Current Trends In Surgical Management Research Articles

Current Trends in Surgical Management of Hepatocellular Carcinoma.

Hepatocellular carcinoma (HCC) is a leading cause of cancer-related deaths worldwide. Surgical management, including hepatic resection, liver transplantation, and ablation, offers the greatest potential for a curative approach. This review aims to discuss recent advancements in HCC surgery and identify unresolved issues in the field. Treatment selection relies on the BCLC staging system, with surgical therapies primarily recommended for early-stage disease. Recent studies have shown that patients previously considered unresectable, such as those with portal vein tumor thrombus and uncomplicated portal hypertension, may benefit from hepatic resection. Minimally invasive surgery and improved visualization techniques are also explored, alongside new techniques for optimizing future liver remnant, ex vivo resection, and advancements in hemorrhage control. Liver transplantation criteria, particularly the long-standing Milan criteria, are critically examined. Alternative criteria proposed and tested in specific regions are presented. In the context of organ shortage, bridging therapy plays a critical role in preventing tumor progression and maintaining patients eligible for transplantation. Lastly, we explore emerging ablation modalities, comparing them with the current standard, radiofrequency ablation. In conclusion, this comprehensive review provides insights into recent trends and future prospects in the surgical management of HCC, highlighting areas that require further investigation.

Obturators: A proposed classification and its associated techniques.

Multiple classifications exist for maxillectomy defects. However, none of the existing classifications describes the defects as favorable or unfavorable from the prosthodontist's standpoint. The most common problem with prosthetic treatment in such patients is in getting adequate retention, stability, and support. The size and location of the defect usually influence the amount of impairment and difficulty in prosthetic rehabilitation. A series of cases has been studied, and a newer type of maxillary defect is seen with a better presurgical involvement of the prosthodontist. This type of defects is not present in any of the existing classification; hence, a modification is proposed, and its requisite cast partial framework design is also given. Another treatment-based classification is also proposed for easy treatment planning in these cases. A case series of maxillectomy patients with varying types of defects rehabilitated with obturators with different designs, modes of retention, and fabrication procedure in accordance to the newer classification is described. Surgical intervention creates communication among the oral cavity, nasal cavity, and maxillary sinus. The obturator prosthesis is commonly used as an effective means for rehabilitating such cases. There is a plethora of classifications available for maxillectomy defects though none of them takes existing dentition into consideration. While remaining dentition and various other favorable and unfavorable factors decide on the final prognosis of the prosthesis. Hence, a newer classification was planned with keeping in mind newer treatment modalities. Prosthodontic rehabilitation with obturator prosthesis design and manufactured by various principles and techniques restores the missing structures and acts as a barrier between the communication among the various cavities and definitely improving their quality of life. Considering the complexities of maxillary anatomy, the various permutations of the maxillectomy defect, the current trends in surgical management with presurgical prosthodontic planning, and various prosthodontic treatment options available, it is imperative that a more objective modification of the current classification described in this article is warranted for and could be more operator friendly in finalizing and communicating of the treatment plan.

Evaluation of the Surgical Management of Achalasia in Children and Young Adults.

Achalasia is a rare esophageal motility disorder in children and is most often treated with the Heller myotomy. This study examines the current trends in surgical management of achalasia and evaluates the safety of the Heller myotomy in children compared to the young adult population. This is a retrospective cohort study of children and young adults aged ≤25y undergoing a Heller myotomy for achalasia. Data were collected using the adult and pediatric National Surgical Quality Improvement Program databases from 2012 to 2018. Patient characteristics, comorbidities, and 30-d outcomes were evaluated. Operative details of interest included surgical specialty and the use of esophagogastroduodenoscopy and esophageal manometry. Outcomes included operative time, length of stay, reoperation, and other postoperative complications. A total of 178 pediatric and 202 young adult patients were included in the study. The majority of surgeries were performed laparoscopically (85.4% pediatric and 95.0% adult). Esophageal manometry was only used in pediatric cases, and esophagogastroduodenoscopy was used in 35 (19.7%) pediatric and 41 (20.3%) adult cases. Thirty-day complications occurred in 7 (3.9%) children and 3 (1.5%) adults. The median operative time for children was 174.5min and the median length of stay (LOS) was 2d. The median operative time for adults was 126min and the median LOS was 1d (P<0.01 for both). There was a longer LOS for cases performed by pediatric surgeons (P=0.03). Heller myotomy continues to be a very safe operation for achalasia with minimal short-term morbidity.

Current Trends in Management of Renal Cell Carcinoma with Venous Thrombus Extension.

To review the evidence regarding the current trends in surgical management of renal cell carcinoma (RCC) with inferior vena cava (IVC) thrombosis. Recent published series have shown the role of minimally invasive surgery in IVC thrombectomy. This review article evaluates the present RCC with venous extent literature to assess the role of open and minimally invasive surgery in this scenario. Robotic urological surgery has shown to have known benefits in radical prostatectomy, partial nephrectomy, and pyeloplasty. Recent published series showed feasibility of robotic IVC thrombectomy even for level IV cases. With growing number of robot-assisted and laparoscopic surgeries worldwide, there is a current tendency to treat this complex and challenging pathology with a minimally invasive approach, without compromising oncological outcomes.

