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Essential Surgical Knowledge

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1946 papers 1000+ followers Papers from the recent literature which are of interest to residents and practicing surgeons
https://www.readbyqxmd.com/read/28591523/completion-dissection-or-observation-for-sentinel-node-metastasis-in-melanoma
#1
RANDOMIZED CONTROLLED TRIAL
Mark B Faries, John F Thompson, Alistair J Cochran, Robert H Andtbacka, Nicola Mozzillo, Jonathan S Zager, Tiina Jahkola, Tawnya L Bowles, Alessandro Testori, Peter D Beitsch, Harald J Hoekstra, Marc Moncrieff, Christian Ingvar, Michel W J M Wouters, Michael S Sabel, Edward A Levine, Doreen Agnese, Michael Henderson, Reinhard Dummer, Carlo R Rossi, Rogerio I Neves, Steven D Trocha, Frances Wright, David R Byrd, Maurice Matter, Eddy Hsueh, Alastair MacKenzie-Ross, Douglas B Johnson, Patrick Terheyden, Adam C Berger, Tara L Huston, Jeffrey D Wayne, B Mark Smithers, Heather B Neuman, Schlomo Schneebaum, Jeffrey E Gershenwald, Charlotte E Ariyan, Darius C Desai, Lisa Jacobs, Kelly M McMasters, Anja Gesierich, Peter Hersey, Steven D Bines, John M Kane, Richard J Barth, Gregory McKinnon, Jeffrey M Farma, Erwin Schultz, Sergi Vidal-Sicart, Richard A Hoefer, James M Lewis, Randall Scheri, Mark C Kelley, Omgo E Nieweg, R Dirk Noyes, Dave S B Hoon, He-Jing Wang, David A Elashoff, Robert M Elashoff
BACKGROUND: Sentinel-lymph-node biopsy is associated with increased melanoma-specific survival (i.e., survival until death from melanoma) among patients with node-positive intermediate-thickness melanomas (1.2 to 3.5 mm). The value of completion lymph-node dissection for patients with sentinel-node metastases is not clear. METHODS: In an international trial, we randomly assigned patients with sentinel-node metastases detected by means of standard pathological assessment or a multimarker molecular assay to immediate completion lymph-node dissection (dissection group) or nodal observation with ultrasonography (observation group)...
June 8, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28634227/evidence-based-medicine-manifesto-for-better-healthcare
#2
EDITORIAL
Carl Heneghan, Kamal R Mahtani, Ben Goldacre, Fiona Godlee, Helen Macdonald, Duncan Jarvies
No abstract text is available yet for this article.
June 20, 2017: BMJ: British Medical Journal
https://www.readbyqxmd.com/read/28600070/colorectal-cancer-screening-recommendations-for-physicians-and-patients-from-the-u-s-multi-society-task-force-on-colorectal-cancer
#3
Douglas K Rex, C Richard Boland, Jason A Dominitz, Francis M Giardiello, David A Johnson, Tonya Kaltenbach, Theodore R Levin, David Lieberman, Douglas J Robertson
No abstract text is available yet for this article.
July 2017: Gastrointestinal Endoscopy
https://www.readbyqxmd.com/read/28619547/a-systematic-review-of-the-management-and-outcome-of-ercp-related-duodenal-perforations-using-a-standardized-classification-system
#4
REVIEW
Roberto Cirocchi, Michael Denis Kelly, Ewen A Griffiths, Renata Tabola, Massimo Sartelli, Luigi Carlini, Stefania Ghersi, Salomone Di Saverio
INTRODUCTION: The incidence of duodenal perforation after ERCP ranges from 0.09% to 1.67% and mortality up to 8%. METHODS: This systematic review was registered in Prospective Register of Systematic Reviews, PROSPERO. Stapfer classification of ERCP-related duodenal perforations was used. RESULTS: The systematic search yielded 259 articles. Most frequent post-ERCP perforation was Stapfer type II (58.4%), type I second most frequent perforation (17...
