The entire surgical world seems to be revolving around morbid obesity. We have come to understand the meaning of ghrelin and its potential role in the surgery of morbid obesity. Now we have, through Dr Lin and his associates, the first article dealing with the effects of dividing the stomach on reducing ghrelin levels in humans. This may explain, in part, the loss of hunger sensation and rapid weight loss following gastric bypass surgery.
Major pelvic fracture with bleeding is a problem faced periodically by trauma surgeons. Kimbrell et al have analyzed their data to note that among trauma patients with significant pelvic fractures, those who are 60 years and older have a very high likelihood of active retroperitoneal bleeding and may well require arteriographic embolization regardless of presumed hemodynamic stability.
Schmidt et al present the problems associated with 516 consecutive patients undergoing a Whipple procedure. With a mean age of 58 years, it was found that 57% had periampullary cancers and 22% were operated on for chronic pancreatitis, 12% for cystic neoplasms, 4% for islet cell neoplasms, and 5%, other. Half of the patients had pylorus-sparing operations, and the operating time was 5 hours with 1.5 U of blood transfused. Postoperatively, complications occurred in 43% of patients including cardiopulmonary in 15% and leak or fistula formation in 9%. Perioperative mortality was 3.9% overall. Survival was high, and adjuvant therapy did not improve survival. They did demonstrate that long-term survival can be predicted by preoperative laboratory results, intraoperative factors, and pathologic characteristics. A worthwhile exercise.
Dr Hamoui and his associates have attempted to bring genetic factors into the discussion of the progression of change in the esophagus eventually leading to carcinoma. They noted a correlation of genetic changes and increased acid exposure in patients with reflux symptoms. The changes in gene expression occur before metaplastic changes in the tissue are apparent and may be helpful in predicting which patients will progress through a metaplasia-dysplasia-carcinoma sequence.
This article illustrates the correct way to carry out a truly double-blind, prospective, randomized study, which all surgeons should appreciate. The study yielded nothing of real consequence to the surgeon even though laparoscopic cholecystectomy with warmed, humidified carbon dioxide had several advantages that were statistically significant (eg, less pain at 14 days postoperatively).
From Barcelona, Spain, comes this exposition regarding a safe, simpler way to find a dissection plane around the facial nerve, especially in parotid surgery. The technique was developed after the dissection of 79 facial nerves, through a 3-cm skin incision, in the center of a triangle formed by the temporomandibular joint, the mastoid process, and the angle of the mandible. This allows for a fast and safe identification of the nerve. See also the Invited Critique by Dr Raymond L. Hilsinger, Jr, a parotid surgeon and teacher.
Metcalfe et al of Australia review the proper surveillance after an initial hepatic resection for colorectal metastases.
This Month in Archives of Surgery. Arch Surg. 2004;139(7):705. doi:10.1001/archsurg.139.7.705