STITCHES - the Best Papers in General Surgery

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  STITCHES - the Best Papers in General Surgery stitches.today · May 11
  Machine learning model predicts anastomotic strictures post-surgery by Hu J, Liu Q (...) Shu Y et 6 al. in Surg Endosc #Surgery #SurgSky #GeneralSurgery #MedSky 🪡 read our summary here 📖 read the article:
  

  Automated machine learning model for predicting anastomotic strictures after esophageal cancer surgery: a retrospective cohort study - Surgical Endoscopy

  Background Anastomotic strictures (AS) frequently occurs in patients following esophageal cancer surgery, significantly affecting their long-term quality of life. This study aims to develop a machine learning model to predict high-risk AS, enabling early intervention and precise management. Methods A total of 1549 patients underwent radical esophageal cancer surgery and were split into a training set (1084) and a validation set (465). Adaptive Synthetic Sampling (ADASYN) handled class imbalance, while Boruta and Least Absolute Shrinkage and Selection Operator (LASSO) with cross-validation refined key features. High-correlation features (r > 0.8) were assessed using variance inflation factors (VIFs) and clinical relevance. Machine learning models were trained and evaluated using area under curve (AUC), accuracy, sensitivity, specificity, calibration curves, and decision curve analysis (DCA). Shapley Additive exPlanations (SHAP) analysis improved model interpretability. Results Seven critical variables were finalized, including anastomotic leakage (AL), neoadjuvant therapy (NCRT), suture method (SM), endoscopic assistance (EA), white blood cell count (WBC), albumin (Alb), and Suture site (SS). The Gradient Boosting Machine (GBM) model achieved the highest AUC, with 0.886 in the training set and 0.872 in the validation set. Shapley Additive Explanations (SHAP) analysis indicated that AL, SM, and NCRT were the most significant variables for model predictions. Conclusion The GBM machine learning model constructed in this study can effectively identify high-risk patients for AS following esophageal cancer surgery, offering strong support for earlier postoperative detection and precise clinical management. Graphical abstract

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  STITCHES - the Best Papers in General Surgery stitches.today · May 7
  Opioids can be safely omitted after major surgeries. by Ottaviano KE, Badar MM (...) Chismark AD et 5 al. in J Gastrointest Surg #Surgery #SurgSky #GeneralSurgery #MedSky 🪡 read our summary here 📖 read the article: sciencedirect.com/science/article/abs…
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  STITCHES - the Best Papers in General Surgery stitches.today · May 7
  ChatGPT-4o is superior in aiding gastric cancer decisions by Li H, Huang J (...) Mao S et 5 al. in Eur J Surg Oncol #Surgery #SurgSky #GeneralSurgery #MedSky 🪡 read our summary here 📖 read the article: ejso.com/article/S0748-7983(…
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  STITCHES - the Best Papers in General Surgery stitches.today · May 7
  Complete closure reduces delayed postpolypectomy bleeding risk. by Li WF, Lai B (...) Xu BX et 7 al. in Therap Adv Gastroenterol #Surgery #SurgSky #GeneralSurgery #MedSky 🪡 read our summary here 📖 read the article: journals.sagepub.com/doi/10.1177/1756284…
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  STITCHES - the Best Papers in General Surgery stitches.today · May 7
  Minimally invasive endoscopic interventions outperform traditional surgery for pancreatic fluid collections by Rana R, Mahapatra SJ and Garg PK in Indian J Gastroenterol #Surgery #SurgSky #GeneralSurgery #MedSky 🪡 read our summary here 📖 read the article:
  

  Endoscopic interventions for managing pancreatic fluid collections associated with acute pancreatitis: A state-of-the-art review (with videos) - Indian Journal of Gastroenterology

  Acute pancreatitis is an acute inflammatory disease, which may be associated with pancreatic and peri-pancreatic necrosis and development of (peri)pancreatic fluid collections (PFCs). Interventions in acute pancreatitis have evolved over the years with a paradigm shift from open surgical drainage and necrosectomy to minimally invasive approaches. Depending on the presence of necrosis, the PFCs may be acute necrotic collections or acute pancreatic fluid collections, which evolve over a period of three to four weeks to walled-off necrosis and pseudocysts, respectively. Patients with symptomatic and infected PFCs require drainage. In general, drainage should be delayed beyond three to four weeks when the collection wall has matured and the necrotic debris is liquefied. However, some patients may merit early drainage (within the first three to four weeks), if they have suspected infected pancreatic necrosis and worsening organ dysfunction despite antibiotics and supporting therapy. Endoscopic transmural drainage and necrosectomy have now emerged as the most favored treatment modality in suitable pancreatic collections located predominantly in the lesser sac. Being minimally invasive, per-oral endoscopic direct necrosectomy is as effective as surgical necrosectomy in patients with infected necrotic collections but with fewer adverse events. Percutaneous endoscopic necrosectomy is an important addition to our armamentarium for laterally placed collections as an effective alternative to surgical video-assisted retroperitoneal debridement. The current review provides an overview of the evolution, indications, approaches, techniques and outcomes of endoscopic interventions in the management of pancreatic fluid collections associated with acute pancreatitis. Future direction for better outcomes has been highlighted.

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