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

Upto $25K Sign On Bonus & Production $$ Near Large Metros & The Atlantic Coast! :: Virginia :: The Curare Group, Inc.

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

Low Crime Rate * Outdoor Enthusiasts Dream Location * Upwards of $260K Salary! :: West Virginia :: The Curare Group, Inc.

JOB DETAILS $320,000 Annual Salary Loan Forgiveness Signing Bonus Call, 1:6 Schedule Full Benefits Bread & Butter Procedures Traditional Inpatient Work Single Specialty Practice COMMUNITY

General Surgeon Position With Upwards of $500K Earnings In Micropolitan City! :: New York :: The Curare Group, Inc.

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

Malpractice Coverage & Outstanding Educational Options In Beautiful Community :: Wisconsin :: The Curare Group, Inc.

JOB DETAILS Two Year Competitive Salary Guarantee Production Incentive Great Benefits Including Malpractice, Health, Relocation, Vacation, CME, And Retirement General Surgeon Sought For Employee/Income

Production & Excellent Earnings ** Low Cost Of Living Community Near Metros! :: Pennsylvania :: The Curare Group, Inc.

JOB DETAILS Highly Competitive Salary Production Incentive Call, 1:3 Schedule Benefits Package Which Would Include Health, Malpractice, CME Stipend, Relocation, Paid Vacation Work From One Hospital

General Surgeon Job With Excellent Earnings With Access Into St. Louis, MO! :: Illinois :: The Curare Group, Inc.

JOB DETAILS Competitive Income Guarantee Production Incentive Loan Forgiveness Call, 1:4 Schedule Great Benefits Can Join Group Of 3, Go Solo, Or Be A Hospital Employee COMMUNITY INFO

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

Surgery Job Minutes From Birmingham * Low Cost of Living * Excellent $$ :: Alabama :: The Curare Group, Inc.

JOB DETAILS Competitive Starting Salary Production Incentive Signing Bonus Employed Or Solo Opportunity No C-Sections Or Trauma Teaching Opportunities Paid Relocation COMMUNITY INFO

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

$400,000+ earnings, Partnership, Easy access to metro, Booming economy! :: North Carolina :: The Curare Group, Inc.

JOB DETAILS Earn Upwards Of $400k With Production Incentives Partnership Opportunity Full Benefits Join Established Group Of 3 Need General Surgeon To Perform Some Vascular Surgery Incredible

Quick Partnership With Excellent Starting Salary * Low Cost Of Living! :: Connecticut :: The Curare Group, Inc.

JOB DETAILS Competitive Starting Salary Production Incentive Negotiable Signing Bonus Call, 1:3 Schedule Very Quick Partnership Employed Or Solo Opportunity Great Patient Census 20 Patients

Beautiful Mountain Community * $275K Starting Salary With Incentives! :: Kentucky :: The Curare Group, Inc.

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

Surgery Job With Starting Salary of $300K + Incentive $$ Near Tulsa! :: Oklahoma :: The Curare Group, Inc.

JOB DETAILS $300,000 Annual Salary Production Incentive Signing Bonus Call, 1:4 Schedule Great Benefits Employed Or Solo Position Excellent Patient Census Hospital Has New State-Of-The-Art

Surgery Job Near Ontario ** $280K Salary + Incentives * Stipend :: Minnesota :: The Curare Group, Inc.

JOB DETAILS $280,000 Annual Salary Production Incentive Full Benefits To Include Negotiable Sign On Bonus Work With Only One Hospital Possible Stipend For Residents Or Fellows COMMUNITY INFO

Surgery Job With Earnings Upwards of $350K & Loan Forgiveness :: Maine :: The Curare Group, Inc.

JOB DETAILS Competitive Starting Salary Production Incentive Loan Forgiveness Available Signing Bonus Excellent Benefits Package Paid Relocation Bread & Butter Surgeries With Little Trauma

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

JOB DETAILS Competitive Starting Salary At MGMA Medium Or More Production Incentive Negotiable Loan Forgiveness Signing Bonus Must Be Trained In LAP, Vascular, C Sections, & Trauma Work Out

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

JOB DETAILS Competitive Income Guarantee Production Incentive Full Benefits Package With Practice Set-Up Assistance From Hospital Great Benefits Seeking BC/BE General Surgeon To Establish A

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

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

Cleveland :: Ohio :: The Curare Group, Inc.

