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 […]
Author: STITCHES Newsletter
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 […]
Transforming Surgical Leadership: From Authority to Influence
Surgeons must adapt their leadership approach to emphasize situational influence rather than control to enhance team dynamics and patient outcomes. Investing in leadership development programs during training can foster this shift. The transition from theoretical knowledge to practical leadership skills is crucial for ongoing professional development in surgery. This shift can improve collaboration and decision-making […]
Video-Assisted Informed Consent Saves Surgeon Time
Using video-assisted informed consent significantly reduces physician consultation time without compromising patient understanding or satisfaction. For cholecystectomy, median consultation time dropped from 8.1 to 1.5 minutes; for colon resection, from 11.9 to 3.3 minutes. Patient understanding and satisfaction remained high across both methods, with strong physician satisfaction noted for the video-assisted approach. Incorporating video into […]
Physiological Emergency Surgery Acuity Score Predicts Risks
The Physiological Emergency Surgery Acuity Score (PESAS) effectively predicts 30-day mortality and anastomotic leak in patients undergoing emergency laparotomy. In a study of 1,086 patients, PESAS demonstrated strong discrimination for 30-day mortality (AUROC 0.86), with a mortality rate of 14.7%. For a subset undergoing bowel anastomosis, PESAS also predicted anastomotic leak (AUROC 0.82) with a […]
Morphology-Based Surgery for Chronic Pancreatitis Varies Widely in Europe
A multicenter European study reveals significant variation in surgical approaches for chronic pancreatitis based on morphology, with no improvement in outcomes linked to guideline adherence. In this cohort of 207 patients, 90-day mortality was low at 1.4%, and 72.6% achieved pain relief at 6 months. Surgical techniques differed notably: duodenum-preserving resections were used most for […]
Single-dose Glucocorticoids Improve Outcomes in GI Surgery
Preoperative single-dose glucocorticoids significantly reduce postoperative complications and length of stay in major gastrointestinal surgery without increasing surgical risks. Total postoperative complications decreased by 31% (OR 0.69), and infectious complications decreased by 38% (OR 0.62). Length of stay was shortened by approximately 1 day on average. Consider incorporating single-dose glucocorticoids into your preoperative protocols to […]
Smart Glasses Improve Surgical Training in Hernia Repair
Smart glasses-assisted telementoring significantly enhances procedural accuracy in inguinal hernia repairs by facilitating real-time mentoring. Local anesthesia administration accuracy improved from 26.7% to 93.3% when using telementoring (p=0.001). Surgical decision-making was influenced positively in 93.3% of telementored cases, with mentees reporting increased confidence (100%). These findings suggest that smart glasses could be a valuable tool […]
Impact of EUS on Cholangiocarcinoma Surgical Decisions
Endoscopic ultrasound (EUS) significantly influences surgical decisions in cholangiocarcinoma by identifying new findings, leading to 10% of patients being excluded from curative-intent surgery. Overall, EUS findings excluded patients from surgery 10% of the time, with 7% for perihilar cholangiocarcinoma. The incremental benefit of EUS over traditional imaging revealed a further 3% of patients with malignant […]
Endoscopic Submucosal Dissection for Ampullary Tumors Yields High Recurrence
Endoscopic submucosal dissection (ESD) effectively achieves en bloc resection of laterally spreading ampullary tumors, but significant recurrence remains a concern. Among 55 patients analyzed, the 3-year cumulative incidence of residual/recurrent tumors was 33%, with all recurrences confined to the papilla. Positive or indeterminate papillary ductal margins emerged as a leading risk factor, increasing the likelihood […]