American Surgeon最新文献_第8页

The Efficacy of Half Purse Suture Technique in Eliminating "Dog-Ear" Deformity at Donor Site Incision in Deep Inferior Epigastric Perforator Flap (DIEP) Breast Reconstruction. 半袋缝合技术消除上腹部深下穿支皮瓣（DIEP）乳房再造术供区切口“狗耳”形畸形的疗效。

IF 1 4区医学

American Surgeon Pub Date : 2025-07-03 DOI: 10.1177/00031348251354841

Xinle Wang, Liu Yang, Haoqi Wang, Meiqi Wang, Kaiye Du, Zhenchuan Song, Yuntao Li

{"title":"The Efficacy of Half Purse Suture Technique in Eliminating \"Dog-Ear\" Deformity at Donor Site Incision in Deep Inferior Epigastric Perforator Flap (DIEP) Breast Reconstruction.","authors":"Xinle Wang, Liu Yang, Haoqi Wang, Meiqi Wang, Kaiye Du, Zhenchuan Song, Yuntao Li","doi":"10.1177/00031348251354841","DOIUrl":"https://doi.org/10.1177/00031348251354841","url":null,"abstract":"BackgroundTo evaluate the effectiveness of the half purse suture technique in eliminating the \"dog-ear\" deformity at the donor site incision of the Deep Inferior Epigastric Perforator flap (DIEP) for breast reconstruction.MethodFrom May to October 2022, the half purse suture technique was employed to suture the lateral ends of the donor site incision in 5 female patients undergoing DIEP breast reconstruction. The patients' ages ranged from 39 to 56 years, with a mean age of 48.2 years. Four patients underwent primary breast reconstruction, while one patient underwent secondary reconstruction. Postoperatively, the donor site on the abdomen was routinely dressed with compression bandages.ResultsAll 5 patients were followed up at one month postoperatively. The flaps survived successfully, and the donor site incisions healed primarily without complications. The skin at the lateral ends of the abdominal incisions appeared smooth, without any dog-ear deformity. No complications such as local concavity or infection were observed.ConclusionThe half purse suture technique effectively eliminates the \"dog-ear\" deformity at the donor site incision of the DIEP flap.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251354841"},"PeriodicalIF":1.0,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144558846","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}

引用次数: 0

Is There Common Ground? A Comparison of Laparoscopic Common Bile Duct Exploration by Acute Care Surgery and Minimally Invasive Surgery Fellowship Trained Surgeons. 有共同点吗？急诊外科与微创外科实习医师腹腔镜胆总管探查的比较。

IF 1 4区医学

American Surgeon Pub Date : 2025-07-03 DOI: 10.1177/00031348251358445

Maggie E Bosley, Elizabeth C Wood, Lucas P Neff, Juhi Saxena, Gabriel E Cambronero, Gloria D Sanin, Shan L Kalmeta, Vahagn C Nikolian, Ranjan Sudan

