Impact of neoadjuvant chemoradiation on perioperative outcomes in patients with rectal cancer.

Background And Objectives: Neoadjuvant chemoradiation for rectal cancer is associated with lower local recurrence rates. The objective of this study is to assess the impact of neoadjuvant therapy on perioperative complications in patients with rectal cancer.

Methods: Using the ACS-NSQIP database (2005-2012), a propensity score was used to match 3592 patients with rectal cancer receiving neoadjuvant therapy to 3592 patients undergoing surgery alone.

Efficacy of fibrin glue therapy for abscess-associated enteric fistulas.

Background: Abdominal abscess that result from bowel injury may require treatment with percutaneous drainage. In some cases, an abscess-associated fistula develops between the injured bowel and the drainage catheter. Fistulas that fail to resolve may require surgery; however, fibrin glue therapy (FGT) may be a suitable alternative.

Separating the Laparoscopic Camera Cord From the Monopolar "Bovie" Cord Reduces Unintended Thermal Injury From Antenna Coupling: A Randomized Controlled Trial.

Objective(s): The monopolar "Bovie" is used in virtually every laparoscopic operation. The active electrode and its cord emit radiofrequency energy that couples (or transfers) to nearby conductive material without direct contact. This phenomenon is increased when the active electrode cord is oriented parallel to another wire/cord.

Unintended stray energy from monopolar instruments: beware the dispersive electrode cord.

Background: The monopolar instrument emits stray radiofrequency energy from its cord when activated. This is a source of unintended thermal injury to patients. Stray energy emitted from the dispersive electrode cord has not been studied.

Surgical Energy-Based Device Injuries and Fatalities Reported to the Food and Drug Administration.

Background: Energy-based devices are used in virtually every operation. Our purposes were to describe causes of energy-based device complications leading to injury or death, and to determine if common mechanisms leading to injury or death can be identified.

Study Design: The FDA's Manufacturer and User Facility Device Experience (MAUDE) database was searched for surgical energy-based device injuries and deaths reported over 20 years (January 1994 to December 2013).

Postoperative pneumoperitoneum: is it normal or pathologic?

Background: Pneumoperitoneum on computed tomography (CT) after abdominal surgery is common, but its incidence, duration, and clinical significance is widely debated.

Materials And Methods: A retrospective, cohort study of patients who underwent abdominal CT within 30 days of abdominal surgery.

Results: Among 344 patients, pneumoperitoneum was found in 39% (135/344) of patients on postoperative days 0-6 in 53%, 7-13 in 41%, 14-20 in 23%, 21-27 in 13%, and 28-30 in 0%.

Electromagnetic interference caused by common surgical energy-based devices on an implanted cardiac defibrillator.

Background: Surgical energy-based devices emit energy, which can interfere with other electronic devices (eg, implanted cardiac pacemakers and/or defibrillators). The purpose of this study was to quantify the amount of unintentional energy (electromagnetic interference [EMI]) transferred to an implanted cardiac defibrillator by common surgical energy-based devices.

Methods: A transvenous cardiac defibrillator was implanted in an anesthetized pig.

Effect of radiofrequency energy emitted from monopolar "Bovie" instruments on cardiac implantable electronic devices.

Background: The monopolar "Bovie" instrument emits radiofrequency energy that can disrupt the function of other implanted electronic devices through a phenomenon termed electromagnetic interference. The purpose of this study was to quantify the electromagnetic interference occurring on cardiac implantable devices (CIEDs) resulting from monopolar instrument use in common, modifiable clinical scenarios.

Study Design: Three anesthetized pigs underwent CIED placement (1 pacemaker and 2 defibrillators).

Slower walking speed forecasts increased postoperative morbidity and 1-year mortality across surgical specialties.

Objective: The purpose of this study was to determine the relationship between the Timed Up and Go test and postoperative morbidity and 1-year mortality, and to compare the Timed Up and Go to the standard-of-care surgical risk calculators for prediction of postoperative complications.

Methods: In this prospective cohort study, patients 65 years and older undergoing elective colorectal and cardiac operations with a minimum of 1-year follow-up were included. The Timed Up and Go test was performed preoperatively.

Blend mode reduces unintended thermal injury by laparoscopic monopolar instruments: a randomized controlled trial.

Background: The purpose of this study was to compare histologic evidence of thermal injury at the epigastric and umbilical incisions after elective laparoscopic cholecystectomy performed using the monopolar "Bovie" instrument set on the higher voltage coag mode versus the lower voltage blend mode. We hypothesized that the higher voltage coag mode would create more unintended thermal tissue injury at the epigastric trocar's incision.

Methods: A prospective blinded randomized controlled trial of patients undergoing elective laparoscopic cholecystectomy was performed.

Antenna coupling--a novel mechanism of radiofrequency electrosurgery complication: practical implications.

Objectives: (1) To determine if antenna coupling occurs in common operating room scenarios. (2) To define modifiable clinical variables that reduce the magnitude of antenna coupling.

Background: Mechanisms of electrosurgical burns where monitoring devices contact the surgical patient are unclear.

Radiofrequency energy antenna coupling to common laparoscopic instruments: practical implications.

Background: Electromagnetic coupling can occur between the monopolar "Bovie" instrument and other laparoscopic instruments without direct contact by a phenomenon termed antenna coupling. The purpose of this study was to determine if, and to what extent, radiofrequency energy couples to other common laparoscopic instruments and to describe practical steps that can minimize the magnitude of antenna coupling.

