International journal of surgery
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Laparoscopic Adjustable Gastric Banding (LAGB) is a safe and effective treatment for obesity. A strong evidence links weight loss with improved fertility outcomes and reduced gestational complications in subsequent pregnancies. Our aim is to describe the impact of LAGB on maternal and neonatal outcomes. ⋯ LAGB is a safe procedure, well tolerated during pregnancy and without negative implications on both the mother and the baby. According to our experience and recent studies, band loosening should be reserved to symptomatic patients to avoid unhealthy weight gain.
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Comparative Study
Hemostatic efficacy of a novel, PEG-coated collagen pad in clinically relevant animal models.
Currently available hemostatic pads are effective in treating oozing bleeds, but otherwise ineffective in more severe bleeding. This study investigates the hemostatic efficacy of a new hemostatic pad with advanced sealing properties using protein-reactive polyethylene glycol-coated collagen (PCC, Hemopatch) versus an oxidized regenerated cellulose (ORC, Tabotamp/Surgicel Original) in a leporine arterial bleeding model of vascular reconstruction and a porcine hepatic model of general surgery. ⋯ PCC provided faster hemostasis than ORC in a vascular and hepatic surgical model with impaired coagulation.
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Operation notes are the only comprehensive account of what took place during surgery. Accurate and detailed documentation of surgical operation notes is crucial, both for post-operative management of patients and for medico-legal clarity. The aims of this study were to compare operation documentation against the Royal College of Surgeons of England guidelines and to compare the before-and-after effect of introducing an electronic operation note system. ⋯ We used our pilot audit to target specific information that was commonly omitted and we 'enforced' these areas using drop-down selections in electronic operation note. This study has demonstrated that implementation of an electronic operation note system markedly improved the quality of documentation, both in terms of information detail and readability. We would recommend this template system as a standard for operation note documentation.
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Sometimes even in adequate graft to recipient weight ratio (GRWR) settings and after ruling out all other causes, recipients still show features of the small for size syndrome. The purpose of this study was to evaluate all causative factors responsible for early graft dysfunction fulfilling the definition of the small for size syndrome, regardless of the GRWR status, and with particular emphasis on portal flow (ml/min/100 g). We also tried to establish whether a high portal flow on intraoperative Doppler study immediately after reperfusion can predict graft dysfunction. ⋯ A portal vein flow immediately after reperfusion >190/ml/min/100 g. reliably predicted whether a graft would behave as small for size or not, regardless of the GRWR status. Portal vein flow was the most significant predictor of graft dysfunction.
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Oesophageal resection is notoriously complicated and produces a cohort of patients prone to postoperative complications. Maintaining quality care demands a systematic approach to patient management yet postoperative recovery after oesophagectomy is often needlessly inefficient, heterogeneous and governed by the idiosyncrasies of the operating surgeon. Enhanced recovery after surgery (ERAS) programmes are now well established in colorectal surgery and here we describe the implementation and effectiveness of an ERAS programme for the postoperative management of Ivor Lewis oesophago-gastrectomy (ILOG). ⋯ The introduction of an ERAS programme after ILOG can significantly reduce TLOS without jeopardising patient safety or clinical outcomes. The successful introduction of an ERAS programme requires full motivation and support from all team members including the patient.