William D Chey, Jana G Hashash, Laura Manning, Lin Chang
DESCRIPTION: Irritable bowel syndrome (IBS) is a commonly diagnosed gastrointestinal disorder that can have a substantial impact on quality of life. Most patients with IBS associate their gastrointestinal symptoms with eating food. Mounting evidence supports dietary modifications, such as the low-fermentable oligo-, di-, and monosaccharides and polyols (FODMAP) diet, as a primary treatment for IBS symptoms. The aim of this American Gastroenterological Association (AGA) Clinical Practice Update (CPU) is to provide best practice advice statements, primarily to clinical gastroenterologists, covering the role of diet in IBS treatment...
May 2022: Gastroenterology
Azarakhsh Baghdadi, Sahar Mirpour, Maryam Ghadimi, Mina Motaghi, Bita Hazhirkarzar, Timothy M Pawlik, Ihab R Kamel
Colorectal cancer (CRC) is one of the most common cancers in the world. The most important determinant of survival and prognosis is the stage and presence of metastasis. The liver is the most common location for CRC metastasis. The only curative treatment for CRC liver metastasis (CRLM) is resection; however, many patients are ineligible for surgical resection of CRLM. Locoregional treatments such as ablation and intra-arterial therapy are also available for patients with CRLM. Assessment of response after chemotherapy is challenging due to anatomical and functional changes...
January 2022: Journal of Gastrointestinal Surgery
N A Henriksen, A Montgomery, R Kaufmann, F Berrevoet, B East, J Fischer, W Hope, D Klassen, R Lorenz, Y Renard, M A Garcia Urena, M P Simons
BACKGROUND: Umbilical and epigastric hernia repairs are frequently performed surgical procedures with an expected low complication rate. Nevertheless, the optimal method of repair with best short- and long-term outcomes remains debatable. The aim was to develop guidelines for the treatment of umbilical and epigastric hernias. METHODS: The guideline group consisted of surgeons from Europe and North America including members from the European Hernia Society and the Americas Hernia Society...
February 2020: British Journal of Surgery
Christopher F Rose, Piero Amodio, Jasmohan S Bajaj, Radha Krishan Dhiman, Sara Montagnese, Simon D Taylor-Robinson, Hendrik Vilstrup, Rajiv Jalan
Hepatic encephalopathy (HE) is a frequent and serious complication of both chronic liver disease and acute liver failure. HE manifests as a wide spectrum of neuropsychiatric abnormalities, from subclinical changes (mild cognitive impairment) to marked disorientation, confusion and coma. The clinical and economic burden of HE is considerable, and it contributes greatly to impaired quality of life, morbidity and mortality. This review will critically discuss the latest classification of HE, as well as the pathogenesis and pathophysiological pathways underlying the neurological decline in patients with end-stage liver disease...
October 20, 2020: Journal of Hepatology
A G Willms, R Schwab, M W von Websky, F Berrevoet, D Tartaglia, K Sörelius, R H Fortelny, M Björck, T Monchal, F Brennfleck, D Bulian, C Beltzer, C T Germer, J F Lock
PURPOSE: Definitive fascial closure is an essential treatment objective after open abdomen treatment and mitigates morbidity and mortality. There is a paucity of evidence on factors that promote or prevent definitive fascial closure. METHODS: A multi-center multivariable analysis of data from the Open Abdomen Route of the European Hernia Society included all cases between 1 May 2015 and 31 December 2019. Different treatment elements, i.e. the use of a visceral protective layer, negative-pressure wound therapy and dynamic closure techniques, as well as patient characteristics were included in the multivariable analysis...
February 2022: Hernia: the Journal of Hernias and Abdominal Wall Surgery
Seth R Bauer, Gretchen L Sacha, Simon W Lam, Lu Wang, Anita J Reddy, Abhijit Duggal, Vidula Vachharajani
BACKGROUND: Arginine vasopressin (AVP) is suggested as an adjunct to norepinephrine in patients with septic shock. Guidelines recommend an AVP dosage up to 0.03 units/min, but 0.04 units/min is commonly used in practice based on initial studies. This study was designed to compare the incidence of hemodynamic response between initial fixed-dosage AVP 0.03 units/min and AVP 0.04 units/min. METHODS: This retrospective, multi-hospital health system, cohort study included adult patients with septic shock receiving AVP as an adjunct to catecholamine vasopressors...
