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Revolutionizing Pediatric Surgery: The Transformative Role of Regional Anesthesia—A Narrative Review
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XplainLungSHAP: Enhancing Lung Cancer Surgery Decision Making with Feature Selection and Explainable AI Insights
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Evaluating the Effect of BMIs on Wound Complications After the Surgical Closure of Pressure Injuries
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Applications of Artificial Intelligence in Minimally Invasive Surgery Training: A Scoping Review
Journal Description
Surgeries
Surgeries
is an international, peer-reviewed, open access journal on findings and developments in surgery published quarterly online by MDPI. The Academy of Surgical Research (ASR) and the Italian Society of Hand Surgery (SICM) are affiliated with Surgeries and their members receive discounts on the article processing charges.
- Open Access— free for readers, with article processing charges (APC) paid by authors or their institutions.
- High Visibility: indexed within ESCI (Web of Science), Scopus, and other databases.
- Rapid Publication: manuscripts are peer-reviewed and a first decision is provided to authors approximately 21.8 days after submission; acceptance to publication is undertaken in 3.4 days (median values for papers published in this journal in the second half of 2024).
- Recognition of Reviewers: APC discount vouchers, optional signed peer review, and reviewer names published annually in the journal.
Latest Articles
Rehabilitation for Women and Men Experiencing Sexual Dysfunction After Abdominal or Pelvic Surgery
Surgeries 2025, 6(2), 40; https://doi.org/10.3390/surgeries6020040 - 14 May 2025
Abstract
Sexual dysfunction following abdominal or pelvic surgery is a significant concern that impacts the quality of life (QoL) for both men and women. This paper explores the multifaceted challenges and re-educational strategies associated with post-surgical sexual dysfunction. It highlights the physical and psychological
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Sexual dysfunction following abdominal or pelvic surgery is a significant concern that impacts the quality of life (QoL) for both men and women. This paper explores the multifaceted challenges and re-educational strategies associated with post-surgical sexual dysfunction. It highlights the physical and psychological repercussions of surgeries such as hysterectomies, pelvic organ prolapse repairs, radical prostatectomies, and rectal cancer resections. These procedures often lead to complications like dyspareunia, erectile dysfunction, and altered body image, necessitating comprehensive re-educational approaches. The review emphasizes the importance of tailored interventions, including pelvic floor muscle training (PFMT), biofeedback, manual therapy, and advanced techniques like botulinum toxin injections and sacral neuromodulation. For men, strategies such as phosphodiesterase type 5 inhibitors (PDE5i), vacuum erection devices (VEDs), intracavernosal injections, and penile prostheses are explored for their efficacy in restoring erectile function. Psychological support, including cognitive–behavioral therapy and couples counseling, is underscored as essential to addressing emotional and relational aspects of recovery. A multidisciplinary approach involving physiatrists, urologists, gynecologists, physiotherapists, psychologists, and sexual health counselors is advocated for to optimize outcomes. Integrating physical therapy modalities, as well as psychological and relational therapies, into individual rehabilitation projects is crucial for improving sexual function and overall QoL post-surgery. Future research should focus on refining these established strategies and investigating the potential of innovative therapeutic modalities.
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Open AccessReview
Isolated Tricuspid Regurgitation: Insights into Pathophysiology, Advanced Diagnostics, and Emerging Therapeutic Strategies
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Mohammed Shaban, Joseph El Roumi, Muhammad Ahmed Malik, Aro Daniela Arockiam, Elio Haroun and Tom Kai Ming Wang
Surgeries 2025, 6(2), 39; https://doi.org/10.3390/surgeries6020039 - 12 May 2025
Abstract
Isolated tricuspid regurgitation (TR) represents a significant yet understudied cardiac condition, primarily arising from structural valve anomalies or secondary to right ventricular (RV) dysfunction. This thesis reviews the pathophysiology, clinical picture, and evolving management strategies for isolated TR, focusing on medical and surgical
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Isolated tricuspid regurgitation (TR) represents a significant yet understudied cardiac condition, primarily arising from structural valve anomalies or secondary to right ventricular (RV) dysfunction. This thesis reviews the pathophysiology, clinical picture, and evolving management strategies for isolated TR, focusing on medical and surgical interventions and emerging transcatheter therapies. Employing a comprehensive literature review and retrospective analyses, we delve into the etiological factors, diagnostic challenges, and treatment outcomes associated with this condition. Notably, we explore the prognostic implications of isolated TR following mitral valve surgery and the efficacy of various treatment modalities in improving patient survival and quality of life.
