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Minimally Invasive/General Surgery
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Effects of honey compared to silver sulfadiazine for the treatment of burns
“Topical dressings containing honey as well as silver sulfadiazine (SSD) have re-emerged as a treatment option for burn wound management. Honey is postulated to facilitate wound healing by its chemical debridement and anti-inflammatory action, and its ability to create a viscous barrier on the wound surface thus preventing the invasion of micro-organisms. Meanwhile, SSD may be considered as the gold standard for topical burn treatment. In contrast to honey, silver-containing dressings are capable of absorbing the burn exudates and releasing silver which has been recognized as an effective antimicrobial agent against a broad range of bacteria, yeast, and viruses. However, recent findings have shown that topical silver delays rather than promotes wound healing and is associated with potentially severe adverse effects.”
The STITCH trial: a summary
One discussion this week mentioned the STITCH trial.
Reference: Deerenberg EB, et al. Small bites versus large bites for closure of abdominal midline incisions (STITCH): a double-blind, multicentre, randomised control trial. Lancet. 2015 Sep 26;386(10000):1254-1260. doi: 10.1016/S0140-6736(15)60459-7.
Summary: Incisional hernia is a frequent complication of abdominal operations with an incidence of 10–23%, which can increase to 38% in specific risk groups. It is associated with pain and discomfort, resulting in a decreased quality of life. Incarceration and strangulation of abdominal contents can take place, for which emergency surgery is indicated, with associated morbidity and mortality. The authors (2015) estimate about 348,000 operations for incisional hernia are done every year in the US with $3.2 billion in annual associated costs.
Myasthenia gravis and vascular endothelial growth factor (VEGF)
“Myasthenia gravis (MG), an antibody-mediated autoimmune disease of the neuromuscular junction, is characterized by muscle weakness and fatigability and is caused by autoantibodies against muscle nicotinic acetylcholine receptor (AChR). The anti-AChR antibody is produced by T cell-dependent and B cell-mediated pathogenic mechanisms, activates the complement system and leads to inflammation of the postsynaptic muscle membrane.” (Uzawa)
Frailty and Emergency Surgery
“Emergency surgery carries higher risk of mortality and morbidity. Appropriate risk assessment, attentive decision-making and carefully selected interventions are the cornerstones of a patient centered management.” (Leiner)
“Frailty, a “syndrome of loss of reserves,” is more than decade old concept. Initially it was used mainly in geriatrics but lately its use has been extended into other specialties including surgery. A meta-analysis demonstrated that frail surgical patients had a higher risk of readmission and increased risk of mortality.” (Leiner)
ACS NSQIP Surgical Risk Calculator
Continue readingDelayed Emergence from Anesthesia
“Despite the medications commonly used in anesthesia allow recovery in a few minutes, a delay in waking up from anesthesia, called delayed emergence, may occur. This phenomenon is associated with delays in the operating room, and an overall increase in costs. Together with the emergence delirium, the phenomenon represents a manifestation of
inadequate emergence. Nevertheless, in delayed emergence, the transition from unconsciousness to complete wakefulness usually occurs along a normal trajectory, although slowed down. On the other hand, this awakening trajectory could proceed abnormally, possibly culminating in the manifestation of emergence delirium. Clinically, delayed emergence often represents a challenge for clinicians who must make an accurate diagnosis of the underlying cause to quickly establish appropriate therapy.”
2020 WSES updated guidelines for the diagnosis and treatment of acute calculus cholecystitis
Pisano M, Allievi N, Gurusamy K, et al. 2020 World Society of Emergency Surgery updated guidelines for the diagnosis and treatment of acute calculus cholecystitis. World J Emerg Surg. 2020 Nov 5;15(1):61. Free full-text.
Conclusions, knowledge gaps and research recommendations: “ELC has a central role in the management of patients with ACC. The value of surgical treatment for high-risk patients should lead to a distinction between high-risk patients and patients who are not suitable for surgery. Further evidence on the role of clinical judgement and the use of clinical scores as adjunctive tools to guide treatment of high-risk patients and patients who are not suitable for surgery is required. The development of local policies for safe laparoscopic cholecystectomy is recommended.”
Surgical Focus 