American journal of surgery
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Several modifications of the classic retromuscular Stoppa technique to facilitate dissection beyond the lateral border of the rectus sheath recently were reported. We describe a novel technique of transversus abdominis muscle release (TAR) for posterior component separation during major abdominal wall reconstructions. ⋯ Our novel technique for posterior component separation was associated with a low perioperative morbidity and a low recurrence rate. Overall, transversus abdominis muscle release may be an important addition to the armamentarium of surgeons undertaking major abdominal wall reconstructions.
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The Accreditation Council for Graduate Medical Education implemented new intern work-hour regulations in July 2011 that have unique implications for surgical training at Veterans Affairs (VA) medical centers. Implementation of these new regulations required profound restructuring of trainee night coverage systems at many VA medical centers. This article offers approaches and potential solutions to the Accreditation Council for Graduate Medical Education regulations used by different surgery programs throughout the country that are applicable to the VA training environment. ⋯ The public expects the medical community to produce safe, experienced surgeons, while demanding they are well rested and directly supervised at all times. The ability to meet these expectations can be challenging.
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The increasing complexity of medical and surgical care often demands comprehensive preoperative work-ups by medical consultants and detailed management recommendations to optimize the patient's medical ailments before surgery. This article aims to review the available evidence and discuss elements of the preoperative medical consultation that are of particular relevance to surgeons. ⋯ Collaborative efforts and adequate communication between the medical and surgical teams are necessary to ensure appropriate patient management before surgery. Although higher-risk patients may require thorough preoperative evaluations, extensive routine investigations may not always be necessary.
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Comparative Study
Management of colorectal anastomotic leakage: differences between salvage and anastomotic takedown.
The aim of this study was to evaluate and compare the morbidity associated with 2 strategies of treatment of colorectal anastomotic leakage: surgical drainage of anastomosis with loop ileostomy versus anastomotic takedown. ⋯ Salvage of anastomosis with loop ileostomy is an effective strategy to control peritoneal sepsis for colorectal anastomotic leakage.