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Author : Waddell Keller | Published On : 22 Apr 2025

ics, and postoperative outcome were noted among 4 Western countries with better outcomes in the United States and Sweden. These large, yet unexplained, differences require further research to ultimately improve patient outcome.
Textbook oncologic outcome has been described in an effort to improve upon traditional outcomes defining care after pancreaticoduodenectomy for adenocarcinoma. We sought to examine whether minimally invasive pancreaticoduodenectomy increased the likelihood of an optimal textbook oncologic outcome.

Patients undergoing open pancreaticoduodenectomy or minimally invasive pancreaticoduodenectomy between 2010 and 2015 were identified in the National Cancer Database. Textbook oncologic outcome was defined as R0 resection with American Joint Committee on Cancer compliant lymphadenectomy, no prolonged duration of stay, no 30-day readmission/mortality, and receipt of adjuvant chemotherapy. Propensity score matching was employed to evaluate adjusted rates of textbook oncologic outcome, in addition to overall survival.

Among 12,854 patients who underwent pancreaticoduodenectomy, 48.3% were female, and the median patient age was 66 years; 87.5% underwent open pancreaticoduodenectomy, and 12.5% underwent whether minirvival advantage, it was only achieved in 1 in 4 patients undergoing pancreaticoduodenectomy for adenocarcinoma. Achievement of textbook oncologic outcome was equivalent among patients who underwent minimally invasive pancreaticoduodenectomy compared with open pancreaticoduodenectomy after propensity score matching.
Gender-affirmation surgery is a rapidly growing field in plastic surgery, urologic surgery, and gynecologic surgery. These procedures offer significant benefit to patients in reducing gender dysphoria and improving well-being. However, the details of gender-affirmation surgery are less well-known to other surgical subspecialties and other medical subspecialties. The data behind gender-affirmation surgery are comparatively sparse, and due to the recency of the field, large gaps exist in the literature.

PubMed searches were carried out specific to gender-affirming mastectomies, vaginoplasty, vulvaplasty, mastectomy, metoidioplasty, and phalloplasty. Combinations and variants of "gender affirming," "gender confirming," "transgender," and other variants were used to ensure broad capture. Historical articles were also reviewed. CDDO-Im The data gathered were collated and summarized.

Gender-affirmation surgery is generally safe. Complication rates for gender-affirming mastectomy and breast augmentation are very low, recommendations for further study.
Children with fulminant ulcerative colitis(UC) traditionally undergo 2-stage operations restorative-proctocolectomy(RP/IPAA) and ileostomy followed by ostomy closure. In the biologic era, surgeons have modified their strategy initial subtotal-colectomy/diversion, followed by RP/IPAA without diversion. Yet, evidence on efficacy and functional outcomes with the "modified 2-stage" approach is limited in children. We sought to compare the timing of pouch creation in 2-stage operations to determine outcomes.

This is a retrospective study of children with UC undergoing either a traditional 2-stage RP/IPAA or modified 2-stage RP/IPAA between 2010 and 2019. Complications (leak, stricture, wound-infection) were recorded at 90-days and 1 year from 2nd operation.

N=57 (Traditional n=40, Modified n=17). Median time to surgery from consultation was shorter in the modified-group (7vs.25 days, p=0.01). Preoperatively, the modified-group had lower albumin(p=0.01), higher CRP(p=0.01), and more frequently took biologics within 90-daysp=0.001). After re-establishing intestinal continuity, stricture requiring dilation was higher in the traditional-group (59% vs.18%, p=0.008). No difference in pouch leak (p=0.38), bowel obstruction(p=0.35), loperamide dose(p=0.21), or incontinence(p=0.38) was observed.

Delaying pouch creation to the second operation without a protective ileostomy as a modified 2-stage is safe in a sicker and more acute pediatric population.
Delaying pouch creation to the second operation without a protective ileostomy as a modified 2-stage is safe in a sicker and more acute pediatric population.
There are many described technique to performing laparoscopic inguinal hernia repair in children. We describe our outcomes using a percutaneous internal ring suturing technique.

A retrospective review of patients under 18 years old who underwent repair between January 2014 - March 2019 was performed. A percutaneous internal ring suturing technique, involving hydro-dissection of the peritoneum, percutaneous suture passage, and cauterization of the peritoneum in the sac prior to high ligation, was used. p<0.05 was considered significant during the analysis.

791 patients were included. The median age at operation was 1.9 years (IQR 0.37, 5.82). The median operative time for a unilateral repair was 21min (IQR 16, 28), while the median time for a bilateral repair was 30.5min (IQR 23, 41). In total, 3 patients required conversion to an open procedure (0.4%), 4 (0.6%) experienced post-operative bleeding, 9 (1.2%) developed a wound infection, and iatrogenic ascent of testis occurred in 10 (1.3%) patients. Twenty patients (2.5%) developed a recurrent hernia. All but two were re-repaired laparoscopically.

The use of percutaneous internal ring suturing for laparoscopic repair of inguinal hernias in the pediatric population is safe and effective with a low rate of complications and recurrence.
The use of percutaneous internal ring suturing for laparoscopic repair of inguinal hernias in the pediatric population is safe and effective with a low rate of complications and recurrence.Endothelial injury and microvascular/macrovascular thrombosis are common pathophysiological features of coronavirus disease-2019 (COVID-19). However, the optimal thromboprophylactic regimens remain unknown across the spectrum of illness severity of COVID-19. A variety of antithrombotic agents, doses, and durations of therapy are being assessed in ongoing randomized controlled trials (RCTs) that focus on outpatients, hospitalized patients in medical wards, and patients critically ill with COVID-19. This paper provides a perspective of the ongoing or completed RCTs related to antithrombotic strategies used in COVID-19, the opportunities and challenges for the clinical trial enterprise, and areas of existing knowledge, as well as data gaps that may motivate the design of future RCTs.