Obesity, Metabolic Syndrome, and Breast Cancer: From Prevention to Intervention
AbstractPurpose of reviewObesity contributes to an estimated forty-percent, or 630,000 cases, of malignant neoplasms diagnosed in the United States, and higher body mass index (BMI) has been associated with at least seventeen types of solid tumors, including 9% of all breast cancer cases. In this review, we discuss the impact of obesity and consequences of obesity, including the metabolic syndrome and type 2 diabetes mellitus, on breast cancer risk and recurrence.Recent findingsRecent work has identified multiple molecular mechanisms that may underlie the association between obesity and breast cancer. In particular, insuli...
Source: Current Surgery Reports - February 24, 2018 Category: Surgery Source Type: research
Oligometastatic Disease in Lung Cancer for Surgeons: An Update
AbstractPurpose of reviewStage IV non-small cell lung cancer (NSCLC) is a heterogenic disease with constant challenges for physicians. In the case of oligometastatic disease, surgery has a crucial role. In selected cases of a possible indolent progression of the malignancy, a surgical approach is recommended to control the disease. The management of this subset of patients should be performed in a multidisciplinary team in order to define the best strategy for each patient.Recent findingsThe implementation of optimizing surgical management has demonstrated better outcomes in terms of long-term survival with no detrimental ...
Source: Current Surgery Reports - February 16, 2018 Category: Surgery Source Type: research
Multimodality Treatment of Advanced Non-small Cell Lung Cancer: Where are we with the Evidence?
This article outlines the current and outstanding evidence for the use of multimodality treatment in this group of patients, including in combination with an increasing number of treatment options, such as immunotherapy and genotype-targeted small molecule inhibitors.Recent findingsOptimal therapy for surgically resectable stage III disease remains debatable and currently the choice of treatment reflects each individual patient ’s disease characteristics and the expertise and opinion of the thoracic multi-disciplinary team. Evidence for a distinct oligometastatic state in which improved outcomes can be achieved remai...
Source: Current Surgery Reports - February 8, 2018 Category: Surgery Source Type: research
Ear Reconstruction and 3D Printing: Is It Reality?
AbstractPurpose of ReviewAutologous reconstruction of microtia, the most common congenital external ear deformity, is one of the more challenging plastic surgical procedures, causing obligatory donor site morbidity and often resulting in suboptimal aesthetic outcomes. Recent advances in the fields of tissue engineering and 3D printing promise to profoundly affect the practice of reconstructive surgery.Recent Findings3D printed guides are already used by reconstructive surgeons during correction of complex anatomic defects. Similarly, the prosthetics industry has benefited from the ability to rapidly prototype customized pi...
Source: Current Surgery Reports - February 1, 2018 Category: Surgery Source Type: research
Physician Wellness in Surgical Residency
AbstractPurpose of ReviewPhysician wellness has become an increasing focus of attention in recent years as burnout among healthcare professionals appears to be on the rise. Within this review, we attempt to define burnout and describe the ways in which resident well-being is being addressed within surgical residency programs.Recent FindingsBurnout is a psychological construct, defined by emotional exhaustion, depersonalization, and a low sense of personal accomplishment, which has been shown to affect physicians beginning in their medical training. In spite of mounting evidence of the negative effects of burnout on physici...
Source: Current Surgery Reports - January 25, 2018 Category: Surgery Source Type: research
Non-classic LCIS Versus Classic LCIS Versus Atypical Hyperplasia: Should Management be the Same?
AbstractPurpose of ReviewThis review summarizes the literature from the last 5 years regarding atypical ductal hyperplasia (ADH), atypical lobular hyperplasia (ALH), classic lobular carcinoma in situ (C-LCIS), and non-classic LCIS (NC-LCIS).Recent FindingsADH, ALH, and C-LCIS are well-established markers of increased breast cancer risk. Recent studies suggest the possibility of observation for select cases of ADH diagnosed on core biopsy; however, guidelines support routine excision. In contrast, accumulating data support observation for ALH and C-LCIS on core biopsy with radiographic –pathologic concordance. D...
