Annals of surgery
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The aim is to discuss the various forms of bias in surgical research, including how it impacts validity and how to recognize and avoid it. ⋯ Familiarity with clinical trials' potential biases helps surgeons assess the believability and applicability of research results. Though these biases may sometimes be ameliorated by randomization, blinding, and intervention standardization, these remedies can present distinctive problems to surgical research. This poses a unique need and opportunity for innovation in surgical research design and evaluation. It necessitates that further research be done on methods to improve not only the internal and external validity of surgical trials but also their assessment.
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Optimization of postoperative outcome requires the application of evidence-based principles of care carefully integrated into a multimodal rehabilitation program. ⋯ Multimodal evidence-based care within the fast-track methodology significantly enhances postoperative recovery and reduces morbidity, and should therefore be more widely adopted. Further improvement is expected by future integration of minimal invasive surgery, pharmacological stress-reduction, and effective multimodal, nonopioid analgesia.
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Comparative Study
Weight loss outcome of revisional bariatric operations varies according to the primary procedure.
Revisional bariatric operations performed for weight loss failure are frequently associated with inconsistent weight reduction and serious perioperative complications. ⋯ Weight loss after revision of pure restrictive operations is significantly better than after revision of operations with malabsorptive components. Improvement of comorbidities in the great majority of patients justifies revision of all types of bariatric operations for unsatisfactory weight loss.
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To prospectively evaluate and accurately describe the rate and type of discrepancies encountered in the surgical count. ⋯ One in 8 surgical cases involves an intraoperative discrepancy in the count. The majority of these discrepancies detect unaccounted-for sponges and instruments, which represent potential RSI. Thus, despite the recognized limitations of manual surgical counts, discrepancies should always prompt a thorough search and reconciliation process and never be ignored.
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Comparative Study
Abdominal trauma after terrorist bombing attacks exhibits a unique pattern of injury.
The recent growth in the volume of civilian blast trauma caused by terrorist bombings warrants special attention to the specific pattern of injury associated with such attacks. ⋯ Terrorist attacks generate more severe injuries to more body regions than other types of trauma. Abdominal injury inflicted by terrorist bombings causes a unique pattern of wounds, mainly injury to hollow organs. Shrapnel is the leading cause of abdominal injury following terrorist bombings.