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GENERALSURGERYNEWS.COM
August 2013 • Volume 40 • Number 8
The Independent Monthly Newspaper for the General Surgeon
Opinion
The Constitution And the ACA B Y J ON C. W HITE , MD
W
hen people mention the Constitution and the Affordable Care Act (ACA) in the same sentence, they are usually commenting on the legality of the ACA and whether its methods are consistent with laws either contained or derived by the Constitution. This commentary usually comes in the form of a tribute to the legislative genius behind the ACA or a vitriolic denunciation of the scoundrels who trampled the U.S. Constitution. This editorial is neither. Rather, it is a reflection on how these two documents have historical similarities, suggesting that the ACA will ultimately be accepted and fine-tuned like the Constitution. On the other hand, their dissimilarities point out certain critical weaknesses of Obamacare.
Prehospital Aspiration Puts Patients at Higher Risk For Developing Pneumonia Health Care–Associated Pneumonia in Trauma Patients Greatly Affected By Events Before Arrival at Hospital B Y C HRISTINA F RANGOU
O
ne of the deadliest typees of hospital-acquired infection ns in adult trauma patients is set in motion long before patients arrive at the hospital, according to a study reported at the 2013 meeting of the Surgical Infection Society. A study involving surgeons and paramedics showed that trauma patients who aspirate before they get to the hospital have a fourfold increased risk for developing health care–associated pneumonia (HCAP) and a more than threeefold increased risk for ventilator-associated pneumonia (VAP).
see PNEUMONIA page 18
How the ACA Is Like the Constitution The U.S. Constitution was negotiated and written over the course of four months by the Second Constitutional Convention. It was based on the core principles of natural rights, espoused by
Study Suggests Gastric Bypass Causes Glucose Spikes, Crashes
see CONSTITUTION page 21
FROM THE BENCH TO THE BEDSIDE Collaboration Between the Anesthesia and Surgical Teams In the Perioperative Setting see page 8
More Overlap Means Fewer Hernia Recurrences Size and Placement of Mesh Key to Success B Y C HRISTINA F RANGOU ORLANDO, FLA A.—When Karl LeBlanc, MD, MBA A, FACS, a private practice general surgeon in Baton Rouge, La., p performed the world’s first lap paroscopic ventral hernia rrepair in 1991, he aimed for a mesh overlap of about 1 cm. Tw wenty years later, he shaakes his head at the notion off a 1-cm overlap. A growing body of evidence suggests that a larger mesh overlap, along with symmetrical placement of the mesh, result in far fewer hernia recurrencees, Dr. LeBlanc said at the 15th Annual Hernia Repair Meeting. “Increasingly, we’re looking at the more overlap, the better, when it comes to recurrence,” said Dr. LeBlanc, who has amassed one of the largest volumes of see MESH OVERLAP page 22
B Y M ONICA S MITH
D
espite its reputation as the gold standard for weight loss, gastric bypass surgery may result in a post-meal glucose spike followed by a blood sugar crash that causes between-meal hunger, according to a new study. The research
examined the effects of different bariatric procedures on post-meal glucose reactions. Mitchell S. Roslin, MD, FACS, Lenox Hill Hospital, New York City, and his colleagues first became
INSIDE In the News
Surgeons’ Lounge
In the News
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Experts Discuss a Controversial Topic: Local Excision or Nonoperative Management for Rectal Cancer
Single-Incision Laparoscopic Cholecystectomy Linked to Higher Hernia Rates in Published Study
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A case of a patient with a pseudocyst; the use of fluorescenceguided surgery.
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see GASTRIC BYPASS page 15
REPORT Clinical Perspectives on Using Advanced Vessel-Sealing Technology: Experience With the Multifunctional THUNDERBEAT TM Device See insert at page 12