Source: Current Surgery Reports - January 23, 2018 Category: Surgery Source Type: research
Rescue in Acute Care Surgery: Evolving Definitions and Metrics
AbstractPurpose of ReviewRescue is salvage of a patient after the development of a complication. This review describes the origins of this concept and provides an update on the factors influencing the ability to rescue acute care surgery (ACS) patients.Recent FindingsThe current literature on rescue in ACS reveals the complex interplay of patient and hospital characteristics that shape the development of complications and mortality during admission. Our unique patient population requires careful monitoring and timely intervention to achieve optimal outcomes. The definition of rescue in ACS patients is evolving based upon o...
Source: Current Surgery Reports - January 22, 2018 Category: Surgery Source Type: research
Intragastric Balloons: Indications, Options, Outcomes
ConclusionIGBs have favorable safety profiles and have shown significant short-term weight-loss improvement over lifestyle modification or pharmacotherapy. Further investigation is required to determine the long-term benefit of these devices for patients with obesity and morbid obesity as well as to monitor the devices ’ long-term safety profiles. (Source: Current Surgery Reports)
Source: Current Surgery Reports - October 20, 2017 Category: Surgery Source Type: research
Understanding Weight Regain and the Need for Life-Long Follow-up After Bariatric Surgery
AbstractPurpose of ReviewCurrently, 15.4% of the population has severe obesity. For adults with severe obesity, bariatric surgery is the most effective and cost-effective treatment available for mortality reduction, weight loss, and comorbidity resolution. Although most surgical patients experience significant weight loss in the year following surgery, a subset of patients experience weight regain thereafter. Weight regain can result in recurrence of comorbidities and reduction in the long-term cost-effectiveness of surgery. Weight regain prompts providers to consider additional interventions.Recent FindingsWe summar...
Source: Current Surgery Reports - October 17, 2017 Category: Surgery Source Type: research
Immunotherapy for Breast Cancer: Current and Future Strategies
AbstractPurpose of ReviewThe breast tumor microenvironment is immunosuppressive and is increasingly recognized to play a significant role in tumorigenesis. A deeper understanding of normal and aberrant interactions between malignant and immune cells has allowed researchers to harness the immune system with novel immunotherapy strategies, many of which have shown promise in breast cancer. This review discusses the application of immunotherapy to the treatment of breast cancer.Recent FindingsBoth basic science and clinical trial data are rapidly developing in the use of immunotherapy for breast cancer. The current clinical t...
Source: Current Surgery Reports - October 10, 2017 Category: Surgery Source Type: research
Training Surgeons in the Current US Healthcare System: A Review of Recent Changes in Resident Education
AbstractPurpose of ReviewThis review highlights research focusing on the quality of surgical education within the current constraints of healthcare delivery in the United States.Recent FindingsThe Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST) trial has provided the first evidence from a randomized controlled trial regarding duty hour regulations. Results of the FIRST trial were instrumental in the 2017 ACGME Common Core Requirement changes that allow for more flexibility in clinical hours to encourage professionalism and accommodate both patient care and educational opportunities. Research focusing on...
Source: Current Surgery Reports - October 10, 2017 Category: Surgery Source Type: research
Frailty in Trauma Patients: An Emerging Geriatric Syndrome
AbstractPurpose of ReviewIn contrast to their younger counterparts, geriatric patients have a decreased physiological reserve. This age-related vulnerability poses unique challenges for clinical decision-making. Additionally, as the population of the United States (U.S.) continues to age at a rapid pace, an increasing number of elderly patients need trauma care. Accordingly, this review examines the relevance of the concept of frailty in trauma cases, as well as its role in identifying vulnerable trauma patients and improving patient care. Moreover, through a process of simplification, we made the fundamental concepts of f...
