Surgeries

Herniation of the transplanted ureter into the inguinal canal is an exceptionally rare complication following renal transplantation. Most cases present as delayed-onset obstructions, typically occurring more than one year post-transplant and often involving the ipsilateral inguinal canal. We presented the case of a 49-year-old male kidney transplant recipient who developed obstructive uropathy due to herniation of the graft ureter into the ipsilateral inguinal canal. Diagnosis was confirmed by computed tomography (CT), which proved superior to ultrasonography in delineating the ureteral course. A JJ ureteral stent was successfully placed, followed by inguinal hernia repair using the Lichtenstein technique. The postoperative course was uneventful, with complete resolution of symptoms and preservation of graft function. Transplanted ureteral herniation is a rare but important cause of late post-transplant obstruction. Cross-sectional imaging, particularly CT, offers greater diagnostic accuracy than ultrasound alone in identifying ureteral displacement. When feasible, primary ureteral stenting may obviate the need for nephrostomy, thereby reducing patient morbidity. Full article

Background: Pulmonary hypertension is common in left-sided heart valve disease, with historical studies reporting mortality rates up to 31% in severe cases undergoing mitral valve surgery. This study evaluates the impact of severe pulmonary hypertension on outcomes of mechanical mitral valve replacement with posterior leaflet preservation by comparing results with patients having mild-to-moderate pulmonary hypertension. Methods: Prospective analysis of 86 patients with mitral valve disease undergoing mechanical valve replacement with posterior leaflet preservation from March 2015 to September 2016 was conducted. Patients were stratified by pulmonary artery pressure: severe (≥60 mmHg, n = 19) versus mild–moderate (35–59 mmHg, n = 67). Primary outcomes included mortality, complications, and functional recovery at 1, 6, and 12 months. Results: The cohort included 67 patients (77.9%) with mild–moderate pulmonary hypertension and 19 patients (22.1%) with severe pulmonary hypertension. Severe pulmonary hypertension patients demonstrated higher NYHA functional class (73.7% class III vs. 46.2%, p = 0.03), larger left atrial diameter (56.3 ± 9.8 vs. 49.5 ± 6.7 mm, p = 0.01), and higher mean pressure gradients (14.4 ± 5.3 vs. 11.3 ± 5.0 mmHg, p = 0.025). Mortality was 5.3% in the severe group versus 0% in the mild–moderate group (p = 0.331). Patients with severe pulmonary hypertension required longer ICU stays (6.3 ± 3.7 vs. 4.7 ± 2.2 days, p = 0.024) but showed no significant differences in ventilation time, reoperation rates, or major complications. At the 12-month follow-up, both groups achieved equivalent outcomes in pulmonary artery pressures, left ventricular function, and cardiac dimensions. Conclusion: In this study with a relatively small sample size, severe pulmonary hypertension was associated with significantly longer intensive care unit stay but not with higher mortality compared to mild–moderate pulmonary hypertension, with both groups attaining comparable functional and hemodynamic parameters at 12 months after mechanical mitral valve replacement with posterior leaflet preservation. Full article

Background: THA is a gold-standard intervention for end-stage hip osteoarthritis, historically performed in older adults. However, the growing global obesity epidemic is reshaping this landscape. Emerging evidence suggests that elevated body mass index (BMI) may not only worsen perioperative outcomes but also accelerate the need for surgery at a younger age. Understanding how BMI influences both the timing and safety of THA is crucial to optimizing care in this evolving patient population. Methods: We conducted a retrospective analysis of 1,626,965 elective THA hospitalizations from the Nationwide Inpatient Sample. Patients were stratified by BMI into three categories: <29.9, 30–34.9, and ≥35. Fracture- and oncology-related cases were excluded. ICD-10 codes identified comorbidities and complications. Primary outcomes included age at surgery, in-hospital mortality, length of stay (LOS), complications, and hospitalization costs. Statistical analysis used Pearson correlation, linear regression, chi-square tests, and t-tests via SPSS version 26.0.0.0. Results: Higher BMI was significantly associated with younger age at THA (r = −0.187, p < 0.001). Each 5-unit BMI increase corresponded to a ~2-year decrease in age at surgery. Obese patients had higher rates of hypertension, diabetes, dyslipidemia, and sleep apnea. Complications including blood loss anemia, acute kidney injury, venous thromboembolism, and postoperative infections were more common in higher BMI groups. LOS increased with BMI, though total hospital charges showed minimal clinical variation. Conclusions: Obesity is a key driver of earlier THA and elevated perioperative risk. These findings underscore the need for BMI-tailored surgical planning and risk stratification. As younger, high-BMI patients increasingly undergo THA, future strategies must focus on preoperative optimization, complication prevention, and long-term implant durability. Full article

