Surgeons can safely use endoscopic ultrasound-guided gallbladder drainage in patients with inoperable acute cholecystitis and Niemeier type II perforation. Technical success was 100% in 14 patients treated with electrocautery-enhanced stents. Clinical success reached 92.9% with only mild adverse events, and no severe complications after a median follow-up of 315 days. Consider this approach in high-risk […]
Category: General Surgery
Flexibility Stigma Complicates Family Life in Surgery Residencies
Surgeons should know that flexibility stigma hinders resident well-being and family formation. 28 residents reported feeling pressured to avoid work-life accommodations to maintain their reputation. Trainees often faced a “double bind,” balancing career expectations with parenting and personal health needs. Addressing these cultural barriers within residency programs is crucial for supporting trainees and improving outcomes. […]
Toupet vs. fundopexy: fewer reoperations with fundopexy
Fundoplication options show noteworthy differences in recurrence rates and patient outcomes. Fewer symptomatic recurrences after fundopexy: 1.3% vs. 17.3% for toupet over 66 months. Comparable rates of postoperative dilation for dysphagia: 21.3% for toupet, 13.3% for fundopexy. Consider fundopexy for patients at risk of recurrence; randomized studies are needed to confirm these findings. Similar complication […]
POEM and LHD show similar long-term outcomes for achalasia.
At 5 years, 87.3% of POEM and 90.1% of LHD patients had an Eckardt score ≤3. POEM patients had a higher need for PPIs (45.6% vs 24.6%) and increased rates of esophagitis (34% vs 10.4%). Surgeons should consider the higher GERD incidence with POEM when selecting treatment. Symptomatic recurrence at 5 years was low in […]
Minimally Invasive vs. Open Pancreatoduodenectomy: Recovery Insights
Minimally invasive pancreatoduodenectomy (mipd) enhances recovery compared to open pancreatoduodenectomy (opd), especially in the month post-surgery. On postoperative day 30, mipd patients averaged 659 more steps and 22 more active minutes daily than those in the opd group. Mipd patients had a 9-millisecond higher heart rate variability, indicating less physiological stress. These early recovery benefits […]
Surgeon Attrition: A Growing Concern for Surgical Care
Surgeon attrition is threatening surgical services, particularly in key specialties. Nearly 10% of surgeons exited active practice in 8 years, peaking at 2.5% in 2019. Oral and maxillofacial surgery (25.1%), obstetrics and gynecology (23.2%), and plastic surgery (19.3%) showed the highest attrition rates. Surgeons with 10-14 years of experience faced more than double the risk […]
Muscle Loss Impacts Survival in Advanced Esophageal Cancer
Excessive muscle loss during neoadjuvant therapy significantly predicts survival outcomes in locally advanced esophageal squamous cell carcinoma. Among 421 patients, 5-year overall survival was 60%, with 26.6% experiencing muscle loss during the initial treatment. Muscle loss at two points during therapy was linked to a higher risk of mortality (stage A HR 1.78; stage B […]
Robotic Pump Placement for Liver Metastasis Key to Minimally Invasive Approach
Minimally invasive robotic placement of hepatic artery infusion pumps shows promise for recurrent colorectal liver metastasis patients post-hemihepatectomy. Operative time was 150 minutes with 75 ml blood loss. Patient discharge occurred on day 3 with no complications. Surgeons can consider this technique to enhance patient recovery while maintaining safety. Postoperative scans confirmed optimal hepatic perfusion […]
Outcomes Similar for Immune Therapy After Nivolumab in Esophageal Cancer
First-line immune checkpoint inhibitor therapy for esophageal cancer recurrence shows no advantage based on prior adjuvant nivolumab treatment. Among 81 patients, early tumor shrinkage rates were similar between those with and without prior nivolumab exposure. No differences in progression-free survival (HR 1.4) or overall survival (HR 1.23), with 2-year overall survival at approximately 44%. This […]
Whole Blood Prehospital Transfusion Doesn’t Lower Mortality
Using whole blood for prehospital transfusions in trauma patients does not significantly decrease 30-day mortality compared to blood components. 30-day mortality was 25.9% for whole blood vs. 20.5% for components (adjusted odds ratio 1.24, p=0.24). No significant differences in adverse events between groups were noted. Surgeons should consider these findings when deciding on prehospital transfusion […]