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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>2026-10-18T16:50:24.997+00:00</pubDate>
        <ttl>60</ttl>
        <item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1818905</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1818905</link>
        <title><![CDATA[Case Report: Spinal cord herniation associated with ankylosing spondylitis]]></title>
        <pubdate>2026-10-16T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Zekai Ke</author><author>Chunguang Duan</author>
        <description><![CDATA[BackgroundSpinal cord herniation (SCH) is a rare clinical entity characterized by the ventral displacement of the spinal cord through a dural defect. While often classified as idiopathic, SCH associated with ankylosing spondylitis (AS) is exceedingly rare. The pathogenesis in such cases remains unclear, and treatment strategies are not well standardized.Case presentationHerein, we report a series of four patients with long-standing ankylosing spondylitis who presented with SCH between August 2018 and August 2021. All patients exhibited severe thoracolumbar kyphosis and restricted spinal mobility. Uniquely, the herniations occurred at the vertebral body level rather than the disc level, and one patient presented with rare multilevel herniations. Two patients underwent pedicle subtraction osteotomy (PSO) with spinal fusion. In both surgical cases, direct dural repair was avoided; stabilization was achieved through indirect cord relaxation via spinal column shortening. Postoperative imaging showed successful kyphosis correction and stabilization of the herniation.ConclusionSCH in patients with AS is a distinct entity secondary to inflammatory and biomechanical changes. PSO with fusion is a viable surgical option that addresses both deformity and cord tethering through an indirect mechanism.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1962424</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1962424</link>
        <title><![CDATA[Thirty-day clinical outcomes, early recovery, and healthcare resource use after planned ambulatory vs. conventional inpatient laparoscopic cholecystectomy: a propensity-score overlap-weighted retrospective cohort study]]></title>
        <pubdate>2026-10-16T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Yi Hao</author><author>Yi Wang</author><author>Qinyang Du</author><author>Rongshen Guan</author><author>Qirui Zhang</author><author>Gaopeng Li</author>
        <description><![CDATA[BackgroundReal-world comparisons of planned ambulatory and conventional inpatient laparoscopic cholecystectomy are vulnerable to patient selection and organisational differences. We used propensity score overlap weighting to compare 30-day safety, early recovery, and recorded healthcare resource use between the two planned pathways.MethodsThis single-centre retrospective cohort included 223 adults who underwent elective laparoscopic cholecystectomy for benign gallstone-related disease at Shanxi Bethune Hospital between May 2025 and June 2026. Patients were classified by their preoperative plan as ambulatory (defined as arrival on the day of surgery and intended discharge within 24 h) or conventional inpatient care. The primary outcome was a 30-day adverse clinical composite comprising Clavien–Dindo grade ≥2 complications, unplanned emergency department visits, readmission, endoscopic retrograde cholangiopancreatography or another intervention, reoperation, or death. Overlap weights balanced preoperative characteristics, and 1:1 propensity score matching served as a sensitivity analysis.ResultsThe ambulatory and inpatient groups included 78 and 145 patients, respectively. All included covariates demonstrated absolute standardised mean differences below 0.10 after overlap weighting. Weighted risks of the 30-day composite were 3.8% and 10.2%, giving a risk ratio of 0.37 (95% confidence interval, 0.02 to 1.25) and a risk difference of −6.4 percentage points (−13.8 to 1.4; P = 0.100). The ambulatory pathway was associated with 70.3 fewer postoperative hours and 100.0 fewer total hospital hours. Ambulation and oral intake occurred 5.7 and 6.9 h earlier, discharge pain was 1.13 points lower, and recorded index-admission hospital charges were CNY 5,200 lower; all P < 0.001. Seven ambulatory patients (9.0%) had pathway failure. Results from 59 matched pairs were directionally consistent.ConclusionsAmong patients with a realistic possibility of receiving either pathway, planned ambulatory care was not associated with an increase in the 30-day adverse clinical composite and was associated with shorter hospital stay and lower recorded healthcare resource utilisation. However, important determinants of pathway selection were incompletely measured. The single-centre observational design, residual confounding, and small number of primary events preclude causal interpretation or claims of safety equivalence.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1962292</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1962292</link>
        <title><![CDATA[Case Report: Ankle fracture caused by anterior-posterior horizontal force: a report of two cases]]></title>
        <pubdate>2026-10-16T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Bang Dou</author><author>Jiaxun Zhao</author><author>Wenqian Ma</author><author>Junshuai Lu</author><author>Jiong Mei</author>
        <description><![CDATA[BackgroundAnkle fractures caused by violence in the anterior-posterior horizontal direction are very rare in clinical practice. Few literatures report on the characteristics and mechanisms of this type of fracture, which should be studied to guide clinical treatment.Case presentationWe presented two cases of ankle fractures caused by horizontal violence in the anterior-posterior direction, and these fractures presented a distinctive morphological pattern. After injury, the affected limbs showed significant swelling, and case 2 had developed osteofascial compartment syndrome, and immediate reduction and incision decompression had been performed. After the soft tissue swelling subsided, an open reduction and internal fixation surgery was performed. We fixed the tibial fractures first and then the fibular fractures, and fixed tibial fractures in anterior and medial biplane, which achieved good clinical efficacy.ConclusionAnkle joint fracture caused by horizontal force in the anterior-posterior direction may be a flexion/extension injury, which is rare and unstable and needs further research on the mechanism of injury. This type of ankle fracture may be accompanied by osteofascial compartment syndrome, which needs careful examination and timely treatment.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1825111</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1825111</link>
