bluuebunny/crossref_metadata_2025 huggingface dataset:
Surgical Management of Melanoma and Other Skin Cancers
Authors: Wargo Jennifer A. , Tenabe Kenneth
Published: January 2021

The prevalence of malignant skin cancers has increased significantly over the past several years. Approximately 1.2 million cases of non-melanoma skin cancer are diagnosed per year. More alarming, up to 80,000 cases of melanoma are diagnosed per year, an incidence that has been steadily increasing, with a lifetime risk of 1 in 50 for the development of melanoma. The disturbing increase in the incidence of both non-melanoma skin cancer and melanoma can largely be attributed to the social attitude toward sun exposure. The clinical assessment and management of skin lesions can be challenging. This review describes the assessment process, including thorough history and examination; the need for possible biopsy; and excision criteria. Specific types of skin cancer are distinguished and include basal cell carcinoma; squamous cell carcinoma; and melanoma; and for each type the incidence; epidemiology; histologic subtypes; diagnosis; and both surgical and non-surgical treatments are provided. Stages I-IV of melanoma are detailed, with prognostic factors described. Surgical treatment for stages I and II include description of the margins of excision and sentinel lymph node biopsy. The surgical treatment of Stage III melanoma further includes therapeutic lymph node dissection and isolated limb perfusion. Adjuvant therapies are also presented and include radiotherapy and chemotherapy. The additional treatment of metastasectomy for Stage IV melanoma is described. For both Stage III and IV melanoma, the study of vaccines to host immune cells is reported. For Stage IV melanoma, the text also describes immunotherapy treatment. Operative procedures specific to superficial and deep groin dissections are outlined.
This review contains 9 figures, 3 tables, and 96 references.
Adenocarcinoma of the Colon and Rectum
Authors: Tan Winson Jianhong , Weiser Martin R.
Published: January 2021

Despite advances in systemic chemotherapy, surgery remains the mainstay of treatment in colorectal cancer. While there are similarities in the principles of colon and rectal cancer surgery, there are specific considerations that are unique to the surgical management of rectal cancer. In this chapter, we discuss the surgical management of colon and rectal cancer and highlight pertinent differences in the surgical management of rectal cancer.
This review contains 9 figures, 2 tables, and 76 references.
Keywords: Colon, Rectal, Colorectal Cancer, Adenocarcinoma, Surgery, Management
Surgical Practice Management
Authors: Nfonsam Valentine N. , Neumayer Leigh A.
Published: January 2021

As individuals complete their surgical residencies and fellowships, their attention must soon turn toward choosing their career path. This review aims to help those individuals in making informed choices that will properly prepare a successful future in surgical practice. Included here is a survey of some principles that will help guide individuals to proper decision making, an analysis of several different practice settings, sections on negotiations, benefits, and contracts, and a guide to making a smooth transition and developing a successful practice. Helpful tips and possible pitfalls, such as general dos and don’ts for applying and interviewing, are also presented to ensure that the trainee is well prepared and well aware. Figures show a template for curriculum vitae format, a sample resume, a sample executive summary, a contract worksheet, an onboarding timeline, and screenshots of Surgeon Specific Registry. Tables list types of surgical practice, a summary of a personnel file, benefits packages, and lessons learned in kindergarten. Also included are suggested readings related to the topic of surgical practice management.
This review contains 6 figures, 4 tables, 13 references, and 8 additional readings.
Inguinal Hernia
Authors: Richmond Bryan K. , Tran Mike Q.
Published: January 2021

Approximately 700,000 inguinal hernia repairs are performed in the United States annually, making it one of the most commonly performed operations in surgical practice. The anatomy of the inguinal region is quite complex, and a thorough understanding of this region is required to successfully and safely repair these defects. The science of inguinal hernia repair continues to evolve and over the past several years has expanded to include laparoscopic and robotic approaches, as well as time-honored open repairs that still play an essential role in treating this disease process. The following review describes the relevant anatomy, types of groin hernias, the role of different hernia prostheses and meshes, common and evolving repair techniques, and the common complications encountered in hernia surgery, including chronic groin pain after inguinal hernia repair. 
The review contains 19 figures, 15 tables, and 50 references.
Keywords: Inguinal hernia, femoral hernia, transabdominal preperitoneal repair, total extraperitoneal repair, laparoscopy, Bassini repair, Lichtenstein repair
Disorders of the Adrenal Glands
Authors: Martinez Carolina , Memeh Kelvin , Caballero Beatrice , Guerrero Marlon A
Published: January 2021

Adrenal tumors are most commonly identified incidentally during imaging for nonadrenal causes. Others may be identified after a patient presents with symptoms of adrenal hormone excess. Adrenal tumors are categorized as functional or nonfunctional, as well as by their malignant potential. It is important to understand the functionality of adrenal glands and properly diagnose potentially hormonally active adrenal tumors. This review outlines the anatomy and physiology of the adrenal glands and details the management of the diseases that result from adrenal hormone excess.
This review contains 8 figures, 7 tables, and 27 references.
Key words: Addison disease, adrenal, aldosterone, catecholamine, Conn syndrome, cortisol, Cushing syndrome, function, glucocorticoid, malignant, pheochromocytoma
Sclerotherapy
Authors: Kirkwood Melissa L , H. Chamseddin Khalil
Published: January 2021

