The American Journal of Surgery

Editorial board

2010-02-01

Differential molecular changes in patients with asymptomatic long-segment Barrett's esophagus treated by antireflux surgery or medical therapy

2009-03-23

Abstract: Background: The Barrett's to adenocarcinoma sequence is characterized by molecular changes including activation of nuclear factor-κB (NF-κB) and related cytokines. In this observational nonrandomized study this molecular environment was compared in matched asymptomatic cohorts who had undergone either fundoplication or therapy with proton pump inhibitors (PPIs).Methods: Asymptomatic patients with long-segment Barrett's esophagus had endoscopic biopsy specimens taken from 2 cm below the squamocolumnar junction for measurement of activated NF-κB and a panel of cytokines and growth factors.Results: Thirty-seven patients were recruited (surgical: n = 18, medical: n = 19). The mean patient age was 51 years, and the mean follow-up period was 5.6 years. There were no differences in the length of Barrett's segment and endoscopic and histopathologic features in both groups. Mean activated NF-κB p50 and p65 subunits, interleukin (IL)-1α, IL-1β, and interleukin-8 levels, were significantly (P < .05) lower in the surgically treated group.Conclusions: This study provides proxy support to the thesis that antireflux surgery may provide an environment that is less inflammatory and tumorigenic than that observed in medically treated patients.

Prospective clinical and functional results of combined rectal and urogynecologic surgery in complex pelvic floor disorders

2009-04-13

Abstract: Background: The aim of this prospective study was to evaluate the results of combined rectal and urogynecologic surgery in women with associated obstructed defecation, urinary incontinence, or genital prolapse.Methods: One hundred forty-two selected patients with obstructed defecation in isolation or associated with urinary incontinence, enterocele, or genital prolapse were consecutively operated on by stapled transanal rectal resection alone or associated with transobturator tape, vaginal repair of the enterocele, or vaginal hysterectomy, respectively, and followed up by clinical controls and defecography.Results: At 2 years, all symptom, quality-of-life, and defecographic parameters had significantly improved in all groups (P < .001). The association with hysterectomy showed higher risk for severe complications, longer operative time, hospital stay, and time of inability (P < .001). Recurrence of urinary incontinence was observed in 3 of 24 patients, while 2 of 21 showed residual vaginal prolapse.Conclusion: The combination of rectal and urogynecologic surgery is effective, with higher morbidity in the association with vaginal hysterectomy. Randomized trials comparing surgery in 1 and more stages and longer follow-up are necessary for a definitive conclusion.

Evaluation of need for angioembolization in blunt renal injury: discontinuity of Gerota's fascia has an increased probability of requiring angioembolization

2010-02-01

Abstract: Background: Angioembolization is an effective adjunct in the management of high-grade renal injuries not surgically treated. However, in some cases, the bleeding may stop spontaneously, without the need for embolization. The aim of this study was to define the characteristics of patients who need angioembolization for high-grade blunt renal injuries (BRIs).Methods: Patients with BRIs between January 2004 and May 2008 were retrospectively reviewed. Patients with contrast extravasation on computed tomographic scans who then underwent angiography were enrolled. Demographics, injury severity scores, abbreviated injury scale scores, amounts of blood transfused, and need for angioembolization were analyzed.Results: Twenty-six patients were enrolled. Patients with discontinuity of Gerota's fascia and pararenal hematoma expansion in BRIs required angioembolization at a higher rate. Furthermore, these patients displayed higher injury severity scores and abbreviated injury scale scores. Five patients experienced complications.Conclusions: In patients with BRIs, discontinuity of Gerota's fascia and pararenal hematoma expansion seemed to be associated with the need for angioembolization. Early angioembolization should be considered in patients with severe associated trauma with BRIs.

