A new definition of major trauma that combines injury severity with urgent trauma-team interventions identified more high-risk patients and deaths than injury scoring alone. In 2.68 million National Trauma Data Bank patients, 22.4% met the combined definition, versus 17.8% with Injury Severity Score above 15. The combined definition had the best discrimination for 24-hour mortality […]
Category: Appendix, Gallbladder and Surgical Emergencies
IVC Filter Use Varies Widely in Trauma Care
In severely injured trauma patients, higher hospital use of inferior vena cava filters did not improve survival and was linked to more thromboembolic events. Among 2.28 million patients at 427 level I and II trauma centers, 0.81% received a filter. Use fell from 1.15% in 2017 to 0.59% in 2024, but rates ranged from 0% […]
Conversion drainage matches primary in acute cholecystitis
For high-risk patients with acute cholecystitis, conversion to endoscopic ultrasound-guided gallbladder drainage after percutaneous drainage achieved outcomes comparable to primary drainage. Multicenter study of 141 patients: technical success was 95.8% after conversion versus 98.3% with primary drainage. Results remained comparable after adjustment, despite more cancer and greater comorbidity in the conversion group. Clinical success, adverse […]
Robotic Cholecystectomy Reduces Bile Duct Injury Risks
Robot-assisted cholecystectomy shows lower bile duct injury rates compared to laparoscopic procedures in complex cases of acute cholecystitis. Bile duct injury rates: 0.65% for robotic vs. 1.02% for laparoscopic. Adjusted odds of bile duct injury were 71% lower for robotic cholecystectomy (AOR 0.29). This suggests that robotic-assisted approaches can enhance surgical safety and outcomes even […]
EUS-Guided Gallbladder Drainage Effective for Symptomatic Cholelithiasis
Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is a safe and effective option for nonoperative candidates with symptomatic cholelithiasis without cholecystitis. Complete gallstone clearance achieved in 100% of patients; 87% cleared in one treatment. All 23 patients had technical success with LAMS placement, and no procedure-related adverse events occurred. No symptom recurrence noted over a mean follow-up […]
Hem-o-lok Clips Outperform Endoloops for Appendiceal Closure
Hem-o-lok clips provide a safer and faster option for appendiceal stump closure in laparoscopic appendectomy compared to endoloops. Intra-abdominal abscess formation was 1.87 times less likely with hem-o-lok clips (p=0.035). Operative time was significantly shorter by an average of 5.41 minutes (p=0.019). Surgeons may consider hem-o-lok clips for improved outcomes and efficiency in appendectomies. No […]
Indocyanine Green Fluorescence Cuts Bile Duct Injury Risk in Cholecystectomy
Intraoperative indocyanine green (ICG) use significantly reduces common bile duct (CBD) injury rates during laparoscopic cholecystectomy. CBD injury decreased from 0.40% to 0.25% with ICG (RR 0.62; p < .001). Postoperative biliary interventions were lower with ICG (4.49% vs 5.39%; RR 0.83; p < .001). Conversion to open surgery also fell (0.84% vs 0.40%; RR […]
Learning curve impacts outcomes in gallstone surgery
Surgical outcomes and operation times improve significantly with experience in laparoscopic cholecystectomies. Mean operation time drops from 111 minutes to 75 minutes after 800 procedures. Complication rates are significantly lower with an assistant present, from 7.0% to 4.7% during the initial 50 procedures (p=0.007). Surgeons should prioritize mentorship and assistance during early cases to enhance […]
Intraoperative Cholangiography Use Doesn’t Lower Bile Duct Injury
Surgeons should know that increased use of intraoperative cholangiography (IOC) during cholecystectomy does not reduce bile duct injury rates, but it does lead to more postoperative ERCP procedures. Among 434,696 patients, BDI rates were low and similar across IOC use groups (0.5% for never, 0.4% for selective, and 0.4% for routine). Postoperative ERCP rates increased […]
Robotic Cholecystectomy Cuts Complications in Complex Cases
Robotic-assisted cholecystectomy significantly reduces the need for unplanned procedures in complex gallbladder surgeries. Patients undergoing robotic cholecystectomy had a 4.24 odds ratio for fewer interventions compared to laparoscopic techniques (p = .02). Operating room costs are higher for robotics: $8,936 vs. $7,720 for laparoscopic in complex cases. Robotic cholecystectomy maintains overall care costs similar to […]