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Background We sought to prospectively identify risk factors for biliary complications and 30-day readmission after cholecystectomy for choledocholithiasis and gallstone pancreatitis across multiple US hospitals. Methods We performed a prospective, observational study of patients who underwent same admission cholecystectomy for choledocholithiasis and gallstone pancreatitis between 2016 and 2019 at 12 US centers. Patients with prior history of endoscopic retrograde cholangiopancreatography or diagnosis of cholangitis were excluded. We used logistic regression to determine associations between preoperative demographics, labs, and imaging on primary outcomes: postoperative biliary complications and 30-day readmission. Results There were 989 patients in the cohort. There were 16 (1.6%) patients with postoperative biliary complications, including intra-abdominal abscesses, endoscopic retrograde cholangiopancreatography-induced pancreatitis, and biliary leaks. Increasing operative time (odds ratio 1.01, 95% confidence interval 1.00–1.01, P = .02), worsening leukocytosis (odds ratio 1.16, 95% confidence interval 1.07–1.25, P = .0002), and jaundice (odds ratio 3.25, 95% confidence interval 1.01–10.42, P = .04) were associated with postoperative biliary complications. There were 36 (3.6%) patients readmitted within 30 days owing to a surgical complication. A prior postoperative biliary complication (odds ratio 7.8, 95% confidence interval 1.63–37.27, P = .01), male sex (odds ratio 2.42, 95% confidence interval 1.2–4.87, P = .01), and index operative duration (odds ratio 1.01, 95% confidence interval 1.00–1.01, P = .03) were associated with 30-day readmission. Conclusion Among patients undergoing cholecystectomy for common bile duct stones, jaundice, worsening leukocytosis, and longer operations are associated with postoperative biliary complications. A prior biliary complication is also predictive of a 30-day readmission. Surgeons should recognize these factors and avoid prematurely discharging at-risk patients given their propensity to develop complications and require readmission.

Colonic stenting has emerged as preferred palliative treatment for left sided malignant obstructions. It shortens hospital stays, decreases healthcare cost, reduces permanent stoma rates, and expedites the start of chemotherapy. The role of stenting as a bridge-to-surgery remains unsettled.For this paper the recommendations of the American and European society of gastroenterology and colorectal surgery were reviewed. We will discuss the benefits and risks of stenting in palliative setting and as bridge-to-surgery. Quality of life, hospital stay, and health care cost will also be considered.Non-traversable colon masses during endoscopy are considered a risk factor of development of intestinal obstruction but preventive stent placement in patients without obstructive symptoms is not recommended. The risk of technical or clinical failure is significant at 25%. If stent placement allows neoadjuvant chemotherapy, it may increase the rate of R0 resections. Perforations may raise local recurrence and mortality rates.

Background In the emergent setting, most paraesophageal hernia (PEH) repairs are done by laparotomy with adjunct gastropexy or gastrostomy tube (GT) placement. This adjunct to the repair can be performed expeditiously by a laparoscopic approach by utilizing T-fasteners. We present our case series of patients with PEHs and acute gastric volvulus that were managed with laparoscopy and how patient characteristics can influence the repair technique. Methods Patients with high operative risk who underwent laparoscopic hiatal hernia repair with adjunct T-fastener gastropexy in the emergent setting between July 2014 and July 2016 were included in this study. Results Thirteen patients underwent successful PEH repair and all were classified as urgent/emergent upon admission. In total, 30.7% were performed laparoscopically. The median patient age was 84 years. A laparoscopic GT or gastropexy was performed for fixation of the stomach. Crural closure by an anterior cruroplasty was performed in all patients. There were no mortalities. One patient required conversion of gastropexy into a GT given symptoms of dysphagia. Prolonged length of stay was related to postdischarge institutionalization. All patients remained free of obstructive symptoms. Conclusions Laparoscopic PEH repair with adjunct gastropexy or GT placement should be considered in emergent cases for elderly patients with predominately obstructive symptoms. Laparoscopy for PEH repair is challenging and requires technical skills. T-fastener gastropexy or GT placement is safe, simple, and obviates the need for intracorporeal suturing. It also may be used to improve physician comfort with laparoscopy and to expedite the repair in this high-risk population.