        <title><![CDATA[Calcaneal tuberosity avulsion fracture fixation: a technical note and results on cases of patients]]></title>
        <pubdate>2026-10-16T00:00:00Z</pubdate>
        <category>Methods</category>
        <author>PengKun Yu</author><author>Fei Zhao</author><author>Qiang Xu</author><author>Yu Wu</author><author>Min Gong</author>
        <description><![CDATA[ObjectiveCalcaneal tuberosity avulsion fractures are more common in elderly osteoporotic populations. According to the Beavis classification, they are divided into 3 types. Types I and III have small bone fragments that are difficult to fix with screws, and traditional open surgery has a high rate of skin necrosis and poor wound healing. This article proposes a modified Bunnell suture combined with calcaneal tunnel fixation technique that can flexibly switch between minimally invasive and open approaches, and explores its short-term clinical efficacy.MethodsFrom January 2024 to February 2026, 2 patients with calcaneal tuberosity avulsion fractures were enrolled. One patient with Beavis type II + I underwent open surgery, and one patient with Beavis type II underwent a minimally invasive procedure. Postoperatively, the Burwell-Charnley criteria were used to assess the quality of fracture reduction. At 6 months postoperatively, the AOFAS ankle-hindfoot scale was used, and the maximum plantarflexion angle and dorsiflexion angle of the ankle joint were recorded. Follow-up recorded incision, fracture healing, and complications, with an average follow-up of 1 year.ResultsBoth patients achieved anatomical reduction postoperatively, and all achieved bony union at 3 months postoperatively without loss of reduction. At 6 months postoperatively, the AOFAS scores were 83 and 96, respectively, and both the maximum plantarflexion and dorsiflexion angles were both within the normal range. Only the patient who underwent open surgery and had diabetes and obesity experienced delayed wound healing, which healed after regular dressing changes for 1 month. The minimally invasive case did not develop complications related to soft tissue, sural nerve, or Achilles tendon.ConclusionThe modified Bunnell suture combined with calcaneal tunnel fixation technique may help balance rigid fixation and soft tissue protection. The minimally invasive approach appears to lower the risk of incision-related complications in the present series. This technique may offer a flexible alternative for selected cases of Beavis calcaneal tuberosity avulsion fractures, especially suitable for minimally invasive fixation of types I and III fractures, and may also act as an auxiliary fixation method for type II fractures. However, the sample size of this study is small, and long-term efficacy still needs to be verified by large-sample controlled studies.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1957028</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1957028</link>
        <title><![CDATA[Early experience with the SHURUI single port serpentine arm robotic system with an auxiliary port in gastrointestinal surgery: a descriptive case series]]></title>
        <pubdate>2026-10-15T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Dipesh Kumar Yadav</author><author>Yuncheng Luo</author><author>Zhangwei Yang</author><author>Yi Huang</author><author>Hanzhang Huang</author><author>Sisi Lin</author><author>Min Li</author><author>Dandan Bao</author><author>Yiren Hu</author>
        <description><![CDATA[BackgroundThe SHURUI single-port (SP) robotic system is a novel platform with serpentine instruments designed for reduced-access surgery. Clinical experience in gastrointestinal malignancies remains limited. This exploratory, descriptive case series reports initial technical experience with the SHURUI SP system in a consecutive series of gastric and colorectal cancer resections.MethodsThis retrospective case series included six consecutive patients who underwent SP robotic gastrointestinal cancer surgery between November 2025 and December 2025 at a single tertiary center. Procedures comprised rectal cancer resection with total mesorectal excision (n = 2), left hemicolectomy (n = 1), right hemicolectomy with D2 lymphadenectomy (n = 1), distal gastrectomy with D2 lymphadenectomy (n = 1), and total gastrectomy with extended D2 lymphadenectomy (n = 1). All cases used a single periumbilical incision (3–4 cm) and a 12 mm auxiliary port for energy devices and staplers. Outcomes included operative parameters, complications (Clavien-Dindo), pathological metrics, and hospital costs.ResultsAll six procedures were completed without conversion. Median operative time was 332.5 min (155–402); median estimated blood loss was 70 mL (10–200). No intraoperative complications or transfusions occurred. Postoperative Grade II complications occurred in two patients (33.3%): anastomotic bleeding requiring transfusion and wound infection. Grade I transient fever occurred in two additional patients (33.3%). No Grade III–V complications, reoperations, or 30-day mortality occurred. All resections achieved R0 margins; median lymph node yield was 18.5 (12–28). Median hospital stay was 14 days (12–20). Mean total hospital cost was ¥30,573 ± ¥14,725, exclusive of robotic platform and instrument fees, which were waived during this initial evaluation period.ConclusionsIn this initial series, the SHURUI SP robotic system achieved complete resection without conversion in all six cases. R0 resection was obtained in every case with no severe early complications; however, the small sample size precludes definitive safety assessment, and oncologic adequacy requires long-term follow-up. The system proved technically feasible for complex gastric and colorectal cancer resections, though the absence of an integrated energy channel necessitated an auxiliary port in all cases, and operative times reflected an early learning curve. Larger comparative studies with long-term follow-up are needed to define the role of this platform.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1996976</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1996976</link>
