ERAS does not remove the case for extended clot prophylaxis after colorectal cancer surgery

The edition in brief

In 1,043 patients having elective minimally invasive colorectal resection for neoplasia within a mature ERAS pathway, symptomatic post-discharge VTE was rare (0.5%) but higher without extended dalteparin prophylaxis than with it (1.4% vs 0.1%), with no difference in bleeding. The study is observational and the absolute difference small, but it supports keeping guideline-recommended 28-day prophylaxis. A prospective Japanese study of 96 laparoscopic cholecystectomies found indocyanine green fluorescence showed all three ducts in only 16.7% of cases at the start of dissection and 46.9% before clipping, and acute cholecystitis independently predicted failure to see the common bile and hepatic ducts; the critical view of safety was achieved in 93.8%. A South African series of 137 haemodynamically stable stab wounds explored laparoscopically had 2.8% conversion, no missed injuries and 0.7% mortality. A Japanese randomised trial of a powdered chondroitin sulfate barrier at open rectal resection cut adhesions under the incision from 93% to 45%. The pearl: if the critical view cannot be achieved, stop and bail out.