In a cohort study of 10,342 acute lower gastrointestinal bleeding (ALGIB) cases, surgery was performed in 1.3%. Colonoscopy (87.7%) and endoscopic hemostasis (26.7%) were common. Surgery indications included diverticular bleeding (24%) and colorectal cancer (22%). Sixty-four percent were for severe refractory bleeding. Postoperative rebleeding rates were 22% (presumptive/obscure source) and 12% (definitive identification). Thirty-day mortality […]
Author: STITCHES Newsletter
Postoperative Atrial Fibrillation and Warfarin: Impact on Mortality
In the Regroup trial focusing on coronary artery bypass grafting (CABG), 28.6% developed postoperative atrial fibrillation (POAF). Among 269 POAF patients, 85 received oral anticoagulation (OAC) with warfarin, and 184 did not. During active follow-up, stroke rates were similar (3.5% OAC vs. 5.4% no-OAC), but major adverse cardiac events were higher with OAC (20% vs. […]
Margin Clearance and Survival in Ampullary Adenocarcinoma After Pancreaticoduodenectomy
Examining 128 patients undergoing pancreaticoduodenectomy for ampullary adenocarcinoma, Danish researchers found that a margin clearance of ≥1 mm was independently associated with significantly improved survival compared to
Hidden Crisis: England’s Elective Procedure Backlog Unveiled
England’s NHS waiting lists hide a daunting truth. A modeling study, dissecting data from Jan 1, 2020, to Dec 31, 2022, revealed a staggering elective procedure backlog of 4,519,467. Shockingly, 80.3% lurked in the hidden waiting list—3,621,423 procedures unnoticed. General surgery and orthopedics bore the brunt. Startlingly, 49.3% affected those aged 16-59. The majority, 84.7%, […]
Reassessing Permanent Hypoparathyroidism After Thyroidectomy
In a Swedish cohort of 1636 total thyroidectomy patients, researchers found an alarming 8.7% developed permanent hypoparathyroidism. Notably, 23.2% with low parathyroid hormone levels post-surgery faced a 6.7% risk of permanency. Critically, discrepancies between quality registers and comprehensive chart reviews signal underestimation of the condition’s prevalence. Overtreatment concerns arise due to inadequate attempts to cease […]
Enhancing Cancer Care: Tailored Interventions for Concerning Patient-Reported Outcomes
A systematic review analyzed 16 studies involving 144,496 cancer patients, focusing on gastrointestinal, lung, and head and neck cancers. The study found that interventions triggered by patient-reported outcomes (PROs) were diverse, including referrals, medication changes, and self-management advice. Notably, in three studies, these interventions significantly improved cancer-related care and patient outcomes, emphasizing the potential of […]
Resecting M1 Lymph Nodes Improves Outcomes in Advanced Esophageal Carcinoma
Examining 682 esophageal carcinoma cases, researchers found resecting metastatic lymph nodes (rm1ln) in stage IVB, especially in specific locations, showed feasibility and improved overall survival without compromising short-term safety. Notably, patients with rm1ln metastasis who underwent curative surgery demonstrated comparable short-term outcomes and overall survival to those without such metastasis. The study emphasizes the potential […]
Improved Insulin Resistance Post-Parathyroidectomy in Primary Hyperparathyroidism Patients with Prediabetes
In a study spanning 2016 to 2021, 231 patients underwent parathyroidectomy for primary hyperparathyroidism. Preoperatively, 32% had prediabetes, and 47% had insulin resistance. Twelve months postoperative, insulin resistance significantly decreased in both prediabetes (-0.69; p = .04) and insulin resistance groups (-0.85; p < .001). In prediabetes patients, 64% reduced insulin resistance, with 31% achieving […]
Optimizing Rectal Cancer Surgery: Benefits of Transanal Total Mesorectal Excision
In a meta-analysis of four randomized controlled trials (1,339 patients), researchers compared laparoscopic total mesorectal excision (TME) with and without transanal dissection for lower rectal cancers. Those undergoing laparoscopic TME with transanal dissection exhibited lower conversion rates, a higher likelihood of achieving complete TME, and fewer harvested lymph nodes compared to the group without transanal […]
Functional Evaluation After Sleeve Gastrectomy: Nuclear Scintigraphy Outperforms Volumetric Analysis
In evaluating post-sleeve gastrectomy patients, this study compared nuclear scintigraphy gastric emptying with three-dimensional multi-detector computed tomography (3D-MDCT) gastric volumetry. Poor weight loss group exhibited delayed gastric emptying compared to optimal weight loss group. Gastric emptying time correlated with weight loss parameters, while gastric volume did not. Nuclear scintigraphy, especially with a threshold of 21.2 […]