Monthly general surgery bulletin — September 28, 2026

Period covered: August 29 to September 28, 2026. Note for the month: a thin month for randomized trials in general surgery; the weightiest item is a Spanish trial of prophylactic mesh in hepatobiliopancreatic surgery, and two multicenter studies in the British Journal of Surgery are of direct interest for the operating room. No primary study from the month could be verified from East Asia, Russia, the Middle East or Latin America (searches in Chinese, Japanese, Korean, Russian, Arabic, Turkish and Portuguese returned only news items without clinical data or material predating the period), and nothing verifiable was found in trauma or in breast, melanoma or sarcoma surgical oncology within the period. Nine items are sent rather than padding.

Abdominal wall and hernia

1. Prophylactic retromuscular mesh reduces incisional hernia after open hepatobiliopancreatic surgery

[Clinical trial] [Spain]
Single-center, double-blind randomized clinical trial (Virgen Macarena Hospital, Seville) in 144 patients with two or more risk factors for incisional hernia undergoing elective hepatobiliopancreatic surgery through a right subcostal laparotomy, randomized to conventional closure or closure reinforced with a retromuscular synthetic mesh. Radiological incisional hernia at 12 months: 5.2% with mesh vs 21% without; at 24 months, 8.1% vs 37.5%. No differences in surgical site occurrences, complications or pain; the J incision was associated with more hernias than the Kocher incision. Published in JAMA Surgery on September 9, 2026; registration NCT07433439.
Why it matters: this is the first randomized evidence specific to the subcostal incision in high-risk patients and the effect size is large, but it is a single center, the abstract gives no hazard or risk ratios with confidence intervals, and follow-up is only two years; it strengthens the recommendation for prophylactic mesh in high-risk laparotomies, now also off the midline.
https://jamanetwork.com/journals/jamasurgery/article-abstract/2853952

2. Robotic versus laparoscopic inguinal hernia repair: seven trials, no difference

[Meta-analysis] [Italy]
Systematic review and meta-analysis restricted to randomized trials (seven trials, nine publications, 691 patients; including RIVAL, DIRECT, VOLTAIRE, ROLAIS and ROGER) from the Gemelli University Hospital in Rome, published in Surgical Endoscopy (September 2026 issue, online since August 20). Overall complications RR 0.76 (95% CI 0.49–1.17); recurrence risk difference 0.00 (95% CI −0.02 to 0.02); same-day discharge RR 1.02 (95% CI 0.93–1.13). All secondary outcomes were non-significant and certainty of evidence was rated low to very low; PROSPERO registration CRD420261370145.
Why it matters: with robotic costs two to three times higher, the available randomized evidence shows no clinical advantage for robotic inguinal repair; acute pain could not be pooled because of heterogeneous scales and the trials are small, so the debate is not closed, but the burden of proof shifts to those advocating the platform.
https://link.springer.com/article/10.1007/s00464-026-13253-y

Hepatobiliary and pancreas

3. An exosomal signature for preoperative detection of occult liver metastasis in pancreatic cancer

[Publication] [United States]
JAMA Surgery published on September 2, 2026 a development and external validation study of a machine-learning model based on circulating exosomal microRNA to predict occult early liver metastasis in pancreatic ductal adenocarcinoma before surgery, accompanied by an invited commentary titled "Toward Biologic Resectability in Pancreatic Cancer." We could not access the figures in the abstract (protected page), so no sensitivity or area-under-the-curve values are reported here.
Why it matters: the clinical problem is real (non-therapeutic laparotomies for liver metastases not seen on imaging), but until the external validation figures and their reproducibility in other centers are reviewed, it should be read as translational research, not as a tool ready to decide whom not to operate on.
https://jamanetwork.com/journals/jamasurgery/fullarticle/2853796

