Article 1
Longitudinal Incidence and Outcomes of Remnant Cholecystitis after Subtotal Cholecystectomy: An Analysis of 2,682 Patients. Egbert LK, Cheung D, Yu S, Tan PH, Jorge IA, Wasif N, Madura JA, Chan YH, Lim PW, Fong ZH. J Am Coll Surg. 2026 Apr 2.
This study was a population-based retrospective cohort study that examined the outcomes of 2,682 patients who underwent either laparoscopic or open subtotal cholecystectomy for the management of acute cholecystitis from 2012 to 2021, utilizing the Healthcare Cost and Utilization Project (HCUP) for New York and Florida. The vast majority of patients (98.7%) underwent laparoscopic subtotal cholecystectomy. Bile duct injury rate was reported as 0.9%. With a median follow up of two years, 11.3% of patients (203/2,682 patients) were diagnosed with remnant cholecystitis (primary outcome) with diagnosis at a median time of 28 days from the index surgery. Those patients who developed remnant cholecystitis were less likely to be White, less likely to have private insurance and more likely to have co-morbidities. Only 70 patients (2.6% of original cohort) underwent completion cholecystectomy. Of those that underwent completion cholecystectomy, 47.1% were performed open, with a median hospital LOS of 3 days and bile duct injury rate of 7.1% (5/70 patients).
While the results of this study are somewhat limited by the retrospective nature and lack of granular data, it supports the concept that subtotal cholecystectomy is a viable and safe option when the critical view of safety is not able to be obtained. This is in alignment with The Safe Cholecystectomy Multi-Society Practice Guideline which was published in 2020 and advocates for subtotal cholecystectomy over a dome-down approach. Remnant cholecystitis is a known complication of subtotal cholecystectomy, however, rates are low and completion cholecystectomy is rarely required. Given the high rates of bile duct injury, referral to a center with advanced hepatobiliary expertise is recommended if completion cholecystectomy is required.
Article 2
Long-Term Outcomes After Laparoscopic vs Open Adhesiolysis for Small Bowel Obstruction: The LASSO Randomized Clinical Trial. Raty P, Mentula P, Haukijarvi E, Juusela R, Wikstrom H, et al. JAMA Surg. 2026 Apr 1;161(4):381-388.
The Laparoscopic vs Open Adhesiolysis for Small Bowel Obstruction (LASSO) trial was a multi-center, international, randomized control trial conducted between July 2013 and April 2018 in patients with radiological signs of adhesive SBO which did not resolve by conservative means who were randomly assigned to either open or laparoscopic surgical intervention. 104 patients were randomized and a total of 100 patients (49 in the open surgery group, 51 in the laparoscopy group) were included in the modified intention-to-treat analyses. The initial publication in 2019 described no differences in 30-day complications and cited a 1.3 day decrease in length of stay in the laparoscopic group compared to the open group.
The 5-year follow up results were published in JAMA Surgery in February 2026 and demonstrated no difference in rates of SBO recurrence, incisional hernia diagnosis or QOL scores in the open vs laparoscopic groups. The 5-year follow up intention-to-treat analyses included a total of 63 patients (31 in the open surgery group and 32 in the laparoscopy group). A total of 3 patients (9.7%) in the open group had a recurrent SBO episode, compared with 4 patients (13%) in the laparoscopy group (p > 0.99). Two incisional hernias were detected in both groups (6.1% vs 6.3%, p > 0.99). With regards to the QOL questionnaires at 5 years, the median SF-36 score was 73.2 in the open surgery group vs 67.1 in the laparoscopy group (p = 0.23). The median GIQLI scores were 118 and 119, respectively (p = 0.54).
When applying this study in practice it is important to understand the exclusion criteria that the authors used to enable the selection of patients to most likely have a single adhesive band, including those with known wide adhesions, 3 or more open surgical procedures, suspected peritoneal carcinomatosis, previous radiotherapy of the abdomen, recent (within 30 days) abdominal operation and Crohn’s disease. Additionally, the study population from Finland and Italy had an average BMI of 23.2 in the open group and 24.8 in the laparoscopy group, which is not representative of the BMI in the United States and certainly would have an effect on incisional hernia rates. Although initial results demonstrated some short-term benefits to the laparoscopic approach, there is no evidence to support superiority to the laparoscopic approach based on the long-term outcomes for management of SBO.
Article 3
Antibiotic Therapy for Uncomplicated Acute Appendicitis: Ten-Year Follow-Up of the APPAC Randomized Clinical Trial. Salminen P, Salminen R, Kallio J, et al. JAMA. 2026 Mar 24;335(12):1041-1049.
