7,928 results match your criteria Surgical Clinics of North America [Journal]


Role of Transplant in Biliary Disease.

Surg Clin North Am 2019 Apr;99(2):387-401

General Surgery, University of Alabama at Birmingham, 1808 7th Avenue South D202 Boshell Building Birmingham, Alabama 35233, USA; Division of Transplantation, University of Alabama at Birmingham, 701 19th Street South 722 Lyons Harrison Birmingham, Alabama 35233. Electronic address:

Orthotopic liver transplantation (OLT) has many roles in biliary disease. OLT provides excellent results for patients with unresectable hilar cholangiocarcinoma. OLT prolongs survival in primary biliary cirrhosis not responsive to therapy and improves quality of life. Read More

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http://dx.doi.org/10.1016/j.suc.2018.12.009DOI Listing
April 2019
2 Reads

Endoscopic Management of Biliary Disorders: Diagnosis and Therapy.

Surg Clin North Am 2019 Apr;99(2):369-386

Digestive Diseases Institute, Virginia Mason Medical Center, Seattle, WA 98101, USA. Electronic address:

Endoscopic retrograde cholangiopancreatography (ERCP) has evolved from a diagnostic and therapeutic tool to a predominantly therapeutic tool. There is a limited role for diagnostic ERCP with widespread availability of magnetic resonance cholangiopancreatography and endoscopic ultrasound (EUS). Since its introduction, EUS evolved from a diagnostic imaging modality to one with combined diagnostic and therapeutic capabilities. Read More

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http://dx.doi.org/10.1016/j.suc.2018.12.002DOI Listing

Ampullary Cancer.

Surg Clin North Am 2019 Apr 10;99(2):357-367. Epub 2019 Feb 10.

Department of Surgery, University of Alabama at Birmingham, 1808 7th Avenue South, BDB 607 Birmingham, AL 35233-3411, USA. Electronic address:

Compared with other periampullary tumors, cancers of the ampulla of Vater are rare. These tumors tend to present earlier than their pancreatic and distal bile duct brethren. In addition to the hypothesis that they are also less biologically aggressive, ampullary cancers tend to have better survival than other types of periampullary cancers. Read More

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http://dx.doi.org/10.1016/j.suc.2018.12.001DOI Listing
April 2019
2 Reads

Gallbladder Cancer: Diagnosis, Surgical Management, and Adjuvant Therapies.

Surg Clin North Am 2019 Apr;99(2):337-355

Division of Surgical Oncology, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA. Electronic address:

Gallbladder cancer (GBC) is an often lethal disease, but surgical resection is potentially curative. Symptoms may be misdiagnosed as biliary colic; over half of new diagnoses are made after laparoscopic cholecystectomy for presumed benign disease. Gallbladder polyps >1 cm should prompt additional imaging and cholecystectomy. Read More

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http://dx.doi.org/10.1016/j.suc.2018.12.008DOI Listing
April 2019
1 Read

Cholangiocarcinoma.

Surg Clin North Am 2019 Apr 10;99(2):315-335. Epub 2019 Feb 10.

Division of Transplant Surgery, Massachusetts General Hospital, 55 Fruit Street, White 511, Boston, MA 02114, USA.

Cholangiocarcinoma is a rare malignancy and accounts for 2% of all malignancies. Incidence is on the increase in the Western world. Cholangiocarcinoma arises from the malignant growth of the epithelial lining of the bile ducts and can be found all along the biliary tree. Read More

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http://dx.doi.org/10.1016/j.suc.2018.12.004DOI Listing
April 2019
4 Reads

Premalignant Lesions of the Biliary Tract.

Surg Clin North Am 2019 Apr 10;99(2):301-314. Epub 2019 Feb 10.

Section of General, Thoracic and Vascular Surgery, Virginia Mason Medical Center, 1100 Ninth Avenue, Seattle, WA 98101, USA. Electronic address:

Although the most common presentation of biliary disorder in North America is secondary to gallstone disease, an awareness of benign biliary cystic neoplasms is important because of the risk of malignant transformation. The incidence of premalignant cystic neoplasms of the bile duct is not well characterized and they often are detected incidentally for suspicion of other abdominal disorders. This article describes the 4 most common premalignant biliary cystic neoplasms: biliary mucinous cystic neoplasms, intraductal papillary mucinous neoplasms of the bile duct, intraductal tubular papillary neoplasms of the bile duct, and choledochal cysts. Read More

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http://dx.doi.org/10.1016/j.suc.2018.11.007DOI Listing
April 2019
1 Read

An Update on Iatrogenic Biliary Injuries: Identification, Classification, and Management.

Surg Clin North Am 2019 Apr 10;99(2):283-299. Epub 2019 Feb 10.

