Featured Articles in Jun 2018 - ISS SIC

Featured Articles in Jun 2018

Welcome New Associate Editors Sandra Wong and Cheng Har Yip to the World Journal of Surgery

 

Author list: Julie Ann Sosa 

 

Abstract:

The World Journal of Surgery is thrilled to announce that Sandra Wong, MD, MS and Cheng Har Yip, MBBS have joined our team of internationally renowned associate editors.

 

Together, Drs. Wong and Yip will provide important guidance around directing publication of high-impact manuscripts in the World Journal of Surgery in their respective fields of expertise in surgical oncology and breast surgery, respectively. This will continue to afford our readership access to the highest quality evidence in order to inform superior surgical care. Welcome to the World Journal of Surgery team, Drs. Wong and Yip!

 

URL: https://rdcu.be/NnVW

 


Quality of Surgery in Malawi: Comparison of Patient-Reported Outcomes After Hernia Surgery Between District and Central Hospitals

 

Author list: Jakub Gajewski, Ronan Conroy, Leon Bijlmakers, Gerald Mwapasa, Tracey McCauley, Eric Borgstein, Ruairi Brugha

 

Abstract:

Background

District hospitals in Africa could meet the essential surgical needs of rural populations. However, evidence on outcomes is needed to justify investment in this option, given that surgery at district hospitals in some African countries is usually undertaken by non-physician clinicians.

 

Methods

Baseline and 2–3-month follow-up measurements were undertaken on 98 patients who had undergone hernia repairs at four district and two central hospitals in Malawi, using a modified quality-of-life tool.

 

Results

There was no significant difference in outcomes between district and central hospital cases, where a good outcome was defined as no more than one severe and three mild symptoms. Outcomes were marginally inferior at district hospitals (OR 0.79, 95% CI 0.63–1.0). However, in the 46 cases that underwent elective surgery at district hospitals, baseline scores for severe symptoms were worse (mean = 3.5) than in the 23 elective central hospital cases (mean = 2.5), p = 0.004. Also, the mean change (improvement) in symptom score was higher in district versus central hospital cases (3.9 vs. 2.3).

 

Conclusion

The study results support the case for investing in district hospital surgery in sub-Saharan Africa to increase access to essential surgical care for rural populations. This could free up specialists to undertake more complex and referred cases and reduce emergency presentations. It will require investments in training and resources for district hospitals and in supervision from higher levels.

 

URL: https://rdcu.be/Nq3E

 


The Economic and Social Burden of Traumatic Injuries: Evidence from a Trauma Hospital in Port-au-Prince, Haiti

 

Author list: Christopher Zuraik, John Sampalis, Alexa Brierre

 

Abstract:

Background

The cost of traumatic injury is unknown in Haiti. This study aims to examine the burden of traumatic injury of patients treated and evaluated at a trauma hospital in the capital city of Port-au-Prince.

 

Methods

A retrospective cross-sectional chart review study was conducted at the Hospital Bernard Mevs Project Medishare for all patients evaluated for traumatic injury from December 2015 to January 2016, as described elsewhere (Zuraik and Sampalis in World J Surg,  https://doi.org/10.1007/s00268-017-4088-2, 2017). Direct medical costs were obtained from patient hospital bills. Indirect and intangible costs were calculated using the human capital approach.

 

Results

A total of 410 patients were evaluated for traumatic injury during the study period. Total costs for all patients were $501,706 with a mean cost of $1224. Indirect costs represented 63% of all costs, direct medical costs 19%, and intangible costs 18%. Surgical costs accounted for the majority of direct medical costs (29%). Patients involved in road traffic accidents accounted for the largest number of injuries (41%) and the largest percentage of total costs (51%). Patients with gunshot wounds had the highest total mean costs ($1566). Mean costs by injury severity ranged from $62 for minor injuries, $1269 for serious injuries, to $13,675 for critical injuries.

 

Conclusion

Injuries lead to a significant economic burden for individuals treated at a semi-private trauma hospital in the capital city of Port-au-Prince, Haiti. Programs aimed at reducing injuries, particularly road traffic accidents, would likely reduce the economic burden to the nation.

 

URL: https://rdcu.be/Nq4l

 


Early Versus Late Tracheostomy in Trauma Patients: A Propensity-Matched Cohort Study of 5 Years’ Data at a Single Institution in Korea

 

Author list: Byung  Hee Kang, Jayun Cho, John Cook-Jong Lee, Kyoungwon Jung

 

Abstract:

Background

Although there have been many studies dealing with tracheostomy timing in trauma patients, the optimal timing is still being debated. This study aimed to compare outcomes between early tracheostomy (ET) and late tracheostomy (LT) in trauma populations to estimate the optimal timing of tracheostomy after intubation.

