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American Journal of Surgery

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https://www.readbyqxmd.com/read/28629609/outcomes-after-laparoscopic-or-robotic-colectomy-and-open-colectomy-when-compared-by-operative-duration-for-the-procedure
#1
Sunu Philip, Nancy Jackson, Vijay Mittal
Laparoscopic colectomy is associated with important early postoperative advantages. These procedures can however increase total operative duration. Our hypothesis is that increased operative duration is associated with post-operative complications that may outweigh the benefits of a minimally invasive approach. We analyzed data from the Michigan Surgical Quality Collaborative (MSQC)R. This is a statewide database of patients who have undergone colon or rectal resections. Colorectal procedures were divided into four groups by surgical approach: open, laparoscopic, robotic and laparoscopic and robotic procedures converted to open...
June 16, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28629608/laparotomy-and-intraoperative-enteroscopy-for-obscure-gastrointestinal-bleeding-before-and-after-the-era-of-video-capsule-endoscopy-and-deep-enteroscopy-a-tertiary-center-experience
#2
Wuttiporn Manatsathit, Usah Khrucharoen, Dennis M Jensen, O Joe Hines, Thomas Kovacs, Gordon Ohning, Rome Jutabha, Kevin Ghassemi, Gareth S Dulai, Gustavo Machicado
BACKGROUND: To evaluate roles of intraoperative endoscopy (IOE) in management of severe obscure GI bleeding (OGIB) before vs. after introduction of video capsule endoscopy (VCE) and deep enteroscopy (DE). METHODS: We retrospectively reviewed prospectively collected data of patients undergoing IOE for severe OGIB in a tertiary referral center. RESULTS: 52 patients had laparotomy/IOE for OGIB, 11 pre and 41 post VCE/DE eras. In the pre VCE/DE era, 36...
June 16, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28624229/a-novel-laparoscopic-transcystic-approach-using-an-ultrathin-choledochoscope-and-holmium-laser-lithotripsy-in-the-management-of-cholecystocholedocholithiasis-an-appraisal-of-their-safety-and-efficacy
#3
Hong-Tian Xia, Yang Liu, Hao Jiang, Tao Yang, Bin Liang, Jian-Ping Zeng, Jia-Hong Dong
BACKGROUND: Although laparoscopic transcystic common bile duct exploration (LTCBDE) is the preferred approach for CBD stone clearance, the success rate can vary between 55% and 85%. This study evaluated if ultrathin choledochoscope and holmium laser lithotripsy could improve the success rate of LTCBDE. METHODS: Records of 126 patients (average age, 46.1 ± 13.8 years) with cholecystocholedocholithiasis treated with laparoscopic cholecystectomy (LC) and LTCBDE were retrospectively reviewed...
June 14, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28622840/systematic-review-of-randomized-controlled-trials-on-the-role-of-coaching-in-surgery-to-improve-learner-outcomes
#4
REVIEW
Louise-Helene Gagnon, Nimrah Abbasi
BACKGROUND: Surgical coaching, with the goal of improving operative performance, has been introduced into residency and fellowship programs. This is the first systematic review on surgical coaching limited to randomized controlled trials. The objective of this review is to synthesize the existing evidence that addresses the following question: "What are the effects of surgical coaching to improve learner outcomes?" METHODS: A comprehensive literature search was performed through the following databases: MEDLINE, EMBASE, ERIC, and Cochrane Central Register of Controlled Trials...
June 13, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28629607/post-operative-management-of-perforated-appendicitis-can-clinical-pathways-improve-outcomes
#5
Robert R Gerard, Barrett A Kielhorn, Laurence E McCahill, Brent Petersen, Andrew J Mullard
BACKGROUND: We sought to decrease organ space infection (OSI) following appendectomy for perforated acute appendicitis (PAA) by minimizing variation in clinical management. OBJECTIVE: A postoperative treatment pathway was developed and four recommendations were implemented: 1) clear documentation of post-operative diagnosis, 2) patients with unknown perforation status to be treated as perforated pending definitive diagnosis, 3) antibiotic therapy to be continued post operatively for 4-7 days after SIRS resolution, and 4) judicious use of abdominal computed tomography (CT) scanning prior to post-operative day 5...
