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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>
        <generator>Frontiers Feed Generator,version:1</generator>
        <pubDate>2026-08-18T03:28:35.759+00:00</pubDate>
        <ttl>60</ttl>
        <item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1860573</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1860573</link>
        <title><![CDATA[An interpretable XGBoost model for predicting arteriovenous fistula dysfunction in end stage renal disease]]></title>
        <pubdate>2026-08-17T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Run Zhang</author><author>Qiongfang Zhang</author><author>Xiaolan Zhao</author><author>Yu Zhou</author><author>Mengjie Cai</author><author>Na Yin</author><author>Pan Xie</author><author>Yi Wu</author><author>Lihua Fu</author>
        <description><![CDATA[BackgroundArteriovenous fistula (AVF) dysfunction remains a major challenge in patients with end-stage renal disease (ESRD) undergoing hemodialysis. This study aimed to develop and evaluate an interpretable machine learning model based on clinical variables and preoperative laboratory parameters to predict AVF dysfunction.MethodsThis retrospective study included patients with ESRD who underwent creation of a new autogenous AVF between January 2021 and December 2023. AVF dysfunction was defined as clinically relevant inadequate access function caused by AVF stenosis, occlusion, or thrombosis within 1 year after AVF creation. Candidate predictors included preoperative clinical variables, routine laboratory parameters, and derived composite indices. The overall cohort was randomly divided into train and test cohorts. Five machine learning models, including XGBoost, random forest, Naive Bayes, support vector machine, and logistic regression, were developed and compared.ResultsAmong the 696 patients, 130 (18.7%) developed AVF dysfunction within 1 year. Through recursive feature elimination-based feature selection, six predictors were selected for the final model, including hemoglobin (HB), aggregate index of systemic inflammation (AISI), dialysis vintage, calcium–phosphorus product, triglycerides, and C-reactive protein-to-albumin ratio. The XGBoost model showed favorable discrimination, with AUCs of 0.915 in the train cohort and 0.912 in the test cohort, as well as favorable overall performance in terms of area under the precision–recall curve, sensitivity, specificity, positive and negative predictive values, accuracy, and F1-score. The calibration plot, Brier scores, calibration intercepts, and calibration slopes of XGBoost were also acceptable. Decision curve analysis indicated positive net benefit across a range of threshold probabilities. SHAP analysis identified HB, AISI, and dialysis vintage as the leading contributors to model predictions.ConclusionAn interpretable XGBoost model based on six preoperative variables was developed to predict AVF dysfunction within 1 year after AVF creation in patients with ESRD.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1845405</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1845405</link>
        <title><![CDATA[Distal resection margins before and after fixation: a comparative analysis in rectal cancer surgery]]></title>
        <pubdate>2026-08-17T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Akay Edizsoy</author><author>Orkhan Mirzayev</author><author>Hatice Barak</author><author>İbrahim Meteoğlu</author><author>Pars Tunçyürek</author>
        <description><![CDATA[BackgroundFormalin fixation may cause measurable changes in the dimensions of surgical specimens, which may potentially affect the pathological assessment of distal margins in rectal cancer surgery. This study aimed to evaluate the differences between distal margin measurements obtained from fresh specimens and those recorded after fixation.MethodsRectal cancer specimens from patients who underwent anterior or low anterior resection were retrospectively analyzed. Distal margins were measured macroscopically on fresh specimens during intraoperative pathological assessment and then remeasured after formalin fixation. Differences between the prefixation and postfixation measurements were calculated, and the shrinkage rates were determined.ResultsSixty patients were included in this analysis. The mean distal margin decreased from 4.39 ± 1.95 cm in fresh specimens to 3.90 ± 2.04 cm after fixation, corresponding to a mean reduction of 0.49 cm (95% CI: 0.26–0.71 cm) and an average shrinkage of 13.2%. No specimen had a distal margin shorter than 1 cm on fresh measurement; however, after fixation, two specimens were reported to have margins below this threshold. During a median follow-up of 46.5 months, exploratory analyses did not identify a clear association between the postfixation distal margin category (<2 cm vs. ≥ 2 cm) and oncological outcomes; however, these analyses were based on small subgroups and should be interpreted with caution. Among the two patients with a distal margin <1 cm after fixation, neither developed a local recurrence, although one developed a distant recurrence during follow-up.ConclusionFormalin fixation results in a measurable reduction in the distal margin length in rectal cancer specimens. Although this reduction is generally modest, it may occasionally influence the pathological interpretation of distal clearance, particularly in borderline cases. These findings should be interpreted in the context of specimen processing and do not necessarily indicate a true oncological inadequacy. Larger studies evaluating long-term oncological outcomes are required to further clarify the clinical implications of fixation-related margin shortening.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1844626</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1844626</link>
        <title><![CDATA[A comparative study on the clinical efficacy of percutaneous transforaminal endoscopic discectomy versus fenestration discectomy for single-level lumbar disc herniation]]></title>
        <pubdate>2026-08-17T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Jie Ma</author><author>Hengjun Wang</author>