Methods: In a laparoscopic simulator, monopolar radiofrequency energy was delivered to an L-hook.

Effect of monopolar radiofrequency energy on pacemaker function.

Background: This study aimed to quantify the clinical parameters of mono- and bipolar instruments that inhibit pacemaker function. The specific aims were to quantify pacer inhibition resulting from the monopolar instrument by altering the generator power setting, the generator mode, the distance between the active electrode and the pacemaker, and the location of the dispersive electrode.

Methods: A transvenous ventricular lead pacemaker overdrive paced the native heart rate of an anesthetized pig.

Frailty predicts increased hospital and six-month healthcare cost following colorectal surgery in older adults.

Background: The purpose of this study was to determine the relationship of frailty and 6-month postoperative costs.

Methods: Subjects aged ≥ 65 years undergoing elective colorectal operations were enrolled in a prospective observational study. Frailty was assessed by a validated measure of function, cognition, nutrition, comorbidity burden, and geriatric syndromes.

Residual heat of laparoscopic energy devices: how long must the surgeon wait to touch additional tissue?

Background: Energy devices are essential laparoscopic tools. Residual heat is defined as the increased instrument temperature after energy activation is completed. This study aimed to determine the length of time a surgeon needs to wait before touching other tissue using four common laparoscopic energy sources.

Surgeon-controlled factors that reduce monopolar electrosurgery capacitive coupling during laparoscopy.

Purpose: To determine the factors that can be modified by the surgeon to reduce monopolar electrosurgery capacitive coupling during laparoscopy. Specific aims were to determine the capacitive coupling energy using different generator power settings, mode settings (cut vs. coagulation), and surgical techniques (desiccation vs.

Endoscopic-assisted closure of persistent gastrocutaneous fistula with a porcine fistula plug: report of a new technique.

Persistent gastrocutaneous (GC) fistula is a rare but problematic complication of gastrostomy feeding tube removal. Several techniques for nonoperative fistula closure have been attempted with mixed results. None has proven both satisfactorily simple and consistently effective.

Insulation failure in laparoscopic instruments.

Background: Electrosurgery is used in virtually every laparoscopic operation. In the early days of laparoscopic surgery, capacitive coupling, associated with hybrid trocars, was thought to be the major cause of laparoscopic electrosurgery injuries. Modern laparoscopy has reduced capacitive coupling, and now insulation failure is thought to be the main cause of electrosurgical complications.

Results of a phase I trial of 12 patients with locally advanced pancreatic carcinoma combining gefitinib, paclitaxel, and 3-dimensional conformal radiation: report of toxicity and evaluation of circulating K-ras as a potential biomarker of response to therapy.

Objective: To evaluate the toxicity of daily gefitinib, an epidermal growth factor receptor-tyrosine kinase inhibitor, with concurrent chemoradiation (CRT) in patients with locally advanced pancreatic adenocarcinoma and prospectively evaluate plasma k-ras as a potential marker of response to gefitinib and CRT.

Methods: Eleven of 12 eligible patients enrolled received a 7-day induction of gefitinib (250 mg PO) followed by daily gefitinib with concurrent CRT. Patients received 50.

Management of duodenal and pancreaticobiliary perforations associated with periampullary endoscopic procedures.

Background: The purpose of this study was to determine the incidence and outcome of pancreaticobiliary and duodenal (PB/D) perforations from periampullary endoscopic procedures and to examine whether clinical indexes are predictive of the need for operative management.

Methods: A retrospective review compared patients who had operative intervention for PB/D perforation with those managed nonoperatively.

Results: Thirty-two PB/D perforations occurred in 4,919 procedures (.

Single-step EUS-guided transmural drainage of simple and complicated pancreatic pseudocysts.

Background: Single-step EUS-guided transmural drainage of pseudocysts has been reported, but there are no published prospective studies on clinical outcomes.

Objective: To assess the safety and the efficacy of single-step EUS-guided placement of large endoprostheses to treat simple and complicated pseudocysts.

Design: Prospective cohort study.

Evolution of endoscopic therapy for esophageal varices.

Endoscopic treatment for bleeding esophageal varices was first described 65 years ago, but the technique was not widely adopted until the 1970s. Rapid progress since then has resulted in new, more effective forms of endoscopic treatment. Currently, endoscopic therapy is the primary treatment for patients with bleeding esophageal varices at most centers.

Endoscopic approaches to upper gastrointestinal bleeding.

Treatment for most patients with upper gastrointestinal bleeding has shifted from the operating room to the endoscopy suite. Endoscopic treatment has resulted in substantial benefit for patients with bleeding from peptic ulcer. Ulcers associated with high-risk stigmata of recent hemorrhage (SRH) not treated endoscopically have 40 per cent to 100 per cent risk of continued or recurrent bleeding and up to a 35 per cent chance of requiring surgical control of bleeding.

Laparoscopic palliation of polycystic liver disease.

The role of laparoscopic surgery in the management of polycystic liver disease (PCLD) is not well defined. The authors hypothesized that laparoscopic fenestration for PCLD relieves symptoms caused by polycystic liver disease. In this study, 11 patients underwent 20 laparoscopic cyst fenestration operations as treatment for symptoms of their PCLD.