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Essential Surgical Knowledge

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2387 papers 1000+ followers Papers from the recent literature which are of interest to residents and practicing surgeons
https://read.qxmd.com/read/31908284/adhesion-related-readmissions-after-open-and-laparoscopic-surgery-a-retrospective-cohort-study-scar-update
#1
Pepijn Krielen, Martijn W J Stommel, Pille Pargmae, Nicole D Bouvy, Erica A Bakkum, Harold Ellis, Michael C Parker, Ewen A Griffiths, Harry van Goor, Richard P G Ten Broek
BACKGROUND: Adhesions are the most common driver of long-term morbidity after abdominal surgery. Although laparoscopy can reduce adhesion formation, the effect of minimally invasive surgery on long-term adhesion-related morbidity remains unknown. We aimed to assess the impact of laparoscopy on adhesion-related readmissions in a population-based cohort. METHODS: We did a retrospective cohort study of patients of any age who had abdominal or pelvic surgery done using laparoscopic or open approaches between June 1, 2009, and June 30, 2011, using validated population data from the Scottish National Health Service...
January 4, 2020: Lancet
https://read.qxmd.com/read/30933675/things-we-do-for-no-reason-prealbumin-testing-to-diagnose-malnutrition-in-the-hospitalized-patient
#2
Mary Lacy, Justin Roesch, Jens Langsjoen
No abstract text is available yet for this article.
April 2019: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://read.qxmd.com/read/31925793/population-based-analysis-of-outcomes-with-early-age-colorectal-cancer
#3
D Saraste, J Järås, A Martling
BACKGROUND: The aim was to evaluate differences in stage, treatment and prognosis in patients aged less than 50 years with colorectal cancer compared with older age groups. METHODS: This population-based study included all patients diagnosed with colorectal cancer in Sweden, 2010-2015. Disease stage, treatment, 5-year disease-free survival (DFS) and relative survival were analysed in relation to age groups: less than 50, 50-74 and at least 75 years. RESULTS: Of 34 434 patients included, 24·1, 19·7 and 14·0 per cent of patients aged less than 50, 50-74 and at least 75 years respectively were diagnosed with stage IV disease (P < 0·001)...
January 10, 2020: British Journal of Surgery
https://read.qxmd.com/read/31903565/the-older-surgical-patient-to-operate-or-not-a-state-of-the-art-review
#4
REVIEW
R Santhirapala, J Partridge, C J MacEwen
The increasing age and subsequent medical complexity of patients presenting for surgery grants the opportunity to examine the processes and delivery of peri-operative care. There is a need to redesign peri-operative pathways allowing room for shared decision making and personalised, evidence-based care. In times of financial constraint, this is no easy task. However, neglecting to transform services now may lead to challenges in the sustainability of the provision of peri-operative care in the long-term. Challenges in redesigning peri-operative care pathways include identification and optimisation of those at highest peri-operative risk to inform the difficult conversations surrounding the appropriateness of surgery...
January 2020: Anaesthesia
https://read.qxmd.com/read/31895720/acg-clinical-guideline-disorders-of-the-hepatic-and-mesenteric-circulation
#5
Douglas A Simonetto, Ashwani K Singal, Guadalupe Garcia-Tsao, Stephen H Caldwell, Joseph Ahn, Patrick S Kamath
Disorders of the mesenteric, portal, and hepatic veins and mesenteric and hepatic arteries have important clinical consequences and may lead to acute liver failure, chronic liver disease, noncirrhotic portal hypertension, cirrhosis, and hepatocellular carcinoma. Although literature in the field of vascular liver disorders is scant, these disorders are common in clinical practice, and general practitioners, gastroenterologists, and hepatologists may benefit from expert guidance and recommendations for management of these conditions...
