Langenbeck's archives of surgery
-
Langenbecks Arch Surg · Feb 2012
Multicenter Study Comparative StudyOpen tension-free hernioplasty using a novel lightweight self-gripping mesh: medium-term experience from two institutions.
The process of mesh fixation and the potential risk of associated chronic pain are always surgeon's main concerns in hernia surgery. A wide variety of lightweight mesh models are currently available on the market to overcome some of these problems showing good preliminary results, but no data representing the medium- or long-term results. The present study aims to report the clinical outcomes of two institutional series of patients who underwent hernia repair using a partially absorbable auto adherent mesh (Parietene™ Progrip™--PP). ⋯ In our experience, the use of the PP mesh for hernioplasties offers a potential benefit not only in the short-term period but also in a medium-term follow-up with low recurrence and late chronic pain rates. However, this particular mesh does not fully prevent all complications and chronic pain and recurrent hernias have been reported for the first time.
-
Langenbecks Arch Surg · Feb 2012
Multicenter Study Comparative StudyAppendectomy and diagnosis-related groups (DRGs): patient classification and hospital reimbursement in 11 European countries.
As part of the EuroDRG project, researchers from 11 countries (i.e., Austria, England, Estonia, Finland, France, Germany, Ireland, Netherlands, Poland, Sweden, and Spain) compared how their diagnosis-related groups (DRG) systems deal with appendectomy patients. The study aims to assist surgeons and national authorities to optimize their DRG systems. ⋯ Large variations in the classification of appendectomy patients raise concerns whether all systems rely on the most appropriate classification variables. Surgeons and national DRG authorities should consider how other countries' DRG systems classify appendectomy patients in order to optimize their DRG system and to ensure fair and appropriate reimbursement.
-
Selection of an optimal surgical technique for inguinal hernia repair, allowing safe performance and rapid recovery without long-term complaints, may contribute significantly to the reduction of national health care costs. ⋯ With regard to recovery and occurrence of chronic pain, TAPP and TEP are superior to open mesh repair in most cases. Greater efforts should be undertaken to make laparoscopic repair easier, safer, and less expensive. If this can be achieved, health care costs could ultimately be reduced.
-
Langenbecks Arch Surg · Feb 2012
Randomized Controlled Trial Comparative StudyA randomised controlled pilot trial to evaluate and optimize the use of anti-platelet agents in the perioperative management in patients undergoing general and abdominal surgery--the APAP trial (ISRCTN45810007).
Surgeons are increasingly confronted by patients on long-term low-dose acetylsalicylic acid (ASA). However, owing to a lack of evidence-based data, a widely accepted consensus on the perioperative management of these patients in the setting of non-cardiac surgery has not yet been reached. Primary objective was to evaluate the safety of continuous versus discontinuous use of ASA in the perioperative period in elective general or abdominal surgery. ⋯ Perioperative intake of ASA does not seem to influence the incidence of severe bleeding in non-high-risk patients undergoing elective general or abdominal surgery. Further, adequately powered trials are required to confirm the findings of this study.