Department of Surgery, Rhode Island Hospital, 2 Dudley Street, Suite 370, Providence, RI 02905, USA. Electronic address:

Common bile duct injury is a feared complication of cholecystectomy, with an incidence of 0.1% to 0.6%. Read More

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http://dx.doi.org/10.1016/j.suc.2018.11.006DOI Listing
April 2019
1 Read

Technical Aspects of Bile Duct Evaluation and Exploration: An Update.

Surg Clin North Am 2019 Apr 10;99(2):259-282. Epub 2019 Feb 10.

Rutgers, New Jersey Medical School, 185 South Orange Avenue, MSB G586, Newark, NJ 07103, USA. Electronic address:

Consensus guidelines recommend patients with symptomatic cholelithiasis and suspected choledocholithiasis have common bile duct exploration (CBDE) at the time of cholecystectomy to prevent downstream problems. Despite superiority of single-stage cholecystectomy with CBDE, 2-stage precholecystectomy/postcholecystectomy with endoscopic clearance of the duct is commonly practiced. This is related to inadequate training in minimally invasive techniques, lack of technical support for efficient and safe CBDE, and surgeons' inexperience with complex biliary pathologic condition. Read More

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http://dx.doi.org/10.1016/j.suc.2018.12.007DOI Listing
April 2019
1 Read

An Update on Technical Aspects of Cholecystectomy.

Surg Clin North Am 2019 Apr 10;99(2):245-258. Epub 2019 Feb 10.

Division of Hepatobiliary, Pancreatic, and Gastrointestinal Surgery, Washington University School of Medicine, 660 South Euclid Avenue Box 8109, St Louis, MO 63110, USA. Electronic address:

Laparoscopic cholecystectomy has revolutionized the field of surgery, and is currently the gold standard in the treatment for symptomatic cholelithiasis. The goal of every laparoscopic cholecystectomy should be attainment of the critical view of safety before cutting the cystic duct and artery to reduce the risk of bile duct injury. Open cholecystectomy is most commonly performed when laparoscopic cholecystectomy is converted to open or when laparoscopic cholecystectomy is contraindicated. Read More

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http://dx.doi.org/10.1016/j.suc.2018.11.005DOI Listing

Gallstone Disease: Cholecystitis, Mirizzi Syndrome, Bouveret Syndrome, Gallstone Ileus.

Surg Clin North Am 2019 Apr;99(2):231-244

Rutgers, New Jersey Medical School, 185 South Orange Avenue, MSB G586, Newark, NJ 07102, USA.

Gallstone disease is a leading cause of morbidity in the United States and usually requires surgical or endoscopic interventions for diagnosis and/or treatment. Although gallstone disease is classically associated with the inflammatory sequela of cholecystitis, gallstones can also contribute to other clinical presentations such as gallstone ileus, Mirizzi syndrome, and Bouveret syndrome. This article explores the common-and uncommon-causes of surgical pathology owing to gallstones with an emphasis on clinical identification, diagnostics, and management options. Read More

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http://dx.doi.org/10.1016/j.suc.2018.12.006DOI Listing
April 2019
1 Read

Bile Metabolism and Lithogenesis: An Update.

Surg Clin North Am 2019 Apr;99(2):215-229

Department of Surgery, University of California Irvine; Hepatobiliary and Pancreas Surgery, Department of Surgery, University of California Irvine, Orange, CA, USA. Electronic address:

Bile is composed of multiple macromolecules, including bile acids, free cholesterol, phospholipids, bilirubin, and inorganic ions that aid in digestion, nutrient absorption, and disposal of the insoluble products of heme catabolism. The synthesis and release of bile acids is tightly controlled and dependent on feedback mechanisms that regulate enterohepatic circulation. Alterations in bile composition, impaired gallbladder relaxation, and accelerated nucleation are the principal mechanisms leading to biliary stone formation. Read More

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http://dx.doi.org/10.1016/j.suc.2018.12.003DOI Listing
April 2019
2 Reads

An Update on Biliary Dyskinesia.

Authors:
Clancy J Clark

Surg Clin North Am 2019 Apr;99(2):203-214

General Surgery Residency, Center for Applied and Experiential Learning, Wake Forest Baptist Health, Medical Center Boulevard, Winston Salem, NC 27157, USA. Electronic address:

Biliary dyskinesia is a functional disorder of the gallbladder or sphincter of Oddi. While cholecystectomy for symptomatic cholelithiasis is widely accepted, debate remains regarding the clinical benefit of invasive procedures for biliary dyskinesia. This article will review current best evidence in the diagnosis and management of biliary dyskinesia. Read More

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http://dx.doi.org/10.1016/j.suc.2018.11.004DOI Listing

Autoimmune Diseases of the Biliary Tract: A Review.

Surg Clin North Am 2019 Apr 10;99(2):185-201. Epub 2019 Feb 10.