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(This article belongs to the Special Issue Cardiothoracic Surgery)
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Open AccessArticle
Exploring the Impact of Diabetes Mellitus on Clinical Outcomes in Patients Following Severe Traumatic Brain Injury Using the TriNetX Database
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Kamal Shaik, Spencer Rasmussen, Rudy Rahme and Michael Karsy
Surgeries 2025, 6(2), 38; https://doi.org/10.3390/surgeries6020038 - 30 Apr 2025
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Introduction: Traumatic brain injury (TBI) involves a diverse group of head blunt and/or penetrating injuries and is a leading cause of death in the U.S., accounting for one-third of all injury-related deaths. A post-injury hyperglycemic state may commonly impact TBI prognosis and strongly
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Introduction: Traumatic brain injury (TBI) involves a diverse group of head blunt and/or penetrating injuries and is a leading cause of death in the U.S., accounting for one-third of all injury-related deaths. A post-injury hyperglycemic state may commonly impact TBI prognosis and strongly correlate with injury severity. Diabetes mellitus (DM) may also be a source of concomitant hyperglycemia that can worsen prognosis, with previous literature suggesting that DM could be an independent predictor of poor outcome and mortality after TBI. Methods: Using the multi-center, national TriNetX database, we performed a propensity score-matched analysis of severe TBI patients with (DM) and without DM (NDM) from 2014 to 2024. We examined the risk of mortality and complications, including sepsis, cerebral infarction, and pulmonary embolism. We also performed a sub-group analysis comparing the risk of mortality and complications between patients with either insulin-dependent or insulin-independent forms of DM. Results: A total of 26,019 patients were included (4604 DM vs. 21,415 NDM). After propensity score matching, patients with DM had a significantly lower risk of mortality (RR: 0.815; 95% CI: 0.771–0.861; p < 0.05) and ventilator dependency (RR: 0.902; 95% CI: 0.844–0.963; p < 0.05) compared to NDM patients. However, patients with DM had a significantly higher risk of cerebral infarctions, seizures, pneumonia, and sepsis (p < 0.05). Sub-group analysis found no significant difference in mortality or complications between insulin-dependent and insulin-independent forms of DM. Conclusion: Our results suggest that hyperglycemia secondary to DM plays a complicated role in the outcomes after severe TBI. Unexpectedly, we identified both increased and decreased complications in patients with DM. These results reflect the current challenges in the literature surrounding pre-existing DM in patients’ outcomes, the impact of diabetic medications on patient outcomes, and the changing role of aggressive glucose management in critical care patients.
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Open AccessSystematic Review
Prophylactic and Therapeutic Indications for Third Molar Extractions as Compared to Observation and Conservative Management: A Systematic Review and Meta-Analysis
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Alexandros Louizakis, Dimitris Tatsis, Theodoros Grivas, Sofia Tilaveridou, Ioannis Tilaveridis and Athanassios Kyrgidis
Surgeries 2025, 6(2), 37; https://doi.org/10.3390/surgeries6020037 - 30 Apr 2025
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Background: Third molar (M3) removal is considered one of the most frequent oral surgical procedures worldwide. Indications for extraction include both prophylactic and therapeutic reasons. However, this does not come without complications, and despite the widespread practice, there is no consensus on
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Background: Third molar (M3) removal is considered one of the most frequent oral surgical procedures worldwide. Indications for extraction include both prophylactic and therapeutic reasons. However, this does not come without complications, and despite the widespread practice, there is no consensus on whether prophylactic M3 extraction is more beneficial than conservative management. Aims: The aim of this systematic review is to highlight and compare the main differences and outcomes between prophylactic and therapeutic removal of third molars with conservative treatment and observation. Several factors have been considered such as post-surgical infection risks and complications, hospitalization indications, economic factors and periodontal health of adjacent teeth. Methods: A literature review and meta-analysis were conducted, which comprises studies describing the incidence of postoperative complications, the periodontal status of the second molar (M2), the prevalence of caries, and the economic aspects of the M3 removal. Periodontal parameters of the adjacent teeth such as periodontal pocket depth (PPD) and clinical attachment level (CAL), as well as inferior alveolar nerve (IAN) damage and post-operative inflammatory complications such as bacteremia, were considered. Finally, hospitalization and the economic burden of this procedure were also stated. Results: Third molar retention is associated with increased periodontal disease such as PPD and accumulation of plaque to the adjacent teeth, as well as risk of caries. Contrarily, prophylactic M3 extraction is often linked to unnecessary morbidity and costs, such as risk of bacteremia, trismus, postoperative pain, IAN damage, and sometimes the need for hospitalization. From an economic aspect, this frequent procedure is mostly associated with higher direct and indirect costs, which can exceed the amount of EUR 1000 per patient without hospitalization. Conclusions: This review tried to determine whether the M3 observation and retention can be more beneficial than M3 extraction, after examining certain parameters. Findings indicate that unnecessary morbidity and costs can be attributed to third molar extraction, with postoperative complications such as pain and trismus and sometimes the need for hospitalization. Transient bacteremia also accompanies third molar removal.
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Open AccessArticle
A New Preclinical Surgical Model for the Assessment of Dental Implant Tissue Integration
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Ryan Noh, Nahrain Warda, Charles Tremblay and John E. Davies
Surgeries 2025, 6(2), 36; https://doi.org/10.3390/surgeries6020036 - 17 Apr 2025
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Background/Objectives: The structural integrity and strength of the transgingival soft tissue seal around dental implant surfaces remain critical challenges. Therefore, animal models should include all three implant/tissue interfaces: bone, connective tissue, and epithelium. Thus, we sought to explore the rabbit mandibular diastema as
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Background/Objectives: The structural integrity and strength of the transgingival soft tissue seal around dental implant surfaces remain critical challenges. Therefore, animal models should include all three implant/tissue interfaces: bone, connective tissue, and epithelium. Thus, we sought to explore the rabbit mandibular diastema as a site for candidate intra-oral implant placement. Methods: Ninety-six custom mini-implants (with one of four different surfaces: machined, acid-etched, and with or without a nanotube coating) made from titanium 6/4 alloy were placed in the mandibular diastemas of twenty-four 16-week-old New Zealand white rabbits, with the implant collar above the alveolar crest. After 7, 21, and 42 days, the bony and connective tissue/implant interfaces were examined by light and scanning electron microscopy (SEM). Results: Of ninety-six implants, eight implants were found exposed to the oral cavity, with no evidence of soft tissue inflammation, suggesting that transmucosal implant placement would have been feasible. No significant differences were observed in collagen fiber orientation and fibrous tissue thickness by polarized light microscopy. However, SEM images showed that at all three time points, topographically complex nanotube surfaces had a profound effect on soft tissue peri-implant deposition, although functionally oriented collagen fibers were not identified attached to the implant surface. These surfaces also showed reparative peri-implant bone in the collar region. An intramembranous form of de novo bone formation was observed, together with tartrate-resistant acid-phosphatase-positive osteoclasts and multinucleate giant cells in the peri-implant endosseous compartment. Conclusions: Our results demonstrate that the rabbit mandibular diastema provides an intra-oral method of implant placement without the necessity of an extra-oral approach, tooth extractions, or bone augmentation procedures. Furthermore, given that three implant tissue interfaces can potentially be studied (bone, connective tissue, and epithelium) this model provides advantages over more traditional implant placement sites in the appendicular skeleton.
