Division Of General Surgery Research Articles

The University of Wisconsin Department of Neurological Surgery

The practice of neurological surgery at the University of Wisconsin has evolved and expanded greatly over the past nearly 70 years. From its beginnings as a 1-man division of general surgery, the Department of Neurosurgery has grown to the current department consisting of 14 neurosurgeons and 12 full-time researchers, along with fellows, residents, nurse practitioners, laboratory personnel, and support staff. The department is able to take advantage of the unique opportunities provided by this large research institution to foster close collaborations between surgeons and researchers, both within and outside of the department. This article chronicles the development of the Department of Neurological Surgery at the University of Wisconsin, directed by its 3 chairmen, in the context of the University, the state of Wisconsin, and the Midwestern United States.

Commentary on the SAGES Guidelines for Surgical Treatment of Gastroesophageal Reflux Disease

The SAGES Guidelines Committee has created a document on the surgical management of gastroesophageal reflux disease (GERD) using the most rigorous methods of systematic review. From this standpoint, the information provided is of the highest quality and the recommendations rest on a solid foundation. All surgeons who care for patients with GERD can look to this document for guidance and support. As reflux disease continues to be a common malady, with well over US $1 billion spent on direct costs, and with an unknown but undoubtedly large amount spent on indirect costs, this is a topic worthy of comparative clinical effectiveness analysis. It must be remembered, however, that these Guidelines are written for the surgical management of GERD. Appropriate references are made to guidelines dealing with medical management, and an analysis of the extant controlled trials comparing medical with surgical management is presented. However, the Guidelines do not settle the controversy regarding whether medical or surgical therapy is superior. This is appropriate, since GERD is a protean disease in its patients and manifestations. No single treatment plan is appropriate for all patients. The indications for an operation are based specifically on the pathology of gastroesophageal reflux, not on the presence of a hiatal hernia. Therefore, the indications for an operation for a paraesophageal hernia are not a part of these Guidelines. However, the indications for an operation for GERD presented are clear, circumscribed, and comprehensive. The preoperative evaluation of the patient with GERD has been an area of confusion—which tests are needed and for whom? These Guidelines provide an evidence-based answer: enough testing to confirm pathologic reflux. Upper gastrointestinal endoscopy is mandatory to confirm mucosal injury as a result of acid reflux. This author believes that endoscopy is also important to rule out other, more sinister, pathologies such as Barrett’s esophagus or even adenocarcinoma. If no such injury is visualized, then 24-h esophageal pH monitoring is mandatory to confirm pathologic reflux. Interestingly, the authors did not find evidence supporting esophageal manometry and gastric emptying scintigraphy. In my opinion, manometry is important to rule out other esophageal motility disorders which may preclude an antireflux operation. As preoperative bloating in not uncommonly found in GERD patients, gastric emptying scintigraphy may identify patients with coexisting gastroparesis in whom concomitant pyloroplasty may be of benefit. In understanding the results of the studies on the comparative treatments for GERD, one must clearly keep in mind the goals of treatment. Much of the controversy regarding medical versus surgical management relates to which endpoints are emphasized: Symptomatic relief, reduction of esophageal acid exposure, reduction in medication use, patient satisfaction, and costs have all been applied as primary endpoints. These endpoints measure different, albeit related, things. The only patient-centered outcomes are symptomatic relief and satisfaction; however, these symptoms, whether occurring preoperatively or postoperatively, may not, in fact, be related to acid reflux. Reduction of acid exposure is the only physiologically objective endpoint, but many of the symptoms of GERD are related to reflux volume, such as regurgitation, or bile reflux, independent of the acid content of the refluxate. The resumption of the use of medications, primarily proton-pump inhibitors (PPIs), is almost always based on a physician or patient judging that postoperative symptoms are due to a failure of the operation rather V. Velanovich (&) Division of General Surgery, K-8, Henry Ford Hospital, 2700 West Grand Blvd., Detroit, MI 48202, USA e-mail: vvelano1@hfhs.org

