Percutaneous Chemical and Mechanical Necrosectomy for Walled-Off Pancreatic Necrosis.

Purpose: To test the hypothesis that percutaneous combined chemical and mechanical necrosectomy using a Malecot anchor drain and an Arrow-Trerotola percutaneous thrombolytic device (PTD) in patients with walled-off pancreatic necrosis (WOPN) is feasible, safe, and effective compared with a control group undergoing mechanical necrosectomy alone.

Materials And Methods: In a retrospective analysis, patients with WOPN not amenable to endoscopic-guided cystogastrostomy placement were studied as case and control groups. The patients in the case group underwent percutaneous combined chemical (hydrogen peroxide 3%) and mechanical necrosectomy using a Malecot anchor drain and/or Arrow-Trerotola PTD from December 2020 to April 2022.

A Novel Approach to Managing a Strangulated De Garengeot's Hernia.

De Garengeot's hernia, the presence of an incarcerated vermiform appendix within a femoral hernia, is a rare general surgery emergency that predominantly affects elderly female patients. Due to its rarity, there is significant variation in surgical technique; however, most case reports favor an open approach. Here we present a case of a De Garengeot's hernia with a unique hybrid open and laparoscopic repair, utilizing the hernia defect as a port site.

Frailty assessment in the acute care surgery population - the agreement and predictive value on length of stay and re-admission of 3 different instruments in a prospective cohort.

Background: We compared the Emergency General Surgery Specific Frailty Index (EGSFI), Risk Analysis Index (RAI-C) and the Katz Index (KI) at assessing frailty in acute care surgery (ACS).

Methods: A prospective cohort of ACS patients was stratified into frail or non-frail by the EGSFI, RAI-C and KI. The agreement between scales were compared.

Cholecystitis.

Cholecystitis is the most prevalent surgical condition affecting populations in industrialized countries. Rather than a single clinical entity, cholecystitis is a class of related disease states with different causes, degrees of severity, clinical courses, and management strategies. Appropriate care of the patient who has a diseased gallbladder requires a broad understanding of the acute, chronic, and acalculous cholecystitis syndromes, and awareness of their particular clinical nuances and potential complications.

Hepatobiliary surgery: lessons learned from live donor hepatectomy.

The liver is unique in the rapid tissue regeneration occurs after resection or injury, and affords the surgeon the opportunity to safely remove up to 60% to 70% of the liver volume for treatment of cancer or for use as a live donor graft for transplantation. The complex development of the liver and biliary system in utero results in multiple and complicated anatomic variations. The hepatobiliary surgeon of today must be able to integrate a broadening array of radiologic and liver resection techniques that may improve patient safety and surgical outcome.

Distal splenorenal shunt: preferred treatment for recurrent variceal hemorrhage in the patient with well-compensated cirrhosis.

Hypothesis: Distal splenorenal shunt (DSRS) is a safe and effective treatment for patients with Child-Pugh class A and B cirrhosis with recurrent variceal hemorrhage after failed transjugular intrahepatic portosystemic shunt.

Design: Retrospective case review.

Setting: Hepatobiliary surgery and liver transplantation department in a tertiary referral medical center.