Journal of the American College of Surgeons
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Randomized Controlled Trial Multicenter Study
A prospective, randomized, controlled trial of the efficacy and safety of fibrin pad as an adjunct to control soft tissue bleeding during abdominal, retroperitoneal, pelvic, and thoracic surgery.
This study evaluated the hemostatic effectiveness and safety of Fibrin Pad (Omrix Biopharmaceuticals Ltd.) vs absorbable hemostat in patients undergoing nonemergent surgery. Fibrin Pad is a topical absorbable hemostat designed to be effective in a variety of soft tissues and across multiple bleeding intensities. ⋯ Fibrin Pad is superior to absorbable hemostat (SURGICEL Original Absorbable Hemostat [Ethicon]) in soft-tissue bleeding control and is safe and effective as an adjunct for rapidly and reliably achieving hemostasis for soft-tissue bleeding during surgery.
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Identification of preoperative factors predictive of non-home discharge after surgery for epithelial ovarian cancer (EOC) may aid counseling and optimize discharge planning. We aimed to determine the association between preoperative risk factors and non-home discharge. ⋯ Identification of preoperative factors associated with non-home discharge can assist patient counseling and postoperative disposition planning.
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Comparative Study
Peroral endoscopic myotomy for the treatment of achalasia: a clinical comparative study of endoscopic full-thickness and circular muscle myotomy.
A circular muscle myotomy preserving the longitudinal outer esophageal muscular layer is often recommended during peroral endoscopic myotomy (POEM) for achalasia. However, because the longitudinal muscle fibers of the esophagus are extremely thin and fragile, and completeness of myotomy is the basis for the excellent results of conventional surgical myotomy, this modification needs to be further debated. Here, we retrospectively analyzed our prospectively maintained POEM database to compare the outcomes of endoscopic full-thickness and circular muscle myotomy. ⋯ Short-term symptom relief and manometry outcomes of each method were comparable. Full-thickness myotomy significantly reduced the procedure time but did not increase the procedure-related adverse events or clinical reflux complications.
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The propensity of desmoid tumors to develop in scars has led some surgeons to limit the complexity of desmoid defect reconstruction as a strategy for avoiding desmoid recurrence. We hypothesized that desmoid recurrence rates are similar despite the magnitude of reconstruction. ⋯ Rates of desmoid recurrence in resection defects are similar for primary closures and complex reconstructions. Therefore, surgeons should not limit the magnitude of reconstructions in an attempt to avoid tumor recurrence. However, given the propensity of desmoids to recur, reconstructions should allow for the possibility of future resections and reconstructions, particularly in tumors with 45F gene mutations.