January 2022: Journal of Intensive Care Medicine
Michele Pisano, Niccolò Allievi, Kurinchi Gurusamy, Giuseppe Borzellino, Stefania Cimbanassi, Djamila Boerna, Federico Coccolini, Andrea Tufo, Marcello Di Martino, Jeffrey Leung, Massimo Sartelli, Marco Ceresoli, Ronald V Maier, Elia Poiasina, Nicola De Angelis, Stefano Magnone, Paola Fugazzola, Ciro Paolillo, Raul Coimbra, Salomone Di Saverio, Belinda De Simone, Dieter G Weber, Boris E Sakakushev, Alessandro Lucianetti, Andrew W Kirkpatrick, Gustavo P Fraga, Imitaz Wani, Walter L Biffl, Osvaldo Chiara, Fikri Abu-Zidan, Ernest E Moore, Ari Leppäniemi, Yoram Kluger, Fausto Catena, Luca Ansaloni
BACKGROUND: Acute calculus cholecystitis (ACC) has a high incidence in the general population. The presence of several areas of uncertainty, along with the availability of new evidence, prompted the current update of the 2016 WSES (World Society of Emergency Surgery) Guidelines on ACC. MATERIALS AND METHODS: The WSES president appointed four members as a scientific secretariat, four members as an organization committee and four members as a scientific committee, choosing them from the expert affiliates of WSES...
November 5, 2020: World Journal of Emergency Surgery: WJES
Alexandre Santos, Panu Mentula, Tarja Pinta, Shamel Ismail, Tero Rautio, Risto Juusela, Aleksi Lähdesmäki, Tom Scheinin, Ville Sallinen
IMPORTANCE: Diverticulitis has a tendency to recur and affect quality of life. OBJECTIVE: To assess whether sigmoid resection is superior to conservative treatment in improving quality of life of patients with recurrent, complicated, or persistent painful diverticulitis. DESIGN, SETTING, AND PARTICIPANTS: This open-label randomized clinical trial assessed for eligibility 128 patients with recurrent, complicated, or persistent painful diverticulitis in 6 Finnish hospitals from September 29, 2014, to October 10, 2018...
February 1, 2021: JAMA Surgery
Salomone Di Saverio, Mauro Podda, Belinda De Simone, Marco Ceresoli, Goran Augustin, Alice Gori, Marja Boermeester, Massimo Sartelli, Federico Coccolini, Antonio Tarasconi, Nicola De' Angelis, Dieter G Weber, Matti Tolonen, Arianna Birindelli, Walter Biffl, Ernest E Moore, Michael Kelly, Kjetil Soreide, Jeffry Kashuk, Richard Ten Broek, Carlos Augusto Gomes, Michael Sugrue, Richard Justin Davies, Dimitrios Damaskos, Ari Leppäniemi, Andrew Kirkpatrick, Andrew B Peitzman, Gustavo P Fraga, Ronald V Maier, Raul Coimbra, Massimo Chiarugi, Gabriele Sganga, Adolfo Pisanu, Gian Luigi De' Angelis, Edward Tan, Harry Van Goor, Francesco Pata, Isidoro Di Carlo, Osvaldo Chiara, Andrey Litvin, Fabio C Campanile, Boris Sakakushev, Gia Tomadze, Zaza Demetrashvili, Rifat Latifi, Fakri Abu-Zidan, Oreste Romeo, Helmut Segovia-Lohse, Gianluca Baiocchi, David Costa, Sandro Rizoli, Zsolt J Balogh, Cino Bendinelli, Thomas Scalea, Rao Ivatury, George Velmahos, Roland Andersson, Yoram Kluger, Luca Ansaloni, Fausto Catena
BACKGROUND AND AIMS: Acute appendicitis (AA) is among the most common causes of acute abdominal pain. Diagnosis of AA is still challenging and some controversies on its management are still present among different settings and practice patterns worldwide. In July 2015, the World Society of Emergency Surgery (WSES) organized in Jerusalem the first consensus conference on the diagnosis and treatment of AA in adult patients with the intention of producing evidence-based guidelines. An updated consensus conference took place in Nijemegen in June 2019 and the guidelines have now been updated in order to provide evidence-based statements and recommendations in keeping with varying clinical practice: use of clinical scores and imaging in diagnosing AA, indications and timing for surgery, use of non-operative management and antibiotics, laparoscopy and surgical techniques, intra-operative scoring, and peri-operative antibiotic therapy...
