Journal of the American College of Surgeons
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Esophagectomy has been recommended for patients when recurrent dysphagia develops after Heller myotomy for achalasia. My colleagues and I prefer to correct the specific anatomic problem with redo myotomy and preserve the esophagus. We examined the results of this approach. ⋯ The majority of failures after Heller myotomy present with dysphagia associated with esophageal narrowing. Upper gastrointestinal series is most useful to plan therapy and predicts outcomes. With few exceptions, patients improve substantially with redo myotomy, which can be accomplished laparoscopically with relatively low risk. These findings challenge the previously held concept that all myotomy failures need to be treated by an esophagectomy.
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Comparative Study
To pump or not to pump: a comparison of machine perfusion vs cold storage for deceased donor kidney transplantation.
A recent multicenter European trial has demonstrated reduced rates of delayed graft function when kidneys undergo machine perfusion before transplantation. This study was undertaken to evaluate the impact of machine perfusion on early kidney transplant function in the United States. ⋯ Machine perfusion of deceased donor kidneys results in significantly decreased rates of DGF.
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Comparative Study
Are commercial negative pressure systems worth the cost in open abdomen management?
A commercial negative pressure product is compared with the Barker technique (sterile x-ray cassette cover, lap pads, adhesive drape with negative pressure) for temporary abdominal closure in open abdomen management. ⋯ A commercially available negative pressure device for temporary abdominal closure had significantly greater success with ultimate closure after open abdomen management compared with the Barker technique. The added cost of the device is offset by improved patient results and savings from successful closure.
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In order to understand how current surgical residents feel about their training, a survey focused on perceptions regarding early entry into a subspecialty and the adequacy of training was sent to selected residency programs in general surgery (GS). ⋯ The choice of fellowship training for 80% of trainees partially reflects that 38% are not confident about their skills with 5 years of training in GS, including 23% of graduating chief residents. Training and certifying groups should update and strengthen the current curriculum for categorical residents in GS and continue their efforts to offer shortened independent or integrated residency training for those who will enter surgical specialties. Innovative solutions are needed to solve the logistic and financial problems involved.
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Little is known about the risk of subsequently developing a new or progressive intraductal papillary mucinous neoplasm (IPMN) after partial pancreatic resection of a noninvasive IPMN. ⋯ Patients who have undergone resection for noninvasive IPMN require indefinite close surveillance because of the risks of developing a new IPMN, of requiring surgery, and of developing cancer. A family history of pancreatic cancer, but not margin status or degree of dysplasia, is associated with a risk of development of a new or progressive IPMN.