Essential Articles for Surgical Residents (2022-2023)

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We are excited to share a new section titled “Essential Articles for Surgical Residents.”

Keeping up with surgical literature in residency can be challenging. This list was created to serve as an easily accessible, up-to-date, and evidence-based resource for residents.

The content has been curated by faculty from each department and is intended to supplement the standard educational curriculum of each rotation with current and relevant literature.

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Histological Margin Positivity in the Prediction of Recurrence After Crohn’s Resection

The presence of involved histological margins at the time of index resection in Crohn’s disease is associated with recurrence, and plexitis shows promise as a marker of more aggressive disease. Further studies with homogeneity of histopathological and recurrence reporting are required.“”The presence of involved histological margins at the time of index resection in Crohn’s disease is associated with recurrence, and plexitis shows promise as a marker of more aggressive disease. Further studies with homogeneity of histopathological and recurrence reporting are required.

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Optimev study. Clinical presentation and mortality in pulmonary embolism

“Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a common clinical problem associated with significant mortality and life-long morbidity among hospitalized patients and outpatients. The diagnosis of VTE is challenging because of the non specific signs and symptoms of this disease.”

“The aim of this study was to investigate the clinical presentation and 3-month mortality associated with some forms of VTE: PE with DVT, and PE without DVT.”

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Life-threatening pelvis sepsis

“Although extremely uncommon, severe sepsis does occur post-treatment for haemorrhoids and all surgeons who treat such patients should be aware of the potential complications and alert to their presenting features. Early presentation without evidence of tissue necrosis may be managed conservatively, although most cases are managed by means of surgery.”

“Treatments for haemorrhoids can be divided in to conservative measures such as anal hygiene and topical ointments or suppositories, and interventions.

These are either office-based such as:
-injection sclerotherapy
-rubber band ligation (RBL)
-surgical procedures.

Haemorrhoidectomy has long been the mainstay of surgical therapy, but recently new techniques have been described, principally the stapled haemorrhoidopexy or procedure for prolapsing haemorrhoids (PPH).”

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Sugammadex and anaphylaxis

“Anaphylaxis is described as a severe, life‑threatening, generalized or systemic hypersensitivity reaction. It occurs rarely during surgery and anesthesia but neuromuscular blocking agents, non‑steroidal anti‑inflammatory drugs (NSAIDs), and antibiotics are considered common causes of anaphylaxis”

“Sugammadex is a synthetic modified gamma‑cyclodextrin derivative first designed to selectively bind to the steroidal neuromuscular blocking agent molecule to provide rapid recovery of neuromuscular function. Sugammadex is extensively used for reversing the effects of rocuronium and to a lesser extent, vecuronium.”

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Identification and Management of Perioperative Anaphylaxis

The most commonly involved agents in perioperative anaphylaxis are NMBAs, antibiotics, antiseptics, latex, and dyes However, any medication or substance the patient comes into contact with perioperatively can be a potential cause. The primary risk factor is a previous perioperative anaphylaxis or allergy to the medications or substances used in the procedure.

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Mesenteric Venous Thrombosis

“Mesenteric venous thrombosis is caused by impairment of venous return of the bowel due to local blood coagulation. Primary mesenteric venous thrombosis is considered spontaneous and idiopathic, whereas secondary mesenteric venous thrombosis is due to an underlying condition. Mesenteric venous thrombosis can lead to venous engorgement and mesenteric ischemia and accounts for 5 to 15 percent of mesenteric ischemic events.”

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Non-Hepatic Abdominal Surgery in Patients with Cirrhotic Liver Disease

Cirrhotic liver disease is an important cause of peri-operative morbidity and mortality in general surgical patients. Early recog-nition and optimization of liver dysfunction is imperative before any elective surgery. Patients with MELD <12 or classified asChild A have a higher morbidity and mortality than matched controls without liver dysfunction, but are generally safe for electiveprocedures with appropriate patient education.

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