (p = 0.013). During multidisciplinary evaluation, 447 patients (16.6%) did not proceed to surgery because of advanced disease, comorbidities, functional limitations, or patient preference.ConclusionsA structured Lung Cancer Pathway was associated with improved efficiency of the diagnostic and decision-making process over a seven-year period. The LCP model allowed standardized evaluation of patients with suspected or confirmed lung cancer, including those ultimately considered unsuitable for surgery. Although the retrospective design does not allow causal inference, these findings support the potential value of structured multidisciplinary pathways in optimizing workflow organization and clinical decision-making in thoracic oncology.]]></description>
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        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1931138</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1931138</link>
        <title><![CDATA[Uniportal VATS for anatomical lung resection: 15 years of innovation]]></title>
        <pubdate>2026-08-20T00:00:00Z</pubdate>
        <category>Review</category>
        <author>Massimiliano Bassi</author><author>Diego Gonzalez-Rivas</author><author>Jacopo Vannucci</author><author>Marco Anile</author>
        <description><![CDATA[The evolution of thoracic surgery has progressively moved toward minimizing surgical trauma while preserving oncological radicality in the treatment of lung cancer. Within this context, uniportal video-assisted thoracoscopic surgery (VATS) has emerged as one of the most significant innovations in minimally invasive thoracic surgery. In fact, uniportal VATS not only represents the evolution of multiportal VATS, with the potential to reduce postoperative pain, chest wall trauma, and recovery time, but has also led to a paradigm shift in thoracic surgery, redefining the limits of minimally invasive pulmonary resection. Initially developed for minor thoracic procedures, the first milestone in its evolution occurred in 2011 with the report of the first uniportal lobectomy. Since then, uniportal VATS technique has rapidly spread and has become an established minimally invasive approach for lung cancer treatment in many centers worldwide. Progressively, this technique has expanded from lobectomy to segmentectomy and from standard anatomical resections to highly complex bronchovascular reconstructions. After 15 years of innovation, uniportal VATS has profoundly transformed the surgical management of lung cancer and continues to redefine the boundaries of minimally invasive thoracic oncology, influencing the evolution of uniportal robotic platforms. This narrative review aims to describe the historical, technical, and conceptual evolution of uniportal VATS for anatomical lung resection over the years, highlighting the milestones that contributed to its global dissemination and current role in thoracic surgical oncology.]]></description>
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        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1904266</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1904266</link>
        <title><![CDATA[Four-point dermo-fascial fixation for umbilical reconstruction following keloid excision: clinical experience in 16 patients]]></title>
        <pubdate>2026-08-19T00:00:00Z</pubdate>
        <category>Brief Research Report</category>
        <author>Peiyu Li</author><author>Haitao Xiao</author><author>Xuewen Xu</author><author>Ru Wang</author>
        <description><![CDATA[BackgroundUmbilical keloids after transumbilical laparoscopic surgery are difficult to manage because excision may leave a contour defect in a concave, mobile, and scar-prone region. Reconstruction must restore a recessed umbilical contour while minimizing additional incisions and scar burden.MethodsThis brief report describes a four-point dermo-fascial fixation technique in 16 patients with round, bulging, or transversely elongated umbilical keloids after laparoscopic surgery. In all patients, the keloid margin extended no more than 1.0 cm beyond the visible umbilical rim. After limited circumferential defatting, adjacent umbilical tissue was anchored to the residual fibrous umbilical stalk and linea alba using a four-point configuration. All patients received postoperative radiotherapy and topical scar therapy.ResultsThe patients were 35–72 years old, and photographic follow-up ranged from 6 to 15 months. All patients maintained a recessed umbilical contour during the available follow-up. No wound complications were observed, and no clinically evident keloid recurrence occurred after combined surgical reconstruction, postoperative radiotherapy, and topical scar therapy. A transverse scar or crease remained visible in some cases.ConclusionThe four-point dermo-fascial fixation technique may provide a simple local-tissue option for scar-control-oriented umbilical reconstruction after keloid excision, although it should not be considered an ideal aesthetic umbilicoplasty. Its main value lies in its simplicity, use of adjacent local tissue, avoidance of graft harvest or complex flap design, and potential reproducibility when scar control and technical practicality are prioritized. Larger studies with longer follow-up and standardized scar assessment are required to clarify long-term recurrence and aesthetic outcomes.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1719697</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1719697</link>
