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“High-risk early triple-negative breast cancer is frequently associated with early recurrence and high mortality. Neo-adjuvant chemotherapy is the preferred treatment approach. In addition to potentially increasing the likelihood of tumor resectability and breast conservation, patients who have a pathological complete response after neoadjuvant therapy have longer event-free survival (defined as the time from randomization to the date of disease progression that precluded definitive surgery, the date of local or distant recurrence or the occurrence of a second primary tumor, or the date of death from any
cause) and overall survival. Accordingly, regulatory guidance supports the use of the pathological complete response as an end point for clinical testing of neoadjuvant treatment in patients with early triple-negative breast cancer.”
“This meta-analysis aims to evaluate the comparative outcomes of drain insertion versus no drain after appendicectomy for complicated appendicitis. Abdominal collection, surgical site infection (SSI), bowel obstruction, faecal fistula, paralytic ileus, length of hospital stay (LOS) and mortality were the evaluated outcome parameters for the meta-analysis. Seventeen studies reporting a total number of 4,255 patients who underwent appendicectomy for complicated appendicitis with (n=1,580) or without (n=2,657) drain were included.
There was no significant difference between the two groups regarding abdominal collection (odds ratio (OR)=1.41, P=0.13). No-drain group was superior to the drain group regarding SSI (OR=1.93, P=0.0001), faecal fistula (OR=4.76, P=0.03), intestinal obstruction (OR=2.40, P=0.04) and paralytic ileus (OR=2.07, P=0.01). There was a difference regarding mortality rate between the two groups (3.4% in the drain group vs 0.5% in the no-drain group, risk difference (RD)=0.01, 95% CI (-0.01, 0.04), P=0.36).”
DG: drain group, NDG: no-drain group, RCT: randomized controlled trial, NA: not available.
| Study | Country | Type of the study | Number of patients | Type of operation | Inclusion/exclusion criteria and definition of complicated appendicitis |
| Stone et al., 1978 [25] | Georgia | Retrospective cohort | Total: 94; DG: 49; NDG: 45 | Open | Inclusion and exclusion criteria: NA. Definition of complicated appendicitis: gangrenous or perforated appendicitis |
| Greenall et al., 1978 [26] | United Kingdom | RCT | Total: 103; DG: 48; NDG: 55 | Open | Exclusion criteria: appendicular mass/abscess. Definition of complicated appendicitis: gangrenous appendicitis, associated with turbid infected fluid |
| Dandapat and Panda, 1992 [27] | India | RCT | Total: 86; DG: 40; NDG: 46 | NA | NA |
| Tander et al., 2003 [28] | Turkey | RCT | Total: 140; DG: 70; NDG: 70 | Open | Inclusion criteria: paediatric cases with uncomplicated perforated appendicitis. Exclusion criteria: appendicular mass/abscess. Definition of complicated appendicitis: gross or microscopic evidence of appendicular perforation with no more discolouration of peritoneal fluid after washing out |
| Narci et al., 2007 [29] | Turkey | Retrospective cohort | Total: 226; DG: 109; NDG: 117 | Open | Inclusion criteria: children with macroscopic perforation. Exclusion criteria: appendix could not be visualized and drained without appendectomy. Definition of complicated appendicitis: macroscopic perforation |
| Allemann et al., 2011 [30] | Switzerland | Case match study | Total: 260; DG: 130; NDG: 130 | Laparoscopic | Exclusion criteria: simple acute appendicitis (i.e., no peritoneal reaction), generalized peritonitis, preoperatively known immunodeficiencies, aged <16 years and incomplete dataset. Definition of complicated appendicitis: localized peritonitis, perforation of the appendix, presence of pus or fibrin membranes around the appendix or frank peri-appendicular abscess |
| Jani and Nyaga, 2011 [31] | Kenya | RCT | Total: 90; DG: 45; NDG: 45 | Open | Inclusion criteria: advanced appendicular pathology and aged over 13 years. Exclusion criteria: simple acute appendicitis or laparoscopic appendicectomy. Definition of complicated appendicitis: perforated, mass or phlegmon |
| Pakula et al., 2014 [32] | USA | Retrospective cohort | Total: 148; DG: 43; NDG: 105 | Laparoscopic | Inclusion criteria: patients with the diagnosis of gangrenous or perforated appendicitis based on the review of pathology and operative reports. Exclusion criteria: simple or suppurative appendicitis and those treated with interval appendectomy. Definition of complicated appendicitis: gangrenous and perforated appendicitis |
| Song and Jung, 2015 [33] | Korea | Retrospective cohort | Total: 342; DG: 108; NDG: 234 | Open: 181; Laparoscopic: 161 | Inclusion criteria: children under 18 years old who were diagnosed with acute appendicitis. Definition of complicated appendicitis: perforated appendicitis |
| Schlottmann et al., 2016 [35] | Argentina | Retrospective cohort | Total: 225; DG: 169; NDG: 56 | Laparoscopic | Inclusion and exclusion criteria: NA. Definition of complicated appendicitis: intraoperatively as the presence of gangrenous/perforated appendicitis with peritonitis |
| Abdulhamid and Sarker, 2018 [36] | Iraq | Retrospective cohort | Total: 227; DG: 114; NDG: 113 | Open | Inclusion criteria: open appendectomy for complicated appendicitis irrespective of age. Definition of complicated appendicitis: perforated with localized abscess formation |
| Aneiros Castro et al., 2018 [37] | Spain | Retrospective cohort | Total: 192; DG: 79; NDG: 63 | Laparoscopic | Inclusion criteria: patients with perforated appendicitis. Exclusion criteria: incidental appendectomy during another laparoscopic surgical procedure and those treated with interval appendectomy. Definition of complicated appendicitis: identifiable macroscopic hole in the appendix during the surgery |