Sclerotherapy involves the injection of a caustic solution into an abnormal vein so as to cause localized destruction of the venous intima and obliteration of the vessel. Over the past 50 years, improvements in the technology have greatly enhanced the results achievable with sclerotherapy. To ensure optimal results, it is essential to have a thorough knowledge not only of the technique but also of the indications, expected outcomes, and possible complications associated with the procedure. This review covers preoperative evaluation, operative planning, technique and complications associated with sclerotherapy. Figures show a 63-year-old woman before and after two treatments with 0.2% sodium tetradecyl sulfate, a 52-year-old woman  before and after two treatments with 0.5% sodium tetradecyl sulfate, a 36-year-old woman before and after four treatments with a combination of 0.5% and 0.2% sodium tetradecyl sulfate, the standard hand position for sclerotherapy, skin necrosis on the left posterior calf of a 48-year-old woman after ultrasound-guided sclerotherapy,  a 56-year-old woman before treatment and with residual hyperpigmentation after treatment with 0.2% sodium tetradecyl sulfate, and telangiectatic matting in a 43-year-old woman after treatment with 0.2% sodium tetradecyl sulfate. Tables list complications of sclerotherapy, suggested polidocanol (POL) and sodium tetradecyl sulfate (STS) concentrations for liquid and foam sclerotherapy, materials needed for sclerotherapy, and absolute and relative contraindications for sclerotherapy for varicose veins.
 Key Words: Varicose veins, Chronic venous insuffiency, sclerotherapy, foam sclerotherapy, reticular veins, venous disorders
This review contains 7 highly rendered figures, 4 tables, and 29 references.
Colonic Volvulus
Authors: Kasten Kevin R. , Marcello Peter W. , Francone Todd D.
Published: January 2021

Colonic volvulus accounts for 3 to 5% of bowel obstructions in the United States. Current data reveal sigmoid volvulus as the most common colonic volvulus, followed by volvulus of the cecum, transverse colon, and splenic fixture. Despite a low incidence in the United States, diagnosis, management, and patient outcome depend on an appropriate index of suspicion and adherence to the proposed algorithm highlighting the approach to the patient with colonic volvulus. This review outlines the definition, pathogenesis, and epidemiology of colonic volvulus, as well as its clinical evaluation and treatment. Tables review the demographics of colonic volvulus in the United States, the differential diagnosis of and risk factors for colonic volvulus, important radiographic findings in colonic volvulus, and nonoperative management of sigmoid volvulus. Figures show the types of ileosigmoid knot; plain radiographs of cecal,  sigmoid, transverse, and splenic flexure volvulus; contrast enema of cecal, transverse, splenic flexure, and sigmoid volvulus; cross-sectional abdominal imaging of cecal, sigmoid, and transverse colon volvulus and ileosigmoid knot; endoscopic evaluation in sigmoid volvulus; use of an esophageal overtube for placement of a rectal tube; necrotic cecum and transverse colon volvulus in the operating suite; and sigmoid volvulus in an elderly gentleman.

This review contains 14 figures, 13 tables, and 165 references
Keywords: Colonic volvulus, colonic obstruction, endoscopy, surgical intervention, ileosigmoid knot, splenic flexure volvulus, sigmoid volvulus, transverse colon volvulus, cecal volvulus
Injuries to the Peripheral Blood Vessels
Authors: Fox Charles J.
Published: January 2021

Contributions from the armed conflicts of the 20th century have defined the standards for vessel ligation or repair of arterial and venous injuries. Since the Vietnam War, there has been considerable modernization in the battlefield medical environment, and forward surgical capability, expeditious evacuation and new and effective resuscitation strategies have provided the foundation for innovation and progress. Lessons learned during current US military operations continue to advance the practice of vascular trauma surgery, and these techniques are directly translated to surgical practices in trauma centers around the world. This review covers mechanisms and sites of extremity vascular injury,  initial assessment,  management, and special considerations. Figures show an avulsion injury, in which an artery is stretched, an algorithm for the workup of a patient with a potential extremity vascular injury, an algorithm for the management of complex extremity trauma, exposure of the axillary artery, exposure of the brachial artery, exposure of the femoral artery, medial exposure of the proximal and distal popliteal arteries, the two-incision technique for lower leg decompression in compartment syndrome, and incisions for forearm decompression in compartment syndrome.
 
This review contains 10 highly rendered figures and 84 references
Liver and Pancreas Transplantation
Authors: Thompson Julie A , Kukla Aleksandra
Published: January 2021