Therapeutic value of sesame oil in the treatment of adhesive small bowel obstruction

2010-02-01

Abstract: Background: The optimal treatment of partial adhesive small bowel obstruction (SBO) is still controversial. The purpose of this study was to determine the effects of oral administration of sesame oil to the standard of conservative treatment in this disease.Methods: Sixty-four cases of partial adhesive SBO were retrospectively allocated into either the control group or the intervention group (with sesame oil added), and clinical results were compared.Results: Of the 64 patients, 33 were in the control group and 31 in the intervention group. Significantly fewer patients required surgical intervention in the intervention group than in the control group (4/31 vs 16/33, P = .0029). Less SBO resolution time (24 hour vs 30 hour, P = .0019) and a shorter hospital stay (6 days vs 10 days, P = .0235) were observed in the interventional group.Conclusions: Our study showed that sesame oil was a safe and effective adjunct to the standard treatment of partial adhesive SBO.

Influence of T3 or T4 sympathicotomy for palmar hyperhidrosis

Won Oak Kim, Hae Keum Kil, Kyung Bong Yoon, Duck Me Yoon, Jung Soo Lee — 2009-04-13

Abstract: Background: This retrospective study aimed to compare the efficacy of video-assisted thoracoscopic sympathicotomy at the T3 or T4 level in the treatment of palmar hyperhidrosis.Methods: Patients were operated on for palmar hyperhidrosis from April 2004 to December 2007, and classified as the T3 (n = 56) or T4 (n = 63) sympathicotomy group.Results: The rate of dryness and compensatory hyperhidrosis (CH) was significantly lower in the T4 sympathicotomy group than the T3 group (P < .01). Satisfaction rate, recurrence, and improvement of plantar sweating were of no statistical significance in either group.Conclusions: Although both sympathicotomies were effective, safe, and minimally invasive methods for the treatment of palmar hyperhidrosis, T4 appeared to be a more optimal technique with less CH.

Prospective randomized controlled trial comparing V–Y advancement flap with primary suture methods in pilonidal disease

2009-04-13

Abstract: Background: An ideal treatment method for the widely prevalent pilonidal sinus disease is not yet available. The most commonly practiced technique is simple closure following resection of the effected tissue. However, high recurrence rates in some series have led to the search for other methods. One of these methods is the V–Y advancement flap (VYAF), which in theory results in the flattening of the natal cleft without tension in the suture line.Methods: In this prospective randomized controlled study, the VYAF method was compared to 2 simple primary closure techniques. In 238 patients, following resection, in the AL (all layers) group, all layers were closed with polypropylene sutures. In the SS (subcutaneous suture) group, polyglactin subcutaneous sutures were used to approximate the wound edges. Skin was closed separately in the SS group. In addition, demographic variables, past history, physical examination findings, defect dimensions, and wound tension were recorded.Results: Surgical site infection was observed in 23.9%, 17.4%, and 10.2% of the patients in AL, SS, and VYAF groups, respectively (P = .129). Early wound dehiscence without infection was detected in 11.9%, 7.4%, and 10.2% of the patients in groups AL, SS, and VYAF, respectively (P = .665). Mean follow-up was 29.7 ± 15.6 months. Survival (time without recurrence) was not significantly different between groups (P = .648). In the whole group, independent predictors of recurrence according to logistic regression analysis were younger age, recurrent disease, presence of discharge on physical examination, and development of postoperative surgical site infection.Conclusions: VYAF is not superior to simple primary closure techniques in terms of postoperative complications, recurrence, and patient satisfaction. For most cases, simple primary closure would suffice. Patients should be informed of the increased risk of recurrence if any of the independent predictors (being a recurrent case, presence of discharge, development of postoperative infection) are present.

Secure placement of a peripancreatic drain after a distal pancreatectomy

2009-03-23

Abstract: Background: A peripancreatic drain that is placed after a distal pancreatectomy sometimes migrates and becomes ineffective postoperatively. We devised a new drainage method with fixation of the tip of a peripancreatic drain using a loose loop of an absorbable suture.Methods: This retrospective study was performed on 84 consecutive patients who underwent a distal pancreatectomy followed by peripancreatic drainage with (n = 31) or without (n = 53) fixation.Results: The fixed drain remained in place postoperatively and was removed easily when the drainage became unnecessary. Pancreatic fistula developed in 4 patients with and 11 patients without drain fixation, the incidence between the patients. None with and 7 patients without fixation required additional drainage (interventional or surgical) for pancreatic fistula, the difference being significant. Time to resolution of pancreatic fistula tended to be shorter after drain fixation than after nonfixation.Conclusions: Fixation of the tip of a peripancreatic drain is a simple but useful technique for effective drainage after distal pancreatectomy.

