Donor Viral Hepatitis and Liver Transplantation
This article presents an overview of the use of HCV positive and HBV positive allografts. (Source: Surgical Clinics of North America)
Source: Surgical Clinics of North America - August 17, 2023 Category: Surgery Authors: Sara-Catherine Whitney Zingg, Kristina Lemon Source Type: research
Living Donor Liver Transplantation
(LDLT) has seen great advancements since its inception in 1988. Herein, the nuances of LDLT are discussed spanning from donor evaluation to the recipient operation. Special attention is given to donor anatomy and graft optimization techniques in the recipient. (Source: Surgical Clinics of North America)
Source: Surgical Clinics of North America - August 17, 2023 Category: Surgery Authors: J. Michael Cullen, Kendra D. Conzen, Elizabeth A. Pomfret Source Type: research
Liver Transplant for Intrahepatic Cholangiocarcinoma
Intrahepatic cholangiocarcinoma (iCCA) tends to be asymptomatic until late stages, leading most of the patients to present at advanced stages of the disease. A combination of medical and surgical therapy is crucial for patient management. Historically, poor outcomes resulted in liver transplantation being formally contraindicated for patients with iCCA; however, recent advances in patient selection and neoadjuvant therapy have resulted in a paradigm shift in liver transplant oncology. As a result, the feasibility of liver transplantation for iCCA is being reevaluated by several centers as a therapeutic alternative for sele...
Source: Surgical Clinics of North America - August 17, 2023 Category: Surgery Authors: Olanrewaju A. Eletta, Guergana G. Panayotova, Keri E. Lunsford Source Type: research
The Tides of Change: Emergencies in General Surgery
Historically general surgeons took care of patients across a breadth of surgical problems. Over time this has changed due to a variety of different reasons: a shift in preference in certain practice settings, changes in the curriculum, and more focused training in current general surgery programs. Surgical education has been restructured with the emergence of more fellowship training programs and with the changes made to the ACGME work hours.1 As a result, the practice patterns of general surgeons have evolved during this period. (Source: Surgical Clinics of North America)
Source: Surgical Clinics of North America - August 17, 2023 Category: Surgery Authors: Viren P. Punja, Paul J. Schenarts Tags: Preface Source Type: research
General Surgical Emergencies
Patients would like to believe that hospitals are capable of helping 24/7/365. Patients also tend to believe (if you believe in polling and focus group responses) that “Quality” is assumed. In other words, most people in the United States are of the belief that in an emergency they can go to any facility and get the care they need—right now. Of course, every locality has its collections of local citizens who hold strong opinions of which hospital they may or may not choose, but beyond their local sense of resources, they do not really think much about hospital capabilities. (Source: Surgical Clinics of North America)
Source: Surgical Clinics of North America - August 17, 2023 Category: Surgery Authors: Ronald F. Martin Tags: Foreword Source Type: research
Downstaging Techniques for Hepatocellular Carcinoma in Candidates Awaiting Liver Transplantation
During the last decade, downstaging for hepatocellular carcinoma has expanded the pool of patients eligible for liver transplantation. The literature is rife with attempts to elucidate best treatment strategies with novel locoregional and systemic therapies continuing to emerge. Several trials have confirmed the large-scale success of downstaging protocols, with equitable long-term survival and recurrence rates after liver transplant. We review the currently available techniques used for downstaging, including their indications, complications, and efficacies. New frontiers have focused on the potential role of immunotherap...
