Because of the cadaveric organ shortage, more centers have embarked on living donor adult liver transplant using right lobe grafts. This paper reviews the experience of the Lahey Clinic Group in the evaluation of prospective donors and the outcome including donor complications. It is noteworthy that of 66 evaluated, only 15 donors participated. Although donor mortality rate was 0%, morbidity was high. Residual liver regeneration of the donors was excellent. Careful evaluation, including helical computed tomography scanning, estimation of right lobe volume, laboratory tests of bodily functions including those for hepatitis and cytomegalo-virus, interviews with potential donors, ultrasonography, and splanchnic arteriography is carried out. Detailed information is provided regarding operation.
To establish that perioperative complications of laparoscopic antireflux procedures are rare, this group studied 538 patients, noting that only 4% suffered significant problems postoperatively, most commonly dysphagia. This was most apparent following redo operations. A plea is made for surgical treatment by an experienced team when reoperation is necessary.
The team at Massachusetts General Hospital, Boston, reviewed their extensive experience with pancreatic resection showing the changing demographics of their patients, the modification of diagnosis and technique, and the altered length of hospital stay throughout the decades.
For the history buff we offer a potpourri of impressions of the development of surgery in the New England states. Included are many vignettes regarding personalities, hospitals and operations relative to this region.
To answer the title question, Dr Birkmeyer and his group at the White River Junction VA Hospital have reviewed 19 months of general surgical procedures, and they have proposed that, in their small series, reoperation rates may be useful for monitoring quality and identifying opportunities for improvement of care locally. (Please read invited commentary.)
For those involved in the administration of surgical residency programs, this thoughtful article by Civetta et al illustrates a contemporary technique for complying with Residency Review Committee requirements in all areas and within a multihospital network, conserving scarce time and personnel and affording satisfaction for faculty and trainees.
This Month in Archives of SurgeryPapers of the New England Surgical Society. Arch Surg. 2001;136(4):375. doi:10.1001/archsurg.136.4.375