Benign prostatic hyperplasia: A review of current trends in surgical management

Benign prostatic hyperplasia (BPH) is a common cause of lower urinary tract symptoms (LUTS) in men. It is a disorder that interferes with normal daily activities, thereby affecting the quality of life of the individual. Multiple modalities of treatment can be utilised. These include lifestyle advice, watchful waiting, medical therapy and surgical therapy. In terms of surgical therapy, varied patient, regional, socioeconomic and prostate characteristics, as well as technical skills, influence therapy choice. Currently, established techniques worldwide still confirm endoscopic resection using monopolar energy in pole position, while open surgery (particularly in sub-Saharan Africa) still prevails in the choice of surgeons because it is more accessible, both from a socio-economic standpoint and in the training of the surgical personnel. In this article, we will review the evolution of surgical therapy and current trends in surgical management and how this can be adapted to developing regions in terms of technological advancement and economic implications. Deliberate focus is placed on those contemporary minimally invasive surgical techniques that are emerging as providing strong and reproducible levels of efficacy.

Current Management of Trigger Digit in Rheumatoid Arthritis Patients: A Survey of ASSH Members.

Traditional dogma regarding management of rheumatoid arthritis (RA) patients with trigger digit symptoms holds that A1 pulley release should be avoided. Surgical release was thought to further destabilize the metacarpophalangeal joint. Biologic disease modifying anti-rheumatic drugs (DMARDs) have limited the development of hand deformities. Despite advances in RA treatment, many textbooks continue to discourage release of the A1 pulley in RA patients. The aim of this study was to determine if this belief is consistent with current trends in surgical management of trigger digits in patients with RA. Active Members of the American Society for Surgery of the Hand (ASSH) were surveyed on their training and current practices as related to RA patients with trigger digits. Five hundred three surveys were completed (16% response rate). During training, 55% of ASSH Members were taught to avoid releasing the A1 pulley in RA patients. Seventy-one percent of respondents currently release the A1 pulley in RA patients with no preexisting deformities, no tenosynovial thickening, or if tenosynovectomy and flexor digitorum superficialis slip excision fail to relieve triggering. Forty percent reported that their practice has evolved toward more frequent release of the A1 pulley in RA patients. The majority of ASSH Active Members were taught during training to avoid surgical release of the A1 pulley in RA patients to prevent acceleration of finger deformities. Indications and contraindications for A1 pulley release are evolving along with the improved natural history of RA associated with the use of biologic DMARDs.

Maxillofacial Gunshot Injuries at an Urban Level I Trauma Center – 10-year Analysis

Optimal management of facial gunshot trauma remains controversial in terms of timing and reconstruction techniques. To analyze current trends in surgical management, a 10-year retrospective study of patients admitted with facial gunshot wounds was undertaken.

Case Report: Traumatic Pneumomediastinum Following Emesis Two Years After Laryngeal Fracture Repair

Case Report: Traumatic Pneumomediastinum Following Emesis Two Years After Laryngeal Fracture Repair Isolated laryngeal trauma is exceedingly rare. Significant morbidity associated with this type of injury necessitates early recognition of symptoms and swift surgical intervention. With such low incidence and limited experience of physicians, proper management of laryngeal trauma is controversial. Here we present a case of a young adult male who sustained fracture of the larynx while playing flag-football, requiring surgical repair. This patient presents 2 years later with extensive pneumomediastinum after an episode of retching. Our immediate and long-term management of a case of laryngeal fracture is presented in hopes that it may help determine optimal treatment protocols in the future. Specifically, the importance of classic presentation and early recognition of symptoms, preferred imaging modalities, possible post-operative complications and current trends in surgical management are discussed.

Contemporary Techniques in Inferior Turbinate Reduction: Survey Results of the American Society for Aesthetic Plastic Surgery

Nasal airway obstruction is a frequently-encountered problem, often secondary to inferior turbinate hypertrophy. Medical treatment can be beneficial but is inadequate for many individuals. For these refractory cases, surgical intervention plays a key role in management. The authors evaluate the current trends in surgical management of inferior turbinate hypertrophy and review the senior author's (SS) preferred technique. A questionnaire was devised and sent to members of the American Society for Aesthetic Plastic Surgery (ASAPS) to determine their preferred methods for assessment and treatment of inferior turbinate hypertrophy. One hundred and twenty-seven physicians responded to the survey, with 85% of surveys completed fully. Of the responses, 117 (92%) respondents were trained solely in plastic surgery and 108 (86.4%) were in private practice. Roughly 81.6% of respondents employ a clinical exam alone to evaluate for airway issues. The most commonly-preferred techniques to treat inferior turbinate hypertrophy were a limited turbinate excision (61.9%) and turbinate outfracture (35.2%). Based on the results of this study, it appears that limited turbinate excision and turbinate outfracture are the most commonly-used techniques in private practice by plastic surgeons. Newer techniques such as radiofrequency coblation have yet to become prevalent in terms of application, despite their current prevalence within the medical literature. The optimal method of management for inferior turbinate reduction should take into consideration the surgeon's skill and preference, access to surgical instruments, mode of anesthesia, and the current literature.