General Surgery

Robotic pancreaticoduodenectomy modestly improves short-term outcomes versus open and laparoscopic approaches

In this Japanese National Clinical Database study, 1,371 robotic pancreaticoduodenectomies were identified among 46,166 cases from 2019 to 2023. After restricting to centers performing at least 20 PDs annually and 1:1 matching, robotic PD showed fewer severe complications than open and laparoscopic PD. Robotic PD also reduced pancreatic fistula incidence and shortened hospital stay compared with both approaches, despite longer operative times. However, deep venous thrombosis occurred more frequently after robotic PD, indicating a trade-off requiring aggressive thromboprophylaxis. 1

Risk-stratified mitigation bundles lower pancreatic fistula after pancreatoduodenectomy

This multicenter cohort of 7,128 pancreatoduodenectomies examined combinations of drains, stents, octreotide, pancreatogastrostomy, and sealants by Fistula Risk Score. For negligible and low Fistula Risk Score glands, no mitigation strategy outperformed omission, suggesting routine interventions add no benefit. For moderate-risk patients, a drain-alone strategy yielded substantially lower postoperative pancreatic fistula rates than more complex combinations. In high-risk patients, combining drain plus stent significantly reduced fistula incidence compared with other observed strategies. 2

Active gastric electrical stimulation adds symptomatic benefit to pyloroplasty in refractory gastroparesis

This double-blind randomized trial enrolled 38 patients with mainly diabetic, medication-refractory gastroparesis undergoing pyloroplasty and gastric stimulator implantation. Participants were randomized to immediate GES activation versus three months OFF, then ON for months three to six. At three months, GES-ON produced significantly greater improvements in Gastroparesis Cardinal Symptom Index and total symptom scores than GES-OFF. Both groups had similarly accelerated gastric emptying, suggesting symptom benefit from GES is not solely mediated through emptying changes. 3

Immunonutrition modestly reduces minor infectious complications after colorectal cancer resection

This systematic review and meta-analysis included 10 recent studies of immunonutrition in colorectal cancer resection, half randomized controlled trials. Formulations varied, using omega-3 fatty acids, arginine, glutamine, nucleotides, or combinations administered preoperatively or perioperatively. Immunonutrition significantly reduced minor infectious complications but did not significantly affect overall infectious events, noninfectious complications, or hospital stay. Higher immunonutrition doses were consistently associated with greater infection risk reduction, identifying dose as an important moderator. 4