This Week in Surgery — May 28, 2026

Welcome to This Week in Surgery. This week we're covering 10 notable papers spanning innovations in abdominal surgery, new techniques from neurosurgery to cardiac surgery, and refining how we manage patients with systemic therapy and post-operative care. Let's dive in.

Innovations in GI and Abdominal Surgery We begin this week in the abdomen, with four papers from JAMA Surgery and Surgical Endoscopy challenging dogma and improving outcomes in hernia repair, gastroparesis, and transplantation. First, a large Danish nationwide cohort study in JAMA Surgery challenges a common trend in hernia repair [7]. In over 17,000 patients undergoing elective primary ventral hernia repair for defects 10 centimeters or smaller, investigators compared different anatomical mesh placements. Compared to a simple onlay mesh, both retromuscular and intraperitoneal onlay mesh, or IPOM, placements were associated with worse outcomes. Retromuscular placement was linked to a roughly 60% higher risk of reoperation for recurrence and double the risk of bowel obstruction. The findings for IPOM were even more striking, with a more than three-fold higher risk of bowel obstruction. The authors conclude that for these smaller primary ventral hernias, the data suggest that onlay and preperitoneal placements may be the preferable options when considering the risks of both recurrence and bowel obstruction.

Staying with JAMA Surgery, a second study provides a new lens through which to view surgery for diabetic gastroparesis [6]. While we typically consider procedures like gastric electrical stimulation or pyloroplasty for refractory symptoms, this study asked about the metabolic effects. Using a large national database from the United States with over 95,000 patients, the researchers performed a propensity-matched analysis comparing patients who underwent surgery to those managed nonoperatively. Over a mean follow-up of 3.5 years, the surgical group saw their HbA1c decrease by about half a percentage point, while the nonoperative group's HbA1c actually increased. At five years, the between-group difference was nearly a full percentage point. This translated into real clinical benefits: the surgical cohort had a higher probability of achieving good glycemic control, a lower probability of severe hyperglycemia, and was less likely to require insulin initiation. They also experienced fewer long-term diabetes-related complications, emergency visits, and hospitalizations, with no difference in mortality. This suggests that the metabolic benefits of surgery for gastroparesis are substantial and should be a key part of the conversation with patients.

Our third paper from JAMA Surgery, the Bridge to HOPE Trial, looks at improving liver transplant outcomes [8]. Ischemia-reperfusion injury is a major contributor to graft dysfunction, especially with extended-criteria donors. This multicenter randomized trial in the United States evaluated hypothermic oxygenated perfusion, or HOPE, where the donor liver is perfused with a cold, oxygenated solution after transport and before implantation. Compared to standard static cold storage, the HOPE group had a significantly lower rate of early allograft dysfunction, dropping from 37% down to 20%. HOPE was also associated with better early graft function scores and a shorter hospital length of stay. While one-year patient and graft survival were similar between groups, the findings strongly support using HOPE as a practical strategy to improve early post-transplant outcomes for marginal donor livers.

Finally in this section, a study in Surgical Endoscopy provides reassuring long-term data for an increasingly common procedure: endoscopic eradication therapy for early Barrett's esophagus-related neoplasia [1]. In a prospective cohort of 330 patients with high-grade dysplasia or early T1 esophageal adenocarcinoma followed for a median of over 55 months, disease-specific mortality was very low at just 2.2%. Endoscopic recurrence was found in about 4% of patients, and fewer than 9% ultimately required an esophagectomy. This study confirms that for well-selected patients with early-stage disease, endoscopic therapy is a durable and effective long-term treatment.

New Techniques and Technologies Next, we turn to new techniques and technologies, with papers from The New England Journal of Medicine, Annals of Surgery, and Annals of Surgical Oncology.

First, from The New England Journal of Medicine, a cluster-randomized trial addresses a persistent question in neurosurgery: for children with Chiari I malformation and syringomyelia, is it necessary to perform a duraplasty during posterior fossa decompression? [4] The trial compared decompression with duraplasty to decompression alone. The primary outcome, surgical complications within 6 months, was not significantly different, though the rate was numerically higher in the duraplasty group at 14% versus 6% in the group without duraplasty. On the other hand, the duraplasty group had better syrinx reduction and a much lower rate of needing repeat decompression—3% versus 14%. However, these secondary outcomes were not statistically powered, and the trial ultimately concludes that larger studies are needed to determine the relative benefits and risks of these two approaches. The question remains open.

Also in The New England Journal of Medicine, we see a glimpse of the future of cardiac surgery with a Phase 1-2 study of a stem-cell-derived biologic ventricular assist tissue, or BioVAT [5]. This engineered heart muscle, derived from allogeneic stem cells, was transplanted onto the hearts of 20 patients with severe heart failure. The goal is cardiac remuscularization. An interim analysis of patients at 3 months showed promising signals: target heart wall thickness increased, the left ventricular ejection fraction improved by nearly 4 percentage points, and quality of life scores trended upward. However, the safety profile is a major flag. All patients experienced at least one adverse event, and in the full cohort of 20, there were three deaths and one patient required a heart transplant. This is very early data, but it demonstrates a potential biologic effect, warranting longer-term follow-up and further investigation with a close eye on safety.