April 15, 2020: World Journal of Emergency Surgery: WJES
Daniël Pv Lambrichts, Pim P Edomskis, Ruben D van der Bogt, Gert-Jan Kleinrensink, Willem A Bemelman, Johan F Lange
PURPOSE: The optimal surgical approach for perforated diverticulitis with purulent or fecal peritonitis (Hinchey grade III or IV) remains debated. In recent years, accumulating evidence comparing sigmoid resection with primary anastomosis (PA) with the Hartmann's procedure (HP) was presented. Therefore, the aim was to provide an updated and extensive synthesis of the available evidence. METHODS: A systematic search in Embase, MEDLINE, Cochrane, and Web of Science databases was performed...
August 2020: International Journal of Colorectal Disease
Howard Thom, Gill Norman, Nicky J Welton, Emma J Crosbie, Jane Blazeby, Jo C Dumville
Background: Surgical site infections (SSIs) are costly and associated with poorer patient outcomes. Intra-operative surgical site irrigation and intra-cavity lavage may reduce the risk of SSIs through removal of dead or damaged tissue, metabolic waste, and site exudate. Irrigation with antibiotic or antiseptic solutions may further reduce the risk of SSI because of bacteriocidal properties. Randomized controlled trials (RCTs) have been conducted comparing irrigation solutions, but important comparisons (e.g...
March 2021: Surgical Infections
Yalini Vigneswaran, Vivek N Prachand, Mitchell C Posner, Jeffrey B Matthews, Mustafa Hussain
INTRODUCTION: Among surgeons worldwide, a concern with the use of minimally invasive techniques has been raised due to a proposed risk of viral transmission of the coronavirus disease of 2019 (COVID-19) with the creation of pneumoperitoneum. Due to this proposed concern, we sought to collect the available data and evaluate the use of laparoscopy and the risk of COVID-19 transmission. METHODS: A literature review of viral transmission in surgery and of the available literature regarding the transmission of the COVID-19 virus was performed...
July 2020: Journal of Gastrointestinal Surgery
Bita Hazhirkarzar, Pegah Khoshpouri, Mohammadreza Shaghaghi, Mounes Aliyari Ghasabeh, Timothy M Pawlik, Ihab R Kamel
One of the most common cancers worldwide, colorectal cancer (CRC) has been associated with significant morbidity and mortality and therefore represents an enormous burden to the health care system. Recent advances in CRC treatments have provided patients with primary and metastatic CRC a better long-term prognosis. The presence of synchronous or metachronous metastasis has been associated, however, with worse survival. The most common site of metastatic disease is the liver. A variety of treatment modalities aimed at targeting colorectal liver metastases (CRLM) has been demonstrated to improve the prognosis of these patients...
February 2020: Hepatobiliary Surgery and Nutrition
Arden M Morris, Scott E Regenbogen, Karin M Hardiman, Samantha Hendren
IMPORTANCE: Diverticulitis is a common disease. Recent changes in understanding its natural history have substantially modified treatment paradigms. OBJECTIVE: To review the etiology and natural history of diverticulitis and recent changes in treatment guidelines. EVIDENCE REVIEW: We searched the MEDLINE and Cochrane databases for English-language articles pertaining to diagnosis and management of diverticulitis published between January 1, 2000, and March 31, 2013...
January 15, 2014: JAMA
Marissa K Srour, Joshua Tseng, Michael Luu, Rodrigo F Alban, Armando E Giuliano, Alice Chung
BACKGROUND: The American College of Surgeons Oncology Group (ACOSOG) Z1071 and Sentinel Neoadjuvant (SENTINA) trials of sentinel node biopsy for node-positive breast cancer treated with neoadjuvant chemotherapy (NAC) demonstrated false-negative rates that varied on the basis of surgical technique. This study evaluated trends in axillary operations before and after publication of these trials. METHODS: This study analyzed patients from National Cancer Database (NCDB) with clinical T0 through T4, N1 and N2, M0 breast cancer who received NAC from 1 January 2012 to 31 December 2015 and sentinel lymph node biopsy (SNB) or axillary lymph node dissection (ALND)...
