Surgeons, anesthesiologists, and geriatricians hold differing views on cardiopulmonary resuscitation (CPR) for frail surgical patients. While judgment on CPR appropriateness depends on multiple factors including patient goals, comorbidities, and arrest cause, moral distress can arise from performing resuscitation in such patients. The study also highlights biases like ableism and ageism affecting clinicians’ perspectives and emphasizes […]
Category: General Surgery
Judgement Errors and Patient Outcomes in Surgery
Researchers examined the impact of judgement errors on surgical patient care using data from a single institution’s national surgery quality improvement program. They found that 18% of surgical patients who experienced morbidity or mortality had an error in judgement during their hospitalization. Patients with specific preoperative variables, such as hepatobiliary procedures, insulin dependent diabetes, severe […]
Double Negativity for MRI-Detected and Pathologically-Diagnosed Extramural Venous Invasion as a Favorable Prognostic Factor in Rectal Cancer
Patients with rectal cancer exhibiting double negativity for extramural venous invasion (EMVI) detected by both MRI and pathology experienced significantly better prognosis compared to those with positivity in either method. The study, involving 186 patients, establishes the combined evaluation of MRI and pathology-detected EMVI as a valuable prognostic predictor for rectal cancer outcomes, highlighting the […]
Laparoscopic vs. Ultrasound-Guided Transversus Abdominis Plane Block in Colorectal Surgery: No Significant Difference in Postoperative Pain Management
The study compared the effectiveness of laparoscopic (L-TAPB) and ultrasound-guided (U-TAPB) transversus abdominis plane block (TAPB) in postoperative pain management for patients undergoing colorectal surgery. Four randomized trials with 359 patients were included. The results showed that L-TAPB was non-inferior to U-TAPB, with no significant difference in opioid consumption at various timepoints post-surgery. There were […]
Structural Disorders in Ileal Pouch-Anal Anastomosis and Implications for Diagnosis and Treatment
Researchers identified structural disorders in the ileal pouch-anal anastomosis, recognizing them as potential causes of chronic pelvic pouch complications following surgery. Understanding the critical pitfalls in pouch construction guides treatment decisions for patients exhibiting signs of pouch failure, helping address postoperative surgical complications and improve patient outcomes. Journal Article by Schwartzberg DM, Kayal M and […]
Adjuvant Nivolumab Shows Promising Results in Patients with Tumor-Positive Resection Margin Following Chemoradiotherapy and Esophagectomy
Approximately 4-9% of patients had a tumor-positive resection margin after neoadjuvant chemoradiotherapy (ncrt) and esophagectomy. Only a small proportion of patients received adjuvant therapy, despite the association of positive margins with decreased survival. However, a real-world study revealed that 61% of patients were treated with adjuvant immunotherapy (specifically nivolumab) in 2021-2022. Notably, patients who underwent […]
Surgical Coaching Programs for Skill Development and Patient Outcomes
Surgeons exhibit substantial variability in their skills, directly impacting patient outcomes. Despite limited efforts to enhance surgical skills, the potential lies in surgical coaching programs. This article discusses the promise of such programs, challenges faced in their development, and lessons learned from existing initiatives like the Wisconsin Surgical Coaching Program, SCOPE, MBSC, and ISQIC. While […]
Subtotal Cholecystectomy—A Safe Alternative for Difficult Gallbladders
The study analyzed 1892 cholecystectomies, including 147 bailout procedures. They found that difficult anatomy and dense adhesions were the main reasons for bailout. Out of the bailout procedures, 63.4% were converted to open surgery, with 66% resulting in complete cholecystectomy. The study revealed that subtotal cholecystectomy is a safe alternative to total cholecystectomy for challenging […]
Prognostic Impact of Peritoneal Washing Cytology in Biliary Tract Cancer: Negative PWC Predicts Longer Survival
Patients with resectable biliary tract cancer (BTC) who had negative peritoneal washing cytology (PWC) exhibited longer recurrence-free survival and overall survival compared to those with positive PWC. Among the analyzed patients, ampullary carcinoma showed uniformly negative PWC. Serum carbohydrate antigen 19-9 level over 80 u/ml and multiple lymph node metastasis were independent factors associated with […]
Prophylactic mesh augmentation reduces incisional hernia incidence in emergency laparotomy closure
Prophylactic mesh augmentation in emergency laparotomy closure was evaluated through a meta-analysis of randomized controlled trials. After reviewing 33 studies, four were included in the analysis, involving 464 patients. The results showed a significant decrease in incisional hernia incidence when mesh reinforcement was used (OR 0.18; 95% CI 0.07-0.44; p