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Intraperitoneal Mesh Implantation to Prevent Incisional Hernia
Incisional hernia remains one of the most frequent complications after abdominal surgery. In an open-label randomized clinical trial of 169 patients undergoing elective open abdominal surgery, Kohler and colleagues assessed whether prophylactic mesh implantation prevents incisional hernia. The authors found that incisional hernia may be prevented by prophylactic mesh implantation. However, in case of surgical site infection, the wounds of patients with mesh implementations need more time to heal than those of patients without mesh implantations.
Continuing Medical Education
Author Audio Interview
Wound Photography for Remote Postoperative Assessment
Surgeons are increasingly interested in using mobile and online applications with wound photography to monitor patients after surgery. In this simulation study, Kummerow Broman and colleagues used case vignettes to determine how wound photography affects surgeons’ abilities to diagnose surgical site infections in a pragmatic setting. Survey results showed that wound photography increased diagnostic specificity and surgeon confidence but worsened diagnostic sensitivity for detection of infections at surgical sites.
Treating Appendicitis With Antibiotics in the Real World
Trials suggest that antibiotics alone can treat appendicitis, but it is unknown how nonoperative management works on a population level. Sceats and colleagues used national insurance claims to compare 58 329 patients with appendicitis treated with surgery or antibiotics. Patients treated nonoperatively had low appendicitis recurrence rates but were more likely to be readmitted and develop an abscess. They also had higher overall costs.
Fluorescent Lymphography–Guided Radical Gastrectomy
Peritumoral injection of indocyanine green as a lymphatic tracing fluorescent agent provides surgeons with effective visualization of the lymphatic anatomy. In a single-arm study, Kwon and colleagues found that injection a day before radical gastrectomy surgery successfully visualized every draining lymph node from the primary lesion under near-infrared imaging. Fluorescent lymphography may be a useful tool for performing complete lymphadenectomy, assessing adequacy of lymphadenectomy intraoperatively, and retrieving lymph nodes thoroughly.
Clinical Review & Education
Presurgical Hormone Discontinuation in Transgender Patients
Transgender patients are routinely asked to discontinue cross-sex hormone treatment prior to surgery, with potentially serious psychological and physiological consequences. This systematic review did not find sufficient evidence to support this recommendation, which suggests that most patients can safely continue cross-sex hormone treatment perioperatively. Further research is needed, particularly on the association of the route of estrogen administration with perioperative risk.
Highlights. JAMA Surg. 2019;154(2):101. doi:10.1001/jamasurg.2018.3791
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