Surgery
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Randomized Controlled Trial Comparative Study
Sutureless fixation with fibrin glue of lightweight mesh in open inguinal hernia repair: effect on postoperative pain: a double-blind, randomized trial versus standard heavyweight mesh.
Open inguinal hernia repair is associated with a low incidence of complications that can be influenced by the type of mesh and its method of fixation. Our aim was to investigate the frequency and severity of postoperative pain and other complications when lightweight, large-pore meshes, compared with heavyweight, small-pore meshes, are fixed with human fibrin glue (HFG) during open inguinal hernia repair. ⋯ Patients who underwent open inguinal hernia repair with lightweight, large-pore mesh fixed with HFG experienced less pain throughout the first month after operation compared with those receiving standard mesh.
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The Ventral Hernia Working Group proposed recently a classification system to grade the risk of surgical site occurrence (SSO) during ventral hernia repair (VHR). Accurately predicting the outcomes of synthetic mesh in open VHR for comorbid patients might guide surgeons in appropriate mesh selection in this patient population. Our objective was to determine the incidence of SSO in open, grade II VHR and to examine the use of synthetic mesh in these comorbid patients. ⋯ Patients with grade II hernias undergoing open VHR are prone to SSO with an incidence of 16%. Although synthetic mesh infections can occur among grade II patients, the majority can be managed conservatively with salvage of the prosthesis, especially if macroporous mesh is used. Given our findings, the use of synthetic mesh in the retrorectus space results in a safe and durable (5% recurrence rate) repair for patients with grade II incisional hernias.
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Review Meta Analysis Comparative Study
Meta-analysis of trials comparing laparoscopic transperitoneal and retroperitoneal adrenalectomy.
Laparoscopic adrenalectomies are being performed increasingly, either with transperitoneal or retroperitoneal approaches. Studies comparing the 2 approaches have not shown the superiority of either technique, but these studies are limited by small sample sizes and single-institution designs. To overcome these limitations, we performed a meta-analysis of studies comparing lateral transperitoneal adrenalectomy and retroperitoneal adrenalectomy. ⋯ Both lateral transperitoneal adrenalectomy and retroperitoneal adrenalectomy are associated with very low rates of perioperative complications. According to our meta-analysis, clinical outcomes after either technique are similar. For most adrenal lesions requiring operation, minimally invasive adrenalectomy can be performed safely and effectively with either transperitoneal or the retroperitoneal approach. Additional studies may be needed to analyze if any difference in long-term results exist.
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There is evidence that the outcomes of head and neck surgery may differ across racial and ethnic groups. Vocal changes related to the operation are an anticipated risk of thyroidectomy and parathyroidectomy. Race-specific voice outcomes after thyroid and parathyroid operations have not been reported. Therefore, our aim was to examine the potential disparity in voice outcomes between white and black patients after thyroid or parathyroid operations. ⋯ We observed greater rates of self-reported, negative voice outcomes among blacks than whites after thyroid or parathyroid operations. The precise mechanism for this disparity has not been described. The observed racial disparity in self-perceived voice impairment in this study merits further investigation.