Division of Surgical Oncology, Department of Surgery, University of Wisconsin School of Medicine and Public Health, University of Wisconsin, 600 Highland Avenue, Madison, WI 53792, USA. Electronic address:

The management of autoimmune hepatobiliary disorders remains a challenging and emerging area of investigation. An awareness of cholestatic liver diseases is critical to appropriate recognition and management of these challenging diseases, because patients often present asymptomatically, and diagnosis is limited by the lack of disease-specific markers and diagnostic studies. Furthermore, there is a paucity of treatment options because the pathophysiology underlying autoimmune biliary diseases remains largely unknown. Read More

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http://dx.doi.org/10.1016/j.suc.2018.11.003DOI Listing
April 2019
2 Reads

Cholangitis: Causes, Diagnosis, and Management.

Surg Clin North Am 2019 Apr 10;99(2):175-184. Epub 2019 Feb 10.

Division of Hepatopancreatobiliary Surgery, Department of Surgery, Atrium Health/Carolinas Medical Center, Charlotte, NC, USA; Division of Hepatopancreatobiliary Surgery, Atrium Health/Carolinas Medical Center - Northeast, 200 Medical Park Drive, Suite 430, Concord, NC 28025, USA. Electronic address:

Acute cholangitis remains a potentially lethal disease if not appropriately diagnosed in a timely fashion. Modern diagnostic and therapeutic modalities have greatly decreased mortality from acute cholangitis. This article aims to provide an up-to-date synopsis of empirically tested diagnostic criteria as well as an overview of the expanding interventions available. Read More

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http://dx.doi.org/10.1016/j.suc.2018.11.002DOI Listing
April 2019
1 Read

Embryology, Anatomy, and Imaging of the Biliary Tree.

Surg Clin North Am 2019 Apr;99(2):163-174

Hepatobiliary and Pancreatic Surgery Unit, The University of Ottawa, The Ottawa Hospital, 501 Smyth Road, Box 202, Ottawa, Ontario K1H8L6, Canada.

"The anatomy of the biliary tree is notoriously variable. This variation is the bane of the hepatobiliary surgeon, to whom an understanding of biliary anatomic variation is key to the planning and safe conduct of liver surgery, from oncological resections to split-liver transplantation. The hepatic diverticulum, also termed "the liver bud," is the first semblance of the biliary system in the human embryo. Read More

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http://dx.doi.org/10.1016/j.suc.2018.12.005DOI Listing

Pancreas Transplantation: Indications, Techniques, and Outcomes.

Surg Clin North Am 2019 Feb;99(1):87-101

Department of Surgery, Division of Abdominal Transplant Surgery, Duke University School of Medicine, 330 Trent Drive Room 217, DUMC Box 3512, Durham, NC 27710, USA. Electronic address:

Pancreas transplantation treats insulin-dependent diabetes with or without concurrent end-stage renal disease. Pancreas transplantation increases survival versus no transplant, increases survival when performed as simultaneous pancreas-kidney versus deceased-donor kidney alone, and improves quality of life. Careful donor and recipient selection are paramount to good outcomes. Read More

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http://dx.doi.org/10.1016/j.suc.2018.09.007DOI Listing
February 2019
3 Reads

Pediatric Abdominal Organ Transplantation.

Surg Clin North Am 2019 Feb;99(1):73-85

Surgery, Solid Organ Transplant Program, Children's Medical Center, University of Texas Southwestern Medical Center, MC B2.02, 1935 Medical District Drive, Dallas, TX 75235, USA. Electronic address:

Pediatric liver and kidney transplantation have become the standard and accepted treatment for children with end-stage renal and liver disease. Since the first successful kidney transplant in 1954 by Dr Joseph Murray and the first liver transplant by Dr Thomas Starzl, the scope of indications for visceral organ transplantation as well as the range of recipient and donor ages has expanded. The first pediatric liver and kidney transplants, simultaneous multivisceral transplants, living-donor and donation-after-cardiac-death organs have evolved rapidly into the standard of care for end-stage renal and liver failure in children. Read More

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http://dx.doi.org/10.1016/j.suc.2018.09.006DOI Listing
February 2019
16 Reads

Liver Transplantation: Patient Selection, Perioperative Surgical Issues, and Expected Outcomes.

Authors:
Erin Maynard

Surg Clin North Am 2019 Feb;99(1):65-72

Oregon Health and Science University, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239, USA. Electronic address:

Liver transplant rates are at an all-time high, with nearly 8000 liver transplants in 2015. Despite the increasing number of liver transplants performed per year, there is a widening gap of supply and demand on limited donor resources. Patient selection is a complex but necessary process to evaluate patients who will benefit from liver transplant while minimizing futile transplants. Read More

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http://dx.doi.org/10.1016/j.suc.2018.09.005DOI Listing
February 2019
3 Reads

Posttransplant Malignancy.

Surg Clin North Am 2019 Feb;99(1):49-64

Department of Transplantation, Piedmont Transplant Institute, Piedmont Atlanta Hospital MTP Mason Transplant, 1968 Peachtree Road Northwest, Building 77, Atlanta, GA 30309, USA.

