FABRIZIO MICHELASSI, M.D.

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Researchers tested TU-100, a traditional Japanese herbal medicine, to see if it could speed up the return of normal gut function after bowel surgery. In a randomized trial of 392 patients, the lower dose (7.5 g/day) led to more patients regaining gut function by the second day after surgery and cut median hospital stay from 3 to 2 days compared to placebo. The results are encouraging enough to justify a larger confirmatory trial, especially because the drug was added on top of modern fast-recovery protocols.

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A blue-ribbon committee of surgical educators examined how well academic surgery supports faculty as teachers and identified major gaps. Through literature review and expert consensus, the group produced recommendations including creating systems to compensate faculty for teaching, accurately measuring the value residents bring to hospitals, and developing a national faculty teaching curriculum. The report provides a concrete roadmap to strengthen surgical education infrastructure across the United States.

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International pancreatic surgery experts developed guidelines for operating on patients whose pancreatic cancer involves nearby blood vessels, a situation where the right approach has been unclear. Using a formal consensus process among specialists worldwide, they produced 34 recommendations covering patient selection, surgical technique, and when to reconstruct or avoid major blood vessels. Most recommendations rest on low-quality evidence, and the group launched a new international registry to accelerate future research.

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Adult polyglucosan body disease is an extremely rare inherited nerve disorder causing walking problems, bladder dysfunction, and spasticity, and almost nothing was known about how it progresses over time. A patient-reported registry of 96 people with the condition showed that diagnosis typically comes about six years after symptoms start, and prior misdiagnosis as peripheral neuropathy or spinal stenosis is common. The data provide a baseline for designing clinical trials of new treatments for this underrecognized disease.

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Immune-mediated necrotizing myopathy is a rare muscle disease marked by sudden severe weakness and very high muscle enzyme levels, and its diagnosis and treatment are difficult. This review lays out how the condition differs based on which autoantibodies a patient has and questions the widely held belief that statin drugs are a common trigger. Early, aggressive immune-suppressing treatment remains the cornerstone of care, and better diagnostic tools are still needed.

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Researchers looked for markers on the surface of pancreatic cancer cells that survive chemotherapy in order to find new ways to target them. They discovered that cells carrying the markers TRA-1-60 and TRA-1-81 are especially drug-resistant and that a protein called UGT1A10 controls these markers; blocking UGT1A10 with a compound called Cymarin made the cancer cells sensitive to chemotherapy again, both in lab dishes and in mice. These markers and the pathway controlling them represent a promising target for attacking the most treatment-resistant cells in pancreatic cancer.

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A surgery department embedded diversity, equity, and inclusion topics directly into routine conferences like morbidity and mortality rounds and grand rounds rather than confining them to separate lectures. After the curriculum launched, DEI topics appeared in 27% of M&M presentations and 18% of grand rounds, and importantly, the majority of M&M presentations were delivered by non-underrepresented minority faculty. Integrating DEI into existing departmental forums is a practical way to broaden engagement and share the workload more equitably.

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A previously healthy woman accidentally swallowed 7 grams of levofloxacin (a common antibiotic) all at once and arrived at the emergency room with one-sided limb weakness that looked like a stroke. Brain scans showed no stroke, and her symptoms resolved within 24 hours, consistent with a transient episode caused by the drug overdose rather than a blocked artery. The case alerts clinicians that a massive levofloxacin overdose can mimic a stroke, which has not been well described before.

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Scientists studied a protein called Munc13 that is essential for nerve cells to release chemical signals at synapses and found a specific module at the protein's tail end that helps prepare synaptic vesicles for release. Experiments in worms showed that removing this module blocked normal neurotransmitter release, and the same module could not be replaced by parts that attach to the cell membrane rather than the vesicles themselves. The finding suggests this tail module evolved to link Munc13 specifically to synaptic vesicles, fine-tuning the reliability of nerve cell communication.

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Crohn's disease frequently causes scarring that narrows sections of the intestine, eventually blocking the bowel, and no medication reliably prevents or reverses this scarring. This review walks through the surgical and endoscopic options available, including various techniques to widen the narrowed segment without removing it (strictureplasty), and explains the considerations for choosing between them. It serves as a practical guide for surgeons managing the complex range of narrowing patterns that Crohn's disease produces.