June 12, 2017: Surgeon: Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland
https://www.readbyqxmd.com/read/28622955/age-specific-risks-severity-time-course-and-outcome-of-bleeding-on-long-term-antiplatelet-treatment-after-vascular-events-a-population-based-cohort-study
#5
Linxin Li, Olivia C Geraghty, Ziyah Mehta, Peter M Rothwell
BACKGROUND: Lifelong antiplatelet treatment is recommended after ischaemic vascular events, on the basis of trials done mainly in patients younger than 75 years. Upper gastrointestinal bleeding is a serious complication, but had low case fatality in trials of aspirin and is not generally thought to cause long-term disability. Consequently, although co-prescription of proton-pump inhibitors (PPIs) reduces upper gastrointestinal bleeds by 70-90%, uptake is low and guidelines are conflicting...
June 13, 2017: Lancet
https://www.readbyqxmd.com/read/28614551/surgeon-variation-in-complications-with-minimally-invasive-and-open-colectomy-results-from-the-michigan-surgical-quality-collaborative
#6
Mark A Healy, Scott E Regenbogen, Arielle E Kanters, Pasithorn A Suwanabol, Oliver A Varban, Darrell A Campbell, Justin B Dimick, John C Byrn
Importance: Minimally invasive colectomy (MIC) is an increasingly common surgical procedure. Although case series and controlled prospective trials have found the procedure to be safe, it is unclear whether safe adaptation of this approach from open colectomy (OC) is occurring among surgeons. Objective: To assess rates of complications for MIC compared with OC among surgeons. Design, Setting, and Participants: We analyzed 5196 patients who underwent MIC or OC from January 1, 2012, through December 31, 2015, by 97 surgeons in the Michigan Surgical Quality Collaborative, with each surgeon performing at least 10 OCs and 10 MICs...
June 14, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/28608276/a-comparison-of-yttrium-90-microsphere-radioembolization-to-hepatic-arterial-infusional-chemotherapy-for-patients-with-chemo-refractory-hepatic-colorectal-metastases
#7
REVIEW
Andrea Cercek, Vyacheslav Gendel, Salma Jabbour, Dirk Moore, Chunxia Chen, John Nosher, Marinela Capanu, Joanne F Chou, Taryn Boucher, Nancy Kemeny, Darren R Carpizo
Patients with unresectable hepatic colorectal metastases who become chemo-refractory have limited treatment options. Systemic chemotherapies such as TAS102 and regorafenib have been used in the refractory setting, but with only modest improvement in overall survival compared to best supportive care. In patients with liver-only or liver-dominant disease, direct chemotherapy to the liver such as hepatic artery infusional (HAI) chemotherapy and radioembolization (yttrium-90 (Y90)) should be considered. Due to the difficulty of HAI therapy post Y90 for technical reasons, we recommend HAI therapy prior to Y90...
July 2017: Current Treatment Options in Oncology
https://www.readbyqxmd.com/read/28619262/the-parkland-grading-scale-for-cholecystitis
#8
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/28550032/a-predictive-score-for-thrombosis-associated-with-breast-colorectal-lung-or-ovarian-cancer-the-prospective-compass-cancer-associated-thrombosis-study
#9
Grigoris T Gerotziafas, Ali Taher, Hikmat Abdel-Razeq, Essam AboElnazar, Alex C Spyropoulos, Salem El Shemmari, Annette K Larsen, Ismail Elalamy
BACKGROUND: The stratification of outpatients on chemotherapy for breast, colorectal, lung, and ovarian cancers at risk of venous thromboembolism (VTE) remains an unmet clinical need. The derivation of a risk assessment model (RAM) for VTE in these patients was the aim of the study "Prospective Comparison of Methods for thromboembolic risk assessment with clinical Perceptions and AwareneSS in real life patients-Cancer Associated Thrombosis" (COMPASS-CAT). PATIENTS AND METHODS: The derivation cohort consisted of 1,023 outpatients...
May 26, 2017: Oncologist
https://www.readbyqxmd.com/read/28594723/is-there-a-role-for-oral-antibiotic-preparation-alone-before-colorectal-surgery-acs-nsqip-analysis-by-coarsened-exact-matching
#10
Richard Garfinkle, Jad Abou-Khalil, Nancy Morin, Gabriela Ghitulescu, Carol-Ann Vasilevsky, Philip Gordon, Marie Demian, Marylise Boutros
BACKGROUND: Recent studies demonstrated reduced postoperative complications using combined mechanical bowel and oral antibiotic preparation before elective colorectal surgery. OBJECTIVE: The aim of this study was to assess the impact of these 2 interventions on surgical site infections, anastomotic leak, ileus, major morbidity, and 30-day mortality in a large cohort of elective colectomies. DESIGN: This is a retrospective comparison of 30-day outcomes using the American College of Surgeons National Surgical Quality Improvement Program colectomy-targeted database with coarsened exact matching...
