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Parathyroid hormone-based algorithm significantly reduces hypocalcemia after surgery

An algorithm utilizing intraoperative parathyroid hormone levels predicted symptomatic hypocalcemia in 90% of patients post-total thyroidectomy. Implementing routine calcium supplementation led to a drop in symptomatic hypocalcemia from 16% to 2.3% and a decrease in readmissions for related complications from 2.7% to 0.01%. While permanent hypoparathyroidism rates remained stable, the study demonstrated the algorithm’s effectiveness in minimizing postoperative complications, showcasing a significant advancement in postoperative care strategies.

Journal Article by Chereau N, Gaujoux S (…) Menegaux F et 3 al. in BMC Surg

Copyright © 2024 Elsevier Inc. All rights reserved.

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Specialization in colorectal surgery improves patient outcomes

Emergency colorectal surgeries performed by specialized surgeons significantly lower 30-day and in-hospital mortality rates. Results from 21 studies indicate a marked increase in primary anastomosis and laparoscopic procedure rates among colorectal specialists, alongside a reduction in stoma formation. The findings, though subject to variability in patient demographics and definitions of specialization globally, emphasize the critical role of surgeon expertise in enhancing postoperative recovery and reducing complications for patients.

Meta-Analysis by Bunjo Z, Traeger L (…) Sammour T et 4 al. in Dis Colon Rectum

Copyright © The ASCRS 2024.

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Hemospray is a more effective and cost-saving treatment.

The analysis indicates that using Hemospray (TC-325) as a first-line treatment for malignant upper gastrointestinal bleeding is both more effective and cost-saving than standard endoscopic therapy (SET). It demonstrated a cost reduction of £245.88, with a slight increase in quality-adjusted life years (0.001 QALYs). In probabilistic simulations, TC-325 proved more effective and economically favorable in 82% of cases. Overall, it resulted in fewer interventions and reduced hospital stays, warranting further research.

Journal Article by Cooper DA, Norton B (…) Barkun A et 5 al. in Endoscopy

The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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Rectoprostatic fascia sparing is feasible and beneficial in surgery.

Feasibility of sparing the rectoprostatic fascia (rpf) during total mesorectal excision for rectal cancer is confirmed. Out of 785 patients, 63.4% successfully had the rpf preserved. Surgical specimen quality remained high. Urogenital function integrity at six months post-surgery was compromised in 27.9% of rpf-sparing cases compared to 41% in traditional surgeries. Notably, local and systemic recurrence rates at three years were comparable between both groups, showcasing the importance of rpf-sparing for preserving urogenital function, especially in younger patients.

Review by Nikolouzakis TK, Gouvas N (…) Tsiaoussis J et 3 al. in Tech Coloproctol

© 2024. Springer Nature Switzerland AG.

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Predictive model effectively identifies surgical margin risks in esophageal cancer.

A pathology-based predictive model for positive surgical margins (PSM) in esophageal squamous cell carcinoma (ESCC) has been established and validated. Analysis of 1,776 patients revealed that multifocal lesions, vascular invasion, and pathomics-based features significantly predict PSM. The decision tree model displayed excellent discrimination with an area under the ROC curve of 0.899, while the nomogram showed slightly lower performance at 0.803. This model may enhance preoperative evaluation and treatment strategies for ESCC patients.

Journal Article by Tang Z, Feng S (…) Zhang Y et 2 al. in Int J Gen Med

© 2024 Tang et al.

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Lymphadenectomy of specific nodes improves survival in pCCA patients

Evaluating lymph nodes during surgery for perihilar cholangiocarcinoma can significantly enhance patient outcomes. In a study of 341 patients, those undergoing lymphadenectomy of stations 12, 8, and 13 demonstrated improved overall survival compared to those receiving only station 12 (HR 0.51). The highest therapeutic index was observed in patients who had six or more lymph nodes harvested. These findings suggest the importance of comprehensive lymph node evaluation for optimal staging and better survival rates.

Journal Article by Kawashima J, Altaf A (…) Pawlik TM et 11 al. in HPB (Oxford)

Copyright © 2024 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.

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High prevalence of Rouvière’s sulcus may reduce bile duct injuries

An analysis of 111 patients reveals that Rouvière’s sulcus (RS) is present in 83.8% of cases, with significant variations classified under Singh-Prasad and Dahmane systems. Specifically, 48.4% of patients exhibit Singh-Prasad type 1a. The high occurrence of RS suggests it can serve as a crucial anatomical landmark during laparoscopic cholecystectomy, potentially mitigating the risk of iatrogenic bile duct injury (IBDI) during surgical procedures.

Journal Article by Cirocchi R, Properzi L (…) Tebala GD et 25 al. in Surg Laparosc Endosc Percutan Tech

Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

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Single-incision gasless trans-subclavian approach enables scarless thyroid surgery

A novel single-incision gasless trans-subclavian endoscopic approach for thyroidectomy has demonstrated feasibility in 243 patients. No conversions to open surgery occurred, with average surgery times of 84.9 minutes for lobectomy plus central neck dissection and 95 minutes for lobectomy alone. Complications included temporary recurrent laryngeal nerve injury in eight cases and one minor lymphatic fistula. With favorable outcomes and cosmetic benefits, this technique presents a promising option for selected patients requiring thyroid surgery.

Journal Article by Jiang J, He G (…) Zhang D et 5 al. in Updates Surg

© 2024. Italian Society of Surgery (SIC).

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Robotic ligament release prevents complications in pancreatic surgery

Preoperative robotic median arcuate ligament release significantly mitigates complications in pancreatoduodenectomy, particularly for patients with celiac artery stenosis. The technique demonstrates a nearly 90% success rate in resolving ischemic complications, preventing hepatic ischemia, and ensuring normal arterial flow to the gastrointestinal tract. A case involving a 49-year-old male with pancreatic adenocarcinoma highlights the effectiveness of this approach, which allows for meticulous dissection and minimizes postoperative risks. Overall, this method proves to be safe and effective.

Journal Article by Ranellone N, Chopra A, Zureikat A and Paniccia A in Updates Surg

© 2024. Italian Society of Surgery (SIC).

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Intravenous iron enhances hemoglobin levels in colorectal cancer patients

In colorectal cancer patients with iron deficiency anemia, preoperative intravenous iron (IVI) significantly raised hemoglobin levels and reduced the need for red blood cell transfusions, complications, and wound dehiscence. An analysis of data from 11 studies involving 2024 patients demonstrated these benefits, highlighting the importance of IVI in managing anemia in this population. However, further randomized controlled trials are necessary to confirm these findings and strengthen the conclusions drawn.

Journal Article by Sydhom P, Shaaban Abdelgalil M (…) Awad AK et 7 al. in Ann Med Surg (Lond)

Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.

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