Surgery RSS : Gourt

Outdoor Paradise With Excellent Cost of Living * $275K or More Starting Salary! :: Kentucky :: The Curare Group, Inc.

JOB DETAILS $320,000 Annual Salary RVU Based Bonus Structure Possible Loan Forgiveness Signing Bonus Call, 1:5 Schedule Employed Surgery Opportunity With Established Single Specialty Practice

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JOB DETAILS Excellent Starting Salary Production Incentive Possible Loan Forgiveness Signing Bonus Call, 1:3 Schedule Employed Position With Established Practice Paid Relocation COMMUNITY

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JOB DETAILS Competitive Salary $500K Earnings Long Term Earning Negotiable Sign On Bonus Call, 1:4 Schedule Full Benefits Package Employed Or Solo Opportunity Bread & Butter Surgeries Partnership

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JOB DETAILS Competitive Starting Salary Production Incentive Loan Forgiveness Available Employed Opportunity With Established Single Specialty Practice Opportunity For Partnership Practice

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Earn Upwards of $325K With A $50K Sign On Bonus * Short Drive From Tulsa! :: Oklahoma :: The Curare Group, Inc.

JOB DETAILS Competitive Starting Salary Production Incentive Signing Bonus Call, 1:3 Schedule Great Benefits Single Specialty Practice Traditional Inpatient Work COMMUNITY INFO Short

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JOB DETAILS Competitive First Year Salary Production Incentive Call, Greater Than 1:7 Schedule Excellent Benefits Package Employed Or Solo Opportunity With Established Single Specialty Practice

General Surgery Job With Great $$ Potential with Easy Access to Memphis :: Tennessee :: The Curare Group, Inc.

JOB DETAILS Competitive First Year Salary Production Incentive Loan Forgiveness Signing Bonus Call, 1:5 Schedule Join Well Established & Respected Physician Owned Group COMMUNITY INFO

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JOB DETAILS Competitive Salary RVU Based Production Incentive Signing Bonus Employed Opportunity With Established Single Specialty Practice Bread & Butter Surgeries COMMUNITY INFO Surrounded

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JOB DETAILS Production Incentive Call, 1:3 Schedule Complete Benefits Package Facility With Level II Trauma Center Seeks General Surgeon For Employment Must Be BC In Surgery And Preference Towards

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JOB DETAILS Competitive Salary Production Incentive Negotiable Loan Forgiveness Possible Signing Bonus Employed Or I/C Opportunity With Single Specialty Grou Work With Only One Hospital Traditional

Northern :: Illinois :: Boone-Scaturro Associates, Inc

Join Growing and Amicable Group Exceptional Compensation in the 80 - 90% of the MGMA! Northern Illinois A well-established, expanding group practice of 5 General Surgeons is seeking a BC/BE General

North :: North Carolina :: Intelligent Placement Solutions, Inc

Looking for a relaxed lifestyle combined with excellent earnings potential? Call of at least one in four and we offer the option of employment, solo practice or joining a group. The hospital administration

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Join this 5 physician single specialty group of General Surgeons. This is an employed practice. Position is for a bread and butter General Surgeon. 1:6 call. This is a Surgical Group Specializing in

AAPM: Facet Graft Quells Refractory Back Pain (CME/CE)

SAN ANTONIO (MedPage Today) -- Minimally invasive facet arthrodesis significantly reduced pain and improved physical function for one year in patients with medically refractory facet arthropathy, according to data from a prospective clinical series.

Minimally Invasive Surgery Takes Toll on MDs, Poll Shows (CME/CE)

Four out of five surgeons agree: Laparoscopic procedures cause substantial discomfort and pain for the doctors who perform them.

Fractured Evidence: Spine Repair Debate Heats Up

Radiologists use vertebroplasty to treat the most painful vertebral compression fractures. But two randomized controlled trials found the procedure was no better than a sham in terms of disability and pain relief. The resulting furor raises questions about evidence-based medicine.

Surgical Database Collects Haiti Cases

An electronic data collection system, now available to track cases in Haiti, should provide valuable information for future disasters, according to the American College of Surgeons.

Physicians Must Treat Transplant Tourists

Patients who travel to foreign countries to have organ transplants may come back with more problems than they left with (MedPage Today) -- and physicians here have a moral responsibility to treat them, researchers say.

Immune Cells Point to Skin Cancer Risk after Transplants (CME/CE)

Monitoring two types of immune cells in kidney transplant recipients might identify patients with an increased risk of skin cancer, British investigators reported.

