Cirrhotic liver disease is an important cause of peri-operative morbidity and mortality in general surgical patients. Early recog-nition and optimization of liver dysfunction is imperative before any elective surgery. Patients with MELD <12 or classified asChild A have a higher morbidity and mortality than matched controls without liver dysfunction, but are generally safe for electiveprocedures with appropriate patient education.
“Forty-eight percent of VTEs after ventral hernia repair occur after discharge, particularly in older, male, obese patients undergoing longer and complex operations that require hospitalization > 1 day. Post-discharge thromboprophylaxis should be considered in these patients, particularly when risk of VTE exceeds 0.3%.”
Continue reading“Urologic injury often occurs in the context of severe multisystem trauma that requires close cooperation with trauma surgeons. The urologist remains an important consultant to the trauma team, helping to ensure that the radiographic evaluation of urogenital structures is performed efficiently and accurately, and that the function of the genitourinary system is preserved whenever possible. Immediate interventions for acute urologic injuries often require flexibility in accordance with damage control principles in critically ill patients. In treating urotrauma patients, urologists must be familiar with both open surgical techniques and minimally invasive techniques for achieving hemostasis and/or urinary drainage.”
Continue reading“This study hypothesized that there may be additional differences between trauma surgery (TS) and emergency general surgery (EGS) patients, because the physiologic conditions are typically dominated by hemodynamic instability from hemorrhage in the former, whereas the latter is predominantly complicated by sepsis. The 2 groups may also have different patient demographics, with TS patients being younger and more likely to be male than EGS patients.”
Continue reading“Pancreatic neuroendocrine tumors (PNETs) comprise a heterogeneous group of neoplasms arising from pancreatic islet cells that remain relatively rare but are increasing in incidence worldwide. While significant advances have been made in recent years with regard to systemic therapies for patients with advanced disease, surgical resection remains the standard of care for most patients with localized tumors. Although formal pancreatectomy with regional lymphadenectomy is the standard approach for most PNETs, pancreas-preserving approaches without formal lymphadenectomy are acceptable for smaller tumors at low risk for lymph node metastases.”
“The purpose of this study was to compare the rates of small bowel obstruction, anastomotic complications, and wound infections between stapled and handsewn closures of loop ileostomies. The diverting loop ileostomy is a commonly used stoma, often employed to diminish the consequences of an anastomotic leak in low colorectal anastomoses, ileal pouch-anal anastomoses, and in situations where reversible patient factors increase the risk of an anastomotic dehiscence. They are also used to divert the fecal stream in the event of an anastomotic leak and, occasionally, in severe fistulizing perianal disease.”
Continue reading“Trials comparing handsewn with stapled anastomoses in colon and rectal surgery have not found statistical differences. Despite this, authors have differed in their conclusions as to which technique is superior. To help determine whether differences in patient outcomes are present, a meta-analysis of all trials was performed.”
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Surgical Focus 