Surgery
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Prophylactic synthetic mesh can be safely used to close emergency laparotomies, even in peritonitis.
This study was conducted to determine the efficacy and safety of the use of a partially absorbable large pore synthetic prophylactic mesh in emergent midline laparotomies for the prevention of evisceration and incisional hernia. ⋯ The use of a partially absorbable, lightweight large pore prophylactic mesh in the closure of emergency midline laparotomies is feasible for the prevention of incisional hernia without adding a substantial rate of morbidity to the procedure, even if high contamination or infections are present.
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Ischemia-reperfusion injury (IRI) of the liver is a well-known cause of morbidity and mortality after liver transplantation. Effective treatment strategies aimed at decreasing hepatic IRI injury and accelerating liver regeneration could offer major benefits in liver transplantation, especially in the case of partial allografts. Human adipose-derived mesenchymal stem cells (HADMSCs) are an attractive source for regenerative medicine because of their anti-inflammatory and regenerative properties. We hypothesized that HADMSCs attenuate IRI and promote liver regeneration. ⋯ HADMSC represents a potential therapeutic strategy to decrease IRI and promote regeneration in liver transplantation.
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Preventable readmissions have become a focal point for controlling cost and improving quality in medicine. The frequency and causes of readmissions after liver transplantation (OLT) at 30 days and 1 year have not been described. We aimed to determine the risk factors, rate, and outcomes of readmissions within the first year after OLT and its potential impact on patient and graft survival. ⋯ Readmissions after OLT represent a significant health care burden, with 41% of patients readmitted within 30 days of discharge and 69% at 1 year. Readmittance is associated with worse long-term outcomes and significantly reduced patient and graft survival. These data confirm that further efforts are needed to predict and circumvent treatable causes for readmission to improve health care costs, quality, and ultimately survival after OLT.
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Readmission after complex gastrointestinal surgery is a frequent occurrence that burdens the health care system and leads to increased cost. Recent studies have demonstrated 30- and 90-day readmission rates of 15% and 19%, respectively, following pancreaticoduodenectomy. Given the psychosocial issues often associated with chronic pancreatitis, we hypothesized that readmission rates following surgery for chronic pancreatitis would be higher than previously reported for pancreaticoduodenectomy. ⋯ To our knowledge, our data represent the first report demonstrating very high readmission rates after surgery for chronic pancreatitis, more than double the previous rates reported for pancreaticoduodenectomy. This cohort of patients requires extensive discharge planning focused on pain control, nutritional optimization, and close postoperative monitoring.