Source: Current Surgery Reports - October 4, 2017 Category: Surgery Source Type: research
Bowel Anastomosis in Acute Care Surgery
AbstractPurpose of ReviewAcute care surgery encompasses the disciplines of trauma, emergency general surgery, and surgical critical care. Inherent in the disease processes of trauma and emergency general surgery is the potential for profound physiologic and anatomic derangements that make the decision to create an intestinal anastomosis, as well as the technique used, a vital step in having a successful outcome for the patient.Recent FindingsThe trauma literature is rife with conflicting data regarding ideal techniques for anastomosis creation. Two series by Brundage and colleagues suggest that handsewn techniques are supe...
Source: Current Surgery Reports - September 15, 2017 Category: Surgery Source Type: research
Tumor-homing Stem Cell Therapy for Brain Cancer
AbstractPurpose of ReviewEmerging evidence has demonstrated that genetically engineered stem cells have unique tumor-homing capacity that allows them to deliver anticancer gene products directly into local and invasive glioblastoma foci. New clinical trials have been launched based on the strength of promising preclinical studies. As such, the focus of the present review is to illustrate how stem cells can be used for the treatment of glioblastoma, various features of the stem cell that make them ideal drug delivery vehicles, modes of action, and recent clinical applications.Recent FindingsIncreasingly, mesenchymal, and ne...
Source: Current Surgery Reports - September 2, 2017 Category: Surgery Source Type: research
Robot-Assisted Thoracoscopic Surgery: Pros and Cons
AbstractPurpose of ReviewIn the last two decades, minimally invasive approaches for thoracic surgery have become the major challenge in the field of thoracic surgery. These techniques became preferable over open surgery (thoracotomy) in terms of reducing pain and having aesthetic advantages. However, patient selection is one of the most important factors for minimally invasive surgery because of related limitations and insufficiency of video-assisted thoracoscopic surgery (VATS).Recent FindingsRobot-assisted thoracoscopic surgery (RATS) has been developed to overcome the limitations of VATS. Better flexibility and transmis...
Source: Current Surgery Reports - September 1, 2017 Category: Surgery Source Type: research
Psychological Outcomes in Face Transplant Recipients: A Literature Review
AbstractPurpose of ReviewTo synthesize findings regarding the psychological outcomes of face transplantation.Recent FindingsThirty-seven face transplants have been done since the world ’s debutant case was featured in 2005. In spite of impressive clinical success, little has been achieved to date in terms of understanding the mental health, quality of life, and psychosocial outcomes of face transplant recipients.SummaryWe conducted a literature search in PubMed for studies reporting any psychosocial measure in face transplant recipients, between 2005 and 2017. We identified 20 articles: 11 articles reported qualitati...
Source: Current Surgery Reports - August 29, 2017 Category: Surgery Source Type: research
Pectus Excavatum Repair in Adults: Indications and How To Do It
AbstractPurpose of ReviewThe minimally invasive Nuss procedure has been effectively used for surgical correction of pediatric and adolescent pectus patients. In the past, the use of this less invasive technique was believed to be limited to young patients. This approach with technique modifications has been successfully extended to the treatment of even advanced aged adults. The presentation, evaluation and minimally invasive surgical treatment of adult pectus excavatum patient is reviewed.Recent FindingsAdult pectus excavatum patients may present with new onset or worsening of symptoms. Repair of the deformity has been sh...
Source: Current Surgery Reports - August 21, 2017 Category: Surgery Source Type: research
Modern Metrics for Evaluating Surgical Technical Skills
AbstractPurpose of reviewAssessment of surgical technical skills has traditionally occurred through informal means using sporadic and subjective feedback. Recent trends in patient safety, simulation training, and technological advances have generated a need for accurate and objective assessment of surgical technical skills. This review is intended to identify the breadth and scope of recent approaches to surgical skill assessment and metrics and define gaps for further development.Recent findingsSurgical skill assessment methods can be broadly categorized as (1) assessments by expert observations using validated task-speci...
