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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>2026-07-29T04:10:20.641+00:00</pubDate>
        <ttl>60</ttl>
        <item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1877150</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1877150</link>
        <title><![CDATA[A comparative analysis of MRI findings versus final pathology in multicentric breast cancer patients at King Abdulaziz Medical City, Jeddah]]></title>
        <pubdate>2026-07-28T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Mohammed F. Alotaibi</author><author>Abdulrahman S. Alghamdi</author><author>Nawaf M. Alharbi</author><author>Saleh G. Alqadi</author><author>Waleed M. Aljehani</author><author>Abdullah M. Balkhi</author><author>Jehad S. Alshawi</author><author>Muhammad A. Khan</author>
        <description><![CDATA[IntroductionMulticentric breast cancer (MCBC) identified on preoperative breast magnetic resonance imaging (MRI) often influences surgical management toward mastectomy. However, MRI may overestimate true multicentric disease when compared with final pathological findings, potentially leading to overtreatment. This study evaluated the agreement between preoperative MRI and final pathology in diagnosing MCBC at a tertiary oncology center in Jeddah, Saudi Arabia, and explored factors associated with final pathological focality, including biopsy strategy and neoadjuvant chemotherapy (NAC).MethodologyA retrospective cohort study was conducted at the Princess Noorah Oncology Center, King Abdulaziz Medical City (KAMC), Jeddah, Saudi Arabia, between January 2016 and December 2024. Adult patients (≥18 years) with MRI-diagnosed multicentric breast cancer who subsequently underwent mastectomy were included. Demographic characteristics, tumor and nodal features, risk factors, biopsy findings, treatment modalities, and final pathological focality were retrospectively collected and analyzed.ResultsA total of 233 patients met the inclusion criteria (mean age: 52.76 ± 10.19 years), of whom 102 (43.8%) received NAC. Although all patients were diagnosed with multicentric disease on preoperative MRI, final pathology confirmed multicentric disease in only 25 patients (10.7%). When stratified by NAC status, multicentric disease was confirmed in 4 of 102 patients (3.9%) who received NAC and 21 of 131 patients (16.0%) who did not receive NAC. Among patients who did not receive NAC, biopsy of multiple suspicious lesions was significantly associated with pathologically confirmed multicentric disease (p = 0.004), whereas biopsy of a single lesion was more frequently followed by unifocal disease on final pathology.ConclusionPreoperative breast MRI demonstrated limited agreement with final pathological findings in patients with presumed multicentric breast cancer, particularly among those who did not receive NAC, in whom only 16.0% had multicentric disease confirmed on final pathology. These findings suggest that histopathological confirmation of all MRI-detected suspicious lesions that may alter surgical management should be considered whenever technically feasible. Integrating MRI with second-look ultrasound, ultrasound-guided biopsy, or MRI-guided biopsy when appropriate may improve diagnostic accuracy, reduce unnecessary mastectomy, and optimize surgical decision-making.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1903991</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1903991</link>
        <title><![CDATA[Case Report: Diagnosis and management of severe pneumonia caused by complex mixed infection with multidrug-resistant bacteria and fungi after liver retransplantation]]></title>
        <pubdate>2026-07-28T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Jiaying Lu</author><author>Yingying Xia</author><author>Han Wang</author><author>Chen Gao</author><author>Xingguo Niu</author><author>Yibo Zhang</author><author>Dalong Zhang</author>
        <description><![CDATA[BackgroundPatients undergoing liver retransplantation remain in a prolonged immunosuppressed state and are at high risk for complex mixed infections caused by multidrug-resistant organisms (MDROs) and invasive fungi. Under such circumstances, accurately identifying the predominant pathogens and developing a treatment strategy that balances anti-infective therapy with organ function preservation remain major challenges in current clinical practice.Case presentationThis article reports the case of a 59-year-old male patient who developed severe pneumonia, septic shock, and multiple organ failure following liver retransplantation. Etiological investigations identified carbapenem-resistant Klebsiella pneumoniae (CRKP) harboring NDM+/KPC+, carbapenem-resistant Acinetobacter baumannii (CRAB) carrying OXA-23+, along with co-infections caused by Aspergillus fumigatus, Aspergillus flavus, and Candida albicans. Targeted anti-infective therapy was initiated promptly, including aztreonam/avibactam, polymyxins, eravacycline, isavuconazole, and caspofungin during the treatment course. During anti-infective therapy, the patient developed severe bone marrow suppression and gastrointestinal bleeding secondary to coagulation dysfunction. Following tailored modification of the antimicrobial regimen and aggressive supportive management with blood product transfusions, the infection was effectively controlled, and the patient was successfully weaned from mechanical ventilation and discharged after recovery.ConclusionsFor complex mixed infections following liver retransplantation, continuous evaluation of pathogen profiles, immune status, and organ function is critical for guiding individualized treatment strategies. This case highlights that, while potent targeted anti-infective therapy may be life-saving, close monitoring and prompt intervention for treatment-related adverse events and complications are equally essential to achieve a balance between therapeutic benefit and clinical risk under critical conditions.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1928265</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1928265</link>
        <title><![CDATA[Editorial: Evaluating surgical techniques and perioperative strategies in colorectal cancer treatment]]></title>
        <pubdate>2026-07-28T00:00:00Z</pubdate>
        <category>Editorial</category>
        <author>Gianpiero Gravante</author><author>Dragomir Dardanov</author><author>Wenpeng Wang</author><author>Shengtao Lin</author>
