https://ijs.ir/ Iranian Journal of Surgery en daily 1 Wed, 01 Oct 2025 00:00:00 +0330 Wed, 01 Oct 2025 00:00:00 +0330 https://ijs.ir/article_731114.html Background and Objective: Acute appendicitis is traditionally treated with operative approaches. Thelatest progress in diagnostic techniques has coincided with the introduction of novel non-invasive treatmentoptions. Original studies on this subject indicate that non-operative management of acute appendicitis in thechildren population is feasible. This review explores current literature on the efficacy, safety, and long-termoutcomes of non-operative treatments and gives an overview of this management method.Materials & Methods: In the pursuit of conducting this narrative review, a systematic search wasperformed utilizing the Scopus, Embase, ISI, and Google Scholar databases. The inclusion criteria comprisedoriginal articles, review papers, and meta-analyses that focus on the non-surgical treatment of acuteappendicitis in the pediatric population. This investigation adopted a descriptive-analytical approach. Allpertinent literature was meticulously evaluated, and data were carefully extracted; the findings and insightsobtained from these sources were subsequently incorporated into various sections of this review.Results: Non-operative management has been reported to have a lesser length of hospital stay and abetter patient satisfaction rate in comparison to operative management. Key factors in selecting theappropriate patients for non-operative management include younger age, lesser symptoms and feverdurations, mild clinical presentations, lower white blood cell and CRP levels on laboratory studies, and lowerappendix diameter on imaging. Further Randomized Controlled Trials with longer follow-up durations andsimilar antibiotic administration are required to address the heterogeneity of previous research.Conclusion: Existing evidence from previous studies advocates for the non-surgical management ofuncomplicated acute appendicitis in children. However, it is imperative to establish comprehensiveguidelines for patient selection. Such guidelines are essential to mitigate the risk of misdiagnosis and toprevent the occurrence of serious complications stemming from inadequate management. https://ijs.ir/article_732420.html Geriatric age usually begins after 65, which slowly and steadily the elderly starts a decline physiologically in all his vital organs, in the heart myocyts decrease in number and fibrosis and fat replaces it, so the elderly developes conduction problems, cardiomegaly due to replacement of fat, Contraction of ventricles decreases, and atrial loose its Kick and pulmonary congestion ensues. The lungs also loose elasticity and loss of alveoli and as a result poor oxygen intake. The brain decreases its cognitive function and memory loss; and may develop delirium post operatively, the immune system gets short of B-cells and T-cells and gets prone to infection post surgery. Usually elderlies have co-morbid diseases, such as malignancy, diabetes, severe arthrosis. Cataract and heart and lungs problems; prostatism, fracturs that all together makes it a difficult postop course. https://ijs.ir/article_731119.html Background and Objective: Breast cancers that overexpress the HER2 receptor tend to exhibit moreaggressive behavior compared to other breast cancer subtypes. As a result, HER2 status plays a critical rolein prognosis and treatment planning. Recently, increasing attention has been given to differences amongHER2 -Negative cases, which include three subgroups: 0, 1+, and 2+ (with Negative results on FISH or CISHtests), collectively referred to as “HER2-low.” Emerging evidence suggests that these subgroups may differbiologically. This study aimed to investigate the clinical and pathological characteristics of these three HER2-Negative subgroups, with a particular focus on tumor features.Materials & Methods: This retrospective, cross-sectional analytical study included data from 3,745patients with HER2-Negative breast cancer. Categorical variables were analyzed using the Chi-Square test,while continuous variables were assessed based on normality with appropriate test.Results: The mean age of the patients was 50.96 ± 11.37 years. Comparative analysis showed thatpatients in the HER2-intermediate ISH-Negative group were significantly younger than those in the othertwo groups (p = 0.03). Tumor size was smaller, and the mean Ki-67 index was higher in this group comparedto the others (p < 0.001). Additionally, grade 3 tumors (22.1%), positive surgical margins (9%), andmetastasis (11.1%) were more common in the HER2-intermediate ISH-Negative group. This group also hadthe highest recurrence (26.1%) and mortality rates (24.7%). Conversely, the HER2-zero group had the largestaverage tumor size (28.74 ± 19.59 mm), the highest lymph node involvement (53.2%), and the greatestincidence of lymphovascular invasion (58.6%). The HER2-low 1+ group