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PGY-specific benchmarks improve resident performance on Fundamentals of Laparoscopic Surgery tasks.
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PGY-specific benchmarks improve resident performance on Fundamentals of Laparoscopic Surgery tasks.

Am J Surg. 2018 Feb 08;:

Authors: Hoops HE, Haley C, Kiraly LN, An E, Brasel KJ, Spight D

Abstract
BACKGROUND: Although expert proficiency times for Fundamentals of Laparoscopic Surgery (FLS) tasks exist, these times are not always attainable for junior residents. We hypothesize that post-graduate year (PGY)-specific benchmarks will improve resident performance of FLS tasks.
METHODS: In 2014, PGY-specific benchmarks were developed for FLS tasks for PGY1-PGY4 general surgery residents by averaging completion times for each task from 2007 to 2013. Resident performance on each FLS task and overall performance was compared for PGY1-PGY4 residents in the 2007-2013 group and the 2014-2016 group, before and after implementation of PGY-specific benchmarks.
RESULTS: There was a significant improvement in FLS performance in the 2014-2016 group at the PGY1 (p = 0.01), PGY2 (p < 0.01), and PGY3 (p = 0.01) levels, but no difference at the PGY4 level (p = 0.71).
CONCLUSIONS: PGY-specific benchmarks may improve efficacy of laparoscopic skills training for junior residents, increasing the efficiency of skill development.

PMID: 29453126 [PubMed - as supplied by publisher]




Positive sentinel lymph nodes in melanoma: Which patients need completion lymph node dissection?
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Positive sentinel lymph nodes in melanoma: Which patients need completion lymph node dissection?

Am J Surg. 2018 Jan 31;:

Authors: Macfarlane JK

PMID: 29453125 [PubMed - as supplied by publisher]




Open abdomen in liver transplantation.
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Open abdomen in liver transplantation.

Am J Surg. 2018 Jan 31;:

Authors: Chan T, Bleszynski MS, Youssef DS, Segedi M, Chung S, Scudamore CH, Buczkowski AK

Abstract
INTRODUCTION: Damage control laparotomy with vacuum assisted closure (VAC) is used for selective cases in trauma. In liver transplantation, VAC has also been applied for management of intra-operative hemorrhage. The primary objective was to evaluate peri-operative blood loss and blood product utilization in VAC compared to primary abdominal closure (PAC) at the index transplant operation.
METHODS: Retrospective review of all adults undergoing deceased donor liver transplantation (2007-2011) at a single center tertiary care institution.
RESULTS: 201 deceased donor liver transplantations were performed, with 167 PAC and 34 VAC cases. Intra-operative blood loss (4.4L vs 10.7L), cell saver return (1399 ml vs 3998 ml), FFP (7.6U vs 15.9U) and PLT requirements (8.5U vs 18.3U), were all significantly elevated in VAC compared to PAC. VAC patients had significantly increased RBC, FFP, PLT, and total volume requirements during initial ICU admission. 30 PAC cases required on demand laparotomy and most commonly for post-operative bleeding.
CONCLUSION: In liver transplantation, application of VAC secondary to massive intra-operative exsanguination was safely utilized. Further evaluation is required to identify long-term morbidity and mortality.

PMID: 29448990 [PubMed - as supplied by publisher]




Redefining "bowel regimen": Pharmacologic strategies and nutritional considerations in the management of small bowel fistulas.
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Redefining "bowel regimen": Pharmacologic strategies and nutritional considerations in the management of small bowel fistulas.

Am J Surg. 2018 Feb 12;:

Authors: Parli SE, Pfeifer C, Oyler DR, Magnuson B, Procter LD

Abstract
Enterocutaneous fistulae (ECF) and enteroatmospheric fistulae (EAF) are difficult complications that primarily arise after abdominal surgical procedures. Development of an ECF or EAF carries significant mortality and morbidity. Effective management of patients with these disease states requires a multidisciplinary approach, which includes surgical, pharmacotherapeutic, and nutritional interventions. This review focuses on the medical and nutritional management of ECF/EAF, providing background on drug agents and nutritional strategies that may be helpful in reducing effluent volume, optimizing fistula healing, and maintaining nutritional health.

