Surgery | Page 2

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T J Edwards, S J Carty, A S Carr, A W Lambert
OBJECTIVE: This study sought to determine the efficacy of post-operative wound infiltration with local anaesthetic following paediatric appendicectomy. METHOD: In a randomised, controlled, prospective, clinical trial children aged between five and sixteen years were assigned to one of three treatment arms; infiltration of the surgical wound with bupivicaine, saline, or no infiltration. Anaesthetic and analgesic protocols were employed. Patients and observers were blinded to the treatment group...
2011: International Journal of Surgery
Jeffrey A Blatnik, L Michael Brunt
Abdominal wall hernia repair is one of the most common operations done by general surgeons today. Patients with incisional hernias can be extremely challenging to manage due to a number of factors that include obesity, prior hernia repairs, previous mesh placement, loss of domain, and other variables. The approach to patients with incisional hernias has evolved considerably over the last 20 years due to both advances in mesh technology and surgical approaches. Key factors in a successful outcome include modification of risk factors prior to surgery such as smoking cessation and weight reduction, selection of mesh appropriate to the hernia type and planned location of the mesh, and broad overlap of mesh beyond the margins of the hernia defect...
April 2019: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
Lisa M Francomacaro, Charles Walker, Kathryn Jaap, James Dove, Marie Hunsinger, Kenneth Widom, Denise Torres, Mohsen Shabahang, Joseph Blansfield, Jeffrey Wild
BACKGROUND: Emergent laparotomies are associated with higher rates of morbidity and mortality. Recent studies suggest sarcopenia predicts worse outcomes in elective operations. The purpose of this study is to examine outcomes following urgent exploratory laparotomy in sarcopenic patients. METHODS: This was a retrospective review of patients in a rural tertiary care facility between 2010 and 2014. Patients underwent a laparotomy within 72 h of admission and had an abdomen/pelvis CT scan were included...
December 2018: American Journal of Surgery
Nicholas G Matthees, James A Mankin, Amy M Trahan, Sharjeel Israr, Michael D Jones, Jonathan L Dameworth, Scott R Petersen, Jordan A Weinberg
BACKGROUND: Pneumomediastinum following blunt trauma is often observed on CT imaging, and concern for associated aerodigestive injury often prompts endoscopy and/or fluoroscopy. In recent years, adoption of multi-detector CT technology has resulted in high resolution images that may clearly identify aerodigestive injuries. The purpose of this study was to evaluate the utility of multi-detector CT in the identification of blunt aerodigestive injuries. METHODS: Over five years, patients with pneumomediastinum following blunt trauma were identified from the registry of a level 1 trauma center...
June 2019: American Journal of Surgery
Karlin Sevensma, Thomas Schleichert, Caroline Schwickerath, Alan Shoemaker, Clayton Miller
BACKGROUND: Improving postoperative pain control may lead to improved outcomes including decreased opioid use, shorter hospital stays, and improved patient satisfaction. This study examined the effects of instilling intraperitoneal bupivacaine following laparoscopic appendectomy. METHODS: In this prospective, randomized, double-blinded, placebo-controlled study, patients with appendicitis were randomized to receive either the bupivacaine or normal saline instilled at the appendectomy site prior to close...
March 2019: American Journal of Surgery
Olivier Lesur, Eugénie Delile, Pierre Asfar, Peter Radermacher
BACKGROUND: Improving sepsis support is one of the three pillars of a 2017 resolution according to the World Health Organization (WHO). Septic shock is indeed a burden issue in the intensive care units. Hemodynamic stabilization is a cornerstone element in the bundle of supportive treatments recommended in the Surviving Sepsis Campaign (SSC) consecutive biannual reports. MAIN BODY: The "Pandera's box" of septic shock hemodynamics is an eternal debate, however, with permanent contentious issues...
October 29, 2018: Annals of Intensive Care
U O Gustafsson, M J Scott, M Hubner, J Nygren, N Demartines, N Francis, T A Rockall, T M Young-Fadok, A G Hill, M Soop, H D de Boer, R D Urman, G J Chang, A Fichera, H Kessler, F Grass, E E Whang, W J Fawcett, F Carli, D N Lobo, K E Rollins, A Balfour, G Baldini, B Riedel, O Ljungqvist
BACKGROUND: This is the fourth updated Enhanced Recovery After Surgery (ERAS® ) Society guideline presenting a consensus for optimal perioperative care in colorectal surgery and providing graded recommendations for each ERAS item within the ERAS® protocol. METHODS: A wide database search on English literature publications was performed. Studies on each item within the protocol were selected with particular attention paid to meta-analyses, randomised controlled trials and large prospective cohorts and examined, reviewed and graded according to Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system...