More than 6,000 liver transplantations are performed annually in the United States. Enhancements in patient selection and surgical technique and the availability of more powerful immunosuppressive agents have resulted in steady improvement in patient survival. As a result, liver transplantation has been accepted as the standard of care for patients with severe acute or chronic liver disease in whom conventional modalities of therapy have failed. The major obstacle to patients receiving the procedure is the critical shortage of donor organs. Many more recipients of liver transplantation are now receiving the bulk of their care from general internists, gastroenterologists, and primary care physicians. As a result, recognition of potential long-term complications and the need for appropriate immunizations and regular screening visits have become increasingly important. This chapter discusses who qualifies as a candidate for liver transplantation, contraindications to transplantation, timing of transplantation, operative procedures, complications of transplantation (e.g., perioperative and surgical complications, immunologic complications, infectious complications, complications of medical and immunosuppressive therapy, and disease-specific complications), and transplantation outcome. Pancreas transplantation, which aims at providing physiologic insulin replacement, is a therapy that reliably achieves euglycemia in patients with type 1 diabetes mellitus. The discussion of pancreas transplantation focuses on topics such as evaluation of candidates for transplantation (including islet transplantation); contraindications to transplantation; operative procedures; outcome survival; and the effect of transplantation on disorders associated with type 1 diabetes mellitus. The figures show estimated 3-month survival as a function of the Model for End-Stage Liver Disease (MELD) score, the sections of the liver that can be used for transplantation, an algorithm for evaluation of patients with type 1 diabetes mellitus being considered for pancreas transplantation, and an illustration of enteric drainage technique used in whole pancreas transplantation. The tables provide the common indications for liver transplantation, the scoring system for the Child-Turcotte-Pugh classification of liver disease severity, drug interactions with immunosuppressants, and immunization recommendations for liver transplant patients.
This chapter contains 4 figures, 4 tables, 101 references, 5 Board-styled MCQs, and 1 Teaching Slide Set.
General Surgery in Patients with End-Stage Organ Disease
Authors: Evenson Amy R. , Seshadri Ramanathan M. , Fryer Jonathan P.
Published: January 2021

The number of patients with end-stage organ disease in the United States is substantial. Patients with end-stage organ disease are susceptible to all of the surgical problems seen in general surgical practice, with the added comorbidities associated with their organ failure. Hence, understanding of the principles of perioperative patient management is important as part of a general surgery practice. The chapter contains details on general and peripheral vascular surgical procedures, including dialysis access for patients with end-stage renal disease. Details on management of abdominal hernias, cholelithiasis, and disorders of the intestine in patients with end-stage liver disease are provided. Table 1 discusses the advantages and disadvantages of arteriovenous (AV) fistulas versus AV grafts. Table 2 describes “the rule of 6’s” for mature AV fistula. Table 3 has information on potential barriers to peritoneal dialysis. Table 4 is the Child-Pugh-Turcotte classification of severity of liver disease. Table 5 discusses the factors affecting the decision to operate and timing of operation in patients with end-stage liver disease. Figure 1 shows the increasing incidence of end-stage renal disease in the United States. Figure 2 is the five-stage classification system for chronic kidney disease. Figure 3 illustrates the various options for upper extremity AV fistula.
This review contains 3 figures, 5 tables, and 68 references.
The Elderly Surgical Patient
Authors: Zenilman Michael E. , Kim Sylvia S.
Published: January 2021

The elderly portion of the US population uses a substantial share of total health care resources, including surgical resources. Accordingly, care of older patients is likely to account for an increasing share of surgeons workloads; therefore, it is incumbent on surgeons to be aware of the particular concerns that apply to this surgical subpopulation. This review discusses the physiologic compromises per organ system seen with aging, highlighting their potential ramifications for surgery. The authors cover the tools available to risk stratify elderly patients beyond single organ system evaluation, such as the Comprehensive Geriatric Assessment, which categorizes patients as fit, intermediate, and frail. This review has 3 figures, 10 highly descriptive tables, and 94 references.
Organ Procurement
Authors: Chaudhury Prosanto , Baker Talia B. , Skaro Anton I. , Alvord Paul
Published: January 2021

Improvements in immunosuppression, organ preservation, surgical technique, and recipient management have led to the widespread adoption of transplantation as a viable therapeutic option for end-stage organ disease. Consequently, more patients than ever are benefiting from organ transplantation. Unfortunately, the rate of organ donation has not kept pace with the increase in the number of recipients awaiting transplantation. The relative shortage of organs has necessitated an increasing reliance on creative strategies aimed at broadening or expanding the limits of the donor pool. For instance, organs now are frequently obtained from so-called extended-criteria donors (i.e., donors who are elderly or who have significant comorbid conditions) or from non-heart-beating donors. A particularly important strategy for alleviating the organ shortage has been the broader application of living donor transplantation. The authors outline the current state of organ procurement from both cadaveric and living donors, including donor evaluation, perioperative management, and the various donor procedures.
This review contains 14 figures, 1 table, and 63 references.
Pharmacologic Considerations in the Elderly Surgical Patient
Authors: Sohn Linda , Hong Joe C. , Yeh Michael W. , Russell Tara A. , Russell Marcia M.
Published: January 2021

The most rapidly growing segment of the elderly population corresponds to persons age 85 and over. As of 2006, elderly patients accounted for 35.3% of the inpatient and 32.1% of the outpatient surgical procedures occurring in the United States. Because age-related changes occur in each organ system in all elderly individuals, this population merits special consideration when undergoing surgical procedures. Furthermore, there is a high probability that older adults will have multiple chronic medical problems, which may present a complex medication management challenge. This review covers the pharmacologic impact of physiologic changes associated with aging, preoperative assessment, preoperative medication management, delirium and the impact of perioperative medications in the elderly, anesthesia and related medications, and specific drug classes and their use in the elderly surgical patient. Figures show an overview of the management of the elderly surgical patient, and preoperative medication management. Tables list medications that should be avoided in older patients with reduced renal function, drugs that exhibit additive adverse effects, medications with high anticholinergic activity, medications that inhibit and induce the CYP450 system, herbal supplements, 2015 Beers Criteria summary of potentially inappropriate medication use in older adults, drugs associated with postoperative delirium, risk factors for postoperative delirium, and clinical pharmacology of commonly used anesthetic agents.
 
