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De-escalating preoperative α-blockade improves outcomes for pheochromocytoma surgery

Implementing a de-escalated preoperative α-blockade protocol for pheochromocytoma adrenalectomy shows promising results. The study involving 82 patients indicated that this approach led to a significantly shorter hospital stay (2.5 days compared to 7.1 days) and reduced duration of postoperative norepinephrine use (0.3 hours versus 5.1 hours). Although symptomatic hypotension was more common in the de-escalated group (34.2% vs. 9.1%, p=0.005), no significant differences in overall complications were observed, suggesting safety in this protocol.

Journal Article by Holscher I, Engelsman AF (…) Nieveen van Dijkum EJM et 3 al. in Ann Surg

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

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Screening improves survival outcomes in colorectal peritoneal metastases.

Analysis of 2,773 colorectal peritoneal metastasis patients revealed that those diagnosed through screening had significantly better survival rates and more often received curative treatment. Specifically, 7% were screen-detected, with a median overall survival of 20 months compared to 10.8 months for clinically detected patients. Additionally, 28% of screen-detected patients underwent cytoreductive surgery with hyperthermic intraperitoneal chemotherapy, versus only 14% in the clinically detected cohort, underscoring the advantages of early detection.

Journal Article by Galanos LJK, Rijken A (…) de Hingh IHJT et 10 al. in Eur J Surg Oncol

Copyright © 2024 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

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Preoperative CT features predict surgical outcomes in gastric tumors

Enhanced lesion size on contrast CT significantly correlates with increased operative duration, extended hospital stays, and higher postoperative antibiotic use. A critical finding highlights the intraoperative perforation rate being markedly higher for tumors exhibiting outgrowth compared to those confined to the lumen (96.88% vs 29.11%, p < 0.001). The study underscores CT's superior accuracy in assessing tumor size and risk, facilitating improved surgical planning and complication management in patients undergoing endoscopic resection for gastric submucosal tumors.

Journal Article by Chen Y, Chen M (…) Deng K et 4 al. in Surg Endosc

© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

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Early surgeon consultation increases cholecystectomy success rates.

In a study of 376 patients with symptomatic cholelithiasis, early surgical consultation significantly improved treatment outcomes. Only 23.7% received successful management, while 76.3% experienced failure. The success rate rose to 67.4% among those who received surgery consultations during hospital admission. Conversely, only 28.5% had outpatient consulting within 30 days post-visit. Factors such as age, sex, language, and insurance status did not affect outcomes, emphasizing the need for prompt surgeon involvement.

Journal Article by Guliani J, Bartelson RI (…) Narula N et 3 al. in World J Surg

© 2024 International Society of Surgery/Société Internationale de Chirurgie (ISS/SIC).

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Kono-S anastomosis shows lower short-term complications compared to stapled method

Short-term complications post-operative show no significant difference between Kono-S and side-to-side stapled anastomosis for Crohn’s disease, with Kono-S yielding an acceptable complication rate. In a matched study involving 76 patients, no anastomotic leaks or bleeds were reported in the Kono-S group, contrasting with two cases in the stapled group. Although Kono-S surgeries took longer, the technique offers immediate postoperative advantages, along with improved long-term outcomes, further enhancing its potential as a treatment option.

Journal Article by Ziegler O, Moyer AM (…) Scow JS et 6 al. in J Surg Res

Copyright © 2024 Elsevier Inc. All rights reserved.

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Trans-cystic stenting reduces hospital stay and improves ERCP efficiency

Implementing trans-cystic biliary stenting during acute cholecystectomy significantly reduced the median total hospital stay from six to five days for patients needing both endoscopic retrograde cholangiopancreatography (ERCP) and cholecystectomy. The stenting process was efficient, with 22 out of 23 attempts successful and a median insertion time of 14 minutes. Post-stenting, outpatient ERCP cases increased dramatically, and complications were absent, showcasing the effectiveness of this quality improvement initiative.

Journal Article by Bull N, Ashton P (…) Loveday BPT et 3 al. in ANZ J Surg

© 2024 Royal Australasian College of Surgeons.

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Healthy collegial relationships boost surgeons’ career satisfaction.

Surgeon career satisfaction is significantly enhanced in cohesive, supportive teams characterized by trust, open communication, and collaboration. Conversely, dissatisfaction arises from interpersonal conflicts, poor leadership, and perceptions of egotism or unequal work distribution, leading to a toxic atmosphere. The study identifies specific team qualities that can be cultivated to improve workplace culture, with recommendations for enhancing psychological safety among surgical teams to foster professional fulfillment and collaboration.

Journal Article by Granek L, Kulkarni AV, Barron DJ and Wong AMF in Surgeon

Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.

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Key pharmacotherapy strategies enhance outcomes in colorectal surgery

A causal model identifies pharmacotherapy methods that improve outcomes for elective colorectal surgery patients. Key strategies associated with better primary and secondary composite outcomes include prehospital oral iron and antibiotics, postoperative sugammadex and neostigmine, limiting morphine to ≤50 MME, and ceasing IV fluids by postoperative day two. Contrarily, preoperative scopolamine patches and perioperative gabapentin showed lesser odds for positive outcomes, emphasizing the need for tailored pharmacotherapy in enhanced recovery programs. Further research is warranted on certain treatment impacts.

Journal Article by Sohn C, Roberts J, Jean-Jacques E and Parrish RH in World J Surg

© 2024 International Society of Surgery/Société Internationale de Chirurgie (ISS/SIC).

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Endoscopic ultrasonography-guided ethanol injections demonstrate efficacy for small pancreatic tumors

A prospective multicenter study evaluated endoscopic ultrasonography-guided ethanol injections (EUS-EI) for treating small pancreatic neuroendocrine neoplasms (PNENs). Of the 25 patients treated, 76% achieved the primary endpoint compared to surgical outcomes, and 88% attained complete ablation at 1 and 6 months. Safety results were promising, with 96% experiencing no severe adverse events within one month. With no severe pancreatic fistulas reported, EUS-EI presents a viable treatment alternative for small PNENs.

Journal Article by Matsumoto K, Kato H (…) Otsuka M et 13 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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Preoperative anemia significantly increases the risk of transfusion.

A study of 15,414 patients undergoing elective gastrointestinal cancer surgery revealed that preoperative anemia affects 55.5% of cases, with 58.3% of anemic patients also iron deficient. Preoperative anemia is linked to a nearly threefold increase in the risk of red blood cell transfusion and adversely impacts postoperative outcomes. Specifically, each 1 g/dl decrease in hemoglobin raises transfusion risk by 40%, highlighting the necessity for improved management of treatable anemia causes.

Journal Article by Skorupski CP, Cheung MC (…) Lin Y et 5 al. in J Surg Oncol

© 2024 The Author(s). Journal of Surgical Oncology published by Wiley Periodicals LLC.

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