appeared to be the least aggressive,showing the lowest rates of grade 3 tumors (13.7%), positive margins (4.3%), and recurrence (11.5%).Regarding treatment, the majority of HER2-zero and HER2-low 1+ patients received adjuvant chemotherapy(62.3% and 51.3%, respectively), while neoadjuvant chemotherapy was more commonly administered topatients in the HER2-intermediate ISH-Negative group (52%).Conclusion: Based on the findings of this study, patients in the HER2-intermediate ISH-Negative groupexhibited more aggressive tumor characteristics and poorer outcomes compared to the other HER2 -Negative subgroups. In contrast, the HER2-low 1+ group demonstrated the most favorable prognosis. Theseresults suggest that patients with HER2-intermediate ISH-Negative status may benefit from closermonitoring and more frequent follow-up to improve clinical outcomes. https://ijs.ir/article_731120.html Background and Objective: Genetic mutations in Familial Mediterranean Fever (FMF) directly causeinflammation and activation of the body's immune system. These inflammations often occur in various areasof the body, including the abdomen, and may resemble symptoms of appendicitis. In many cases, theseabdominal inflammations recur, and at times, it can be challenging for physicians to determine whether theinflammation is due to appendicitis or FMF. Therefore, the present study was conducted to address this gapand aimed to determine the correlation between the type of mutations and the decision to performappendectomy in patients under 18 years old with FMF.Materials & Methods: This descriptive cross-sectional study was conducted at Ardabil University ofMedical Sciences, involving patients with Familial Mediterranean Fever who presented to the emergencydepartment of Kowsar Hospital in Ardabil. Data were collected from the clinical records of the patients andsystematically analyzed. Between March 2023 and September 2024, 120 patients under 18 years old whovisited the emergency department were included in the study. Information regarding age, gender, type ofmutation, and previous surgical history was collected, and the relationships between demographic andclinical variables with treatment outcomes were assessed.Results: Among the 120 patients with FMF, only 14 (11.67%) underwent appendectomy. The patientswere divided into two groups based on whether they had undergone appendectomy or not, and thefrequency of appendectomy was compared according to the type of genetic mutation. The results showed nosignificant difference between the two groups regarding the type of mutation (P=0.7), meaning that differentmutations did not influence the decision to perform appendectomy in these patients.Conclusion: This study concludes that in patients with Familial Mediterranean Fever, different geneticmutations do not have a significant impact on the decision to perform appendectomy. These findingshighlight the importance of considering other clinical factors, such as medical history, immune status, andclinical signs, when making treatment decisions. https://ijs.ir/article_731132.html Background and Objective: Hemodialysis through temporary catheters in the femoral vein is essentialfor patients with End-Stage Renal Disease (ESRD) requiring urgent vascular access. This study evaluates theefficacy and safety of two different catheter lengths (20 cm and 24 cm) to determine the optimal clinicalchoice. The aim is to compare two catheters in an effort to identify one with lower malfunction rates,reduced infection incidence, and improved long-term efficacy in ESRD patients.Materials & Methods: In this randomized controlled clinical trial, 80 ESRD patients in need oftemporary hemodialysis were randomly assigned to receive either a 20 cm or 24 cm femoral catheter.Patients were monitored over two weeks for catheter performance and complications, including infection,thrombosis, and hematoma.Results: Among 80 patients (53 men [66.25%], 27 women [33.75%]), the mean age was 52.5 ± 13.7 yearsin the 20 cm group and 56.0 ± 12.9 years in the 24 cm group. Demographics were statistically similar. Themost common complication was thrombosis (23.75%); observed in 17.5% of the 20 cm group and 30% of the24 cm group. Infections occurred in 20% of the 20 cm group and 12.5% of the 24 cm group. Hematomas wereseen in 20% of the 20 cm group and 7.5% of the 24 cm group. Catheter functionality at two weeks was 65% inthe 20 cm group and 60% in the 24 cm group (P = 0.712).Conclusion: Both catheter lengths demonstrated similar performance and complication rates over thetwo-week period. Catheter selection can beindividualized based on patient-specific factors, as both sizesoffer acceptable efficacy and safety profiles. https://ijs.ir/article_731133.html Background and Objective: Evaluating the effects of nutritional prehabilitation on postoperativecomplications in patients with esophageal cancer can not only contribute to optimizing clinical outcomes butalso represents