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; […]
Author: STITCHES Newsletter
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 […]
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, […]
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 < […]
Cultural Change in Surgical Training Aids Diversity
A new initiative to support pregnant surgical residents demonstrates that personalized approaches can create sustainable culture changes in training programs. Implementing a pregnancy curriculum resulted in significant institutional changes to support pregnant residents. Acknowledging the individuality of residents can enhance recruitment and retention of women and underrepresented minorities in surgery. Surgeons should consider how tailored […]
Laparoscopic Cholecystectomy Skills Assessment Needs Improvement
This systematic review assesses the effectiveness of objective technical skills assessment tools for laparoscopic cholecystectomy, highlighting gaps in validation. Manual assessment tools have the most validity evidence but inconsistent reliability and no clear outcome correlations. Kinematic tools provide motion data but lack robust validation. AI-based systems show promise for real-time use, specifically for critical view […]
Robotic Surgery Equally Effective for Esophagogastric Adenocarcinoma
Robotic surgical resection for Siewert II/III adenocarcinoma at the gastro-esophageal junction shows comparable overall survival to both laparoscopic and open techniques. Overall survival rates at 3 and 5 years are similar among robotic (OS OR 1.17; CI 0.10–14.06 and OS OR 0.66; CI 0.39–1.12), laparoscopic, and open approaches. A nonsignificant trend suggests improved disease-free survival […]
Gastric Cancer Recurrence Drastically Impacts Survival
Recurrence after curative gastrectomy significantly reduces survival, especially in patients with high lymph node ratios (LNR). The probability of being alive and recurrence-free drops from 66.5% at 12 months to just 33.6% by 58 months. In high-LNR patients, 100% experience recurrence by 36 months, and only 11.3% are alive after recurrence at 12 months. Low-LNR […]
Advanced Techniques for Difficult Biliary Cannulation Show Similar Outcomes
A study assessing advanced techniques for difficult biliary cannulation shows they are similarly effective, challenging the notion of a superior method in ERCP. Initial cannulation success rates were 72% for double-guidewire, 68% for transpancreatic sphincterotomy, and 68% for precut fistulotomy (p = .882); all techniques achieved 100% final success. Median cannulation times were comparable, with […]
Frailty Affects Recovery Post-Colorectal Surgery
Frailty significantly impacts the ability of older adults to achieve early recovery milestones after colorectal surgery, but those who do experience reduced adverse outcomes. Only 42% of frail patients achieve early ambulation compared to 73% of nonfrail patients; early nutrition rates are 31% among frail versus 53% in nonfrail. Among frail patients, achieving early ambulation […]