Surgery Journal最新文献

{"title":"Resident Endoscopy Experience Correlates Poorly with Performance on a Virtual Reality Simulator","authors":"Kurun Oberoi, Michael T Scott, Jacob Schwartzman, Jasmine Mahajan, Nell Maloney Patel, Melissa M Alvarez-Downing, A. Merchant, Anastasia Kunac","doi":"10.1055/s-0042-1743517","DOIUrl":"https://doi.org/10.1055/s-0042-1743517","url":null,"abstract":"Background  Endoscopy training has become increasingly emphasized during general surgery residency as reflected by introduction of the Fundamentals of Endoscopic Surgery (FES) examination, which includes testing of skills on virtual reality (VR) simulators. Although studies exist to assess the ability of the simulator to differentiate between novices and experienced endoscopists, it is not well understood how simulators can differentiate skills among resident cohort. Objective  To assess the utility of the VR simulator, we evaluated the correlation between resident endoscopy experience and performance on two VR simulator colonoscopy modules on the GI-BRONCH Mentor (Simbionix Ltd, Airport City, Israel). Methods  Postgraduate years 2 to 5 residents completed “easy” and “difficult” VR colonoscopies, and performance metrics were recorded from October 2017 to February 2018 at Rutgers' two general surgery residency programs. Resident endoscopy experience was obtained through Accreditation Council for Graduate Medical Education case logs. Correlations between resident endoscopy experience and VR colonoscopy performance metrics were assessed using Spearman's rho (ρ) correlation statistic and bivariate logistic regression. Results  Fifty-five residents out of 65 (84.6%) eligible participants completed the study. There were limited correlations found between resident endoscopy experience and FES performance metrics and no correlations were found between resident endoscopy experience and binary metrics of colonoscopy—ability to complete colonoscopy, ability to retroflex, and withdrawal time of less than 6 minutes. Conclusion  The VR simulator may have a limited ability to discriminate between experience levels among resident cohort. Future studies are needed to further understand how well the VR simulator metrics correlate with resident endoscopy experience.","PeriodicalId":44614,"journal":{"name":"Surgery Journal","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49099097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Giant Adrenal Pseudocysts: An Enigma for Surgeons","authors":"K. Parasar, Shantam Mohan, A. John, J. Nigam, U. Anand, C. Jha","doi":"10.1055/s-0042-1744153","DOIUrl":"https://doi.org/10.1055/s-0042-1744153","url":null,"abstract":"Adrenal pseudocysts are cystic lesions arising within the adrenal gland enclosed by a fibrous connective tissue wall that lacks lining cells. They can attain a huge size and pose a diagnostic challenge with a broad range of differentials including benign and malignant neoplasms. There are only a few small case series and case reports describing these lesions. We report a series of five patients who presented with “indeterminate” abdominal cystic lesions and were later on found to have adrenal pseudocyst. Four out of five patients presented with non-specific abdominal symptoms, and one patient presented with symptoms suggestive of a functional adrenal tumor. The size of these tumors ranged from 6 to 30 cm. They had variable radiological features and in two cases even a percutaneous biopsy could not establish the diagnosis. In four of these “indeterminate” abdominal masses, an adrenal origin was not suspected preoperatively. Surgical excision provided a resolution of symptoms, ruled out malignancy, and clinched the diagnosis.","PeriodicalId":44614,"journal":{"name":"Surgery Journal","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46710301","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic Factors for Conversion to Arthroplasty after Hip Arthroscopy. Review of the Literature.","authors":"Roberto Seijas,&nbsp;David Barastegui,&nbsp;Ferran Montaña,&nbsp;Marta Rius,&nbsp;Xavier Cuscó,&nbsp;Ramón Cugat","doi":"10.1055/s-0041-1741512","DOIUrl":"10.1055/s-0041-1741512","url":null,"abstract":"<p><p>Arthroscopic techniques in the treatment of femoroacetabular impingement have experienced an exponential increase over recent years for both diagnosis and treatment. The main risks with treatment are poor clinical outcomes and the conversion to prosthesis. Better knowledge and understanding of the various risk factors leading to prosthesis will improve patient selection for arthroscopic treatments rendering better results. The published papers that have been selected are related to series of hip arthroscopies with risk factors that lead to total hip arthroplasty (THA), in the PubMed database, without a time limit, number of patients, or follow-up time. We selected over 302 papers, 19 papers that show risk factors for conversion to THA. The main risk factors found were femoral chondropathy grade III/IV (relative risk 58.1-12 times increased), acetabular (20-2.96 times), an articular space <2 mm (39-4.26 times), age (14.6-1.06 times), Tönnis 2 in radiographic studies (7.73-3.1 times), obesity (5.6-2.3 times), and osteoarthritis (4.6-2.4 times). There are several risk factors which in an isolated way, highly increase the risk of THA. Some of them have a clear relationship (chondropathy, reduced joint space, Tönnis 2, and osteoarthritis). Based on the review we observed that the elements that are most associated with a conversion to THA after a hip arthroscopy are a high degree of femoral and acetabular chondropathy, a reduced joint space below 2 mm, older age, Tönnis 2, obesity, and hip osteoarthritis.