General Surgery

Minor papillotomy fails to prevent recurrent pancreatitis in pancreas divisum

In adults with unexplained recurrent acute pancreatitis and pancreas divisum, ERCP with minor papillotomy did not significantly reduce recurrent pancreatitis versus sham ERCP. Rates of subsequent acute pancreatitis were similar between groups, with a non-significant hazard ratio favoring papillotomy. There were no meaningful differences in progression to chronic calcific pancreatitis, diabetes, or exocrine pancreatic dysfunction. These data challenge routine therapeutic ERCP with minor papillotomy for idiopathic recurrent pancreatitis in pancreas divisum and support more conservative use. 1

Clinically relevant celiac axis stenosis doubles major complications after PD/total pancreatectomy

Among 1,698 patients undergoing pancreatoduodenectomy or total pancreatectomy, celiac axis stenosis (CAS) was present in 16%. Grade B/C CAS (>50% stenosis) independently doubled severe postoperative complications and liver perfusion failure and markedly increased gastric ischemia. Atherosclerotic CAS had higher bile leak rates than median arcuate ligament–related CAS, suggesting differing risk profiles and management needs. Centers with standardized CAS protocols identified and treated CAS more frequently, supporting systematic preoperative CT review and targeted intervention. 2

Intraoperative AI “Black Box” underdelivers versus surgeon expectations

Surgeons using an intraoperative AI-based Operating Room Black Box reported substantial gaps between expectations and real-world performance. They found the AI models required extensive additional training before becoming clinically usable. Accessing case data was difficult, and the system showed limited accuracy for predicting postoperative complications. Perceived academic and quality-improvement returns were modest, highlighting that successful AI implementation needs clear deliverables and realistic expectations. 3