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Essential Surgical Knowledge

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1912 papers 1000+ followers Papers from the recent literature which are of interest to residents and practicing surgeons
https://www.readbyqxmd.com/read/28437313/enhanced-recovery-after-surgery-for-noncolorectal-surgery-a-systematic-review-and-meta-analysis-of-major-abdominal-surgery
#1
Anthony Visioni, Rupen Shah, Emmanuel Gabriel, Kristopher Attwood, Moshim Kukar, Steven Nurkin
OBJECTIVE: To evaluate the impact of enhanced recovery after surgery (ERAS) protocols across noncolorectal abdominal surgical procedures. BACKGROUND: ERAS programs have been studied extensively in colorectal surgery and adopted at many centers. Several studies testing such protocols have shown promising results in improving postoperative outcomes across various surgical procedures. However, surgeons performing major abdominal procedures have been slower to adopt these ERAS protocols...
April 21, 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28431186/unfractionated-heparin-versus-low-molecular-weight-heparins-for-avoiding-heparin-induced-thrombocytopenia-in-postoperative-patients
#2
REVIEW
Daniela R Junqueira, Liliane M Zorzela, Edson Perini
BACKGROUND: Heparin-induced thrombocytopenia (HIT) is an adverse drug reaction presenting as a prothrombotic disorder related to antibody-mediated platelet activation. It is a paradoxical immune reaction resulting in thrombin generation in vivo, which leads to a hypercoagulable state and the potential to initiate venous or arterial thrombosis. A number of factors are thought to influence the incidence of HIT including the type and preparation of heparin (unfractionated heparin (UFH) or low molecular weight heparin (LMWH)) and the heparin-exposed patient population, with the postoperative patient population at higher risk...
April 21, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28431202/pharmacological-interventions-for-acute-pancreatitis
#3
REVIEW
Elisabetta Moggia, Rahul Koti, Ajay P Belgaumkar, Federico Fazio, Stephen P Pereira, Brian R Davidson, Kurinchi Selvan Gurusamy
BACKGROUND: In people with acute pancreatitis, it is unclear what the role should be for medical treatment as an addition to supportive care such as fluid and electrolyte balance and organ support in people with organ failure. OBJECTIVES: To assess the effects of different pharmacological interventions in people with acute pancreatitis. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL, 2016, Issue 9), MEDLINE, Embase, Science Citation Index Expanded, and trial registers to October 2016 to identify randomised controlled trials (RCTs)...
April 21, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28420040/semi-end-to-end-esophagojejunostomy-after-laparoscopy-assisted-total-gastrectomy-better-reduces-stricture-and-leakage-than-the-conventional-end-to-side-procedure-a-retrospective-study
#4
Wei Duan, Kaijun Liu, Xiaolong Fu, Xuqi Shen, Jun Chen, Chongyu Su, Peiwu Yu, Yongliang Zhao
BACKGROUND AND OBJECTIVE: Laparoscopy-assisted total gastrectomy (LATG) has not gained popularity due to the technical difficulty of esophagojejunostomy (EJ) and the high incidence of EJ-related complications. Herein, we compared two types of EJ for Roux-en-Y reconstruction to determine whether semi-end-to-end (SETE) EJ is more convenient than the end-to-side (ETS) procedure and is capable of reducing stricture and leakage. METHODS: A total of 268 patients who underwent LATG with Roux-en-Y reconstruction were included in this study...
April 18, 2017: Journal of Surgical Oncology
https://www.readbyqxmd.com/read/28395784/acute-mesenteric-ischemia-part-i-incidence-etiologies-and-how-to-improve-early-diagnosis
#5
REVIEW
Jussi M Kärkkäinen, Stefan Acosta
Acute mesenteric ischemia (AMI) is generally thought to be a rare disease, but in fact, it is more common cause of acute abdomen than appendicitis or ruptured abdominal aortic aneurysm in patients over 75 years of age. In occlusive AMI, surgical treatment without revascularization is associated with as high as 80% overall mortality. It has been shown that early diagnosis with contrast-enhanced computed tomography and revascularization can reduce the overall mortality in AMI by up to 50%. However, only a minority of patients with AMI are being treated actively with revascularization in the United States, and the situation is very likely similar in Europe as well...
