Background and Aims:The lack of consensus on how to define and grade adverse postoperative events has greatly hampered the evaluation of surgical procedures. A new classification of complications, initiated in 1992, was updated 5 years ago. It is based on the type of therapy needed to correct the co

The Clavien-Dindo classification of surgical complications: five-year experience.

https://aasldpubs.onlinelibrary.wiley.com/doi/epdf/10.1053/jhep.2001.22172

A model to predict survival in patients with end‐stage liver disease

https://globalhealth.duke.edu/sites/default/files/event-attachments/2.18_meara.pdf

Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development

Background The technical skill of surgical trainees is not well assessed. This study aimed (1) to compare the reliability of three scoring systems, (2) to compare live and bench formats and (3) to assess construct validity of a test of operative skill.

Methods Parallel examinations of operative skill, one using live animals and one using simulations, were developed. Performance was graded using operation-specific checklists, detailed global rating forms and pass/fail judgements. Twenty surgical residents each took both formats.

Results Disattenuated correlations between live and bench scores were high (0.69–0.72). Mean inter-rater reliability across stations ranged from 0.64 to 0.72. Internal consistency was moderate to high (α: 0.61–0.74) for the live format using the checklist and for live and bench formats using global ratings. Global ratings discriminated between resident levels for both formats (bench: F(2,17) = 4.45, P < 0.05; live: F(2,17) = 3.5, P < 0.05), checklists did not.

Conclusion This preliminary study suggests that the Objective Structured Assessment of Technical Skill can reliably and validly assess surgical skills. Global ratings are a better method of assessment than task-specific checklists. Bench model simulation gives equivalent results to use of live animals for this test format.

Objective structured assessment of technical skill (OSATS) for surgical residents.

Consensus statement on the pathology of IgG4-related disease

Summary Resection was carried out in 118 patients for periampullary lesions. Ninety-eight of these were adenocarcinomas and were treated by the Whipple operation, total pancreatectomy, or local resection (87 patients, 7 patients, and 4 patients, respectively). Diagnosis of pancreatic head carcinoma before resection was falsely positive in 27 percent of the patients. Mortality for radical resection was 4 percent. Five year survival for ampullary carcinoma was 32 percent, and for pancreatic head carcinoma it was 7 percent. Resection of all periampullary tumors is recommended, with the Whipple operation being the standard in most cases.

Periampullary tumors: which ones should be resected?

https://www.gastrojournal.org/article/0016-5085(85)90502-5/pdf

Further Report of a Prospective Randomized Trial Comparing Distal Splenorenal Shunt With End-to-Side Portacaval Shunt An Analysis of Encephalopathy, Survival, and Quality of Life

Background Budd-Chiari syndrome is an uncommon disorder caused by obstruction to hepatic venous outflow, causing varying degrees of hepatic injury depending on the extent, severity, and acuity of the obstruction. Patients and methods We reviewed the Indications for operative intervention and the results of treating 32 patients with Budd-Chiari syndrome seen at Toronto Hospital between 1968 and 1995. Results Twenty-one patients underwent porto-systemic shunt (PSS) and 7 patients underwent liver transplantation (LT) as their initial operative management. Three patients who initially had PSS subsequently required LT. Patients with cirrhosis found on biopsy and preservation of hepatocellular function were treated with PSS and showed no difference in outcome when compared with patients without cirrhosis ( P = 0.35). Patients who were treated by PSS with retrohepatic vena caval compression, as shown by high caval gradients had outcomes similar to those for patients with low gradients ( P = 0.31). Using the Kaplan-Meier method, 5-year survival of PSS patients was 57%. Liver transplantation was used to manage patients with hepatic decompensation, as well as patients with vena caval occlusion or failed PSS. The 5-year Kaplan-Meier survival for LT was 67%. Conclusions Both PSS and LT are effective options in the management of Budd-Chiari syndrome. Portosystemic shunt is the preferred initial approach even with cirrhosis or retrohepatic caval compression as long as there is preservation of liver function and a patent vena cava. Liver transplantation should be used as primary therapy for patients with irreversible hepatic decompensation or vena caval occlusion, and it can be an effective salvage procedure following failed PSS.

Treatment of Budd-Chiari syndrome with portosystemic shunt or liver transplantation

The results and complications in our first 23 consecutive patients receiving the peritoneovenous shunt for intractiable hepatic ascites are presented. A good initial diuretic effect was obtained in 20 of the 23 patients, with reversal of hepatorenal failure in 3 of 5 patients. The postoperative complication rate was high (74 percent). Infection, coagulopathy and complication of the underlying liver disease contributed to a mortality rate of 26 percent. Late complications were related to the primary liver disease. The 6 month survival rate was 58 percent and the 1 hear survival rate 52 percent with five patients followed up for more than 2 years. Because of the significant morbidity and mortality associated with the peritoneovenous shunt, we recommend it only for patients with massive intractable hepatic ascites whose condition is refractory to maximal medical therapy.

Bryce R. Taylor

Papers

Periampullary tumors: which ones should be resected?

Further Report of a Prospective Randomized Trial Comparing Distal Splenorenal Shunt With End-to-Side Portacaval Shunt An Analysis of Encephalopathy, Survival, and Quality of Life

Treatment of Budd-Chiari syndrome with portosystemic shunt or liver transplantation

Complications after peritoneovenous shunting for ascites

Carcinoma of the extrahepatic bile ducts: results of an aggressive surgical approach.