Journal of the American College of Surgeons
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Review Meta Analysis
Safety of Foregoing Operation for Small Bowel Obstruction in the Virgin Abdomen: Systematic Review and Meta-Analysis.
Our objective was to assess the safety of foregoing surgery in patients without abdominopelvic surgery history presenting with small bowel obstruction (SBO). Classic dogma has counseled early surgical intervention for SBO in the virgin abdomen-patients without abdominopelvic surgery history-given their presumed higher risk of malignant or potentially catastrophic etiologies compared with those who had undergone previous abdominal operations. The term virgin abdomen was coined before widespread use of CT, which now elucidates many SBO etiologies. ⋯ De novo adhesions (54%) were the most common etiology. More than half of patients underwent a trial of nonoperative management, which often failed. Subgroups of patients likely have variable risk profiles for underlying malignant etiologies, yet no study had consistent follow-up data and we did not find convincing evidence that foregoing operative management altogether in this population can be generally recommended.
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Review Meta Analysis
Laparoscopic-Guided Transversus Abdominis Plane Block for Postoperative Pain Management in Minimally Invasive Surgery: Systematic Review and Meta-Analysis.
Optimal postoperative pain therapy for patients undergoing minimally invasive surgery remains controversial. The aim of this meta-analysis was to compare the efficacy and safety of the novel laparoscopic-guided transversus abdominis plane block (L-TAP) with other analgesic alternatives in adults undergoing minimally invasive surgery. ⋯ L-TAP is safe, and superior to LIA with respect to early pain control, opioid consumption, and patient satisfaction in adults undergoing minimally invasive surgery. Given its equivalence to US-TAP, L-TAP can be used as a safer and pragmatic alternative to epidural analgesia in this patient population.
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Meta Analysis
Pain and Dysfunction with Sexual Activity after Inguinal Hernia Repair: Systematic Review and Meta-Analysis.
The reported incidence rates of sexual dysfunction (SD) and pain with sexual activity (PSA) after inguinal hernia repair in males vary considerably. This meta-analysis explores the rates of SD and PSA after different surgical and anesthesia types to understand patient risk after inguinal hernia repair. ⋯ Sexual dysfunction and PSA are not rare after inguinal hernia repair. They should be included in preoperative discussions and as standard metrics in reporting outcomes of repair in large cohorts or trials.
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The acute care surgery (ACS) model was developed to acknowledge the complexity of a traditionally fractured emergency general surgery patient population, however, there are variations in the design of ACS service models. This meta-analysis analyzes the impact of implementation of different ACS models on the outcomes for appendicitis and biliary disease. ⋯ The ACS model has been shown to benefit acute care surgery patients with improved access to care, fewer complications, and decreased length of stay for 2 common disease processes. The design and implementation of an ACS service can impact the magnitude of effect.
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Meta Analysis
Patient-Reported Outcomes Measurement Information System (PROMIS) Use in Surgical Care: A Scoping Study.
Surgeons recognize the importance of patient reported outcomes in the evaluation of health care. Documenting health related quality of life (HRQOL) can enhance surgical quality improvement efforts. Systematic documentation of HRQOL began in 1963. Currently, multiple varied and unstandardized instruments make it difficult to compare quality of life measures across studies. The NIH developed the Patient Reported Outcomes Measurement Information System (PROMIS) to provide a standardized assessment designed to complement traditional outcomes measures. ⋯ This study revealed that PROMIS performed efficiently, accurately, and reliably in assessing patient-reported HRQOL in multidisciplinary surgical publications.