Preop CT May Reduce Unnecessary Appendectomy (CME/CE)

The use of computed tomography to diagnose appendicitis may reduce the likelihood of removing healthy organs in women under 45, but not among other groups, a retrospective study showed.

STS: Delay in Treating Blunt Aortic Trauma Works Best (CME/CE)

FORT LAUDERDALE (MedPage Today) -- Researchers here suggest that delaying treatment of selected blunt thoracic aortic injuries appears to improve overall survival of these critically ill patients.

STS: Aorta Repair Done at Warmer Temperatures (CME/CE)

FORT LAUDERDALE (MedPage Today) -- Doctors here suggest it is safe to perform aortic arch surgery using moderate hypothermia -- cooling the body to about 26 degrees C rather than 18 degrees C -- without jeopardizing cerebral protection.

STS: Leg Artery Access Linked to Dissection (CME/CE)

FORT LAUDERDALE (MedPage Today) -- Avoiding femoral artery cannulization during cardiac surgery might eliminate some of the rare but potentially catastrophic aortic dissections that occur during the procedure, researchers said here.

AAP Releases Tips on Preventing Soccer Injuries (CME/CE)

Coaches, parents, doctors and soccer officials can help prevent soccer-related injuries as the popularity of the sport grows, according to a report from the American Academy of Pediatrics.

No Need for Most Moms to Fast During Labor (CME/CE)

Although conventional wisdom has long held that women shouldn't eat or drink during labor, the scientific evidence suggests otherwise, researchers conducting a meta-analysis said.

Viral Cause of Appendicitis Called Unlikely (CME/CE)

The cause of appendicitis remains a mystery, according to a study that discounts flu and intestinal infection as candidates.

Adjuvant Therapy Improves Survival in Pancreatic Cancer (CME/CE)

Adjuvant chemoradiotherapy significantly improves survival of patients with resectable pancreatic cancer, according to medical records of almost 3,000 patients.

High Marks for Laparoscopic Liver Resection (CME/CE)

Laparoscopic liver resection compares favorably with laparotomy for removal of colorectal cancer metastases, data from a 10-year retrospective study suggest.

About This Journal [About This Journal]

Our 5 Years of Achievements [Editorial]

A Cautionary Note Regarding Safety of Thyroidectomy in the Elderly [From the Archives]

Error in Table in: Risk Factors for Recurrence After Repair of Enterocutaneous Fistula [Correction]

Association Between a High Number of Isolated Lymph Nodes in T1 to T4 N0M0 Colorectal Cancer and the Microsatellite Instability Phenotype [Original Article]

Hypothesis Stage I or II colorectal carcinomas with microsatellite instability (MSI) are characterized by more isolated lymph nodes in the resected specimen than their counterparts with microsatellite stability (MSS). Design Prospective study. Setting Academic research. Patients Using a pentaplex polymerase chain reaction assay, MSI status was determined prospectively for 135 operative patients. Main Outcome Measures Mismatch repair defects were investigated by immunohistochemistry on tumors demonstrating MSI. Results Among 82 stage I or II colorectal carcinomas, 11 had MSI, and 71 had MSS, with a mean (SD) number of 23.6 (3.1) and 13.7 (1.0) negative lymph nodes, respectively (P = .001). The mean number of lymph nodes for all resected stage I or II colorectal carcinomas analyzed at our hospital was 15. The prevalence of MSI among tumors with more than 15 lymph nodes in the specimen was 25% (9 of 36), and 82% (9 of 11) of MSI tumors belonged to this group. Conclusions A high number of isolated lymph nodes in stage I or II colorectal carcinomas was associated with the MSI phenotype. Good prognosis that is usually associated with tumors having a high number of uninvolved lymph nodes might reflect the high prevalence of MSI among these tumors. The number of examined lymph nodes as a quality criterion should be used with caution. For stage I or stage II colorectal carcinomas, restricting MSI phenotyping to tumors with more than the mean number of lymph nodes identifies almost all MSI tumors.

