Combined Proctectomy and Hepatectomy for Metastatic Rectal Cancer Should be Undertaken with Caution: Results of a National Cohort Study

Annals of Surgical Oncology - Simultaneous proctectomy and hepatic resection for stage IV rectal cancer remains controversial due to concerns for increased morbidity and mortality. While small...     

Simple Bone Cysts: Results of a Pilot Survey

A study of simple bone cysts is reported, giving the results of a pilot study of all cases traceable over the past 10 years in Auckland. Curettage and grafting arc shown to be of dubious value. The natural history of some examples is described to illustrate principles thought to contradict earlier concepts of the origin of these lesions.     

Reporting Results in Obesity Surgery: Evaluation of a Limited Survey

Background: Perhaps the most difficult problem in evaluating results of obesity surgery is the lack of standards for comparison, and the absence of consensus among professionals in definitions, classifications, and standard systems for reporting results, particularly in the analysis of successes and failures. Methods: Evaluation of the answers to a questionnaire submitted to 22 surgeons activity involved in the treatment of morbid obesity, members of the American Society for Bariatric Surgery. A total of 18 (82%) returned the survey. Results: There was consensus among the respondents for the need to use the metric system, Body Mass Index and measures for fat distribution. Patients should be divided into subgroups, according to gender, type of obesity, previous obesity surgery, those requiring reoperations, and when the original technique underwent modifications. The number and percentage of reoperations should be clearly stated, as well as the patients lost to follow-up, for each time period. The minimum long-term follow-up was considered to be 5 years. When expressing weight loss, percentage of excess weight lost and BMI were found to be most widely accepted. Quality of life measures and improvement of medical conditions are important in evaluating the results, although further discussion is necessary on these issues. There was lack of consensus in the best classification of obesity and super obesity, as well as in the definition of success and failure. Conclusions: This limited survey demonstrated general agreement in several important aspects amongst surgeons when analysing and reporting results. Further discussion is necessary in other significant issues, to reach uniformity in the assessment of outcomes in obesity surgery.     

Hysterectomies and Urologic Symptoms: Results from the Boston Area Community Health (BACH) Survey

OBJECTIVES: To describe the characteristics of women who have had a hysterectomy and to assess the association of a past hysterectomy on current urologic symptoms. METHODS: The Boston Area Community Health (BACH) survey is a random sample of Boston, Massachusetts residents aged 30-79 years using a stratified two-stage cluster design (3202 women; 1067 Black, 1111 Hispanic, 1024 White). Urologic symptoms, hysterectomy, co-morbidities, lifestyle factors, and medical indications for a hysterectomy were by self-report. Socioeconomic status was measured as a combination of education and income. RESULTS: Hysterectomies were reported by 587 women and 1782 women reported one or more urologic symptoms. Minorities and those of lower socioeconomic status are more likely to have had a hysterectomy, even after adjusting for age and potential medical indications for a hysterectomy. Hispanic women were least likely to report fibroids, polycystic ovarian syndrome, or genitourinary cancers, but they were more likely to have had a hysterectomy if they reported these conditions than Black or White women. Women with a hysterectomy were more likely to report lower urinary tract symptoms, painful bladder syndrome, urinary frequency, urgency, and overactive bladder after adjusting for age, race/ethnicity, socioeconomic status, body mass index, depression, diabetes, heart disease, hypertension, smoking history, alcohol use, and physical activity. CONCLUSIONS: Minorities and those of lower socioeconomic status are more likely to report having a hysterectomy and urologic symptoms (including painful bladder syndrome) may be an unintended consequence of a hysterectomy.     

