General Surgery

Early surgery for adhesive SBO lowers short-term mortality and long-term recurrence

This French nationwide cohort analyzed 71,573 surgically treated adhesive SBO episodes between 2015 and 2024 using administrative health data. Thirty-day mortality rose from 3.6% with surgery on days 0–1 to 7.1% when surgery occurred at or after day 9. Bowel resection rates similarly increased with delay, from 18.0% early to 24.5% with operations performed on or after day 9. Long-term recurrence was 23.5% after nonoperative management versus 8.8% after surgery (sHR 0.30; 95% CI 0.29–0.32). 1

SOFRIB: routine rib fixation does not shorten ICU stay and increases pneumonia

The multicenter SOFRIB RCT randomized 236 adults with ≥3 displaced rib fractures and compromise to SSRF within 5 days or standardized nonoperative care. ICU length of stay did not differ significantly (mean difference 1.8 days; 95% CI -0.8 to 4.4; P=0.17). SSRF increased hospital length of stay by 3.3 days (P=0.01) and raised pneumonia incidence (11.4% vs 3.3%; RR 3.45; P=0.02). However, SSRF improved SF-36 general health, bodily pain, and physical component scores, all exceeding minimal clinically important differences. 2

Incidental appendiceal tumors in acute appendicitis are uncommon and often low risk

This single-center cohort included 2,293 consecutive adult appendectomies for acute appendicitis over nine years at a tertiary emergency surgery center. Malignant or premalignant lesions were found in 37 cases (1.6%), and benign nondysplastic lesions in 8 cases (0.3%). Neuroendocrine tumors predominated (22 cases), all grade 1 and <2 cm; 86% were ≤1 cm, with no recurrences at 34 months’ follow-up. Other lesions included low-grade appendiceal mucinous neoplasms, metastatic tumors, goblet cell carcinomas, mucinous adenocarcinoma, and low-grade dysplastic polyps. 3

Updated SVS guideline clarifies contemporary management of blunt thoracic aortic injury

This focused Society for Vascular Surgery update revises the 2011 blunt thoracic aortic injury guideline using new systematic reviews and GRADE methodology. Thirteen recommendations cover indications and timing of definitive repair, with emphasis on endovascular approaches over open surgery when feasible. The guideline addresses perioperative anticoagulation, left subclavian artery management, and structured post-repair imaging surveillance protocols. Anti-impulse therapy is reinforced as essential initial medical management, especially when balancing concomitant brain or solid-organ injuries. 4