The relationship between weight loss and psychosocial functioning among bariatric surgery patients

2009-04-13

Abstract: Background: Success after bariatric surgery should also reflect improvement in psychosocial functioning. The objective of this study was to assess the relationships between both mental health and eating disorders and weight loss in morbidly obese patients 2 years after gastric bypass.Methods: Forty-three obese women (mean age, 39.3 ± 1.4 years; mean body mass index, 44.7 ± 0.4 kg/m2) were evaluated before and 1 and 2 years after gastric bypass. The Beck Depression Inventory and the Hospital Anxiety and Depression Scale were used for depression and anxiety evaluation and the Eating Disorder Inventory for eating disorder assessment.Results: Decreases in depression (P <.01), anxiety (P <.05), and eating disorder (P <.01) scores were measured 2 years after surgery. Both excess weight loss and change in body mass index were associated with improvements in all measured psychologic outcomes 2 years after surgery.Conclusions: The importance of weight loss is in relation to mental health 2 years after bariatric surgery. Psychologic outcomes and eating disorders did not predict weight loss 2 years after gastric bypass. However, these factors improved significantly after weight loss.

ATA practice guidelines for the treatment of differentiated thyroid cancer: were they followed in the United States?

Olatokunbo M. Famakinwa, Sanziana A. Roman, Tracy S. Wang, Julie Ann Sosa — 2010-02-01

Abstract: Background: The aim of this study was to benchmark national practice patterns against American Thyroid Association guidelines for thyroidectomy, lymphadenectomy, and radioactive iodine (RAI) for differentiated thyroid cancer (DTC).Methods: A cross-sectional analysis of patients with DTC in Surveillance, Epidemiology, and End Results was performed. Outcomes were practice accordance with guidelines for extent of surgery and RAI treatment. Predictors of accordance were identified.Results: A total of 52,964 patients with DTC were included. Seventy-six percent were women, and 83% white. There was 71% accordance with surgery recommendations; among these, 15% underwent central lymphadenectomy, 31% had RAI but no lymphadenectomy, and 25% had RAI and lymphadenectomy. The highest accordance with guidelines was for patients aged <45 years with stage II disease (80%); the lowest accordance was for patients aged ≥45 years with stage II disease (52%). Patients aged >65 years and of black race had the lowest accordance (P < .001).Conclusions: Variation in practice suggests variation in the quality of care for DTC. Greater dissemination of evidence-based recommendations is needed for elderly and minority patients.

Omission of routine chest x-ray after chest tube removal is safe in selected trauma patients

Michael D. Goodman, Nathan L. Huber, Jay A. Johannigman, Timothy A. Pritts — 2010-02-01

Abstract: Background: Definitive practice guidelines regarding the utility of chest x-ray (CXR) following chest tube removal in trauma patients have not been established. The authors hypothesized that the selective use of CXR following chest tube removal is safe and cost effective.Methods: A retrospective review of chest tube insertions performed at a level I trauma center was conducted.Results: Patients who underwent chest tube removal without subsequent CXR had a lower mean Injury Severity Score and were less likely to have suffered penetrating thoracic injuries. These patients received fewer total CXRs and had shorter durations of chest tube therapy and shorter lengths of stay following tube removal. Subsequent reinterventions were performed more frequently in the CXR group. The annual decrease in hospital charges by foregoing a CXR was $16,280.Conclusions: The selective omission of CXR following chest tube removal in less severely injured, nonventilated patients does not adversely affect outcomes or increase reintervention rates. Avoiding unnecessary routine CXR after chest tube removal could provide a significant reduction in total hospital charges.

