JAMA Surgery

📝 JAMA Surgery : In adhesive small-bowel obstruction, tube decompression remains a standard component of nonoperative management when there are no signs of bowel compromise or peritonitis.

https://ja.ma/4w8pXzn

Across nonclinical learning activities, residents generally rated effectiveness lower than faculty, even when importance ratings were similar.

Attending rounds and technique or operative simulation were viewed as highly important but showed some of the largest perceived gaps in effectiveness, which may help guide educational quality improvement efforts.

https://ja.ma/3RWiHsk

Among patients listed for , those with had greater comorbidity burden at listing, including more diabetes and kidney dysfunction, despite identical biologic Model for End-Stage Liver Disease scores compared with matched patients without MASH.

They also had worse long-term overall, waiting-list, and posttransplant mortality, indicating that comorbidities may contribute importantly to outcomes beyond liver disease severity alone.

https://ja.ma/4hmH7ps

remain a mainstay of treatment for when there is no intestinal compromise, while routine use after many gastrointestinal operations has become more selective in the era of enhanced recovery after surgery.

Jamie Coleman, MD, and Brian Zuckerbraun, MD, discuss how the evidence supports selective rather than routine postoperative nasogastric decompression, with attention to recovery, bowel function, mobilization, and aspiration risk.

🎧 Listen now: https://ja.ma/4z6oE6G

Nasogastric Tubes—Indications, Placement, and Management Interview with Brian S. Zuckerbraun, MD, MBA, author of Nasogastric Tubes—Indications, Placement, and Management: A Review. Hosted by Jamie Coleman, MD.

📝 JAMA Surgery : tubes remain a core component of management for adhesive small-bowel obstruction, where decompression is part of nonoperative care in patients without ischemia, strangulation, or peritonitis.

This Review indicates that a short trial of decompression, combined with fluid and electrolyte management and serial reassessment, remains standard practice, while criteria to identify patients who may safely avoid tube decompression are still limited.

https://ja.ma/4wq16re

Among patients with recurrent , hematogenous spread was associated with greater chromosomal instability, whole-genome duplication, and alterations in cell cycle signaling compared with peritoneal recurrence.

Bone metastasis appeared distinct, arising from more genomically stable tumors and more often from Lauren diffuse-type histology, which may help personalize postoperative surveillance strategies.

https://ja.ma/4wjLwNr

💬 Viewpoint: Rapid growth in may be contributing to decline in foundational skills among both trainees and experienced . This erosion may affect patient safety when robotic systems are unavailable, because loss of laparoscopic proficiency can narrow minimally invasive options and increase reliance on open surgery.

Laparoscopic Deskilling This Viewpoint reflects on a decay in surgical skill related to falling laparoscopic case volumes and describes strategies to preserve laparoscopic proficiency amid the rapid adoption of robotic platforms.

In prospective validation of hepatobiliary videos, automated skill scores showed closer agreement with expert ratings than ratings from resident and attending surgeons.

The findings indicate that video-based artificial intelligence tools may support more consistent assessment and targeted feedback within surgical training and quality review. https://ja.ma/4ftH5L7

In private payer data, operative complexity for procedures included in The Transforming Episode Accountability Model was associated with higher intensive care unit use, longer length of stay, more readmissions, and more postacute care. Hospital payments rose only modestly in some categories and not in others, indicating that may not fully account for higher-cost complex surgical episodes. https://ja.ma/4pNztX9