Case report 4: Elderly patient with concomitant conditions

MycosesVolume 53, Issue s2 p. 10-11 Case report 4: Elderly patient with concomitant conditions Gabriele Sganga, Gabriele Sganga Department of Surgery, Division of General Surgery and Organ Transplantation, Catholic University, A. Gemelli Hospital, Rome, ItalySearch for more papers by this author Gabriele Sganga, Gabriele Sganga Department of Surgery, Division of General Surgery and Organ Transplantation, Catholic University, A. Gemelli Hospital, Rome, ItalySearch for more papers by this author First published: 27 May 2010 https://doi.org/10.1111/j.1439-0507.2010.01909.xCitations: 1 Gabriele Sganga, Department of Surgery, Division of General Surgery and Organ Transplantation, Catholic University, A. Gemelli Hospital, Rome, Italy.Tel.: +39 06 3015 4806. Fax: +39 06 3015 6520.E-mail: [email protected] Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article.Citing Literature Volume53, Issues2Special Issue: Invasive Fungal Infections in Immunocompromised PatientsJuly 2010Pages 10-11 RelatedInformation

Radiofrequency Ablation for Resectable Colorectal Hepatic Metastases

From the Department of Surgery, Section of Abdominal Transplantation, Washington University School of Medicine, St. Louis, MO. Reprints: William C. Chapman, MD, Division of General Surgery, Chief, Section of Transplantation, Washington University School of Medicine, 660 S. Euclid Avenue, Campus Box 8109, St. Louis, MO 63110. E-mail: [email protected].

Howard A. Reber, M.D., Distinguished Professor of Surgery, UCLA School of Medicine

Howard A. Reber, M.D., Distinguished Professor of Surgery, UCLA School of Medicine

Computed tomography-guided percutaneous gastrostomy for management of gastric remnant leak after Roux-en- Y gastric bypass

Computed tomography-guided percutaneous gastrostomy for management of gastric remnant leak after Roux-en-Y gastric bypass Shahzeer Karmali, M.D., F.R.C.S.C.*, Nader Azer, M.D., Vadim Sherman, M.D., F.R.C.S.C., F.A.C.S., Daniel W. Birch, M.Sc., M.D., F.R.C.S.C., F.A.C.S. Centre for Advancement of Minimally Invasive Surgery, Department of Surgery, Division of General Surgery, University of Alberta, Edmonton, Alberta, Canada Michael E. Debakey Department of Surgery, Division of General Surgery, Baylor College of Medicine, Houston, Texas Surgery for Obesity and Related Diseases 7 (2011) 227–231

Inverted appendix in an asymptomatic patient without intussusception or previous appendectomy

Colorectal DiseaseVolume 12, Issue 10Online p. e339-e340 Inverted appendix in an asymptomatic patient without intussusception or previous appendectomy S.-L. Yan, S.-L. Yan Division of Gastroenterology, Department of Internal Medicine, Chang Bing Show-Chwan Memorial Hospital, Taiwan Department and Graduate Program of Bioindustry Technology, Dayeh University, Changhua County, TaiwanSearch for more papers by this authorY.-H. Yeh, Y.-H. Yeh Division of Gastroenterology, Department of Internal Medicine, Chang Bing Show-Chwan Memorial Hospital, TaiwanSearch for more papers by this authorM.-T. Lai, M.-T. Lai Department of Pahology, Chang Bing Show-Chwan Memorial Hospital, TaiwanSearch for more papers by this authorY.-T. Lee, Y.-T. Lee Division of General Surgery, Department of Surgery, Chang Bing Show-hwan Memorial Hospital, Taiwan Department of Life Sciences, National Chung Hsing University, Taichung City, Taiwan, ChinaSearch for more papers by this author S.-L. Yan, S.-L. Yan Division of Gastroenterology, Department of Internal Medicine, Chang Bing Show-Chwan Memorial Hospital, Taiwan Department and Graduate Program of Bioindustry Technology, Dayeh University, Changhua County, TaiwanSearch for more papers by this authorY.-H. Yeh, Y.-H. Yeh Division of Gastroenterology, Department of Internal Medicine, Chang Bing Show-Chwan Memorial Hospital, TaiwanSearch for more papers by this authorM.-T. Lai, M.-T. Lai Department of Pahology, Chang Bing Show-Chwan Memorial Hospital, TaiwanSearch for more papers by this authorY.-T. Lee, Y.-T. Lee Division of General Surgery, Department of Surgery, Chang Bing Show-hwan Memorial Hospital, Taiwan Department of Life Sciences, National Chung Hsing University, Taichung City, Taiwan, ChinaSearch for more papers by this author First published: 12 January 2010 https://doi.org/10.1111/j.1463-1318.2010.02197.xCitations: 3 Yueh-Tsung Lee MD, Division of General Surgery, Department of Surgery, Chang Bing Show- Chwan Memorial Hospital, No 6, Lugong Rd, Lugang Township, Changhua County 505, Taiwan, China.E-mail: [email protected] Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume12, Issue10OnlineOctober 2010Pages e339-e340 RelatedInformation

