Patient controlled opioid analgesia versus non-patient controlled opioid analgesia for postoperative pain

“Patients may control pain after surgery by self administration of analgesics (pain killers) using devices designed for this purpose (patient controlled analgesia or PCA). PCA involves self administration (by pushing a button) of small doses of opioids (such as morphine)
intravenously by means of a programmable pump. Previous studies have shown that often patients prefer PCA to traditional methods of pain management, such as a nurse administering an analgesic upon a patient’s request. This review demonstrated moderate to low quality evidence that PCA provided slightly better pain control and increased patient satisfaction when compared with non-patient controlled methods. Patients tended to use slightly higher doses of medication with PCA and suffered a higher occurrence of itching, but otherwise side effects were similar between groups.”

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Mesh Suture and Mesh Strips to Prevent Incisional Hernia Following Abdominal Wall Closure or Ventral Hernia Repair

“Incisional hernias are an increasingly common complication encountered by surgeons and their patients, as survival rates from major abdominal surgery continue to improve. The
incidence of incisional hernia after midline laparotomy is estimated to be 9%–20% after 1 year, resulting in approximately 8000 UK repairs annually. While patient factors such as obesity, smoking and diabetes certainly contribute, excessive suture tension during the critical wound healing period causes local ischaemia at the suture-tissue interface and may initiate incisional hernia. Subsequent suture “cheese-wiring” through fascia creates small linear defects that enlarge over time with repeated abdominal wall straining. The clinical
and economic implications of incisional hernia have precipitated preventative research, including Jenkins rule, small-bite closure, and prophylactic mesh implantation which are
discussed in recent high-profile international guidelines. However, many surgeons continue to adopt suture closure over prophylactic planar mesh since this prolongs surgery and risks
infection in a contaminated field.”

Nip, Lawrence et al. “Mesh Suture and Mesh Strips to Prevent Incisional Hernia Following Abdominal Wall Closure or Ventral Hernia Repair: Systematic Review.” Journal of abdominal wall surgery : JAWS vol. 4 14573. 14 May. 2025 Free Full Text

Definition and grading of postoperative pancreatic fistula

“Based on the literature since 2005 investigating the validity and clinical use of the original
International Study Group of Pancreatic Fistula classification, a clinically relevant postoperative pancreatic fistula is now redefined as a drain output of any measurable volume of fluid with an amylase level >3 times the upper limit of institutional normal serum amylase activity, associated with a clinically relevant development/condition related directly to the postoperative pancreatic fistula. Consequently, the former “grade A postoperative pancreatic fistula” is now redefined and called a “biochemical leak,” because it has no clinical importance and is no longer referred to a true pancreatic fistula. Postoperative pancreatic fistula grades B and C are confirmed but defined more strictly. In particular, grade B requires a change in the postoperative management; drains are either left in place >3 weeks or repositioned through endoscopic or percutaneous procedures. Grade C postoperative pancreatic fistula refers to those postoperative pancreatic fistula that require eoperation or lead to single or multiple organ failure and/or mortality attributable to the pancreatic fistula.”

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Management of Patients With Acute Lower Gastrointestinal Bleeding

“Acute lower gastrointestinal bleeding (LGIB) is one of the most common reasons for hospitalization in the United States due to a digestive disorder, accounting for over 100,000 admissions annually. Although historically LGIB has referred to a bleeding source originating distal to the ligament of Treitz, small bowel bleeding is considered a separate entity, with a distinct diagnostic and therapeutic algorithm. For the purposes of this clinical practice guideline, LGIB refers to hematochezia or bright red blood per rectum originating from a colorectal source.”

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Direct Acting Oral Anticoagulants Following Gastrointestinal Tract Surgery

“Direct-acting oral anticoagulants (DOACs) are recommended over vitamin K antagonists (VKAs) for both the treatment of venous thromboembolism (VTE) and the prevention of stroke and systemic embolism in nonvalvular atrial fibrillation (AF). Two classes of DOACs are currently approved by the European Medication Agency and the US Food and Drug Administration: the direct factor Xa inhibitors, including rivaroxaban, apixaban, and edoxaban, and a direct thrombin inhibitor, dabigatran. 5 Unlike the VKAs,
which have a narrow therapeutic range and require dose individualization to maintain a therapeutic international normalized ratio, DOACs have a wide therapeutic range, allowing
for fixed dose regimens.
Efficacious DOAC doses were determined in Phase III trials that were designed based on studies conducted in healthy subjects with an intact gastrointestinal tract (GIT). Therefore, it is difficult to extrapolate outcomes with DOAC treatment to patients who undergo surgical
resection or bypass of the GIT, which may result in alteration of absorptive capacity. Because of the potential of reduced efficacy, the Update on Guidelines for the
Management of Cancer-Associated Thrombosis has recently expressed concerns regarding the use of DOAC in patients with proximal GIT resection.”

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Multi-Institutional Analysis of Pancreaticoduodenectomy for Nonfamilial Periampullary Adenoma: A Novel Risk Score to Guide Shared Decision-Making

“Periampullary adenomas (PA), including both ampullary adenomas (AAs) and duodenal adenomas (DAs), are benign or premalignant mucosal lesions that are either hereditary, most associated with familial adenomatous polyposis (FAP) syndrome, or sporadic, with no known genetic predisposition. In both cases, these uncommon mucosal-based lesions carry malignancy risk and present management dilemmas when not amenable to endoscopic
removal requiring surgical resection. FAP-related PAs are typically large and multifocal and often managed using the Spigelman classification, a point-based system that alerts the clinician of malignancy risk. This classification guides the decision toward continued endoscopic surveillance vs resection vis-à-vis pancreaticoduodenectomy (PD, also known as the “Whipple procedure”). No such scoring system exists for non-FAP-related PAs.”

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Retracting the thyroid matters: Who develops asymptomatic transient thyrotoxicosis after parathyroidectomy

“Thyrotoxicosis has been reported as a postoperative complication of parathyroidectomy
(PTx), attributed to palpation thyroiditis. Palpation thyroiditis was first described by Carney et al., in 1975 as a pathologic response to the traumatic injury of thyroid follicles, characterized by multifocal granulomatous folliculitis. The existing cohort studies in post-PTx thyrotoxicosis are limited. A prospective study of patients who underwent PTx for primary and secondary HPT reported that the incidence rate of thyrotoxicosis after PTx was 31.2 % and 77 %, respectively. The clinical significance of post-PTx thyrotoxicosis remains controversial. While
various manifestations of thyrotoxicosis, including tremors, palpitations, new-onset atrial fibrillation, and angina pectoris mimicking myocardial infarction, were described by case reports, Stang et al. in a cohort study reported that only 15 % of patients developed symptoms of thyrotoxicosis 1–2 weeks after the operation. They further concluded
that the degree of neck dissection appeared explanatory but did not specify which maneuvers were contributory.”

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