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Open AccessReview
Exploring Immersive Solutions for Surgery in the Virtuality Continuum: A Review
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Belén Palma, Pablo Casanova-Salas, Jesús Gimeno, Manuel Pérez-Aixendri and José Vicente Riera
Surgeries 2025, 6(2), 35; https://doi.org/10.3390/surgeries6020035 - 16 Apr 2025
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The evolution of technology and computer graphics algorithms has had a significant impact on the healthcare sector. It is possible to find proposals using virtual reality or augmented reality devices focused on multiple areas, such as education and skills acquisition, the visualisation of
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The evolution of technology and computer graphics algorithms has had a significant impact on the healthcare sector. It is possible to find proposals using virtual reality or augmented reality devices focused on multiple areas, such as education and skills acquisition, the visualisation of results, and disease detection or surgical planning. The use of these new technologies allows the generation of flexible spaces in which the spatial visualisation of clinical data, such as medical images, is enhanced. This also promotes collaboration between different members of the healthcare community. This study aims to review and synthesise current research and the status of applications using systems within Milgram’s continuum of virtuality as tools to facilitate educational or surgical processes in the healthcare sector. We highlight recent approaches to tackling the various key challenges, as well as the limitations of these approaches, and point toward areas of future development.
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Graphical abstract
Open AccessCase Report
Neocondylar Formation with Vascularized Fibular Free Flap: A Report of Three Rare Cases and Review of Literature
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Mark Lim, Ignacio A. Velasco Martinez, Tina Woods, Ben McIntyre, Ibrahim Sevki Bayrakdar, Sevda Kurt-Bayrakdar and Rohan Jagtap
Surgeries 2025, 6(2), 34; https://doi.org/10.3390/surgeries6020034 - 14 Apr 2025
Abstract
Background: Neocondylar formation is an uncommon finding that can result after the reconstruction of a vascularized free flap. Three case reports were presented in the current article. (1) A 64-year-old male presented with clear cell Odontogenic Carcinoma to the left mandible. (2) A
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Background: Neocondylar formation is an uncommon finding that can result after the reconstruction of a vascularized free flap. Three case reports were presented in the current article. (1) A 64-year-old male presented with clear cell Odontogenic Carcinoma to the left mandible. (2) A 14-year-old male presented with an ameloblastoma to the right mandibular associated with tooth 48. (3) A 13-year-old female presented with an ameloblastoma to the right mandible. Methods and Results: All three cases required a surgical resection of the mandible involving the temporomandibular joint. Reconstruction was performed using a vascularized free flap, and Neocondylar formation was observed during the healing process in all three cases. Neocondylar formation after a vascularized free flap reconstruction can improve anatomical functions such as mastication and decrease post-operative complications. Knowledge of this finding can improve future surgical treatment planning and outcome. Conclusion: This report contributes to the existing literature by offering new insights into neo-condylar formation following mandibular reconstruction with vascularized free fibular flap, particularly in complex resective surgeries, and highlights its potential clinical implications.
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(This article belongs to the Special Issue Dental Surgery and Care)
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Open AccessArticle
A Five-Year Review of Temporal Bone Fractures at a Level One Trauma Center and Examination of the Impact of the COVID-19 Pandemic
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Walter M. Jongbloed, Desiree Campbell, Chia-Ling Kuo, Kelin Zhong and Norman J. Cavanagh
Surgeries 2025, 6(2), 33; https://doi.org/10.3390/surgeries6020033 - 9 Apr 2025
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Background/Objectives: This study identifies and characterizes temporal bone fractures over a five-year period at a level one trauma center, focusing on the injury mechanism, otic capsule involvement, facial nerve involvement, fracture orientation, and the impact of the COVID-19 pandemic on skull base trauma.
