Journal of the American College of Surgeons
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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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Limited data exist for the use of nasogastric decompression after pancreaticoduodenectomy (PD), when postoperative nasogastric tube (NGT) use remains the standard of care. This study seeks to evaluate the effects on patient outcomes of routine vs selective NGT use after PD. ⋯ Routine postoperative nasogastric decompression in patients undergoing PD appears unnecessary in many cases, and can adversely impact postoperative course. Selective NGT usage seems an appropriate treatment strategy.
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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.
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Cross-leg flaps are a good choice for reconstructing traumatized lower extremities, especially when free flaps cannot be used. In this article, we present our experience in the treatment of traumatic lower extremity wounds by using cross-leg flaps. ⋯ The cross-leg flap is an effective and simple method for treating traumatic lower extremity wounds. It should have priority over microsurgery, not just be an alternative to it.
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Due to its short duration of therapy and low rates of local recurrence, women undergoing breast conservation are increasingly opting for partial breast irradiation with the MammoSite (Cytyc/Hologic) catheter. In early follow-up studies, few complications were reported. Few data, however, exist regarding longer-term complications. We compared the long-term local toxicities of MammoSite partial breast irradiation with those resulting from whole breast radiation. ⋯ Palpable masses and telangiectasias are frequent long-term complications after MammoSite brachytherapy and occur at a significantly higher rate after MammoSite brachytherapy than after WBRT. This increased rate of long-term local toxicity should be considered when counseling women on options for adjuvant radiation therapy after breast-conserving surgery.