ADVANCES INSurgery

CONTENTS VOLUME 46 � 2012

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Associate Editors

Contributors

Who Should Have or Not Have an Axillary NodeDissection with Breast Cancer?Richelle T. Williams, David P. Winchester, Katharine Yao,and David J. Winchester

The evolution of axillary surgery for breast cancer 1Surgical approaches for the clinically positive axilla 3Surgical approaches for the clinically negative axilla 4Sentinel lymph node biopsy 4

Safety and outcomes 5Indications, contraindications, and limitations 5

The positive sentinel node 8ALND versus SLNB only: the evidence 11

Recurrence 11Survival 12Staging 12Implications and limitations 12

Summary 14References 15

Intestinal Stomas: Indications, Management,and ComplicationsSean T. Martin and Jon D. Vogel

Introduction 19Indications for ileostomy creation 20Ileostomy physiology 21Enterostomal therapy 22End ileostomy 22Loop ileostomy 25Laparoscopic ileostomy 26Single-port ileostomy 27Ileostomy complications and their management 27Peristomal skin problems 28Ileostomy ischemia 32

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High-output ileostomy 32Stoma retraction 33Stoma prolapse/herniae 33Small bowel obstruction 34Loop jejunostomy 35QoL after ileostomy surgery 35Colostomy: indications, construction, and management 36Colostomy physiology 37Creation of an end colostomy 37Creation of a loop colostomy 39Laparoscopic loop colostomy 42Turnbull blowhole colostomy 42Complications of colostomy 43Summary 45

References 46

Zero Surgical Site Infections: Is It Possible?C. Daniel Smith

Background 51SSI Defined 52SSI Classification 52

Prevention strategies 52Surgical care improvement project 53An SSI reduction process and bundle 54SSI reduction lessons 56

References 59

Does Simulation Training Improve Outcomes inLaparoscopic Procedures?Benjamin Zendejas, Roberto Hernandez-Irizarry, andDavid R. Farley

Appraisal of evidence 63Evidence of transferability 63

Simulation versus no intervention 63Simulation versus simulation studies 69

Summary of current evidence and implications 69Acknowledgments 70References 70

Hypertonic Resuscitation After Severe Injury: Is itof Benefit?Eileen M. Bulger and David B. Hoyt

Introduction 73Mechanism of action 74

Physiologic mechanism 74Microcirculatory effects 74Immunologic effects 75Impact on physiology after traumatic brain injury 76

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Clinical trial results 77Summary 81

References 82

What is the Prognosis After Retransplantationof the Liver?Ali Zarrinpar and Johnny C. Hong

Introduction 87Incidence/epidemiology 89Indications for retransplantation 89Surgical/technical difficulties 92Timing of retransplantation 93Causes of death 93Prognosis/models 94Summary 97

References 98

Screening for Abdominal Aortic AneurysmsJoseph L. Bobadilla and K. Craig Kent

Overview 101Screening principles 102Screening techniques 102Screening trials 104Current screening recommendations in the United States 105New directions in screening 105Summary 107

References 108

Novel Management Strategies in the Treatment ofSevere Clostridium difficile InfectionIbrahim Nassour, Evie H. Carchman, Richard L. Simmons,and Brian S. Zuckerbraun

Pathophysiology 112The epidemiology of CDI 113Risk factors for the development of CDI 114Clinical manifestations 114Severity and prognostic scoring criteria 116Established management strategies 117

Established antibiotic management 118Antibiotic management for severe, complicated disease 119The role of surgery for severe, complicated CDI 119Recurrent CDI 121

Advances in medical management 122Advances in diagnosis 123Immunization strategies against Clostridium difficile 124Novel antibiotics for CDI 125Biotherapeutic strategies 126

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Advances in surgical management 127Summary 130

References 130

The Genetic Counselor: An Important Surgical Allyin the Optimal Care of the Cancer PatientErin Salo-Mullen and Jose Guillem

Definition of genetic counseling and genetic counselors 138Elements of genetic counseling 139

Pretest genetic counseling 139Post-test genetic counseling 139

Presurgical genetic counseling 139Step 1: Identify who warrants genetic counseling 140Step 2: Making the referral 142Step 3: The genetic counseling consultation, testing process,and result Implications 142

Postsurgical genetic counseling 147Other considerations 149Summary 150

Acknowledgments 150References 151

Readmission Rates after Abdominal Surgery: CanThey Be Decreased to a Minimum?Thomas J. Lee and Robert C.G. Martin II