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Researchers analyzed over 450 Crohn's disease operations to understand when laparoscopic surgery works and when it must be converted to open surgery. One in five laparoscopic cases required conversion, usually within the first 15 minutes, most often because of dense scar tissue, pelvic infection with fistulas, or a large inflammatory mass. Knowing these risk factors before the operation can help surgeons choose the right approach from the start and avoid unnecessary attempts at laparoscopy.

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This 25-year follow-up study tracked 60 Crohn's disease patients who underwent the side-to-side isoperistaltic strictureplasty, a bowel-preserving operation for extensive small intestinal scarring. Symptoms recurred in 61% of patients over a median 11 years, but 86% still retained their original reconstruction, and many recurrences at the repair site could be fixed with a further procedure rather than removal. The data confirm that this bowel-sparing operation is durable and safe over the long term.

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This paper describes a new variation of bowel-preserving surgery for severe Crohn's disease in which three badly scarred and deformed bowel loops separated by diseased segments are addressed in a single operation. Rather than removing all the diseased bowel, the surgeon removes the worst segments and reconnects the two remaining discontinuous segments side-to-side, then attaches the ends to the normal bowel above and below. The technique extends the existing Michelassi strictureplasty approach to an even more complex pattern of disease, offering a way to save more intestine.

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Ulcerative colitis normally requires removal of the entire colon, but this international study examined what happens when surgeons instead remove only the diseased segment for a non-colitis reason such as cancer or narrowing. Among 72 patients followed for a median of 40 months, 35% needed a second operation — usually a full colectomy — mainly because colitis spread through the remaining colon. Partial colectomy may be acceptable for selected patients whose colitis is not currently active, but the risk of eventually needing a total colectomy is real.

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Most high-risk Crohn's disease patients who have bowel surgery should start preventive biologic therapy within weeks to reduce the chance of disease recurrence, but this study found that over two-thirds experienced delays of more than four weeks. Publicly insured patients had a 100% delay rate, while patients who were already on a biologic before surgery were much more likely to restart it promptly. Targeting publicly insured patients and ensuring IBD specialist involvement before surgery could meaningfully reduce these harmful delays.

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A 13-year review of over 900 Crohn's disease operations found that patients coming to surgery in recent years were sicker — with more complications, more prior biologic drug use, and more complex penetrating disease — yet surgical complication rates stayed the same. Increased use of laparoscopy and less blood loss during surgery appear to have helped offset the growing difficulty of the cases. The findings highlight how both the patient population and surgical technique for Crohn's disease have shifted since the widespread adoption of biologic drugs.

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After surgical nursing guidelines mandated new operating room clothing requirements in 2015, researchers compared infection rates and costs before and after the policy was implemented across more than 25,000 surgical patients. Surgical site infection rates did not change, yet the cost of attire per person entering the OR jumped roughly tenfold, translating to over $1 million extra per year at one hospital and an estimated $540 million annually across the US. The findings challenge the evidence base for the policy and raise concerns about costly mandates that do not improve patient outcomes.

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A broad group of IBD researchers and clinicians identified key technology gaps that are limiting progress in treating inflammatory bowel diseases. The most pressing needs include better non-invasive ways to monitor inflammation, smarter drug delivery systems that target only the gut lining, and new materials to prevent leaks after surgery and treat fistulas. The paper sets a research agenda for technology developers and funders to address these unmet needs.

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Using New York State hospital data on over 7,000 ulcerative colitis surgeries from 1995 to 2013, researchers compared outcomes before and after biologic drugs became available. Patients who had surgery after 2005, when biologics were widely used, were more likely to need multiple procedures and had worse outcomes — more complications, longer stays, and more non-home discharges — despite statistical adjustments for disease severity. The findings suggest that patients coming to surgery in the biologic era are more complex and that current surgical strategies may need to be refined for this harder-to-treat group.

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A nine-year national follow-up of nearly 840 surgery residents found that overall dropout from training was about 21%, with most occurring in the intern year but continuing at lower rates throughout residency. Hispanic residents and those in military programs left earlier, while women and residents in large programs were more likely to drop out in the later years. Understanding when different groups are most at risk allows residency programs to direct support and intervention at the right time rather than using a one-size-fits-all approach.