        <description><![CDATA[ObjectiveTo compare the clinical outcomes of percutaneous transforaminal endoscopic discectomy (PTED) with traditional fenestration discectomy (FD) for single-level lumbar disc herniation (LDH).MethodsWe retrospectively reviewed 368 patients with single-level LDH treated surgically between January 2019 and December 2021. Propensity score matching (PSM) was used to create balanced groups (n = 150 per group). Outcomes included clinical effectiveness (modified MacNab criteria), functional disability (ODI), pain severity (VAS), perioperative parameters, complications, and recurrence rates at 12 months. Analysis of covariance (ANCOVA) adjusting for preoperative scores was performed for primary functional outcomes.ResultsClinical effectiveness at 12 months was higher in the PTED group (92.67% vs. 80.00%, P < 0.001). After adjusting for preoperative values, ODI scores at 12 months remained significantly lower in PTED patients (12.4 ± 5.1 vs. 25.8 ± 8.3, adjusted P < 0.001), as were VAS scores (1.1 ± 0.7 vs. 2.7 ± 1.0, adjusted P < 0.001). The PTED group showed reduced blood loss (55.8 ± 26.3 mL vs. 88.3 ± 39.4 mL, P < 0.001), shorter hospitalisation (1.5 ± 0.6 vs. 5.5 ± 0.6 days, P < 0.001), and lower complication rates (2.67% vs. 13.33%, P = 0.001). Recurrence at 12 months was 2.67% in PTED versus 8.67% in FD (P = 0.025).ConclusionPTED offers favourable short-term clinical outcomes compared with open FD for single-level LDH, with less perioperative morbidity and lower early recurrence rates. Longer follow-up is needed to confirm durability of these results.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1818308</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1818308</link>
        <title><![CDATA[Navigation-guided elective primary total hip arthroplasty is associated with reduced 90-day readmission and early revision at increased index cost: a national analysis]]></title>
        <pubdate>2026-08-17T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>David Maman</author><author>Yaniv Steinfeld</author><author>Yaron Berkovich</author>
        <description><![CDATA[BackgroundNavigation-guided total hip arthroplasty (THA) has been increasingly adopted to improve implant positioning and early outcomes; however, its population-level clinical and economic impact remains uncertain.MethodsUsing the Nationwide Readmissions Database (NRD) (2020–2022), elective primary THA performed on hospital day 0 was identified in this study. Navigation-guided cases were compared with conventional THA. A 1:5 propensity score–matched cohort was constructed adjusting for demographics, payer, comorbidities, calendar year, and hospital characteristics. Primary outcomes included index hospitalization complications and 90-day readmission with readmission-associated procedural escalation. Readmission resource utilization and modeled 100-case episode-of-care costs were assessed.ResultsAmong 366,375 elective THA procedures, navigation use increased from 2.9% (2020) to 4.3% (2022). In the matched cohort (n = 77,214), navigation was associated with shorter length of stay and lower rates of intraoperative fracture, blood loss anemia, acute kidney injury, and hip dislocation (all p < 0.01). Ninety-day readmission was lower with navigation (3.6% vs. 4.9%; odds ratio 0.72, 95% confidence interval 0.65–0.79), as were early revision and reoperation events. However, index hospitalization charges were higher (+$15,384 per case), and a modeled episode-of-care analysis did not demonstrate cost offset within 90 days.ConclusionsNavigation-guided elective THA was associated with improved short-term outcomes but higher upfront charges. Because the NRD does not capture surgical approach, implant positioning, implant-specific details, surgeon volume, or longer-term outcomes, these findings should be interpreted as hypothesis-generating associations rather than definitive evidence of a causal technology effect.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1881730</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1881730</link>
        <title><![CDATA[Association between postoperative silver sulfadiazine dressings and surgical site infection after skin cancer excision: an observational cohort study with historical controls]]></title>
        <pubdate>2026-08-17T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Barbara De Angelis</author><author>Davide Johan Bottini</author><author>Chiara Di Segni</author><author>Lorenzo Secondi</author><author>Marco Gerardi</author><author>Margarida Fernandes Lopes Morais D’Autilio</author><author>Nico Preite</author><author>Alfredo Pisapia</author><author>Pietro Gentile</author><author>Dario Crocoli</author><author>Daniele Di Giovanni</author><author>Mariachiara Carestia</author><author>Leonardo Palombi</author><author>Fabrizio Orlandi</author><author>Valerio Cervelli</author>
        <description><![CDATA[BackgroundSurgical site infections (SSIs) remain a relevant postoperative complication in dermatologic surgery, negatively affecting wound healing, patient outcomes, and healthcare costs. Although the baseline infection risk after clean skin cancer surgery is relatively low, preventive strategies remain clinically important. Silver sulfadiazine (SSD) is a topical antimicrobial agent with broad-spectrum antibacterial activity; however, its preventive role in clean oncologic dermatologic surgery remains insufficiently investigated. This study evaluated the association between postoperative SSD-based dressings and SSI occurrence after skin cancer excision.MethodsA non-randomized observational cohort study with a non-concurrent historical control group was conducted including 800 patients undergoing excision of basal cell carcinoma or squamous cell carcinoma. The intervention group (n = 400) prospectively received postoperative SSD-based dressings, whereas the control group (n = 400) consisted of historical controls treated with paraffin gauze alone before implementation of the SSD protocol. The primary endpoint was SSI occurrence at postoperative day 3 (T1), defined as Southampton Wound Assessment Scale (SWAS) grade ≥ II. Relative risk (RR) and 95% confidence intervals (CIs) were calculated.ResultsAt T1, SSIs occurred in 36/400 patients (9.0%) in the SSD group compared with 72/400 patients (18.0%) in the control group (RR = 0.50; 95% CI: 0.34–0.73; p < 0.001). No additional infections were observed during subsequent follow-up evaluations (T2–T4). Recorded baseline demographic and clinical characteristics were broadly comparable between groups.ConclusionPostoperative SSD-based dressings were associated with a lower incidence of early SSI after skin cancer excision. Because of the non-randomized design and the use of non-concurrent historical controls, the observed reduction should be interpreted as an association rather than proof of causality. Further prospective randomized studies are warranted.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1884577</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1884577</link>