</p>","PeriodicalId":44614,"journal":{"name":"Surgery Journal","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2021-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8718264/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39662321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical Diseases Management during COVID-19 Crisis at a Tertiary Care Hospital of India: Our Institutional Strategy.","authors":"Sudhir Kumar Singh,&nbsp;Amit Gupta,&nbsp;Harindra Sandhu,&nbsp;Rishit Mani,&nbsp;Jyoti Sharma,&nbsp;Praveen Kumar,&nbsp;Deepak Rajput,&nbsp;Navin Kumar,&nbsp;Farhanul Huda,&nbsp;Som Prakas Basu,&nbsp;Bina Ravi,&nbsp;Ravi Kant","doi":"10.1055/s-0041-1740452","DOIUrl":"10.1055/s-0041-1740452","url":null,"abstract":"<p><p><b>Introduction</b>  In response to the national coronavirus disease 2019 (COVID-19) pandemic, all hospitals and medical institutes gave priority to COVID-19 screening and to the management of patients who required hospitalization for COVID-19 infection. Surgical departments postponed all elective operative procedures and provided only essential surgical care to patients who presented with acute surgical conditions or suspected malignancy. Ample literature has emerged during this pandemic regarding the guidelines for safe surgical care. We report our experience during the lockdown period including the surgical procedures performed, the perioperative care provided, and the specific precautions implemented in response to the COVID-19 crisis. <b>Materials and Methods</b>  We extracted patient clinical data from the medical records of all surgical patients admitted to our tertiary care hospital between the March 24th, 2020 and May 31st, 2020. Data collected included: patient demographics, surgical diagnoses, surgical procedures, nonoperative management, and patient outcomes. <b>Results</b>  Seventy-seven patients were included in this report: 23 patients were managed medically, 28 patients underwent a radiologic intervention, and 23 patients required an operative procedure. In total eight of the 77 patients died due to ongoing sepsis, multiorgan failure, or advanced malignancy. <b>Conclusion</b>  During the COVID-19 lockdown period, our surgical team performed many lifesaving surgical procedures and appropriately selected cancer operations. We implemented and standardized essential perioperative measures to reduce the spread of COVID-19 infection. When the lockdown measures were phased out a large number of patients remained in need of delayed elective and semi-elective operative treatment. Hospitals, medical institutes, and surgical leadership must adjust their priorities, foster stewardship of limited surgical care resources, and rapidly implement effective strategies to assure perioperative safety for both patients and operating room staff during periods of crisis.</p>","PeriodicalId":44614,"journal":{"name":"Surgery Journal","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2021-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8714410/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39782098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Are YouTube Videos a Reliable Training Method for Safe Laparoscopic Cholecystectomy? A Simulated Decision-Making Exercise to Assess the Critical View of Safety.","authors":"Dimitrios K Manatakis,&nbsp;Emmanouil Mylonakis,&nbsp;Petros Anagnostopoulos,&nbsp;Konstantinos Lamprakakis,&nbsp;Christos Agalianos,&nbsp;Dimitrios P Korkolis,&nbsp;Christos Dervenis","doi":"10.1055/s-0041-1740627","DOIUrl":"https://doi.org/10.1055/s-0041-1740627","url":null,"abstract":"<p><p><b>Background</b>  The present study assesses the educational value of laparoscopic cholecystectomy videos on YouTube regarding the correct application of the critical view of safety (CVS), and evaluates… surgical trainees' perceptions of the CVS criteria in a simulated, operative decision-making exercise. <b>Methods</b>  YouTube was systematically searched for laparoscopic cholecystectomy videos, explicitly reporting a satisfactory CVS. The top 30 most popular videos, by number of views, were identified and scored on the 6-point scale by three experienced consultants. After watching a training module on CVS rationale and criteria, 10 trainees, blinded to the consultants' assessment, were instructed to view the videos, score each criterion and answer the binary question \"Would you divide the cystic structures?