Closing an ileostomy at three weeks made the operation easier, with similar complication rates

The edition in brief

Today's general surgery edition ends on a randomised trial about ileostomy timing. In 224 patients with confirmed anastomotic healing after restorative colorectal resection, closure at 3 weeks rather than the conventional delay shortened the operation by about 40 minutes and cut the need for extended adhesiolysis from 21.4% to 5.4%, with similar complications, length of stay and readmissions; 3.6% of early-closure patients had chemotherapy delayed by 1–4 weeks. A US database cohort of 522,629 emergency or urgent cholecystectomies, propensity matched, found robotic surgery associated with fewer bile duct injuries at 30 days (0.06% vs 0.11%) and fewer conversions, with longer operating time; residual confounding is possible and absolute rates were very low. A meta-analysis of 12 studies of prehabilitation before pancreatic resection found fewer overall complications and less delayed gastric emptying, but mostly from observational studies and two small trials, and no effect on fistula, major complications or mortality. A Danish video study of 89 surgeons found moderate agreement on whether an appendix was inflamed or complex, and high agreement on postoperative antibiotics once perforated. The pearl revisits the critical view of safety.