Posttransplant malignancy is a leading cause of death after solid organ transplantation (SOT). Recipients of SOT are at significantly higher risk of multiple cancers compared with the general population, most notably nonmelanoma skin cancer and posttransplant lymphoproliferative disorders. Risk factors for posttransplant malignancy include history of malignancy, immunosuppression, oncogenic viral infections, sun exposure, and disease-specific associations. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S00396109183012
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http://dx.doi.org/10.1016/j.suc.2018.09.004DOI Listing
February 2019
15 Reads

Living Kidney Donation: Strategies to Increase the Donor Pool.

Surg Clin North Am 2019 Feb;99(1):37-47

Surgery, Abdominal Transplantation, Stanford University, 750 Welch Road, Palo Alto, CA 94304, USA. Electronic address:

End-stage renal disease (ESRD) is a significant health care burden. Although kidney transplantation is the optimal treatment modality, less than 25% of waiting list patients are transplanted because of organ shortage. Living kidney donation can lead to better recipient and graft survival and increase the number of donors. Read More

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http://dx.doi.org/10.1016/j.suc.2018.09.003DOI Listing
February 2019
2 Reads
1.879 Impact Factor

Safe Living Following Solid Organ Transplantation.

Authors:
Barbra M Blair

Surg Clin North Am 2019 Feb;99(1):153-161

Division of Infectious Diseases, Beth Israel Deaconess Medical Center, 110 Francis Street, Suite GB, Boston, MA 02215, USA. Electronic address:

Living safely after organ transplantation starts before transplant and continues after transplant. To minimize a solid organ transplant (SOT) recipient's risk for infection and risk for injury, it is important to plan for numerous potential exposures after transplant. These include potential exposure to others with viral or bacterial illness, potential exposure to food and water sources, participation in recreational activities, resuming sexual activity, living with pets, and opportunities for travel, especially internationally. Read More

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http://dx.doi.org/10.1016/j.suc.2018.09.011DOI Listing
February 2019
1 Read

Composite and Multivisceral Transplantation: Nomenclature, Surgical Techniques, Current Practice, and Long-term Outcome.

Surg Clin North Am 2019 Feb;99(1):129-151

Center for Gut Rehabilitation and Transplantation, Cleveland Clinic, 9500 Euclid Avenue, Desk A100, Cleveland, OH 44195, USA; Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, 9500 Euclid Avenue, Desk A100, Cleveland, OH 44195, USA. Electronic address:

The successful development of multivisceral and composite visceral transplantation is among the milestones in the recent history of human organ transplantation. All types of gastrointestinal transplantation have evolved to be the standard of care for patients with gut failure and complex abdominal pathologic conditions. The outcome has markedly improved over the last 3 decades owing to technical innovation, novel immunosuppression, and better postoperative care. Read More

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http://dx.doi.org/10.1016/j.suc.2018.09.010DOI Listing
February 2019
7 Reads

Is This Organ Donor Safe?: Donor-Derived Infections in Solid Organ Transplantation.

Authors:
Staci A Fischer

Surg Clin North Am 2019 Feb;99(1):117-128

The Warren Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI 02903, USA; Accreditation Council for Graduate Medical Education, 401 North Michigan Avenue, Suite 2000, Chicago, IL 60611, USA. Electronic address:

Infection is an inevitable complication of solid organ transplantation. Unrecognized infection may be transmitted from a donor and result in disseminated disease in the immunosuppressed host. Recent outbreaks of deceased donor-derived infections resulting in high rates of mortality and severe morbidity have emphasized the need to be cautious in using donors with possible meningoencephalitis. Read More

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http://dx.doi.org/10.1016/j.suc.2018.09.009DOI Listing
February 2019
1 Read

Small Bowel Transplantation.

Surg Clin North Am 2019 Feb;99(1):103-116

Division of Abdominal Transplant Surgery, Duke University Medical Center, DUMC Box 3522, Durham, NC 27710, USA. Electronic address:

Intestinal and multivisceral transplants are complex technical procedures that present unique challenges in the field of solid organ transplantation. This review aims to highlight the indications, techniques, outcomes, and complications specific to intestinal transplantation. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S00396109183013
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http://dx.doi.org/10.1016/j.suc.2018.09.008DOI Listing
February 2019
14 Reads

Patient Selection for Kidney Transplant.

Surg Clin North Am 2019 Feb;99(1):1-35

Transplant, Immunology and Hepatobiliary Surgery, Department of Surgery, University of Vermont, 111 Colchester Avenue, Burlington, VT 05401, USA. Electronic address:

The incidence of end-stage renal disease has continued to increase. Similarly, the number of patients living with a functioning renal allograft has also increased. Transplantation has improved with advances in surgical techniques, immunosuppression, and better control of comorbid conditions. Read More

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http://dx.doi.org/10.1016/j.suc.2018.09.002DOI Listing
February 2019
1 Read

Foreword.