‘Keep at It! Accept the Challenges of Your Critics’: An Interview with John M. Howard, MD, Professor Emeritus, Division of General Surgery, University of Toledo, Toledo, Ohio, USA

In this article, Professor John Howard shares with our readers his life experiences as a pancreatic surgeon-researcher and gives advice to junior pancreatologists starting a career in pancreatic research. Professor Howard made an outstanding contribution to the understanding of acute pacreatitis and he is a pioneer in the development of management approaches for pancreatic diseases.

Robin P. Boushey, M.D., Ph.D.

Dr. Robin Boushey is a colorectal surgeon and an Assistant Professor of Surgery in the Department of Surgery, Division of General Surgery at the University of Ottawa, Ontario, Canada. Robin was born in Ottawa and received his undergraduate, medical degree, and general surgery residency training at the University of Toronto. During his residency, he also completed a PhD focusing on the biologic actions of glucagon-like peptide-2 at the Institute of Medical Science and the School of Graduate Studies at the University of Toronto. After his residency, he completed a Minimally Invasive Surgery Fellowship at The Centre for Minimally Invasive Surgery at St. Michael's Hospital, University of Toronto. This was followed by additional training in colon and rectal surgery at the Lahey Clinic in Boston, Massachusetts. He then joined the University of Ottawa where he also serves as the Research Director for the Division of General Surgery at the University of Ottawa. He is an investigator with the Ottawa Health Research Institute (OHRI) and heads up a research team whose major interests are in knowledge transfer. He owns several patents and has received multiple grants. Robin is an active clinician, whose main clinical interests focus on all types of colorectal diseases with an emphasis on minimal invasive surgery of colon and rectal cancer, diverticular disease, anal sphincter reconstructions, as well as other benign conditions such as hemorrhoids, fistulas, and anal fissures. Robin is a dynamic participant in multiple surgical societies. His contributions to the medical literature include 48 peer-reviewed manuscripts and 16 book chapters. He has made multiple presentations at national meetings. He educates students and residents on a daily basis. Robin, his wife France Bourbonnais, and two children Emma and Alexandra live in Ottawa. When not working, Robin enjoys alpine skiing, golf, and cycling. He is also an avid gardener and fine art collector. On behalf of the readers and staff of Clinics in Colon and Rectal Surgery, I sincerely thank Dr. Boushey for serving as a Guest Editor and for providing us with a superb issue on colorectal cancer.

No Silver Bullet in Liver Transection

From the Department of Surgery, Section of Abdominal Transplantation, Washington University School of Medicine, St. Louis, MO. Reprints: William C. Chapman, MD, Division of General Surgery, Section of Transplantation, Washington University School of Medicine, 660 S. Euclid Avenue, Campus Box 8109, St. Louis, MO 63110. E-mail: [email protected].

