The edition · General Surgery
A laparoscopic TAP block improved next-day recovery after colorectal surgery
A three-arm trial favours surgeon-placed dual TAP over rectus sheath block; leaving a normal appendix looks safe; robotic and laparoscopic ventral hernia repair leave fewer unhappy scars; a reoperated oesophageal leak costs survival; and EUS gallbladder drainage is not yet proven superior.
The edition in brief
In a blinded three-arm trial of 320 patients having minimally invasive colorectal cancer resection in Japan, a surgeon-placed laparoscopic bilateral dual transversus abdominis plane (TAP) block added to IV patient-controlled analgesia improved 24-hour Quality of Recovery-15 scores by 10.4 points (3.1 to 17.8); surgical rectus sheath block did not reach significance. Both delayed first rescue analgesia by about a day, but opioid use and stay did not change. A Danish multicentre cohort of 1,145 patients found that leaving a macroscopically normal appendix at diagnostic laparoscopy carried a 3.5% chance of a second laparoscopy over about five years and under 1% subsequent appendicitis, questioning routine removal. A Danish survey of 9,552 patients after primary ventral hernia repair found similar chronic pain across approaches, less scar dissatisfaction after robotic (4.2%) and laparoscopic (5.7%) than open (10.2%) repair, and slightly more self-reported recurrence after laparoscopic repair. In 2,905 oesophagectomies across 17 European centres, only leaks needing reoperation were associated with worse survival (HR 1.51). A meta-analysis of six mostly observational studies found EUS-guided gallbladder drainage had fewer device-related readmissions in every study, but the pooled estimate was imprecise and certainty very low.
Leaving a normal appendix at diagnostic laparoscopy carried little later risk
Leaving a macroscopically normal appendix at diagnostic laparoscopy appears safe; if you do, document the reasoning and counsel the patient.
Minimally invasive ventral hernia repair left fewer unhappy scars, not less pain
For small primary ventral hernias, choose the approach by patient priorities — minimally invasive for scar concerns, open where cost or access matters; pain outcomes are similar.
Only oesophageal leaks needing reoperation were linked to shorter survival
After oesophagectomy, aim to control leaks without reoperation, and make sure a leak does not quietly cost the patient their adjuvant therapy.
EUS gallbladder drainage: fewer readmissions in every study, but no firm pooled answer
For high-risk acute cholecystitis, EUS drainage is a reasonable option where expertise exists, but percutaneous drainage has not been shown inferior.
Place the TAP block under direct vision before you close
Add a laparoscopic TAP block under direct vision at the end of the case, within a calculated local anaesthetic dose.
A surgeon-placed bilateral dual TAP block improved 24-hour recovery after colorectal resection
Add a surgeon-placed laparoscopic bilateral dual TAP block at the end of minimally invasive colorectal resections.
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