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A hospital department with poor patient safety scores and substandard surgical outcomes launched a culture-change initiative centered on communication and safety, then tracked what happened over the next two years. Both the culture scores and the surgical outcomes, as measured by the national ACS-NSQIP database, improved significantly, with the institution moving into the exemplary category. The results suggest that investing in cultural change — not just technical fixes — can translate into measurable improvements in surgical patient outcomes.

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A national prospective study of over 800 surgery interns found that two specific expectation patterns at the start of training were linked to dropout rates over the following nine years. Interns who chose their program primarily based on reputation were more likely to leave, while those who entered training with realistic expectations of the demands of surgical life — including long hours and the possibility of malpractice suits — were more likely to finish. Giving prospective residents honest, detailed previews of what surgical careers entail may help reduce attrition.

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A review of nearly 1,000 Crohn's disease operations found that about 9% of patients were readmitted to the hospital within three months, often for wound infection, abscess, bowel obstruction, or dehydration. Three factors predicted readmission: older age, a prior proctectomy, and greater blood loss during surgery. Identifying these higher-risk patients allows for closer post-discharge monitoring and earlier intervention to prevent serious complications.

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The American Surgical Association convened a task force to honestly assess and address the underrepresentation of women and minorities in academic surgery. Nine working groups reviewed research, conducted interviews, and identified both structural barriers and practical solutions, resulting in a published handbook with specific benchmarks for departments to track and improve diversity. The report calls for surgery to treat improving diversity not as a secondary goal but as directly tied to better patient care and institutional performance.

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A single-center study of 50 patients examined outcomes and the learning curve for a complex minimally invasive technique to repair large aortic aneurysms involving the abdominal organs. Technical success was nearly perfect at 99.5%, and as the team's experience grew, procedure time, radiation exposure, contrast dye use, and blood loss all fell significantly. The data show the approach is safe and that outcomes improve substantially as a surgical team gains experience, supporting its wider adoption at specialized centers.

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A national survey of over 790 general surgery interns found that the amount of surgical exposure in medical school did not strongly predict who would drop out of residency. What did matter was the quality of role models: interns who perceived their medical school surgeons as satisfied with their careers were less likely to quit, while unexpectedly, those who got along well with attending surgeons had a higher dropout rate. Investing in positive, realistic, and demanding mentorship in medical school may do more to retain future surgeons than simply increasing rotation time.

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Researchers developed the New York/California (NYCA) score, a new tool to select liver transplant candidates with liver cancer that goes beyond tumor size and count to include how the AFP blood marker changes over time before transplant. The score outperformed the standard Milan Criteria in predicting cancer-free survival and would allow 85% of patients currently excluded under Milan Criteria to safely receive a transplant. This model gives U.S. transplant programs a practical, evidence-based tool to expand liver cancer transplant eligibility.

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This research paper discusses the need for better training programs for surgeons who specialize in advanced gastrointestinal (GI) surgery. The authors found that many surgeons today need to be skilled in various types of GI procedures rather than just one narrow area. This broader training approach would help ensure that surgeons are well-prepared to handle the diverse needs of their patients and improve healthcare outcomes. Who this helps: This benefits patients who require advanced GI surgeries and the doctors who perform them.

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This study focused on a protein called UNC13A that plays a key role in how brain cells communicate. The researchers discovered a specific genetic change in a patient that led to increased activity in this protein, which resulted in movement issues and developmental challenges. The findings emphasize how important it is for brain signaling to be finely regulated, and they may help us understand certain brain disorders better. Who this helps: This helps patients with movement disorders and their doctors.

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This research studied two surgical methods for patients who have both colorectal cancer and liver metastases, comparing simultaneous surgery (where both conditions are treated at once) to staged surgery (where they are treated in separate operations). Researchers looked at data from 1,430 patients and found that simultaneous resection resulted in shorter hospital stays (about 72% less likely to be longer) and lower hospital costs (about 76% less likely to be high charges) without increasing the risk of complications. This is important because it means that treating both cancers at the same time can be safer and more cost-effective for patients. Who this helps: This helps patients with colorectal cancer and liver metastases by offering a more efficient and potentially safer treatment option.

