Abstract Background Anastomotic leak (AL) is the leading cause of major morbidity after right colectomy, affecting 5–10% of patients and accounting for up to one-third of postoperative deaths. The multicentre EAGLE randomized trial demonstrated reductions in AL when surgeons completed a digital safe-anastomosis training package, but its effectiveness outside a trial setting remains untested. Methods EAGLE-2 was an international prospective cohort study conducted across participating centres over an 8-week intervals (June–September 2024). Consecutive adults undergoing right colectomy surgery with primary anastomosis were included. The EAGLE safe-anastomosis training platform was made open access and surgeons were categorized according to whether they had completed the modules before surgery. The primary outcome was 30-day AL, defined as a defect of intestinal wall integrity at the anastomotic site leading to frank AL and/or intra-abdominal collection. Secondary outcomes included collection alone, training uptake, and implementation of the recommended checklist. Mixed-effects logistic regression adjusting for ASA grade, urgency, and intraoperative contamination was performed with hospital as a random effect. Results A total of 2875 patients were recruited across 332 hospitals in 60 countries. Of these, 2242 (78.0%) operations were performed by trained surgeons and 633 (22.0%) by untrained surgeons. AL/collection occurred in 16.4% of the non-trained group versus 9.1% of the trained group, giving a difference of 7.3% (P < 0.001). Adjusted analysis found training was associated with almost a halving of the OR for AL (adjusted OR (aOR) 0.56 (95% c.i. 0.41 to 0.78)), as well as lower reoperation (aOR 0.64) and readmission (aOR 0.65) rates. Conclusion Completion of a brief digital training programme was associated with a clinically and statistically significant lower rate of AL after right colectomy, alongside lower rates of reoperation, readmission, and death. Scalable digital education should be embedded into colorectal quality improvement programmes worldwide.
BACKGROUND:The aim was to investigate the increased risk for siblings to have similar aortic pathology (wide or small) in an abdominal aortic aneurysm (AAA) screening population with ultrasonographic measurement of infrarenal aortic diameter (IAD). METHODS:The population-based cohort of men who had participated in the Stockholm AAA screening programme between 2010 and 2024 (107 336 men) were linked to the Swedish Multigeneration Registry (MGR), via the STRIREG cohort. All individuals except one had data available in the MGR. A subaneurysmal aorta (SAA) was defined as having an IAD of 25-29 mm, an AAA was defined as having an IAD of ≥30 mm, and a small aorta was defined as having an IAD of <17 mm. Descriptive statistics and cumulative probability models were stratified for relatedness. Quantitative genetic modelling was used to estimate heritability. RESULTS:From 16 005 screened 65-year-old men, 8987 sibling pairs (7625 pairs of full siblings, 1152 pairs of half siblings, and 210 pairs of twins) were included. In total, 161 (1.0%) had an AAA, 155 (1.0%) had an SAA, and 2700 (16.9%) had a small aorta. IAD correlated stronger in twins than full siblings and weakest among half siblings (half siblings, r = 0.1; full siblings, r = 0.19; and twins, r = 0.52). Overall, 316 (2.0%) individuals had an IAD ≥25 mm and, if a sibling's IAD was 30 mm, the estimated probability of IAD ≥25 mm was 2.7% (95% c.i. 1.9% to 3.7%) in half siblings, 5.3% (95% c.i. 4.5% to 6.2%) in full siblings, and 21% (95% c.i. 10.2% to 38.2%) in twins. Heritability estimates were 0.41 for IAD, 0.61 for SAA/AAA, and 0.58 for small aorta. CONCLUSION:This study provides further evidence for familial aggregation and heritability of IAD and pathologies of the infrarenal aorta, which reinforces the advice for screening of siblings, and especially twins, of individuals with an abnormal aortic diameter including subaneurysms.
BACKGROUND:Effective multimodal analgesia is essential after minimally invasive colorectal surgery. This randomized trial evaluated whether adding surgeon-performed surgical rectus sheath block (SRSB) or laparoscopic bilateral dual transversus abdominis plane (BD-TAP) block to intravenous patient-controlled analgesia (IV-PCA) improved postoperative quality of recovery. METHODS:This single-centre, three-arm superiority trial randomized adults undergoing minimally invasive colorectal resection (1 : 1 : 1) by stratified block allocation at a Japanese cancer centre. Patients and outcome assessors were blinded. The primary outcome was the Japanese version of the 15-item Quality of Recovery questionnaire (QoR-15) score 24 h after arrival in the postanaesthesia care unit. Missing postoperative QoR-15 item responses were handled using multiple imputation, and treatment effects were estimated using ANCOVA adjusted for the four randomization stratification factors. Each primary comparison used a Bonferroni-adjusted one-sided significance level of 0.025. Secondary outcomes included the 48-h QoR-15 score, postoperative pain scores, time to first rescue analgesia, and cumulative consumption of analgesics and antiemetics over 48 h. RESULTS:Between July 2024 and December 2025, 320 patients were randomized (control, 110; SRSB, 107; and BD-TAP block, 103); 309 were analysed (105, 103, and 101 respectively). Compared with control, BD-TAP block resulted in a higher 24-h QoR-15 score (adjusted mean difference 10.44 (95% c.i. 3.06 to 17.83) points; one-sided P = 0.003), whereas superiority of SRSB was not demonstrated (adjusted mean difference 5.50 (95% c.i. -1.88 to 12.89) points; one-sided P = 0.072). At 48 h, the adjusted mean difference for BD-TAP block versus control was 8.01 (95% c.i. 0.18 to 15.83) points (two-sided P = 0.045), an exploratory finding unadjusted for multiplicity. The median time to first rescue analgesia was longer with SRSB (27.8 h) and BD-TAP block (25.3 h) than control (3.3 h), but cumulative 48-h fentanyl consumption and length of hospital stay did not differ significantly. No block-related complications were observed. CONCLUSION:BD-TAP block resulted in better 24-h recovery than IV-PCA alone. Superiority of SRSB was not demonstrated. REGISTRATION NUMBER:jRCT1031240153 (Japan Registry of Clinical Trials).
