A study of 16,921 cases of nonelective sigmoidectomy for acute complicated diverticulitis revealed a rising trend in the use of primary anastomosis with diverting loop ileostomy, from 5.3% in 2012 to 8.4% in 2020. Compared to Hartmann’s procedure, primary anastomosis with diverting loop ileostomy was associated with lower rates of major adverse events (24.6% vs […]
Author: STITCHES Newsletter
Significant Variability in Managing Malignant Gastric Outlet Obstruction in Pancreatic Cancer, with Rising Use of EUS-Gastrojejunostomy
Survey of 290 pancreatologists revealed significant differences in managing malignant gastric outlet obstruction (MGOO) due to pancreatic cancer. Endoscopic stenting (ES) was most common, but EUS-Gastrojejunostomy (EUS-GJ) adoption is increasing. Decision drivers include life expectancy and patient frailty, with lack of standardized algorithms. Availability of EUS-GJ remains suboptimal, attributed to the steep learning curve. Journal […]
Nonoperative Management of Uncomplicated Appendicitis in Adults Linked to Longer Hospital Stays and Higher Costs
Researchers examined 167,125 patients with uncomplicated appendicitis, finding that 82.4% underwent surgical management, while 17.6% underwent nonoperative management (NOM). The NOM group had older patients (53 vs. 43 years), more Medicare recipients (33.6% vs. 16.1%), and higher rates of comorbidities like diabetes (7.8% vs. 5.5%). NOM was associated with longer hospital stays (5.4 vs. 2.3 […]
Nomogram Predicts Survival in Lymph Node-Negative Hepatocellular Carcinoma
Clinicians developed a nomogram to predict cancer-specific survival (CSS) in hepatocellular carcinoma (HCC) patients without lymph node metastasis (LNM), achieving high accuracy in both internal and external validation. Analysis of 6,840 HCC patients revealed age, gender, bone metastasis, lung metastasis, AFP, T stage, surgery, and chemotherapy as significant prognostic factors. The nomogram’s concordance index (C-index) […]
Straight Stomach Reconstruction Reduces Delayed Gastric Emptying After Pancreaticoduodenectomy
Clinicians found that anchored straight stomach reconstruction (SSR) significantly reduces the incidence of delayed gastric emptying (DGE) after pancreaticoduodenectomy (PD), also leading to improved postoperative nutritional recovery. A case series analysis of 125 PD patients showed that those in the SSR group had a DGE rate of 13%, compared to 33% in the non-SSR group. […]
Accuracy of Conflicts in Interest Reporting in General Surgery Journals
Study finds high inaccuracy (31%) in self-reported conflicts of interest (COIs) in prominent general surgical journals. Authors from the US had the lowest accuracy rate at 69%, compared to the UK (93%) and Australia (96%). Most inaccuracies were observed in corresponding/senior authors (39%), highlighting the need for journals to verify COIs for more accurate reporting. […]
Post-Discharge Mental Healthcare Reduces Readmissions in Emergency General Surgery Patients with Serious Mental Illness
A study of 88,092 Medicare patients over 65 with serious mental illness (SMI) found that a post-discharge mental health visit (MHV) within 30 days after emergency general surgery (EGS) hospitalization was associated with significantly lower odds of acute care readmission in both operative (odds ratio 0.60) and non-operative (odds ratio 0.67) groups. There was no […]
Pancreas-Preserving Duodenectomy Achieves High Resection Rates with Lower Complications
Pancreas-preserving duodenectomy (PPrD) achieved an R0 resection rate of 93% among patients treated for duodenal neoplasms. In a retrospective cohort of 29 patients, postoperative complications occurred in 34.4% of cases, with 13.7% at Clavien-Dindo grade III-V. PPrD had lower rates of pancreatic leak, delayed gastric emptying, and deep surgical site infection compared to pancreaticoduodenectomy. This […]
Longer Operative Times Linked to Lower Textbook Outcomes in Minimally Invasive Esophagectomy
Longer operative time is associated with higher odds of major complications and prolonged postoperative stay in minimally invasive esophagectomy. The relationship between operative time and achieving textbook outcome (TO) is characterized by an inverse U-shaped correlation, with a significant peak at 298 minutes. Prolonged operative time may indicate targets for quality improvement and risk adjustment […]
Improved Intraoperative ICGFA Guidance for Bowel Transection
A novel patient-calibrated quantitative ICGFA method was developed to recommend optimal bowel transection sites during surgery, showing 85% agreement with baseline perfusion. The software successfully identified expert surgical transection sites in almost all cases, reducing the risk of anastomotic complications. High-resolution augmented reality heatmaps were generated for guidance, integrating seamlessly into existing clinical workflow and […]