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“Hemorrhoids are vascular structures that arise from a channel of arteriovenous connective tissues and drain into the superior and inferior hemorrhoidal veins. Although hemorrhoids are categorized as external or internal based on their relationship with the dentate line, they communicate with one another and often coexist. Symptoms related to hemorrhoids are very common in the Western hemisphere and other industrialized societies. Although published estimates of prevalence vary, hemorrhoidal disease represents one of the most common medical and surgical disease processes encountered in the United States, resulting in more than 2.2 million outpatient evaluations per year. Many diverse symptoms may be, correctly or incorrectly, attributed to hemorrhoids by both patients and referring physicians. As a result, it is important to identify symptomatic hemorrhoids as the underlying source of the
anorectal report and to have a clear understanding of the evaluation and management of this disease process. These guidelines address diagnostic and therapeutic modalities
in the management of hemorrhoidal disease.”
“Acute severe gastrointestinal bleeding is a common cause of death worldwide. Bleeding can occur from the upper or lower gastrointestinal tract, but upper gastrointestinal bleeding is more common. The leading causes are peptic ulcer, oesophageal varices, and malignancy. The case fatality rate is approximately 10% for upper gastrointestinal bleeding and 3% for lower gastrointestinal bleeding. Many patients re-bleed after initial haemostasis and those that do have a four times increased risk of death. Patients with acute severe gastrointestinal bleeding usually present with haematemesis or melaena. Patients are often haemodynamically unstable and in need of urgent resuscitation. Acute management
of gastrointestinal bleeding includes blood product transfusion, medical or endoscopic therapy, and surgery.”
“Central venous catheters (CVC) are commonly used for monitoring and administering medication. The Seldinger technique is routinely used for CVC insertion; however, this technique has an inherent risk of guidewire retention. The mechanism behind guidewire retention is debated, with some authors reporting cases where guidewires “slip” or are sucked into the vasculature at the point of insertion, presumably due to physiological blood flow exhibiting a force on the guidewire that overcomes the frictional force between the guidewire and the CVC lumen, which should prevent guidewire slippage. This is the basis for widely adopted guidance that mandates that operators should hold onto the guidewire at all times while it remains intravascular during CVC insertion. However, this may be an
oversimplification of retention events, as most guidewires are likely to remain intraluminally should the operator inadvertently take their hand off them during the procedure. Indeed, the forces exerted by blood flow and pressure differentials are much greater during arterial
procedures, although in the opposite direction. If these forces were sufficient to overcome friction, guidewires would be ejected from catheters whenever the operator took his/her hand off the guidewire. When retention occurs, the guidewire can migrate from the catheter
into the patient’s vasculature and heart and may cause complications such as arrhythmia, vascular damage, thrombosis, cardiac perforation, and tamponade.”
“Wound healing is a complex process requiring a finely tuned immune response. Cancer patients often have risk factors for impaired healing, including older age, malnutrition, steroid use, and prior treatments. Traditionally, oncologic therapies like cytotoxic chemotherapy or anti-angiogenic drugs (e.g., bevacizumab) are known to delay wound healing by suppressing cell proliferation or blood vessel growth. In contrast, immunotherapies stimulate immune activity rather than directly inhibiting regenerative pathways. The net effect of immunotherapy on wound repair is not yet fully understood. Early clinical observations have been mixed—some reports suggest immunotherapy can be given safely during the perioperative period, whereas others have noted higher rates of wound complications in certain settings. Given the increasing overlap of surgery, wound care, and immunotherapy in oncology, a thorough review of current evidence is warranted.”
“Anastomotic leak (AL) represents a dreaded complication following colorectal surgery, with a prevalence of 1-19 per cent. There remains a lack of consensus regarding factors that may predispose to AL and the relative risks associated with them. The objective was to perform a systematic review of the literature, focusing on the role of preoperative, intraoperative and postoperative factors in the development of colorectal ALs.”
“In recent years, indocyanine green (ICG) fluorescence imaging has emerged as an alternative tool to enhance the visualization of biliary structures during LC. ICG is a fluorescent dye that, when injected intravenously, is preferentially taken up by the liver and excreted into the bile ducts. When exposed to near-infrared light, ICG causes the biliary structures, such as the CD, CBD, and CA, to fluoresce, making them more distinguishable from surrounding tissues thereby facilitating real-time visualization of biliary structures during the dissection of Calot’s triangle. The timing of ICG injection is critical to ensure that the biliary anatomy lights up distinctly without interference from non-biliary structures.
