Surgery today
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Laparoscopic hiatal hernia repair with additional fundoplication is a commonly recommended standard surgical treatment for symptomatic large hiatal hernias with paraesophageal involvement (PEH). However, due to the risk of persistent side effects, this method remains controversial. Laparoscopic mesh-augmented hiatoplasty without fundoplication (LMAH), which combines hiatal repair and mesh reinforcement, might therefore be an alternative. ⋯ LMAH is feasible, safe and provides an anti-reflux effect, even without fundoplication. As operation-related side effects seem to be rare, LMAH is a potential treatment option for large hiatal hernias with paraesophageal involvement.
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Chest tubes are used for drainage of the pleural cavity. Traditionally, large-bore catheters are inserted for all indications, but there has been a recent tendency to use small-bore catheters. We share the results of our experience of using small-bore catheters for almost all indications routinely in our clinic. ⋯ Based on our clinical experience of using small-bore catheters, we believe that they are potentially effective for almost all pleural pathologies. Our results concur with those in the literature, but this series also includes different pleural diseases requiring chest tube insertion.
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The rapid growth of the elderly population and the progress in surgical techniques in Japan have led to increased numbers of patients who undergo surgery. Anesthetics are essential for surgery. A survey conducted by the Japanese Society of Anesthesiologists showed that, during the past 10 years, the proportion of females among all the members has increased from 27 to 35 %, and the proportion of female councilors has risen from 3.9 to 6.7 %. ⋯ Therefore, many female physicians in their 30s or older do not work as anesthesiologists. To support female anesthesiologists and their vital roles in surgical diagnosis and treatment, return-to-work assistance programs have been developed. It is also necessary to improve the working conditions for female anesthesiologists to allow them to continue their work, and to provide education for young female physicians to enhance their professional pride.
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Randomized Controlled Trial
Short-term intravenous antimicrobial prophylaxis for elective rectal cancer surgery: results of a prospective randomized non-inferiority trial.
To investigate the non-inferiority of postoperative single-dose intravenous antimicrobial prophylaxis to multiple-dose intravenous antimicrobial prophylaxis in terms of the incidence of surgical site infections (SSIs) in patients undergoing elective rectal cancer surgery by a prospective randomized study. ⋯ The incidence of SSIs was not significantly different in patients undergoing elective rectal surgery who were treated using a single dose of postoperative antibiotics compared to those treated using multiple-dose antibiotics when preoperative mechanical and chemical bowel preparations were employed.
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There is no established treatment for intercostal neuralgia associated with thoracotomy. We investigated the administration of pregabalin as a new perioperative treatment, assessing its safety and efficacy for intercostal neuralgia after thoracotomy. ⋯ Pregabalin was highly effective for neuralgia associated with intercostal damage after thoracotomy.