World journal of surgery
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World journal of surgery · Jun 2014
Factors affecting success rate of Advanced Trauma Life Support (ATLS) courses.
The aim of the present study was to define the factors that affect passing the assessments for successful completion of the Advanced Trauma Life Support (ATLS) Provider Courses in the United Arab Emirates (UAE). ⋯ Prior knowledge and preparation is essential to passing the ATLS exam. Doctors who deal clinically with all aspects of airway, breathing, and circulation of the ATLS course are more likely to pass the MCQ exam in our setting, followed by those who usually manage only the circulation or disability aspects of ATLS. It is possible that the interactive approach to teaching ATLS has improved the overall ATLS success rate.
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World journal of surgery · Jun 2014
Review Meta AnalysisEnhanced recovery program in colorectal surgery: a meta-analysis of randomized controlled trials.
Meta-analyses in the literature show that enhanced recovery after surgery (ERAS) is associated with lower morbidity rate and shorter hospital stay after elective colorectal surgery. However, a recent Cochrane review did not indicate the ERAS pathway as being the new standard of care due to the limited number of published trials, together with their poor quality. We conducted a meta-analysis of randomized controlled trials (RCTs) to assess the impact of the ERAS pathway on overall morbidity, single postoperative complications, length of hospital stay, and readmission rate following colorectal surgery. ⋯ The ERAS pathway reduced overall morbidity rates and shortened the length of hospital stay, without increasing readmission rates. A significant reduction in nonsurgical complications was evident, while no significant reduction was found for surgical complications.
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World journal of surgery · Jun 2014
Review Meta Analysis Comparative StudyThe acute surgical unit model verses the traditional "on call" model: a systematic review and meta-analysis.
The acute surgical unit (ASU) is a novel model for the provision of emergency general surgery care. The ASU model was initially developed in New South Wales hospitals during 2005 and 2006. Several studies have analysed the effects on patient outcomes and timeliness of care for nontrauma patients presenting with acute general surgical conditions. The purpose of this study was to perform a meta-analysis to determine the efficacy of the ASU model compared with the traditional on-call model for specific conditions. ⋯ The ASU model provides a safe surgical environment for patients and is associated with a reduced complication rate for appendectomy and laparoscopic cholecystectomy for acute cholecystitis. There is a reduced conversion rate and a shorter length of stay for patients with acute cholecystitis. Overall, the ASU model has translated to better outcomes for patients presenting with acute general surgical conditions.
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World journal of surgery · Jun 2014
ALPPS for patients with colorectal liver metastases: effective liver hypertrophy, but early tumor recurrence.
Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is a promising method to increase resectability rates of liver tumors. Little has been published about oncological results so far. This report describes clinical evidence regarding a possible effect of ALPPS on tumor recurrence. ⋯ The patient group operable only through ALPPS is at high risk for recurrence and early tumor progression. Still, this new method is the only chance for an oncological treatment strategy including a surgical approach and possibly better outcome.
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World journal of surgery · Jun 2014
The ALPPS procedure: a surgical option for hepatocellular carcinoma with major vascular invasion.
Hepatocellular carcinoma (HCC) tends to have a particular invasiveness toward the portal vein (PV) branches and hepatic veins. This situation can hamper major surgical resection with a risk of postoperative liver failure due to the small future liver remnant (FLR) in cirrhotic livers. These patients are then usually directed to palliative treatments with poor results. The associating liver partition and PV ligation (PVL) in staged hepatectomy (ALPPS) strategy is one of the main surgical innovations in recent years in the field of liver surgical oncology. The ALPPS approach could allow surgical resection in patients with HCC and associated major vascular invasion. ⋯ This novel strategy could expand the number of patients undergoing major liver resections that were previously considered non-resectable because of the risk of liver decompensation for an insufficient FLR.