Thirty-day readmissions after inpatient laparoscopic cholecystectomy: factors and outcomes.

Background: 30-day readmissions are a considerable financial burden on medical institutions due to penalties faced from the Centers for Medicaid and Medicare.

Methods: A retrospective review of 30-day readmissions was performed. The data were subdivided into medical severity-diagnostic related groups 417, 418, and 419, as categorized by the Centers for Medicaid and Medicare.

Total laparoscopic removal of accessory gallbladder: A case report and review of literature.

Accessory gallbladder is a rare congenital anomaly occurring in 1 in 4000 births, that is not associated with any specific symptoms. Usually this cannot be diagnosed on ultrasonography and hence they are usually not diagnosed preoperatively. Removal of the accessory gallbladder is necessary to avoid recurrence of symptoms.

Gastric remnant twist in the immediate post-operative period following laparoscopic sleeve gastrectomy.

Twist of stomach remnant post sleeve gastrectomy is a rare entity and difficult to diagnose pre-operatively. We are reporting a case of gastric volvulus post laparoscopic sleeve gastrectomy, which was managed conservatively. A 38-year-old lady with a body mass index of 54 underwent laparoscopic sleeve gastrectomy.

Present Status of Autonomy in Surgical Residency--a Program Director's Perspective.

As surgery residents graduate and begin their careers as junior attending surgeons, the question of whether a surgeon can complete a case alone still lingers. Allowing autonomy during residency answers this question. The purpose of this study was to gather input from general surgery residency program directors on how they achieve autonomy for residents in their programs.

Percutaneous drainage of a diverticular abscess should be limited to two attempts for a resilient diverticular abscess.

Management of a resilient diverticular abscess poses a big challenge. Currently there are no guidelines for the number of percutaneous drainages to be performed in resilient diverticular abscesses before attempting surgery. All patients (n = 117) who presented with a computed tomography scan-proven diverticular abscess from July 2008 to June 2011 were studied.

A true orthotopic gastric cancer murine model using electrocoagulation.

Background: Orthotopic mouse models of human gastric cancer represent an important in vivo tool for testing chemotherapeutic agents and for studying intraluminal factors. Currently, orthotopic mouse models of gastric cancer require an operative procedure involving either injection or implantation of tumor cells in stomach layers. The resultant tumor does not grow from the stomach's mucosal surface, so it does not mimic the human disease process.

Transvesical NOTES: survival study in porcine model.

Background And Objectives: The optimal access route and method for natural orifice transluminal endoscopic surgery (NOTES) has not been established. A transvesical approach, with its low rate of peritoneal contamination, is an effective clean portal of entry, but a safe urinary bladder closure has been a challenge. We developed a new technique for a safe, pure transvesical NOTES approach.

Intratumoral acetic acid injection eradicates human prostate cancer tumors in a murine model.

Introduction: To treat localized prostate cancer without substantial morbidity, an ideal treatment would be an effective local therapy with minimal morbidity. Direct injections have been used to treat benign prostatic hyperplasia without major complications, but in limited cases. We evaluated the local oncotoxic effects of acetic acid in a prostate cancer xenograft murine model.

Single-incision laparoscopic cholecystectomy (SILC) using non-articulating instruments and conventional trocars-single surgeon experience.

Purpose: Single-incision laparoscopic cholecystectomy (SILC) was first described in 1999. Many techniques using newer instruments have emerged but none has been standardized. We describe our technique and experience, using non-articulating instruments with conventional trocars.

Setons in the treatment of anal fistula: review of variations in materials and techniques.

Aim: Anorectal fistulas have been a common surgical problem since ancient times. Age-old seton techniques are still practiced successfully in the treatment of complex anal fistulas. Many variations in materials and techniques are described in the literature.

Parathyroidectomies using intraoperative parathormone monitoring: when should we stop measuring intraoperative parathormone levels?

Intraoperative parathyroid hormone monitoring (IOPM), in use for the last 15 years, has facilitated focused parathyroidectomy. We undertook this study to determine if a drop in IOPT hormone levels below 50 per cent of baseline were sufficient to terminate the procedure. We conducted a retrospective chart review (January 2007 to September 2010) of 104 patients who underwent initial parathyroidectomies with IOPM by general surgeons for primary hyperparathyroidism.

Receptor changes in metachronous breast tumors--our experience of 10 years.

Introduction: Patients with primary breast cancer (PBC) are at 2 to 6 times higher risk for developing synchronous and metachronous breast cancer (MBC). The pathology and behavior of MBC still remains unclear.

Methods: We reviewed the charts of 108 women with MBC at our hospital over the past 10 years.

Prolonged (longer than 3 hours) laparoscopic cholecystectomy: reasons and results.

For the experienced surgeon, the average operative time for a laparoscopic cholecystectomy is less than 1 hour. There has been no study documenting the causes and results of prolonged (longer than 3 hours) surgery. A retrospective study was done of patients who underwent cholecystectomy between January 2003 and December 2007.

Minimally invasive training during surgical residency.

The field of postgraduate minimally invasive surgery training has undergone substantial growth and change. A survey was sent to all program directors in surgery. Minimally invasive training patterns, facilities, their views, and performance of residents were examined.

Hydatid disease presenting as cutaneous fistula: review of a rare clinical presentation.

Hydatid disease has a worldwide distribution as a result of more global travel. Liver and lungs are the most common sites for the primary hydatid cysts in the human body. We managed a 68-year-old man who presented with abdominal distension and umbilical fistula, discharging daughter cysts.

Review of third and fourth re-excision for narrow or positive margins of invasive and intraductal carcinoma.

The trend in breast surgery has shifted toward breast conservation. We reviewed our third and fourth breast re-excision cases, with an analysis of various factors used in making this decision. A retrospective analysis identified 585 patients who underwent re-excision surgery for positive or close margins of invasive carcinoma or ductal carcinoma in situ (DCIS).

Creation of reversible cholestatic rat model.

Cholestasis is a clinical condition commonly encountered by both surgeons and gastroenterologists. Cholestasis can cause various physiological changes and affect the nutritional status and surgical outcomes. Study of the pathophysiological changes occurring in the liver and other organs is of importance.

Laparoscopic three-port distal pancreatectomy.

Aims: Laparoscopic distal pancreatectomy is becoming a more commonly used procedure, which may involve the use of four to seven ports, depending on the technique. Initial data on feasibility, safety and outcome with the three-port laparoscopic distal pancreatectomy are presented.

Methods: The patient is placed in a partial thoracoabdominal position exposing the left flank in a reverse Trendelenberg position.

A novel nonoperative orthotopic colorectal cancer murine model using electrocoagulation.

Background: Orthotopic mouse models of human colorectal cancer represent an important in vivo tool for testing chemotherapeutic agents and studying intraluminal factors that may alter the growth of cancers. Currently the orthotopic mouse models of colorectal cancer require either an operative procedure or creation of colitis to implant the cancer cells in rectum. We have developed a nonoperative, minimally invasive technique to create a true orthotopic colon cancer mouse model.

Non-cutting setons for progressive migration of complex fistula tracts: a new spin on an old technique.

Aim: We introduced a modification of the loose seton for high transsphincteric fistula which involved daily self-rotation of the seton by 360°, which we call the progressive migration technique. The outcomes were evaluated.

Method: A retrospective review was undertaken of all operations for anal fistula performed by a single colorectal surgeon from Jan.