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This Month in
November 1, 2004

This Month in Archives of Surgery

Author Affiliations

Gerald W.PeskinMD

Arch Surg. 2004;139(11):1145. doi:10.1001/archsurg.139.11.1145

Three articles this month deal with complications of operative techniques. The first of these is the routine cholecystectomy performed by laparoscopic means. As the authors state, about 40% of iatrogenic injury occurs in the operating room. To combat this problem and provide awareness of it, Tang et al applied the Observational Clinical Human Reliability Assessment to an analysis of 200 laparoscopic cholecystectomies performed by 26 surgeons and found that the error rate could be documented by this program, as wellas the stage of the operation where the errors were enacted most frequently (the hazard zone).

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Using 107 patients in each limb of the study, Kikuchi et al noted that the complication rate for patients with radiation-induced neoplasms was equivalent to that for patients without a history of radiation. The low long-term complication rate helps support prophylactic total thyroidectomy for patients with thyroid nodules and a history of radiation exposure.

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Everyone is cognizant of the problems related to the efficiency of institutions and its effect on error production. Friedman and Berger surveyed teamwork initiatives and their effect on specific variables related to patient care. The belief was that length of stay would be significantly decreased without compromising the quality of patient care.

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Comparison of a New Fibrin Sealant With Standard Topical Hemostatic Agents

This multicenter study suggests an advance that may prove useful to all general surgeons who tackle liver problems, including metastases and trauma. A new hemostatic agent will soon be available that proved superior to old methods of hemostasis for liver problems. It reduced the time required to achieve hemostasis and produced fewer complications related to its use.

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Multicenter, Prospective, Double-blind, Randomized Trial of Laparoscopic Nissen vs Anterior 90° Partial Fundoplication

This Australian study defies a previous American review of the type of fundoplication for gastroesophageal reflux disease. At 6-month follow-up, they found that a 90° partial anterior fundoplication was followed by fewer adverse effects than a full Nissen and achieves a higher rate of satisfaction with the overall results. However, this offset to some extent is neutralized by a greater likelihood of recurrent reflux symptoms.

Table 9. 
Outcome, Satisfaction, and Visick Grading*
Outcome, Satisfaction, and Visick Grading*

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Impact of Primary Resection on the Outcome of Patients With Perforated Diverticulitis

This study from Chandra et al, though colored by confusing nomenclature and various categories of patients, does illustrate the current trend toward resectional therapy for diverticulitis and left colon lesions in general, as opposed to drainage and colostomy. Primary resection has become the standard practice for patients with generalized peritonitis-complicating diverticulitis even with advanced age and other combined factors present. Perhaps, as this article suggests, we need to focus on medical management of the comorbid conditions and systemic manifestations of sepsis.

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