Journal of the American College of Surgeons
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Comparative Study
Quality of life after antireflux surgery compared with nonoperative management for severe gastroesophageal reflux disease.
Gastroesophageal reflux disease significantly affects a patient's quality of life (QOL). Laparoscopic fundoplication offers an alternative to medical therapy, but few studies have compared outcomes. Our objective was to examine QOL scores in gastroesophageal reflux disease patients treated medically and surgically. ⋯ Heartburn scores and global QOL scores were superior after laparoscopic fundoplication compared with medical management in this patient population. Laparoscopic fundoplication should be considered for patients who are dissatisfied with medical treatment.
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Ageism has been suggested as a cause for the undertreatment of elderly breast cancer patients. The purpose of this study was to determine the rate and causes of elderly patients not receiving standard therapy. ⋯ Population-based studies of breast cancer treatment do not adequately assess the complex decision making associated with breast cancer in the elderly. Patients do not receive standard care for specific reasons.
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Surgical subspecialization has croded the traditional domain of the general surgeon. The purpose of this study was to assess the volume and distribution of colon and rectal cases performed by general surgeons. ⋯ General surgeons perform a substantial number of colon resections and relatively few anorectal cases. It is unclear whether this is an issue of anorectal training in general surgery programs or referral patterns.
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The purpose of this study was to analyze the impact of stent-graft design and operator skills on outcomes after endovascular abdominal aortic aneurysm repair. ⋯ Enhanced stent-graft design has improved the probability of stent-graft success after endovascular abdominal aortic aneurysm repair. Better technical skills and increased use of intraoperative adjunctive procedures may also have contributed to improved results.