Annals of surgery
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Randomized Controlled Trial Multicenter Study
Effect of the World Health Organization checklist on patient outcomes: a stepped wedge cluster randomized controlled trial.
Implementing the WHO Safe Surgery Checklist may reduce morbidity, length of stay and mortality, although many questions remain.
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A preoperative weight-reducing regimen is usually adhered to in most centers performing bariatric surgery for obesity. The potential to reduce postoperative complications by such a routine is yet to be defined. ⋯ Weight loss before bariatric surgery is associated with marked reduction of risk of postoperative complications. Moreover, the degree of risk reduction seems to be related to amount of weight lost and patients in the higher range of BMI are likely to benefit most from preoperative weight reduction.
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The aim of the study was to compare the short- and long-term outcomes of colopharyngoplasty and esophagocoloplasty for caustic injuries of the upper digestive tract. ⋯ Overall Kaplan-Meyer survival at 1, 5, and 10 years after colopharyngoplasty and esophagocoloplasty were 92%, 74%, 67% and 92%, 83%, 73%, respectively (P = 0.56). Quality of life and functional results (success: 57% vs 95%, P < 0.0001) were impaired after colopharyngoplasty. On multivariate analysis, older age (odds ratio [OR]: 0.94; confidence interval [CI]: 0.91-0.97 P < 0.0001) and pharyngeal reconstruction (OR: 0.05; CI: 0.02-0.13, P < 0.0001) were associated with failure. The decline in success with age was more pronounced after colopharyngoplasty with only 1 (7%) of 15 patients operated after the age of 55 being self-sufficient for eating and breathing. Laryngeal resection during colopharyngoplasty had no influence on success (54% vs 58%, P = 0.67) CONCLUSIONS:: The need to associate pharyngeal reconstruction during esophageal reconstruction for caustic injuries has a long-term negative impact on functional outcome.
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Randomized Controlled Trial
Randomized controlled trial of the use of a large-pore polypropylene mesh to prevent incisional hernia in colorectal surgery.
To reduce the incidence of incisional hernia (IH) in colorectal surgery by implanting a mesh on the overlay position. ⋯ The incidence of IH is high in patients undergoing elective or emergency surgery for colorectal diseases. The addition of a prophylactic large-pore polypropylene mesh on the overlay position decreases the incidence of IH without adding morbidity.