Source: Surgical Clinics of North America - August 12, 2023 Category: Surgery Authors: Lauren Matevish, Madhukar S. Patel, Parsia A. Vagefi Source Type: research
Thoracic Emergencies for the General Surgeon
In this review article, we aim to provide an overview of common and uncommon general surgery thoracic emergencies as well as basic thoracic anatomy, common diagnostic tests, and operative positioning and access considerations. We also describe specific thoracic procedures. We hope that this article simplifies some of the challenges associated with the management of thoracic emergencies. (Source: Surgical Clinics of North America)
Source: Surgical Clinics of North America - August 8, 2023 Category: Surgery Authors: Jane Zhao, Desmond M. D ’Souza Source Type: research
Management of Colonic Emergencies
The etiology of colonic emergencies includes a wide-ranging and diverse set of pathologic conditions. Fortunately, for the surgeon treating a patient with one of these emergencies, the surgical management of these various causes is limited to choosing among proximal diversion, segmental colectomy with or without proximal diversion, or a total abdominal colectomy with end ileostomy (or rarely, an ileorectal anastomosis). The nuanced complexity in these situations usually revolves around the nonsurgical and/or endoscopic options and deciding when to proceed to the operating room. (Source: Surgical Clinics of North America)
Source: Surgical Clinics of North America - July 28, 2023 Category: Surgery Authors: Haddon Pantel, Vikram B. Reddy Source Type: research
Diabetic Soft Tissue Infections
Diabetes is a systemic illness that can cause a broad range of physiologic effects. Infection rates and wound healing are both affected through multiple mechanisms. Other physiologic changes increase risk for wounds as well as complex soft tissue infections ranging from simple cellulitis to necrotizing soft tissue infections. Clinicians and surgeons need to have a low index of suspicion for severe infection in a patient presenting with diabetes, and even more so in patients with uncontrolled diabetes. (Source: Surgical Clinics of North America)
Source: Surgical Clinics of North America - July 27, 2023 Category: Surgery Authors: Christine Castater, Elliot Bishop, Adora Santos, Mari Freedberg, Phillip Kim, Christopher Sciarretta Source Type: research
Non-Traumatic Hepatobiliary Emergencies
This article explores the diagnostic workup and evaluation as well as the current therapeutic interventions for a variety of these nontraumatic hepatobiliary emergencies based on the most current literature. (Source: Surgical Clinics of North America)
Source: Surgical Clinics of North America - July 24, 2023 Category: Surgery Authors: Christopher Decker, Dorothy Liu Source Type: research
Surgical Emergencies in Patients with Significant Comorbid Diseases
Emergency surgery in patients with significant comorbidities benefits from a structured approach to preoperative evaluation, intra-operative intervention, and postoperative management. Providing goal concordant care is ideal using shared decision-making. When operation cannot achieve the patient ’s goal, non-operative therapy including Comfort Care is appropriate. When surgical therapy is offered, preoperative physiology-improving interventions are far fewer than in other phases. Reevaluation of clinical care progress helps define trajectory and inform goals of care. Palliative Care Medic ine may be critical in supportin...
Source: Surgical Clinics of North America - July 24, 2023 Category: Surgery Authors: Jacqueline Blank, Adam M. Shiroff, Lewis J. Kaplan Source Type: research
Palliative Emergency General Surgery
Acute care surgeons encounter patients experiencing surgical emergencies related to advanced malignancy, catastrophic vascular events, or associated with multisystem organ failure. The acute nature is a factor in establishing a relationship between surgeon, patient, and family. Surgeons must use effective communication skills, empathy, and a knowledge of legal and ethical foundations. Training in palliative care principles is limited in many medical school and residency curricula. We offer examples of clinical situations facing acute care surgeons and discuss evidence-based recommendations to facilitate successful treatmen...
Source: Surgical Clinics of North America - July 24, 2023 Category: Surgery Authors: Gregory Schaefer, Daniel Regier, Conley Stout Source Type: research
Abdominal Core
Of all the statements one hears along the way in learning or practicing surgery, the one that by far and away is most untrue is, “hernia repairs and appendectomies are intern cases.” Utter nonsense. Any surgeon who has been around for any length of time will be the first to tell you that a difficult hernia operation—or for that matter a difficult appendectomy—will try the soul of the most capable surgeon. In part, bec ause when these cases are challenging, they are usually very challenging. Also, that patients and providers may expect that these cases will be “easy” further ups the emotional ante when they are ...
Source: Surgical Clinics of North America - July 24, 2023 Category: Surgery Authors: Ronald F. Martin Tags: Foreword Source Type: research
Anorectal Emergencies
This article provides a review of pertinent anatomy; examination techniques; and workup, diagnosis, and management of common anorectal emergencies including thrombosed hemorrhoids, incarcerated hemorrhoids, anal fissure, anorectal abscess, rectal prolapse, and pilonidal abscess and unique situations including rectal foreign body and anorectal sexually transmitted infections. (Source: Surgical Clinics of North America)
Source: Surgical Clinics of North America - July 21, 2023 Category: Surgery Authors: Melissa K. Drezdzon, Carrie Y. Peterson Source Type: research
Evaluation of Abdominal Emergencies
Early primary assessment and abdominal examination can often be enough to triage the patient with abdominal pain into those with less severe underlying pathologic condition from those with more acute findings. A focused history of the patient can then allow the clinician to develop their differential diagnosis. Once the differential diagnoses are determined, diagnostic imaging and laboratory findings can help confirm the diagnosis and allow for expeditious treatment and intervention. (Source: Surgical Clinics of North America)
Source: Surgical Clinics of North America - July 17, 2023 Category: Surgery Authors: Zana Alattar, Natasha Keric Source Type: research
