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Durability of the Posterior Rectus Sheath Flap for Hiatal Repair

Vascularized posterior rectus sheath flap (PORSHA) shows promising results for complex paraesophageal hernia repair, with low recurrence rates and minimal donor-site morbidity.

  • Radiologic recurrence was 1.4% at 12 months and 13.8% at 24 months, stabilizing at 18.1% through 48 months.
  • Excluding the procedural maturation phase, recurrence improved to 9.2% at 24 and 36 months, with no reoperations.

These findings suggest that PORSHA may be a viable option for reducing recurrence in this challenging surgical population.

Journal Article by Vigneswaran Y, Campbell M (…) Hussain M et 2 al. in Ann Surg

Copyright © 2026 The Author(s). Published by Wolters Kluwer Health, LLC.

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Digital Training Reduces Anastomotic Leak After Right Colectomy

A brief digital training program for surgeons is associated with a significant reduction in anastomotic leak rates following right colectomy, suggesting a crucial role in quality improvement initiatives.

  • Anastomotic leak occurred in 16.4% of untrained surgeons vs. 9.1% of trained surgeons, a 7.3% absolute risk reduction (p < 0.001).
  • Adjusted odds for anastomotic leak halved (aOR 0.56), with lower rates of reoperation (aOR 0.64) and readmission (aOR 0.65).

Integrating this training into surgical practice could enhance patient outcomes globally.

Multicenter Study by None None in Br J Surg

© The Author(s) 2026. Published by Oxford University Press on behalf of BJS Foundation Ltd.

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Prophylactic Mesh Reduces Incisional Hernias in Hepatobiliary Surgery

Placing prophylactic synthetic mesh during abdominal closure significantly lowers incisional hernia rates after hepatobiliopancreatic surgery.

  • At 12 months, incisional hernia rates were 5.2% in the mesh group vs. 21% in the non-mesh group (p<0.01).
  • At 24 months, hernia rates were 8.1% in the mesh group vs. 37.5% in the non-mesh group (p<0.001).

Patients receiving mesh also showed improved functional recovery without increased complications. This data suggests that surgeons may consider prophylactic mesh in high-risk patients undergoing subcostal incisions to mitigate hernia formation.

Journal Article by Bellido-Luque J, Sanchez-Matamoros Martín I (…) Nogales Muñoz A et 3 al. in JAMA Surg

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Disparities in Liver Resection for Colorectal Metastases

Patients with colorectal liver metastases (CRLM) in New York City are significantly less likely to undergo potentially curative liver resection compared to those in New York State.

  • CRLM resection rates were 20% in NYC versus 24% in NYS, with factors like low-volume facilities (OR 0.23) and positive lymph nodes (OR 0.34) decreasing the likelihood of surgery.
  • Surprisingly, 18% of patients chose farther, lower-volume centers over closer, higher-volume facilities, suggesting potential underuse of specialized care.

These findings highlight the need for targeted interventions to improve access to curative surgical options for CRLM in urban settings.

Journal Article by Zaki OA, Schleimer LE (…) Wei AC et 10 al. in Ann Surg Oncol

© 2026. The Author(s).

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Five-Year Survival After Neoadjuvant Therapy for PDAC Is 34.5%

Actual 5-year survival after neoadjuvant therapy and resection for localized pancreatic ductal adenocarcinoma is 34.5%, with early recurrence as the leading cause of treatment failure.

  • Among 660 patients, recurrence occurred in 74.1%, predominantly within the first year post-surgery.
  • Survival rates were stratified: 42.5% for resectable, 29.0% for borderline-resectable, and 17.5% for locally advanced disease.
  • Key predictors for long-term survival included lower comorbidity, baseline CA19-9 <200 U/mL, and complete R0 resection.

Awareness of these survival outcomes and predictors can guide patient selection and management strategies in practice.

Journal Article by De Stefano F, Belfiori G (…) Castillo CF et 19 al. in Ann Surg

Copyright © 2026 Wolters Kluwer Health, LLC. All rights reserved.

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Hospital Management Ratios Affect Older Adult Outcomes

Higher operative-to-nonoperative management ratios in emergency general surgery are linked to better home discharge rates for older patients.

