Scandinavian Journal of Surgery

All Nordic countries have reported a high female admission rate to medical schools over the past decades. A similar female rate is not observed among surgical specialists. The aim of this study was to report the observed female rate in admission to medical school and compare to the female recruitment rate observed in surgical training.

An observational, cross-sectional, nationwide, point-prevalence study (index year 2024) derived from registered medical students (from 2010 to 2025), number of trainees, and certified specialists’ statistics of active specialists (defined <70 years of age) in 10 surgical specialties. The national averages of female rate were compared.

The female rate of medical students was 70% (n = 3460 females; n = 1491 males) in Norway in 2024 (with stable rate since 2020 and >60% female rate since 2010). In 2024, there were a total of 9601 doctors in training across 46 medical specialties, with a female rate of 62.7% (n = 6022) of trainees. Among all trainees, some 13.6% (n = 1304) were registered in one of 10 surgical specialties, with 62.7% (n = 817) female rate. Gynecology (n = 324) stands out with >90% of the trainees being female. Excluding gynecology, the female rate of surgeon trainees drops to 53.5% (524 of 980). Even though breast-endocrine and plastic surgery have a high female rate of trainees (>80% and >70%, respectively), they make up for a relatively small actual number of surgical trainees altogether (n = 23 and n = 40, respectively). For 2024, the total number of certified surgeons (n = 3636), with 1409 (38.8%) being female, was lower than the national average for all specialties (48.9%). A considerable number of male surgeons (>30%) are approaching retirement age within the next decade.

Female rate of admission to medical school has been >60% for two decades. Female rate of trainees and specialist surgeons remains lower than the reported national average while improving in general surgery, orthopedics, and gastrointestinal surgery in terms of numbers and rate of females. Research into recruitment, retention and retirement projections is needed.

Gender balance in surgical specialization has received increased focus, as women have traditionally made up a minority in surgical specialties. Little is known about how surgical disciplines are approaching gender equity and balance in general and subspecialty surgery in Norway. The aim of this study was to explore gender distributions across surgical disciplines to investigate gender balance and changes over time.

An observational, cross-national study derived from specialists statistics on board certification in Norway. We investigated gender balance for surgical disciplines for the time period 2008 to 2024. Temporal time trends were investigated for fiscal years 2010, 2015, 2020, and 2024. Statistical analyses were done by the Poisson regression for temporal trends and gender distribution.

For the 10 surgical disciplines investigated, the total number (n) of surgical specialists increased by 33.3% during the period. Numerically, general surgery, gynecology, and orthopedics made up 72% of all surgeon specialists in 2024. The female rate increased from 20.2% to 36.2% across all surgical disciplines. The observed female rate in 2024 was the highest in gynecology (75% women) and the lowest in thoracic surgery (<10% women). Despite a significant increase (with P < 0.001) in the female rate in all specialties, only gynecology and breast-endocrine surgery achieved >50% female rate among specialist surgeons.

Considerable variation in the rate and speed of obtaining gender equity exists across surgical specialties, concerningly in some of the larger surgical specialties. Further investigations should focus on identifying and addressing factors influencing the recruitment and retention of women in surgical specializations.

Indeterminate biliary strictures, that is, a stricture with benign brush cytology but without clear etiology in clinical or radiological assessment, pose a challenge for clinicians. This study aimed to assess the incidence and risk factors for malignant disease in patients with indeterminate biliary strictures.

This is a single-center retrospective study of patients with indeterminate biliary stricture undergoing first endoscopic retrograde cholangiopancreatography (ERCP) and biliary brushing between March 2011 and March 2020. The study included patients with atypical cytology in the first ERCP biliary brushing samples. Main exclusion criteria were primary sclerosing cholangitis, apparent malignancy or tumor in imaging studies, postoperative strictures, chronic pancreatitis, biliary tract stone, and no ≥12-month follow-up or a final pathological diagnosis.

A total of 2279 patients underwent first ERCP procedure because of a biliary tract stricture during the study period, of which 51 patients (2.2%) had an indeterminate biliary stricture and were included. A total of 30 patients (58.8%) had final diagnosis of malignant disease. The patients with final diagnosis of malignant disease were mostly men (n = 19, 63.3%), had jaundice (n = 25, 86.2%), and had significantly higher bilirubin and CA19-9 values than those with benign disease. A total of 25 patients were operated on, of which 21 patients (84%) had malignant disease. Twenty-six patients were followed up only, of whom nine patients (34.6%) had a malignant disease.