The Safety of Liposuction: Results of a National Survey

BACKGROUND: Liposuction procedures are increasing in frequency and may be performed in hospitals, ambulatory surgery centers, or physician offices. Deaths associated with liposuction and previous surveys of liposuction safety have raised concern about the safety of office-based surgery. OBJECTIVE: To determine the safety of office-based, tumescent liposuction among dermatologic surgeons. METHODS: A survey mailed out to dermatologic surgeons in August 2001 requested retrospective information regarding the number of patients undergoing liposuction, the setting in which the procedures were performed, and the complications that occurred during the 7-year period from 1994 to 2000. A detailed complication record was requested for each serious adverse event or death reported. Surveys were mailed to 517 worldwide members of the American Society for Dermatologic Surgery (ASDS) listed as performing liposuction; 505 had adequate contact information. The main outcome mesure was the rate of serious adverse events (SAEs) or deaths per 1000 liposuction procedures for each service setting and for each level of conscious sedation. RESULTS: The overall response rate was 89% (450/505), and of these, 78% (349/450) perform liposuction. A total of 267 dermatologic surgeons completed the survey; 261 provided data on 66,570 liposuction procedures. No deaths were reported. The overall serious adverse event rate was 0.68 per 1000 cases. The SAE rates were higher for hospitals and ambulatory surgery centers than for nonaccredited office settings. SAE rates were also higher for tumescent liposuction combined with intravenous or intramuscular sedation than combined with oral or no sedation. CONCLUSION: Office-based tumescent liposuction performed by dermatologic surgeons is safe, with a lower complication rate than hospital-based procedures. Future legislation should recognize the proven safety of this procedure as performed by dermatologic surgeons in their offices.     

Safety Measures During Cholecystectomy: Results of a Nationwide Survey

Background  

This study aimed to identify safety measures practiced by Dutch surgeons during laparoscopic cholecystectomy.     

Defining Postoperative Ileus: Results of a Systematic Review and Global Survey

Background

There is a lack of an internationally accepted standardised clinical definition for postoperative ileus (POI). This has made it difficult to estimate incidence and identify risk factors and has compromised external validity of clinical trials.

Aim

To clarify terminology of POI and propose concise, clinically quantifiable definitions.

Methods

A systematic review extracted definitions from randomised trials published between 1996 and 2011 investigating POI after abdominal surgery. This was followed by a global survey seeking opinions of those who have published in the field.

Results

Definitions were extracted from 52 identified trials. Responses were received in the survey from 45 of 118 corresponding authors. Data were amalgamated to synthesise the following definitions: postoperative ileus (POI) “interval from surgery until passage of flatus/stool AND tolerance of an oral diet”; prolonged POI “two or more of nausea/vomiting, inability to tolerate oral diet over 24 h, absence of flatus over 24 h, distension, radiologic confirmation occurring on or after day 4 postoperatively without prior resolution of POI”; recurrent POI “two or more of nausea/vomiting, inability to tolerate oral diet over 24 h, absence of flatus over 24 h, distension, radiologic confirmation, occurring after apparent resolution of POI”. Concordance of the latter two definitions with survey responses were ≥75 %.

Conclusion

We have proposed standardised endpoints for use in future studies to facilitate objective comparison of competing interventions.     

Results of adrenal surgery. Data of a Spanish National Survey

Purpose

Given the availability of laparoscopy and the rising detection of incidentalomas, indications for adrenalectomy may be changing. The Endocrine Surgery Section of the Spanish Association of Surgeons designed a survey to assess its indications, techniques, and results in Spanish Surgical Departments.

Methods

Collected data included hospital and department type, yearly hospital volume of procedures; location studies and preoperative preparation performed, indications, surgical approach and instruments used, and results in terms of morbidity and overall hospital stay. The analysis included a comparison between results of high- or low-volume centers and surgeons, using the Student's t test for quantitative and chi-square test for qualitative variables. Level of significance was set at 0.05.

Results

Nineteen centers returned the questionnaire, including 155 adrenalectomies performed in 2008. Most frequent indications were pheochromocytoma (23.2%), aldosteronoma (16.7%), incidentaloma (12.2%), metastasis (10.3%), Cushing adenoma (9.6%), and carcinoma (3.8%). Laparoscopy was performed in 83.9% of cases (9.4% required conversion to laparotomy). Four patients required urgent reoperation. Average hospital stay: 4.6 days (3.3 days after laparoscopy, 7 days after laparotomy). High-volume centers had a greater proportion of laparoscopically treated cases (p?=?0.008), more malignant lesions treated (p?=?0.03), a shorter overall stay (p?<?0.0001), and a shorter stay after laparotomic adrenalectomy (p?=?0.01). High-volume surgeons had similar results, and less in-hospital morbidity (p?=?0.02).

Conclusions

In Spain, adrenalectomy is performed in hospitals of varying complexity. Laparoscopic approach is the rule, with good results in terms of morbidty and stay. High-volume centers and surgeons had best results in terms of use of minimally invasive surgery and hospital stay.