        <title><![CDATA[Synchronous multiple primary colorectal cancer with discordant RAS status between primary lesions: a case report in an elderly patient]]></title>
        <pubdate>2026-08-17T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Junting Guan</author><author>Jiyuan Chen</author><author>Shengqi Pan</author><author>Qi Li</author><author>Guiyu Wang</author><author>Qingchao Tang</author>
        <description><![CDATA[BackgroundSynchronous multiple primary colorectal cancer (SMPCRC) is rare and often shows molecular heterogeneity between primary lesions. Treatment decisions are particularly challenging in complex scenarios involving multiple independent lesions, distant metastasis, and advanced age with intolerance to standard chemotherapy.Case presentationA 77-year-old man presented with hematochezia and was diagnosed with four independent neoplastic lesions within three months: a primary rectal lesion (pT3N1aM0), a sigmoid colon primary carcinoma, a proximal rectal adenoma with focal intramucosal carcinoma, and an adenocarcinoma of the transverse colon near the splenic flexure [resected by endoscopic submucosal dissection (ESD) three months later]. Bilateral hepatic metastases were detected six months postoperatively, with the carcinoembryonic antigen (CEA) level still within the reference range at diagnosis. Molecular testing of the two primary carcinomas revealed marked discordance: the primary rectal lesion carried mutation signals in both KRAS exon 4 and NRAS exon 2, whereas the sigmoid colon lesion was entirely RAS/RAF/PIK3CA wild-type — testing either lesion alone would have led to opposite anti-EGFR treatment decisions. Given the patient's advanced age and intolerance to standard chemotherapy, a staged, multimodal integrated strategy was adopted: synchronous surgery for three primary lesions, minimally invasive ESD of the transverse colon lesion, artificial ascites-assisted percutaneous microwave ablation (AA-MWA) for liver metastases, and individualized adjustment of chemotherapy (switched from CAPEOX to oxaliplatin plus raltitrexed because of intolerance). Over 18 months of follow-up, no radiological recurrence was observed and the patient remained in good general condition.ConclusionsThis case demonstrates that primary lesions in SMPCRC can harbor substantial molecular heterogeneity, such that single-lesion testing may be insufficient to guide treatment decisions in complex scenarios. For elderly patients intolerant to standard regimens, a staged, multimodal integrated approach (synchronous surgery + ESD + AA-MWA + individualized chemotherapy adjustment) may serve as a feasible comprehensive treatment option.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1875200</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1875200</link>
        <title><![CDATA[Clinical phenotypes of children undergoing adenotonsillectomy: a cluster analysis based on comorbidities and Its association with surgical strategy and length of stay]]></title>
        <pubdate>2026-08-17T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Chen Liu</author><author>Jiali Zhang</author><author>Liu Yang</author><author>Lifang Tan</author>
        <description><![CDATA[ObjectiveTo identify clinical phenotypes among children undergoing surgery for adenotonsillar hypertrophy using unsupervised cluster analysis based on comorbidities, and to explore the association of phenotypes with obstructive sleep apnea (OSA) severity, surgical procedures, and length of hospital stay (LOS).MethodsThis retrospective cohort study included 199 consecutive children who underwent adenoidectomy or adenotonsillectomy between August 2023 and April 2026. Nine binary comorbidity variables were extracted. K-modes clustering was used to partition patients into phenotypic groups. Demographic characteristics, OSA severity, surgical procedures, and LOS were compared. Multivariable negative binomial regression identified independent predictors of LOS.ResultsFour phenotypes emerged: allergic-inflammatory (n = 48), sinusitis-dominant (n = 90), otitis-prone (n = 22), and hypertrophy-only (n = 39). Age, OSA prevalence, and severity varied significantly among clusters (P < 0.05). Tympanostomy tube insertion was concentrated in the otitis-prone cluster (86.4%, P < 0.001). LOS differed modestly (P = 0.043), with the otitis-prone cluster staying longest. Only surgical extent independently predicted LOS: standard T&A (IRR 1.27, 95% CI 1.07–1.51) and extended surgery (IRR 1.45, 95% CI 1.01–2.03).ConclusionsComorbidity-based clustering reveals four clinically meaningful phenotypes differing in age, OSA, and otologic surgery needs. LOS is driven by surgical complexity, yet phenotyping aids preoperative planning.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1848812</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1848812</link>
        <title><![CDATA[Case Report: Single-incision robotic-assisted nephrectomy and heterotopic renal autotransplantation for a large complex renal artery aneurysm]]></title>
        <pubdate>2026-08-14T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Matthew Gaynor</author><author>Mahmoud Morsi</author><author>Javier Gonzalez</author><author>Omaida Velazquez</author><author>Henry Ocando Nava</author><author>Gaetano Ciancio</author>
        <description><![CDATA[Renal artery aneurysms (RAAs) may require complex open vascular surgery. We describe a 50-year-old female with a large, intricate right RAA involving multiple branches. Management consisted of single-incision robotic-assisted right nephrectomy, ex vivo aneurysm excision, and arterial and venous reconstruction with heterotopic kidney autotransplantation to the right iliac fossa. Following reperfusion, partial thrombosis of the reconstructed branches occurred, which was successfully revised using reconstruction with the patient's right internal iliac artery. Postoperatively, kidney function was preserved, and no complications developed. Ex vivo repair with heterotopic kidney autotransplantation may represent a safe and effective strategy in selected patients with complex RAAs.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1887903</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1887903</link>
        <title><![CDATA[Case Report: Adult liver transplantation using a long-standing mesocaval shunt as portal inflow in congenital absence of the portal vein with atypical variceal bleeding and refractory shunt encephalopathy]]></title>
