This Month in Archives of Surgery

We all know and understand that functional limitations such as the type and severity of injury, age, preinjury function, income, and social support can contribute to disability after trauma. Recent investigations suggest that other factors may play an equally important role in determining the progression of postinjury impairment. The study by Dr Zatzick et al reveals that posttraumatic stress disorder persists in 30% of patients 1 year after traumatic injury and is independently associated with a broad profile of functional impairment. Thus, a treatment plan for these patients seems warranted.

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One of the many problems that evades resolution is that of combining elective abdominal aortic reconstruction with simultaneous gastrointestinal intervention, even in a prepared bowel. The article by Dr Luebke et al attempts answer in their series of 84 patients, half of whom underwent aortic grafting and a simultaneous operation for gastrointestinal abnormalities. Comparing the matched pairs revealed no significant difference as to morbidity, mortality, or length of intensive care unit and hospital stays. They conclude that a 1-stage procedure is feasible, presuming appropriate attention to details and antisepsis. In an invited critique, Dr Quiñones-Baldrich presents a balancing opinion of the work and Dr Bredenberg some other thoughts.

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An interesting observation by Dr Siperstein et al furthers the argument that the harmonic scalpel is a valuable adjunct in thyroid operations to control vessel bleeding, shortening operative time without compromising the intervention.

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The procedure of distal pancreatectomy has traditionally included splenectomy. Few reports in the literature comparing distal pancreatectomy with or without splenectomy have analyzed the results following operation for benign or low-grade malignant disease of the pancreas. This article by the Memorial Sloan-Kettering Cancer Center group reviews 125 patients: 79 with splenectomy and 46 with splenic preservation. Their conclusions were that leaving the spleen under these circumstances was safe and was associated with a reduction in perioperative infectious complications and length of stay. Accordingly, it was their thought that splenic preservation should be considered in this group of patients.

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Many patients with pancreatic cancer are exposed to laparoscopy for either diagnosis or staging at some point during their illness. Using a linked cancer registry and administrative claims database, Dr Urbach et al compared patients who had either a laparoscopic evaluation or a laparotomy but no pancreatic resection and demonstrated that exposure to laparoscopy did not adversely affect survival in this elderly population. Obviously, this is an indirect study, but it does provide some important evidence.

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In 94 of 98 patients with primary exploration for solitary parathyroid adenoma, the Lund group found that parathyroid hormone levels decreased at least 60% 15 minutes after gland excision, which was predictive of later postoperative normocalcemia.

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