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Customized bacteriophage therapy effectively cures chronic wounds and promotes healing

A randomized, placebo-controlled, double-blind clinical trial evaluated the efficacy and safety of bacteriophage therapy for chronic wounds. Customized bacteriophage cocktails were applied to wounds, resulting in 93.3% becoming sterile in 39 days, followed by complete healing within 90 days. In contrast, 83.3% of wounds treated with placebo remained colonized by bacteria without healing. The study concludes that customized bacteriophage therapy effectively cures chronic wounds regardless of patient characteristics, such as age, sex, diabetes, or multidrug-resistant bacteria infection.

Journal Article by Karn SL, Bhartiya SK (…) Nath G et 5 al. in Int J Low Extrem Wounds

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Robotic enucleation improves outcomes for tumors in the pancreatic head and uncinate process

Post author By STITCHES Newsletter
Post date 01/02/2024
Categories In General Surgery, HPB & Spleen

A retrospective analysis compared short-term and long-term outcomes of robotic enucleation (ren) versus open enucleation (oen) for tumors in the pancreatic head and uncinate process. Of the 146 patients, 92 underwent ren with superior results in terms of shorter operative time, decreased blood loss, and lower postoperative pancreatic fistula rate. Bile leakage, major morbidity, mortality, and hospital stay were comparable between groups. Ren demonstrated comparable long-term oncological and functional outcomes to oen. Subgroup analyses did not show inferior outcomes based on tumor location or proximity to the main pancreatic duct.

Journal Article by Ou H, Chen M (…) Jin J et 9 al. in Ann Surg

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Optimal Pancreaticoduodenectomy Volume for Specialist Services

Post author By STITCHES Newsletter
Post date 01/02/2024
Categories In General Surgery, HPB & Spleen

A systematic review and spline regression analysis of 33 cohort studies involving 198,377 patients were conducted to determine the minimum volume threshold required for a specialist pancreas service to achieve optimal outcomes. The results showed that 55 pancreaticoduodenectomies (PDs) per year were needed to achieve the lowest morbidity, while 43 PDs per year were required for the highest lymph node harvest. A minimum threshold of 45 PDs per year was necessary for mortality benefit, with the optimum value at approximately 70 PDs per year. No significant association was found for cost and length of stay.

Journal Article by Kotecha K, Tree K (…) Mittal A et 4 al. in Ann Surg

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Mindfulness-Based Interventions Improve Well-being and Performance in Surgeons

Post author By STITCHES Newsletter
Post date 01/02/2024
Categories In General Surgery, Perspectives, Opinions and Curiosities

A scoping review of 24 studies on mindfulness-based interventions (MBIs) for surgeons found that MBIs are feasible in surgical contexts and can increase mindfulness, improve well-being (including burnout and psychological measures of stress), and enhance performance in terms of executive function, surgical skills, and communication skills. The conclusions are supported by psychometric measures, observations of technical skills, and neurophysiological evidence. Further research should explore MBIs in larger and more diverse populations and tailor them to other healthcare contexts.

Journal Article by Coopersmith AS, Shroff YV (…) Lebares CC et 4 al. in Ann Surg

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Prognostic Value of Circulating Tumor DNA in Localized Pancreatic Cancer

Post author By STITCHES Newsletter
Post date 01/02/2024
Categories In General Surgery, HPB & Spleen

In a prospective study, researchers evaluated the prognostic value of circulating tumor DNA (ctDNA) using next-generation sequencing (NGS) in patients with localized pancreatic cancer (PDAC) undergoing neoadjuvant chemotherapy (NAC). They found that ctDNA detection was associated with higher CA19-9 levels and predicted worse progression-free survival. Moreover, the presence of KRAS ctDNA at diagnosis independently predicted poorer survival in patients treated with NAC. These findings highlight the potential of ctDNA analysis with NGS as a biomarker for treatment response and survival prediction in localized PDAC.