        <title><![CDATA[Quality of life before and after sympathectomy in primary hyperhidrosis: a recall-based paired analysis of 94 patients]]></title>
        <pubdate>2026-10-15T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Yazeed A. Alrodiman</author><author>Qais A. Almuhaideb</author><author>Nasser M. AbuDujain</author><author>Khalid M. Alghamdi</author>
        <description><![CDATA[ObjectivesPrimary hyperhidrosis substantially impairs quality of life. Sympathectomy is an established treatment for severe focal hyperhidrosis; however, patient-reported outcomes in Arab populations remain limited. This study evaluated recalled preoperative and current postoperative quality of life after sympathectomy using validated Arabic instruments.MethodsWe conducted a secondary, recall-based paired analysis of a cross-sectional survey of 94 participants with primary hyperhidrosis who reported having undergone bilateral sympathectomy. Participants completed an Arabic electronic survey between May 2024 and April 2025. Current postoperative quality-of-life scores were compared with retrospectively recalled preoperative scores using the Arabic Hyperhidrosis Quality of Life Index (HidroQoL©); severity was assessed using the Arabic Hyperhidrosis Disease Severity Scale. Wilcoxon signed-rank tests were primary; paired t tests were sensitivity analyses.ResultsThe mean participant age was 30.7 ± 8.9 years, and 63.8% were men. At the recalled preoperative assessment, 55 participants (58.5%) reported Grade 4 disease severity. All 94 participants provided complete paired data. The mean daily-life score decreased from 8.5 ± 2.8 to 4.9 ± 4.5 [mean paired change −3.6; 95% confidence interval (CI) −4.5 to −2.8; dz = −0.88]. The mean psychosocial score decreased from 16.9 ± 5.5 to 8.8 ± 8.7 (−8.1; 95% CI −9.7 to −6.4; dz = −0.97). The total score decreased from 25.4 ± 7.5 to 13.7 ± 12.8 (−11.7; 95% CI −14.1 to −9.3; dz = −0.98); all p < 0.001. Thirteen participants (13.8%) reported a higher total score after surgery.ConclusionsParticipants reported substantially lower hyperhidrosis-related daily-life and psychosocial impairment after sympathectomy. Recall bias may affect the magnitude and direction of these differences, which do not establish causal treatment effects. Prospective studies incorporating true preoperative baseline assessment, operative details, compensatory sweating, and longer follow-up are needed to confirm the magnitude and durability of these improvements.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.2004684</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.2004684</link>
        <title><![CDATA[Editorial: Integrating musculoskeletal ultrasound and emerging imaging modalities in surgical planning and rehabilitation]]></title>
        <pubdate>2026-10-15T00:00:00Z</pubdate>
        <category>Editorial</category>
        <author>Jaime Almazán-Polo</author><author>Ángel González-de-la-Flor</author><author>César Calvo-Lobo</author>
        <description></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1878735</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1878735</link>
        <title><![CDATA[Association between preoperative E/e′ and early left ventricular systolic recovery after coronary artery bypass grafting]]></title>
        <pubdate>2026-10-15T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Jungsuk Choi</author><author>Hee Kyung Kim</author><author>Joon Kyu Kang</author>
        <description><![CDATA[BackgroundIn patients with reduced or mildly reduced ejection fraction, the degree of systolic recovery after coronary artery bypass grafting (CABG) is heterogeneous. We assessed whether routine preoperative transthoracic echocardiography (TTE) indices—particularly E/e′—are associated with early postoperative improvement in left ventricular function.MethodsWe retrospectively analyzed patients undergoing isolated CABG at a single tertiary center (April 2019 to July 2025). Eligibility required a preoperative left ventricular ejection fraction (LVEF) of <50%. Emergency/salvage operations, 30-day deaths, and patients without an evaluable early postoperative TTE were excluded. The primary outcome was an absolute increase in the LVEF of ≥10 percentage points. Because of the limited number of outcome events, the primary association analysis used a single-predictor logistic regression model with preoperative E/e′. Sensitivity analyses excluded patients with preoperative atrial fibrillation (AF) and modeled postoperative LVEF as a continuous outcome adjusted for baseline LVEF.ResultsOf 75 otherwise clinically eligible patients, three lacked an evaluable early postoperative TTE, leaving 72 patients for outcome analysis; 17 (23.6%) achieved an LVEF increase of ≥10 percentage points. A higher preoperative E/e′ was associated with early LVEF improvement (OR 1.155 per 1-unit increase; 95% CI 1.04–1.28; p = 0.005; N = 66; 16 events). The apparent AUC was 0.700; after 1,000-resample bootstrap internal validation, the estimated optimism was 0.004 and the optimism-corrected AUC was 0.696 (95% bootstrap CI 0.526–0.885). The association persisted after excluding patients with AF (OR 1.14; 95% CI 1.02–1.27; p = 0.025). In a sensitivity analysis using postoperative LVEF as a continuous outcome, E/e′ remained associated with postoperative LVEF after adjustment for baseline LVEF (β = 0.31 percentage points per 1-unit increase; 95% CI 0.01–0.61; p = 0.042).ConclusionA higher preoperative E/e′ was associated with early improvement in LV systolic function after CABG among patients with a preoperative LVEF of <50% who survived to undergo early postoperative echocardiographic assessment. Given the small number of events and the single-center retrospective design, these findings are hypothesis-generating and require external validation.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1886344</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1886344</link>
        <title><![CDATA[Clinical observation of laparoscopic surgery for pediatric periappendiceal abscess]]></title>
        <pubdate>2026-10-14T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Danjing Sun</author><author>Xuechao An</author><author>Xiangming Wu</author><author>Lili Xiao</author><author>Hailong Zhang</author><author>Lin Yang</author><author>Wenfeng Gao</author><author>Jianguo Zhang</author>