Colorectal and digestive oncology

4. EAGLE-2: digital safe-anastomosis training and 30-day leak after right colectomy

[Publication] [International, 60 countries]
International prospective cohort led by the ESCP and the NIHR Global Surgery Unit, published in the British Journal of Surgery on September 11, 2026: 2,875 patients undergoing right colectomy with a single anastomosis in 332 hospitals across 60 countries. When the operating surgeon had completed the free online safe-anastomosis modules (78% of cases), 30-day anastomotic leak or intra-abdominal collection was 9.1% vs 16.4% (difference 7.3 points; adjusted OR 0.56, 95% CI 0.41–0.78); reoperation adjusted OR 0.64 and readmission 0.65. Overall leak 10.6%, mortality 3.4%.
Why it matters: it is observational and surgeons who complete the course probably differ from those who do not (confounding by indication), but the intervention is free, scalable and consistent with the earlier EAGLE trial; in resource-limited hospitals it is one of the few low-cost measures with a signal on anastomotic leak.
https://academic.oup.com/bjs/article/113/9/znag107/8790652

5. iGreenGO: indocyanine green in D2 lymphadenectomy for gastric cancer, little stage migration

[Publication] [Italy]
Prospective multicenter observational study in 15 Italian referral centers (British Journal of Surgery, September 24, 2026): 316 patients with cT2–4a gastric adenocarcinoma undergoing minimally invasive gastrectomy with D2 lymphadenectomy, after endoscopic peritumoral injection of indocyanine green (2 ml at 0.125 mg/ml) within the previous 20 hours. Residual fluorescence prompted additional dissection in 61 patients (19.3%); extra nodes were retrieved in 47 and were metastatic in 10 (21.3% of those dissected); stage migration in only 3 of 316 (0.9%); median of 38 nodes.
Why it matters: in a Western population with a standardized D2, fluorescence adds nodes but almost never changes the stage and has a high false-positive rate; it does not support routine use outside research protocols, unlike earlier Korean results, and there is no randomized comparator.
https://academic.oup.com/bjs/article/113/9/znag116/8833809

6. Appendectomy versus antibiotics: less subsequent colorectal cancer in a matched cohort

[Meeting] [United States]
Scientific Forum abstract at the American College of Surgeons Clinical Congress 2026 (Washington, DC, September 26–29), presented by Morehouse School of Medicine using the TriNetX network (168 health care organizations): after matching, 15,616 patients treated with appendectomy vs 15,295 treated with antibiotics alone for acute appendicitis. Subsequent colorectal cancer diagnosis in 110 (0.7%) vs 254 (1.7%), a 58% relative reduction. No hazard ratios, confidence intervals or follow-up time are reported; the authors declare no conflicts.
Why it matters: it is retrospective, not peer reviewed and carries an obvious bias (appendectomy removes occult appendiceal and cecal tumors, and the antibiotic group includes patients with an undiagnosed tumor that mimicked appendicitis), so it does not demonstrate a protective effect; it does underline the need for follow-up colonoscopy in adults treated without surgery.
https://www.newswise.com/articles/appendectomy-for-appendicitis-associated-with-58-lower-colorectal-cancer-risk-than-antibiotics-alone

7. Localized appendiceal adenocarcinoma: relapse is uncommon and adjuvant chemotherapy shows no benefit

[Publication] [United States]
Retrospective cohort from MD Anderson (439 patients with stage I–III disease, 2000–2024; 202 operated on at the center) with validation in 128 stage II patients from Memorial Sloan Kettering, published in JAMA Surgery on September 9, 2026. Relapse in 19 of 202 (9.4%): 6% in stage II and 19.5% in stage III. Mucinous (HR 5.60) and enteric-type (HR 6.60) histology versus goblet cell, and pT4 (HR 3.30), were associated with relapse; adjuvant chemotherapy was not associated with better relapse-free survival on multivariable analysis (HR 0.98, 95% CI 0.43–2.28) or overall survival (HR 0.71, 95% CI 0.24–2.10).
Why it matters: the tumor is rare and the study retrospective, with possible indication bias in who received adjuvant therapy, but it is the largest series with molecular profiling (TP53 in goblet cell, GNAS in non-goblet tumors) and supports individualizing adjuvant therapy by histology and stage rather than extrapolating from colon cancer.
https://jamanetwork.com/journals/jamasurgery/article-abstract/2853953

