The British journal of surgery
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Multicenter Study Clinical Trial
Prophylactic nipple-sparing mastectomy with immediate breast reconstruction: results of a French prospective trial.
Nipple-sparing mastectomy (NSM) with immediate breast reconstruction (IBR) is used increasingly when performing a prophylactic mastectomy. Few prospective studies have reported on complication rates. This complementary trial to the French prospective multicentre MAPAM trial aimed to evaluate the nipple-areola complex (NAC) necrosis rate in prophylactic NSM with IBR. ⋯ Results of this prospective study confirm that prophylactic NSM with IBR is associated with a low risk of total NAC necrosis.
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In the March issue of BJS several hot topics within the breast surgery field are highlighted in beautifully planned and executed prospective multicentre trials. BJS encourages the surgical communities in most fields to move towards prospective collaborative and multicentre studies, thereby increasing both power and generalizability as well as reducing the risk of bias.
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Nationwide study of surgery for primary infected abdominal aortic and common iliac artery aneurysms.
Primary infected aneurysms of the abdominal aorta and iliac arteries are potentially life-threatening. However, because of the rarity of the disease, its pathogenesis and optimal treatment strategy remain poorly defined. ⋯ In patients undergoing surgical intervention for primary infected abdominal aortic and CIA aneursyms, postoperative survival rates were encouraging. Eradication of infection following EVAR appeared less likely than with open repair, but survival rates were similar in matched patients between EVAR and in situ graft replacement.
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Long-term results after non-operative treatment for children with simple appendicitis seem promising, possibly avoiding appendicectomy in 70 per cent of children after a median follow-up of 5 years. The need for delayed appendicectomy more than 2 years after the initial treatment is rare (0–5 per cent) and no complications occurred past 1 year, including children who underwent delayed appendicectomy.
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Surgical interventions, such as paraoesophageal hernia (POH) repair, are complex with multiple components that require consideration in the reporting of clinical trials. Many aspects of POH repair, including mesh hiatal reinforcement and fundoplication type, are contentious. This review summarizes the reporting of components and outcomes in RCTs of POH repair. ⋯ This lack of detail on the surgical intervention in POH repair RCTs prevents full understanding of what exact procedure was evaluated and how it should be delivered in clinical practice to gain the desired treatment effects. Improved focus on the definitions, descriptions and reporting of surgical interventions in POH repair is required for better future RCTs.