Journal of the American College of Surgeons
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After the first case of per-oral endoscopic myotomy (POEM) at our institution in 2008, the procedure was quickly accepted as an alternative to surgical myotomy and is now established as an excellent treatment option for achalasia. This study aimed to examine the safety and outcomes of POEM at our institution. ⋯ Per-oral endoscopic myotomy was successfully completed in all cases, even when extended indications (extremes of age, previous interventions, or sigmoid esophagus) were used. Adverse events were rare (3.2%), and there were no mortalities. Significant improvements in Eckardt scores and LES pressures were seen at 2 months, 1 year, and 3 years post-POEM. Based on our large series, POEM is a safe and effective treatment for achalasia; there are relatively few contraindications, and the procedure may be used as either first- or second-line therapy.
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We investigated the rate of persistent and recurrent hyperparathyroidism after focused unilateral exploration (UE) with intraoperative monitoring of intact parathyroid hormone (IOPTH). ⋯ The low rate of recurrent PHP after focused unilateral exploration with IOPTH suggests that this procedure should not be abandoned.
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The number of renal columns invaded by tumor (NRC) can determine the tumor complexity and perioperative outcomes of off-clamp open partial nephrectomy (OPN). We aimed to propose a novel and simple scoring system and examine the relationship between NRC and perioperative outcomes after off-clamp OPN. ⋯ The number of renal columns invaded by tumor is a novel, intuitive, and practical parameter that could be used to quantify renal tumor complexity and predict the risk of perioperative outcomes after off-clamp OPN. Specifically, NRC correlates with estimated blood loss, operative time, surgical complications, renal function, and conversion to on-clamp. In the future, NRC can be integrated with other parameters, such as tumor location, to assemble a new scoring system.
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Surgical management of liver lesions has moved toward "parenchymal-sparing" strategies. Although open parenchymal-sparing liver resections are supported by encouraging results, the applicability of the laparoscopic approach for nonperipheral tumors is still questionable. Our aim was to assess the feasibility, safety, and oncologic adequacy of laparoscopic parenchymal-sparing liver resection for nonperipheral lesions with a description of the technique adopted in this setting. ⋯ Laparoscopic parenchymal-sparing liver resections for nonperipheral liver lesions are feasible and can be performed safely without compromising perioperative and oncological outcomes.
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The purpose of this study was to examine the impact of the sequential implementation of the enhanced recovery program (ERP) and surgical site infection bundle (SSIB) on short-term outcomes in colorectal surgery (CRS) to determine if the presence of multiple standardized care programs provides additive benefit. ⋯ Sequential implementation of the ERP and SSIB provided incremental improvements in CRS outcomes while controlling hospital costs, supporting their combined use as an effective strategy toward improving the quality of patient care.