Texture-Optimized Early Enteral Nutrition Enhances Gastrointestinal Recovery and Caloric Intake After General Surgery: A Randomized Controlled Trial.

To apply a machine learning (ML) model that we developed and internally validated for predicting postoperative infection likelihood after elective general abdominal surgery, SMART, among 2716 patients. The United Kingdom Health Data Research (UKHDR) Hub for Acute Care (PIONEER) supplied retrospective pseudonymised data for model training. These data contained demographic information, vital signs, microbiological investigations, comorbidities, surgical information, and infection diagnosis for elective general surgical patients (n = 2,716). Predictors were selected using an integrated approach of ML methods (feature elimination) and expert input. Recursive feature elimination with cross-validation was run on these predictors using Python(v3.8.2). Twelve algorithms were used, and an ensemble model with the three highest performing models was developed. Nineteen predictors were selected to build the model, including demographics (e.g. age), comorbidities, microbiology data (e.g. multidrug-resistant infections), and laboratory investigation (CRP). The gradient-boosting classifier was found to be the best-performing model. The ensemble model showed high performance during training with 85.3% sensitivity, 74.6% specificity, and AUC=0.89, and during internal validation, with 96.9% sensitivity, 74.1% specificity, and AUC=0.86. The ML model showed high performance in predicting postoperative infections in elective surgery. It used modifiable predicators that aided its clinical application. Identifying patients at higher risk of postoperative infections before surgery can promote early interventions and reduce antimicrobial resistance risk. External validation and testing are necessary for successful clinical implementation.

Secondary intention healing (SIH) is an underappreciated yet valuable method for repairing facial skin and soft tissue defects, particularly for general surgeons practicing in trauma, rural, or community settings. This review reframes SIH from a general surgical perspective, focusing on clinical decision-making-including core principles, indications, contraindications, technical essentials, and referral criteria. We integrate evidence from recent years to highlight when SIH can safely yield acceptable functional and cosmetic outcomes, and when referral for advanced reconstruction is necessary. For small, concave facial defects (eg, medial canthus and nasal ala) in patients with good wound healing capacity, SIH offers simplicity, cost-effectiveness, and minimal scarring; however, it is inappropriate for convex/tension-bearing regions (eg, nasal tip and lip margin) or large/deep defects. This practical framework equips general surgeons to incorporate SIH into routine practice for facial soft-tissue injuries and oncologic defects.

Evaluating the Impact of an Orientation Program on General Surgery Junior Residents Using Objective Structured Clinical Examination (OSCE) Assessment Tool in a Tertiary Teaching Hospital in India.

Utilization Trends and Surgical Outcomes of Technology-Assisted Total Hip Arthroplasty in the United States From 2014 Through 2024.

Patients living with HIV in the modern era: Postoperative outcomes and healthcare utilization.

Medical innovations have extended patient lifespans while also increasing the clinical complexity associated with aging and chronic conditions. As patients live longer, surgeons may encounter an array of perioperative challenges including patients with multiple comorbidities. Consequently, surgical teams must manage bleeding risks while balancing potential thromboembolic complications. This retrospective observational study evaluated trends in perioperative bleeding management and associated surgical care challenges over 22 years, utilizing data from the Premier Perspective Hospital Database. The analysis included 13,358,404 adult surgical patients, examining patient complexity via Charlson Comorbidity Index (CCI), preoperative anticoagulant/antiplatelet usage, and topical hemostatic agent (THA) utilization. Patient complexity, as indicated by CCI, significantly increased annually across all surgical types, with the greatest increase in cardiovascular surgery (0.029/year). Overall preoperative use of anticoagulants and antiplatelets rose by 0.5 % per year, with marked variations across surgical cohorts. Notably, general surgery exhibited the highest annual increase (2.0 %), while knee and hip replacements showed a decline in anticoagulant/antiplatelet use. Overall, use of THA strategies increased by 0.56 % annually, particularly in neurosurgery, spinal, and cardiovascular procedures. Multivariate analysis demonstrated significant associations between patient complexity, anticoagulant/antiplatelet use, and higher use of THA strategies across various surgical disciplines. Elective surgeries were more likely to be associated with THA charges than emergent or urgent procedures. This large retrospective analysis describes evolving patient complexity, antithrombotic medication use, and associated use of THA strategies across surgical specialties over two decades. These findings characterize practice patterns and may inform future hypothesis-driven studies evaluating the clinical role of THAs in different surgical contexts.

