Patients undergoing diagnostic laparoscopy for suspected appendicitis experience low rates of subsequent surgery and complications, reinforcing that routine removal of a macroscopically normal appendix is not justified. 3.5% of patients who underwent diagnostic laparoscopy required a repeat procedure, with a 0.96% risk of actual appendicitis after follow-up averaging 5.2 years. Surgical complications were significantly higher […]
Category: Appendix, Gallbladder and Surgical Emergencies
Endoscopic Approach for Cystic Duct Remnant Stones Effective
Endoscopic retrograde cholangiopancreatography (ERCP) offers a highly successful and safe alternative for managing symptomatic cystic duct remnant (CDR) stones in postcholecystectomy syndrome, achieving 95% technical success. Out of 21 patients, clinical success was 91%, with balloon sweeps clearing 43% of stones. Cholangioscopy was necessary for 43% of cases, and electrohydraulic lithotripsy was used in 89% […]
Trauma-Informed Care Lags for Spanish-Speaking Patients
This study reveals significant disparities in the delivery of trauma-informed care (TIC) between English- and Spanish-speaking patients in trauma settings, highlighting a need for improvement in communication practices. Only 6.1% of Spanish-speaking patients had a physician introduction compared to 34.1% of English-speaking patients (p<.001). Verbal reassurances were given to a median of 1.0 Spanish-speaking patient […]
Robotic Cholecystectomy Shows Fewer Complications but Higher Costs
In a study of nearly 1,830 patients, robotic cholecystectomy (rc) demonstrated lower complication rates compared to laparoscopic cholecystectomy (lc), particularly beneficial for high-risk patients with elevated BMI. Adverse outcomes for rc were 3.3% versus 8.7% for lc (p < .001), with significant advantages in patients at high risk or with a BMI ≥ 30-35. Total […]
Outcomes after Emergency Surgery in Older GI Cancer Patients
Older adults with gastrointestinal cancer show varied 12-month recovery trajectories post-emergency surgery, with significant implications for patient counseling and planning. In a cohort of 15,398 patients, 7.2% had prolonged recovery and 13.2% faced sustained institutional dependence after surgery. Key risk factors for prolonged recovery included stage IV disease (adjusted relative risk [ARR] 1.92), a Charlson […]
Hospital Management Ratios Affect Older Adult Outcomes
Higher operative-to-nonoperative management ratios in emergency general surgery are linked to better home discharge rates for older patients. Older adults treated at hospitals in the highest tertile of the operative-to-nonoperative ratio had 10% higher odds of being discharged home (OR 1.10, 95% CI: 1.06-1.14). Traditional metrics of morbidity and mortality may not capture what matters […]
Thoracoscopic Repair of Chronic Diaphragmatic Hernias is Safe and Effective
Thoracoscopic repair of chronic post-traumatic diaphragmatic hernia shows promising outcomes with significant advantages over open surgery for defect sizes up to 100 mm. In a study of 21 patients, thoracoscopic repair resulted in lower median blood loss (10 ml vs. 200 ml), shorter chest tube duration (1 vs. 4 days), and reduced hospital stay (5 […]
Laparoscopic Cholecystectomy Skills Assessment Needs Improvement
This systematic review assesses the effectiveness of objective technical skills assessment tools for laparoscopic cholecystectomy, highlighting gaps in validation. Manual assessment tools have the most validity evidence but inconsistent reliability and no clear outcome correlations. Kinematic tools provide motion data but lack robust validation. AI-based systems show promise for real-time use, specifically for critical view […]
Physiological Emergency Surgery Acuity Score Predicts Risks
The Physiological Emergency Surgery Acuity Score (PESAS) effectively predicts 30-day mortality and anastomotic leak in patients undergoing emergency laparotomy. In a study of 1,086 patients, PESAS demonstrated strong discrimination for 30-day mortality (AUROC 0.86), with a mortality rate of 14.7%. For a subset undergoing bowel anastomosis, PESAS also predicted anastomotic leak (AUROC 0.82) with a […]
Colectomy Improves Quality of Life and Lowers Recurrence in Diverticulitis
Patients with recurrent sigmoid diverticulitis opting for colectomy reported significantly better quality of life after one year compared to those choosing observation, alongside a lower 1-year recurrence rate. Colectomy was linked to a 1.73-point improvement in quality of life scores (95% CI: 1.02-2.46) compared to observation. Recurrence rates were 17% in the colectomy group versus […]