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Decision-Making Factors and Frequency of Intraoperative Changes to Hartmann’s Procedure in Rectal Cancer Surgery

Post author By STITCHES Newsletter
Post date 17/02/2024
Categories In General Surgery, Intestine and Lower Gastrointestinal Tract

Rectal cancer patients who underwent Hartmann’s procedure were significantly older, had more comorbidities, and were more likely to have the procedure preoperatively due to comorbidities or oncological reasons. In 23% of cases, the decision to perform Hartmann’s procedure was made intraoperatively, mainly due to anastomotic difficulties and oncological reasons. Factors increasing the risk of intraoperative anastomotic difficulties included mid-rectal cancer, male gender, and age. The study highlights the need to consider Hartmann’s procedure preoperatively, especially in older and frail patients with mid-rectal cancer and/or male gender.

Journal Article by Mariusdottir E, Jörgren F (…) Buchwald P et 3 al. in Langenbecks Arch Surg

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Poor quality of surgical outcome reporting persists in medical literature

Post author By STITCHES Newsletter
Post date 16/02/2024
Categories In General Surgery, Perspectives, Opinions and Curiosities

Out of 627 articles reporting surgical outcomes, only 1 met all quality criteria, while 356 articles fulfilled less than half. Cumulative morbidity burden and patient-reported outcomes were commonly missing. Higher impact medical journals had better reporting compared to surgical journals. There has been little improvement in the quality of outcome reporting over the past 20 years. Standardized outcome reporting is urgently needed to improve patient care and guidelines.

Journal Article by Abbassi F, Pfister M (…) Clavien PA et 2 al. in Ann Surg

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Understanding Patient Decision-Making for Colectomy in Recurrent Diverticulitis

Post author By STITCHES Newsletter
Post date 16/02/2024
Categories In General Surgery, Intestine and Lower Gastrointestinal Tract

Patients’ perspectives on colectomy for recurrent diverticulitis were explored through focus groups. A conceptual framework was developed to capture major themes identified in the qualitative data. The study found that the decision to pursue colectomy is highly preference sensitive, influenced by patients’ beliefs about surgery, psychosocial context, and moderating factors. These factors included clinical history, clinical protocols, and provider-specific factors. This knowledge is essential for clinicians counseling patients considering colectomy and for optimizing care in recurrent diverticulitis.

Journal Article by Hawkins AT, Penson DF (…) Rothman RL et 5 al. in Ann Surg

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Intraoperative and Postoperative Complications in Antireflux and Hiatus Hernia Surgery

Post author By STITCHES Newsletter
Post date 16/02/2024
Categories In General Surgery, Hernia, Upper Gastrointestinal Tract

A comprehensive cohort study of 4,301 patients undergoing antireflux and hiatus hernia surgeries in Australia revealed a 12.6% incidence of intraoperative complications and a 13.3% incidence of postoperative complications. Independent predictors of complications included the Charlson comorbidity index, hernia size, revisional surgery, and baseline anticoagulant usage. These risk factors had distinct complication profiles and their cumulative impact on the development of intraoperative and postoperative complications were visualized using risk matrices. These findings enhance understanding of perioperative morbidity associated with such surgeries and inform individualized care and resource allocation.

Journal Article by Liu DS, Wong DJ (…) Watson DI et 6 al. in Ann Surg

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A Novel Serum Exosomal miRNA Signature Predicts Persistent Organ Failure in Acute Pancreatitis

Post author By STITCHES Newsletter
Post date 16/02/2024
Categories In Appendix, Gallbladder and Surgical Emergencies, General Surgery, HPB & Spleen

This study aimed to identify potential biomarkers for early prediction of persistent organ failure (POF) in acute pancreatitis (AP) patients. Using serum exosomal miRNAs, researchers identified a classifier comprising three miRNAs (miR-4265, 1208, 3127-5p) that demonstrated high predictive value for POF. This classifier outperformed other clinical indicators and was effective in identifying prediagnostic POF in post-ERCP pancreatitis cases. Higher levels of the classifier were associated with poor prognosis, suggesting its potential as an early predictor for POF in AP patients, even within the “golden hours” after AP onset.