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

AASLD: Liver Reserve Measured in Breath Test (CME/CE)

BOSTON (MedPage Today) -- A simple breath test gives a good overall measure of liver function in patients with chronic viral hepatitis and could help in evaluating potential liver transplant candidates, a researcher said here.

AASLD: Treating Before Transplant Cuts HCV Recurrence (CME/CE)

BOSTON (MedPage Today) -- In patients with advanced liver disease related to hepatitis C, a course of pegylated interferon and ribavirin (Rebetol) before liver transplant may help them avoid recurrence of infection, a researcher said here.

Resident Duty-Hour Cuts Said to Impair Surgical Education, Safety (CME/CE)

Limiting surgical residents' work hours has compromised both surgical education and patient safety, according to an analysis concluding that the 80-hour work week in the U.S. isn't enough.

Traditional CABG Edges Off-Pump Approach (CME/CE, with audio)

Use of a heart-lung machine during coronary-artery bypass grafting (CABG) doesn't impair outcomes or cognition any more than "off-pump" procedures, according to results of a large randomized trial.

Hospital Fined for Wrong-Site Surgery

Rhode Island Hospital, located in Providence, will pay $150,000 and install video cameras in all of its operating rooms after performing its fifth wrong-site surgery since 2007, according to the state's department of health.

AASLD: Liver Transplants Okay in Superobese Patients (CME/CE)

BOSTON (MedPage Today) -- Liver transplants can work as well in extremely fat patients as in anyone else, although the surgery and post-transplant management is more complex, researchers said here.

ASN: No CVD Benefit for Folic Acid in Kidney Transplant (CME/CE)

SAN DIEGO (MedPage Today) -- Lowering homocysteine levels with folic acid supplementation yielded no cardiovascular benefit for stable renal transplant recipients, a randomized trial showed.

ACC/AHA Say Don't Start Beta-Blockers on Day of Surgery (CME/CE)

High-risk patients who are not taking beta-blockers should have beta-blocker therapy started well before scheduled cardiovascular surgery, with doses titrated up as the surgery date approaches, according to updated guidelines released today by the American College of Cardiology and American Heart Association.

AASLD: Survival Lower in HCV-Infected Women after Liver Transplant (CME/CE)

BOSTON (MedPage Today) -- Women undergoing liver transplant as a result of hepatitis C virus (HCV) infection show poorer long-term survival rates and more frequent failure of the donor liver, compared with male recipients.

Stryker Charged with Marketing Fraud

Stryker Corp.'s biotech division and four current and former executives have been indicted on federal fraud charges related to their marketing of two bone-growth products.

AAO: Mixed Results for Pediatric Eye Surgery (CME/CE)

SAN FRANCISCO (MedPage Today) -- Refractive surgery provides good long-term outcomes for kids when lasers are used to correct anisometropia, but problems arise over time after lens implantation, two studies revealed.

H1N1 Flu Challenges Heart and Lung Transplants (CME/CE)

The pandemic H1N1 flu poses special problems for people getting heart and lung transplants, according to an advisory from the International Society for Heart and Lung Transplantation.

ACR: Joint Surgery Declines Hint at Better RA Drugs (CME/CE)

PHILADELPHIA (MedPage Today) -- Declining rates of major joint surgery appear to be the result of improving medical treatment for rheumatoid arthritis, researchers suggested here.

Heart Disease Raises Hip Fracture Risk (CME/CE)

A diagnosis of cardiovascular disease (CVD) significantly increased the risk of subsequent hip fracture in both women and men, a Swedish twin study found.

Exercise Eases Patellofemoral Pain (CME/CE)

Exercise supervised by a physical therapist was more effective for pain and function than rest and avoidance of stress on the knee in patients with patellofemoral pain syndrome, a randomized Dutch study found.