        <pubdate>2026-08-14T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>A. V. Shabunin</author><author>M. G. Minina</author><author>P. A. Drozdov</author><author>O. N. Levina</author><author>S. A. Astapovich</author><author>D. A. Makeev</author><author>D. A. Solomatin</author><author>I. I. Kurbanov</author><author>A. I. Yurik</author>
        <description><![CDATA[Congenital absence of the portal vein (CAPV) is an exceedingly rare vascular malformation in which mesenteric and splenic venous blood bypasses the liver and drains into the systemic circulation. Because congenital portosystemic drainage usually decompresses the splanchnic venous bed, classical portal hypertension is uncommon, and CAPV typically presents with metabolic and vascular complications rather than variceal bleeding. We report the case of a 36-year-old woman with CAPV that presented atypically in early childhood with esophageal variceal hemorrhage, suggesting functional inadequacy or early loss of the native decompressive pathway. At the age of three years, she underwent H-type mesocaval shunting and remained clinically compensated for more than three decades. She later developed refractory shunt-related hyperammonemic encephalopathy with recurrent functional bowel obstruction, without evidence of mechanical obstruction on repeated imaging and laparotomy. Orthotopic liver transplantation was performed using a graft from a brain-dead donor. Because the native portal vein was absent, portal inflow was reconstructed by an end-to-end shunt-to-portal anastomosis using the long-standing mesocaval shunt, avoiding the need for an interposition venous graft. The postoperative course was complicated by a biliary anastomotic stricture managed with staged endoscopic stenting and by late stenosis of the shunt-to-portal anastomosis on postoperative day 212, successfully treated with balloon angioplasty and portal vein stenting. At the 275-day follow-up, the patient remained clinically stable, with no recurrence of encephalopathy and resolution of intestinal dysmotility. This case highlights a rare adult presentation of CAPV requiring liver transplantation and demonstrates that a long-standing mesocaval shunt may serve as a feasible source of portal inflow when the native portal vein is absent.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1923049</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1923049</link>
        <title><![CDATA[Synchronous right colon adenocarcinoma and sigmoid endometriosis mimicking a second primary carcinoma: a case report]]></title>
        <pubdate>2026-08-13T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Ke Yang</author><author>Ping Li</author><author>Xuan Long</author>
        <description><![CDATA[Intestinal endometriosis is a benign gynecological condition that frequently involves the rectosigmoid colon. Its synchronous occurrence with colorectal cancer is exceptionally rare and diagnostically challenging, particularly when mimicking a second primary malignancy. We report a case of a 48-year-old woman presenting with altered bowel habits. Colonoscopy revealed synchronous lesions: an adenocarcinoma at the hepatic flexure and a suspicious mass in the sigmoid colon. Repeated biopsies of the sigmoid lesion were inconclusive, ranging from dysplasia to chronic inflammation, raising concern for a second primary tumor. The patient underwent right hemicolectomy with partial sigmoidectomy. Intraoperative frozen section unexpectedly identified endometriosis, subsequently confirmed by definitive pathology and immunohistochemistry. At 12-month follow-up, the patient remained well with no evidence of recurrence.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1814943</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1814943</link>
        <title><![CDATA[Assessment of brachial plexus and upper-extremity peripheral nerve injuries at the anatomical level using multimodal generative models]]></title>
        <pubdate>2026-08-13T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Vincent G. J. Guillaume</author><author>Ron Martin</author><author>Jonas Roos</author><author>Robert Kaczmarczyk</author><author>Justus P. Beier</author><author>Benedikt Schäfer</author><author>Tim Leypold</author>
        <description><![CDATA[IntroductionInjuries to the brachial plexus and its terminal branches can be devastating at the functional and occupational levels, as loss of even partial functions causes major disruptions in dexterity and mobility. The brachial plexus comprises multiple interconnected anatomical layers, making thorough anatomical knowledge essential for determining the extent of injury and the best treatment. Thus, the correlation between functional deficit and precise localization of the injury site is crucial to avoid extensive surgical explorations and restore anatomical integrity.MethodIn this study, we presented Medical Research Council (MRC) muscle strength grades from 50 standardized real-world-inspired fictional benchmark cases of brachial plexus and upper-extremity peripheral nerve injuries at different anatomical levels (roots, trunks, cords, terminal branches, and combined patterns) to various Multimodal Generative Models (MM-GMs), namely GPT-5 (OpenAI), Gemini 2.5 Pro (Google), Grok 4 (xAI), and Claude Opus 4.1 (Anthropic), and evaluated their ability to localize anatomical lesion sites based solely on functional motor deficits.ResultsGPT-5 achieved the highest overall accuracy with 39/50 correct responses (78.0%; 95% CI 64.8–87.2), followed by Grok 4 and Claude Opus 4.1 with 26/50 correct responses each (52.0%; 95% CI 38.5–65.2) and Gemini 2.5 Pro with 22/50 correct responses (44.0%; 95% CI 31.2–57.7). Cochran's Q test showed a significant difference between the models, and Holm-adjusted exact McNemar post-hoc comparisons demonstrated the superior performance of GPT-5 compared with the other models. Combination injuries involving various anatomical sites proved challenging for MM-GMs, with only 20% of answers correct.DiscussionCollectively, this controlled benchmark suggests that MM-GMs can assign standardized MRC strength-grade patterns to anatomical levels of brachial plexus and peripheral nerve injuries. However, performance varies substantially across models and lesion categories, requiring validation in real clinical cohorts before clinical implementation.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1936791</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1936791</link>
        <title><![CDATA[Giant cervical internal carotid artery aneurysm associated with multiple intra- and extracranial aneurysms: a case report]]></title>