Background: Pelvic autonomic nerve injury during colorectal surgery causes debilitating urinary, bowel, and sexual dysfunction. This review synthesizes contemporary evidence on neuroanatomy, nerve-sparing techniques, and functional outcomes to minimize iatrogenic injury while maintaining oncologic efficacy. Methods: Systematic analysis of cadaveric studies, clinical trials, and imaging advancements focused on the superior hypogastric plexus, hypogastric nerves, pelvic splanchnic nerves (S2–S4), and inferior hypogastric plexus. Surgical innovations evaluated included robotic-assisted dissection, fluorescence-guided visualization, and intraoperative neuromonitoring. We distinguished evidence for nerve identification from evidence for functional protection and graded study designs accordingly. Results: Anatomical variability (e.g., superior hypogastric plexus leftward deviation 58.8%; hypogastric nerve median width 3.5 mm) necessitates precision techniques. Nerve-sparing approaches reduce urinary dysfunction from 30–70% to 10–30% and sexual dysfunction from 40–80% to 15–30%. However, the functional benefit of specific technical steps is often derived from anatomical rationale and cohort studies, with limited randomized trials for individual maneuvers. While technique refinements such as Denonvilliers’ fascia preservation may offer early sexual function benefits, randomized evidence shows no 12-month urinary advantage and uncertainty regarding longer-term durability; routine adoption should be individualized. Advanced imaging (3 T MRI, diffusion tensor imaging) and fluorescence guidance improve pre-/intraoperative visualization, but randomized evidence for improved postoperative urinary or sexual function is limited. Randomized data support pelvic intraoperative neuromonitoring in reducing urinary deterioration; most adjuncts have observational or feasibility-level support. Conclusions: Integrating neuroanatomical knowledge with advanced technologies enhances identification and may support nerve-sparing execution; however, robust randomized evidence for durable functional protection of novel technologies and specific technical steps remains limited. Priorities include standardizing preservation protocols, conducting randomized trials that validate the efficacy of individual surgical maneuvers, linking identification to functional outcomes, and validating long-term patient-reported outcomes. Full article

Background: Upper eyelid blepharoplasty is one of the most common aesthetic surgeries performed worldwide. The procedure consists of removing excess skin with or without muscle and/or fat from the upper eyelid by a transcutaneous approach and placement of a supratarsal crease. The surgery is performed in a cosmetically sensitive area and every attempt to avoid poor scar formation should be made. Methods: This review presents a conspectus of the existing medical literature regarding scar-avoiding strategies in upper blepharoplasty with the aim of contributing to the reduction in postoperative scar formation. The Medline, Embase, and Cochrane databases were searched on 2 September 2025. Results: The search yielded a total of 562 records, and, following screening, eleven publications were included. Conclusions: A systematic approach to pre-, intra-, and postoperative measures to minimize scarring are presented. There is a need to standardize scar assessment and reporting to facilitate inter-study comparison of effects, as well as prospective, randomized studies comparing suture materials and techniques. Full article