| Miranda-Rosales et al., 2019 [38] | Peru | Retrospective cohort | Total: 150; DG: 50; NDG: 100 | Open | Inclusion criteria: aged >18 years with complicated appendicitis. Exclusion criteria: laparoscopic appendicectomy, patients on anticoagulation, immunocompromised and pregnancy. Definition of complicated appendicitis: localized or generalized peritonitis and appendicular abscess |
| Fujishiro et al., 2021 [39] | Japan | Propensity-matched study | Total: 1,762; DG: 485; NDG: 1304 | Open: 346; Laparoscopic: 958 | Inclusion criteria: complicated appendicitis in children (aged 15 years and below). Exclusion criteria: interval appendectomies. Definition of complicated appendicitis: perforation, gangrene or intra-abdominal abscess |
| Nazarian et al., 2021 [40] | UK | Retrospective cohort | Total: 76; DG: 26; NDG: 50 | Laparoscopic | Inclusion criteria: over the age of 16 with complicated appendicitis. Exclusion criteria: caecal/appendicular malignancy. Definition of complicated appendicitis: histologically proven gangrenous or perforated appendicitis |
| Schmidt et al., 2020 [41] | Germany | Retrospective cohort | Total: 65; DG: 32; NDG: 33 | Open: 11; Laparoscopic: 55 | Inclusion criteria: age range from two to 17 years who presented with perforated appendicitis. Exclusion criteria: severe neurological dysfunction and inflammatory bowel disease. Definition of complicated appendicitis: perforated appendicitis on histology |
| Mustafa et al., 2020 [34] | Pakistan | RCT | Total: 68; DG: 34; NDG: 34 | Open | Exclusion criteria: immunocompromised patients and those with generalized peritonitis (perforated appendix with pus in three or more quadrants of the abdominal cavity visible per-operatively). Definition of complicated appendicitis: perforated appendicitis intra-operatively |
“Hepatic resection has been thought to he the most effective treatment modality for selected patients who have left-sided hepatolithiasis and meet the criteria of resection.” Under the same criteria the role of right hepatic resection, especially right hepatic lobectomy, is still ambiguous for patients who have right-sided hepatolithiasis because of the higher operative risk. This report presents the results of right hepatic lobectomy in the treatment of patients with right-sided hepatolithiasis after careful selection. In particular, we focus on the
rationale and indications for this procedure,”
“Trauma to abdominal wall blood vessels occurs in 0.2% to 2% of laparoscopic procedures. Both superficial and deep abdominal wall vessels are at risk. The superficial vessels may be located by transillumination; however, the deep epigastric vessels cannot be effectively located by transillumination and, thus, other techniques should be used to minimize the risk of injury to these vessels.”
“The development of an anastomotic stricture at the site of the gastrojejunostomy following Roux-en-Y gastric bypass (RYGBP) is associated with substantial morbidity. Various techniques are available for creating the gastrojejunal anastomosis, including hand-sewing and using a circular or linear stapler, to reduce complication rates. The aim of this study was to assess the incidence of gastrojejunal anastomotic strictures in patients who underwent antecolic antegastric Roux-en-Y gastric bypass (AA-RYGBP) with the use of a linear stapler and to evaluate the outcomes of endoscopic pneumatic dilatation as a treatment option for patients with anastomotic stricture.”
Continue reading2013
“Annually, more than 20 million inguinal herniorrhaphies are performed worldwide, and it is one of the most common operations performed by general surgeons. Up to one third of patients with inguinal hernias are asymptomatic or minimally symptomatic at the time of presentation. Historically, surgeons have recommended repair of an inguinal hernia at diagnosis even if minimally symptomatic to avoid a hernia accident, which is defined as a bowel obstruction caused by the hernia or strangulation of the contents of the hernia, or both. However, on the basis of the results of 2 recent randomized clinical trials (RCTs), one conducted in the United Kingdom and the other in North America, watchful waiting (WW) has now become an accepted alternative to routine repair. In 2011, the longer-term
results of the United Kingdom trial were published. Using Kaplan-Meier analysis, 72% of patients were predicted to crossover (CO) from WW to surgery by 7.5 years causing the authors to conclude that routine repair should be recommended for minimally symptomatic
patients without medical contraindications to surgery.”
“The results of this study show that WW remains a safe strategy even on long-term follow-up. However, patients who present to their physicians to have the hernia evaluated, especially if they are elderly, should be informed that they will almost certainly come to
surgery eventually. These results should not be extrapolated to the broader population of all patients with asymptomatic or minimally symptomatic hernias.”
Fitzgibbons, Robert J Jr et al. “Long-term results of a randomized controlled trial of a nonoperative strategy (watchful waiting) for men with minimally symptomatic inguinal hernias.” Annals of surgery vol. 258,3 (2013): 508-15. Full Text for Emory Users
Continue reading“Rates of postoperative bleeding and transfusion are either widely variable or often unreported. As a high-volume center, we have anecdotally appreciated significant rates of each but admittedly have not accurately reported the degree of this specific morbidity in
our practice. This study aims to quantify postoperative blood loss, rates of blood transfusion, and the incidence of operative or endovascular intervention for bleeding, as well as associated risk factors contributing to this morbidity in patients undergoing open TAR.”
Surgical Focus 