        <pubdate>2026-08-13T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Xavier Wong-Achi</author><author>Ambar Riley-Moguel</author><author>José Guillermo Flores-Vázquez</author><author>Alejandro Becerril-Mejía</author><author>Dora Yvette Lugo-Hilario</author><author>Edgar Nathal</author>
        <description><![CDATA[The coexistence of intracranial and extracranial aneurysms is an uncommon association and suggests an underlying systemic aneurysmal disorder that involves complex therapeutic challenges. We report a young patient with multiple intra- and extracranial aneurysms, including a giant, partially thrombosed cervical internal carotid artery aneurysm causing severe hemodynamic compromise and ischemic stroke. The cervical lesion was managed with surgical trapping and aneurysmectomy without cerebral revascularization, resulting in favorable short-term clinical and angiographic outcomes. This case highlights the importance of comprehensive vascular assessment, detailed angiographic and hemodynamic assessment, and individualized decision-making regarding extracranial–intracranial bypass. Careful patient selection and detailed hemodynamic assessment may support aneurysm exclusion without bypass in selected patients with adequate collateral circulation, although long-term surveillance remains essential.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1890509</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1890509</link>
        <title><![CDATA[Case Report: Persistent urogenital sinus (PUGS) associated with complete bicorporeal uterus, double cervix and partial longitudinal non-obstructing vaginal septum: a one-stop diagnostic and operative hysteroscopic approach]]></title>
        <pubdate>2026-08-13T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Emma Bonetti Palermo</author><author>Michela Zorzi</author><author>Federica Pozzati</author><author>Federico Ferrari</author><author>Franco Odicino</author><author>Antonia Carla Testa</author><author>Ursula Catena</author>
        <description><![CDATA[IntroductionPersistent urogenital sinus (PUGS) is a rare congenital malformation characterized by the confluence of the urethra and vagina into a single distal channel. It may be associated with other congenital anomalies, including Müllerian malformations. Although typically diagnosed in childhood, delayed diagnosis may occur, particularly in patients with mild or nonspecific symptoms.Case presentationWe report the case of a 39-year-old nulliparous woman referred for suspected complex genital malformation, presenting with chronic pelvic pain, dyspareunia, and recurrent urogenital infections. A one-stop diagnostic and operative approach, combining transvaginal ultrasound and hysteroscopy, identified PUGS associated with a complete bicorporeal uterus, double cervix, and partial longitudinal non-obstructing vaginal septum (U3bC2V1 according to the ESHRE/ESGE classification). A 15-Fr bipolar mini-resectoscope was used for incision of the vaginal septum and removal of a concomitant FIGO type 0 fibroid in the right hemiuterus. The procedure was completed without complications.DiscussionThe integration of expert ultrasound and endoscopic evaluation enabled accurate anatomical characterization and guided tailored surgical management. The use of a 15-Fr bipolar mini-resectoscope allowed effective treatment in a complex anatomical setting, avoiding cervical dilation while providing adequate maneuverability and simultaneous cutting and coagulation.ConclusionA one-stop approach in a specialized center may improve diagnostic accuracy and support safe, individualized minimally invasive management of complex congenital urogenital anomalies.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1862072</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1862072</link>
        <title><![CDATA[Feasibility and clinical efficacy of minimally invasive techniques in the treatment of type Ⅱ/Ⅲ brucellar spondylitis]]></title>
        <pubdate>2026-08-13T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Xinming Yang</author><author>Yakun Du</author><author>Ye Tian</author><author>Yao Yao</author><author>Lixing Chen</author><author>NingKui Niu</author>
        <description><![CDATA[ObjectiveTo explore the clinical feasibility and perioperative superiority of combined minimally invasive techniques in treating type II/III Brucellar Spondylitis (BS), clarify the stratified surgical indications for different minimally invasive procedures and key technical points, provide evidence-based medical evidence for selecting appropriate surgical methods in the clinical treatment of type II/III BS, and provide a reference for formulating clinical norms for minimally invasive techniques in treating BS, thereby promoting the standardized and popularized application of minimally invasive spinal surgery techniques in the treatment of BS. Limitations of the retrospective single-center design and mixed minimally invasive intervention heterogeneity are fully discussed to avoid overgeneralized inference.MethodsA retrospective controlled study was conducted with stratified subgroup description of different minimally invasive procedures and clear preoperative allocation criteria for surgical approaches to reduce selection bias. Patients diagnosed with type II/III BS and undergoing surgical treatment in our hospital from January 2020 to March 2025 were selected as the research subjects. They were divided into the minimally invasive group and the traditional open surgery group according to standardized preoperative surgical allocation criteria based on abscess scale, vertebral destruction range, spinal instability degree and spinal canal occupation ratio. The minimally invasive group integrated three types of distinct minimally invasive techniques including unilateral biportal endoscopy (UBE), percutaneous spine endoscopy, and CT-guided lesion drainage combined with minimally invasive percutaneous internal fixation; baseline lesion characteristics of patients receiving different minimally invasive modalities were separately described to reflect intervention heterogeneity. The open group underwent conventional anterior or posterior open debridement, bone graft fusion, and pedicle screw internal fixation. Through postoperative follow-up, the clinical baseline data, perioperative core indicators, pain visual analogue scale (VAS) score, Oswestry Disability Index (ODI), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) inflammatory indicators, ASIA neurological function grading, radiological