July 2017: Diseases of the Colon and Rectum
https://www.readbyqxmd.com/read/28594741/characterization-and-optimal-management-of-high-risk-pancreatic-anastomoses-during-pancreatoduodenectomy
#11
Brett L Ecker, Matthew T McMillan, Horacio J Asbun, Chad G Ball, Claudio Bassi, Joal D Beane, Stephen W Behrman, Adam C Berger, Euan J Dickson, Mark Bloomston, Mark P Callery, John D Christein, Elijah Dixon, Jeffrey A Drebin, Carlos Fernandez-Del Castillo, William E Fisher, Zhi Ven Fong, Ericka Haverick, Robert H Hollis, Michael G House, Steven J Hughes, Nigel B Jamieson, Ammar A Javed, Tara S Kent, Stacy J Kowalsky, John W Kunstman, Giuseppe Malleo, Katherine E Poruk, Ronald R Salem, Carl R Schmidt, Kevin Soares, John A Stauffer, Vicente Valero, Lavanniya K P Velu, Amarra A Watkins, Christopher L Wolfgang, Amer H Zureikat, Charles M Vollmer
OBJECTIVE: The aim of this study was to identify the optimal fistula mitigation strategy following pancreaticoduodenectomy. BACKGROUND: The utility of technical strategies to prevent clinically relevant postoperative pancreatic fistula (CR-POPF) following pancreatoduodenectomy (PD) may vary by the circumstances of the anastomosis. The Fistula Risk Score (FRS) identifies a distinct high-risk cohort (FRS 7 to 10) that demonstrates substantially worse clinical outcomes...
June 7, 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28577726/updates-in-hepatic-oncology-imaging
#12
REVIEW
Pallavi Pandey, Heather Lewis, Ankur Pandey, Carl Schmidt, Mary Dillhoff, Ihab R Kamel, Timothy M Pawlik
The utilization of advanced imaging modalities play an important role in the detection and differentiation of benign and malignant hepatic lesions. Imaging characteristics of hepatic tumors can sometimes be atypical, often leading to diagnostic challenges. Recent technical improvements in contrast enhanced ultrasound (CEUS), computed tomography (CT), and magnetic resonance imaging (MRI) have helped to better characterize hepatic lesions. For example, contrast agents used in US can now better delineate liver lesions, while the ability to reliably produce multiplanar and 3-D reconstructions through the use of MDCT provides an additional advantage in the context of therapeutic decision making for patients with hepatic lesions...
June 2017: Surgical Oncology
https://www.readbyqxmd.com/read/28590505/carotid-endarterectomy-for-symptomatic-carotid-stenosis
#13
REVIEW
Saritphat Orrapin, Kittipan Rerkasem
BACKGROUND: Stroke is the third leading cause of death and the most common cause of long-term disability. Severe narrowing (stenosis) of the carotid artery is an important cause of stroke. Surgical treatment (carotid endarterectomy) may reduce the risk of stroke, but carries a risk of operative complications. This is an update of the Cochrane Review, originally published in 1999, and most recently updated in 2011. OBJECTIVES: To determine the balance of benefit versus risk of endarterectomy plus best medical management compared with best medical management alone, in people with a recent symptomatic carotid stenosis (i...
June 7, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28518415/systematic-review-of-transarterial-embolization-for-hepatocellular-adenomas
#14
REVIEW
B V van Rosmalen, R J S Coelen, M Bieze, O M van Delden, J Verheij, C H C Dejong, T M van Gulik
BACKGROUND: Hepatocellular adenoma (HCA) larger than 5 cm in diameter is considered an indication for elective surgery, because of the risk of haemorrhage and malignant transformation. Transarterial embolization (TAE) is used to manage bleeding HCA and occasionally to reduce tumour size. TAE might have potential as an elective therapy, but its current role in this context is uncertain. This systematic review provides an overview of clinical outcomes after TAE, in bleeding and non-bleeding HCA...
