The edition · General Surgery
A day-2 CRP below 100 identified colon resections at low risk of leak
A two-cohort diagnostic study gives ERAS pathways an earlier discharge check. Plus a negative steroid trial, and where incisional negative pressure earns its place.
The edition in brief
A Danish two-cohort diagnostic accuracy study of 614 elective colon cancer resections found that a C-reactive protein below 100 mg/L on postoperative day 2 had a negative predictive value of about 99% for clinically significant anastomotic leak, and that adding a falling day-3 value in the rest let nearly nine in ten patients leave by day 2 or 3 with leak risk near 1%. A French double-blind trial of 1,210 patients found that a single 20 mg/kg methylprednisolone dose at induction did not reduce major complications after digestive cancer surgery (23% vs 20%). A meta-analysis of 85 trials found incisional negative pressure therapy was associated with fewer surgical site infections (RR 0.64, NNT 21) but more blistering and device problems, supporting selective use. A meta-analysis of mostly observational studies of adhesive small bowel obstruction found operation associated with fewer recurrences but more early harm, at very low certainty. The pearl covers when non-operative management of adhesive obstruction should stop.
A pulse of methylprednisolone did not reduce complications after cancer surgery
A high-dose methylprednisolone pulse at induction did not reduce complications and should not be used for that purpose.
Incisional negative pressure cut infections, at the cost of blisters
Use incisional negative pressure selectively in high-risk wounds, not routinely on every incision.
Operating for adhesive obstruction: fewer recurrences, more early harm
Use conservative management first in uncomplicated adhesive obstruction, and discuss surgery's lower recurrence risk with patients who keep coming back.
When to stop waiting in adhesive obstruction
Treat non-operative management of adhesive obstruction as a time-limited trial with explicit triggers for theatre.
A day-2 CRP under 100 identified colon resections at low risk of leak
After elective colon resection, a day-2 CRP below 100 mg/L in a well patient supports discharge; repeat on day 3 if higher.
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