Surgery (SURGERY)

Publications in this journal

• Article: Scrotal sepsis

  Fahal AH, Nasr A
  Surgery 02/2013; 13(8):2-3.
• Article: Construct Validation and Comparison of a Novel Postoperative Quality of Life Metric and the Short Form 36 in Colorectal Surgery Patients

  DS Keller
  Surgery 01/2013; Submitted.
• Article: A Five-year Review of a Trauma-trained Hospitalist Program for Trauma Patients: A Matched Cohort Study

  Alessandro Orlando, Kristin Salottolo, Phyllis Uribe, Patricia A Howell, Denetta S Slone, David Bar-Or
  Surgery 01/2012;
• Article: Impact of subcentimeter margin on outcome after hepatic resection for colorectal metastases: A meta-regression approach.

  Cucchetti A, Ercolani G, Cescon M, Bigonzi E, Peri E, Ravaioli M, Pinna AD
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  ABSTRACT: BACKGROUND: The optimal margin width and its influence on outcomes after hepatic resection for colorectal liver metastases is still controversial: a meta-analysis was conducted to analyze the impact of subcentimeter margin width on patient and disease-free survival after resection. METHODS: A systematic search was performed, covering the last decade, following the Meta-analysis Of Observational Studies in Epidemiology guidelines. Relative risks (RRs) for patient and disease-free survival (DFS) were calculated after resection in relationship to a margin width >1 cm (R0 > 1 cm) and between 1 mm and 1 cm (R0 < 1 cm) using the DerSimonian and Laird random-effects model. Meta-regression was applied for covariate adjustment. RESULTS: Eleven observational studies were identified involving 2823 patients. Overall, 59.1% of patients were R0 < 1 cm and 40.9% were R0 > 1 cm. Meta-analysis showed that compared with patients with margins R0 > 1 cm, a R0 < 1 cm margin lead to decreased 1-, 3-, and 5-year DFS with a RR of 1.17 (95% confidence interval [CI] 1.07-1.27), 1.38 (95% CI 1.16-1.65), and 1.55 (95% CI 1.25-1.91), respectively, but patient survival was not obviously affected (P > .05 in all cases). Patients with margins of R0 < 1 cm differ from those with R0 > 1 cm for greater proportions of multiple metastases (RR 1.43; 95% CI 0.25-1.61) and synchronous bowel disease (RR 1.42; 95% CI 0.8-1.92). Meta-regression showed that these two covariates had a significant impact on DFS but not on patient survival. CONCLUSION: A resection margin width >1 cm is desirable even if patient survival is at best only slightly affected by subcentimeter margin as a consequence of a decreased DFS. The presence of multiple metastases and synchronous bowel neoplasm represent potential study selection biases that significantly decrease DFS; well-conducted, matched analyses consequently are essential to clarify the issue.
  Surgery 01/2012;
• Article: BH surgery TECHNIQUES: SUTURING AND KNOT TYING IN LAPAROSCOPY

  Hasukic S
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  ABSTRACT: ABSTRACT Many of the principles of operative laparoscopic surgery are quite different from those of conventional surgery and adequate time and training are required to master the necessary skills. Laparoscopic procedures are performed while monitoring a two-dimensional television screen with up to six times magnification; this eliminates depth perception and direct tactile feeling of the tissue. Thus the operations require significant hand-eye coordination. Each surgeon must be thoroughly familiar with the basic principles, instrumentation, and limitations of these operations. This review of suturing and knot tying procedures may be helpful to both the established surgeons and the beginners as it gives a comprehensive review of laparoscopic suturing and knot tying techniques. Every laparoscopic surgeon must master these techniques perfectly.
  Surgery 06/2011; 1(1):53-58.
• Article: Minimally invasive transthoracotomy-transphrenotomy for concurrent hepatic and pulmonary hydatid disease.

  Lone GN, Bhat MA, Ali N, Ahangar AG, Dar AM, Sana I
  Surgery 06/2011; 92(6):729-23.
• Article: E-cadherin and hereditary diffuse gastric cancer.

  Corrado Pedrazzani, Giovanni Corso, Daniele Marrelli, Franco Roviello
  Surgery 12/2007; 142(5):645-57.
• Article: A letter from the battlefront.

  Chad J Davis
  Surgery 12/2007; 142(5):773-5.
• Article: Femoral neck fracture as a complication of lipase-secreting pancreatic acinar cell carcinoma.

  Masao Hashimoto, Kenji Miki, Yoshifumi Beck, Norihiro Kokudo, Masatoshi Makuuchi, Hiroshi Tanaka
  Surgery 12/2007; 142(5):779-80.
• Article: Synergistic effect of intratumoral IL-12 and TNF-alpha microspheres: systemic anti-tumor immunity is mediated by both CD8+ CTL and NK cells.