Artificial intelligence for surgical care in war-torn sudan: Feasibility, barriers, and ethical perspectives from a conflict zone.

Single-port (SP) robotic surgery is uncommon in paediatric abdominal pathologies. We report early experiences with SP robotic general surgery in children. We retrospectively analysed children undergoing SP robotic procedures between August 2023 and September 2025 at two tertiary centres in South Korea. Surgeries were performed with the da Vinci SP system. Twenty-one patients (median 4.2years, 47.6% male) were included, choledochal cyst excision (n=7) with cholecystectomy, Kasai portoenterostomy, splenectomy, and hiatal hernia repair (n=2 each). Single cases included anorectoplasty, redo-fundoplication, retroperitoneal teratoma excision, abdominal lymphatic malformation, and Swenson pull-through. The median operative time was 315min; blood loss, 10mL; median time to oral intake, 2 (1-6)days; and hospital stay, 6 (1-16)days. One conversion occurred. Six experienced complications (two grade≥IIIa; mortality, 0%). The median follow-up was 335 (8-587)days. SP robotic surgery appears feasible and safe in selected children but requires multicenter evaluation.

Hepatobiliary surgical training in a changing educational landscape: An 18-year longitudinal analysis of a high-volume international fellowship programme.

SIMPL Study of Surgical Feedback: Faculty Identity Outweighs Trainee Factors in Narrative Assessments.

Opportunities and Challenges in Using Smartphone Sensor Data to Capture Surgeon Behavior and Well-Being: A Qualitative Analysis of Surgical Residents' Perspectives.

Postgraduate training to become a surgical oncologist involves a general surgery residency and a Complex General Surgical Oncology (CGSO) Fellowship, with most graduates spending approximately 9years in training. This paradigm remains dependent on devoting a specific, fixed amount of time to training. A competency-based medical education (CBME) approach acknowledges that learners progress through different milestones at variable paces. Currently, several oversight organizations are involved in training surgical oncologists, which are still dependent on time-based training. A narrative review was conducted reviewing literature and current guidelines on CGSO training. The interplay between the various organizations was outlined in hypothetical models. Many organizations are involved in the ultimate oversight of surgical oncology training, including at the residency, fellowship, match, and board certification level. These organizations still rely on time spent in training for the ultimate approval of a trainee through each step of training. New initiatives are slowly introducing CBME, notably the Entrustable Professional Activity initiative through the American Board of Surgery. Our current training environment faces many challenges, including duty hours, increasing use of technology, and employment models that are quite different from those present at the outset of CGSO as a specialty. To improve our approach to training surgical oncologists, it is necessary to understand the current framework for oversight. We have reviewed the most relevant oversight bodies to allow for a better understanding of the machinery involved in any attempt to modify CGSO Fellowship towards a CBME model.

Introduction: Obesity is a recognised risk factor for complications in abdominal surgery wounds. The “dead space” formed by inadequately vascularised subcutaneous adipose tissue permits the accumulation of serous fluid and blood. Bacteria proliferate in this environment, heightening the risk of Surgical Site Infections (SSI) and wound dehiscence. Aim: To determine the efficacy of prophylactic subcutaneous closed-tube drainage in reducing local wound complications following elective abdominal surgery in morbidly obese individuals. Materials and Methods: This prospective interventional study was conducted in the Department of General Surgery, Dr. Vithalrao Vikhe Patil Medical College and Hospital, Maharashtra, India, between April 2025 and December 2025. The study included 200 patients with a Body Mass Index (BMI) exceeding 30 kg/m² and subcutaneous fat thickness greater than 3 cm. The study group (n=100) received a subcutaneous closed-tube suction drain, whereas the control group (n=100) underwent standard closure without drainage. The principal outcomes were seroma, haematoma, and SSI within 30 days postoperatively. The secondary outcomes encompassed the duration of hospital stay and the necessity for supplementary interventions. Results: The baseline demographic and clinical characteristics, including mean age (p-value=0.34), BMI (p-value=0.58), and subcutaneous fat thickness (p-value=0.67), showed no statistically significant differences between the drain and nodrain groups. Use of subcutaneous suction drains significantly reduced wound complications. Seroma formation was 6% in the drain group and 24% in the control group (p-value <0.001). Also, there were fewer haematomas (2% vs 8%, p-value=0.048). Most significantly, the SSI rate was significantly lower in the study group (5% vs 18%, p-value=0.004). Consequently, the drain group had a markedly lower need for secondary interventions such as needle aspiration or re-suturing (4% vs 22%) and a shorter hospital stay (4.2±1.1 vs 6.8±2.5 days). Conclusion: Prophylactic subcutaneous closed-tube suction drainage is an effective, low-risk intervention that reduces wound morbidity in morbidly obese individuals and optimises hospital resource utilisation by reducing fluid accumulation and bacterial proliferation.