February 2017: Best Practice & Research. Clinical Gastroenterology
https://www.readbyqxmd.com/read/28385477/espen-guideline-clinical-nutrition-in-surgery
#6
Arved Weimann, Marco Braga, Franco Carli, Takashi Higashiguchi, Martin Hübner, Stanislaw Klek, Alessandro Laviano, Olle Ljungqvist, Dileep N Lobo, Robert Martindale, Dan L Waitzberg, Stephan C Bischoff, Pierre Singer
Early oral feeding is the preferred mode of nutrition for surgical patients. Avoidance of any nutritional therapy bears the risk of underfeeding during the postoperative course after major surgery. Considering that malnutrition and underfeeding are risk factors for postoperative complications, early enteral feeding is especially relevant for any surgical patient at nutritional risk, especially for those undergoing upper gastrointestinal surgery. The focus of this guideline is to cover nutritional aspects of the Enhanced Recovery After Surgery (ERAS) concept and the special nutritional needs of patients undergoing major surgery, e...
June 2017: Clinical Nutrition: Official Journal of the European Society of Parenteral and Enteral Nutrition
https://www.readbyqxmd.com/read/28407088/borderline-resectable-pancreatic-cancer-conceptual-evolution-and-current-approach-to-image-based-classification
#7
J W Gilbert, B Wolpin, T Clancy, J Wang, H Mamon, A B Shinagare, J Jagannathan, M Rosenthal
BACKGROUND: Diagnostic imaging plays a critical role in the initial diagnosis and therapeutic monitoring of pancreatic adenocarcinoma. Over the past decade, the concept of "borderline resectable" pancreatic cancer has emerged to describe a distinct subset of patients existing along the spectrum from resectable to locally advanced disease for whom a microscopically margin-positive (R1) resection is considered relatively more likely, primarily due to the relationship of the primary tumor with surrounding vasculature...
April 12, 2017: Annals of Oncology: Official Journal of the European Society for Medical Oncology
https://www.readbyqxmd.com/read/28410272/management-of-severe-bleeding-in-patients-treated-with-direct-oral-anticoagulants-an-observational-registry-analysis
#8
Pierre Albaladejo, Charles-Marc Samama, Pierre Sié, Sophie Kauffmann, Vincent Mémier, Pierre Suchon, Alain Viallon, Jean Stéphane David, Yves Gruel, Lorenn Bellamy, Emmanuel de Maistre, Pauline Romegoux, Sophie Thoret, Gilles Pernod, Jean-Luc Bosson
BACKGROUND: The use of prothrombin complex concentrates and the role of plasma concentration of anticoagulants in the management of bleeding in patients treated with direct oral anticoagulants are still debated. Our aim was to describe management strategies and outcomes of severe bleeding events in patients treated with direct oral anticoagulants. METHODS: We performed a prospective cohort study of 732 patients treated with dabigatran, rivaroxaban, or apixaban hospitalized for severe bleeding, included prospectively in the registry from June 2013 to November 2015...
April 14, 2017: Anesthesiology
https://www.readbyqxmd.com/read/28363675/effect-of-ongoing-assessment-of-resident-operative-autonomy-on-the-operating-room-environment
#9
Jonathan P Fryer, Ezra N Teitelbaum, Brian C George, Mary C Schuller, Shari L Meyerson, Christina M Theodorou, Joseph Kang, Amy Yang, Lihui Zhao, Debra A DaRosa
OBJECTIVE: We have previously demonstrated the feasibility and validity of a smartphone-based system called Procedural Autonomy and Supervision System (PASS), which uses the Zwisch autonomy scale to facilitate assessment of the operative performances of surgical residents and promote progressive autonomy. To determine whether the use of PASS in a general surgery residency program is associated with any negative consequences, we tested the null hypothesis that PASS implementation at our institution would not negatively affect resident or faculty satisfaction in the operating room (OR) nor increase mean OR times for cases performed together by residents and faculty...
