The edition · General Surgery
Waiting after a pulmonary embolism, and the recurrent hernia that should go posterior
Emergency surgery more than 60 days after a pulmonary embolism was linked to half the major adverse events; posterior repair after a failed anterior one was associated with less wound infection.
The edition in brief
A US readmissions database study of 3,785 patients who needed emergency general surgery after an acute pulmonary embolism found a risk inflection at 60 days: later operations were associated with less than half the odds of major adverse events. A single-centre series that scanned every patient after colorectal cancer surgery found asymptomatic portomesenteric venous thrombosis in 4.1%, almost all in peripheral intrahepatic branches, and every case resolved within a year, including those not anticoagulated. A GRADE-assessed meta-analysis of five studies found no difference in morbidity between early and delayed ileostomy closure after low anterior resection, without establishing equivalence. The practice-changer is a meta-analysis of recurrent inguinal hernia: after a failed anterior repair, a posterior repair gave similar recurrence and lower odds of wound infection, supporting the European Hernia Society's plane-switching advice.
Emergency surgery after pulmonary embolism: fewer adverse events beyond 60 days
When an emergency operation has some latitude, consider deferring it beyond 60 days after an acute pulmonary embolism.
Incidental portomesenteric thrombosis after colorectal surgery resolved without treatment
Consider surveillance rather than reflexive anticoagulation for small, peripheral portomesenteric thrombi found incidentally after colorectal surgery.
Early ileostomy closure after low anterior resection: no clear difference in morbidity
Early ileostomy closure is an option for selected, well-recovered patients with an intact anastomosis, not a new default.
No routine antibiotics after appendicectomy for simple appendicitis
Stop antibiotics after appendicectomy for uncomplicated appendicitis; reserve a short course for complicated disease.
Recurrent inguinal hernia after anterior repair: go posterior
Repair a recurrent inguinal hernia through the posterior plane when the first repair was anterior.
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