        <description></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1793999</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1793999</link>
        <title><![CDATA[Case Report: Retrosternal parathyroid lipoadenoma in an obese male patient—diagnostic pitfalls and postoperative biphasic parathyroid hormone dynamics]]></title>
        <pubdate>2026-07-28T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Jin-shen Hu</author><author>Tao Zuo</author><author>Jun Fu</author><author>Kang-le Kong</author><author>Yong Liu</author>
        <description><![CDATA[IntroductionParathyroid lipoadenoma is a rare histologic variant of parathyroid adenoma. Its occurrence in the retrosternal mediastinum poses significant diagnostic and surgical challenges. The clinical significance lies not in its rarity, but in the diagnostic pitfalls it presents, particularly when located in the retrosternal mediastinum. We present a case that underscores the pitfalls in preoperative diagnosis and the intricacies of minimally invasive resection.Case presentationA 36-year-old obese man (BMI 31 kg/m2, WHO Class I obesity) presented with an incidental anterior superior mediastinal mass. Preoperative computed tomography revealed a soft-tissue density lesion suspected to be a thymoma. The clinical implications of his recurrent nephrolithiasis and retrospectively identified albumin-corrected hypercalcemia (2.98 mmol/L, serum albumin: 46.5 g/L; reference range: 40–55 g/L) were overlooked. Given the patient's body habitus and the tumor's location cephalad to the innominate vein, subxiphoid video-assisted thoracoscopic surgery (VATS) under artificial pneumothorax was performed. Severe hypocalcemic tetany on postoperative day 1, followed by a characteristic biphasic parathyroid hormone (PTH) response, provided key diagnostic clues and ultimately led to a pathological diagnosis of parathyroid lipoadenoma.ConclusionFor patients with a mediastinal mass accompanied by hypercalcemia, comprehensive clinical evaluation is required to exclude ectopic primary hyperparathyroidism, rather than interpreting imaging findings in isolation. Subxiphoid VATS is the preferred technique for high retrosternal tumors in patients with challenging anatomical features. Familiarity with postoperative biphasic PTH changes and Hungry Bone Syndrome is essential for accurate interpretation of perioperative biochemical results.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1851638</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1851638</link>
        <title><![CDATA[Early wound closure with negative-pressure irrigation-drainage accelerates healing and improves early appearance: a comparative study]]></title>
        <pubdate>2026-07-28T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Yan Nie</author><author>Quanli Geng</author><author>Shuang Jin</author><author>Zhi Liu</author><author>Xu Ma</author><author>Jinsheng Ye</author>
        <description><![CDATA[ObjectiveDelayed wound healing remains a common clinical challenge and is associated with increased infection risk, prolonged hospitalization, and poor scar outcomes. Whether a multimodal strategy comprising early wound closure supported by continuous negative-pressure irrigation and drainage can improve healing dynamics compared with conventional open management remains insufficiently explored.MethodsThis comparative clinical study included 62 patients with wounds who were admitted to Yanqing Hospital of Beijing Chinese Medicine Hospital between January and December 2023. Thirty-two patients received conventional open wound care (control group), and 30 patients underwent early primary closure with post-operative continuous negative-pressure irrigation and drainage (intervention group).Baseline characteristics, clinical outcomes, and wound healing trajectories were analyzed. Time to wound healing was evaluated using Kaplan–Meier analysis and Cox proportional hazards models. Multivariable logistic regression analyses were performed to assess wound healing within 14 and 28 days after adjustment for potential confounders.ResultsPatients in the intervention group exhibited a significantly shorter median wound healing time compared with controls (17.5 vs. 24.5 days, P = 0.003). The cumulative probability of wound healing was significantly higher in the intervention group(log-rank P = 0.003), and this association remained significant after multivariable adjustment (adjusted HR = 3.17, 95% CI: 1.66–6.05). Although no significant difference in healing within 14 days was observed after adjustment, the intervention was associated with a higher likelihood of complete wound healing within 28 days (adjusted OR = 11.63, 95% CI: 1.06–127.72). In addition, the intervention was associated with faster wound area reduction and better early wound cosmetic scores.ConclusionsA multimodal strategy consisting of early primary closure supported by continuous negative-pressure irrigation and drainage was associated with accelerated wound healing and improved early wound appearance. E-value analysis suggested that unmeasured confounding is unlikely to fully explain the observed association, though residual confounding from selection bias cannot be excluded.No increase in adverse events was observed. Due to the retrospective design and relatively small sample size, these findings are hypothesis-generating. Prospective randomized trials are required to establish definitive clinical recommendations.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1847729</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1847729</link>
        <title><![CDATA[Clinical factors associated with postoperative fever after bipolar TURP and GreenLight laser vaporization: a retrospective cohort study]]></title>
        <pubdate>2026-07-28T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Lei Huang</author><author>Fang Guo</author><author>Can Liu</author><author>Shujun Bai</author><author>Yu Chen</author><author>Qiong Bao</author><author>Xing Luo</author><author>Jingzhen Zhu</author><author>Weihua Fu</author><author>Bishao Sun</author><author>Jiang Zhao</author><author>Jia Li</author>