This review contains 2 highly rendered figures, 9 tables, and 61 references
Compartment Syndrome
Authors: Attum Basem , Obremskey William , Dennis Bradley , Miller Richard
Published: January 2021

Compartment syndrome is a process that can develop anywhere skeletal muscle or abdominal organs are encased by a rigid fascial layer. This review describes the different aspects of these conditions, including the epidemiology, pathophysiology, diagnosis, and management of compartment syndrome in the extremities and abdomen. Diagnosis is expanded on further to describe clinical signs in the alert patient and the different methods of compartment measurement in the obtunded patient or when a physical examination is inconclusive. The anatomy of the leg, thigh, buttocks, forearm, and arm is described, along with surgical techniques for fasciotomy. Postoperative care, the different methods of wound management and skin closure, and diagnostic criteria for the diagnosis and management of abdominal compartment syndrome are discussed. Treatment of abdominal compartment syndrome with decompressive laparotomy and temporary abdominal closure is also described. Figures depict various fasciotomies and an algorithmic approach to management. Tables show the contents and function of the compartments of the leg and forearm.
Key words: abdominal compartment syndrome, compartment syndrome, decompressive laparotomy, extremity, fasciotomy, intra-abdominal hypertension, intra-abdominal pressure, temporary abdominal closure, tibia fracture
Anterior Retroperitoneal Spine Exposure
Authors: Teruya Theodore H. , Jr Ahmed M. Abou-Zamzam
Published: January 2021

Anterior surgical exposure of the lumbar spine has been increasingly performed by general and vascular surgeons over the past decade. Owing to the predominance of spinal pathology at the lower lumbar levels and the spinal surgeons’ need for assistance, the “exposure surgeon” has emerged. The knowledge and expertise for performing the anterior exposures lie within general surgery. Manipulation of the ureter, aorta, and iliac vessels must be done with precision and is an excellent opportunity for surgeons to use their expertise to aid the spinal surgeon. This review covers the relevant aspects of anterior surgical exposure of the spine.
This review contains 8 figures, and 39 references.
Key words: anterior lumbar interbody fusion, anterior retroperitoneal spine exposure, extraperitoneal, retroperitoneal, spondylolisthesis, spondylosis, total disk replacement
Cancer Immunology
Authors: Cho Clifford S. , Contreras Amanda
Published: January 2021

The immune system conducts a continuous process of immunologic surveillance for new cancer cells that is likely capable of eradicating many potential malignancies before they become clinically evident. Nascent tumors can, however, use escape mechanisms to avoid this control. It is hoped that therapeutic manipulation of this balance between cancer and host may allow us to harness the immune system as an effective means of treating established tumors. This review summarizes the immunologic response, immunoediting, and clinical strategies in cancer immunotherapy. Figures show activation of CD8+ cytotoxic T lymphocytes and CD4+ T helper cells by an antigen-presenting cell; inhibition of T cells specific for an antigen being presented in the absence of a full complement of costimulatory interactions, as might be present on an immature dendritic cell, engagement of cytotoxic T lymphocyte–associated protein 4 by B7, which serves to downregulate T cell function, and downregulation of major histocompatibility proteins on the surfaces of tumor cells; and the kinetics of activated T cell homeostasis in the presence of cancer.
This review contains 3 figures and 39 references.
The Morbidly Obese Surgical Patient
Authors: Schweitzer Michael A. , Grimberg Gregory
Published: January 2021

Over the past few decades, the incidence of obesity has been steadily rising in the United States. The Centers for Disease Control and Prevention estimates greater than 40% of the US adult population is obese. Rising obesity rates are also increasing among children and adolescents as well, with nearly one in five children and adolescents considered obese. As a result, surgeons today face the challenge of caring for an increasing number of morbidly obese patients, and this trend is expected to worsen over time. This review covers preoperative evaluation, obesity-related comorbidities, respiratory insufficiency, anesthesia in patients with respiratory insufficiency, intraoperative management, postoperative management, complications of gastric surgery for obesity, diabetes mellitus, wound care, and other obesity-related diseases. Figures show impaired pulmonary function in the morbidly obese improved significantly after weight loss induced by bariatric surgery, significant improvement in mean pulmonary arterial pressure in 18 patients, 3 to 9 months after gastric surgery-induced weight loss of 42% ± 19% of excess weight, and a chronic venous stasis ulcer present for several years in a morbidly obese patient. The tables list evaluation and treatment of obstructive sleep apnea, and indications for extended postoperative chemoprophylaxis for venous thromboembolism in morbidly obese patients.
This review contains 3 highly rendered figures, 2 tables, and 46 references
Keywords: morbid obesity, obesity, metabolic surgery, venous thromboembolism chemoprophylaxis, Obstructive Sleep Apnea
The Colon, Appendix, Rectum, and Anus
Authors: Chu Daniel I. , Romine Margaret M
Published: January 2021

