American journal of surgery
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The ideal prosthetic material for ventral hernia repair has yet to be described. Each prosthetic material has unique advantages and disadvantages in terms of tissue ingrowth, adhesion formation, and shrinkage profiles. Polyester-based mesh has shown minimal shrinkage and excellent tissue ingrowth in animal models. However, the macroporous, braided nature of this material has raised several concerns regarding the incidence of infections, fistulas, and bowel obstructions. We have reviewed our experience with polyester-based mesh for the repair of ventral hernias. ⋯ This study shows that in this complex group of patients, polyester mesh placed during ventral hernia repair results in acceptable infection rates, and no direct bowel complications or fistulas. Given the macroporous nature of the mesh, each case of infection was treated successfully with local wound measures or partial mesh resection. Polyester-based meshes with an anti-adhesive barrier appear safe for intraperitoneal placement.
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There is a paucity of literature concerning general anesthesia and surgery in patients with amyotrophic lateral sclerosis (ALS or Lou Gehrig's disease). This report summarizes the largest series of surgical cases in ALS during multicenter prospective trials of the laparoscopic diaphragm pacing system (DPS) to delay respiratory failure. ⋯ Laparoscopic surgery with general anesthesia can be safely performed in patients with ALS undergoing DPS.
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Compartment syndrome of the lower extremity can be a difficult diagnosis to make with serious consequences if diagnosis and intervention is delayed. Identifying patients who are more likely to develop this syndrome can help prevent the associated complications. The purpose of this study was to evaluate whether the anatomic location of the penetrating lower-extremity injuries can predict development of compartment syndrome. ⋯ Injuries to the proximal half of the BK segment are the most common cause for the development of compartment syndrome from penetrating injuries of the lower extremity. Development of BK compartment syndrome because of penetrating AK injury is rare without an associated surgically significant vascular injury. Observational admission for compartment syndrome development in patients with penetrating injury to the AK segment or distal BK segment is unnecessary.
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We present the results of combining protocols of standardized laparoscopic rectal resection (LRR) and perioperative fast track care. ⋯ LRRs can be performed safely and effectively for rectal pathologies. Laparoscopy in conjunction with modern perioperative care provides rapid recovery with efficient use of hospital resources.
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Splenic artery embolization (SAE) is an adjunct to nonoperative management (NOM) of splenic injuries. We reviewed our experience with SAE to identify its impact on splenic operations. ⋯ SAE is associated with a reduction in splenic operations, although it did not alter the failure rate of NOM.