        <title><![CDATA[Spontaneous intermuscular hematoma in mixed connective tissue disease: a case report]]></title>
        <pubdate>2026-08-19T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Zhaohua Pei</author><author>Yun Chen</author><author>Linjun Zhao</author><author>Long Zheng</author><author>Yuanhan Lin</author><author>Xue Zhao</author>
        <description><![CDATA[Spontaneous large intermuscular hematoma secondary to mixed connective tissue disease (MCTD) is extremely rare. We report a 57-year-old female with long-standing MCTD admitted for abdominal pain and fever (septic shock due to E. coli pyelonephritis). On hospital day 8, she developed a left thigh hematoma (10  ×  14 cm). CTA failed to identify the bleeding vessel, but transcatheter arterial embolization (TAE) stabilized the hematoma. Subsequent surgical debridement was performed for hematoma-induced tissue necrosis. This case highlights that MCTD-related vascular fragility, combined with sepsis and DIC, increases hematoma risk. Prompt TAE and surgical intervention are critical to prevent catastrophic outcomes.]]></description>
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        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1761198</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1761198</link>
        <title><![CDATA[An internally validated nomogram for predicting impaired wound healing after calcaneal fracture surgery in patients with type 2 diabetes Mellitus]]></title>
        <pubdate>2026-08-19T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Xiaowei Huang</author><author>Heng Wang</author>
        <description><![CDATA[BackgroundImpaired wound healing remains a major complication following calcaneal fracture surgery in patients with type 2 diabetes mellitus (T2DM), yet reliable tools for individualized risk prediction are lacking.MethodsOf 553 T2DM patients screened, 360 were eligible and randomly allocated to a training set (n = 269 after excluding 1 for incomplete outcome adjudication; 66 outcome events) and an internal validation set (n = 90; 22 outcome events, 24.4%). A nomogram was developed using multivariable logistic regression based on predictors selected via LASSO. Model performance was assessed by area under the ROC curve (AUC), calibration (evaluated by the Brier score and the Hosmer-Lemeshow goodness-of-fit test), and decision curve analysis (DCA).ResultsThe final model incorporated five predictors: HbA1c, insulin use, diabetic peripheral neuropathy, C-reactive protein, and platelet count. In the training set, the nomogram achieved an apparent AUC of 0.886 (95% CI: 0.846–0.925),with an optimism-corrected AUC of 0.875 (optimism estimate = 0.011). In the internal validation set, the AUC was 0.891 (95% CI: 0.789–0.965). The model showed favorable calibration in the training set [Brier score = 0.113 (95% CI: 0.088–0.140); Hosmer–Lemeshow test, χ2 = 7.215, df = 8, P = 0.514] and good calibration in the validation set (Brier score = 0.106 (95% CI: 0.067–0.147);calibration slope = 1.27 (95% CI: 0.75–2.89),intercept = 0.44 (95% CI:–0.24–1.85); Hosmer–Lemeshow test, χ2 = 10.552, df = 8, P = 0.228), and provided higher net benefit than treat-all or treat-none strategies across threshold probabilities from 0.01 to 0.95in both the training and validation sets. At a threshold of 0.4, it identified approximately one-fifth of patients as high-risk, with a high proportion of events among them.ConclusionThe internally validated nomogram provides a promising tool for risk stratification of postoperative wound complications in T2DM patients with calcaneal fractures. The model is exploratory and limited to internal validation; external validation in multicenter cohorts is required before routine clinical adoption.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1756737</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1756737</link>
        <title><![CDATA[Aortic dissection precipitated by superwarfarin (brodifacoum) poisoning: a case report and pathophysiological review]]></title>
        <pubdate>2026-08-19T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Yuxin Xiao</author><author>Yutao Wang</author><author>Kuiquan Song</author><author>Yan Sun</author>