The colon, appendix, rectum, and anus have unique anatomic features, both structural and functional, that contribute to normal and pathologic states. Structural features discussed in this review include the layers of the intestinal wall, vascular anatomy, lymphatic drainage, and innervation. Functional features highlighted include the role(s) each organ plays in immunity, nutrient absorption, electrolyte secretion, water absorption, continence, and elimination of waste. A clear understanding of these structural and functional details is the foundation on which surgical techniques and treatment strategies are based when addressing surgical pathology.
Key words: anus, appendix, colon, colorectal pathology, colorectal surgery, rectum
Preoperative Evaluation of the Elderly Surgical Patient
Authors: Wang Tracy S. , Roberts Jennifer , Berger Nicholas G
Published: January 2021

The elderly population uses a significant portion of health care resources in the United States and poses an increasing challenge to perioperative care. Many reports point to both increasing age and frailty as important risk factors for short-term mortality; cardiovascular, pulmonary, and renal complications; and increased length of stay and hospital costs following operation. To provide the best care for the aging US population, it is important for the clinician to be familiar with the appropriate presurgical workup specific to the comorbidities prevalent to the elderly population. This review discusses the postoperative complications facing elderly surgical patients and the physiologic complications of aging, with a particular emphasis on the concept of frailty as a predictor of major morbidity and mortality. With age and comorbidities in mind, this review discusses the relevant preoperative cardiovascular, respiratory, and renal workup and includes important guidelines for appropriate risk assessment and reduction in the elderly surgical patient.
This review contains 1 figure, 5 tables, and 86 references.
Key words: aging, anesthesia, elderly, frailty, outcomes, preoperative workup, risk assessment
Tumors of the Liver and Biliary Tract
Authors: Vargas Gabriela M. , Parikh Purvi , Brown Kimberly M
Published: January 2021

This review discusses several different types of tumors that affect the liver, biliary tree, and gallbladder. Primary and secondary liver cancers are discussed, including hepatocellular carcinoma, intrahepatic cholangiocarcinoma, colorectal metastases, neuroendocrine metastases, and noncolorectal, nonneuroendocrine metastases. Clinical evaluation, investigative studies, tumor staging, and treatment options are presented for each. Benign or premalignant hepatic lesions are also discussed, including the appropriate workup and surgical options for hemangioma, hepatic adenoma, focal nodular hyperplasia, and nonparasitic cystic tumors. Cancers of the biliary tract (cholangiocarcinomas) are subdivided into intrahepatic and extrahepatic cholangiocarcinomas. The latter are subdivided into hilar and distal cholangiocarcinoma; their clinical evaluation, investigative studies, staging, and management are discussed. The clinical evaluation, investigative studies, testing, imaging, staging, and management are presented for gallbladder cancer, including incidentally discovered gallbladder cancer and gallbladder polyps. Figures include the anatomic divisions of the liver and Brisbane terminology for resections, CT and MR images showing characteristic features of the liver and biliary tract tumors, Bismuth-Corlette classification of hilar cholangiocarcinoma, and algorithms for the management of hepatocellular carcinoma and neuroendocrine metastases. Tables include the American Joint Committee on Cancer’s classification and staging systems for hepatocellular carcinoma, cholangiocarcinoma, and gallbladder cancer; Brisbane terminology for liver resections; and neuroendocrine tumors with their corresponding biochemical markers.
This review contains 14 figures, 7 tables, and 83 references.
Minimally Invasive Approaches in Pancreatic and Liver Surgery
Authors: Boone Brian A. , Downs-Canner Stephanie , Zeh Herbert J.
Published: January 2021

The rapid expansion of minimally invasive techniques over the last two decades has dramatically expanded the use of these approaches in hepatopancreaticobiliary surgery. While implementation of minimally invasive surgery has been slowed by the technically complex nature of liver and pancreatic surgery, the feasibility of laparoscopic and robotic major liver and pancreatic resections has been demonstrated at select centers. This review discusses the preoperative evaluation, indications and contraindications, operative techniques, and outcomes of minimally invasive major pancreatic and hepatic resections; including distal pancreatectomy, pancreaticoduodenectomy, right and left hepatectomy, segmentectomy, and ablative liver surgery. Tables list the clinical outcomes of large series of patients treated with laparoscopic and robotic approaches to each operation. Figures detail port placement and include a number of intraoperative photographs demonstrating anatomic and technical considerations. Videos of a robotic pancreaticojejunostomy and a robotic retropancreatic dissection are included to highlight some of the technical advantages of this approach. While the current literature suggests the safety and feasibility of minimally invasive pancreatic and liver surgery with encouraging early results, ongoing study is needed to more definitively demonstrate outcome benefits of these approaches while maintaining patient safety and oncologic principles and justifying costs associated with the technology. As more data emerges, it is likely that utilization of minimally invasive approaches for hepatopancreaticobiliary surgery will continue to expand.
This review contains 12 figures, 2 videos, 10 tables, and 129 references.
Hemorrhoids
Authors: Senagore Anthony J. , Rojas-Khalil Yesenia
Published: January 2021

