Mesh roughly halves recurrence after small umbilical hernia repair, at the cost of more wound problems

The edition in brief

Today's general surgery edition leads on small umbilical hernias. A Hernia meta-analysis of repairs for defects of 2 cm or less found mesh associated with fewer recurrences than suture (RR 0.46, 95% CI 0.38 to 0.55, I² = 0%), but suture repair had less haematoma or bleeding and less infection; pain did not differ significantly. The STOPS trial in JAMA Surgery randomised 252 adults with refractory slow-transit constipation in China to subtotal colectomy with caecorectal anastomosis or total colectomy with ileorectal anastomosis; the subtotal operation was non-inferior on the 12-month Wexner constipation score (difference 0.17, 95% CI −0.93 to 1.27) and caused less incontinence at three months (8.7% vs 21.4%), though satisfaction slightly favoured total colectomy. A Nordic registry cohort of 784,105 adults with obesity associated bariatric surgery with fewer obesity-related cancers (adjusted IRR 0.81), similar across ages and sexes, but with more pancreatic cancer, especially in younger adults. The PREBOTPilot trial stopped for futility: endoscopic botulinum toxin into the sphincter of Oddi before distal pancreatectomy did not reduce clinically relevant fistula (28.6% vs 15%). The pearl is the critical view of safety in laparoscopic cholecystectomy.