Surgical technology international
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Review Comparative Study
Preoperative risk factors for postoperative Staphylococcus aureus nosocomial infections.
Of the 40 million patients who undergo surgery each year in the United States, 20% may develop a postoperative nosocomial infection. Staphylococcus aureus (S. aureus) is the most common organism involved, and carriage of S. aureus in the anterior nares has been identified as a risk factor for these infections. Topical mupirocin applied to the anterior nares has been successful in eliminating S. aureus and decreasing nosocomial infections due to S. aureus. ⋯ Recently, a large study identified risk factors linked to S. aureus nasal colonization, which included obesity, male gender, and a history of a cerebrovascular accident. Protective factors included older age, current smoking, and alcohol use. Thus, by modulating these variables, investigators may create interventions aimed at reducing S. aureus nasal carriage and ultimately, postoperative nosocomial infections.
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In the mid-1990s, the authors introduced a minimally invasive system of cesarean delivery. This article illustrates the improvements made since the technique's initial publication. ⋯ The procedure described herein features a short operating time, minimal instrumentation, reduced surgical dissection, decreased postoperative pain, and reduced risk of blood loss, infection, and wound complications. It is easily learned and cost-effective, with a brief postoperative recovery period.
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Review Comparative Study
Pelosi minilaparotomy hysterectomy: a non-endoscopic minimally invasive alternative to laparoscopy and laparotomy.
T he authors' technique of minilaparotomy hysterotomy is a new modality that combines the technical benefits of conventional laparotomy with the minimally invasive convalescent and cosmetic advantages of laparoscopic surgery. For patients in whom vaginal hysterectomy is considered contraindicated, this procedure offers an effective and safe minimal access alternative. This redesigned minilaparotomy approach relies on traditional open techniques and experience instrumentation that avoid the cost of expensive equipment, long learning curve, and prolonged operating time associated with laparoscopic surgery, as well as the convalescent disadvantages of a standard laparotomy.
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Review
Rapid recovery protocol for peri-operative care of total hip and total knee arthroplasty patients.
Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are among the most successful procedures performed in terms of quality-of-life years gained. The long-term goals of arthroplasty, to relieve pain, increase function, provide stability, and obtain durability, are accomplished in the vast majority of cases. The short-term goals, however, have become the target of aggressive peri-operative programs that aim to speed recovery, reduce morbidity and complications, and create a program of efficiency while maintaining the highest level of patient care. ⋯ This article outlines the specific elements of the rapid-recovery program for lower-extremity arthroplasty patients, including pre-operative patient education, peri-operative nutrition, vitamin and herbal medication supplementation, preemptive analgesia, and post-operative rehabilitation. A holistic peri-operative, rapid-recovery program has lead to a significantly decreased hospital length of stay and significantly lower hospital readmission rates in patients who undergo primary THAs and TKAs. Combining these results with minimally invasive techniques and instrumentation should make recovery even faster.
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Surgery of the groin hernia has become more a question of the applied tension-free, mesh technique. Whereas studies on laparascopic versus open tension-free hernia repair or open-mesh versus open-nonmesh repair have been performed sufficiently, data regarding the open tension-free plug-and-patch technique are rather poor. During the period from January 2001 to October 2003, we followed and filed 766 hernia repairs in the plug-and-patch technique of Rutkow. ⋯ Tension-free repair of the inguinal hernia by the plug-and-patch technique is a quick and secure method that simplifies hernia surgery without compromising the high-quality standards such as a low recurrence rate and low pain load of the patient. Patients had a fast recovery with a subsequent short work leave. The method is a simple, effective, and economical operation, suitable as a standard performed in local anesthesia on an out-patient basis.