Advances in the Relationship Between Lymph Node Status and Prognosis: Comment on "Association Between a High Number of Isolated Lymph Nodes in T1 to T4 N0M0 Colorectal Cancer and the Microsatellite Instability" [Invited Critique]

Total Laparoscopic Pancreaticoduodenectomy: Feasibility and Outcome in an Early Experience [Original Article]

Hypothesis Total laparoscopic pancreaticoduodenectomy is a safe and effective therapeutic approach. Design Single-institutional retrospective review. Setting Tertiary referral center. Patients All consecutive patients undergoing total laparoscopic pancreaticoduodenectomy from July 2007 through July 2009 at a single center (n = 62). Main Outcome Measures Blood loss, operative time, postoperative morbidity, length of hospital stay, and 30-day or in-hospital mortality. Results Of 65 patients undergoing laparoscopic resection, 62 patients with a mean age of 66 years (SD, 12 years) underwent total laparoscopic pancreaticoduodenectomy. The pancreaticojejunostomy consisted of a duct-to-mucosa anastomosis with interrupted suture. Median operative time was 368 minutes (range, 258-608 minutes) and median blood loss was 240 mL (range, 30-1200 mL). Diagnosis was pancreatic adenocarcinoma (n = 31), intraductal papillary mucinous neoplasm (n = 12), periampullary adenocarcinoma (n = 8), neuroendocrine tumor (n = 4), chronic pancreatitis (n = 3), cholangiocarcinoma (n = 1), metastatic renal cell carcinoma (n = 1), cystadenoma (n = 1), and duodenal adenoma (n = 1). Median tumor size was 3 cm (range, 0.9-10.0 cm) and the median number of lymph nodes harvested was 15 (range, 6-31). Perioperative morbidity occurred in 26 patients and included pancreatic fistula (n = 11), delayed gastric emptying (n = 9), bleeding (n = 5), and deep vein thrombosis (n = 2). There was 1 postoperative mortality. Median length of hospital stay was 7 days (range, 4-69 days). Conclusions Laparoscopic pancreaticoduodenectomy is feasible, safe, and effective. Outcomes appear comparable with those via the open approach; however, controlled trials are needed. Despite this series representing experience within the learning curve, laparoscopic pancreaticoduodenectomy holds promise for providing advantages seen with minimally invasive approaches in other procedures.

Prospective Randomized Trial of LC+LCBDE vs ERCP/S+LC for Common Bile Duct Stone Disease [Original Article]

Objective To compare outcome parameters for good-risk patients with classic signs, symptoms, and laboratory and abdominal imaging features of cholecystolithiasis and choledocholithiasis randomized to either laparoscopic cholecystectomy plus laparoscopic common bile duct exploration (LC+LCBDE) or endoscopic retrograde cholangiopancreatography sphincterotomy plus laparoscopic cholecystectomy (ERCP/S+LC). Design Our study was a prospective trial conducted following written informed consent, with randomization by the serially numbered, opaque envelope technique. Setting Our institution is an academic teaching hospital and the central receiving and trauma center for the City and County of San Francisco, California. Patients We randomized 122 patients (American Society of Anesthesiologists grade 1 or 2) meeting entry criteria. Ten of these patients, excluded from outcome analysis, were protocol violators having signed out of the hospital against medical advice before 1 or both procedures were completed. Interventions Treatment was preoperative ERCP/S followed by LC, or LC+LCBDE. Main Outcome Measures The primary outcome measure was efficacy of stone clearance from the common bile duct. Secondary end points were length of hospital stay, cost of index hospitalization, professional fees, hospital charges, morbidity and mortality, and patient acceptance and quality of life scores. Results The baseline characteristics of the 2 randomized groups were similar. Efficacy of stone clearance was likewise equivalent for both groups. The time from first procedure to discharge was significantly shorter for LC+LCBDE (mean [SD], 55 [45] hours vs 98 [83] hours; P < .001). Hospital service and total charges for index hospitalization were likewise lower for LC+LCBDE, but the differences were not statistically significant. The professional fee charges for LC+LCBDE were significantly lower than those for ERCP/S+LC (median [SD], $4820 [1637] vs $6139 [1583]; P < .001). Patient acceptance and quality of life scores were equivalent for both groups. Conclusions Both ERCP/S+LC and LC+LCBDE were highly effective in detecting and removing common bile duct stones and were equivalent in overall cost and patient acceptance. However, the overall duration of hospitalization was shorter and physician fees lower for LC+LCBDE. Trial Registration clinicaltrials.gov Identifier: NCT00807729

Laparoscopic Liver Resection for Malignant and Benign Lesions: Ten-Year Norwegian Single-Center Experience [Original Article]