March 28, 2017: Journal of Surgical Education
https://www.readbyqxmd.com/read/28364952/early-complications-after-percutaneous-radiofrequency-ablation-for-hepatocellular-carcinoma-an-analysis-of-1-843-ablations-in-1-211-patients-in-a-single-centre-experience-over-10-years
#10
J G Park, S Y Park, W Y Tak, Y O Kweon, S Y Jang, Y R Lee, K Hur, H J Lee, H W Lee
AIM: To evaluate the incidence of adverse events and associated factors after radiofrequency ablation (RFA) in patients with hepatocellular carcinoma within 30 days. MATERIALS AND METHODS: The early complications that occurred within 30 days after RFA at a single institution from January 2000 to July 2010 were reviewed in order to evaluate the morbidity, mortality, and risk factors associated with the complications. In total, 1,211 patients (845 men, 70.5%) with a mean age of 68 years (range, 27-88 years) underwent 1,843 RFA procedures...
March 29, 2017: Clinical Radiology
https://www.readbyqxmd.com/read/28398961/accreditation-council-for-graduate-medical-education-acgme-surgery-resident-operative-logs-the-last-quarter-century
#11
Frederick Thurston Drake, Shahram Aarabi, Brandon T Garland, Ciara R Huntington, Jarod P McAteer, Morgan K Richards, Nicole Kansier Zern, Kenneth W Gow
STUDY OBJECTIVE: To describe secular trends in operative experience for surgical trainees across an extended period using the most comprehensive data available, the Accreditation Council for Graduate Medical Education (ACGME) case logs. BACKGROUND: Some experts have expressed concern that current trainees are inadequately prepared for independent practice. One frequently mentioned factor is whether duty hours' restrictions (DHR) implemented in 2003 and 2004 contributed by reducing time spent in the operating room...
May 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28391975/evaluation-of-endorectal-ultrasound-erus-and-mri-for-prediction-of-circumferential-resection-margin-crm-for-rectal-cancer
#12
Catherine Tsai, Cameron Hague, Wei Xiong, Manoj Raval, Ahmer Karimuddin, Carl Brown, P Terry Phang
ERUS and MRI are used for preoperative imaging of rectal cancer. Here, we compare ERUS and MRI for accuracy of CRM prediction at mid- and distal rectal locations. In retrospective review, 20 rectal cancer patients having TME surgery had both ERUS and MRI preoperatively: 8 mid rectum and 12 in distal rectum. Predicted CRM by ERUS and MRI were compared to TME pathology. Overall, predicted CRM was 6.5 ± 3.6 mm by ERUS, 7.7 ± 5.0 mm by MRI, and 6.0 ± 4.6 mm by pathology. Overall, correlation coefficients to pathology were 0...
March 27, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28386715/radiologically-determined-sarcopenia-predicts-morbidity-and-mortality-following-abdominal-surgery-a-systematic-review-and-meta-analysis
#13
REVIEW
Keaton Jones, Alex Gordon-Weeks, Claire Coleman, Michael Silva
BACKGROUND: Individualised risk prediction is crucial if targeted pre-operative risk reduction strategies are to be deployed effectively. Radiologically determined sarcopenia has been shown to predict outcomes across a range of intra-abdominal pathologies. Access to pre-operative cross-sectional imaging has resulted in a number of studies investigating the predictive value of radiologically assessed sarcopenia over recent years. This systematic review and meta-analysis aimed to determine whether radiologically determined sarcopenia predicts post-operative morbidity and mortality following abdominal surgery...
April 6, 2017: World Journal of Surgery
https://www.readbyqxmd.com/read/28383453/predictors-of-anastomotic-leak-in-elderly-patients-after-colectomy-nomogram-based-assessment-from-the-american-college-of-surgeons-national-surgical-quality-program-procedure-targeted-cohort
#14
Ahmet Rencuzogullari, Cigdem Benlice, Michael Valente, Maher A Abbas, Feza H Remzi, Emre Gorgun
BACKGROUND: Elderly patients undergoing colorectal surgery have increasingly become under scrutiny by accounting for the largest fraction of geriatric postoperative deaths and a significant proportion of all postoperative complications, including anastomotic leak. OBJECTIVE: This study aimed to determine predictors of anastomotic leak in elderly patients undergoing colectomy by creating a novel nomogram for simplistic prediction of anastomotic leak risk in a given patient...
