General Surgery

Intrathecal morphine enhances early recovery after laparoscopic colorectal surgery within ERAS

Adults undergoing elective laparoscopic colorectal surgery within an ERAS pathway were randomized to intrathecal morphine (3 µg/kg) or intrathecal saline, both with TAP blocks using liposomal bupivacaine. Intrathecal morphine significantly improved 24-hour Quality of Recovery-15 scores versus control, indicating better early global recovery. Postoperative opioid consumption was lower with intrathecal morphine, while nausea was less frequent despite reduced systemic opioids. Pruritus was substantially more common with intrathecal morphine, representing the main trade-off to consider in protocol adoption. 1

Preoperative nutrition sharply reduces early enterocolitis after Hirschsprung pull-through

This multicenter randomized trial assigned 110 children undergoing pull-through for Hirschsprung disease to preoperative nutritional support or standard care. At three months, Hirschsprung-associated enterocolitis occurred far less often with nutritional support than standard care, with a large absolute risk reduction. No adverse events from nutritional support were reported, supporting safety in this vulnerable pediatric cohort. These findings support routine, structured preoperative nutritional optimization to lower early enterocolitis risk after Hirschsprung surgery. 2

Perioperative multimodal rehab improves frailty status after GI cancer surgery in older adults

Frail older adults undergoing gastric or colorectal cancer surgery were randomized to perioperative multimodal rehabilitation or routine care. Intervention patients received combined nutritional support, exercise, and psychological care extending through the perioperative course. At discharge and one week after discharge, intervention patients were markedly more likely to be pre-frail and less likely to be frail than controls. Early postoperative frailty states did not differ, suggesting benefits accrue during recovery rather than immediately after surgery. 3

Neoadjuvant DOS improves pathologic response and DFS versus SOX in HER2-negative gastric cancer

This multicenter real-world cohort compared neoadjuvant docetaxel–oxaliplatin–S-1 (DOS) with S-1–oxaliplatin (SOX) in 1283 HER2-negative locally advanced gastric cancers. DOS produced a higher major pathologic response rate than SOX after propensity-score matching, indicating deeper tumor regression. Disease-free survival favored DOS in multivariable and weighted analyses, while overall survival remained similar at roughly three years’ follow-up. Severe postoperative complication rates were low and identical between regimens, suggesting triplet intensification did not compromise surgical safety. 4