American journal of surgery
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The Accreditation Council for Graduate Medical Education implemented new intern work-hour regulations in July 2011 that have unique implications for surgical training at Veterans Affairs (VA) medical centers. Implementation of these new regulations required profound restructuring of trainee night coverage systems at many VA medical centers. This article offers approaches and potential solutions to the Accreditation Council for Graduate Medical Education regulations used by different surgery programs throughout the country that are applicable to the VA training environment. ⋯ The public expects the medical community to produce safe, experienced surgeons, while demanding they are well rested and directly supervised at all times. The ability to meet these expectations can be challenging.
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Meta Analysis Comparative Study
Comparison of open preperitoneal and Lichtenstein repair for inguinal hernia repair: a meta-analysis of randomized controlled trials.
The aim of this article was to compare the outcomes of the open preperitoneal approaches and the Lichtenstein technique in the repair of inguinal hernias. ⋯ The open preperitoneal approach is a feasible alternative for the standard Lichtenstein procedure with similar complication rates and potentially less postoperative recurrence.
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Comparative Study
Differential effect of nutritional status on vascular surgery outcomes in a Veterans Affairs versus private hospital setting.
The goal of this study was to determine whether preoperative albumin level in vascular surgery patients is predictive of postoperative outcomes in the Veterans Affairs (VA) versus private sector and in open versus endovascular interventions. ⋯ Preoperative malnutrition has important prognostic implications for vascular surgery patients in both the VA and private hospital settings, especially for those patients undergoing open repair.
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Comparative Study
Management of colorectal anastomotic leakage: differences between salvage and anastomotic takedown.
The aim of this study was to evaluate and compare the morbidity associated with 2 strategies of treatment of colorectal anastomotic leakage: surgical drainage of anastomosis with loop ileostomy versus anastomotic takedown. ⋯ Salvage of anastomosis with loop ileostomy is an effective strategy to control peritoneal sepsis for colorectal anastomotic leakage.
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Several modifications of the classic retromuscular Stoppa technique to facilitate dissection beyond the lateral border of the rectus sheath recently were reported. We describe a novel technique of transversus abdominis muscle release (TAR) for posterior component separation during major abdominal wall reconstructions. ⋯ Our novel technique for posterior component separation was associated with a low perioperative morbidity and a low recurrence rate. Overall, transversus abdominis muscle release may be an important addition to the armamentarium of surgeons undertaking major abdominal wall reconstructions.