The edition · General Surgery
Keeping the caecum in slow-transit constipation surgery, and where ICG earns its cost in hot gallbladders
A Chinese trial finds subtotal colectomy noninferior to total colectomy with less early incontinence, a CRP-stratified cohort points ICG at the hardest cholecystectomies, and two hernia studies on mesh position and abdominal wall blocks.
The edition in brief
The STOPS trial randomised 252 adults with refractory slow-transit constipation to subtotal colectomy with caecorectal anastomosis or total colectomy with ileorectal anastomosis. At one year constipation scores were noninferior (difference 0.17, 95% CI -0.93 to 1.27), and incontinence at three months was lower after subtotal colectomy (8.7% vs 21.4%), though satisfaction slightly favoured total colectomy. In 221 patients having emergency laparoscopic cholecystectomy, conversion occurred only without indocyanine green fluorescence, and the apparent benefit was concentrated in patients with the highest CRP; the conversion interaction was not significant and the study is hypothesis-generating. A Danish nationwide survey of 2,348 incisional hernia repairs found onlay mesh linked to more foreign body sensation than retromuscular mesh, with no difference in severe chronic pain or recurrence. A US registry comparison of quadratus lumborum and TAP blocks in open ventral hernia repair found no difference in stay or opioid use. The pearl covers the bailout when a critical view of safety cannot be reached.
ICG cholangiography in acute cholecystitis: the benefit may sit with high CRP
If ICG is rationed in your unit, consider using it for acute cholecystitis with a high CRP; this is hypothesis-generating evidence.
Onlay mesh linked to more foreign body sensation after incisional hernia repair
When counselling for incisional hernia repair, mention that mesh sensation is common, and slightly more so with onlay placement.
Quadratus lumborum or TAP block for open ventral hernia repair: no clear winner
Consider the TAP block adequate for open ventral hernia repair; this registry found no advantage for the QL block.
When the critical view will not come, bail out early
If you cannot achieve the critical view of safety, stop and choose a bailout rather than push on.
Subtotal colectomy with caecorectal anastomosis holds up against total colectomy for slow-transit constipation
For refractory slow-transit constipation, consider offering subtotal colectomy with caecorectal anastomosis; one-year function matched total colectomy with less early incontinence.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this one is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for general surgery, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free