Annals of surgery
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Differences in opinion exist as to the feasibility of establishing sustainable laparoscopic programs in resource-restricted environments. At the request of local surgeons and the Ministry of Health in Botswana, a training program was established to assist local colleagues with laparoscopic surgery. We reviewed our multifaceted and evolving international collaboration and highlighted those factors that have helped or hindered this program. ⋯ A contextually appropriate long-term partnership may assist with laparoscopic upskilling of colleagues in low- and middle-income countries. This type of collaboration promotes local ownership and may translate into better patient outcomes associated with laparoscopic surgery. In resource-restricted environments, the factors threatening sustainability may differ from those in high-income countries and should be identified and addressed.
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To elucidate clinical mechanisms underlying variation in hospital mortality after cancer surgery ⋯ Low mortality and high mortality hospitals are distinguished less by their complication rates than by how frequently patients die after a complication. Strategies for ensuring the timely recognition and effective management of postoperative complications will be essential in reducing mortality after cancer surgery.
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Meta-analyses are useful tools for summarizing surgical evidence as they aim to encompass multiple sources of information on a particular research question, but they may be prone to methodological and reporting biases. We evaluated the conduct and reporting of meta-analyses of surgical interventions. ⋯ Substantial gaps in the conduct and reporting of meta-analyses within the surgical literature exist, mainly in the specification of aims and/or objectives, the use of preplanned protocols, and the evaluation of potential bias at the review (rather than trial) level. Editorial insistence on using reporting guidelines would improve this situation.
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This study describes the cause, management, and outcomes of abdominal injury in a mature deployed military trauma system, with particular focus on damage control, hollow visceral injury (HVI), and stoma utilization. ⋯ Damage control is now used routinely for battlefield abdominal trauma. In a well-practiced Combat Support Hospital, this strategy is associated with low mortality and infrequent fecal diversion.
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To establish a structured international expert consensus on a detailed technical description of the laparoscopic total mesorectal excision (TME). ⋯ This detailed and agreed technical description of laparoscopic TME may have implications on training, assessment, quality control, and future research.