The edition · General Surgery
A new perioperative cardiac guideline, and when to repair rather than divert
Plus enucleation versus pancreatoduodenectomy for low-grade head tumours, how robotic hernia approaches compare, and a selective, physiology-led turn in colorectal trauma.
The edition in brief
Today's general surgery edition opens on a reference change: the 2026 multisociety guideline on perioperative cardiovascular management for noncardiac surgery replaces the 2014 version, consolidating new evidence on preoperative evaluation, drug therapy, monitoring and devices. A multicentre cohort of 660 patients found pancreatic enucleation for benign and low-grade head tumours carried more clinically relevant pancreatic fistula than pancreatoduodenectomy (33.2% vs 10.6%) but fewer major complications, less delayed gastric emptying, shorter stay, less new-onset diabetes and better quality of life, with the advantage greatest for tumours 2.5 cm or smaller. A network meta-analysis of robotic ventral and incisional hernia repair favoured preperitoneal approaches over intraperitoneal mesh on early outcomes, though certainty was low. A clinic pearl reaffirms venous thromboembolism risk assessment and prophylaxis for every surgical inpatient. The practice-changer: World Society of Emergency Surgery recommendations move colorectal trauma firmly towards selective primary repair or anastomosis over routine diversion, guided by physiology rather than the injured organ — reserving diversion for persistent vasopressor need, failure to close the fascia, or compounded physiological derangement.
A new perioperative cardiovascular guideline supersedes the 2014 version
Adopt the 2026 perioperative cardiovascular guideline as your reference for preoperative cardiac assessment; it replaces the 2014 version.
Enucleation trades more fistula for fewer major complications in low-grade head tumours
For benign or low-grade pancreatic head tumours, consider enucleation as a parenchyma-sparing option, accepting more fistula for fewer major complications — especially for tumours 2.5 cm or smaller.
Preperitoneal robotic hernia approaches edged out intraperitoneal mesh
Where expertise allows, favour preperitoneal or retromuscular robotic planes over intraperitoneal mesh for ventral and incisional hernia, while recognising the evidence is low-certainty.
Risk-assess every surgical inpatient for venous thromboembolism
Risk-assess every surgical inpatient for venous thromboembolism and prescribe mechanical and, where appropriate, pharmacological prophylaxis with a defined duration.
Colorectal trauma: repair or anastomose rather than divert by default
In colorectal trauma, let physiology, contamination and perfusion guide the decision — favouring primary repair or anastomosis over routine diversion in stable patients.
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