Intraoperative Wound Irrigation for the Prevention of Surgical Site Infection After Laparotomy. A randomized clinical trial by CHIR-Net.

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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Kimball AB, Jemec GBE, Sayed CJ, Kirby JS, Prens E, Ingram JR et al.

Lancet 2024;  403: 2504-2519.

These two RCTs included over 1000 patients randomized to different doses of bimekizumab for up to 48 months. Responder rates were superior in those who received bimekizumab in both trials over placebo (I – 48 versus 29 per cent, P=0.006; II – 52 versus 32 per cent, P=0.0032). Side effects were infrequent.

Comment: At last, a meaningful treatment compared with surgery. Now for the direct comparison?

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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