Front Matter| Volume 55, Pxv-xxiii, September 2021


        Associate Editors ix
        Contributors xi

        Optimal Surgical Treatment for Type 2 Diabetes: Sleeve Gastrectomy or Gastric Bypass?

        Amanda Mueller, Sarah Palilla, and Jonathan Carter
         Introduction 1
         Clinical evidence from randomized, controlled trials 2
         The physiology of obesity as it relates to diabetes 3
         Mechanisms of diabetes resolution after sleeve gastrectomy or gastric bypass 4
        Ghrelin 4
        PYY3-36 5
        Incretins 5
        Bile acids and gut microbiome 5
        Duodenal bypass 6
         Summary 6
        Disclosure 7

        Advances in the Diagnosis and Management of Appendicitis in Children

        Katherine He and Shawn J. Rangel
         Introduction 9
         Relevance and approach to severity classification 10
         Diagnostic evaluation 10
        Diagnostic utility of clinical prediction rules and clinical scoring systems 11
        Strategies to optimize the diagnostic quality of US 13
        Strategies to leverage the combined predictive value of US, laboratory and clinical data 13
        Role of standardized diagnostic clinical pathways 13
         Surgical management 16
        Influence of operative timing on outcomes and resource utilization 16
        Operative approach 16
        Initial medical versus operative management for complicated appendicitis 16
        Role of irrigation and drains 18
        Antibiotic management of uncomplicated appendicitis 18
        Antibiotic management for complicated appendicitis 19
        Screening and management of OSIs 20
        Role of parenteral nutrition 21
        Indications and timing of interval appendectomy for complicated appendicitis 21
        Same-day discharge for patients with uncomplicated appendicitis 22
        Approach to perioperative pain management 22
         Medical management as definitive treatment for early appendicitis 22
         Outcome, process, and resource utilization benchmarks 27
         Future directions and priorities 27
         Clinics care points 29
         Disclosure 29

        Malignant Bowel Obstruction

        Nadege T. Fackche and Fabian M. Johnston
         Introduction 35
         Epidemiology and pathophysiology 36
         Evaluation of the patient with malignant bowel obstruction 36
         Management 38
        Medical therapy 38
        Interventional palliation 41
        Surgical Palliation 42
         Summary 43
         Clinics care points 44
         Disclosure 44

        Nonoperative Treatment of Diverticulitis

        Matthew Symer and Heather L. Yeo
         Introduction 49
         Epidemiology 50
         Diverticulitis recurrence 51
         Advantages of the nonoperative approach 51
         Uncomplicated diverticulitis 52
         Complicated diverticulitis 52
         Symptomatic uncomplicated diverticular disease and chronic abdominal pain 53
         Need for endoscopic examination 53
         Summary 53
         Clinics care points 54

        The Current Management of Visceral Artery Aneurysms

        Bara Zuhaili and James H. Black III
         Background 57
        Anatomic distribution 57
        Causes 58
         Clinical presentation 58
        Nonruptured visceral artery aneurysm 58
        Ruptured visceral artery aneurysm 58
         Physical examination 58
         Work-up 58
         Medical treatment 59
         Interventional treatment 59
        Indication for intervention 59
        Intervention options 59
         Surgical and endovascular techniques 60
        Splenic artery aneurysm 60
        Hepatic artery aneurysm 62
        Superior mesenteric artery aneurysm 63
        Pancreaticoduodenal and gastroduodenal artery aneurysms 64
        Gastric/gastroepiploic artery aneurysms 66
        Jejunal, ileal, and colic artery aneurysms 66
        Renal artery aneurysms 67
         Complications/long-term outcomes 68
         Long-term recommendations 70
         New developments 70
         Clinics care points 71

        Mesenteric Ischemia: When and How to Revascularize

        Kristofor A. Olson and Pedro G. Teixeira
         Introduction 75
         Anatomy 76
         Acute mesenteric ischemia 76
        Epidemiology 76
        Pathogenesis 76
        Clinical presentation 77
        Management of acute thrombotic or embolic mesenteric ischemia 77
         Management of mesenteric venous thrombosis 82
        Medical management 82
        Indications for interventions 82
        Open surgical versus endovascular 82
         Management of non-occlusive mesenteric ischemia 82
         Chronic mesenteric ischemia 83
        Epidemiology and pathogenesis 83
        Clinical presentation 83
        Medical management 83
        Indications for interventions 83
        Surgical versus endovascular 83
         Postoperative care 84
         Long-term follow-up 85
         Summary 85
         Clinics care points 85