Background/Objectives: Ultrasound-guided carpal tunnel release (UGCTR) has emerged as a minimally invasive alternative to open surgery for the treatment of carpal tunnel syndrome (CTS). This study aimed to evaluate the clinical outcomes, complication rates, and recovery profiles associated with UGCTR in a large multicenter cohort. Methods: A retrospective observational study was conducted across Italian hand surgery centers, including 735 patients who underwent UGCTR between January 2012 and April 2025. Data were collected on demographics, comorbidities, ultrasound measurements, and surgical outcomes. Primary endpoints included pain (measured using the Visual Analog Scale [VAS]), symptom severity and function (assessed via the Boston Carpal Tunnel Questionnaire [BCTQ]), complication rates, time to return to daily activities (RDA), and return to work (RTW). Follow-up assessments were performed at 1, 4, and 12 weeks postoperatively. Results: A significant improvement in pain was observed, with mean VAS scores decreasing from 6.37 preoperatively to 0.58 at 12 weeks. The mean cross-sectional area (CSA) of the median nerve decreased from 12.81 mm² to 8.83 mm² at 4 weeks. Both the BCTQ Symptom Severity Scale (BCTQ-SS) and Functional Status Scale (BCTQ-FS) scores showed significant improvement by week 1. The mean RDA was 5.7 days, and RTW was 14.5 days. Complication rates were low and decreasing over time, from 8.7% at 1 week to 3.4% at 12 weeks. Conclusions: UGCTR is a safe and effective technique for the treatment of CTS, offering rapid functional recovery and a favorable complication profile. Its feasibility in outpatient settings and potential for cost-effectiveness support its role as a viable alternative to open surgery and as a model of image-guided, minimally invasive intervention. Full article

Background: Lumbar foraminal stenosis (LFS) is a prevalent degenerative condition associated with significant radicular pain and impaired quality of life. Advances in minimally invasive and fusion-based surgical techniques have introduced new strategies for decompressing the neural elements. However, comparative data correlating volumetric foraminal expansion with functional outcomes remain limited. Methods: This retrospective cohort study analyzed 256 patients treated surgically for symptomatic LFS between December 2017 and December 2023. Patients were categorized into four surgical subgroups: endoscopic decompression, anterior lumbar interbody fusion (ALIF), microsurgical decompression, and transforaminal lumbar interbody fusion (TLIF). Preoperative and postoperative assessments included magnetic resonance imaging (MRI) to calculate foraminal volume and standardized clinical scales: the Oswestry Disability Index (ODI), Visual Analogue Scale (VAS) for back and leg pain, and SF-36 health-related quality-of-life scores. Statistical significance was determined using p-values, and inter-observer agreement was evaluated via κ-statistics. Results: Postoperative imaging demonstrated a significant increase in foraminal canal volume across all surgical groups: endoscopy (29.9%), ALIF (71.8%), microsurgery (48.06%), and TLIF (67.0%). ODI scores improved from a preoperative mean of 55.25 to 18.27 at 24 months post-surgery (p < 0.001). VAS scores for back pain decreased from 6.37 to 2.1 (p < 0.001), while leg pain scores declined from 6.85 to 2.05 (p < 0.001). Functional improvement reached or exceeded the minimal clinically important difference (MCID) threshold in over 66% of patients. Conclusions: Modern surgical strategies for LFS, particularly fusion-based techniques, yield significant volumetric decompression and durable clinical improvement. Volumetric gain in the foraminal canal is closely associated with pain reduction and enhanced functional outcomes. These findings support a tailored surgical approach based on anatomical pathology and segmental stability. Full article

