Journal of the American College of Surgeons
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Pilonidal disease is a common condition of the gluteal crease, affecting around 1 in 2,000 adolescents and young adults. 1 Traditional options for management of pilonidal disease include improved hygiene with or without hair removal or resection of the nidus. Given a high recurrence rate associated with hygiene alone, nidus resection is often recommended, even for patients with mild pilonidal disease, despite significant postoperative morbidity. We present a consecutive series of patients with mild pilonidal disease managed in a dedicated Pilonidal Care Clinic using an alternate approach directed toward source control: improved hygiene to limit debris in the gluteal crease, excision of midline pilonidal pits under local anesthesia to prevent intrusion of debris with drainage of any nidus present, and laser ablation of midline follicles to prevent new pits from forming. 2. ⋯ Mild pilonidal disease may be resolved with improved hygiene, pit excision, and laser epilation with minimal morbidity and no activity restrictions. Adoption of this approach may keep a large number of patients with pilonidal disease from undergoing unindicated resection.
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Randomized Controlled Trial
Alvimopan for Enhanced Gastrointestinal Recovery after Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: A Randomized Controlled Trial.
Surgical management of peritoneal metastases with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is associated with prolonged length of stay and time to return of bowel function. Alvimopan is a peripherally acting opioid antagonist that reduces postoperative ileus. We sought to determine the efficacy of alvimopan on return of bowel function in patients undergoing CRS-HIPEC. ⋯ Perioperative alvimopan was well tolerated and accelerated bowel function recovery in patients undergoing CRS-HIPEC.
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Multicenter Study
Do General Surgery Residents Begin Specializing Before Fellowship? A Multi-Institutional Study from the US ROPE Consortium.
Single-center data suggest that general surgery residents perform more cases related to their future fellowship compared with their peers. This study aimed to determine whether this experience was true for residents across multiple programs. ⋯ General surgery residents perform more cases related to their future specialty choice compared with their peers. These data suggest that the specialization process begins during residency. This tendency among residents should be considered as general surgery residency undergoes structural redesign in the future.
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Observational Study
Analyzing Impact of Multimorbidity on Long-Term Outcomes after Emergency General Surgery: A Retrospective Observational Cohort Study.
Little is known about the impact of multimorbidity on long-term outcomes for older emergency general surgery patients. ⋯ Older, multimorbid patients experience worse outcomes, including survival and independent function, after emergency general surgery than nonmultimorbid patients through 6 months after discharge from index hospitalization. This information is important for setting recovery expectations for high-risk patients to improve shared decision-making.