Journal Article by Shah D, Wells A (…) Chawla A et 10 al. in Ann Surg

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Surgical Sabermetrics Can Enhance Non-Technical Skills in the Operating Room

Post author By STITCHES Newsletter
Post date 01/02/2024
Categories In General Surgery, Perspectives, Opinions and Curiosities

Researchers conducted a scoping review to evaluate the evidence for surgical sabermetrics, which refers to digital methods of assessing surgical non-technical skills. From a total of 19,229 articles, 81 studies met the inclusion criteria. These studies utilized 122 distinct objective, digital metrics to assess various non-technical skills, such as cognitive load, situation awareness, communication, teamwork, and leadership. However, no studies focused on measuring intraoperative decision-making. The findings highlight the potential of surgical sabermetrics to enhance surgical performance and patient safety, while also identifying the need for objective assessment of decision-making in future research.

Journal Article by Howie EE, Ambler O (…) Yule SJ et 4 al. in Ann Surg

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Provider Perspectives on Cardiopulmonary Resuscitation for Frail Surgical Patients

Post author By STITCHES Newsletter
Post date 01/02/2024
Categories In General Surgery, Perspectives, Opinions and Curiosities

Surgeons, anesthesiologists, and geriatricians hold differing views on cardiopulmonary resuscitation (CPR) for frail surgical patients. While judgment on CPR appropriateness depends on multiple factors including patient goals, comorbidities, and arrest cause, moral distress can arise from performing resuscitation in such patients. The study also highlights biases like ableism and ageism affecting clinicians’ perspectives and emphasizes the inadequacy of evidence for risk stratification of frail patients undergoing CPR. The divergent views impede goal-concordant care, necessitating further research on risk stratification, patient-centered outcomes, and addressing potential biases.

Journal Article by Allen MB, Reich A (…) Bader AM et 5 al. in Ann Surg

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Judgement Errors and Patient Outcomes in Surgery

Post author By STITCHES Newsletter
Post date 01/02/2024
Categories In General Surgery, Perspectives, Opinions and Curiosities

Researchers examined the impact of judgement errors on surgical patient care using data from a single institution’s national surgery quality improvement program. They found that 18% of surgical patients who experienced morbidity or mortality had an error in judgement during their hospitalization. Patients with specific preoperative variables, such as hepatobiliary procedures, insulin dependent diabetes, severe chronic obstructive pulmonary disease, or infected wounds, were at increased risk for judgement errors. These errors adversely impacted the outcomes of surgical patients, highlighting the importance of preventing or mitigating errors and monitoring patients closely after an error in judgement.

Journal Article by Marsh KM, Turrentine FE (…) Jones RS et 5 al. in J Am Coll Surg

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Double Negativity for MRI-Detected and Pathologically-Diagnosed Extramural Venous Invasion as a Favorable Prognostic Factor in Rectal Cancer

Post author By STITCHES Newsletter
Post date 01/02/2024
Categories In General Surgery, Intestine and Lower Gastrointestinal Tract

Patients with rectal cancer exhibiting double negativity for extramural venous invasion (EMVI) detected by both MRI and pathology experienced significantly better prognosis compared to those with positivity in either method. The study, involving 186 patients, establishes the combined evaluation of MRI and pathology-detected EMVI as a valuable prognostic predictor for rectal cancer outcomes, highlighting the potential benefit of postoperative adjuvant chemotherapy for patients with EMVI positivity.

Journal Article by Sakanaka T, Iwamoto H (…) Kawai M et 16 al. in Ann Surg Oncol

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Laparoscopic vs. Ultrasound-Guided Transversus Abdominis Plane Block in Colorectal Surgery: No Significant Difference in Postoperative Pain Management

Post author By STITCHES Newsletter
Post date 01/02/2024
Categories In General Surgery, Intestine and Lower Gastrointestinal Tract

The study compared the effectiveness of laparoscopic (L-TAPB) and ultrasound-guided (U-TAPB) transversus abdominis plane block (TAPB) in postoperative pain management for patients undergoing colorectal surgery. Four randomized trials with 359 patients were included. The results showed that L-TAPB was non-inferior to U-TAPB, with no significant difference in opioid consumption at various timepoints post-surgery. There were also no significant differences in postoperative pain, nausea and vomiting, and length of hospital stay between the two delivery methods. Both L-TAPB and U-TAPB showed similar outcomes for multimodal analgesia in colorectal surgery.

Review by Iaquinandi F, Mongelli F (…) La Regina D et 5 al. in Surg Endosc

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