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Complex Bariatric Surgery Sequencing: Double Conversions from Adjustable Gastric Band to Sleeve Gastrectomy and Then to Roux-en-Y Gastric Bypass

Examining 276 cases, researchers found that patients undergoing double conversions from adjustable gastric band (AGB) to sleeve gastrectomy (SG) and then to Roux-en-Y gastric bypass (RYGB) primarily did so due to gastroesophageal reflux disease (GERD) or inadequate weight loss/weight regain. Those converted for weight issues had higher baseline body mass index and sleep apnea prevalence, while the “other reasons” group exhibited elevated complication rates and mortality, emphasizing the need for optimal primary surgery to minimize multiple conversions.

Journal Article by Dang JT, Hage K (…) Clapp B et 4 al. in Surg Endosc

© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

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Surgical Management of Esophageal Cancer in Patients with Right Aortic Arch or Double Aortic Arch: A Case Series

Analyzing 34 cases with right aortic arch (RAA) or double aortic arch (DAA) and esophageal cancer, the study found that esophagectomy, whether via thoracotomy or thoracoscopic surgery, can be safely performed for both conditions. Patients, predominantly Japanese males with squamous cell carcinoma, commonly underwent left thoracotomy for RAA and showed similar left and right approaches for DAA. An auxiliary incision or the left door open method is crucial for dissecting superior mediastinal lymph nodes, ensuring a safe postoperative course for most patients.

Journal Article by Zhang G, Wang Z (…) Li X et 9 al. in Surg Endosc

© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

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Video-Based Coaching in Surgery: Practical Implementation and Risk Mitigation

Video-based surgical coaching, recognized as a valuable tool for continuous professional growth, is explored further in this second part of the series. Researchers focus on its practical applications for team-based quality improvement, particularly in trauma bay settings. The paper delves into the associated risks, addressing legal and ethical concerns in video recording, storage, and distribution. A comprehensive framework is proposed to guide healthcare institutions in the effective and ethically sound implementation of video coaching, contributing to informed decision-making.

Journal Article by Keller DS, Alli VV (…) Ahuja V et 3 al. in J Gastrointest Surg

© 2023. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.

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Disparities and Challenges in Surgical Cancer Care at Safety-Net Hospitals

Analyzing 37 studies covering January 2000 to October 2021, researchers explored surgical cancer care in US safety-net hospitals (SNHs). Breast cancer (43%), colorectal (30%), and hepatopancreatobiliary (16%) cases were most represented. Barriers like financial constraints, cultural/language issues, and insurance limitations were common, contributing to advanced disease presentation (24-61% of patients). Limited data on cancer survival comparisons underscored variability in SNH care. The study emphasizes the need for enhanced access and quality in surgical oncology for safety-net hospital patients.

Review by Wong P, Victorino GP (…) Thornblade LW et 3 al. in J Gastrointest Surg

© 2023. The Society for Surgery of the Alimentary Tract.

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Patient and Case Disparities in Resident-Performed Surgeries at Teaching Hospitals

Analyzing over 600,000 cases at Veterans Affairs teaching hospitals, this study delves into resident operative autonomy, revealing distinct patient and case differences. In cases where residents operate independently, patients were younger, had lower comorbidities, and underwent less complex procedures. Notably, core general surgery cases dominated, indicating attending judgment in allowing autonomy. However, despite some patients being sicker, the study emphasizes that increased complexity alone shouldn’t preclude resident involvement in these cases.

Journal Article by Tsui GO, Kunac A (…) Anjaria DJ et 2 al. in J Surg Res

Published by Elsevier Inc.

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Laparoscopic vs. Open Pancreatoduodenectomy in Long-Term OS Battle

In the clash of surgical titans for pancreatic or periampullary tumors, laparoscopic and open approaches square off. The 3-year showdown reveals no knockout punches. Among the contenders, laparoscopic pancreaticoduodenectomy (LPD) doesn’t outshine open PD in the ring of overall survival (OS). Both LPD and open PD go the distance with a similar 3-year OS, showcasing that in this surgical duel, no clear winner emerges.

Journal Article by Qin T, Zhang H (…) Qin R et 30 al. in Ann Surg

Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.

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Thyroid Carcinoma: Unraveling the Biomarker Enigma in High-Stakes Diagnosis

In the thyroid cancer arena, the study unveils the tricky identity crisis of anaplastic thyroid carcinoma (ATC). Often emerging from differentiated thyroid carcinoma (DTC), ATC’s rebel nature complicates diagnosis. Researchers scoured 36 cases, discovering ATC’s deceptive biomarker profile. While TTF1 stays mum, PAX8 and divergent markers like GATA3 and SATB2 stage a confusing spectacle. These markers, akin to other malignancies, turn ATC diagnosis into a diagnostic puzzle, revealing the nuanced challenge of distinguishing it from its high-grade neck rivals.

Journal Article by Mneimneh WS and Asa SL in Am J Surg Pathol

Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

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Cholecystectomy in Pregnancy: A Script for Better Outcomes

A retrospective study scrutinizes the dilemma of managing acute cholecystitis during pregnancy. Cholecystectomy, performed in just 34.5% of cases, emerges as a protagonist, significantly lowering adverse pregnancy outcomes (APOs) risk throughout all trimesters. While supporting guidelines, the study suggests a potential plot twist—greater adherence to guidelines and increased surgery, especially in trimester 3, could enhance outcomes for pregnant individuals with acute cholecystitis, paving the way for improved decision-making discussions in clinical practice.

Journal Article by Hantouli MN, Droullard DJ (…) Davidson GH et 4 al. in JAMA Surg

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Innovative Maneuvers in Laparoscopic Spleen-Preserving Distal Pancreatectomy: The Gastrohepatic Ligament Approach

Surgeons pioneering laparoscopic spleen-preserving distal pancreatectomy (lspdp) embraced the gastrohepatic ligament approach, deftly navigating preservation of splenic vessels. With a concise operation time of 186 minutes and minimal blood loss (37 ml), their approach, showcased in a video, emerges as a strategic option for low-grade malignant tumors. This professional journey promises smoother seas for lspdp, blending innovation with efficiency.

Journal Article by Tsunematsu M, Onda S (…) Ikegami T et 3 al. in Ann Surg Oncol

© 2023. Society of Surgical Oncology.

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Snap, Scan, Predict: CT Measurements Forecast Pancreatic Fistula Risk After Pancreatoduodenectomy

In the realm of pancreatoduodenectomy, a study unfolds a CT-based crystal ball. Researchers spot predictive markers—pancreatic neck thickness (>1.3 cm), intra-abdominal distance (>5.8 cm), soft pancreas, and narrow duct—signaling heightened risk of postoperative pancreatic fistula. Notably, abdominal wall thickness and obesity play no role. This snapshot tool not only forecasts complications but introduces a potential game-changer for personalized risk assessment in the preoperative dance of pancreatoduodenectomy.

Journal Article by Sok C, Sandhu S (…) Shah MM et 9 al. in Ann Surg Oncol

© 2023. Society of Surgical Oncology.

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