Long-term outcomes after subtotal reconstituting cholecystectomy: A retrospective case series.

Background: Subtotal cholecystectomy, where the gallbladder infundibulum is transected to avoid dissecting within the triangle of Calot, has been suggested to conclude laparoscopic cholecystectomy while avoiding common bile duct injury. However, some reports suggest the possibility of recurrent symptoms from a remnant gallbladder.

Methods: A retrospective database containing 900 randomly selected cholecystectomies occurring between 2009 and 2015 was reviewed for instances of subtotal cholecystectomy.

Primary Care Physicians' Perceptions of Bariatric Surgery and Major Barriers to Referral.

Background: Each year from 2011 to 2017, fewer than 1% of eligible Americans underwent bariatric surgery to treat obesity and obesity-related comorbidities. Recent studies have suggested that a lack of knowledge within the primary care specialty about the safety and efficacy of bariatric surgery greatly affects referral. This study aimed to analyze a large cohort of primary care physicians' (PCPs) clinical perceptions regarding bariatric surgery and to identify major barriers to referral that could inform the implementation of a future educational strategy to address underutilization of bariatric surgery.

A 1-day simulation-based boot camp for incoming general surgery residents improves confidence and technical skills.

Background: For surgery residents, opportunities to systematically learn about surgical equipment are limited. Our facility holds a simulation-based boot camp for incoming, first-year general surgery residents. The aim of this study was to assess the effectiveness of this boot camp at increasing resident confidence and improving technical skills.

Laparoscopic inguinal hernia repair after prostatectomy: Evaluating safety, efficacy, and efficiency.

Background: For many surgeons, a prior prostatectomy is considered a contraindication to laparoscopic totally extraperitoneal hernia repair. This study aims to evaluate the safety, efficacy, and efficiency of totally extraperitoneal in these patients.

Methods: This is a review of a prospectively collected hernia database evaluating patients who underwent totally extraperitoneal repair between October 2009 and March 2018.

Effects of dexamethasone on postoperative urinary retention after laparoscopic inguinal hernia repair.

Background: Postoperative urinary retention (POUR) is a complication of laparoscopic inguinal hernia repair (LIHR). Previous research has identified predictive factors of POUR, such as age and history of benign prostatic hyperplasia (BPH). There is currently limited work on preventative measures.

Patient-Centered Outcomes after Laparoscopic Paraesophageal Hernia Repair.

Background: The aim of this study is to investigate patient-centered quality of life (QOL) outcomes in patients undergoing laparoscopic paraesophageal hernia repair.

Study Design: We prospectively followed patients who underwent laparoscopic paraesophageal hernia repair between 2009 and 2016. The QOL outcomes were measured using the 36-Item Short Form Health Survey, GERD Health Related Quality of Life, Reflux Symptom Index, and Dysphagia score surveys administered preoperatively and at 3 weeks, 6 months, 1 year, and 2 years postoperatively.

Characterization of common bile duct injury after laparoscopic cholecystectomy in a high-volume hospital system.

Background: Despite the popularity of laparoscopic cholecystectomy, rates of common bile duct injury remain higher than previously observed in open cholecystectomy. This retrospective chart review sought to determine the prevalence of, and risk factors for, biliary injury during laparoscopic cholecystectomy within a high-volume healthcare system.

Methods: 800 of approximately 3000 cases between 2009 and 2015 were randomly selected and retrospectively reviewed.

Long-term patterns and predictors of pain following laparoscopic inguinal hernia repair: a patient-centered analysis.

Background: Laparoscopic inguinal hernia repair has been shown to offer patients the benefit of less postoperative pain as compared to traditional open techniques. However, the risk of experiencing significant postoperative pain may affect patient's decision making. We aimed to elucidate potential patterns of pain and the predictors of such, up to 2 years postoperatively, using both generic and specific quality of life tools.

Laparoscopic Totally Extraperitoneal Groin Hernia Repair and Quality of Life at 2-Year Follow-Up.

Background: The lack of long-term data on quality of life after groin hernia repair presents a challenge in setting patients' postoperative expectations. This study aimed to describe quality of life outcomes after laparoscopic totally extraperitoneal groin hernia repair with a minimum of 2 years follow-up.

Study Design: We prospectively evaluated 293 patients who had laparoscopic totally extraperitoneal groin hernia repair in an IRB-approved study.

Efficacy of a Required Preoperative Weight Loss Program for Patients Undergoing Bariatric Surgery.

The efficacy of mandatory medically supervised preoperative weight loss (MPWL) prior to bariatric surgery continues to be a controversial topic. The purpose of this observational study was to assess the efficacy of a MPWL program in a single institution, which mandated at least 10% excess body weight loss before surgery, by comparing outcomes of patients undergoing primary bariatric surgery with and without a compulsory preoperative weight loss regimen. We analyzed our database of 757 patients who underwent primary bariatric surgery between March 2008 and January 2015.

Gastroesophageal reflux disease in lung transplant patients with cystic fibrosis.

Background: Gastroesophageal reflux disease (GERD) in lung transplant patients is being increasingly investigated because of its reported association with chronic rejection. However, information concerning the characteristics of GERD in cystic fibrosis (CF) patients is scarce.

Methods: We compared esophageal pH monitoring, manometry, gastric emptying studies, and barium swallow of 10 lung transplant patients with CF with those of 78 lung transplant patients with other end-stage pulmonary diseases.

Primary aortoenteric fistula following disseminated bacillus Calmette-Guérin infection: a case report.