        <description><![CDATA[BackgroundPoisoning by rodenticides, particularly anticoagulant agents, has been well-documented. Brodifacoum, a second-generation “superwarfarin”, is a long-acting anticoagulant rodenticide (LAAR) characterized by an extended half-life. Its toxicity primarily manifests as excessive or abnormal bleeding from the skin, mucous membranes, gastrointestinal tract, and urinary tract. However, aortic dissection (AD)—a rare and catastrophic medical event—has seldom been reported as a complication of such poisoning. We present a case of extensive aortic dissection triggered by Brodifacoum poisoning. This case aims to elucidate the potential pathophysiological link between superwarfarin intoxication and the development of aortic dissection.Case presentationA 69-year-old man was admitted to the hospital with a 9-day history of oral bleeding and an 8-day history of pain in the lower back, abdomen, and chest. Initial examinations at another facility were inconclusive. Upon transfer to our hospital, computed tomography angiography (CTA) revealed an extensive aortic dissection extending from the distal abdominal aorta to the bilateral iliac arteries. Key coagulation tests on admission indicated severe coagulopathy: both prothrombin time (PT) and the international normalized ratio (INR) were undetectable, and the activated partial thromboplastin time (APTT) was markedly prolonged to 160.1 s. Concurrent hematological tests revealed anemia (hemoglobin 102 g/L). Toxicological screening confirmed the presence of Brodifacoum in his blood. The patient's condition was stabilized through aggressive management, including infusion of fresh frozen plasma (FFP), high-dose intravenous vitamin K, and strict blood pressure control. His coagulation parameters gradually normalized over two weeks.ConclusionThis case highlights a life-threatening complication of superwarfarin poisoning—aortic dissection. It underscores the critical importance of considering toxicological etiologies in patients with unexplained coagulopathy. Early reversal of the coagulation deficit and rigorous blood pressure control are paramount in preventing the progression of dissection.]]></description>
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        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1876422</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1876422</link>
        <title><![CDATA[Case Report: Segment-specific minimally invasive surgical management of lumbar spinal epidural lipomatosis with adjacent-level degenerative stenosis]]></title>
        <pubdate>2026-08-19T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Tongtong Zhang</author><author>Fuhai Yan</author><author>Lingna Shi</author><author>Hui Zhang</author>
        <description><![CDATA[BackgroundSpinal epidural lipomatosis (SEL) is characterized by excessive accumulation of unencapsulated adipose tissue within the epidural space and may cause clinically relevant neural compression. When SEL coexists with degenerative stenosis at an adjacent lumbar level, the involved segments may require different decompression and stabilization strategies.Case presentationA 56-year-old man presented with chronic low back pain, progressive bilateral lower-extremity pain and numbness, and neurogenic claudication. Lumbar magnetic resonance imaging demonstrated excessive posterior epidural adipose tissue at L3-L4 with marked dural sac compression, together with degenerative central and lateral recess stenosis and Meyerding grade I degenerative spondylolisthesis at L4-L5. A single-stage, segment-specific minimally invasive procedure was performed. Tubular unilateral laminotomy with bilateral decompression and debulking of epidural adipose tissue were performed at L3-L4, whereas decompression, transforaminal lumbar interbody fusion, and bilateral pedicle screw fixation were performed at L4-L5. The operative time was 150 min, and estimated blood loss was 100 mL.OutcomeEarly postoperative axial CT demonstrated the L3-L4 laminotomy and enlargement of the osseous canal. Side-by-side sagittal T2-weighted images obtained in comparable planes showed reduced posterior indentation of the dural sac at L3-L4 after surgery. At the 12-month follow-up, comparison with the early postoperative radiographs showed no obvious interval hardware displacement or loss of L4-L5 alignment. Plain radiographs did not establish solid interbody fusion.ConclusionThis case illustrates a segment-specific minimally invasive strategy for adjacent lumbar pathologies with different treatment requirements. Decompression without fusion may preserve an otherwise stable SEL-involved segment, whereas fusion at an adjacent degenerative level should be based on patient-specific clinical, radiological, and biomechanical considerations. Comparative safety or effectiveness cannot be inferred from a single case.]]></description>
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