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American Surgeon

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https://www.readbyqxmd.com/read/27780001/small-bowel-obstructions-in-a-virgin-abdomen-is-an-operation-mandatory
#1
Farees Ricky Tavangari, Michael Batech, J Craig Collins, Talar Tejirian
Though conventionally not considered standard of care, nonoperative management of patients with small bowel obstruction (SBO) without previous abdominal operations, so called "virgin abdomens," (VA) is presently being practiced. We aimed to determine outcomes of patients with VA undergoing operative and nonoperative management of SBO. A retrospective review of patients with SBO was performed; outcomes of patients with VA were analyzed. SBO with a VA was found in 103 patients over a 5-year period. With a mean follow-up of 4...
October 2016: American Surgeon
https://www.readbyqxmd.com/read/27780000/complications-of-diverting-ileostomy-after-low-anterior-resection-for-rectal-carcinoma
#2
Sean Maroney, Carlos Chavez de Paz, Marjunphilip Duldulao, Tracey Kim, Mark E Reeves, Kevork K Kazanjian, Naveenraj Solomon, Carlos Garberoglio
There have been few studies directly comparing the postoperative complications in patients with a diverting ileostomy to patients who were not diverted after low anterior resection (LAR) for rectal carcinoma. This study is a retrospective chart review of all rectal carcinoma patients (99) who underwent a LAR from January 2009 to December 2014 at Loma Linda University Medical Center and Veterans Affairs Loma Linda Healthcare System. A majority of patients were diverted (58% vs 42%). The diverted patients were more likely to have a low tumor location (P < 0...
October 2016: American Surgeon
https://www.readbyqxmd.com/read/27779999/appendicitis-in-cancer-patients-is-often-observed-and-can-represent-appendiceal-malignancy
#3
David Santos, Yi-Ju Chiang, Brian Badgwell
Appendectomy is standard of care for uncomplicated appendicitis, but cancer patients may not be optimal surgical candidates. Interval appendectomy is controversial, and appendiceal malignancy is rare. Study objectives were to review the role of surgery, observation, and interventional radiology (IR)-guided drainage in patients with appendicitis and advanced malignancy. Retrospective review was performed on cancer patients presenting to a tertiary academic cancer center from January 1, 2001 to December 31, 2014...
October 2016: American Surgeon
https://www.readbyqxmd.com/read/27779998/examining-the-quality-of-rectal-cancer-operative-reports-in-teaching-institutions-is-there-an-opportunity-for-resident-education
#4
Aaron B Parrish, Yas Sanaiha, Beverley A Petrie, Marcia M Russell, Formosa Chen
The American Society of Colon and Rectal Surgeons rectal cancer checklist describes a set of best practices for rectal cancer surgery. The objective of this study was to assess the quality of operative reports for rectal cancer surgery based on the intraoperative American Society of Colon and Rectal Surgeons checklist items. Patients undergoing rectal cancer surgery at two public teaching hospitals from 2009 to 2015 were included. A total of 12 intraoperative checklist items were assessed. One hundred and fifty-eight operative reports were reviewed...
October 2016: American Surgeon
https://www.readbyqxmd.com/read/27779997/negative-appendectomy-clinical-and-economic-implications
#5
Yang Lu, Scott Friedlander, Steven L Lee
Historically, performing a negative appendectomy (NA) was justified to reduce the incidence of perforation. Furthermore, it is also believed that NA is associated with minimal morbidity and cost. The purpose of this study was to evaluate the frequency, clinical characteristics, and economic implications of NA. We reviewed the inpatient admissions on 274,405 patients who underwent nonincidental appendectomy as their primary procedure from the California State Inpatient Databases (2005-2011). Overall, 96.9 per cent had appendicitis (nonperforated = 73...
