The British journal of surgery
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Randomized Controlled Trial Comparative Study Clinical Trial
Prospective randomized trial comparing postoperative pain and return to physical activity after transabdominal preperitoneal, total preperitoneal or Shouldice technique for inguinal hernia repair.
In a prospective randomized study postoperative pain, analgesic consumption, return to physical activity and work, cosmetic result and experience with the type of operation were assessed in 86 patients undergoing inguinal hernia repair by means of either the Shouldice technique (n = 34), the laparoscopic transabdominal preperitoneal (TAPP) (n = 28) or total preperitoneal (TPP) (n = 24) repair. Patients having TAPP repair had decreased visual analogue scale scores for pain on the day of operation compared with those undergoing TPP and Shouldice repair (4.8 versus 6.5 and 6.2 respectively, P = 0.02) and on the first postoperative day compared with TPP (4.0 versus 6.0, P = 0.01). ⋯ There was a better cosmetic result after TAPP and TPP repair. This study failed to demonstrate significant benefits from laparoscopic hernia repair over the Shouldice technique.
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This study is a retrospective review of 17 patients aged 16 and under with a total of 18 goitres, who were investigated and treated at Bristol Children's Hospital and Bristol Royal Infirmary between 1967 and 1994. There were five neoplasms, comprising follicular adenoma (three) and papillary carcinoma (two). Other benign causes of goitre included nodular goitre (four), non-toxic hyperplasia (three) and chronic lymphocytic thyroiditis (three). The authors suggest some guidelines to help in the diagnosis and management of goitre in young patients, as a consequence of significant difficulties encountered in 12 of the 17 patients in this series.
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A total of 653 referrals from general practitioners to an acute surgical service were audited prospectively over a period of 4 months. Middle-grade staff accepting these referrals were able to deal with 182 (27.9 per cent) of these cells without surgical admission. ⋯ The resultant cost saving was approximately 10,000 pounds. This confirms that the ready provision of an experienced surgical opinion in combination with early assessment can reduce the number of unnecessary acute surgical admissions referred from general practitioners.
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Fifteen Beagle dogs underwent oesophagogastric anastomosis with a new device which enables a 'sutureless' compression anastomosis. The device fragmented and was passed in bits anally without causing obstruction. ⋯ The anastomoses of the remaining dogs were examined macroscopically and microscopically from day 6 to day 30. Healing was excellent with good muscular apposition and minimal residual inflammation.
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Randomized Controlled Trial Clinical Trial
Prospective randomized trial comparing sequential avulsion with stripping of the long saphenous vein.
Eighty patients with primary varicose veins of the long saphenous system were randomized to have the long saphenous vein removed either by stripping to below the knee or by sequential avulsion. There was no difference between the two methods in the time taken to remove the vein. ⋯ Median area of bruising measured at 1 week was 160 (range 0-1800) cm2 for stripping and 56 (range 0-544) cm2 for sequential avulsion (P < 0.01). Sequential avulsion is less painful, reduces bruising and avoids a significant scar below the knee.