Surgery
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Randomized Controlled Trial Clinical Trial
Continuous local anesthetic infusion for pain management after outpatient inguinal herniorrhaphy.
The purpose of the present study is to compare postoperative pain and functional outcomes in patients undergoing inguinal herniorrhaphy who receive a continuous wound infusion of bupivacaine to those who receive an infusion of saline. ⋯ Continuous infusion of local anesthetic after inguinal herniorrhaphy provides modest improvements in pain scores and functional outcomes when compared with placebo. However, these effects are limited to the first postoperative day only. The additional costs associated with this intervention may limit its widespread use in clinical practice.
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Comparative Study
Blunt splenic injury: operation versus angiographic embolization.
Splenic injuries, like other blunt traumatic injuries, are increasingly treated with non-operative management. Angiographic embolization (AE) has emerged as an alternative modality for treatment of splenic injuries. We hypothesized that splenic embolization would lead to equivalent, if not improved, outcomes in terms of mortality, total costs, complications, and duration of stay. ⋯ AE of splenic injuries is safe and associated with fewer complications. The spleen AIS, heart rate, age, and GCS did not correlate with the need for an operation. Higher ISS, lower blood pressure, lower pH, and increased number of packed red blood cell transfusions were better indicators of the need for an operation versus embolization.
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Comparative Study
Fertility is reduced after restorative proctocolectomy with ileal pouch anal anastomosis: a study of 300 patients.
Restorative proctocolectomy and ileal pouch anal anastomosis (RP/IPAA) has become the gold standard surgical therapy for the majority of patients with mucosal ulcerative colitis and familial adenomatous polyposis. The aims of this study were to evaluate the fertility rates before and after RP/IPAA, to compare them with the reproductive data of the general United States population, and to determine surgical parameters that might influence subsequent fertility. ⋯ There was an increase in the infertility rate after RP/IPAA. Intraoperative blood transfusion had a negative impact on the fertility rate after operation in patients who tried to conceive both before and after RP/IPAA.
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Comparative Study
Utility of total mechanical stapled cervical esophagogastric anastomosis after esophagectomy: a comparison to conventional anastomotic techniques.
Cervical esophagogastric anastomosis after esophagectomy is often troubled with anastomotic leak resulting in local sepsis, postoperative stricture, and prolonged hospitalization. We compared the anastomotic outcomes and clinical course of esophagectomy patients undergoing total mechanical stapled esophagogastric anastomosis versus a partial handsewn/mechanical stapled cervical anastomotic technique. ⋯ Total mechanical stapled technique after esophagectomy with cervical esophagogastric anastomosis appears to be effective in reducing hospitalization and anastomotic complications compared to partial or complete handsewn techniques. Liberal use of endoscopic staplers might shorten operative time. Esophageal surgeons should be aware of the advantages and become skilled with these techniques.
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Conventional resuscitation (CR) from hemorrhagic shock often culminates in multisystem organ failure and death, commonly attributed to a progressive splanchnic vasoconstriction and hypoperfusion, a gut-derived systemic inflammatory response (SIR), and fluid sequestration. Direct peritoneal resuscitation (DPR) produces a sustained state of tissue hyperperfusion in splanchnic and distant organs. In this study we evaluated the therapeutic potential of DPR on the SIR and fluid sequestration as parameters of treatment outcome. ⋯ This study demonstrates that DPR as adjunct to CR has beneficial effects on the pathophysiology of resuscitated hemorrhagic shock. In addition to restoration of tissue perfusion, DPR has immunomodulation and anti-fluid sequestration effects. These modulations result in improved outcome.