Abstract Purpose Surgeons performing total knee arthroplasty (TKA) on the osteoarthritic valgus deformity often use a posterior stabilized (PS) and semi-constrained implants to substitute for the release of a contracted posterior cruciate ligament (PCL) instead of a cruciate retaining (CR) implant. Calipered kinematic alignment (KA) strives to retain the PCL and use a CR implant. The aim of this study

BACKGROUND Spinal arteriovenous fistula (AVF) represents the most common type of spinal vascular lesions and is often associated with progressive neurological dysfunction. METHOD Here, we present a unique case of a spinal vascular malformation that does not fit the traditional classification schemes. The patient presented with progressive neurologic deficits resembling partial Brown-Sequard syndrome

BACKGROUND Skull base reconstruction after extended endoscopic endonasal approaches (EEAs) can be challenging. In addition to the nasoseptal flap, which has been adopted by most centers, autologous fascia lata is also often utilized. Harvesting of fascia lata requires a separate thigh incision, may prolong recovery, and results in a visible scar. In principal, the use of non-autologous materials would

Extravasation of Onyx is a rare complication during embolization of arteriovenous malformations (AVM). We present a case of embolization that was complicated by leakage of Onyx into the cerebellum which was later encountered during surgical excision of the AVM. Our goal is to report this rare event and to outline successful treatment of this complication. The patient's records were reviewed for medical

BACKGROUND Posterior fossa arteriovenous malformations (pfAVMs) can be challenging lesions to manage. AVMs in this location may have distinct features compared with supratentorial AVMs. Our aim was to systematically review the literature on the presenting characteristics of pfAVMs and compare clinical and angiographic outcomes after the various types of treatment employed. METHODS The review was conducted

BACKGROUND The morbidly obese (MO) patient presents a unique challenge to pain control in the postoperative period due to associated comorbidities and the amplified impact of opiates. In order to reduce potential complications associated with narcotic use in the MO patient, multimodal analgesia has been advocated. In this study, we examined the effect of laparoscopic-guided transversus abdominis plane

INTRODUCTION Post-operative non-urgent hospital visits (NUR-HV) are an important quality target for reducing unnecessary healthcare utilization. The primary objective of this study was to characterize 90-day post-operative hospital use and determine independent predictors for NUR-HV and urgent (UR)-HV after elective laparoscopic paraesophageal hernia repair (LPEHR) and Nissen Fundoplication (LNF).

BACKGROUND Right-sided colonic diverticulitis (RCD) is an Asian-centric disease. The optimal treatment for acute uncomplicated RCD remains a controversial area. This study aimed to compare the safety and efficacy of laparoscopic diverticulectomy (LD) with non-operative treatment (NT) in patients with uncomplicated RCD. METHODS A single-center, prospective, non-randomized controlled study ran from 2009

BACKGROUND A procedure-based laparoscopic liver resection (LLR) classification (IMM classification) stratified 11 different LLR procedures into 3 grades. IMM classification assessed the difficulty of LLR differently than an index-based LLR classification (IWATE criteria), which scored each procedure on an index scale of 12. We validated the difference of 3 IMM grades using an external cohort, evaluated

BACKGROUND Cognitive deficits are observed in individuals with obesity. While bariatric surgery can reverse these deficits, it remains unclear whether surgery type differentially influences cognitive outcome. We compared the extent to which vertical sleeve gastrectomy (VSG) and Roux-en Y gastric bypass (RYGB) ameliorated cognitive impairments associated with obesity. METHODS Female participants approved

BACKGROUND The study aim is to determine if patients who have undergone endoscopic gastrojejunostomy revision (EGJR) maintain weight loss up to 5 years postoperatively. METHODS This is a retrospective review of patients who underwent EGJR with a full-thickness endoscopic suturing device between April 2009 and June 2018. Percent of excess body weight loss (%EBWL) was calculated using the weight on day

INTRODUCTION An unusually high surgical site infection (SSI) rate after Roux-en-Y gastric bypass (RYGB) was noted on routine outcomes review. Surgeon A, who had a rate of 8.9%, utilized the transoral technique (passage down esophagus into gastric pouch) for anvil insertion for the circular-stapled gastrojejunostomy. By comparison, SSI rate was 0% for Surgeon B, who inserted anvil transabdominally (direct

BACKGROUND Inguinal hernia repair belongs to the most frequently performed surgical procedures. Endoscopic techniques like TAPP and TEP have become standard of care together with the conventional open techniques. Especially in endoscopic techniques, there is a confusing amount of different meshes and fixation techniques with impact on perioperative and long-term outcome. We present the first single-center

BACKGROUND Few investigations to date assessing the effectiveness of robot-assisted intersphincteric resection (ISR) have included sufficient patients and follow-up period. This study assessed the utility and safety of robot-assisted ISR by comparing groups of patients who underwent low anterior resection (LAR) with or without ISR and ISR extent. METHODS This study enrolled 897 patients who underwent

BACKGROUND Conversion of Nissen fundoplication to Roux-en-Y (RnY) anatomy may be indicated in patients with post-surgical complications or who fail to achieve durable control of their disease. Herein we describe the largest series of patients at a single institution who underwent minimally invasive conversion of Nissen fundoplication to RnY reconstruction. METHODS All patients with prior Nissen fundoplication

