Journal of the American College of Surgeons
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Comparative Study
Laparoscopic vs open pancreaticoduodenectomy: overall outcomes and severity of complications using the Accordion Severity Grading System.
Minimal access surgery techniques have evolved to include complex surgical procedures. Laparoscopic pancreaticoduodenectomy (LPD) is a complex operation that pancreas surgeons have been slow to adopt. This article reviews our experience with patients undergoing LPD and compares their outcomes with those of patients undergoing open pancreaticoduodenectomy (OPD). ⋯ This series demonstrates that LPD appears to be safe and feasible, with benefits over the open counterpart. However, the increased complexity and effort demanded by the technique pose the need for multi-institutional series and standardization in reporting. The goal should be to assess if LPD can result in a better procedure with better outcomes.
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Multicenter Study
The road to curative surgery in gastric cancer treatment: a different path in the elderly?
The aim of this study was to evaluate the possibility of a different path to achieve curative surgery in patients older than age 70 years and affected by resectable gastric cancer. ⋯ Age should not be considered as a factor in the selection of treatment for gastric cancer patients. Curative surgery can be performed as safely in elderly patients as in younger patients, with comparable postoperative results and long-term survival rates, although the life expectancy of elderly patients is shorter.
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Thirty-day postoperative complications from unintended harm adversely affect patients and their families and increase institutional health care costs. A surgical checklist is an inexpensive tool that will facilitate effective communication and teamwork. Surgical team training has demonstrated the opportunity for stakeholders to professionally engage one another through leveling of the authority gradient to prevent patient harm. The American College of Surgeons National Surgical Quality Improvement Program database is an outcomes reporting tool capable of validating the use of surgical checklists. ⋯ Use of a comprehensive surgical safety checklist and implementation of a structured team training curriculum produced a statistically significant decrease in 30-day morbidity. Adoption of a comprehensive checklist is feasible with team training intervention and can produce measurable improvements in patient outcomes.
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Comparative Study
Surgical residents' perception of the 16-hour work day restriction: concern for negative impact on resident education and patient care.
Effective July 1, 2011, the Accreditation Council for Graduate Medical Education (ACGME) instituted a 16-hour duty period limitation for postgraduate year I (PGY I) residents. Our aim was to assess the attitudes and perception of general surgery residents regarding the new duty hour limitation as well as the transfer of care process under the new guidelines. ⋯ The results of the survey suggest that the majority of general surgery residents are concerned over the potential negative impact of the duty limitation on resident education and patient care. Further research is needed to address these concerns.