Essential Surgical Knowledge

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2364 papers 1000+ followers Papers from the recent literature which are of interest to residents and practicing surgeons
Ajit K Sachdeva
Expertise in surgery is essential to ensure the best outcomes across various phases of surgical care. Expertise is multidimensional and is both domain- and context-specific. It encompasses a broad range of knowledge, skills, and professional attributes. General expertise is characterized by pattern recognition, rapid and effective decision-making, fluency of actions, and efficiency in performance. Adaptive expertise involves complex decision-making and exceptional performance within the context of unexpected findings, unusual circumstances, complex systems, and the rapidly changing surgical environment...
November 4, 2019: Surgery
Harry E Fuentes, Robert D McBane, Waldemar E Wysokinski, Alfonso J Tafur, Charles L Loprinzi, Mohammad H Murad, Irbaz Bin Riaz
OBJECTIVE: To explore the efficacy and safety of direct oral factor Xa inhibitors in the treatment of cancer-associated acute venous thromboembolism (VTE). PATIENTS AND METHODS: MEDLINE, CENTRAL (Cochrane Central Register of Controlled Trials), and Embase databases were searched for trials comparing direct oral anticoagulants (DOACs) to dalteparin for the management of cancer-associated acute VTE. Databases were searched from inception to September 19, 2018. A network meta-analysis using both frequentist and Bayesian methods was performed to analyze VTE recurrence and major and clinically relevant nonmajor bleeding...
November 1, 2019: Mayo Clinic Proceedings
Awad Jarrar, Armin Edalatpour, Audry Sebikali-Potts, Dominic Vitello, Michael Valente, David Liska, Matthew Kalady, Conor P Delaney, Scott R Steele
INTRODUCTION: Our aim was to develop a nomogram taking into account factors such as tumor biology to predict overall and disease-free survival for patients with primary rectal adenocarcinoma undergoing curative intent surgical resection. METHODS: Patients undergoing resection for primary rectal adenocarcinoma (2007-2017) were included. Factors reflecting tumor biology and important clinical prognosticators were included in nomogram development. Prognostic factors were assessed with multivariable analysis using Cox regression...
October 30, 2019: American Journal of Surgery
Adam Truong, Karen Zaghiyan, Phillip Fleshner
Medical treatment remains the mainstay of perianal disease management for CD; however, aggressive surgical management should be considered for severe or recurrent disease. In all cases of perianal CD, medical and surgical treatments should be used in tandem by a multidisciplinary team. Significant development has been made in the treatment of Crohn's-related fistulas, particularly minimally invasive options with recent clinical trials showing success with mesenchymal stem cell applications. Inevitably, some patients with severe refractory disease may require fecal diversion or proctectomy...
December 2019: Surgical Clinics of North America
Melissa A Hornor, Meixi Ma, Lynn Zhou, Mark E Cohen, Ronnie A Rosenthal, Marcia M Russell, Clifford Y Ko
BACKGROUND: The ACS NSQIP Surgical Risk Calculator (SRC) plays an important role in risk prediction and decision-making. We sought to 1) enhance the existing ACS NSQIP SRC with functionality to predict geriatric-specific outcomes and 2) assess the predictive value of geriatric-specific risk factors by comparing performance in outcome prediction using the traditional ACS NSQIP SRC versus models that also included geriatric risk factors. STUDY DESIGN: Data were collected from 21 ACS NSQIP Geriatric Surgery Pilot Project (GSPP) hospitals between 2014-2017...
October 15, 2019: Journal of the American College of Surgeons
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
Yue-Yung Hu, Ryan J Ellis, D Brock Hewitt, Anthony D Yang, Elaine Ooi Cheung, Judith T Moskowitz, John R Potts, Jo Buyske, David B Hoyt, Thomas R Nasca, Karl Y Bilimoria
BACKGROUND: Physicians, particularly trainees and those in surgical subspecialties, are at risk for burnout. Mistreatment (i.e., discrimination, verbal or physical abuse, and sexual harassment) may contribute to burnout and suicidal thoughts. METHODS: A cross-sectional national survey of general surgery residents administered with the 2018 American Board of Surgery In-Training Examination assessed mistreatment, burnout (evaluated with the use of the modified Maslach Burnout Inventory), and suicidal thoughts during the past year...
October 28, 2019: New England Journal of Medicine
Evelien Dekker, Pieter J Tanis, Jasper L A Vleugels, Pashtoon M Kasi, Michael B Wallace
Several decades ago, colorectal cancer was infrequently diagnosed. Nowadays, it is the world's fourth most deadly cancer with almost 900 000 deaths annually. Besides an ageing population and dietary habits of high-income countries, unfavourable risk factors such as obesity, lack of physical exercise, and smoking increase the risk of colorectal cancer. Advancements in pathophysiological understanding have increased the array of treatment options for local and advanced disease leading to individual treatment plans...