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Background/Objectives: This study identifies and characterizes temporal bone fractures over a five-year period at a level one trauma center, focusing on the injury mechanism, otic capsule involvement, facial nerve involvement, fracture orientation, and the impact of the COVID-19 pandemic on skull base trauma. Methods: This retrospective cross-sectional study from a single level one trauma center reviewed skull base fractures from March 2018 to July 2023, identified with ICD-10 codes. Temporal bone fractures were categorized as otic capsule-sparing or -involving and by orientation (transverse, longitudinal, or oblique). Data were grouped into before, during, and after the COVID-19 lockdown period to address the impact of the COVID-19 pandemic. Data were also grouped into facial nerve injury and no facial nerve injury. Fisher’s exact test (5% significance) and descriptive statistics were used to compare groups. Results: A total of 364 fractures were identified. Facial nerve injuries (6.1%) were more likely in otic-capsule-involving (p < 0.001) and transverse or oblique fractures (p < 0.001). During the COVID-19 lockdown, hospital stays (p = 0.011) and ICU days (p = 0.035) were shorter. Among 22 facial nerve injury cases, half received high-dose steroids, but 6 died before evaluation. Six had complete paralysis; all received steroids, and three had surgical decompression. Only two had documented recovery. Of the 10 patients with partial paralysis, 5 received steroids, but only 2 showed improvement. All patients with incomplete eye closure received protective measures. Conclusions: Temporal bone fractures involving the otic capsule or transverse/oblique patterns are more likely to result in facial nerve injury. There are treatment discrepancies, which highlight a lack of a standard approach to treating those with facial nerve injury. An analysis of the impact of the COVID-19 pandemic revealed shorter hospital and intensive care stays during this time.
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Open AccessArticle
Epidemiology of Symptomatic Non-Union/Malunion Rib Fractures
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Daniel Akyeampong, Alexander Hoey, Ronald Gross and Evert A. Eriksson
Surgeries 2025, 6(2), 32; https://doi.org/10.3390/surgeries6020032 - 8 Apr 2025
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Background: Some rib fractures do not heal appropriately and can cause significant pain and morbidity. Little is known about the locations likely to experience dysfunctional healing. We sought to determine the location of symptomatic non-union/malunion (NU/MU) rib fractures presenting to our Chest Wall
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Background: Some rib fractures do not heal appropriately and can cause significant pain and morbidity. Little is known about the locations likely to experience dysfunctional healing. We sought to determine the location of symptomatic non-union/malunion (NU/MU) rib fractures presenting to our Chest Wall Injury and Reconstruction Center. Methods: A single-center retrospective cohort study was conducted on all patients with NU/MU fractures presenting for evaluation at our CWIRC from 1 January 2019 to 30 July 2023. Their rib injury locations were mapped using computed tomography scans of the chest and a physical exam was used to characterize the location of their symptomatic NU/MU fractures. The location of the NU/MU injury was identified as either the anterior (A), anterior–lateral (AL), lateral (L), posterior–lateral (PL), or posterior (P) region of the chest wall. The results are presented as a mean +/− standard deviation for normally distributed data and median (minimum—maximum) for non-normally distributed data. Results: A total of 28 cases were evaluated. The average age at time of presentation was 48+/−14 years and 71% of patients were male. A total of 72 NU/MU fractures (median/pt 2(1–11)) were evaluated. Sixty-one percent of the injuries were on the right side. In most patients (25/28, 89%), the injuries were all in the same anatomic location in the rib cage. Three patients had NU/MU injuries in multiple anatomic locations. All multilevel injuries were sequential, without any normally healed ribs between NU/MU injuries. The most common locations were the L and PL regions (A–3, AL–8, L–19, PL–42, P–0). The most commonly symptomatic ribs were in ribs 6–10. Conclusions: Symptomatic NU/MU healing often occurs in the L and PL locations along the bony chest wall. Symptomatic NU/MU injuries also occur in the cartilaginous extensions of the bony ribs and along the costal margin. Symptomatic NU/MU healing is uncommon in the A and AL upper rib cage, as well as in P injuries.
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Open AccessArticle
How Weight Loss After Bariatric Surgery Affects Sarcopenia Parameters and Diagnosis
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Cláudia Mendes, Manuel Carvalho, Jorge Bravo, Sandra Martins and Armando Raimundo
Surgeries 2025, 6(2), 31; https://doi.org/10.3390/surgeries6020031 - 7 Apr 2025
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Introduction: Obesity affects over 650 million individuals worldwide and poses a significant public health challenge. Bariatric surgery is the most effective treatment for severe obesity, resulting in substantial weight loss and improvements in obesity-related conditions. However, the weight loss achieved through bariatric
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Introduction: Obesity affects over 650 million individuals worldwide and poses a significant public health challenge. Bariatric surgery is the most effective treatment for severe obesity, resulting in substantial weight loss and improvements in obesity-related conditions. However, the weight loss achieved through bariatric surgery is often associated with a notable decline in skeletal muscle. This association suggests an elevated risk of sarcopenia among patients following surgery. The purpose of this study was to assess the effects of obesity and bariatric surgery on indicators and diagnoses related to sarcopenia before and after surgery. Methods: A total of 17 bariatric surgery patients participated in this prospective study. The parameters for diagnosing sarcopenia were established for each participant, based on the EWGSOP2 and EASO/ESPEN consensuses. All evaluations were conducted at five time points throughout this study: before surgery and at 1, 6, 12, and 18 months post-surgery. Results: In this study, 88.2% of the subjects were female, with an average BMI of 42.9 kg/m2 and a mean weight of 105.9 kg. After surgery, the average weight consistently decreased, with all differences from baseline being statistically significant (p < 0.001). Utilizing the SARC-F questionnaire for screening, the risk of sarcopenia increased post-surgery, then decreased at 12 months, ultimately reaching zero at 18 months. Muscle strength significantly decreased (p = 0.002) during the one-month post-surgery assessment, with slight variations thereafter, none of which were statistically significant. Muscle mass was normal prior to surgery but showed a significant decline post-surgery (p < 0.001). When applying the ESPEN/EASO consensus cut-off criteria for sarcopenic obesity, 35.3% of patients met the criteria preoperatively. After surgery, this figure rose to 70.6% in the first month but then decreased to 41.2% at 6 months. Conclusions: The findings reveal a distinct detrimental impact of bariatric surgery on muscle strength and mass, which are crucial indicators of sarcopenia. Additionally, this impact appears to arise very early after surgery, suggesting that the optimal timeframe for efforts to mitigate this effect may be during the prehabilitation period followed by the post-surgery timeframe.