However, the routine use of ICG fluorescence imaging in LC has not yet been standardized, and there is ongoing debate about whether its widespread adoption would significantly reduce the incidence of BDI and improve patient outcomes. This systematic review aims to provide a comprehensive evaluation of the efficacy and safety of ICG fluorescence imaging in LC, specifically comparing its impact on the incidence of BDI to that of conventional white light (WL) imaging.”
BDI, bile duct injury; CBD, common bile duct; CD, cystic duct; CHD, common hepatic duct; ICG, indocyanine green; LC, laparoscopic cholecystectomy; WL, white light; -, not specified
| Author(s) and year | Visualization of CD | Visualization of CBD | Visualization of CHD | Visualization of the CD-CBD junction | Incidence of BDI using ICG | Incidence of BDI using WL |
| Symeonidis et al., 2024 | No significant difference (p = 0.225) | No significant difference (p = 0.276) | No significant difference (p = 0.940) | No significant difference (p = 0.827) | 0 | 0 |
| Ma et al., 2023 | Before dissecting Calot’s: no significant difference (p = 0.075). After dissecting Calot’s: ICG signifi-cantly improved visualization (p = 0.02) | Before dissecting Calot’s: no significant difference (p = 0.075). After dissecting Calot’s: ICG signifi-cantly improved visualization (p = 0.02) | – | – | 0 | 0 |
| Xu et al., 2023 | – | – | – | – | 0 | 0 |
| Stolz et al., 2023 | No significant difference | No significant difference | No significant difference | No significant difference | – | – |
| Lie et al., 2023 | Improved RR 1.24, 95% CI 1.07–1.43, p = 0.003 | Improved: RR 1.31, 95% CI 1.07–1.60, p = 0.009 | – | – | No significant difference: (RR 0.34, 95% CI 0.07–1.58, p = 0.17) | No significant difference: (RR 0.34, 95% CI 0.07–1.58, p = 0.17) |
| Losurdo et al., 2022 | – | – | – | – | 0 | 1.4%, p = 0.728 |
| Lacuzzo et al., 2022 | – | – | – | – | 0 | 0 |
| Jin et al., 2022 | – | – | – | – | 0 | 1.83%, p = 0.389 |
| Lim et al., 2021 | No significant difference: RR = 0.90, p = 0.12, 95% CI 0.79– 1.03, I² = 74% | No significant difference: RR = 0.82, p = 0.09, 95% CI 0.65– 1.03, I² = 87% | ICG significantly improved visualization: RR = 0.58, p = 0.03, 95% CI 0.35–0.93, I² = 91% | No significant difference: RR = 0.68, p = 0.06, 95% CI 0.45– 1.02, I² = 94% | 0 | 2 (0.55%) |
| Dip et al., 2021 | – | – | – | – | 1 (0.06%) | 12 (0.25%) |
| Broderick et al., 2021 | – | – | – | – | 0 | 1 (0.1%), p = 1 |
| Keeratibharat, 2021 | ICG signifi-cantly improved visualization, p = 0.001 | ICG signifi-cantly improved visualization, p = 0.002 | ICG signifi-cantly improved visualization, p = 0.000 | – | 0 | 0 |
| Ambe et al., 2019 | – | – | – | – | 0 | 0 |
| Dip et al., 2019 | Before dissecting Calot’s: ICG signifi-cantly improved visualization (p ≤ 0.001). After dissecting Calot’s: no significant difference (p = 0.83) | Before and after dissecting Calot’s: ICG signifi-cantly improved visualization (p < 0.001) | Before and after dissecting Calot’s: ICG signifi-cantly improved visualization (p < 0.001) | Before and after dissecting Calot’s: ICG signifi-cantly improved visualization (p < 0.001) | 0 | 2 (0.62%) |
“Aspiration is a process whereby material from the oropharynx and stomach enter the larynx or lower respiratory tract; it is reported to occur in 10.3% of patients who are diagnosed with community-acquired pneumonia and 30% of patients with pneumonia who are admitted from a long-term care facility. Approximately 90% of patients in intensive care units (ICU) also experience aspiration events at least once during their ICU stay.
Aspiration pneumonia is an infectious and inflammatory process of microorganisms, which colonize in the aspirated materials. It has been demonstrated that bronchoscopy accompanied with bronchoalveolar lavage (BAL) is helpful for patients with aspiration-induced lung injury in order to reveal causative organisms and determine the appropriate duration of antibiotic treatment. It is also known that the initial administration of appropriate antibiotics can lower the mortality rate in these patients.”
Surgical Focus 