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        <title>Frontiers in Surgery | New and Recent Articles</title>
        <link>https://www.frontiersin.org/journals/surgery</link>
        <description>RSS Feed for Frontiers in Surgery | New and Recent Articles</description>
        <language>en-us</language>
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        <pubDate>2026-08-19T12:41:22.922+00:00</pubDate>
        <ttl>60</ttl>
        <item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1719697</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1719697</link>
        <title><![CDATA[Spontaneous intermuscular hematoma in mixed connective tissue disease: a case report]]></title>
        <pubdate>2026-08-19T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Zhaohua Pei</author><author>Yun Chen</author><author>Linjun Zhao</author><author>Long Zheng</author><author>Yuanhan Lin</author><author>Xue Zhao</author>
        <description><![CDATA[Spontaneous large intermuscular hematoma secondary to mixed connective tissue disease (MCTD) is extremely rare. We report a 57-year-old female with long-standing MCTD admitted for abdominal pain and fever (septic shock due to E. coli pyelonephritis). On hospital day 8, she developed a left thigh hematoma (10  ×  14 cm). CTA failed to identify the bleeding vessel, but transcatheter arterial embolization (TAE) stabilized the hematoma. Subsequent surgical debridement was performed for hematoma-induced tissue necrosis. This case highlights that MCTD-related vascular fragility, combined with sepsis and DIC, increases hematoma risk. Prompt TAE and surgical intervention are critical to prevent catastrophic outcomes.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1761198</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1761198</link>
        <title><![CDATA[An internally validated nomogram for predicting impaired wound healing after calcaneal fracture surgery in patients with type 2 diabetes Mellitus]]></title>
        <pubdate>2026-08-19T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Xiaowei Huang</author><author>Heng Wang</author>
        <description><![CDATA[BackgroundImpaired wound healing remains a major complication following calcaneal fracture surgery in patients with type 2 diabetes mellitus (T2DM), yet reliable tools for individualized risk prediction are lacking.MethodsOf 553 T2DM patients screened, 360 were eligible and randomly allocated to a training set (n = 269 after excluding 1 for incomplete outcome adjudication; 66 outcome events) and an internal validation set (n = 90; 22 outcome events, 24.4%). A nomogram was developed using multivariable logistic regression based on predictors selected via LASSO. Model performance was assessed by area under the ROC curve (AUC), calibration (evaluated by the Brier score and the Hosmer-Lemeshow goodness-of-fit test), and decision curve analysis (DCA).ResultsThe final model incorporated five predictors: HbA1c, insulin use, diabetic peripheral neuropathy, C-reactive protein, and platelet count. In the training set, the nomogram achieved an apparent AUC of 0.886 (95% CI: 0.846–0.925),with an optimism-corrected AUC of 0.875 (optimism estimate = 0.011). In the internal validation set, the AUC was 0.891 (95% CI: 0.789–0.965). The model showed favorable calibration in the training set [Brier score = 0.113 (95% CI: 0.088–0.140); Hosmer–Lemeshow test, χ2 = 7.215, df = 8, P = 0.514] and good calibration in the validation set (Brier score = 0.106 (95% CI: 0.067–0.147);calibration slope = 1.27 (95% CI: 0.75–2.89),intercept = 0.44 (95% CI:–0.24–1.85); Hosmer–Lemeshow test, χ2 = 10.552, df = 8, P = 0.228), and provided higher net benefit than treat-all or treat-none strategies across threshold probabilities from 0.01 to 0.95in both the training and validation sets. At a threshold of 0.4, it identified approximately one-fifth of patients as high-risk, with a high proportion of events among them.ConclusionThe internally validated nomogram provides a promising tool for risk stratification of postoperative wound complications in T2DM patients with calcaneal fractures. The model is exploratory and limited to internal validation; external validation in multicenter cohorts is required before routine clinical adoption.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1934871</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1934871</link>
        <title><![CDATA[Clinically constrained Bayesian network analysis of immune–metabolic factors associated with bone mineral density in a real-world orthopedic cohort]]></title>
        <pubdate>2026-08-19T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Chong Zhao</author><author>Yuemei Hu</author><author>Zhenqi Zhu</author><author>Weiwei Xia</author><author>Haiying Liu</author>
