The edition · General Surgery
Primary repair over diversion for most colon trauma, and robotic emergency cholecystectomy linked to fewer bile duct injuries
World Society of Emergency Surgery recommendations put physiology, not the injured organ, at the centre of colorectal trauma; a 146,000-patient matched cohort compares robotic and laparoscopic urgent cholecystectomy; and two studies weigh robotic access in rectal cancer and hernia repair.
The edition in brief
World Society of Emergency Surgery recommendations on colon and rectal trauma, graded with GRADE across 17 questions, favour primary repair or resection with anastomosis over routine diversion for most stable patients. Diversion is kept for persistent vasopressor need after damage control, failure to close the fascia at the first relook, or compounded physiological derangement; proximal diversion remains the default for extraperitoneal rectal injury, without presacral drains or distal washout. Antibiotic prophylaxis should not exceed 24 hours. A negative CT does not exclude colonic injury, and adding proctoscopy to CT raises sensitivity for rectal injury to about 97%. In a US database of 522,629 emergency or urgent cholecystectomies, robotic surgery in a propensity-matched comparison was associated with fewer 30-day bile duct injuries (0.06% vs 0.11%; OR 0.56) and fewer conversions, with operations 11 minutes longer; residual confounding is possible. A meta-analysis of 20 studies (7,133 patients) found robotic total mesorectal excision associated with more restorative resections (OR 1.43) and fewer conversions, without a difference in leaks. A Danish survey of 9,552 patients after primary ventral hernia repair found similar chronic pain across approaches, less scar dissatisfaction after minimally invasive repair, and slightly more self-reported recurrence after laparoscopic repair. The pearl: in a hostile gallbladder, the bailout is a decision to make early.
Robotic emergency cholecystectomy associated with half the bile duct injury rate in a matched cohort
Robotic urgent cholecystectomy was associated with fewer bile duct injuries, but the absolute gain is small and observational; the critical view of safety matters more than the platform.
Robotic TME associated with more sphincter-preserving rectal resections
Robotic TME is associated with more restorative resections and fewer conversions without more leaks, but the evidence is largely non-randomised.
Primary ventral hernia repair: similar long-term pain, better scar satisfaction with minimally invasive access
For small primary ventral hernias, offer the approach that fits the patient's priorities: long-term pain was similar, and minimally invasive repair mainly improved scar satisfaction.
Decide on the bailout early in a hostile gallbladder
Set the bailout threshold before a difficult acute cholecystectomy, and use it when the critical view of safety cannot be reached.
Colon trauma: primary repair or anastomosis for most stable patients, diversion only by physiology
In stable colon trauma, choose primary repair or anastomosis and keep diversion for patients whose physiology or open abdomen demands it.
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