The rate of ileostomy site incisional hernias: more common than we think?

Purpose: Incisional hernias (IH) rates after diverting loop ileostomy reversal (DLI-R) have been reported up to 24%. We aimed to characterize the incidence rate and risk factors associated with DLI-R site IH formation within 1-year in a large patient cohort.

Methods: A retrospective review at a single quaternary referral center hospital of adult patients who underwent DLI-R over a 5-year period and abdominal computerized tomography (CT) imaging performed within 1-year for any indication postoperatively was conducted.

Understanding General Surgery Recruitment and Attrition During the COVID-Era: A 1-Year Follow-Up Study.

Introduction: The COVID-19 pandemic resulted in modifications to resident selection. The success of these new recruitment strategies as well as the impact on trainee attrition and competency is unknown. We previously evaluated how selection of general surgery applicants changed early in the pandemic.

Patient engagement and satisfaction with early phase cell therapy clinical trials at a tertiary inflammatory bowel disease center.

Several clinical trials are underway investigating cell and gene therapy, and while these trials are meant to significantly impact patient care, they rely on patient engagement and participation. Unfortunately, clinical trials generally require extensive commitment by subjects. While several studies are using validated surveys to measure patient-reported outcomes, there is a lack of characterization of the patient experience as a subject in these trials.

Surgical Options for the Treatment of Perianal and Anovaginal Fistulas in the Setting of Ileoanal Pouch Crohn's Disease: Experience of a Tertiary Center.

Background: The leading cause of pouch failure following ileal pouch-anal anastomosis are peri-pouch fistulas and pelvic sepsis.

Objective: Determine the overall efficacy of current surgical therapy for the treatment of perianal and anovaginal fistulizing disease related to Crohn's disease phenotype of the pouch.

Design: Retrospective cohort study of a prospectively maintained, IRB-approved database.

Use of the Kono-S anastomosis in pediatric Crohn's disease: a single-institution experience.

Objectives: About 24% of children with Crohn's Disease (CD) require surgery. In 2003, Kono et al. described a novel anastomosis reported to decrease the rate of anastomotic CD recurrence.

Management of Perianal Crohn's Disease.

Perianal Crohn's disease affects 25%-35% of patients with Crohn's disease and has proven to be one of the most difficult complications of the disease to treat. Patients with perianal Crohn's disease have lower health-related quality of life scores typically related to pain and fecal incontinence. In addition, patients with perianal Crohn's disease have higher rates of hospitalizations, surgeries, and overall healthcare costs.

Anorectal Anatomy Quiz: Test Your Knowledge.

The anorectal region is a commonly misunderstood area of the gastrointestinal tract, but a thorough understanding of the anatomy provides significant insight into anorectal pathology and pathophysiology. This knowledge can thus guide optimal medical and surgical management of either benign or malignant disease processes. This quiz contains clinically relevant concepts and anatomical pearls meant for surgeons at all stages of training to be able to review and improve one's fund of knowledge of the anatomy and function of the anal canal.

Young Black Women May be More Likely to Have First Mammogram Cancers: A New Perspective in Breast Cancer Disparities.

Introduction: Black women are diagnosed with breast cancer at earlier ages and are 42% more likely to die from the disease than White women. Recommendations for commencement of screening mammography remain discordant. This study sought to determine the frequency of first mammogram cancers among Black women versus other self-reported racial groups.

Submassive Pulmonary Embolism: A Re-evaluation of Hemodynamic Instability.

Current medical management of pulmonary embolism (PE) is driven by risk stratification, with thrombolytic treatment reserved for patients with hemodynamic instability. We describe a case of a man with acute submassive bilateral pulmonary emboli and a right popliteal deep vein thrombosis (DVT), who had persistent shortness of breath, tachycardia, and hypoxemia but remained normotensive and was therefore not treated with thrombolytics until he suffered a fatal cardiac arrest on hospital day six. We examine the indications, risks, and potential benefits of thrombolytic treatment in patients with submassive PE who exhibit signs of instability but do not meet current indications for thrombolytic treatment with persistent hypotension or shock.

Neonatal Hyponatremia in the Setting of Untreated Progressive Hydrocephalus.

Background: Hyponatremia in the neonatal population is an uncommon occurrence and can be associated with significant increase in morbidity and mortality. In the neonatal population, it is typically associated with an excess of antidiuretic hormone and rarely has been found to be associated with hydrocephalus, short of being caused by the subsequent treatment of hydrocephalus.

Case Description: We present a case report of a patient with neonatal hydrocephalus, secondary to intraventricular hemorrhage in the setting of prematurity, treated at our institution, in whom sodium levels reached a nadir as head circumference peaked and subsequent treatment of hydrocephalus resolved the associated hyponatremia.

Interventions to Increase Depression Treatment Initiation in Primary Care Patients: a Systematic Review.

Introduction: Nearly 50% of depressed primary care patients referred to mental health services do not initiate mental health treatment. The most promising interventions for increasing depression treatment initiation in primary care settings remain unclear.

Methods: We performed a systematic search of publicly available databases from inception through August 2017 to identify interventions designed to increase depression treatment initiation.