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 […]
Category: Appendix, Gallbladder and Surgical Emergencies
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 […]
Early Laparoscopic Cholecystectomy Reduces Hospital Stay in Acute Cholecystitis
Early laparoscopic cholecystectomy significantly cuts hospital stays for patients with acute cholecystitis without raising major complication risks. Early surgery reduced total hospital stay by 3.5 days (p < 0.00001) compared to delayed surgery. No significant increase in conversion to open surgery, bile duct injury, or overall postoperative complications was found. Surgeons can confidently opt for […]
EUS-Guided Drainage for Symptomatic Gallstones Works
EUS-Guided Gallbladder Drainage shows strong promise for non-surgical patients with symptomatic cholelithiasis without cholecystitis. 100% technical success, with complete stone clearance achieved in all 23 patients. 87% achieved clearance in just one treatment; no procedure-related complications reported. Improving patient selection and outcomes may lead to broader acceptance of this technique in practice. Journal Article by […]
Cholecystectomy Beats ERCP for Gallstone-Related Pancreatitis
Same-admission cholecystectomy lowers recurrence of acute pancreatitis compared to ERCP or no intervention. Recurrence rates post-discharge: 3.4% (cholecystectomy), 4.9% (ERCP), and 17.5% (no intervention). Other gallstone complications: 1.6% in the cholecystectomy group versus 19.9% (ERCP) and 16.3% (no intervention). Prioritizing immediate cholecystectomy can improve long-term outcomes in suitable patients. Risk of recurrence surged 8 to […]
Trauma Center Level Impacts Mortality in Shock Patients
Trauma outcomes differ significantly based on treatment at level I versus level II centers, impacting patient selection for serious injuries. Analyzing 363,470 trauma patients, level I centers had a higher unadjusted mortality (8.2%) compared to level II (6.9%), but adjusted outcomes showed no overall difference. Level I centers had lower adjusted mortality for shock patients […]
New Score Improves Safe Discharge in GI Bleeding Patients
Risk scores outperform clinical judgment for safe discharge in lower gastrointestinal bleeding—better patient selection can enhance outcomes. The Oakland score showed the highest accuracy (AUC 0.77) for predicting safe discharge, compared to clinical judgment (AUC 0.76). Overall, 76.7% of patients achieved safe discharge within 28 days; however, 41 needed transfusions, 24 required endoscopic intervention, and […]
Declining IVC filter use in trauma patients raises flags
IVC filter placement in trauma patients is declining but shows wide variation among hospitals, affecting patient outcomes. Among 2.3 million trauma patients, only 0.81% had IVC filters placed, down from 1.15% in 2017 to 0.59% in 2024 (p<0.001). 22.5% of centers had insertion rates ≥1%, highlighting significant interhospital differences. Higher IVC filter use did not […]
High Accuracy in Simplified Triage for Military Trauma
A simplified triage system shows promise for prioritizing trauma care in combat settings, but surgeons must be aware of its overtriage rate. Undertriage for major trauma (ISS ≥16) was just 3.6% with a sensitivity of 96.4%. Overall undertriage was 8.5% for all injuries with an AIS score of 3 or greater, with a sensitivity of […]
Whole Blood Transfusion in Trauma Not Superior to Standard Care
Prehospital whole blood transfusion offers no clear advantage over standard care for major trauma patients. In a study of 616 trauma patients, 48.7% in the whole-blood group and 47.7% in standard care experienced death or massive transfusion within 24 hours (p=0.84). Serious adverse events were slightly higher in the standard-care group (37 vs. 31). Consider […]