bone fusion rate, postoperative complication occurrence rate and disease recurrence rate of the two groups of patients were systematically compared. Effect size calculation and minimal clinically important difference (MCID) analysis were supplemented for all continuous outcome indicators to distinguish statistical difference from clinical meaningful difference.ResultsA total of 72 patients met the inclusion criteria, among which 38 were in the minimally invasive group and 34 were in the open surgery group. There were no statistically significant differences in clinical data such as gender, age, type of BS, affected vertebrae segments, presence of paravertebral abscess, and ASIA classification of neurological function between the two groups (P > 0.05); supplementary stratified comparison of abscess size, vertebral destruction severity and spinal canal occupation ratio between groups was performed to further verify intergroup clinical comparability, indicating good comparability. The minimally invasive group was significantly superior to the open group in perioperative indicators including operation time, intraoperative blood loss, surgical incision length, postoperative bed rest time, and hospital stay (P < 0.05), with medium-to-large effect sizes confirming clinical meaningful gaps. At 1 week, 1 month, 3 months, 6 months, and 12 months postoperatively, the reductions in VAS score, ODI, ESR, and CRP in the minimally invasive group were significantly greater than those in the open group (P < 0.05), and MCID thresholds were reached in most time points, representing clinically meaningful pain relief and inflammatory improvement. The excellent and good rate of neurological function recovery was 90.9% in the minimally invasive group and 75.0% in the open group, with no significant difference between the two groups (P > 0.05). The bone fusion rate was 92.1% in the minimally invasive group and 88.2% in the open group, showing comparable spinal fusion effects (P > 0.05). The postoperative complication rate was 21.05% in the minimally invasive group, significantly lower than 76.47% in the open group (P < 0.05), with large effect size supporting clinical safety advantages. At 12-month follow-up, the disease recurrence rate was 2.6% in the minimally invasive group and 8.8% in the open group, with no significant difference between the two groups (P > 0.05).ConclusionMinimally invasive spine surgery techniques are safe and feasible in the treatment of Type Ⅱ/Ⅲ BS, achieving thorough debridement, reliable infection control reflected by reduced inflammatory markers, and sufficient nerve decompression. They are comparable to conventional open surgery in neurological recovery, clinical efficacy and spinal fusion outcomes, while possessing significant perioperative advantages such as less surgical trauma, less intraoperative bleeding, faster postoperative recovery, and lower complication rate. Considering the retrospective design, mixed minimally invasive intervention heterogeneity and lack of long-term follow-up beyond 12 months, minimally invasive techniques may serve as a preferred alternative surgical option for appropriately selected Type Ⅱ/Ⅲ BS patients who meet strict minimally invasive surgical indications, rather than a universal first-line scheme for all Type Ⅱ/Ⅲ BS cases.]]></description>
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        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1906216</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1906216</link>
        <title><![CDATA[Management of iatrogenic rectal injury following radical prostatectomy: a 10-year experience from a regional Australian hospital and an algorithm for management]]></title>
        <pubdate>2026-08-12T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Khang Duy Ricky Le</author><author>Kevin Kah Wai Yoong</author><author>Leon Yeung</author><author>Iman Hameed</author><author>Nicholas Ang</author><author>David Patrick Heath</author><author>David Lloyd</author><author>Minh Hung Nguyen</author>
        <description><![CDATA[BackgroundIatrogenic rectal injury following radical prostatectomy or cystoprostatectomy is a rare but significant complication associated with significant morbidity, including sepsis, rectourethral or rectovesical fistulas, and death. The management of these injuries remains highly heterogeneous, particularly in regional contexts where surgical rescue expertise is varied. This case series explores a decade of regional Australian experience in the management of rectal injuries following radical prostatectomy and proposes a practical management algorithm for multidisciplinary decision-making.MethodsA retrospective consecutive case series was conducted at a regional Australian tertiary hospital. Adult patients diagnosed with an iatrogenic rectal injury following a radical prostatectomy between January 2015 and December 2025 were identified. Demographic, operative, diagnostic, management, and outcome data were collected and analysed descriptively.ResultsEight patients were included. Rectal injuries were identified intraoperatively in three patients (37.5%) and postoperatively in five (62.5%), with delayed presentation ranging from 5 days to 2.5 years. Injury size ranged from <1 to 4 cm, and all defects involved a full-thickness rectal wall injury. Management strategies varied according to the timing of diagnosis, defect characteristics, tissue quality, and fistula formation. Immediate injuries were successfully managed with primary repair, with or without faecal diversion. Three patients developed rectourethral or rectovesical fistulas, requiring staged reconstruction using a transperineal approach with interposition of a pedicled gracilis flap. All patients achieved successful healing without mortality, and all diverting stomas were ultimately reversed.ConclusionsRectal injury following prostatectomy requires prompt recognition and individualised multidisciplinary management. Early diagnosis facilitates simpler repair strategies, whereas delayed recognition is associated with fistula formation and the need for complex reconstructive procedures.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1880320</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1880320</link>
        <title><![CDATA[Retrograde robot-assisted radical prostatectomy in a patient with localized prostate cancer: a case report]]></title>
        <pubdate>2026-08-12T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Zdravka Harizanova</author><author>Ferihan Ahmed-Popova</author><author>Vasil Pavlov</author><author>Elena Bozhikova</author>
