https://www.caspjs.com/ Caspian Journal of Surgery en daily 1 Sun, 01 Mar 2026 00:00:00 +0330 Sun, 01 Mar 2026 00:00:00 +0330 https://www.caspjs.com/article_735168.html Surgical procedures, while crucial for physical healing, often impose substantial psychological stress on patients, impacting recovery and overall well-being. This editorial advocates for a paradigm shift towards integrating mental health support throughout the surgical journey. It highlights the prevalence of perioperative psychological challenges, including preoperative anxiety and postoperative mood disturbances, and their detrimental effects on clinical outcomes. The piece emphasizes the necessity of a multidisciplinary approach, incorporating systematic psychological screening, enhanced patient communication, optimized pain management, and robust postoperative support. By moving beyond a purely biomedical focus, healthcare providers can foster holistic patient recovery, improve satisfaction, and ultimately enhance the effectiveness of surgical interventions. https://www.caspjs.com/article_735314.html Background: Carpal tunnel syndrome (CTS) is one of the most prevalent entrapment neuropathies of the upper extremity. Hydrodissection, a technique guided by ultrasound, has gained increased interest in the last decade for managing entrapment neuropathies. However, the comparison of ultrasound-guided hydrodissection versus open surgery for the treatment of CTS remains challenging due to uncertainty in current findings from limited studies. This trial compared the effects on function and severity of ultrasound-guided hydrodissection with methylprednisolone against open surgery in patients with moderate-to-severe CTS.Methods: In this randomized parallel-group, single-blinded clinical trial, 46 patients with CTS aged 20 to 65 were randomly allocated to either hydrodissection (injection of methylprednisolone, n=23) or open surgery (n=23) group. The functional status and severity scores of the Boston Carpal Tunnel Questionnaire (BCTQ) were the primary outcome and were assessed at baseline and one and three months after each intervention. Results: 44 patients, with a mean age of 48±10.3, successfully completed the study. Adjusting for baseline outcomes, the mixed model ANCOVA did not reveal significant Group*Time interactions for either severity (F=1.006; P=0.330; ηp2 =0.056) nor function (F=0.856; P=0.368; ηp2 =0.048) scales of the BCTQ. Both groups experienced similar improvements in both severity (one month: Δ0.1, 95%CI -0.4 to 0.6; three months: Δ0.4, 95%CI -0.25 to 1.05) and function (one month: Δ0.25, 95%CI -0.3 to 0.8; three months: Δ0.5, 95%CI -0.2 to 1.2) outcomes.Conclusions: This clinical trial showed that ultrasound-guided methylprednisolone hydrodissection and open surgery were similarly effective in moderate-to-severe CTS patients in the short term. https://www.caspjs.com/article_735334.html Background: Colorectal cancer surgery improves outcomes but often leads to long-term physical and psychosocial challenges for patients and families. Limited evidence exists on the relationship between postoperative quality of life (QoL) and spousal caregiver burden, especially in non-Western settings. This study aimed to assess the QoL of colorectal cancer patients post-surgery and examine its association with the psychological burden experienced by their spouses.Methods: This descriptive cross-sectional study recruited 99 colorectal cancer patients and their spouses from two hospitals in northern Iran in 2023. Patients’ QoL was measured using the WHO Disability Assessment Schedule II (WHODAS II), and caregiver burden was assessed using the Zarit Burden Interview (ZBI). Adults with confirmed colorectal cancer living with a caregiving spouse were included; those with severe cognitive impairment or incomplete data were excluded. Associations were analyzed using Pearson correlation and Chi-square tests.Results: The patients’ mean age was 61.84 ± 12.10 years, while spouses averaged 51.14 ± 13.12 years. The majority underwent anterior resection (55.6%) or low anterior resection (30.3%). Patients reported moderate disability (mean WHODAS II score 22.20), particularly in social participation. The average caregiver burden was 6.98. Significant correlations existed between social participation difficulties and caregiver burden (r=0.308, p=0.002) and communication difficulties (r=0.202, p=0.045).Conclusion: Postoperative QoL among colorectal cancer patients was suboptimal, with lower QoL associated with higher caregiver burden. These findings underscore the need for family-centered care and support strategies for caregivers. https://www.caspjs.com/article_735735.html Background:Depression is highly