World journal of surgery
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World journal of surgery · May 2015
Comparative StudyLaparoscopic liver resection in obese patients.
Obesity has been associated with worse postoperative outcomes than those for normal weight. Data on the short-term results of laparoscopic liver resection (LLR) in patients with obesity are scarce. Furthermore, the long-term outcomes of LLR versus open liver resection (OLR) have not been adequately assessed. The aims of this study were to analyze the outcomes of obese patients undergoing LLR and to compare these to the outcomes of obese patients undergoing OLR. ⋯ LLR in obese patients results in decreased intraoperative blood loss and shorter postoperative hospital stays compared with OLR. When performed in selected patients, LLR may be a safe and feasible option for obese patients.
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World journal of surgery · May 2015
Tracheobronchial fistula during the perioperative period of esophagectomy for esophageal cancer.
Tracheobronchial (TB) injury and fistula formation during the perioperative period of esophagectomy is a rare but life-threatening complication. ⋯ Careful dissection with direct vision of the esophagus, as well as oversewing of the staplers on the gastric tube, is mandatory for preventing TB injury and fistula formation. Appropriate drainage is effective in cases with peri-tracheal abscesses. If the TB fistula fails to heal within a 4- to 6-week period, conservative management should be abandoned. Direct surgical intervention with coverage by a muscle flap is important for TB fistulas.
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World journal of surgery · May 2015
Observational StudyChanging operative strategy from abdominoperineal resection to sphincter preservation in T3 low rectal cancer after downstaging by neoadjuvant chemoradiation: a preliminary report.
The objective of this study is to assess oncological outcome after changing operative strategy from abdominoperineal resection (APR) to sphincter preservation (SP) in T3 low rectal carcinomas downstaged by neoadjuvant chemoradiation (nCRT). ⋯ For selected patients of T3 low rectal cancer, changing operative strategy from APR to SP after downstaging by nCRT can be done in motivated patients with good sphincter function. Disease-free survival rates and continence are comparable to patients had APR and to previous publications with decision made before nCRT. With strict follow-up, early diagnosis of recurrence and salvage surgery with free resection margins can be achieved.
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World journal of surgery · May 2015
Randomized Controlled Trial Comparative StudyClamshell incision versus left anterolateral thoracotomy. Which one is faster when performing a resuscitative thoracotomy? The tortoise and the hare revisited.
The clamshell incision (CI) offers a better exposure than the left anterolateral thoracotomy (LAT) as a resuscitative thoracotomy. Most surgeons will have to manage a heart wound only once or twice in their career. The patient's survival depends on how fast the surgeon can control the heart wound; however, it is unclear which of the two incisions allows for faster control in the hands of inexperienced surgeons. The aim of this study was to compare the time needed to access and control a standardized stab wound to the right ventricle, by inexperienced surgical trainees, by LAT or CI; we hypothesized that the CI does not take longer than the LAT. ⋯ The time needed from skin incision until cardiac wound control via CI was not longer than via LAT and the easier control of the cardiac wound when using CI was confirmed.
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World journal of surgery · May 2015
ReviewNear-infrared fluorescence imaging for real-time intraoperative anatomical guidance in minimally invasive surgery: a systematic review of the literature.
Near-infrared fluorescence (NIRF) imaging, using contrast agents with fluorescent characteristics in the near-infrared (NIR: 700-900 nm) window, is considered to possess great potential for clinical practice in the future of minimally invasive surgery (MIS), given its capacity for intraoperative, real-time anatomical navigation, and identification. The aim of this review is to provide an overview of the literature concerning the current and potential future applications of fluorescence imaging in supporting anatomical guidance during MIS, and thereby guiding future research. ⋯ Future implementation of new intraoperative optical methods, such as NIRF, could significantly contribute to intraoperative anatomy navigation and facilitate critical decision-making in MIS. Further research (i.e., large multi-center randomized controlled trials) is needed to establish the true value of this innovative optical imaging technique in standard clinical practice.