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Significant Variability in Managing Malignant Gastric Outlet Obstruction in Pancreatic Cancer, with Rising Use of EUS-Gastrojejunostomy

Survey of 290 pancreatologists revealed significant differences in managing malignant gastric outlet obstruction (MGOO) due to pancreatic cancer. Endoscopic stenting (ES) was most common, but EUS-Gastrojejunostomy (EUS-GJ) adoption is increasing. Decision drivers include life expectancy and patient frailty, with lack of standardized algorithms. Availability of EUS-GJ remains suboptimal, attributed to the steep learning curve.

Journal Article by De Ponthaud C, Bozkirli B (…) Vanella G et 5 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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Nonoperative Management of Uncomplicated Appendicitis in Adults Linked to Longer Hospital Stays and Higher Costs

Researchers examined 167,125 patients with uncomplicated appendicitis, finding that 82.4% underwent surgical management, while 17.6% underwent nonoperative management (NOM). The NOM group had older patients (53 vs. 43 years), more Medicare recipients (33.6% vs. 16.1%), and higher rates of comorbidities like diabetes (7.8% vs. 5.5%). NOM was associated with longer hospital stays (5.4 vs. 2.3 days) and higher costs ($15,584 vs. $11,559). Older age significantly increased the odds of NOM. Further guidelines are needed to identify which patients benefit from NOM.

Journal Article by Korah M, Tennakoon L (…) Ko A et 3 al. in J Surg Res

Copyright © 2024. Published by Elsevier Inc.

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Nomogram Predicts Survival in Lymph Node-Negative Hepatocellular Carcinoma

Clinicians developed a nomogram to predict cancer-specific survival (CSS) in hepatocellular carcinoma (HCC) patients without lymph node metastasis (LNM), achieving high accuracy in both internal and external validation. Analysis of 6,840 HCC patients revealed age, gender, bone metastasis, lung metastasis, AFP, T stage, surgery, and chemotherapy as significant prognostic factors. The nomogram’s concordance index (C-index) reached 0.746 to 0.777, and the area under curve (AUC) was 0.81, 0.800, and 0.800 at 1, 3, and 5 years, respectively. These results suggest potential for guiding clinical decisions.

Journal Article by Li Z, Hong Q and Li K in Eur J Gastroenterol Hepatol

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

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Straight Stomach Reconstruction Reduces Delayed Gastric Emptying After Pancreaticoduodenectomy

Clinicians found that anchored straight stomach reconstruction (SSR) significantly reduces the incidence of delayed gastric emptying (DGE) after pancreaticoduodenectomy (PD), also leading to improved postoperative nutritional recovery. A case series analysis of 125 PD patients showed that those in the SSR group had a DGE rate of 13%, compared to 33% in the non-SSR group. The study also noted that patients in the SSR group experienced better recovery of body weight and serum albumin levels during the 12-month postoperative period.

Journal Article by Iwanaga N, Ito Y (…) Sugo H et 3 al. in Am Surg

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Accuracy of Conflicts in Interest Reporting in General Surgery Journals

Study finds high inaccuracy (31%) in self-reported conflicts of interest (COIs) in prominent general surgical journals. Authors from the US had the lowest accuracy rate at 69%, compared to the UK (93%) and Australia (96%). Most inaccuracies were observed in corresponding/senior authors (39%), highlighting the need for journals to verify COIs for more accurate reporting.

Journal Article by Bharani T, Yuan C (…) Agarwal D et 5 al. in Ann Surg

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

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Post-Discharge Mental Healthcare Reduces Readmissions in Emergency General Surgery Patients with Serious Mental Illness

A study of 88,092 Medicare patients over 65 with serious mental illness (SMI) found that a post-discharge mental health visit (MHV) within 30 days after emergency general surgery (EGS) hospitalization was associated with significantly lower odds of acute care readmission in both operative (odds ratio 0.60) and non-operative (odds ratio 0.67) groups. There was no observed impact on emergency department presentation or psychiatric admission. These findings suggest that post-discharge mental health care could help reduce readmission rates in this population.

Journal Article by Brown DE, Rosen CB (…) Kelz R et 3 al. in Ann Surg

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

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Pancreas-Preserving Duodenectomy Achieves High Resection Rates with Lower Complications

Pancreas-preserving duodenectomy (PPrD) achieved an R0 resection rate of 93% among patients treated for duodenal neoplasms. In a retrospective cohort of 29 patients, postoperative complications occurred in 34.4% of cases, with 13.7% at Clavien-Dindo grade III-V. PPrD had lower rates of pancreatic leak, delayed gastric emptying, and deep surgical site infection compared to pancreaticoduodenectomy. This suggests PPrD is a safe and effective alternative for treating duodenal neoplasms.

Journal Article by Chung C, Stovall S (…) Biehl T et 4 al. in Am J Surg

Copyright © 2024 Elsevier Inc. All rights reserved.

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Longer Operative Times Linked to Lower Textbook Outcomes in Minimally Invasive Esophagectomy

Longer operative time is associated with higher odds of major complications and prolonged postoperative stay in minimally invasive esophagectomy. The relationship between operative time and achieving textbook outcome (TO) is characterized by an inverse U-shaped correlation, with a significant peak at 298 minutes. Prolonged operative time may indicate targets for quality improvement and risk adjustment processes.

Journal Article by Yang Y, Jiang C (…) Li Z et 5 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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Improved Intraoperative ICGFA Guidance for Bowel Transection

A novel patient-calibrated quantitative ICGFA method was developed to recommend optimal bowel transection sites during surgery, showing 85% agreement with baseline perfusion. The software successfully identified expert surgical transection sites in almost all cases, reducing the risk of anastomotic complications. High-resolution augmented reality heatmaps were generated for guidance, integrating seamlessly into existing clinical workflow and improving patient outcomes.

Journal Article by Dalli J, Epperlein JP (…) Cahill RA et 3 al. in Surg Endosc

© 2024. The Author(s).

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Magnetic Compression Anastomosis: A Sutureless Alternative for Superior Gastrointestinal Outcomes

Magnetic compression anastomosis (MCA) offers sutureless passage construction for tubular organs, showing promise due to low recurrence rates and improved clinical outcomes compared to conventional treatments. The review highlights MCA’s use in various gastrointestinal diseases, showcasing superior anastomotic results compared to surgical sutures. Although initial studies demonstrate safety and feasibility, larger prospective studies are needed for further validation and optimization of commercial magnets in this emerging field.

Review by Zhang G, Liang Z, Zhao G and Zhang S in J Gastroenterol Hepatol

© 2024 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

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