Annals of surgery
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To describe the details of the surgical technique of pancreatoduodenectomy (PD) with systematic mesopancreas dissection (SMD-PD), using a supracolic anterior artery-first approach. ⋯ SMD-PD using an SAA is feasible across PD cases, with acceptable short-term outcomes, and we propose this procedure as a promising option for PD.
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This study aims to determine the long-term outcomes of diverticulitis and to apply the findings to current practice patterns. ⋯ Eighty-five percent of emergent diverticulitis patients do not recur after initial medical treatment. However, in view of significantly worse outcomes associated with diverticulitis recurrence, resection should be strongly considered for diverticulitis patients older than 50 years or those who present with a complicated clinical picture.
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Evaluate the current status of Hepatopancreatobiliary (HPB) Surgery workforce in North America. ⋯ A cohesive strategy for responsibly responding to the HPB surgical workforce requirements of North America is needed. Elevation of training standards, standardization of requirements for certification, and careful modeling that accounts for regionalization of care should be pursued to prevent overtraining and decentralization of HPB surgical care in the future.
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We sought to define the overall utilization of fresh frozen plasma (FFP) and platelets and the impact on perioperative outcomes among patients undergoing hepatopancreaticobiliary and colorectal resections, as well as analyze the utility of laboratory triggers in guiding transfusion practice. ⋯ The utilization and indication of non-RBC components vary significantly across surgical specialties. Nearly one-half of patients transfused with FFP during the postoperative period had an INR of less than 1.7, indicating possible overutilization of these products. Furthermore, the use of FFP and platelets are associated with poorer perioperative outcomes. Further studies are needed to study the impact and management of a more restrictive use of FFP and platelets on surgical patients.
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To evaluate the role of bile routing modification on the beneficial effects of gastric bypass surgery on glucose and energy metabolism. ⋯ This study shows that bile routing modification is a key mechanistic feature in the beneficial outcomes of GBP.