The Effect of Tack Fixation Methods on Outcomes in Laparoscopic Ventral Hernia Repair.

There are weak data comparing the safety and efficacy of absorbable and permanent tacks in laparoscopic ventral hernia repair with tack-only mesh fixation. In this study, we compared recurrence and complications rates following hernia repair using either only absorbable or only permanent tacks. Data from the Americas Hernia Society Quality Collaborative database were retrospectively reviewed as accessed on June 30, 2017.

Negative Pressure Wound Therapy for Surgical-site Infections: A Randomized Trial.

Objective: This study seeks to evaluate the efficacy of negative pressure wound therapy for surgical-site infection (SSI) after open pancreaticoduodenectomy.

Background: Despite improvement in infection control, SSIs remain a common cause of morbidity after abdominal surgery. SSI has been associated with an increased risk of reoperation, prolonged hospitalization, readmission, and higher costs.

Rationale and Technique for Measuring Abdominal Wall Tension in Hernia Repair.

We describe a method to measure abdominal wall tension during hernia surgery and evaluate a possible correlation between hernia defect width and abdominal wall tension. After Institutional Review Board approval and informed consent, a prospective trial to measure intraabdominal tension was undertaken (May 2013 through March 2017). Tension measurements were obtained using tensiometers.

Long-term outcomes of sandwich ventral hernia repair paired with hybrid vacuum-assisted closure.

Background: Sandwich ventral hernia repair (SVHR) may reduce ventral hernia recurrence rates, although with an increased risk of surgical site occurrences (SSOs) and surgical site infections (SSIs). Previously, we found that a modified negative pressure wound therapy (hybrid vacuum-assisted closure [HVAC]) system reduced SSOs and SSIs after ventral hernia repair. We aimed to describe our outcomes after SVHR paired with HVAC closure.

Early hospital readmission for gastrointestinal-related complications predicts long-term mortality after pancreatectomy.

Background: The purpose of this study was to investigate the prognostic significance of early (30-day) hospital readmission (EHR) on mortality after pancreatectomy.

Methods: Using a prospectively collected institutional database linked with a statewide dataset, we evaluated the association between EHR and overall mortality in all patients undergoing pancreatectomy at our tertiary institution (2005 to 2010).

Results: Of 595 pancreatectomy patients, EHR occurred in 21.

Negative-Pressure Wound Therapy in the Management of High-Grade Ventral Hernia Repairs.

Background: Despite improved operative techniques, open ventral hernia repair (VHR) surgery in high-risk, potentially contaminated patients remains challenging. As previously reported by our group, the use of a modified negative-pressure wound therapy system (hybrid-VAC or HVAC) in patients with grade 2 hernias is associated with lower surgical site occurrence (SSO) and surgical site infection (SSI) rates. Accordingly, the authors aim to evaluate whether the HVAC would similarly improve surgical site outcomes following VHR in patients with grade 3 hernias.

What is the Significance of Indeterminate Pulmonary Nodules in Patients Undergoing Resection for Pancreatic Adenocarcinoma?

Objective: The significance of indeterminate pulmonary nodules (IPNs) in patients undergoing resection of pancreatic ductal adenocarcinoma (PDAC) is unknown. We sought to define the prevalence and impact of IPN in such patients.

Methods: We studied all patients who underwent surgical resection of PDAC between 1980 and 2013.

Tracking early readmission after pancreatectomy to index and nonindex institutions: a more accurate assessment of readmission.

Importance: Readmission after pancreatectomy is common, but few data compare patterns of readmission to index and nonindex hospitals.

Objectives: To evaluate the rate of readmission to index and nonindex institutions following pancreatectomy at a tertiary high-volume institution and to identify patient-level factors predictive of those readmissions.

Design, Setting, And Participants: Retrospective analysis of a prospectively collected institutional database linked to statewide data of patients who underwent pancreatectomy at a tertiary care referral center between January 1, 2005, and December 2, 2010.

Novel wound management system reduction of surgical site morbidity after ventral hernia repairs: a critical analysis.

Background: Prophylactic incisional negative-pressure wound therapy use after ventral hernia repairs (VHRs) remains controversial. We assessed the impact of a modified negative-pressure wound therapy system (hybrid-VAC or HVAC) on outcomes of open VHR.

Methods: A 5-year retrospective analysis of all VHRs performed by a single surgeon at a single institution compared outcomes after HVAC versus standard wound dressings.

Functional abdominal wall reconstruction using an innervated abdominal wall vascularized composite tissue allograft: a cadaveric study and review of the literature.

Background: Large, composite abdominal wall defects represent complex problems requiring a multidisciplinary approach for reconstruction. Abdominal wall vascularized composite allotransplantation (AW-VCA) has been successfully performed in 21 patients, already receiving solid organ transplants, to provide immediate abdominal closure. The current study aims to establish a novel anatomic model for AW-VCA that retains motor and sensory function in an effort to preserve form and function while preventing complications.

Adenocarcinoma of the Ileal Conduit in a Patient Born With Classic Bladder Exstrophy.