Background The introduction of laparoscopic liver resection has been challenging because new and safe surgical techniques have had to be developed, and skepticism remains about the use of laparoscopy for malignant neoplasms. We present herein a large-volume single-center experience with laparoscopic liver resection. Design Retrospective study. Setting Rikshospitalet University Hospital. Patients One hundred thirty-nine patients who underwent 177 laparoscopic liver resections in 149 procedures from August 18, 1998, through October 14, 2008. One hundred thirteen patients had malignant lesions, of whom 96 had colorectal metastases. Intervention Laparoscopic liver resection for malignant and benign lesions. Main Outcome Measures Perioperative and oncologic outcomes and survival. Results Five procedures (3.4%) were converted to laparotomy and 1 (0.7%) to laparoscopic radiofrequency ablation. The remaining 143 procedures were completed laparoscopically, during which 177 liver resections were undertaken, including 131 nonanatomic and 46 anatomic resections. The median operative time and blood loss were 164 (50-488) minutes and 350 (<50-4000) mL, respectively. There were 10 intraoperative (6.7%) and 18 postoperative (12.6%) complications. One patient (0.7%) died. The median postoperative stay and opioid requirement were 3 (1-42) and 1 (0-11) days, respectively. Tumor-free resection margins determined by histopathologic evaluation were achieved in 140 of 149 malignant specimens (94.0%). The 5-year actuarial survival for patients undergoing procedures for colorectal metastases was 46%. Conclusions In experienced hands, laparoscopic liver resection is a favorable alternative to open resection. Perioperative morbidity and mortality and long-term survival after laparoscopic resection of colorectal metastases appear to be comparable to those after open resections.

Small Incision, Big Surgeon: Laparoscopic Liver Resection for Tumors Without a Doubt: Comment on "Laparoscopic Liver Resection for Malignant and Benign Lesions: Ten-Year Norwegian Single-Center Experience" [Invited Critique]

Error in Author Affiliations in: Downwardly Mobile: the Accidental Cost of Being Uninsured [Correction]

Recurrence and Impact of Postoperative Prophylaxis in Laparoscopically Treated Primary Ileocolic Crohn Disease [Original Article]

Objectives To define risk factors for recurrence and to determine whether postoperative prophylaxis would influence time to recurrence after primary laparoscopic ileocolectomy for Crohn disease. Design Retrospective record review. Setting Tertiary academic medical center. Patients All patients who underwent primary laparoscopic ileocolectomy for terminal ileal Crohn disease between April 28, 1994, and August 3, 2006, at the Mayo Clinic, Rochester, Minnesota. Main Outcome Measures All patients were reviewed for follow-up, recurrence, risk factors for recurrence, and use of postoperative immunosuppressive prophylaxis. Results One hundred nine patients were identified, of whom 89 were followed up postoperatively at Mayo Clinic with a median follow-up of 3.5 years (range, 1.8 months to 11.9 years). Recurrence was discovered in 54 patients (61%) at a median of 13.1 months (range, 1.3 months to 8.7 years). Forty-four patients (49%) received postoperative immunosuppressive prophylaxis (37 [42%] received azathioprine, 8 [9%] received 6-mercaptopurine, and 3 [3%] received infliximab). In a multivariate model of various risk factors for recurrence, presence of granulomas was the only significant predictor of recurrence (P = .01). The 2-year cumulative recurrence rates in the prophylaxis and nonprophylaxis groups were 37.5% and 52.6%, respectively (log-rank test, P = .87). Conclusions Recurrence occurred in more than half of the patients with Crohn disease after primary laparoscopic ileocolectomy. In this highly selected patient population, use of immunosuppressive prophylaxis was not associated with a delay in recurrence. Presence of granulomas was the only significant predictor of recurrence. These findings should be further explored in larger and less selected patient populations.

Preventing Crohn Disease Recurrence With Drugs After Ileocolectomy: An Exercise in Futility?: Comment on "Recurrence and Impact of Postoperative Prophylaxis in Laparoscopically Treated Primary Ileocolic Crohn Disease" [Invited Critique]

Survival Effects of Adjuvant Chemoradiotherapy After Resection for Pancreatic Carcinoma [Original Article]