        Watch-and-wait Management for Rectal Cancer After Clinical Complete Response to Neoadjuvant Therapy

        Jonathan B. Yuval and Julio Garcia-Aguilar
         Introduction 90
         Terminology 91
         History of watch and wait 91
         Patient perspectives on watch and wait 92
         Patient evaluation 92
        Work-up 92
        Selection of patients based on tumor stage 92
        Selection of patients based on tumor location 93
        Baseline characteristics associated with response to neoadjuvant therapy 93
         Radiotherapy regimens 93
         Enhancing the response to neoadjuvant therapy 94
        Interval to assessment 94
        Radiation dose 95
        Addition of neoadjuvant systemic chemotherapy 95
        Induction versus consolidation chemotherapy in total neoadjuvant therapy 96
         Complications of neoadjuvant therapy 96
         Assessment of response 97
         Long-term monitoring of response 97
         Long-term outcomes 97
        Oncological outcomes 97
        Rates of organ preservation 100
        Functional outcomes 100
         Summary, discussion, and future directions 103
         Clinics care points 104
         Disclosure 104
         Financial support 104

        Paraesophageal Hernia: Current Management

        Laura Mazer and Dana A. Telem
         Introduction 109
        Presentation 110
        Diagnosis 111
        Indications for repair 112
        Management of acute presentation 113
        Surgical repair 114
        Need for esophageal lengthening procedure 118
        Need for gastropexy 119
         Summary 119
         Disclosure 119

        Surgery During a Pandemic: Guidelines

        Cole S. Brown and Andrew M. Cameron
         Introduction: COVID-19’s impact on health care systems: shutdown of elective procedures 123
         After the shutdown: guidelines for ramping back up safely 124
        Overview 124
        Priorities 124
        Acuity 125
        Supplies 126
        Capacity 126
         An unpredictable pandemic: guidelines for ramping back down as needed 127
         Guidelines on other important considerations 128
        Patient placement and bed management 128
        Infection prevention obligations and social distancing 128
        Patient and visitor flow 129
        Preoperative screening 129
        Staff safety and well-being 129
         Summary on guidelines for surgery in the time of pandemic 130
         Disclosure 130

        The Role of Node Dissection for Thyroid Cancer

        Reese W. Randle and Susan C. Pitt
         Background 131
         Epidemiology 132
         Patient evaluation overview 132
        Initial evaluation 132
        Evaluation for recurrence 132
        Lymph node imaging 133
        Functional imaging 134
        Lymph node biopsy 134
         Treatment options 134
        Central neck dissection 136
        Lateral neck dissection 137
        Reoperative neck dissection 139
         Evaluation of outcomes 139
        Complications 139
        Completeness of resection 140
        Recurrence 141
        Survival 141
         Long-term recommendations 141
        Surveillance 141
        Adjuvant RAI 141
         Summary 141
         Future directions 142
         Clinics care points 142
         Disclosure 142

        Multimodal Pain Control in Surgery 2020

        Hannah Decker, Christopher L. Wu, and Elizabeth Wick
         Introduction 147
         Discussion 149
        Nonsteroidal anti-inflammatory agents 149
        Acetaminophen 150
        Gabapentinoids 150
        N-methyl-d-aspartate antagonists 151
        Local anesthetics 152
        Regional anesthesia/analgesia 153
         Summary 153
         Clinics care points 154
        Disclosure 154

        What is the Current Role of Hyperthermic Intraperitoneal Chemotherapy in Colorectal Cancer?

        Catherine H. Davis and H. Richard Alexander Jr.
         Clinical background 159
         Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy technique 160
         Historical perspective: survival after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for patients with colorectal cancer peritoneal metastasis 161
         Toxicity and morbidity associated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy 163
         Current status of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in colorectal cancer peritoneal metastasis 167
        Mitomycin C versus oxaliplatin 167
        Use of systemic chemotherapy with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy 168
        Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy versus cytoreductive surgery alone 169
        Hyperthermic intraperitoneal chemotherapy as prophylactic therapy 170
         Summary 170
         Clinics care points 171
         Disclosure 171