        <description><![CDATA[IntroductionProstate cancer represents one of the most prevalent malignancies affecting the male population worldwide. With increasing survival rates, greater attention has been directed toward postoperative complications, particularly erectile dysfunction and urinary incontinence.Patient concernsA 70-year-old male patient with histologically confirmed prostate carcinoma reported lower urinary tract symptoms including dysuria and nocturia.DiagnosisThe pathological diagnosis was organ-confined acinar adenocarcinoma of the prostate, pT2, ISUP Grade Group 1, with negative surgical margins (R0).Interventions and outcomesAfter pelvic ultrasound, consultation with an anesthesiologist and a cardiologist, the patient underwent retrograde robot-assisted radical prostatectomy.ConclusionThis case illustrates the practical application of the retrograde approach, emphasizing its anatomical rationale and technical considerations rather than demonstrating superiority over conventional antegrade nerve sparing. Careful patient selection, sound anatomical knowledge, and adherence to oncological principles remain essential for balancing cancer control with functional preservation. Further prospective comparative studies are required to clarify the role of retrograde nerve-sparing dissection in contemporary robot-assisted radical prostatectomy.]]></description>
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        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1915384</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1915384</link>
        <title><![CDATA[Functional nutritional frailty predicts complications after microvascular free flap reconstruction]]></title>
        <pubdate>2026-08-12T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Çağla Çiçek</author><author>Samed O. Akın</author><author>Cem Aydın</author><author>Gaye Filinte</author>
        <description><![CDATA[BackgroundOutcomes after microvascular free flap reconstruction depend not only on surgical technique but also on patient-related factors such as nutritional and functional reserve. However, conventional biochemical markers may not fully reflect the patient's physiological reserve. This study aimed to evaluate whether functional nutritional screening tools can predict free flap–related complications.MethodsEighty patients who underwent microvascular free flap reconstruction were retrospectively analyzed. Preoperative nutritional status was assessed using the Mini Nutritional Assessment (MNA) and SARC-F questionnaire. Patients were categorized as high risk (HR) or low risk (LR) according to these screening tools. Free flap–related complications within 30 days were compared between groups. Multivariable logistic regression analysis was performed as an exploratory analysis to evaluate the association between functional nutritional frailty and flap-related complications.ResultsTwenty-nine patients (36.3%) were classified as high risk. Flap-related complications, defined as a composite outcome including total flap loss, partial flap necrosis, vascular thrombosis requiring re-exploration, surgical site infection, and wound dehiscence, occurred in 17 patients (21.3%). Complication rates were significantly higher in the HR group compared with the LR group (55.2% vs. 1.9%, p < 0.001), corresponding to an approximately 29-fold increase in risk. In multivariable analysis, functional nutritional frailty remained associated with postoperative complications in the exploratory multivariable model (OR 74.4, 95% CI 8.8–629.6, p < 0.001), whereas diabetes mellitus and smoking were not associated with complication development.ConclusionFunctional nutritional frailty assessed by simple clinical screening tools such as MNA and SARC-F was strongly associated with flap-related complications after free flap reconstruction. Incorporating these tools into routine preoperative assessment may help identify high-risk patients and optimize perioperative management.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1889766</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1889766</link>
        <title><![CDATA[Case Report: Concurrent thyroid tuberculosis and tuberculous lymphadenitis initially misdiagnosed as malignancy by 18F-FDG PET/CT]]></title>
        <pubdate>2026-08-12T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Zhenyu Zhang</author><author>Huiling Wang</author><author>Yaqin Wu</author><author>Yali Lei</author><author>Chaojie Zhang</author>
        <description><![CDATA[BackgroundTuberculous lymphadenitis (TBL) is a common manifestation of extrapulmonary tuberculosis (EPTB). However, establishing a definitive diagnosis can be challenging, particularly in primary healthcare settings, when the clinical presentation is atypical or when TBL coexists with another rare form of EPTB—thyroid tuberculosis (TB). Whether primary or secondary, TB remains an exceedingly uncommon clinical entity, even in the context of the persistently high overall prevalence of tuberculosis in China. Thyroid tuberculosis accounts for approximately 0.1%–0.4% of all thyroid diseases, with an even lower incidence of primary thyroid involvement. Herein, we report a case in which 1⁸F-FDG PET/CT imaging initially suggested malignant lesions involving thyroid nodules and cervical lymph nodes; however, the final histopathological assessment and subsequent favorable response to diagnostic anti-tubercular therapy confirmed the diagnosis of concurrent thyroid tuberculosis and tuberculous lymphadenitis.Case descriptionThe patient was a 68-year-old male presenting with a 10-day history of a palpable neck mass. Thyroid ultrasonography revealed multiple bilateral thyroid nodules classified as TI-RADS category 4b, accompanied by markedly elevated serum anti-thyroglobulin antibody (TGAb) and anti-thyroid peroxidase antibody (TPOAb) levels. An enlarged lymph node was detected in the right cervical region. An 1⁸F-FDG PET/CT scan performed at an external institution demonstrated lesions with increased FDG uptake involving the thyroid gland, multiple systemic lymph nodes, and the lungs. To clarify the diagnosis, ultrasound-guided core needle biopsy (CNB) was performed on the bilateral thyroid nodules and the right cervical lymph node. Histopathological examination revealed granulomatous inflammation, and tuberculosis could not be excluded. Polymerase chain reaction (PCR) testing and fungal polysaccharide immunofluorescence (IF) staining were both negative, while acid-fast bacilli staining showed suspicious positive results. The patient exhibited no specific clinical symptoms and denied a history of exposure to tuberculosis-endemic areas. Based on these findings, diagnostic anti-tubercular therapy was initiated. A limited initial follow-up assessment demonstrated a favorable therapeutic response, supporting the diagnosis, although the patient was subsequently lost to long-term follow-up due to financial and adherence issues.ConclusionThis case highlights the importance of considering the possibility of thyroid tuberculosis in clinical practice. With the increasing detection of thyroid nodules during routine examinations, accurate differentiation between benign and malignant etiologies is crucial. Incorporating tuberculosis infection into the differential diagnosis may help prevent unnecessary surgical interventions for suspected thyroid malignancy.]]></description>