November 13, 2018: World Journal of Surgery
Charles Walker, Katelyn Young, Ali Moosavi, Nicholas Molacek, James Dove, Marie Hunsinger, Joseph Blansfield, Kenneth Widom, Denise Torres, James Gregory, Jeffrey Wild
BACKGROUND: Current guidelines do not specifically address optimal antibiotic duration following cholecystostomy. This study compares outcomes for short-course (<7 days) and long-course (≥7 days) antibiotics post-cholecystostomy. METHODS: This was a retrospective review of cholecystostomy patients (≥18 years) admitted (1/1/2007-12/31/2017) to one healthcare system. RESULTS: Overall, 214 patients were studied. Demographics were similar, except short-course patients had higher Charlson Comorbidity Index (p < 0...
March 2019: American Journal of Surgery
Zobair M Younossi, David Bernstein, Mitchell L Shiffman, Paul Kwo, W Ray Kim, Kris V Kowdley, Ira M Jacobson
Primary biliary cholangitis (PBC) is a chronic, cholestatic, autoimmune disease with a variable progressive course. PBC can cause debilitating symptoms including fatigue and pruritus and, if left untreated, is associated with a high risk of cirrhosis and related complications, liver failure, and death. Recent changes to the PBC landscape include a name change, updated guidelines for diagnosis and treatment as well as new treatment options that have recently become available. Practicing clinicians face many unanswered questions when managing PBC...
January 2019: American Journal of Gastroenterology
John W Kunstman, Debra A Goldman, Mithat Gönen, Vinod P Balachandran, Michael I D'Angelica, T Peter Kingham, William R Jarnagin, Peter J Allen
BACKGROUND: Morbidity after pancreatectomy is commonly due to leakage of exocrine secretions resulting in abscess or pancreatic fistula (PF). Previously, we authored a double-blind randomized controlled trial demonstrating that perioperative pasireotide administration lowers abscess or PF formation by >50%. Accordingly, we adopted pasireotide use as standard practice after pancreatectomy in October 2014 and hypothesized a similar PF/abscess rate reduction would be observed. STUDY DESIGN: A prospectively maintained database was queried for all patients who underwent pancreatectomy between October 2014 and July 2017...
February 2019: Journal of the American College of Surgeons
Sheldon Feldman, Hannah Bansil, Jeffrey Ascherman, Robert Grant, Billie Borden, Peter Henderson, Adewuni Ojo, Bret Taback, Margaret Chen, Preya Ananthakrishnan, Amiya Vaz, Fatih Balci, Chaitanya R Divgi, David Leung, Christine Rohde
BACKGROUND: As many as 40 % of breast cancer patients undergoing axillary lymph node dissection (ALND) and radiotherapy develop lymphedema. We report our experience performing lymphatic-venous anastomosis using the lymphatic microsurgical preventive healing approach (LYMPHA) at the time of ALND. This technique was described by Boccardo, Campisi in 2009. METHODS: LYMPHA was offered to node-positive women with breast cancer requiring ALND. Afferent lymphatic vessels, identified by injection of blue dye in the ipsilateral arm, were sutured into a branch of the axillary vein distal to a competent valve...
October 2015: Annals of Surgical Oncology
Tolga Ozmen, Mesa Lazaro, Yan Zhou, Alicia Vinyard, Eli Avisar
OBJECTIVE: To assess the efficiency of Simplified Lymphatic Microsurgical Preventing Healing Approach (S-LYMPHA) in preventing lymphedema (LE) in a prospective cohort of patients. BACKGROUND: LE is a serious complication of axillary lymph node dissection (ALND) with an incidence rate of 25%. LYMPHA has been proposed as an effective adjunct to ALND for the prevention of LE. This procedure, however, requires microsurgical techniques and significant coordination between services...
December 2019: Annals of Surgery
Jennifer Wellington, Thomas Sanders, Charles Mylander, Ashley Alden, Christine Harris, Robert Buras, Lorraine Tafra, Wen Liang, Lacey Stelle, Martin Rosman, Rubie Sue Jackson
BACKGROUND: Since publication of the American College of Surgeons Oncology Group Z0011 trial results, demonstrating that many patients with nonpalpable axillary lymph nodes and one or two positive sentinel nodes do not require axillary lymph node dissection (ALND), preoperative axillary ultrasound (AUS) has become controversial. Clinicians are concerned that AUS may lead to unnecessary ALND. The authors developed an algorithm (Algorithm 1) in which the number of AUS-suspicious nodes and tumor biology direct management...
