Surgical Infection Society Guidelines for Antibiotic Use in Patients Undergoing Cholecystectomy for Gallbladder Disease.

Background: Manifestations of gallbladder disease range from intermittent abdominal pain (symptomatic cholelithiasis) to potentially life-threatening illness (gangrenous cholecystitis). Although surgical intervention to treat acute cholecystitis is well defined, the role of antibiotic administration before or after cholecystectomy to decrease morbidity or mortality is less clear. Methods: The Surgical Infection Society's Therapeutics and Guidelines Committee convened to develop guidelines for antibiotic use in patients undergoing cholecystectomy for gallbladder disease to prevent surgical site infection, other infection, hospital length of stay, or mortality. PubMed, Embase, and the Cochrane Database were searched for relevant studies. Evaluation of the published evidence was performed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) system. Using a process of iterative consensus, all authors voted to accept or reject each recommendation. Results: We recommend against routine use of peri-operative antibiotic agents in low-risk patients undergoing elective laparoscopic cholecystectomy. We recommend use of peri-operative antibiotic agents for patients undergoing laparoscopic cholecystectomy for acute cholecystitis. We recommend against use of post-operative antibiotic agents after elective laparoscopic cholecystectomy for symptomatic cholelithiasis. We recommend against use of post-operative antibiotic agents in patients undergoing laparoscopic cholecystectomy for mild or moderate acute cholecystitis. We recommend a maximum of four days of antibiotic agents, and perhaps a shorter duration in patients undergoing cholecystectomy for severe (Tokyo Guidelines grade III) cholecystitis. Conclusions: This guideline summarizes the current Surgical Infection Society recommendations for antibiotic use in patients undergoing cholecystectomy for gallbladder disease.

Creating a Rural Surgery Track and a Review of Rural Surgery Training Programs.

OBJECTIVE: The objective of this study was to present the process of developing a rural surgery training track within an established residency program and review the current rural surgery training programs in the nation. DESIGN: This study reviews current rural surgery training opportunities at Accreditation Council for Graduate Medical Education accredited surgical residencies in the United States and presents the process of creating the University of Minnesota's rural surgery training track. SETTING: This study was performed at the University of Minnesota, in Minneapolis, Minnesota, and at Essentia Health-Saint Mary's Medical Center, in Duluth, Minnesota. PARTICIPANTS: Accredited general surgery residencies were reviewed. The creation of a designated rural surgery training track added an additional rural-designated surgical resident during each postgraduation year and created a required postgraduation year 2 rural surgery rotation for all categorical surgical residents. RESULTS: Two hundred sixty-eight surgery residency programs were reviewed. Twenty-seven had required rural rotations, 10 offered only elective rural rotations, and 4 had dedicated National Resident Matching Program codes for rural training tracks. After review of national rural surgery training opportunities, the University of Minnesota's process of creating a designated rural surgery training program required attention to 5 main components: needs assessment and review of local opportunities, surgery residency review committee approval, funding, surgical education, and clinical/operative education. CONCLUSIONS: Increasing opportunities for surgical residents to train in rural settings may help with recruitment of medical students and retention of surgeons pursuing careers in rural surgery.

Tensile testing as a novel method for quantitatively evaluating bioabsorbable material degradation.

Bioabsorbable metallic materials have become a topic of interest in the field of interventional cardiology because of their potential application in stents. A well-defined, quantitative method for evaluating the degradation rate of candidate materials is currently needed in this area. In this study, biodegradation of 0.25-mm iron and magnesium wires was simulated in vitro through immersion in cell-culture medium with and without a fibrin coating (meant to imitate the neointima). The immersed samples were corroded under physiological conditions (37°C, 5% CO(2)). Iron degraded in a highly localized manner, producing voluminous corrosion product while magnesium degraded more uniformly. To estimate the degradation rate in a quantitative manner, both raw and corroded samples underwent tensile testing using a protocol similar to that used on polymeric nanofibers. The effective ultimate tensile stress (tensile stress holding constant cross-sectional area) was determined to be the mechanical metric that exhibited the smallest amount of variability. When the effective tensile stress data were aggregated, a statistically significant downward, linear trend in strength was observed in both materials (Fe and Mg) with and without the fibrin coating. It was also demonstrated that tensile testing is able to distinguish between the higher degradation rate of the bare wires and the lower degradation rate of the fibrin-coated wires with confidence.