 

Methods

We retrospectively reviewed the 5 years’ data of trauma patients who underwent tracheostomy during their acute intensive care unit (ICU) stay. The cases were divided into two groups: ET was defined as tracheostomy performed within 7 days after intubation, and LT, after the seventh day. Propensity score matching was utilized using a 1-to-1 matching technique, and outcomes between two groups were compared.

 

Results

Among 236 enrolled patients, 76 met the criteria for ET and 160 were included for LT. Using propensity matching, 70 patients who met the criteria for ET were matched to 70 patients in the LT. Based on the comparison of outcomes after matching, ET showed significantly shorter values than LT in overall ventilator duration, length of stay at the ICU, and post-tracheostomy ventilation duration. Furthermore, the incidence of pneumonia was significantly lower with ET than with LT, although the rate of postoperative complications showed no significant differences.

 

Conclusions

We suggest that ET should be considered in trauma patients needing prolonged mechanical ventilation. Also, we recommend that surgeons perform tracheostomy as early as within 7 days after intubation to not only reduce the ventilation and ICU days but also prevent pneumonia without worrying about an increase in postoperative complications.

 

URL: https://rdcu.be/Nq4L


Impact of “Tailored” Parathyroidectomy for Treatment of Primary Hyperparathyroidism in Patients with Multiple Endocrine Neoplasia Type 1

 

Author list: Kiyomi Horiuchi, Momoko Sakurai, Kento Haniu, Erin Nagai, Hiroki Tokumitsu, Yusaku Yoshida, Yoko Omi, Akiko Sakamoto, Takahiro Okamoto

 

Abstract:

Background

Whether total parathyroidectomy (TPTX) or subtotal parathyroidectomy (SPTX) should be performed for primary hyperparathyroidism (PHPT) in patients with multiple endocrine neoplasia type 1 (MEN1) is controversial. At our institution, the parathyroidectomy strategy is based on the number of enlarged intraoperative parathyroid glands. We retrospectively analyzed our parathyroidectomy procedures.

 

Methods

Data of PHPT treatment in patients with MEN1 who underwent parathyroidectomy from 1982 to 2012 at our department were retrospectively collected. The data were grouped according to the surgical procedure: TPTX, SPTX, and less than SPTX (LPTX). TPTX or SPTX was selected based on the preoperative examination findings and number of enlarged intraoperative parathyroid glands. The outcomes were the disease-free survival (DFS) rate and postoperative calcium replacement rate based on Kaplan–Meier analysis for each type of surgical procedure.

 

Results

Forty-five patients were analyzed. The overall 5- and 10-year DFS was 91.7 and 55.8%, respectively. The 5- and 10-year DFS in each subgroup was 100.0 and 85.7% in the TPTX group, 89.4 and 57.3% in the SPTX group, and 91.6 and 57.3% in the LPTX group, respectively. The postoperative calcium replacement rate at 1 and 12 months was 91.7 and 58.3% in the TPTX group, 21.1 and 7.0% in the SPTX group, and 30.0 and 0.0% in the LPTX group, respectively.

 

Conclusion

Although LPTX was not satisfactory as a standard procedure, both SPTX and TPTX are effective treatment methods for PHPT in patients with MEN1. The parathyroidectomy strategy should be based on intraoperative evaluation of the parathyroid glands.

 

URL: https://rdcu.be/Nq5c

 


Antireflux Surgery and Barrett’s Esophagus: Myth or Reality?

 

Author list: Fernando A. M. Herbella, Francisco Schlottmann, Marco G. Patti

 

Abstract:

Background

It may seem questionable if antireflux surgery still has a role in the management of patients with Barrett’s esophagus (BE) in the current era when antireflux surgery is facing a steady decline, obesity is increasing, pharmacologic treatment for gastroesophageal reflux disease (GERD) is in its splendor, and endoscopic techniques are used more frequently. It is questionable if patients with BE should be operated to stop GERD and to prevent cancer. The aim of this study was to determine the role of antireflux surgery in patients with BE.

 

Methods

Literature review.

 

Results

The role of antireflux operations is, in fact, very controversial and neglected. BE is a different phenotype of GERD with a distinct pathophysiology linked to severe reflux of bile and acid, due to a marked anatomic disruption of the gastroesophageal barrier. Published series show that a fundoplication adequately controls GERD and symptoms in BE patients. A fundoplication (or even better a bile diversion antireflux procedure) may prevent esophageal adenocarcinoma.