Authors:
Ronald F Martin

Surg Clin North Am 2018 12 28;98(6):xiii-xv. Epub 2018 Sep 28.

Department of Surgery, York Hospital, 16 Hospital Drive, Suite A, York, ME 03909, USA. Electronic address:

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http://dx.doi.org/10.1016/j.suc.2018.09.012DOI Listing
December 2018
1 Read

Enhanced Recovery After Surgery and Future Directions.

Surg Clin North Am 2018 Dec 24;98(6):1287-1292. Epub 2018 Aug 24.

Division of Colon and Rectal Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.

Although the utilization of enhanced recovery after surgery (ERAS) pathways has become more prevalent, issues of compliance and implementation remain. Limiting the complexity of new ERAS protocols by maintaining the core elements of ERAS, along with the development of complementary protocols (prehabilitation, the perioperative surgical home, and telemedicine) may improve overall uptake and subsequent patient outcomes. The future directions of ERAS should be centered on improving the dissemination of the practice and ongoing expansion of patient care outside the immediate hospital period. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S00396109183010
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http://dx.doi.org/10.1016/j.suc.2018.07.014DOI Listing
December 2018
22 Reads

Enhanced Recovery After Surgery in Surgical Specialties: Gynecologic Oncology.

Surg Clin North Am 2018 Dec 21;98(6):1275-1285. Epub 2018 Aug 21.

Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, 176F Room 10250, 619 19th Street South, Birmingham, AL 35249-7333, USA. Electronic address:

Many of the enhanced recovery after surgery principles initially developed for colorectal surgery can be successfully applied to gynecologic oncology and lead to significant improvements in perioperative care. Enhanced recovery after surgery guidelines specific to gynecologic oncology were published in 2016 and provide a framework for the development and implementation of institutional protocols. Identification of key stakeholders and a multidisciplinary approach are critical to identifying which principles are best suited for implementation at a particular institution and for ensuring success of the protocol. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S00396109183010
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http://dx.doi.org/10.1016/j.suc.2018.07.013DOI Listing
December 2018
21 Reads

Enhanced Recovery After Surgery: Urology.

Surg Clin North Am 2018 Dec;98(6):1265-1274

Department Urology, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL 35294, USA. Electronic address:

Enhanced recovery after surgery programs were developed as a type of standardized evidence-based perioperative care protocols. The necessity and benefit of clinical care pathways is not a new phenomenon in urology and have been a big part of the evolution of care for urology patients, especially in terms of urologic oncology. This article discusses the key components of evidence-based perioperative care in key urologic procedures. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S00396109183010
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http://dx.doi.org/10.1016/j.suc.2018.07.012DOI Listing
December 2018
22 Reads

Enhanced Recovery After Surgery: Hepatobiliary.

Surg Clin North Am 2018 Dec 24;98(6):1251-1264. Epub 2018 Aug 24.

Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. Electronic address:

Enhanced recovery after surgery (ERAS) pathways target specific areas within perioperative patient care in a multidisciplinary and evidence-based manner. Because of the subsequent positive outcomes associated with its use, ERAS has expanded to most surgical subspecialties, including hepatopancreatobiliary surgery. Although certain concepts are universal to all ERAS protocols, there are unique areas of emphasis pertaining to the hepatopancreatobiliary specialties, which will be highlighted throughout this article. Read More

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http://dx.doi.org/10.1016/j.suc.2018.07.011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6345553PMC
December 2018
1 Read

Enhanced Recovery After Surgery: Recent Developments in Colorectal Surgery.

Surg Clin North Am 2018 Dec 24;98(6):1241-1249. Epub 2018 Aug 24.

Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Avenue, A30, Cleveland, OH 44195, USA. Electronic address:

Enhanced recovery after surgery (ERAS) has been established as a safe and effective tool for early recovery and discharge after colorectal resection. This article reviews the latest additions and refinements to ERAS protocols and also examines those interventions that seem to have limited clinical benefit for colorectal patients. Read More

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http://dx.doi.org/10.1016/j.suc.2018.07.010DOI Listing
December 2018
1 Read

Enhanced Recovery After Surgery in Community Hospitals.

Authors:
Amanda Hayman

Surg Clin North Am 2018 Dec 28;98(6):1233-1239. Epub 2018 Aug 28.

Division of Gastrointestinal and Minimally Invasive Surgery, The Oregon Clinic, 4805 Northeast Glisan Street, Suite 6N60, Portland, OR 97212, USA; Department of Surgery, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA. Electronic address:

Multidisciplinary collaboration and administrative support are essential to enhanced recovery program (ERP) success. The key tenets for ERP are opiate-sparing pain regimen, decreased fasting, and minimizing intravenous fluids. Getting buy-in from community surgeons may be difficult due to varied practice patterns and clinical fragmentation. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S00396109183010
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http://dx.doi.org/10.1016/j.suc.2018.07.009DOI Listing
December 2018
14 Reads

Enhanced Recovery After Surgery and Surgical Disparities.