Bladder exstrophy is a rare birth defect that typically requires patients to undergo multiple surgical procedures throughout the course of their childhood. Many ultimately undergo operations that use segments of bowel for the reconstruction and/or augmentation of the urinary tract, which imparts an increased risk of malignancy in these patients. We present the case of a 59-year-old man with a history of bladder exstrophy managed with ureterosigmoidostomies revised to an ileal conduit who developed a large adenocarcinoma in the ileal conduit that extended into small bowel, sigmoid colon, and ureter.

2564 resected periampullary adenocarcinomas at a single institution: trends over three decades.

Objective: This study was carried out to determine relative survival rates and trends in outcomes in patients who underwent resection of periampullary adenocarcinomas (PACs) with curative intent at a single institution over the last three decades.

Methods: From 1980 to 2011, 2564 pancreaticoduodenectomies (PDs) were performed for PACs. Pathological diagnosis, therapy and survival were retrospectively analysed.

Superior mesenteric artery syndrome: spectrum of CT findings with multiplanar reconstructions and 3-D imaging.

Objective: This article reviews the causes, clinical presentation, and CT diagnosis of superior mesenteric artery (SMA) syndrome.

Conclusion: In conjunction with an appropriate clinical history, several CT findings can suggest the diagnosis of SMA syndrome. These findings include narrowing of the aortomesenteric angle and distance, distension of the stomach and duodenum, and dilatation of the left renal vein with left-sided venous collaterals.

Double Hamoudi: A case report.

Introduction: Solid pseudopapillary neoplasms are rare pancreatic neoplasms with low malignant potential and favorable prognosis that are typically seen in young women.

Presentation Of Case: We report a case of two large solid pseudopapillary neoplasms in a 23-year old woman who was treated successfully with a total pancreatectomy.

Conclusion: To the best of our knowledge, this is the first report of two discrete solid pseudopapillary neoplasms in the same patient.

Predicting the risk of perioperative mortality in patients undergoing pancreaticoduodenectomy: a novel scoring system.

Objective: To develop and validate a risk score to predict the 30- and 90-day mortality after a pancreaticoduodenectomy or total pancreatectomy on the basis of preoperative risk factors in a high-volume program.

Design: Data from a prospectively maintained institutional database were collected. In a random subset of 70% of patients (training cohort), multivariate logistic regression was used to develop a simple integer score, which was then validated in the remaining 30% of patients (validation cohort).

Obturator nerve transfer as an option for femoral nerve repair: case report.

Objective: Nerve transfers have proved to be an important addition to the armamentarium in the repair of brachial plexus lesions, but have been used sparingly for lower extremity nerve repair. Here, we present what is believed to be the first description of a successful transfer of the obturator nerve to the femoral nerve.

Clinical Presentation: A 45-year-old woman presented with a complete femoral nerve lesion after removal of a large (15-cm) schwannoma of the retroperitoneum involving the lumbar plexus.

Adjuvant therapy in pancreatic cancer: Phase I trial of radiation dose escalation with concurrent full-dose gemcitabine.

Purpose: To determine the maximal tolerated dose of radiation delivered to the primary tumor bed, in combination with full-dose gemcitabine (1000 mg/m(2) weekly x 3), after resection of pancreatic cancer.

Methods And Materials: Patients with resected pancreatic carcinoma and poor prognostic features, a positive resection margin, or involved lymph nodes were eligible. Radiotherapy (RT) was directed at the preoperative tumor volume with a conformal technique.

Surgical resection following radiation therapy with concurrent gemcitabine in patients with previously unresectable adenocarcinoma of the pancreas.

The combination of gemcitabine with concurrent radiation therapy (Gem/RT) is a promising new approach that is being investigated in patients with unresectable pancreatic cancer. However, substantial toxicity with this combination has also been observed. This review was conducted to determine whether Gem/RT could be safely delivered in the neoadjuvant setting, based on our experience with this combined therapy in a cohort of patients with previously unresectable pancreatic cancer, who subsequently underwent surgical resection.

Carcinoid tumor of the biliary tract: treating a rare cause of bile duct obstruction.

Biliary carcinoids are rare with fewer than 30 cases reported in the English literature. The objective of this report is to describe an additional patient found to have a biliary carcinoid and to define the presentation, diagnosis, and management of patients with this rare biliary tumor. In our case the patient initially presented with clinical jaundice and elevated transaminases.

Influence of functional bowel disease on outcome of surgical antireflux procedures.

Patients with gastroesophageal reflux disease (GERD) have a coexisting diagnosis of functional bowel disease (FBD) in approximately 30% of cases. Symptom improvement after surgical therapy for GERD may be less in patients with FBD when compared to patients without this coexisting problem. A retrospective review of patients undergoing Nissen fundoplication between 1996 and 2000 evaluated patients with documented FBD or FBD symptoms to determine operative outcome.

Resectional therapy for cystic neoplasms of the pancreas.

Currently there is uncertainty in diagnosis between the serous (benign) and mucinous (premalignant) forms of cystic neoplasms of the pancreas without operation. Our objective is to evaluate resectional therapy as a treatment for these lesions. A retrospective review of cases from 1985 to 1999 were performed.