August 2018: Annals of Surgical Oncology
Ingrid G M Poodt, Guusje Vugts, Robert-Jan Schipper, Grard A P Nieuwenhuijzen
BACKGROUND: During recent years, an increasing number of patients with ipsilateral breast tumor recurrence (IBTR) and previous axillary surgery have undergone repeat sentinel lymph node biopsy (rSLNB). The influence of axillary nodal status on prognosis for IBTR patients remains unclear. This study aimed to evaluate the technical success rate, follow-up assessment, and prognostic value of rSLNB for patients with IBTR. METHODS: A systematic search conducted in MEDLINE, Embase, and the Cochrane Library up to July 2017 included all studies on rSLNB in IBTR...
May 2018: Annals of Surgical Oncology
Abdi-Fatah Hersi, Staffan Eriksson, Joakim Ramos, Shahin Abdsaleh, Fredrik Wärnberg, Andreas Karakatsanis
BACKGROUND: Surgery for non-palpable breast cancer may often be a challenging procedure. Recently, a magnetic seed (Magseed® ) used for tumour localization has been developed. Superparamagnetic iron oxide nanoparticles (SPIO) for sentinel lymph node (SN) detection is a novel tracer that may be injected up to four weeks preoperatively. This study is the first combining the magnetic seed and SPIO. MATERIAL AND METHODS: Patients planned for breast conserving surgery and SN-biopsy (SNB) were recruited from two units in Sweden...
April 2019: European Journal of Surgical Oncology
Joseph C Anderson, Charles J Kahi, Andrew Sullivan, Margaret MacPhail, Jonathan Garcia, Douglas K Rex
BACKGROUND AND AIMS: Although water exchange may improve adenoma detection compared with CO2 , it is unclear whether water is a better medium to fill the lumen during withdrawal and visualize the mucosa. Total underwater colonoscopy (TUC) involves the use of water exchange with the air valve off during insertion followed by the inspection of the mucosa under water. Our goal was to compare miss rates for TUC with standard CO2 for polyps and adenomas using a tandem colonoscopy design. METHODS: We randomized participants to undergo tandem colonoscopies using TUC or CO2 first...
March 2019: Gastrointestinal Endoscopy
Stephanie Wong, Andrew Ruszkiewicz, Richard H Holloway, Nam Q Nguyen
Eosinophilic oesophagitis (EoE) and gastro-oesophageal reflux disease (GORD) are the most common causes of chronic oesophagitis and dysphagia associated with oesophageal mucosal eosinophilia. Distinguishing between the two is imperative but challenging due to overlapping clinical and histological features. A diagnosis of EoE requires clinical, histological and endoscopic correlation whereas a diagnosis of GORD is mainly clinical without the need for other investigations. Both entities may exhibit oesophageal eosinophilia at a similar level making a histological distinction between them difficult...
October 25, 2018: World Journal of Gastrointestinal Pathophysiology
Tristen S Park, Samantha M Thomas, Laura H Rosenberger, Oluwadamilola M Fayanju, Jennifer K Plichta, Rachel C Blitzblau, Cecilia T Ong, Terry Hyslop, E Shelley Hwang, Rachel A Greenup
BACKGROUND: Although surgical management of the axilla for breast cancer continues to evolve, axillary lymphadenectomy remains the standard of care for women with advanced nodal disease. We sought to evaluate national patterns of care in axillary surgery, and its association with overall survival (OS) among women with N2-3 invasive breast cancer. METHODS: Women (18-90 years) with clinical N2-3 invasive breast cancer who underwent axillary surgery were identified from the National Cancer Data Base (NCDB) from 2004 to 2013...
October 2018: Annals of Surgical Oncology
Douglas J Robertson
Systematic application of the fecal immunochemical test (FIT) as a screen for colorectal cancer has been shown to meaningfully impact colorectal cancer incidence and mortality. However, there is room for improvement. FIT performance is impacted by a host of patient level factors such as sex and medication use. Meta-analysis has defined those factors most likely to result in a false positive or false negative test. Further work determining how best to gather information on important factors and incorporate them into the FIT result will further enhance the accuracy and outcomes accomplished with this valuable screening test...
December 2018: American Journal of Gastroenterology
Ekin Ozturk, Marianne van Iersel, Martijn Mwj Stommel, Yvonne Schoon, Richard Rpg Ten Broek, Harry van Goor
Small bowel obstruction is one of the most frequent emergencies in general surgery, commonly affecting elderly patients. Morbidity and mortality from small bowel obstruction in elderly is high. Significant progress has been made in the diagnosis and management of bowel obstruction in recent years. But little is known whether this progress has benefitted outcomes in elderly patients, particularly those who are frail or have a malignancy as cause of the obstruction, and when considering quality of life and functioning as outcomes...
2018: World Journal of Emergency Surgery: WJES
2018-11-16 02:08:34
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