Gastrojejunostomy configuration did not change delayed gastric emptying after Whipple

The edition in brief

The IPAD trial randomised 158 patients undergoing pancreatoduodenectomy at two French high-volume centres to side-to-side or end-to-side gastrojejunostomy. Delayed gastric emptying occurred in 38.0% and 30.4% respectively (RR 1.25, 95% CI 0.81–1.94), with no differences in fistula, reintervention, mortality, nutrition or quality of life at 90 days. Surgeons can use whichever configuration they do well. In 384,617 US emergency cholecystectomies for acute cholecystitis, the robotic approach was associated with slightly more bailouts — more conversions and subtotal cholecystectomies, fewer cholecystostomy tubes — the same bile duct injury rate and higher one-year costs. Among 497 trauma deaths attended by London's Air Ambulance, 77% occurred before hospital, a median 12 minutes after injury, and almost all haemorrhage deaths were prehospital. A Korean single-centre matched cohort found no mortality difference between a 1 g tranexamic acid bolus alone and bolus plus infusion. The pearl: when the critical view of safety cannot be achieved, a bailout is the safe operation, not a failure.