Surgery today
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Randomized Controlled Trial
Randomized prospective trial comparing clinical outcomes 3 years after surgery by Marcy repair and Prolene Hernia System repair for adult indirect inguinal hernia.
The use of mesh in the surgical repair of adult indirect inguinal hernias is widely recommended in Western countries, but no randomized controlled trials have so far been reported in Japan. The purpose of the present randomized prospective trial was to compare a mesh method with non-mesh method for surgical repair of primary adult indirect inguinal hernias in which the diameter of the internal inguinal ring was up to 3.0 cm (I-1 or I-2 of Japanese Hernia Society Classification). ⋯ This randomized prospective trial of I-1 and I-2 inguinal hernias suggests that Marcy repair is not inferior to PHS repair. A large-scale randomized controlled trial appears warranted to confirm whether to use mesh for Japanese adult I-1 and I-2 hernias.
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Postoperative atrial fibrillation/flutter (AF) is still the most common complication after cardiovascular surgery, and it is important to determine the risk factors in order to establish effective management for recent postoperative AF. This study investigated the clinical predictors of postoperative AF using a prospectively collected database. ⋯ An older age, transfusion, and aortic surgery are strong independent predictors of postoperative AF. These findings help to identify high-risk patients for AF after cardiovascular surgery. Careful perioperative management is required for older patients undergoing aortic surgery with cardiopulmonary bypass.
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Japan lags behind other industrialized nations in terms of gender equality. To improve the work environment for surgeons, the opinions of female surgeons must be respected. The Committee on Women Surgeons of the Japan Surgical Society (JSS) conducted two surveys 3 years apart of the numbers of female councilors and directors in the member societies of the Japanese Association of Medical Sciences. ⋯ The JSS was founded in 1899. No female surgeon has ever been elected as director and there are currently no female councilors due to the new election system. The Gender Equality Bureau of the Cabinet Office should therefore provide greater support to improve gender equality in Japan.
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Randomized Controlled Trial
Paravertebral block via the surgical field versus epidural block for patients undergoing thoracotomy: a randomized clinical trial.
A paravertebral block (PVB) given via the surgical field can be safer and technically simpler than an epidural block (EP) for postoperative pain control. We conducted this clinical trial to confirm the effectiveness of PVB after thoracotomy. ⋯ PVB may replace EP for postoperative pain control because of its technical simplicity and safety.
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Case Reports
Management of postoperative hemorrhage associated with factor VIII inhibitor: report of a case.
This report presents a case that was successfully treated for acquired factor VIII inhibitor after extensive visceral surgery. A 71-year-old male who underwent surgery for bile duct cancer had active bleeding in the abdominal drainage tube on postoperative day (POD) 5, and prolonged activated partial thromboplastin time (aPTT) was detected (83.1 s) on POD 7. An extensive coagulation work-up revealed factor VIII deficiency (1 %), and a diagnosis of an acquired factor VIII deficiency was established when a factor VIII inhibitor of 8 Bethesda units was demonstrated. ⋯ Inhibitor elimination was started using prednisolone on POD 20; rituximab, was administered on POD 74 and 81. Factor VIII inhibitor had disappeared by POD 124, and factor VIII (72 %) and aPTT recovered to 45.9 s. This case report demonstrated the efficacy of aPCCs and rituximab in the treatment of acquired hemophilia associated with visceral surgery.