Background The survival benefit of adjuvant chemotherapy alone or chemoradiotherapy in patients with pancreatic cancer who have undergone surgical resection remains unclear. Objective To identify the additional benefit of adjuvant therapy by retrospectively examining a large population-based registry of patients who underwent definitive surgical resection for pancreatic adenocarcinoma. Design and Setting The Florida cancer registry and state inpatient and outpatient hospital data records were queried for pancreatic adenocarcinoma diagnosed between 1998 and 2002. Patients A total of 2877 patients who underwent surgical resection with curative intent for pancreatic adenocarcinoma were identified. Main Outcome Measure Overall survival time. Results Overall, 58.7% of patients were older than 65 years. Most patients were white (90.7%), were non-Hispanic (86.7%), and did not consume alcohol abusively (89.2%). Approximately half of the patients (51.9%) did not receive chemotherapy or chemoradiotherapy. Approximately 25.0% of the patients underwent chemoradiotherapy, and 10.0% received chemotherapy alone. Patients were more frequently treated at low-volume centers (57.6%) and nonteaching facilities (72.8%). Multivariate analysis correcting for patient comorbidities demonstrated that postoperative chemoradiotherapy (hazard ratio = 0.69, P = .04) and treatment at high-volume centers (hazard ratio = 0.85, P < .001) and teaching facilities (hazard ratio = 0.84, P < .001) were independent predictors of improved survival. Conclusions Adjuvant chemoradiotherapy was found to provide a significant additional survival benefit to surgical resection for patients with pancreatic adenocarcinoma. Furthermore, this benefit is independent of the additional survival advantage when patients are treated at teaching facilities or high-volume centers. Although selection bias may be contributing to the observed differences, these data nonetheless support the use of adjuvant chemoradiotherapy for pancreatic cancer.

Is the Debate Finally Over?: Comment on "Survival Effects of Adjuvant Chemoradiation Following Chemoradiotherapy After Resection for Pancreatic Carcinoma" [Invited Critique]

Decision Modeling to Estimate the Impact of Gastric Bypass Surgery on Life Expectancy for the Treatment of Morbid Obesity [Original Article]

Objective To create a decision analytic model to estimate the balance between treatment risks and benefits for patients with morbid obesity. Design Decision analytic Markov state transition model with multiple logistic regression models as inputs. Data from the 2005 National Inpatient Survey were used to calculate in-hospital mortality risk associated with bariatric surgery and then adjusted for 30-day mortality. To calculate excess mortality associated with obesity, we used the 1991-1996 National Health Interview Survey linked to the National Death Index. Bariatric surgery was assumed to influence mortality only through its impact on the excess mortality associated with obesity, and the efficacy of surgery was estimated from a recent large observational trial. Intervention Gastric bypass surgery. Main Outcome Measure Life expectancy. Results Our base case, a 42-year-old woman with a body mass index of 45, gained an additional 2.95 years of life expectancy with bariatric surgery. No surgical treatment was favored in our base case when the 30-day surgical mortality exceeded 9.5% (baseline 30-day mortality, 0.2%) or when the efficacy of bariatric surgery for reducing mortality decreased to 2% or less (baseline efficacy, 53%). Conclusions The optimal decision for individual patients varies based on the balance of risk between perioperative mortality, excess annual mortality risk associated with increasing body mass index, and the efficacy of surgery; however, for the average morbidly obese patient, gastric bypass improves life expectancy.

Association of Viral Infection and Appendicitis [Original Article]

Hypothesis What causes appendicitis is not known; however, studies have suggested a relationship between viral diseases and appendicitis. Building on evidence of cyclic patterns of appendicitis with apparent outbreaks consistent with an infectious etiology, we hypothesized that there is a relationship between population rates of appendicitis and several infectious diseases. Design Epidemiologic study. Setting The National Hospital Discharge Survey Patients Estimated US hospitalized population. Main Outcome Measures International Classification of Diseases, Ninth Revision, Clinical Modification discharge diagnosis codes of the National Hospital Discharge Survey were queried from 1970 to 2006 to identify admissions for appendicitis, influenza, rotavirus, and enteric infections. Cointegration analysis of time series data was used to determine if the disease incidence trends for these various disease entities varied over time together. Results Rates of influenza and nonperforating appendicitis declined progressively from the late 1970s to 1995 and rose thereafter, but influenza rates exhibited more distinct seasonal variation than appendicitis rates. Rotavirus infection showed no association with the incidence of nonperforating appendicitis. Perforating appendicitis showed a dissimilar trend to both nonperforating appendicitis and viral infection. Hospital admissions for enteric infections substantially increased over the years but were not related to appendicitis cases. Conclusions Neither influenza nor rotavirus are likely proximate causes of appendicitis given the lack of a seasonal relationship between these disease entities. However, because of significant cointegration between the annual incidence rates of influenza and nonperforated appendicitis, it is possible that these diseases share common etiologic determinates, pathogenetic mechanisms, or environmental factors that similarly affect their incidence.