        <description><![CDATA[ObjectiveThis study aimed to investigate the changes in inflammatory markers such as CRP, PCT, and IL-6 in the treatment of pediatric periappendiceal abscess and to explore more effective treatment strategies by observing the changes in inflammatory and general indicators after laparoscopic surgery and conservative treatment. The findings are expected to provide more precise guidance for clinicians in making diagnostic and treatment decisions.MethodsThis study conducted a single-center retrospective analysis of 80 eligible pediatric patients with periappendiceal abscess treated in our hospital's Pediatric Surgery Department from January 1, 2019, to December 31, 2024. All patients were definitively diagnosed with periappendiceal abscess based on symptoms/signs, serological examinations, and imaging studies (right lower abdominal color Doppler ultrasound, lower abdominal CT), meeting the inclusion criteria. All patients presented with fever ± nausea/vomiting, right lower abdominal pain, rebound tenderness (+), McBurney's point tenderness (+), positive colonic inflation test, and ultrasound-confirmed inflammatory mass in the right lower quadrant. Patients were allocated to surgical treatment group or conservative treatment group according to intervention methods. Clinical efficacy, inflammatory indicators, and general condition changes were compared between groups.ResultsIn terms of clinical efficacy, there was a statistically significant difference between children undergoing laparoscopic surgery and those receiving conservative treatment (P < 0.05); in terms of inflammatory indicators, both the surgical treatment group and the conservative treatment group showed rapidly declining trends in inflammatory markers including WBC, IL-6, CRP, and PCT (P < 0.05), with no significant difference in the rate of decline between the surgical and conservative groups (P > 0.05); in terms of general conditions, there was no statistically significant difference in hospitalization days between the two groups (P > 0.05), while the time to first flatus and duration of abdominal pain were significantly better in the surgical treatment group compared to the conservative treatment group (P < 0.05).ConclusionThis study demonstrates that laparoscopic appendectomy in children with periappendiceal abscess yields superior outcomes in general recovery compared to conservative treatment (P < 0.05), while both groups exhibit equivalent efficacy in inflammatory marker resolution, with rapid declining trends observed post-intervention. These findings confirm that conservative management requires prolonged duration and achieves suboptimal therapeutic efficacy for pediatric periappendiceal abscess; whereas laparoscopic surgery more effectively enhances patients’ immune function, accelerates inflammation resolution, improves treatment outcomes, and significantly shortens clinical management duration, thereby providing precise guidance for clinical decision-making. However, as a single-center retrospective study with limited sample size, further validation through large-scale prospective studies is warranted.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1972877</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1972877</link>
        <title><![CDATA[Abdominal aortic angiosarcoma following endovascular aneurysm repair: case report and analysis of existing literature]]></title>
        <pubdate>2026-10-14T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Loes H. Willems</author><author>Marcus Steinbach</author><author>Daniel Pink</author><author>Thomas Herold</author><author>Alexander Meyer</author><author>Roger Wahba</author>
        <description><![CDATA[Abdominal aortic angiosarcoma following endovascular aneurysm repair (EVAR) is an exceptionally rare and aggressive malignancy that may mimic common EVAR-related complications. We report the case of a 72-year-old man who presented with progressive lower back pain and was initially suspected of having a graft infection. Imaging revealed a periaortic mass involving a previously treated abdominal aortic aneurysm. Biopsy confirmed aortic angiosarcoma. No regional lymph node or distant metastases were identified. The patient underwent neoadjuvant chemotherapy with gemcitabine and docetaxel, followed by radiotherapy and surgical resection of the abdominal aorta and EVAR graft with aortic reconstruction. Histopathological examination demonstrated complete pathological response without evidence of residual angiosarcoma. Our literature review identified only 21 reported cases of abdominal aortic angiosarcoma following EVAR, including the present case, underscoring the exceptional rarity of this entity and the limited evidence available to guide diagnosis and treatment. This case highlights the importance of considering aortic angiosarcoma in patients with persistent symptoms and atypical periaortic findings after EVAR and suggests that early biopsy and a multidisciplinary, multimodal treatment approach may improve outcomes despite the generally poor prognosis associated with this disease.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1955075</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1955075</link>
        <title><![CDATA[Pressure-modulated dural repair during unilateral biportal endoscopic spine surgery: technique description and preliminary feasibility report]]></title>
        <pubdate>2026-10-14T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Bon-Jour Lin</author><author>Hao-Yuan Hung</author><author>Kuan-Yin Tseng</author><author>Dueng-Yuan Hueng</author><author>Yuan-Hao Chen</author><author>Da-Tong Ju</author><author>Hsin-I. Ma</author><author>Ming-Ying Liu</author><author>Hong-Jaan Wang</author>
