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Biliary Tract and Pancreas Part, II

Selected Readings in General Surgery Cover ImageVol. 44, No. 8

  • Gallbladder Polyps
  • Gallbladder Cancer
  • Caroli Disease
  • The Role of Liver Transplantation
  • Chronic Pancreatitis
  • Pancreas Transplantation
  • Neuroendocrine Tumors
  • Intraductal Papillary Mucinous Neoplasms of the Pancreas
  • Pancreatic Cancer
  • Ampullary Adenocarcinoma
  • Solid Pseudopapillary Tumors of the Pancreas
  • Postoperative Pancreatic Fistulas
  • Pancreatic Fistulas and Pancreatitis
  • Outcomes of Pancreas Surgery

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Featured Commentary

The online formats of SRGS include access to What You Should Know (WYSK): commentaries on articles published recently in top medical journals. These commentaries, written by practicing surgeons and other medical experts, focus on the strengths and weaknesses of the research, as well as on the articles' contributions in advancing the field of surgery.

Below is a sample of one of the commentaries published in the current edition of WYSK.

DiMaggio C, Avraham J, Berry C, et al. Changes in US mass shooting deaths associated with the 1994-2004 federal assault weapons ban: Analysis of open-source data. J Trauma Acute Care Surg. 2019 Jan;86(1):11-19. doi: 10.1097/TA.0000000000002060.

Commentary by: Lenworth Jacobs, MD, FACS

The epidemic of mass casualty shooting deaths is a major problem for the United States. It not only affects the victims and their families, but it is distressing to the psyche of the nation. The epidemic must be seen through the lens of a public health epidemic. It is essential to determine the causes of the epidemic, the factors that cause its propagation, and then determine appropriate methods to stop the epidemic.

In the same way that the Anopheles mosquito is the vector for malaria, and Dr. John Snow’s identification of the water pump on Broad Street in London England as the key determinant in identifying that contaminated water was the cause of the Cholera epidemic from 1846 to 1860, it is critical to identify the determinants of mass shooting deaths in the United States.

This epidemic has clinical, societal, constitutional, and legal implications. There is no doubt that gun violence is directly related to increasing deaths in the society. There has been a substantial debate as to whether it is the gun that is the main factor in this epidemic or the person who fires the gun that is the issue. This discussion rapidly devolves into a discussion of the Second Amendment right to bear firearms of any type and the importance of various methods to manage the procurement and usage of guns as well as the type of weapon used. Independent of the political and societal discussion about firearms, gun violence and mass shooting deaths are increasing.

The authors identified that this is an important problem that needs to be addressed in a scientific, analytical, and nonemotional way. They have used a public health approach and sophisticated statistical methodologies to identify if the 1994 to 2004 federal assault weapons ban was associated with an increase or decrease in mass shooting deaths. This thoughtful and carefully designed study obtained mass incidence shooting data from three independent and well-documented and referenced online sources (several previous studies have also been based on these same sources). DiMaggio et al. used the Federal Bureau of Investigation’s definition of mass shooting. These authors also defined an assault weapon as a semi- automatic rifle that incorporates military style features and high-capacity detachable magazines. The total number of mass shooting for fatalities were aggregated by year and merged with the yearly firearm homicide data.

The authors revealed that a federal assault weapons ban had been implemented in 1994; this ban made a defined set of automatic and semi-automatic weapons and large capacity magazines illegal. The ban expired in 2004. The fact that the ban was in place and then rescinded made for a pre-ban, ban, and post-ban analysis of firearm-related homicides. They also reviewed and discussed the incidence of firearm related deaths in those time periods.

The results in figure 3 and figure 4 of the article outlined the shooting deaths before, during, and after the assault weapon ban was imposed and then rescinded. The increase in deaths after the ban was rescinded is striking. Figure 4 is particularly relevant since it displays firearm-related homicides restricted to incidents involving assault weapons. The results show a clear relationship between the assault weapons ban and the deaths from assault weapons. Furthermore, incidents of assault weapon-related firearm deaths dramatically increased after the ban was removed and access to these weapons increased.

The authors in their discussion are careful to note that an assault weapon ban is not a panacea, nor does their analysis indicate that the ban will result in fewer firearm-related homicides; however, there is no doubt that mass-casualty shootings dramatically increased after the ban on assault weapons was rescinded. This well-reasoned, well thought out study clearly identified the assault weapon as an important vector in this epidemic. In any public health epidemiologic proposition, once an important vector that causes the epidemic is identified, strategies to minimize or decrease the vector must be implemented.

Recommended Reading

The editor has carefully selected a group of current, classic, and seminal articles for further study in certain formats of SRGS. The citations below are linked to their abstract on PubMed; free full-text is available where indicated.

SRGS has obtained permission from journal publishers to reprint these articles. Copying and distributing these reprints is a violation of our licensing agreement with these publishers and is strictly prohibited.

Adams DB. The Puestow procedure: how I do it. J Gastrointest Surg. 2013;17(6):1138–42.

Fong ZV, Ferrone CR, Lillemoe KD, Fernández-Del Castillo C. Intraductal Papillary Mucinous Neoplasm of the Pancreas: Current State of the Art and Ongoing Controversies. Ann Surg. 2016;263(5):908–17.

Hartwig W, Vollmer CM, Fingerhut A, et al. International Study Group on Pancreatic Surgery. Extended pancreatectomy in pancreatic ductal adenocarcinoma: definition and consensus of the International Study Group for Pancreatic Surgery (ISGPS). Surgery. 2014;156(1):1–14.