Source: Current Surgery Reports - August 18, 2017 Category: Surgery Source Type: research
The Current Status of REBOA in Traumatic Shock
AbstractPurpose of ReviewHemorrhagic shock remains a major cause of potentially preventable death in civilian and military trauma. Balloon occlusion of the aorta has emerged as a viable technique to address non-compressible torso hemorrhage. The purpose of this review is to describe the current state of translational and clinical data on REBOA and help define its role in modern trauma algorithms.Recent FindingsRecent findings suggest that REBOA is feasible in many clinical areas including prehospital. Robust animal data define a reasonable safety profile and current clinical data suggest that there are subset(s) of patient...
Source: Current Surgery Reports - August 7, 2017 Category: Surgery Source Type: research
Surgical Stabilization of Rib Fractures
AbstractPurpose of ReviewSurgical stabilization of rib fractures (aka rib plating) is underutilized, partly due to a perceived lack of evidence of benefit and unfamiliarity with the operation. The goal of this review is to identify and summarize the evidence surrounding surgical stabilization of chest wall injury in flail and non-flail injury patterns and highlight the limitations of our current knowledge.Recent FindingsRecent meta-analyses and prior trials have provided evidence that rib fixation in flail chest injuries decreases the need for mechanical ventilation, decreases risk of pneumonia, and decreases mortality. Ad...
Source: Current Surgery Reports - August 3, 2017 Category: Surgery Source Type: research
Surgical Management of Flail Chest: State of Art and Future Perspectives
AbstractPurpose of ReviewRib fractures are common among trauma patients with both blunt chest wall and thoraco-abdominal trauma, seen in up to 39% of patients following blunt chest trauma and present in 10% of all trauma admissions and, in these individuals, mortality rates can reach 9 –16%. Notwithstanding, the objective of surgical stabilization is to recover thoracic wall rigidity and restore normal ventilation and functions, thus decreasing mortality and morbidity.Recent FindingsCurrently, all possible indications for surgical rib fixation are far away from a consensus statement backed up with strong evidence.Sum...
Source: Current Surgery Reports - July 25, 2017 Category: Surgery Source Type: research
Simulation Training in Surgical Education
AbstractPurpose of ReviewOur review aims to describe the use of simulation-based training throughout the continuum of surgical education.Recent FindingsIn addition to well-known procedural-based surgical simulation modalities like the Fundamentals of Laparoscopic Surgery and Fundamentals of Endoscopic Surgery, there are several novel uses of simulation including its use for preparing medical students for surgical residency, resident interviews and onboarding, residency training, mental skills training, and continuing education for practicing surgeons.SummarySimulation is a cost effective and useful method to improve traine...
Source: Current Surgery Reports - July 21, 2017 Category: Surgery Source Type: research
Transoral Robotic Thyroidectomy
AbstractPurpose of ReviewTransoral approach is nowadays gaining the enormous attention among the thyroid surgeons, as it showed definite merits over the previously developed remote-access approaches for thyroidectomy, such as the ideal cosmetic outcome without remaining the postoperative scars, and the lesser dissection of the flap resulting in the decreased operation time and lesser postoperative pain.Recent FindingsInstead of using the conventional endoscopic operation apparatus and instruments, we could successfully introduce the robotic surgical system to this novel surgical approach, and, in turn, could have the optim...
Source: Current Surgery Reports - July 17, 2017 Category: Surgery Source Type: research
Evidence-Based Support for Nutrition Therapy in Head and Neck Cancer
This article aims to review the current nutrition literature pertaining to H&N cancer patients and to present evidence-based strategies for nutritional support specific to this population.Recent FindingsAggressive nutritional intervention is frequently required in the H&N cancer patient population. Rehabilitating nutrition during operative and nonoperative treatment improves compliance with treatment, quality of life, and clinical outcomes. When and whether to establishing alternative enteral access are points of controversy, although recent evidence suggests prophylactic enteral feeding tube placement should not b...
Source: Current Surgery Reports - July 6, 2017 Category: Surgery Source Type: research
Advances in Robotic Transaxillary Thyroidectomy in Europe
AbstractPurpose of reviewThe robotic surgical approach for minimally invasive thyroid surgery has been well described from the Korean surgeons and shows a wide spread diffusion in Asian area. This paper gives a systematic review aiming to pointed out the interest and the way of behaving of the European surgeons about the role of the robotic thyroidectomy (RT).Recent findingsA literature search was performed using Pubmed, MEDLINE, Cochrane and ClinicalTrials.gov databases, including only papers wrote from european surgeons enrolling patients operated in Europe. Outcomes of interest included patients characteristics, patient...