October 2019: Annals of Surgical Oncology
Ingrid G M Poodt, Coco J E F Walstra, Guusje Vugts, Adriana J G Maaskant-Braat, Adri C Voogd, Robert-Jan Schipper, Grard A P Nieuwenhuijzen
BACKGROUND: Unlike sentinel lymph node biopsy (SLNB) in the primary setting, the repeat SLNB (rSLNB) in patients with ipsilateral breast tumor recurrence (IBTR) is challenging, because it is difficult to visualize and/or harvest a sentinel lymph node in every patient. Regional treatments options and safety in terms of regional disease control after such an unsuccessful rSLNB remain unclear. This study assesses factors associated with the performance of axillary lymph node dissection (ALND) after unsuccessful rSLNB and evaluates the occurrence of regional recurrences...
August 2019: Annals of Surgical Oncology
Dominique Farge, Corinne Frere, Jean M Connors, Cihan Ay, Alok A Khorana, Andres Munoz, Benjamin Brenner, Ajay Kakkar, Hanadi Rafii, Susan Solymoss, Dialina Brilhante, Manuel Monreal, Henri Bounameaux, Ingrid Pabinger, James Douketis
Venous thromboembolism (VTE) is the second leading cause of death in patients with cancer. These patients are at a high risk of VTE recurrence and bleeding during anticoagulant therapy. The International Initiative on Thrombosis and Cancer is an independent academic working group aimed at establishing a global consensus for the treatment and prophylaxis of VTE in patients with cancer. The International Initiative on Thrombosis and Cancer last updated its evidence-based clinical practice guidelines in 2016 with a free, web-based mobile phone application, which was subsequently endorsed by the International Society on Thrombosis and Haemostasis...
October 2019: Lancet Oncology
Michael D Alvarado, Elizabeth A Mittendorf, Mediget Teshome, Alastair M Thompson, Richard J Bold, Mark A Gittleman, Peter D Beitsch, Sarah L Blair, Kaisa Kivilaid, Quentin J Harmer, Kelly K Hunt
BACKGROUND: Sentinel lymph node biopsy (SLNB) is a highly accurate method for staging the axilla in early breast cancer. Superparamagnetic iron oxide mapping agents have been explored to overcome the disadvantages of the standard SLNB technique, which uses a radioisotope tracer with or without blue dye. One such agent, Sienna+, was shown to be non-inferior to the standard technique for SLNB in a number of studies. The SentimagIC trial was designed to establish the non-inferiority of a new formulation of this magnetic tracer, Magtrace (formerly SiennaXP)...
October 2019: Annals of Surgical Oncology
Loris Pironi, Anna Simona Sasdelli
Chronic intestinal pseudo-obstruction (CIPO) is a severe form of intestinal dysmotility disorder, characterized by the impairment of gastrointestinal propulsion of the gut content in the absence of fixed occluding lesions. CIPO is a rare disease that can develop in both children and adults. CIPO is classified as primary/idiopathic, when no underlying disorder is demonstrated, or secondary, when related to systemic diseases. Diagnosis relies on the finding of chronic/recurrent obstructive type symptoms with radiological features of dilated intestine with air/fluid levels without any lumen occluding lesion...
December 2019: Gastroenterology Clinics of North America
Neena S Abraham
The management of antiplatelet and anticoagulant (ie, antithrombotic) agents is challenging in the periendoscopic setting. In this state-of-the-art update, we review current best practice recommendations focusing on the risk of immediate and delayed postpolypectomy bleeding in the context of drug discontinuation (ie, temporary interruption) and drug continuation. The data regarding polypectomy technique (cold snare vs conventional thermal-based) and prophylactic placement of hemostatic clips are evaluated to assess whether these endoscopic techniques are beneficial in reducing postpolypectomy bleeding...
February 2020: Gastrointestinal Endoscopy
2019-10-18 22:04:02
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