May 2017: Diseases of the Colon and Rectum
https://www.readbyqxmd.com/read/28359718/impact-of-surgeon-and-hospital-experience-on-outcomes-of-abdominal-aortic-aneurysm-repair-in-new-york-state
#15
Andrew J Meltzer, Peter H Connolly, Darren B Schneider, Art Sedrakyan
OBJECTIVE: This study aimed to assess the impact of the surgeon's and hospital's experience on the outcomes of open surgical repair (OSR) and endovascular aneurysm repair (EVAR) of intact and ruptured abdominal aortic aneurysms (AAAs) in New York State. METHODS: New York Statewide Planning and Research Cooperative System data were used to identify patients undergoing AAA repair from 2000 to 2011. Characteristics of the provider and hospital were determined by linkage to the New York Office of Professions and National Provider Identification databases...
March 27, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28364951/between-the-lines-the-50th-anniversary-of-long-term-central-venous-catheters
#16
REVIEW
Kenneth W Gow, David Tapper, Robert O Hickman
BACKGROUND: Tunneled central venous catheters (CVC) were developed five decades ago. Since then, several clinician-inventors have created a variety of catheters with different functions. Indeed, many catheters have been named after their inventor. Many have wondered who the inventors were of each catheter, and what specifically inspired their inventions. Many of these compelling stories have yet to be told. DATA SOURCE: A literature review of common catheters and personal communication with inventors...
March 24, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28237645/nonelective-colon-cancer-resection-a-continued-public-health-concern
#17
Christopher T Aquina, Adan Z Becerra, Zhaomin Xu, Francis P Boscoe, Maria J Schymura, Katia Noyes, John R T Monson, Fergal J Fleming
BACKGROUND: Little is known regarding recent trends in the rate of nonelective colon cancer resection in the United States and its impact on both short-term and long-term outcomes. METHODS: The New York State Cancer Registry and Statewide Planning & Research Cooperative System identified stage I-III colon cancer resections from 2004-2011. Propensity-matched analyses assessed differences in short-term adverse outcomes and 5-year disease-specific and overall survival between elective and nonelective colon cancer operations...
February 22, 2017: Surgery
https://www.readbyqxmd.com/read/28289816/current-state-of-the-art-for-renal-replacement-therapy-in-critically-ill-patients-with-acute-kidney-injury
#18
REVIEW
Sean M Bagshaw, Michael Darmon, Marlies Ostermann, Fredric O Finkelstein, Ron Wald, Ashita J Tolwani, Stuart L Goldstein, David J Gattas, Shigehiko Uchino, Eric A Hoste, Stephane Gaudry
Acute kidney injury (AKI) is associated with incremental risk for death and chronic kidney disease and represents a mounting clinical challenge for healthcare professionals. Renal replacement therapy (RRT) use in ICU settings is rising, likely in response to similar trends in AKI, taken together with an ageing population burdened by high prevalence of multi-morbidity and high illness acuity. Numerous features of RRT prescription and delivery are not standardized, nor are they supported from high-quality evidence derived from randomized trials...
March 13, 2017: Intensive Care Medicine
https://www.readbyqxmd.com/read/28341513/impact-of-inferior-vena-cava-filter-placement-on-short-term-outcomes-in-patients-with-acute-pulmonary-embolism
#19
Nathan L Liang, Elizabeth A Genovese, Efthymios D Avgerinos, Michael J Singh, Michel S Makaroun, Rabih A Chaer
BACKGROUND: Inferior vena cava filters (IVCF) have been associated with improved survival in patients with acute pulmonary embolism (PE) in some studies. However, without randomization, those with early mortality who did not receive an IVCF may have died prior to treatment decision about filter placement, falsely contributing a survival advantage to those receiving IVCF and biasing the results of previous observational studies. The objective of this study is to evaluate the impact of IVCF on in-hospital mortality after adjusting for this survivor treatment selection...
March 21, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28320242/early-goal-directed-therapy-for-septic-shock-a-patient-level-meta-analysis
#20
(no author information available yet)
Background After a single-center trial and observational studies suggesting that early, goal-directed therapy (EGDT) reduced mortality from septic shock, three multicenter trials (ProCESS, ARISE, and ProMISe) showed no benefit. This meta-analysis of individual patient data from the three recent trials was designed prospectively to improve statistical power and explore heterogeneity of treatment effect of EGDT. Methods We harmonized entry criteria, intervention protocols, outcomes, resource-use measures, and data collection across the trials and specified all analyses before unblinding...
March 21, 2017: New England Journal of Medicine
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