Journal Article by Li L, Zhang Q (…) Kong X et 12 al. in Ann Surg

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CR/HIPEC Study Shows Decreased Opioid Use and Shortened Hospital Stay with Continuous Wound Irrigation and Intraoperative Methadone

Post author By STITCHES Newsletter
Post date 16/02/2024
Categories In Cytoreductive Surgery & Peritoneum, General Surgery

Continuous wound irrigation and intraoperative methadone usage in cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) significantly reduced opioid use and shortened length of hospital stay compared to epidural analgesia. The combination of continuous wound infusion system (CWIS) and methadone resulted in lower total and daily opioid exposure. The CWIS-only group had lower oral opioid exposure but longer hospital stay. There were no complications associated with CWIS or methadone, except for one epidural abscess.

Journal Article by Boesl MA, Brown N (…) Lambert LA et 3 al. in Ann Surg Oncol

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Embracing Minimally Invasive Coloproctology: Navigating the Future

Post author By STITCHES Newsletter
Post date 16/02/2024
Categories In General Surgery, Intestine and Lower Gastrointestinal Tract

The field of coloproctology is witnessing a paradigm shift towards less invasive treatments due to remarkable advancements in medical care. This shift is particularly notable in gastroenterology, specifically in colorectal surgery. Both benign and malignant colorectal conditions are now being treated with more conservative and less invasive approaches. The study highlights the avoidance of radical resection in rectal cancer patients who had a complete response to neoadjuvant treatment. The research signifies an ongoing emphasis on developing novel, safer, and more effective methods in the realm of colorectal care.

Editorial by Emile SH and Ragheb J in World J Gastroenterol

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Transanal Total Mesorectal Excision (TaTME) Shows High Local Recurrence-Free Survival in Rectal Cancer Patients

Post author By STITCHES Newsletter
Post date 16/02/2024
Categories In General Surgery, Intestine and Lower Gastrointestinal Tract

Researchers analyzed local recurrence and disease-free survival in patients treated with transanal total mesorectal excision (TaTME) for rectal cancer. The study included 279 patients treated at a high-volume tertiary center in Vancouver, Canada. The results showed that the local recurrence rate was 4.7%, and the estimated 2-year local recurrence-free survival was 95.0% with 94.5% at 5 years. These findings support the oncologic safety of TaTME and its acceptable outcomes.

Journal Article by Hershorn O, Ghuman A (…) Brown CJ et 3 al. in Dis Colon Rectum

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Predicting Surgical Complications in Colonic Neoplasia Patients Using Machine Learning

Post author By STITCHES Newsletter
Post date 16/02/2024
Categories In Digital Surgery and Telemedicine, General Surgery, Intestine and Lower Gastrointestinal Tract

A study investigated the utility of machine learning algorithms in predicting complications for patients undergoing colectomy for colonic neoplasia. The three machine learning models successfully identified patients who developed complications, with the neural network scoring highest in predicting anastomotic leak, prolonged length of stay, and inpatient mortality. Although differences in model performance were largely insignificant, these machine learning tools show great promise in assisting surgeons with perioperative risk-stratification and improving postoperative outcomes.

Journal Article by Nwaiwu CA, Perla KR (…) Shah N et 7 al. in Dis Colon Rectum

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Internal Orifice Narrowing Reduces Seroma Formation in Laparoscopic Inguinoscrotal Hernia Repair

Internal orifice narrowing achieved by suturing the distal hernia sac in laparoscopic repair of inguinoscrotal hernias significantly reduces the incidence and volume of seroma formation. A double-blind randomized controlled trial with 58 patients showed a lower seroma incidence at 7 days and reduced seroma volume on postoperative day 7 in the experimental group. Neither chronic pain nor early recurrence were observed in either group, and no other postoperative complications occurred during the follow-up period of 6-18 months.

Journal Article by Shao X, Cheng T (…) Li J et 2 al. in Surg Endosc

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