Articles: surgery.
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Mayo Clinic proceedings · Sep 2024
ReviewBariatric and Metabolic Surgery in the Adult Population: What a Primary Care Provider Needs to Know.
Obesity is a significant public health concern worldwide and a leading cause of preventable death and morbidity, but the management of this condition remains a challenge. Metabolic and bariatric surgery (MBS) is safe and currently has the most consistent and robust data among anti-obesity interventions for ameliorating obesity and its associated complications. Despite the benefits and safety of MBS, it is significantly underused. ⋯ The purpose of this review is to summarize key points of the 2022 American Society for Metabolic and Bariatric Surgery/International Federation for the Surgery of Obesity and Metabolic Disorders guidelines regarding MBS, as well as to discuss indications, benefits and risks, most common types of MBS, and barriers to access, thereby increasing awareness of MBS among primary care physicians. This narrative review was based on articles found by searching PubMed from its inception until April 2024 for the terms sleeve gastrectomy, gastric bypass, and metabolic and bariatric surgery. Our search was confined to English-language publications, with emphasis placed on evidence derived from systematic literature reviews, meta-analyses, and randomized clinical trials whenever available.
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Superficial venous thrombosis (SVT) is a fairly common disorder, characterized by the formation of thrombi inside superficial veins, with or without an associated inflammatory reaction. Its evolution is frequently self-limited. However, serious complications may change this clinical course with extension to deep vein thrombosis (DVT) and pulmonary embolism (PE). ⋯ There are several guidelines that provide recommendations, and despite the need for more consensus and for further studies, the treatment of SVT should be mainly medical, including anticoagulation in specific clinical situations and symptom relief, with invasive treatment in a minority of cases. Initiation, intensity, and length of anticoagulant treatment should be based on the eventual risk of progression to DVT or PE, which can be high, intermediate, or low, based on the location of SVT and the clot length. Our review summarizes the evaluation and proper management of SVT and highlights the importance of a shared decision within the heart team regarding this condition in order to prevent further complications.
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Every year, many opioid users undergo surgery, experiencing increased postoperative complications, inadequate pain control, and opioid-related adverse effects. This overview aims to summarise and critically assess the systematic reviews about perioperative pain management interventions, identify the knowledge gaps, and potentially provide high-quality recommendations to improve postoperative analgesia and surgical outcomes. ⋯ Perioperative continuation of buprenorphine and ketamine administration as a multimodal analgesia approach, with moderate to very low-quality evidence, improves pain management in opioid users and decreases opioid-related adverse effects. However, high-quality systematic reviews are required to fill the identified gaps in knowledge.
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To compare robotic-assisted proctectomy with ileal pouch-anal anastomosis (R-IPAA) outcomes and laparoscopic proctectomy with ileal pouch-anal anastomosis (L-IPAA) within a specialized robotic surgery center, using matching techniques to minimize potential confounding factors. ⋯ In a high-volume robotic surgery center, R-IPAA reduced the risk of conversion to open surgery while reducing intraoperative blood loss and providing shorter length of stay with equivalent perioperative outcomes. Promising trends to reduce 30-day reoperations and surgical complications following DLI closure were observed after a matching analysis.