        <description><![CDATA[ObjectivesOsteoporosis substantially influences surgical decision-making, implant fixation, fracture risk, and postoperative outcomes in orthopaedic practice. However, the systemic biological interactions underlying bone loss remain difficult to characterize using conventional statistical models. We aimed to integrate clinically constrained Bayesian network learning with routine biochemical data to identify immune–metabolic factors associated with bone mineral density (BMD) and to provide a clinically interpretable framework for bone health assessment.MethodsIn a retrospective real-world orthopedic cohort of 2,880 individuals with concurrent DXA and biochemical data, we constructed a 20-node network comprising BMD, bone metabolism biomarkers, and immune-inflammatory, metabolic, renal, and endocrine indicators. Gaussian graphical models and prior-constrained Bayesian networks were applied, blacklisting edges that pointed to age or menopause status to enforce physiological plausibility. Bridge mediation analysis systematically scanned source—bone biochemistry—BMD pathways, using bootstrap confidence intervals. Analyses were repeated in the postmenopausal subgroup (n = 1,546).ResultsNetwork hubs included parathyroid hormone (PTH), phosphorus, neutrophil-to-lymphocyte ratio (NLR), high-density lipoprotein (HDL), and triglycerides (TG). Prior constraints eliminated all prespecified prohibited edges. NLR–ALP–BMD emerged as the most robust negative bridging pattern (indirect effect for lumbar spine: −0.045; mediation proportion: 70.5% in the full cohort), with similar findings in postmenopausal women. NLR–PTH–BMD and NLR–phosphorus–BMD were also significant. The NLR–ALP–BMD indirect associations remained significant after hepatic-marker adjustment and in participants without elevated ALP or ALT, whereas the ALB–ALP–BMD signal was attenuated and inconsistent across subgroups. Positive indirect effects involving glucose, TG, and uric acid may reflect unmeasured adiposity and DXA measurement artifacts.ConclusionClinically constrained network analysis identified immune–metabolic factors associated with bone mineral density and provided a biologically plausible framework for interpreting bone–immune–metabolic interrelationships in orthopedic patients.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1904266</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1904266</link>
        <title><![CDATA[Four-point dermo-fascial fixation for umbilical reconstruction following keloid excision: clinical experience in 16 patients]]></title>
        <pubdate>2026-08-19T00:00:00Z</pubdate>
        <category>Brief Research Report</category>
        <author>Peiyu Li</author><author>Haitao Xiao</author><author>Xuewen Xu</author><author>Ru Wang</author>
        <description><![CDATA[BackgroundUmbilical keloids after transumbilical laparoscopic surgery are difficult to manage because excision may leave a contour defect in a concave, mobile, and scar-prone region. Reconstruction must restore a recessed umbilical contour while minimizing additional incisions and scar burden.MethodsThis brief report describes a four-point dermo-fascial fixation technique in 16 patients with round, bulging, or transversely elongated umbilical keloids after laparoscopic surgery. In all patients, the keloid margin extended no more than 1.0 cm beyond the visible umbilical rim. After limited circumferential defatting, adjacent umbilical tissue was anchored to the residual fibrous umbilical stalk and linea alba using a four-point configuration. All patients received postoperative radiotherapy and topical scar therapy.ResultsThe patients were 35–72 years old, and photographic follow-up ranged from 6 to 15 months. All patients maintained a recessed umbilical contour during the available follow-up. No wound complications were observed, and no clinically evident keloid recurrence occurred after combined surgical reconstruction, postoperative radiotherapy, and topical scar therapy. A transverse scar or crease remained visible in some cases.ConclusionThe four-point dermo-fascial fixation technique may provide a simple local-tissue option for scar-control-oriented umbilical reconstruction after keloid excision, although it should not be considered an ideal aesthetic umbilicoplasty. Its main value lies in its simplicity, use of adjacent local tissue, avoidance of graft harvest or complex flap design, and potential reproducibility when scar control and technical practicality are prioritized. Larger studies with longer follow-up and standardized scar assessment are required to clarify long-term recurrence and aesthetic outcomes.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1913013</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1913013</link>
        <title><![CDATA[Pyogenic granuloma of the lower labial mucosa during pregnancy: a case report]]></title>
        <pubdate>2026-08-19T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Heng Pan</author><author>Jiashan Li</author><author>Zhouhuan Chen</author>
