World journal of surgery
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The quality of trauma care in New Zealand is good, but not optimal; it is characterized by skilled and dedicated staff relying on personal knowledge and institutional guidelines to deliver care. Quality assessment, standardization, and coordination of care continue to be hampered by the absence of a national trauma registry within the framework of a national trauma system. There is some hope that a planned regional pilot of the national trauma database will lead to more robust trauma system development, although this will only be achievable with solid governmental support.
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World journal of surgery · Jul 2008
Effects of posture and prolonged pneumoperitoneum on hemodynamic parameters during laparoscopy.
The present prospective study was designed to evaluate hemodynamic changes associated with head-down positioning and prolonged pneumoperitoneum during totally endoscopic robot-assisted radical prostatectomy. ⋯ Patients undergoing totally endoscopic radical prostatectomy with 4 h of pneumoperitoneum in the Trendelenburg position experienced no significant hemodynamic depression during posture and pneumoperitoneum.
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World journal of surgery · Jul 2008
Randomized Controlled TrialPropofol decreases early postoperative nausea and vomiting in patients undergoing thyroid and parathyroid operations.
As the practice of parathyroid and thyroid surgery shifts toward short stay and outpatient treatment, the occurrence and management of postoperative nausea and vomiting (PONV) increases in importance due to its potential to delay discharge. PONV also may contribute negatively to the patient's experience and thus their level of satisfaction. The purpose of this study was to determine whether anesthetic technique based on propofol decreases the incidence of PONV and, consequently, improves patient satisfaction with their care. ⋯ A propofol-based anesthetic decreases PONV immediately after the operation but this influence does not persist throughout the episode of care or significantly contribute to patient perceptions of satisfaction.
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A number of reports have been published concerning the surgical treatment of substernal goiters; however, there is yet to be a comprehensive review of this body of literature using evidence-based methodology. ⋯ Evidence-based recommendations provide reliable information regarding the pathologic findings and operative management of substernal goiters in expert hands.
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World journal of surgery · Jul 2008
Long-term experience with the laparoscopic approach to perforated diverticulitis plus generalized peritonitis.
The treatment of perforated diverticulitis is changing form the current standard of laparotomy with resection, Hartmann procedure, and colostomy to a minimally invasive technique. In patients with complicated acute diverticulitis and peritonitis without gross fecal contamination, laparoscopic peritoneal lavage, inspection of the colon, and intraoperative drain placement of the peritoneal cavity appears to alleviate morbidity and improve the outcome. In this article, we report our experience of a laparoscopic peritoneal lavage technique with delayed definitive resection when necessary. ⋯ Laparoscopic lavage of the peritoneal cavity and drainage is a safe alternative to the current standard of treatment for the management of perforated diverticulitis with or without gross fecal contamination. It is associated with a decrease in the overall cost of treatment; the use of a colostomy is avoided; patient improvement is immediate; and there is a reduction in mortality and morbidity as definitive laparoscopic resection can be performed in a nonemergent fashion. Perhaps the most important benefit, other than avoiding a colostomy, is the association of fewer wound complications such as dehiscence, wound infection, and the high risk of hernia formation. Laparoscopic lavage and drainage should be considered in all patients in whom medical and/or percutaneous treatment is not feasible. It carries minimal morbidity and should be considered the standard of care.