June 10, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28610935/prone-positioning-reduces-perineal-infections-when-performing-the-miles-procedure
#6
Anne M Dinaux, Ramzi Amri, David L Berger
BACKGROUND: Abdominoperineal resection (APR) remains the cornerstone treatment for rectal cancers less than 5 cm from the anal verge. The perineal portion of an APR can be done with the patient in lithotomy or repositioned to prone jack-knife position, which influences accessibility, visualization and ability to close the wound. This paper analyses the effect of patient positioning on perineal wound dehiscence and infections. METHODS: A retrospective review of all rectal cancer patients who underwent an APR at Massachusetts General Hospital between 2004 and 2014 (n = 149)...
June 10, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28610934/boarding-icu-patients-are-our-rounding-practices-subpar
#7
Andrew M Nunn, Justin S Hatchimonji, Daniel N Holena, Mark J Seamon, Brian P Smith, Lewis J Kaplan, Niels D Martin, Patrick M Reilly, C William Schwab, Jose L Pascual
INTRODUCTION: Surgical Intensive Care Unit (SICU) patients "boarding" in ICUs other than the designated home unit have been shown to suffer increased rates of complications. We hypothesized that ICU rounding practices are different when SICU patients are housed in home vs. boarding ICUs. MATERIAL AND METHODS: SICU rounds were observed at an academic quaternary medical center. Individual patient rounding time and order seen on rounds along with patient data and demographics were recorded...
June 10, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28606707/disparities-in-compliance-with-the-oncotype-dx-breast-cancer-test-in-the-united-states-a-national-cancer-data-base-assessment
#8
Zachary Kozick, Ammar Hashmi, James Dove, Marie Hunsinger, Tania Arora, Jeffrey Wild, Mohsen Shabahang, Joseph Blansfield
BACKGROUND: Oncotype DX (ODX) is a multi-gene tumor assay for breast cancer patients. Our objective is to assess whether eligible ODX patients received the test and whether recommendations were followed based on respective risk. METHODS: We retrospectively analyzed testing in patients deemed eligible for ODX using the National Cancer Data Base. RESULTS: A total of 158,235 patients met ODX eligibility criteria. Sixty-four percent of eligible patients did not receive the test...
June 9, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28624230/the-correlation-between-fundamental-characteristics-and-first-time-performance-in-laparoscopic-tasks
#9
Cuan M Harrington, Richard Bresler, Donncha Ryan, Patrick Dicker, Oscar Traynor, Dara O Kavanagh
BACKGROUND: The ability of characteristics to predict first time performance in laparoscopic tasks is not well described. Videogame experience predicts positive performance in laparoscopic experiences but its mechanism and confounding-association with aptitude remains to be elucidated. This study sought to evaluate for innate predictors of laparoscopic performance in surgically naive individuals with minimal videogame exposure. METHODS: Participants with no prior laparoscopic exposure and minimal videogaming experience were recruited consecutively from preclinical years at a medical university...
June 8, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28622838/do-patients-requiring-a-multivisceral-resection-for-rectal-cancer-have-worse-oncologic-outcomes-than-patients-undergoing-only-abdominoperineal-resection
#10
Eslam M G Dosokey, Justin T Brady, Ruel Neupane, Murad A Jabir, Sharon L Stein, Harry L Reynolds, Conor P Delaney, Scott R Steele
INTRODUCTION: Abdominoperineal Resection (APR) remains an important option for patients with advanced rectal cancer though some may require multivisceral resection (MVR) in addition to APR. We hypothesized that oncological outcomes would be worse with MVR. METHODS: A retrospective review from 2006 to 2015 of 161 patients undergoing APR or MVR for rectal cancer, of whom 118 underwent curative APR or APR with MVR. Perioperative, oncologic and survival metrics were evaluated...