June 2017: British Journal of Surgery
https://www.readbyqxmd.com/read/28467190/risk-of-gastrointestinal-bleeding-during-anticoagulant-treatment
#15
REVIEW
Aitor Lanas-Gimeno, Angel Lanas
Gastrointestinal bleeding (GIB) is a major problem in patients on oral anticoagulation therapy. This issue has become even more pressing since the introduction of direct oral anticoagulants (DOACs) in 2009. Areas covered: Here we review current evidence related to GIB associated with oral anticoagulants, focusing on randomized controlled trials, meta-analyses, and post-marketing observational studies. Dabigatran 150 mg twice daily and rivaroxaban 20 mg once daily increase the risk of GIB compared to warfarin...
June 2017: Expert Opinion on Drug Safety
https://www.readbyqxmd.com/read/28448383/the-groinpain-trial-a-randomized-controlled-trial-of-injection-therapy-versus-neurectomy-for-postherniorraphy-inguinal-neuralgia
#16
Tim Verhagen, Maarten J A Loos, Marc R M Scheltinga, Rudi M H Roumen
OBJECTIVE: This study compares tender point infiltration (TPI) and a tailored neurectomy as the preferred treatment for chronic inguinodynia after inguinal herniorraphy. BACKGROUND: Some 11% of patients develop chronic discomfort after open inguinal herniorraphy. Both TPI and neurectomy have been suggested as treatment options, but evidence is conflicting. METHODS: Patients with chronic neuropathic pain after primary Lichtenstein repair and >50% pain reduction after a diagnostic TPI were randomized for repeated TPI (combined Lidocaine/corticosteroids /hyaluronic acid injection) or for a neurectomy...
April 26, 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28561005/management-of-patients-at-risk-of-acute-kidney-injury
#17
REVIEW
Jill Vanmassenhove, Jan Kielstein, Achim Jörres, Wim Van Biesen
Acute kidney injury (AKI) is a multifaceted syndrome that occurs in different settings. The course of AKI can be variable, from single hit and complete recovery, to multiple hits resulting in end-stage renal disease. No interventions to improve outcomes of established AKI have yet been developed, so prevention and early diagnosis are key. Awareness campaigns and education for health-care professionals on diagnosis and management of AKI-with attention to avoidance of volume depletion, hypotension, and nephrotoxic interventions-coupled with electronic early warning systems where available can improve outcomes...
May 27, 2017: Lancet
https://www.readbyqxmd.com/read/28547631/management-of-diverticulitis-in-2017
#18
Sarah E Deery, Richard A Hodin
Diverticulitis has become increasingly more common in the 20(th) century and is now one of the most frequent indications for gastrointestinal tract-related hospitalizations. The spectrum of clinical presentation can vary widely from mild, uncomplicated disease that can be managed as an outpatient, to complicated diverticulitis with peritonitis and sepsis. Historically, all patients with diverticulitis were managed with, at a minimum, a course of antibiotics, with many patients undergoing urgent or emergent surgery with a sigmoid colectomy, end colostomy, and oversewn rectosigmoid "Hartmann's" stump...
May 25, 2017: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
https://www.readbyqxmd.com/read/28560888/the-evolution-of-acute-burn-care-retiring-the-split-skin-graft
#19
J E Greenwood
The skin graft was born in 1869 and since then, surgeons have been using split skin grafts for wound repair. Nevertheless, this asset fails the big burn patient, who deserves an elastic, mobile and robust outcome but who receives the poorest possible outcome based on donor site paucity. Negating the need for the skin graft requires an autologous composite cultured skin and a material capable of temporising the burn wound for four weeks until the composite is produced. A novel, biodegradable polyurethane chemistry has been used to create two such products...
May 31, 2017: Annals of the Royal College of Surgeons of England
https://www.readbyqxmd.com/read/28548204/endovascular-treatment-for-ruptured-abdominal-aortic-aneurysm
#20
REVIEW
Stephen Badger, Rachel Forster, Paul H Blair, Peter Ellis, Frank Kee, Denis W Harkin
BACKGROUND: An abdominal aortic aneurysm (AAA) (pathological enlargement of the aorta) is a condition that can occur as a person ages. It is most commonly seen in men older than 65 years of age. Progressive aneurysm enlargement can lead to rupture and massive internal bleeding, which is fatal unless timely repair can be achieved. Despite improvements in perioperative care, mortality remains high (approximately 50%) after conventional open surgical repair. Endovascular aneurysm repair (EVAR), a minimally invasive technique, has been shown to reduce early morbidity and mortality as compared to conventional open surgery for planned AAA repair...
May 26, 2017: Cochrane Database of Systematic Reviews
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