Still Looking for Reasons in Appendicitis: Comment on "Association of Viral Infection and Appendicitis" [Invited Critique]

Improved Bariatric Surgery Outcomes for Medicare Beneficiaries After Implementation of the Medicare National Coverage Determination [Original Article]

Objective To compare the outcomes of Medicare beneficiaries who underwent bariatric surgery within 18 months before and after implementation of the national coverage determination (NCD) for bariatric surgery. Design Analysis of the University HealthSystem Consortium database from October 1, 2004, through September 31, 2007. Setting A total of 102 academic medical centers and approximately 150 of their affiliated hospitals, representing more than 90% of the nation's nonprofit academic medical centers. Patients Medicare and Medicaid patients who underwent bariatric surgery to treat morbid obesity. Main Outcome Measures Demographics, length of stay, 30-day readmission, morbidity, observed-to-expected mortality ratio, and costs. Results A total of 3196 bariatric procedures were performed before and 3068 after the NCD. After the implementation of the NCD, the volume of gastric banding doubled and the proportion of laparoscopic gastric bypass increased from 60.0% to 77.2%. Patients who underwent bariatric surgery after the NCD benefited from a shorter length of stay (3.5 vs 3.1 days, P < .001) and lower overall complication rates (12.2% vs 10.0%, P < .001), with no significant differences in the in-hospital mortality rates (0.28% vs 0.20%). Among Medicare patients, there was a 29.3% reduction in the number of bariatric procedures performed within the first 2 quarters after the NCD. However, the number of procedures returned to baseline volume within 1 year and exceeded baseline volume after 2 years of the NCD. Conclusion The bariatric surgery NCD resulted in improved outcomes for Medicare beneficiaries without limiting access to care for individuals with medical disability.

Impact of Surgical Specialization on Emergency Colorectal Surgery Outcomes [Original Article]

Objective To evaluate the impact of surgeon specialization on emergency colorectal resection in terms of mortality, morbidity, and type of operation performed. Design Observational study from January 1, 1993, through December 31, 2006. Setting Bellvitge University Hospital, Barcelona, Spain. Patients A total of 1046 patients underwent emergency colorectal resection. Patients were classified into 2 groups: those operated on by a colorectal surgeon (CS) and those operated on by a general surgeon (GS). Main Outcome Measures Preoperative variables studied were sex, age, American Society of Anesthesiologists grade, associated medical disease, presentation, reason for surgery, and type of operation. Univariate relations between predictors and outcomes were estimated, and multivariate logistic regression analysis was used to assess the prognostic effect of the combination of the variables. Results Patients in the CS group underwent a significantly higher percentage of resection and primary anastomosis. The postoperative morbidity rate was 52.2% in the CS group and 60.5% in the GS group (P = .01). The anastomotic dehiscence rate was lower in the CS group (6.2%) than in the GS group (12.1%) (P = .01). Postoperative mortality decreased among patients in the CS group (17.9%) with respect to the patients in the GS group (28.3%) (P < .001). Being operated on by a CS was predictive in both the univariate and multivariate analyses for postoperative complications and mortality, and it was the only variable with predictive value for anastomotic dehiscence. Conclusions Specialization in colorectal surgery has a significant influence on morbidity, mortality, and anastomotic dehiscence after emergency operations.

Conversion of Emergent Cricothyrotomy to Tracheotomy in Trauma Patients [Review Article]

Objectives To review the literature to determine the rates of airway stenosis after cricothyrotomy, particularly as they compare with previously documented rates of this complication after tracheotomy, and to examine the complications associated with conversion. Data Sources We conducted a review of the medical literature by the use of PubMed and OVID MEDLINE databases. Study Selection We identified all published series that describe the use of cricothyrotomy, with the inclusion of the subset of patients who require an emergency airway after trauma, from January 1, 1978, to January 1, 2008. Data Extraction Only 20 published series of cricothyrotomy were identified: 17 retrospective reports and 3 prospective, observational series. Data Synthesis Considerable variance in methods and follow-up periods were noted between examinations. Published experiences documented the results of 1134 total patients for whom cricothyrotomy was performed, including 368 trauma patients who underwent emergent cricothyrotomy. The rate of chronic subglottic stenosis among survivors after cricothyrotomy was 2.2% (11/511) overall and 1.1% (4/368) among trauma patients for follow-up periods with a range from 2 to 60 months. Only 1 (0.27%) of the 368 trauma patients in whom an emergent cricothyrotomy was performed required surgical treatment for chronic subglottic stenosis. Although the literature that documents complications of surgical airway conversion is scarce, rates of severe complications of up to 43% were reported. Conclusions Cricothyrotomy after trauma is safe for initial airway access among patients who require the establishment of an emergent airway. The prolonged use of a cricothyrotomy tube, however, remains controversial. Although no study to date has demonstrated any benefit of routine conversion to tracheostomy, considerable deficiencies in existing studies highlight the need for further investigations of this practice.

