American Surgeon最新文献

{"title":"Remnant Gallbladder Cholecystitis After Subtotal Cholecystectomy: Management and Outcome.","authors":"Aviv Ben Zvi, Amir Dagan, Michael R Freund, Shlomo Yellinek, Menahem Ben-Haim, Elad Boaz","doi":"10.1177/00031348251328493","DOIUrl":"10.1177/00031348251328493","url":null,"abstract":"<p><p>BackgroundSubtotal cholecystectomy (STC) is a viable alternative for challenging cases of severely acute or chronic inflammation of the gallbladder. However, despite its advantages, patients undergoing STC still face the risk of developing symptomatic gallstones in the remnant gallbladder. In such cases, redo resection of the gallbladder remnant is required, posing some technical challenges. In this report, we share our experience in diagnosing and surgical management of remnant gallbladder cholecystitis.MethodsA retrospective study of all patients admitted to a tertiary care hospital with symptoms directly linked to gallbladder remnant stones from 2018 to 2023 was performed.ResultsSix patients were admitted with symptoms directly linked to gallbladder remnant stones. The median age at presentation was 50 years (IQR 25-75), with median interval between the index surgery and the current presentation of 9.5 months (IQR 3-90). The presentation varied and included stump cholecystitis, cholangitis, Mirizzi syndrome, and liver abscess. All 6 patients underwent laparoscopic redo cholecystectomy, with 1 conversion to open surgery and without major complications. Symptoms resolved in all patients.ConclusionsSymptomatic gallstone disease in remnant gallbladder is rare and requires redo cholecystectomy. According to our limited series, laparoscopic redo cholecystectomy may be feasible and safe.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"1006-1009"},"PeriodicalIF":1.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143741993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deep Venous Thromboembolism Following Ambulatory General Surgery.","authors":"Daniel Kerekes, Alexander Frey, Leah Kim, Peter Zhan, Nathan Coppersmith, Elise Presser, Eric B Schneider, Ayaka Tsutsumi, Shaan Bhandarkar, Alexandria Brackett, Gillian Page, Vanita Ahuja","doi":"10.1177/00031348251331278","DOIUrl":"10.1177/00031348251331278","url":null,"abstract":"<p><p>BackgroundVenous thromboembolism (VTE) is a well-established risk of inpatient surgery, but VTEs among ambulatory surgical patients are comparatively understudied.MethodsThis review assesses VTE risk after outpatient general surgeries. PubMed and Embase were queried for studies mentioning deep venous thrombosis or pulmonary embolism (PE) and outpatient or ambulatory surgery published between January 2000 and February 2022. Results were restricted to peer-reviewed English articles reporting postoperative VTE incidence or risk factors in adults undergoing elective, outpatient general surgery. Bariatric, oncologic, orthopedic, vascular, and plastic surgeries were excluded.ResultsA total of 678 unique articles were retrieved from PubMed (n = 198) and Embase (n = 480) with 12 articles meeting inclusion and exclusion criteria. Of the articles included, 3 articles focused on cholecystectomy and 2 on hernia repair. Reported risk factors for VTE included older age, higher BMI, prolonged operative duration, Trendelenburg positioning, and pneumoperitoneum. Reported postoperative VTE/PE incidence ranged from 0.0% to 0.5% regardless of procedure, comparable to the baseline annual VTE incidence in the general population.DiscussionThis study is the first review of recent literature on outpatient surgery VTEs. Limitations included patients presenting to different facilities for VTE evaluation, no standardized definition for ambulatory surgery, and short follow-up periods. Whether VTE/PE prophylaxis benefit outweighs associated risks should be addressed in future research.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"1019-1024"},"PeriodicalIF":1.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143762841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pre-operative Characteristics and Clinical Outcomes After Sleeve Gastrectomy (Sleeve) Vary According to Health Insurance Carrier: Self-Pay vs. Private Insurance vs. Medicaid vs. Medicare in 8,393 BOLD Patients.","authors":"Jasmine J Park, Nicole Stouffer, Emily Tran, Gus J Slotman","doi":"10.1177/00031348251329487","DOIUrl":"10.1177/00031348251329487","url":null,"abstract":"","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"1046-1049"},"PeriodicalIF":1.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143958923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter re: Response to Letter to the Editor Re: Open Versus Minimally Invasive Emergent Colectomy for Diverticulitis.","authors":"Nguyen K Le, Nam Yong Cho, Saad Mallick, Nikhil Chervu, Shineui Kim, Sara Sakowitz, Peyman Benharash, Hanjoo Lee","doi":"10.1177/00031348251318394","DOIUrl":"10.1177/00031348251318394","url":null,"abstract":"","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"1050-1051"},"PeriodicalIF":1.