The edition · General Surgery
Incidental portomesenteric clots after colorectal surgery all resolved, with or without anticoagulation
Routine day-6 CT found asymptomatic thrombosis in 4% of 799 patients with no harm from surveillance, enucleation trades more fistulas for fewer major complications than a Whipple, and the sleeve still outperforms endoscopic gastroplasty at six months.
The edition in brief
In 799 consecutive patients with routine CT on day 6 after colorectal cancer surgery (World Journal of Surgery, 18 October 2026), asymptomatic portomesenteric venous thrombosis was found in 33 (4.1%), mostly in peripheral intrahepatic branches; all resolved within a year, including the 12 managed by surveillance alone, with no extension or bowel ischaemia. A propensity-matched cohort of 434 patients found enucleation of benign or low-grade pancreatic head tumours had more clinically relevant fistulas than pancreatoduodenectomy (33.2% vs 10.6%) but fewer major complications (8.8% vs 17.1%), shorter stays, less new diabetes and better quality of life. In the US MBSAQIP registry, laparoscopic sleeve gastrectomy produced about twice the six-month weight loss of endoscopic sleeve gastroplasty. Medium- and heavyweight mesh gave similar one-year recurrence after minimally invasive extraperitoneal ventral hernia repair. Danish surgeons agreed moderately on intraoperative appendicitis grading but highly on antibiotic decisions. Pearl: four days of antibiotics after source control.
Enucleation for small pancreatic head tumours: more fistulas, fewer major complications than a Whipple
For small benign or low-grade pancreatic head tumours, discuss enucleation as a parenchyma-sparing option, with an explicit warning about fistula risk.
Sleeve gastrectomy roughly doubled six-month weight loss compared with endoscopic sleeve gastroplasty
Do not present endoscopic sleeve gastroplasty as equivalent to sleeve gastrectomy for weight or metabolic outcomes.
Medium- or heavyweight mesh: similar one-year results in minimally invasive extraperitoneal hernia repair
Heavyweight mesh did not lower one-year recurrence over medium-weight mesh in minimally invasive extraperitoneal ventral repair.
Surgeons agreed only moderately on how bad an appendix looked, but almost always on antibiotics
Standardise how your unit grades appendicitis at laparoscopy, especially gangrenous appendices, because that grade drives antibiotics.
After adequate source control, four days of antibiotics is usually enough
Set a stop date of about four days after source control rather than waiting for every marker to normalise.
Asymptomatic portomesenteric thrombosis after colorectal surgery resolved without anticoagulation
Consider surveillance rather than reflex anticoagulation for a small, asymptomatic peripheral portal clot found after colorectal surgery.
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