Annals of surgery
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Multicenter Study Comparative Study
Clinical Health Service Research on the Surgical Therapy of Acute Appendicitis: Comparison of Outcomes Based on 3 German Multicenter Quality Assurance Studies Over 21 Years.
The treatment of acute appendicitis has seen changes in diagnosis and therapy in Germany. The objective of this analysis was to assess changes in therapy and outcome after open appendectomy (OA) and laparoscopic appendectomy (LA) over the last 21 years. ⋯ Changes in patient data reflected demographic changes. Preoperative selection leads to 2 clearly defined groups. LA is the most dominant method of current operative therapy. The negative selection in OA group has influenced the worse outcome of that group.
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Comparative Study
Minimally Invasive Versus Open Pancreaticoduodenectomy for Cancer: Practice Patterns and Short-term Outcomes Among 7061 Patients.
To describe national practice patterns regarding utilization of minimally invasive pancreaticoduodenectomy (MIPD) and compare short-term outcomes with those following open pancreaticoduodenectomy for cancer. ⋯ While there is increasing interest in employing MIPD for adenocarcinoma, its use is associated with increased 30-day mortality. The majority of hospitals performing MIPD were low volume. These results may suggest that MIPD is a complex procedure for which comprehensive protocols outlining criteria for implementation might be warranted to optimize patient safety.
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We describe the technical details and evaluate the safety, feasibility, and usefulness of a combined lateral and abdominal (CLA) approach for laparoscopic resection of liver segments 7 and 8. ⋯ The CLA approach permits safe laparoscopic resection of lesions in the posterosuperior area of segments 7 and 8, allowing surgeons to overcome the difficulties of limited visualization and access to the target lesions.
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To establish a risk model for distal gastrectomy in Japanese patients with gastric cancer. ⋯ The risk model developed using nationwide Japanese data on distal gastrectomy in gastric cancer can predict surgical outcomes.
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The purpose of this study was to explore how risk is perceived and experienced by the surgeon and how risk is actively managed in individual practice. ⋯ A framework for understanding surgeon's unique assessment of risk was elaborated. Increased awareness of the factors and strategies identified in this study can foster critical self-reflection by surgeons of their own risk assessments and those of their colleagues, and provide avenues for more explicit educational strategies for surgical training.