Surg Clin North Am 2018 Dec 21;98(6):1223-1232. Epub 2018 Aug 21.

Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA. Electronic address:

Surgical disparities exist. Certain surgical populations suffer from disproportionately worse access, care, and outcomes in surgery. Opportunities exist to better identify, understand, and reduce these disparities. Read More

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http://dx.doi.org/10.1016/j.suc.2018.07.015DOI Listing
December 2018
1 Read

Nursing Perspectives on Enhanced Recovery After Surgery.

Surg Clin North Am 2018 Dec 24;98(6):1211-1221. Epub 2018 Aug 24.

Quality, Patient Safety and Clinical Effectiveness, UAB Hospital, 619 19th Street South JT1402, Birmingham, AL 35249, USA.

A growing body of evidence suggests that the implementation of an enhanced recovery after surgery (ERAS) clinical pathway can accelerate recovery and reduce length of stay through the use of a multimodal program that includes guidelines for optimal pain relief, stress reduction, early nutrition, and early mobilization. The article discusses the importance of the nursing body in improving institutional compliance to ERAS clinical pathway measures and describes specific nursing barriers observed in the ERAS implementation in an academic medical center. Read More

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http://dx.doi.org/10.1016/j.suc.2018.07.008DOI Listing
December 2018
1 Read

Enhanced Recovery After Surgery: Implementation Strategies, Barriers and Facilitators.

Surg Clin North Am 2018 Dec 24;98(6):1201-1210. Epub 2018 Aug 24.

Quality and Best Practices, Department of Surgery, University of Toronto, 149 College Street, 5th Floor, Toronto Ontario M5T 1P5, Canada; Clinical Programs and Quality Initiatives, Cancer Care Ontario, 620 University Avenue, 16th floor, Toronto, ON M5G 2L7, Canada. Electronic address:

Numerous reports have documented the effectiveness of Enhanced Recovery after Surgery (ERAS) pathways in improving recovery and decreasing morbidity and length of stay. However, there is also increasing evidence that ERAS guidelines are difficult to adopt and require the commitment of all members of the perioperative team. Multiple barriers related to limited hospital resources (financial, staffing, space restrictions, and education), active or passive resistance from members of the perioperative team, and lack of data and/or education have been identified. Read More

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http://dx.doi.org/10.1016/j.suc.2018.07.007DOI Listing
December 2018
2 Reads

Enhanced Recovery After Surgery: Intraoperative Fluid Management Strategies.

Surg Clin North Am 2018 Dec 24;98(6):1185-1200. Epub 2018 Aug 24.

Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham School of Medicine, JT 845, 619 South 19th Street, Birmingham, AL 35249, USA.

Ideal fluid management is a critical component of enhanced recovery after surgery protocols and should be considered throughout the perioperative period. The goal of preoperative fluid management is for the patient to arrive to the operating room euvolemic. Intraoperative goals of fluid management are to preserve intravascular volume and minimize salt and water uptake through intravenous crystalloid infusions. Read More

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http://dx.doi.org/10.1016/j.suc.2018.07.006DOI Listing
December 2018
1 Read

Enhanced Recovery After Surgery and Multimodal Strategies for Analgesia.

Surg Clin North Am 2018 Dec 22;98(6):1171-1184. Epub 2018 Aug 22.

Department of Anesthesiology, Duke University, Duke University Medical Center, Box 3094, Durham, NC 27710, USA.

Enhanced recovery after surgery is an evidence-based, multimodal approach to the perioperative care of a patient undergoing surgery. These pathways seek to attenuate the stress response to surgery facilitating postoperative recovery. Analgesia is a critical component of these pathways, because optimal pain relief is critical for patients to mobilize quickly after surgery, preventing such complications as infection and thromboembolism. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S00396109183009
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http://dx.doi.org/10.1016/j.suc.2018.07.005DOI Listing
December 2018
8 Reads

Preoperative Preparations for Enhanced Recovery After Surgery Programs: A Role for Prehabilitation.

Surg Clin North Am 2018 Dec 24;98(6):1149-1169. Epub 2018 Aug 24.

Department of Anesthesia, McGill University Health Centre, 1650 Cedar Avenue, Montreal, Québec H3G 1A4, Canada. Electronic address:

Preoperative risk assessment is valuable only if subsequent targeted optimization of patient care is allowed. Early assessment of high-risk surgical patients is essential to facilitate appropriate optimization. Preoperative assessment and optimization should not be exclusively focused on patients' comorbidities, but also include nutritional assessment, functional capacity, and promote healthy life style habits that affect surgical outcomes (eg, smoking cessation); it requires a multidisciplinary approach. Read More

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http://dx.doi.org/10.1016/j.suc.2018.07.004DOI Listing
December 2018
2 Reads

Enhanced Recovery After Surgery: Economic Impact and Value.