Resident training in minimally invasive surgery: a survey of Canadian department and division chairs

This study aimed to seek the opinions of academic surgical chairs on minimally invasive surgery (MIS) education for general surgery residents and to identify perceived gaps and trends in educational strategies. A national survey on attitudes toward MIS was sent to the chairs of departments of surgery and divisions of general surgery across the 16 Canadian academic centers. The survey contained 34 questions consisting of Likert scales, single answers, and multiple-choice questions. Nonresponders were contacted directly. At the time of the survey, two department chair positions were vacant. The response rate was 87% (26/30). The majority of the centers used early operating room exposure to basic MIS cases (92%) and animal labs (85%). Two-thirds of the institutions used early operating room exposure to advanced MIS cases (69%) and didactic lectures (65%). Half of the academic centers used MIS video (54%) and the laparoscopic virtual reality simulator (54%). The least used method was computer software (19%). The surgical division and department chairs believed the most effective teaching method was early operating room exposure to basic MIS cases (100%), followed by the laparoscopic virtual reality simulator (91%) and animal labs (88%). Computer software was considered 42% useful, and the least useful method was didactic lectures (16%). In the next 5 years, 62% of academic centers plan to add laparoscopic virtual reality simulators to their MIS curriculum. The chairs' opinion on the most effective MIS teaching method for residents is basic MIS cases followed by laparoscopic virtual reality simulators. The majority of academic institutions plan to add laparoscopic virtual reality simulators to the curriculum in the next 5 years.

Mastery of Endoscopic and Laparoscopic Surgery, 3rd Edition

Indiana University School of Medicine; Department of Surgery; Division of General Surgery; 545 Barnhill Drive, Emerson Hall #234; Indianapolis, IN 46202; Phone: 317-274-0931; Fax: 317-274-0241; E-mail: [email protected]

Acute appendicitis in the geriatric patient

Background Acute appendicitis in geriatric patients represents the 7– 12% of all acute abdomen cases. Elderly patients with appendicitis more frequently show generalized outwearing pain, with abdominal wall rigidity and distension and appearance of abdominal mass. The difference in the clinical presentation between the young and the aged patient may be due to the elderly person's delay in addressing himself to the doctor, and not to differences in the pathologic process itself. The aim of this trial is to underline, through an analysis of the patients who underwent surgery for suspected acute appendicitis at the Division of General and Emergency Surgery of the University of Perugia, Hospital S. Maria in Terni, the clinical aspects of this pathology in the geriatric patient, in order to stress out the useful elements that may lead us to a early diagnosis and a reduced post operatory mortality.

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Division of General Surgery, Universitgy of Cape Town

Division of General Surgery, Universitgy of Cape Town

Laparoscopy influences hiring practices within academic surgical departments

This study aimed to determine whether the increasing emphasis on minimally invasive surgery (MIS) influences hiring practices within academic surgical departments. A questionnaire was mailed to chairs of surgery departments and divisions of general surgery at the 16 Canadian academic institutions. Nonresponders were identified and contacted directly. The survey consisted of 34 questions, including Likert scales, single answers, and multiple-choice questions. Data were collected on demographics, perceptions of MIS, and recruitment/hiring. At the time of the survey, two department chair positions were vacant. A response rate of 87% (26/30) was obtained, with representation from 94% of departments (15/16). Of those surveyed, 88% intend to increase the importance of MIS at their institution within 5 years, and 87% intend to achieve this objective through new hirings. Networking (73%) and retention of recent graduates (89%) were cited most frequently as recruitment strategies. Strengthening the division, research, and education were considered important or extremely important by more than 90% of the respondents with respect to recruitment goals, whereas strengthening MIS was considered important or extremely important by 50%. Within 5 years, surgical departments intend to hire a median of four general surgeons, 50% of whom will have formal MIS training. In comparison, over the past 10 years, only 25% of new recruits had formal MIS training. More than 90% of the respondents considered formal MIS fellowship, MIS fellowship plus a second fellowship, and proctorship to be adequate training for performing advanced MIS, whereas traditional methods were considered inadequate. Lack of operative time and resource issues were considered most limiting in the hiring of new MIS surgeons. Minimally invasive surgery is growing in importance within academic surgical departments, but it remains an intermediate recruitment priority. Formal MIS training appears to be important in the recruiting of new surgeons, whereas traditional training methods are considered inadequate.

