Annals of surgery
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Comparative Study
Laparoscopic versus open intersphincteric resection and coloanal anastomosis for low rectal cancer: intermediate-term oncologic outcomes.
To compare the surgical outcome and intermediate oncological outcomes for laparoscopic versus open intersphincteric resection (ISR). ⋯ Laparoscopic ISR can be performed safely and offers a minimally invasive sphincter-sparing alternative. The oncological adequacy of laparoscopic ISR requires long-term follow-up data, but the intermediate-term outcomes seem equivalent to those achieved with OS.
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To explore the prevalence of and to identify possible risk factors for chronic pain after surgery for femoral hernia. ⋯ Chronic postoperative pain is as important a complication after femoral hernia surgery as it is after inguinal hernia surgery. In contrast to inguinal hernia surgery, no risk factor related to surgical technique was found. Further investigations into the role of preoperative pain are necessary.
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This study aimed to assess the attributable risk and potential benefit of smoking cessation on surgical outcomes. ⋯ This is the first study to assess the risk of current versus prior smoking on surgical outcomes. Despite being younger and healthier, current smokers had more adverse perioperative events, particularly respiratory complications. Smoking cessation interventions could potentially reduce the occurrence and costs of adverse perioperative events.
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To determine the impact of the Centers for Medicare and Medicaid Services' (CMS) bariatric surgery national coverage decision (NCD) on the use, safety, and cost of care CMS beneficiaries. ⋯ The NCD was associated with a temporary reduction in procedure rate and a shift in types of procedures and patients undergoing bariatric surgery. It was associated with a significant decrease in the risk of death, complications, readmissions, and per patient payments.
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To prospectively examine the clinical role of routine repeat computed tomographic scans of the brain (CTB) in patients with traumatic head injury. ⋯ No patients from our cohort with a "routine" repeat CTB required a change in management. Given the costs and potential risks of routine repeat CTB, and lack of demonstrable benefit, the practice should be reconsidered. Repeat CTB is clearly indicated in patients with deteriorating neurological status, especially younger and more severely head-injured patients.