The American surgeon
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The American surgeon · Oct 2013
Comparative StudyRate of re-excision after breast-conserving surgery for invasive lobular carcinoma.
Invasive lobular carcinoma (ILC) accounts for approximately 5 to 20 per cent of all breast cancers and is often multicentric. Despite pre- and intraoperative assessments to achieve negative margins, ILC is reported to be associated with higher rates of positive margin. This cross-sectional study examined patients with breast cancer treated at our institution from 2000 to 2010. ⋯ In this single-institution review, BCS for ILC had significantly higher rates of re-excision as a result of positive margins when compared with IDC and DCIS. Tumor size greater than 2 cm and lymph node involvement were identified as factors associated with positive surgical margin in ILC. The higher possibility of positive margins and the need for additional procedures should be discussed with patients undergoing BCS for ILC.
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The American surgeon · Oct 2013
Predictive risk factors of early postoperative enteric fistula in colon and rectal surgery.
Early postoperative enteric fistula (PEF) is a complication associated with a high rate of morbidity and mortality in colon and rectal surgery. We evaluated the effect of patient characteristics, comorbidities, pathology, resection type, surgical technique, lysis of adhesions, and admission type on the rate of PEF in colorectal surgery. Using the National Inpatient Sample database, we examined the clinical data of patients who underwent colon and rectal resection from 2009 to 2010. ⋯ Although teaching hospitals (AOR, 1.69), obesity (AOR, 1.40), male gender (AOR, 1.30), emergent surgery (AOR, 1.27), age older than 65 years (AOR, 1.24), and diabetes mellitus (AOR, 1.21) also had statistically significant impact on rates of PEF, these were less clinically significant than the other factors. The presence of Crohn's disease and lysis of abdominal adhesions are strongly associated with the development of PEF after colorectal surgery. Laparoscopic surgery was associated with a lower rate of PEF; further studies would be needed to evaluate the importance of this finding.
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The American surgeon · Oct 2013
Emergency department thoracotomy: too little, too much, or too late.
Emergency department thoracotomy (EDT) is a dramatic lifesaving procedure demanding timely surgical intervention, technical expertise, and coordinated resuscitation efforts. Inappropriate use is costly and futile. All patients admitted to a Level II trauma center who underwent EDT from January 2003 to July 2012 were studied. ⋯ Surgeons adhered to guidelines more compared with ED physicians (OR, 4.9; P = 0.03) whose patients were more likely to die (OR, 3.52; P = 0.124). Survivors (11 of 13 [84.6%]) were discharged home without significant long-term neurologic disability. EDT is lifesaving when performed for penetrating injury by experienced surgeons following established guidelines but futile in blunt injury or when performed by nonsurgeons regardless of mechanism.
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The American surgeon · Oct 2013
Outcome of abdominal wall hernia repair with Permacol™ biologic mesh.
The use of biologic mesh in abdominal wall operations has gained popularity despite a paucity of outcome data. We aimed to review the experience of a large healthcare organization with Permacol™. A retrospective study was conducted of patients who underwent abdominal hernia repair with Permacol™ in 14 Southern California hospitals. ⋯ With a mean follow-up of 2.1 years, morbid obesity was associated with a higher recurrence. To date this is the largest study on the use of Permacol™ in abdominal wall hernia repair. In our patient population undergoing heterogeneous operations with a majority of wounds as Class II or higher, use of Permacol™ did not eliminate wound morbidity or prevent recurrence, especially in morbidly obese patients.
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The American surgeon · Oct 2013
Minimally invasive resection of benign gastric tumors in challenging locations: prepyloric region or gastroesophageal junction.
Benign gastric tumors in a prepyloric location or within 3 cm adjacent of the gastroesophageal junction (GEJ) are often challenging to resect using minimally invasive surgical techniques. The aim of this study was to examine the outcomes of patients who underwent minimally invasive enucleation or resection of benign gastric tumors at these difficult locations. The charts of patients undergoing minimally invasive resection of benign-appearing submucosal gastric tumors between June 2001 and December 2012 were reviewed. ⋯ Minimally invasive enucleation or formal anatomic resection of submucosal tumors located adjacent to the GEJ or at the prepyloric region is safe and carries a low risk for tumor recurrence. Submucosal gastric lesions adjacent to the GEJ are amenable to laparoscopic enucleation or wedge resection unless they extend proximally into the esophagus. Prepyloric lesions often require formal anatomic resection with reconstruction.