The management of symptomatic hemorrhoidal disease is based on the severity of symptoms and preexisting medical conditions that may preclude one treatment option over another. The majority of patients can be managed in the office setting with nonexcisional methods including injection sclerotherapy, rubber band ligation, and infrared coagulation. The small percentage of patients that fail this management warrant evaluation for surgical excisional hemorrhoidectomy. In recent years, newer techniques such as advanced energy devices for excision, circular stapled hemorrhoidopexy, and Doppler-guided hemorrhoidal artery ligation have been introduced. The purported advantage of these device-driven surgical options is similar efficacy with less pain. Unfortunately, although there are proponents for each approach, the device costs remain problematic, and the outcome improvement has been limited, especially in terms of long-term efficacy. Surgeons are urged to learn the standard techniques so that they can assess the newer options for themselves.

This review contains 9 figures, 4 tables, and 71 references.
Key Words: bipolar diathermy, direct current electrocautery, Doppler-guided hemorrhoidal artery ligation, excisional hemorrhoidectomy, harmonic, infrared coagulation, LigaSure, rubber band ligation, stapled hemorrhoidopexy
The Spleen
Authors: Schinnerer Eric A , Grams Jayleen M
Published: January 2021

This review focuses on the normal anatomy and physiology of the spleen. The spleen functions as a hematologic organ, filtering blood, metabolizing iron, and acting as a reservoir for blood cells. The spleen, the largest lymphatic organ, also plays a key role in adaptive and innate immunity.   
This review contains 7 figures of highly rendered artwork and 26 references.
Key words: immune system, spleen, spleen anatomy, spleen physiology, splenectomy vaccine guidelines
Treatment of Diabetic Foot
Authors: Hingorani Anil
Published: January 2021

The diabetic foot is a commonly encountered problem in surgical practice. Since treatment of the diabetic foot is quite complex, its management can mandate a multidisciplinary approach, including vascular surgery, acute care surgery, intensive care, podiatry, internal medicine, endocrinology, infectious disease, nursing, case management, and social work. This review highlights some of the details of the management of the diabetic foot from such an approach.

This review contains 1 figure and 21 referencesKey words: diabetic foot ulcer, infection, ischemia, off-loading, revascularization
Endovascular Procedures For Lower Extremity Vascular Disease: Basics of Endovascular Intervention
Authors: Jayakumar Lalithapriya , Davies Mark
Published: January 2021

The application of endovascular procedures to lower-extremity vascular disease is well established for many common vascular diseases and has often supplanted conventional open surgical approaches. Endovascular therapy for arterial disease in the lower extremity encompasses treatment of acute ischemia, chronic ischemia, and aneurysmal disease. The fundamental skill set and techniques employed are common to all these processes. This chapter details these techniques and therapies.
Key words: access closure, access complications, acute limb ischemia, chronic limb ischemia, intravascular ultrasonography, lower-extremity angiogram, transcollateral access, transpopliteal access
Mechanical Ventilation: Advanced Ventilation and Adjuncts
Authors: Maung Adrian A. , Kaplan Lewis J
Published: January 2021

In this chapter, we continue the discussion of mechanical ventilation by reviewing advanced ventilation modes such as airway pressure release ventilation and high-frequency oscillation as well as adjuncts that can be used in patients with respiratory failure. Each segment is intended to build on the preceding one and therefore establishes a functional unit with regard to mechanical ventilation, whether it is provided in an invasive or a noninvasive fashion.

This review contains 6 Figures and 69 references
Key Words: acute respiratory failure, airway pressure–release ventilation, acute respiratory distress syndrome, high-flow nasal cannula, mechanical ventilation, non-invasive ventilation, prone positioning
Health Economics: National Health Expenditures
Authors: Hall Bruce L
Published: January 2021

A picture of the overall structure of the US health care industry can be garnered by examining national health expenditures. In 2015, US national health expenditures grew to $3.2 trillion (US), outpacing growth in gross domestic product. Valuable insights are found by examining categories of spending, sources of funds, and target areas of spending, raising questions about the logic and performance of the US system. These perspectives can inform deeper consideration of healthcare policy and reform.

This review contains 3 tables and 20 references.
Key Words: health economics, health policy, Medicaid, Medicare, national health expenditures, opportunity cost, projections
Injuries to the Chest Part 2 : Mediastinal Injuries
Authors: Painter Matthew D. , Hildreth Amy N. , Hoth J. Jason
Published: January 2021

Blunt thoracic trauma comprises approximately 8% of all traumatic admissions in the United States. While chest wall injuries comprise much of this burden, mediastinal injuries, including cardiac and great vessel injuries, are being recognized more frequently given the diagnostic capabilities of modern CT imaging. In penetrating trauma, close proximity of structures in the mediastinal space, comes with a higher incidence of injury to multiple structures. Further, cardiac injury is estimated to comprise 10% of the mortality of gunshot wound victims, while more than 90% of great vessel injury is associated with penetrating injury, representing a significant burden of disease. Management and care of these injuries requires consideration of multiple details and exposure techniques. This article will address diagnosis, management and repair of esophageal, thoracic duct, cardiac, and great vessel injuries.
This review contains 4 figures, 2 tables, and 49 references.
Keywords: Mediastinal structures, esophageal injury, esophageal repair, thoracic duct injury, thoracic duct ligation, blunt cardiac injury, penetrating cardiac injury, blunt aortic injury, great vessel injury, endovascular stenting
Preoperative Evaluation of the Vascular Patient
Authors: Koleilat Issam , Carsten Christopher G.
Published: January 2021

