Postoperative feeding after colorectal surgery has historically adhered to the principle of “nil per os until flatus or stool,” a practice rooted in theoretical concerns about anastomotic disruption, postoperative ileus, vomiting and aspiration. These concerns became entrenched in practice despite limited prospective evidence to support them. Over the past two decades, enhanced recovery after surgery (ERAS) programs have challenged this dogma, establishing early oral feeding as a core pathway component. This review synthesizes the physiologic rationale for early oral feeding, the clinical trial evidence supporting it, the available evidence and evidence gaps in IBD and high-risk populations, and the cognitive and system-level barriers that perpetuate delayed feeding despite modern guidelines. In general elective colorectal surgery, early oral feeding, defined as initiation within 24 h of surgery, reduces length of hospital stay and accelerates return of bowel function without increasing anastomotic leak, wound infection, pneumonia, or mortality. These findings have prompted strong guideline endorsement from major surgical societies. In IBD surgery, disease-specific randomized feeding trials are limited; however, ERAS cohort studies, systematic reviews, and expert consensus support the feasibility and safety of early oral feeding for most patients when integrated into structured care pathways. The key differentiators in IBD are the inflammatory burden of disease, steroid and immunosuppressant exposure, and the high prevalence of malnutrition and sarcopenia. These factors argue for enhanced monitoring and individualized care rather than routine delayed feeding. IBD patients also have independently higher anastomotic leak rates compared with cancer patients, though there is no evidence that delayed feeding mitigates this disease-related risk. Persistent variation in clinical practice is driven more by physician cognitive bias and system-level implementation barriers than by unresolved safety questions. For most patients undergoing colorectal surgery, including those with IBD, early oral feeding should be the default approach, with individualized modification reserved for defined high-risk scenarios. The persistent gap between evidence and practice reflects cognitive biases and system-level implementation barriers rather than genuine safety concerns. Future research should prioritize IBD-specific feeding trials in high-risk subgroups and implementation strategies that help evidence translate into clinical practice.
Oral and Maxillofacial Surgery (OMFS) has a small workforce tasked with managing a high volume of triage alongside clinical work. Large Language Models (LLMs) represent a potential route towards streamlining triage and enabling prioritisation of clinical work. LLM research is an emerging area with a relatively small evidence base within OMFS. This scoping review aims to address this by identifying and summarising studies using LLMs for triage, diagnostics and management in OMFS and allied specialities. 11 articles were included after screening 39 unique records. Diagnostic accuracy was high where synthetic cases were used (88–100
Obesity is a chronic, progressive disease driven by persistent neurohormonal and metabolic mechanisms that continue despite substantial weight loss after metabolic bariatric surgery (MBS). Although MBS remains one of the most effective treatments for severe obesity, it controls but does not cure the disease, and many patients experience suboptimal weight loss or weight recurrence over time. This review examines the evidence for obesity medications as adjunctive therapy following MBS and their role in achieving long-term disease control. Obesity medications, particularly glucagon-like peptide-1 (GLP-1) receptor agonists and newer incretin-based therapies, have emerged as an effective adjunctive therapy after MBS. The BARI-OPTIMISE trial demonstrated that liraglutide 3.0 mg produced 8.8
This review examines inefficiencies in opioid prescribing within oral and maxillofacial surgery (OMS) and explores the role of artificial intelligence (AI) in reducing overprescription while maintaining effective postoperative pain management amid the opioid crisis. Opioid prescribing in OMS has declined over the past decade, yet prescribing patterns remain inconsistent with patient analgesic requirements, with a substantial proportion of medications remaining unused and at risk for diversion. Current stewardship has variable effectiveness and contribution to treatment. AI-based approaches could demonstrate ability to predict opioid use with greater precision than traditional methods. Opioid prescribing remains constrained by generalized frameworks that fail to capture patient-level variability in pain and risk assessment. AI offers a scalable approach to individualize prescribing through data-driven prediction and real-time clinical support, reducing excess prescribing while preserving adequate pain control. Validation and careful implementation will be essential to ensure equitable, effective integration into clinical practice at a generalizable level.