BACKGROUND In patients with acute cholecystitis who are deemed high risk for cholecystectomy, percutaneous cholecystostomy (PC) was historically performed for gallbladder drainage (GBD). There are several limitations associated with PC. Endoscopic GBD [Endoscopic transpapillary GBD (ET-GBD) and EUS-guided GBD (EUS-GBD)] is an alternative to PC. We performed a systematic review and meta-analysis to

Abstract Background During esophagectomy for esophageal cancer, meticulous attention is needed to prevent thermal injury to the vital organs, such as the recurrent laryngeal nerve (RLN) and tracheobronchus. In order to clarify the novel mechanism behind thermal injury induced by energy devices, we investigated the temperature of steam with the use of two different devices under wet and dry conditions

BACKGROUND Enhanced recovery after surgery (ERAS) protocols have been extensively proven in lower gastrointestinal surgery to decrease postoperative physiologic stress and length of stay (LOS). ERAS in bariatric surgery (ERABS) varies immensely from each program with inconsistent results with a predominant goal of reducing LOS. Our focus in implementing enhanced recovery after bariatric surgery (ERABS)

BACKGROUND The aim is to evaluate safety and efficacy of near infra-red (NIR) indocyanine green (ICG) fluorescence structural imaging during laparoscopic cholecystectomy (LC) (Group A) and to compare perioperative data, including operative time, with a series of patients who underwent LC with routine traditional intraoperative cholangiography (IOC) (Group B). METHODS Forty-four patients with acute

BACKGROUND The outcome of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) depends on the extent of peritoneal metastases (PM) and the completeness of cytoreduction (CCR). The role of preoperative assessment of PM is to identify potential candidates for CRS/HIPEC and to prevent unwarranted laparotomy for those who are not. Laparoscopy has been utilized for that purpose

BACKGROUND Laparoscopy is being increasingly applied as either a diagnostic or therapeutic intervention in the management of abdominal trauma. However, its outcomes in comparison with conventional laparotomy remain unclear, especially in terms of therapeutic management. METHODS This retrospective cohort study included patients from three trauma centers in Beijing, China. Fifty-four patients undergoing

BACKGROUND With advances in surgical technique and instrumentation, intracorporeal anastomosis is increasingly being performed for laparoscopic total gastrectomy (LTG). However, the benefits of intracorporeal anastomosis in reducing postoperative complications have not been demonstrated, although its technical feasibility has been proven in many studies. In this study, we investigated the impact of

BACKGROUND Malignant afferent loop obstruction (mALO) can cause cholangitis, pancreatitis, and perforation due to blind loop dilatation. However, peritoneal dissemination, lymph node metastasis, and recurrence of the tumor are the main causes of mALO, and most cases are in the advanced stage with thoracicoabdominal fluid retention, for which surgery and percutaneous transhepatic treatment are challenging

BACKGROUND Despite the increasing obesity prevalence among American adults, relatively few qualified patients proceed to bariatric surgery. Suggested explanations include referral barriers for weight loss management at primary care provider (PCP) visits. This study aims to assess the referral and practice patterns of PCPs treating patients with obesity. Our goal is to understand treatment barriers

BACKGROUND Ileal pouch-anal anastomosis has become the standard surgical procedure for patients with ulcerative colitis who require colectomy. Presacral sinus is a common complication after the surgery. Pouch sinus results from chronic anastomotic or suture line leak. An excessive gain in body mass index (BMI) has been shown to be associated with poor pouch outcome. The aim of this study was to evaluate

Abstract Purpose The use of an accessory anteromedial portal to drill the femoral graft tunnel in primary anterior cruciate ligament (ACL) reconstruction was introduced in the 2000s in an effort to achieve a more anatomic femoral tunnel position. However, some early studies reported an increase in revision ACL reconstruction compared to the traditional transtibial technique. The aim of this study was

Abstract Purpose Although several small-scale studies have reported risk factors for surgical site infection (SSI) after high tibial osteotomy (HTO), no study has collectively analysed risk factors in a large cohort. The present study aimed to clarify the risk factors for SSI after HTO using a national database. Methods Data of inpatients who underwent HTO from 2010 to 2017 were obtained from the Diagnosis

Abstract Purpose The management of posterolateral corner (PLC) injuries has significantly evolved over the past 2 decades. The purpose of this study was to determine the current worldview of key concepts on the diagnosis, treatment strategy, and rehabilitation for patients presenting with PLC injuries. Methods A 12-question multiple-choice online survey was designed to address key questions in the

Authors would like to correct the errors in figure 4 legend.

The Original Investigation titled “Association of Low-Dose Whole-Body Computed Tomography With Missed Injury Diagnoses and Radiation Exposure in Patients With Blunt Multiple Trauma,”1 published online January 15, 2020, was corrected to add missing affiliations for Drs Mutze and Ekkernkamp and to add a missing data point in eTable 4 in the Supplement. This article was corrected online.