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Open AccessArticle
Nanometric-Scale-Polished, Engineered Surgical Scalpel Blades Reduce Tissue Inflammation and Scarring
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Lydia Martin, Michelle X. Ling, Victoria Bigdelle and Raphael C. Lee
Surgeries 2025, 6(2), 30; https://doi.org/10.3390/surgeries6020030 - 5 Apr 2025
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Background/Objectives: The insertion of engineered scaffolds and tissues requires precise surgical implantation with minimal interfacial scarring. Nanometric scale material polishing technologies developed for manufacturing microelectronic circuits make it possible to polish and sharpen surgical instruments at near-atomic-scale precision. We tested the hypothesis that
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Background/Objectives: The insertion of engineered scaffolds and tissues requires precise surgical implantation with minimal interfacial scarring. Nanometric scale material polishing technologies developed for manufacturing microelectronic circuits make it possible to polish and sharpen surgical instruments at near-atomic-scale precision. We tested the hypothesis that the use of precision-sharpened scalpel blades would result in less tissue inflammation and incisional scarring. Methods: Parallel contralateral para-spinal longitudinal 4 cm long skin incisions in guinea pigs were performed, one side with a standard scalpel blade (SB) and the other with a polished nanometric scale, engineered experimental scalpel blade (EB). The side used for the polished blade was alternated and blinded from the histochemistry analysis team. The wound was excised at five time points (1, 3, 7, 16, and 60 days) with five animals per group. Histological and histochemical differences were compared. Results: The EB resulted in less bleeding, better wound adherence, relatively less macrophage density, scar volume, and granulation tissue, and significantly reduced levels of M1, M2, and TGF-β expression. Conclusions: Nanometric-scale-polished surgical scalpel blades produce significantly less tissue inflammation, scarring, and fibrosis.
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Open AccessArticle
Uniportal VATS Treatment of Giant Bullous Emphysema: Is It Safe and Effective?
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Antonio Giulio Napolitano, Khrystyna Kuzmych, Claudia Bellettati, Giuseppe Calabrese, Adriana Nocera, Maria Letizia Vita, Mahmoud Ismail, Maria Teresa Congedo, Elisa Meacci, Stefano Margaritora and Dania Nachira
Surgeries 2025, 6(2), 29; https://doi.org/10.3390/surgeries6020029 - 31 Mar 2025
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Background: Emphysema is a chronic lung disease characterized by alveolar wall destruction, leading to impaired gas exchange. Giant bullous emphysema (GBE) is a severe form of emphysema, often requiring surgical intervention. Video-assisted thoracoscopic surgery (VATS) is a minimally invasive approach for various thoracic
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Background: Emphysema is a chronic lung disease characterized by alveolar wall destruction, leading to impaired gas exchange. Giant bullous emphysema (GBE) is a severe form of emphysema, often requiring surgical intervention. Video-assisted thoracoscopic surgery (VATS) is a minimally invasive approach for various thoracic pathologies, including lung volume reduction surgery (LVRS) and bullectomy for emphysematous bullae. Uniportal VATS (U–VATS), a further refinement, offers benefits such as reduced postoperative pain and faster recovery. Methods: This retrospective study analyzed data from two high-volume European Thoracic Surgery centers between August 2016 to January 2024. A total of 29 patients underwent U–VATS bullectomy for GBE. Results: Nineteen patients were males (65.5%) with a mean age of 44.7 ± 8.8 years. Ten (34.5%) were active smokers. Eighteen patients (62.1%) presented with a single giant bulla, while the remaining cases were in the context of pulmonary emphysema. Four patients (13.8%) presented with pneumothorax, with one requiring preoperative chest drainage. Twenty-eight patients (96.6%) underwent only U–VATS bullectomy, with additional chemical pleurodesis in eleven cases (37.9%). One patient (3.4%) underwent a left upper lobectomy for a giant bulla and NSCLC. In cases of severe lung emphysema and fragile pulmonary tissue, the stapler line was buttressed with Gore® Seamguard®. No conversions to thoracotomy, postoperative air-leaks, or major complications were recorded. At a mean follow-up time of 22.0 ± 14.0 months, no pneumothorax recurrence was documented. At about six months after surgery, pulmonary function significantly improved. Conclusions: U–VATS bullectomy appears to be a safe and feasible technique for the treatment of bullae in GBE, offering promising postoperative outcomes.
