Diverticulitis guidance: fewer antibiotics, fewer colonoscopies, earlier resection after abscess

The edition in brief

Today's general surgery edition opens on cholecystectomy. A retrospective analysis of 1,828 operations in eight US hospitals, by surgeons doing both approaches, found robotic cholecystectomy was associated with fewer conversions and major complications than laparoscopy (3.3% vs 8.7%), with the gap concentrated in difficult gallbladders and higher BMI, at about $2,200 to $2,400 more per case. A Japanese randomised trial of 131 patients undergoing open rectal resection found that a powdered chondroitin sulfate adhesion barrier lowered adhesions under the incision at ileostomy closure from 93% to 45%. A Danish nationwide survey of 2,348 patients after incisional hernia repair linked onlay mesh to more foreign-body sensation than retromuscular mesh (37.1% vs 30.3%), with no difference in chronic pain or self-reported recurrence. The pearl covers judging a difficult gallbladder before the first incision. The edition closes on the EAES-SAGES guideline update on diverticular disease: no routine antibiotics for uncomplicated diverticulitis, no routine colonoscopy after a first uncomplicated episode, and elective resection suggested after recovery from an abscess or for persistent symptoms after recurrent episodes. All recommendations are conditional and rest on very low to moderate certainty evidence.