 

Conclusions

In conclusion, a fundoplication efficiently controls GERD and symptoms in BE patients. A fundoplication (or even better a bile diversion procedure) may also prevent esophageal adenocarcinoma.

 

URL: https://rdcu.be/Nq5K

 


Image-Guided Proper Liver Segmentectomy

 

Author list: L. Roncati, A. Manenti, E. Simonini

 

Abstract:

Background

The new cross-sectional radiological tools, 3D computed tomography and magnetic resonance, allow a precise study of the liver anatomy. Thanks to these imaging techniques, a new space inside the liver parenchyma, the “hepatic core,” was recently recognized, where the hila of liver segments are present.

 

Methods

On the basis of anatomical and radiological observations, we identified a new virtual plane of dissection, named “hepato-portal,” which is useful in liver segmentectomy, if integrated with the classical planes of dissection.

 

Results

Simulated surgical procedures can be intra-operatively transferred by ultrasounds. In this way, we performed ten “proper” liver segmentectomies through preliminary sections of the hilar vessels and a precise dissection of the boundaries of each segment.

 

Conclusions

Our experience underlines the value of integrating anatomy and radiology in the simulated liver surgery.

 

URL: https://rdcu.be/Nq54

 


Competitive Advantage of MBA for Physician Executives: A Systematic Literature Review

Author list: Anthony D. Turner, Stanislaw P. Stawicki, Weidun Alan Guo

 

Abstract:

In response to systemic challenges facing the US healthcare system, many medical students, residents and practicing physicians are pursuing a Master in Business Administration (MBA) degree. The value of such proposition remains poorly defined. The aim of this review is to analyze current literature pertaining to the added value of MBA training for physician executives (PEs). We hypothesized that physicians who supplement their clinical expertise with business education gain a significant competitive advantage. A detailed literature search of four electronic databases (PubMed, SCOPUS, Embase and ERIC) was performed. Included were studies published between Jan 2000 and June 2017, focusing specifically on PEs. Among 1580 non-duplicative titles, we identified 23 relevant articles. Attributes which were found to add value to one’s competitiveness as PE were recorded. A quality index score was assigned to each article in order to minimize bias. Results were tabulated by attributes and by publication. We found that competitive domains deemed to be most important for PEs in the context of MBA training were leadership (n = 17), career advancement opportunities (n = 12), understanding of financial aspects of medicine (n = 9) and team-building skills (n = 10). Among other prominent factors associated with the desire to engage in an MBA were higher compensation, awareness of public health issues/strategy, increased negotiation skills and enhanced work–life balance. Of interest, the learning of strategies for reducing malpractice litigation was less important than the other drivers. This comprehensive systemic review supports our hypothesis that a business degree confers a competitive advantage for PEs. Physician executives equipped with an MBA degree appear to be better equipped to face the challenge of the dynamically evolving healthcare landscape. This information may be beneficial to medical schools designing or implementing combined dual-degree curricula.

 

URL: https://rdcu.be/Nq6E


Meta-analysis on Materials and Techniques for Laparotomy Closure: The MATCH Review

Author list: N. A. Henriksen, E. B. Deerenberg, L. Venclauskas, R. H. Fortelny, M. Miserez, F. E. Muysoms

 

Abstract:

Background

The aim of this systematic review and meta-analysis was to evaluate closure materials and suture techniques for emergency and elective laparotomies. The primary outcome was incisional hernia after 12 months, and the secondary outcomes were burst abdomen and surgical site infection.

 

Methods

A systematic literature search was conducted until September 2017. The quality of the RCTs was evaluated by at least 3 assessors using critical appraisal checklists. Meta-analyses were performed.

 

Results

A total of 23 RCTs were included in the meta-analysis. There was no evidence from RCTs using the same suture technique in both study arms that any suture material (fast-absorbable/slowly absorbable/non-absorbable) is superior in reducing incisional hernias. There is no evidence that continuous suturing is superior in reducing incisional hernias compared to interrupted suturing. When using a slowly absorbable suture for continuous suturing in elective midline closure, the small bites technique results in significantly less incisional hernias than a large bites technique (OR 0.41; 95% CI 0.19, 0.86).

 

Conclusions

There is no high-quality evidence available concerning the best suture material or technique to reduce incisional hernia rate when closing a laparotomy. When using a slowly absorbable suture and a continuous suturing technique with small tissue bites, the incisional hernia rate is significantly reduced compared with a large bites technique.

 

URL: https://rdcu.be/Nq7a

 

 

 

 


 

BACK