PMID: 29448989 [PubMed - as supplied by publisher]




Right ventricular fractional area of change is predictive of ventilator support days in trauma and burn patients.
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Right ventricular fractional area of change is predictive of ventilator support days in trauma and burn patients.

Am J Surg. 2018 Feb 05;:

Authors: Younan D, Pigott DC, Gibson CB, Gullett JP, Zaky A

Abstract
Echocardiography has contributed to the care of critically ill patients but there remains a need for more publications about its association with outcomes to confirm its role. We conducted a retrospective review of trauma and burn patients that were admitted to our intensive care unit between 2015 and 2017 that underwent hemodynamic transesophageal echocardiography. Data collected included demographics, clinical and laboratory data. Right ventricle fractional area of change (RVFAC) measurements were performed on still mages obtained from mid-esophageal four-chamber-view clips. There were 74 patients, mean age was 51 years, and were predominantly white and male. Linear regression was used to test for the association between RVFAC and clinical outcomes. Adjusting for age, injury mechanism and injury severity, higher RVFAC was significantly associated with lower ventilator days (p = 0.03). Conclusion, higher right ventricle systolic function is associated with a lower number of ventilator support days in critically injured trauma and burn patients.

PMID: 29439775 [PubMed - as supplied by publisher]




Panniculectomy after bariatric surgical weight loss: Analysis of complications and modifiable risk factors.
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Panniculectomy after bariatric surgical weight loss: Analysis of complications and modifiable risk factors.

Am J Surg. 2018 Feb 07;:

Authors: Derickson M, Phillips C, Barron M, Kuckelman J, Martin M, DeBarros M

Abstract
INTRODUCTION: Bariatric surgery results in massive weight loss, leaving many patients with redundant skin that can cause significant physical and psychosocial limitations. We sought to identify variables associated with postoperative complications and adjuncts associated with the mitigation of postoperative complications.
METHODS: A retrospective review was performed of all post-bariatric surgery patients who underwent panniculectomy over a 10-year period.
RESULTS: Total 706 patients included. Overall complication rate was 56%: dehiscence (24%), surgical site infection (22%), seroma (18%), and post-operative bleeding (5%). Return to operating room rate was 12%. Significant factors were: BMI >26 (p < 0.01), fleur-de-lis panniculectomy (p < 0.01), concomitant hernia repair (p < 0.01). Multivariate regression analysis demonstrated ASA class >2 (OR 1.97, p < 0.05) and incision type (OR 1.64, p < 0.05) to be independent predictors of morbidity.
CONCLUSION: High morbidity for post-bariatric panniculectomy is primarily local wound complications. Potentially modifiable factors that increase the complication risk profile include higher BMI, higher ASA class, and the use of fleur-de-lis incision.

PMID: 29439774 [PubMed - as supplied by publisher]




Sarcopenia is not associated with morbidity, mortality, or recurrence after esophagectomy for cancer.
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Sarcopenia is not associated with morbidity, mortality, or recurrence after esophagectomy for cancer.

Am J Surg. 2018 Jan 31;:

Authors: Aye Md RW

PMID: 29433749 [PubMed - as supplied by publisher]




Commentary on NPSA paper: Uptake and impact of synoptic reporting in a community care setting. Jordan Eng, Colleen McGahan, Eric Cai, Christopher Baliski.
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Commentary on NPSA paper: Uptake and impact of synoptic reporting in a community care setting. Jordan Eng, Colleen McGahan, Eric Cai, Christopher Baliski.

Am J Surg. 2018 Jan 31;:

Authors: Harvey A

PMID: 29433748 [PubMed - as supplied by publisher]




Importance of mesh overlap on hernia recurrence after open umbilical hernia repair with bilayer prosthesis.
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Importance of mesh overlap on hernia recurrence after open umbilical hernia repair with bilayer prosthesis.