Trauma, emergency and bariatric surgery

8. Declining bariatric surgery utilization in fee-for-service Medicare (2014–2024)

[Publication] [United States]
Research letter from the University of Michigan (Howard, Dimick et al.) in JAMA Surgery, September 9, 2026: a cross-sectional study of fee-for-service Medicare claims describing bariatric surgery utilization from 2014 to 2024 and its temporal relationship with the arrival of GLP-1 receptor agonists, the COVID-19 disruption and preexisting trends. The figures are in the paywalled full text and could not be verified.
Why it matters: it confirms with public-payer data what U.S. commercial registries show (less surgery in the incretin era); for the bariatric surgeon it means more revisional surgery and more patients arriving after pharmacologic failure or discontinuation, and this year's evidence suggests prior GLP-1 use does not diminish surgical effectiveness.
https://jamanetwork.com/journals/jamasurgery/article-abstract/2853955

Trauma and emergency surgery: no verifiable new trial or guideline was identified within the period.

General surgical oncology

No verifiable items this month: JAMA Surgery published on September 2 a research letter on the long-term results of the Wisconsin initiative to reduce margin re-excisions after lumpectomy, and a feasibility trial of lobectomy versus total thyroidectomy in indeterminate molecular risk thyroid cancer (JAMA Otolaryngology) circulated, but for neither could we confirm the date and the figures, so they are not included.

Cross-cutting

9. FDA clears the LigaSure Maryland vessel sealer for the Hugo robot

[Regulatory FDA] [United States]
Medtronic announced on September 16, 2026 the 510(k) clearance of the LigaSure RAS Maryland instrument for the Hugo RAS system, its first robotic vessel sealer in the United States (CE marked since July 2025). Hugo is cleared in the United States only for urology (December 2025); the submissions for general surgery, including hernia repair, and gynecology were filed in the spring and remain pending. The company expects to exceed 50,000 Hugo procedures this fiscal year.
Why it matters: it is a necessary step for Hugo to compete in general surgery, but there are no comparative clinical data against Intuitive and the U.S. general surgery indication does not yet exist; for Latin America, where Hugo already operates under CE mark, what will matter is the cost per procedure and instrument availability, not the press release.
https://www.medtechdive.com/news/fda-clears-vessel-sealing-device-for-medtronics-hugo-robot/830625/

Upcoming meetings and dates

American College of Surgeons Clinical Congress 2026: Washington, DC, September 26–29 (ongoing at press time; Scientific Forum abstracts, such as item 6, are not yet peer reviewed). No other dates within the next six weeks could be verified.

Monthly general surgery bulletin — September 28, 2026
Nine verified items from the past month: JAMA Surgery, British Journal of Surgery, Surgical Endoscopy, the ACS Clinical Congress and one FDA clearance.
Three worth your time:
• Prophylactic retromuscular mesh in high-risk subcostal laparotomy: incisional hernia at 24 months 8.1% vs 37.5% (double-blind RCT, Seville, n = 144). Single center, two-year follow-up.
• EAGLE-2: when the surgeon had completed the free safe-anastomosis modules, 30-day leak after right colectomy was 9.1% vs 16.4% (adjusted OR 0.56; 2,875 patients, 60 countries). Observational, with likely confounding by indication.
• Robotic vs laparoscopic inguinal hernia repair: meta-analysis of 7 RCTs (691 patients) with no difference in complications or recurrence, low certainty, and two- to threefold higher cost.
Full bulletin, with a critical reading of each study and links to the primary sources:
https://boletinesmedicos.com/en/cirugia-general/2026-09-28.html
#GeneralSurgery #Surgery #SurgicalOncology #Hernia #ColorectalSurgery

General surgery, Sept 2026: prophylactic mesh in high-risk subcostal laparotomy: incisional hernia at 24 mo 8.1% vs 37.5% (RCT, n=144). Safe-anastomosis training: leak 9.1% vs 16.4% (EAGLE-2). https://boletinesmedicos.com/en/cirugia-general/2026-09-28.html