\" by \"yes\" or \"no.\" <b>Results</b>  An inadequate CVS was found in 30% of the included videos. No statistical association was noted between number of views, likes, or dislikes with successful CVS rates. Inter-observer agreement between consultants and trainees ranged from minimal to moderate ( <i>k</i>  = 0.07-0.60). Discrepancy between trainees' CVS scores and their simulated decision to proceed to division of the cystic structures was found in 15% of assessments, with intra-observer agreement ranging from minimal to excellent ( <i>k</i>  = 0.27-1.0). For the CVS requirements, inter-observer agreement was minimal for the dissection of the cystic plate ( <i>k</i>  = 0.26) and triangle clearance ( <i>k</i>  = 0.39) and moderate for the identification of two and only two structures ( <i>k</i>  = 0.42). <b>Conclusion</b>  The CVS is central to the culture of safety in laparoscopic cholecystectomy. Surgical videos are a useful training tool as simulated, operative decision-making exercises. However, public video platforms should be used judiciously, since their content is not peer-reviewed or quality-controlled.</p>","PeriodicalId":44614,"journal":{"name":"Surgery Journal","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2021-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8702373/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39774118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bochdalek Hernia and Partial Diaphragmatic Agenesis: Pedicled Intercostal Muscle Flap and Mesh Repair in a Young Adult with Sickle Cell Disease.","authors":"Klein Dantis,&nbsp;Devendra Kumar Rathore,&nbsp;Nilesh Gupta,&nbsp;Subrata Kumar Singha","doi":"10.1055/s-0041-1740628","DOIUrl":"https://doi.org/10.1055/s-0041-1740628","url":null,"abstract":"Congenital Bochdalek hernia (BH) in an adult is rare and has an unusual presentation. They are confined to the pediatric age group with an incidence of 1:3,000 live births. It rarely persists asymptomatic until adulthood. Surgical repair by thoracic, abdominal, or thoraco-abdominal approach is the treatment of choice with diaphragmatic reconstruction in associated diaphragmatic agenesis. With only 10 cases of BH with partial diaphragmatic agenesis reported to date, we discuss the rarity, unusual presentation, and management of BH in a young adult with sickle cell disease that has not been reported in the literature.","PeriodicalId":44614,"journal":{"name":"Surgery Journal","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2021-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8702300/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39774119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhanced Drainage Protocol in Large Amoebic Liver Abscess.","authors":"Jignesh A Gandhi,&nbsp;Pravin H Shinde,&nbsp;Sadashiv N Chaudhari,&nbsp;Amay M Banker","doi":"10.1055/s-0041-1740625","DOIUrl":"https://doi.org/10.1055/s-0041-1740625","url":null,"abstract":"<p><p><b>Background</b>  Amebic liver abscess (ALA) contributes significantly to morbidity and mortality in patients of the developing world. Even though medical management is the primary modality of treatment, 15% of the cases are refractory and require intervention for drainage. Pigtail catheterization is inefficient and results in a long duration of hospital stay. So, we conducted a prospective observational study to determine the efficacy and safety of drainage of large ALA using a wide bore 24 French (Fr) drain compared with a conventionally used 10 Fr pigtail catheter. <b>Materials and Methods</b>  A single center prospective observational study was conducted over a period of 5 years and data of 122 patients was collected. After starting empirical medical therapy, patients underwent drainage of ALA with either a 10 French pigtail or a 24 Fr drain. The primary outcome variables were resolution of clinical symptoms such as fever and pain in abdomen, length of hospital stay, and resolution of abscess on imaging at day 3. Secondary outcome was complications related to the procedures. <b>Results</b>  Data of 122 patients was collected. Males constituted a vast majority (96%) of the study population and the fifth decade was the most common age group involved. Alcoholics had a higher chance of developing a large ALA. Sixty-eight patients underwent drainage of the ALA using a 24 Fr drain which resulted in faster resolution of symptoms (2.4 vs. 5.1 days, <i>p</i> -value 0.033), a shorter duration of catheter in situ (6.4 vs. 13.2, <i>p</i> -value 0.011), and a faster drainage of ALA (residual volume at day 3; 177 vs. 212 mL, <i>p</i> -value 0.021). Twenty-eight patients had a biliary communication of which 26 required therapeutic endoscopic retrograde cholangiopancreatography. <b>Conclusion</b>  In patients with a large ALA, placement of a wide bore 24 Fr catheter hastens recovery of the patients when compared with drainage with a standard 10 Fr pigtail catheter. Placement of a biliary stent serves as a useful adjunct for their management and it may obliviate the need for a major biliary diversion surgery.