Almost as critical as an operation itself is the preparation of the patient. Although this often includes psychosocial concerns such as expectations of recovery, inpatient stay, and other patient-centered issues, the discussion prior to surgery should not be limited to these factors. A medical assessment of the patient’s fitness and physiologic preparedness for the planned procedure must be performed by the surgeon and the resultant findings and plan reviewed with the patient. Although vascular disease affects multiple organ systems requiring a thorough general preoperative patient assessment, the focus of preoperative risk reduction strategies center on cardiac outcomes. Therefore, this review focuses on cardiac-related interventions with added coverage of preoperative strategies regarding diabetes, pulmonary and renal risk assessment, and infection reduction. Lastly, the perioperative management of anticoagulation/antiplatelet medications and cerebrovascular disease are discussed Techniques and treatments to optimize patients for surgery are integrated into the respective sections, allowing for a primer to guide this critical phase in a patient’s journey through surgery. Tables outline the Revised Cardiac Risk Index, assessment of functional capacity from patient self-reported activities, optimal delay in elective surgery after percutaneous coronary revascularization according to the 2014 American College of Cardiology/American Heart Association clinical practice guidelines, Respiratory Failure Risk Index, Szilagyi classification of vascular surgical site infection, and recommendations regarding perioperative management of anticoagulants and antiplatelet agents. A suggested algorithm for preoperative cardiac workup and the Cockcroff-Gault equation are provided.
 
This review contains 2 figures, 6 tables, and 115 references.
Video Capsule Endoscopy and Deep Enteroscopy
Authors: Marya Neil , Baptista Veronica , Singh Anupam , Charpentier Joseph , Cave David
Published: January 2021

Until 2001, the nonsurgical evaluation of the small intestine was largely limited to the use of radiologic imaging (e.g., small bowel follow-through or enteroclysis). With the now widespread availability of video capsule endoscopy and deep enteroscopy since 2001, we are now able to visualize the length and most of the mucosa of the small intestine and manage small bowel lesions that were previously inaccessible except by surgical intervention. This review serves as an overview for these two procedures, detailing the indications and contraindications, proper timing of the procedure, technical aspects of the devices themselves, possible complications, and outcomes. Figures show endoscopic images that demonstrate multiple angioectasias, bleeding during capsule endoscopy, active Crohn disease of the small bowel, severe mucosal scalloping, small bowel carcinoid tumor, small bowel polyp associated with Peutz-Jeghers syndrome, and nonsteroidal antiinflammatory drug enteropathy; serial x-rays of a patient with a patency capsule retained inside the small intestine; a computer image showing the distribution of small bowel tumors; and a pie chart displaying the breakdown of the distribution of benign and malignant tumors that can be found in the small intestine. Videos show multiple angioectasias, bleeding during capsule endoscopy, active Crohn disease of the small bowel, small bowel carcinoid tumor, and small bowel polyp associated with Peutz-Jeghers syndrome.
This review contains 10 highly rendered figures, 5 videos, and 50 references.
Endoscopic Ultrasonography
Authors: Ryou Marvin , Kumar Nitkin
Published: January 2021

Endoscopic ultrasonography (EUS) is a versatile tool that can be used to perform a variety of diagnostic and therapeutic procedures in the upper or lower gastrointestinal tract. The proximity of the echoendoscope to the pancreas, liver, and other thoracic and abdominal organs allows detailed examination or minimally invasive intervention that would not be feasible by surgical or percutaneous approaches. EUS is available with radial or linear scanning arrays and is capable of guiding fine-needle aspiration to acquire tissue for cytologic analysis. This review covers the role of EUS in chronic pancreatitis; pancreatic cysts; submucosal tumors; suspected choledocholithiasis; fecal incontinence; staging of malignancy in esophageal, pancreatic, gastric, and rectal cancer; celiac plexus block/neurolysis; fiducial placement; pseudocyst drainage and cystogastrostomy/cystoduodenostomy; endoscopic necrosectomy; and biliary drainage. Figures show peripancreatic cysts, gastrointestinal stromal tumor, common bile duct stone, esophageal adenocarcinoma, pancreatic head mass causing biliary obstruction and invading portal confluence, fine-needle aspiration of a pancreatic head mass, rectal adenocarcinoma, abdominal aorta with celiac artery and superior mesenteric artery, celiac plexus neurolysis, necrosectomy, and EUS-guided choledochoduodenostomy for failed endoscopic retrograde cholangiopancreatography. Tables list the Rosemont criteria for chronic pancreatitis and pancreatic cystic lesions.
 This review contains 12 highly rendered figures, 2 tables, and 62 references.
Key words: bile duct stone, biliary drainage, echoendoscope, endoscopic ultrasonography, fine-needle aspiration, pancreatic cyst
Ischemic Cardiac Event
Authors: Lanigan Megan , Culling Matthew , Gould Robert , Wall Michael , Thomas Joss
Published: January 2021

