International journal of surgery
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Comparative Study
Incisional hernia rates following laparoscopic colorectal resection.
In published series with satisfactory follow-up incisional hernia rates following laparotomy vary between 4 and 18%, with up to 75% developing within two years of operation. This therefore represents the commonest complication following open abdominal surgery and a substantial added workload for the colorectal/general surgeon. ⋯ The well-documented advantages of laparoscopic surgery include reduced hospital stay, early return to activity, decreased analgesic requirements and improved cosmesis. However, the results of this study suggest that incisional hernia rates are not decreased by laparoscopic surgery, although the hernias may be smaller and more amenable to repair by laparoscopic approaches.
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Acute appendicitis is one of the most commonly encountered surgical problems in everyday practice. With the recent increase in popularity of single incision laparoscopic surgery (SILS), several techniques for SILS appendectomy have already been described. We herein describe our own simplified technique for single incision transumbilical laparoscopic appendectomy. ⋯ Our technique for single incision laparoscopic transumbilical appendectomy is safe feasible, and reproducible. Prospective randomized studies comparing the single incision laparoscopic approach with its conventional multiport counterpart are necessary to confirm the conclusions of our early experience.
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Peri-operative monitoring technology has made great strides in the last 20 years with the introduction of minimally invasive devices to measure inter alia stroke volume, cardiac output, depth of anaesthesia and cerebral and tissue oxygen monitoring. Despite these technological advances, peri-operative management of the high risk major surgery patient has remained virtually unchanged. The vast majority of patients undergo a pre-operative assessment which is neither designed to quantify functional capacity nor predict outcome. ⋯ It is perhaps not surprising that outcome still remains poor in high-risk patients.(1) In this review, we will briefly describe the role of peri-operative optimization, some of the available monitors and indicate how their combined use might be beneficial in managing the high-risk surgical patient. We believe that although there is now evidence to suggest that the use of individual new monitors (such as assessment of fluid status, depth of anaesthesia, tissue oxygenation and blood flow) can influence outcome, it will only be their combination that will radically improve the peri-operative management and outcome of high-risk surgical patients. It is a matter of some urgency that large scale, prospective and collaborative studies be designed, funded and executed to prove or disprove this hypothesis.
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Randomized Controlled Trial Comparative Study
Evaluation of recurrent laryngeal nerve monitoring in thyroid surgery.
Thyroidectomy creates a potential risk for all parathyroid glands and nerves. Nerve identification has decreased the rates of nerve injury during thyroidectomy. Intraoperative nerve monitoring (IONM) has been used as an adjunct to the visual identification of the nerve. The aim of this clinical trial is to evaluate the effect of the identification time of RLN during thyroidectomy using IONM. ⋯ Although the operating time was lower with IONM than with visualization alone, the shortened surgical time may not seem to have great clinical relevance. However, the shorter the nerve is identified the lower is the surgeon's level of stress. We think that it is important to use IONM to decrease the identification time of RLN in the course of thyroidectomy.
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Comparative Study
Emergency laparoscopic cholecystectomy in an unselected cohort: a safe and viable option in a specialist centre.
Patients presenting acutely with symptomatic gallstone-related disease have historically had their laparoscopic cholecystectomy (LC) deferred due to perceived increased operative risks in the acute setting, particularly conversion to open surgery. The aim of this study was to compare morbidity and mortality between unselected cohorts of patients undergoing elective and 'emergency' LC in a District General Hospital. ⋯ When performed by specialist laparoscopic surgeons, LC in the acute setting is safe with mortality and morbidity rates, including conversion to open surgery, comparable to elective LC.