Prehospital whole-blood transfusion does not improve outcomes for major traumatic hemorrhage compared to standard blood component therapy. In a study of 616 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 occurred more frequently in the standard-care group (37 vs. 31 […]
Category: General Surgery
Preoperative Low-Energy Diets May Reduce Surgical Risks
Patients with obesity undergoing non-bariatric surgery who follow low-energy diets show promise for better outcomes. In a pilot study, 91 patients were randomized to a low-energy diet or standard care; adherence to the diet was 81.7%. Patients on the diet lost an average of 4.5 kg in three weeks. A meta-analysis indicated an 18% relative […]
Pre-hospital deaths dominate trauma fatalities in urban systems
Most trauma deaths happen before hospital arrival, highlighting urgent needs in trauma care. Of 3,089 adult trauma patients, 497 (16.1%) died; 77.1% died pre-hospital, typically within 12 minutes of injury. Hemorrhage and traumatic brain injury accounted for 81.9% of deaths, with 96.2% of hemorrhage deaths occurring pre-hospital. Surgeons should focus on improving pre-hospital interventions to […]
Liver Transplant Offers Hope for Colorectal Liver Metastases
Deceased donor liver transplantation (DDLT) improves survival for patients with unresectable colorectal liver metastases (CLM). Overall survival is impressive at 96.9% at one year and 84.8% at two years. Disease-free survival at one year is 62.7%; however, recurrence occurs in 42.9% of cases. Accurate patient selection is crucial; KRAS mutation significantly links to recurrence (p=0.01). […]
Timing of Necrosectomy in Infected Pancreatic Necrosis Matters
Immediate necrosectomy for infected walled-off pancreatic necrosis offers no advantages over an on-demand approach. Clinical success rates were similar: 92% (immediate) vs. 88% (on-demand), p = .5. On-demand patients required fewer necrosectomy sessions (1 vs. 2, p ≤ .01) and had fewer adverse events (24% vs. 40%, p = .2). This suggests that a selective […]
Obesity Linked to Higher Cancer Rates: Significant Implications for Surgery
Surgeons should recognize that managing obesity could notably decrease cancer rates among patients. Obesity contributes to about 10% of new cancer diagnoses in the U.S., with specific cancers like endometrial and hepatobiliary seeing rates as high as 50%. Patients losing over 10% of their body weight through bariatric surgery or medication showed modest reductions in […]
New Models for Predicting Hospital Choice in Pancreatic Surgery
Distance-only models fail to accurately predict where patients receive pancreaticoduodenectomy (PD). Accuracy: distance-only model (16.3%), distance + volume model (32.9%), comprehensive model (24.3%). Patients correctly predicted by volume models were more often from urban areas (74.7% vs. 61.0%) and had lower in-hospital mortality (1.3% vs. 3.3%). Surgeons need to consider additional factors beyond distance, like […]
Novel Laparoscopic Method for Bile Duct Resection in PBM
A retroperitoneal-first laparoscopic technique is promising for bile duct resection in pancreaticobiliary maljunction, improving surgical outcomes. Operative time was 480 minutes, with 210 minutes for the retroperitoneal approach and only 40 ml blood loss. Postoperative recovery was smooth; the patient was discharged on day 14 and remains recurrence-free after 3 years post-chemotherapy. This technique offers […]
Fluorescence Lymphography in Esophagectomy Shows No Chyle Leakage Benefit
New study evaluates indocyanine green fluorescence to prevent chyle leakage during esophagectomy, but results are mixed. Chyle leakage incidence: 17% in the ICG group vs. 10% in controls (p = 0.163). ICG influenced intraoperative decisions in 36% of cases, with successful thoracic duct visualization in 85%. Surgeons may not see a reduction in chyle leakage, […]
Gallium-68 PET for Pancreatic Neuroendocrine Tumors: Limited Sensitivity
A study shows Gallium-68 DOTATATE PET has high specificity but low sensitivity in identifying lymph node metastases in pancreatic neuroendocrine tumors, affecting surgical decisions. Detected suspicious lymph nodes in 24% of cases; pathology confirmed involvement in 42%. Sensitivity was 46%, specificity 92%, with a positive predictive value of 81%. Consider it for preoperative evaluations, especially […]