        <description><![CDATA[BackgroundPostoperative fever after transurethral surgery for benign prostatic hyperplasia may prompt evaluation for infection, but interpretation is complicated by catheterization, perioperative inflammation, variable microbiological sampling, and procedure-specific differences.MethodsWe retrospectively analysed 401 patients who underwent bipolar transurethral resection of the prostate (bTURP) or GreenLight laser photoselective vaporization of the prostate (GL-PVP) from October 2019 to February 2023. The primary outcome was postoperative fever recorded during the index admission. Multivariable logistic regression was used to identify associated factors. Post hoc model checks included assessment of multicollinearity, calibration, goodness of fit, discrimination, and five-fold internal cross-validation where feasible. Available postoperative culture and antimicrobial susceptibility records were analysed descriptively.ResultsPostoperative fever was recorded in 48 of 401 patients (11.97%), with no significant difference between bTURP and GL-PVP (11.44% vs. 12.73%; P = 0.755). In the reported multivariable model, diabetes mellitus, a positive preoperative urine culture, preoperative lower urinary tract functional testing, preoperative indwelling catheterization, and longer operative time were associated with postoperative fever. Post hoc diagnostics showed no severe multicollinearity and acceptable apparent discrimination, but the limited number of events supports cautious interpretation. The supplied postoperative culture dataset contained 24 isolate records from 22 patients; Escherichia coli (11/24) and Klebsiella pneumoniae (6/24) were most frequent. Susceptibility-test denominators varied by antimicrobial agent.ConclusionSeveral preoperative and procedural factors were associated with postoperative fever after bTURP or GL-PVP. These associations are hypothesis-generating and should not be interpreted as causal. Because exact fever onset, complete SIRS components, culture specimen source, and standardized perioperative antibiotic protocols were unavailable, the microbiological findings should be interpreted as exploratory local surveillance data.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1847180</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1847180</link>
        <title><![CDATA[Case Report: Debridement with vacuum sealing drainage for conservative management of post-cranioplasty surgical site infection]]></title>
        <pubdate>2026-07-28T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Tong Ma</author><author>Chen Yang</author><author>Zhi Zheng</author><author>Xufeng Meng</author><author>Yunfei Hao</author>
        <description><![CDATA[Post-cranioplasty infection represents a challenging complication in neurosurgical practice. Conventional therapeutic strategies typically necessitate implant removal or decompressive craniectomy, often resulting in secondary trauma and increased healthcare burden. We report a 55-year-old male patient who underwent decompressive craniectomy following traumatic brain injury and subsequently received cranioplasty with polyetheretherketone (PEEK) material. Four months postoperatively, he presented with wound dehiscence and purulent discharge, and was diagnosed with combined intracranial and scalp infection caused by methicillin-resistant Staphylococcus aureus (MRSA). Following rigorous patient selection, two sessions of precise debridement were performed, combined with vacuum sealing drainage (VSD) therapy and individualized antimicrobial regimen based on susceptibility testing, with the PEEK implant preserved throughout. The infection was rapidly controlled, the VSD device was removed on postoperative day 6 with favorable wound healing, and no recurrence was observed at 3-month follow-up. Neurological function was fully restored with a modified Rankin Scale score of 0. This case demonstrates that for patients with post-cranioplasty infection involving PEEK material, a comprehensive approach incorporating debridement, VSD drainage, and targeted antimicrobial therapy—following strict evaluation—can achieve optimal outcomes with implant retention, offering a conservative treatment paradigm for such complex cases.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1909015</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1909015</link>
        <title><![CDATA[Impact of parental psychological intervention on long-term outcomes following bariatric surgery: a retrospective cohort study]]></title>
        <pubdate>2026-07-28T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>ChenXing Cui</author><author>Kai Ma</author>
        <description><![CDATA[BackgroundThe efficacy of bariatric surgery is often compromised by psychosocial factors within the family environment. Clinical observations suggest that parents of patients with obesity frequently exhibit maladaptive psychological traits, such as anxiety and excessive control, which may hinder long-term postoperative weight loss.MethodsWe conducted a retrospective cohort study involving 200 patients who underwent bariatric surgery (Laparoscopic Sleeve Gastrectomy or Roux-en-Y Gastric Bypass) at our institution between January 2018 and January 2024. Patients treated from 2018 to early 2021 (n = 100) comprised the Control Group (standard surgical care). Patients treated from 2021 to 2024 (n = 100) comprised the Observation Group, who received standard surgical care plus a structured, multi-session psychological intervention for their parents, based on Cognitive Behavioral Therapy (CBT) and Family Systems Therapy. The primary outcomes were the percentage of excess weight loss (%EWL) and weight regain rate at 24 months postoperatively.ResultsBaseline demographics and preoperative BMI were comparable between groups. At the 24-month follow-up, the Observation Group demonstrated significantly superior outcomes. The mean %EWL was 78.2% ± 6.1% in the Observation Group vs. 55.1% ± 7.5% in the Control Group (P < 0.001). The weight regain rate was significantly lower in the Observation Group (4.2% vs. 18.5%, P < 0.01). Pearson correlation analysis revealed a significant positive correlation between the reduction in parental control scores and patient dietary adherence scores at 24 months (r = 0.86, P < 0.001) within the Observation Group.ConclusionIntegrating targeted psychological intervention for parents into bariatric surgery protocols is associated with significantly improved long-term weight loss and reduced weight regain. Addressing maladaptive family dynamics, specifically parental anxiety and controlling behaviors, appears to be a crucial component for the durable success of metabolic surgery. Due to the quasi-experimental design, these findings warrant confirmation in prospective, randomized controlled trials.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1785296</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1785296</link>
