The Surgical clinics of North America
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Surg. Clin. North Am. · Jun 2017
ReviewCytoreduction and Hyperthermic Intraperitoneal Chemotherapy in the Management of Colorectal Peritoneal Metastasis.
Historically, patients with peritoneal carcinomatosis secondary to colorectal cancer have a poor overall prognosis. Recent data support the use of cytoreductive surgery and heated intraperitoneal chemotherapy (CRS + HIPEC) to specifically address the peritoneal disease. ⋯ However, CRS + HIPEC carries morbidity similar to other advance oncology procedures such as liver resection and pancreatoduonectomy. It is hoped that ongoing clinical trials will clarify its role in the treatment of patients with peritoneal metastatic colorectal cancer.
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Appendicitis is one of the most common surgical pathologies in children. It can present with right lower quadrant pain. Scoring systems in combination with selective imaging and surgical examination will diagnose most children with appendicitis. ⋯ Most surgical interventions for appendicitis are now almost exclusively laparoscopic, with trials demonstrating better outcomes for children who undergo index hospitalization appendectomies when perforated. Nonoperative management has a role in the treatment of both uncomplicated and complicated appendicitis. This article discusses the workup and management, modes of treatment, and continued areas of controversy in pediatric appendicitis.
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Rotation abnormalities may be asymptomatic or may be associated with obstruction caused by bands, midgut volvulus, or associated atresia or web. The most important goal of clinicians is to determine whether the patient has midgut volvulus with intestinal ischemia, in which case an emergency laparotomy should be done. If the patient is not acutely ill, the next goal is to determine whether the patient has a narrow-based small bowel mesentery. In general, the outcomes for children with a rotation abnormality are excellent, unless there has been midgut volvulus with significant intestinal ischemia.
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Surg. Clin. North Am. · Aug 2016
ReviewResolution of Comorbidities and Impact on Longevity Following Bariatric and Metabolic Surgery.
Bariatric surgery is the most effective and durable treatment of severe obesity. In addition to weight loss, these operations result in significant improvement or resolution of many obesity-related comorbid diseases. There are now numerous studies demonstrating that bariatric surgery decreases all-cause mortality long-term compared with cohorts of patients who did not undergo surgery. Decreases in cancer, diabetes, and cardiovascular-related mortality are major contributors to this overall effect on life expectancy after bariatric surgery.
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Liver anatomy can be variable, and understanding of anatomic variations is crucial to performing hepatic resections, particularly parenchymal-sparing resections. Anatomic knowledge is a critical prerequisite for effective hepatic resection with minimal blood loss, parenchymal preservation, and optimal oncologic outcome. Each anatomic resection has pitfalls, about which the operating surgeon should be aware and comfortable managing intraoperatively.