        <description><![CDATA[Extragingival pyogenic granuloma (PG) of the lower labial mucosa is rare during pregnancy, with only a few cases previously reported. This report describes the management of a PG on the lower labial mucosa in a 26-year-old patient at 18 weeks of gestation, representing the earliest reported gestational presentation requiring surgical intervention. The patient presented with a progressively enlarging mass and recurrent bleeding. Given these clinical indications and the lack of established safety data for non-surgical treatments during pregnancy, surgical excision was performed under local anesthesia using lidocaine without epinephrine rather than deferring treatment until after delivery. Histopathology confirmed lobular capillary hemangioma with surface ulceration. At 3-month follow-up, no recurrence was observed, and both maternal and fetal conditions remained stable. This case demonstrates that surgical excision during the second trimester under local anesthesia is feasible and safe, and provides a perioperative management reference for clinicians facing similar cases.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1904895</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1904895</link>
        <title><![CDATA[Rare forms of small intestinal diverticulum and diagnostic features. A clinical case report]]></title>
        <pubdate>2026-08-19T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Vitaliy Feoktistov</author><author>Madina Rashova</author><author>Talgat Temirbekov</author>
        <description><![CDATA[IntroductionSmall intestinal diverticulosis is a rare pathology compared with colonic diverticular disease and is often characterized by nonspecific clinical manifestations. Diagnostic difficulties increase significantly in emergency surgery, especially when diverticulitis mimics other acute abdominal conditions.ObjectiveTo present a clinical case of jejunal diverticulosis complicated by diverticulitis and intestinal paresis, highlighting the diagnostic challenges encountered in emergency surgical practice.Materials and methodsA retrospective analysis of the clinical course, diagnostic findings, surgical treatment, and outcomes of a 69-year-old patient admitted with a presumed diagnosis of perforated gastric ulcer was performed.ResultsThe patient was hospitalized with acute abdominal pain, nausea, vomiting, and signs of peritoneal irritation. Laboratory examination revealed moderate leukocytosis. Plain abdominal radiography demonstrated dilated small bowel loops. Emergency laparotomy revealed serohemorrhagic peritoneal effusion, signs of acute pancreatitis, and multiple diverticula along the mesenteric border of the jejunum extending approximately 1 m from the ligament of Treitz. No evidence of perforation was found. The final diagnosis was jejunal diverticulosis complicated by diverticulitis and paralytic ileus. Conservative postoperative management, including antibacterial, detoxification, antiulcer, and symptomatic therapy, resulted in complete recovery. The patient was discharged in satisfactory condition on postoperative day 10.ConclusionJejunal diverticulosis may present as acute abdominal pathology and mimic intestinal obstruction or perforated peptic ulcer. Accurate diagnosis remains challenging due to nonspecific clinical and instrumental findings. In emergency settings, surgical exploration remains the most reliable diagnostic method, allowing appropriate assessment of disease severity and selection of optimal treatment strategy. The presence of small intestinal diverticulosis without perforation or severe complications does not necessarily require bowel resection.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1876422</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1876422</link>
        <title><![CDATA[Case Report: Segment-specific minimally invasive surgical management of lumbar spinal epidural lipomatosis with adjacent-level degenerative stenosis]]></title>
        <pubdate>2026-08-19T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Tongtong Zhang</author><author>Fuhai Yan</author><author>Lingna Shi</author><author>Hui Zhang</author>
        <description><![CDATA[BackgroundSpinal epidural lipomatosis (SEL) is characterized by excessive accumulation of unencapsulated adipose tissue within the epidural space and may cause clinically relevant neural compression. When SEL coexists with degenerative stenosis at an adjacent lumbar level, the involved segments may require different decompression and stabilization strategies.Case presentationA 56-year-old man presented with chronic low back pain, progressive bilateral lower-extremity pain and numbness, and neurogenic claudication. Lumbar magnetic resonance imaging demonstrated excessive posterior epidural adipose tissue at L3-L4 with marked dural sac compression, together with degenerative central and lateral recess stenosis and Meyerding grade I degenerative spondylolisthesis at L4-L5. A single-stage, segment-specific minimally invasive procedure was performed. Tubular unilateral laminotomy with bilateral decompression and debulking of epidural adipose tissue were performed at L3-L4, whereas decompression, transforaminal lumbar interbody fusion, and bilateral pedicle screw fixation were performed at L4-L5. The operative time was 150 min, and estimated blood loss was 100 mL.OutcomeEarly postoperative axial CT demonstrated the L3-L4 laminotomy and enlargement of the osseous canal. Side-by-side sagittal T2-weighted images obtained in comparable planes showed reduced posterior indentation of the dural sac at L3-L4 after surgery. At the 12-month follow-up, comparison with the early postoperative radiographs showed no obvious interval hardware displacement or loss of L4-L5 alignment. Plain radiographs did not establish solid interbody fusion.ConclusionThis case illustrates a segment-specific minimally invasive strategy for adjacent lumbar pathologies with different treatment requirements. Decompression without fusion may preserve an otherwise stable SEL-involved segment, whereas fusion at an adjacent degenerative level should be based on patient-specific clinical, radiological, and biomechanical considerations. Comparative safety or effectiveness cannot be inferred from a single case.