Surgical endoscopy
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Incisional hernias are a common postoperative complication with abdominal surgery. The major risk factors for their development include wound infection, obesity, and age. This study aimed to evaluate the impact of extraction-site location and technique on incisional hernia rates in laparoscopic colorectal surgery. ⋯ In this series, the midline extraction site resulted in a significantly higher incisional hernia rate statistically than the off-midline extraction sites. The authors therefore have adopted an off-midline blunt muscle-splitting extraction site when performing laparoscopic colorectal surgery.
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Comparative Study
Cold nebulization used to prevent heat loss during laparoscopic surgery: an experimental study in pigs.
Prolonged abdominal laparoscopy is responsible for a significant drop in core body temperature. Various modifications of the conditioning for the insufflating carbon dioxide (CO(2)) to prevent the specific hypothermia related to the insufflated gas have been tested. This study aimed to investigate the effects on core temperature of insufflation with unheated humidified CO(2) using the Aeroneb system compared with the use of standard gas and gas made hot and wet using a warming and humidifying system (Pall system). ⋯ Cold humidification of insufflating CO(2) prevents heat loss associated with pneumoperitoneal insufflation at least as efficaciously as warmed humidification of the gas.
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Reduction in hospital stay, blood loss, postoperative pain and complications are common findings after laparoscopic liver resection, suggesting that the laparoscopic approach may be a suitable alternative to open surgery. Some concerns have been raised regarding cost effectiveness of this procedure and potential implications of its large-scale application. Our aim has been to determine cost effectiveness of laparoscopic liver surgery by a case-matched, case-control, intention-to-treat analysis of its costs and short-term clinical outcomes compared with open surgery. ⋯ Laparoscopic liver segmentectomy and bisegmentectomy are feasible, safe and cost effective compared to similar open resections. Large-scale application of laparoscopic liver surgery could translate into significant savings to hospitals and health care programmes.
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Review Meta Analysis Comparative Study
Is smaller necessarily better? A systematic review comparing the effects of minilaparoscopic and conventional laparoscopic cholecystectomy on patient outcomes.
In recent years, minilaparoscopic cholecystectomy (MLC; total size of trocar incision < 25 mm) has been increasingly advocated for the removal of the gallbladder, due to potentially better surgical outcomes (e.g., better cosmetic result, reduced pain, shorter hospital stay, quicker return to activity), but an evidence-based approach has been lacking. The current systematic review was undertaken to evaluate the importance of total size of trocar incision in improving surgical outcomes in adult laparoscopic cholecystectomy (LC). ⋯ The data included in this review suggest that reducing the size of trocar incision results in some limited improvements in surgical outcomes after LC. However, it carries a higher risk of conversion to conventional LC or open cholecystectomy.
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The project aimed at testing the feasibility of a quality improvement system based on patient-reported outcomes in short-stay surgery for cholecystectomy. ⋯ The low response rate was mainly due to nondelivery of questionnaires at T1 during the regular postoperative visit by the operating physician. Though nonresponse occurs under conditions of routine care, meaningful information was gained, which should be used for quality improvement activities. Because the preoperative level is a major determinant of the postoperative health outcomes, the prospective pre-post measurement should be preferred if institutional comparisons are intended.