Background and Objectives: Effective pain management is essential for optimizing recovery after laparoscopic cholecystectomy (LC). Ultrasound-guided erector spinae plane (ESP) and transversus abdominis plane (TAP) blocks are validated techniques, but may be limited by equipment requirements and technical complexity. This study aimed to evaluate whether surgeon-delivered local anesthetic infiltration provides comparable analgesic efficacy. Materials and Methods: This prospective, randomized, controlled, single-center trial enrolled 172 patients undergoing elective LC between November 2020 and June 2022. Patients were randomized into four groups: Group A—surgeon-delivered port-site and intraperitoneal bupivacaine infiltration; Group B—ESP block; Group C—TAP block; and Group D—control. Primary outcomes were postoperative pain assessed by Visual Analog Scale (VAS) scores at 1, 3, 6, 12, and 24 h, and Behavioral Pain Scale (BPS) scores at 1 and 3 h. Secondary outcomes included 24 h tramadol consumption, patient satisfaction, additional rescue analgesia requirement, and procedure duration. Results: All intervention groups (A–C) demonstrated significantly lower VAS and BPS scores compared to controls (VAS at 24 h: 1.8 ± 0.9 vs. 2.8 ± 1.3, p < 0.001). Tramadol use was also reduced (≈82 mg vs. 97 mg, p < 0.001), with fewer opioid-related adverse effects. No significant differences were observed among Groups A–C. Patient satisfaction was higher in the intervention groups, and no major complications were reported. Conclusions: Surgeon-delivered local infiltration achieved analgesic efficacy equivalent to ESP and TAP blocks. Considering its simplicity, safety, and minimal resource demands, this method may represent a practical alternative for enhanced recovery pathways following LC. Full article

Background/Objectives: The use of vaginal mesh for pelvic organ prolapse (POP) repair remains controversial following global restrictions due to safety concerns. This study evaluated intra- and perioperative morbidity following a standardized single-incision, six-point fixation approach using an ultralight vaginal mesh in primary surgery for anterior/central POP. Methods: We conducted a retrospective multicenter study including 426 women who underwent primary POP repair with the InGYNious mesh system between May 2016 and February 2024. All surgeries followed a uniform technique across seven Italian centers. Data were collected on perioperative complications, urinary function, postoperative pain, and catheter duration. Results: The overall morbidity rate was 7.3% (31/426), primarily due to hematomas (4.5%), bladder injuries (1.4%), and ureteral injuries (0.7%). Median surgery duration was 40 min with minimal blood loss. Early postoperative pain was associated with higher POP-Q scores, longer surgical duration, and lower BMI. No cases of de novo urinary incontinence or urinary tract infection were reported in the perioperative period. Conclusions: This large multicenter case series suggests that, in experienced hands, this standardized vaginal mesh approach is associated with a low perioperative complication rate. However, the absence of a control group and the short follow-up are major limitations. Long-term outcome data, particularly regarding mesh-related complications, are essential before drawing firm conclusions on the broader safety or role of vaginal mesh in POP repair. Full article

Background/Objectives: Surgical site infections (SSIs) following pancreaticoduodenectomy contribute to significant morbidity and healthcare costs. Negative pressure wound therapy (NPWT) has emerged as a potential preventive intervention; however, evidence regarding its efficacy in pancreatic surgery remains limited. This systematic review and meta-analysis aimed to evaluate the efficacy of NPWT compared to conventional dressings in preventing SSI following pancreaticoduodenectomy. Methods: PubMed, Scopus, BASE, Cochrane CENTRAL, and ClinicalTrials.gov were systematically searched from their inception to 2 April 2025. Randomized clinical trials and observational studies comparing NPWT with conventional dressings in patients undergoing pancreaticoduodenectomy were included. Two independent reviewers extracted the data and assessed the methodological quality. Random-effects meta-analysis was performed to calculate the pooled relative risks (RRs) with 95% CIs. The primary outcome was the incidence of SSI. The secondary outcomes included pancreatic fistula, seroma formation, incisional hernia, and readmission rates. Results: Nine studies (three randomized clinical trials and six observational studies) comprising 1247 patients were included. NPWT was associated with a significant reduction in SSI compared with conventional dressings (RR, 0.61; 95% CI, 0.41–0.90). Subgroup analysis revealed varying effects by study design: retrospective cohort studies showed a nonsignificant trend toward SSI reduction (RR, 0.53; 95% CI, 0.19–1.48), randomized clinical trials demonstrated a nonsignificant trend favoring NPWT (RR, 0.67; 95% CI, 0.37–1.23), and the single prospective cohort study showed significant SSI reduction (RR, 0.48; 95% CI, 0.28–0.84). No significant differences were observed in pancreatic fistula rates between the NPWT and conventional dressing groups. Prophylactic NPWT application, longer duration (≥5 days), and higher negative pressure settings (−125 mmHg) appeared more effective than therapeutic application, shorter duration, and lower-pressure settings, respectively. Conclusions: This systematic review and meta-analysis suggests that NPWT is associated with a reduced SSI risk following pancreaticoduodenectomy. The greatest benefit may be achieved with prophylactic application in high-risk patients, longer therapy duration, and higher negative pressure settings. These findings support the consideration of NPWT as part of SSI prevention strategies in pancreatic surgery, particularly for patients with identified risk factors. Full article

