A study of patients with pancreatic cancer found that 31% were initially diagnosed with
gastroesophageal refux disease or gallbladder disease, which in some cases led to cholecystectomy.
Pancreatic cancer frequently
mistaken for gallbladder disease
for bariatric surgery
comes of age
Components studied to refine protocol.
BY PATRICE WENDLING
Frontline Medical News
As the Enhanced Recovery After Surgery (ERAS) proto- col moves beyond its roots in colorectal surgery into ther major surgical domains, its role in bariatric surgery is being refned.
Practices such as avoiding opiates and early discharge
have been a part of bariatric surgery for the last 10 years.
“What’s becoming more apparent is bundling all the elements and using them as a unit,” said Dr. John Magaña
Morton, president of the American Society for Metabolic
and Bariatric Surgery (ASMBS). Dr. Morton is an ACS Fellow and chief of bariatric and minimally invasive surgery
at Stanford (Calif.) University.
Two-day discharge from morbid obesity surgery is
broadly implemented, refecting the fact that almost all primary bariatric surgery is now laparoscopic. This compares
with about 40% of cases nationally for colorectal surgery.
The American College of Surgeons (ACS) and the
ASMBS combined their respective national bariatric surgery accreditation programs into a single unifed program
to achieve one national accreditation standard for bariatric surgery centers, the Metabolic and Bariatric Surgery
Accreditation and Quality Improvement Program (MB-
VOL. 11 • NO. 8
Pre s orte d Sta n d ard
banon Jct. K Y
A C S Surgery N e ws C H A N G E SE R VIC E R E Q U ES T E D
151 Fairchild Ave.,
S uite 2,
Plainvie w, N Y 11803-1709
See Bariatric Â page 4
8 l Practice Economics
Value-based payment brings
legal risks for physicians.
16 l General Surgery
Surgical follow-up after emergency
department gallstone episides reduced
22 l Endocrine Surgery
ATA guidelines focus on pediatric
Online & In-Depth
Four preop variables predict
mortality in ruptured AAAs
Dr. Ty Garland explains the need
for predictive tools and their value
to surgeons who must counsel
BY ELIZABETH MECHCATIE
Frontline Medical News
WASHINGTON – Initial misdiagnoses were
common and were associated with a later
disease stage at diagnosis, in a study of 313
patients diagnosed with pancreatic cancer, Dr.
Douglas Swords said at the annual Digestive
“By far, the most common misdiagnosis
was gallbladder disease,” and there was about
a 3-month longer time period, on average,
from the frst visit to a physician to the actual
cancer diagnosis, in patients who were initial-
ly misdiagnosed, said Dr. Swords, a surgery
resident at the University of Utah, Salt Lake
In the series of 313 patients diagnosed with
pancreatic cancer, 98 (31.3%) were initially
misdiagnosed, with a total of 119 diagnoses
other than pancreatic cancer, he said. The
most common misdiagnosis was gallbladder
disease, which led to a cholecystectomy in
38 cases, followed by gastroesophageal refux
disease in 15 cases, and peptic ulcer disease in
See Pancreatic Â page 2
The Rural Surgeon:
The burden of transfer
Dr. Glenn L. Levine gives us a glimpse into the
process of deciding when to transfer a critically
ill patient from a small rural hospital.
Â Page 5