Cutting edge blog
This section is designed to add value to the articles published in BJS and BJS Open.
If you wish to send a written (or even recorded) comment on one of the published articles, please send it to katie@bjsacademy.com.
If you wish to respond more immediately, please use social media directly by tagging @BJSurgery, @BjsOpen or @BJSAcademy
Multimodal prehabilitation: beyond physical preparation
Fernando Dana
Major digestive surgery not only carries clinical risks but also imposes a significant functional and emotional burden. In this context, prehabilitation emerges as a key strategy to optimize patient readiness before entering the operating room.
This analysis is based on a prospective cohort study conducted at a tertiary hospital, including 188 patients undergoing major elective gastrointestinal surgery. Of these, 94 completed a multimodal prehabilitation program, while 94 received standard preoperative care (Table 1). Outcomes were assessed using the validated QoR-15 questionnaire at baseline, discharge, and 30 days post-discharge, alongside clinical and functional recovery indicators (Figure 1).
Preoperative clinic data and type of surgery by group
Comment on: Endoscopic and surgical treatment options for gastroparesis: systematic review and network meta-analysis.
Martin Storr, Thomas Frieling, Jutta Keller, Felix Gundling, Robert Patejdl
Correspondence to: Martin Storr (email: m.storr@internistenzentrum.de)
Center for Endoscopy
Starnberg
Author response: Endoscopic and surgical treatment options for gastroparesis: systematic review and network metaanalysis
Daniel Eckhardt, Moustafa Elshafei, Katja Fechner, Markus K. Diener, Felix J. Hüttner
Correspondence to: Daniel Eckhardt (email: daniel.eckhardt@klinikum-nuernberg.de)
Department of General, Visceral, and Thoracic Surgery
Klinikum Nürnberg
Comment on: Breast satisfaction and health-related quality of life following total mastectomy, breast-conserving surgery, or immediate breast reconstruction in Japanese patients with breast cancer: multicentre cross-sectional controlled study (Reborn)
Janhavi Venkataraman, Kefah Mokbel
Correspondence to: Janhavi Venkataraman (email: Janhavi.Venkataraman@hcahealthcare.co.uk; janhavivraman@gmail.com)
The London Breast Institute
Princess Grace Hospital
Author response: Decreasing aortic diameter and decreasing prevalence of infrarenal aortic aneurysms in a population-based screening programme
Antti Siika, Rebecka Hultgren
Correspondence to: Rebecka Hultgren (email: rebecka.hultgren@ki.se)
Department of Vascular Surgery
Karolinska Institutet
Comment on: Decreasing aortic diameter and decreasing prevalence of infrarenal aortic aneurysms in a population-based screening programme
Antonio Manenti, Gianluca Pagnoni, Aurora Vicenzi, Francesca Coppi
Correspondence to: Antonio Manenti (e-mail: antonio.manenti_2024@libero.it)
Department of Surgery
Polyclinic Hospital
Pancreatic Cancer Awareness 2025
To honour Pancreatic Cancer Awareness Month, we are highlighting some of the most important research published this year in BJS Journals, BJS and BJS Open, on pancreatic cancer. Advancing research in this field is essential to improving patient outcomes and offering hope. Together, we can make a difference.
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Science and art of decision-making in surgery
Susan J Moug
Surgeons come from different cultures, have different religious beliefs, work in varying health systems and resources and are ultimately guided by legal requirements of the country they work in. We link all of these factors by describing the science behind decisions, heuristics, cognitive processing and human factors. We discuss how surgeons interpret the risk of surgery to the patient but have to be conscious that they are also balancing the risk to themselves. The latter being an increasing consideration as surgical outcomes are reported according to key quality performance indices, such as anastomotic leak. The personality of the surgeon is explored finding not a ‘bad’ trait but traits that may respond suboptimally in certain circumstances. To overcome this, achieving ‘personality awareness’ is proposed.
Most surgeons would say that they learnt decision-making through experience in their day-to-day job, with few having had formal training within their surgical training programmes. Residents also describe indirect training and alongside a medical student, give us insights into the progression of decision-making from student to independent surgeon.
