Editorial Board ix
Contributors xi
Controversies in the Management of Diverticulitis
Thomas Curran and Mary R. Kwaan
Introduction 1
Indications for urgent or emergent operative procedures in patients with acute diverticulitis 2
Assessing the intraoperative environment to determine an operative plan 3
Role of damage-control surgery/second-look laparotomy 4
Postoperative morbidity and mortality 5
Anastomotic leak 6
Laparoscopic approach 7
Hartmann procedure versus primary anastomosis: observational data 8
Hartmann procedure versus primary anastomosis: randomized trial data 9
Hartmann procedure versus primary anastomosis: patient selection for inclusion in randomized controlled trials and crossover 11
Hartmann procedure versus primary anastomosis: primary anastomosis with or without diverting ostomy 12
Colostomy takedown 12
Summary 13
Disclosure 14
Venous Thromboembolism Prevention and Treatment in Cancer Surgery
Lawrence B. Brown, Michael B. Streiff, and Elliott R. Haut
Introduction 18
Epidemiology 18
Risk stratification 19
Prevention 21
Perioperative venous thromboembolism prophylaxis for cancer surgery patients 21
Preoperative thromboprophylaxis 21
Postoperative thromboprophylaxis 21
Extended (outpatient) prophylaxis 22
Mechanical prevention 22
Diagnosis 23
Imaging 23
The role of D dimer 23
Treatment 24
Acute treatment of venous thromboembolism 24
Extended therapy 25
Role of inferior vena cava filters 26
Summary 26
Disclosure 27
The Value of Surgical Coaching Beyond Training
Jason C. Pradarelli, Yue-Yung Hu, Justin B. Dimick, and Caprice C. Greenberg
Overview of surgical coaching 32
Motivation for surgical coaching 32
Established surgical coaching programs 33
Wisconsin Surgical Coaching Program 33
Surgical coaching initiative in the Michigan Bariatric Surgery Collaborative 35
Illinois Surgical Quality Improvement Collaborative video-based coaching project 36
Harvard Surgical Coaching for Operative Performance Enhancement 38
Other notable surgical coaching interventions 41
Benefits of surgical coaching for practicing surgeons 41
Addressing barriers to implementing surgical coaching 42
Time and money 42
Value-based health care 43
Logistics 43
Culture 44
Future directions for surgical coaching 44
Disclosure 45
Neoadjuvant Therapy: When Should It Be Used for Pancreatic Cancer?
Kristin N. Kelly, Francisco I. Macedo, and Nipun B. Merchant
Introduction 49
Classification 50
Resection margins 53
Role of neoadjuvant chemotherapy with or without radiation therapy 56
Neoadjuvant chemotherapy alone 56
Neoadjuvant chemoradiation therapy 58
Pathologic complete response 59
Upcoming studies 59
Surgical considerations after neoadjuvant chemotherapy 61
Summary 63
Disclosure 64
Islet Tumors: Resect or Follow?
Tiffany J. Sinclair and George A. Poultsides
Introduction 69
Treatment guidelines 71
Potential for metastasis 72
Accuracy of preoperative biopsy in defining grade 74
Can tumor morphology on preoperative imaging predict grade and metastatic potential? 74
Survival after resection versus observation for islet cell tumors 76
Natural history of small islet cell tumors 82
Morbidity and mortality after resection of small islet tumors 84
Summary 85
The Role of Artificial Intelligence in Surgery
Daniel A. Hashimoto, Thomas M. Ward, and Ozanan R. Meireles
Introduction 89
Techniques in artificial intelligence 90
Machine Learning 91
Neural networks 92
Deep neural networks 93
Applicative fields of artificial intelligence 93
Computer vision 93
Natural language processing 94
Specific applications of artificial intelligence in surgery 95
Preoperative risk prediction 95
Intraoperative video analysis 96
Electronic Health Records 98
Regulatory and legal considerations 98
Surgeon’s role 98
Summary 99
Disclosures 99
What Is the Current Status of Lung Transplantation?
