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ALPPS mortality drops with IDEAL-guided global registry collaboration

Once considered dangerously high-risk, ALPPS has evolved from >15% to <5% 90-day mortality in high-volume centers through a global registry, consensus guidelines, and the IDEAL framework. Since its 2012 debut, the procedure has been tracked in 1,349 cases across 46 countries, enabling evidence-based refinement. This structured approach contrasts with the chaotic adoption of earlier surgical innovations and the current scrutiny of robotic surgery. ALPPS now stands as a model for evaluating disruptive techniques.

Journal Article by Linecker M, Pfister M (…) Clavien PA et 4 al. in Ann Surg

Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved.

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Protease Inhibitors Could Prevent Bleeding After Pancreatic Surgery

Enzymatic interactions from pancreatic juice cause critical vascular damage post-surgery, leading to severe hemorrhage. A study on porcine models reveals that trypsin and chymotrypsin significantly weaken arterial walls when mixed with intestinal fluids. However, administering nafamostat mesylate, a protease inhibitor, effectively mitigates this histopathologic damage. This finding underscores the potential for localized delivery of inhibitors around vascular stumps to reduce life-threatening complications following pancreatoduodenectomy.

Journal Article by Seki Y, Ishizawa T (…) Hasegawa K et 9 al. in BMC Surg

Copyright © 2025 The Author(s). Published by Elsevier Inc. All rights reserved.

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Prolonged Hospital Stays Linked to Surgical Patient Risks

Surgical patients in Addis Ababa face median hospital stays of six days, primarily due to comorbidities, infections, and functional impairments. Key predictors include weight loss and dietary changes, all stressing the need for targeted preoperative assessments. A proactive approach could enhance recovery and minimize healthcare costs, vital in resource-limited settings.

Journal Article by Sifer SD, Abdela AA (…) Abere AM et 2 al. in Front Surg

© 2025 Sifer, Abdela, Getachew, Assefa and Abere.

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Tumor Stage and Histology Crucial for Esophageal Cancer Outcomes

Advanced tumor stage, location, and rare histological types predict poor disease-free survival in surgically treated esophageal cancer patients. Multimodal therapy significantly enhances survival in stage III cases. Notably, squamous cell carcinoma poses a higher locoregional recurrence risk while offering protection against distant metastases. These findings emphasize the need for tailored treatment approaches based on tumor characteristics to improve patient outcomes in a disease known for its aggressive nature.

Journal Article by Fonseca S, Ramos IGS (…) Tustumi F et 2 al. in Arq Bras Cir Dig

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Bariatric Surgery Safety Improves, But Progress Stalls

Bariatric surgery has significantly enhanced safety, evidenced by a 40% reduction in 90-day mortality over 15 years and declining severe complications. Among 486,161 procedures, sleeve gastrectomy and gastric bypass remain prevalent. However, improvements have plateaued since 2018, signaling a need for fresh optimization strategies. Notably, postoperative medication use has shifted, with analgesic and antidepressant prescriptions falling sharply while laxatives surged. These trends underline the potential for further advancement in surgical intervention for obesity.

Journal Article by Muller O, Marciniak C (…) Caiazzo R et 10 al. in Ann Surg

Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved.

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Robotic Surgery Proves Safe for Gastric Tumors

A fully robotic, ultrasound-guided technique for organ-sparing resection of gastric gastrointestinal stromal tumors (GISTs) yields impressive results. In a cohort of 46 patients, the procedure demonstrated no intraoperative complications and a postoperative morbidity rate below 5%. All surgeries achieved R0 resection with a median follow-up of 36 months showing a disease-free survival rate of 98%. This method is particularly adept at addressing anatomically challenging lesions while minimizing organ sacrifice.

Journal Article by Guerra F, Matarazzo F (…) Coratti A et 2 al. in J Gastrointest Surg

Copyright © 2025 Society for Surgery of the Alimentary Tract. Published by Elsevier Inc. All rights reserved.

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Endoscopic Techniques Outperform Surgery for Necrotizing Pancreatitis

Infected necrotizing pancreatitis treatment benefits from endoscopic strategies, outperforming traditional surgical methods. The systematic review revealed that upfront endoscopic necrosectomy (uen) ranked highest, showing significantly lower mortality rates, fewer complications, and shorter hospital stays. Endoscopic step-up (esu) approaches also displayed favorable results. A cost-effectiveness analysis confirmed endoscopic methods as the most economical choice, with a 97.2% probability of being cost-effective at a $100,000 threshold. Overall, these findings advocate for endoscopic interventions when feasible.

Review by Tan HL, Zhao Y (…) Koh YX et 6 al. in J Gastrointest Surg

Copyright © 2025 Society for Surgery of the Alimentary Tract. Published by Elsevier Inc. All rights reserved.

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Enhanced Instructions Boost Bowel Prep in Hospitalized Patients

Enhanced instructions (EIs) significantly improve bowel preparation (BP) for hospitalized patients undergoing colonoscopy, achieving a Boston Bowel Preparation Scale (BBPS) ≥6 in 76% of cases compared to 60.5% with regular instructions (RIs). This systematic review and meta-analysis of 1,070 patients across six trials demonstrated that EIs, which incorporate clearer guidance and visual aids, lead to better BP quality and higher BBPS scores, ultimately enhancing colonoscopy accuracy.

Review by Faveri MC, Souza D (…) Tustumi F et 4 al. in J Surg Res

Copyright © 2025 Elsevier Inc. All rights reserved.

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Generative AI Advances High-Resolution Laparoscopy Videos

The HiEndo framework revolutionizes gastrointestinal laparoscopy video generation, producing high-resolution, high-fidelity visuals essential for robotic surgery. It leverages a two-stage architecture, first creating low-resolution videos via a diffusion transformer, then enhancing clarity with a super-resolution module. Training on a comprehensive dataset of 61,270 clips, HiEndo outperforms previous models, achieving significant gains in video quality metrics like a 15.1% reduction in Fréchet video distance. This innovation addresses critical needs in surgical visualization.

Journal Article by Wang Z, Zhang Y (…) Zhang Z et 9 al. in Comput Assist Surg (Abingdon)

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Outpatient Stoma Closure: Feasible and Effective Care

Outpatient stoma closure proves safe and efficient for 130 patients, with 90% discharged the same day. The procedure, primarily for loop ileostomies, demonstrates a median operative time of 48 minutes and a low severe morbidity rate of just 3%. Postoperative complications led to a 16% readmission rate, often linked to direct wound closure and steroid therapy. Enhanced protocols may optimize outcomes and reduce hospital stays significantly.

Journal Article by Cleret de Langavant B, Camerlo A (…) Lefevre JH et 5 al. in Ann Surg

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