Langenbeck's archives of surgery
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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.
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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.
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Langenbecks Arch Surg · Dec 2011
Comparative StudySuperior mesenteric artery first combined with uncinate process approach versus uncinate process first approach in pancreatoduodenectomy: a comparative study evaluating perioperative outcomes.
During pancreatoduodenectomy (PD), two techniques have been described to dissect the head of pancreas, viz. the superior mesenteric artery (SMA) approach by dissecting the uncinate process and the uncinate process first approach. ⋯ SMA first is a safe technique. It compares well with the uncinate first approach in terms of operative time, blood loss, number of lymph nodes retrieved, margin positivity and operative morbidity. Both techniques may be useful in situations such as a large uncinate process tumor or when superior mesenteric vein/portal vein/superior mesenteric artery involvement is suspected or present. Further studies, evaluating data related to specific predefined uncinate tumors, would be the next logical step in further defining the precise role of these techniques.
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Langenbecks Arch Surg · Dec 2011
Comparative StudyEnucleation in pancreatic surgery: indications, technique, and outcome compared to standard pancreatic resections.
Pancreatic surgery is a technically challenging intervention with high demands for preoperative diagnostics and perioperative management. A perioperative mortality rate below 5% is achieved in high-volume centers due to the high level of standardization in surgical procedures and perioperative care. Besides standard resections, certain indications may require individualized surgical concepts such as tumor enucleations. The aim of the study was to evaluate the indications, technique, and outcome of this limited local approach compared to major resections. ⋯ Pancreatic tumor enucleations can be carried out with good results and no mortality. Decisions regarding enucleations are highly individual compared to standard resections, underlining the importance of treatment in experienced high-volume institutions. Enucleations should be carried out whenever possible and oncologically feasible to prevent the typical complications of major pancreatic resection.
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Langenbecks Arch Surg · Dec 2011
Comparative StudyComparison of two electromyographical endotracheal tube systems for intraoperative recurrent laryngeal nerve monitoring: reliability and side effects.
Recurrent laryngeal nerve (RLN) monitoring systems should be reliable and safe. Monitoring via electromyographical systems on an endotracheal tube (ETT) is widely spread. The MagStim™ system consists of an adhesive electrode to be fixed on an endotracheal tube. The Xomed™ endotracheal tube provides integrated electrodes. Reliability and side effects had never been compared. As both systems have very different morphological properties, we hypothesized that there might be differences in reliability and the incidence of side effects. ⋯ Both MagStim™ and Xomed™ ETT were reliable in detecting the RLN. The Xomed™ ETT, however, might cause milder laryngeal side effects compared with the MagStim™ electrode.