Daniel A. Walker, Fatima G. Wilder, and Errol L. Bush
History of lung transplantation 103
Early experimental activity 103
Clinical experience 104
Evolution in techniques 105
Current lung transplant volume and outcomes 106
Trends in changing diagnosis 108
Significant lung allocation changes in 2005 108
Indications 110
Contraindications 112
Surgical technique 112
Donor organ recovery 112
Complications 116
Primary graft dysfunction 116
Readmission 116
Outcomes 116
Extracorporeal membrane oxygenation as a bridge to transplant 118
Venovenous and venoarterial extracorporeal membrane oxygenation 118
Extracorporeal membrane oxygenation outcomes 119
Intraoperative use 120
Combined heart-lung transplant 121
Expanding the donor pool 122
Hepatitis C mismatch 122
Ex vivo lung perfusion 122
Summary 124
Disclosure 124
Contemporary Management of Mitral Valve Disease
Brian D. Cohen, Michael A. Napolitano, J. James Edelman, Keegan V. Thourani, and Vinod H. Thourani
Introduction 129
Evaluation 131
Classification 132
Primary mitral regurgitation 134
Secondary mitral regurgitation 137
Median sternotomy and minithoracotomy 138
Summary 142
Disclosure 143
Surgery Resident Wellness Programs: The Current State of the Field and Recommendations for Creation and Implementation
Rebecca L. Williams-Karnesky, Alissa Greenbaum, and Jasmeet S. Paul
Introduction 149
Burnout in medical training 150
Initiatives to address resident wellness 151
Current state of the field 151
Best practice recommendations for designing a resident wellness program 156
Conceptual models used to develop trainee wellness programs 157
Maslow’s hierarchy of needs 157
Domains of wellness model 159
Ensuring the success of a surgery resident wellness program 163
Future advances in resident wellness 166
Summary 166
Disclosure 166
Evidence-Based Management of Gallstone Pancreatitis
Lillian S. Kao and Jayne S. McCauley
Introduction 173
Stratification and prediction of severity of acute gallstone pancreatitis 174
Medical management 177
Fluid resuscitation 177
Nutritional support 178
Analgesia 179
Endoscopic and surgical management of acute gallstone pancreatitis 179
Routine endoscopic retrograde cholangiopancreatography in gallstone pancreatitis 179
Management of common bile duct stones in acute gallstone pancreatitis 179
The role of endoscopic sphincterotomy in the management of acute gallstone pancreatitis 180
Timing of cholecystectomy after mild acute gallstone pancreatitis 181
Management of necrotizing gallstone pancreatitis 184
Future advances 185
Disclosure 186
Management of Melanoma Patients with Positive Nodes
Rachel M. Lee, Keith A. Delman, and Michael C. Lowe
Introduction 192
Background 192
The clinically node-positive patient 193
The patient with nodal recurrence 195
The evolving role of neoadjuvant therapy 195
The patient with a positive sentinel lymph node biopsy 197
Summary 201
Disclosure 202
Video Assessment of Surgeons and Surgery
Elif Bilgic, Sofia Valanci-Aroesty, and Gerald M. Fried
Why is video-based assessment important? 206
What are the limitations of video-based assessment? 206
What is the impact of technology on video-based assessment? 207
Metrics 208
Video-based assessment 208
Peer review 208
Crowd sourcing 208
Artificial intelligence 209
Applications of video review 210
Quality improvement and education 210
Privileges and credentials 210
Future applications 211
Summary 211
Disclosure 211
Fascial Closure: New Surgery Paradigms
Gregory A. Dumanian and Simon Moradian
Introduction 215
Wound healing, inflammatory response to biomaterials, and the foreign body reaction 216
Strength of tissues repaired with sutures 219
Suture composition 219
Suture tension 220
Suture size 220
New options for fascial closure to decrease hernia recurrence 221
Prophylactic mesh augmentation 223
Mesh sutured repairs 225
Mesh suture 225
Summary 226
Disclosure 227
Enteral Feeding: Percutaneous Endoscopic Gastrostomies, Tubes, and Formulas
Colin G. DeLong and Eric M. Pauli
Introduction 231
Updates on the indications for percutaneous endoscopic gastrostomy 232
Perioperative considerations 234
Adjuncts to standard percutaneous endoscopic gastrostomy techniques 236
Gastrointestinal T-anchors placement 236
Overtube placement 237
Difficult percutaneous endoscopic gastrostomy: strategies and options 238
Laparoscopic-assisted percutaneous endoscopic gastrostomy 239
Image-guided percutaneous endoscopic gastrostomy 239
Colonoscopy-assisted percutaneous endoscopic gastrostomy 239
Minimally invasive jejunal access 240
Percutaneous endoscopic gastrostomy with jejunal extension 240
Direct percutaneous endoscopic jejunostomy 241
Alternative methods for enteral access 242
Sabnis, Liu, and Chand technique 242
Percutaneous transesophageal gastrostomy 242
Fistuloclysis 243
Endoscopic management of percutaneous endoscopic gastrostomy complications 244
Enteral feeding decisions in surgical patients 245
Summary 246
Disclosure 246
Increasing Importance of Ethics in Surgical Decision Making
Anghela Z. Paredes, Christopher T. Aquina, Luke V. Selby, Stephanie DiFilippo, and Timothy M. Pawlik
Introduction 251
Principles of biomedical ethics 252
Autonomy 252
Nonmaleficence 253
Beneficence 253
Justice 253
Integration of ethics in surgery 254
Informed consent 254
Goals of care and futility 256
Surgical palliation 258
Decisional regret 260
Summary 261
Disclosure 261
Per Oral Pyloromyotomy for Gastroparesis
John H. Rodriguez and Jeffrey Ponsky
Introduction 265
History 267
Evaluation 267
Patient selection 268
Equipment 269
Technique 269
Postoperative management 271
What Is the Role of Neoadjuvant Radiation Therapy for Retroperitoneal Sarcoma?
Sophia K. McKinley, Thomas F. DeLaney, and John T. Mullen
Introduction 273
Incidence of retroperitoneal sarcoma 273
Current treatment challenges 274
Neoadjuvant radiotherapy for retroperitoneal sarcoma 275
Current use of radiotherapy for retroperitoneal sarcoma 275
Rationale for neoadjuvant radiation therapy for retroperitoneal sarcoma 276
Summary of current evidence 278
Safety of neoadjuvant radiation therapy 280
Future directions 280
Summary 281
Disclosure 281
New Models of Surgical Training
Christopher C. Stahl and Rebecca M. Minter
Introduction 285
Concerns regarding the ability of graduating general surgery residents 285
The spectrum of surgical training and participating organizations 286
Defining competency-based education 288
The transition to competency-based medical and surgical education 289
Fundamentals of laparoscopic and endoscopic surgery 289
Milestones 290
Operative Performance Rating System 291
End of rotation evaluations 292
Microassessments 292
Entrustable professional activities 293
Summary 296
Disclosure 297