Background/Objectives: Machine learning has been suggested as a way to improve how we predict anesthesia-related complications after surgery. However, many studies report overly optimistic results due to issues like data leakage and not fully using information from clinical notes. This study provides a transparent comparison of different machine learning models using both structured data and preoperative notes, with a focus on avoiding data leakage and involving clinicians throughout. We show how high reported metrics in the literature can result from methodological pitfalls and may not be clinically meaningful. Methods: We used a dataset containing both structured patient and surgery information and preoperative clinical notes. To avoid data leakage, we excluded any variables that could directly reveal the outcome. The data was cleaned and processed, and information from clinical notes was summarized into features suitable for modeling. We tested a range of machine learning methods, including simple, tree-based, and modern language-based models. Models were evaluated using a standard split of the data and cross-validation, and we addressed class imbalance with sampling techniques. Results: All models showed only modest ability to distinguish between patients with and without complications. The best performance was achieved by a simple model using both structured and summarized text features, with an area under the curve of 0.644 and accuracy of 60%. Other models, including those using advanced language techniques, performed similarly or slightly worse. Adding information from clinical notes gave small improvements, but no single type of data dominated. Overall, the results did not reach the high levels reported in some previous studies. Conclusions: In this analysis, machine learning models using both structured and unstructured preoperative data achieved only modest predictive performance for postoperative complications. These findings highlight the importance of transparent methodology and clinical oversight to avoid data leakage and inflated results. Future progress will require better control of data leakage, richer data sources, and external validation to develop clinically useful prediction tools. Full article

(1) Background: trays are surgery-specific sets of required materials and medical devices, assembled in consultation between manufacturer and user, and provided in a sterile package. (2) Methods: in a high-volume urological center performing 11,920 operations/procedures annually (2023), we prospectively evaluated the effect of trays compared with the standard approach in a comparative study of 64 operations conducted between 29 October and 30 November 2024. The primary endpoints were the amount of operating room (OR) waste (volume/cm³, weight/g) and setup time (minutes). The secondary endpoint was the workflow assessment by nursing staff, rated on a numerical score (0–10) across seven relevant domains. (3) Results: for endourological procedures, setup time was reduced by 35%, operating room (OR) waste by 34%, and waste volume by 19.0%. Workflow was positively rated with a mean score of 9.75/10. For major open procedures, setup time was reduced by 43%, waste weight by 24.8%, and waste volume by 32%. Workflow was positively rated with a mean score of 8.9/10. (4) Conclusions: Trays have a sustainable and significant impact on reducing OR waste, save nursing staff preparation time, and facilitate improved workflow in the operating room. Full article

