General Surgery Evidence Evolution

5 evidence evolution narratives tracing how landmark trials and guideline updates reshaped general surgery practice.

Appendicitis Non-Operative Management

Do we still need to operate?

Appendectomy always → APPAC (2015) → CODA (2020) → antibiotics-first → patient selection

Mesh, laparoscopy, and watchful waiting

Open tension → Lichtenstein mesh → laparoscopic (TEP/TAPP) → watchful waiting (INCA/HERNIA) → tailored

Metabolic surgery proves its worth

JIB → RYGB → SOS (2004) → sleeve rise → STAMPEDE metabolic → 10-year comparisons

Same-admission is better

Cool-down-and-delay → early surgery RCTs → Tokyo Guidelines → same-admission standard

Bundle compliance reduces infections

Individual measures → WHO/CDC bundles → CHG bathing → antibiotic timing → NPWT