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1756737</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1756737</link>
        <title><![CDATA[Aortic dissection precipitated by superwarfarin (brodifacoum) poisoning: a case report and pathophysiological review]]></title>
        <pubdate>2026-08-19T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Yuxin Xiao</author><author>Yutao Wang</author><author>Kuiquan Song</author><author>Yan Sun</author>
        <description><![CDATA[BackgroundPoisoning by rodenticides, particularly anticoagulant agents, has been well-documented. Brodifacoum, a second-generation “superwarfarin”, is a long-acting anticoagulant rodenticide (LAAR) characterized by an extended half-life. Its toxicity primarily manifests as excessive or abnormal bleeding from the skin, mucous membranes, gastrointestinal tract, and urinary tract. However, aortic dissection (AD)—a rare and catastrophic medical event—has seldom been reported as a complication of such poisoning. We present a case of extensive aortic dissection triggered by Brodifacoum poisoning. This case aims to elucidate the potential pathophysiological link between superwarfarin intoxication and the development of aortic dissection.Case presentationA 69-year-old man was admitted to the hospital with a 9-day history of oral bleeding and an 8-day history of pain in the lower back, abdomen, and chest. Initial examinations at another facility were inconclusive. Upon transfer to our hospital, computed tomography angiography (CTA) revealed an extensive aortic dissection extending from the distal abdominal aorta to the bilateral iliac arteries. Key coagulation tests on admission indicated severe coagulopathy: both prothrombin time (PT) and the international normalized ratio (INR) were undetectable, and the activated partial thromboplastin time (APTT) was markedly prolonged to 160.1 s. Concurrent hematological tests revealed anemia (hemoglobin 102 g/L). Toxicological screening confirmed the presence of Brodifacoum in his blood. The patient's condition was stabilized through aggressive management, including infusion of fresh frozen plasma (FFP), high-dose intravenous vitamin K, and strict blood pressure control. His coagulation parameters gradually normalized over two weeks.ConclusionThis case highlights a life-threatening complication of superwarfarin poisoning—aortic dissection. It underscores the critical importance of considering toxicological etiologies in patients with unexplained coagulopathy. Early reversal of the coagulation deficit and rigorous blood pressure control are paramount in preventing the progression of dissection.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1933488</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1933488</link>
        <title><![CDATA[Dose tapering and treatment de-escalation of biologic therapies in chronic rhinosinusitis with nasal polyps: a narrative review]]></title>
        <pubdate>2026-08-18T00:00:00Z</pubdate>
        <category>Review</category>
        <author>Salma S. AlSharhan</author><author>Hussain J. Aljubran</author>
        <description><![CDATA[BackgroundBiologic therapies have transformed the management of severe chronic rhinosinusitis with nasal polyps (CRSwNP), particularly in patients with uncontrolled type 2 inflammation. Although dupilumab, omalizumab, mepolizumab, benralizumab, tezepelumab, depemokimab, and stapokibart have demonstrated substantial clinical efficacy, the optimal duration and maintenance strategy for biologic therapy remain uncertain. The chronic nature of CRSwNP and the high cost of biologic treatment have stimulated growing interest in dose tapering and treatment de-escalation.ObjectiveTo review the current evidence on biologic dose tapering in CRSwNP, summarize published tapering strategies, evaluate clinical outcomes, and discuss patient selection, monitoring, and future research priorities.MethodsA narrative review of the published literature on biologic dose tapering and treatment optimization in CRSwNP, including pivotal clinical trials, prospective observational studies, real-world cohorts, and current guideline recommendations.ResultsCurrent evidence, derived predominantly from prospective observational studies and real-world cohorts, suggests that gradual extension of biologic dosing intervals can maintain disease control in carefully selected patients with sustained remission. Most studies reported preserved