A rising proportion of geriatric patients in trauma centers significantly influences outcomes. While mortality for geriatric patients improves with increased numbers, a threshold of 65% total volume results in a plateau. Alarmingly, when the geriatric share exceeds 61%, mortality rates among nongeriatric adults start to climb. This study underscores the need for trauma systems to […]
Category: Appendix, Gallbladder and Surgical Emergencies
Operator Gestalt Outperforms Other Techniques in Blood Bag Filling Accuracy
In prehospital settings, novices using operator gestalt achieved a 69% success rate in correctly filling donor blood bags, significantly surpassing the beaded cable tie (37%) and paracord (52%). For experts, the paracord reached an 80% success rate; however, operator gestalt (70%) was not statistically different. Both groups preferred operator gestalt, while the beaded cable tie […]
Comorbidities and Age Elevate Non-Operative Management Failure in Adhesive Bowel Obstruction
In a substantial analysis of over 1.6 million adhesive small bowel obstruction cases, failure rates for non-operative management soared with increasing age and chronic health issues. Patients over 65 and those with multiple comorbidities faced notably higher risks, with failure rates climbing from 21% in the absence of comorbidities to 26.5% in affected individuals. Surgical […]
Nonoperative management of small bowel obstruction leads to higher readmission and mortality risks
A retrospective analysis of 122,778 patients revealed that nonoperative management (NOM) of small bowel obstruction (SBO) significantly increases the likelihood of readmission and mortality. Readmission occurred in 29.8% of cases, with NOM patients exhibiting a 32% higher risk of readmission compared to those who underwent operative management (OM). Notably, NOM patients had a 50% greater […]
New guidelines endorse routine use of intraoperative cholangiography in gallbladder surgery
Surgeons now have clear guidance favoring routine intraoperative cholangiography (IOC) during laparoscopic cholecystectomy for benign biliary disease. Conditional recommendations highlight IOC’s superiority over fluorescence imaging and confirm its use in both adult and pediatric patients. Additionally, laparoscopic ultrasound remains a viable option. The guidelines stem from a systematic review and input from practicing surgeons, aiming […]
Indocyanine Green Fluorescence Speeds Up Bile Duct Procedures in Complex Cases
In patients with prior abdominal surgeries, indocyanine green (ICG) fluorescence cholangiography significantly enhances laparoscopic bile duct exploration. A study involving 122 matched patients revealed that the ICG group experienced an 88.5% incidence of positive fluorescence, reducing the time to identify the common bile duct and overall surgical duration. Additionally, the ICG cohort had less intraoperative […]
Laparoscopic Bailout Procedures Show Varied Outcomes in Severe Cholecystitis
In managing severe cholecystitis, laparoscopic subtotal cholecystectomy and cholecystostomy tube placement yield lower bile duct injury rates compared to converting to open surgery. Analysis of nearly 385,000 laparoscopic cholecystectomies from 2012 to 2021 revealed a drop in conversion rates and an increase in subtotal cholecystectomy procedures. Despite better bile duct outcomes, subtotal cholecystectomy had a […]
Gut Microbiota Plays a Pivotal Role in Surgical Outcomes
The gut microbiome significantly influences recovery trajectories after surgery and trauma, reshaping patient outcomes beyond genetic predispositions. Individual life histories dictate microbiota composition, which can affect organ systems such as the liver, kidneys, and brain. This review shifts the focus from solely pathogenic bacteria to the complex interactions among pathogens, hosts, and the microbiome, termed […]
Index Admission Cholecystectomy Cuts Mortality and Readmissions in Acute Cholangitis
Cholecystectomy performed during index admission for acute cholangitis significantly reduces in-hospital mortality and lowers 30- and 90-day readmission rates. In a study of over 29,000 patients, those who underwent surgery exhibited a 60% lower risk of death and nearly halved their likelihood of readmission compared to non-surgical counterparts. These benefits persisted across varying severity levels […]
Laparoscopic Repair Cuts Complications in Inguinal Hernia Surgery
Laparoscopic repair of incarcerated inguinal hernias, combined with an enhanced recovery after surgery (ERAS) protocol, significantly reduces postoperative complications. In a comparison involving 200 patients, those undergoing laparoscopy reported only 9% complications, compared to 38% in the open surgery group. This paradigm shift not only streamlines recovery but also positions laparoscopic techniques as the preferred […]