  Michael S Sabel, Alisha Arora, Gang Su, Edith Mathiowitz, Joshua J Reineke, Alfred E Chang
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  ABSTRACT: Neoadjuvant immunotherapy with the combination of intratumoral IL-12 and TNF-alpha encapsulated in poly-lactic acid microspheres (PLAM) generate a greater systemic immune response than either cytokine alone. We sought to examine the effector cells responsible for this synergy using the poorly immunogenic B16 melanoma and MCA205 sarcoma cell lines. Splenocytes from MCA205 bearing mice treated with IL-12 and TNF-alpha PLAM contained significantly more tumor-specific IFN-gamma secreting cells than IL-12 alone. Adoptive transfer of lymphocytes from mice treated by the combination mediated significant tumor regression in mice bearing established pulmonary metastases. In mice bearing bilateral tumors, treatment of the primary with IL-12 and TNF-alpha PLAM, resulted in suppression of contralateral tumor growth. Both the local and distant effects were absent in mice depleted of CD8+ T-cells. In B16 bearing mice with established pulmonary disease, only the combination of intratumoral IL-12 and TNF-alpha resulted in a significant reduction of lung nodules. Both the local and distant effects were eradicated in mice depleted of either CD8+ T-cells or NK cells. The local and sustained release of IL-12 and TNF-alpha using PLAM synergistically activate both a cytotoxic T-cell and NK cell response, although their impact varies with MHC class I expression.
  Surgery 12/2007; 142(5):749-60.
• Article: Traumatic ventricular septal defect.

  C Clay Cothren, Ernest E Moore
  Surgery 12/2007; 142(5):776-7.
• Article: An anticancer drug sensitivity test to determine the effectiveness of UFT as postoperative adjuvant chemotherapy for patients with stage III colorectal cancer.

  Akiko Isogai, Masaki Nagaya, Hiromitsu Matsuoka, Taiji Watanabe, Satoshi Tsukikawa, Sunao Kubota
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  ABSTRACT: Tissue samples from patients with pathologic ((p)) stage III colorectal cancer were tested for sensitivity to 5-fluorouracil (5-FU). On the basis of the results, patients were divided into 5-FU-sensitive and 5-FU-resistant groups, and both groups were treated with fluoropyrimidine (UFT) as postoperative adjuvant chemotherapy. Recurrence, 5-year survival rates, and 5-year recurrence-free survival rates were compared. The anticancer sensitivity test described in this study was carried out using tumor samples obtained surgically from 34 patients with curatively resectable colorectal cancer that had been diagnosed definitively as (p)stage III (IIIa, 23 patients; IIIb, 11 patients). Regardless of tumor sensitivity or resistance to 5-FU, all 34 patients were subsequently treated daily with UFT at 300 mg/day as postoperative adjuvant chemotherapy. Treatment was initiated 3 weeks after surgery and continued for 2 years. Of the 34 patients with (p)stage III colorectal cancer, the tumors of 16 (47%) were 5-FU-sensitive (S group) and 18 (53%) were 5-FU-resistant (R group). The recurrence rates in the S and R groups following postadjuvant therapy with UFT were 25% and 61%, respectively, which is a significantly lower response in the S group (P = .045). The odds ratio of recurrence in the R group vs. the S group was 4.71. The 5-year survival rate was 85.7% in the S group and 46.7% in the R group, but the difference was not significant (P = .066). The 5-year recurrence-free survival rate was significantly higher in the S group than in the R groups (71% vs. 32%, P = .010). According to Cox's multivariate analysis of recurrence-free survival, the sensitivity test was significantly predictive. Administration of UFT as postoperative adjuvant therapy to 5-FU-resistant patients had no significant effect on outcome.
  Surgery 12/2007; 142(5):741-8.
• Article: Consensus defining postpancreatectomy complications: an opportunity we cannot ignore.

  Carlos Fernández-del Castillo
  Surgery 12/2007; 142(5):771-2.
• Article: Surgical site infections after colorectal surgery: do risk factors vary depending on the type of infection considered?

