Archives of surgery (Chicago, Ill. : 1960)
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Review Comparative Study
Conversion of emergent cricothyrotomy to tracheotomy in trauma patients.
To review the literature to determine the rates of airway stenosis after cricothyrotomy, particularly as they compare with previously documented rates of this complication after tracheotomy, and to examine the complications associated with conversion. ⋯ Cricothyrotomy after trauma is safe for initial airway access among patients who require the establishment of an emergent airway. The prolonged use of a cricothyrotomy tube, however, remains controversial. Although no study to date has demonstrated any benefit of routine conversion to tracheostomy, considerable deficiencies in existing studies highlight the need for further investigations of this practice.
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To create a decision analytic model to estimate the balance between treatment risks and benefits for patients with morbid obesity. ⋯ The optimal decision for individual patients varies based on the balance of risk between perioperative mortality, excess annual mortality risk associated with increasing body mass index, and the efficacy of surgery; however, for the average morbidly obese patient, gastric bypass improves life expectancy.
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The introduction of laparoscopic liver resection has been challenging because new and safe surgical techniques have had to be developed, and skepticism remains about the use of laparoscopy for malignant neoplasms. We present herein a large-volume single-center experience with laparoscopic liver resection. ⋯ In experienced hands, laparoscopic liver resection is a favorable alternative to open resection. Perioperative morbidity and mortality and long-term survival after laparoscopic resection of colorectal metastases appear to be comparable to those after open resections.
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Total laparoscopic pancreaticoduodenectomy is a safe and effective therapeutic approach. ⋯ Laparoscopic pancreaticoduodenectomy is feasible, safe, and effective. Outcomes appear comparable with those via the open approach; however, controlled trials are needed. Despite this series representing experience within the learning curve, laparoscopic pancreaticoduodenectomy holds promise for providing advantages seen with minimally invasive approaches in other procedures.
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Comparative Study
Improved bariatric surgery outcomes for Medicare beneficiaries after implementation of the medicare national coverage determination.
To compare the outcomes of Medicare beneficiaries who underwent bariatric surgery within 18 months before and after implementation of the national coverage determination (NCD) for bariatric surgery. ⋯ The bariatric surgery NCD resulted in improved outcomes for Medicare beneficiaries without limiting access to care for individuals with medical disability.