Surgical endoscopy
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Laparoscopic and endoscopic procedures generally are accepted for repair of primary and recurrent hernias that follow conventional (anterior) repair. This report discusses transabdominal preperitoneal (TAPP) for incarcerated hernias, scrotal hernias, and hernias after radical prostatectomy, as well as hernia recurrences after TAPP and totally extraperitoneal (TEP) procedures (complex hernias). Studies with long-term results of hernia recurrences are missing. This study aimed to determine hernia recurrence rates for adults after a modified TAPP procedure. The records of patients who had hernia repair surgery at a general hospital 2, 7, 12, and 17 years earlier were analyzed. Living patients were requested to complete a questionnaire to complement information from their hospital records. ⋯ In a retrospective long-term study (2-17 years) from a single center with 1,108 patients and 1,123 modified TAPP procedures (93.9% of all hernia repairs), the hernia recurrence rate was 1.7% for adults with primary hernias (n = 765 patients) and 2.3% for adults with recurrent hernias after anterior repair (n = 131 patients). A modified TAPP procedure with suturing of hernia defects larger than 1 × 1 cm can be used as the standard procedure without recurrences for femoral hernias, incarcerated hernias, and hernias after radical prostatectomy, with low recurrence rates for scrotal hernias (2%). To collect quantitative data on hernia recurrence rates, postoperative follow-up studies longer than 10 years are needed (4% of recurrences developed later than 10 years after surgery).
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Metabolic and inflammatory disturbances associated with obesity are considered important trigger factors for venous thromboembolism (VTE). Identification of clinical markers indicating a hypercoagulability state could define a group of high-risk patients in the surgical setting. This study aimed to identify these markers using rotational thrombelastometry (ROTEM) analysis, an established method for hemostasis testing that can detect hyperfunctional stages of the clotting process. ⋯ A hypercoagulability state in obese patients is associated with central obesity and high fibrinogen levels, which should be considered clinical hallmarks of this state. More aggressive perioperative prophylaxis for VTE should be recommended when these hallmarks are present in obese patients.
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Multicenter Study
The prevalence of laparoscopy and patient safety outcomes: an analysis of colorectal resections.
Although laparoscopic colorectal surgery is associated with faster postoperative recovery and shorter hospital stays than open surgery, perioperative patient safety analyses using process-focused, validated measures have yet to be performed. ⋯ Laparoscopic colorectal surgery was associated with a lower risk of adverse patient safety events, a difference that became more pronounced as the prevalence of laparoscopy increased. Future studies should focus on factors that promote the safe adoption of innovative surgical techniques and optimize surgical outcomes.
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Comparative Study
Total abdominal colectomy for severe ulcerative colitis: does the laparoscopic approach really have benefit?
It is still unknown to what extent the reported morbidity and recovery benefits of laparoscopic total abdominal colectomy (TAC) for severe ulcerative colitis (UC) are associated with patient selection bias. This study aimed to evaluate whether laparoscopic TAC has any advantages over open surgery after control for perioperative confounding factors. ⋯ The data suggest that laparoscopic TAC retains recovery advantages over open surgery even after adjustments for confounders.
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Questions have emerged as to whether single-incision laparoscopy has reproducible or superior patient outcomes compared with traditional laparoscopy. A retrospective review comparing single-incision laparoscopic (SILS) appendectomy and traditional multiport laparoscopic (MP) appendectomy was conducted to assess the safety and feasibility of the less invasive laparoscopic technique. ⋯ The findings showed SILS appendectomy to be a safe and feasible alternative to traditional MP appendectomy that can be conducted with operative times, lengths of stay, and complication rates similar to those of the standardized technique. This review is a precursor to prospective studies, which are warranted to demonstrate conclusively the equivalence of operative times, complications, and lengths of hospital stay, as well as to elucidate differences in patient-centered outcomes including postoperative pain, cosmesis, and quality of life.