American journal of surgery
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Randomized Controlled Trial Clinical Trial
Drainage is unnecessary after elective liver resection.
A prospective, randomized trial was performed to determine if intra-abdominal drainage catheters are necessary after elective liver resection. ⋯ In the first 50 consecutive resections performed since the conclusion of this trial, only 4 patients (8%) have required subsequent percutaneous drainage. We conclude that abdominal drainage is unnecessary after elective liver resection.
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Surgical management of distal duodenal pathology is challenging because of the duodenum's retroperitoneal location and its shared blood supply with the pancreas. For infra-ampullary pathology, surgical treatment may include local excision, pancreaticoduodenectomy, or pancreas-sparing duodenectomy (PSD). ⋯ Pancreas-sparing duodenectomy is a safe and effective treatment in patients with distal duodenal benign neoplasms or trauma, and PSD appears to have limited effectiveness for malignant distal duodenal pathology.
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This paper addresses the current status of General Surgery, the direction in which it is moving, and how to prepare for future changes. The paper points out that, since the predicted effects of new technology on the practice of General Surgery are more technical complexity, decreasing invasiveness, and fewer traditional operations, the consequences for the training of surgeons, the division of responsibilities among specialists, and the organization of surgical care will be substantial. In light of the current difficulty in dealing with the stresses within General Surgery, the paper discusses how changes in residency training and an increased use of Fellowships will enable the specialty to handle such disruptive changes in the future.
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Since the role of a hiatal hernia in the pathophysiology of gastroesophageal reflux disease (GERD) has not been fully elucidated, we studied the effects of hiatal hernias on the function of the lower esophageal sphincter (LES) and esophageal acid clearance. ⋯ Among patients with proven GERD, those with a small hiatal hernia and those with no hiatal hernia had similar abnormalities of LES function and acid clearance. In patients with larger hiatal hernias, however, the LES was shorter and weaker, the amount of reflux was greater, and acid clearance was less efficient. Consequently, the degree of esophagitis was worse in the presence of a large hiatal hernia.
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Intra-abdominal infection is generally considered a contraindication to primary colon anastomosis. In order to elucidate the mechanisms by which sepsis affects colonic healing, we studied anastomotic new collagen and protein synthesis and collagen gene expression in a relevant animal model. ⋯ Intra-abdominal infection impairs colonic reparative collagen and protein synthesis. In addition, regulation of type I and type III collagen genes is altered by intra-abdominal sepsis, and the alteration likely contributes to impaired new collagen synthesis and decreased colonic mechanical strength.