Six-year experience: long-term disease control outcomes for partial breast irradiation using MammoSite balloon brachytherapy

2009-10-19

Abstract: Background: This report describes estimated 4-year tumor bed and ipsilateral breast recurrence-free intervals, event-free survival, disease-specific survival, and overall survival in a cohort of MammoSite brachytherapy (MBT) patients with mature follow-up treated at a single institution over a 6-year period.Methods and Materials: An analysis of MBT cases was performed by using a prospectively collected quality-assurance database, departmental chart review, and electronic medical records. Patient-, tumor-, treatment-, and outcome-specific data were extracted and recorded into a research database. Patients were eligible for inclusion in this analysis if they were at least 6 months post-MBT.Results: From May 2002 through March 2008, 111 MBT patients have been treated and were eligible for the present analysis. With a median follow-up of 46 months, the estimated 4-year outcomes for the entire cohort were tumor bed control 99%, ipsilateral breast control 95%, event-free survival 88%, disease-specific survival 97%, and overall survival 92%.Conclusions: The present study shows low rates of local and ipsilateral breast disease failure in a well-defined cohort of MBT patients with mature follow-up.

Severity of head computed tomography scan findings fail to explain racial differences in mortality following child abuse

2009-11-06

Abstract: Introduction: Differences in head injury severity may not be fully appreciated in child abuse victims. The purpose of this study was to determine if differential findings on initial head computed tomography (CT) scan could explain observed differential outcome by race.Methods: We identified 164 abuse patients from our trauma registry with an Injury Severity Score (ISS) ≥ 15. Their initial head CT scan was graded from 1 to 4 (normal to severe). Statistical analysis was performed to asses the correlation between race, head CT grade, Glascow Coma Scale (GCS) score, and mortality.Results: Overall mortality was 17%: 11% for white children, 32% for African-American children (P < .05). In review of the head CT scans there was no difference by race in types of injuries or head CT grade. Using a multivariate regression model, African-American race remained an independent risk factor for mortality with an odd ratio of 4.3 (95% confidence interval [CI] 1.6–11.5).Conclusion: African-American children had a significantly higher mortality rate despite similar findings on initial head CT scans. Factors other than injury severity may explain these disparate outcomes.

American Board of Surgery examinations: can we identify surgery residency applicants and residents who will pass the examinations on the first attempt?

John L. Shellito, Jacqueline S. Osland, Stephen D. Helmer, Frederic C. Chang — 2009-11-06

Abstract: Background: The Residency Review Committee requires that 65% of general surgery residents pass the American Board of Surgery qualifying and certifying examinations on the first attempt. The aim of this study was to identify predictors of successful first-attempt completion of the examinations.Methods: Age, sex, Alpha Omega Alpha Honor Medical Society status, class rank, honors in third-year surgery clerkship, interview score, rank list number, National Board of Medical Examiners/United States Medical Licensing Examination scores, American Board of Surgery In-Training Examination scores, resident awards, and faculty evaluations of senior residents were reviewed. Graduates who passed both examinations on the first attempt were compared with those who failed either examination on the first attempt.Results: No subjective evaluations of performance predicted success other than resident awards. Significant objective predictors of successful first-attempt completion of the examinations were Alpha Omega Alpha status, ranking within the top one third of one's medical student class, National Board of Medical Examiners/United States Medical Licensing Examination Step 1 (>200, top 50%) and Step 2 (>186.5, top 3 quartiles) scores, and American Board of Surgery In-Training Examination scores >50th percentile (postgraduate years 1 and 3) and >33rd percentile (postgraduate years 4 and 5).Conclusions: Residency programs can use this information in selecting residents and in identifying residents who may need remediation.