When things do not go as planned, we question our decisions and although often not wrong, we can have a strong and negative emotional response. We describe the difference between adverse events and errors and how both can lead to burnout. Human factors can cause both as a result of a longer term stress with the delicate interplay of the surgeon, hospital and job discussed. Mentoring or support programmes could play an important role.
An introduction: 'Presidents Under the Knife' blog series
Per-Olof Hasselgren, MD, PhD
The health of political leaders has always been of public interest. In the US, in particular, health issues surrounding the president continue to create headlines, and although it may be debated whether private information about diseases and their treatments should be made public, nowadays everyone, including the presidents, agree that information about the health of officials could and should be open to the public eye. After all, conditions that may affect the wellbeing of the president, especially when surgery is involved, could have huge implications from both a political and economic standpoint.
My book, Presidents Under the Knife. Surgical Successes, Failures, and Deceptions, narrates surgeries performed on presidents while they were in office. The surgical procedures are described from a surgeon’s perspective, but importantly, the book also recounts many of the political fallouts and implications of the procedures. As implied in the subtitle of the book, we find successes, failures, and deceptions when learning about the surgeries on American presidents.
Even the country’s first president had surgery. In June of 1789, only a couple of months into his presidency, Washington had surgery for a “tumor” on his left leg. It turned out to be a large abscess giving rise to immense pain and “threatening” fevers. The cutting open of the abscess and drainage of its content may have saved the president from dying of sepsis.
Comment on: Quality of life in patients with permanent hypoparathyroidism after thyroidectomy for benign thyroid disease: population-based study with long-term follow-up
Zhaoyu Peng, Yongjin Chen, Zou Meng, Wenjiang Wu
Correspondence to: Wenjiang Wu (email: 1053660645@qq.com)
Shenzhen Hospital (Futian) of Guangzhou University of Chinese Medicine
Shenzhen
Author response: Quality of life in patients with permanent hypoparathyroidism after thyroidectomy for benign thyroid disease: population-based study with long-term follow-up
Matilda Annebäck, Sofia Wachtmeister, Jakob Hedberg, Peter Stålberg, Olov Norlén
Correspondence to: Matilda Annebäck (email: matilda.anneback@uu.se)
Department of Surgical Sciences
Uppsala University
Fascial closure in IPOM repair: the case for long-term follow-up and clinical transparency
Ming Wang
Department of Gastrointestinal Surgery
Heze Municipal Hospital
Author response: Fascial closure in IPOM repair: the case for long-term follow-up and clinical transparency
Mikael Lindmark, Jael Tall, Bahman Darkahi, Johanna Österberg, Karin Strigård, Anders Thorell
Correspondence to: Mikael Lindmark (e-mail: mikael.e.lindmark@umu.se)
Norrlands Universitetssjukhus
1A, 9 tr, Kirurgcentrum Umeå 901 85
Assessing reinforced tension line sutures for hernia prevention: methodological considerations from the Rein4CeTo1 trial
Anshika Upasani
Correspondence to: Anshika Upasani (email: anshikaupasani11@gmail.com)
Department of General Surgery
All India Institute of Medical Sciences
Comment on: Management of bilioenteric anastomosis leakage after major liver resection
Christian Sturesson, Melroy D’Souza, Cecilia Strömberg, Ernesto Sparrelid, Stefan Gilg
Correspondence to: Christian Sturesson (email: christian.sturesson@ki.se)
Department of Clinical Science
Intervention and Technology
Surgery and the future of breast cancer care: breast cancer awareness month 2025
Matthew Lee PhD FRCS
Breast cancer is the most common cancer affecting women worldwide. It is likely that many people reading this know someone who has been affected by this condition. For many, surgery remains the cornerstone of curative treatment. Breast cancer surgery has advanced significantly since the first radical mastectomies of the late 19th century to today’s refined breast-conserving and reconstructive techniques.
Surgery remains a key component of treatment of breast cancer. For early-stage disease, removing the tumour can be enough to eradicate cancer completely. In more advanced cases, surgery is complemented by chemotherapy, radiotherapy, and hormone therapy.
