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Balancing Act: Bariatric Surgery and Anticoagulation’s Bleeding Dilemma

In a study spanning 2008–2022, researchers delved into the post-bariatric bleeding risks for patients on chronic anticoagulation (CAT). Examining 132 cases (82 Roux-en-Y gastric bypass, 50 sleeve gastrectomy), the incidence of long-term bleeding was significantly higher in the Roux-en-Y group (18.3%) than the sleeve gastrectomy group (4%). Notably, bleeding marginal ulcer (MU) prevailed in the Roux-en-Y group (13.4%). The study urges informed counseling on bleeding risks for CAT patients considering metabolic and bariatric surgery.

Journal Article by Abi Mosleh K, Belluzzi A (…) Ghanem OM et 4 al. in Obes Surg

© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

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Novice Surgeons’ Success in Laparoscopic Sleeve Gastrectomy

In South Korea’s non-tertiary hospitals, where bariatric surgery lacks specialized training, researchers examined outcomes of laparoscopic sleeve gastrectomy (LSG). Analyzing data from a novice surgeon’s cases before and after the learning curve, they found comparable safety and efficacy. Post-learning curve, operation time significantly decreased (118.4 to 61.9 minutes), showcasing that LSG can be proficiently performed by novice surgeons in non-tertiary settings with careful patient selection, challenging assumptions about the procedure’s complexity.

Journal Article by Lee S and Mun S in Asian J Surg

Copyright © 2023 Asian Surgical Association and Taiwan Robotic Surgery Association. Published by Elsevier B.V. All rights reserved.

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Liquid Biopsy in Cancer Care: A Game Changer for Surgical Patients

This review delves into the evolving realm of liquid biopsy, a groundbreaking tool with the potential to transform cancer care. Researchers explored its clinical applications in the context of surgical patients. While circulating tumor cells (CTCs) and circulating tumor DNA (ctDNA) have been studied extensively, their practical use in surgical settings is not yet fully defined. They show promise in detecting disease progression, guiding systemic therapy, and predicting recurrence, particularly for early-stage cases. However, there is still much to learn, and surgeons need to actively engage in clinical trials to advance this game-changing technology.

Journal Article by Mahuron KM and Fong Y in JAMA Surg

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Early Discharge Proves Safe After Uncomplicated Colectomy

This retrospective study explored the relationship between postoperative discharge timing and complications in patients who underwent uncomplicated elective colectomy. Findings from over 113,000 patients revealed that early discharge (≥3 days for laparoscopic/robotic, or ≥5 days for open surgery) after minimally invasive colectomy significantly lowered the odds of post-discharge complications. The same benefit wasn’t observed in open surgery. Importantly, there were no notable differences in the risk of return to the operating room. This suggests that early discharge is a safe option for select patients, especially in minimally invasive approaches.

Journal Article by Balas M, Quereshy F, Bohnen J and Jung JJ in J Am Coll Surg

Copyright © 2023 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.

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Enhancing Quality of Life in Opioid and Psychotropic Medication Users Post CRS-HIPEC

A study investigated the impact of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) on the quality of life (QoL) for patients taking opioids and psychotropic medications preoperatively. The research found that patients using these medications had worse baseline QoL but achieved similar scores to those who didn’t postoperatively, except in emotional functioning. The data suggests the potential benefit of psychosocial intervention to enhance emotional adaptation, supporting CRS-HIPEC’s role in improving QoL for these patients.

Journal Article by Solsky I, Patel A (…) Levine EA et 6 al. in Ann Surg Oncol

© 2023. Society of Surgical Oncology.

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Effective Treatment for Gastric Cancer with Peritoneal Metastasis

A study examined cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) using paclitaxel and cisplatin in 22 patients with gastric cancer and peritoneal metastasis. Results showed that this treatment was well-tolerated with favorable oncologic outcomes. Patients experienced high rates of complete cytoreduction and R0 resection, and the treatment led to promising survival rates. Major complications were limited, and no deaths occurred within 90 days of the procedure. This approach shows promise in improving the prognosis for gastric cancer patients with peritoneal metastasis.

Journal Article by Buckarma E, Thiels CA, Jin Z and Grotz TE in Ann Surg Oncol

© 2023. Society of Surgical Oncology.

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Shifting Trends in End-of-Life Care: Where Colorectal Cancer Patients Die in the US

Researchers investigated the locations of death among colorectal cancer (CRC) patients in the United States, aiming to identify determinants and trends. From 2003 to 2019, they observed a shift from hospital and institutional settings toward home and hospice as preferred places for end-of-life care. However, disparities existed among racial and educational groups, with non-white and less-educated individuals less likely to die at home or in hospice. This highlights the need for equitable end-of-life care policies to address healthcare disparities in CRC patients.

Journal Article by Sonal S, Jain B (…) Berger DL et 11 al. in Ann Surg Oncol

© 2023. Society of Surgical Oncology.

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New Surgical Guidelines for Paraesophageal Hernias Offer Key Recommendations

The European Association for Endoscopic Surgery conducted a comprehensive review to update guidelines for paraesophageal hernias. They gathered an interdisciplinary panel of experts, including surgeons, gastroenterologists, and patient advocates, and utilized the latest evidence and methodology. Their recommendations emphasize surgery for asymptomatic/minimally symptomatic cases but recommend conservative management for frail patients. They also provide guidance on hiatal closure methods and fundoplication in paraesophageal hernia repair. These updated guidelines aim to offer clarity and help healthcare professionals and patients make informed decisions.

Journal Article by Markar SR, Menon N (…) Antoniou SA et 18 al. in Surg Endosc

© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

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Sequential Treatment Outperforms Open Abdomen Approach for Duodenal Leakage-Induced Intra-Abdominal Bleeding

A cohort study examined treatments for intra-abdominal bleeding caused by duodenal leakage. The two approaches were “Sequential Treatment” (ST), which combines arterial embolization and drainage, and “Open Abdomen” (OA), a simultaneous method. ST had a lower mortality rate (28.2% vs. 51.3%) and better initial hemostasis success (94.4% vs. 77.8%) compared to OA. After propensity score matching, ST remained superior, reducing mortality and rebleeding. The study suggests that ST, involving arterial embolization and subsequent drainage, may be more effective in lowering mortality in this context.

Journal Article by Yao Z, Zhao G (…) Chen K et 5 al. in Surg Endosc

© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

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Intraoperative Pancreatoscopy Safe and Beneficial in Managing Pancreatic Neoplasms

A systematic scoping review explored the role of intraoperative pancreatoscopy (IOP) in the surgical management of intraductal papillary mucinous neoplasms (IPMN) in the pancreas. IOP allows for the visualization of the main pancreatic duct, aiding in surgical planning. The review of five studies revealed IOP to be safe, detecting additional lesions in 34% of cases and prompting changes in surgical plans. While promising, larger, multi-center prospective studies are needed to further define IOP’s role in IPMN surgical strategy.

Review by Ciprani D, Frampton A (…) Aroori S et 3 al. in Surg Endosc

© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

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