Source: Current Surgery Reports - June 26, 2017 Category: Surgery Source Type: research
Minimizing Deterioration of Simulator-Acquired Skills During Transfer to the Operating Room: A Novel Approach
AbstractPurpose of ReviewSurgical skill deteriorates due to stress, but mental skills may negate this skill deterioration. We recently developed a mental skills curriculum (MSC) to address this, and present findings of its effectiveness compared to historical controls.Recent FindingsThe MSC was implemented with surgical novices during simulator training, and results were compared to historical controls who had no mental skills training. The groups were comparable at baseline. Compared with the MSC group, historical controls trained longer and achieved higher performance on the simulator but without appreciable differences ...
Source: Current Surgery Reports - June 22, 2017 Category: Surgery Source Type: research
Intentional Segmentectomies for Stage I Lung Cancer: An Up-to-Date Systematic Review
AbstractPurpose of ReviewThe role of this systematic review is to analyse and compare with a meta-analytic approach the outcomes of lobectomy versus intentional segmentectomy in the surgical treatment of stage I non-small cell lung cancer (NSCLC) as reported in the largest studies on the subject published to date.Recent FindingsRegarding the results, most of these studies were based on the retrospective data. The size of the cohorts varied from 17 to 11,520 with a total number of 31,684 patients. The pooled hazard ratio was 1.08 (95% CI = 0.97–1.21;p = 0.16).SummaryThe survival in the lobectomy g...
Source: Current Surgery Reports - June 12, 2017 Category: Surgery Source Type: research
Autologous Fat Grafts: Can We Match the Donor Fat Site and the Host Environment for Better Postoperative Outcomes and Safety?
AbstractPurpose of ReviewAutologous fat grafting is the gold standard for soft tissue repair. The donor fat depot is chosen where a surplus of subcutaneous fat is found. However, the adipose tissues from different parts of the body are not equivalent. Despite the heterogeneity in fat depots, it is still considered that any adipose tissue site is a suitable fat depot donor for transplantation.Recent FindingsMatching embryonic origins andHox code between transplanted stem cells and the host microenvironment emerges as a critical parameter to achieve correct repair in different preclinical models. It has also recently been re...
Source: Current Surgery Reports - May 30, 2017 Category: Surgery Source Type: research
Nutrition in the Post-surgical Patient: Myths and Misconceptions
This article addresses myths and misconceptions of enteral nutrition in surgical patients. (Source: Current Surgery Reports)
Source: Current Surgery Reports - May 27, 2017 Category: Surgery Source Type: research
Transoral Robotic Surgery for Obstructive Sleep Apnea Syndrome: 9 Years of Experience
ConclusionIn selected patients, using a robot for tongue base resection or partial epiglottectomy, is really useful for treatment of patients with OSA and these areas of the human body are very difficult to visualize and operate, unless a robot is used. It was found that using a robot is not only useful , but also safe with proper training and better techniques can be developed in future. (Source: Current Surgery Reports)
Source: Current Surgery Reports - May 13, 2017 Category: Surgery Source Type: research
Fat Grafting: Its Role in Breast Reconstruction
AbstractPurpose of ReviewFat grafting is a useful adjunct to both implant and autologous reconstruction, in both immediate and delayed settings. More recently it has also been used as a standalone method of breast reconstruction. Herein we discuss the recent literature and experience with autologous fat grafting for breast reconstruction.Recent FindingsThere are multiple methods of fat harvest, and preparation. More recently, new techniques have been developed for larger volume fat grafting, as well as external volume expansion of the breast. In general the procedure is safe with few complications —however, some such...