October 2016: American Surgeon
https://www.readbyqxmd.com/read/27779996/robotic-inguinal-hernia-repair-technique-and-early-experience
#6
Massimo Arcerito, Eric Changchien, Oscar Bernal, Adam Konkoly-Thege, John Moon
Laparoscopic inguinal hernia repair has been shown to have multiple advantages compared with open repair such as less postoperative pain and earlier resume of daily activities with a comparable recurrence rate. We speculate robotic inguinal hernia repair may yield equivalent benefits, while providing the surgeon added dexterity. One hundred consecutive robotic inguinal hernia repairs with mesh were performed with a mean age of 56 years (25-96). Fifty-six unilateral hernias and 22 bilateral hernias were repaired amongst 62 males and 16 females...
October 2016: American Surgeon
https://www.readbyqxmd.com/read/27779995/second-primary-melanoma-risk-factors-histopathologic-features-survival-and-implications-for-follow-up
#7
Maris S Jones, Hitoe Torisu-Itakura, Devin C Flaherty, Hans F Schoellhammer, Jihey Lee, Myung-Shim Sim, Mark B Faries
The impact on survival of a second primary melanoma (SPM) is unclear. We used our melanoma center's database to examine clinicopathologic risk factors and outcomes of stage 0 to IV cutaneous melanoma in patients with one versus two primaries. Among 12,325 patients with primary melanoma, 969 (7.86%) developed SPM. SPMs were significantly thinner than autologous primary melanomas (P = 0.01), and 451 SPM patients had better overall and melanoma-specific survival than 451 prognostically matched non-SPM patients (P < 0...
October 2016: American Surgeon
https://www.readbyqxmd.com/read/27779994/staging-rectal-cancer-the-utility-of-chest-radiograph-and-chest-computed-tomography
#8
Michael P O'Leary, Aaron B Parrish, Cynthia M Tom, Brian W MacLaughlin, Beverley A Petrie
The National Comprehensive Cancer Network recommends that patients who are newly diagnosed with rectal cancer undergo staging CT scan of the chest. It is unclear whether posteroanterior and lateral chest radiography (X-ray) alone would provide adequate staging for most of these patients. A retrospective review was performed on all patients who had a two-view chest X-ray along with a chest CT for rectal cancer staging from 2007 to 2015. A total of 74 patients had both modalities. Sixty-three (85%) had a normal chest X-ray and 11 (15%) had an abnormal chest X-ray...
October 2016: American Surgeon
https://www.readbyqxmd.com/read/27779993/initiating-a-standard-venous-thromboembolism-prophylaxis-order-set-designed-to-improve-patient-outcomes-at-los-angeles-county-university-of-southern-california
#9
Daniel Gardner, Andrew Liman, Victoria Autelli, Casey O'Connell, Nicholas Testa, Glenn Ault
Improving patient safety is vital for all hospitals due to increasing public reporting and pay-for-performance reimbursement. Venous thromboembolism (VTE) remains a leading cause of preventable mortality accounting for 5 per cent of inpatient deaths. The purpose of this study was to outline the process of implementing standard VTE prophylactic order sets in a 600-bed academic safety net hospital and assess the resulting change in patient outcomes. Outcomes were assessed by comparing the rate that eligible inpatients receive VTE prophylaxis and the rate of preventable VTE's compared with total VTE's...
October 2016: American Surgeon
https://www.readbyqxmd.com/read/27779992/survival-difference-in-patients-with-malignant-pleural-effusions-treated-with-pleural-catheter-or-talc-pleurodesis
#10
Douglas Z Liou, Derek Serna-Gallegos, Joshua L Chan, Jerald Borgella, Shah Akhmerov, Harmik J Soukiasian
Malignant pleural effusions (MPE) are commonly managed with either pleural catheter (PC) or talc pleurodesis (TP). The aim of this study was to compare survival in MPE patients treated with either PC or TP. A retrospective review of our cancer center database was performed. Patients with metastatic cancer and MPE were analyzed. Demographic and clinical data were tabulated and compared. A total of 238 patients with MPE treated by either PC or TP were included. Of these, 79 patients comprised the PC group and 159 the TP group...