The success of breast cancer surgery has not happened by chance. It reflects decades of rigorous research, often led by surgeons. Trials that once compared radical mastectomy with breast-conserving surgery laid the foundations for a global shift in practice. Randomised studies in axillary surgery demonstrated that less can be more, avoiding major complications such as lymphoedema without compromising oncological standards. The surgical research forces driving this rapid development have changed lives. They also act as an exemplar for other specialties.
Team design as innovation in perioperative care: the case of HPB anesthesiology
Julie Hallet, MD MSC, Naheed Jivraj, MD MSc
Change takes time – in all fields, including surgery. Yet, innovation is highly prized. The latest tools and technologies are celebrated and heavily invested in. But not all improvements require new technology.
For example, robotic pancreatic surgery is being adopted worldwide at a cost of millions in capital investment and ongoing expenses. Evidence shows it is mostly non-inferior to the standard of care.1–4 Another example is histotripsy for liver tumors, which has been rapidly purchased across multiple centers since FDA approval in 2023, spreading like mushrooms after the rain. Evidence is limited to technical feasibility, with no proof of superiority over standard care.5 Both technologies are used only in selected patients. By contrast, high-volume anesthesiology care for hepato-pancreato-biliary (HPB) surgery is associated with15% lower odds of 90-day major morbidity (OR 0.85, 95% CI 0.76–0.94), requires no capital investment, no recurring costs, and applies to all patients.
We are not debating or questioning the benefits of these technologies or the need to invest in new treatments. Rather, we would like to ask: if we are so willing to spend vast sums on new technology, why are we far less inclined to redesign how operative teams are organized?
Author response: Missing the split? Reconsidering the scope of biliary complications in the classification proposed at the BileducTx meeting
Hannah Esser, Iris de Jong, Floris M Roos, Robert J Porte, Stefan Schneeberger
Correspondence to: Stefan Schneeberger (e-mail: stefan.schneeberger@i-med.ac.at)
Department of Visceral
Transplant and Thoracic Surgery
Comment on: Ultra-low dose superparamagnetic iron oxide nanoparticle injection for sentinel lymph node detection in breast cancer: prospective cohort study
Lielong Yang, Yuzhou Zhu
Correspondence to: Yuzhou Zhu (e-mail: Zhuyuzhou@scu.edu.cn)
Colorectal Cancer Center
Department of General Surgery
Author response: Ultra-low dose superparamagnetic iron oxide nanoparticle injection for sentinel lymph node detection in breast cancer: prospective cohort study
Fredrik Wärnberg, Andreas Karakatsanis, Roger Olofsson Bagge
Correspondence to: Fredrik Wärnberg (e-mail: fredrik.warnberg@vgregion.se)
Department of Surgery
Sahlgrenska University Hospital
Reproductive outcomes after ileo-pouch anal anastomosis: clarifications and the importance of fertility counselling
Anders Mark-Christensen, Kirstine Kirkegaard, Mette Julsgaard
Correspondence to: Anders Mark-Christensen (e-mail: andersmark@dadlnet.dk)
Department of Surgery
Odense University Hospital
Birth rates and fertility are not the same
Eugenia Shmidt, Zoë S. Gottlieb, Marla C. Dubinsky
Correspondence to: Eugenia Shmidt (email: eshmidt@umn.edu)
Department of Medicine
University of Minnesota
Comment on: Oncological, surgical, and cosmetic outcomes of endoscopic versus conventional nipple-sparing mastectomy: a meta-analysis
Kefah Mokbel, MBBS, MS, FRCS
Correspondence to: Kefah Mokbel (email: kefahmokbel2@gmail.com)
The London Breast Institute
Princess Grace Hospital
Endoscopic mastectomy meta-analysis: commentary
Ayla Carroll, Carlos Robles, Hung-Wen Lai, Lidia Blay, Piotr Pluta, Gauthier Rathat, Guillermo Peralta, Rami Younan, Giada Pozzi, Daniel Martinez Campo, Robert Milligan, Glenn Vergauwen, Paolo Carcoforo, Antonio Toesca
Division of Breast Surgical Oncology
Candiolo Cancer Institute
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