A Systematic Review of Single-Layer Versus Double-Layer Intestinal Anastomosis: Is One Better?

Introduction: To perform a systematic review of randomized controlled trials comparing outcomes from handsewn single-layer and double-layer intestinal anastomosis in adults.

Methods: A literature search was conducted using PubMed, SCOPUS, and Web of Science databases for studies published up to September 14, 2023 using the following keyword search query: ((one) OR (single)) AND ((two) OR (double)) AND (layer) AND ((anastomoses) OR (anastomosis)).

Results: In seven of the eight studies, there was no significant difference in anastomotic leakage rate.

Appendicitis in the Neutropenic Patient: A Systematic Review.

Neutropenia increases the complexity of surgical decision-making in cases of acute appendicitis. In this systematic review, we discuss medical vs surgical management and timing of appendectomy in the neutropenic adult patient. We queried databases utilizing the key words "neutropenia" and "appendicitis.

Wellbeing as Defined by Resident Physicians: A Qualitative Study.

The importance of resident wellbeing is increasingly recognized by the ACGME as essential. While prior studies have quantified wellbeing/burnout, few have defined wellbeing from the resident-physician perspective. A REDCap® survey was distributed to residents in various programs, responses were grouped by theme, and data analyzed via chi-square.

Trainee Utilization of the SCORE Curriculum is Associated With Improved ABSITE Performance: A Multi-institutional Study.

Background: The Surgical Council on Resident Education's (SCORE) structured educational curriculum for general surgery residents uses a 2-year repeating cycle of modules and quizzes called "This Week in SCORE" (TWIS) to organize and sequence the curricular content on the SCORE portal. The purpose of this study was to evaluate the impact of using the SCORE content and TWIS curriculum on American Board of Surgery In-Training Examination (ABSITE) performance. To date, no multi-institutional studies have examined this effect.

Incidence of Complicated Appendicitis as a Metric of Health Care Delivery.

Background: Complicated acute appendicitis (CAA) has been linked to extremes of age, racial and socioeconomic disparities, public insurance, and remote residency. CAA rate has been used from 2005 to 2018 as a health care quality metric, with the assumption that delay in treatment was a main cause of perforation. We studied factors that could contribute to CAA focusing on modifiable factors which could be altered as part of a health care delivery system.

Use of CT Scans for Abdominal Pain in the ED: Factors in Choice.

Overutilization of healthcare resources is a threat to long-term healthcare sustainability and patient outcomes. CT is a costly but efficient means of assessing abdominal pain; however, 97 per cent of ED physicians acknowledge its overutilization. This study sought to understand factors that influence ED providers' decision regarding CT use in the evaluation of abdominal pain.

Measured Estimated Blood Loss: Interim Analysis of a Prospective Quality Improvement Study.

Estimated blood loss (EBL) is an increasingly important factor used to predict outcomes, such as morbidity and mortality, length of stay, and readmissions, after major abdominal operations. However, blood loss is difficult to estimate, with frequent under- and overestimations, consequences of which can be potentially dangerous for individual patients and confounding for scoring systems relying on EBL. We hypothesized that EBL is often inaccurate and have prospectively enrolled consecutive patients undergoing major elective intra-abdominal operations.

Group G streptococcus leading to necrotizing soft tissue infection after left lower extremity radiofrequency venous ablation.

A 73-year-old morbidly obese woman developed a severe group G Streptococcus (GGS) necrotizing soft tissue infection (NSTI), superimposed by toxic shock-like syndrome after undergoing radiofrequency venous ablation of her left lower extremity. NSTI secondary to GGS are relatively uncommon, with only nine cases described in the literature. We present a case of GGS NSTI, a debilitating wound infection, occurring after radiofrequency venous ablation.

Detecting accidental punctures and lacerations during cholecystectomy in large datasets: Two methods of analysis.

Background: After the Institute of Medicine (IOM) report To Err Is Human highlighted the impact of medical errors, the Agency for Healthcare Research and Quality (AHRQ) developed Patient-Safety Indicators (PSI) to improve quality by identifying potential inpatient safety problems. PSI-15 was created to study accidental punctures and lacerations (APL), but PSI-15 may underestimate APLs in populations of patients. This study compares PSI-15 with a more inclusive approach using a novel composite of secondary diagnostic and procedural codes.