The Research Letter titled “Evaluation of Triple-Negative Breast Cancer Early Detection Via Mammography Screening and Outcomes in African American and White American Patients,”1 published online February 19, 2020, included an error in the Methods section and another in the Results section. The Methods section notes the date of study termination as April 30, 2018. In fact, it was September 14, 2018

Gastrointestinal stromal tumors (GISTs) are malignant tumors arising from interstitial cells of cajal that can be located in any part of the digestive system.1 Their most common sites are the stomach and small intestine.2 Surgery either upfront or after preoperative treatment with tyrosine kinase inhibitors (TKIs) is still the most important treatment modality in GIST.2 In this issue of JAMA Surgery

Abstract Purpose The purpose of this study was to reveal the influence of the variance in width between the tibial spine and the femoral intercondylar notch on the occurrence of ACL injury. Methods Thirty-nine subjects undergoing anatomical ACL reconstruction (30 female, 9 male; average age 29 ± 15.2) and 37 subjects with intact ACL (21 female, 16 male; average age 29 ± 12.5) were included in this

Abstract Purpose The primary aim of this study was to investigate the potential benefit of stress radiographs for diagnosis of unstable total knee arthroplasty (TKA) and to identify clinically relevant cut-off values to differentiate between unstable and stable TKAs. Methods Data of 40 patients with 49 cruciate retaining (CR) TKA who underwent stress radiographs as part of the diagnostic algorithm

Rectal cancer (RC) surgery often results in permanent colostomy, seriously limiting the quality of life (QOL) in patients in terms of bowel function. This study aimed to examine defecation function and QOL in RC patients who underwent non-ostomy or ostomy surgery, at different time-points after surgery. In total, 82 patients who underwent an ostomy and 141 who did not undergo an ostomy for the treatment

Single-stage repair of incisional hernias in contaminated fields has a high rate of surgical site infection (30–42%) when biologic grafts are used for repair. In an attempt to decrease this risk, a novel graft incorporating gentamicin into a biologic extracellular matrix derived from porcine small intestine submucosa was developed. This prospective, multicenter, single-arm observational study was designed

To assess the safety, tumor control and renal function preservation of the emergency retroperitoneal laparoscopic partial nephrectomy (LPN) for ruptured renal angiomyolipoma (AML) and summarize our single-center initial experience. We performed a retrospective analysis of 15 patients pathologically confirmed renal AML treated with emergency retroperitoneal LPN between January 2016 and May 2019. The

Abstract Purpose To evaluate the incidence of intraoperative anchor pullout during arthroscopic rotator cuff repair, to compare the outcomes of different methods of managing anchor pullout, and to introduce a new technique for anchor pullout. Methods 1076 patients who underwent arthroscopic rotator cuff repair using a single-row repair technique were included. In 483 patients, rotator cuff repair was

Abstract Purpose Patient-specific instrumentation (PSI) in total knee arthroplasty (TKA) uses individually designed disposable guides to determine intraoperative bone cuts. The manufacturer provides the surgeon with proposed planning which can be modified and should be approved by the surgeon before the guides are produced. This study aims to assess the intra- and inter-observer reliability among preoperative

Abstract Purpose This study aimed to analyze the morphology of the anterior femoral condyle using a quantitative three-dimensional reconstruction method. The morphological data were compared between genders. Methods Computed tomography scans of femurs were taken from 90 healthy subjects and then reconstructed in 3D modeling software. Coaxial cutting planes were created at 10° increments to measure

Abstract Purpose To determine the component fit by radiography or computed tomography after total knee arthroplasty and the relation of imaging with clinical examination of residual knee pain. Methods The study was conducted in 172 patients with residual knee pain after total knee arthroplasty. The patients were examined to determine whether they experienced pain upon palpation at nine regions surrounding

The immune microenvironment in ductal carcinoma in situ (DCIS) and its significance are not well established. This study was conducted to evaluate the immune microenvironment of DCIS including the composition of tumor-infiltrating lymphocyte (TIL) subsets and PD-L1+ immune cells and to compare it with that of invasive breast cancer. A total of 671 cases including three different disease groups of pure

Background Clinical trials are expensive and often require funding from the pharmaceutical industry (PI). We aimed to compare studies funded by the PI with studies funded by other sources in terms of costs, reported results and strength of evidence. Methods We searched PubMed for clinical trial reports on metastatic NSCLC published between 2012 and 2017. We divided all studies into two groups: studies

Suresh Agarwal Hasan B. Alam Karim Alavi

In Reply We thank Tian et al for their letter and interest in our article.1 We agree with the authors that ex vivo lung perfusion (EVLP), regardless of platform, has consistently been shown to provide short-term outcomes similar to those of conventional lung transplantation.2,3 In our article, we focused on the longer-term outcomes, and these too were similar between EVLP-treated and non-EVLP donor

To the Editor We read with great interest the article by Divithotawela et al,1 which demonstrated the posttransplant long-term outcomes were similar between ex vivo lung perfusion (EVLP)–treated lung transplant (LTx) and standard LTx, although the quality of donor lungs was worse with EVLP-treated LTx. To our knowledge, this study is the largest study of EVLP and includes 230 EVLP cases. We congratulate