Malnutrition, sarcopenia, and frailty are highly prevalent in patients with cirrhosis awaiting liver transplantation (LT) and are strongly associated with waitlist dropout, postoperative complications, and mortality. Nutritional prehabilitation has emerged as a feasible strategy to preserve muscle mass, improve functional capacity, and optimize transplant readiness. The aim of this review was to operationalize nutritional prehabilitation across the full continuum of care in patients with cirrhosis awaiting LT. Prehabilitation has emerged as a feasible and safe strategy in patients with cirrhosis awaiting LT, but the nutritional pillar remains relatively understudied. Established nutrition guidelines in cirrhosis provide a basis for nutritional prehabilitation but do not provide a structured approach to nutritional prehabilitation across the frequent transitions between outpatient, inpatient, and critical care settings. Nutritional prehabilitation should be framed as a dynamic, continuous process rather than a fixed intervention. This review provides clinicians with a practical, setting-specific roadmap to optimize nutritional care throughout the LT waitlist journey.
Pediatric heart transplantation remains the definitive therapy for children with end-stage heart failure and irreparable congenital heart disease, but remains limited by donor scarcity, lifelong immunosuppression, and non-growing valve replacement options. This review examines emerging strategies that may address these barriers. Advances in immune tolerance, including thymus-heart co-transplantation, may reduce or eliminate the need for chronic immunosuppression. Partial heart transplantation introduces living valve tissue capable of somatic growth, addressing a major limitation of existing prosthetic and bioprosthetic valves. Donation after circulatory death, normothermic regional perfusion, and on-table reanimation are expanding access to transplantable organs. Xenotransplantation and genetically engineered donor organs may further overcome donor availability constraints. These innovations suggest a transition toward a pediatric heart transplantation paradigm centered on biological integration, organ stewardship, and precision immunology. Further research is needed to define durability, immunologic consequences, feasibility, and long-term outcomes.
The purpose of this review article is to provide a comprehensive overview of xenotransplantation, including historical background, current state of the field, and future directions. In 2021, a team from NYU successfully transplanted a porcine kidney into a brain-dead recipient, with the xenograft maintaining function for the entirety of the 54-hour trial period. This was followed by several additional successful trials, culminating in 2022 with the successful transplantation of a cardiac xenograft from a 10-gene-edited pig into a human recipient with end-stage cardiomyopathy. In 2023, the same team repeated their success, with a second patient surviving for several weeks after cardiac xenotransplantation. Concurrently, a team from Massachusetts General Hospital achieved another breakthrough with the successful transplantation of a porcine kidney into a human recipient with end-stage renal disease, with the graft functioning until the patient died from other causes roughly two months later. Several exciting clinical trials are currently ongoing. The field of xenotransplantation has fundamentally evolved, from a theoretical concept marred by seemingly insurmountable hurdles, to a rapidly advancing reality that has already achieved clinical success. Progress has been driven by advances in in tissue engineering, immunology, and organ preservation. While long-term graft viability has yet to be achieved, it is likely that xenotransplantation will continue to improve and play a major role clinically moving forward. Here, we summarize the history, current status, and future directions of xenotransplantation.
To review the current data on preoperative workup, operative approach, and multi-modality therapy for cholangiocarcinoma. Essential preoperative work-up starts with a comprehensive history and physical exam, assessing the patient’s performance status. Tumor markers and cross-sectional imaging should be obtained including computed tomography (CT) of the chest, multi-phase thin-slice CT of the abdomen and pelvis and magnetic resonance cholangiopancreatography (MRCP). Additional imaging and technical considerations vary widely based on anatomic location (intrahepatic, perihilar, distal). General operative principles include resection to negative margins and performing a regional lymphadenectomy, both of which are associated with improved outcomes. After resection, most patients receive multimodality treatment with adjuvant chemotherapy. Thorough preoperative planning is needed to determine resectability for patients with cholangiocarcinoma. Multi-modality therapy should be considered, especially in the adjuvant setting, with future studies needed to evaluate the role and efficacy of neoadjuvant therapy.
