J Visc Surg
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Multicenter Study Comparative Study
Is non-operative management of severe blunt splenic injury safer than embolization or surgery? Results from a French prospective multicenter study.
The management of the severe blunt splenic injuries remains debated. The aim of this study is to evaluate the morbidity and mortality of splenic injury according to severity and management (surgery, embolization, non-operative management [NOM]). ⋯ Embolization, because of its important specific morbidity, should not be performed as a prophylactic measure, but only in presence of clinical or laboratory signs of bleeding.
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Evaluate the learning curve of SILS (Single Incision Laparoscopic Surgery) on a simulator, based on two tests of the Fundamentals of Laparoscopic Surgery certification program (FLS(®)), in a population of novice medical students, and compare their performance to those of senior surgeons practicing both "conventional" laparoscopic surgery and SILS. ⋯ FLS(®) "low fidelity" simulator training is effective for the training of novice medical students. To minimize the risk of technical errors, novice medical students should practice a minimum of six simulator-training sessions before starting their practical learning of SILS in the operating room.
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The presence of an appendiceal fecalith should not be considered as a categorical sign of acute appendicitis. The fecalith may, however, be responsible for abdominal pain--right lower quadrant tenderness without associated appendicitis, i.e. appendiceal colic. When a patient presents with right lower quadrant abdominal tenderness, abdomino-pelvic computerized tomography (CT) may establish this diagnosis by demonstrating the presence of the appendicolith but without evidence of appendiceal inflammation or infection. ⋯ In this previously unpublished clinical case, the CT demonstrates the spontaneous passage of the appendicolith, which coincided in time with the resolution of the abdominal pain syndrome. When a patient presents with typical symptoms of appendiceal colic and CT findings of an appendicolith without appendicitis, appendectomy will certainly relieve the pain. But if the stone passes spontaneously, the need for appendectomy is debatable, particularly in a high-risk patient.
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Gastrointestinal surgery is feasible in patients with Child A cirrhosis, but is associated with higher morbidity and mortality. Hernia repair, biliary and colonic surgery are the most frequently performed interventions in this context. Esophageal and pancreatic surgery are more controversial and less frequently performed. ⋯ During emergency surgery, histologic diagnosis of cirrhosis should be confirmed by liver biopsy because the histologic diagnosis has therapeutic and prognostic implications. The management of patients with Child A cirrhosis without portal hypertension is little different from the management of patients without cirrhosis. However, the management of patients with Child B or C cirrhosis or with portal hypertension is more complex and requires an accurate assessment of the balance of benefit vs. risk for surgical intervention on a case-by-case basis.