Patients’ lived experiences of excisional breast biopsy: a phenomenological study1

The purpose of this study was to explore the lived experience of patients undergoing an excisional breast biopsy. It has been determined that women who feel a lump or a lesion in their breast delay seeking medical treatment because it could be cancer and they might need a mastectomy and/or the cancer may not be treatable. After women go to a health-care facility and are told that they need to have a biopsy to make a clear diagnosis they want to have the biopsy performed as soon as possible. A phenomenological approach from a Heideggerian hermeneutical perspective was used. Participants were 20 patients who had an excisional breast biopsy in the day surgery of a university research and training hospital general surgery division under general anaesthesia between the dates of 1 December 2004-30 June 2005 and who returned one week later for monitoring, who were over 18 years old and who volunteered to participate in the research. Data were collected using in-depth interviewing and analysed using the principles of Heideggerian hermeneutics. Three themes were identified: need for information, fear, spiritual needs. It was determined that patients undergoing excisional breast biopsy had significant information and spiritual needs and experienced a fear of having cancer, losing their breasts and dying in surgery. Relevance to clinical practice. Although there are many studies about breast cancer and day surgery patients' experiences in the literature, no studies were found about patients' experiences with day surgery excisional breast biopsy procedures. The results provide a possible framework for patient care.

Evaluation of a Preoperative Checklist and Team Briefing Among Surgeons, Nurses, and Anesthesiologists to Reduce Failures in Communication

To assess whether structured team briefings improve operating room communication. This 13-month prospective study used a preintervention/postintervention design. All staff and trainees in the division of general surgery at a Canadian academic tertiary care hospital were invited to participate. Participants included 11 general surgeons, 24 surgical trainees, 41 operating room nurses, 28 anesthesiologists, and 24 anesthesia trainees. Surgeons, nurses, and anesthesiologists gathered before 302 patient procedures for a short team briefing structured by a checklist. Main Outcome Measure The primary outcome measure was the number of communication failures (late, inaccurate, unresolved, or exclusive communication) per procedure. Communication failures and their consequences were documented by 1 of 4 trained observers using a validated observational scale. Secondary outcomes were the number of checklist briefings that demonstrated "utility" (an effect on the knowledge or actions of the team) and participants' perceptions of the briefing experience. One hundred seventy-two procedures were observed (86 preintervention, 86 postintervention). The mean (SD) number of communication failures per procedure declined from 3.95 (3.20) before the intervention to 1.31 (1.53) after the intervention (P < .001). Thirty-four percent of briefings demonstrated utility, including identification of problems, resolution of critical knowledge gaps, decision-making, and follow-up actions. Interprofessional checklist briefings reduced the number of communication failures and promoted proactive and collaborative team communication.

Anal dilatation versus left lateral sphincterotomy for chronic anal fissure: a prospective randomized study.

BACKGROUND: Several surgical methods are accepted for the treatment of chronic anal fissure. The most popular are anal dilatation (AD) and left lateral sphincterotomy (LLS). The objective of the current study was to prospectively evaluate the results of these two procedures in terms of recurrence rate, complications and patient satisfaction. METHODS: The study enrolled all patients who required operation for chronic anal fissure in the Division of General Surgery, Campus Golda, Rabin Medical Center, between the years 1997 and 2001. Exclusion criteria were acute anal fissure or inflammatory bowel disease. RESULTS: A total of 108 patients participated in the study, at an average age of 42.4 years (SD=12.5). The patients were randomly assigned to two groups; one for LLS (53 patients, 49.1%) and one for AD (55 patients, 50.9%). The study protocol included a questionnaire and a physical examination performed 1, 2, 3, 6 and 12 months after operation. The questionnaire contained questions about pain, bloody stool, incontinence for gas, fluid or hard feces, during the day or night, and soiling. The patients were also asked about their satisfaction on an analog scale from 1 to 10. The average follow-up was 11.2 months (SD=4.1). Minor incontinence occurred in 8 patients of AD group and in 2 patients of LLS group (p<0.005). Recurrence occurred in 6 cases of the AD group and in one case of the LLS group (p<0.003). Satisfaction score was insignificantly higher in the LLS group (9.1+/-0.8 in the LLS group and 7.4+/-2.0 in the AD group). CONCLUSIONS: These results suggest that LLS is the preferred method for the treatment for chronic anal fissure.

Clinical and Economic Validation of the International Study Group of Pancreatic Fistula Classification Scheme

Department of Surgery; Beth Israel Deaconess Medical Center; Division of General Surgery; Boston, Massachusetts