Laparoscopic-assisted transversus abdominis plane (LTAP) block significantly improves postoperative pain management compared to port-site infiltration (PSI). LTAP group had lower VAS pain scores (-1.7) at 6 and 12 hours post-op (p < 0.001). Patients receiving LTAP required less oxycodone (0.8 vs. 1.2, p = 0.032). Consider implementing LTAP block into your analgesic protocols for better […]
Author: STITCHES Newsletter
Avoid Feeding Jejunostomy in Pancreatoduodenectomy
Feeding jejunostomy (FJT) after pancreatoduodenectomy increases complications and length of stay. Delayed gastric emptying occurred in 55% of FJT patients vs. 25% in nasojejunal tube (NJT) patients (p = 0.006). FJT led to a longer hospital stay: 11 days compared to 9 days for NJT (p = 0.007). Omit FJT to reduce postoperative complications without […]
Delirium in Surgery: High Rates, Big Impacts
Postoperative delirium is a common and serious complication affecting surgical patients, significantly influencing outcomes and care. Delirium occurred in 10.6% of screened patients; those affected were older and had higher comorbidity rates. Key predictors include dementia (37% vs 7.9% in non-delirium), urgent surgery (55% vs 26%), and each 10-min increase in surgery time raises delirium […]
Advancing HPB Surgical Techniques Show Improved Outcomes
Minimally invasive and robotic-assisted surgeries enhance recovery in hepatopancreatobiliary procedures. Patients who underwent robotic-assisted gastrectomy had shorter hospital stays and less intraoperative bleeding than those who had open surgeries. Operative times differed among procedures due to technical complexity and learning curves. Surgeons should consider robotic techniques for better postoperative recovery in select patients. Overall, advances […]
Endoscopic Dissection Transforms Early Upper GI Carcinoma Care
Endoscopic Submucosal Dissection (ESD) provides an advanced local treatment option for early upper gastrointestinal carcinomas, enabling complete tumor removal and improved patient outcomes. ESD allows for en bloc resection of early GI neoplasia, aiding in precise pathology and risk assessment. Key candidates for ESD include high-grade intraepithelial neoplasia and superficial early carcinomas without visible deep […]
Impact of Textbook Outcome on Biliary Tract Cancer Surgery
Achieving a textbook outcome (TO) significantly enhances overall survival in biliary tract cancer (BTC) post-hepatectomy. Patients who achieved TO had a 31% reduced hazard of mortality (HR 0.69, 95% CI 0.58-0.82). Thirteen predictors of TO were identified, including younger age (OR 1.61), lower ASA score (OR 1.83), and smaller tumor size (OR 1.08). Laparoscopic surgery […]
Laparoscopic Appendectomy Beats Open Surgery in Africa
Laparoscopic appendectomy reduces complications for acute appendicitis in Sub-Saharan Africa, offering a safer option for surgeons. Laparoscopic appendectomy lowers the risk of surgical site infections by 60% (risk ratio 0.40). It also leads to shorter hospital stays compared to open surgery. Surgeons should consider adopting laparoscopic techniques where feasible to improve patient outcomes. Cost-effectiveness is […]
Predicting Lateral Lymph Node Metastasis in Low Rectal Cancer
MRI criteria can accurately identify patients with low rectal cancer at risk for lateral lymph node metastasis, impacting surgical strategies. In a study of 163 patients, 16.6% had pathological lateral lymph node metastasis (pllnm). Among 130 initially classified as llnm-negative, 3.8% were later found to have pllnm. The radiological criterion (short-axis diameter ≥6 mm) demonstrated […]
Predicting Lateral Lymph Node Metastasis in Low Rectal Cancer
MRI criteria can accurately identify patients with low rectal cancer at risk for lateral lymph node metastasis, impacting surgical strategies. In a study of 163 patients, 16.6% had pathological lateral lymph node metastasis (pllnm). Among 130 initially classified as llnm-negative, 3.8% were later found to have pllnm. The radiological criterion (short-axis diameter ≥6 mm) demonstrated […]
Optimal Management of Celiac Artery Stenosis in Surgery
Surgeons must prioritize preoperative identification of celiac artery stenosis in patients undergoing pancreaticoduodenectomy to reduce ischemic complications. Celiac artery stenosis occurs in 6.1% of patients undergoing the procedure; only 2.2% had preemptive median arcuate ligament release. Stenosis over 80% significantly increases the risk of postoperative ischemia. Identifying stenosis preoperatively results in fewer complications (5.8% vs. […]