{"title":"Is There Common Ground? A Comparison of Laparoscopic Common Bile Duct Exploration by Acute Care Surgery and Minimally Invasive Surgery Fellowship Trained Surgeons.","authors":"Maggie E Bosley, Elizabeth C Wood, Lucas P Neff, Juhi Saxena, Gabriel E Cambronero, Gloria D Sanin, Shan L Kalmeta, Vahagn C Nikolian, Ranjan Sudan","doi":"10.1177/00031348251358445","DOIUrl":"https://doi.org/10.1177/00031348251358445","url":null,"abstract":"BackgroundLaparoscopic common bile duct exploration (LCBDE) is underutilized by surgeons to treat choledocholithiasis. We hypothesized that fellowship training in acute care surgery (ACS) vs minimally invasive surgery (MIS) results in different LCBDE practices and perceptions, thus producing unique barriers to implementation.MethodsA survey was distributed by email to members of Society of American Gastrointestinal and Endoscopic Surgeons and the American Association for the Surgery of Trauma to assess surgeon demographics, surgeon-specific perceptions, practice patterns, and barriers to LCBDE utilization. Categorical data were compared with Pearson's chi-square, and continuous parametric data were compared with a t test.Results543 US surgeons who perform laparoscopic cholecystectomy completed the survey. Of all, 124 survey respondents were ACS trained and 175 were MIS trained. Similar proportions of MIS and ACS surgeons prefer to manage choledocholithiasis with LCBDE (28% vs 27%, P = 0.79). The most utilized LCBDE technique was choledochoscopy (71% vs 69%, P = 0.17). MIS surgeons more frequently perform intraoperative cholangiogram (IOC) compared to ACS surgeons (P = 0.02). A third of MIS surgeons felt that LCBDE is too time consuming to be of value, vs 25% of ACS surgeons (P = 0.37). When asked if LCBDE is difficult to master, 56% of MIS surgeons agreed compared to 32% of ACS surgeons (P < 0.01).DiscussionBoth MIS and ACS surgeons utilize LCBDE infrequently despite responding that choledocholithiasis should be managed by surgeons. Compared to MIS, fewer ACS surgeons consider time to perform LCBDE and difficulty as barriers. Understanding these barriers can influence education and efforts toward increasing adoption in both groups.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251358445"},"PeriodicalIF":1.0,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144551703","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}

引用次数: 0

Mesenchymal and Biliary Hamartomas of the Liver: A Systematic Review and Management Algorithm. 肝脏间充质和胆道错构瘤：系统回顾和管理算法。

IF 1 4区医学

American Surgeon Pub Date : 2025-07-02 DOI: 10.1177/00031348251353808

Kshiraj V Talati, Christine M G Schammel, A Michael Devane, David P Schammel, Steven D Trocha

引用次数: 0

Impacts of Inner-City Hospital Closures on Access to Surgical Care in Urban Communities. 市中心医院关闭对城市社区获得外科护理的影响。

IF 1 4区医学

American Surgeon Pub Date : 2025-07-02 DOI: 10.1177/00031348251355935

Eliel N Arrey, Anahit Mehranian, Aaron M Alford

{"title":"Impacts of Inner-City Hospital Closures on Access to Surgical Care in Urban Communities.","authors":"Eliel N Arrey, Anahit Mehranian, Aaron M Alford","doi":"10.1177/00031348251355935","DOIUrl":"https://doi.org/10.1177/00031348251355935","url":null,"abstract":"Disparities in health care access have long affected both rural and urban communities across the United States. While much of the discourse has focused on rural hospital closures, inner-city hospitals-often safety-net institutions serving vulnerable populations-are increasingly shutting down due to financial instability, systemic underfunding, and policy changes. These closures have profound consequences for access to surgical care, exacerbating existing disparities and straining remaining health care infrastructure. Patients in affected urban areas face longer travel distances, increased wait times, and, in some cases, the inability to receive critical surgical interventions. This paper explores the impact of inner-city hospital closures on surgical care access, examining trends in urban hospital insolvency, disparities in surgical outcomes, and the financial and policy challenges that contribute to these closures. Through case studies of major hospital shutdowns, including Atlanta Medical Center and Hahnemann University Hospital, we highlight the real-world consequences of losing essential surgical services. We further analyze policy solutions such as Medicaid expansion, financial stabilization strategies, and community-driven health care initiatives that may mitigate these effects. Addressing urban hospital closures is imperative to ensuring equitable access to timely surgical care in underserved populations.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251355935"},"PeriodicalIF":1.0,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144537792","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}

引用次数: 0

Surgical Management of a Marjolin's Ulcer of the Scalp Following Recurrent Chemical Burns. 复发性化学烧伤后头皮马卓林溃疡的外科治疗。

IF 1 4区医学

American Surgeon Pub Date : 2025-07-02 DOI: 10.1177/00031348251358427

Andrew N Hendrix, Anna V Yumen, Ashton Norris, Mariangela Rivera

引用次数: 0

A Comparison of the Laparoscopic vs Robotic Approaches for Transanal Minimally Invasive Surgery (TAMIS). 腹腔镜与机器人入路经肛门微创手术（TAMIS）的比较