  Jennifer Blumetti, Myda Luu, George Sarosi, Kathleen Hartless, Jackie McFarlin, Betty Parker, Sean Dineen, Sergio Huerta, Massimo Asolati, Esteban Varela, Thomas Anthony
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  ABSTRACT: The purpose of this study was to compare risk factors for the development of incisional versus organ/space infections in patients undergoing colorectal surgery. An institutional review board-approved retrospective review was performed examining a 4-year period (January 2002 to December 2005). Patients were included if they had undergone abdominal operations (open or laparoscopic) in which the colon/rectum was surgically manipulated. Patients were excluded if the surgical wound was not closed primarily. A standardized definition of incisional and organ/space infection was employed. A total of 428 operations were performed. Overall, 105 infections were identified (25%); 73 involved the incision and 32 were classified as organ/space. Multivariate analysis suggested that incisional infection was independently associated with body mass index (odds ratio [OR], 1.07; 95% confidence interval [CI], 1.02-1.11) and creation/revision/reversal of an ostomy (OR, 2.2; 95% CI, 1.3-3.9). Organ/space infection was independently associated with perioperative transfusion (OR, 2.3; 95% CI, 1.1-5.5) and with previous abdominal surgery (OR, 2.5; 95% CI, 1.2-5.3). Factors associated with infection differed based on the type of surgical site infection being considered. The lack of overlap between factors associated with incisional infection and organ/space infection suggests that separate risk models and treatment strategies should be developed.
  Surgery 12/2007; 142(5):704-11.
• Article: Role of three-dimensional imaging in operative planning for hilar cholangiocarcinoma.

  Itaru Endo, Hiroshi Shimada, Mitsutaka Sugita, Yoshiro Fujii, Daisuke Morioka, Kazuhisa Takeda, Sadatoshi Sugae, Kuniya Tanaka, Shinji Togo, Holger Bourquain, Heinz O Peitgen
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  ABSTRACT: Complex, highly variable, anatomic relationships in the portal hilum complicate the surgical management at hilar cholangiocarcinoma. Preoperative three-dimensional (3D) imaging to stage the tumor and define anatomy may help in planning for curative resection. Between 2003 and 2006, 20 consecutive patients with hilar cholangiocarcinoma underwent preoperative multidetector row computed tomography (MDCT) cholangiography; 3D images of the portal vein, hepatic artery, and bile ducts were created and viewed simultaneously. Longitudinal tumor extension was evaluated by direct cholangiography and 3D cholangiography, and contiguous spread by 2D computed tomography (CT). Of 20 patients, 15 underwent surgical resection. Liver resection was planned based on 3D imaging that allowed visualization of the relationship between the tumor and the umbilical portion of the left portal vein, or the bifurcation of the anterior and posterior branch of the right portal vein. Preoperative and operative findings were compared. All patients tolerated 3D CT without serious complication. The accuracy rates of longitudinal tumor extension, using the Bismuth-Corlette classification system, were 85% (11/13) and 87% (13/15) with direct cholangiography and 3D cholangiography, respectively. The sensitivity, specificity, and accuracy rates were 100%, 80%, and 87% for portal invasion and 75%, 91%, and 87% for hepatic arterial invasion. The number of bile duct orifices in the cut end of the hilar plate was estimated correctly in 13 of 15 patients. There were no operative deaths. Potentially curative resection was achieved in 14 of 15 patients. 3D images provide accurate information about the relationship between hilar cholangiocarcinoma and adjacent vessels. This technique is a powerful new tool for improving the proportion of potentially curative resection.
  Surgery 12/2007; 142(5):666-75.
• Article: A cost-effective approach to establishing a surgical skills laboratory.

  David A Berg, Richard E Milner, Carol A Fisher, Amy J Goldberg, Daniel T Dempsey, Harsh Grewal
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  ABSTRACT: Recent studies comparing inexpensive low-fidelity box trainers to expensive computer-based virtual reality systems demonstrate similar acquisition of surgical skills and transferability to the clinical setting. With new mandates emerging that all surgical residency programs have access to a surgical skills laboratory, we describe our cost-effective approach to teaching basic and advanced open and laparoscopic skills utilizing inexpensive bench models, box trainers, and animate models. Open models (basic skills, bowel anastomosis, vascular anastomosis, trauma skills) and laparoscopic models (basic skills, cholecystectomy, Nissen fundoplication, suturing and knot tying, advanced in vivo skills) are constructed using a combination of materials found in our surgical research laboratories, retail stores, or donated by industry. Expired surgical materials are obtained from our hospital operating room and animal organs from food-processing plants. In vivo models are performed in an approved research facility. Operation, maintenance, and administration of the surgical skills laboratory are coordinated by a salaried manager, and instruction is the responsibility of all surgical faculty from our institution. Overall, the cost analyses of our initial startup costs and operational expenditures over a 3-year period revealed a progressive decrease in yearly cost per resident (2002-2003, $1,151; 2003-2004, $1,049; and 2004-2005, $982). Our approach to surgical skills education can serve as a template for any surgery program with limited financial resources.
  Surgery 12/2007; 142(5):712-21.
• Article: C-reactive protein and natural IgM antibodies are activators of complement in a rat model of intestinal ischemia and reperfusion.