improvements in nasal polyp score, symptom burden, olfactory function, asthma control, and quality of life after extending treatment from every 2 weeks to every 4 weeks, with some patients successfully maintaining remission at 6-, 8-, 10-, or 12-week intervals. However, available evidence remains predominantly observational, and tapering protocols, eligibility criteria, and definitions of remission are heterogeneous.ConclusionBiologic dose tapering represents a promising treatment optimization strategy for carefully selected patients with stable CRSwNP, particularly those receiving dupilumab. However, standardized tapering protocols and high-quality randomized controlled trials are required before routine implementation. Future research should focus on biomarker-guided patient selection, long-term clinical outcomes, and the cost-effectiveness of biologic dose optimization.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1890003</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1890003</link>
        <title><![CDATA[Emerging technologies in thoracic surgery: artificial intelligence, robotic-assisted surgery, and telesurgery]]></title>
        <pubdate>2026-08-18T00:00:00Z</pubdate>
        <category>Review</category>
        <author>Zaid Yacoub</author><author>Mohammad Shweiki</author><author>Rita Yacoub</author><author>Nabil Khan</author><author>Hamzeh Yacoub</author><author>Mohammad Eid Al Mohtasib</author><author>Anas Salhab</author><author>Fahim Kanani</author><author>Firas Abu Akar</author>
        <description><![CDATA[BackgroundEmerging technologies are increasingly reshaping thoracic surgery across the continuum of care, from imaging-based diagnosis and risk stratification to operative planning, minimally invasive intervention, postoperative monitoring, and remote surgical delivery. Artificial intelligence, robotic-assisted thoracic surgery, and telesurgery represent three major domains with the potential to improve precision, personalization, and access to specialized thoracic care.ObjectiveThis review aims to synthesize current evidence on the applications, clinical value, limitations, and future directions of artificial intelligence, robotic-assisted surgery, and telesurgery in thoracic surgical practice.MethodsA narrative review of recent literature was conducted, focusing on studies and reviews addressing artificial intelligence–enabled thoracic imaging, pulmonary nodule assessment, radiomics, three-dimensional reconstruction, intraoperative navigation, perioperative risk prediction, robotic thoracic procedures, and 5G-enabled telesurgical systems.FindingsArtificial intelligence has demonstrated increasing utility in pulmonary nodule detection, malignancy risk estimation, automated segmentation, surgical planning, augmented intraoperative visualization, and prediction of postoperative complications. Robotic-assisted thoracic surgery has expanded the scope of minimally invasive thoracic surgery by providing enhanced three-dimensional visualization, articulated instrumentation, improved dexterity, and favorable perioperative outcomes across lung, mediastinal, and esophageal procedures. Telesurgery, particularly when supported by ultra-low-latency 5G connectivity, has shown early feasibility in extending expert surgical care across long distances and enabling remote collaboration.ConclusionArtificial intelligence, robotic-assisted surgery, and telesurgery are redefining thoracic surgery toward a more precise, data-driven, minimally invasive, and globally connected discipline. Responsible integration will be essential to ensure that technological innovation translates into safer procedures, improved outcomes, and equitable access to advanced thoracic surgical care.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1881593</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1881593</link>
        <title><![CDATA[Improved foraminal expansion and pain scores following placement of novel expandable interlaminar stabilization device for lumbar spinal stenosis]]></title>
        <pubdate>2026-08-18T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Robert P. Norton</author><author>Ian Koch</author><author>Kendra Primavera</author><author>Roy Y. Miloh</author><author>Alexander R. Vaccaro</author><author>Mitchell Ng</author>
        <description><![CDATA[Study designRetrospective cohort study.ObjectiveTo evaluate radiographic durability and clinical outcomes following placement of a novel expandable interlaminar stabilization device for single-level lumbar spinal stenosis. Specifically, we aimed to: 1) quantify immediate postoperative posterior column distraction; 2) determine whether foraminal expansion is improved postoperatively without radiographic subsidence; and (3) assess potential improvements in patient-reported pain/clinical outcomes.MethodsA retrospective review was performed of adult patients undergoing single-level decompression supplemented by an interlaminar device for symptomatic lumbar spinal stenosis by a single surgeon from 2024 to 2025. Radiographic parameters included anterior, middle, and posterior disc height, foraminal height, and segmental