Surgical endoscopy
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The aim of this study was to evaluate laparoscopic versus open surgery for suspected appendicitis during pregnancy. ⋯ This article is the largest hospital-based series evaluating the laparoscopic versus open approach for pregnant patients with presumed acute appendicitis. While methodological limitations preclude a definitive recommendation, laparoscopy appears to be a safe, feasible, and efficacious approach for pregnant patients with presumed acute appendicitis. We conclude that it is likely not the surgical approach but the underlying diagnosis combined with maternal factors that determine the risk for pregnancy complications. A benefit of laparoscopy is the diagnostic ability to identify other intra-abdominal pathology which may mimic appendicitis and harbor pregnancy risks.
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Self-expandable metallic stent (SEMS) for malignant colorectal obstruction is widely used in palliative treatment and as an alternative to surgery. The aims of this study are to evaluate the effectiveness of stent placement for palliative treatment and to identify the predictive factors associated with stent occlusion. ⋯ Uncovered SEMS placement is an effective palliative treatment for malignant colorectal obstruction. The degree of stent expansion 48 h after stent placement is significantly associated with the maintenance of stent patency and is a predictive factor for stent occlusion.
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Surgical-site infections (SSIs) are nosocomial infectious complications causing significant morbidity, mortality, and hospital costs. Recently, the US Department of Human Health Services and the Centers for Medicare and Medicare Services outlined measures intended to decrease and prevent hospital-acquired infections such as SSI. This study aimed to compare the incidence of SSI after laparoscopic and open surgery. ⋯ In US academic medical centers, laparoscopy significantly reduces SSI. Patients treated with laparoscopic procedures are less likely to experience SSI. After stratification by severity of illness, admission status, and wound classification, laparoscopic techniques showed a protective effect against SSI.