Surg Clin North Am 2018 Dec 24;98(6):1137-1148. Epub 2018 Aug 24.

Division of General Surgery, McGill University Health Centre, Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, 1650 Cedar Avenue, L9-404, Montreal, Quebec H3G 1A4, Canada.

Value in health care is defined as the best outcome that matters to the patient at the lowest cost. Therefore, a valuable intervention is one that either results in better outcomes at the same cost, the same outcomes at lower cost, or in the best-case scenario, better outcomes at lower cost. Enhanced recovery pathways (ERPs) increase value by improving clinical outcomes without increasing costs. Read More

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http://dx.doi.org/10.1016/j.suc.2018.07.003DOI Listing
December 2018
8 Reads

Enhanced Recovery After Surgery and Its Effects on Patient Reported Outcomes.

Authors:
Jai Bikhchandani

Surg Clin North Am 2018 Dec 28;98(6):1129-1135. Epub 2018 Sep 28.

Department of Surgery, St Elizabeth Physicians, St Elizabeth Hospital, 20 Medical Village Drive, Suite 132, Edgewood, KT 41017, USA. Electronic address:

Enhanced recovery programs were developed as a means for improving patient recovery after surgery with a multifaceted approach including several interventions in the perioperative period. There is now sufficient evidence in the literature that enhanced recovery programs have actually shortened hospital length of stay after colorectal surgery. Nonetheless, the impact of these successful programs on patient-reported outcomes like functional recovery and return to baseline quality of life is not known. Read More

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http://dx.doi.org/10.1016/j.suc.2018.07.002DOI Listing
December 2018
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Enhanced Recovery After Surgery and Effects on Quality Metrics.

Surg Clin North Am 2018 Dec 24;98(6):1119-1127. Epub 2018 Aug 24.

Division of General Surgery, University of California San Francisco, 513 Parnassus Avenue, Room HSW1601, San Francisco, CA 94143, USA.

Enhanced recovery after surgery (ERAS) is an evidence-based protocol that aims to decrease the physiologic stress response to surgery and maintain postoperative physiologic function. This best practice bundle plays a significant role in improving surgical quality by impacting important quality metrics such as length of stay, hospital-acquired infections, readmissions, and patient experience. Adherence to ERAS as a collective bundle is more important than individual components in improving quality metrics, and this can only be achieved with data-driven information through auditing and interdisciplinary collaboration. Read More

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http://dx.doi.org/10.1016/j.suc.2018.07.001DOI Listing
December 2018
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Overview of Enhanced Recovery After Surgery: The Evolution and Adoption of Enhanced Recovery After Surgery in North America.

Authors:
Julie Thacker

Surg Clin North Am 2018 Dec;98(6):1109-1117

Duke University Health Center, Department of Surgery, DUMC, HAFS 7678, Durham, NC 27710, USA. Electronic address:

Enhanced Recovery is broadly defined as the application of evidence based perioperative care elements for improved surgical outcomes. Demonstration of decreasing surgical stress with innovation of surgical technique, in combination with pressure to drive down health care costs, have coalesced into a unique version of perioperative medicine in the United States. The US government has failed to show interest; there are no performance metrics, no participation requirements, and certainly no monetary incentives for implementation of best perioperative practices. Read More

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http://dx.doi.org/10.1016/j.suc.2018.07.016DOI Listing
December 2018
1 Read

Acute Gut Ischemia.

Authors:
Bryan A Ehlert

Surg Clin North Am 2018 Oct 29;98(5):995-1004. Epub 2018 Jul 29.

Department of Cardiovascular Sciences, East Carolina University Brody School of Medicine, 115 Heart Drive, Mail Stop 651, Greenville, NC 27834, USA. Electronic address:

Acute mesenteric ischemia is a surgical emergency commonly caused by embolic or thrombotic occlusion of the superior mesenteric artery. Prompt diagnosis, fluid resuscitation, systemic anticoagulation, and mesenteric revascularization are key tenants to the treatment of this lethal condition. Revascularization can be performed via open thromboembolectomy or surgical bypass, endovascular techniques, or a hybrid approach of the 2. Read More

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http://dx.doi.org/10.1016/j.suc.2018.06.002DOI Listing
October 2018
5 Reads

Volvulus.

Surg Clin North Am 2018 Oct 31;98(5):973-993. Epub 2018 Jul 31.

Division of Trauma, Emergency General Surgery and Critical Care Surgery, Department of General Surgery, University of Nebraska Medical Center, 983280 Nebraska Medical Center, Omaha, NE 68198-3280, USA.