        <title><![CDATA[Case Report: Glossopharyngeal neuralgia secondary to syncope: insights into microvascular decompression treatment]]></title>
        <pubdate>2026-07-28T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Ying Dang</author><author>Aichao Du</author><author>Jingjing Han</author><author>Zhe Shi</author>
        <description><![CDATA[This article reports a case of a 56-year-old male patient with glossopharyngeal-vagal nerve syndrome. The main clinical manifestations were paroxysmal, sharp, knife-like pain in the right root of the tongue and pharynx, which occurred synchronously with syncope without any premonitory dizziness or nausea during pain episodes. Preoperative imaging suggested neurovascular compression, with the right posterior inferior cerebellar artery traversing and compressing the rootlets of both the glossopharyngeal nerve and proximal vagus nerve. The patient underwent a right retrosigmoid craniotomy for microvascular decompression targeting both nerves. Postoperatively, the patient's tongue root pain and pain-induced syncope resolved completely. The patient recovered well without serious complications. Notably, 24-h Holter monitoring captured real-time synchronous sinus bradycardia strictly matched with pain attacks, providing direct objective neurophysiological evidence for the pain-triggered cardioinhibitory reflex. A 6-month long-term follow-up further confirmed sustained resolution of all symptoms, without sensory deficits, recurrent neuralgia or syncope. This case confirms that microvascular decompression is a safe and effective treatment for glossopharyngeal-vagal nerve syndrome, addressing the root cause of both pain and syncope. It also highlights a easily misdiagnosed clinical phenotype and provides novel electrophysiological and surgical references for this rare cranial nerve disorder.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1817062</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1817062</link>
        <title><![CDATA[Comparison of skip-level ACDF vs. contiguous ACDF in the treatment of skip-level cervical degenerative disease: a systematic review and meta-analysis]]></title>
        <pubdate>2026-07-28T00:00:00Z</pubdate>
        <category>Systematic Review</category>
        <author>Juan Xie</author><author>Ling Zhu</author><author>Jianna Zhang</author>
        <description><![CDATA[BackgroundThe selection of surgical regimens for skip-level cervical degenerative disease (CDD) has long been controversial, with a core focus on whether intact intervertebral discs at intermediate levels should be preserved. This systematic review and meta-analysis compared the clinical and radiological outcomes as well as complication rates between skip-level anterior cervical discectomy and fusion (ACDF) and contiguous ACDF for skip-level CDD.MethodsThis systematic review and meta-analysis was performed in accordance with the PRISMA 2020 Statement. The PubMed, Web of Science core collection, Embase (via Ovid), CNKI and WanFang databases were systematically searched from inception to November 30, 2025. This systematic review and meta-analysis was conducted via Review Manager 5.3.ResultsFive studies with 116 patients in the skip-level ACDF group and 158 patients in the contiguous ACDF group were included. The surgical time [MD: −42.18, 95% CI (−50.91, −33.45), I2 = 72%] and intraoperative blood loss [MD: −28.89, 95% CI (−33.63, −24.14), I2 = 78%] were significantly lower in the skip-level ACDF group than in the contiguous ACDF group. No significant differences in the JOA score, C2-7 ROM, C2-7 SVA, T1 slope, complication rate or adjacent segment degeneration were detected between the two groups.ConclusionCurrent evidence suggests that skip-level ACDF can reduce surgical time and intraoperative blood loss. Current evidence does not reveal a statistically significant increase in adjacent segment degeneration following skip-level ACDF. However, the available evidence remains limited.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420251243686, Identifier CRD420251243686.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1887309</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1887309</link>
        <title><![CDATA[Prediction of intraoperative hypothermia in esophageal cancer radical surgery under general anesthesia: development and validation of a nomogram model]]></title>
        <pubdate>2026-07-28T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Hui Dong</author><author>Ziyan Gu</author><author>Aifen Pan</author><author>Haijuan Jiang</author>
        <description><![CDATA[PurposeThe incidence of unintended intraoperative hypothermia is high in patients undergoing esophageal cancer radical surgery under general anesthesia, which may lead to a series of complications. To effectively prevent intraoperative hypothermia, this study aimed to establish and validate a predictive model for assessing the risk of intraoperative hypothermia in these patients.MethodsThis study retrospectively collected clinical data from 601 patients who underwent esophageal cancer radical surgery under general anesthesia at a university hospital between January 1, 2020 and January 31, 2024. Using bootstrap resampling (with 1,000 replications), the data were divided into a modeling cohort of 421 cases and a validation cohort of 180 cases in a 70%:30% ratio. A total of 17 potential risk factors were analyzed, including demographic characteristics, disease status, and surgical factors. The least absolute shrinkage and selection operator (LASSO) regression model was first employed to screen and optimize risk factors. Subsequently, based on the selected important variables, Multivariable logistic regression analysis was used to construct the final intraoperative hypothermia risk prediction model. To evaluate model performance, the C-index was calculated, and calibration curves and clinical decision curves were plotted. The predictive accuracy and clinical applicability of the model were further validated using the validation cohort.ResultsA nomogram for intraoperative hypothermia risk prediction was constructed based on three predictors: body mass index (OR = 0.039, 95% CI: 0.008–0.148), preoperative body temperature (OR = 0.130, 95% CI: 0.078–0.213), and intraoperative blood loss (OR = 0.130, 95% CI: 0.078–0.213). The model showed a C-index of 0.816 (95% confidence interval: 0.779–0.853), indicating