October 19, 2019: Lancet
Umair Iqbal, Harshit Khara, Yirui Hu, Muhammad Ali Khan, Anais Ovalle, Osama Siddique, Haiyan Sun, Matthew Joshua Shellenberger
BACKGROUND AND AIMS: Acute cholangitis (AC) is characterized by abdominal pain, fever, and jaundice. The majority of the patients respond to medical management with intravenous hydration and antibiotics. Almost 20% to 30% require biliary drainage, and ERCP is the procedure of choice. We conducted a systematic review and meta-analysis to evaluate the impact of emergent biliary drainage on patients' outcomes. METHODS: A comprehensive literature review was conducted by searching the Embase and PubMed databases from inception to April 2019 to identify all studies that evaluated the impact of timing of ERCP on patient outcomes...
October 16, 2019: Gastrointestinal Endoscopy
George Demetriou, Ahmed Nassar, Sriram Subramonia
There are currently no guidelines on the long-term management of patients after an episode of acute ischaemic colitis. Our aim was to review the literature on the pattern of presentation and the pathophysiology of this condition and to understand the current status of the acute and long-term management of ischaemic colitis. Furthermore, we aim to provide recommendations for the clinicians in regard to the acute and long-term management of ischaemic colitis. A review of the English literature over the last 15 years was performed using Embase and Medline...
October 23, 2019: World Journal of Surgery
Vinay K Rathi, Joseph S Ross
No abstract text is available yet for this article.
October 23, 2019: New England Journal of Medicine
Aurélien Lambert, Lilian Schwarz, Ivan Borbath, Aline Henry, Jean-Luc Van Laethem, David Malka, Michel Ducreux, Thierry Conroy
Pancreatic cancer is one of the most lethal solid organ tumors. Due to the rising incidence, late diagnosis, and limited treatment options, it is expected to be the second leading cause of cancer deaths in high income countries in the next decade. The multidisciplinary treatment of this disease depends on the stage of cancer at diagnosis (resectable, borderline, locally advanced, and metastatic disease), and combines surgery, chemotherapy, chemoradiotherapy, and supportive care. The landscape of multidisciplinary pancreatic cancer treatment is changing rapidly, especially in locally advanced disease, and the number of treatment options in metastatic disease, including personalized medicine, innovative targets, immunotherapy, therapeutic vaccines, adoptive T-cell transfer, or stemness inhibitors, will probably expand in the near future...
2019: Therapeutic Advances in Medical Oncology
Alan N Barkun, Majid Almadi, Ernst J Kuipers, Loren Laine, Joseph Sung, Frances Tse, Grigorios I Leontiadis, Neena S Abraham, Xavier Calvet, Francis K L Chan, James Douketis, Robert Enns, Ian M Gralnek, Vipul Jairath, Dennis Jensen, James Lau, Gregory Y H Lip, Romaric Loffroy, Fauze Maluf-Filho, Andrew C Meltzer, Nageshwar Reddy, John R Saltzman, John K Marshall, Marc Bardou
Description: This update of the 2010 International Consensus Recommendations on the Management of Patients With Nonvariceal Upper Gastrointestinal Bleeding (UGIB) refines previous important statements and presents new clinically relevant recommendations. Methods: An international multidisciplinary group of experts developed the recommendations. Data sources included evidence summarized in previous recommendations, as well as systematic reviews and trials identified from a series of literature searches of several electronic bibliographic databases from inception to April 2018...
October 22, 2019: Annals of Internal Medicine
Christian E Oberkofler, Jacob F Hamming, Roxane D Staiger, Philippe Brosi, Sebastiano Biondo, Olivier Farges, Dink A Legemate, Mario Morino, Antonio D Pinna, Hugo Pinto-Marques, John V Reynolds, Ricardo Robles Campos, Xavier Rogiers, Kjetil Soreide, Milo A Puhan, Pierre-Alain Clavien, Inne Borel Rinkes
OBJECTIVE: To assess the adoption of recommendation from randomized clinical trials (RCTs) and investigate factors favoring or preventing adoption. BACKGROUND: RCT are considered to be the cornerstone of evidence-based medicine by representing the highest level of evidence. As such, we expect RCT's recommendations to be followed rigorously in daily surgical practice. METHODS: We performed a structured search for RCTs published in the medical and surgical literature from 2009 to 2013, allowing a minimum of 5-year follow-up to convincingly test implementation...