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Open AccessCase Report
Odontogenic Myxoma in the Anterior Part of the Mandible—A Case Report
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Monika Burja Vladić, Marko Vuletić, Sven Seiwerth and Dragana Gabrić
Surgeries 2025, 6(2), 28; https://doi.org/10.3390/surgeries6020028 - 31 Mar 2025
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Odontogenic myxoma (OM) is a rare, benign intraosseous tumor that arises from the dental follicle, dental papilla, or periodontal ligament. It typically affects the mandible, maxilla, and sinuses, more frequently in women than men. The histopathology of OM is characterized by a myxoid
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Odontogenic myxoma (OM) is a rare, benign intraosseous tumor that arises from the dental follicle, dental papilla, or periodontal ligament. It typically affects the mandible, maxilla, and sinuses, more frequently in women than men. The histopathology of OM is characterized by a myxoid stroma with varying degrees of collagenization and spindle cells. Treatment is surgical, but there are no standardized guidelines. Available options include enucleation and curettage, with conservative approaches offering better aesthetics and functionality but a higher recurrence risk. This case report aims to discuss a rare presentation of OM in the anterior part of the mandible of a 22-year-old female patient with Hashimoto’s thyroiditis and idiopathic thrombocytopenic purpura. The patient presented with painless swelling and tooth mobility in the symphysis region. Radiographic evaluation revealed a unilocular lesion extending from the left second incisor to the right first incisor, with no root resorption. Histopathological analysis confirmed the OM diagnosis. Due to the patient’s young age and the size of the lesion, a conservative treatment approach was chosen, with the potential for future implant-prosthodontics rehabilitation. The case underscores the importance of thorough clinical, radiological, and histopathological assessment to ensure accurate diagnosis and management of OM. Long-term follow-up is essential due to the increased risk of recurrence in younger patients.
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Open AccessArticle
Early and Long-Term Performance of Stent Grafts Released in Dacron vs. Native Ascending Aorta During Hybrid Aortic Arch Repair
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Silvia Di Sibio, Giulio Pellegrini, Giacomo Turco, Antonio Rizza, Cataldo Palmieri, Pier Andrea Farneti, Giovanni Credi, Marco Solinas, Sergio Berti and Michele Murzi
Surgeries 2025, 6(2), 27; https://doi.org/10.3390/surgeries6020027 - 28 Mar 2025
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Objective: To evaluate the impact of a prosthetic and native aorta proximal landing zone (PLZ) for hybrid thoracic aorta repair with a stent graft deployed in the Zone 0 ascending aorta. Methods: Retrospective analysis of 100 patients who underwent Zone 0
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Objective: To evaluate the impact of a prosthetic and native aorta proximal landing zone (PLZ) for hybrid thoracic aorta repair with a stent graft deployed in the Zone 0 ascending aorta. Methods: Retrospective analysis of 100 patients who underwent Zone 0 hybrid thoracic aorta repair between 2005 and 2022, at a single institution. Fifty-eight (58%) had a Dacron PLZ (ascending aorta replacement with debranching), and forty-two (42%) had a native ascending aorta PLZ (off-pump aortic arch debranching). All the surviving patients had at least one radiological follow-up. Results: Patients with a native aorta PLZ were older (p = 0.01) and had higher rates of pulmonary disease (p = 0.01) and chronic kidney disease (p = 0.01) and a higher Logistic EUROscore (p = 0.02). In-hospital mortality was similar between the two groups (2.3% vs. 1.7%; p = 0.68). Retrograde aortic dissection was observed in four (9.2%) of the native PLZ group. The mean follow-up was 37 ± 22 months in the Dacron PLZ group and 42 ± 20 months in the native PLZ group (p = 0.05). At 1,3, and 5 years, freedom from Type Ia endoleak was significantly higher in patients with a Dacron PLZ: 100% vs. 96 ± 0.3%, 100% vs. 85 ± 1%, and 100% vs. 66 ± 1.3% (p = 0.03). Despite this, the 1-, 3-, and 5-year survival was similar between groups: 100% vs. 96 ± 0.4%, 90 ± 1% vs. 89 ± 0.6%, and 66 ± 1% vs. 64 ± 2%. (p = 0.96). Conclusions: Endograft deployment in a prosthetic ascending aorta is a safe and durable option for aortic repair. A Dacron PLZ is associated with a lower rate of Type Ia endoleak and can prevent retrograde aortic dissection when compared with native aorta.
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Open AccessReview
Hindfoot Valgus and First Ray Insufficiency: Is There Correlation?
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Gabriele Colò, Federico Fusini, Daniele Marcolli, Massimiliano Leigheb and Michele Francesco Surace
Surgeries 2025, 6(2), 26; https://doi.org/10.3390/surgeries6020026 - 27 Mar 2025
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The first metatarsal has the greatest inclination of all metatarsals and carries about 40% of body weight during the static stance. The rearfoot and the first ray (FR) are two distinct structures, but they are strongly related to the latest studies in the
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The first metatarsal has the greatest inclination of all metatarsals and carries about 40% of body weight during the static stance. The rearfoot and the first ray (FR) are two distinct structures, but they are strongly related to the latest studies in the literature; however, their mutual involvement in the foot biomechanics appears not to be fully explored. Understanding their interdependence is essential to approaching the patient in his totality. This overview aims to analyze the current evidence from the latest studies that examine the correlation between FR insufficiency (FRI) and hindfoot valgus (HV), focusing on their biomechanical interaction, clinical implications, and treatment approaches. All analyzed studies showed that plantarflexion of the first metatarsophalangeal (MTP1) joint in correct alignment increased by 26% compared to a deviated articulation. In FRI, the “windlass” mechanism appears compromised, and FR lacks the necessary stability and plantarflexion; consequently, the medial arch collapses, and the foot moves into excessive pronation. On the other hand, in HV condition, the pulley system is significantly diminished, and peroneus longus contraction cannot stabilize the FR with resultant FRI and dorsal migration. A significant correlation was found between hindfoot alignment and first metatarsal rotation (86% of patients) and between HV and hallux valgus. Foot orthoses, physical therapy, and exercise programs, especially in the initial stages of symptomatic HV, provide satisfactory results in 67% to 90% of cases, improving foot alignment and pain relief in FRI patients. In more severe cases, surgical intervention to realign the hindfoot is indicated with a very low complication rate (1–4%), which can vary from 24% to 55% in stage 4 flatfoot. No study in the literature has been found to address both pathologies simultaneously from a treatment point of view, and, although not all HV patients are affected by FRI, most patients seem to benefit from surgical stabilization of the FR in 80% of individuals with symptomatic HV. However, despite a predominance of FRI among HV individuals, not all clinical studies have confirmed this correlation.
