Annals of surgery
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The purpose of this study was to assess indebtedness among academic surgeons and its repercussions on personal finances, quality of life, and career choices. ⋯ Many academic surgeons reported that their educational debt affected their academic productivity, career choices, and quality of life. Consequently, efforts to mitigate the impact of educational debt on academic surgeons are required to ensure medical students continue to pursue academic surgical careers.
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Editorial Comment
Fluid overload and surgical outcome: another piece in the jigsaw.
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Randomized Controlled Trial Comparative Study
Latest results (12-21 years) of a prospective randomized study comparing Billroth II and Roux-en-Y anastomosis after a partial gastrectomy plus vagotomy in patients with duodenal ulcers.
After a partial resection of the stomach, the continuity of the gastrointestinal tract can be restored either by a Billroth II gastrojejunal anastomosis or a Roux-en-Y gastrojejunostomy. Each procedure has its advantages and disadvantages. ⋯ This prospective and random study showed that Roux-en-Y gastrojejunostomy is significantly better than a Billroth II reconstruction in patients with duodenal ulcers, through subjective and objective endoscopic and histologic evaluations during the latest follow-up evaluation.
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Clinical Trial
The effect of mesh removal and selective neurectomy on persistent postherniotomy pain.
SUMMARY BACKGROUND DATA AND OBJECTIVE: Persistent pain affects everyday activities in 5% to 8% of patients after groin hernia repair. Because previous reports on the effect of neurectomy and/or mesh removal suffer from methodological problems we performed a detailed prospective trial of the effect of neurectomy and mesh removal on persistent postherniotomy pain. ⋯ Selective neurectomy and mesh removal may improve pain-related activity impairment in patients with persistent postherniotomy pain. Detailed neurophysiologic assessment is recommended to identify patients who may or may not benefit from reoperation and to allocate patients to specific surgical and/or medical intervention.
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Diverticular disease imposes an impressive clinical burden to the United States population, with over 300,000 admissions and 1.5 million days of inpatient care annually. Consensus regarding the treatment of diverticulitis has evolved over time, with increasing advocacy of primary anastomosis for acute diverticulitis, and nonoperative treatment of recurrent mild/moderate diverticulitis. We analyzed whether these changes are reflected in patterns of practice in a nationally-representative patient cohort. ⋯ We are the first to report dramatic changes in rates of treatment for diverticulitis in the United States. The causes of this emerging disease pattern are unknown, but certainly deserve further investigation. For patients undergoing surgery for acute diverticulitis, there was little change over time in the likelihood of a primary anastomosis.