Open abdominopelvic surgeries are becoming less common, often linked to complications from conversions from minimally invasive techniques. Minimally invasive approaches dominate: 98% for appendectomy and cholecystectomy; 84% for low anterior resection. Conversions to open surgery lead to longer operative times: appendectomy takes 147% longer, cholecystectomy 116% longer compared to minimally invasive methods. Surgeons should reconsider […]
Author: STITCHES Newsletter
Diverticulitis Admissions Show Seasonal Patterns Worldwide
Diverticulitis incidence peaks in warmer months, highlighting potential environmental triggers. 1.1 million cases across 8 studies show a summer/autumn peak and winter trough, with amplitude variation of 16% to 27%. Phase reversal observed between hemispheres confirms this pattern. Surgeons should consider seasonal trends when making preoperative assessments and advising patients on preventive measures. Further research […]
Preoperative Biliary Drainage with Metal Stents Safe in Pancreatic Cancer
Preoperative biliary drainage (PBD) using self-expanding metal stents (SEMS) is noninferior to early surgery for pancreatic cancer patients, impacting surgical timing decisions. Serious adverse events were similar: 29.0% in PBD vs. 26.5% in early surgery (p = 0.011 for noninferiority). 82.6% of PBD patients had curative surgery versus 88.5% in the early surgery group. Surgeons […]
High Readmission Rates After Emergency Laparotomy
Readmission rates post-emergency laparotomy are alarmingly high, impacting surgical practice and patient outcomes. 30-day readmission rate is 17%, with a range of 16-19%. 30-day emergency department utilization is 28%, with a range of 18-40%. Surgeons should prioritize patient education and post-discharge follow-ups to mitigate these rates. Common causes of readmission include wound issues, abdominal complaints, […]
Improved Collaboration Enhances Surgical Outcomes
Effective teamwork in the OR is critical for patient safety and surgical success. Key facilitators include professional skills, team familiarity, and effective leadership. Major barriers involve individualistic behavior, hierarchical culture, and inadequate resources. Surgeons should focus on cultivating competencies and positive team dynamics while addressing systemic issues to enhance collaboration and improve perioperative outcomes. Interventions […]
Access Gaps in Violence Intervention Programs Impact Care
Patients treated for firearm injuries at non-violence intervention programs (VIPs) miss critical support services, affecting outcomes. Two-thirds of patients were at VIP facilities, but 81.5% did not receive VIP services. Assault-related injuries were the strongest predictor of VIP service use (OR 3.00; p=0.002). High-risk patients at non-VIP facilities are older and less likely to receive […]
Patterns of Recurrence After Esophageal Cancer Surgery
Half of esophageal cancer patients face recurrence after surgery, with significant implications for patient management. Of 1,310 patients with recurrence, 37.3% had it at multiple distant sites, while 14.4% experienced isolated local recurrence. Liver-only recurrence was detected significantly earlier (median 9 months) and had the poorest survival (7.4 months post-recurrence). Surgeons should tailor postoperative surveillance […]
Neoadjuvant Chemo Fails to Improve Outcomes in Colorectal Metastases
Neoadjuvant chemotherapy before CRS/HIPEC for metachronous colorectal peritoneal metastases offers no survival benefit and increases complication risks. Patients receiving neoadjuvant chemotherapy had a complication rate of 25% versus 12.7% for those undergoing upfront surgery. Length of hospital stay increased to 12 days with neoadjuvant treatment compared to 10 days without. Surgeons should weigh these risks […]
Robotic en bloc resection for pancreatic cancer is safe.
A robotic approach combined distal splenopancreatectomy and left nephrectomy in a complex case with renal infiltration from pancreatic adenocarcinoma. The procedure achieved negative margins and involved a multidisciplinary team to minimize conversion risk and enhance oncological outcomes. The patient was discharged on postoperative day 6, indicating a favorable recovery. Pathology revealed T4 cancer with two […]
Effectiveness of Anti-Adhesion Agents in Surgery
Anti-adhesion agents significantly reduce adhesive intestinal obstruction rates in intra-abdominal surgery, impacting surgical outcomes and costs. Incidence of adhesive intestinal obstruction was 12.4% in patients using anti-adhesion agents, versus 18.5% in non-users. Patients receiving these agents had higher quality-adjusted life years (1.992 QALYs) and lower average costs ($3,794, saving $1,330). Consider broader use of anti-adhesion […]