The UK Proposals for Revalidation of Physicians: Implications for the Recertification of Surgeons [Special Article]

The editorial titled "For the Protection of the Public and the Good of the Specialty: Maintenance of Certification" (published in the February 2009 issue of the Archives of Surgery) has prompted us to offer the following article to inform the debate about how assessing surgical care and sorting out the variables to be included in maintenance of certification may develop worldwide. The proposals for revalidation of UK physicians involve the relicensing of all physicians and recertification of all specialists on the specialist register of the General Medical Council. The process will be on a 5-year cycle and is currently under development by the General Medical Council. The Royal Colleges have been charged with creating the standards for recertification, and the responsibility will fall on the Royal Colleges to support their fellows and members as the new regulation is introduced and as it develops. This article outlines developments so far, with particular reference to surgeons.

The Pedicle Effect and Direct Coupling: Delayed Thermal Injuries to the Bile Duct After Laparoscopic Cholecystectomy [Resident's Forum]

Electrothermal energy, especially in the form of monopolar diathermy, is used widely for dissection during laparoscopic cholecystectomy. While this is largely safe, occasionally there can be unrecognized transfer of energy in the operating area, resulting in electrothermal injury. We report a series of 3 patients who underwent uneventful laparoscopic cholecystectomies but were readmitted 4 to 5 days later with pinhole leaks from the common bile duct as a result of coagulative necrosis caused by unrecognized energy transfer. We suggest that surgeons keep the use of monopolar diathermy to a minimum while dissecting near vital structures.

New Board Member Announcement [Announcement]

Image of the Month--Quiz Case [Special Feature]

Image of the Month--Diagnosis [Special Feature]

Image of the Month--Quiz Case [Special Feature]

Image of the Month--Diagnosis [Special Feature]

Defining an Enterocutaneous Fistula [Correspondence]

Defining an Enterocutaneous Fistula--Reply [Correspondence]

Careful Approach to the ABCs of the Management of Portal Venous Gas [Correspondence]

Careful Approach to the ABCs of the Management of Portal Venous Gas--Reply [Correspondence]

More About the "Heterogeneity" of Merkel Cell Carcinoma [Correspondence]

Designation Does Matter [Correspondence]

Bariatric Centers of Excellence Programs Do Improve Surgical Outcomes [Correspondence]

Centers of Excellence [Correspondence]

Centers of Excellence--Reply [Correspondence]

Surgery RSS : Gourt

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$500K Long Term Earnings ** Easy Access to Charleston West Virginia! :: West Virginia :: The Curare Group, Inc.

Metropolitan Ohio Teaching Opportunity * General Surgery Job In Ohio :: Ohio :: The Curare Group, Inc.

Surgery Job Earning $301K+ in St. Louis Region * Low Call :: Illinois :: The Curare Group, Inc.

Easy Access To Memphis * Tremendous Earning Potential :: Tennessee :: The Curare Group, Inc.

$400,000 potential ~ Easy Access to Chattanooga :: Alabama :: The Curare Group, Inc.

Northern :: Illinois :: Boone-Scaturro Associates, Inc

North :: North Carolina :: Intelligent Placement Solutions, Inc

East :: Georgia :: Intelligent Placement Solutions, Inc

AAPM: Facet Graft Quells Refractory Back Pain (CME/CE)

Minimally Invasive Surgery Takes Toll on MDs, Poll Shows (CME/CE)

Fractured Evidence: Spine Repair Debate Heats Up

Surgical Database Collects Haiti Cases

Physicians Must Treat Transplant Tourists

Immune Cells Point to Skin Cancer Risk after Transplants (CME/CE)

Preop CT May Reduce Unnecessary Appendectomy (CME/CE)

STS: Delay in Treating Blunt Aortic Trauma Works Best (CME/CE)