Ischemic preconditioning of small bowel mitigates the late phase of reperfusion injury: heme oxygenase mediates cytoprotection

Ismail H. Mallick, Marc C. Winslet, Alexander M. Seifalian — 2009-04-13

Abstract: Background: Ischemia and reperfusion (IR) injury of the intestine is a major cause of morbidity and mortality following small bowel transplantation. The current study evaluates the effect of ischemic preconditioning (IPC) on the intestinal microcirculation in the late phase of IR injury of the intestine.Methods: Sixty rats were randomly allocated to 5 study groups (n = 12 per group): (1) sham, (2) IR (3) IPC, (4) pyrrolidine dithiocarbamate (PDTC) (HO-1 inducer), and (5) zinc protoporhyrin (ZnPP) (HO-1 inhibitor). Mucosal perfusion and leukocyte–endothelial interactions were measured with the aid of an intravital microscope. At the end of the experiments, blood samples for lactate dehydrogenase (LDH) levels and biopsies of ileum for histologic evaluation were obtained.Results: IPC significantly improved the mucosal perfusion and decreased the leukocyte–endothelial interactions. Histologic examination showed that ileal mucosa was significantly less injured in the IPC and PDTC groups as compared with the IR group.Conclusions: IPC protects the intestine from late reperfusion injury. HO-1 is involved in this protection. These findings may be of significant importance in clinical small bowel transplantation.

Hydroxyethyl starch 130/0.4 augments healing of colonic anastomosis in a rat model of peritonitis

Pengfei Wang, Guanwen Gong, Yousheng Li, Jieshou Li — 2009-11-09

Abstract: Background: This study was designed to investigate the role of hydroxyethyl starch (HES) 130/0.4 on the wound healing process in left colonic anastomoses in the presence of intra-abdominal sepsis.Methods: The left colonic anastomosis was performed in 40 rats that were divided into 4 groups: (1) group SHAM, laparatomy plus cecal mobilization (n = 10); (2) group SHAM + HES, HES130/.4–treated controls (n = 10); and (3) group CLP, cecal ligation and puncture (n = 10); (4) group CLP + HES, CLP plus HES130/.4 (n = 10). HES130/.4 was administrated before the construction of colonic anastomosis, 15 mL/kg/24 hours and daily for 4 postoperative days. Anastomotic bursting pressures (ABPs) were measured in vivo on day 5. Tissue samples were obtained for analyses of hydroxyproline (HP) contents, myeloperoxidase (MPO) activity, malondialdehyde (MDA), reduced glutathione (GSH) levels, and nuclear factor-κB (NF-κB) activation. The plasma levels of tumor necrosis factor (TNF)-α, interleukin (IL)-6, d-dimer, and protein C (PC) were also measured. Anastomotic granulation tissues were fixed for transmission electron microscopic (TEM) analyses.Results: Intra-abdominal sepsis led to significant decreases in colonic anastomotic bursting pressures, perianastomotic tissue HP contents, GSH levels, and plasma levels of PC, along with increases in perianastomotic tissue MPO activity, MDA levels, NF-κB activation, and plasma levels of TNF-α, IL-6, and d-dimer. However, HES130/.4 treatment significantly inhibited all these responses. TEM analyses revealed that there was a trend toward a higher density of fibroblast distribution and a higher rate of fibroblast activation in the SHAM- and HES 130/0.4-treated animals, compared with the CLP group.Conclusions: This study showed that moderate doses (15 mL/kg) of HES 130/0.4 administration significantly prevented this intraperitoneal sepsis-induced impaired anastomotic healing of the left colon. This beneficial effect of HES 130/0.4 can be mainly attributed to its anti-inflammatory and antioxidant properties and beneficial effects of modulating endothelial-associated coagulopathy.

Peri-operative hyperglycemia: a consideration for general surgery?

2010-02-01

Abstract: Background: Intraoperative hyperglycemia in cardiac and neurosurgical patients is significantly associated with morbidity. Little is known about the perioperative glycemic profile or its impact in other surgical populations or in nondiabetic patients.Methods: A systematic review of blood glucose values during major general surgical procedures reported since 1980 was conducted. Data extracted included blood glucose measures, study sample size, gender distribution, age grouping, study purpose, surgical procedure, anesthetic details, and infusion regime. Excluded studies were those with subjects with diabetes insipidus, insulin-treated diabetes, renal or hepatic failure, adrenal gland tumors or dysfunction, pregnancy, and emergency or trauma surgery.Results: Blood glucose levels rose significantly with the induction of anesthesia (P < .001) in nondiabetic patients. At incision, 2 hours, 4 hours, and 6 hours, 30%, 40%, 38%, and 40% of studies, respectively, reported hyperglycemia.Conclusions: Factors that confound or protect against significant rises in perioperative glycemic levels in nondiabetic patients were identified. The findings facilitate investigating the impact of hyperglycemia on general surgical outcomes.

