Vertebral Artery Injury: An Update on Screening, Diagnosis and Treatment
AbstractPurpose of ReviewThe purpose of this review is to describe the current evidence for screening, diagnosis and treatment options for vertebral artery injuries (VAI).Recent FindingsData on vertebral artery injuries are relatively sparse. The available data on this topic are primarily derived from single institution series. Recent studies have suggested that screening protocols increase detection, CTA is the optimal diagnostic tool, and the most effect treatment strategy is not well established.SummaryGuidelines and data on vertebral artery injury are often based on pooled vertebral and carotid data, termed blunt cereb...
Source: Current Surgery Reports - October 16, 2018 Category: Surgery Source Type: research

Next-Generation Sequencing and Personalized Medicine for Brain Cancer
(Source: Current Surgery Reports)
Source: Current Surgery Reports - October 16, 2018 Category: Surgery Source Type: research

Current and Future Perspectives in Robotic Endovascular Surgery
AbstractPurpose of ReviewEndovascular robotic surgery remains a little known entity in the general medical community shrouded with misconception and intrigue. However, with continued evolution of robotic technology, it will inevitably become an integral part of the future vascular surgery practice.Recent FindingsReceiving 501(k) clearance for use in peripheral vascular interventions from the US Food and Drug Administration in February 2018, the Corindus CorPath® GRX is the latest advancement in endovascular robotics. With seven motors controlled from a remote workstation, its ability to control guidewire and catheter m...
Source: Current Surgery Reports - October 11, 2018 Category: Surgery Source Type: research

Isolated and Combined Duodenal and Pancreatic Injuries: A Review and Update
AbstractPurpose of ReviewDuodenal and pancreatic injuries are challenging to diagnose and treat. Over the last several decades, appropriate and optimal surgical management of these injuries have been debated. This is a review of the latest literature regarding diagnosis and operative management of these injuries.Recent FindingsIn duodenal injury, primary repair should be pursued for partial or complete transection with little tissue loss and no ampulla involvement. In more complex injuries, where tension-free repair is not possible, Roux-en-Y duodenojejunostomy or pyloric exclusion with diverting gastrojejunostomy can be u...
Source: Current Surgery Reports - September 18, 2018 Category: Surgery Source Type: research

Management of Penetrating Injury to the Left Colon
AbstractPurpose of ReviewDoes management and outcomes of penetrating injuries to the left colon differ?Recent FindingsManagement pendulum has swung from non-operative management during the Civil War era, to mandatory exploration and fecal diversion by WWII. Continuing advancements in medical management, anesthesia, and surgical techniques have led to the transition from mandatory fecal diversion to primary repair. Civilian trauma experience further supported this paradigm shift with identification of risk factors better defining the role of primary repair. Patients with non-destructive injuries benefited from primary repai...
Source: Current Surgery Reports - September 18, 2018 Category: Surgery Source Type: research

Isolated and Combined Duodenal and Pancreatic Injuries: A Review and Update
AbstractPurpose of ReviewDuodenal and pancreatic injuries are challenging to diagnose and treat. Over the last several decades, appropriate and optimal surgical management of these injuries have been debated. This is a review of the latest literature regarding diagnosis and operative management of these injuries.Recent FindingsIn duodenal injury, primary repair should be pursued for partial or complete transection with little tissue loss and no ampulla involvement. In more complex injuries, where tension-free repair is not possible, Roux-en-Y duodenojejunostomy or pyloric exclusion with diverting gastrojejunostomy can be u...
Source: Current Surgery Reports - September 18, 2018 Category: Surgery Source Type: research

Management of Penetrating Injury to the Left Colon
AbstractPurpose of ReviewDoes management and outcomes of penetrating injuries to the left colon differ?Recent FindingsManagement pendulum has swung from non-operative management during the Civil War era, to mandatory exploration and fecal diversion by WWII. Continuing advancements in medical management, anesthesia, and surgical techniques have led to the transition from mandatory fecal diversion to primary repair. Civilian trauma experience further supported this paradigm shift with identification of risk factors better defining the role of primary repair. Patients with non-destructive injuries benefited from primary repai...
Source: Current Surgery Reports - September 18, 2018 Category: Surgery Source Type: research

