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Essential Surgical Knowledge

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2263 papers 1000+ followers Papers from the recent literature which are of interest to residents and practicing surgeons
Veljko Strajina, Brian D Kim, Martin D Zielinski
INTRODUCTION: Surgical exploration is still considered mandatory in the setting of small bowel obstruction (SBO) and a virgin abdomen by some large centers. The aim of this study is to determine the etiology of SBO in patients without prior abdominal operation. METHODS: Retrospective review of the patients treated for SBO and virgin abdomen at the Mayo Clinic between 2006 and 2016 was performed. Follow up data, operative and pathologic findings were examined to determine the etiology of SBO...
February 12, 2019: American Journal of Surgery
Rui Zheng-Pywell, Sushanth Reddy
Compared with other periampullary tumors, cancers of the ampulla of Vater are rare. These tumors tend to present earlier than their pancreatic and distal bile duct brethren. In addition to the hypothesis that they are also less biologically aggressive, ampullary cancers tend to have better survival than other types of periampullary cancers. The mortality from this disease remains high, and much can still be learned about ampullary cancers.
April 2019: Surgical Clinics of North America
Laura M Fernandez, Albert Parlade, Elliot Wasser, Giovanna Dasilva, Rafael U de Azevedo, Cinthia Ortega, Rodrigo O Perez, Angelita Habr-Gama, Mariana Berho, Steven D Wexner
BACKGROUND: The observation of inferior oncologic outcomes after surgery for proximal colon cancers has led to the investigation of alternative treatment strategies, including surgical procedures and neoadjuvant systemic chemotherapy in selective patients. OBJECTIVE: The purpose of this study was to determine the accuracy of CT staging in proximal colon cancer in detecting unfavorable pathologic features that may aid in the selection of ideal candidates with unfavorable pathologic features for alternative treatment strategies, including extended lymph node dissection and/or neoadjuvant chemotherapy...
March 8, 2019: Diseases of the Colon and Rectum
Toshirou Nishida, Toto Hølmebakk, Chandrajit P Raut, Piotr Rutkowski
Tumor rupture is an important risk factor predictive of recurrence after macroscopically complete resection of gastrointestinal stromal tumors (GISTs), and an indication for defined interval or even lifelong adjuvant therapy with imatinib according to guidelines. However, there is no consensus or universally accepted definition of the term 'tumor rupture', and, consequently, its incidence varies greatly across reported series. Without predefined criteria, the clinical significance of rupture has also been difficult to assess on multivariate analysis of retrospective data...
March 13, 2019: Annals of Surgical Oncology
Cheng Quan, Sang Su Lee
Purpose: A prospective study was conducted to compare radiation exposure to different parts of an endovascular surgeon's body when using a mobile C-arm with that in a hybrid room. Methods: Exposure during individual procedures performed on 39 patients with a mobile C-arm and 42 patients in a hybrid room, from July 2016 to December 2016, was evaluated. Results: The procedures performed, fluoroscopy time, and dose-area product were not significantly different between groups...
March 2019: Annals of Surgical Treatment and Research
Kathryn Oakland, Georgina Chadwick, James E East, Richard Guy, Adam Humphries, Vipul Jairath, Simon McPherson, Magdalena Metzner, A John Morris, Mike F Murphy, Tony Tham, Raman Uberoi, Andrew McCulloch Veitch, James Wheeler, Cuthbert Regan, Jonathan Hoare
This is the first UK national guideline to concentrate on acute lower gastrointestinal bleeding (LGIB) and has been commissioned by the Clinical Services and Standards Committee of the British Society of Gastroenterology (BSG). The Guidelines Development Group consisted of representatives from the BSG Endoscopy Committee, the Association of Coloproctology of Great Britain and Ireland, the British Society of Interventional Radiology, the Royal College of Radiologists, NHS Blood and Transplant and a patient representative...
February 12, 2019: Gut
Roheena Z Panni, Jarot Guerra, William G Hawkins, Bruce L Hall, Horacio J Asbun, Dominic E Sanford
BACKGROUND: There is a substantial learning curve associated with minimally invasive pancreaticoduodenectomy (MIPD). We sought to determine if national MIPD pancreatic fistula rates are decreasing with time. METHODS: All patients undergoing elective MIPD and accrued into the pancreatectomy targeted NSQIP database between 2014-2017 were included in the study. Trends in MIPD outcomes by year were examined using Cochran-Armitage and Mann-Kendall tests for trend. Multivariable logistic regression was used to assess for an independent association between increasing year of operation and pancreatic fistula...
