This study examines the effectiveness of different biliary stents for treating bile leaks post-fenestrated cholecystectomy, revealing significant implications for patient management. PCBL resolution rates were similar across stent types: 93.8% for 10 fr stents, 92.3% for 7 fr stents, and 88.9% for fully covered self-expanding metal stents. Plastic stents, including single and double pigtail options, […]
Category: Appendix, Gallbladder and Surgical Emergencies
Cholecystectomy Outcomes: Complications Down, Complexity Up
Surgical complications in minimally invasive cholecystectomy have significantly decreased despite rising patient complexity. Overall complication rates fell from 21.5% in 2011 to 16.5% in 2021. Serious complications dropped from 12.3% to 7.0% in the same period. Surgery has improved, with specific gains in intraoperative hemorrhage (1.07% to 0.54%) and blood transfusions (5.47% to 1.87%). However, […]
Optimal Management of Severe Splenic Injuries in Trauma Patients
Salvaging the spleen shows lower mortality and complications than splenectomy in severe blunt splenic injuries for trauma patients. Mortality risk for splenic angioembolization (0.62) and observation (0.61) is significantly lower than for open splenectomy. Both angioembolization and observation have fewer complications compared to splenectomy, with odds ratios of 0.74 and 0.75, respectively. Spleen preservation should […]
Revised approach to gallbladder and sphincter disorders
More accurate diagnosis is shifting surgical practice for abdominal pain and pancreatitis. New criteria for dysfunctional gallbladder disorder (DGBD) focus on typical biliary pain and symptom persistence. Sphincter of Oddi disorder (SOD) now requires objective evidence of obstruction or pancreatitis. Surgeons should be cautious, as these disorders are often over-diagnosed, leading to unnecessary risky treatments. […]
The Future of Acute Care Surgery Practice Models
Acute care surgery is essential for effective trauma and emergency care but faces sustainability challenges. Current staffing models vary—traditional vs. time delineated—affecting workload and academic involvement. Compensation often relies on work relative value units, which don’t reflect the full scope of ACS responsibilities. Sustainable staffing and fair compensation are crucial for maintaining quality care and […]
Improving Readiness in Deployed Field Hospitals
Surgeons need to know that clinical readiness among personnel in deployed field hospitals shows significant gaps, particularly affecting surgical outcomes. Only 8% of enlisted personnel held full-time clinical roles, impacting their preparedness for patient care. 69% of respondents felt more pre-deployment training could have prevented clinical errors. Surgeons should advocate for enhanced training and clinical […]
Vascular Injuries in Homicide Victims: A Call for Action
Most homicide victims with isolated extremity injuries face a high risk of fatal vascular damage, emphasizing the need for bystander intervention training. Among 5,765 homicide autopsies, 84% had gunshot wounds; extremity injuries occurred in 47% of these cases. Isolated gunshot extremity wounds were linked to a 10-fold increase in major vascular injuries compared to nonisolated […]
Hispanic/Latinx Injury Survivors Face Language-Related Outcomes Gap
Hispanic/Latinx patients with limited English proficiency show worse post-discharge outcomes after traumatic injury. Spanish-speaking Hispanic/Latinx survivors had a lower quality of life score (38.5) than non-Hispanic whites (41.6). They had reduced odds of returning to work (OR 0.47) and lower rates of engaging in non-injury-related care (OR 0.45). Improving access for these patients could help […]
Volume of EMS Clinicians Linked to Lower Trauma Mortality
Increased annual trauma volumes per EMS clinician significantly lower early mortality in severely injured patients. For every 5 additional adult trauma patients annually, 6-hour mortality decreases by 10% (adjusted odds ratio 0.899). A 2.6% reduction in in-hospital mortality is also observed with increased volume (aor 0.974). Consider optimizing EMS staffing and training to improve early […]
Long-Term Outcomes: Laparoscopic vs Open Adhesiolysis
Laparoscopic adhesiolysis for small bowel obstruction (SBO) offers short-term recovery advantages but shows no long-term superiority over open surgery. At five years, recurrence rates were similar: 9.7% for open vs. 12.5% for laparoscopic (p>.99). Incisional hernia rates were also comparable at 6.1% for open vs. 6.3% for laparoscopic (p>.99). Quality of life scores, based on […]