a key step toward evidence-based care and reducing variability in current treatmentpractices. This systematic review and meta-analysis aimed to critically analyze the existing evidenceregarding the impact of preoperative nutrition-based prehabilitation on the severity of postoperativecomplications in patients with esophageal cancer.Materials & Methods: This systematic review and meta-analysis, conducted in accordance withPRISMA guidelines, aimed to assess the effects of preoperative nutrition-based prehabilitation—with orwithout adjunctive physical and psychological interventions—on the severity of postoperative complicationsin patients with esophageal cancer. A comprehensive literature search was conducted in five internationaland two Iranian databases up to September 2025. Only randomized controlled trials (RCTs) were included.Nutritional prehabilitation was defined as the administration of oral supplements or enteral nutrition for aminimum of 7 days, and some studies also incorporated physical training and psychological support. Dataextraction, quality assessment, and statistical analyses were performed independently by two reviewers.Risk ratios (RR), weighted mean differences (WMD), and I² statistics for heterogeneity were used for datasynthesis. Analyses were conducted using RevMan software, and a p-value of <0.05 was consideredstatistically significant.Results: Five RCTs involving a total of 405 patients were included in this systematic review and metaanalysis.The pooled analysis demonstrated a significant reduction in the incidence of severe postoperativecomplications in favor of preoperative nutritional prehabilitation (RR = 0.66, 95% CI: 0.48–0.92). Similarly, acomparable reduction was observed in studies employing multimodal prehabilitation (RR = 0.69, 95% CI:0.49–0.97).Conclusion: The findings of this systematic review and meta-analysis suggest that preoperativenutrition-based prehabilitation—particularly when implemented as part of a multimodal program—caneffectively reduce the severity of postoperative complications in patients undergoing surgery for esophagealcancer. Nutritional interventions should be considered an essential component of preoperative care in thispatient population. https://ijs.ir/article_731135.html Background and Objective: Pancreatic cancer is one of the most deathly malignancies, which causesmany deaths in Iran and the world every year. Despite advances and new information about cancers,pancreatic tumors can be diagnosed with different clinical and laboratory symptoms. Therefore, this studywas conducted with the aim of investigating the clinical and paraclinical findings of patients withperiampullary and pancreatic head tumors.Materials & Methods: In this retrospective cross-sectional study, patients with mass in pancreatichead and periampullary region who underwent surgery at Imam Khomeini Hospital in Tehran between 2011and 2016 were included in the study according to the inclusion and exclusion criteria. By using the patients'medical records, personal information including age, sex, history of alcohol consumption and presentationsymptoms of the patients were recorded. Then laboratory and imaging findings (CT scan and ultrasound) aswell as the histopathological types of resected tumor were collected based on the pathology report.Results: This study included 65 patients; the frequency of men (67.6%) was higher than women(32.4%). The mean age of the patients was 60.6 years. No underlying disease was reported and there was ahistory of alcohol consumption in 18 patients (27.6%). Jaundice was the most common complaint in allpatients and diarrhea was the least common symptom (12 patients). The mortality rate was 4.6%. The meantotal bilirubin level was 13.4±3.3, and most of the patients (44 people) had higher than 8. The mean of directbilirubin was 10.9±2.2, which was more than 8 in most patients (39 people). The mean of alkalinephosphatase, PT, AST and ALT were also increased and were higher than the normal range. Abdominalultrasound was performed in all patients, which showed dilatation of intra- and extra-hepatic ducts. Otherimaging findings included pancreatic head lesions, gallbladder enlargement, and hepatic metastases. CTscan, which was performed in 45 cases, showed similar findings with hypodense foci in the pancreas andhepatic metastases. The most common histopathology observed in the present study was adenocarcinoma(34 patients, 52.3%), while serous adenoma cyst was reported in only one patient (1.5%).Conclusion: The findings of the present study showed that the prevalence of pancreatic cancer ishigher in older and men patients. Also, jaundice and dilation of both intra- and extra-hepatic ducts were themost common clinical and paraclinical findings, respectively. Also, increased bilirubin and alkalinephosphatase are common laboratory symptoms in patients, and adenocarcinoma is the most reportedpathology in pancreatic cancer