prevalent in patients following coronary artery bypass graft (CABG) surgery and negatively affects recovery and prognosis. Selecting an appropriate antidepressant in this cardiac population remains a clinical challenge.Objective:This study aimed to compare the efficacy and safety of bupropion versus escitalopram in the treatment of major depressive disorder (MDD) in post-CABG patients. Both medication have limited cardiac side effects and drug intraction.Methods:In a double-blind, randomized controlled trial, 100 patients diagnosed with post-CABG depression based on DSM-5 criteria were assigned to receive either bupropion (150–300 mg/day) or escitalopram (10–20 mg/day) for 8 weeks. Depression severity was assessed using the Hamilton Depression Rating Scale (HAM-D) and the Beck Depression Inventory-II (BDI-II) at baseline, and after 2, 4, and 8 weeks of treatment. Primary outcome was change in HAM-D score; secondary outcome was change in BDI-II.Results:Both groups demonstrated significant improvements in depression scores over time. At week 8, mean HAM-D scores decreased from 15.8 to 8.1 in the bupropion group and from 16.3 to 7.8 in the escitalopram group (p > 0.05). Similar patterns were observed in BDI-II scores. No serious adverse events were reported.Conclusion:Following cardiac surgery, the risk of developing symptoms of depression and anxiety is high. Identifying and determining of suitable medication with low cardiac vascular side effects and interaction is helpful in clinical decision making for physician. Both tracs were equally effective and well-tolerated in treating post-CABG depression. The findings support flexible antidepressant selection based on individual patient profiles. https://www.caspjs.com/article_736958.html Background: Lumbar intervertebral disc herniation and degenerative disc disease have traditionally been considered consequences of mechanical stress and degenerative changes. This study aimed to evaluate the microbiological profile and antimicrobial resistance patterns of bacteria isolated from extruded lumbar disc specimens obtained from patients undergoing lumbar discectomy.Methods: In this cross-sectional study, 115 patients undergoing lumbar discectomy were evaluated. Demographic data, clinical characteristics, and MRI findings were recorded. Disc samples were collected intraoperatively under sterile conditions and immediately transported for microbiological analysis. Specimens were homogenized and cultured on blood agar, MacConkey agar, and thioglycollate broth under aerobic and anaerobic conditions at 37°C. Isolated colonies were identified using standard microbiological techniques. Antimicrobial susceptibility testing was conducted according to CLSI guidelines, and multidrug resistance patterns were assessed.Results: The mean age of patients was 44.7 ± 5.76 years, and 60% were male. Spondylolisthesis (38.3%) was the most frequent MRI finding. Microbiological analysis revealed no bacterial growth in 62.6% of samples. Among positive cultures, anaerobic bacteria (9.5%) were the most common isolates, followed by coagulase-negative staphylococci (6.1%) and diphtheroids (6.1%). Antimicrobial susceptibility testing demonstrated multidrug resistance patterns, particularly among E. coli and P. aeruginosa, with concerning carbapenem resistance observed in Pseudomonas isolates. Conclusion: The observed antimicrobial resistance patterns highlight potential clinical concerns. These findings support the hypothesis that bacterial involvement may contribute to disc pathology in a subset of patients; however, further large-scale studies using advanced molecular techniques are required to clarify causality. https://www.caspjs.com/article_735571.html AbstractBackground: Surgical site infections (SSIs) are common healthcare-associated infections that increase mortality, prolong hospital stays, and impose substantial economic costs.Aim: This review aims to clearly summarize the current evidence on the definition, classification, risk factors, common pathogens (including multidrug resistant organisms), and principles of management and prevention of SSIs, with emphasis on global guidelines to reduce infection related morbidity.Key findings: SSIs occur within 30 days post surgery and are classified as superficial incisional, deep incisional, or organ/space. Risk factors include patient related (smoking, obesity, age) and procedure related (prolonged surgery, implants, contamination) variables. Staphylococcus aureus and methicillin resistant S. aureus (MRSA) are predominant pathogens. Management involves surgical exploration, microbiological sampling, and appropriate antibiotic therapy. Prevention strategies are outlined in WHO based