January 2020: American Journal of Gastroenterology
https://read.qxmd.com/read/31895096/is-surgery-first-still-a-reasonable-option-in-the-era-of-neoadjuvant-chemotherapy-for-resectable-pancreatic-cancer
#6
Ashish Saharia, Lucy M Potter, Flavio Baio, Ahmed Elaileh, Constance Mobley, Rafik M Ghobrial, Maen Abdelrahim, Kirk Heyne
The incidence of pancreatic ductal adenocarcinoma has risen rapidly. By 2030, it is likely to be the second most prevalent cause of death by cancer, following cancer of the lung. Unfortunately, most patients present with advanced disease. In fact, only 20% of patients are candidates for surgery. More research is needed to find dependable treatment options for this disease. Although we wait for more effective treatments to be developed, we continue using chemotherapy, radiation, and surgery-all with less than optimal outcomes...
December 27, 2019: American Journal of Clinical Oncology
https://read.qxmd.com/read/31869834/preoperative-n-terminal-pro-b-type-natriuretic-peptide-and-cardiovascular-events-after-noncardiac-surgery-a-cohort-study
#7
Emmanuelle Duceppe, Ameen Patel, Matthew T V Chan, Otavio Berwanger, Gareth Ackland, Peter A Kavsak, Reitze Rodseth, Bruce Biccard, Clara K Chow, Flavia K Borges, Gordon Guyatt, Rupert Pearse, Daniel I Sessler, Diane Heels-Ansdell, Andrea Kurz, Chew Yin Wang, Wojciech Szczeklik, Sadeesh Srinathan, Amit X Garg, Shirley Pettit, Erin N Sloan, James L Januzzi, Matthew McQueen, Giovanna Lurati Buse, Nicholas L Mills, Lin Zhang, Robert Sapsford, Guillaume Paré, Michael Walsh, Richard Whitlock, Andre Lamy, Stephen Hill, Lehana Thabane, Salim Yusuf, P J Devereaux
Background: Preliminary data suggest that preoperative N-terminal pro-B-type natriuretic peptide (NT-proBNP) may improve risk prediction in patients undergoing noncardiac surgery. Objective: To determine whether preoperative NT-proBNP has additional predictive value beyond a clinical risk score for the composite of vascular death and myocardial injury after noncardiac surgery (MINS) within 30 days after surgery. Design: Prospective cohort study...
December 24, 2019: Annals of Internal Medicine
https://read.qxmd.com/read/31863440/ercp-related-adverse-events-european-society-of-gastrointestinal-endoscopy-esge-guideline
#8
Jean-Marc Dumonceau, Christine Kapral, Lars Aabakken, Ioannis S Papanikolaou, Andrea Tringali, Geoffroy Vanbiervliet, Torsten Beyna, Mario Dinis-Ribeiro, Istvan Hritz, Alberto Mariani, Gregorios Paspatis, Franco Radaelli, Sundeep Lakhtakia, Andrew M Veitch, Jeanin E van Hooft
PROPHYLAXIS: 1:  ESGE recommends routine rectal administration of 100 mg of diclofenac or indomethacin immediately before endoscopic retrograde cholangiopancreatography (ERCP) in all patients without contraindications to nonsteroidal anti-inflammatory drug administration.Strong recommendation, moderate quality evidence. 2:  ESGE recommends prophylactic pancreatic stenting in selected patients at high risk for post-ERCP pancreatitis (inadvertent guidewire insertion/opacification of the pancreatic duct, double-guidewire cannulation)...
December 20, 2019: Endoscopy
https://read.qxmd.com/read/31851001/are-postoperative-intravenous-antibiotics-indicated-after-laparoscopic-appendicectomy-for-simple-appendicitis-a-prospective-double-blinded-randomized-controlled-trial
#9
Nicole Mennie, Gayathri Panabokke, Annette Chang, Sharman Tan Tanny, Wei Cheng, Maurizio Pacilli, Peter Ferguson, Ramesh M Nataraja
BACKGROUND: There is limited evidence for the use of postoperative antibiotics for simple appendicitis (SA) in children. Our aim was to conduct a prospective double-blinded randomized controlled trial to investigate this after a laparoscopic appendicectomy. METHODS: Following ethical approval, children (≤16 years) undergoing appendicectomy were recruited at a single institution. Patients were randomized intraoperatively to receive either 2 postoperative intravenous doses of placebo or antibiotics (Abx)...