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Open AccessArticle
Predictors of Research Productivity in General Surgery Residency and Beyond: A Single Institutional Analysis
by
Aaron L. Albuck, Katherine Cironi, Augustus Anderson, Gilad Hampel, Michael Ghio, David C. Yu and Jacquelyn Turner
Surgeries 2025, 6(1), 25; https://doi.org/10.3390/surgeries6010025 - 19 Mar 2025
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Background/Objectives: Research is widely recognized as an essential element of medical education across all levels. This study explores the association between publishing before, during, and after general surgery residency, shedding light on research productivity trends in medical education. By examining a diverse
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Background/Objectives: Research is widely recognized as an essential element of medical education across all levels. This study explores the association between publishing before, during, and after general surgery residency, shedding light on research productivity trends in medical education. By examining a diverse cohort of general surgery residents, the research aims to uncover factors influencing research output at various training levels. Methods: This study analyzed graduates’ Curriculum Vitae from a single institution’s general surgery residency program from 2017–2024. Linear regression models assessed whether variables encompassing total research output (manuscripts, abstracts, posters, and podium presentations) could predict graduates’ research outcomes in the next stage of training. Results: Out of the 38 eligible graduates, 20 submitted their Curriculum Vitae and were included in the study, resulting in a response rate of 52.6%. Total research activity before residency was not found to be predictive of total research activity in residency (t(18) = 1.020, p = 0.322) but was found to be related to total research activity in fellowship (t(10) = 5.399, p < 0.005). Total research activity during residency was not found to be related to fellowship research (t(10) = 0.834, p = 0.424). No sequential correlation was found between undergraduate, medical school, residency, or fellowship publications. Additionally, there was no correlation between first authorship and publication total in the subsequent phase of medical education. Conclusions: Research productivity during medical school does not have predictive value for future research during residency but is found to be predictive of future works in fellowship. These findings suggest that the research emphasis should be strategically managed throughout medical education to sustain long-term academic engagement.
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Open AccessReview
Balancing Stability and Recovery: A Scoping Review on Conservative vs. Surgical Management of Acute Posterior Cruciate Ligament Injuries
by
Roberto Tedeschi, Federica Giorgi, Daniela Platano, Lisa Berti, Fabio Vita and Danilo Donati
Surgeries 2025, 6(1), 24; https://doi.org/10.3390/surgeries6010024 - 15 Mar 2025
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Background: Posterior cruciate ligament (PCL) injuries are relatively rare, with limited consensus on the optimal treatment for isolated acute cases. Conservative management and surgical reconstruction each offer potential benefits, but their comparative efficacy remains unclear. Methods: A scoping review was conducted following the
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Background: Posterior cruciate ligament (PCL) injuries are relatively rare, with limited consensus on the optimal treatment for isolated acute cases. Conservative management and surgical reconstruction each offer potential benefits, but their comparative efficacy remains unclear. Methods: A scoping review was conducted following the Joanna Briggs Institute (JBI) framework and PRISMA-ScR guidelines. A systematic search of MEDLINE, Cochrane CENTRAL, Scopus, PEDro, and Web of Science was completed on 23 December 2024. Studies comparing conservative treatment and surgical reconstruction for isolated acute PCL injuries were included. Outcomes such as functional recovery, stability, and long-term complications were extracted and synthesized qualitatively. Results: Six studies were included, comprising case series, prospective, retrospective, and review designs. Conservative treatment demonstrated significant improvements in functional recovery (IKDC scores: 67–90.3/100) but showed limited improvement in stability (STSD reduction: 0–3 mm). Surgical reconstruction yielded superior stability (STSD reduction: 8.2 to 2.7 mm) and lower rates of degenerative changes but was associated with a higher risk of complications. Functional outcomes were comparable between approaches in some studies, although surgical patients showed slightly better long-term stability. Conclusions: Both conservative and surgical treatments achieve satisfactory outcomes for isolated acute PCL injuries. Treatment selection should be tailored to patient-specific factors, considering functional demands and injury severity.