About This Journal [About This Journal]

Use of a Saline Bag as a Shoulder Roll During Surgery Not Recommended [Commentary]

Quantifying Access to Surgical Care [From JAMA]

Use of Seamguard to Prevent Pancreatic Leak Following Distal Pancreatectomy [Original Article]

Objective To investigate the use of Seamguard, a bioabsorbable staple line–reinforcement product, to prevent pancreatic leak after distal pancreatectomy. Design, Setting, and Participants A retrospective study examined 85 consecutive patients undergoing distal pancreatectomy at an academic institution from September 5, 1997, to September 30, 2007. Main Outcome Measures Pancreatic fistula and overall mortality and morbidity. Results In February 2004, the use of Seamguard in distal pancreas resections was introduced at our institution. Indications for resection included trauma (11 patients), neoplasms (62 patients), and chronic pancreatitis (12 patients). Pancreatic leak was defined as drain output of 25 mL/d or more 7 days postoperatively with a drain amylase level of 1000 U/L or more. Pancreatic leak occurred in 10 of 38 patients (26%) undergoing conventional resection with suture ligation of the pancreatic duct or nonreinforced stapled resection vs 2 of 47 patients (4%) undergoing staple resection using Seamguard reinforcement. Multivariate analysis showed that use of Seamguard with the stapler independently decreased the risk for pancreatic fistula after distal pancreatectomy (odds ratio, 0.07; 95% confidence interval, 0.01-0.43; P = .01). Conclusions The use of Seamguard is quickly becoming a common adjunct in distal pancreas resections. Our study shows a lower incidence of pancreatic leak after distal pancreatectomy with the use of this staple line–reinforcing product.

To Mesh or Not to Mesh, That Is the Question: Comment on "Use of Seamguard to Prevent Pancreatic Leak Following Distal Pancreatectomy" [Invited Critique]

Ischemic Colitis After Endovascular Aortoiliac Aneurysm Repair: A 10-Year Retrospective Study [Original Article]

Objective To examine the incidence, cause, and outcomes of ischemic colitis after endovascular stent graft repair of aortoiliac aneurysms (EVAR). Design Medical record review. Setting University teaching hospital. Patients Eight hundred nine patients treated during 10 years were included in the study. Preoperative data regarding the size of the aneurysm, hypogastric coil embolization, and inferior mesenteric artery patency were evaluated by means of computed tomographic scans and aortograms. Ischemic colitis was diagnosed by lower endoscopy or pathology reports. Main Outcome Measures Ischemic colitis after EVAR. Results Eleven patients (1.4%) developed ischemic colitis. Seven patients' episode occurred less than 30 days from repair (early), whereas 4 occurred 30 days or more from repair (late). Ten of 11 patients had preoperative inferior mesenteric artery occlusion. Microembolization was seen histologically in 2 patients in the early group, both of whom died. A significant increase in ischemic colitis was seen in patients undergoing preoperative unilateral hypogastric coil embolization (P = .02). Three of the patients with late ischemic colitis had comorbidities other than the EVAR to explain the ischemia. Conclusions The incidence of ischemic colitis is decreased in patients undergoing EVAR vs open repair. The cause of the ischemia is multifactorial and seems to differ between patients in the early and late groups. Microembolization tends to produce severe ischemic colitis and is usually fatal. There should be a low threshold for performing endoscopy in any patient thought to have ischemic colitis after EVAR.

"Hardening of the Arteries" Is a Systemic Disease: Comment on "Ischemic Colitis After Endovascular Aortoiliac Aneurysm Repair" [Invited Critique]

Role of Hepatitis B Virus Infection in the Prognosis After Hepatectomy for Hepatocellular Carcinoma in Patients With Cirrhosis: A Western Dual-Center Experience [Original Article]

