The edition · General Surgery
A day-2 CRP under 100 may let most colon resections go home a day earlier
A multicentre two-cohort study found leaks in about 1% of patients below the threshold. Also: cirrhosis regression after bariatric surgery on paired biopsies, and what operating on adhesive obstruction trades against recurrence.
The edition in brief
A multicentre diagnostic accuracy study of 614 patients after elective colon cancer resection found that a C-reactive protein below 100 mg/L on postoperative day 2 carried a negative predictive value of about 99% for anastomotic leak needing intervention (leak in 1.3% and 1.0% of low-CRP patients in test and validation cohorts). For patients above the threshold, a falling CRP on day 3 identified further low-risk patients, so nearly 90% could be discharged by day 2 or 3 with a leak risk near 1%. This moves the familiar day-3 rule a day earlier for enhanced recovery pathways. A Cleveland Clinic paired-biopsy series of 30 patients with compensated MASH cirrhosis found histological regression from stage 4 in a third after bariatric surgery, over a median of six years, with median total weight loss of 24%. The series is small and selected. A meta-analysis of 45 mostly observational studies (205,717 patients) of adhesive small bowel obstruction associated operative management with higher in-hospital mortality and complications but lower five-year recurrence (OR 0.41), at very low to low certainty and with strong confounding by indication. The pearl sets out the warning signs that should end a trial of conservative management.
Compensated MASH cirrhosis regressed in a third after bariatric surgery
Consider compensated MASH cirrhosis a reason for careful bariatric assessment, not an automatic exclusion.
Operating for adhesive obstruction: less recurrence, more early harm
Keep conservative management first-line, but raise the recurrence benefit of surgery with patients who keep coming back.
Proctored team training for robotic Whipple: 486 first cases across 20 centres
Introduce robotic pancreatoduodenectomy through structured, proctored team training and audit outcomes from the first case.
When to stop waiting in adhesive obstruction
Define in advance what will end a conservative trial, and check for it at each review.
Day-2 CRP below 100 makes a colon anastomotic leak unlikely
Use a day-2 CRP below 100 mg/L, with a well patient, to support discharge after elective colon resection, and repeat on day 3 if higher.
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