World journal of surgery
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World journal of surgery · Jun 2009
Randomized Controlled TrialPreoperative fasting of 2 hours minimizes insulin resistance and organic response to trauma after video-cholecystectomy: a randomized, controlled, clinical trial.
Studies showing the improvement of insulin sensitivity by reducing the term of preoperative fasting are mostly done in patients undergoing major operations. More information about the role of shortened preoperative fasting in perioperative metabolism is needed for such elective minor/moderate abdominal procedures as laparoscopic cholecystectomy. We investigated the influence of a carbohydrate-rich drink given 2 h before laparoscopic cholecystectomy on insulin resistance and the metabolic response to trauma. ⋯ Abbreviation of the period of preoperative fasting and administration of a carbohydrate beverage diminishes insulin resistance and the organic response to trauma.
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World journal of surgery · Jun 2009
ReviewPostinjury abdominal compartment syndrome: are we winning the battle?
Postinjury (primary) abdominal compartment syndrome (ACS) was described more than 15 years ago as severe abdominal distension with high peak airway pressures, CO(2) retention, and oliguria, which led to unplanned re-exploration after damage-control laparotomy. Later, a more elusive type of ACS was recognized, which develops without abdominal injuries (secondary ACS). ⋯ Once viewed as a syndrome with almost uniform mortality, systematic preventative strategies and therapeutic efforts have reduced the prevalence, morbidity, and mortality of the syndrome. This review was designed to summarize the recent advances in the management of ACS, to classify the currently available evidence, and to identify future directions of research and clinical care.
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World journal of surgery · Jun 2009
Comparative StudyImpact of surgical training on incidence of surgical site infection.
Despite availability of other training forms, tutorial assistance cannot be entirely replaced in surgical education. Concerns exist that tutorial assistance may lead to an increased rate of surgical site infection (SSI). The purpose of the present study was to investigate whether the risk of SSI is higher after surgery with tutorial assistance than after surgery performed autonomously by a fully trained surgeon. ⋯ Surgical training does not lead to higher SSI rate if trainees are adequately supervised and interventions are carefully selected. Although other forms of training are useful, tutorial assistance in the operating room continues to be the mainstay of surgical education.
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World journal of surgery · Jun 2009
Intrahepatic cholangiocarcinoma: prognostic factors after surgical resection.
Intrahepatic cholangiocarcinoma (ICC) is the second most common primary liver tumor. The resectability rate is low because at the time of diagnosis this disease is frequently beyond the limits of surgical therapy. Curative resection (R0) is the most effective treatment and the only therapy associated with prolonged disease-free survival. Based on the gross appearance of the tumor the Liver Cancer Study Group of Japan (LCSGJ) defined three types: mass-forming type (MF), periductal infiltrating type (PI), intraductal growth (IG) type. The prognostic significance of gross type has been demonstrated in Eastern countries, but this issue has not been clarified in Western countries. The aim of this study was to identify the prognostic factors for survival in a group of patients submitted to surgical resection for ICC. ⋯ Curative resection of ICC is the only therapy that can achieve long-term survival. The best results were observed in patients who underwent R0 resection for MF tumors without lymph node metastases or vascular invasion. Important predictive factors related to poor survival are MF + PI macroscopic tumor type, lymph node metastases, and vascular invasion. In these patients, other therapeutic approaches (i.e., adjuvant or neoadjuvant therapy) should be evaluated to improve results.
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World journal of surgery · Jun 2009
Improved operating room teamwork via SAFETY prep: a rural community hospital's experience.
Effective teamwork contributes to patient safety in the operating room (OR). For the busy rural surgeon, enhancing OR teamwork can be difficult. This manuscript describes results from the initial implementation of a preoperative briefing protocol at a rural community hospital. ⋯ Implementation of a preoperative briefing protocol improved overall preoperative briefing and OR team interaction in the study setting. These findings are encouraging for enhancing teamwork and patient safety through implementation of a systematic protocol.