December 9, 2019: Annals of Surgery
https://read.qxmd.com/read/31860549/prophylactic-negative-pressure-wound-therapy-for-closed-laparotomy-incisions-a-meta-analysis-of-randomized-controlled-trials
#10
Tanya M Kuper, Patrick B Murphy, Bandeep Kaur, Michael C Ott
OBJECTIVE: The aim of this study was to determine whether negative pressure wound therapy (NPWT) applied to primarily closed incisions decreases surgical site infections (SSIs) following open abdominal surgery. BACKGROUND: SSIs are a common cause of morbidity following open abdominal surgery. Prophylactic NPWT has shown promise for SSI reduction. However, the results of randomized controlled trials (RCTs) conducted among patients undergoing laparotomy have been inconsistent...
January 2020: Annals of Surgery
https://read.qxmd.com/read/31800081/tailoring-treatment-of-hyperkalemia
#11
Maxime Coutrot, Francois Dépret, Matthieu Legrand
Hyperkalemia is a common electrolyte disorder that may be rapidly life-threatening because of its cardiac toxicity. Hyperkalemia risk factors are numerous and often combined in the same patient. Most of the strategies to control serum potassium level in the short term have been used for decades. However, evidence for their efficacy and safety remains low. Treatment of hyperkalemia remains challenging, poorly codified, with a risk of overtreatment, including short-term side effects, and with the priority of avoiding unnecessary hospital stays or chronic medication changes...
December 1, 2019: Nephrology, Dialysis, Transplantation
https://read.qxmd.com/read/31833844/negative-trials-and-what-to-do-with-them-first-stop-calling-them-negative
#12
Daniel I Sessler
No abstract text is available yet for this article.
December 11, 2019: Anesthesiology
https://read.qxmd.com/read/31800003/association-of-high-mortality-with-postoperative-myocardial-infarction-after-major-vascular-surgery-despite-use-of-evidence-based-therapies
#13
Robert J Beaulieu, Danielle C Sutzko, Jeremy Albright, Erin Jeruzal, Nicholas H Osborne, Peter K Henke
Importance: Patients undergoing vascular surgery are at high risk of postoperative myocardial infarction (POMI). Postoperative myocardial infarction is independently associated with significant risk of in-hospital mortality. Objective: To examine the association of patient and procedural characteristics with the risk of POMI after vascular surgery and determine the association of evidence-based therapies with longer-term outcomes. Design, Setting, and Participants: A retrospective cohort study of prospectively collected data within a statewide quality improvement collaborative database between January 2012 and December 2017...
December 4, 2019: JAMA Surgery
https://read.qxmd.com/read/31757315/genomics-testing-and-personalized-medicine-in-the-preoperative-setting
#14
REVIEW
Rodney A Gabriel, Brittany N Burton, Richard D Urman, Ruth S Waterman
Pharmacogenomics (PGx) is the study of how individuals' personal genotypes may affect their responses to various pharmacologic agents. The application of PGx principles in perioperative medicine is fairly novel. Challenges in executing PGx programs into health care systems include physician buy-in and integration into usual clinical workflow, including the electronic health record. This article discusses the current evidence highlighting the potential of PGx with various drug categories (including opioids, nonopioid analgesics, sedatives, β-blockers, antiemetics, and anticoagulants) used in the perioperative process and the challenges of integrating PGx into a health care system and relevant workflows...
