World journal of surgery
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World journal of surgery · Aug 2011
Randomized Controlled Trial Comparative StudyEarly postoperative and one year results of a randomized controlled trial comparing the impact of extralight titanized polypropylene mesh and traditional heavyweight polypropylene mesh on pain and seroma production in laparoscopic hernia repair (TAPP).
Today the main goals of inguinal hernia repair are maximum postoperative comfort and a minimal rate of chronic pain. This randomized trial compares these parameters after laparoscopic hernia repair (TAPP) using an extralight titanized polypropylene mesh (ELW group) TiMesh(®) 16 g/m(2) without any fixation with those using a standard heavyweight mesh (HW) Prolene 90 g/m(2) fixed in a standardized way with two absorbable sutures. ⋯ Use of titanized ELW mesh for laparoscopic hernia repair did not affect the rate of chronic pain but it seems to improve early postoperative convalescence. Its use without any fixation can be recommended in TAPP for inguinal hernia patients with a defect size ≤3 cm.
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World journal of surgery · Aug 2011
Rwandan surgical and anesthesia infrastructure: a survey of district hospitals.
In low-income countries, unmet surgical needs lead to a high incidence of death. Information on the incidence and safety of current surgical care in low-income countries is limited by the paucity of data in the literature. The aim of this survey was to assess the surgical and anesthesia infrastructure in Rwanda as part of a larger study examining surgical and anesthesia capacity in low-income African countries. ⋯ This survey provides strong evidence of the need for continued development of emergency and essential surgical services at district hospitals in Rwanda to improve health care and to comply with World Health Organization recommendations. It has identified serious deficiencies in both financial and human resources-areas where the international community can play a role.
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World journal of surgery · Aug 2011
Long-term health-related quality of life for disease-free esophageal cancer patients.
Health-related quality of life (HRQL) has been studied extensively during the first year following esophagectomy, but little is known about HRQL in long-term survivors. The aim of this study was to investigate HRQL in patients alive at least 1 year after surgical resection for esophageal cancer using validated European Organisation for Research and Treatment of Cancer (EORTC) quality of life (QOL) questionnaires (QLQ). ⋯ Global health status remains significantly reduced in long-term survivors after esophagectomy compared with population controls, and swallowing dysfunction is highly associated with this compromised QOL.
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World journal of surgery · Aug 2011
Comparative StudyLaparoscopic simple closure alone is adequate for low risk patients with perforated peptic ulcer.
Helicobacter pylori (H.P.) eradication has led to a significant decline in peptic ulcer prevalence; however, the number of patients requiring surgical intervention remains relatively unchanged. Laparoscopy suture repair is the most commonly used procedure for perforated peptic ulcer (PPU). Whether omental patch adds any benefit than simple closure alone is not answered. ⋯ In terms of leakage rate and surgical outcome, the maneuver to cover an omental patch on the repaired PPU did not show additional advantages compared to simple closure alone. Further prospective randomized study is required to clarify the safety and feasibility of simple closure alone without buttressing an omentum patch.
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World journal of surgery · Aug 2011
Swan-Ganz catheter use in trauma patients can be reduced without negatively affecting outcomes.
The use of pulmonary artery catheter (PAC) is controversial. The purpose of this study was to document the changing pattern of PAC use and to determine its effect on outcome. ⋯ The use of PAC has decreased almost 10-fold over the last decade at our institution. The PAC is being used later during the ICU course and for a shorter period of time. In a matched population, the use of PAC is associated with a significantly higher mortality and complication rate, but the reason for this association remains uncertain. The use of PAC is invasive and is associated with known complications and financial costs. While the use of PAC maybe useful in a select population, routine and widespread use of the PAC should be avoided.