Immediate endoscopic necrosectomy (den) after drainage significantly speeds recovery in patients with necrotizing pancreatitis. Time to clinical success was 29 days with immediate den, compared to 44 days with the step-up approach (p = .009). Adverse events were similar between groups: 24% for immediate den vs. 22% for step-up (p = .79). Consider immediate den […]
Author: STITCHES Newsletter
Revised approach to gallbladder and sphincter disorders
More accurate diagnosis is shifting surgical practice for abdominal pain and pancreatitis. New criteria for dysfunctional gallbladder disorder (DGBD) focus on typical biliary pain and symptom persistence. Sphincter of Oddi disorder (SOD) now requires objective evidence of obstruction or pancreatitis. Surgeons should be cautious, as these disorders are often over-diagnosed, leading to unnecessary risky treatments. […]
The Future of Acute Care Surgery Practice Models
Acute care surgery is essential for effective trauma and emergency care but faces sustainability challenges. Current staffing models vary—traditional vs. time delineated—affecting workload and academic involvement. Compensation often relies on work relative value units, which don’t reflect the full scope of ACS responsibilities. Sustainable staffing and fair compensation are crucial for maintaining quality care and […]
New Model Predicts Postoperative AKI Risk for Surgeons
Surgeons now have a validated model to predict acute kidney injury in surgical patients, crucial for improving outcomes and reducing costs. AKI incidence was 1.8% in the training set and 2.4% in the external validation set. The model achieved an AUC of 0.87-0.88 and identified key risk factors: inpatient status, ascites, renal failure, preoperative creatinine, […]
Korean Surgical Outcomes Registry Sets Benchmark
A new nationwide surgical registry in Korea reveals important data on 30-day complications, which can help surgeons improve patient selection and surgical outcomes. Overall 30-day complication rate is 38.7%, with major complications at 12.7% and mortality at 0.59%. Mortality is highest after pancreatic surgery (1.17%) and lowest after gastric surgery (0.16%). Understanding these results can […]
Synthetic Mesh Outperforms Biologic in Hernia Repairs
Using synthetic mesh in contaminated ventral hernia repairs shows better long-term outcomes than biologic mesh, crucial for surgical decision-making. Midline hernia recurrence rate was 11.8% with synthetic mesh vs. 23.6% with biologic, translating to an 11.8% absolute risk reduction. No new mesh infections or excisions reported beyond 2 years; only 1.2% needed intervention for wound […]
Improving Readiness in Deployed Field Hospitals
Surgeons need to know that clinical readiness among personnel in deployed field hospitals shows significant gaps, particularly affecting surgical outcomes. Only 8% of enlisted personnel held full-time clinical roles, impacting their preparedness for patient care. 69% of respondents felt more pre-deployment training could have prevented clinical errors. Surgeons should advocate for enhanced training and clinical […]
Vascular Injuries in Homicide Victims: A Call for Action
Most homicide victims with isolated extremity injuries face a high risk of fatal vascular damage, emphasizing the need for bystander intervention training. Among 5,765 homicide autopsies, 84% had gunshot wounds; extremity injuries occurred in 47% of these cases. Isolated gunshot extremity wounds were linked to a 10-fold increase in major vascular injuries compared to nonisolated […]
Volume and Quality Impact TME Outcomes in Rectal Cancer
Surgeons should note that higher surgical volume correlates with better outcomes in total mesorectal excision (TME) for rectal cancer. Facilities performing 16 or more TME annually were more likely to report TME grades (p=0.02). Robotic-assisted surgery achieved the highest complete TME rates (p<0.001) and lower conversion rates compared to laparoscopy (4.6% vs 14.6%, p<0.001). Complete […]
New Approaches for Refractory GERD Management
Surgeons need to rethink strategies for managing refractory gastroesophageal reflux disease (rGERD). Prolonged disease duration and anxiety are new high-risk factors for rGERD. Moderate exercise (90+ minutes/week) may help protect against rGERD. Adjusting treatments, including dose modifications or switching to vonoprazan, is crucial for rGERD patients. Consider lifestyle interventions like anti-anxiety therapy and supervised exercise […]