To highlight the urgent need for structured international oral and maxillofacial surgery (OMS) observership programs in addressing persistent global disparities in surgical training and care, and to describe the design, implementation, and early outcomes of such a program, emphasizing its role as a timely and scalable model for global capacity-building and academic collaboration. Global disparities in OMS access persist, particularly in low- and middle-income countries (LMICs). Billions of people worldwide continue to lack access to safe, timely, and affordable surgical care, underscoring critical deficiencies in surgical workforce distribution and specialty training. Structured observership programs provide a feasible mechanism for capacity-building by offering exposure to advanced clinical systems, interdisciplinary care, and academic environments without requiring licensure. The University of Maryland OMS Observership Program demonstrates that short-term, structured international training initiatives can promote global surgical education, mentorship, and sustainable collaboration. Participants demonstrated educational advancement, professional development, and application of acquired knowledge in their home countries. Such programs represent scalable models for improving global oral health equity and strengthening the global OMS workforce.
Orthognathic surgery is a core procedure performed by oral and maxillofacial surgeons worldwide and has been described as early as 1849. Over the past several decades, this growing field of surgery has undergone multiple advancements in workflow and surgical techniques that have ultimately impacted patient experience and outcomes. Recent developments in technology and medical knowledge have allowed for changes to be made in the traditional workflows involved in this meticulous surgical field at multiple steps that focus on improving efficiency, patient communication, and ultimately patient outcomes. These developments include virtual surgical planning, patient specific implants, surgery first approaches, and the integration of artificial intelligence into the workflow. As our understanding of advancements in technology and medicine improve, we anticipate increased incorporation of these recent developments into workflows in orthognathic surgery, ultimately leading to improved patient outcomes.
This review aims to examine the current practice and future potential of artificial intelligence (AI) in plastic and reconstructive surgery. The manuscript explores AI technologies currently being utilized in clinical practice, surgical education, patient counseling and research. The goal is to identify both the opportunities and challenges posed by these innovations and consider the ethical implications. Recent studies highlight the capability of AI in improving diagnostic accuracy, surgical planning, and aesthetic outcome prediction. Machine learning algorithms are being used for automated image analysis, while AI-driven virtual assistants are enhancing patient education and preoperative communication. Furthermore, large language models are increasingly integrated into clinical decision making and medical education. Recent studies highlight the capability of AI in improving diagnostic accuracy, surgical planning, and aesthetic outcome prediction. Machine learning algorithms are being used for automated image analysis, while AI-driven virtual assistants are enhancing patient education and preoperative communication. Furthermore, large language models are increasingly integrated into clinical decision making and medical education.
This study attempts to shed light on the possibility of TA-NRP to safely and successfully increase the pool of donor lungs while preserving acceptable transplant results by synthesizing the body of available literature. In order to minimize the organ shortage and enhance the overall effectiveness of lung transplantation, it is imperative to comprehend the subtleties of TA-NRP in order to integrate it into clinical practice as effectively as possible. Lung transplantation is the most effective life-saving procedure in end-stage pulmonary diseases. The availability of life-saving lung transplantation (LTx) for patients with end-stage pulmonary illnesses is severely restricted by the ongoing scarcity of donor lungs. Although Donation after Circulatory Death (DCD) has been a popular approach to increase the number of donors, there are still worries about the possibility of more early problems and primary graft dysfunction (PGD) as a result of mild ischemia injury than with Donation after Brain Death (DBD). Thoracoabdominal Normothermic Regional Perfusion (TA-NRP), a unique DCD lung recovery approach, was developed to address these issues by restoring in-situ circulation before organ procurement, hence decreasing warm ischemia. The technical factors and donor selection standards unique to TA-NRP in lung transplantation are examined in detail in this review. Additionally, by comparing TA-NRP to other DCD lung recovery techniques, such as Direct Procurement and Preservation (DPP) and the Organ Care System (OCS), this study offers a comparative viewpoint.
Rigid support, stable epithelial lining, and vascularization are prerequisites for successful and durable long-segment tracheal reconstruction. This review critically evaluates each of the five main approaches to long-segment tracheal reconstruction using this three-prerequisite framework and highlights recent scientific and clinical advances. Aortic allografts have emerged as one of the most systematically studied techniques, with fifty patients enrolling in the prospective TRITON-01 registry between 2009 and 2025. The first and only case of single-stage long-segment tracheal transplantation was successfully completed in 2021. Autologous tissue flaps are the most widely used and reported approach, with 87 cases published between 2000 and 2025. Despite recent major advances in decellularization protocols, scaffold synthesis, and cellular seeding and conditioning, widespread clinical application of tissue-engineered tracheal grafts will require rigorous preclinical validation in large-animal models and regulatory approval. There is no clearly superior approach to long-segment tracheal reconstruction. Preclinical validation, standardized and prospective outcomes reporting, and large-sample, controlled trials are required to address this challenging clinical question.
