Canadian journal of surgery. Journal canadien de chirurgie
-
Randomized Controlled Trial Multicenter Study Comparative Study
Topical nifedipine with lidocaine ointment versus active control for pain after hemorrhoidectomy: results of a multicentre, prospective, randomized, double-blind study.
Spasm through the internal anal sphincter is one of the supposed causes for pain after hemorrhoidectomy, a common and distressing experience. We hypothesized that the addition of topical nifedipine to lidocaine would improve pain control by causing a relaxation of the smooth muscle of the internal anal sphincter. ⋯ Although there was no difference between groups for time of administration of rescue analgesic after open hemorrhoidectomy, the patients' assessment of pain using ACCS showed that the use of topical nifedipine with lidocaine may provide a slight significant difference in favour of the study group at 6 hours and at day 7 after surgery. Narcotic analgesics and nonsteroidal anti-inflammatory drug administration should continue to be recommended. Further research focusing on these outcomes is warranted.
-
Comparative Study
Five-year outcomes of laparoscopic adjustable gastric banding and laparoscopic Roux-en-Y gastric bypass in a comprehensive bariatric surgery program in Canada.
Bariatric surgery remains the most effective modality to induce sustainable weight loss in the morbidly obese. Our aim was to compare outcomes between the laparoscopic Roux-en-Y gastric bypass (LRYGBP) and the laparoscopic adjustable gastric banding device (LAGBD) method with 5-year follow-up in a Canadian bariatric surgery centre. ⋯ Laparoscopic weight loss surgery can be performed safely with acceptable mortality. Our study suggests superior weight loss and low revision requirement for the LRYGBP, making this a more durable procedure in a publicly funded health care system.
-
Waiting times to see a spinal surgeon are among the highest in Canada. However, most patients who are referred would not benefit from surgical care. Effective triaging of surgical candidates may reduce morbidity related to prolonged waiting times and optimize use of limited resources. ⋯ Use of the questionnaire when triaging patients may decrease the number of unnecessary referrals to spine surgeons. Adopting such a method of triaging could reduce waiting times for appropriate surgical candidates and potentially improve the outcomes of any resulting spinal surgery performed in a timely fashion.
-
Comparative Study
Impact of orthopedic trauma consolidation on resident education.
In July 2005, the Saskatoon Health Region, in conjunction with its orthopedic surgeons, consolidated its management of orthopedic emergencies from 3 sites to 1, resulting in trauma patients being directed to the university hospital site (Royal University Hospital; RUH) where orthopedic residents were the first responders. We sought to measure resident workload in the emergency department, operating room and ward before and after consolidation and to measure the perceptions of residents and faculty on the newly established orthopedic trauma service. ⋯ Sudden substantial increases in the volume of patients seen by orthopedic residents may not prompt negative resident responses when the overall gains offset, if not exceed, the perceived losses.