Hypothesis The role of hepatitis B virus (HBV) infection in determining the prognosis after hepatectomy for hepatocellular carcinoma (HCC) in patients with cirrhosis is controversial. Design Retrospective study based on multicenter prospectively updated databases. Setting Two tertiary referral centers specializing in hepatobiliary surgery. Patients Two hundred four consecutive patients with cirrhosis undergoing hepatectomy for single nodules of HCC of 5 cm or smaller from January 1, 1997, through September 30, 2006. Interventions Patients were divided into the following groups according to their preoperative viral status: HBV positive and hepatitis C virus (HCV) negative (group 1); HBV negative and HCV positive (group 2); HBV negative and HCV negative (group 3); and HBV positive and HCV positive (group 4). Main Outcome Measures A multivariate analysis was performed to determine factors associated with recurrence-free survival (RFS) among demographic, clinical, pathological, and surgical variables. Results The 2 centers had comparable RFS and early and late recurrence rates. Five-year RFS was significantly higher in groups 2 and 3 compared with group 1 (38%, 34%, and 9%, respectively; P = .007 and P = .05). Factors independently associated with RFS were HBV infection (P = .009; odds ratio, 1.79; 95% confidence interval, 1.15-2.78) and poor tumor differentiation (P < .001; odds ratio, 2.01; 95% confidence interval, 1.36-2.96). The concomitance of 0, 1, or 2 risk factors led to 5-year RFS rates of 49%, 20%, and 8%, respectively (P < .001). Conclusions Infection with HBV is a strong predictive factor for lower RFS after hepatectomy for a single nodule of HCC of 5 cm or smaller in patients with cirrhosis, providing a further basis for adjuvant antiviral treatment. Patients who are seropositive for HBV with poorly differentiated HCC should also be considered to be at a high risk of recurrence and possibly included in a policy of salvage liver transplantation.

HBV and HCC: Comment on "Role of Hepatitis B Virus Infection in the Prognosis After Hepatectomy for Hepatocellular Carcinomain Patients With Cirrhosis:A Western Dual-Center Experience" [Invited Critique]

Predictors of Long-term Mortality After Bariatric Surgery Performed in Veterans Affairs Medical Centers [Original Article]

Hypothesis The purpose of this study was to examine patient factors associated with mortality among veterans who undergo bariatric surgery. Design Prospective study that uses data from the Veterans Affairs (VA) National Surgical Quality Improvement Program. Setting Group Health Center for Health Studies, the VA North Texas Health Care System, the Denver VA Medical Center, and the Durham VA Medical Center. Patients We identified 856 veterans who had undergone bariatric surgery in 1 of 12 VA bariatric centers from January 1, 2000, through December 31, 2006. Main Outcome Measures The risk of death was estimated via Cox proportional hazards. Results The 856 veterans had a mean body mass index (BMI) of 48.7, a mean age of 54 years, and a mean DCG score of 0.76; 73.0% were men, 83.9% were white, and 7.0% had an ASA class equal to 4. Fifty-four veterans (6.3%) had died by the end of 2006. In our Cox models, patients with a BMI greater than 50 (superobesity; hazard ratio [HR], 1.8; P = .04) or a DCG score greater than or equal to 2 (HR, 3.4; P < .001) had an increased risk of death. Conclusion Superobese veterans and those with a greater burden of chronic disease had a greater risk of death after bariatric surgery from 2000 through 2006.

Possible Lack of Survival Advantage for One Group: Comment on "Predictors of Long-term Mortality After Bariatric Surgery Performed in Veterans Affairs Medical Centers" [Invited Critique]

Late Results of the Surgical Treatment of 125 Patients With Short-Segment Barrett Esophagus [Original Article]

Hypothesis The results of surgical treatment of patients with long-segment Barrett esophagus (BE) have been extensively reported. However, few publications refer to the results of surgery 5 years after the fact among patients with short-segment BE. This study aimed to determine the late results of 3 surgical procedures in patients with short-segment BE by subjective and objective measurements. Design Prospective, nonrandomized study starting on March 1, 1987, and ending on December 31, 2005. Setting A prospective, descriptive study of a group of patients. Patients A total of 125 patients with short-segment BE underwent 3 operations in different periods: duodenal switch plus highly selective vagotomy and antireflux technique in 31 patients, vagotomy plus partial gastrectomy and Roux-en-Y loop with antireflux surgery in 58 patients, and laparoscopic Nissen fundoplication in 36 patients. Main Outcome Measures Late subjective and objective outcomes of the 3 different surgical procedures. Results No operative mortality and only 2 postoperative complications (1.6%) occurred. The regression from intestinal metaplasia to cardiac or oxyntocardiac mucosa occurred in 60.8% to 65.4% of the patients, at a mean time of 39 to 56 months after surgery. Visick grading showed Visick grade I or II in 86.3% to 100.0% of the patients. No progression to low- or high-grade dysplasia or adenocarcinoma occurred. Conclusions On the basis of these results, laparoscopic Nissen fundoplication seems to be the surgical option for patients with short-segment BE because it is less invasive, has fewer side effects, and produces good results in the long-term follow-up.