Background: Hemorrhoids and anal fissure are among the most common benign anorectal conditions. The incidence of synchronous symptomatic hemorrhoids and chronic anal fissure is unknown. In this study we evaluated the outcomes of our experience with concomitant surgical treatment for both these conditions. Methods: In this retrospective study we included consecutive patients who underwent surgical treatment for symptomatic hemorrhoids combined with lateral internal sphincterotomy for chronic anal fissure, during a time period of over 5 years. Eligible patients were contacted by phone and were asked to answer a questionnaire to evaluate recurrent symptoms, fecal incontinence, satisfaction, and improvement in quality-of-life. Results: A total of 56 patients were included, and 29 (51.8%) were female; the mean age was 46.9 ± 13.7 years, and the median follow-up time was 45.4 months. The median self-assessed improvement in quality-of-life on a scale of 0–10 was 10 [IQR 8, 10]. No significant differences were observed in satisfaction or self-assessed improvement in quality-of-life between genders or across different surgical procedures for hemorrhoids. Conclusions: Patients who underwent concomitant surgical treatment for hemorrhoids and chronic anal fissure were satisfied. This study supports our approach for synchronous treatment for different anorectal pathologies given the right patient selection, being safe and feasible. Full article

Background: Pulmonary lobectomy remains the gold standard for early-stage non-small cell lung cancer, with the primary goal of complete tumor removal. Postoperative imaging is critical for evaluating recovery and identifying complications, yet systematic descriptions of radiologic patterns after lobectomy are limited. Methods: We conducted a retrospective analysis of 125 patients who underwent pulmonary lobectomy between 2019 and 2024 at a tertiary thoracic surgery center. Preoperative and postoperative imaging findings were coded and compared using a standardized classification system. Modalities included chest radiography, thoracic CT, ultrasound, PET-CT and MRI. Results: Postoperative imaging demonstrated a clear reduction in pathological findings. Emphysema decreased from 29.6% to 21.6%, pleural effusion from 12.8% to 3.2%, atelectasis/pleural thickening from 15.2% to 8.8%, and ground-glass infiltrates from 12.0% to 8.0%. The proportion of patients without abnormalities increased from 18.5% to 24.8%. Chest radiography (92%) and CT (89.6%) were the most frequently employed modalities. Patients treated with VATS lobectomy showed slightly fewer postoperative abnormalities compared with those undergoing open surgery. Conclusions: Pulmonary lobectomy is associated with measurable radiologic improvement, reflecting favorable structural recovery. Routine imaging follow-up, particularly chest radiography, remains essential for early detection of complications and guiding postoperative care. However, the retrospective single-center design and limited generalizability represent important limitations that should be considered when interpreting these findings. Full article

Background/Objectives: Surgical ward rounds are central to trainee education but are often associated with stress, cognitive overload, and inconsistent learning. Advances in artificial intelligence (AI), particularly large language models (LLMs), offer new ways to support trainees by simulating ward-round questioning, enhancing preparedness, and reducing anxiety. This study explores the role of generative AI in surgical ward-round education. Methods: Hypothetical plastic and reconstructive surgery ward-round scenarios were developed, including flexor tenosynovitis, DIEP flap monitoring, acute burns, and abscess management. Using de-identified vignettes, AI platforms (ChatGPT-4.5 and Gemini 2.0) generated consultant-level questions and structured responses. Outputs were assessed qualitatively for relevance, educational value, and alignment with surgical competencies. Results: ChatGPT-4.5 showed a strong ability to anticipate consultant-style questions and deliver concise, accurate answers across multiple surgical domains. ChatGPT-4.5 consistently outperformed Gemini 2.0 across all domains, with higher expert Likert ratings for accuracy, clarity, and educational value. It was particularly effective in pre-ward round preparation, enabling simulated questioning that mirrored consultant expectations. AI also aided post-round consolidation by providing tailored summaries and revision materials. Limitations included occasional inaccuracies, risk of over-reliance, and privacy considerations. Conclusions: Generative AI, particularly ChatGPT-4.5, shows promise as a supplementary tool in surgical ward-round education. While both models demonstrated utility, ChatGPT-4.5 was superior in replicating consultant-level questioning and providing structured responses. Pilot programs with ethical oversight are needed to evaluate their impact on trainee confidence, performance, and outcomes. Although plastic surgery cases were used for proof of concept, the findings are relevant to surgical education across subspecialties. Full article