good discriminative ability. Decision curve analysis further confirmed that when the threshold probability for intraoperative hypothermia ranged from 6% to 91%, the nomogram provided significant clinical net benefit, suggesting its value in practical applications. Internal validation results supported the robustness of the model, with a C-index of 0.822, further verifying the accuracy and reliability of the nomogram in predicting intraoperative hypothermia risk.ConclusionsLower body mass index, lower preoperative body temperature, and greater intraoperative blood loss were identified as independent predictors of intraoperative hypothermia in patients undergoing radical esophagectomy under general anesthesia. In particular, patients with BMI <23.9 kg/m2, preoperative body temperature <36.5°C, and estimated intraoperative blood loss ≥500 mL were at significantly higher risk. The predictive model constructed based on these key indicators demonstrated good discrimination and calibration, and can serve as an important tool in clinical practice for identifying high-risk patients and guiding individualized temperature management strategies.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1887173</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1887173</link>
        <title><![CDATA[Patient satisfaction with postoperative analgesia after hepatobiliary and pancreatic surgery: a retrospective analysis]]></title>
        <pubdate>2026-07-28T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Wending Chen</author><author>Yeke Zhu</author><author>Xiaodong Tang</author><author>Xiangyang Cheng</author><author>Xuwu Xiang</author><author>Weiliu Zhu</author><author>Pin Wu</author><author>Canji Shou</author><author>Diansan Su</author><author>Shuyuan Gan</author>
        <description><![CDATA[ObjectivesPatient satisfaction is a key metric for evaluating healthcare quality. Patients undergoing hepatobiliary and pancreatic surgery frequently experience severe postoperative pain, necessitating patient-controlled intravenous analgesia (PCIA). This study aimed to identify factors associated with reduced satisfaction regarding PCIA in this context.MethodsA retrospective observational study analyzed data from adults receiving PCIA after elective hepatobiliary and pancreatic surgery. Univariate and multivariate logistic regression, employing a forced-entry method to adjust for a comprehensive panel of clinically relevant confounders [including age, sex, body mass index (BMI), American Society of Anesthesiologists (ASA) status, surgical trauma category, surgical approach, malignancy, and major postoperative complications], were used to examine associations between satisfaction and demographics, surgical details, analgesic regimens, postoperative pain (NRS), and adverse effects.ResultsAmong 1,667 patients, 108 (6.5%) were dissatisfied. Multivariable analysis identified moderate-to-severe pain (NRS > 3; aOR = 14.93, 95%CI: 9.52–26.32) and hyperhidrosis (aOR = 6.29, 95% CI: 3.05–13.89) as strong independent predictors of dissatisfaction (both P < 0.001). A significant interaction was found between dezocine and pain severity (P < 0.001). Among patients with NRS > 3, dezocine was associated with significantly lower odds of dissatisfaction (aOR = 0.18, 95% CI: 0.06–0.55), corresponding to an ∼87% reduction, whereas no significant benefit was observed in those with mild pain (aOR = 1.22, 95% CI: 0.33–4.68, P = 0.771). Hyperhidrosis was independently associated with rescue analgesia (OR = 8.82, P = 0.016).ConclusionsDissatisfaction is driven by moderate-to-severe pain and hyperhidrosis. The benefit of dezocine is context-dependent. Optimizing satisfaction requires managing pain, autonomic side effects, and personalized analgesic selection.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1821255</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1821255</link>
        <title><![CDATA[Neck–tongue syndrome secondary to atlantoaxial dislocation]]></title>
        <pubdate>2026-07-28T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Jing Wang</author><author>Jin Zhang</author><author>Haihong Zhang</author>
        <description><![CDATA[BackgroundNeck–tongue syndrome is a rare paroxysmal disorder characterised by occipito-cervical pain with ipsilateral hemilingual numbness or dysaesthesia, typically triggered by head rotation or prolonged speaking. Although abnormal mechanical stimulation of the C2 spinal nerve/ root ventral ramus near the lateral atlantoaxial joint is widely implicated, neck-tongue syndrome occurring in patients with atlantoaxial dislocation has been seldom described.MethodsWe retrospectively reviewed 176 consecutive patients with atlantoaxial dislocation who underwent posterior reduction and instrumented fusion between September 2018 and October 2025. Patients fulfilling prespecified diagnostic criteria for neck-tongue syndrome were identified. Demographics, aetiology, symptom duration, pain severity assessed using the visual analogue scale, neurological status assessed using the Frankel grade, imaging findings, operative details, and postoperative outcomes were analysed.ResultsSix patients met criteria for NTS, yielding a prevalence of 3.4% (6/176). Symptom duration was 3–17 months with a median of 9 months. Preoperative visual analogue scale scores ranged from 4 to 8with a mean of 5.67 ± 1.37. All patients reported reproducible tongue symptoms including pain, numbness, or dysaesthesia, provoked by head turning or sustained speaking; symptoms were alleviated by cervical immobilisation or complete neck muscle relaxation in the supine position. Two patients showed mild hemilingual atrophy with dysarthria. Four patients had limb sensory symptoms; preoperative Frankel grades were B in one patient, C in one patient, and E in four patients. All six underwent. All six underwent posterior atlantoaxial reduction and fusion; C2 root sacrifice was performed in two cases to facilitate joint release and implant placement. During follow-upof 3–63 months, with a median of 30 months, neck-tongue syndrome-related symptoms improved in all patients, with visual analogue scale scores decreasing to 0–3 at the last follow-up with a mean of 1.16 ± 1.47. Radiographs confirmed satisfactory reductiondefined as an atlantodental interval of less than 3 mm, and solid fusion. Two patients who underwent C2 root sacrifice had persistent focal occipital or scalp hypoesthesia without neurogenic ulceration or pressure sores.ConclusionIn atlantoaxial dislocation, pathological hypermobility of the lateral atlantoaxial joint may cause repeated dynamic impingement and traction on the C2 root ventral ramus, triggering tongue- related afferent disturbances and the clinical phenotype of neck-tongue syndrome. Posterior reduction and instrumented fusion can interrupt this dynamic irritation and are associated with substantial symptom relief.]]></description>
