Journal of the American College of Surgeons
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Open abdomen treatment because of severe abdominal sepsis and abdominal compartment syndrome remains a difficult task. Different surgical techniques are available and are often used according to the surgeon's personal experience. Recently, the abdominal vacuum-assisted closure (VAC) system has been introduced, providing a new possibility to treat an open abdomen. In this study, we evaluate the role of this treatment option. ⋯ Treatment of laparostomy with VAC for abdominal sepsis and abdominal compartment syndrome results in a high rate of successful abdominal closure. In addition, patients recover more rapidly, although hypertrophic scars might interfere with body perception. We recommend abdominal VAC system as first option if open abdomen treatment is indicated.
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The efficacy of prophylactic octreotide after pancreaticoduodenectomy has been rigorously scrutinized, yet few studies have specifically illustrated its impact in patients at high risk for pancreatic fistula. Applying a previously validated clinical classification scheme (International Study Group on Pancreatic Fistula) for postoperative pancreatic fistula severity, we examined whether prophylactic octreotide could effectuate a clinical or fiscal benefit, or both, after pancreatic resection. ⋯ Octreotide prophylaxis is an effective approach to mitigate the negative impact of pancreatic fistulas, but to obtain maximal clinical value and cost benefit, octreotide should be administered exclusively to patients with high-risk glands.
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An early predictive model for massive transfusion (MT) is critical for management of combat casualties because of limited blood product availability, component preparation, and the time necessary to mobilize fresh whole blood donors. The purpose of this study was to determine which variables, available early after injury, are associated with MT. We hypothesized that International Normalized Ratio and penetrating mechanism would be predictive. ⋯ MT after combat injury is associated with high mortality. Simple variables available early after admission allow accurate prediction of MT.
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Minimally invasive parathyroidectomy (MIP) has become increasingly popular for the treatment of patients with primary hyperparathyroidism (pHPT), and the specific techniques used vary from surgeon to surgeon. This strategy depends on preoperative localization tests, of which the MIBI scan is the most commonly used. This study details one surgeon's MIP experience and examines factors that correlate with the results of sestamibi (MIBI) scans. ⋯ The MIBI scan is a good localization test that made unilateral exploration and MIP possible in 76% of the cases. MIBI scans are more likely to be correct with higher preoperative PTH and larger adenomas.