Disease-Specific Diets in Surgical Diseases
We present data for several common surgical diseases including dietary recommendations post-esophagectomy, post-Nissen fundoplication, and post-colectomy. We will also discuss the evidence in diverticulitis, inflammatory bowel disease, dumping syndrome, and short bowel syndrome.Recent FindingsDietary consistency may make a difference in post-esophageal surgery diets. Other past dietary recommendations in diseases such as diverticulitis may not make as much difference. Dumping syndrome and Short bowel syndrome have some newer interventions in timing of oral intake and some medications.SummaryDiet may make less difference ov...
Source: Current Surgery Reports - August 16, 2018 Category: Surgery Source Type: research

Advocacy for Bariatric and Metabolic Surgery
AbstractPurpose of reviewThe goal of this publication is to review the strengths, weaknesses, opportunities, threats, and history to advocacy in bariatric surgery.Recent findingsBariatric surgery has increased in insurance coverage through recognition of the disease process and safety and efficacy of procedure.SummaryWhile bariatric surgery coverage has increased, patients with obesity still have multiple barriers to care. (Source: Current Surgery Reports)
Source: Current Surgery Reports - August 16, 2018 Category: Surgery Source Type: research

Disease-Specific Diets in Surgical Diseases
We present data for several common surgical diseases including dietary recommendations post-esophagectomy, post-Nissen fundoplication, and post-colectomy. We will also discuss the evidence in diverticulitis, inflammatory bowel disease, dumping syndrome, and short bowel syndrome.Recent FindingsDietary consistency may make a difference in post-esophageal surgery diets. Other past dietary recommendations in diseases such as diverticulitis may not make as much difference. Dumping syndrome and Short bowel syndrome have some newer interventions in timing of oral intake and some medications.SummaryDiet may make less difference ov...
Source: Current Surgery Reports - August 16, 2018 Category: Surgery Source Type: research

Advocacy for Bariatric and Metabolic Surgery
AbstractPurpose of reviewThe goal of this publication is to review the strengths, weaknesses, opportunities, threats, and history to advocacy in bariatric surgery.Recent findingsBariatric surgery has increased in insurance coverage through recognition of the disease process and safety and efficacy of procedure.SummaryWhile bariatric surgery coverage has increased, patients with obesity still have multiple barriers to care. (Source: Current Surgery Reports)
Source: Current Surgery Reports - August 16, 2018 Category: Surgery Source Type: research

How to Teach Surgical Residents during Damage Control Surgery
AbstractPurpose of ReviewDamage control can be difficult to teach. Residents have few operative trauma experiences. During damage control situations, the resident ’s education may be lost in the stressful and fast, paced operating room due to patient care taking priority. Fortunately, there are numerous other opportunities to teach this important concept outside of the operating room.Recent FindingsDamage control can be taught in a three step cycle from war games to intraoperative teaching during a crisis and ending with an after action review. This process is also applicable to other intraoperative crises and acute ...
Source: Current Surgery Reports - August 10, 2018 Category: Surgery Source Type: research

Update on Feeding the Open Abdomen in the Trauma Patient
AbstractPurpose of ReviewDescribe how and when nutrition for trauma patients should be provided after damage control laparotomy.Recent FindingsEarly enteral nutrition is a requisite component of open abdomen critical care support to achieve optimal outcomes. Providing trophic enteral nutrition is beneficial. Enteral nutrition with an open abdomen complicated by enteroatmospheric fistula is safe and feasible.SummaryEnteral nutrition is initiated with resolution of acidosis, coagulopathy, and hypothermia. Absent intestinal discontinuity, the only absolute contraindication, enteral nutrition is started as soon as possible via...
Source: Current Surgery Reports - July 19, 2018 Category: Surgery Source Type: research