Questions Regarding Surgery to Correct Short-Segment BE: Comment on "Late Results of the Surgical Treatment of 125 Patients With Short-Segment Barrett Esophagus" [Invited Critique]

Pulmonary Embolism and Deep Venous Thrombosis in Trauma: Are They Related? [Original Article]

Hypothesis Pulmonary embolism (PE) and deep venous thrombosis (DVT) in trauma are related. Design Retrospective review of medical records. Setting Academic level I trauma center. Patients Trauma patients who underwent computed tomographic pulmonary angiography (CTPA) with computed tomographic venography (CTV) of the pelvic and proximal lower extremity veins over a 3-year period (January 1, 2004, to December 31, 2006) were reviewed. Data on demographics, injury type and severity, imaging findings, hospital length of stay, and mortality were collected. Main Outcome Measures Pulmonary embolism and DVT. Results Among 247 trauma patients undergoing CTPA/CTV, PE was diagnosed in 46 (19%) and DVT in 18 (7%). Eighteen PEs were central (main or lobar pulmonary arteries), and 28 PEs were peripheral (segmental or subsegmental branches). Pulmonary embolism occurred within the first week of injury in two-thirds of patients. Seven patients with PE (4 femoral, 2 popliteal, and 1 iliac) had DVT. Pulmonary embolism was central in 5 patients and peripheral in 2 patients. No significant differences were noted in any of the examined variables between patients with PE having DVT and those not having DVT. Conclusions Few patients with PE have DVT of the pelvic or proximal lower extremity veins. Pulmonary embolism may not originate from these veins, as commonly believed, but instead may occur de novo in the lungs. These findings have implications for thromboprophylaxis and, particularly, the value of vena cava filters.

Searching for the Source of Venous Clots: An Unsolved Old Problem: Comment on "Pulmonary Embolism and Deep Venous Thrombosis in Trauma: Are They Related?" [Invited Critique]

Continuous Postoperative Blood Glucose Monitoring and Control by Artificial Pancreas in Patients Having Pancreatic Resection: A Prospective Randomized Clinical Trial [Original Article]

Objective To evaluate a closed-loop system providing continuous monitoring and strict control of perioperative blood glucose following pancreatic resection. Design Prospective, randomized clinical trial. Patients Thirty patients who had pancreatic resection for pancreatic neoplasm. Interventions Patients were prospectively randomized. Perioperative blood glucose levels were continuously monitored using an artificial endocrine pancreas (STG-22). Glucose levels were controlled using either the sliding scale method (sliding scale group, n = 13) or the artificial pancreas (artificial pancreas group, n = 17). Main Outcome Measures Incidence of severe hypoglycemia (<40 mg/dL) during the intensive care period following pancreatic resection in patients monitored with the artificial pancreas. The secondary outcome measure was the total amount of insulin required for glycemic control in the first 18 hours after pancreatic resection in each patient group. Results In the sliding scale group, postoperative blood glucose levels rose initially before reaching a plateau of approximately 200 mg/dL between 4 and 6 hours after pancreatectomy. The levels remained high for 18 hours postoperatively. In the artificial pancreas group, blood glucose levels reduced steadily, reaching the target zone (80-110 mg/dL) by 6 hours after surgery. The total insulin dose administered per patient during the first postoperative 18 hours was significantly higher in the artificial pancreas group (mean [SD], 107 [109] IU) than the sliding scale group (8 [6] IU; P < .01). Neither group showed hypoglycemia. Conclusions Perioperative use of an artificial endocrine pancreas to control pancreatogenic diabetes after pancreatic resection is an easy and effective way to maintain near-normal blood glucose levels. The artificial pancreas shows promise for use as insulin treatment for patients with pancreatogenic diabetes after pancreatic resection.