IF 1 4区医学

American Surgeon Pub Date : 2025-07-02 DOI: 10.1177/00031348251358439

Erica Dobbs, Damayanti Samanta, Bryan K Richmond

{"title":"A Comparison of the Laparoscopic vs Robotic Approaches for Transanal Minimally Invasive Surgery (TAMIS).","authors":"Erica Dobbs, Damayanti Samanta, Bryan K Richmond","doi":"10.1177/00031348251358439","DOIUrl":"https://doi.org/10.1177/00031348251358439","url":null,"abstract":"IntroductionTransanal minimally invasive surgery (TAMIS) is a technique used for the management of low rectal neoplasms in properly selected patients. Transanal minimally invasive surgery may be performed using either laparoscopic or robotic platforms. Little data exists in the literature comparing the two. We hypothesize that the use of the robotic platform will facilitate superior outcomes due the advantages of the robotic platform in terms of its superior maneuverability, ease of suturing, and 3-dimensional visualization.MethodsThis retrospective study included adults who underwent a TAMIS via a robotic or laparoscopic approach in a rural tertiary care hospital between January 2016 and December 2023. Following IRB approval, patients who underwent TAMIS were identified using CPT codes 45171, 45172, 0184T, and S2900. Chart review was performed comparing approaches. Variables included patient demographics, operative time, blood loss, need for reoperation, presence of positive margins, and cost. Outcomes were compared using Fisher's Exact and Mann-Whitney U-tests (SPSS version 22.0, IBM, Armonk NY).ResultsTwenty-seven patients met inclusion criteria (19 laparoscopic and 8 robotic). Both groups did not differ significantly in age (65.47 ± 12.16 vs 54.75 ± 19.09, P = 0.26) and sex (male, 73.7% vs 75.0%, P = 1.00). Outcomes did not differ statistically across the two groups with respect to operative time (1.54 ± 0.58 vs 1.35 ± 0.22 hours, P = 0.33), blood loss (89.5% minimal vs 100.0% minimal, P = 1.00), and incidence of positive margins (10.5% vs 12.5%, P = 1.00). The cost of the laparoscopic TAMIS was significantly lower ($2271/case vs $15,948/case, P < 0.001) compared to the robotic TAMIS approach.ConclusionsLaparoscopic and robotic TAMIS yield comparable results, but the laparoscopic approach is much less costly. Prospective studies comparing surgical outcomes and procedural costs are therefore warranted.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251358439"},"PeriodicalIF":1.0,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144537791","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}

引用次数: 0

Quality Verification in Surgical Subspecialty Programs. 外科专科项目的质量验证。

IF 1 4区医学

American Surgeon Pub Date : 2025-07-01 Epub Date: 2025-03-25 DOI: 10.1177/00031348241298073

Anton N Sidawy

{"title":"Quality Verification in Surgical Subspecialty Programs.","authors":"Anton N Sidawy","doi":"10.1177/00031348241298073","DOIUrl":"10.1177/00031348241298073","url":null,"abstract":"In 2001, the Institute of Medicine defined 6 domains in quality health care: safe, effective, patient-centered, timely, efficient, and equitable. In 2010, the Affordable Care Act (ACA) or Obamacare, was passed into law. In addition to the well-known health insurance reform, it introduced delivery system redesign based on quality performance. Basically, it heralded a transition of reimbursement from payment for service and volume to payment for quality and value. Defining value is rather elusive; but if one considers that value equals quality divided by cost, payers aim to increase the value of a service either by improving quality, decreasing cost, or, preferably for them, both. The question is who defines value and quality of surgical services. Surgical specialists and their professional organizations should. Such organizations have the knowledge in their specialty but usually lack the infrastructure necessary to do so; but quality verification programs can be established in collaboration with the American College of Surgeons (ACS). ACS has had a long history of establishing quality verification programs; it has the infrastructure and the experienced personnel to do so. All ACS verification programs are based on four guiding principles: Setting standards based on evidence based guidelines, building the right infrastructure based on the standards, collecting the appropriate outcome data, and verifying compliance with the standards by site visit by outside experts. In this article, I outline the reasons for establishing verification programs, the process used to establish and maintain such programs, and their implications using the ACS/SVS (Society for Vascular Surgery) Vascular Verification Program as an example.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"1065-1072"},"PeriodicalIF":1.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143699421","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}