Can the gastrocolic trunk of Henle serve as an anatomical landmark in laparoscopic right colectomy? A postmortem anatomical study

Dejan Ignjatovic, Milan Spasojevic, Bojan Stimec — 2009-11-06

Abstract: Background: The use of the gastrocolic trunk of Henle (GTH) as a landmark has been advocated in laparoscopic right colectomy. The aim of this study was to evaluate the GTH as a possible landmark in laparoscopic right colectomy in the context of the adjacent arteries.Methods: Corrosion casting (30 specimens) and anatomic dissection were performed on formol-fixed cadavers (12 specimens).Results: The GTH was found in 34 specimens (81.0%). Among its closely related neighboring arterial vessels, the right colic artery was the most frequent (19 cases [55.9%]). It passed by the GTH at a mean distance of 3.6 mm. The course of the arteries in relation to the GTH was caudal and parallel in most cases (29 [85.3%]), but there was also a significant portion of crossing schemes (11.7%).Conclusions: Although the GTH is a constant and conspicuous anatomic entity, it is not easily accessible, because of its tight relations to the right colon arteries. Instead, the authors advocate the use the superior right colic vein as an anatomic landmark leading to the GTH during laparoscopic right colectomy.

Addressing the paucity of underrepresented minorities in academic surgery: can the “Rooney Rule” be applied to academic surgery?

Paris D. Butler, Michael T. Longaker, L.D. Britt — 2010-02-01

Healthcare disparities remain a significant problem facing the US healthcare system. Despite the fact that average life expectancy rates have steadily increased for both Caucasians and African Americans over the last 35 years, the approximate 6-year difference between the 2 ethnic groups has not significantly narrowed over this same period of time. Beyond life expectancy, there is also a significant amount of literature describing the vast number of healthcare disparities that currently plague the US healthcare system. The field of surgery, in particular, is laden with these disparities.

Minimally invasive surgery

Giselle G. Hamad, Myriam Curet — 2010-02-01

Abstract: Minimally invasive surgery (MIS), or laparoscopic surgery, plays a vital role in residency training in a number of surgical disciplines including general surgery, surgical oncology, colorectal surgery, pediatric surgery, and thoracic surgery. The tremendous patient demand for MIS over the past 2 decades has resulted in surgeons rapidly embracing this technique. Many general surgery residencies cover basic laparoscopy within their residency program; however, the experience with more advanced cases is more variable. This career resource guides the interested medical student and physician to opportunities for fellowship training in MIS. It includes a discussion of the specialty, training requirements, grant funding, research fellowships, and pertinent societies.

Trauma/critical care surgery

M. Margaret Knudson — 2010-02-01

Abstract: The specialty of trauma/critical care is relatively new and is currently in a state of evolution as we now face not only a shortage of surgeons but also an alarmingly increasing number of well-trained surgeons who are unwilling to provide emergency care. Regionalization of both trauma and emergency surgical care nationwide is on the horizon and will require major changes in our surgical training programs. However, careers in trauma/critical care and emergency surgery can offer a controlled lifestyle, challenging cases that cross over many disciplines, and a rich field for scientific investigation.

Missionary surgery

Rebekah Naylor — 2010-02-01

Abstract: A career in missionary surgery offers professional challenge, much opportunity, and high job satisfaction. Preparation, financial support, job requirements, and difficulties are issues to be considered. However, these are secondary in the context of seeing needy people made whole physically and spiritually.

Career development resource for plastic and reconstructive surgery

Jennifer L. Walden, Linda G. Phillips — 2010-02-01

Abstract: Plastic surgery is a broad-based discipline with emphasis on areas such as breast, craniomaxillofacial, burn, aesthetic, and hand surgery as well as complex wounds and wound healing. Plastic surgery as a specialty captures a great deal of media attention over many other fields of medicine, so education, training, and credentialing have become an area of national interest. The purpose of this article was to provide information on the organization, basic requirements for training, fellowship, and volunteer opportunities within the specialty.

