Journal of the American College of Surgeons
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Randomized Controlled Trial Comparative Study Clinical Trial
Wound closure technique and acute wound complications in gastric surgery for morbid obesity: a prospective randomized trial.
During the past 10 years, numerous clinical studies have supported the use of continuous monofilament fascial closure after laparotomy. Because of the increased incidence of surgical-site infections and other acute wound complications in the morbidly obese, these patients are well suited for a study of technical factors that may affect the frequency of these wound complications. ⋯ Continuous fascial closure reduces major acute wound complications in morbidly obese patients undergoing gastric operations for obesity.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
The first randomized trial of human polymerized hemoglobin as a blood substitute in acute trauma and emergent surgery.
Human polymerized hemoglobin (PolyHeme) is a universally compatible, disease-free, oxygen-carrying resuscitative fluid. This is the first prospective, randomized trial to compare directly the therapeutic benefit of PolyHeme with that of allogeneic red blood cells (RBCs) in the treatment of acute blood loss. ⋯ PolyHeme is safe in acute blood loss, maintains total [Hb] in lieu of red cells despite the marked fall in RBC [Hb], and reduces the use of allogeneic blood. PolyHeme appears to be a clinically useful blood substitute.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Prevention of postoperative abdominal adhesions by a sodium hyaluronate-based bioresorbable membrane: a prospective, randomized, double-blind multicenter study.
Postoperative abdominal adhesions are associated with numerous complications, including small bowel obstruction, difficult and dangerous reoperations, and infertility. A sodium hyaluronate and carboxymethylcellulose bioresorbable membrane (HA membrane) was developed to reduce formation of postoperative adhesions. The objectives of our prospective study were to assess the incidence of adhesions that recurred after a standardized major abdominal operation using direct laparoscopic peritoneal imaging and to determine the safety and effectiveness of HA membrane in preventing postoperative adhesions. ⋯ This study represents the first controlled, prospective evaluation of postoperative abdominal adhesion formation and prevention after general abdominal surgery using standardized, direct peritoneal visualization. In this study, HA membrane was safe and significantly reduced the incidence, extent, and severity of postoperative abdominal adhesions.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparative clinical study of port-closure techniques following laparoscopic surgery.
Recently, a number of laparoscopic port-closure techniques have been reported to avoid the complications associated with the port closure after laparoscopic surgery. To evaluate these port-closure techniques, we compared seven new laparoscopic port-closure techniques with the standard technique of a hand-sutured closure. ⋯ The Carter-Thomason device is our preferred method for the closure of port sites after laparoscopic surgery.
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Randomized Controlled Trial Comparative Study Clinical Trial
A prospective randomized comparison of the metabolic and stress hormonal responses of laparoscopic and open cholecystectomy.
In a relatively short period of time, therapeutic laparoscopy has become an everyday part of the general surgeon's life. Although laparoscopy provides distinct clinical advantages, it is not yet clear that it lessens the stress response typical of elective surgical procedures, and as such, the morbidity of surgery. The hypothesis that laparoscopic cholecystectomy produces less of a metabolic and stress hormonal response than open cholecystectomy was tested in a prospective randomized trial. ⋯ Elective laparoscopic and open cholecystectomy for uncomplicated cholelithiasis result in similar degrees of perioperative hormonal stimulation. The different hormonal responses in the immediate and later postoperative periods after laparoscopic and open cholecystectomy suggest differential stressful stimuli between the two procedures.