Source: Current Surgery Reports - May 11, 2017 Category: Surgery Source Type: research
Pediatric Small Bowel Transplantation
AbstractPurpose of ReviewSmall bowel transplantation is the only currently available option for children with permanent intestinal failure that can allow for full enteral nutrition. The aim of this article is to provide a comprehensive review of the indications, surgical technique, allograft types, perioperative management, and outcomes of children who undergo intestinal transplantation.Recent FindingsAdvancements in the management of immunosuppression and associated complications have been the most recent contributor to improved patient outcomes following intestinal transplantation. Most centers have adopted protocols tha...
Source: Current Surgery Reports - April 21, 2017 Category: Surgery Source Type: research
The Shifting Microbiome in Surgical Stress
AbstractPurpose of Review The development of rapid gene sequencing and analytical techniques over the past few decades has enabled researchers to enhance their understanding of the immensely complicated microbiota living within the human gut, including the role microbes play in the pathogenesis of several surgical disease states as well as the perioperative period. The purpose of this review is to summarize recent findings regarding the changing microbiome within presurgical conditions and during surgical stress states.Recent FindingsOur close and constant contact with these microbial organisms has wide-ranging implication...
Source: Current Surgery Reports - April 20, 2017 Category: Surgery Source Type: research
An Update on Ex Vivo Lung Perfusion in Pulmonary Transplantation
AbstractPurpose of ReviewLung transplantation provides quality of life and survival benefits for patients with end-stage lung disease. However, the demand for donor lungs continues to exceed the supply. Using standard selection criteria, only 20% of lungs from solid organ donors are currently used for lung transplant. Ex vivo lung perfusion may provide a means to evaluate and to potentially rehabilitate marginal donor lungs prior to transplantation.Recent FindingsOutcomes after transplantation of marginal lungs evaluated using ex vivo lung perfusion, after initially being declined using standard criteria, have been reporte...
Source: Current Surgery Reports - February 26, 2017 Category: Surgery Source Type: research
Hilar Cholangiocarcinoma: Resection or Transplantation?
AbstractPurpose of ReviewThis is a review of the current status of surgical resection and liver transplantation in the treatment of hilar cholangiocarcinoma (CCA).Recent FindingsFor patients with hilar CCA and underlying parenchymal disease, specifically those with primary sclerosing cholangitis, liver transplantation is generally favored as there is risk of hepatic insufficiency and multicentric disease with extended resection. For de novo patients with no underlying liver disease, the decision between resection and transplantation proves to be more difficult. Results have shown that when margin- and node-negative resecti...
Source: Current Surgery Reports - February 12, 2017 Category: Surgery Source Type: research
Using Video Analysis to Understand and Improve Technical Quality in Bariatric Surgery
AbstractPurpose of ReviewBariatric surgery is the most effective and durable treatment for severe obesity. Operative technique for some bariatric procedures can be technically challenging and requires an advanced skill set. Variation in procedure type, operative technique, and surgeon skill can affect outcomes.Recent FindingsMost bariatric surgery is performed laparoscopically, allowing for video recording and thus an opportunity to study videos for quality improvement.SummaryCurrent strategies for utilizing surgical videos are discussed herein, along with our early experience and specific areas for future growth. (Source:...
Source: Current Surgery Reports - February 10, 2017 Category: Surgery Source Type: research
Adipose-Derived Stem Cells in Peripheral Nerve Regeneration
AbstractPurpose of the ReviewPeripheral nerve injuries are common, debilitating, and costly. The human body ’s innate regenerative capacity is slow, and nerves are often misguided. The purpose of this article is to review a specific cellular, regenerative engineering technique that holds promise for the treatment of peripheral nerve injuries.Recent FindingsOver the past several decades, research has focused on the utilization of stem cells for peripheral nerve repair. More recently, stem cells collected from adipose tissue (adipose-derived stem cells or ADSCs) have gained traction due to their relative ease of collec...
