J Visc Surg
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Multicenter Study Observational Study
Preventable deaths in a French regional trauma system: A six-year analysis of severe trauma mortality.
Analyzing mortality in a mature trauma system is useful to improve quality of care of severe trauma patients. Standardization of error reporting can be done using the classification of the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO). The aim of our study was to describe preventable deaths in our trauma system and to classify errors according to the JCAHO taxonomy. ⋯ Standardization of error reporting is the first step to improve the efficiency of trauma systems. Preventable deaths are frequently related to clinical performance in the early phase of trauma management. Universal strategies are necessary to prevent or mitigate these errors.
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Multicenter Study Comparative Study
Feasibility of selective non-operative management for penetrating abdominal trauma in France.
In France, non-operative management (NOM) is not the widely accepted treatment for penetrating wounds. The aim of our study was to evaluate the feasibility of NOM for the treatment of penetrating abdominal traumas at 3 hospitals in the Southeast of France. ⋯ Implementation of NOM of penetrating trauma is feasible and safe in France. Indications may be extended even for some GSW. Clinical criteria are clearly defined but CT scan criteria should be better described to improve patient selection. NOM reduced costs and length of hospital stay.
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Multicenter Study
Total midgut volvulus in adults with intestinal malrotation. Report of eleven patients.
Total small-intestinal volvulus with malrotation (TSIVM) classically presents in the neonatal period; it occurs much less frequently in the adult and is often misdiagnosed. Prognosis is directly related to the degree and duration of intestinal ischemia. Our goal is to describe our experience with TSIVM in the adult, to identify any specific findings and to discuss its management. ⋯ TSIVM is a very unusual finding in adult patients. The diagnosis can be made by CT scan with IV and oral contrast, but it often comes to light only at the time of surgery, even though the patients have often had recurrent episodes of abdominal symptomatology that dated back to childhood. The Ladd procedure, consisting of division of Ladd's bands, widening of the mesentery, and incidental appendectomy, remains the standard surgical repair. Digestive surgeons who care for adults should be familiar with this procedure, and it should be performed, as often as possible, with the assistance of a pediatric surgeon.
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Multicenter Study Clinical Trial
Totally extraperitoneal (TEP) endoscopic inguinal hernia repair with TAP (transversus abdominis plane) block as a day-case: a prospective cohort study.
Totally extraperitoneal (TEP) endoscopic inguinal hernia repair is indicated for recurrent and bilateral inguinal hernias and traditionally is performed under general anesthesia. However, interventions that minimize pain and reduce opioid consumption have certain advantages for patients by avoiding side effects such as nausea and vomiting. The transversus abdominis plane (TAP) block has been used to minimize pain in a diverse range of surgical procedures but its safety on patients undergoing TEP repair has yet to be investigated. ⋯ These preliminary results suggest that day-case endoscopic hernia repair (TEP) with TAP block without curare is effective, safe, reproducible and can be proposed in all patients.
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Multicenter Study Comparative Study
Is non-operative management of severe blunt splenic injury safer than embolization or surgery? Results from a French prospective multicenter study.
The management of the severe blunt splenic injuries remains debated. The aim of this study is to evaluate the morbidity and mortality of splenic injury according to severity and management (surgery, embolization, non-operative management [NOM]). ⋯ Embolization, because of its important specific morbidity, should not be performed as a prophylactic measure, but only in presence of clinical or laboratory signs of bleeding.