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This study looked at surgical residents who started their training in 2007-2008 to find out who is most likely to drop out before finishing. It found that nearly 1 in 4 of these residents do not complete their training. The research revealed that factors like gender, program size, and marital status play a significant role in predicting which residents are at risk; for example, white, non-Hispanic, married men in small community programs had a dropout rate of just 6%, while women in smaller academic programs had an 11% dropout rate. Who this helps: This research benefits medical educators and program directors by helping them identify at-risk residents early and potentially improve retention strategies.

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This study looked at a protein called Munc13, which is important for communication between nerve cells. Researchers discovered that a part of this protein, known as C2B, normally helps keep neurotransmitter release in check, but when this part was removed, the release of neurotransmitters increased significantly. Specifically, deleting C2B allowed for greater calcium-dependent release of neurotransmitters, showing its role in controlling nerve communication dynamics. Who this helps: This research benefits scientists and doctors studying neurobiology and potential treatments for neurological disorders.

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Researchers studied nearly 2,100 liver transplants performed at one hospital between 1998 and 2016, looking at whether using "marginal" livers—organs that are older, have been preserved longer, or have other quality issues—produces acceptable results compared to standard or living-donor livers. They found that patients who received marginal livers had survival rates nearly identical to those who received standard livers, and the hospital successfully transplanted these lower-quality organs to almost half its patients without compromising overall outcomes or increasing deaths on the waiting list. This matters because marginal livers are typically rejected and wasted, but this hospital proved these organs can be safely used, which could allow more patients to receive transplants sooner and save more lives.

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This research looked at whether hospitals are focusing on performing more complex surgeries, specifically a type of surgery called pancreatoduodenectomy (PD), at a smaller number of high-volume hospitals. The study found that over ten years, many cases moved from low-volume hospitals to medium, high, and very high-volume hospitals, resulting in better outcomes; specifically, patients at high-volume hospitals had lower rates of death and complications, and spent fewer days in the hospital but had similar readmission rates within 30 days. This matters because centralizing these complex surgeries at higher-volume hospitals can lead to safer and more effective patient care. Who this helps: Patients undergoing pancreatoduodenectomy.

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The Society for Surgery of the Alimentary Tract (SSAT) focused on improving diversity and inclusion within its organization and the field of gastrointestinal surgery. They formed a task force that evaluated how diverse their membership is and proposed long-lasting initiatives to enhance these efforts. Their goal is to ensure that surgeons come from varied backgrounds, which can lead to better healthcare for patients and address existing inequalities in treatment. Who this helps: This benefits patients by promoting more equitable healthcare practices and improving the quality of care they receive.

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This study focused on how surgical residents at New York Presbyterian Hospital learned to improve the quality of patient care through presentations that reviewed complications from surgeries, specifically urinary tract infections (UTIs) and surgical site infections (SSIs). Since 2009, chief residents have presented 16 reports that led to new interventions, resulting in better patient outcomes as indicated by improved data from the National Surgical Quality Improvement Program (NSQIP). This matters because it shows a successful method for training future surgeons to prioritize patient safety and quality of care. Who this helps: This helps patients undergoing surgery by improving their care and reducing complications.

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This study looked at how age affects the chances of survival and recovery for older patients (65 and older) undergoing major surgeries for gastrointestinal cancer. The research found that older patients had twice the likelihood of having additional health problems and higher death rates after surgery, particularly with liver surgeries where the risk of death was more than five times greater. It is important to understand these risks so that doctors can better prepare and support older patients who need these surgeries. Who this helps: This helps patients and doctors by highlighting the risks older adults face during major cancer surgeries.

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Most adult living-donor liver transplants use the larger right lobe because of worries that the smaller left lobe won't provide enough liver mass to the recipient. This largest North American report on left lobe adult-to-adult living donor transplants showed comparable outcomes to right lobe grafts when donors and recipients were well selected. Left lobe donation is safer for donors and more feasible than commonly assumed.

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This research looked at the effectiveness of laparoscopic (minimally invasive) surgery compared to traditional open surgery for patients with advanced colon cancer (T4 stage) who had not spread to other areas. They studied 83 patients and found that laparoscopic surgery led to a complete removal of cancer in all cases, while open surgery had a 96% success rate. Both methods had similar survival rates after three years (82% for laparoscopic and 81% for open surgery), but patients who had laparoscopic surgery had shorter hospital stays and faster recoveries. Who this helps: This benefits patients with advanced colon cancer by offering a less invasive surgical option that allows for quicker recovery.