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.
Continue reading“Malignancies develop in 2⋅5–26 per cent of patients with choledochal malformation. Choledochal malformations are classified according to Todani and colleagues.
Several authors consider the development of malignancy in choledochal malformations to be related to the aetiology of the different types of malformation. It could be speculated that prolonged reflux of pancreatic secretions into the biliary tract occurs in Todani types I and IV,
which frequently present with abnormal pancreaticobiliary duct junctions. Prolonged reflux might lead to malignant degeneration of the biliary epithelium. The situation is supposedly different in types II and III choledochal malformations, which might be true congenital malformations in which reflux is absent”
“Due to the close anatomical relationship between the superior mesenteric vein/portal vein (SMV/PV) and the posterior neck of the pancreas, venous involvement by tumor or
inflammation occurs frequently. SMV/PV involvement was historically considered a sign of advanced pancreatic cancer; however, surgeons, seeking to expand the number of
patients who could benefit from pancreatectomy for cancer, introduced en bloc venous resection. An early pioneer in this work was Fortner who in 1984 described the concept
of regional pancreatectomy with vascular resection in 35 patients. This procedure encountered high mortality (26%) and morbidity that nullified any potential survival benefit.
Over the past three decades, SMV/PV resection during pancreatectomy has grown in frequency as improved surgical outcomes were observed after careful preoperative planning
with the aid of enhanced radiographic imaging. As indications for venous resection during pancreatectomy were refined, observational studies validated the safety of SMV/PV resection.”
“Postoperative small bowel or colic anastomotic bleeding (PSCAB) is often a mild complication and is generally treated by a conservative approach. Other therapeutic options are surgery, endoscopic management and angiographic embolization. Our aim is to review our cases of postoperative anastomotic bleeding in patients with small bowel or colic anastomosis, with special attention to their treatment and complications.”
Continue reading“The incidence of melanoma across the developed world is increasing; in England, the incidence has almost doubled from 6000 cases in 2000 to 11,000 cases in 2011. The 5-
year disease specific survival rate for localised melanoma is 80%2 and for patients with regional (stage III) and distant (stage IV) disease it is 39% and 33% respectively. Sentinel
lymph node biopsy (SLNB) is a minimally invasive technique that identifies patients who have occult lymph node micrometastasis. Research shows that regional lymph node status is the most powerful predictor of survival, and since 2009 the American Joint Committee on Cancer (AJCC) classification for melanoma has incorporated it into the staging system. Since SLNB with dynamic lymph node mapping was introduced in 1992, it is considered the
gold standard of staging for melanoma.”
“The purpose of these guidelines is to provide evidence-based recommendations for the use of intraoperative imaging modalities during laparoscopic cholecystectomy. We assessed surgical outcomes that were deemed to be important to both surgeons and patients by a panel of surgeons. Specifically, the imaging modalities investigated were contrast
intraoperative cholangiography (IOC), fluorescence imaging (FI) with indocyanine green (ICG), and laparoscopic ultrasound (LUS). The target audience for these guidelines
includes surgeons and patients. A patient–physician perspective was taken, so cost-effectiveness, resources requirements, and availability of said resources were not evaluated. These imaging modalities were primarily assessed in the context of the American healthcare system. Therefore, these recommendations may not apply in settings where the relevant
technology is not easily accessible.”
“Laparoscopic cholecystectomy is one of the most common abdominal operations performed in the United States. Injury to the common bile duct is a rare but dreaded complication, often requiring additional surgery or endoscopic intervention. Its occurrence has been increasing since the introduction and widespread adoption of laparoscopy
(0.4–1.5% of cases) compared to open cholecystectomy. Multiple factors may contribute to the risk of common bile duct injury, including the presence of acute inflammation and anatomical variability of the CBD. Strategies such as achieving the Critical View of Safety (CVS) were developed to mitigate this risk.”
“Intraoperative cholangiography (IOC) helps to clarify the biliary tree anatomy, detect common bile duct (CBD) stones, and may prevent or promptly detect BDI. However,
the use of routine (RC) or selective (SC) IOC remains controversial. Some authors have suggested that RC allows for early detection of BDI and repair in the same surgical
procedure, reducing morbidity and mortality.6–8 Also, IOC facilitates the detection and treatment of CBD stones, reducing potential complications and readmissions. In
contrast, opponents emphasize that RC often detects asymptomatic CBD stones leading to unnecessary procedures, increases operating time, costs, and exposes the surgical team and patients to radiation.”
“Direct oral anticoagulants, including rivaroxaban and apixaban, are the most frequently prescribed treatments for acute venous thromboembolism. In randomized clinical trials, rivaroxaban at a dose of 15 mg twice daily for 21 days followed by 20 mg daily and apixaban at a dose of 10 mg twice daily for 7 days followed by 5 mg twice daily were noninferior to vitamin K antagonists regarding efficacy (risk of recurrent venous thromboembolism). These trials showed that clinically relevant bleeding, a composite of major bleeding or clinically relevant nonmajor bleeding, occurred in 4.3% of the patients who received apixaban as
compared with 9.7% of those who received vitamin K antagonists9 and in 8.1% of patients who received rivaroxaban as compared with 8.1% of those who received vitamin K antagonists. The difference between apixaban and rivaroxaban therapy regarding the risk of clinically relevant bleeding was hypothesized to be related to heterogeneity in the patient populations and differences in the trial designs. Owing to a lack of trials that have compared rivaroxaban with apixaban regarding the risk of bleeding, clinical practice guidelines do not recommend one anticoagulant over the other.”
Surgical Focus 