Implementation of Colectomy Guidelines: Increasing Rate of Safe Anastomosis in Emergency General Surgery Patients.

Maintaining expeditionary surgical readiness during peacetime is a persistent Military Health System challenge, particularly for general surgeons assigned to low-volume military treatment facilities. Knowledge, Skills, and Abilities-Clinical Activity (KSA-CA) metrics quantify procedural readiness against operational benchmarks, yet many active-duty surgeons do not meet established thresholds. The American Association for the Surgery of Trauma (AAST) Acute Care Surgery (ACS) fellowship includes a dedicated operative year with high-volume trauma and emergency general surgery exposure that could offer insights for how to accelerate procedural readiness, but its performance against KSA-CA standards has not been evaluated. We performed a retrospective, cross-sectional analysis of procedural case logs from fellows enrolled in AAST ACS fellowship programs between February 2021 and April 2023, limited to procedures performed during the 12-month ACS operative year. Each logged Current Procedural Terminology code was scored using the general surgery KSA-CA algorithm, which maps >2,000 Current Procedural Terminology codes to 49 procedure groups. Readiness was defined as achieving a KSA-CA score at or above the established threshold. Case logs from 26 of 32 approved AAST ACS fellowship sites contained eligible entries, representing 102 fellows and 24,493 logged procedures. Among fellows meeting inclusion criteria (n = 73), the median cumulative KSA-CA score was 25,464 (IQR, 7,132-42,415). All fellows who completed the ACS year achieved the KSA-CA readiness threshold (100%); 95% achieved readiness before the end of the year, and 93% met readiness within 6 months. Top contributing procedure groups included intra-abdominal open hollow viscus operations, thoracic (or "pneumonectomy" group in KSA nomenclature), and debridement of muscle and fascia. The AAST ACS fellowship curriculum reliably meets military procedural readiness standards as measured by KSA-CA metrics in 12 months or less. The ACS fellowship sites and curricular structure have the potential to accelerate expeditionary readiness among Military Health System general surgeons. (J Trauma Acute Care Surg. 2026;000: 000-000. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.). Diagnostic Tests or Criteria, Level IV.

Emergency general surgery (EGS) is an essential part of general surgery. However, the service configuration for EGS in the United Kingdom (UK) and Ireland varies significantly. This study aims to clarify current and desired future roles of EGS surgeons in the UK and Ireland, particularly regarding operative procedures. An e-survey, designed by the Association of Surgeons of Great Britain and Ireland (ASGBI) Moynihan Academy, was distributed to ASGBI members at two national conferences in 2023. Data collection included the operative roles of EGS surgeons and factors influencing the appeal of a dedicated EGS career. The study was conducted and reported according to the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). There were 132 of 347 (response rate 38.0%) complete responses analysed. Respondents identified a core set of procedures that could be safely performed by EGS surgeons, regardless of dedicated EGS service configuration. A minority of respondents stated that EGS surgeons - rather than a surgeon with a specialist interest - should operate on specific conditions: emergency colonic resection for cancer (65 of 132 [49.2%]) or for inflammatory bowel disease (49 of 132 [37.1%]), laparoscopic cholecystectomy plus intraoperative cholangiogram with or without common bile duct exploration (45 of 132 [34.1%]), operations for gastric volvulus (45 of 132 [34.1%), operations for Boerhaave's (37 of 132 [28.0%]) and operations for bariatric complications (34 of 132 [25.8%]). Factors that might improve future EGS careers included pragmatic job planning, minimally invasive elective surgical opportunities and dedicated continuing professional development. This study outlines the operative role of EGS surgeons within the broader general surgical profession and highlights controversies regarding whether EGS surgeons should perform specific complex operations.

