Gerald W.PeskinMDGerald W.PeskinMD
In an attempt to prevent residual esophagogastric junction high pressure, signifying incomplete myotomy, Chapman et al suggest operative manometry to identify the problem and correct it at the time of the initial surgery.
The 80-hour workweek has forced surgical residency programs to reexamine call schedules, monitor duty hours, and grapple with the financial burden of a reduced resident workforce. At the same time, programs are instituting efforts to ensure resident competence in accordance with the Accreditation Council on Graduate Medical Education outcomes project. Brasel et al surveyed their resident staff and found that residents spent a large amount of time in noneducational activities. Eliminating a significant percentage of this time would bring all our rotations into compliance without major restructuring.
At a tertiary care university medical center, a retrospective study was performed of 123 patients treated for carcinoma of the esophagus; 31 received neoadjuvant chemoradiation followed by surgery, 27 underwent surgery followed by adjuvant chemoradiation, and 65 underwent surgery alone. Malaisrie et al found that neoadjuvant chemoradiation effectively downstaged patients with locally advanced esophageal cancer with a trend at 3 years toward significance.
Several controversies have arisen regarding this month's articles. The first of these deals with the question of the quality of life after bile duct injury as part of a laparoscopic cholecystectomy. This type of injury is still occurring. The article by Moore et alArticlefrom Vanderbilt University differs from that of Sarmiento et alArticleof the Mayo Clinic. Sarmiento et al feel that when properly repaired, with a minimum of 5 years' follow-up, the quality of life compares favorably with both those undergoing uneventful cholecystectomy and national norms, but Moore et al found that after bile duct injury and repair, there are long-term detrimental effects, including lawsuits.
Second, the question of the appropriate examination for acute appendicitis raises its head. Mittal et al evaluated 91 patients with an uncertain diagnosis of acute appendicitis divided into a group of 52 undergoing a triple-contrast computed tomographic scan (oral, lower gastrointestinal tract, and intravenous) and 39 undergoing a new focused computed tomographic scan with rectal contrast only. The groups were otherwise similar. The results in terms of cost, negative appendectomy rate, tolerance level by patients, decreased time delay to diagnosis, and perforation rate all favored the focused rectal-contrast-only route.
Finally, should aldosteronomas be used as a beginning for performing laparoscopic adrenalectomy to avoid the potential pitfalls associated with adrenalectomy for pheochromocytomas? Kim et al argue that this is a reasonable approach.
This Month in Archives of Surgery. Arch Surg. 2004;139(5):465. doi:10.1001/archsurg.139.5.465