Open preperitoneal groin hernia repair with mesh: A qualitative systematic review.
Am J Surg. 2017 Jan 10;:
Authors: Andresen K, Rosenberg J
BACKGROUND: For the repair of inguinal hernias, several surgical methods have been presented where the purpose is to place a mesh in the preperitoneal plane through an open access. The aim of this systematic review was to describe preperitoneal repairs with emphasis on the technique.
DATA SOURCES: A systematic review was conducted and reported according to the PRISMA statement. PubMed, Cochrane library and Embase were searched systematically. Studies were included if they provided clinical data with more than 30 days follow up following repair of an inguinal hernia with an open preperitoneal mesh technique.
CONCLUSIONS: A total of 67 articles were included, describing nine different methods: Kugel, TREPP, TIPP, Onstep, Horton/Florence, Nyhus, Ugahary, Read, and Stoppa. In general, results regarding pain, recurrences and complications seem promising. It was not possible to conduct a meta-analysis. Open preperitoneal techniques with placement of a mesh through an open approach seem promising compared with the standard anterior techniques. This systematic review provides an overview of these techniques together with a description of surgical methods and clinical outcomes.
PMID: 28095985 [PubMed - as supplied by publisher]
Post-extubation stridor in the trauma ICU: Still a problem overly complex.
Am J Surg. 2017 Jan 09;:
Authors: Blanco JB, Esquinas AM
PMID: 28095984 [PubMed - as supplied by publisher]
Impact of minimally invasive vs. open distal pancreatectomy on use of adjuvant chemoradiation for pancreatic adenocarcinoma.
Am J Surg. 2017 Jan 07;:
Authors: Anderson KL, Adam MA, Thomas S, Roman SA, Sosa JA
BACKGROUND: Published data examining the impact of minimally invasive distal pancreatectomy (MIDP) on survival are generally limited to experiences from high-volume institutions. Our aim was to compare utilization of adjuvant chemoradiation and time from surgery until its initiation following MIDP vs. open surgery (ODP) at a national level.
METHODS: Adult patients undergoing distal pancreatectomy for Stage I and II pancreatic adenocarcinoma were identified from the National Cancer Data Base, 2010-2012.
RESULTS: A total of 1807 patients underwent distal pancreatectomy for adenocarcinoma at 506 institutions (27.9% MIDP). After adjustment, those who underwent MIDP were more likely to have complete tumor resections and a shorter hospital length of stay. Patients undergoing MIDP vs. ODP were more likely to receive adjuvant chemotherapy; time to initiation of adjuvant chemotherapy or radiation was not different between groups. After adjustment, overall survival for MIDP vs. ODP remained similar (HR 0.85, CI 0.67-1.10, p = 0.21).
CONCLUSION: MIDP is associated with increased use of adjuvant chemotherapy; further study is needed to understand the etiology and impact of this association.
PMID: 28093119 [PubMed - as supplied by publisher]
Surgical Fires and Operative Burns: Lessons Learned From a 33-Year Review of Medical Litigation.
Am J Surg. 2016 Dec 12;:
Authors: Choudhry AJ, Haddad NN, Khasawneh MA, Cullinane DC, Zielinski MD
OBJECTIVE: We aimed to understand the setting and litigation outcomes of surgical fires and operative burns.
METHODS: Westlaw, an online legal research data-set, was utilized. Data were collected on patient, procedure, and case characteristics.
RESULTS: One hundred thirty-nine cases were identified; 114 (82%) operative burns and 25 (18%) surgical fires. Median plaintiff (patient) age was 46 (IQR:28-59). Most common site of operative burn was the face (26% [n = 36]). Most common source of injury was a high energy device (43% [n = 52]). Death was reported in 2 (1.4%) cases. Plaintiff age <18 vs age 18-50 and mention of a non-surgical physician as a defendant both were shown to be independently associated with an award payout (OR = 4.90 [95% CI, 1.23-25.45]; p = .02) and (OR = 4.50 [95% CI, 1.63-13.63]; p = .003) respectively. Plaintiff award payment (settlement or plaintiff verdict) was reported in 83 (60%) cases; median award payout was $215,000 (IQR: $82,000-$518,000).
CONCLUSION: High energy devices remain as the most common cause of injury. Understanding and addressing pitfalls in operative care may mitigate errors and potentially lessen future liability.
LEVEL OF EVIDENCE: III.
PMID: 28093118 [PubMed - as supplied by publisher]
The biological prosthesis is a viable option for abdominal wall reconstruction in pediatric high risk defects.
Am J Surg. 2017 Jan 06;:
Authors: Zmora O, Castle SL, Papillon S, Stein JE
BACKGROUND: Our aim was to explore the indications for and outcome of biological prostheses to repair high risk abdominal wall defects in children.
METHODS: A retrospective chart review was performed of all cases of abdominal wall reconstruction in a single institution between 2007 and 2015. Demographic and clinical variables, technique and complications were described and compared between prosthesis types.
RESULTS: A total of 23 patients underwent abdominal wall reconstruction using a biological prosthesis including 17 neonates. The main indication was gastroschisis (17 patients) followed by ruptured omphalocele and miscellaneous conditions. Alloderm™ was most commonly used followed by Surgisis™, Strattice™, Flex-HD™ and Permacol™. In 22 cases wounds were contaminated or infected. Open bowel/stomas were present in 9 cases. Skin was not closed in 11 cases. Post-operative complication rate was 30% and hernia recurrence rate was 17% after a mean follow-up time of 16 months.
CONCLUSIONS: The use of a biological prosthesis may offer advantages over a synthetic mesh in pediatric high risk abdominal wall defects. The surgeon should be ready to consider its use in selected cases.
PMID: 28093117 [PubMed - as supplied by publisher]