30-Second Takeaway
- Inpatient minimally invasive cholecystectomy outcomes are improving in older, sicker Medicare patients, with bile duct injury now rare.
- Nonoperative splenic salvage, including angioembolization, is associated with lower mortality than splenectomy in severe blunt splenic injury.
- Postpancreatectomy hemorrhage remains uncommon but carries ~10-fold higher mortality, especially with complex resections and CR-POPF.
- Synthetic mesh lowers 5-year parastomal hernia recurrence versus biologic mesh, without added mesh-related complications.
- EUS-guided gastrojejunostomy offers superior clinical success and durability for malignant gastric outlet obstruction compared with stents or surgery.
Week ending February 28, 2026
New data reshaping everyday decisions in general surgery and perioperative care
Cholecystectomy complications and bile duct injury continue to fall despite rising case complexity
Among 516,372 Medicare patients undergoing inpatient minimally invasive cholecystectomy from 2011–2021, comorbidity burden and unplanned admissions increased substantially over time. Despite sicker patients, risk-adjusted overall complications fell from 21.5% to 16.5%, and serious complications from 12.3% to 7.0%. Specific complications declined, including intraoperative hemorrhage, transfusion, and bile duct injury, which dropped from 0.19% to 0.12%. In contrast, postoperative percutaneous drainage use increased from 1.32% to 2.91%, suggesting evolving management of postoperative collections or leaks.
Splenic salvage beats splenectomy for severe blunt splenic injuries with multiple trauma
This TQIP-based cohort included 12,930 adults with severe blunt splenic injury and significant extra-abdominal trauma from 2017–2022. Patients treated with splenic angioembolization or observation had lower in-hospital mortality than those undergoing open splenectomy (adjusted HRs about 0.6). Nonoperative strategies also had fewer complications, including less ARDS, cardiac arrest, and severe sepsis, and shorter ICU and hospital stays. Findings support prioritizing splenic salvage, including angioembolization, even in high-risk polytrauma, when hemodynamics and resources permit.
Postpancreatectomy hemorrhage is infrequent but drives a tenfold increase in mortality
Among 10,467 elective pancreatic resections, postpancreatectomy hemorrhage (PPH) occurred in 5.9% of patients. PPH was associated with a nearly 10-fold higher mortality compared with no PPH (20.7% vs 2.2%). Clinically relevant postoperative pancreatic fistula was a strong predictor of PPH, with an odds ratio of 5.93. PPH incidence and mortality rose markedly with increasing resection complexity, reaching 13% and 36% respectively in the most complex procedures. In PPH after head or distal resections, advanced age, relaparotomy for bleeding, very late bleeding, arterial source, and sepsis independently predicted death.
References
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Additional Reads
Optional additional studies from this edition.