</p>","PeriodicalId":44614,"journal":{"name":"Surgery Journal","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2021-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8702372/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39774117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trauma-Induced Rupture of Liver Hydatid Cyst: A Rare Cause of Anaphylactic Shock.","authors":"Charif Khaled,&nbsp;Antoine Kachi","doi":"10.1055/s-0041-1740624","DOIUrl":"https://doi.org/10.1055/s-0041-1740624","url":null,"abstract":"<p><p>Hydatid disease is rare; nevertheless, several areas of the world are endemic. Lebanon is one of the endemic countries. This disease requires careful management, as its diagnosis is tough, and its complications are severe and can lead to sudden death. These complications include fistulas, infection, and rupture. Rupture of a hydatid cyst can mimic acute abdomen and show an array of nonspecific symptoms. It could be mistaken for hemorrhagic shock, trauma, or injury to an intra-abdominal organ. The diagnosis of ruptured hydatid cyst should be kept in mind in cattle-raising countries. We report the case of a polytrauma patient who was suspected to have severe intra-abdominal bleeding and hemorrhagic shock, but imaging and laparotomy showed the rupture of a liver hydatid cyst that drove the patient into anaphylactic shock. This article reviews similar cases in the literature and discusses the diagnostic tools, appropriate management, and expected complications.</p>","PeriodicalId":44614,"journal":{"name":"Surgery Journal","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2021-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8702299/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39774116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Isolated Intramedullary Lumbar Spine Neurocysticercosis: A Rare Occurrence and Review of Literature.","authors":"Anil Dhar, Sanjeev Dua, Hershdeep Singh","doi":"10.1055/s-0041-1739118","DOIUrl":"10.1055/s-0041-1739118","url":null,"abstract":"<p><p>Neurocysticercosis (NCC) is the most common parasitic infection of the central nervous system. Spinal cysticercosis is a rather rare clinical occurrence. Intramedullary (IM) spinal NCC is rarer still. Furthermore, cases of IM-NCC at lumbar levels are few and far between. We present a case of a 35-year-old male patient who was diagnosed to have IM-NCC at L2-3 level and was managed surgically with no recurrence at 2 years of follow-up. A systematic literature review (1992-2020) highlights it to be only the third case reported with exclusive lumbar involvement.</p>","PeriodicalId":44614,"journal":{"name":"Surgery Journal","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2021-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8674092/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39740286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laparoscopic Transgastric Resection of a Large Gastric GIST: A Case Report and Review of Literature.","authors":"Eham Arora,&nbsp;Jaini Gala,&nbsp;Aditya Nanavati,&nbsp;Arun Patil,&nbsp;Ajay Bhandarwar","doi":"10.1055/s-0041-1739116","DOIUrl":"https://doi.org/10.1055/s-0041-1739116","url":null,"abstract":"<p><p><b>Introduction</b>  Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the gastrointestinal (GI) tract. Their primary treatment is surgical. <b>Case Report</b>  Here we report a case of a 36-year-old male patient who was being evaluated for weakness, anemia, and melena. Upper GI endoscopy showed a mass projecting into the lumen and an abdominal computed tomography (CT) confirmed a well-defined mass close to the lesser curvature on the posterior wall. An endoscopic ultrasound-guided fine needle aspiration suggested a diagnosis of GIST. After optimization, the patient was taken up for a laparoscopic transgastric resection of the GIST. The resected specimen measured 9.5 × 8.5 × 7.5 cm. Postoperatively, the patient recovered well and was discharged by the fifth postoperative day. <b>Discussion</b>  While traditionally, open surgery has been advocated for GISTs, for fear of spillage and peritoneal seeding, the role of minimal access surgery has been growing in recent years. The use of a transgastric approach avoids the potential complication of luminal stenosis following a wedge resection of a tumor close to the cardia. Because lymphadenectomies are rarely required and local invasion is uncommon, a wide local resection is usually curative. Thus, a laparoscopic approach can be considered as the first line in uncomplicated GISTs, irrespective of tumor size.</p>","PeriodicalId":44614,"journal":{"name":"Surgery Journal","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2021-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8679662/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39746705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}