November 2019: Annals of Surgery
Nicole A Meredyth, Inmaculada de Melo-Martin
No abstract text is available yet for this article.
October 14, 2019: Journal of the American College of Surgeons
Zenon Pogorelić, Josipa Domjanović, Miro Jukić, Tina Poklepović Peričić
Background: The aim of this study is the evaluation of clinical signs and outcomes of treatment in children under five years of age who underwent appendectomy because of acute appendicitis. Patients and Methods: From January 2009 until December 2018, 90 patients (54 boys and 36 girls) younger than five years of age, treated with appendectomy because of acute appendicitis, were included in this study. Patients were divided into two groups, depending on the intra-operative finding of non-perforated (Group I; n = 32) or perforated (Group II; n = 58) appendicitis...
October 16, 2019: Surgical Infections
Christopher Andrew Lamb, Nicholas A Kennedy, Tim Raine, Philip Anthony Hendy, Philip J Smith, Jimmy K Limdi, Bu'Hussain Hayee, Miranda C E Lomer, Gareth C Parkes, Christian Selinger, Kevin J Barrett, R Justin Davies, Cathy Bennett, Stuart Gittens, Malcolm G Dunlop, Omar Faiz, Aileen Fraser, Vikki Garrick, Paul D Johnston, Miles Parkes, Jeremy Sanderson, Helen Terry, Daniel R Gaya, Tariq H Iqbal, Stuart A Taylor, Melissa Smith, Matthew Brookes, Richard Hansen, A Barney Hawthorne
Ulcerative colitis and Crohn's disease are the principal forms of inflammatory bowel disease. Both represent chronic inflammation of the gastrointestinal tract, which displays heterogeneity in inflammatory and symptomatic burden between patients and within individuals over time. Optimal management relies on understanding and tailoring evidence-based interventions by clinicians in partnership with patients. This guideline for management of inflammatory bowel disease in adults over 16 years of age was developed by Stakeholders representing UK physicians (British Society of Gastroenterology), surgeons (Association of Coloproctology of Great Britain and Ireland), specialist nurses (Royal College of Nursing), paediatricians (British Society of Paediatric Gastroenterology, Hepatology and Nutrition), dietitians (British Dietetic Association), radiologists (British Society of Gastrointestinal and Abdominal Radiology), general practitioners (Primary Care Society for Gastroenterology) and patients (Crohn's and Colitis UK)...
September 27, 2019: Gut
Lise M Helsingen, Per Olav Vandvik, Henriette C Jodal, Thomas Agoritsas, Lyubov Lytvyn, Joseph C Anderson, Reto Auer, Silje Bjerkelund Murphy, Majid Abdulrahman Almadi, Douglas A Corley, Casey Quinlan, Jonathan M Fuchs, Annette McKinnon, Amir Qaseem, Anja Fog Heen, Reed A C Siemieniuk, Mette Kalager, Juliet A Usher-Smith, Iris Lansdorp-Vogelaar, Michael Bretthauer, Gordon Guyatt
CLINICAL QUESTION: Recent 15-year updates of sigmoidoscopy screening trials provide new evidence on the effectiveness of colorectal cancer screening. Prompted by the new evidence, we asked: "Does colorectal cancer screening make an important difference to health outcomes in individuals initiating screening at age 50 to 79? And which screening option is best?" CURRENT PRACTICE: Numerous guidelines recommend screening, but vary on recommended test, age and screening frequency...
October 2, 2019: BMJ: British Medical Journal
Shun Zhang, Hajime Orita, Tetsu Fukunaga
The incidence of esophagogastric junction (EGJ) adenocarcinoma has shown an upward trend over the past several decades worldwide. In this article, we review previous studies and aimed to provide an update on the factors related to the surgical treatment of EGJ adenocarcinoma. The Siewert classification has implications for lymph node spread and is the most commonly used classification. Different types of EGJ cancer have different incidences of mediastinal and abdominal lymph node metastases, and different surgical approaches have unique advantages and disadvantages...
August 15, 2019: World Journal of Gastrointestinal Oncology
C V Angeles, S L Wong, G Karakousis
Between 1980 and 2004, six randomized, controlled trials (RCTs) have been performed to evaluate the width of surgical margin excision for primary cutaneous melanoma and its influence on recurrence and survival. These trials have led to the current recommendation of not more than a 2-cm margin excision and have allowed reduced morbidity of surgery for primary melanoma. Long-term follow-up data has been published which has led to impactful knowledge of the natural history of this disease, yet controversy remains for 1- to 2-mm thickness melanomas...
September 27, 2019: Annals of Surgical Oncology
2019-10-01 13:51:24
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