Use of Computerized Tomography in Abdominal Pain.

Annually, approximately 70 million computed tomography (CT) scans are performed in emergency department (ED) settings in the United States of America. From 1995 to 2007, there has been a 5.9-fold increase in the use of CT scans nationally.

Effectiveness of an Early Ultrasound Training Curriculum for General Surgery Residents.

Ultrasound (US) is fast becoming an extension of the physical examination in most surgical settings. Unfortunately, few residency programs offer a formal US training curriculum to their general surgical residents. This study aimed to assess the efficacy of a formal US training module for general surgery residents.

Clues to predict incidental gallbladder cancer.

Background: Consequences of incidental gallbladder cancer (iGBC) following cholecystectomy may include repeat operation (depending on T stage) and worse survival (if bile spillage occurred), both avoidable if iGBC were suspected preoperatively.

Methods: A retrospective single-institution review was done. Ultrasound images for cases and controls were blindly reviewed by a radiologist.

HIDA scan for functional gallbladder disorder: ensure that you know how the scan was done.

Background: Despite the increasing use of fatty meal (FM) as a substitute for cholecystokinin (CCK) in pain reproduction during hepato-imino-diacetic acid (HIDA) scan in functional gallbladder disorder, there are no studies comparing the differences between CCK and FM. The present study was to compare the efficacy of FM in comparison of CCK in FGBD application.

Methods: Patients undergoing HIDA scans from August 2013 to May 2014 were divided into two groups: those undergoing CCK-stimulated HIDA scan versus FM-stimulated HIDA scan.

Age-related differences pre-, intra-, and postcholecystectomy: A retrospective cohort study of 6,868 patients.

Background: Cholecystectomy (CCY) is increasingly performed in older individuals. We sought to examine age-related differences in pre-, intra-, and postoperative factors at a community hospital, using a very large, single-institution cholecystectomy database.

Materials And Methods: A retrospective review of 6868 patients who underwent CCY from 2001 to 2013 was performed.

The role of surgery in the treatment of endoscopic complications.

As the number, diversity, and complexity of endoscopic complications has increased, so too has the number, diversity, and complexity of operative interventions required to treat them. The most common complications of endoscopy in general are bleeding and perforation, but each endoscopic modality has specific nuances of these and other complications. Accordingly, this review considers the surgical complications of endoscopy by location within the gastrointestinal tract, as opposed to by complication types, since there are many complication types that are specific for only one or few locations, such as buried-bumper syndrome after percutaneous endoscopic gastrostomy and pancreatitis after endoscopic retrograde cholangiopancreatography, and since the management of a given complication, such as perforation, may be vastly different in one area than in another area, such as perforations of the esophagus versus the retroperitoneal duodenum versus the intraperitoneal duodenum.

Laparoscopic Adrenalectomy for Adrenal Cancer-A Systematic Review.

Laparoscopic adrenalectomy is increasingly employed for removal of adrenal masses. As adrenal tumors increase in size, however, their malignant potential likewise increases, raising concerns for the use of laparoscopy for removal of large adrenal malignancies. We present a systematic review of the use of laparoscopic adrenalectomy of large malignant tumors.

Effect of Residents on Operative Time and Complications: Focus on Laparoscopic Cholecystectomy in the Community.

Objective: To better understand important aspects of resident education in the perioperative setting, given that there are conflicting data regarding resident training and outcomes (e.g., operative times and complications).

Verbal Aggressiveness Among Physicians and Trainees.

Objective: To better understand verbal aggressiveness among physicians and trainees, including specialty-specific differences.

Design And Participants: The Infante Verbal Aggressiveness Scale (IVAS) was administered as part of a survey to 48 medical students, 24 residents, and 257 attending physicians. The 72 trainees received the IVAS and demographic questions, whereas the attending physicians received additional questions regarding type of practice, career satisfaction, litigation, and personality type.