Source: Current Surgery Reports - February 6, 2017 Category: Surgery Source Type: research
Novel Technologies in Bariatric Surgery
This article will review the current state of these novel surgical and endoscopic therapies. (Source: Current Surgery Reports)
Source: Current Surgery Reports - January 17, 2017 Category: Surgery Source Type: research
Renal Artery Stenosis: Recent Evidence, Evidence Gaps, and Practical Approaches to Diagnosis and Management
This article will review the pathophysiology, epidemiology, clinical presentation, diagnostic evaluation, and clinical management of renal artery stenosis in adults, focusing on atherosclerosis and fibromuscular dysplasia (the most common etiologies in adults). Review of clinical trials will focus on the most recent studies, including their outcomes, inclusion and exclusion criteria, and limitations. (Source: Current Surgery Reports)
Source: Current Surgery Reports - January 16, 2017 Category: Surgery Source Type: research
Adolescent Bariatric Surgery: Quality, Outcomes, and Debates
AbstractPurpose of ReviewTo provide an updated evaluation of the literature regarding safety and outcomes in pediatric bariatric surgery and to explore associated controversies related to surgical timing and age concerns, as well as other ethical issues.Recent FindingsNonsurgical management of pediatric patients with obesity becomes less effective with increasing age and severity of disease. For carefully selected adolescent patients, bariatric surgery has been shown to provide sustained weight loss, reduction in comorbidities, and improved quality of life; however, high-level evidence is limited. Current data support surg...
Source: Current Surgery Reports - January 16, 2017 Category: Surgery Source Type: research
Chronic Type B Aortic Dissection: Endovascular and Hybrid Aortic Management
AbstractPurpose of ReviewChronic and subacute type B aortic dissection (TBAD) management has advanced drastically over the past decade. We review the major progress reported in the scientific literature.Recent FindingsSince early twenty first century, endovascular aortic repair has been on the rise for management of chronic and subacute TBAD. The technique has shown a mortality benefit in comparison to the open approach. High-risk patients who cannot tolerate open procedure and had challenging aortic anatomy benefit from hybrid approaches. More recently, total endovascular approaches are being investigated to treat these h...
Source: Current Surgery Reports - January 12, 2017 Category: Surgery Source Type: research
Nutrition Therapy in Shock
AbstractPurpose of ReviewThe dictum of surgical metabolism describing the ebb and flow of nutrients after injury can be seen as an alteration of the hormonal milieu. Shock, therefore, is a state by which nutrients are delivered only by diffusion, while shock resolution is marked by a transition to nutrient diversion into essential and salvage pathways. The gut requires significant cardiac output at rest, and this demand increases during enteral feeding. The mismatch between supply and demand can be exacerbated during the shock state, or, paradoxically, improved.Recent FindingsEnteral nutrition (EN) should be initiated with...
Source: Current Surgery Reports - October 26, 2016 Category: Surgery Source Type: research
Overcoming Immunologic Barriers to Kidney Transplantation: Desensitization and Paired Donation
AbstractPurpose of ReviewRenal transplantation offers a significant survival benefit over dialysis for patients with end-stage renal disease. Furthermore, transplantation with a living donor kidney offers superior survival when compared to a deceased donor. However, supply of transplantable kidneys continues to fall short of demand; living donation offers a solution to help decrease this disparity. For those patients who have willing donors, many will be incompatible secondary to blood group or tissue mismatches. In this setting, a crucial decision must be made —pursue living donor transplantation by overcoming the i...
Source: Current Surgery Reports - October 25, 2016 Category: Surgery Source Type: research
Surgery Versus Stereotactic Body Radiotherapy for Resectable Lung Cancer
AbstractPurpose of ReviewRadiotherapy has been considered in the past an option for local control of resectable lung cancer only in cases of patients considered unfit or declining surgical treatment.Recent FindingsRecent technological improvements allow radiation oncologists to deliver precisely targeted radiation at much higher doses compared to traditional radiation therapy, in one single or few sessions, minimizing damage to the surrounding healthy tissue. In this review, we discuss the advantages and inconveniences of surgery and stereotactic body radiotherapy (SBRT) for the treatment of resectable non-small cell lung ...
