International journal of surgery
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Surgically correctable pathology accounts for a sizeable proportion of the overall global burden of disease. Over the last decade the role of surgery in the public health agenda has increased in prominence and attempts to quantify surgical capacity suggest that it is a significant public health issue, with a great disparity between high-income, and low- and middle-income countries (LMICs). Although barriers such as accessibility, availability, affordability and acceptability of surgical care hinder improvements in LMICs, evidence suggests that interventions to improve surgical care in these settings can be cost-effective. ⋯ In this article, we discuss the current burden of global surgical disease and explore some of the barriers that may be encountered in improving surgical capacity in LMICs. We go on to consider the role that international organisations can have in improving surgical care globally. We conclude by discussing surgery as a global health priority and possible solutions to improving surgical care globally.
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Review Meta Analysis
Preoperative infliximab use and postoperative complications in Crohn's disease: a systematic review and meta-analysis.
Infliximab revolutionized the treatment paradigm of Crohn's disease (CD), but did not reduce the need for surgery. The impact of biologic agents on surgical complication rates remains debated. The aim of this study was to determine the effect of preoperative infliximab use on early postoperative complications in patients with CD undergoing abdominal surgery. ⋯ Preoperative infliximab use modestly increases the risk of total early postoperative complications, and particularly infectious complications in CD patients.
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Review
Benign cystic neoplasm and endocrine tumours of the pancreas--when and how to operate--an overview.
The recent evolution of limited local operative procedures for benign pancreatic lesions shifted surgical treatment options to the application of local techniques, although major resections of pancreatic head and left resection are still the standard. ⋯ The application of tumour enucleation, pancreatic middle segment resection and duodenum preserving subtotal or total pancreatic head resection are associated with low level surgery related early post-operative complications and a very low hospital mortality. The major advantage of the limited procedures is preservation of exo- and endocrine pancreatic functions.
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This best evidence topic was investigated according to a described protocol. The question asked was: should patients on acetylsalicylic acid (ASA) for secondary prevention stop or continue the medication prior to elective, abdominal surgery. Using the reported search 826 papers were found of which five represented the best evidence to answer the clinical question. ⋯ This heterogeneity in methodology makes it difficult to draw justifiable conclusions from the data. However, it appears that continuing ASA isn't associated with excessive bleeding. Further adequately powered trials with well-defined end points are needed to answer this important clinical question.
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Partial hepatectomy with clear surgical margins is the main curative treatment for hepatic malignancies. The safety of liver resection, to a great extent, depends on the volume of future liver remnant. This manuscript reviews some important strategies that have been developed to increase resectability for patients with borderline volume of future liver remnant, particularly associating liver partition and portal vein ligation for staged hepatectomy (ALPPS). ⋯ ALPPS has emerged as a new strategy to increase resectability of hepatic malignancies. Due to high morbidity and mortality rates of ALPPS procedure, the surgical candidates should be selected carefully. Moreover, there are very limited available evidence for its technical feasibility, safety and oncological outcome which are needed for further evaluation in larger scale of studies.