February 20, 2019: Journal of the American College of Surgeons
S Brinkmann, D H Chang, K Kuhr, A H Hoelscher, J Spiro, C J Bruns, W Schroeder
Transthoracic esophagectomy with gastric tube formation is the surgical treatment of choice for esophageal cancer. The surgical reconstruction induces changes of gastric microcirculation, which are recognized as potential risk factors of anastomotic leak. This prospective observational study investigates the association of celiac trunk (TC) stenosis with postoperative anastomotic leak. One hundred fifty-four consecutive patients with esophageal cancer scheduled for Ivor-Lewis esophagectomy were included. Preoperative staging computed tomography (CT) was used to identify TC stenosis...
March 1, 2019: Diseases of the Esophagus: Official Journal of the International Society for Diseases of the Esophagus
François Dépret, W Frank Peacock, Kathleen D Liu, Zubaid Rafique, Patrick Rossignol, Matthieu Legrand
PURPOSE: To review the mechanisms of action, expected efficacy and side effects of strategies to control hyperkalemia in acutely ill patients. METHODS: We searched MEDLINE and EMBASE for relevant papers published in English between Jan 1, 1938, and July 1, 2018, in accordance with the PRISMA Statement using the following terms: "hyperkalemia," "intensive care," "acute kidney injury," "acute kidney failure," "hyperkalemia treatment," "renal replacement therapy," "dialysis," "sodium bicarbonate," "emergency," "acute...
February 28, 2019: Annals of Intensive Care
Trisha M Parab, Michael J DeRogatis, Alexander M Boaz, Salvatore A Grasso, Paul S Issack, David A Duarte, Olivier Urayeneza, Saloomeh Vahdat, Jian-Hua Qiao, Gudata S Hinika
Gastrointestinal stromal tumors (GISTs) are rare neoplasms of the gastrointestinal tract associated with high rates of malignant transformation. Most GISTs present asymptomatically. They are best identified by computed tomography (CT) scan and most stain positive for CD117 (C-Kit), CD34, and/or DOG-1. There have been many risk stratification classifications systems which are calculated based on tumor size, mitotic rate, location, and perforation. The approaches to treating GISTs are to resect primary low-risk tumors, resect high-risk primary or metastatic tumors with imatinib 400 mg daily for 12 months, or if the tumor is unresectable, neoadjuvant imatinib 400 mg daily followed by surgical resection is recommended...
February 2019: Journal of Gastrointestinal Oncology
A Sun Myint, A Stewart, J Mills, R Sripadam, K Whitmarsh, R Roy, A Franklin, A Dhadda
No abstract text is available yet for this article.
March 2019: Colorectal Disease: the Official Journal of the Association of Coloproctology of Great Britain and Ireland
Zhi Ven Fong, Henry A Pitt, Steven M Strasberg, Rose L Molina, Numa P Perez, Cassandra M Kelleher, Andrew P Loehrer, Jason K Sicklick, Mark A Talamini, Keith D Lillemoe, David C Chang
BACKGROUND: Current guidelines suggest that cholecystectomy during the third trimester of pregnancy is safe for both the women and the fetus. However, no population-based study has examined this issue. The aim of this analysis was to compare the results of cholecystectomy during the third trimester of pregnancy with outcomes in women operated on in the early postpartum period in a large population. METHODS: The California Office of Statewide Health Planning and Development database was queried from 2005 to 2014...
January 8, 2019: Journal of the American College of Surgeons
J Hewitt, B Carter, K McCarthy, L Pearce, J Law, F V Wilson, H S Tay, C McCormack, M J Stechman, S J Moug, P K Myint
BACKGROUND: frail patients in any age group are more likely to die than those that are not frail. We aimed to evaluate the impact of frailty on clinical mortality, readmission rate and length of stay for emergency surgical patients of all ages. METHODS: a multi-centre prospective cohort study was conducted on adult admissions to acute surgical units. Every patient presenting as a surgical emergency to secondary care, regardless of whether they ultimately underwent a surgical procedure was included...
February 19, 2019: Age and Ageing
Justin G Wilkes, Jessica L Evans, B Stephen Prato, Steven A Hess, Dougald C MacGillivary, Timothy L Fitzgerald
BACKGROUND: Frailty in the surgical patient has been associated with increased morbidity, mortality, and failure-to-rescue. However, there is little understanding of the economic impact of frailty. STUDY DESIGN: A prospective database of elective surgery patients at an academic medical center was utilized to create a modified version of the Risk Analysis Index, a validated frailty index. This included 10,257 patients undergoing elective surgery from 2016-2017. Patients were classified as not frail (RAI = 0), somewhat frail (RAI = 1-10), or significantly frail (RAI > 10)...