Indeterminate biliary strictures are uncommon, but two-thirds of the initially indeterminate biliary strictures are malignant. The presence of clinical jaundice and elevated bilirubin and CA19-9 values are associated with increased risk of malignancy.

Long-term studies exploring factors associated with glycemic control of type 2 diabetes mellitus (T2DM) after bariatric surgery are being requested. This prospective cohort study aimed to evaluate potential predictors of long-term glycemic control 5 years after surgery.

Patients were operated between 2002 and 2014. Data were collected prospectively in a database after obtaining written informed consent from the patients. Surgical methods were sleeve gastrectomy (SG) or biliopancreatic diversion with duodenal switch (BPDDS). Possible predictors of postoperative long-term glycemic control (HbA1c) were investigated using multiple path regression analysis, which handles missing data.

A total of 181 patients were included consecutively, 87 after SG and 94 after BPDDS. The follow-up rate was 124/181 (69%), 57 (66%) after SG and 67 (71%) after BPDDS. We found that 39/57 (68%) of the patients who underwent SG and 54/67 (81%) of the patients who underwent BPDDS had remission of T2DM at 5 years. Lower preoperative HbA1c (P < 0.010), higher preoperative C-peptide (P = 0.004), greater percent total weight loss (P < 0.005), and the BPDDS procedure (P < 0.001) were associated with better postoperative long-term glycemic control (explained variance = 39.4%).

Both procedures, especially BPDDS, were effective in achieving long-term glycemic control. Lower preoperative HbA1c, higher C-peptide levels, greater weight loss, and the BPDDS procedure were key predictors of better long-term glycemic control.

Current international guidelines recommend a center volume of at least 20 minimally invasive pancreatic procedures a year to perform laparoscopic left pancreatectomy. Iceland is a small, isolated country that is unavoidably low volume in terms of pancreatic surgery. To ensure good quality of care, there is a long tradition of surgeons training abroad, but this system has not been formally evaluated. The aim of this study was to evaluate the outcomes of laparoscopic and open left pancreatectomy over the last 20 years in Iceland.

This was a national retrospective cohort study including all patients who underwent left-sided pancreatic resection in Iceland from 2003 to 2022.

A total of 244 patients underwent a pancreatic procedure during the study period. Eighty of these underwent left-sided resections, 41 of whom had a laparoscopic left pancreatectomy (LLP). Resection rates increased over the study period, and a significantly larger proportion of patients underwent LLP in the latter half of the study period. The laparoscopy group had statistically significantly lower rates of splenectomy (<0.001) and blood loss (<0.001) compared with open surgery. The morbidity rate of severe complications (Clavien–Dindo grade IIIa or higher) was 23%. The in-hospital and 90-day mortality rates were 1% and 4%, respectively.

Overall, the operative and postoperative outcomes of left-sided pancreatic resections in a low-volume setting in Iceland were comparable to current reported studies from other Western countries.

NCT06738914.

Retrospective cohort study.

In orthopedic surgery, the use of antibiotic-impregnated spacers is a well-established method for treating periprosthetic joint infections with excellent outcomes. However, their application in head and neck surgery remains poorly documented, despite the high susceptibility of these patients to persistent infections. The objective of this study was to evaluate the 10-year outcomes of antibiotic spacers in the treatment of persistent mandibular infections unresponsive to conventional methods, prior to definitive reconstruction.

We retrospectively reviewed patients with persistent mandibular infections treated with antibiotic-impregnated spacers between 2014 and 2023. Patient characteristics, surgical details, infection type, and clinical outcomes were assessed. The two-stage surgical protocol was described.

Seven patients (mean age 49 years, range 20–77) were included. Six had undergone complex mandibular reconstructions for malignant tumors (n = 3), benign tumors (n = 1), or congenital anomalies (n = 2). One patient had osteomyelitis of the jaw with extensive necrosis. Following spacer placement, complete resolution of infection occurred in 3/7 patients, a transition to non-suppurative infection in 3/7, and suppurative infection in 1/7. On average, infections recurred 5 months postoperatively. All infections resolved by the time of spacer removal, allowing definitive reconstruction.

Antibiotic-impregnated spacers appear to be a promising adjunct in managing persistent mandibular infections, facilitating successful permanent reconstruction in complex head and neck cases.

The prognosis of differentiated thyroid cancer (DTC) is good, and radical surgery has been questioned, especially for small tumors. Size alone cannot, however, predict prognosis. Recurrences occur after several decades, and other risk factors should be included when deciding on an optimal treatment strategy.

