General Surgery

Early enteral feeding reduces complication burden after pancreatoduodenectomy in nutritionally at-risk patients

In nutritionally at-risk pancreatoduodenectomy patients, early enteral nutrition via intraoperatively placed nasojejunal tube reduced 90-day comprehensive complication index versus oral diet alone. Mean CCI at 90 days was 25.5 with early enteral nutrition and 35.8 with oral nutrition, with a significant adjusted difference favoring enteral feeding. Rates of specific complications, including delayed gastric emptying, pancreatic fistula, hemorrhage, and surgical site infection, were similar between groups. Nasojejunal tube-related issues were common, with tube replacement required in a notable proportion due to accidental dislodgement. These findings support routine early enteral feeding for high nutritional risk pancreatoduodenectomy patients, balancing lower overall morbidity against tube-related management demands. 1

Funnel-shaped mesh significantly lowers 3-year parastomal hernia after permanent colostomy

In patients undergoing abdominoperineal excision or Hartmann procedure for rectal adenocarcinoma, prophylactic funnel-shaped mesh markedly reduced parastomal hernia at 3 years. CT-confirmed parastomal hernia occurred in 57% with mesh versus 82% without mesh, a 25% absolute reduction. Clinically diagnosed hernia was also less frequent with mesh, 10% versus 39% in controls, and hernias were smaller in volume when they occurred. Importantly, mesh placement did not increase other complications over 3-year follow-up. These results support routine funnel-shaped mesh placement at permanent colostomy creation in appropriate oncologic patients. 2

KDIGO kidney protection bundles prevent moderate–severe AKI after major surgery in high-risk patients

An individual participant data meta-analysis of four RCTs evaluated KDIGO-based kidney protection bundles in 1,851 high-risk major surgery patients. The bundle included hemodynamic and fluid optimization, nephrotoxin and contrast avoidance, frequent renal monitoring, and glycemic control versus usual care. Moderate or severe AKI within 72 hours occurred in 17.7% with the bundle versus 27.1% with standard care, with an odds ratio of 0.55. There was no heterogeneity across trials, and secondary outcomes generally showed no major harms from the intervention. These data support structured kidney protection pathways for biomarker-identified high-risk surgical patients in perioperative protocols. 3

Perioperative myocardial injury is frequent and prognostically serious in older noncardiac surgery patients

In a multicenter cohort of 4,634 high-risk older patients undergoing major noncardiac surgery, perioperative myocardial injury occurred in 19.2%. One-year mortality was 26.2% with myocardial injury versus 13.2% without, and major adverse cardiac events were 30% versus 13%. After adjustment, the hazard for mortality and MACE was highest on postoperative day 1 and remained elevated through 90 days and 1 year. These findings highlight perioperative myocardial injury as a common, high-impact event in older surgical patients, not just a biomarker abnormality. Routine surveillance and aggressive early secondary prevention may be warranted in this population. 4