Source: Current Surgery Reports - October 12, 2016 Category: Surgery Source Type: research
Fenestrated Aortic Endografts in the Last 3 Years: An Update
AbstractPurpose of ReviewFenestrated endovascular aortic aneurysm repair (FEVAR) is an accepted treatment option for patients who are not suitable for conventional endovascular aortic aneurysm repair or open surgical repair (OSR). Five years ago, the FDA approved the use of FEVAR in patients with inadequate infrarenal aortic seal zones (short necks). This procedural paradigm continues to gain in popularity compared to OSR for complex aortic disease. We seek to define the current state of fenestrated endovascular repair by reviewing relevant literature over the past 3 years.Recent FindingsFEVAR continues to prove to be effi...
Source: Current Surgery Reports - September 30, 2016 Category: Surgery Source Type: research
Enhanced Recovery Pathways in Bariatric Surgery: A Contemporary Review
This article presents a review of the practice of bariatric and metabolic surgeries in regard to enhanced recovery pathways (ERP) and its expansion in the field.Recent FindingsGeneral surgery perioperative care evolved in recent years with upcoming data mainly from colorectal surgery. Recent evidence showed a reduction in the length of stay and cost, without a raise in morbidity in the fragile obese population. Some groups even present how they achieve ambulatory bariatric surgery with careful patient selection. With research data coming from different fields and more recent studies in bariatric surgery specifically, exper...
Source: Current Surgery Reports - September 26, 2016 Category: Surgery Source Type: research
Risk Stratification in Lung Resection
AbstractPurpose of ReviewSurgery is considered the best treatment option for patients with early stage lung cancer. Nevertheless, lung resection may cause a variable functional impairment that could influence the whole cardio-respiratory system with potential life-threatening complications. The aim of the present study is to review the most relevant evidences about the evaluation of surgical risk before lung resection, in order to define a practical approach for the preoperative functional assessment in lung cancer patients.Recent FindingsThe first step in the preoperative functional evaluation of a lung resection candidat...
Source: Current Surgery Reports - September 19, 2016 Category: Surgery Source Type: research
The Utility of Preoperative Frailty Assessment
AbstractPurpose of reviewThe geriatric patient population represents an ever increasing proportion of a surgeon ’s practice spectrum. With this comes the need to understand the factors largely impacting the geriatric surgical population. One of these factors is frailty. At first glance frailty appears as a simple concept. However, a review of the literature reveals a plethora of definitions, quantification endeavors, and theories attempting to delineate its principle attributes.Recent findingsDespite the variety of theories, the literature supports a strong link between frailty and poor surgical outcomes. While this ...
Source: Current Surgery Reports - September 14, 2016 Category: Surgery Source Type: research
Stomach Intestinal Pyloric Sparing Surgery or SIPS
AbstractPurpose of ReviewAs the field of bariatric surgery expands, the demand for a procedure that optimizes weight loss while minimizing complications grows ever higher. This paper proposes to give a rationale for this procedure as a salvage option for vertical sleeve gastrectomies (VSG) or as an initial bariatric procedure for patients requiring more weight loss and reduction in comorbidities than a VSG can offer. Stomach intestinal pyloric sparing surgery (SIPS) is a form of modified duodenal switch which is comprised a slightly larger than average vertical sleeve gastrectomy with a single postpyloric duodenal-enteral ...
Source: Current Surgery Reports - September 12, 2016 Category: Surgery Source Type: research
Review of Complex Iliocaval Reconstructions
AbstractPurpose of ReviewReconstruction of the iliocaval system is primarily performed in symptomatic patients with obstructive chronic venous disease (CVD). Such pathology can be primary/nonthrombotic or secondary/postthrombotic. The former encompasses pathology including May –Thurner syndrome, the most common etiology of primary CVD responsible for up to a third of the disease burden. Secondary CVD is usually due to postthrombotic syndrome. Other indications for iliocaval reconstructions include malignancy involving the iliocaval territory, trauma, or radiation injury . In this review, we evaluate complex iliocaval...
Source: Current Surgery Reports - August 25, 2016 Category: Surgery Source Type: research