From big-picture trials to a focused technical innovation, a paper in Annals of Surgical Oncology introduces a novel technique for robotic pancreatic enucleation [10]. Pancreatic enucleation is often hampered by diffuse bleeding, which obscures the field. The authors describe a method of complete segmental parenchymal vascular occlusion. By temporarily encircling the pancreas on both sides of the tumor with custom loops, they achieve a localized, bloodless field without clamping major arterial or venous trunks. The accompanying video demonstrates how this improves visualization and precision, facilitating safer dissection, especially for tumors that are large, deep, or close to the main pancreatic duct. This technique could expand the feasibility of parenchyma-sparing pancreatic surgery.

Rounding out this section, a study in Annals of Surgery tackles a problem familiar to anyone involved in quality improvement: the difficulty of tracking postoperative complications [3]. Researchers developed and validated an algorithm to automatically assign Clavien-Dindo grades using only administrative procedure codes from the electronic health record. Tested on nearly 1,000 liver resections, the expert-derived algorithm was remarkably accurate, achieving a macro-F1 score of over 0.96 and outperforming several machine learning approaches. Because it maps to international classification codes, the algorithm is portable and could enable real-time, automated complication surveillance for benchmarking and research, saving countless hours of manual chart review.

Refining Patient Management Finally, two papers focus on refining patient management, one in the immediate post-operative period and the other for advanced cancer.

A highly practical study from the Journal of the American College of Surgeons looks at antibiotic stewardship in children after surgery for complicated appendicitis [2]. Using a multicenter database of over 29,000 children, the study confirms that a fever on postoperative day 3 or 4 is a powerful predictor of surgical site infection, increasing the odds by about six-fold. The more important finding, however, relates to children discharged on day 3 or 4 who are afebrile. In this group, receiving a prescription for discharge antibiotics was not associated with any reduction in post-discharge surgical site infections. The rates were virtually identical—about 5.8% with antibiotics versus 5.5% without. This provides strong evidence to support a fever-guided antibiotic stewardship strategy, suggesting that for afebrile children, routine discharge antibiotics may be unnecessary.

Lastly, in Annals of Surgical Oncology, investigators asked if early response to immunotherapy can predict long-term outcomes in patients with unresectable or recurrent esophageal squamous cell carcinoma [9]. They defined early tumor shrinkage, or ETS, as a decrease of 20% or more in tumor size at the first evaluation. About half of the 128 patients in the study met this criterion. The results were dramatic. Patients who exhibited early tumor shrinkage had significantly longer progression-free survival, with an adjusted hazard ratio of 0.23, and overall survival, with an adjusted hazard ratio of 0.15. This means their risk of progression or death was reduced by roughly 75-85% compared to those without early shrinkage. ETS appears to be a powerful and easily measured prognostic marker that could help clinicians identify responders early and stratify patients for future treatment strategies.

Editor's Pick If you only have time for one paper this week, make it the Danish nationwide study on ventral hernia repair in JAMA Surgery [7]. For a common operation, it provides surprising and compelling evidence that for smaller hernias, onlay or preperitoneal mesh placement may be superior to retromuscular or IPOM placement in terms of both recurrence and bowel obstruction risk.

Clinical Bottom Line Here are the key takeaways from this week in Surgery.

First, for small primary ventral hernias, onlay and preperitoneal mesh placement appear to have lower risks of recurrence and bowel obstruction compared to retromuscular and intraperitoneal techniques [7].

Second, in children with complicated appendicitis, postoperative day 3 or 4 fever is a strong predictor of surgical site infection. However, for afebrile children, discharge antibiotics do not seem to reduce the risk of post-discharge infection, supporting a fever-guided approach to antibiotic stewardship [2].

Third, surgery for diabetic gastroparesis is associated with significant metabolic benefits, including improved HbA1c, reduced insulin needs, and fewer long-term diabetes complications, adding a key consideration beyond just symptom control [6].

Fourth, for extended criteria donor livers, hypothermic oxygenated perfusion, or HOPE, reduces early allograft dysfunction and length of stay compared to static cold storage alone, supporting its use to improve early transplant outcomes [8].

And finally, in esophageal cancer patients on immunotherapy, early tumor shrinkage on the first scan is a powerful prognostic marker for better survival, helping to identify responders early in their treatment course [9].

That's your roundup for This Week in Surgery. The full transcript and references are available on the episode page in your AudioScholar library. This is an AI-curated summary — for clinical decisions, always consult primary sources and current guidelines. See you next week.