recommendations.Conclusion: Improving post discharge surveillance, validating risk tools, and conducting high quality trials on dressings and negative pressure therapy are future priorities. A multidisciplinary approach is essential for better outcomes. https://www.caspjs.com/article_733798.html Biliary ileus is a rare but notable cause of mechanical intestinal obstruction, often seen in patients with a history of gallbladder disease. This image captures the intraoperative removal of a gallstone that had impacted in the ileum, obstructing the bowel. The case highlights the diagnostic and surgical importance of recognizing biliary ileus in the context of small bowel obstructions. https://www.caspjs.com/article_735572.html Background:Paraneoplastic neurological syndromes (PNS) are rare immune-mediated disorders associated with malignancies, often preceding or complicating cancer diagnosis and treatment. Among them, paraneoplastic cerebellar degeneration (PCD) is a severe subtype.Case Presentation:A 41-year-old woman with high-grade serous ovarian carcinoma developed progressive cerebellar symptoms including dizziness, diplopia, gait instability, and dysarthria approximately two months after initiation of neoadjuvant carboplatin/paclitaxel chemotherapy. Neurological examination revealed nystagmus, positive Romberg test, and ataxic gait. Brain and spinal MRI were unremarkable. Differential diagnoses including cerebellar stroke, multiple sclerosis relapse, chemotherapy-induced neurotoxicity, and metabolic encephalopathy were excluded. Although onconeural antibody testing (Anti-Hu, Anti-Yo, Anti-Ri, and Anti-Ma2) was not available, the clinical presentation supported a probable diagnosis of PNS. The patient received high-dose intravenous immunoglobulin (0.4 g/kg/day for 5 days), corticosteroids (methylprednisolone 1 g/day for 5 days), and plasmapheresis, resulting in partial neurological improvement.Outcome:Following cytoreductive surgery and continuation of oncologic management, gradual improvement in neurological symptoms was observed over four months, although residual gait impairment persisted.Conclusion:PNS should be considered in patients with ovarian cancer presenting with unexplained neurological symptoms despite normal imaging. Early recognition and immunotherapy may improve outcomes. https://www.caspjs.com/article_736903.html Introduction:Retrorectal tumors are rare and often present with nonspecific symptoms, leading to delayed diagnosis. Epidermoid cysts constitute an uncommon subgroup of retrorectal lesions and are typically benign; however, they may rarely undergo malignant transformation or develop secondary to trauma or surgery.Case Presentation:We report a very rare case of a retrorectal epidermoid cyst in a 66-year-old man that developed following a fistulectomy. The patient presented with an erythematous bulge in the sacrococcygeal region associated with mild tenderness and a palpable mass on the right side of the rectum. Imaging studies revealed a retrorectal cystic lesion. Surgical excision was performed, and the specimen was submitted for histopathological examination, which confirmed the diagnosis of an epidermoid cyst.Discussion:Retrorectal epidermoid cysts are rare and may be either congenital or acquired. Surgical implantation of epithelial elements following procedures such as fistulectomy may contribute to their development. Despite their benign nature, these cysts carry a risk of recurrence and, rarely, malignant transformation, necessitating complete surgical excision.Conclusions:Retrorectal epidermoid cysts should be considered in patients presenting with presacral masses, particularly those with a history of prior anorectal surgery. Early diagnosis and complete surgical excision are essential to achieve optimal outcomes and prevent recurrence.Keywords: Retrorectal tumor; Epidermoid cyst; Epidermal inclusion cyst; Fistulectomy; Presacral mass; Case report https://www.caspjs.com/article_736201.html Introduction: Chronic exertional compartment syndrome (CECS) is a recognized cause of activity‑related leg pain, most commonly reported in young athletes. However, long‑standing cases that persist for decades and present in middle‑aged individuals are uncommon and may lead to delayed or challenging diagnosis. This report describes a rare case of CECS with an unusually prolonged clinical course and underscores important diagnostic considerations. Case Presentation: A 53‑year‑old man presented with a 37‑year history of severe bilateral anterior leg pain provoked by running, physical exertion, and deep squatting. The symptoms were associated with visible, reducible fascial herniations over the anterolateral compartments of both