Background: Liver biopsy performed after less invasive workup, including imaging, for evaluation of abnormal liver function studies occasionally reveals large bile duct obstruction on histology without evidence of biliary obstruction on prior imaging. The utility of ERCP in this setting has not been studied in pediatrics. In the present study, we address this important clinical issue. Methods: A retrospective review of pediatric pathology and clinical records from 2010 to 2019 identified 123 pediatric patients with large duct obstruction on liver biopsy performed after imaging revealed no evidence of biliary obstruction. The absolute standardized difference (ASD) was used to compare baseline covariates between patients who underwent ERCP vs. all others. Covariates included age, gender, race, ethnicity, BMI, and labs (total bilirubin, GGT, alkaline phosphatase, AST, ALT, platelets, and INR). Results: Of 85 unique patients who met inclusion/exclusion criteria, 15 (17.6%) underwent ERCP. The majority of these patients who underwent ERCP (80%) had a therapeutic endoscopic intervention with a favorable impact on clinical trajectory. The mean age of patients with large duct obstruction was 7 years old. Most patients were white (47%), followed by Asian (17%). Only 25% of patients identified as Hispanic. The mean laboratory values were as follows: total bilirubin 4.61 mg/dL, GGT 353 U/L, alkaline phosphatase 403 U/L, AST 343 U/L, ALT 251 U/L, platelets 289 K/uL, and INR 1.19. Absolute standardized differences comparing baseline covariates between the ERCP and non-ERCP groups are included in Table 1. The largest absolute standardized difference between the two groups was for race (1.17), ethnicity (0.553), and GGT (0.463). Age, alkaline phosphatase, and INR were not significantly different between the two groups (ASD <0.2 for both). Conclusions: Only 17.6% of pediatric patients with large ducts undergo ERCP. Pediatric patients who underwent ERCP were more likely to be white, non-Hispanic, and have elevated GGT. Of interest, age did not differ significantly between the two groups, which may reflect enhanced uniformity of utilization of ERCP across age groups in pediatrics. Additional multi-center studies, including more patients and focused on understanding the utility of ERCP and the range of outcomes following the diagnosis of large duct obstruction in pediatrics, would be informative to guide pediatric hepatology and endoscopic practices. Full article

Background/Objectives: The global incidence of thyroid cancer has been increasing, necessitating improved diagnostic strategies for detecting lymph node metastases. Fine-Needle Aspiration Biopsy (FNA) is a widely used diagnostic tool; however, its accuracy is sometimes limited, particularly in cases with non-diagnostic results. Washout Thyroglobulin (Washout Tg) measurement has emerged as an important adjunctive tool in refining thyroid cancer diagnosis. Methods: This retrospective study analyzed 723 patients who underwent thyroid cancer surgery at Samsung Medical Center from 2013 to 2023. The patients were categorized based on their thyroid status into three groups: 1. total thyroidectomy with modified radical neck dissection (mRND); 2. completion thyroidectomy with mRND; and 3. mRND or selective neck dissection (SND) without thyroidectomy. The Washout Tg levels and their diagnostic performance were evaluated using Receiver Operating Characteristic (ROC) analysis, determining the optimal cutoff values for predicting lymph node metastasis. Results: Washout Tg demonstrated high sensitivity for detecting metastases, with the optimal cutoff values varying based on thyroid status. For the patients who had total thyroidectomy, the cutoff was 23.3 ng/mL (AUC = 0.85, sensitivity = 82.6%, and specificity = 75.0%). In completion thyroidectomy cases, a threshold of 7.2 ng/mL (AUC = 0.879) achieved 98.4% sensitivity and 80.0% specificity. For patients without thyroidectomy (mRND/SND group), a cutoff of 0.1 ng/mL (AUC = 0.766) yielded 98.9% sensitivity but lower specificity (60.0%). Additionally, the Washout Tg/serum Tg ratio demonstrated high diagnostic accuracy with a cutoff of >1 (sensitivity = 97.09% and specificity = 63.64%). Conclusions: The Washout Tg measurement and the Washout Tg/serum Tg ratio play a crucial role in detecting lymph node metastases, particularly in patients post-thyroidectomy. The findings emphasize the necessity of adjusting the Washout Tg cutoff values based on thyroid status to enhance diagnostic accuracy. Further prospective studies are required to validate these thresholds and optimize their clinical application. Full article