Pediatric surgery: a career resource

Danielle Walsh — 2010-02-01

Abstract: Pediatric surgeons provide care to neonates and children with a unique range of congenital, oncologic, infectious, and traumatic disorders. This unique surgical subspecialty continues to recruit outstanding trainees, despite the additional training required. This career resource guides the interested medical student and physician through the pathway to a practice in pediatric surgery. It includes a discussion of training requirements, research opportunities, board certification, and continuing education.

Duty-hour limitations: a flawed concept

L.D. Britt — 2010-02-01

In responding to the editorial by Fischer et al in the February issue, Dr Søreide boldly takes the role of devil's advocate with respect to duty-hour limitations and concern about the continuity of care. He highlights that current training in Scandinavia is restricted to a 40-hour (on average) week and that most “European surgeons” will be trained under a 48-hour work limitation. Admittedly, the case-scenario format might not have been the best approach to address our concern about the Institute of Medicine report and, possibly, further duty-hour restrictions. However, the fact still remains that no substantive analysis has been done to objectively evaluate the impact of the initial mandate that was broadly implemented in 2003. Before embarking on a path toward further resident work-hour modifications, such a scientific investigation should be done. In addition, Dr Søreide failed to underscore the well-documented escalating problems that our European colleagues are experiencing as a direct result of the work-hour restrictions. Also, to conduct a comparative analysis of the impact that this action has on the health care communities (United States and Europe), the assumption must be made that the communities are indeed similar and that there are minimal confounding variables. The antithesis of such is actually the case. The situation in the United States is indeed a unique one. The “keeping up with the Joneses” approach is undoubtedly flawed. If the focus remains on “trainees,” there are marked differences. For example, because of limited graduate medical education funded positions, the options for programs in the United States to extend the duration of residency years to fulfill curricular obligations are nonexistent. In this country, adherence to the recommendations underscored in the Institute of Medicine's report would definitely be “strike three” in the final out of the last inning of the game!

Retroperitoneal inflammatory myofibroblastic tumor

2009-10-19

Abstract: Inflammatory myofibroblastic tumors are rare, and those located retroperitoneally are even rarer. The authors present the case of a 52-year-old male farmer with a lump in the lower abdomen of 2 months in duration that was retroperitoneal in location. It was excised, and histopathologic examination revealed an inflammatory myofibroblastic tumor. The present case is presented by virtue of its rare location.

Cystic lymphangioma of the lesser omentum in an adult

Elena Martín-Pérez, Daniel Tejedor, Ricardo Brime, Eduardo Larrañaga — 2009-10-19

Abstract: Abdominal lymphangiomas are uncommon congenital benign tumors that occur mainly in children. The authors report the case of a 37-year-old woman with a cystic lymphangioma of the lesser omentum. The lesion was removed surgically with a complete resection. The histologic diagnosis was omental lymphangioma. Complete surgical resection with negative surgical margins is the treatment of choice, and the results are excellent. Incomplete resection may lead to recurrence.

Multiple abdominal granuloma caused by spilled gallstones with imaging findings that mimic malignancy

2010-02-01

Abstract: Multiple abdominal granulomas caused by spilled gallstones during a laparoscopic cholecystectomy are a rare complication. The images of the granuloma mimicked malignancy.

Primary hydatid cyst of the retroperitoneum

2009-12-03

Abstract: Retroperitoneal contamination may occur during the natural history of hydatid disease. Primary hydatid cyst of the retroperitoneum is extremely rare. The authors report a case of a giant retroperitoneal hydatid cyst. Clinicians and surgeons must be aware of this possibility and follow a policy of nonsystematic puncture of an abdominal cyst and avoid spillage during surgery. Symptoms are related to the size, location, or ensuing complications of a cyst. Its occurrence should be strongly suspected ahead of any abdominal cyst, especially in an endemic area, where it may act as a parasite. Total and careful surgical excision is the gold-standard therapy.