October 2016: American Surgeon
https://www.readbyqxmd.com/read/27779991/predictors-of-ischemic-bowel-in-patients-with-small-bowel-obstruction
#11
Michael P O'Leary, Angela L Neville, Jessica A Keeley, Dennis Y Kim, Christian de Virgilio, David S Plurad
Preoperative diagnosis of ischemic bowel in patients with small bowel obstruction (SBO) is a clinical challenge. The aim of this study was to identify preoperative variables associated with ischemic bowel found at operative exploration. We performed a 5-year retrospective review of patients admitted to a university affiliated, county funded hospital who underwent exploratory laparoscopy or laparotomy for SBO. Patients were excluded if they had a known preoperative malignancy or hernia on physical examination...
October 2016: American Surgeon
https://www.readbyqxmd.com/read/27779990/type-and-quantity-of-pharmacologic-therapy-for-crohn-s-disease-before-eventual-surgical-treatment
#12
Jan P Kamiński, Emily Miraflor, Karen Zaghiyan, Phillip Fleshner
Treatment of Crohn's disease (CD) relies on medical therapy with surgery reserved for medically refractory cases. This study measured pharmaceutical therapies that CD patients receive before surgery. Prospective data were collected on 558 patients undergoing surgery for medically refractory CD from November 1999 through June 2014. Patient demographics and preoperative medical therapies were tabulated, including types and number of doses of aminosalicylic acid, corticosteroids, immunomodulators, and biologic therapies...
October 2016: American Surgeon
https://www.readbyqxmd.com/read/27779989/analysis-of-endoscopic-retrograde-cholangiopancreatography-after-positive-intraoperative-cholangiogram-is-it-necessary
#13
John V Gahagan, Steven Maximus, Matthew D Whealon, Michael J Phelan, Aram Demirjian, Victor C Joe
The necessity of routine endoscopic retrograde cholangiopancreatography (ERCP) after positive intraoperative cholangiogram (IOC) during laparoscopic cholecystectomy is not well defined. We aimed to examine the incidence of positive IOC among patients who undergo IOC during cholecystectomy and the rate of subsequent ERCP stone extraction. The Nationwide Inpatient Sample database was reviewed for all patients undergoing cholecystectomy with IOC from 2002 to 2012. Patients were then analyzed for ERCP and stone extraction...
October 2016: American Surgeon
https://www.readbyqxmd.com/read/27779988/is-sentinel-lymph-node-dissection-necessary-in-all-patients-with-ductal-carcinoma-in-situ-undergoing-total-mastectomy
#14
Valentina Bonev, Carlos Chavez De Paz Villanueva, Naveenraj Solomon, Maheswari Senthil, Mark E Reeves, Carlos Garberoglio, Sharon S Lum
When ductal carcinoma in situ (DCIS) is found on core needle biopsy, rates of upgrade to invasive cancer of 25 per cent and nodal positivity of 10 per cent have been reported. Sentinel lymph node dissection (SLND) is recommended when mastectomy is performed for DCIS. We investigated the role of SLND in DCIS patients undergoing partial and total mastectomy (TM). During the study period 2004 to 2013, 170 patients with DCIS were identified with a median age of 60 years (range 26-84 years). Of these, 58.2 per cent had partial mastectomy (PM) alone, 10...
October 2016: American Surgeon
https://www.readbyqxmd.com/read/27779987/de-novo-crohn-s-disease-after-ileal-pouch-anal-anastomosis-for-ulcerative-colitis-and-inflammatory-bowel-disease-unclassified-long-term-follow-up-of-a-prospective-inflammatory-bowel-disease-registry
#15
Karen Zaghiyan, Jan P Kamiński, Galinos Barmparas, Phillip Fleshner
The risk of de novo Crohn's disease (CD) after ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC) versus inflammatory bowel disease unclassified (IBDU) or indeterminate colitis (IC) remains debatable. Here, we present updated results after long-term follow-up of a previously studied cohort of 334 patients with UC, IBDU, or IC who underwent IPAA during a 10-year period ending 2007. Of 334 study patients, 56 per cent were male and median age was 38 years (range: 8-81). Patients were classified as UC (n = 237) or IBDU (n = 97) preoperatively and UC (n = 236) or IC (n = 98) postoperatively...
