Showing papers in "Advances in Surgery in 2024"
Abstract: Over the last few decades, our understanding of the pathophysiology and natural history of sigmoid diverticulitis has greatly improved. This knowledge has challenged many of the traditional principles in the management for diverticulitis, such as routine antibiotic administration in all cases, number-based recommendations for elective surgery, and the necessity for an end colostomy in emergency surgery. This review will cover the breadth of management for sigmoid diverticulitis, covering both uncomplicated and complicated disease as well as elective and emergent disease presentations. New and emerging concepts in management will be highlighted with a particular focus on level-1 data, when available.
7 citations
TL;DR: Despite modern devices, burn shock treatment remains unresolved, with "fluid creep" persisting. Colloids, particularly albumin, reduce fluid requirements, and a multi-center trial is underway to compare crystalloids with albumin for burn resuscitation.
Abstract: The optimal treatment of burn shock is still unresolved. The problem of "fluid creep" continues despite modern devices that fail to improve outcomes over hourly urine output. Colloids, especially albumin, reduce fluid requirements. Albumin can be used either immediately at the start of resuscitation, or as a "rescue" when crystalloid use is excessive. Several studies confirm that when crystalloid resuscitation is "out of control" the majority of caregivers will add albumin to reduce fluid rates. A multi-center trial is underway comparing crystalloids with albumin to confirm the benefit of colloids. The next question is whether albumin or plasma is as the better colloid choice.
2 citations
TL;DR: Young-onset rectal cancer incidence is rising, with distinct features, poor histology, and advanced presentation, necessitating aggressive management, but offering limited survival benefit compared to older patients, highlighting the need for targeted risk factor and treatment strategies.
Abstract: The incidence of early-onset colorectal cancer has been rising over the last two decades. Tumors in young patients have distinct features compared to older patients. They predominantly arise in the distal colon and rectum and have poor histological features. Patients tend to present at a more advanced stage and be exposed to more aggressive management approaches; however, this has not translated into a significant survival benefit compared to their older counterparts. This chapter will share current evidence on risk factors and management options for early onset colorectal cancer with a focus on rectal cancer.
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TL;DR: Breast cancer survivors are at risk of lymphedema, a condition that severely impacts quality of life. Prevention involves minimizing axillary surgery and radiation, while early detection is critical through surveillance methods and multidisciplinary care.
Abstract: Breast cancer related lymphedema (BCRL) affects many breast cancer survivors and drastically affects their quality of life. There are several surveillance methods for BCRL that are critical at early detection. Prevention of BCRL involves knowledge of alternatives to aggressive axillary surgery, avoidance of axillary surgery, and de-escalation of axillary surgery. There are also techniques to better delineate the anatomy in the axilla to avoid taking nodes that drain the upper extremity. A multidisciplinary approach with medical oncology and radiation oncology can also help avoid unnecessary surgery or radiation that can together strongly increase the risk of BCRL.
TL;DR: This study reviews the management of Crohn's disease complications, emphasizing nutritional optimization, bowel preservation, and recent advances in medical and surgical techniques, including mesenteric resection and the Kono-S anastomosis.
Abstract: Complications of Crohn's disease reach far beyond postsurgical leak, infection, and enterocutaneous fistula. Malnutrition, intestinal failure, and recurrent disease all will require ongoing attentions. The management of these patients may further be complicated by the need for chronic immunosuppression. The underlying principles continue to include optimization of nutritional status, and preservation of bowel length when possible. However, there have been several recent advances in both the medical and surgical management of the disease. Understanding the contribution of the mesentery to inflammation, new surgical techniques such as the Kono-S anastomosis and extended mesenteric resection is decreasing the need for repeated resections.
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TL;DR: Parastomal hernias are a common complication of ostomy formation, with multiple repair techniques and sparse literature on optimal methods. This review discusses commonly adopted techniques, preventative measures, and perioperative outcomes, aiming to inform hernia repair strategies.
Abstract: Parastomal hernias are an inevitable consequence of ostomy formation and their repairs remain a challenge to many surgeons. With multiple systems of classification and a multitude of techniques for hernia repair ranging from suture to mesh repair, the literature remains sparse with regards to the optimal method of repair. The authors describe the most commonly adopted techniques, discuss preventative measures, and review the current literature in the context of perioperative outcomes and hernia recurrence.