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Which Antibiotic Regimen Fails in Nonoperative Treatment of Diverticulitis and Appendicitis?

Empiric antibiotic treatment of appendicitis is more likely to be associated with the need for additional antibiotics or procedure within 90 days compared to diverticulitis. Cephalosporin + metronidazole (c + m) was the most commonly used antibiotic regimen for appendicitis, while quinolone + metronidazole was more commonly used for diverticulitis. Treatment with c + m for diverticulitis was more likely to be correlated with the need for additional antibiotics or procedures within 90 days. However, the choice of antibiotic did not affect the rate of death for both conditions.

Journal Article by Klinker S, Fitzsimmons A, Borgert A and Fisher M in J Surg Res

Copyright © 2023 Elsevier Inc. All rights reserved.

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Netosis in Surgery: Implications, Impact, and Potential Treatments for Surgeons

Netosis, the formation of neutrophil extracellular traps (NETs), is a novel function of neutrophils. These NETs play a crucial role in trapping microorganisms and preventing their spread throughout the body. However, they can also lead to tissue damage and contribute to various diseases like gallstone formation, acute pancreatitis, impaired wound healing, intravascular coagulation, cancer growth, and metastasis. Promising treatments targeting NET formation or removal have been identified, but more extensive clinical trials are needed to validate their efficacy for surgeons.

Journal Article by James P, Kaushal D and Beaumont Wilson R in Ann Surg

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

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Prophylactic Clipping Does Not Prevent Delayed Bleeding After Colorectal Cold Snare Polypectomy in Patients on Antithrombotic Agents

Prophylactic clipping may not be necessary to prevent delayed bleeding after colorectal cold snare polypectomy in patients on antithrombotic agents, according to a retrospective study. The rates of delayed bleeding and hematochezia did not significantly differ between patients with and without prophylactic clipping. These findings suggest that prophylactic clipping may not be effective in preventing delayed bleeding in this patient population.

Journal Article by Akizue N, Okimoto K (…) Kato N et 13 al. in Gastrointest Endosc

Copyright © 2024 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

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Optimal Surveillance Interval for Branch Duct Intraductal Papillary Mucinous Neoplasm of the Pancreas Depends on Cyst Size and Morphologic Changes

The optimal surveillance interval for branch duct intraductal papillary mucinous neoplasm (IPMN) of the pancreas depends on the size of the cyst and morphologic changes detected during the initial 6-month follow-up. Findings from a large-scale, international cohort study suggest that for patients with cysts smaller than 20 mm and no morphologic changes during a 5-year surveillance period, surveillance may be discontinued if they are unfit for surgery or have a limited life expectancy of 10 years or less.

Journal Article by Han Y, Kwon W (…) Jang JY et 10 al. in JAMA Surg

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Compromised Intestinal Integrity is Associated with Increased Postoperative Complications in Cancer Patients

In this study, it was found that compromised intestinal integrity during oncologic surgery is associated with an increased risk of postoperative complications in cancer patients. The gut wall becomes more permeable due to splanchnic hypoperfusion, allowing intraluminal microbes to enter the splanchnic circulation and potentially contribute to complications. Intestinal fatty acid binding protein (i-fabp) was used as a marker for intestinal integrity, and its levels were found to increase significantly postoperatively. Older age and longer anesthesia time were related to a stronger increase in i-fabp levels, and patients who experienced complications had a greater increase in i-fabp compared to those who did not have complications.

Journal Article by Hendriks S, Huisman MG (…) de Haan JJ et 8 al. in Ann Surg Oncol

© 2024. The Author(s).

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Comparison of Fenestrating and Reconstituting Approaches in Laparoscopic Subtotal Cholecystectomy: Higher Complication Rates with Fenestrating Technique

The study analyzed 170 cases of laparoscopic subtotal cholecystectomy (LSC) and compared the outcomes of fenestrating LSC (F-LSC) and reconstituting LSC (R-LSC). They found that F-LSC had higher complications, including bile leaks, the need for postoperative endoscopic retrograde cholangiopancreatography, and longer length of stay. The study suggests that if LSC is performed, the reconstituted technique should be chosen, if feasible, to minimize the associated high morbidity.

Journal Article by Thomas C, Wintrip D, Horgan L and Brown J in Surg Endosc

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

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No Significant Impact of Preoperative Glycemic Control on Bariatric Surgery Outcomes

The study aimed to determine the impact of preoperative glycemic control on bariatric and metabolic surgery outcomes. The researchers conducted a retrospective cohort study on patients with type 2 diabetes who underwent surgery after completion of a specialist weight management program. The study found no significant differences in complications between patients with preoperative HbA1c levels below or above 69 mmol/mol. The results suggest that achieving the recommended target HbA1c prior to surgery may not reduce the risk of complications.

Journal Article by Wilmington R, Abuawwad M (…) Idris I et 4 al. in Obes Surg

© 2024. The Author(s).

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Surgery alone may provide similar outcomes to neoadjuvant treatment for T3 rectal cancer.

Neoadjuvant treatment (NCRT) may not be necessary for all patients with T3 rectal cancer. This study compared the outcomes of patients with mid-low rectal cancer treated with either surgery alone or NCRT followed by surgery. After analyzing 1,509 patients, the study found that surgery alone provided similar long-term outcomes to NCRT followed by surgery. While NCRT offered advantages in sphincter-preserving surgery and tumor downstaging, it also resulted in a higher rate of enterostomies. Therefore, NCRT may lead to overtreatment in some patients.

Journal Article by Zeng Z, Li Z (…) Kang L et 7 al. in J Gastroenterol Hepatol

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

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Grade A Post-Hepatectomy Liver Failure: Mortality Similar, but Increased Morbidity Compared to No PHLF

A study analyzing hepatectomy outcomes identified grade A post-hepatectomy liver failure (PHLF) as a distinct entity. Although mortality rates were similar between patients with grade A PHLF and those without, the former exhibited notably inferior postoperative outcomes, including increased morbidity, reoperation, nonoperative intervention, longer hospital stays, and higher readmission rates.

Journal Article by Vitello DJ, Shah D (…) Bentrem DJ et 5 al. in J Surg Oncol

© 2024 The Authors. Journal of Surgical Oncology published by Wiley Periodicals LLC.

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Cost-Effective Management of Locally Advanced Gastric Cancer: Preoperative Chemotherapy Dominates

Based on a cost-effectiveness analysis, researchers found that PCT is the most cost-effective management modality for LAGC compared to upfront surgery (US). PCT yielded 3.11 quality-adjusted life-years (QALYs) at a cost of $40,792.16, while US yielded 3.15 QALYs at a cost of $55,575.57. The incremental cost-effectiveness ratio (ICER) was $369,585.25. Sensitivity analyses consistently favored PCT, and across 100,000 simulations, 100% of trials favored PCT as the most cost-effective treatment option for LAGC.

Journal Article by Prasath V, Quinn PL (…) Chokshi RJ et 6 al. in Am Surg

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