American journal of surgery
-
Incisional hernia (IH) remains a very frequent postoperative complication. The 2 techniques most frequently used are the onlay repair and sublay repair. However, it remains unclear which technique is superior. ⋯ Although the majority of the included studies were retrospective studies, sublay repair seems the preferred technique for IH repair.
-
Penetrating cardiac injuries (PCI) causing tamponade causes subendocardial ischemia, arrhythmias, and cardiac arrest. Pericardial drainage is an important principle, but where drainage should be performed is debated. We hypothesize that drainage in the emergency department (ED) does not delay definitive repair. ⋯ ED pericardial drainage for PCI did not appear to delay operation and had an acceptably low mortality rate. Pericardial drainage is a viable option for stabilization before definitive surgery when surgical intervention is not immediately available in the hemodynamically marginal patient.
-
The presence of a vermiform appendix in an inguinal hernia sac is known as Amyand's hernia. The aim of this systematic review was to gather information concerning its prevalence, clinical image, diagnosis, and treatment. ⋯ The true prevalence of Amyand's hernia seems lower than classically described. Its usual clinical image is identical to that of an incarcerated hernia, and thus it is almost impossible to diagnose preoperatively, although ultrasound and computed tomography can help. Treatment includes hernioplasty with or without appendectomy and/or mesh repair depending on the vermiform appendix's inflammation status, the patient's general condition, and other factors. Amyand's hernia generally has a good prognosis, although serious complications have been described. Surgeons should be prepared if they encounter Amyand's hernia because appropriate treatment ensures hernia repair without complications and with avoidance of recurrence.
-
The aim of this study was to assess the prognostic value of metastatic lymph node (LN) ratio (MLNR) in stage III rectal cancer and whether this prognostic value remains significant when <12 LNs are retrieved. ⋯ MLNR is an independent prognostic factor for recurrence and survival after the resection of stage III rectal cancer, with high sensitivity and specificity in patients who received neoadjuvant chemoradiation and postoperative chemotherapy. The total number of LN retrieved did not affect the prognostic value of MLNR even if <12.
-
Multicenter Study
Successful interventions to reduce first-case tardiness in Dutch university medical centers: results of a nationwide operating room benchmark study.
First-case tardiness is still a common source of frustration. In this study, a nationwide operating room (OR) Benchmark database was used to assess the effectiveness of interventions implemented to reduce tardiness and calculate its economic impact. ⋯ Nationwide benchmarking can be applied to identify and measure the effectiveness of interventions to reduce first-case tardiness in a university hospital OR environment. The implemented interventions in 4 centers were successful in significantly reducing first-case tardiness.