A consecutive series of 231 patients with DTC were treated in 2004–2016 at Borås Hospital in Sweden. Follow-up was performed in 2023, after a mean of 10.7 years (range = 6.5–19.1). Data on type of surgery, adjuvant radioiodine treatment, thyroglobulin levels, deaths, and recurrences were collected. Patients with negative thyroglobulin levels after treatment were compared with those who had measurable thyroglobulin or high levels of anti-thyroglobulin.

In 63/231 patients (27.3%), there was no preoperative suspicion of malignancy, 214 (92.6%) patients underwent total thyroidectomy, and the complication rate was low. There were 181 patients (84.6%) with negative thyroglobulin after treatment, and 33 patients (14.3%) with measurable thyroglobulin and/or anti-thyroglobulin levels. Fifteen patients died from thyroid cancer, and all were in the latter group. Risk factors for recurrence were tumor size, vascular invasion, extra-thyroidal growth, lymph node metastases, and male sex. Multifocality was frequent (32.5%) and patients with bi/multifocal cancers had significantly more lymph node metastases. Ten patients with recurrences had at least two of the identified risk factors.

Total thyroidectomy or hemithyroidectomy in DTC is recommended, preferably including the central lymph node clearance. Total thyroidectomy has the advantage of allowing follow-up with thyroglobulin measurements to detect recurrences in time for treatment.

This study investigated patients with type B aortic dissection (TBAD) who were treated with thoracic endovascular aortic repair (TEVAR). The aim was to study whether patients who needed secondary aortic intervention (SAI) had worse survival than patients who did not require SAI after the initial TEVAR.

Data were collected from the National Care Register for Health Care (CRHC) at the Finnish National Institute for Health and Welfare. All Patients over 15 years of age with TBAD (ICD-10; I71.01) treated with TEVAR during the years 2000–2019 were included in the study. Data were collected retrospectively. A data search of the Official Statistics of Finland Cause of Death registry was carried out to identify the date and cause of death in patients with TBAD.

236 patients with TBAD received TEVAR as primary operative treatment from year 2000 to 2019. SAI after initial TEVAR was performed in 45 (17%) patients during median follow-up time of 5.1 years. There was no significant difference in survival between the patients who underwent primary TEVAR alone and those who required additional SAI (p = 0.063). Age-adjusted survival did not differ between the groups either. Median follow-up time was significantly longer in the SAI group compared to patients with no SAI (5.9 vs 4.9 years, p = 0.047). The most common cause of death in both groups was an aortic-related event (47%).

Based on this study, SAIs may not impair the overall survival of patients previously treated with TEVAR for TBAD. Systematic follow-up after the initial TEVAR may be beneficial in identifying patients with TBAD who may require secondary operation.

Arteriovenous access ischemic steal (AVAIS) is a rare complication that causes morbidity and threatens hemodialysis access usability in patients with end-stage kidney disease (ESKD). This study aimed to determine the incidence of AVAIS over a 15-year period and assess the access usability after surgical correction.

Access operations between January 2007 and August 2022 at Helsinki University Hospital were reviewed. Demographics, clinical, duplex, and contrast examinations with brachial artery volume flows, finger pressures, and delays to surgery were evaluated. Symptom relief, complications, access closures/re-interventions, primary, secondary, and functional patencies were assessed. Endpoints were permanent cessation of access use due to complication(s), transplantation, closure, definitive occlusion, or death.

Among 2914 access-related operations, the overall incidence of AVAIS was 2.2%. At the first vascular consultation 52% had ulcer(s) or gangrene(s) resulting in 28 direct closures, and 30 corrections as follows: 20 proximalization of arterial inflow (PAI), 6 flow reduction procedures, 2 distal revascularization with interval ligation (DRIL), 1 distal radial artery ligation (DRAL), and 1 venous bypass. The median time from consultation to surgery was 18 days (range: 0–348 days) for direct closures and 43 days (0–170 days) for corrective surgery. The functional patencies after correction were 60% at 1 year and 55% at 2 years; the primary patencies were 45% and 28% and secondary patencies 61% and 57%, respectively. The functional patencies after PAI were 41% and 31%, respectively.

In AVAIS, access preservation is challenging in ESKD patients with multiple diseases. Attention should be paid to the original choice of vascular access by considering each patient’s risks. Delay to vascular consultation and intervention should be minimized. PAI should be reserved for selected patients when no other option is preferable.