        <description><![CDATA[BackgroundThe clinical management of incidental durotomy during the performance of endoscopic spine surgery presents a significant clinical challenge. Instrument maneuverability is limited, and the unique aqueous environment that introduces complications secondary to the intradural influx of irrigation fluid. The purpose of this study was twofold: first, to describe in detail a novel water-pressure modulation technique for collagen matrix inlay graft placement for incidental durotomy repair during unilateral biportal endoscopic spine surgery (UBES); and second, to evaluate the efficacy of this technique in three specific clinical cases, focusing on its feasibility and safety.MethodsThis retrospective study was conducted on clinical cases involving patients who underwent UBES for degenerative lumbar spine pathology from September 2022 to September 2024, based on a review of medical records. Surgical documentation was rigorously examined to ascertain occurrence of incidental durotomy during UBES. The clinical characteristics associated with the durotomy were systemically documented alongside the specific repair technique employed.ResultsA total of three incidental durotomies were identified from 91 UBES procedures performed, resulting in an incidence rate of 3.29%. In each case, the incidental durotomy was successfully repaired through the modulation of irrigation pressure to facilitate the placement of a collagen matrix inlay graft. No patients experienced postoperative cerebrospinal fluid leak or required revision surgery.ConclusionsAnalysis of these clinical cases demonstrated the technical feasibility and preliminary safety of irrigation pressure modulation for collagen matrix inlay graft placement for incidental durotomy repair during UBES. However, further studies with a larger sample size are required to confirm these findings.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1946603</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1946603</link>
        <title><![CDATA[Incidental parathyroidectomy during thyroid surgery and postoperative hypocalcemia: a multicenter retrospective cohort study]]></title>
        <pubdate>2026-10-14T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Nuha Alsaleh</author><author>Khadija AlKhawaja</author><author>Abdullah S. Al-Darwish</author><author>Saad Alshehri</author><author>Ammar Alzahim</author><author>Osama N. Almubadel</author><author>Hala Abu-Qasem</author><author>Reema M. Almutairi</author><author>Reem AlaaEldeen Ahmed</author>
        <description><![CDATA[BackgroundPostoperative hypocalcemia is the most frequent metabolic complication of thyroidectomy, and incidental parathyroidectomy (IPT) is a commonly cited but incompletely characterized contributor. Despite a substantial published literature, the independent clinical impact of IPT on postoperative calcium homeostasis remains debated, and multicenter data from high-volume endocrine surgery settings in Saudi Arabia are lacking.MethodsA retrospective multicenter cohort study was conducted across high-volume endocrine surgery units in Saudi Arabia between January 2020 and December 2024. A total of 455 patients who underwent total or subtotal thyroidectomy were included. IPT was defined histopathologically. Predictors of IPT and of postoperative hypocalcemia were assessed using pre-specified multivariable logistic regression, with cluster-robust standard errors accounting for the multicenter structure. Adjusted odds ratios (aORs) with 95% confidence intervals are reported.ResultsIPT was confirmed in 145 of 455 patients (31.9%). In a pre-specified multivariable model, age ≥60 years was associated with IPT with conventional standard errors (aOR 1.72, 95% CI 1.04–2.85; p = 0.035) but not after accounting for clustering by operating surgeon (aOR 1.72, 95% CI 0.70–4.24; p = 0.24); no variable was a robust independent predictor. When postoperative hypocalcemia was modeled directly, IPT was not associated with it (aOR 0.94, 95% CI 0.44–2.00; p = 0.87), whereas total thyroidectomy was the dominant predictor (aOR 4.82, 95% CI 1.44–16.07; p = 0.011). Preoperative parathyroid hormone was available for only 112 of 455 patients (24.6%) and, using an appropriate non-parametric test, did not differ significantly by IPT status (4.00 ± 1.98 vs. 5.73 ± 4.88 pg/mL; p = 0.14, Mann–Whitney U test). IPT was not associated with calcium supplementation requirement or readmission for hypocalcemia.ConclusionsIPT occurred in nearly one-third of patients but did not predict postoperative hypocalcemia; the extent of surgery, specifically total thyroidectomy, was the principal determinant of postoperative calcium disturbance. Age and preoperative parathyroid hormone were not robust independent correlates once clustering and appropriate testing were applied. These results support universal postoperative calcium monitoring after total thyroidectomy rather than reliance on histologic parathyroid findings.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1888647</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1888647</link>
        <title><![CDATA[Measurement-level clustering of ligamentum flavum thickness identifies distinct phenotypes associated with lumbar lordosis in adult spinal deformity: a proof-of-concept study]]></title>
        <pubdate>2026-10-14T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Dylan Glaser</author><author>Ahmad K. AlMekkawi</author><author>Ashlesha Bhojane</author><author>Ali Ebada</author><author>Christopher Carron</author><author>Salah G. Aoun</author><author>Andrew Abumoussa</author><author>Carlos A. Bagley</author>
        <description><![CDATA[Study designRetrospective cohort study.ObjectivesTo identify distinct ligamentum flavum (LF) thickness phenotypes in adult spinal deformity (ASD) using measurement-level clustering and to characterize their association with traditional spinopelvic parameters in a proof-of-concept analysis.MethodsLF thickness was measured on preoperative MRI in 44 consecutive ASD patients (2018–2023), yielding 1,250 measurements; complete clinical and radiographic data were available in 40. K-means clustering (k = 3) was performed at the measurement level, treating thickness regimes as exploratory and unsupervised. Patients were assigned to a dominant phenotype, and all inferential comparisons were performed at the patient level. Between-phenotype differences in spinopelvic parameters were assessed with independent-samples t-tests and Mann–Whitney U-tests, with Hedges g effect sizes. Preliminary clinical and radiological outcomes were reported descriptively.ResultsThree measurement-level thickness regimes were identified: Low LF (2.21 ± 0.51 mm, n = 619 measurements), Medium LF (3.92 ± 0.56 mm, n = 499), and High LF (6.11 ± 0.90 mm, n = 132). High-cluster measurements were distributed across 32 patients, but only one patient had High LF as a dominant phenotype and was excluded from comparisons (43 patients analyzed; 25 Low, 18 Medium). Lumbar lordosis differed significantly between Low and Medium phenotypes (Low: −44.6 ± 12.0° vs. Medium: −32.5 ± 8.9°; p = 0.003; Hedges g = −1.10, 95% CI −1.81 to −0.39), a large effect that was robust to nonparametric testing. Cluster purity was higher in Low LF (61.9% vs. 53.3%, p = 0.027; g = 0.70). Principal component analysis of standard parameters showed that mean LF thickness was moderately correlated with the dominant pelvic-morphology component (r = −0.44, p = 0.008), indicating that LF thickness is partially related to, rather than independent of, traditional parameters. Intra-rater reliability, assessed by blinded re-measurement of 15 patients, was moderate [ICC(2,1) = 0.632, 95% CI 0.242–0.855; Cohen kappa for phenotype = 0.524], and sensitivity analysis showed that the phenotype-lordosis association does not survive substitution of the re-read values (p = 0.005 to p = 0.245). In contrast, the continuous rank correlation does (rho =  + 0.496, p = 0.0015).ConclusionsMeasurement-level clustering identifies distinct LF thickness phenotypes in ASD that are associated with lumbar lordosis. These exploratory findings establish a methodological foundation and motivate larger, outcome-based studies with formal measurement-reliability assessment to determine clinical utility.