Infected primary retroperitoneal teratoma presenting as a subhepatic abscess in a postpartum woman

2010-02-01

Abstract: It is highly unusual for a 20-cm retroperitoneal teratoma to present as a subhepatic abscess with septic shock in a postpartum woman. We present a case of a multilocular cystic teratoma densely adherent to adjacent viscera and vessels. Because of the complexity of the case and the clinical condition of the patient, a 2-stage operation was employed for this special case. An initial emergency drainage effectively relieved symptoms of acute infection and facilitated the 2nd-stage resection of the tumor.

Modified duodenal diverticulization technique for the management of duodenal fistulas

Ruy J. Cruz, Rodrigo Vincenzi — 2009-10-19

Abstract: Background: Duodenal leaks can still occur in up to 25% of trauma patients who have undergone duodenal diverticulization and pyloric exclusion with gastrojejunostomy (PE). We herein describe an alternative technique of duodenal diverticulization used to treat 3 patients that sustained posttraumatic duodenal fistula.Methods: The modified duodenal diverticulization entails stapling of the first and third parts of the duodenum, a distal gastrectomy and a side-to-side duodenojejunostomy. The gastrointestinal transit reconstruction can be performed either with a standard Billroth II gastrojejunostomy, or, preferably, with a Roux-en-Y anastomosis.Results: We did not observe any postoperative complications related to the procedure itself in any of the 3 cases treated by our group.Conclusions: The technique described offers a relatively simple and an apparently safe approach for the treatment of posttraumatic duodenal fistulas. This technique can be used even if the patient was subjected previously to diverting procedures, including duodenal diverticulization or PE.

2010-02-01

The American Journal of Surgery

Editorial board

Differential molecular changes in patients with asymptomatic long-segment Barrett's esophagus treated by antireflux surgery or medical therapy

Prospective clinical and functional results of combined rectal and urogynecologic surgery in complex pelvic floor disorders

Evaluation of need for angioembolization in blunt renal injury: discontinuity of Gerota's fascia has an increased probability of requiring angioembolization

Therapeutic value of sesame oil in the treatment of adhesive small bowel obstruction

Influence of T3 or T4 sympathicotomy for palmar hyperhidrosis

Prospective randomized controlled trial comparing V–Y advancement flap with primary suture methods in pilonidal disease

Secure placement of a peripancreatic drain after a distal pancreatectomy

The relationship between weight loss and psychosocial functioning among bariatric surgery patients

ATA practice guidelines for the treatment of differentiated thyroid cancer: were they followed in the United States?

Omission of routine chest x-ray after chest tube removal is safe in selected trauma patients

Six-year experience: long-term disease control outcomes for partial breast irradiation using MammoSite balloon brachytherapy

Severity of head computed tomography scan findings fail to explain racial differences in mortality following child abuse

American Board of Surgery examinations: can we identify surgery residency applicants and residents who will pass the examinations on the first attempt?

Ischemic preconditioning of small bowel mitigates the late phase of reperfusion injury: heme oxygenase mediates cytoprotection

Hydroxyethyl starch 130/0.4 augments healing of colonic anastomosis in a rat model of peritonitis

Peri-operative hyperglycemia: a consideration for general surgery?

Can the gastrocolic trunk of Henle serve as an anatomical landmark in laparoscopic right colectomy? A postmortem anatomical study

Addressing the paucity of underrepresented minorities in academic surgery: can the “Rooney Rule” be applied to academic surgery?

Minimally invasive surgery

Trauma/critical care surgery

Missionary surgery

Career development resource for plastic and reconstructive surgery

Pediatric surgery: a career resource

Duty-hour limitations: a flawed concept

Retroperitoneal inflammatory myofibroblastic tumor

Cystic lymphangioma of the lesser omentum in an adult

Multiple abdominal granuloma caused by spilled gallstones with imaging findings that mimic malignancy

Primary hydatid cyst of the retroperitoneum

Infected primary retroperitoneal teratoma presenting as a subhepatic abscess in a postpartum woman

Modified duodenal diverticulization technique for the management of duodenal fistulas

Table of contents