International medical graduates (IMGs) are vital to U.S. surgical care, but face significant barriers in training and integration. IMGs represent a substantial part of the physician workforce yet are underrepresented in many surgical specialties. Persistent challenges include licensing issues, financial burdens, and biases within training environments. Support through mentorship and policy reform is critical for […]
Author: STITCHES Newsletter
Improved Decision-Making for Pancreatic Cysts
Endoscopic ultrasound (EUS) significantly enhances diagnosis for pancreatic cystic neoplasms when MRI results are inconclusive. EUS detected morphologic high-risk features in 24% of cases, while MRI detected 28%, with 26% discordance between the two. In surgical patients, using EUS after normal MRI increased specificity by 14%, reaching 38% when combined with fine needle aspiration (FNA). […]
Guidelines for Colonic Diverticulitis Management
New recommendations on colonic diverticulitis highlight key insights for surgical practice. Lifetime risk of diverticulitis is 3%-5%, with outpatient management often insufficient. Routine antibiotics are not recommended for low-risk patients; reserved for high-risk cases. Consider lifestyle modifications for patients to reduce recurrence risk, such as diet changes and regular exercise. Complications most often arise at […]
Prehabilitation Cuts Complications in Esophago-Gastric Surgery
Multimodal prehabilitation significantly reduces postoperative complications in esophago-gastric cancer surgery, highlighting its importance in surgical care. Respiratory complications fell from 43.8% to 20.9% with prehabilitation (p=0.010). Cardiac issues decreased from 22.3% to 7.0% (p=0.037), and hepatic and renal complications were eliminated in the prehabilitation cohort. Integrating prehabilitation can improve patient selection and optimize outcomes. Hospital […]
Preoperative Liver Function Score Predicts Outcomes in Cancer Resection
High baseline liver function scores predict worse long-term survival in biliary tract cancer surgery. In a study of 616 patients, high APRI+ALBI scores correlated with median overall survival of 39.8 months vs. 62.9 months for low scores. The high score group also faced more complications and a 90-day mortality rate linked to major hepatectomy and […]
Endoscopic Drainage Comparison: Primary vs. Conversion Methods
Conversion endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is as effective and safe as primary EUS-GBD in acute cholecystitis, crucial for high-risk surgical patients. Technical success rates were similar: 98.3% for primary EUS-GBD vs. 95.8% for conversion EUS-GBD. Despite longer initial procedure times for conversion (adjusted later), overall safety metrics were comparable. Consider conversion EUS-GBD in cases […]
Lymph Node Yield Impacts Outcomes in Esophageal Cancer Surgery
Higher lymph node yield after neoadjuvant chemoimmunotherapy improves disease-free survival in esophageal squamous cell carcinoma, guiding surgical practices. Patients with no residual disease (ypt0-2n0) saw improved survival with 20-30 lymph nodes; benefits plateau beyond this range. In cases with residual disease (ypn1-3), higher yields correlated with longer disease-free survival. Improving lymph node dissection may serve […]
Extended Liver Resection in Locally Advanced Cholangiocarcinoma
Extended liver resection for locally advanced intrahepatic cholangiocarcinoma (LAICC) shows promising outcomes, challenging previous doubts about surgical futility. 90-day mortality is low at 5% with an overall morbidity of 56%. Median overall survival is 58 months; recurrence-free survival is 23 months. Nodal status is crucial for prognosis—patients with nodal involvement had significantly lower survival rates. […]
Enhanced Imaging Boosts Liver Cancer Detection
Adding indocyanine green fluorescence imaging to intraoperative ultrasound significantly improves the detection of liver cancer lesions, a crucial advancement for surgical outcomes. Sensitivity increases dramatically to 99.78% compared to just 86.8% with ultrasound alone. The combination showed a 15.07 odds ratio over ultrasound alone, indicating a substantial advantage in lesion detection. This technique could reduce […]
Advancing Laparoscopic Training in Low-Resource Settings
Minimally invasive surgery can enhance patient outcomes, but it’s underutilized in low- and middle-income countries due to training gaps. The Global Laparoscopic Advancement Program (GLAP) has trained over 400 surgeons in Latin America and Africa using a structured 10-step guideline. Key areas include establishing operational skills and local ownership for sustainability. Surgeons can leverage these […]