American journal of surgery
-
Revascularization of ischemic bowel may induce further local tissue damage due to reperfusion injury. Therefore, we aimed to investigate the effect of ischemia-reperfusion injury on the healing of intestinal anastomosis in experimental models. ⋯ The present study demonstrated that ischemia-reperfusion impairs anastomotic healing. Despite the fact that the intestines are well perfused and viable after revascularization, one must bear in mind that intestinal reperfusion may compromise anastomotic healing.
-
Randomized Controlled Trial Comparative Study Clinical Trial
A prospective randomized trial of intraoperative bupivacaine irrigation for management of shoulder-tip pain following laparoscopy.
Postoperative shoulder-tip pain (STP) frequently occurs following laparoscopic surgery. In an attempt to abrogate this complication we prospectively evaluated the efficacy of intraoperative irrigation of the diaphragm with bupivacaine. ⋯ Intraperitoneal irrigation with bupivacaine to both hemidiaphragms at the end of surgery significantly reduces both frequency and intensity of STP following laparoscopic procedures thus reducing patient morbidity.
-
Management of the pancreatic stump after pancreaticoduodenectomy (PD) is still a matter of debate. Pancreaticojejunostomy (PJ) is used commonly but is associated with a significant incidence of pancreatic leaks. Pancreaticogastrostomy (PG) is an alternative that has been reported to be safer. ⋯ In world literature (including the current series), the leakage rate of PG is 2.5% (14 of 553) with only 2 deaths (2 of 14) due to leakage from PG. Our large experience and these data conclusively prove the safety of pancreaticogastrostomy, which should be the drainage procedure of choice for the pancreatic stump following pancreaticoduodenectomy.
-
This retrospective study was undertaken to determine the mechanism by which cardiac tamponade (CT) occurs after placement of central venous catheters (CVC), and to determine if physicians are aware of this potentially lethal complication. ⋯ Cardiac tamponade from central venous catheters is preventable if the tip of the catheter is outside the cardiac silhouette on chest radiograph. Any patient with a CVC in place who develops unexplained hypotension, chest tightness, or shortness of breath should have an emergency echocardiogram to rule out cardiac tamponade.
-
Morbidity is today's concern in thyroid surgery. The purpose of this paper was to quantify risk factors' contribution to morbidity rates. ⋯ High surgical volume, identifying parathyroids and RLNs, failed to reduce morbidity. Completion and total thyroidectomy with node dissection increased PH and TRLNP (not PRLNP) rates.