ERISA and medical professional liability.
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Clinical Competence↗
Biomedical subjects
F D Griffen
Publications and source records attributed to F D Griffen.
Practice guidelines and liability implications.
It should be clear that the authors of this article are not enamored of practice guidelines, thinking them of much more potential harm than good. On the other hand, if practice guidelines are deemed essential, then they must be written with the goal of quality patient care advocacy and with an eye toward the possible damage they may do.
Liability, Legal↗
Practice guidelines and liability implications.
It should be clear that the authors of this article are not enamored of practice guidelines, thinking them of much more potential harm than good. On the other hand, if practice guidelines are deemed essential, then they must be written with the goal of quality patient care advocacy and with an eye toward the possible damage they may do.
Humans↗
Prevention of seromas in mastectomy wounds. The effect of shoulder immobilization.
OBJECTIVE: To determine if postoperative shoulder immobilization decreases the incidence of postmastectomy seromas. DESIGN AND SETTING: A prospective randomized trial of three surgeons' experiences at a community hospital. PATIENTS: Thirty-eight patients who underwent modified radical mastectomy from March 1991 through February 1993. MAIN OUTCOME MEASURES: Incidence of postmastectomy seromas and time required for patients to gain 110 degrees of shoulder abduction after surgery. RESULTS: Thirteen (72%) of 18 wounds in the maximum range of motion cohort developed seromas (72%) compared with one (6%) of 17 in the minimum range of motion cohort (P = .0005). The average time required for the patients with maximum range of motion to gain 110 degrees of shoulder abduction was 2.6 weeks, whereas the patients with minimum range of motion required an average of 5.0 weeks (P = .0127). CONCLUSION: Postmastectomy shoulder immobilization significantly decreases the incidence of wound seromas. Although this protocol resulted in a delay in return to normal shoulder mobility, no patients sustained long-term musculoskeletal dysfunction.
Aged↗
The double stapling technique for low anterior resection. Results, modifications, and observations.
Since the introduction of the end-to-end anastomosis (EEA) stapler for rectal reconstruction, we have used a modification of the conventional technique in which the lower rectal segment is closed with the linear stapler (TA-55) and the anastomosis is performed using the EEA instrument across the linear staple line (double stapling technique). Our experience with this procedure includes stapled colorectal anastomoses in 75 patients and is the basis for the report. This review presents the details and advantages of the technique and the results. Complications include two patients with anastomotic leak (2.7%), and two with stenosis that required treatment (2.7%). Protective colostomy was not done in this series. There were no deaths. Our experience and that of others suggests that this modification of the EEA technique can allow a lower anastomosis in some patients, and that it can be done with greater safety and facility.
Aged↗
Stapling technique for primary and secondary rectal anastomoses.
The EEA stapler now offers an alternative to hand-sewn techniques for primary and staged low colorectal anastomoses. The stapler may allow a safer and lower resection than was previously possible. A review of 52 primary and 8 staged EEA anastomoses is presented, with emphasis on the combined stapler technique.
Evaluation Studies as Topic↗
Abdominal wound closure with a continuous monofilament polypropylene suture. Experience with 1,000 consecutive cases.
We report our experience with 1,000 consecutive abdominal wound closures using continuous monofilament polypropylene (Prolene) sutures. Wound dehiscence occurred in four patients (0.4%), and incisional hernia occurred in seven patients (0.7%). The incidence of persistent suture sinus was less than 1%. A comparison of these results with the reported data showed that this method was at least equal to other types of wound closure. While the polypropylene suture is more difficult to handle than traditional sutures, it is probably the preferred suture for contaminated and dirty wounds. It has eliminated the need for retention sutures in our practice, and its use as a continuous, running closure has offered the advantage over the usual interrupted technique of being simpler, faster, and more cost effective. Sepsis has continued to be the greatest cause of failure of abdominal wounds to heal.
Abdomen↗
Techniques of low rectal reconstruction.
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Anal Canal↗
An improved technique for low anterior resection of the rectum using the EEA stapler.
The technique using the EEA stapler for low anterior resection of the rectum has been modified to permit a low anastomosis that can be done with greater facility and safety. The method eliminates the bulky puckering of the ampullary purse string and avoids the disadvantage of joining segments of bowel of different sizes. It also decreases intraoperative contamination and minimizes chances for sepsis. Additionally, it affords an opportunity to check the integrity of the anastomosis. Success of the method seems to document the safety of stapling across a staple line. Results of this method used in a small group of patients are encouraging.
Humans↗
Results of the double stapling procedure in pelvic surgery.
The double stapling technique for rectal reconstruction after resection involves closing the lower rectal segment with a linear stapler and performing the anastomosis using a circular stapler across the linear staple row. The purpose of this report is to review the results of double stapling, present our experience, and draw conclusions from the material available. We have utilized the double stapling technique in 80 patients for primary anastomoses and in 11 patients for secondary anastomoses following Hartmann procedures. Twenty-one anastomoses were at or near the dentate line. Fifty-six patients had rectal carcinoma, 29 patients had diverticulitis, 3 patients had carcinoma of the ovary, and 1 patient each had traumatic rectal perforation, volvulus, or rectal prolapse. Complications in the total 91 patients included 3 anastomotic leaks (3.3%), 1 postoperative hemoperitoneum (1.1%), and 3 strictures (3.3%). No anastomosis was protected by diverting colostomy. There were no operative deaths. Of 43 patients with cancer available for follow-up, 4 patients have developed local recurrence. The technique has been modified for ileoanal anastomosis during abdominal restorative proctocolectomy for ulcerative colitis and familial polyposis and early results are favorable. The double stapling technique provides a safe method for rectal reconstruction at or near the dentate line and offers the following advantages over other stapler techniques: (1) It eliminates the frustrating distal pursestring; (2) The rectal segment is not opened, minimizing contamination; and (3) It avoids gathering the sometimes generous circumference of the rectum on a pursestring thus allowing a more precise distal donut.
Anal Canal↗