        Machine Perfusion in Liver Transplantation

        Malcolm MacConmara and Parsia A. Vagefi
        Video content accompanies this article at
         Introduction 175
         History of organ preservation 176
        Early experimental work with machine perfusion 176
        Contemporary advances in machine perfusion 177
         Types of machine perfusion of the liver 177
        Hypothermic perfusion 177
        Normothermic machine perfusion 178
        Advantages of machine perfusion 178
         Technique of machine perfusion 178
        Preparation for perfusion 178
        Assessment of donor organs 179
         Clinical trials 179
        Hypothermic machine perfusion 179
        Normothermic machine perfusion 182
         Current status of clinical practice in the United States 185
        Trends in normothermic machine perfusion application 185
        Normothermic machine perfusion of marginal organs 186
        Cost and organ allocation 186
         Biomarkers 186
        Current biomarkers 186
        Novel biomarkers 187
        Composite viability scores 187
         Future advances 188
        Expanding marginal livers 188
        Enhancing livers 189
        Integration with other novel technologies 190
         Summary 191
         Clinics care points 191
        Conflicts of interest 191
         Supplementary data 191

        What Is the Proper Technique for Primary Laparotomy Closure?

        Charlotte Horne and Eric Pauli
         Introduction 197
        What layer(s) should be closed? 198
        How should the linea alba be sutured? 199
         Proper fascial closure technique 207
        Closure adjuncts 209
         Summary and recommendations 211
         Clinics care points 211
        Disclosure 212

        Can Pancreatic Organoids Help in the Treatment of Pancreatic Cancer?

        Toni T. Seppälä and Richard A. Burkhart
        Video content accompanies this article at
         Introduction 215
        Nature of the problem 216
         Significance (in depth analysis) 216
        What biomarkers predict treatment response? 216
        What is an organoid? 218
        Capacity to model human disease 219
        How to make use of the pure ductal cancer cell population? 220
        Success rates in organoid establishment protocols 222
        How are pancreatic ductal adenocarcinoma organoids used currently in research? 223
        Proposed frameworks of care 225
        Barriers to clinical implementation today and strategies for the future 226
         Summary 227
         Clinics care points 227
         Disclosure 227
         Supplementary material 227

        Necrosectomy in the Management of Necrotizing Pancreatitis

        Amy Y. Li, John R. Bergquist, and Brendan C. Visser
        Video content accompanies this article at
         Introduction 232
         Background and definitions 232
         Indications and timing for necrosectomy 233
         Approaches to necrosectomy 235
        Open necrosectomy 236
        Laparoscopic necrosectomy 237
        Retroperitoneal debridement 238
        Endoscopic transgastric drainage and necrosectomy 240
        Surgical transgastric necrosectomy 242
        Percutaneous drainage 245
         Summary 245
         Clinics care points 246
        Acknowledgments 246
         Supplementary data 246

        Vascular Reconstructions for Traumatic Injuries

        Ali Khalifeh and Todd E. Rasmussen
         Introduction 251
         Diagnosis and initial management 252
        Mechanism of Injuries and Diagnosis 252
        Operating Room and Setup 255
        Temporary Vascular Shunts 256
        Endovascular Balloon Occlusion of The Aorta 257
        Other Types of Balloon Occlusion 258
        Endovascular Repair of Vascular Trauma 258
        Conduits for Vascular Reconstruction 259
        Anticoagulation and Antiplatelet Use 262
         Anatomic regions 262
        Extremity injuries 262
        Cervical 264
        Torso 266
         Summary 269
         Clinics care points 269

        Evolution of Point-Of-Care Ultrasound in Surgical Management

        William A. Teeter and Thomas Scalea
         Focused assessment with sonography for trauma 273
         Patient placement 274
         Evaluation of the heart and pericardium 275
        Subxiphoid view 275
        Parasternal long view 276
         Morison's's pouch 276
         Splenorenal recess 277
         Pouch of Douglas 277
         Thoracic views 278
         Cardiac ultrasound 280
        Parasternal long view 280
        Parasternal short view 284
        Apical four-chamber and five-chamber views 287
        Assessment of hypovolemia using cardiac ultrasound 288
         Intravascular catheter placement 289
         Summary 294
         Clinics care points: fast 295
         Disclosure 295

        Breast Implant–Associated Anaplastic Large Cell Lymphoma

        Melissa Camp
         Introduction 299
         Background 300
         Epidemiology 300
         Presentation 301
         Diagnosis and workup 301
         Treatment 302
         Staging 303
         Food and Drug Administration warnings on implants 303
         Management of patients who currently have implants 303
         Summary/Conclusions 304
         Clinics care points 305
         Disclosure 305