The optimal management of acute uncomplicated appendicitis continues to be controversial. The Appendicitis Acuta (APPAC) trial, a multicenter RCT, conducted in 6 Finnish hospitals from November 2009 to June 2012, compared 530 adult patients (aged 18-60 years old) receiving antibiotic therapy (n=257) with open or laparoscopic appendectomy (n=273) for patients with CT-confirmed uncomplicated acute appendicitis. The study demonstrated that 61% of all patients treated with antibiotics alone did not undergo surgery at 5-year follow-up. A recent review was conducted at 10-year follow-up interval of the 253/257 patients (98.4%) randomized to antibiotic therapy demonstrated a cumulative appendectomy rate of 44.3% (112/253), true appendicitis recurrence rate (+ histopathology) of 37.8% (87/230). Complications among patients randomized to antibiotics were reported as 8.5% (19/224), compared to appendectomy randomization at 27.4% (62/226). Complications included wound infection, persistent incisional/abdominal pain, incisional hernia, possible-adhesion-related problems (e.g. bowel obstruction) and other general postoperative complications. Post hoc outcomes analysis of appendiceal tumor prevalence among the antibiotic arm, using MRI imaging or histopathological findings after appendectomy, determined no statistically significant difference in tumor prevalence between the appendectomy group 1.5% (4/272) and antibiotic group 0.9% (2/212).
The findings demonstrate that most uncomplicated appendicitis recurrences occur within the first two years, with a modest increase in the overall rate at ten years to 44%. The applicability of the findings are limited due to the inclusion of an open surgical approach. Laparoscopic appendectomy is the standard approach in the United States; the open approach likely resulted in increased postoperative complication rates and negatively affected patient satisfaction of the operative arm. The findings suggest that non-operative management is unlikely to lead to a delay in diagnosis of an underlying appendiceal malignancy, as no difference between the groups was identified. Of those patients with late identification of what was likely an incidental tumor, none required more than an appendectomy. Management of uncomplicated acute appendicitis remains nuanced. If a non-operative approach is patient preference, then a thorough discussion regarding tolerance for treatment failure and readmission is imperative.
Article 4
Diverting loop ileostomy with antegrade colonic lavage compared with colectomy in Clostridioides difficile colitis: A decade-long propensity score-matched analysis. Zangbar B, Mehta R, Kirsch J, Jose A, Froula G, Bronstein M, Carlson A, Shnaydman I, Prabhakaran K. J Trauma Acute Care Surg. 2026 Mar 1;100(3):386-392.
Management of fulminant Clostridioides difficile colitis (CDC) that is not effectively managed through medical therapy has been traditionally managed by total abdominal colectomy (TAC). TAC remains the standard of care as it provides effective and immediate source control but results in significant morbidity and 30-40% mortality rate. Diverting loop ileostomy with antegrade colonic lavage (DLI) has emerged as a less invasive, colon-preserving alternative to TAC. The study is a retrospective analysis that compared outcomes between patients undergoing surgery for fulminant CDC, of which 10.7 % received DLI and 89.3% underwent TAC. A total of 6,618 patients were identified, after propensity score matching (1:1) 668 patients remained in each cohort, with patients that failed DLI requiring TAC remained in the DLI cohort. The mortality rate between the groups was not significantly different (24.2% DLI vs. 26% TAC, p=0.60). The DLI cohort was noted to have significantly lower rates of postoperative wound disruption (2.8% vs. 5.2%, p=0.03) and wound infection (4.6% vs. 8.2%, p=0.010). DLI was associated with longer hospital LOS (18 vs. 16 days), and costs were also noted to be higher. Remarkably, among the failed DLI cohort (n=116) that required conversion to TAC, when compared with matched patients that underwent primary TAC, no significant differences in mortality (26.5% vs. 27.2%), LOS or complications were identified. The patients within the Failed DLI cohort were observed to have higher vasopressor use and the highest rates of APRDRG severity subclass designation.
The findings demonstrate DLI to be associated with lower rates of postoperative wound complications, without significant differences in mortality compared with TAC. The data suggests a DLI-first approach to be a safe alternative to immediate colectomy in appropriately selected patients, offering the potential for colon preservation without compromising outcomes when DLI fails. Previous early studies suggested a survival advantage with DLI, but more recent literature offers a potential explanation that DLI patients likely had an earlier time to operation compared to TAC. The DLI arm was observed to be non-inferior and lacked any survival benefit over TAC, as there was no difference in time to operation between the groups. These findings align with more recent literature suggesting timing to operation may have a greater impact on survival when compared to the operative approach. The authors note the study is limited by its retrospective design, reliance on administrative coding, and lack of long-term outcomes including rates of stoma reversal and recurrence of infection. To better determine the role of DLI in clinical practice, future prospective studies are needed to gain a better understanding of clinical factors that would best guide appropriate patient selection and criteria for surgical intervention in CDC.