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        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1855285</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1855285</link>
        <title><![CDATA[Prognostic value of preoperative sarcopenia and inflammatory markers in patients undergoing pancreaticoduodenectomy]]></title>
        <pubdate>2026-08-12T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Hang Yu</author><author>JianJun Wu</author><author>XiuLin Wang</author><author>JiaHao Luo</author><author>WeiLong Du</author><author>YuXue Luo</author><author>ZhongPing Xu</author><author>YunBing Wang</author><author>Xiong Ding</author>
        <description><![CDATA[IntroductionThe combined role of preoperative sarcopenia and inflammatory response in patients undergoing pancreaticoduodenectomy (PD) remains unclear. This study investigates the predictive value of sarcopenia combined with inflammatory markers for postoperative overall survival (OS).MethodsWe retrospectively analyzed 318 patients who underwent PD between February 2019 and March 2025. Sarcopenia was defined by CT-derived skeletal muscle index (SMI) using sex- and BMI-specific thresholds. Inflammatory markers included NLR, PLR, LMR and CAR. Optimal cutoffs were determined via ROC curves, and prognostic factors were identified using Cox proportional hazards models. Survival analysis was performed using the Kaplan–Meier method.ResultsOf the 318 patients, 196 (61.64%) were diagnosed with preoperative sarcopenia. Multivariable analysis showed no significant association between sarcopenia or inflammatory markers and postoperative complications evaluated in this study (P > 0.05). CA19-9 (OR:0.999,P=0.027) was a protective factor for POPF. SMI (OR: 1.165, P = 0.041), neutrophils (OR: 1.191, P = 0.005), and Operative blood loss (OR: 1.001, P = 0.022) were independent risk factors for 30-day readmission. Multivariable analysis identified sarcopenia (HR=1.935,P=0.012) as an independent predictor of OS. Based on ROC curve analysis, the optimal cutoff values for NLR and CAR were exploratorily identified as 2.705 and 0.372. Survival analysis revealed that patients with sarcopenia combined with either high NLR (>2.705) or high CAR (>0.372) had significantly shorter mean OS compared to non-sarcopenic patients with low NLR or low CAR (P=0.007,P=0.001). Specifically, the concurrent presence of sarcopenia and high NLR was associated with the highest mortality risk (HR=5.155,P=0.007), followed by the combination of sarcopenia and high CAR (HR=2.808,P=0.001).ConclusionPreoperative sarcopenia is an independent predictor of poor OS following PD. The coexistence of sarcopenia and a high inflammatory state (i.e., high NLR or high CAR) significantly increases the risk of mortality. Therefore, preoperative assessment of skeletal muscle mass and inflammatory status may be crucial for identifying high-risk patients.]]></description>
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        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1901971</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1901971</link>
        <title><![CDATA[Preoperative predictors of persistent enteropathic diarrhea after one-anastomosis gastric bypass in patients with type 2 diabetes mellitus]]></title>
        <pubdate>2026-08-12T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Ilkhom B. Khayitov</author><author>Akhmadjon B. Babajonov</author><author>Saidislomxon S. Sayidburxonov</author>
        <description><![CDATA[BackgroundPersistent enteropathic diarrhea is a quality-of-life-limiting complication after one-anastomosis gastric bypass (OAGB). Patients with type 2 diabetes mellitus (T2DM) may be especially vulnerable owing to subclinical diabetic enteropathy and reduced pancreatic exocrine reserve, but no validated preoperative tool identifies them. We aimed to identify and internally validate routine preoperative predictors of persistent enteropathic diarrhea 12 months after OAGB in a T2DM cohort.MethodsIn this single-center prospective cohort of 87 consecutive patients with T2DM who underwent primary OAGB (January 2020 – December 2024) and completed ≥ 12 months of follow-up, the primary outcome was persistent enteropathic diarrhea, defined as loose or watery stools at all three of the 3-, 6-, and 12-month visits. Preoperative HbA1c, serum albumin, C-reactive protein, coprogram findings, T2DM duration, and antidiabetic regimen were assessed by univariate and multivariable logistic regression, with internal validation by bootstrap resampling.ResultsPersistent enteropathic diarrhea occurred in 26 of 87 patients (29.9%, 95% CI 20.5–40.6%). Three preoperative variables were independently associated with the outcome: HbA1c (OR 2.28 per 1%, 95% CI 1.53–3.73), steatorrhea on coprogram (aOR 4.36, 95% CI 1.21–16.82), and T2DM duration ≥ 10 years (OR 3.90, 95% CI 1.02–16.16). The multivariable model showed good calibration and discrimination, with an area under the receiver operating characteristic curve (AUC) of 0.863, but HbA1c alone provided comparable performance (AUC 0.827) with no significant additional gain from the full model. At a Youden-optimal HbA1c threshold of ≥ 8.25%, the negative predictive value reached 95.2%.ConclusionIn T2DM patients undergoing OAGB, preoperative HbA1c is a robust, clinically accessible single-variable predictor of persistent enteropathic diarrhea at 12 months; coprogram steatorrhea and long-standing diabetes add complementary pathophysiological context. These routine metrics can inform preoperative counseling and risk-adapted postoperative surveillance, and warrant prospective external validation.]]></description>
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