June 8, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28622837/risk-assessment-of-the-blunt-trauma-victim-the-role-of-the-quick-sequential-organ-failure-assessment-score-qsofa
#11
Randeep S Jawa, James A Vosswinkel, Jane E McCormack, Emily C Huang, Henry C Thode, Marc J Shapiro, Adam J Singer
BACKGROUND: A number or risk assessment tools are used in trauma victims. Because of its simplicity, we examined the ability of the recently described quick Sequential Organ Failure Assessment Score (qSOFA) to predict outcomes in blunt trauma patients presenting to the Emergency Department. METHODS: We queried the trauma registry at a Level 1 Trauma Center for all adult blunt trauma admissions between 1/1/10 and 9/30/15. qSOFA scores were the sum of binary scores for 3 variables (RR ≥ 22, SBP≤100 mmHg, and GCS≤13)...
June 8, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28622834/morbid-obesity-and-functional-status-as-predictors-of-surgical-complication-after-renal-transplantation
#12
Tara M Veasey, James N Fleming, Sara E Strout, Ryan Miller, Nicole A Pilch, Holly B Meadows, Caitlin R Mardis, Benjamin A Mardis, Sunil Shenvi, John McGillicuddy, Kenneth D Chavin, Prabhakar Baliga, David J Taber
BACKGROUND: This study evaluated the impact of body mass index (BMI) and patient functional status on the risk for surgical complications after kidney transplant. METHODS: This retrospective cohort study of adult kidney transplant recipients grouped patients by baseline Karnofsky status (low function ≤ 70%) and further stratified by morbid obesity (BMI ≥ 35 kg/m(2)) to assess surgical complication risk. RESULTS: 736 patients were included with surgical complications occurring in 25%...
June 8, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28619264/institutional-variants-for-lymph-node-counts-after-pancreatic-resections
#13
Roderich E Schwarz
BACKGROUND: Lymph node (LN) counts from pancreatectomy are postulated as quality metric for surgical therapy of pancreatic malignancy. METHODS: Prospectively collected data from a single surgeon's pancreatectomy experience were analyzed for predictors of LN counts. RESULTS: Of 315 consecutive patients (54% female, median age: 65, range 18-88), 239 had a proven cancer diagnosis (76%). Operations included pancreatoduodenectomy (69%), distal pancreatectomy (26%), total pancreatectomy (1%) and others (4%)...
June 8, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28615138/wide-versus-narrow-margins-after-partial-hepatectomy-for-hepatocellular-carcinoma-balancing-recurrence-risk-and-liver-function
#14
Wesley B S Field, Jack W Rostas, Prejesh Philps, Charles R Scoggins, Kelly M McMasters, Robert C G Martin
BACKGROUND: The goal of this study was to compare the outcome after partial hepatectomy for hepatocellular carcinoma (HCC) in which a margin less than or equal to 5 mm or greater than 5 mm was achieved. METHODS: A review of our 3300-patient prospective HPB database was performed from 12/2002 to 4/2015. Patients were stratified into two groups: resection margins ≤5 ("narrow") and >5 mm ("wide") as measured on final pathologic assessment. RESULTS: One-hundred thirty patients were included in the analysis (margin ≤5 mm, n = 41 and margin >5 mm, n = 89)...
June 8, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28622836/safety-assessment-of-the-use-of-ultrasonic-energy-in-the-proximity-of-the-recurrent-laryngeal-nerve-in-a-porcine-model
#15
Karla V Chávez, Elpidio M Barajas, Francisco Soroa, Armando Gamboa-Dominguez, Samuel Ordóñez, Juan P Pantoja, Mauricio Sierra, David Velázquez-Fernández, Miguel F Herrera
BACKGROUND: Advanced bipolar and ultrasonic energy have demonstrated reduction of operating time and blood loss in thyroidectomy. However, these devices generate heat and thermal dispersion that may damage adjacent structures such as the recurrent laryngeal nerve (RLN). This study was designed to evaluate the safety profile of the Harmonic Focus+(®) (HF+) device through the evaluation of thermal injury to the RLN using different algorithms of distance and time with state of the art technology...