  Niubel Diaz Padilla, Arlène K van Vliet, Ivo G Schoots, Mercedes Valls Seron, M Adrie Maas, Esther E Posno Peltenburg, Annebeth de Vries, Hans W M Niessen, C Erik Hack, Thomas M van Gulik
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  ABSTRACT: The role of C-reactive protein (CRP), natural immunoglobulin M (IgM), and natural IgM against phosphorylcholine (anti-Pc IgM) was investigated in relation with complement activation in a rat model of intestinal ischemia and reperfusion (II/R). The effect of C1-esterase inhibitor (C1-Inh) on this complement activation along with other inflammatory mediators was also studied. Rats were subjected to 1 h of superior mesenteric artery occlusion and 3 h of reperfusion. Intravenous administration of vehicle (human albumin) or C1-Inh (200 U/kg) was performed before (n = 8) or after ischemia (n = 8). II/R increased levels of C4b/c, CRP, IgM, anti-Pc IgM, and myeloperoxidase activity in the intestinal homogenates and induced vascular leakage. A good correlation was observed in the intestinal homogenates between C4b/c and CRP levels. Clear depositions of C3, CRP, and IgM in intestinal tissue were demonstrated after II/R, and a strong correlation of both CRP and IgM with complement was observed. C1-Inh administered before ischemia reduced the complement activation response after II/R, as reflected by decreased levels of C4b/c in conjunction with reduced anti-Pc IgM in the intestinal homogenates. C1-Inh also decreased leakage of albumin when administered before ischemia. C1-Inh after ischemia reduced C4b/c levels and myeloperoxidase activity in the homogenates. CRP and IgM depositions correlated well with local complement activation, which suggests a role of these molecules in complement activation. Furthermore, C1-Inh inhibited potentially II/R injury either administered before or after ischemia, by attenuating complement activation induced by CRP and/or natural IgM antibodies.
  Surgery 12/2007; 142(5):722-33.
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  Article: Endosalpingiosis of choledochal duct.

  Isabel Mesquita, Ana Encinas, Cátia Gradil, José Davide, Jorge Daniel, Luís Graça, Manuel Teixeira
  Surgery 12/2007; 142(5):778.
• Article: Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS).

  Moritz N Wente, Claudio Bassi, Christos Dervenis, Abe Fingerhut, Dirk J Gouma, Jakob R Izbicki, John P Neoptolemos, Robert T Padbury, Michael G Sarr, L William Traverso, Charles J Yeo, Markus W Büchler
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  ABSTRACT: Delayed gastric emptying (DGE) is one of the most common complications after pancreatic resection. In the literature, the reported incidence of DGE after pancreatic surgery varies considerably between different surgical centers, primarily because an internationally accepted consensus definition of DGE is not available. Several surgical centers use a different definition of DGE. Hence, a valid comparison of different study reports and operative techniques is not possible. After a literature review on DGE after pancreatic resection, the International Study Group of Pancreatic Surgery (ISGPS) developed an objective and generally applicable definition with grades of DGE based primarily on severity and clinical impact. DGE represents the inability to return to a standard diet by the end of the first postoperative week and includes prolonged nasogastric intubation of the patient. Three different grades (A, B, and C) were defined based on the impact on the clinical course and on postoperative management. The proposed definition, which includes a clinical grading of DGE, should allow objective and accurate comparison of the results of future clinical trials and will facilitate the objective evaluation of novel interventions and surgical modalities in the field of pancreatic surgery.
  Surgery 12/2007; 142(5):761-8.
• Article: Randomized clinical trial of mesh versus non-mesh primary inguinal hernia repair: long-term chronic pain at 10 years.

  Ruben N van Veen, Arthur R Wijsmuller, Wietske W Vrijland, Wim C J Hop, Johan F Lange, Johannus Jeekel
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  ABSTRACT: Open mesh or non-mesh inguinal hernia repair may influence the incidence of chronic postoperative pain differently. A total of 300 patients scheduled for repair of a primary unilateral inguinal hernia were randomized to non-mesh or mesh repair. The primary outcome measure was clinical outcome including persistent pain and discomfort interfering with daily activity. Long-term results at 3 years of follow-up have been published. Included here are 10-year follow-up results with respect to pain. Of the 300 patients, 87 patients (30%) died and 49 patients (17%) were lost to follow-up. A total of 153 were physically examined in the outpatient clinic after a median long-term follow-up of 129 months (range, 109 to 148 months). None of the patients in the non-mesh or mesh group suffered from persistent pain and discomfort interfering with daily activity. Our 10-year follow-up study provides evidence that mesh repair of inguinal hernia is equal to non-mesh repair with respect to long-term persistent pain and discomfort interfering with daily activity. An important new finding from the patient's perspective is that chronic postoperative pain seems to dissipate over time.
  Surgery 12/2007; 142(5):695-8.