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        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1871976</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1871976</link>
        <title><![CDATA[Uni-portal non-coaxial spinal endoscopic surgery on percutaneous hollow screw fixation for atypical hangman's fracture: a novel minimally invasive technique case report]]></title>
        <pubdate>2026-07-28T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Kai Luo</author><author>Fei Sun</author><author>Wenxian Huang</author><author>Haijun Tang</author><author>Mingxiu Yang</author><author>Wei Dai</author><author>Hongcai Teng</author><author>Shangyu Liu</author><author>Danting Xiao</author><author>Jianming Hu</author><author>Jingxin Deng</author><author>Haiyi Quan</author><author>Shengde Liang</author><author>En Song</author><author>Yun Liu</author>
        <description><![CDATA[PurposeThis study reports a case of type B1 atypical Hangman's fracture and introduces a novel minimally invasive hollow pedicle screw insertion technique for the treatment of unstable Hangman's fracture.MethodsA 65-year-old male was admitted after an electric bicycle fall, presenting with occipital and cervical pain and numbness. Upon admission, his pain level was assessed as 7 on the Visual Analogue Scale (VAS), with a Neck Disability Index (NDI) score of 19. Cervical CT examination revealed multiple lucent lines in the axis, accompanied by diastasis, displacement, and fractures of the lateral transverse processes, leading to a diagnosis of type B1 atypical Hangman's fracture (AHF). The patient underwent percutaneous hollow pedicle screw fixation assisted by uni-portal non-coaxial spinal endoscopic surgery (UNSES).ResultsIntraoperative blood loss was minimal, and postoperative CT confirmed satisfactory reduction of the axis fracture. At the 1-month follow-up, the patient's incision had healed well, symptoms had markedly improved (VAS score of 1, NDI score of 7). At the 10th-month follow-up, cervical CT showed significant fracture healing compared to previous examinations. By the 1-year follow-up, the patient's symptoms further improved (VAS score 0, NDI score 3).ConclusionPercutaneous hollow pedicle screw fixation for AHF under the assistance of UNSES is feasible, offering advantages such as minimal invasiveness, a broad surgical field, and rapid postoperative recovery.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1871490</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1871490</link>
        <title><![CDATA[Complicated versus uncomplicated acute appendicitis: clinical characteristics, diagnostic scores, surgical management, and outcomes in a tertiary hospital in Mogadishu, Somalia]]></title>
        <pubdate>2026-07-27T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Abdisalam Ismail Hassan</author><author>Shu’ayb Mohamed Hassan</author><author>Yakub Burhan Abdullahi</author><author>Abdikani Mohamednor Mohamed</author><author>Nimo Mohamednor Mohamed</author><author>Nuradin Mohamed Nur</author><author>Balqiz Mohamed Kulle</author><author>Abdijalil Abdullahi Ali</author><author>Ahmed Muhammad Bashir</author>
        <description><![CDATA[BackgroundAcute appendicitis is the leading cause of acute surgical abdomen worldwide and is associated with substantial morbidity, particularly in complicated cases. Differentiating complicated from uncomplicated appendicitis remains challenging, especially in resource-limited settings where delayed presentation is common. This study compared the clinical characteristics, diagnostic scores, surgical management, and outcomes of complicated and uncomplicated acute appendicitis in a tertiary hospital in Mogadishu, Somalia.MethodsA retrospective cohort study was conducted among 168 patients who underwent appendectomy between January and December 2025. Data were extracted from medical records and analyzed using R software. Multivariable logistic regression was performed to identify independent predictors of complicated appendicitis.ResultsComplicated appendicitis accounted for 36.3% of cases. Delayed presentation beyond 48 h was more common in complicated appendicitis but was not independently associated with disease severity after multivariable adjustment. Patients with complicated appendicitis had significantly higher inflammatory markers and higher median Alvarado and Appendicitis Inflammatory Response (AIR) scores, whereas modified Alvarado and RIPASA scores did not differ significantly. Because formal diagnostic performance analyses were not performed, these findings should be interpreted as descriptive comparisons rather than evidence of superior diagnostic accuracy. Laparoscopic appendectomy was the predominant surgical approach, although open surgery and conversion were more frequent in complicated cases. Complicated appendicitis was also associated with higher rates of intra-abdominal complications, ICU admission, and longer hospital stay. Increasing age (adjusted OR 1.03, 95% CI 1.00–1.07) and elevated C-reactive protein (adjusted OR 1.11 per 10 mg/L increase, 95% CI 1.05–1.17) were independently associated with complicated appendicitis.ConclusionComplicated appendicitis was associated with worse postoperative outcomes. Increasing age and elevated C-reactive protein were independent predictors of complicated appendicitis, whereas delayed presentation was not independently associated after adjustment. Higher median Alvarado and AIR scores were observed in complicated appendicitis; however, formal diagnostic accuracy analyses were not performed. Prospective studies are needed to validate risk stratification tools and improve early diagnosis and timely surgical management in resource-limited settings.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1778866</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1778866</link>
        <title><![CDATA[Development and validation of a clinical predictive model for the risk of recurrence after unilateral biportal endoscopic diskectomy]]></title>