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1994124</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1994124</link>
        <title><![CDATA[Case Report: Phosphaturic mesenchymal tumor arising from the jugular bulb without symptomatic osteomalacia]]></title>
        <pubdate>2026-10-14T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Sen Yang</author><author>Jianan He</author><author>Hui Yang</author><author>Bin Hu</author><author>Ziyu Chen</author><author>Zhonghui Wen</author>
        <description><![CDATA[BackgroundPhosphaturic mesenchymal tumor (PMT) is a rare mesenchymal neoplasm that may be associated with tumor-induced osteomalacia (TIO), typically through fibroblast growth factor 23 (FGF23)-mediated phosphate wasting. Skull-base PMTs are uncommon, and lesions centered on the jugular foramen or jugular bulb are particularly rare.Case presentationA 32-year-old man presented with progressive headache and dizziness for 2 months without bone pain, muscle weakness, or pathological fractures. Routine preoperative biochemical testing showed mild hypophosphatemia (0.78 mmol/L); this finding prompted further evaluation with a 24-h urinary phosphate measurement, which was elevated (48 mmol/24 h), together with mildly elevated alkaline phosphatase (147 U/L). Contrast-enhanced magnetic resonance imaging demonstrated a 2.4 × 2.5 × 2.0 cm enhancing mass in the left jugular foramen region. Preoperative CT showed a mixed-density lesion with multiple patchy calcifications, and bone-window CT demonstrated adjacent skull-base bone destruction involving the left jugular foramen and left hypoglossal canal. Magnetic resonance venography showed absent flow signals in the ipsilateral transverse sinus, sigmoid sinus, and internal jugular vein. The tumor was resected through a Fisch type A infratemporal fossa approach. Histopathological and immunohistochemical findings supported the diagnosis of PMT. The patient had no new postoperative neurological deficit or clinically apparent hearing deterioration. Without phosphate or vitamin D supplementation, serum phosphate, urinary phosphate, and alkaline phosphatase normalized after resection and remained within the reference range at 3 months.ConclusionPMT should be considered in the differential diagnosis of unusual jugular foramen masses, particularly when abnormalities of phosphate metabolism are present. This case illustrates that a jugular bulb PMT may be identified before symptomatic osteomalacia develops. In this patient, gross-total resection was followed by normalization of phosphate-related biochemical abnormalities and a favorable short-term clinical outcome.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1979361</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1979361</link>
        <title><![CDATA[Factors influencing future liver remnant hypertrophy after portal vein embolization: a mini review]]></title>
        <pubdate>2026-10-14T00:00:00Z</pubdate>
        <category>Mini Review</category>
        <author>Yuxuan Lu</author><author>Hangcheng Liu</author><author>Boyang Wu</author><author>Canhong Xiang</author><author>Jianping Zeng</author><author>Quanyu Guo</author><author>Hongwei Lu</author><author>Shizhong Yang</author><author>Jitao Wang</author><author>Jiahong Dong</author>
        <description><![CDATA[BackgroundPortal vein embolization (PVE) promotes future liver remnant (FLR) hypertrophy before major hepatectomy, but the response varies substantially among patients. This review summarizes determinants of post-PVE FLR hypertrophy to support preoperative risk stratification and individualized planning.MethodsTargeted searches of PubMed/MEDLINE, Web of Science, Scopus, Embase, and China National Knowledge Infrastructure (CNKI) through 26 August 2026 combined terms for PVE, liver regeneration or FLR hypertrophy, and predictors or associated factors. Reference lists and the authors’ existing reference collection were also screened, and evidence was narratively synthesized across five domains.ResultsFLR hypertrophy reflects multiple interacting determinants. Advanced age, selected chemotherapy exposures, and liver fibrosis have been associated with weaker regenerative responses. Elevated inflammatory markers and biliary infection may impair hypertrophy, whereas adequate embolization extent and appropriate embolic material selection may improve the response.ConclusionFLR hypertrophy after PVE is determined by interacting demographic and clinical, laboratory, hepatic and biliary, tumor-related, and procedure-related factors. Recognizing these determinants may improve patient selection, help predict insufficient hypertrophy, and guide individualized PVE strategies to increase the safety of major hepatectomy.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1959580</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1959580</link>
        <title><![CDATA[Function-preserving plasma kinetic enucleation of the prostate with bladder neck and 12 o'clock urethral mucosal preservation for large-volume benign prostatic hyperplasia: a single-center retrospective case series]]></title>
        <pubdate>2026-10-14T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Wenshuai Yan</author><author>Jie Jia</author><author>Yanming Huo</author><author>Jixue Gao</author><author>Feng Wang</author><author>Hongxiong Song</author>