patients. https://ijs.ir/article_731136.html Large adnexal cystic masses, particularly in elderly patients, pose significant diagnostic and therapeuticchallenges. In this report, we present the case of a 71-year-old woman with a complex 10-kg adnexal cysticmass suspected to be either cystadenoma or cystadenocarcinoma. The patient experienced progressiveabdominal pain, distention, dyspnea, and functional impairments such as difficulty walking and sleeping overa six-month period. Laboratory tests revealed a marked elevation of tumor markers CA-125 and CA-19-9,supporting the suspicion of malignancy. Abdominopelvic CT scan confirmed the presence of a large septatedcystic mass extending into the upper abdomen. The patient underwent total abdominal hysterectomy withbilateral oophorectomy, and the 10-kg mass was successfully excised without complications. Postoperatively,she was referred to an oncologist for additional evaluation and further management. This case highlights theimportance of early diagnosis, meticulous surgical planning, and multidisciplinary management of largeadnexal masses. https://ijs.ir/article_731137.html Polyurethanes are a broad family of polymers. These materials have a significant position in the medicalindustry. The use of polyurethanes is unlimited. But it should be kept in mind that polyurethanes are actuallythe best materials for producing devices for specific applications (Figure 1). Accordingly, we provide anoverview of some applications, which may not be exhaustive, but focus on specific processes, debatableresults, and potential for future developments.Cardiac surgeons' equipment shows no significant role for polyurethanes in intra-aortic balloons, bloodbags for ventricular assist devices (VADs), catheters, and pacemaker leads as the most important. The resultsof testing polyurethanes as blood vessels are not yet complete due to the lack of long-term resistance todegradation. Breast implants covered with PU foam are part of the scientific debate. The use of polyurethaneis limited, but these materials have interesting properties. Cardiac dressings and tissue engineering scaffoldsenable new developments. https://ijs.ir/article_731138.html John Syng Dorsey (1783–1818), the nephew of Philip Syng Dorsey, commenced his medicalapprenticeship under the guidance of his uncle. During his tenure in his uncle’s practice, Dorseyattended classes at the University of Pennsylvania, where he earned his medical degree in 1802. In1803, he embarked on a journey to London and Paris to further enhance his education. Upon hisreturn to the United States, he established a medical practice in Philadelphia and, in 1807, wasappointed as a professor of surgery at his alma mater. Shortly thereafter, he was designated as asurgeon at Pennsylvania Hospital. https://ijs.ir/article_731139.html Background and Objective: Medical errors are defined as negligence or mistakes in planning orexecution that lead to unintended results or complications. This study aimed to investigate complaintsfollowing vascular surgeries referred to forensic medicine in Fars province from 1387 to 1397.Materials & Methods: This retrospective analytical study reviewed all complaints related to vascularsurgeries across various fields, including surgery, orthopedics, urology, gynecology, ENT, maxillofacialsurgery, general practitioners, and specialists. Data were collected from files at the General Directorate ofForensic Medicine of Fars province.Results: The study examined 59 complaints related to vascular surgeries, involving 33 men (55.9%) and25 women (42.4%). The suspects included 42 men (71.2%) and 7 women (11.9%). Complainants typically hadprimary education and were self-employed, while suspects generally had specialized education. Thefrequency of complaints against vascular surgery malpractice increased annually, with all cases beingprovincial or re-provincial. Of the cases reviewed, 37 were acquitted, and 21 were convicted, representing35.6% of the cases. Public hospitals were the most frequently mentioned sites of malpractice, followed byprivate hospitals and board of trustees’ hospitals. The most common cause of complaint was patient death,accounting for 27 cases.Conclusion: The study of medical malpractice cases related to vascular surgery from 1387 to 1397revealed that most complainants had low educational levels, while suspects had higher education levels.Most complainants and suspects were male. Complaints primarily involved public hospitals, followed byprivate hospitals. Patient death was the most common complication associated with medical malpractice,followed by treatment complications. After review by the primary and re-provincial commissions, mostsuspects were acquitted, with about one-third convicted of malpractice. https://ijs.ir/article_731140.html Within the domain of epidemiology, the term "incidence" denotes the number of newly diagnosed casesof a disease occurring within a defined population over a specified period.