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40th Anniversary 1972-2012
GENERALSURGERYNEWS.COM
November 2012 • Volume 39 • Number 11
The Independent Monthly Newspaper for the General Surgeon
In the News
Radiofrequency May Be Alternative To Radiation After Breast Excision
Multispecialty Corner
Therapy for Barrett’s Esophagus:
What, When and in Which Patients? That Depends on Whom You Ask: General Surgeons, Thoracic Surgeons and Gastroenterologists Give Their Perspectives
B Y M ONICA J. S MITH PHOENIX X—The combination of excision and radiofrequency ablation (eRFA) of the lumpectomy site at the time of surgery may reduce the need for further operations and provide an inexpensive and accessible alternative to radiation therapy for breast cancer, according to research presented at the 2012 meeting of the American Society of Breast Surgeons (ASBrS).
‘The fact is it’s more important what I left behind than what I took out.‘ “Margin activity is the only prognostic factor that surgeons can affect,” said Misti Wilson, MD, University of Arkansas for Medical Sciences (UAMS), in Little Rock. “Studies have shown that [the] margin factor is the strongest predictor of local recurrence, which can range from 7% with negative margins to 27% in positive margins. But even with our best efforts, 20% to 40% of patients require re-excision for close or positive margins.” The biggest obstacle to achieving negative margins is that there is no way for a surgeon to be certain that he or she has attained that goal at the time of surgery, explained V. Suzanne Klimberg, MD, Muriel Balsam Kohn Chair in breast surgical oncology, UAMS, and president of ASBrS. see RADIOFREQUENCY page 22
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Within Three Days May Be W O Optimal, According to Study
B Y M AUREEN S ULLIVAN
O
ver the past decade, n new advancements in ablatioon therapy have expanded treat-ment options for patients with Barrett’s esophagus (BE). Introduced to clinical practice in 2005, radiofrequency ablation (RFA) is one of the most recent ablation techniquess available for the treatment of th his disease and is widely used in the medical community. Although studies are now em merging that provide evidence of the medium-term effectiveness of RFA, RFA controversy exists among medical see BARRETT'S ESOPHAGUS page 16
B Y J AMES E. B ARONE , MD
Endoscopic mucosal resection for Barrett’s esophagus. Courtesy of Prasad G. Iyer, MD, Mayo Clinic.
Benefits of SILS and NOTES as Bariatric Procedures Still Unproven Desire To Push the Envelope Needs To Be Balanced With Safety B Y M ONICA J. S MITH SAN DIEGO—The use of natural orifice translumenal endoscopic surgery (NOTES) and single-incision laparoscopic surgery (SILS) as techniques in bariatric surgery are still largely experimental and controversial, according to Ricardo Zorron, MD, PhD,
When Is Best To Operate on A Small-Bowel Obstruction?
director, Innovative Surgery Division, Klinikum Bremerhaven Reinkenheide, Bremerhaven, Germany. Speaking at a session on innovations in obesity and metabolic surgery at the 2012 meeting of the Society of
“Never let the sun to rise or set on a small bowel obstruction.” Although these words were written more than 100 years ago, some surgeons still believe them. But recent studies show that about B 775% of patients with a small-bowel obstruction will get better without surggery. So how many sunsets should you wait to operate? A paper presented at the 2012 annual m meeting of the American Association for tthe Surgery of Trauma suggests that surgeons probably should wait no longer than three days. In an email to General Surgery News, senior author Frederick H. Millham, MD, chair, Department of Surgery, Newton–Wellesley Hospital, in Newton, Mass., and associate professor of surgery at Harvard Medical School, in Boston, said, “[Small-bowel obstruction] is a complex problem. Some patients need surgery right away; some need it eventually; and some don’t need it at all. The first group tells us they see SMALL BOWEL PAGE 8
REPORT Clinical Experience Using Multifunctional LigaSure™ Small Jaw Instrument in Vessel Sealing Procedures
see BARIATRIC SILS page 25
see insert at page 16
INSIDE In the News
Surgeons’ Lounge
Letters
Early Surgery for Acute Cholecystitis Leads to Shorter Hospital Stays .................. 4
Analgesia care following reconstructive thoracic surgery after tumor extirpation ....................... 18
ER Call, Beeper Anxiety and Credit Ratings: Surgeons Voice Views on Recent Opinion Article .... 24