Annals of surgery
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Multicenter Study
Characterization and Optimal Management of High-Risk Pancreatic Anastomoses During Pancreatoduodenectomy.
The aim of this study was to identify the optimal fistula mitigation strategy following pancreaticoduodenectomy. ⋯ The scenarios identified by the high-risk FRS zone represent challenging anastomoses associated with markedly elevated rates of fistula. Externalized stents and omission of prophylactic octreotide, in the setting of intraperitoneal drainage and pancreaticojejunostomy reconstruction, provides optimal outcomes.
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The aim of this study was to report the utilization and experience of the nurse telephonic triage service for after-hour patient calls in Neurosurgery. ⋯ CAS has been able to provide well-coordinated care to Neurosurgery patients while reducing physician workload.
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Comment Letter
Surveillance of Surgical Meshes in Ventral Hernias and Unpredictability of the Their History.
: The authors read the article "The importance of registries in the postmarketing surveillance of surgical meshes" by Kockerling et al, and they completely agree on the role of a clinical follow-up of surgical meshes even if they suggest that a surveillance longer than one year is advisable, particularly in IPOM repair, to collect not only late complications but also more serious adverse events. This seems be the only way to properly assess the safety of the mesh.
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To determine the role of reoperation in patients with persistent or recurrent Zollinger-Ellison Syndrome (ZES). ⋯ These results demonstrate that a significant proportion of patients with ZES will develop resectable persistent or recurrent disease after an initial operation. These patients generally have prolonged survival after reoperation and 25% can be cured with repeat surgery, suggesting all ZES patients postresection should have systematic imaging, and if tumor recurs, advise repeat operation.
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We sought to characterize patterns of communication extrinsic to a decision aid that may impede goal-concordant care. ⋯ A decision aid alone may be insufficient to facilitate a decision that is truly shared. Attention to elements beyond provision of treatment information has the potential to improve communication and promote goal-concordant care for seriously ill older patients.