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143389603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using Large Language Models in the Diagnosis of Acute Cholecystitis: Assessing Accuracy and Guidelines Compliance.","authors":"Marta Goglia, Arianna Cicolani, Francesco Maria Carrano, Niccolò Petrucciani, Francesco D'Angelo, Marco Pace, Lucio Chiarini, Gianfranco Silecchia, Paolo Aurello","doi":"10.1177/00031348251323719","DOIUrl":"10.1177/00031348251323719","url":null,"abstract":"<p><p>BackgroundLarge language models (LLMs) are advanced tools capable of understanding and generating human-like text. This study evaluated the accuracy of several commercial LLMs in addressing clinical questions related to diagnosis and management of acute cholecystitis, as outlined in the Tokyo Guidelines 2018 (TG18). We assessed their congruence with the expert panel discussions presented in the guidelines.MethodsWe evaluated ChatGPT4.0, Gemini Advanced, and GPTo1-preview on ten clinical questions. Eight derived from TG18, and two were formulated by the authors. Two authors independently rated the accuracy of each LLM's responses on a four-point scale: (1) accurate and comprehensive, (2) accurate but not comprehensive, (3) partially accurate, partially inaccurate, and (4) entirely inaccurate. A third author resolved any scoring discrepancies. Then, we comparatively analyzed the performance of ChatGPT4.0 against newer large language models (LLMs), specifically Gemini Advanced and GPTo1-preview, on the same set of questions to delineate their respective strengths and limitations.ResultsChatGPT4.0 provided consistent responses for 90% of the questions. It delivered \"accurate and comprehensive\" answers for 4/10 (40%) questions and \"accurate but not comprehensive\" answers for 5/10 (50%). One response (10%) was rated as \"partially accurate, partially inaccurate.\" Gemini Advanced demonstrated higher accuracy on some questions but yielded a similar percentage of \"partially accurate, partially inaccurate\" responses. Notably, neither model produced \"entirely inaccurate\" answers.DiscussionLLMs, such as ChatGPT and Gemini Advanced, demonstrate potential in accurately addressing clinical questions regarding acute cholecystitis. With awareness of their limitations, their careful implementation, and ongoing refinement, LLMs could serve as valuable resources for physician education and patient information, potentially improving clinical decision-making in the future.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"967-977"},"PeriodicalIF":1.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143612756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Access to Surgery and Health Care for Justice-Involved Individuals.","authors":"D Fletcher, K Morgan, K Miller-Hammond, S Johnson","doi":"10.1177/00031348251318382","DOIUrl":"10.1177/00031348251318382","url":null,"abstract":"<p><p>Justice-involved individuals, encompassing those with prior interactions with the correctional system, represent a population with significant unmet healthcare needs. Approximately 95% of incarcerated individuals return to society, often with unresolved chronic conditions or infectious diseases such as HIV and Hepatitis C, and face considerable barriers to accessing healthcare. Institutional constraints, logistical complications, inadequate resources, and cultural biases exacerbate disparities, contributing to suboptimal health outcomes and public health risks. Healthcare access for justice-involved individuals is hindered by multiple factors, including limited availability of medications like opioid use disorder treatments, restricted surgical and preventive care, and systemic challenges in initiating healthcare. The suspension of Medicaid during incarceration, compounded by high uninsurance rates post-release, further exacerbates these inequities. Despite legislative efforts such as the Affordable Care Act and state-level policies addressing restraint use, healthcare services for this population remain inadequate and inconsistent. Recommendations include leveraging correctional facilities to enhance healthcare delivery, incorporating justice-involved populations in hospital design and planning, and fostering collaborations between correctional facilities and healthcare organizations. Training healthcare professionals in correctional medicine and tailoring care programs to justice-involved patients' needs are critical. Research should focus on improving care models, expanding insurance enrollment initiatives, and addressing long-term health outcomes for this vulnerable group. Efforts to integrate justice-involved individuals into broader healthcare frameworks can reduce health disparities, improve public health, and promote equitable access to care. Addressing these systemic issues requires collaborative approaches across healthcare, correctional, and policy sectors.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"928-932"},"PeriodicalIF":1.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143961738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Use of Holistic Review in Colon and Rectal Surgery Residency Applications.","authors":"Saher-Zahra Khan, Sharon L Stein, Emily Steinhagen","doi":"10.1177/00031348251329478","DOIUrl":"10.1177/00031348251329478","url":null,"abstract":"<p><p><b>Background:</b> Advice regarding application preparation is often anecdotal; there is limited information about how programs evaluate applicants. It is unclear if holistic review is being properly used in an increasingly competitive field. This study aims to describe desirable applicant characteristics and the application review process of CRS programs. <b>Methods:</b> A survey was distributed to all United States CRS Program Directors (PD) during the 2022 application cycle. The survey had questions regarding number of applicants received and the review process including which screening parameters were used and which criteria were valued when evaluating applications. Descriptive statistics are reported. <b>Results:</b> Thirty-six responses from the 67 CRS residency PD (54%) were received. Most (72%) characterized their review process as \"holistic.