October 2016: American Surgeon
https://www.readbyqxmd.com/read/27779986/racial-and-gender-differences-in-arterial-anatomy-of-the-arm
#16
Xuan-Binh D Pham, Jerry J Kim, Aaron B Parrish, Cynthia Tom, Ezinne J Ihenachor, David Mina, Christian de Virgilio
Prior studies have shown racial and gender differences with respect to maturation of arteriovenous fistulas. Women and minorities have lower maturation rates for unclear reasons. Small arterial diameter and high brachial artery bifurcation (HBB) are also implicated in reduced maturation rates. We sought to correlate differences in upper extremity arterial anatomy to race and gender. All upper extremity vascular mapping ultrasounds from 2013 to 2014 were retrospectively reviewed. A total of 509 arms in 284 patients were evaluated...
October 2016: American Surgeon
https://www.readbyqxmd.com/read/27779985/do-antiplatelet-and-anticoagulation-agents-matter-after-repair-of-traumatic-arterial-injuries
#17
Eugene Wang, Kenji Inaba, Jayun Cho, Saskya Byerly, Vincent Rowe, Elizabeth Benjamin, Lydia Lam, Demetrios Demetriades
Thrombosis is a devastating complication after repair of traumatic vascular injury. Although thrombosis rates have been described, the value of anticoagulation in preventing postrepair thrombosis is unknown. We hypothesize that postoperative anticoagulation reduces thrombosis rates. A total of 1524 consecutive patients with traumatic arterial injuries from January 2005 to June 2015 were identified, and 381 patients underwent the following repair types: direct suture of vessel wall, primary anastomosis, extra-anatomic reconstruction, tissue and synthetic interposition reconstruction...
October 2016: American Surgeon
https://www.readbyqxmd.com/read/27779984/excision-and-primary-closure-may-be-the-better-option-in-the-surgical-management-of-pilonidal-disease-in-the-pediatric-population
#18
Jessica A Zagory, Jamie Golden, Kathleen Holoyda, Natalie Demeter, Nam X Nguyen
The optimal management of pilonidal disease in the pediatric population is still debated. We conducted a retrospective review of patients 21 years old and younger who underwent surgical management for pilonidal disease between 2009 and 2013 at a single pediatric institution. Sixty patients (41.7% male) were included in the analysis, with a mean age of 15.0 years (range, 13-20). Twelve (20%) had a prior drainage procedure for pilonidal abscess before the definitive operative treatment. After excision to the presacral fascia, 36 (60%) had primary closure, 17 (28...
October 2016: American Surgeon
https://www.readbyqxmd.com/read/27779983/factors-associated-with-a-short-2-days-or-long-10-days-length-of-stay-after-colectomy-a-multivariate-analysis-of-over-400-patients
#19
Kyle G Cologne, Sean Byers, David R Rosen, Grace S Hwang, Adrian E Ortega, Glenn T Ault, Sang W Lee
A prospectively maintained database of 415 patients undergoing colectomy was evaluated. We performed a logistic regression analysis to identify factors associated with 1) length of stay (LOS) of 2 days or less and 2) LOS of 10 days or more. Investigated variables included demographics, American Society of Anesthesiology (ASA) score, diagnosis, operative procedure, approach and time, transfusion requirements, and occurrence of any complications. Factors associated with a LOS of two days or less included ASA [odds ratio (OR): 0...
October 2016: American Surgeon
https://www.readbyqxmd.com/read/27779982/impact-of-massive-transfusion-and-aging-blood-in-acute-trauma
#20
Tanya Anand, Rajesh Ramnanan, Ruby Skinner, Maureen Martin
Blood transfusions cause altered immunity and the duration of storage is contributory. In the era of massive transfusion protocols (MTPs) this impact is unclear, particularly as it relates to balanced transfusions. Trauma patients requiring our MTP after admission to our Level II trauma center were studied. The average age of blood transfused was calculated; old blood was a storage time of ≥14 days versus new blood <14 days. Blood to plasma ratios of 1:1 were compared with ratios >1:1. Infections, organ dysfunction multiorgan injury (MOI), and death were compared based on ratios and blood storage times...
October 2016: American Surgeon
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