A rod and a tighter fascial opening cut parastomal hernia after loop ileostomy

The edition in brief

Five items for general surgeons. In the UNSEAL randomised trial of 216 patients with a protective loop ileostomy at the extraction site after laparoscopic anterior resection, an unsutured technique (supporting rod, smaller tailored fascial aperture, no fascial fixation) had fewer parastomal hernias before reversal than fascial/peritoneal suturing: 4.8% vs 13.5%, risk ratio 0.35 (0.13 to 0.94), and took seven minutes less. In 752 Danish patients after major emergency abdominal surgery, 23% developed delirium, which was associated with 30-day mortality of 22% vs 8% and coincided with the peak complication rate. A meta-analysis of 10,785 patients with non-variceal upper GI bleeding found endoscopy within 6 hours did not reduce mortality (OR 0.88, 0.58 to 1.34) or rebleeding but raised ICU admission. Actual, not estimated, 5-year survival after neoadjuvant therapy and pancreatectomy for pancreatic cancer was 34.5% in 660 patients, rising to 81.9% for those recurrence-free at 2 years. The pearl covers delirium screening after emergency surgery.