Full thickness abdominal wall reconstruction following oncologic resection remains a complex reconstructive challenge. The standard technique of bridging mesh repair has extremely high rates of long-term recurrent hernia. Functional muscle transfer, often in combination with bridging mesh, addresses this challenge by providing vascularized muscle as a functional counterforce to intra-abdominal pressure. Oncologic safety, timing, and recipient nerve identification are important considerations. The purpose of the review is to summarize flap options, technical considerations, and outcome data for both pedicled and free functional muscle reconstruction of the abdominal wall. Options for innervated abdominal wall reconstruction generally include the latissimus dorsi and regional muscle flaps from the thigh: the vastus lateralis, gracilis, rectus femoris, and tensor fascia lata. Pedicled flaps such as the vastus lateralis offer the advantage of immediate innervation and decreased complexity compared to free tissue transfer but suffer from limitations in pedicle reach and non-synergistic innervation with the abdominal wall. The latissimus dorsi free flap benefits from a large surface area and the potential for synergistic innervation to the abdominal wall. The ability to harvest the muscle in the supine position facilitates transfer to the abdomen and avoids position change. The vastus lateralis flap has been described as both a pedicled flap with reach extending to periumbilical defects as well as a free flap to extend reach. This flap may be harvested alone or in combination with the ALT flap when skin coverage is necessary. The vastus benefits from excellent bulk and maintained function when performed as a pedicled flap but suffers from limitations in reach and orientation for many defects. The gracilis muscle is a thin flap that offers minimal donor site morbidity, excellent muscle excursion, and a reliable anatomy and has been described as both a pedicled and free flap for smaller defects. Several modifications are described to extend reach to the level of the xiphoid and increase the cross-sectional area for coverage. The rectus femoris may be used as a pedicled or free flap to reconstruct abdominal wall defects. However, given the functional morbidity in knee extension, the rectus femoris is generally not considered a first line option. The pedicled tensor fascia lata flap is suited for infraumbilical and lateral abdominal wall reconstruction whereas free tensor fascia lata flap has improved coverage of supraumbilical and larger defects in case reports in the literature. The TFL flap, similar to the vastus, provides acceptable donor site morbidity and muscle bulk, but is limited in its reach and coverage. Given the inordinately high rates of recurrent hernia in the setting of bridged mesh repair for complex full thickness defects of the abdominal wall, free or pedicled functional muscle transfer may be considered as an adjunct to bridging mesh, as it provides vascularized coverage, additional strength to the repair, and a functional counterforce to intra-abdominal pressure overtime.
This critical narrative review evaluates the current role of thermal ablation (TA) for low-risk papillary thyroid microcarcinoma (PTMC) within the contemporary de-escalation framework, with particular attention to its position relative to active surveillance (AS) and surgery. TA, including radiofrequency ablation, microwave ablation, and laser ablation, has emerged as a minimally invasive local treatment for carefully selected low-risk PTMC. Current evidence suggests that TA can achieve high rates of local tumor disappearance with low major complication rates when performed at expert centers. However, most available data remain retrospective, single-arm, and geographically concentrated. Direct high-quality comparative evidence between TA and AS is lacking, and TA does not eliminate several central management issues in low-risk PTMC, including occult multifocality, limited pathologic information, the need for continued surveillance, and dependence on operator expertise and institutional systems. TA appears best understood as a selectively deployable, center-dependent intervention rather than a replacement for AS or surgery. On the basis of current literature, its most plausible present role is in carefully selected adults with biopsy-proven, low-risk intrathyroidal PTMC who decline surgery and remain unwilling or unable to pursue long-term AS, provided treatment is delivered in a high-expertise setting with structured follow-up.