calves. The patient reported partial symptom control through a consistent warm‑up routine before activity. Clinical evaluation and intracompartmental pressure measurements supported the diagnosis of CECS. Following unsuccessful long‑term conservative management, the patient underwent bilateral anterior and anterolateral compartment fasciotomies, resulting in adequate compartment decompression. Conclusion: This case illustrates that CECS may remain unrecognized for many years and can present later in life. Visible fascial herniations may serve as an important clinical indicator, and individualized conservative measures may provide temporary symptom relief. Nevertheless, surgical decompression remains an effective treatment option when conservative strategies fail. https://www.caspjs.com/article_737966.html Major surgery in older adults is increasingly common as life expectancy rises and advances in surgical, anesthetic, and intensive care practices expand treatment options for this population. However, conventional surgical outcomes do not fully reflect the complexity of recovery in older patients. Psychological and neurocognitive complications represent frequent, clinically meaningful, and often under-recognized determinants of postoperative recovery. Older adults undergoing coronary artery bypass grafting, valve surgery, aortic and major vascular procedures, thoracic surgery, abdominal oncologic surgery, and hip fracture repair are particularly vulnerable to postoperative delirium, perioperative neurocognitive disorders, depression, anxiety, sleep disturbances, post-traumatic stress symptoms, and post-intensive care syndrome. The development of these complications is multifactorial, involving interacting biological factors (neuroinflammation, cerebral hypoperfusion, and systemic stress responses), patient-related clinical factors (frailty, pre-existing cognitive impairment, pain, and polypharmacy), environmental and healthcare-related factors (intensive care exposure, sensory deprivation, and sleep disruption), and psychosocial factors (social isolation, emotional distress, and psychological stress associated with life-threatening illness). This narrative review integrates evidence from diverse surgical populations to provide a comprehensive framework linking preoperative vulnerability, perioperative insults, and postoperative psychological and neurocognitive outcomes. Beyond summarizing existing knowledge, this review proposes a patient-centered model of surgical success that extends beyond survival and technical outcomes to include preservation of cognition, emotional well-being, sleep recovery, functional independence, and return to meaningful daily activities. By integrating geriatric, surgical, anesthetic, and psychological perspectives, this review highlights the need for a multidimensional approach to evaluating outcomes after major surgery in older adults. https://www.caspjs.com/article_738285.html Modern surgery has optimized the operation, but not always the patient. Despite major advances in operative technique, anesthesia, imaging, surgical devices, and enhanced recovery pathways, the physiological readiness of patients before surgery remains insufficiently integrated into routine surgical decision-making. Many modifiable risk factors, including poor functional capacity, frailty, sarcopenia, malnutrition, anemia, smoking, psychological stress, and reduced cardiopulmonary reserve, are often documented but not systematically treated as actionable surgical risks. Prehabilitation offers a practical opportunity to transform the preoperative waiting period into an active therapeutic window aimed at improving resilience before the incision. This editorial makes the case for prehabilitation as a missing surgical vital sign: a measurable, modifiable, and clinically meaningful marker of readiness that should be routinely assessed before surgery and integrated into perioperative decision-making. Although evidence regarding prehabilitation remains heterogeneous, recent trials and meta-analyses suggest that its effectiveness depends on appropriate patient selection, individualized intervention, adherence, monitoring, and integration into surgical pathways. A structured model based on screening, risk stratification, targeted prescription, monitoring, and incorporation into shared decision-making may allow prehabilitation to move from isolated programs to standard perioperative infrastructure. Redefining surgical success beyond technical completion and short-term outcomes requires a shift from procedure-centered surgery to patient-readiness-centered surgery. Prehabilitation should become a visible part of surgical culture before the first incision is made.