Efficacy and safety of bimekizumab in patients with moderate-to-severe hidradenitis suppurativa (BE HEARD I and BE HEARD II): two 48-week, randomised, double-blind, placebo-controlled, multicentre phase 3 trials.

Croghan SM, O’Meara S, Cunnane EM, Purtill H, Walsh MT, O’Brien FJ et al.

Br J Surg 2024; 111: znae137.

Variable intrarenal pressure during endorenal (stone) surgery may affect renal function adversely. An automatic pressurized pump was compared with manual hand-pump irrigation in 38 patients. The automatic pump gave lower (mean 38 versus 62 mmHg, P=0.005) and more consistent intrarenal pressure, and a better view for the surgeon.

Comment: Machine beats human.

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Mueller C, Kehl V, Dimpel R, Blankenstein C, Egert-Schwender SE, Strudthoff J, Lock JF et al, for the IOWISI Study Group.

JAMA Surg. 2024;159: 484-492.

This three armed RCT included 689 patients randomized to saline, polyhexanide or no wound irrigation. Respective wound infection rates were 12.5, 10.6 and 12.8 per cent. Compared to controls, polyhexanide did not reduce infection rates: hazard rate 1.23, 95 per cent confidence interval 0.64 to 2.36.

Comment: Wound irrigation remains controversial, and unproven.

Cihoric M, Kehlet H, Lauritsen ML, Højlund J, Kanstrup K, Kärnsund S et al.  

Br J Surg 2024; 111: znae130.

A single dose of dexamethasone given at the start of emergency laparotomy reduced the mean C-reactive protein level after 24h from  220 to 170 mg/l, P=0.015. It also reduced postoperative major complications (27 versus 45 per cent, P=0.032) and 90-day mortality (7 versus 23 per cent, P=0.023).

Comment: Is there enough evidence yet for this to be the standard of care?

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