Intestinal volvulus, regardless of location, is a rare disease process, but one that requires high suspicion and timely diagnosis given the increased incidence of intestinal necrosis and potential mortality. Most patients with intestinal volvulus require some form of surgical intervention. However, over the last few decades, the work-up and management of intestinal volvulus has changed given constant advancements in technology and patient care. Read More

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http://dx.doi.org/10.1016/j.suc.2018.06.005DOI Listing
October 2018
15 Reads

Small Bowel Obstruction.

Surg Clin North Am 2018 Oct 7;98(5):945-971. Epub 2018 Aug 7.

Carilion Clinic and Virginia Tech Carilion School of Medicine, Carilion Clinic Department of Surgery, 1906 Belleview Avenue, Med. Ed., 3rd Floor, Suite 332, Roanoke, VA 24014, USA.

Identifying patients with small bowel obstruction who need operative intervention and those who will fail nonoperative management is a challenge. Without indications for urgent intervention, a computed tomography scan with/without intravenous contrast should be obtained to identify location, grade, and etiology of the obstruction. Most small bowel obstructions resolve with nonoperative management. Read More

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http://dx.doi.org/10.1016/j.suc.2018.05.007DOI Listing
October 2018
29 Reads

Acid Peptic Disease.

Surg Clin North Am 2018 Oct;98(5):933-944

Department of Surgery, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA.

The management of peptic ulcer disease has radically changed over the last 40 years from primarily surgical treatment to medical therapy nearly eliminating the need for elective surgery in these patients. Although there has been a decline in patients requiring acute surgical intervention for complications of peptic ulcer disease (perforation, bleeding, and obstruction), these patients still make up a significant proportion of hospital admissions every year. The modern acute care surgeon must have significant knowledge of the multiple treatment modalities used to appropriately care for these patients. Read More

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http://dx.doi.org/10.1016/j.suc.2018.06.003DOI Listing
October 2018
7 Reads

Pneumoperitoneum.

Surg Clin North Am 2018 Oct;98(5):915-932

Department of Surgery- Section of General Surgery, 983280 Nebraska Medical Center Omaha, NE 68198-3280, USA.

Pneumoperitoneum has a wide differential diagnosis and presents with varying degrees of severity; however, not all etiologies require operative intervention. It is imperative that all patients with this diagnosis are evaluated by a surgeon. A thorough history, physical examination, and workup, aimed at localization of the source of pneumoperitoneum will ultimately determine the necessary treatments, including the need for operative intervention. Read More

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http://dx.doi.org/10.1016/j.suc.2018.06.004DOI Listing
October 2018
4 Reads

Pancreatitis.

Surg Clin North Am 2018 Oct 17;98(5):895-913. Epub 2018 Jul 17.

Department of Surgery, Allegheny General Hospital, 320 East North Avenue, Pittsburgh, PA 15212, USA. Electronic address:

Acute pancreatitis is an inflammation of the glandular parenchyma of the retroperitoneal organ that leads to injury with or without subsequent destruction of the pancreatic acini. This inflammatory process can either result in a self-limited disease or involve life-threatening multiorgan complications. Chronic pancreatitis consists of endocrine and exocrine gland dysfunction that develops secondary to progressive inflammation and chronic fibrosis of the pancreatic acini with permanent structural damage. Read More

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http://dx.doi.org/10.1016/j.suc.2018.06.001DOI Listing
October 2018
4 Reads

Acute Biliary Disease.

Surg Clin North Am 2018 Oct 29;98(5):877-894. Epub 2018 Jul 29.

Department of Surgery, University of North Carolina-Chapel Hill, 4035 Burnett-Womack, Campus Box 7081, Chapel Hill, NC 27599-7081, USA.

Acute biliary disease is a ubiquitous acute surgical complaint. General surgeons managing emergency surgical patients must be knowledgeable and capable of identifying and caring for common presentations. This article discusses the work-up, diagnosis, and management of the varying pathologies that make up biliary disease including cholelithiasis, cholecystitis, biliary dyskinesia, choledocholithiasis, cholangitis, gallstone pancreatitis, and gallstone ileus. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S00396109183006
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http://dx.doi.org/10.1016/j.suc.2018.05.003DOI Listing
October 2018
11 Reads

Aggressive Soft Tissue Infections.

Surg Clin North Am 2018 Oct 29;98(5):1097-1108. Epub 2018 Jul 29.

Department of Surgery, Division of Trauma and Acute Care Surgery, East Carolina University, Brody School of Medicine, 600 Moye Boulevard, Greenville, NC 27858, USA.

Necrotizing soft tissue infections (NSTI) are characterized by rapidly progressive infection that causes tissue necrosis with associated sepsis and multisystem organ failure. A rapid diagnosis is essential to decreasing the morbidity and mortality of NSTIs. There must be a high index of suspicion based on history and physical examination. Read More

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http://dx.doi.org/10.1016/j.suc.2018.05.001DOI Listing
October 2018
4 Reads