American journal of surgery
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Realizing the trends toward minimally invasive procedures, the Accreditation Council for Graduate Medical Education (ACGME) increased the requirements for laparoscopic procedures effective 2007 to 2008. Our purpose was to analyze the trend of laparoscopic versus open cases. ⋯ The rising number of laparoscopic procedures performed by surgical residents is associated with a drastic decrease in the number of basic open procedures. Although the number of open procedures is sufficient to meet ACGME requirements for now, this is an area of concern for the adequacy of training in the future.
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Chronic neurogenic pain after surgery, especially inguinal herniorrhaphy, remains a major cause of morbidity. The traditional treatment of postinguinal herniorrhaphy neurogenic pain has included triple neurectomy with the removal of any mesh. This report describes a directed, minimally invasive surgical neurectomy that provided pain relief in 28 patients with minimal morbidity. ⋯ This simple directed neurectomy method typically provides long-term relief for patients suffering from chronic postsurgical neurogenic pain.
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Laparoscopic colorectal procedures require specimen extraction. It is unclear whether extraction site affects the incidence of incisional hernia (IH). ⋯ Although midline hernia rates were lower than traditionally reported with open surgery, midline extraction sites have a higher chance of IH than nonmidline sites.
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There is no consensus when the designation of nonoperative management (NOM) for splenic injury (BSI) should start. We evaluated NOM success rates based on different time points after admission. ⋯ The grade of injury is an important predictor for failure of NOM. If a 5% failure rate is to be considered a benchmark, then the 5-hour time point after admission should be used for the calculation of NOM success rates.
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Diagnostic laparoscopy (DL) has decreased the rate of nontherapeutic laparotomy for patients suffering from penetrating injuries. We evaluated whether DL similarly lowers the rate of nontherapeutic laparotomy for patients with blunt injuries. ⋯ DL, when coupled with computed tomographic findings, is an effective tool for the initial management of patients with blunt injuries.