International journal of surgery
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Review
Strategies to reduce deep sternal wound infection after bilateral internal mammary artery grafting.
Deep sternal wound infections (DSWI) continue to be an infrequent but potentially devastating complication after cardiac surgical procedures. Its prevalence is more after coronary artery bypass grafting using single internal mammary artery (IMA) graft. Bilateral internal mammary artery (BIMA) harvesting carries a higher risk of sternal infection than harvesting single IMA. ⋯ Strategies that reduce DSWI target the modifiable risk factors that include microbiological factors, appropriate antibiotic prophylaxis, tight glycemic control. Surgical strategies to reduce DSWI following BIMA harvest include techniques of IMA harvesting with lesser devascularization of sternum using skeletonized, semiskeletonized and modified pedicle harvest are associated with greater preservation of sternal blood supply and sternal closure and stability techniques. The various strategies to minimize sternal wound infections during preoperative, intra and postoperative periods are summarized in this article.
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Randomized Controlled Trial
Comparative study between duct to mucosa and invagination pancreaticojejunostomy after pancreaticoduodenectomy: a prospective randomized study.
The ideal technical pancreatic reconstruction following pancreaticoduodenectomy (PD) is still debated. The aim of the study was to assess the surgical outcomes of duct to mucosa pancreaticojejunostomy (PJ) (G1) and invagination PJ (G2) after PD. ⋯ NCT02142517.
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To evaluate epidural analgesia role after cytoreductive surgery with peritonectomy combined with heated intraperitoneal chemotherapy. ⋯ Epidural analgesia ensures adequate pain relief and is well tolerated by patients after cytoreductive surgery with peritonectomy combined with heated intraperitoneal chemotherapy. Hypotension is common in this context and careful monitoring of coagulation parameters, especially in the first 3 days after surgery, is advisable to reduce the risk of neuraxial complications.
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Additional arterial grafts such as the right internal mammary artery (RIMA) or the radial artery (RA) have been proposed to improve long term outcomes in coronary artery bypass grafting (CABG). RA is largely preferred over RIMA as it is less technically demanding and there is a perception that bilateral IMA usage increases the risk of sternal wound complications. However, there is a paucity of direct comparison of the two conduits to guide surgeons to choose the best second arterial conduit for CABG. ⋯ RIMA as a second conduit did not increase the operative risk including sternal wound complications and improved long term outcomes including overall survival when compared to RA. This advantage was stronger among diabetic and obese patients. These findings strongly support RIMA as the first choice second arterial conduit in CABG. Further randomized studies with angiographic control and long-term follow-up are needed to address this issue.
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Although various surgical procedures have been described for pilonidal sinus disease, the best surgical technique is still controversial. Aim of this study was to compare the short term results of modified limberg flap (MLF) and modified elliptical rotation flap (MERF) for pilonidal sinus disease in terms of postoperative complications, recurrence and patient satisfaction. ⋯ Modified limberg flap reconstruction is still one of the most commonly performed procedures for pilonidal sinus disease because of its low complication and recurrence rate and higher postoperative quality of life. This study shows that modified elliptical rotation flap technique is at least effective as modified limberg flap reconstruction. Further prospective clinical trials are needed to show the effectiveness of this technique on long term.