Background: Primary cicatricial alopecias (PCA) are inflammatory disorders that cause permanent hair loss through follicular destruction and fibrosis. Hair transplantation (HT) may restore coverage in stable or end-stage PCA cases. This review assesses the efficacy of HT in PCA including optimal timing, graft survival rates, and the risk of disease reactivation. Material & Methods: A PubMed literature search identified 33 studies of HT in lichen planopilaris (LPP), frontal fibrosing alopecia (FFA), discoid lupus erythematosus, central centrifugal cicatricial alopecia, pseudopelade of Brocq, morphea en coup de sabre, and folliculitis decalvans from the 1960s to present. Reviews were excluded. Results: Among 147 PCA patients, 87.8% had positive HT outcomes. LPP showed high graft survival (70–90%). In contrast, eyebrow FFA (75%), folliculitis decalvans (25%), and scalp FFA (8.6%) had the highest failure rates. Follicular unit extraction was used slightly more than follicular unit transplantation. Notably, 46 patients developed PCA post-HT for presumed androgenetic alopecia. Discussion: HT in PCA can succeed with careful patient selection and stable disease (ideally ≥12–24 months). Graft survival varies by subtype. LPP has consistently reported successful outcomes post-transplantation, whereas folliculitis decalvans and FFA had the poorest outcomes. Adjuncts like immunosuppressants, PRP, and minoxidil may enhance results. Conclusions: Hair transplantation is viable in quiescent PCA, but outcomes are subtype-dependent. Many surgeons already perform these surgeries, but the published literature is lacking, and more research is needed to establish standardized timing, improve long-term graft survival, and clarify the risk of post-HT PCA onset. Full article

Background/Objectives: Meniscectomy is commonly performed to treat meniscal injury. Recovery of patients and restoration of functional capacity may be influenced by several factors, among which postoperative rehabilitation could play a significant role. The objective was to compare clinical and functional status in patients undergoing meniscectomy according to receipt of postoperative rehabilitation. Methods: An ambispective cohort study was conducted in 89 patients who underwent meniscectomy. The primary outcome was functional capacity, assessed using the Timed Up and Go (TUG) test. The primary exposure was receipt of postoperative rehabilitation. Secondary outcomes included knee range of motion (goniometry), pain intensity (visual analogue scale, VAS), and kinesiophobia (Tampa Scale of Kinesiophobia). Results: Functional capacity differed significantly between patients who received postoperative rehabilitation and those who did not (U = 490; p = 0.03), with lower (better) TUG times in the rehabilitation group. A significant difference was also observed between patients who did and did not engage in preoperative regular physical exercise (U = 680.0; p = 0.01), with better postoperative functional performance in those who had not exercised preoperatively. A sex difference was identified, with females demonstrating superior functional performances compared with males (U = 1187.0; p = 0.01). Older age was positively associated with functional impairment (β = 0.02; p = 0.02). Conclusions: Postoperative rehabilitation was associated with superior objective functional performance after meniscectomy, alongside improvements in pain, range of motion, and kinesiophobia. Female sex and younger age predicted better function; preoperative inactivity was associated with superior postoperative performance, while postoperative exercise showed no clear association. Findings should be interpreted cautiously in view of potential residual confounding and the small non-rehabilitation subgroup, and warrant validation in larger, preferably randomised, cohorts. Full article