An estimated 92.1 million Americans have at least one type of cardiovascular disease (CAD).1  Even though death rates due to CAD have declined, at least 2200 Americans die each day of CAD. 2 In the U.S. at least 50 million operations occur every year and up to 4% are associated with adverse cardiac events. 3There are many identifiable risk factors for cardiac disease such as diabetes, hypertension, obesity, smoking, and high cholesterol. 1In addition, there are non-modifiable risks for cardiac disease; these include age, gender, family history, and homocysteine levels. 4 Hypotension and tachycardia are the most common causes of ischemic cardiac events in the intra-operative phase. The failure to detect myocardial injury early on may contribute to complications as long as 30 days post-operatively. Typically, ischemic findings on electrocardiography and elevated troponin measurements have been used as potential indicators of ischemia or myocardial injury after non-cardiac surgery in the peri-operative setting. In the treatment of ischemic cardiac events, intensified medical therapy (antiplatelet, beta-blocker, ACE inhibitor, or a statin) in patients who suffered from a troponin elevation in the postoperative period reduces the risk of having a major cardiac event within a year. 
This review contains 1 figure, 2 tables, and 74 references. 
Keywords: Myocardial Injury after Non Cardiac Surgery (MINS), Perioperative ischemia, Troponin assay, VISION study, Coronary artery disease
Disclosure of Error in the Intensive Care Unit
Authors: Hale Leslie , Kirksey Harper Katrina , Bovill Shapiro Anna
Published: January 2021

Each year, as many as 98,000 hospital deaths in the United States can be attributed to medical error. Considering that at least half of all medical errors go unreported, the impact they have on mortality, morbidity, prolonged hospital stay, rising hospital costs, and the doctor-patient relationship cannot be overemphasized. At the heart of the dilemma are patients and their family members, who rely on clinicians to provide optimal medical care, devoid of mistakes and error, and want an apology if an error has taken place. In this review, we discuss the moral obligation of hospitals to disclose medical error, no matter what the impact. Whereas in the past, a paternalistic approach to medicine viewed this acknowledgment as weakness, there is now a consensus to advocate for full disclosure, apology, and discussions that facilitate early disclosure of error using teams representing administration, patient care liaisons, and treatment providers. Many institutions now recognize that medical errors are commonly the result of a breakdown of checks and balances, and an increasing number are implementing protocols that target system errors to prevent similar future occurrences. We examine institutions across the United States that take a proactive approach by assembling “communication and resolution” programs to address the concerns of patients and their families through the process of disclosure. We also explore barriers to disclosure, which are attributed to lack of training, fear of litigation, and the “shame and blame culture.” We discuss the benefit, to both patient and provider, of disclosure of accountability as we move toward a culture of strengthening systems and improving patient care and patient-provider relationships.
Key words: apology, culture, disclosure, error, resolution
Fluid and Electrolyte Considerations for the Pediatric Surgical Patient
Authors: Klinkner Denise B , Polites Stephanie , Pandian TK
Published: January 2021

Fluid and electrolyte management is critical to successful care of neonatal and pediatric surgical patients. Although infants and toddlers in particular are clearly different from adults in their fluid requirements, recent literature supports a shift away from hypotonic intravenous fluids to isotonic fluids. The importance of glucose regulation and electrolyte management in the development of neonates has been established, and they are essential goals in the care of these patients. Specific surgical diseases included in this review are hypertrophic pyloric stenosis, gastrointestinal atresia and bowel obstructions, ileostomy management, and burns. 
Key words: electrolyte replacement; fluid and electrolytes; neonatal surgical critical care; oral rehydration; pediatric hypernatremia; pediatric hyponatremia; pediatric maintenance fluids; pediatric surgical critical care; pediatric total body water
Postoperative Management of Liver Transplant Patients
Authors: Brubaker Aleah L. , Chen Marianne , Gallo Amy
Published: January 2021

Management of the postoperative liver transplant patient can be extremely challenging. The combination of preoperative comorbidities and intraoperative complexity can make for a tenuous postoperative critical care course. Consideration and monitoring of graft function are paramount as poor graft function or primary graft nonfunction will affect every aspect of care. Our goal in this review is to use a systems-based approach to highlight the key tenets for postoperative management of liver transplant patients to help orchestrate integrated care across subspecialties. 
This review contains 2 figures, 2 tables, and 94 references.
Key words: critical care, liver transplant, systems-based management
Renal Support Therapy
Authors: Galvagno Jr Samuel M , Tannous Anthony E
Published: January 2021

Knowledge regarding the practical aspects of managing continuous renal replacement therapy (CRRT) in the surgical intensive care unit is a prerequisite for achieving desired physiologic end points. Familiarity with the initiation, dosing, adjustment, and termination of CRRT is a core skill for surgical intensivists. Modalities, terminology, and components of CRRT are discussed in this review, with an emphasis on the practical aspects of dosing, adjustments, and termination. Filter selection and management of electrolyte and acid-base derangements are emphasized.
Key words: continuous renal replacement therapy, continuous venovenous hemofiltration, continuous venovenous hemofiltration dialysis, dialysis, intensive care unit