Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract
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J. Gastrointest. Surg. · Oct 2010
Comparative StudyComparison of outlier identification methods in hospital surgical quality improvement programs.
Surgeons and hospitals are being increasingly assessed by third parties regarding surgical quality and outcomes, and much of this information is reported publicly. Our objective was to compare various methods used to classify hospitals as outliers in established surgical quality assessment programs by applying each approach to a single data set. ⋯ There was considerable variation in the number of outliers identified using different detection approaches. Quality programs seem to be utilizing outlier identification methods contrary to what might be expected, thus they should justify their methodology based on the intent of the program (i.e., quality improvement vs. reimbursement). Surgeons and hospitals should be aware of variability in methods used to assess their performance as these outlier designations will likely have referral and reimbursement consequences.
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J. Gastrointest. Surg. · Sep 2010
Case ReportsLeft-sided acute appendicitis with situs inversus totalis: review of 63 published cases and report of two cases.
Situs inversus (SI) and midgut malrotation (MM) are uncommon anatomic anomalies that complicate diagnosis and management of acute abdominal pain. ⋯ SIT and MM should be taken into consideration in patients with findings of the physical examination suspicious for left-sided acute appendicitis. X-ray, USG, CT and diagnostic laparoscopy are beneficial in developing the differential diagnosis.
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J. Gastrointest. Surg. · Sep 2010
Comparative StudyManagement of leaks after laparoscopic sleeve gastrectomy in patients with obesity.
Laparoscopic sleeve gastrectomy (LSG) is a surgical procedure that is being increasingly performed on obese patients. The most frequent postoperative complication is the appearance of a gastric leak. ⋯ Close clinical observation detects gastric leaks early on inpatients who underwent LSG. We suggest evaluating these leaks based on three parameters: time of appearance, the location, and its severity, in order to propose the best medical or surgical treatment in these patients.
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J. Gastrointest. Surg. · Aug 2010
Comparative StudyCan adequate lymphadenectomy be obtained by laparoscopic resection in rectal cancer? Results of a case-control study in 200 patients.
The aim of this study is to compare pathological findings in rectal cancer specimens obtained by laparoscopy or laparotomy. ⋯ There is no difference between laparoscopic or open approaches concerning specimen's length, distal margin, circumferential margin, and total and positive lymph nodes. Laparoscopic rectal resection is not only technically feasible but it seems also oncologically safe.
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J. Gastrointest. Surg. · Aug 2010
Comparative StudyRole of factor VII in correcting dilutional coagulopathy and reducing re-operations for bleeding following non-traumatic major gastrointestinal and abdominal surgery.
The objective of this study is to evaluate the effectiveness of rfVIIa in reducing blood product requirements and re-operation for postoperative bleeding after major abdominal surgery. ⋯ Use of rfVIIa in resuscitation for hemorrhage after non-traumatic major abdominal and gastrointestinal surgery can correct dilutional coagulopathy, reducing blood product requirements and need for re-operation.