  • Older adults treated at hospitals in the highest tertile of the operative-to-nonoperative ratio had 10% higher odds of being discharged home (OR 1.10, 95% CI: 1.06-1.14).
  • Traditional metrics of morbidity and mortality may not capture what matters most to older patients, such as their ability to return home post-surgery.

Surgeons may want to consider the operative-to-nonoperative management ratio as a quality indicator when treating older adults in emergency settings.

Journal Article by Castillo-Angeles M, Dey T, Salim A and Havens JM in Ann Surg

Copyright © 2026 Wolters Kluwer Health, LLC. All rights reserved.

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Clinical Guidance on Ampullary Neoplasms: Key Recommendations

This expert review provides crucial best practice guidance for managing ampullary adenomas, emphasizing improved endoscopic assessment and resection strategies to optimize patient outcomes.

  • Ampullary adenomas can harbor malignancy in 20%-40% of cases; obtaining at least six biopsies is essential for accurate histopathological assessment.
  • Use side-viewing duodenoscopes for better visualization and reduced pancreatitis risk during biopsy; avoid pancreatic orifice during procedures.
  • Endoscopic resection is generally appropriate for lesions <4-5 cm with minimal intraductal extension, while significant intraductal extension (>1 cm) warrants surgical referral.

Surgeons should prioritize early detection and careful evaluation of ampullary neoplasms, integrating multidisciplinary discussions for high-risk cases.

Practice Guideline by Barakat M, Maranki J, Irani S and Chahal P in Clin Gastroenterol Hepatol

Copyright © 2026 American Gastroenterological Association Institute. Published by Elsevier Inc. All rights reserved.

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Thoracoscopic Repair of Chronic Diaphragmatic Hernias is Safe and Effective

Thoracoscopic repair of chronic post-traumatic diaphragmatic hernia shows promising outcomes with significant advantages over open surgery for defect sizes up to 100 mm.

  • In a study of 21 patients, thoracoscopic repair resulted in lower median blood loss (10 ml vs. 200 ml), shorter chest tube duration (1 vs. 4 days), and reduced hospital stay (5 vs. 10 days).
  • No recurrences or major complications occurred during follow-up, bolstering the feasibility of the minimally invasive approach for selected patients.

Surgeons should consider thoracoscopic repair for appropriately sized chronic defects, as adverse factors often favor an open approach.

Journal Article by Topolnitskiy EB, Marchenko ES and Volinsky AA in Surg Endosc

© 2026. The Author(s).

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Bowel-Sparing Procedures for Small Bowel Tumors Show Promise

A novel approach to small bowel tumors using artery-specific resections allows for effective lymphadenectomy while preserving bowel length, reporting no short-term mortality.

  • In a study of 86 patients, standardized D3-volume lymphadenectomy coupled with tailored resections yielded a median lymph node harvest of 31, with D3 positivity in 33 cases.
  • Vascular injuries occurred in 20 patients, and 11 required reoperation, indicating a need for caution in surgical planning.

This technique supports greater bowel preservation and may influence surgical strategies in managing small bowel tumors.

Journal Article by Ignjatovic D, Vasic T, Luzon JA and Stimec BV in J Gastrointest Surg

Copyright © 2026. Published by Elsevier Inc.

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Early Acute Kidney Injury After Hepatectomy Increases Complications

Early acute kidney injury (AKI) post-hepatic surgery significantly raises the risk of major complications and lengthens hospital stays, making careful monitoring essential.

  • In a cohort of 1,658 patients, 11% developed early AKI by postoperative day 2, leading to a median hospital stay of 5 days compared to 3 days for those without AKI (p < .001).
  • Patients with early AKI saw a major complication rate of 22%, double that of patients without AKI (10%, p < .001).
  • Key predictors for major complications included early AKI (odds ratio 1.81), high-risk hepatectomy (1.57), and operative time exceeding 7 hours (2.66).

Surgeons should consider these factors when planning outcomes and managing postoperative care.

Journal Article by Madi M, Haddad A (…) Vauthey JN et 10 al. in BMC Surg

Copyright © 2026 Elsevier Inc. All rights reserved.

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