\" The majority (58%) of PD classified their hospital setting as academic. The median number of applications reviewed per program was 100, with a median of 26% (IQR 20-31%) of applicants invited to interview. When deciding who to interview, in-training examination (ABSITE) score (92%), letter of recommendation (LOR) content (89%), LOR writer (83%), and research productivity (83%) were the most commonly considered criteria. The \"Top 3 Criteria\" cited by PD in choosing applicants to interview were LOR, ABSITE and Publications/Research. <b>Discussion:</b> CRS residencies continue to value traditional metrics such as ABSITE scores, publications, and LOR with both the content and identity writer appearing to be important. Despite many PDs claiming they use a holistic review process, our results indicate otherwise. Increased education providing the rationale behind holistic review should be provided.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"984-990"},"PeriodicalIF":1.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143690775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative Oral Antibiotics Preparation is Associated With Improved 30-day Outcomes in Elective Colectomy for Ulcerative Colitis.","authors":"Renxi Li, Susan Kartiko","doi":"10.1177/00031348251323704","DOIUrl":"10.1177/00031348251323704","url":null,"abstract":"<p><p>BackgroundUlcerative colitis (UC) is characterized by colonic involvement, where the 10-year risk of colectomy remains high at about 20%. The use of preoperative oral antibiotic preparation (OAP) in colectomy remains a subject of debate and there was limited evidence for UC patients. This study aimed to retrospectively investigate the relationship between OAP and 30-day outcomes following elective colectomy in UC patients using a multi-institutional national dataset.MethodsPatients with UC as the primary indication for colectomy were selected from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2013 to 2022. Thirty-day postoperative outcomes were compared by multivariable logistic regression, where demographics, baseline characteristics, preoperative preparation, and operative approaches were adjusted.ResultsAmong 6075 patients who underwent elective colectomy for UC, 3193 (52.56%) of them received preoperative OAP. Patients with OAP had lower cardiac complications (aOR = 0.358, 95 CI = 0.137-0.932, <i>P</i> = 0.04), pulmonary complications (aOR = 0.686, 95 CI = 0.494-0.952, <i>P</i> = 0.02), bleeding requiring transfusion (aOR = 0.738, 95 CI = 0.601-0.906, <i>P</i> < 0.01), wound complications (aOR = 0.626, 95 CI = 0.527-0.743, <i>P</i> < 0.01), prolonged postoperative nothing by mouth (NPO) or nasogastric tube (NGT) use (aOR = 0.781, 95 CI = 0.678-0.901, <i>P</i> < 0.01), and 30-day readmission (aOR = 0.811, 95 CI = 0.676-0.972, <i>P</i> = 0.02). Moreover, patients with OAP had shorter length of stay (<i>P</i> < 0.01).ConclusionThe use of OAP in elective UC colectomy was shown to have additional benefits beyond surgical site infections. Further large-scale randomized trials may be needed to determine the cause and effect of these observations.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"954-960"},"PeriodicalIF":1.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cancer and Trauma Collide: Injury Patterns and Outcomes in the Pediatric Trauma Patient With Cancer.","authors":"Brittany Sullivan, John Schomberg, Josephine Haduong, Sourav K Bose, Yigit S Guner, Andreina Giron, Maryam Gholizadeh, Peter T Yu","doi":"10.1177/00031348251323703","DOIUrl":"10.1177/00031348251323703","url":null,"abstract":"<p><p>PurposeThere is a lack of data regarding pediatric trauma patients with a cancer diagnosis. The purpose of our study is to analyze demographics, ED admissions, procedures, and characteristics pertaining to this population.MethodsThe NTDB database was queried from 2007 to 2022. This study collected 1,726,681 trauma admissions ≤18. Of these patients, 397 were identified with a cancer diagnosis and had received chemotherapy within 30 days of their trauma admission.ResultsThe median age of trauma patients with cancer was 9 years old vs 12 years old for non-cancer patients (<i>P</i> = 0.14), but cancer patients had a longer length of stay compared to patients without a cancer diagnosis (4.3 +/- 10 vs 3 +/- 5.7, <i>P</i> < 0.001).ConclusionWe conclude that pediatric trauma patients with a cancer diagnosis had a longer length of stay despite a similar injury severity score, were less likely to sustain spinal cord injuries, but more likely to receive transfusions when compared to non-cancer trauma patients. There is need for further research regarding traumatic injuries in this patient population.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"961-966"},"PeriodicalIF":1.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143497886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From Helplessness to Purpose: Beginning a Journey in Surgery.","authors":"Amir Farah","doi":"10.1177/00031348251318395","DOIUrl":"10.1177/00031348251318395","url":null,"abstract":"<p><p>This piece explores a personal path to becoming a surgeon, driven by a moment of helplessness at a beloved family member's bedside. Unable to alleviate their suffering, the sense of inadequacy and helplessness fueled a determination to pursue surgery, particularly trauma surgery. Through rigorous training, purpose was found in the ability to act decisively and compassionately in moments of crisis. This journey, shaped by personal loss, reflects how vulnerability can transform into a deep commitment to healing and service of those in need.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"1054"},"PeriodicalIF":1.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143073531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}