February 8, 2019: Journal of the American College of Surgeons
Mauro Podda, Chiara Gerardi, Nicola Cillara, Nicola Fearnhead, Carlos Augusto Gomes, Arianna Birindelli, Andrea Mulliri, Richard Justin Davies, Salomone Di Saverio
MINI: The present meta-analysis demonstrates that, although limited by a lower efficacy compared to surgery, NOM with antibiotics could be considered a safe option for adults and pediatric patients with uncomplicated appendicitis, as it is successful in almost 75% of cases, and does not statistically increase the perforation rate. OBJECTIVE: The aim of this meta-analysis was to summarize the current available evidence on nonoperative management (NOM) with antibiotics for uncomplicated appendicitis, both in adults and children...
January 31, 2019: Annals of Surgery
Marion Piñeros, D Maxwell Parkin, Kevin Ward, Eric Chokunonga, Morten Ervik, Helen Farrugia, Mary Gospodarowicz, Brian O'Sullivan, Isabelle Soerjomataram, Rajaraman Swaminathan, Ariana Znaor, Freddie Bray, James Brierley
Accurate information on the extent of disease around the time of diagnosis is an important component of cancer care, in defining disease prognosis, and evaluating national and international cancer control policies. However, the collection of stage data by population-based cancer registries remains a challenge in both high-income and low and middle-income countries. We emphasise the lack of availability and comparability of staging information in many population-based cancer registries and propose Essential TNM, a simplified staging system for cancer registries when information on full Tumour, Node, Metastasis (TNM) is absent...
February 2019: Lancet Oncology
Priya Vijayvargiya, Michael Camilleri, Victor Chedid, Aditya Mandawat, Patricia J Erwin, M Hassan Murad
BACKGROUND & AIMS: Studies have reported a lack of association between improvements in gastric emptying (GE) and upper gastrointestinal (UGI) symptoms with promotility drugs. However, GE test methods were suboptimal in some studies. We assessed improvements in GE and UGI symptoms in patients given promotility agents in studies with optimal or moderate test methods (scintigraphy or breath test, solid meal, >2 hr duration) compared to studies with suboptimal GE test methods. METHODS: With an expert librarian, we completed an extensive search of publications in the Ovid MEDLINE (1946 to present), EMBASE (1988-January 2018), and EBM Reviews Cochrane Central Register of Controlled Trials, without restrictions on language or year...
January 31, 2019: Gastroenterology
Ramy Behman, Avery B Nathens, Stephanie Mason, James P Byrne, Nicole Look Hong, Petros Pechlivanoglou, Paul Karanicolas
Importance: Adhesive small-bowel obstruction (aSBO) is a potentially chronic, recurring surgical illness. Although guidelines suggest trials of nonoperative management, the long-term association of this approach with recurrence is poorly understood. Objective: To compare the incidence of recurrence of aSBO in patients undergoing operative management at their first admission compared with nonoperative management. Design, Setting, and Participants: This longitudinal, propensity-matched, retrospective cohort study used health administrative data for the province of Ontario, Canada, for patients treated from April 1, 2005, through March 31, 2014...
January 30, 2019: JAMA Surgery
Laura Beyer-Berjot, Léon Maggiori, Didier Loiseau, Jean-Dominique De Korwin, Jean-Pierre Bongiovanni, Philippe Lesprit, Nathalie Salles, Pascal Rousset, Thomas Lescot, Aymeric Henriot, Magalie Lefrançois, Eddy Cotte, Yann Parc
BACKGROUND: Acute diverticulitis is a common disease with public health significance. Many studies with a high level of evidence have been published recently on the surgical management of acute diverticulitis. OBJECTIVE: The aim of this systematic review was to define the accurate surgical management of acute diverticulitis. DATA SOURCES: Medline, Embase, and the Cochrane Library were sources used. STUDY SELECTION: One reviewer conducted a systematic study with combinations of key words for the disease and the surgical procedure...
January 25, 2019: Diseases of the Colon and Rectum
C Andolfi, P M Fisichella
BACKGROUND: The introduction of high-resolution manometry and the Chicago classification has made it possible to diagnose achalasia and predict treatment response accurately. The aim of this study was to compare the effect of the different treatments available on symptomatic outcomes across all achalasia subtypes. METHODS: The study was conducted according to PRISMA and MOOSE guidelines. A literature search of PubMed and MEDLINE databases was undertaken to identify all relevant articles reporting clinical outcomes of patients with achalasia after botulinum toxin injection, pneumatic dilatation, laparoscopic Heller myotomy (LHM) and peroral endoscopic myotomy (POEM) based on manometric subtypes...
January 28, 2019: British Journal of Surgery
2019-01-31 19:08:48
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