General Surgery

Laparoscopic CBD exploration is safe and effective in elderly patients at high-volume centers

In this single-center retrospective cohort of 494 LCBDEs, 119 patients were aged ≥70 years with higher ASA and Charlson scores. Complete common bile duct clearance exceeded 99% overall and was 100% in the elderly group, with no perioperative mortality reported. Conversion to open surgery was rare, and 30-day morbidity was similar between younger and older patients. Elderly patients had a modestly longer length of stay (3 vs 2 days), but no excess early complications, supporting one-stage LCBDE in selected older adults. 1

Topical TXA plus sucralfate prevents delayed bleeding after endoscopic sphincterotomy

In a single-center RCT of 120 EST patients with choledocholithiasis, 60 received topical tranexamic acid 1 g plus sucralfate 2 g. Delayed post-EST bleeding within 14 days occurred in 0% of treated patients versus 8.3% of controls, with significantly better bleeding-free survival. Substantial blood loss was less frequent with TXA–sucralfate (1.6% vs 16.6%), without reported safety concerns. These findings support routine topical TXA plus sucralfate application after EST in appropriate patients, especially those at higher bleeding risk. 2

Preoperative FFP:RBC ratio shows no mortality advantage in abdominal trauma laparotomy

This planned secondary analysis of the GOAL-Trauma cohort included 1768 patients undergoing laparotomy for blunt or penetrating abdominal trauma. About 41% received preoperative blood products, with higher component use in high-HDI countries and greater whole blood use in low-HDI settings. Despite wide variation in preoperative FFP:PRBC ratios, high- versus low-ratio groups had similar 30-day postoperative mortality (OR 1.52, 95% CI 0.89–2.64). Tranexamic acid use was low across all HDI tertiles, highlighting underuse of a low-cost adjunct. These data support ongoing equipoise around optimal preoperative component ratios and emphasize system-level disparities in trauma resuscitation. 3

Delphi-derived episode-based quality measures extend surgical assessment beyond 30-day outcomes

Using modified Delphi panels, VA and private-sector experts developed an expanded episode-based surgical quality measurement model. From 594 candidate measures and recommendations, 61 were rated and 40 measures reached appropriateness consensus for carpal tunnel release, inguinal hernia repair, and total knee arthroplasty. Measures spanned preoperative evaluation, intraoperative best practices, and postoperative complication minimization, emphasizing the full perioperative continuum. This framework offers a roadmap for episode-based quality benchmarking that could be adapted to general surgical procedures beyond the VA. 4