引用次数: 0

Reconstruction of a Sternal Cleft and Ventral Hernia in an Adolescent with Pentalogy of Cantrell Utilizing Titanium Plates. 钛板重建术治疗青少年Cantrell五联症胸骨裂腹疝1例。

IF 1 4区医学

American Surgeon Pub Date : 2025-07-01 Epub Date: 2025-04-01 DOI: 10.1177/00031348251332686

Allison B Frederick, Terence J Camilon, Evert A Eriksson, Minoo N Kavarana, Christian J Streck

引用次数: 0

Management of Synchronous Metastatic Colorectal Cancer With Recurrent Liver Metastasis. 同步转移性结直肠癌伴复发性肝转移的治疗。

IF 1 4区医学

American Surgeon Pub Date : 2025-07-01 Epub Date: 2025-04-29 DOI: 10.1177/00031348251339527

Aram Rojas, Pierce Paterakos, Sarah Hays, Melissa E Hogg

引用次数: 0

Comparison of Outcomes Following Surgery for Diverticulitis Among Immunocompetent and Immunosuppressed Patients. 免疫正常和免疫抑制患者憩室炎手术后预后的比较。

IF 1 4区医学

American Surgeon Pub Date : 2025-07-01 Epub Date: 2025-05-23 DOI: 10.1177/00031348251346532

Usama Waqar, Christina Gozza, Courtney L Devin, Terrah J Paul Olson, Seth A Rosen

{"title":"Comparison of Outcomes Following Surgery for Diverticulitis Among Immunocompetent and Immunosuppressed Patients.","authors":"Usama Waqar, Christina Gozza, Courtney L Devin, Terrah J Paul Olson, Seth A Rosen","doi":"10.1177/00031348251346532","DOIUrl":"10.1177/00031348251346532","url":null,"abstract":"BackgroundThe prevalence of immunosuppressed (IS) patients is on the rise, posing unique challenges during colectomy for diverticulitis. This study compares outcomes between immunocompetent (IC) and IS patients.MethodsWe identified all patients undergoing surgery for diverticulitis between 2021 and 2022 in the National Surgical Quality Improvement Program. We measured the textbook outcome (TO), defined as absence of prolonged length of stay (LOS), mortality, major morbidity, readmission, or reoperation within 30 days. Regression analyses were used to compare outcomes between IS and IC groups, stratified by case acuity.ResultsWe identified 16,679 patients, including 1102 (6.6%) IS patients. Immunosuppressed patients were more likely to present with complicated diverticulitis and preoperative sepsis and more often required urgent or emergent surgery, open surgery, or diversion. Textbook outcome was achieved less often in IS patients (37.2% vs 61.5%), and they had higher rates of major morbidity (37.7% vs 19.5%) (P < 0.001). On regression, IS patients undergoing elective surgery were less likely to achieve TO (OR 0.668 [95% CI 0.538-0.830]) and more likely to experience major morbidity (1.356 [1.065-1.726]), prolonged LOS, sepsis, or readmission. In the urgent setting, IS was associated with higher odds of major morbidity (1.595 [1.072-2.372]), readmission (1.877 [1.160-3.037]), and mortality (3.149 [1.549-6.402]). In the emergency setting, IS patients had increased odds of reoperation (1.566 [1.035-2.370]) and mortality (1.545 [1.033-2.310]).ConclusionEmergent or urgent surgery is associated with higher mortality in IS patients compared to IC patients. In the elective setting, IS patients have similar mortality but lower TO achievement and higher morbidity.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"1093-1100"},"PeriodicalIF":1.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144126630","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}

引用次数: 0