Current Management of Splenic Injuries: Who Needs a Splenectomy?
AbstractPurpose of ReviewThis is a review of the current indications for splenectomy for trauma.Recent FindingsAs the role of interventional radiology and the acceptance of non-operative strategies gain wider acceptance, the role of splenectomy is decreasing. There continues to be questions on how far the role of non-operative management can be pushed and at what cost. Alternatively, that risk must be weighed against the long and short term consequences of a splenectomy.SummaryEmergent surgical exploration of the abdomen is indicated for hemodynamically unstable trauma patients and patients with peritonitis from an associa...
Source: Current Surgery Reports - June 29, 2018 Category: Surgery Source Type: research

Surgical Management of Hilar Cholangiocarcinoma
AbstractPurpose of ReviewTo provide a comprehensive review of the preoperative and operative considerations for the surgical management of hilar cholangiocarcinoma.Recent FindingsThe management of hilar cholangiocarcinoma has evolved over the past 20  years, with data from large institutional series emerging, which has influenced decisions regarding the need for preoperative biliary drainage, portal-vein embolization, extent of surgical resection, role of transplantation, and efficacy of adjuvant and palliative therapies.SummaryHepatectomy has become the standard of care for resectable hilar cholangiocarcinoma, while ...
Source: Current Surgery Reports - June 18, 2018 Category: Surgery Source Type: research

Fasting and its Therapeutic Impact in Brain Tumors
This article is an attempt to review a controversial strategy of modulating tumor biology by understanding their metabolic characteristics, how they differ from normal healthy cells, and implementing therapies that include nutritional interventions.SummaryAlthough fasting as part of the management of brain malignancies is controversial and may be contrary to popular opinion, developing supportive evidence in targeting their special metabolic profile is promising and fascinating. (Source: Current Surgery Reports)
Source: Current Surgery Reports - May 31, 2018 Category: Surgery Source Type: research

Curing Diabetes Through Bariatric Surgery: Evolution of Our Understanding
AbstractPurpose of ReviewThe goal of this review is to summarize available data on the impact of bariatric surgery on diabetes and to explore the mechanisms responsible for these outcomes.Recent FindingsIn randomized controlled trials and when compared to standard medical management, bariatric surgery is consistently superior with regards to weight loss and remission of type 2 diabetes. Remission rates are proportional to weight loss. The likelihood of remission from type 2 diabetes after bariatric surgery can be estimated from several available clinical parameters.SummaryBariatric surgery is superior in improving glycemic...
Source: Current Surgery Reports - May 29, 2018 Category: Surgery Source Type: research

The Criteria for Treating Appendicitis Non-operatively
AbstractPurpose of reviewThere has been growing interest in the role of non-operative management of appendicitis. There have been multiple trials in adults, and there is a growing body of research in pediatric patients. This manuscript reviews the most recent trials and meta-analyses of non-operative management of acute, uncomplicated appendicitis in pediatric patients.Recent findingsAntibiotics alone are a safe treatment alternative for uncomplicated acute appendicitis without an appendicolith. There are no increased risks of complications or progression to complicated appendicitis with non-operative management with antib...
Source: Current Surgery Reports - May 8, 2018 Category: Surgery Source Type: research

Parenteral Nutrition for Management of Malignant Bowel Obstruction
AbstractPurpose of ReviewThis review article focuses on the practice of providing parenteral nutrition in cases of malignant bowel obstruction (MBO) where the enteral route of feeding is unavailable.Recent FindingsParenteral nutrition is an option in patients with MBO in whom enteral nutrition cannot be provided. However, its use is associated with complications that should lead to careful patient selection in determining who will benefit from its use. MBO often represents the end stage of the disease process, and not all patient presentations will benefit from parental nutrition (PN). Recent research does indicate that ce...
Source: Current Surgery Reports - May 2, 2018 Category: Surgery Source Type: research

Repair of Sternal Cleft in Children
AbstractPurpose of ReviewThe goal of this paper is to review the surgical techniques for the correction of sternal cleft in children.Recent FindingsVarious surgical techniques have been developed for the correction of sternal cleft since 1949, when the first successful repair was reported.SummarySternal cleft is an uncommon congenital chest wall deformity. The optimal correction can be achieved by primary repair of the defect in patients younger than 1  year of age, especially during the neonatal period, mostly with an easy technique. In older children, more extensive techniques are applied, using either autologous ti...
Source: Current Surgery Reports - April 7, 2018 Category: Surgery Source Type: research

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