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Open AccessReview
Overview of Radiological Reporting and Data System (RADS) Guidelines Currently Applicable in Surgery
by
Marco Parillo and Carlo Cosimo Quattrocchi
Surgeries 2025, 6(1), 23; https://doi.org/10.3390/surgeries6010023 - 14 Mar 2025
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Standardized frameworks for interpreting medical images, such as the radiological Reporting and Data Systems (RADS), are designed to improve the consistency and accuracy of radiological assessments across different imaging modalities, anatomical locations, and disease processes. Clear communication and information sharing between radiologists and
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Standardized frameworks for interpreting medical images, such as the radiological Reporting and Data Systems (RADS), are designed to improve the consistency and accuracy of radiological assessments across different imaging modalities, anatomical locations, and disease processes. Clear communication and information sharing between radiologists and referring physicians, including surgeons, is a key goal of the RADS guidelines. Therefore, familiarity with these guidelines is crucial for all physicians involved in patient care. This review synthesizes current RADS guidelines relevant to surgical practice. Our analysis identified 28 radiological RADS with potential applications in surgical workflows, primarily in oncology. Of the RADS examined, nine were validated by the American College of Radiology (ACR), one was validated through a collaboration between the ACR and other scientific societies, and seventeen were developed by other scientific organizations. Numerous surgical specialties may encounter RADS in clinical practice, including neurosurgery, head and neck surgery, cardiovascular surgery, thoracic surgery, endocrine surgery, breast surgery, gastrointestinal surgery, hepatobiliary surgery, gynecological surgery, urological surgery, orthopedic surgery, emergency surgery, and surgical oncology. The effective utilization and validation of RADS necessitates close collaboration between radiologists and surgeons, coupled with widespread education for all healthcare professionals involved in patient care. Artificial intelligence software will play an important role in facilitating the dissemination and use of RADS in clinical practice.
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Open AccessArticle
The Efficacy of Oral Dexamethasone in the Management of Symptomatic Irreversible Pulpitis Without Pulpotomy: A Non-Randomized Clinical Trial
by
Sara Chehab, Roula Abiad, Lara Nasr, Hala Sacre, Pascale Salameh, Reem Chamseddine, Romy Zouein, Louis Hardan, Naji Kharouf, Rim Bourgi and Roula El Hachem
Surgeries 2025, 6(1), 22; https://doi.org/10.3390/surgeries6010022 - 14 Mar 2025
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Background: Irreversible pulpitis is a severe inflammation of the dental pulp. The purpose of this clinical trial was to evaluate the effectiveness of an inferior alveolar nerve block (IANB) injection followed by oral dexamethasone administration in reducing the pain associated with symptomatic irreversible
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Background: Irreversible pulpitis is a severe inflammation of the dental pulp. The purpose of this clinical trial was to evaluate the effectiveness of an inferior alveolar nerve block (IANB) injection followed by oral dexamethasone administration in reducing the pain associated with symptomatic irreversible pulpitis (SIP) in mandibular molars, without performing conventional pulpotomy. Methods: A sample of 80 subjects suffering from acute pain due to SIP on a mandibular molar were assigned to the dexamethasone group, who received an IANB injection followed by one oral dose of 4 mg of dexamethasone during the emergency visit followed by one dose of 4 mg after 8 h, or the control group, who received a conventional pulpotomy. Both groups received complete endodontic treatment after five to six days. The intensity of the preoperative pain and pain levels were measured in both groups at different times after each intervention. The Mann–Whitney U test was used to compare the pain scores between the groups at the same time point, while Friedman’s test was used to compare the pain scores between the four time points within the same intervention group, followed by the Bonferroni correction for multiple pairwise comparisons. Success was determined when the pain score on the visual analogue scale (VAS) was 20 or lower. Results: A survival analysis was conducted, where the event was considered as the disappearance of symptoms (or success: pain score ≤ 20). For both groups, the pain significantly decreased 8 h postoperatively (p < 0.05). The success rates at 8 and 12 h were significantly higher in the dexamethasone group compared to the control group (p = 0.05). However, the pain scores at 24 h remained comparable. Conclusions: An IANB injection followed by 8 mg of oral dexamethasone could reduce pain significantly in patients with SIP without performing conventional pulpotomy. The oral administration of dexamethasone could therefore be a valuable strategy to temporarily alleviate SIP symptoms until definitive treatment becomes feasible. Dexamethasone is a temporary pain management strategy rather than a replacement for pulpotomy.
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Open AccessArticle
Volume Restoration in Mid-Facial Aging: A Quantitative Evaluation of the Efficacy of Hyaluronic Acid Gel Injections—The Imperative to Optimize the Injection Volume Based on Anatomical Considerations
by
Alberto Diaspro and Giuseppe Sito
Surgeries 2025, 6(1), 21; https://doi.org/10.3390/surgeries6010021 - 11 Mar 2025
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Background: The attractiveness of the central area (the so-called mid-face area or middle third) has a strong impact on the observer, and the treatment of aging in this area is therefore considered a key component in facial rejuvenation. A standardized photographic and three-dimensional
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Background: The attractiveness of the central area (the so-called mid-face area or middle third) has a strong impact on the observer, and the treatment of aging in this area is therefore considered a key component in facial rejuvenation. A standardized photographic and three-dimensional analysis was conducted in this observational study to determine the outcome of volumetric restoration procedures of the mid-face area with HA injection, providing an objective, repetitive, and reliable evaluation of this facial rejuvenation technique. Methods: In total, 47 patients were treated with two types of HA-based dermal fillers, and calibrated, stereoscopic images of the face were taken with volume reconstruction and analysis software performed before (t0), 45 days after HA implantation (t1), and at the check-up after the end of follow-up (t2). Results: In total, 39 out of 47 patients completed the study, which showed an overall volume restoration of 4.46 ± 1.34 mL at 45 days (t0–t1) after HA implantation, maintaining a value of 1.23 ± 0.68 mL at the end of the 318-day follow-up (t0–t2). Conclusions: The results of this study indicate that rejuvenation of the mid-facial region through volumetric restoration with an HA filler leads to an indirect volumetric effect that is clinically more significant than the actual injected volume and equally long-lasting.
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