Acta Chir Belg
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Infiltration of a local anesthetic to provide postoperative analgesia is a frequently used method. However the infiltrated agents may have negative effects on wound healing. This study aimed to investigate the effects of tramadol, a weak opioid with a local anesthetic effect, on wound healing. ⋯ It was concluded that tramadol infiltration in a surgical incision site has no adverse effect on wound healing.
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Randomized Controlled Trial
Influence of postoperative fluid management on pulmonary function after esophagectomy.
The aim of this study was to investigate the effects of a restrictive vs. a liberal postoperative fluid therapy guided by intrathoracic blood volume index (ITBVI) on hemodynamic and pulmonary function in patients undergoing elective esophagectomy. Perioperative fluid therapy may influence postoperative physiology and morbidity after esophageal surgery. Definitions of adequate infusion amounts and evident rules for a fluid therapy are missing. ⋯ ITBVI guided restrictive infusion therapy yields a lower fluid uptake, but may not result in a difference of clinical relevant parameters. A fluid restriction after esophagectomy should always be combined with hemodynamic monitoring because additional infusions may be required.
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We present the case of a 17-year old male patient with a symptomatic congenital posterolateral diaphragmatic hernia with acute onset of symptoms. He was admitted to our emergency department a few days after the onset of symptoms. A large thoracic herniation on the left side was seen on chest X-ray. ⋯ Semi-urgent surgery was performed by a laparoscopic approach. The diaphragmatic defect was closed with interrupted sutures. The operation and postoperative recovery were uneventful.
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Laparo-endoscopic single site cholecystectomy receives great interest from the surgical community. It has potential for reducing postoperative pain, length of hospital stay and improving cosmesis. Minimally invasive surgeons have been forced to develop techniques for providing adequate retraction of the gallbladder. Herein, we describe a new retraction technique to improve the dissection of Calot's triangle. ⋯ Adequate retraction greatly simplifies laparo-endoscopic single site cholecystectomy. New retraction techniques will enable wider use of this novel minimally invasive approach. Further work is needed to investigate the advantages of this new technique.
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A traumatic abdominal wall hernia (TAWH) is an uncommon complication of abdominal trauma. Handlebar hernia is an even rarer type of traumatic abdominal wall hernia, with only 33 previously reported cases in literature. It is caused by a local trauma with a handlebar-like object which is not sharp enough to penetrate the elastic skin, but has sufficient focused force to breach the muscle and fascia of the abdominal wall. ⋯ Early repair is mandatory to avoid complications. The choice for primary repair versus mesh repair will be discussed according to the size of the hernia and the amount of tissue destruction by the trauma. The type of mesh used for the repair will be determined by presence or absence of contamination in the abdomen.