Colorectal Surgery

Intrathecal morphine plus TAP block enhances early recovery after laparoscopic colorectal surgery

Adults undergoing elective laparoscopic colorectal surgery within an ERAS pathway were randomized to intrathecal morphine 3 µg/kg or intrathecal saline placebo. All patients received liposomal bupivacaine TAP blocks; intrathecal morphine increased 24-hour QoR-15 scores versus control (114.95 vs 102.22; mean difference 12.21). Systemic opioid consumption was lower with intrathecal morphine (4.4 vs 10.4 MME; mean difference −6.59; 95% CI −8.88 to −4.31). Intrathecal morphine reduced postoperative nausea but substantially increased pruritus compared with placebo. These results support intrathecal morphine plus TAP block as an effective ERAS analgesic option, requiring anticipatory management of pruritus. 1

Segmental colectomy for colonic Crohn’s disease shows high recurrence; TNFα prophylaxis is protective

In this multicenter retrospective study of 108 patients undergoing segmental colectomy for colonic Crohn’s disease, 63.9% developed postoperative endoscopic recurrence. Age under 40 years and disease duration ≤156 months increased recurrence risk on univariable analysis. Abdominoperineal resection, malignancy as surgical indication, and postoperative prophylactic TNFα inhibitor use were associated with lower recurrence odds. On multivariable modeling, shorter disease duration predicted recurrence, while prophylactic TNFα inhibitor therapy remained protective (OR 0.26; P = .013). These data favor considering early postoperative TNFα inhibitor prophylaxis after segmental colectomy in appropriately selected Crohn’s colitis patients. 2

Cloud-based CADe improves adenoma, SSL, and large polyp detection in colonoscopy

This parallel-group RCT randomized 841 patients across eight European centers to standard versus real-time cloud-based CADe-assisted colonoscopy. CADe increased adenomas per colonoscopy (0.82 vs 0.62; ratio 1.33; 95% CI 1.06–1.67) and adenoma detection rate (43.2% vs 35.9%). Detection of sessile serrated lesions and large polyps (≥10 mm) improved markedly, with lesion-count ratios of 3.30 and 2.36, respectively. Positive percent agreement for clinically relevant resections was non-inferior, indicating no reduction in resection appropriateness. Average network latency was low, demonstrating feasibility of real-time CADe using low-specification hardware streaming to the cloud. 3

Global Fiesole Consensus updates diverticular disease definitions and management

This international Delphi consensus from 32 experts delivers updated, GRADE-based recommendations on epidemiology, diagnosis, and management of diverticulosis and diverticular disease. High dietary fiber intake is protective, while smoking, obesity, NSAIDs, corticosteroids, opioids, and immunotherapy increase risk of diverticular disease or complications. Imaging is recommended for suspected acute diverticulitis, with ultrasound acceptable in experienced hands and CT preferred for complicated presentations. Diverticulosis alone requires no treatment, and symptomatic uncomplicated disease may benefit from dietary fiber and selected adjunctive agents. Routine antibiotics are not advised for acute uncomplicated diverticulitis, and elective surgery should be individualized, prioritizing quality of life over episode count. 4