        <pubdate>2026-07-27T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Zhen Yi</author><author>Changhe Liao</author><author>Ting Wu</author><author>Jinping Liu</author><author>Kunhua Zeng</author><author>Xian He</author>
        <description><![CDATA[BackgroundTo identify the independent risk factors for postoperative recurrence following unilateral biportal endoscopic discectomy (UBED) for lumbar disc herniation (LDH), and to develop and validate a recurrence risk prediction model.ObjectiveTo analyze the risk factors contributing to postoperative recurrence in patients with LDH treated by UBED, and to construct and validate a predictive nomogram for recurrence risk after UBED.MethodsA total of 257 patients with single-level LDH who underwent UBED were retrospectively enrolled, among whom 24 presented postoperative recurrence, corresponding to a recurrence rate of 9.34%. The cohort was split into a training set (n = 179) and a validation set (n = 78) at a 7:3 ratio. Thirty clinical and radiological parameters were collected. Least Absolute Shrinkage and Selection Operator (LASSO) regression combined with multivariate logistic regression was applied to screen independent risk factors, and a nomogram prediction model was subsequently established. Model performance was assessed via receiver operating characteristic (ROC) curves, Hosmer-Lemeshow (H-L) test, calibration curves, and decision curve analysis (DCA).ResultsTwelve independent risk factors for postoperative recurrence were identified. The area under the ROC curve (AUC) reached 0.976 in the training set and 0.953 in the validation set. The P values of the H-L test were both >0.05 in the two datasets, indicating favorable model calibration. The model yielded significant clinical net benefit within threshold probabilities of 0–0.92 (training set) and 0–0.89 (validation set).ConclusionsThe established nomogram incorporating 12 clinical and radiological variables exhibits satisfactory discrimination and calibration for predicting recurrence after UBED. It serves as a quantitative tool for rapid identification of patients at high recurrence risk in clinical practice. Nevertheless, limitations including single-center retrospective design, relatively small sample size, and an events-per-variable (EPV) ratio of approximately 2:1 (far below the recommended threshold) introduce potential overfitting and limited generalizability. This model is only applicable for preliminary screening of high-risk individuals and preoperative patient counseling, rather than acting as the sole basis for clinical decision-making. Multicenter, large-sample prospective cohort studies are warranted for further external validation and model refinement in the future.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1882842</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1882842</link>
        <title><![CDATA[Preliminary experience with the transoral endoscopic thyroidectomy vestibular approach in selected complex cases: a case series and literature review]]></title>
        <pubdate>2026-07-27T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Zeyu Li</author><author>Hui Li</author><author>Shiwei Zhou</author><author>Peng Wu</author><author>Yulong Tang</author><author>Xiaohua Song</author><author>Xiaowei Peng</author><author>Wu Li</author>
        <description><![CDATA[BackgroundThe transoral endoscopic thyroidectomy vestibular approach (TOETVA) offers a scarless alternative to conventional thyroidectomy. Although established selection criteria exist, clinical scenarios exceeding these parameters are increasingly encountered in practice, yet evidence regarding their safety and feasibility remains limited. This study aimed to systematically review published indications for TOETVA and to preliminarily explore its feasibility in patients with conditions beyond conventional criteria through a case series analysis.MethodsA comprehensive literature review was conducted across PubMed, Web of Science, and the Cochrane Library for studies published up to July 2026, yielding 800 records, of which 131 studies met the inclusion criteria and were analyzed. Articles reporting specific inclusion criteria for TOETVA were analyzed, including thyroid size, gland volume, and maximum resected benign or malignant nodule sizes. In addition, a retrospective case series was performed involving seven patients who underwent TOETVA at a tertiary center between January 2021 and February 2024. Indications included bulky thyroid glands, large benign nodules, intrathyroidal T3a papillary thyroid carcinoma (PTC), and PTC with concomitant neck masses. Surgical feasibility, perioperative outcomes, complications, and recurrence were evaluated.ResultsA total of 131 studies met the inclusion criteria. Most reports limited thyroid diameter to ≤10 cm and gland volume to ≤45–50 mL. For benign nodules, the most frequent upper limit was ≤6 cm, while for malignant tumors, ≤2 cm was the most common criterion. The case series included one bulky thyroid gland, one large benign nodule, two intrathyroidal T3a PTCs, and three PTCs with concomitant neck masses. All operations were successfully completed via TOETVA without conversion to open surgery. The mean operative time was 196 ± 25.3 min, mean drainage volume was 104 ± 67 mL, and mean postoperative hospital stay was 3.14 ± 1.68 days. One patient experienced transient hypoparathyroidism, and no recurrences or major complications were observed during a median follow-up of 34 months (range, 25–58 months).ConclusionsTOETVA is feasible for carefully selected patients beyond standard indications strictly within highly experienced centers, following thorough preoperative imaging and multidisciplinary team (MDT) evaluation. However, we strongly caution against a generalized expansion of indications. In these complex cases, oncologic safety must always be prioritized over cosmetic benefits, and further multicenter evidence is required to confirm long-term outcomes.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1885360</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1885360</link>
        <title><![CDATA[Comparison of retrograde vs. antegrade intramedullary nailing for extra-articular distal tibial fracture: a retrospective matched case-control study]]></title>
        <pubdate>2026-07-27T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Xiaofeng Zheng</author><author>Bobin Fu</author><author>Yinhua Chen</author><author>Lifu Wang</author><author>Lijuan Liu</author><author>Shaoyun Zhang</author><author>Cong Xiao</author>
