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“Since Ravitch and Steichen introduced a modified form of the Soviet-developed stapling instruments in the 1960s, various types of staplers and stapling techniques have been adopted worldwide. There are two main types of stapled intestinal anastomoses: anatomical end-to-end anastomoses, performed with circular staplers, and functional side-to-side anastomoses, performed with linear staplers. According to several studies, stapled anastomoses have rendered hand-sewn anastomoses obsolete. It is known that less time is required for stapled intestinal anastomosis than for conventional hand-sewn anastomosis, and that the rate of anastomostic-related complications after stapling is acceptably low. However, some articles have pointed out that stapled anastomoses are unfavorable in certain situations. To our knowledge there are no papers in the literature comparing stapled and manual anastomosis in emergency traumatic or nontraumatic intestinal surgery. Thus, we conducted a prospective randomized study to compare emergency intestinal surgical
stapling with manual suturing.”
“EL is a procedure performed for a heterogenous group of patients for a diverse range of pathologies, such as intestinal obstruction, perforation and peritonitis. Patients are often
frail with limited physiological reserve. The in-hospital mortality rate is 9.3%, increasing to 15.3% in patients aged >65 years, compared with 1—2% for elective procedures. EL
carries a higher risk of postoperative complications, and SSI is more likely after dirty procedures where the surgical site is already contaminated.
Use of a care bundle has been shown to reduce the SSI rate by 40—50% in patients undergoing elective colorectal surgery and 7.6% in patients undergoing EL. There is
no consensus on what constitutes a care bundle for SSI, except inclusion of three or more interventions.”
“The impact of rotation of the Roux limb after initial staple division, and creation of the jejunojejunal anastomosis and its relation to the biliopancreatic limb on the development of internal herniation has not been adequately addressed. It is probable, due to the wide range of reported incidences, that there are details to the construction of the limb that play a vital role in the propensity for development of internal hernias. The objective of current study was to investigate whether direction of rotation of the Roux limb to create the jejunojejunostomy has any influence on rates of internal herniation. We hypothesized that counterclockwise rotation of Roux limb with the jejunojejunostomy performed on the left side of the axis of the mesentery with biliopancreatic limb remaining on the left side of the axis, is associated with better orientation and decreased incidence of internal herniation.”
“Statistics regarding ostomy-related metrics remain elusive in the United States because of underreporting and coding limitations. The estimated number of ostomates in the United States is 750,000 to 1 million, with approximately 150,000 new ostomies created each year. Stoma creation has a relatively high rate of associated morbidity, ranging from 20% to 80%; peristomal skin complications and parastomal hernia (PSH) are the most common associ-
ated morbidities. A population-based study using the Michigan Surgical Quality Collaborative, which included 4250 patients, identified a 37% unadjusted surgical complication rate for elective cases involving an ostomy and 55% unadjusted surgical complication rate for emergency cases involving an ostomy. In this study, risk-adjusted stomarelated morbidity rates varied significantly among hospitals, indicating a potential to improve outcomes in outlying institutions.”
Incisional hernia ‘(IH0 is a relatively common complication after liver transplant
(LT). The overall incidence of 15.1% reported within this analysis is comparable to that documented in patients undergoing “major abdominal laparotomy” where meta-analyses suggests that IH occurs at a rate approaching 13%. Within aggregate laparotomy data, procedure-specific incidences can vary considerably from the median; rates of IH after open aortic aneurysm repair, for example, exceed 30%. This highlights the importance of understanding incidence in a procedure-specific fashion. Among laparotomy patients, LT represents a unique combination of patient- and procedure-specific factors that challenge the relevance of non-transplantation data to this population; as such we have provided the first aggregate analysis of IH after LT to better understand this disease.”
“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.”
Surgical Focus 