Am J Surg. 2018 Feb 02;:

Authors: Porrero JL, Cano-Valderrama O, Castillo MJ, Marcos A, Tejerina G, Cendrero M, Porrero B, Alonso MT, Torres AJ

Abstract
BACKGROUND: importance of mesh overlap on recurrence after open umbilical hernia repair has been poorly studied.
METHODS: a retrospective cohort study was performed with patients who underwent open umbilical hernia repair with bilayer prosthesis between 2004 and 2015.
RESULTS: 1538 patients were included. Fifty patients (3.3%) had a mesh overlap lower than 1 cm. After a mean follow-up of 4.1 years 53 patients (3.5%) developed a recurrence. Recurrence was associated with a mesh overlap smaller than 1 cm (10.2% vs. 3.3%, p = 0.010, OR = 3.3). In the logistic regression model an overlap smaller than 1 cm was not statistically associated with recurrence (OR = 2.5, p = 0.123). Female gender, postoperative complications and prosthesis size were associated with hernia recurrence.
CONCLUSIONS: mesh overlap seems to be an important factor for hernia recurrence. A mesh overlap of at least 1 cm should be used until more studies are performed about this issue.

PMID: 29429547 [PubMed - as supplied by publisher]




Percutaneous cholecystostomy: A simple bridge to surgery or an alternative option for the management of acute cholecystitis?
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Percutaneous cholecystostomy: A simple bridge to surgery or an alternative option for the management of acute cholecystitis?

Am J Surg. 2018 Jan 31;:

Authors: Stanek A, Dohan A, Barkun J, Barkun A, Reinhold C, Valenti D, Cassinotto C, Gallix B

Abstract
BACKGROUND: Percutaneous cholecystostomy (PC) is an alternative among high-risk surgical patients or those with multiple comorbidities, but its indications have not been clearly established in the literature. The aim of this paper is to provide the reader with an updated review of the literature summarizing what is known on this topic.
DATA SOURCES: We reviewed articles from 1979 to 2016 using the PubMed/Medline Database on PC and especially those evaluating this option as a bridge to surgery.
CONCLUSIONS: There remains a paucity of randomized control trials to ascertain the use of PC as a definitive treatment for acute cholecystitis. In most studies, more than 50% of patients underwent PC as a definite treatment without subsequent cholecystectomy. A newer avenue of endoscopic ultrasound is also discussed, which requires rigorous trials to determine its appropriate applications.

PMID: 29429546 [PubMed - as supplied by publisher]




Retraction notice to "High-concentration supplemental perioperative oxygen and surgical site infection following elective colorectal surgery for rectal cancer: A prospective, randomized, double-blind, controlled, single-site trial" [Am J Surg 208 (2014) 719-726].
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Retraction notice to "High-concentration supplemental perioperative oxygen and surgical site infection following elective colorectal surgery for rectal cancer: A prospective, randomized, double-blind, controlled, single-site trial" [Am J Surg 208 (2014) 719-726].

Am J Surg. 2018 Feb 07;:

Authors: Schietroma M, Cecilia EM, Sista F, Carlei F, Pessia B, Amicucci G

PMID: 29428157 [PubMed - as supplied by publisher]




Midwest surgical association 2017 presidential address.
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Midwest surgical association 2017 presidential address.

Am J Surg. 2018 Feb 07;:

Authors: Shoup M

PMID: 29428156 [PubMed - as supplied by publisher]




Statin medications are associated with decreased risk of sepsis and anastomotic leaks after rectal resections.
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Statin medications are associated with decreased risk of sepsis and anastomotic leaks after rectal resections.

Am J Surg. 2018 Jan 31;:

Authors: Disbrow D, Seelbach CL, Albright J, Ferraro J, Wu J, Hain JM, Shanker BA, Cleary RK

Abstract
BACKGROUND: This study was designed to determine the effect of statins on colorectal postoperative complications related to sepsis. Previous studies have reported conflicting results.
METHODS: This is a retrospective propensity score analysis of postoperative outcomes from a large regional database of patients who underwent elective colorectal resection from June 2012-July 2015.
RESULTS: 7285 patients met inclusion criteria: 34.5% received statins. Propensity score matching revealed that patients taking statins had reduced risk of sepsis (3.75% vs 5.32%, p = .03). Subgroup analysis revealed that this difference was driven by patients undergoing rectal resections. Among the rectal resection group, anastomotic leaks were more common in the non-statins group (4.1% vs. 1.3%, p = .01). There was no significant difference between those taking statins and those not on statin medications with respect to composite SSI or 30-day mortality.
CONCLUSIONS: Statin medications are associated with decreased risk of sepsis after colorectal surgery and anastomotic leaks after rectal resection. Future studies should focus on medication type, dosage, and duration to confirm these results and identify patient populations that would benefit most from statin therapy.

PMID: 29428155 [PubMed - as supplied by publisher]