BACKGROUND Pancreas transplantation is the best causal treatment for type I diabetes. The triglyceride-glucose (TyG) index is a validated marker of the long-term risk of cardiovascular episodes. The purpose of this study is to evaluate the potential reduction in cardiovascular risk, using the TyG index as a surrogate marker, in patients undergoing pancreas transplantation. MATERIAL AND METHODS The analysis was conducted on data obtained from 86 patients undergoing pancreas transplantation at the Department of General and Transplantation Surgery, Medical University of Warsaw. Serum triglyceride and glucose levels were recorded at the stage of qualification for transplantation and at 1, 3, 6, and 12 months after transplantation. The repeated measures ANOVA model was applied to the group of patients with complete data (n=14), showing a statistically significant effect of time. The difference between values before and after 12 months was statistically significant. RESULTS The mixed model confirmed the significant effect of time on the TyG index value. The mean TyG index value decreased significantly 1 month after transplantation and remained stable. Trend analysis was performed for the TyG index values at 3 time points: before transplant, early follow-up, and late follow-up. The mean TyG index decreased significantly as early as 1 to 3 months. CONCLUSIONS In this cohort of pancreas transplant recipients, transplantation was strongly associated with a reduction in the TyG index, suggesting a lower long-term risk of cardiovascular events.

Acute mesenteric ischemia (AMI) remains one of the most lethal vascular emergencies, with in-hospital mortality rates frequently exceeding 50%. Although early diagnosis and timely revascularization are critical, clinical practice remains highly variable. This study aimed to evaluate the real-world management of AMI in Spain, identifying gaps in resources, protocols, and interhospital coordination. A national cross-sectional survey was conducted between March and August 2024 using the Survio® platform. The questionnaire was distributed to general surgeons through national surgical societies and included 27 items covering hospital infrastructure, clinical protocols, diagnostic and therapeutic availability, personal experience, and perceived system-level barriers. A total of 291 surgeons responded. The median age was 40 years (IQR: 17). Most were consultants (76.3%) working in tertiary (42.6%), secondary (33%), or community hospitals (24.4%). While 97.6% reported access to 24/7 multiphasic CT and 90.4% to round-the-clock radiology, only 51.9% had 24/7 interventional radiology and 60.1% vascular surgery. Just 26.8% had institutional AMI protocols. The median distance to a referral center was 25km (range: 2-250km), and 68.4% reported difficulty in patient transfers. While 96.9% felt competent managing AMI, only 36.4% were familiar with the term "intestinal stroke." A total of 76.3% expressed interest in joining a national AMI registry. Spanish surgeons report high self-perceived clinical competence in AMI management, but systemic fragmentation, lack of protocols, and logistical barriers limit optimal care. These findings underscore the urgent need for coordinated regional networks, standardized care pathways, and multidisciplinary collaboration to improve outcomes in acute mesenteric ischemia across European healthcare systems. Retrospectively registred and recorded in Clinical Trials. NCT06428240, registration date on 20th/05/2024.

Perianal abscess is a common anorectal emergency, and simple incision and drainage (I&D) remains the standard initial treatment. However, failure to address an underlying fistulous tract at the primary surgery may result in high rates of abscess recurrence and subsequent fistula formation. The role of drainage with concurrent initial fistula management remains debated due to concerns regarding anal continence. To compare outcomes of simple incision and drainage versus drainage with initial fistula management in patients with acute perianal abscess, with special reference to abscess recurrence. This Prospective observation studies was conducted in the Department of General Surgery at SRM Medical College Hospital and Research Centre from march 2025 to December 2025. A total of 142 patients with acute perianal abscess were randomized into two groups: Group A underwent simple I&D (n = 71) and Group B underwent I&D with primary fistula management (n = 71). Patients were followed for 10months. Primary outcomes included abscess recurrence and fistula formation. Secondary outcomes included anal incontinence assessed using the Fecal Incontinence Severity Index (FISI), postoperative pain, wound healing time, and hospital stay. Statistical analysis was performed using SPSS v25.0 with p < 0.05 considered significant. Abscess recurrence was significantly higher in the simple drainage group (23.9%) compared to the drainage with fistula management group (4.2%) (p = 0.001). Fistula formation occurred exclusively in the simple drainage group (25.4%) (p < 0.001). Mean FISI scores were higher following simple drainage (5.10 ± 3.15) than drainage with fistula management (3.30 ± 2.13) (p < 0.001). Hospital stay was significantly shorter in the combined procedure group (p < 0.001), while postoperative pain scores were comparable. Drainage with initial fistula management significantly reduces abscess recurrence and fistula formation without increasing postoperative pain, and is associated with better continence outcomes and shorter hospital stay compared to simple drainage alone.