Become a member and receive career-enhancing benefits
Our top priority is providing value to members. Your Member Services team is here to ensure you maximize your ACS member benefits, participate in College activities, and engage with your ACS colleagues. It's all here.
Become a member and receive career-enhancing benefits
Our top priority is providing value to members. Your Member Services team is here to ensure you maximize your ACS member benefits, participate in College activities, and engage with your ACS colleagues. It's all here.
This article reported results of the deliberations of an expert consensus panel that was convened to develop recommendations regarding the essential elements that should be included in an operative note dealing with repair of ventral hernias. The process resembles the effort sponsored by the ACS National Surgical Quality Improvement Program and Commission on Cancer to develop synoptic operative notes holding standardized elements for accurately describing the procedure. The driving concept for this effort is that accurate, consistent data included in operative notes will improve surgeon performance, facilitate research projects, and provide evidence to support quality improvement efforts.
The final set of recommendations included 18 essential items, among them detailed description of the operative approach, estimated blood loss, drain placement, intraoperative complications, and a summary of the findings and repair techniques utilized. These elements are described in a helpful illustration included in the article. It is important to note that recommendations for smooth, effective implementation of a synoptic operative report, including financing and the processes for obtaining and documenting surgeon compliance, were not included.
View Updated Guideline for Closure of Abdominal Wall Incisions from the European and American Hernia Societies
Eva Deerenberg, MD, PhD, and coauthors reported the results of a systematic review of the literature that was used to develop an updated set of guidelines for closure of abdominal wall incisions. This effort was supported by two international societies focusing on abdominal wall hernias. The systematic review included data from 39 studies, and the recommendations focused on seven key questions. (Of note is that the grade of evidence supporting each of the recommendations was weak.)
The guideline recommended use of non-midline incisions or laparoscopic approaches whenever possible. When laparoscopic approaches are used, closure of trocar sites that exceed 10 mm in length and any umbilical trocar site was recommended. Midline abdominal incisions should be closed with a continuous, slowly absorbing suture using the small bite technique, which consists of suture placement in the abdominal aponeurosis 5 mm to 9 mm from the edge with sutures placed 5 mm apart. Gentle approximation was recommended. Reinforcement of the midline abdominal incision with mash can be considered. Synthetic permanent mesh using onlay or retromuscular placement was recommended.
Additional studies that provide data on the use of these techniques are needed.
Comparison of 6-Month Outcomes of Endovascular vs Surgical Revascularization for Patients with Critical Limb Ischemia
Endovascular management of patients with critical limb ischemia is increasing nationwide. This article reported data on 66,277 patients from a national database who underwent endovascular or standard vascular surgical procedures. Patients with incomplete data on outcomes of treatment were excluded. The primary outcome of interest was major amputation within 6 months of the index procedure. Propensity scoring was used to facilitate an accurate, risk-adjusted comparison of outcomes from endovascular and conventional vascular surgery approaches.
Major amputation was required in 9.9% of patients who underwent endovascular procedures and 8.4% of patients who underwent standard vascular surgery procedures; this difference was statistically significant (p<0.001). Of note was the observation that this difference was not observed in patients treated in centers that performed a high volume of endovascular procedures. There were no differences in mortality rates or risks for other types of postoperative complications in the two propensity matched comparison groups.
The authors concluded that endovascular approaches were safe but associated with a significantly higher risk for major amputation compared with standard vascular surgery procedures.