The aim of this paper is to illustrate a rare case of primary aortoenteric fistula in the presence of disseminated infection and review the critical decision-making process. A clinical case was reviewed for its initial presentation, planning of treatment strategy and outcome. A secondary literature search for discussion on current accepted recommendations for primary aortoenteric fistula was then completed.

The prevalence and extent of gastroesophageal reflux disease correlates to the type of lung transplantation.

Background: Evidence is increasingly convincing that lung transplantation is a risk factor of gastroesophageal reflux disease (GERD). However, it is still not known if the type of lung transplant (unilateral, bilateral, or retransplant) plays a role in the pathogenesis of GERD.

Study Design: The records of 61 lung transplant patients who underwent esophageal function tests between September 2008 and May 2010, were retrospectively reviewed.

Assessing residents in surgical ethics: we do it a lot; we only know a little.

Background: PGY-1 year of surgical residency brings together many persons of disparate experiences and educational backgrounds, including their exposure to ethics. We hypothesized that surgical PGY-1s would have a similar exposure to ethical scenarios but lack the confidence in practice and understanding of ethical principles compared with more senior residents.

Materials And Methods: Surgical residents were invited to resident-initiated surgical ethics workshops utilizing a standardized text.

The evolution and long-term results of laparoscopic antireflux surgery for the treatment of gastroesophageal reflux disease.

Background: For nearly 2 decades, the laparoscopic correction of gastroesophageal reflux disease (GERD) has demonstrated its utility. However, the surgical technique has evolved over time, with mixed long-term results. We briefly review the evolution of antireflux surgery for the treatment of GERD, provide an update specific to the long-term efficacy of laparoscopic antireflux surgery (LARS), and analyze the factors predictive of a desirable outcome.

Comparison of resident self-assessments with trained faculty and standardized patient assessments of clinical and technical skills in a structured educational module.

Background: This study assessed the reliability of surgical resident self-assessment in comparison with faculty and standardized patient (SP) assessments during a structured educational module focused on perioperative management of a simulated adverse event.

Methods: Seven general surgery residents participated in this module. Residents were assessed during videotaped preoperative and postoperative SP encounters and when dissecting a tumor off of a standardized inanimate vena cava model in a simulated operating room.

Causes of high mortality in colorectal surgery: a review of episodes of care in Veterans Affairs hospitals.

Background: The episode of care for colorectal surgery in 8 outlier Veterans Affairs Hospitals with high mortality and the volume outcome relationship in 118 Hospitals are examined.

Methods: A total of 103 deaths were reviewed. Mean age was 74 with 63% of the patients undergoing emergency surgery; 54% of the patients had malignant disease and 21% had metastatic disease.

Preoperative evaluation: pulmonary, cardiac, renal dysfunction and comorbidities.

This article reviews evidence supporting the exercise of risk assessment and demonstrates how it assists in determining which patients should undergo a planned invasive procedure. The article focuses on the preoperative functional assessment of three major organ systems--cardiac, pulmonary, and renal--and reviews guide-lines for determining which patients need additional testing of organ system function. The article also discusses how to improve the condition of selected patients so that the surgeon can achieve the best possible result and outcome.

Exacerbation of acute pancreatitis by combined cholinergic stimulation and duct obstruction.

Background: The role of cholinergic pathways in the pathogenesis of bile-pancreatic duct ligation (BPDL)-induced acute pancreatitis in rats remains controversial. We hypothesized that cholinergic stimulation exacerbates acute pancreatic inflammation in the presence of duct obstruction.

Methods: We studied 34 rats divided into 5 groups as follows: (1) sham operation; (2) BPDL; (3) BPDL with duodenal bile-pancreatic juice (BPJ) replacement fresh from a donor rat; (4) BPDL with BPJ replacement as in 3 above, and carbachol (CCh) 5 ug/h subcutaneously; or (5) CCh 5 ug/h subcutaneously only.

Management of adverse surgical events: a structured education module for residents.

Background: This pilot project involved the development of a structured, experiential, educational module using a bench model technical skills simulation and standardized patients. It integrated teaching and assessment of clinical, technical, and interpersonal skills, as well as professionalism within the context of an adverse surgical event.

Methods: General surgery residents (postgraduate year [PGY] 2, 3) were asked to participate in the pre-, intra-, and postoperative management of a patient with a retroperitoneal sarcoma.

The role of the Veterans Affairs Medical Centers in patient care, surgical education, research and faculty development.

Veterans Administration (VA) medical centers have had a long history of providing medical care to those who have served their country. Over time, the VA has evolved into a facility that has had a major role in graduate medical education. In surgery, this had provided experience in the medical and surgical management of complex surgical disease involving the head and neck, chest, and gastrointestinal tract, and in the fields of surgical oncology, peripheral vascular disease, and the subspecialties of urology, orthopedics, and neurosurgery.

Restoration of normal distensive characteristics of the esophagogastric junction after fundoplication.

Objective: To study the mechanical characteristics of the esophagogastric junction (EGJ) of postfundoplication patients and compare them with previously reported data on normal subjects and GERD patients.

Methods: Eight normal subjects, 9 GERD patients, and 8 fundoplication patients were studied with concurrent manometry, fluoroscopy, and stepwise controlled barostat distention of the EGJ. The minimal barostat pressure required to open the EGJ during the interswallow period was determined.

The mechanical basis of impaired esophageal emptying postfundoplication.

Fundoplication (FP) efficacy is a trade-off between protection against reflux and postoperative dysphagia from the surgically altered mechanical balance within the esophagogastric segment. The purpose of the study was to contrast quantitatively the mechanical balance between normal and post-FP esophageal emptying. Physiological data were combined with mathematical models based on the laws of mechanics.