Abstract Background: Postoperative nausea and vomiting (PONV) remains a common complication following laparoscopic cholecystectomy (LC). Objective: To evaluate efficacy of a Traditional Chinese medicine (TCM) acupoint stimulation model in reducing PONV incidence and improving gastrointestinal recovery after LC. Methods: In this randomized controlled trial, 160 patients undergoing LC were assigned to standard care alone or standard care plus acupoint stimulation. After excluding 2 patients converted to open surgery, 79 patients in each group were analyzed. The intervention included transcutaneous electrical stimulation at Neiguan (PC6) and press needles at Hegu (LI4) and Zusanli (ST36). The primary outcome was PONV incidence and severity within 48 hours after surgery. Results: Compared with the control group, the intervention group had a higher proportion of patients without PONV (69.6% vs. 25.3%, P < 0.001) and a lower overall incidence of PONV (30.38% vs. 74.68%, P < 0.001). Time to first bowel movement was also shorter in the intervention group (1.96 ± 0.71 vs. 2.27 ± 0.92 days, P = 0.021). No significant differences were observed in time to first flatus or length of hospital stay. Conclusion: Multi-method, multi-target TCM acupoint stimulation reduced PONV after LC and modestly improved gastrointestinal recovery. This simple and well-tolerated approach may serve as an adjunct to multimodal PONV prevention.
Introduction: The aim of this study was to evaluate whether a dilated cecum (>= 9 cm) and small-bowel distention on preoperative CT are associated with worse postoperative outcomes in patients with left-sided obstructive colon cancer (LSOCC) undergoing an emergency resection (ER) or a bridge-to-surgery (BTS). Methods: A national multicenter cohort study was conducted using data from a prospective audit performed in 75 Dutch hospitals. Patients undergoing curative resection for LSOCC (2009-2016) with available CT data on cecal diameter and small-bowel distention were included. Primary outcomes were 90-day postoperative complications and mortality, analyzed by multivariable logistic regression and stratified by treatment strategy (ER vs. BTS). Results: Of 1,282 patients, 967 underwent ER and 315 BTS. Among ER patients, concurrent cecal dilatation (>= 9 cm) and small-bowel distention were independently associated with higher 90-day complications (58.8% vs. 42.7%; OR 1.91, 95% CI: 1.25-2.93; p = 0.003) and 30-day mortality (7.0% vs. 2.7%; p = 0.038). These associations were absent in BTS patients. In this high-risk CT subgroup, BTS yielded fewer complications (37.4% vs. 58.8%), lower permanent stoma rates (23.0% vs. 52.1%), and higher primary anastomosis rates (85.4% vs. 30.6%). In young (<70 years) and healthy patients (ASA I-II) without a dilated coecum or small bowel on CT, no outcome differences were found between ER and BTS. Conclusion: Concurrent cecal dilatation and small-bowel distention on CT identify high-risk patients after ER, whereas BTS mitigates these risks. Routine CT-assessment may aid individualized management.
Introduction: Despite the growing proportion of women in medicine, gender disparities persist in academic leadership. Editorial board membership is a key indicator of academic influence, yet data on gender representation in digestive surgery and gastroenterology journals remain limited. Methods: Journals in general surgery, digestive surgery, and gastroenterology were identified using the Clarivate database. Data collected in November 2024 included gender distribution across editorial roles, Journal Impact Factor (JIF), and the h-index of editors-in-chief. Journals with a JIF <2, non-English language, nonrelevant specialty focus, or unknown editor gender were excluded. Statistical analyses were performed using GraphPad Prism, with significance set at p < 0.05. Results: A total of 124 journals comprising 2,542 editors were analyzed. Women represented 18% of editorial board members overall and only 10% of editors-in-chief. Twenty-four journals had no female representation. Female representation was higher among deputy and associate editors but remained lower than that of men. No significant differences were observed between surgical and gastroenterology journals. A positive association was found between JIF and the proportion of women on editorial boards (p = 0.0009). Female editors-in-chief had a lower mean h-index than male editors-in-chief. Conclusion: Women remain markedly underrepresented on editorial boards of digestive surgery and gastroenterology journals, particularly in leadership roles. Although higher impact journals show modestly greater female representation, substantial gender inequities persist.
Postoperative pancreatic fistula is a complex and dreaded complication after pancreatic surgery. Its management is complex and dependent on clinical presentation and severity and clear guidelines are often lacking. This review aims to present the current evidence-based strategies for mitigating the deleterious effects of POPF in the peri- and postoperative setting. Therapy of pancreatic fistula clearly means treatment of complications. Therefore, we discuss medical, interventional and surgical approaches for the management of POPF and its related complications. Furthermore, we discuss surgical as well as physical and chemical intra-operative techniques to prevent POPF. Evidence-based strategies are necessary to further reduce morbidity and mortality following pancreatic surgery and improve overall quality of care.
BACKGROUND:Third- and IV-degree hemorrhoids often require surgery due to prolapse, bleeding and discomfort. Among the available procedures, there is no consensus on which surgical technique offers better results. This systematic review with meta-analysis aims to compare harmonic scalpel hemorrhoidectomy (HSH) versus stapled hemorrhoidopexy (SH). METHODS:A search was conducted in the PubMed, Scopus, and Cochrane Library databases. Inclusion criteria were (a) randomized controlled trials, (b) comparing HSH and SH, (c) in patients with grade III/IV hemorrhoids, and (d) reporting at least one outcome of interest. Statistical analyses were performed in Review Manager 5.4.1 and RStudio, using a random-effects model to calculate the risk ratio (RR) and mean differences (MD) with 95% confidence intervals (CIs). RESULTS:We included six randomized controlled trials with a total of 375 patients. HSH was associated with a lower recurrence compared to SH. However, there were no significant differences in bleeding, fecal incontinence, operative time, hospital stay and urinary retention. SH group was associated with less postoperative severe pain and overall pain. CONCLUSION:HSH and SH are comparable in the treatment of grade III/IV hemorrhoids, analyzing postoperative bleeding, fecal incontinence, operative time, hospital stay and urinary retention. However, SH presented less severe and overall pain, showing better results in the short term and HSH presented lower recurrence, highlighting as a better outcome in the long term.
