Annals of surgery
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Review Meta Analysis
Laparoscopic surgery compared with open surgery decreases surgical site infection in obese patients: a systematic review and meta-analysis.
To compare surgical site infections rate in obese patients after laparoscopic surgery with open general abdominal surgery. ⋯ Laparoscopic surgery in obese patients reduces surgical site infection rate by 70%-80% compared with open surgery across general abdominal surgical procedures. Future efforts should be focused on further development of laparoscopic surgery for the growing obese population.
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Randomized Controlled Trial Multicenter Study Comparative Study
A double-blinded randomized controlled trial of laparoendoscopic single-site access versus conventional 3-port appendectomy.
The aim of the current study was to perform a multicentered prospective double-blinded randomized controlled trial comparing laparoendoscopic single-site access (LESS) versus conventional three-port laparoscopic appendectomy (TPLA). ⋯ LESS and conventional appendectomy resulted in similar perioperative outcomes. However, LESS appendectomy resulted in worst pain scores upon exertion and required a higher dosage of intravenous analgesics when compared with TPLA. On the contrary, wound cosmesis and satisfaction scores were better in the LESS group. Hence, adoption of the technique for appendectomy will depend on patient preferences and the presence of local expertise.
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Meta Analysis
Should perioperative supplemental oxygen be routinely recommended for surgery patients? A Bayesian meta-analysis.
The purpose of this study is to use updated data and Bayesian methods to evaluate the effectiveness of hyperoxia to reduce surgical site infections (SSIs) and/or mortality in both colorectal and all surgery patients. Because few trials assessed potential harms of hyperoxia, hazards were not included. ⋯ There is a moderately high probability of a benefit to hyperoxia in reducing SSIs in colorectal surgery patients; however, the magnitude of benefit is relatively small and might not exceed treatment hazards. Further studies should focus on generalizability to other patient populations or on treatment hazards and other outcomes.
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Randomized Controlled Trial Comparative Study
Axillary dissection versus no axillary dissection in older patients with T1N0 breast cancer: 15-year results of a randomized controlled trial.
To assess the role of axillary dissection in older breast cancer patients with a clinically clear axilla. ⋯ Older patients with early breast cancer and a clinically clear axilla treated by conservative surgery, postoperative radiotherapy, and adjuvant tamoxifen do not benefit from axillary dissection. This study was registered at clinicaltrials.gov (ID NCT00002720).
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Review
Objective structured assessment of debriefing: bringing science to the art of debriefing in surgery.
: To identify the features of effective debriefing and to use this to develop and validate a tool for assessing such debriefings. ⋯ : OSAD provides an evidence-based, end-user informed approach to debriefing in surgery. By quantifying the quality of a debriefing, OSAD has the potential to identify areas for improving practice and to optimize learning during simulation-based training.