lordosis that were measured preoperatively and longitudinally through 12 months. Postoperative changes were assessed relative to preoperative using paired t-tests, with longitudinal trends analyzed by linear mixed-effects modeling. Clinical outcomes were assessed using Visual Analog Scale (VAS) pain scores. Complications and reoperations were recorded, with statistical significance defined as P < 0.05.ResultsA total of 33 patients (mean age 72.6 ± 10.0 years) were included. Posterior disc height increased from 0.46 cm to 0.58 cm (mean +0.12 cm, P < 0.001), and foraminal height increased from 1.88 cm to 2.13 cm (mean +0.26 cm, P < 0.001). There were no significant changes in anterior disc height, middle disc height, or segmental lordosis. Mixed-effects modeling demonstrated no progressive loss of posterior disc height/foraminal expansion through 12 months postoperatively. Mean VAS improved from 6.8 preoperatively to 4.5 at latest follow-up (mean −2.36, P < 0.001). 31/33 patients (93.9%) had no perioperative complications; two (6.1%) required hardware removal following unrelated postoperative trauma or spinous process fracture.ConclusionsExpandable interlaminar stabilization produced immediate posterior column distraction and foraminal expansion improved at 12 months postoperatively. Clinically meaningful pain reduction was observed in this lumbar stenosis cohort. Our findings support the biomechanical durability and clinical efficacy of interlaminar posterior column stabilization as an adjunct to decompression.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1914334</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1914334</link>
        <title><![CDATA[Longitudinal association of subjective sleep quality and health-related quality of life improvements with Vagus nerve stimulation in drug-resistant epilepsy: a 24-month retrospective cohort study]]></title>
        <pubdate>2026-08-18T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Jiabo Xiao</author><author>Mengsi Ren</author><author>Bo Zhang</author><author>Shichang Guo</author><author>Xiaohui Liu</author><author>Binhong Li</author><author>Changzheng Dong</author>
        <description><![CDATA[ObjectiveTo evaluate the longitudinal trajectories of subjective sleep quality and health-related quality of life (HRQOL) over a 24-month period in adult patients with drug-resistant epilepsy (DRE) following vagus nerve stimulation (VNS) implantation, and to explore the adjusted longitudinal association of these improvements alongside concurrent seizure-frequency reduction.MethodsThis retrospective cohort study consecutively enrolled 29 adult patients (≥18 years) with DRE who underwent VNS implantation. Data regarding seizure frequency, Pittsburgh Sleep Quality Index (PSQI), and Quality of Life in Epilepsy-31 (QOLIE-31) scores were extracted from medical records at baseline, 6, 12, and 24 months post-implantation. Repeated-measures analysis of variance (RM-ANOVA) and generalized estimating equations (GEE) were utilized to assess temporal trends and adjust for concurrent seizure frequency (as a continuous, time-varying covariate) and baseline psychiatric comorbidities.ResultsOver the 24-month follow-up, the cohort demonstrated a significant and progressive reduction in mean monthly seizure frequency. Concurrently, profound and sustained improvements were observed in both overall PSQI scores and total QOLIE-31 scores (all p < 0.001). Crucially, the re-analyzed GEE model revealed that the temporal improvements in sleep and HRQOL demonstrated a significant adjusted longitudinal association with VNS therapy. The time factor remained a highly significant predictor for improvements in both PSQI and QOLIE-31 (p < 0.01 for all time points) even when continuously adjusting for concurrent seizure frequency and baseline psychiatric comorbidities.ConclusionVNS therapy provides significant, progressive, and sustained improvements in subjective sleep quality and overall HRQOL in adult patients with DRE. Furthermore, these neurobehavioral benefits demonstrate a robust adjusted longitudinal association that is not exclusively tethered to the degree of seizure-frequency reduction. However, causality and complete physiological independence cannot be established due to the observational, uncontrolled design.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1935349</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1935349</link>
        <title><![CDATA[Editorial: Perspectives in the use of hyaluronic acid in genitourinary diseases]]></title>
        <pubdate>2026-08-18T00:00:00Z</pubdate>
        <category>Editorial</category>
        <author>Marilena Gubbiotti</author>
        <description></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.2026.1844626</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.2026.1884577</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.2026.1845405</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.2026.1875200</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.2026.1860573</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>
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