Annals of surgery
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Data on the incidence of recurrent adhesive small bowel obstruction (ASBO) following index admission for ASBO in children are limited. We sought to determine if operative management was associated with a lower rate of recurrence compared to non-operative management (NOM). ⋯ Although the rate of recurrent ASBO in children is nearly 15% within one year, this rate does not differ based on the initial management strategy. Among children with recurrent ASBO, one-third underwent an urgent or emergent operation at readmission. NOM appears to be as effective in preventing recurrent ASBO as surgery.
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We analyzed perioperative outcomes of patients undergoing pancreatectomy with portal vein resection for pancreatic cancer using temporary intraoperative mesoportal or mesocaval bypass. ⋯ Temporary intraoperative venous bypass graft first techniques are important surgical approaches for safe resection of advanced pancreatic tumors. Mesoportal and mesocaval shunts are both safe with comparable postoperative morbidity and mortality rates. The decision for mesoportal versus mesocaval bypass should be made according to the anatomy, particularly taking into account the extent of arterial involvement and the potential need for concomitant arterial resection.
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The aim of this study was to evaluate pre-resection risk factors for neurodevelopmental impairment (NDI) in infants with necrotizing enterocolitis (NEC) that might better inform the timing of intestinal resection. ⋯ Risk for NDI in surgical NEC was associated with the number and trajectory of identification of indicators of metabolic derangement prior to resection. As these indicators progressively appear over hours to days, their assessment might offer an objective means of defining failure of medical management and lead to improvement in neurodevelopmental outcomes in NEC.
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To perform a cost-analysis during the implementation of robot-assisted pancreatoduodenectomy (RPD) in a high-volume center. ⋯ Implementing RPD is associated with considerable additional costs compared to OPD. With growing experience, both the outcomes and cost-efficiency of RPD improve, with costs decreasing by approximately a third, leading to similar costs as OPD. Large scale randomized trials will have to confirm these findings.
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To determine whether ACS NSQIP risk calculator (RC) accuracy can be improved by incorporating CPT codes beyond the principal code. ⋯ While the current RC, relying on XGB and the principal CPT code, remains a viable approach to routine surgical risk assessment, an advanced version of the RC, based on the CATB algorithm and accommodating multiple CPT codes, may provide more accurate estimates.