June 7, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28619266/patterns-of-use-and-factors-associated-with-early-discontinuation-of-opioids-following-major-trauma
#16
Muhammad Ali Chaudhary, Rebecca Scully, Wei Jiang, Ritam Chowdhury, Cheryl K Zogg, Meesha Sharma, Anju Ranjit, Tracey Koehlmoos, Adil H Haider, Andrew J Schoenfeld
BACKGROUND: Inappropriate use of prescription opioids is a growing public-health issue. We sought to estimate the proportion of traumatic injury patients using legal prescription opioids up to 1-year after hospitalization. METHODS: We used 2006-2014 claims data from TRICARE insurance to identify adults hospitalized secondary to trauma between 2007 and 2013. Prescription opioid use was evaluated for one-year post-discharge. Risk-adjusted Cox Proportional-hazards models were used to evaluate predictors of opioid discontinuation...
June 7, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28622839/water-lavage-as-an-adjunct-to-cytoreductive-surgery-with-hyperthermic-intraperitoneal-chemotherapy-crs-hipec
#17
Emmanuel Gabriel, Smit Singla, Minhyung Kim, Daniel Fisher, Colin Powers, Anthony Visioni, Kristopher Attwood, Joseph Skitzki
BACKGROUND: Water lavage (WL) during gastrointestinal cancer surgery has osmotically mediated lytic effects on tumor cells. We investigated the safety and efficacy of WL with CRS-HIPEC. METHODS: This is a retrospective review, 1/2003-7/2014, of a single institution experience with CRS-HIPEC comparing patients who had WL (WL+) to those who did not (WL-). RESULTS: Of 157 CRS-HIPECs, 16 (10.2%) were WL+. WL+ had more PCI scores >20 compared to WL- (56...
June 6, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28619263/cancer-care-in-the-developed-world-a-comparison-of-surgical-oncology-training-programs
#18
Motaz Qadan, Andrew R Davies, Hiram C Polk, William H Allum, Murray F Brennan
No abstract text is available yet for this article.
June 6, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28619262/the-parkland-grading-scale-for-cholecystitis
#19
Tarik D Madni, David E Leshikar, Christian T Minshall, Paul A Nakonezny, Canon C Cornelius, Jonathan B Imran, Audra T Clark, Brian H Williams, Alexander L Eastman, Joseph P Minei, Herb A Phelan, Michael W Cripps
BACKGROUND: Gallbladders (GBs) with severe inflammation have longer operative times and an increased risk for complications. We propose a grading system using intraoperative images to better stratify GB inflammation. METHODS: After reviewing the intraoperative images of GBs obtained during several hundred laparoscopic cholecystectomies, we developed a five-tiered grading system based on anatomy and inflammatory changes. Fifty intraoperative photographs were taken prior to dissection and then distributed to 11 surgeons who rated each GB's severity per the grading system...
June 6, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28615137/stress-measurement-in-surgeons-and-residents-using-a-smart-patch
#20
Mariska Weenk, Alexander P B Alken, Lucien J L P G Engelen, Sebastian J H Bredie, Tom H van de Belt, Harry van Goor
BACKGROUND: Stress may negatively affect surgeons' performance during surgical procedures, jeopardizing patient safety. For measuring stress, complex methods are used that cannot record stress real time. This study reports stress measurements in surgeons and residents using a novel patch sensor to identify activities and risk factors of stress. METHODS: In this explorative study, surgeons and residents wore the HealthPatch™ during all daily activities for 2-3 days...
June 6, 2017: American Journal of Surgery
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