January 2020: Surgical Oncology Clinics of North America
https://read.qxmd.com/read/31791953/management-of-severe-acute-pancreatitis
#15
REVIEW
O Joe Hines, Stephen J Pandol
The risks, measurements of severity, and management of severe acute pancreatitis and its complications have evolved rapidly over the past decade. Evidence suggests that initial goal directed therapy, nutritional support, and vigilance for pancreatic complications are best practice. Patients can develop pancreatic fluid collections including acute pancreatic fluid collections, pancreatic pseudocysts, acute necrotic collections, and walled-off necrosis. Several randomized controlled trials and cohort studies have recently highlighted the advantage of managing these conditions with a progressive approach, with initial draining for infection followed by less invasive techniques...
December 2, 2019: BMJ: British Medical Journal
https://read.qxmd.com/read/31581983/current-strategies-for-the-management-of-inguinal-hernia-what-are-the-available-approaches-and-the-key-considerations
#16
Bryan K Richmond, Crystal Totten, John Scott Roth, Jonathon Tsai, Vashisht Madabhushi
No abstract text is available yet for this article.
October 2019: Current Problems in Surgery
https://read.qxmd.com/read/31779779/advances-in-the-management-of-rectal-cancer
#17
REVIEW
Elise H Lawson, Joseph C Melvin, Cristina B Geltzeiler, Charles P Heise, Eugene F Foley, Ray S King, Bruce A Harms, Evie H Carchman
No abstract text is available yet for this article.
November 2019: Current Problems in Surgery
https://read.qxmd.com/read/31753115/pathology-of-melanoma
#18
REVIEW
Asmita Chopra, Rohit Sharma, Uma N M Rao
Melanoma is an aggressive malignancy arising from melanocytes in the skin and rarely in extracutaneous sites. The understanding of pathology of melanoma has evolved over the years, with the initial classifications based on the clinical and microscopic features to the current use of immunohistochemistry and genetic sequencing. The depth of invasion and lymph node metastasis are still the most important prognostic features of melanoma. Other important prognostic features include ulceration, lymphovascular invasion, mitosis, and tumor-infiltrating lymphocytes...
February 2020: Surgical Clinics of North America
https://read.qxmd.com/read/31759657/vignettes-from-the-history-of-pediatric-surgery
#19
REVIEW
Don K Nakayama
A series of historical vignettes were shared with the membership of the American Pediatric Surgical Association (APSA) in the months leading up to its 50th anniversary meeting in May, 2019. Some stories were less-known episodes from the lives of such prominent figures as William Ladd and C. Everett Koop. Others highlighted were surgeons who made significant contributions but with time have been overlooked. Examples included Herbert Coe and Oswald Wyatt, the first surgeons to devote their practices entirely to infants and children; Helen Noblett, a pediatric surgeon in Melbourne who invented a now standard device perfectly suited to sample the rectal mucosa of infants suspected of having Hirschsprung Disease; and Barbara Barlow, who fed baby rats in her Manhattan apartment to show the protective effect of breast milk on the development of experimental necrotizing enterocolitis...
November 9, 2019: Journal of Pediatric Surgery
https://read.qxmd.com/read/31756173/international-validation-of-reduced-major-morbidity-after-minimally-invasive-distal-pancreatectomy-compared-with-open-pancreatectomy
#20
Sjors Klompmaker, Thijs de Rooij, Bas Groot Koerkamp, Anuraj H Shankar, Uwe Siebert, Marc G Besselink, A James Moser
OBJECTIVE: To quantify the nationwide impact of minimally invasive distal pancreatectomy (MIDP) on major morbidity as compared with open distal pancreatectomy (ODP). BACKGROUND: A recent randomized controlled trial (RCT) demonstrated significant reduction in time to functional recovery after MIDP compared with ODP, but was not powered to assess potential risk reductions in major morbidity. METHODS: International cohort study using the American College of Surgeons' National Quality Improvement Program (ACS-NSQIP) (88 centers; 2014-2016) to evaluate the association between surgical approach (MIDP vs ODP) and 30-day composite major morbidity (CMM; death or severe complications) with external model validation using Dutch Pancreatic Cancer Group data (17 centers; 2005-2016)...
October 17, 2019: Annals of Surgery
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