Journal of the American College of Surgeons
-
Alberto Peña's contributions to our understanding of pediatric perineal surgery and anatomy make this the rarest of anomalies both discernable and reparable. We diagnosed, managed and operated on the 24 th ever reported case of pure perineal groove. We review here the embryology, workup and surgical management necessary to successfully dispatch this disabling defect. ⋯ Others that are referenced to are derivatives of imperforate anus anomalies. A perineal groove is a wet mucus membrane that courses the perineal space from the anus to the vagina in a female, or, far more rarely, from the anus to the penoscrotal junction in a male. 2 Most clinicians, including those in the realm of pediatrics, are unfamiliar with the presentation of this rare anomaly and thus, its management. It is often misdiagnosed as an anal fissure, perineal trauma, diaper dermatitis, infection, or sexual abuse. 3 We present to you not only a description of the condition, but also a treatment paradigm on how to surgically excise it without damaging the normal anus and the normal vagina.
-
Trauma center benchmarking has become standard practice for assessing quality. The American College of Surgeons adult trauma center verification standards do not specifically require participation in a pediatric-specific benchmarking program. Centers that treat adults and children may therefore rely solely on adult benchmarking metrics as a surrogate for pediatric quality. This study assessed discordance between adult and pediatric mortality within mixed trauma centers to determine the need to independently report pediatric-specific quality metrics. ⋯ Adult mortality is not a reliable surrogate for pediatric mortality in mixed trauma centers. Incorporation of pediatric-specific benchmarks should be required for centers that admit children.
-
The use of Zone 1 REBOA for life-threatening trauma has increased dramatically. ⋯ In-hospital survival is higher for patients undergoing REBOA than RT for all injury patterns. Complete AO by REBOA or RT should be limited to less than 30 minutes. Neither hospital and procedure volume nor trauma verification level impacts outcomes for REBOA or RT.
-
The internal anatomy of the liver is extremely complex. Laparoscopic anatomical segmentectomy requires reference to the position and alignment of intrahepatic vascular. However, the surface of the liver lacks anatomical landmarks and the liver segment boundaries cannot be identified with the naked eye. Augmented reality navigation (ARN) and indocyanine green fluorescence imaging (FI) are emerging navigation tools in liver resection. This study aimed to explore the efficacy and application value of laparoscopic anatomical segmentectomy guided by ARN combined with indocyanine green FI. ⋯ The ARN-FI technology provides a more standardized approach for liver parenchyma section during laparoscopic liver resection, effectively minimizing intraoperative blood loss, reducing postoperative remnant liver ischemia, and improving oncological prognosis. This method is safe and feasible and has good clinical application prospects.