International journal of surgery
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Randomized Controlled Trial
Pain after surgery: can protective analgesia reduce pain? A randomised clinical trial.
To improve the patients postoperative pain experience using protective analgesia for patients undergoing third molar surgery under day case general anaesthesia. ⋯ There was no difference in the protective analgesia group compared with conventional analgesia group in improving postoperative pain experience. A different protective analgesia regime may be necessary, which employs a more aggressive and multimodal strategy for postoperative pain management.
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Randomized Controlled Trial Comparative Study
Prophylactic antibiotics in open mesh repair of inguinal hernia - a randomized controlled trial.
The role of prophylactic antibiotics in mesh repair of inguinal hernia is unclear. A Cochrane meta-analysis in 2005 concluded that "antibiotic prophylaxis for elective inguinal hernia repair cannot be firmly recommended or discarded" and "further studies are needed, particularly on the use for mesh repair." So, we designed a study to define the role of prophylactic antibiotics in mesh repair of inguinal hernia. We conducted a prospective, randomized, double-blind, trial comparing wound infection rates in 450 patients (225 received intravenous Cefazolin, 225 received a placebo) undergoing primary inguinal hernia repair electively using polypropylene mesh. 334 patients who completed a followup period of one month were analyzed. ⋯ Most of the infections occurred between the 7th and 12th post-operative day after discharge from the hospital. Antibiotic prophylaxis was associated with decreased incidence of wound infection when compared to control group, but the difference was not statistically significant. Based on our results we do not recommend the routine use of antibiotic prophylaxis in elective mesh repair of inguinal hernias.
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Surgery is increasingly becoming an integral part of public health and health systems development worldwide. Such surgical care should be provided at the same type and level in both urban and rural settings. However, provision of essential surgery in remote and rural areas of developed as well as low and middle income countries remains totally inadequate and poses great challenges. ⋯ The best means of bringing surgical care to rural dwellers is yet to be clearly determined. However, modern surgical techniques integrated with the strategy as outlined by the World Health Organization can be brought to rural areas through specially organized camps. Sophisticated surgery can thus be performed in a high-volume and cost-effective manner, even in temporary settings. However, provision of essential surgery to rural and remote areas can only partly be met both in developed and in low and middle income countries and it will take years to solve the problem of unmet surgical needs in these areas.
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Obesity is fast becoming one of the world's leading health problems and together with its many associated medical sequelae significantly increases morbidity and mortality. In this review, we briefly explore the history of bariatric surgery, the benefits of surgery and the various procedures carried out.
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Comparative Study
Emergency laparoscopic cholecystectomy in an unselected cohort: a safe and viable option in a specialist centre.
Patients presenting acutely with symptomatic gallstone-related disease have historically had their laparoscopic cholecystectomy (LC) deferred due to perceived increased operative risks in the acute setting, particularly conversion to open surgery. The aim of this study was to compare morbidity and mortality between unselected cohorts of patients undergoing elective and 'emergency' LC in a District General Hospital. ⋯ When performed by specialist laparoscopic surgeons, LC in the acute setting is safe with mortality and morbidity rates, including conversion to open surgery, comparable to elective LC.