Surgical endoscopy
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Enhanced recovery pathways have become standard practice after elective colorectal surgery to improve postoperative care while reducing length of stay in hospital. However, there is concern that early discharge may result in increased rates of adverse events including readmission. This study aims to determine whether it is safe to discharge patients on postoperative day 1 or 2 if they have undergone an elective colorectal operation for cancer. ⋯ Patients discharged by POD 2 after elective oncologic colon resections did not have significantly more adverse events or readmissions compared to patients discharged later. Select patients may be safely discharged earlier.
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Recurrent paraesophageal hernia (PEH) repair is performed for symptomatic recurrent hiatal hernia and/or reflux with little understanding as to outcomes related to perioperative and subjective patient variables. The aim of this study was to understand what differences exist between patients undergoing initial paraesophageal hernia (IPEH) repair and those undergoing redo paraesophageal hernia (RPEH) repair. ⋯ Recurrent PEH repair is performed with similar outcomes to IPEH repair with the exception of increased operative time and blood loss. Collis gastroplasty is required more frequently in RPEH patients. Persistent symptoms exist following RPEH repair. Despite recurrent symptomatology, patient satisfaction is high. RPEH repair may be safely performed in patients with recurrent paraesophageal hernias with outcomes similar to IPEH repairs.
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Comparative Study
Laparoscopic ventral hernia repair with primary fascial closure versus bridged repair: a risk-adjusted comparative study.
Laparoscopy, specifically the bridged mesh technique, is a popular means used for ventral hernia repair. While laparoscopy has decreased the incidence of surgical site infection (SSI), hernia recurrence rates remain unchanged. Some surgeons advocate laparoscopic primary fascial closure (PFC) with placement of intraperitoneal mesh to decrease recurrence rates. We hypothesize that in patients undergoing laparoscopic ventral hernia repair (LVHR), PFC compared to a bridged mesh repair decreases hernia recurrence rates. ⋯ Primary fascial closure during laparoscopic hernia repairs did not result in reduced recurrence, seroma, and SSI as compared to bridge repairs in a retrospective, multi-institutional study. However, additional research is needed to further evaluate benefits to the patient in terms of pain, function, cosmesis, and overall satisfaction. Randomized, blinded, control trials should focus on these parameters in future investigations.
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Multicenter Study
Laparoscopic distal pancreatectomy for pancreatic ductal adenocarcinoma: results of a multicenter cohort study on 196 patients.
Laparoscopy is widely accepted as a feasible option for distal pancreatectomy. However, the experience in laparoscopic distal pancreatectomy (LDP) for pancreatic ductal adenocarcinoma (PDAC) is limited to a small number of studies, reported by expert centers. The present study aimed to evaluate perioperative and oncological outcomes after LDP for PDAC in a large, multicenter cohort of patients. ⋯ LDP seems to be a feasible and safe procedure, providing satisfactory oncological outcomes in patients with PDAC.
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Randomized Controlled Trial
Dexmedetomidine versus morphine infusion following laparoscopic bariatric surgery: effect on supplemental narcotic requirement during the first 24 h.
The primary aim of this pilot study was to determine whether the dexmedetomidine infusion initiated immediately after laparoscopic bariatric surgery, offers an advantage over a morphine infusion with respect to rescue morphine and paracetamol requirements over the first 24 post-operative hours. ⋯ An intravenous infusion of dexmedetomidine, initiated and continued for 24 h following laparoscopic bariatric surgery, can decrease the overall morphine requirements during this period. This pilot study demonstrated that the post-operative initiation of dexmedetomidine can be morphine sparing following laparoscopic bariatric surgery.