        <description><![CDATA[ObjectiveTo compare the clinical efficacy of retrograde vs. antegrade intramedullary nailing(RIN vs. AIN)for extra-articular distal tibial fracture.MethodsThis retrospective matched case-control study included 42 patients treated between April 2020 and April 2024—21 with RIN and 21 with AIN. Patients were matched by age and sex. Perioperative parameters, radiographic reduction quality, malunion rate, time to weight-bearing, functional outcomes (Baird-Jackson and AOFAS scores), and complications were assessed. Pain at the knee and ankle was also recorded. All patients were followed for at least 12 months. A post hoc power analysis was performed based on key outcome variables. Binary outcomes were analyzed using conditional logistic regression accounting for the matched design, with sensitivity analyses adjusting for fracture type and fibular fracture. A post-hoc power analysis based on discordant pairs was performed.ResultsBoth groups had comparable baseline characteristics. RIN resulted in significantly lower intraoperative blood loss (34.38 ± 2.27 mL vs.49.38 ± 7.00 mL, P < 0.05), shorter hospital stays (8.00 ± 2.07 days vs.11.00 ± 2.10 days, P < 0.05), earlier weight-bearing (11.86 ± 0.96 days vs.12.76 ± 1.04 days, P < 0.05). The RIN group showed a numerically higher rate of excellent fracture reduction (90.5% vs. 76.2%), though this difference was not statistically significant in the matched-pair analysis (OR = 3.50, 95% CI: 0.73–16.85, P = 0.119). post-hoc power analysis indicated that this non-significant finding likely reflected insufficient power (<10%) due to a limited number of discordant pairs. Functional scores improved significantly over time in both groups, with no inter-group differences at any time point. The incidence of anterior knee pain was significantly lower in the RIN group (9.5% vs. 47.6%, OR = 0.10, 95% CI: 0.01–0.82, P = 0.032), whereas malunion rates and other complications were comparable.ConclusionBoth RIN and AIN provide reliable fixation and satisfactory functional outcomes for extra-articular distal tibial fracture. RIN significantly reduces the incidence of anterior knee pain compared to AIN, a finding supported by adequate statistical power. RIN also reduces intraoperative blood loss and shortens hospital stay. The observed numerical advantage in excellent reduction requires further confirmation in larger, appropriately powered studies. RIN may be the preferred approach in selected patients, especially those with high functional demands or preexisting anterior knee pathology.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1857509</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1857509</link>
        <title><![CDATA[Surgical resection of spinal dural arteriovenous fistula with micro-tubular retractors under CT guidance: cases report and literature review]]></title>
        <pubdate>2026-07-24T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Wei Liu</author><author>Shengzi Dongye</author><author>Yuanqin Liu</author><author>Yanda Lin</author><author>Feng Li</author>
        <description><![CDATA[ObjectiveThis case report describes the surgical management of spinal dural arteriovenous fistulas (SDAVFs) using micro-tubular retractors under CT guidance, along with a review and analysis of the relevant literature.MethodsThe surgical approach involved the use of micro-tubular retractors for a minimally invasive microsurgical technique, guided by CT imaging to treat two cases of spinal dural arteriovenous fistula (SDAVF). The procedure included intraoperative computed tomography (CT) for precise localization of the fistula and indocyanine green angiography to confirm the position and obliteration of the fistula. Preoperative symptoms and postoperative outcomes were documented.ResultsComplete obliteration of the fistula was achieved in both patients through minimally invasive microsurgery via a micro-tubular retractor. Clinical improvement was observed postoperatively, and no complications related to the surgical procedure were noted. Early postoperative follow-up (during hospitalization) demonstrated no recurrence of the fistula or postoperative complications.Traditional open surgery may compromise spinal stability; however, the use of a micro-tubular retractor significantly mitigates this risk.ConclusionMicrosurgery via a micro-tubular retractor under CT guidance is a feasible and effective approach for the surgical treatment of spinal dural arteriovenous fistulas (SDAVFs). This method achieves precise localization and minimizes surgical trauma by reducing damage to muscles, ligaments, and bony structures, thereby shortening postoperative recovery time. However, long-term follow-up and additional cases are needed to further validate the clinical efficacy of this technique.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1878507</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1878507</link>
        <title><![CDATA[Case Report: Life-saving external hemipelvectomy after missed external iliac artery occlusion in severe pelvic trauma]]></title>
        <pubdate>2026-07-24T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Nian-Jhen Wu</author><author>Dun-Hao Chang</author><author>Yu-Hung Chen</author>
        <description><![CDATA[External hemipelvectomy is a radical procedure traditionally reserved for advanced malignancy, with its use in trauma being exceedingly rare. We report a 15-year-old female with severe pelvic trauma complicated by a missed external iliac artery occlusion following internal iliac artery embolization, resulting in irreversible limb ischemia and progressive soft-tissue necrosis. Despite fasciotomy, above-knee amputation, and repeated debridement, the infection advanced proximally with recurrent sepsis, ultimately necessitating a life-saving external hemipelvectomy. Reconstruction was achieved using a deep inferior epigastric artery perforator flap, followed by staged wound management and rehabilitation, leading to complete wound healing. At 28 months of follow-up, the patient was able to ambulate independently with a customized hemipelvic prosthesis. This case highlights a critical diagnostic pitfall in pelvic trauma and demonstrates that timely recognition, multidisciplinary management, and advanced reconstructive strategies can achieve meaningful functional recovery even after radical limb-sacrificing procedures.]]></description>
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