        <description><![CDATA[BackgroundLarge-volume benign prostatic hyperplasia (BPH) poses a significant surgical challenge, as conventional transurethral resection yields suboptimal tissue removal efficiency and high rates of ejaculatory dysfunction. While endoscopic enucleation techniques (e.g., HoLEP and PKEP) offer improved efficacy, the systematic preservation of functional anatomical structures — particularly the bladder neck and anterior urethral mucosa — remains inadequately addressed in current practice.ObjectiveTo evaluate the safety, efficacy, and functional outcomes of function-preserving plasma kinetic enucleation of the prostate (FP-PKEP) — a modified technique incorporating systematic preservation of the bladder neck circular fibers and the 12 o'clock urethral mucosal strip — in patients with large-volume BPH.MethodsThis single-center, retrospective case series included 52 consecutive patients with large-volume BPH (prostate volume >80 mL, International Prostate Symptom Score [IPSS] > 20, maximum urinary flow rate [Qmax] < 10 mL/s) who underwent FP-PKEP between January 2025 and December 2025. The primary outcome was the change in IPSS at 3 months postoperatively; secondary outcomes included Qmax, post-void residual urine volume (PVR), quality of life (QoL) score, perioperative safety parameters, and functional preservation outcomes (urinary continence and ejaculatory function at 6 months).ResultsAll 52 patients (mean age 67.8 ± 7.2 years; mean prostate volume 93.7 ± 15.2 mL) successfully underwent FP-PKEP without conversion. Mean operative time was 72.5 ± 15.8 min; postoperative hemoglobin decrease was 9.8 ± 4.2 g/L; catheterization duration was 2.8 ± 0.9 days; and hospital stay was 4.2 ± 1.3 days. At 3 months, IPSS decreased from 26.1 ± 3.0 to 6.8 ± 2.6 (P < 0.001), and Qmax increased from 7.2 ± 1.6 to 21.2 ± 4.5 mL/s (P < 0.001). Transient stress urinary incontinence occurred in 4 patients (7.7%), all requiring no more than one pad per day and resolving within 1 month without surgical intervention. Among the 16 patients who were sexually active before surgery, antegrade ejaculation was preserved in 14 (87.5%) and suspected retrograde ejaculation was recorded in 2 (12.5%). No clinically apparent cases of permanent urinary incontinence, bladder neck contracture, or urethral stricture were observed during the 6-month follow-up.ConclusionsIn this uncontrolled case series, FP-PKEP showed a favorable safety profile and achieved significant relief of bladder outlet obstruction, with promising early urinary continence and ejaculatory outcomes. The systematic preservation of the bladder neck and 12 o'clock urethral mucosa warrants further evaluation in prospective randomized controlled trials, as these preliminary findings are exploratory and hypothesis-generating.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1921693</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1921693</link>
        <title><![CDATA[Factors associated with prolonged postoperative hospital stay after cholecystectomy for acute cholecystitis in a Peruvian emergency hospital]]></title>
        <pubdate>2026-10-14T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Yudi N. Tolentino-Alania</author><author>Fiorella A. Sanchez-Ubaldo</author><author>Miguel A. Arce-Huamani</author>
        <description><![CDATA[BackgroundProlonged postoperative hospital stay after cholecystectomy for acute cholecystitis may reflect baseline vulnerability and disease severity. We assessed preoperative factors associated with prolonged postoperative stay in a Peruvian emergency hospital.MethodsWe conducted a retrospective cohort study of patients undergoing cholecystectomy for acute cholecystitis in 2024. All potentially eligible source records were screened. Prolonged postoperative stay was defined as >3 days from surgery to discharge. Adjusted risk ratios (aRRs) and 95% confidence intervals (CIs) were estimated using modified Poisson regression with robust variance in a prespecified model restricted to preoperative variables.ResultsOf 540 records screened, 422 patients were eligible. Median postoperative stay was 2.4 days (IQR, 1.0–3.8), and 158 patients (37.4%) stayed >3 days. Higher risk was observed for age 45–64 years (aRR, 1.51; 95% CI, 1.09–2.10), age ≥65 years (aRR, 1.95; 95% CI, 1.37–2.76), diabetes mellitus (aRR, 1.31; 95% CI, 1.02–1.67), and ASA IV–V status (aRR, 1.50; 95% CI, 1.04–2.16). Hypertension and active smoking showed inverse associations and require cautious interpretation. Postoperative complications occurred in 111 patients (26.3%) and were analyzed descriptively.ConclusionOlder age, diabetes mellitus, and higher preoperative ASA status were associated with prolonged postoperative stay. These findings warrant prospective validation and should not be interpreted as causal.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1944873</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1944873</link>
        <title><![CDATA[Case Report: Solitary fibrous tumor (SFT) of cerebellum: report of 2 cases]]></title>
        <pubdate>2026-10-14T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Gaochao Guo</author><author>Zongzong Ma</author><author>Liming Zhao</author><author>Tao Gao</author><author>Yuxue Sun</author><author>Ziqiang Liu</author><author>Yang Liu</author><author>Chaoyue Li</author>
        <description><![CDATA[ObjectiveTo elucidate the neuroradiological characteristics, clinical manifestations, and surgical outcomes of intracranial cerebellar solitary fibrous tumors (SFTs) to improve diagnostic accuracy and therapeutic strategies.MethodA retrospective analysis was conducted on the clinical data of two histopathologically confirmed cases of cerebellar SFT, supplemented by a review of the relevant literature.ResultsBoth patients underwent total surgical excision followed by postoperative radiotherapy. At the latest follow-up, neither patient showed radiological evidence of tumor recurrence (Case 1: 18 months; Case 2: 12 months]). Given the potential for late recurrence in SFTs, long-term surveillance is mandatory.ConclusionIntracranial cerebellar SFTs are rare neoplasms that are frequently misdiagnosed despite exhibiting distinctive magnetic resonance imaging (MRI) features. Definitive diagnosis relies on histopathological and immunohistochemical analyses. In this study, MRI demonstrated T1-weighted imaging (T1WI) hypointensity or isointensity, T2-weighted imaging (T2WI) heterogeneity, and inconsistent post-contrast enhancement. Immunohistochemical evaluation revealed positivity for CD34, CD99, and STAT6. Prompt surgical intervention accompanied by adjuvant therapy was associated with a favorable prognosis.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1931071</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1931071</link>
