30-Second Takeaway
- Pyloroplasty during minimally invasive esophagectomy lowers early pneumonia and reoperation-requiring leak.
- Prophylactic tranexamic acid modestly reduces bleeding and transfusion without clear VTE or mortality signal.
- Long-term outcomes after laparoscopic Nissen fundoplication show durable reflux control but frequent gas-bloat and dysphagia.
- Comprehensive Complication Index is reliable for cumulative morbidity reporting after pancreatic surgery and in trials.
- Risk tools and geriatric assessment help stratify recurrence, pulmonary, cardiac, and aneurysm repair decisions.
Week ending December 20, 2025
General surgery highlights: perioperative risk, tailoring operative strategy, and long-term outcomes
Pyloroplasty during minimally invasive esophagectomy lowers early pulmonary and anastomotic complications
In this phase III RCT, 143 patients undergoing minimally invasive or robot-assisted esophagectomy were randomized to pyloroplasty or no pyloroplasty. Among 134 evaluable patients, pneumonia or anastomotic leak requiring surgery within 30 days occurred in 18% with pyloroplasty versus 27% without. An adaptive design favored allocation to pyloroplasty, and the trial stopped early once a 90% posterior probability of superiority was reached. These data support routinely adding pyloroplasty during minimally invasive esophagectomy to reduce serious short-term postoperative complications.
Tranexamic acid in general surgery modestly reduces bleeding without clear thrombotic cost
This meta-analysis of 26 RCTs including 6976 general surgery patients evaluated prophylactic tranexamic acid versus placebo. Tranexamic acid reduced intraoperative blood loss, transfusion requirements (RR 0.75), and major bleeding events (RR 0.72). No significant differences were observed in venous thromboembolism, mortality, or length of stay overall. Benefits were attenuated in abdominal procedures but persisted for major bleeding in hepatobiliary surgery, suggesting procedure-specific value. These findings support selective perioperative tranexamic acid use when bleeding or transfusion risk is high and thrombotic risk acceptable.
>10-year outcomes after laparoscopic Nissen fundoplication: durable control with trade-offs
This systematic review and meta-analysis pooled 12 studies with 1334 patients undergoing laparoscopic Nissen fundoplication for GERD, with mean follow-up 13.1 years. Heartburn, regurgitation, and esophagitis were all markedly reduced long term, with symptom recurrence in about 17% of patients. However, gas-bloating and dysphagia occurred in substantial proportions, and approximately one-quarter used proton pump inhibitors postoperatively. Overall satisfaction and willingness to undergo surgery again were high (both about 87%), and reoperation was required in a minority. These data support LNF as a durable option but highlight the need to counsel patients on chronic gas-bloat, dysphagia, and possible PPI use.
References
Numbered in order of appearance. Click any reference to view details.
Additional Reads
Optional additional studies from this edition.