Anastomotic leaks (ALs) are a significant source of morbidity and mortality. Every step should be implemented to prevent AL, including careful patient selection, optimizing patient's clinical and nutritional status, and ensuring proper technique. The appropriate management of an AL depends on several factors, such as patient's clinical status, the type of surgery, location of the AL, induction therapies, and the resources available. Surgeons should be familiar with the armamentarium of treatment modalities available to manage AL and use a patient-tailored approach when selecting the most appropriate treatment.
Minimally invasive colon and rectal surgery provides oncologic outcomes at least equivalent to open surgery with a multitude of benefits. While laparoscopic colectomy remains effective and widely practiced, its adoption rate has stalled and robotic surgery offers an opportunity to expand minimally invasive oncologic colorectal surgery. Robotic colectomy overcomes many of the laparoscopic limitations and is increasing in popularity in colorectal practice. Broader dissemination remains constrained by cost, operative setup demands, and the need for structured training. Emerging technologies, including single-port systems, artificial intelligence-enhanced platforms, and flexible robotics, are expected to further enhance minimally invasive colectomy for cancer.
Despite signing a consent form, many surgical patients subsequently report gaps in understanding an operation, its alternatives, and its impact on everyday life. Observational studies, patient surveys, and audio-recordings of preoperative interactions suggest that surgeons reliably meet legal requirements for informed consent but less often achieve informed, preference-concordant decisions-especially for older adults facing high-risk procedures. Emerging tools such as structured decision aids, scenario-based frameworks, risk visualization, and patient-reported outcome measures can improve knowledge, expectations, and satisfaction. This article reviews the state of the science, highlights practical communication frameworks, and outlines persistent gaps and future directions.
Acute diverticulitis (AD) is the most common complications of diverticular disease. AD can present with a spectrum of symptoms, ranging from mild, self-limiting inflammation to severe peritonitis. A paradigm shift in the treatment of uncomplicated diverticulitis has been noted, with cumulating evidence challenging the routine use of antibiotics. High-quality evidence suggests that antibiotics may be safely omitted in healthy patients with mild AD. Nonetheless, surgery remains the mainstay treatment of patients with generalized peritonitis or recurrent, debilitating disease. In summary, current guidelines recommend an individualized approach to AD, balancing disease severity, comorbidities, quality of life, and patient preference in decision-making.
Robotic platforms have made it possible to replicate open retromuscular component separation principles through small incisions in a way that was not possible on the laparoscopic platform. However, it is crucial to keep in mind that the optimal repair (not the platform) is key to achieving the best patient outcomes. Robotic abdominal wall reconstruction offers short-term advantages over open repair, including shorter hospital stay and fewer wound complications, albeit with longer operative times, higher procedural costs, and a steep learning curve. Current evidence suggests comparable hernia recurrence rates between approaches, but long-term, high-quality data remain limited.