Introduction 155Methods 156Hernia 157Esophagus and stomach 158Bariatric 160Cholecystectomy 162Pancreas 163Colon 164Abdominal aortic aneurysm 166Discussion 167

References 169

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Superiority of Minimally Invasive ParathyroidectomJohn W. Kunstman and Robert Udelsman
Introduction 171Historical perspective and rationale for focused parathyroidectomy 172Defining MIP 174Indications for MIP 175Preoperative imaging 175

Scintigraphy 175Ultrasound 176Axial imaging 177

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Invasive localization 177Surgical procedure 177Outcomes following MIP 179

Cure rate 179Complications 180Durability of cure 181Economic considerations 182Patient satisfaction 183Additional considerations 184


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Current Treatment of Papillary Thyroid MicrocarcinoXiao-Min Yu, Ricardo Lloyd, and Herbert Chen
Diagnosis 192Prognosis and prognostic factors 195

Age and gender 195Size 196Extrathyroidal invasion 196Multifocality 196Lymph node metastasis 197Distant metastasis 197Molecular biomarkers 197

Treatment 197Surgery 198RAI ablation 200Postoperative monitoring 200


Use of Computed Tomography in the EmergencyRoom to Evaluate Blunt Cerebrovascular InjuryNancy A. Parks and Martin A. Croce

Screening criteria for BCVI 208Diagnostic modalities to screen for BCVI 210Summary 215

References 216

How Important is Glycemic Control DuringCoronary Artery Bypass?Harold L. Lazar

Impact of diabetes mellitus on outcomes in patients undergoingCABG surgery 220

Detrimental effects of hyperglycemia on the cardiovascularsystem and its reversal with insulin 220

Detrimental effects of hyperglycemia in the perioperative period 222

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Glycemic control improves outcomes in patients undergoing CABGsurgery 223

Insulin as a component of glucose-insulin-potassium solutions 224Favorable effects of insulin infusions in patients undergoing CABG 225Is tight glycemic control necessary in nondiabetic patientsundergoing CABG? 228

Current guidelines for glycemic control during cardiacsurgery 229

What is the optimal goal for perioperative glycemiccontrol: is too aggressive detrimental? 230


Capillary Leak Syndrome in Trauma: What is it andWhat are the Consequences?Deborah M. Stein and Thomas M. Scalea

Introduction 237Epidemiology 238Diagnosis 238Pathophysiology and etiology of TICS 239

Inflammation 240Fluid administration 240Catabolism 241Direct tissue injury 242Postcapillary hypertension 242

Organ-specific effects of TICS 242Abdominal compartment syndrome 242Lung injury 243Neurologic injury 244

Treatment 244Prevention 245

Hemostatic resuscitation 245Goal-directed resuscitation 246


Morbidity and Effectiveness of Laparoscopic SleeveGastrectomy, Adjustable Gastric Band, and GastricBypass for Morbid ObesityTimothy D. Jackson and Matthew M. Hutter

Obesity as a surgical disease 255Contemporary surgical options 256

LSG 256LAGB 256LRYGB 257

Quality improvement in bariatric surgery 257Mortality 259Morbidity 260

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Comparative effectiveness 263Reduction in weight 263Reduction in weight-related comorbidities 264

Toward optimizing outcomes 265Summary 265

References 265

Are Cancer Trials Valid and Useful for the GeneralSurgeon and Surgical Oncologist?Waddah B. Al-Refaie and Selwyn M. Vickers

Cancer clinical trials and their importance to all stakeholders 269Why are clinical trials unique to persons with cancer? 270Wide-scale dissemination and adoption: expectations versuschallenges 271

Participation in cancer clinical trials 273Cancer trials versus the real-world in the United States 274Efforts to enhance applicability of cancer trials toreal-world settings 275Comparative effectiveness research 275Research on the implementation gap between efficacyversus effectiveness of cancer trials 275

The underappreciated impact of hospital attributes oncancer clinical trials 277

Considerations for valid and useful cancer trials to thegeneral surgeon and surgical oncologist in the real-world 278


The Current Management of PancreaticNeuroendocrine TumorsTrevor A. Ellison and Barish H. Edil

Introduction 283Classification 283Presentation and diagnosis 284

Syndromic PanNETs 284Functional PanNETs 285Nonfunctional PanNETs 288

Imaging 288Special considerations 289

Treatment 290Special considerations 291Special considerations 292Special considerations 292

Surveillance and prognosis 294Latest updates 294Summary 295

References 296

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Index
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