STS: Aorta Repair Done at Warmer Temperatures (CME/CE)

STS: Leg Artery Access Linked to Dissection (CME/CE)

AAP Releases Tips on Preventing Soccer Injuries (CME/CE)

No Need for Most Moms to Fast During Labor (CME/CE)

Viral Cause of Appendicitis Called Unlikely (CME/CE)

Adjuvant Therapy Improves Survival in Pancreatic Cancer (CME/CE)

High Marks for Laparoscopic Liver Resection (CME/CE)

About This Journal [About This Journal]

Our 5 Years of Achievements [Editorial]

A Cautionary Note Regarding Safety of Thyroidectomy in the Elderly [From the Archives]

Error in Table in: Risk Factors for Recurrence After Repair of Enterocutaneous Fistula [Correction]

Association Between a High Number of Isolated Lymph Nodes in T1 to T4 N0M0 Colorectal Cancer and the Microsatellite Instability Phenotype [Original Article]

Advances in the Relationship Between Lymph Node Status and Prognosis: Comment on "Association Between a High Number of Isolated Lymph Nodes in T1 to T4 N0M0 Colorectal Cancer and the Microsatellite Instability" [Invited Critique]

Total Laparoscopic Pancreaticoduodenectomy: Feasibility and Outcome in an Early Experience [Original Article]

Prospective Randomized Trial of LC+LCBDE vs ERCP/S+LC for Common Bile Duct Stone Disease [Original Article]

Laparoscopic Liver Resection for Malignant and Benign Lesions: Ten-Year Norwegian Single-Center Experience [Original Article]

Small Incision, Big Surgeon: Laparoscopic Liver Resection for Tumors Without a Doubt: Comment on "Laparoscopic Liver Resection for Malignant and Benign Lesions: Ten-Year Norwegian Single-Center Experience" [Invited Critique]

Error in Author Affiliations in: Downwardly Mobile: the Accidental Cost of Being Uninsured [Correction]

Recurrence and Impact of Postoperative Prophylaxis in Laparoscopically Treated Primary Ileocolic Crohn Disease [Original Article]

Preventing Crohn Disease Recurrence With Drugs After Ileocolectomy: An Exercise in Futility?: Comment on "Recurrence and Impact of Postoperative Prophylaxis in Laparoscopically Treated Primary Ileocolic Crohn Disease" [Invited Critique]

Survival Effects of Adjuvant Chemoradiotherapy After Resection for Pancreatic Carcinoma [Original Article]

Is the Debate Finally Over?: Comment on "Survival Effects of Adjuvant Chemoradiation Following Chemoradiotherapy After Resection for Pancreatic Carcinoma" [Invited Critique]

Decision Modeling to Estimate the Impact of Gastric Bypass Surgery on Life Expectancy for the Treatment of Morbid Obesity [Original Article]

Association of Viral Infection and Appendicitis [Original Article]

Still Looking for Reasons in Appendicitis: Comment on "Association of Viral Infection and Appendicitis" [Invited Critique]

Improved Bariatric Surgery Outcomes for Medicare Beneficiaries After Implementation of the Medicare National Coverage Determination [Original Article]

Impact of Surgical Specialization on Emergency Colorectal Surgery Outcomes [Original Article]

Conversion of Emergent Cricothyrotomy to Tracheotomy in Trauma Patients [Review Article]

The UK Proposals for Revalidation of Physicians: Implications for the Recertification of Surgeons [Special Article]

The Pedicle Effect and Direct Coupling: Delayed Thermal Injuries to the Bile Duct After Laparoscopic Cholecystectomy [Resident's Forum]

New Board Member Announcement [Announcement]

Image of the Month--Quiz Case [Special Feature]

Image of the Month--Diagnosis [Special Feature]

Image of the Month--Quiz Case [Special Feature]

Image of the Month--Diagnosis [Special Feature]

Defining an Enterocutaneous Fistula [Correspondence]

Defining an Enterocutaneous Fistula--Reply [Correspondence]

Careful Approach to the ABCs of the Management of Portal Venous Gas [Correspondence]

Careful Approach to the ABCs of the Management of Portal Venous Gas--Reply [Correspondence]

More About the "Heterogeneity" of Merkel Cell Carcinoma [Correspondence]

Designation Does Matter [Correspondence]

Bariatric Centers of Excellence Programs Do Improve Surgical Outcomes [Correspondence]

Centers of Excellence [Correspondence]

Centers of Excellence--Reply [Correspondence]

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