Statin Use and the Risk of Surgical Site Infections in Elderly Patients Undergoing Elective Surgery [Original Article]

Objective To examine whether preoperative statin use is associated with a reduced risk of surgical site infections. Design, Setting, and Patients Population-based retrospective cohort study of all elderly patients undergoing elective surgery in Ontario from April 1, 1992, through March 31, 2006. Preoperative statin use was identified using provincewide pharmacy records. Procedure and patient characteristics were derived from hospital and physician claims databases within Canada's single-payer universal health care system. Main Outcome Measure The 30-day risk of surgical site infection was derived from the initial admission, outpatient consultations, and hospital readmissions. Results The cohort included 469 349 distinct elderly patients undergoing elective surgery, of whom 68 387 (14.6%) were statin users. The primary analysis included 53 565 statin users matched to 53 565 statin nonusers undergoing the same procedure in the same hospital by the same surgeon. Unadjusted analysis revealed a slight increase in the risk of surgical site infection among statin users compared with nonusers (8.9% vs 8.7%; P < .001), which disappeared after adjustment for demographics, health care utilization variables, comorbidities, and concurrent medication therapy (odds ratio, 1.00; 95% confidence interval, 0.95-1.04; P = .85). A similar lack of association was seen when matching was extended to include propensity scores (odds ratio, 0.99; 95% confidence interval, 0.94-1.05; P = .82). The lack of association persisted across pharmacologic, patient, and procedure subgroups. Conclusions Statin use is not associated with an altered risk of surgical site infection. Prevention efforts should be directed toward other evidence-based strategies.

Management and Treatment of Iliopsoas Abscess [Original Article]

Hypothesis Even with improved diagnostic modalities, the optimum management strategy for iliopsoas abscess (IPA) is not uniform, and a better understanding of treatment options is needed. Design Retrospective case series. Setting Academic center. Patients Sixty-one consecutive patients diagnosed as having IPA at the Mount Sinai Medical Center, New York, New York, from August 1, 2000, to December 30, 2007. Main Outcome Measures Development and cause of IPA, the need for additional interventions, morbidity, and mortality. Results The mean age of the patients was 53 years. Most patients were initially seen with pain (95% [58 of 61]), gastrointestinal tract complaints (43% [26 of 61]), and lower extremity pain (30% [18 of 61]). Primary and secondary abscesses occurred in 11% (7 of 61) and 89% (54 of 61), respectively. The most frequent underlying cause of secondary abscesses was inflammatory bowel disease. Broad-spectrum antibiotics were prescribed in all patients. Computed tomography was the most common diagnostic modality used. Abscesses were larger than 6 cm in 39% of patients (24 of 61), bilateral in 13% (8 of 61), and multiple in 25% (15 of 61). Nine patients were treated using antibiotics alone, with a success rate of 78% (7 of 9). Forty-eight patients initially underwent percutaneous drainage, which was successful in 40% (19 of 48). Among those with unresolved IPAs, 71% of patients ultimately required surgery, and the IPAs were typically associated with underlying gastrointestinal tract causes. Seven percent (4 of 61) of patients directly underwent exploratory surgery and drainage, and all of these interventions were successful. The overall mortality was 5% (3 of 61). Conclusions Iliopsoas abscess remains a therapeutic challenge. Gastrointestinal tract disease is the most common cause, with computed tomography as the diagnostic modality of choice. Percutaneous drainage remains the initial treatment modality but is rarely the sole therapy required. Patients with inflammatory bowel disease are likely to require ultimate operative management.

Establishing Standards of Quality for Elderly Patients Undergoing Pancreatic Resection [Original Article]

Objective To evaluate pancreatic surgery as a model for high-acuity surgery in elderly patients for immediate and long-term outcomes, predictors of adverse outcomes, and hospital costs. Design Retrospective case series. Setting University tertiary care referral center. Patients Four hundred twelve consecutive patients who underwent pancreatic resection from October 1, 2001, through March 31, 2008, for benign and malignant periampullary conditions. Main Outcome Measures Clinical outcomes were compared for elderly (≥75 years) and nonelderly patient cohorts. Quality assessment analyses were performed to show the differential impact of complications and resource utilization between the groups. Results The elderly cohort constituted one-fifth of all patients. Benchmark standards of quality were achieved in this group, including low operative mortality (1%). Despite higher patient acuity, clinical outcomes were comparable to those of nonelderly patients at a marginal cost increase (median, $2202 per case). Cost modeling analysis showed further that minor and moderate complications were more frequent but no more debilitating for elderly patients. Major complications, however, were far more threatening to older patients. In these cases, duration of hospital stay doubled, and invasive interventions were more commonly deployed. Conclusions Quality standards for pancreatic resection in the elderly can—and should—mirror those for younger patients. Age-related care, including geriatric consultation, supplemental enteral nutrition, and early rehabilitation placement planning, can be designed to mitigate the impact of complications in the elderly and guarantee quality.

