Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract
-
J. Gastrointest. Surg. · Feb 2015
Current recommendations for surveillance and surgery of intraductal papillary mucinous neoplasms may overlook some patients with cancer.
The 2012 Sendai Criteria recommend that patients with 3 cm or larger branch duct intraductal papillary mucinous neoplasms (BD-IPMN) without any additional "worrisome features" or "high-risk stigmata" may undergo close observation. Furthermore, endoscopic ultrasound (EUS) is not recommended for BD-IPMN <2 cm. These changes have generated concern among physicians treating patients with pancreatic diseases. The purposes of this study were to (i) apply the new Sendai guidelines to our institution's surgically resected BD-IPMN and (ii) reevaluate cyst size cutoffs in identifying patients with lesions harboring high-grade dysplasia or invasive cancer. ⋯ Our results suggest that "larger" size on noninvasive imaging can indicate high-grade/invasive cysts, and EUS-FNA may help identify "smaller" cysts with high-grade/invasive pathology.
-
J. Gastrointest. Surg. · Feb 2015
Surgical site infections (SSIs) after stoma reversal (SR): risk factors, implications, and protective strategies.
Stoma reversals (SRs) are commonly performed with potentially significant postoperative complications including surgical site infections (SSIs). Our aim was to determine the incidence and risk factors for SSIs in a large cohort of SR patients. ⋯ Smoking increased the risk of SR SSIs in patients by over twofold, and SR SSIs are associated with additional significant morbidities. Smoking cessation should be an important part of any SSI risk-reduction strategy.
-
J. Gastrointest. Surg. · Feb 2015
Risk factors for 30-day readmissions after hepatectomy: analysis of 2444 patients from the ACS-NSQIP database.
The aim of this study was to identify risk factors associated with unplanned readmissions after hepatectomies. ⋯ Transfusion, complexity of procedure, and duration of operation were the strongest predictors of unplanned readmissions after liver resection.
-
J. Gastrointest. Surg. · Jan 2015
Multicenter StudySurgeon volume plays a significant role in outcomes and cost following open incisional hernia repair.
Surgeon Volume Plays a Significant Role in Outcomes and Cost Following Open Incisional Hernia Repair ⋯ This study found a strong association between individual surgeon incisional hernia repair volume and hernia reoperation rates, operative efficiency, and charges. Preferential referral to high-volume surgeons may lead to improved outcomes and lower costs.
-
J. Gastrointest. Surg. · Jan 2015
Randomized Controlled Trial Multicenter StudyThe value of drains as a fistula mitigation strategy for pancreatoduodenectomy: something for everyone? Results of a randomized prospective multi-institutional study.
A recent randomized, controlled trial investigating intraperitoneal drain use during pancreatoduodenectomy (PD) had a primary goal of assessing overall morbidity. It was terminated early with findings that routine elimination of drains in PD increases mortality and the severity and frequency of overall complications. Here, we provide a follow-up analysis of drain value in reference to clinically relevant postoperative pancreatic fistula (CR-POPF). ⋯ The results of this analysis suggest that drains diminish the rate and severity of CR-POPF in patients with moderate/high risk, but they could possibly be avoided in the roughly one third of patients with negligible/low risk.