Ablative maxillary defects represent complex surgical three-dimensional problems with predictable functional and aesthetic morbidity. The reconstructive paradigm has shifted from prosthetic obturation towards microvascular free tissue transfer. This review outlines current reconstructive options taking a pragmatic approach in considering both patient and defect factors. There has been a paradigm shift in recognising that free tissue transfer provides the gold standard approach to reconstructing maxillary ablative defects. The versatility offered provides improved functional outcomes, whilst all the time increasing the possibility of subsequent oral rehabilitation with dental implants. Prosthetic obturation remains an option in selected low-volume defects and high-risk patients. Regional flaps offer a limited but often under-utilized approach. Microvascular free tissue transfer provides a reliable restoration of oro-nasal separation, midface contour, and the possibility of more advanced dental rehabilitation, and should be considered the gold standard for extensive defects.
This review will summarize the current indications and future directions for surgical resection of pulmonary metastases in patients with metastatic cancer. Minimally invasive surgical approaches have significantly improved the risk/benefit ratios in patients with metastatic cancer who are candidates for pulmonary metastasectomy. Advancements in diagnostic technologies leveraging novel, patient-specific biomarkers, in conjunction with improved oncologic systemic treatments incorporating chemotherapy, immunotherapy, and checkpoint inhibitors, have facilitated the continued evolution of surgical management in cancer patients with pulmonary metastases. Pulmonary metastases are a common occurrence in cancer patients and are associated with increased morbidity and mortality, and decreased quality of life. In select patients with cancer metastases limited to the lung, there exists a continuously evolving role for surgical resection with curative intent. Multidisciplinary teams are essential in the identification of patients who will benefit from pulmonary metastasectomy.
This review highlights recent advances in adrenal endocrine surgery and oncology, emphasizing progress in pathology, imaging, perioperative planning, and systemic therapy. In pathology, the World Health Organization recently refined the classifications of adrenocortical lesions as well as pheochromocytomas and paragangliomas. In radiology, new molecular imaging tracers and theranostics have advanced adrenal functional imaging. Novel applications of artificial intelligence and 3D anatomical modeling have also aided tumor diagnosis and adrenal surgery preoperative planning. In endocrine oncology, the expansion of tumor molecular profiling and the application of new targeted therapies has improved progression-free survival in patients with advanced pheochromocytomas and paragangliomas. Dual immunotherapy has modestly improved progression-free survival in patients with adrenocortical carcinoma. Recent changes in pathologic classification, imaging analysis, and novel applications of targeted systemic therapies have transformed care of patients with adrenal tumors, shepherding surgical and endocrine oncology into an era of precision medicine.
Acute cholecystitis (AC) is a potentially life-threatening condition whose incidence increases with age. Given the progressive increase in life expectancy, the number of elderly patients presenting with AC is expected to rise. The aim of this review is to analyze the current state of the art and future perspectives regarding management strategies and potential complications in elderly patients. Currently, there is still no clear consensus in terms of guidelines for the management of AC in the elderly. Older patients undergo conservative treatment more frequently than younger individuals. However, an increasing number of studies have demonstrated the feasibility and safety of operative management, including laparoscopic cholecystectomy, although it remains associated with higher mortality and morbidity rates compared with younger populations. Patients who are fit for surgery should undergo laparoscopic cholecystectomy, whereas those unfit for surgery should be managed conservatively and, in selected cases, with percutaneous cholecystostomy. Rather than chronological age alone, comorbidities and patient frailty are emerging as the most relevant factors for predicting mortality, overall complications, and readmission rates. Management of AC in elderly patients should therefore be considered a risk-stratified decision-making process rather than a binary choice between operative and non-operative management.
This review aims to present contemporary strategies for the evaluation and treatment of facial paralysis, with particular emphasis on postparetic synkinesis. It explores the anatomy and function of the facial nerve, mechanisms of injury, classification systems, and current management paradigms, highlighting the distinct pathophysiology and therapeutic considerations for synkinesis. Postparetic synkinesis is a common sequela of facial paralysis, best managed through a tailored, multimodal approach. In most scenarios, treatment focuses on weakening hypertonic muscles and interrupting aberrant neural pathways responsible for abnormal movements, using botulinum toxin and targeted surgical interventions, although variations in treatment exist and should be patient specific. Common procedures include selective myectomies and selective neurectomies. In certain cases, free functional muscle transfer can improve smile dynamics. Combined therapies typically offer better outcomes than single modalities. Facial paralysis management, particularly for synkinesis, requires an individualized, multidisciplinary approach integrating aesthetic and functional goals. Ongoing research and innovation continue to refine therapeutic techniques and outcome metrics, improving quality of life for affected patients.
