American journal of surgery
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The open abdomen is a necessary sequela after damage-control surgery or abdominal compartment syndrome. Management of the patient in the intensive care unit continues to evolve, with considerations of fluid resuscitation, enteral nutrition, and supportive care. Management of the abdominal contents incorporates several basic techniques and considerations: appropriate temporary covering, enteric injury repair in most patients, placement of an anastomosis in an area of the abdomen with minimal manipulation without exposure to the atmosphere, acquiring enteral access for initiation of enteral nutrition, and ultimate abdominal closure. An understanding of these complex factors is instrumental for the practicing surgeon.
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Enteral feeding tube placement has been performed by nurses, gastroenterologists using endoscopy, and interventional radiologists. We hypothesized that midlevel providers placed feeding tubes at bedside using fluoroscopy safely, rapidly, and cost-effectively. ⋯ The placement of feeding tubes under fluoroscopy by nurse practitioners is safe, timely, and cost-effective.
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The purpose of this study was to evaluate the effect of epidural analgesia use on postoperative complications in patients undergoing pancreaticoduodenectomy. ⋯ In patients who underwent pancreaticoduodenectomy, epidural analgesia was associated with significantly lower postoperative composite complications.
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Open abdomen management applies to a variety of traumatic and inflammatory abdominal conditions. One complication of this technique is inability to achieve primary closure of the abdominal wall. The aim of this study was to determine if the number of abdominal reexplorations influences the success of abdominal closure. ⋯ Greater than 4 reoperations is significantly associated with failure of the primary fascia closure. Efforts to obtain closure should be undertaken within 4 reoperations.