The edition · General Surgery
Muscle is lost within two weeks of major abdominal surgery, and chronic pain after thyroidectomy is commoner than assumed
Pooled data show rapid perioperative muscle loss and an 18% rate of chronic pain three months after thyroidectomy, while a small trial supports an opioid-sparing fascial plane block after laparoscopic cholecystectomy and robotic hernia repair shows no ergonomic gain.
The edition in brief
A meta-analysis of 17 studies (2,213 patients) found measurable loss of skeletal muscle mass within two weeks of major abdominal surgery (standardised mean change 0.34) and by three to six weeks (0.39), with reduced handgrip strength; high heterogeneity and no tested intervention. A meta-analysis of 16 studies (1,538 patients) estimated chronic pain after thyroidectomy at 18.4% at three months, with neuropathic pain in 40.9% at three months and 9.5% at six months among those affected. A meta-analysis of 13 mostly retrospective studies linked total intravenous anaesthesia with better overall survival after oesophagogastric cancer surgery (HR 0.80), a result that cannot show cause. A Dutch cohort of 1,009 patients found gastrointestinal symptoms in 95% before pancreatectomy, peaking in the first three months after it. A four-trial meta-analysis found no clear ergonomic or complication advantage for robotic over laparoscopic inguinal hernia repair. A 56-patient trial found a bilateral external oblique intercostal block cut 24-hour opioid use by 46.5% after laparoscopic cholecystectomy.
Muscle loss begins within two weeks of major abdominal surgery
Consider recording handgrip strength before major abdominal surgery and pairing it with early nutrition and mobilisation, recognising that benefit of any specific intervention is not established here.
TIVA versus volatile anaesthesia in oesophagogastric cancer surgery: a survival association from mostly retrospective data
Note the signal and discuss it with the anaesthesia team, but do not request a technique on the strength of retrospective data.
Gastrointestinal symptoms around pancreatectomy for pancreatic cancer
Ask about gastrointestinal symptoms before pancreatectomy and at each early follow-up, since more than half of patients stay severely affected.
Chronic pain after thyroidectomy: about one in five at three months
Consider adding persistent neck pain to thyroidectomy consent and to the three-month follow-up checklist.
Robotic versus laparoscopic inguinal hernia repair: no ergonomic gain in four trials
Do not choose robotic hernia repair on ergonomic grounds alone; the trial evidence does not yet show an advantage.
Ask about opioid use at discharge after every cholecystectomy
At follow-up, ask how much opioid was actually used and adjust the next discharge prescription.
External oblique intercostal block roughly halved early opioid use after laparoscopic cholecystectomy
Consider asking your anaesthesia team whether a fascial plane block fits your enhanced recovery pathway for laparoscopic cholecystectomy, noting the evidence is a small single-centre trial.
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