Transumbilical Laparoscopic Cholecystectomy: A Novel Technique [Operative Technique]

Objective To describe a novel technique for performing laparoscopic cholecystectomies using no proprietary or specially designed equipment, while still minimizing the incision and leaving a nearly invisible scar. Design Retrospective review. Setting Community teaching hospital. Patients Twelve patients having uncomplicated laparoscopic cholecystectomy. Main Outcome Measures Number and appearance of postoperative scars. Results Twelve attempts to perform the procedure with our new technique were completed successfully. None of the patients required conversion to the standard technique, which requires additional ports. All of the patients were pleased with their results. No identifiable mark was visible in the right upper quadrant of any of the patients; at the 2-week follow-up, the umbilical incisions were nearly invisible, even to the patients. Conclusion This novel technique can be performed safely and effectively while minimizing the number and extent of incisions.

Consensus Review of Optimal Perioperative Care in Colorectal Surgery: Enhanced Recovery After Surgery (ERAS) Group Recommendations [Review Article]

Objectives To describe a consensus review of optimal perioperative care in colorectal surgery and to provide consensus recommendations for each item of an evidence-based protocol for optimal perioperative care. Data Sources For every item of the perioperative treatment pathway, available English-language literature has been examined. Study Selection Particular attention was paid to meta-analyses, randomized controlled trials, and systematic reviews. Data Extraction A consensus recommendation for each protocol item was reached after critical appraisal of the literature by the group. Data Synthesis For most protocol items, recommendations are based on good-quality trials or meta-analyses of such trials. Conclusions The Enhanced Recovery After Surgery (ERAS) Group presents a comprehensive evidence-based consensus review of perioperative care for colorectal surgery. It is based on the evidence available for each element of the multimodal perioperative care pathway.

Simultaneous Bicavitary Hyperthermic Chemoperfusion in the Management of Pseudomyxoma Peritonei With Synchronous Pleural Extension [Resident's Forum]

Extra-abdominal spread of pseudomyxoma peritonei (PMP) is a rare event, but extension of the tumor beyond the abdomen into the pleural cavity has been reported. We report a case with synchronous pleural manifestation of PMP confirmed during abdominal cytoreductive surgery that was managed by simultaneous bicavitary hyperthermic chemoperfusion. To the best of our knowledge, this is the first report of bicavitary hyperthermic chemoperfusion for PMP. During the abdominal cytoreductive surgery in a patient with known history of PMP, extensive disease under the right hemidiaphragm was noted, requiring partial diaphragmatic resection. Once the pleural space was entered, separate mucinous deposits on the pleural surface of the diaphragm and lung surface were observed. The involved portion of the right hemidiaphragm and lung were resected. The diaphragmatic defect was left open during the hyperthermic chemoperfusion to treat both the pleural and peritoneal surfaces. The patient's postoperative course was uneventful. Simultaneous bicavitary hyperthermic chemoperfusion is a potential therapeutic option for patients with pleural extension identified during cytoreductive surgery.

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]

Feasibility of Colonic and Gastric Standard Laparoscopic Procedures With a Single Skin Incision Approach [Correspondence]

Feasibility of Colonic and Gastric Standard Laparoscopic Procedures With a Single Skin Incision Approach--Reply [Correspondence]

No Anastomotic Leaks After Colorectal Surgery in Rural Community Hospitals [Correspondence]

No Anastomotic Leaks After Colorectal Surgery in Rural Community Hospitals--Reply [Correspondence]

Fluorescent Indocyanine Green for Imaging of Bile Ducts During Laparoscopic Cholecystectomy [Correspondence]

Patient Safety in Laparoscopic Cholecystectomy [Correspondence]

Patient Safety in Laparoscopic Cholecystectomy--Reply [Correspondence]

Hospital Costs of Conventional and Stapled 1-Day Hemorrhoidectomy [Correspondence]

Hospital Costs of Conventional and Stapled 1-Day Hemorrhoidectomy--Reply [Correspondence]