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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Mesh placement in ventral hernia repair

Abdominal wall reconstruction is a relevant and important topic not only in plastic and reconstructive surgery, but in the practice of general surgeons. The ideal anatomic location for mesh placement during the repair of ventral hernias has been debated; however, the most common anatomic locations include onlay, inlay, sublay-retromuscular, sublaypreperitoneal, and sublay-intraperitoneal techniques (Alimi)

(Alimi)
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Anterior versus posterior component separationfor hernia repair in a cadaveric mode

Component separation via both anterior and posterior approaches provide substantial myofascial advancement.In our model, we noted statistically greater anterior fascial medialization after PCS versus ACS as a whole, and especiallyin the upper and mid-abdomen. We advocate PCS as a reliable and possibly superior alternative for linea alba restoration forreconstructive repairs, especially for large defects in the upper and mid-abdomen.

Majumder

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Component separation index

“Abdominal wall reconstruction in the ventral hernia patient represents a constant challenge to the general surgeon and plastic and reconstructive surgeon. Current studies lack a predictive value or objective 3-dimensional measurement to assist in the treatment algorithm or to assess and analyze surgical outcomes. On the basis of our current data, we believe the component seperation index, much like other commonly used anthropomorphic measurements, can assist with decisions for reconstructive options preoperatively.”

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Fundoplication at the Time of Laparoscopic Paraesophageal Hernia Repair

“Laparoscopic paraesophageal hernia repair is a complex surgical problem with many variables that can affect the outcome. Based on the results of our carefully selected patients, the addition of a fundoplication minimizes postoperative reflux symptoms without additional operative time. In addition, neither dysphagia nor paraesophageal hernia recurrence is affected by the presence of a fundoplication.”

van der Westhuizen
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Management controversies for paraesophageal hernia

“Paraesophageal hernia repair remains a staple in the armamentarium of the foregut surgeon. Current literature suggests paraesophageal hernia repair should be approached
in a patient-centered, precision medicine manner. In general, hernia reduction, sac excision, and primary suture approximation of the hiatal crura are mandatory. Use of mesh should be based on individual risk factors; if mesh is used, biological meshes appear to have a more favorable safety profile, with the “reverse C” or keyhole configuration allowing for increase in crural tensile strength at it most vulnerable areas.”

Hiatal hernias are categorized into four types (Rogers)
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