        <title><![CDATA[Comparison of cardiopulmonary function in patients with scoliosis at rest and during exercise: a case-control study]]></title>
        <pubdate>2026-10-13T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Bo Zhou</author><author>Zhibo Song</author><author>Ni Bi</author><author>Li Zhang</author><author>Zhiyue Shi</author><author>Tao Li</author><author>Chengquan Cao</author><author>Zhi Zhao</author><author>Yingsong Wang</author>
        <description><![CDATA[BackgroundPreoperative cardiopulmonary assessment in scoliosis is typically dominated by resting spirometry and the Cobb angle, yet resting tests may understate functional impairment and curve magnitude predicts it only weakly. This study integrated resting echocardiography, static pulmonary function testing, CT lung volume, and cardiopulmonary exercise testing (CPET) in the same preoperative patients to characterize cardiopulmonary impairment and to separate the structural determinants of lung volume from those of exercise reserve.MethodsIn this single-center case-control study, 33 consecutive preoperative patients with scoliosis [21 adolescent idiopathic scoliosis (AIS), 12 congenital scoliosis (CS); aged 10–20 years] were compared with 20 age- and sex-matched healthy controls. Predicted spirometric values were derived from arm span with the GLI Global equations. Analyses used effect sizes with false-discovery-rate (FDR) correction, body-size-adjusted hierarchical regression, and cross-validated ROC analysis.ResultsResting cardiac function was preserved (left ventricular ejection fraction, cardiac output and cardiac index all non-significant after FDR), whereas restrictive ventilation and exercise reserve were reduced: FVC 72.0% vs. 92.8% predicted (q < 0.001), peak oxygen uptake 21.8 vs. 29.6 mL/min/kg (q < 0.001), O₂ pulse 5.9 vs. 9.7 mL/beat (q < 0.001), and VE/VCO₂ slope 32.4 vs. 27.5 (q < 0.001). Among 13 patients normal at rest, 10 (77%) were abnormal on CPET. Thoracic height independently predicted restrictive impairment beyond the Cobb angle, kyphosis, and body size (FVC %predicted B = 3.65 per cm, 95% CI   1.64–5.65; AUC 0.90, cross-validated 0.84; threshold 19.6 cm), whereas no deformity parameter independently predicted exercise capacity. At matched thoracic height, congenital scoliosis had lower CT lung volume than idiopathic scoliosis (1,881 vs. 2,356 cm3; p = 0.030).ConclusionPreoperative scoliosis is characterized by preserved resting indices but a frequently occult reduction in exercise reserve, including an exercise cardiac limitation revealed by O₂ pulse that resting echocardiography does not show. Thoracic height is a body-size-independent predictor of restrictive lung volume with a clinically usable threshold, while exercise reserve is multifactorial and requires direct CPET assessment. The two dimensions of preoperative cardiopulmonary risk should therefore be measured separately.]]></description>
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        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1898654</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1898654</link>
        <title><![CDATA[Trans-arcuate line vs. transumbilical access in single-port TEP groin hernia repair: a propensity score-matched retrospective cohort study]]></title>
        <pubdate>2026-10-13T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Ji-Feng Zhang</author><author>Chun-Tu Wen</author><author>Ning-Shi Zhang</author><author>Gan-Kun Wang</author><author>Shun-Kang Zheng</author><author>Pei-De Liang</author><author>Xiao-Qian Luo</author><author>Qi-Yan Li</author><author>Shang-Jun Zhou</author><author>Jun Liu</author>
        <description><![CDATA[Background/objectiveGroin hernia is a common surgical condition requiring improved techniques. This study compares perioperative and postoperative outcomes of trans-arcuate line vs. pre-posterior sheath transumbilical approaches in single-port totally extraperitoneal (TEP)hernia repair.MethodA retrospective cohort study included 297 patients with groin hernia who underwent single-port TEP hernia repair. After excluding 5 cases and applying propensity score matching (PSM), patients were divided into the transumbilical group (n = 83) and the trans-arcuate line group (n = 83) according to the surgical approach. Outcomes included operative time, peritoneal injury rate, postoperative pain score measured by the Visual Analogue Scale (VAS), haematoma, and intraoperative blood loss. CUSUM analysis was performed to assess operative-time learning curves in both groups, followed by subgroup analyses stratified into the learning and post-transition phases. Baseline characteristics were generally comparable between groups in the learning phase, although some imbalances were observed given the small sample size. For post-transition cases, propensity score re-matching was performed before comparison.ResultsAfter PSM, the trans-arcuate line group had significantly shorter operative time and a markedly lower incidence of intraoperative peritoneal injury than the transumbilical group. Early postoperative VAS pain scores were also significantly lower in the trans-arcuate line group (P < 0.001). However, no statistically significant differences were observed in intraoperative blood loss or haematoma between the two groups. CUSUM analysis further revealed a longer learning phase in the trans-arcuate line group. Within the learning phase, this group had a lower peritoneum or hernia sac tearing rate, whereas in the post-transition phase, it had shorter operative time. Notably, when the comparison was restricted to post-transition cases after re-matching, peritoneum or hernia sac tearing rate and VAS scores no longer differed between groups.ConclusionAfter PSM and phase-stratified analysis, the trans-arcuate line approach was associated with a lower peritoneum or hernia sac tearing rate during the learning phase, and with shorter operative time after proficiency was reached. These findings suggest that the trans-arcuate line approach may offer distinct advantages at different stages of the learning curve, and the trans-arcuate line approach may be considered a favorable alternative after sufficient surgical experience has been acquired.]]></description>
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