PubMed · 13346822
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G C PRATHER. 1956. Elective prostatectomy.. https://doi.org/10.1016/s0022-5347(17)66671-0
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OBJECTIVE: The spectrum of reoperations after macular surgery was investigated retrospectively in a large group of patients. All secondary surgical procedures except for cataract surgery were considered. METHODS: Between July 1995 and June 2001 353 eyes underwent macular surgery (218 due to macular pucker, 135 due to macular hole) with a pars-plana vitrectomy (PPV), creation of vitreous detachment, membrane peeling and SF(6)/air-instillation. The vitrectomies were performed by 4 different surgeons. In all patients a preoperative circular peripheral cryoretinopexy was performed 3-4 weeks before macular surgery. The follow-up was 20.9 months on average. The number of revitrectomies as well as the postoperative retinal detachment rate were investigated. RESULTS: In 33 cases (9.3%) a second vitrectomy had to be performed due to an unsatisfying postoperative macular finding: 17/218 (7.8%) after macular pucker surgery with a recurrent pucker and 16/135 (11.8%) after macular hole surgery with persistent or recurrent macular hole. In 7/353 (2.0%) a postoperative rhegmatogenous retinal detachment was observed and in 2/353 (0.6%) a postoperative endophthalmitis had to be treated. CONCLUSION: In 9.3% of our patients a second PPV due to an unsatisfying macular finding became necessary. The rate of postoperative retinal detachment of 2.0% is considerably lower than in most other studies. Therefore, a possible prophylactic effect of the preoperative circular peripheral cryoretinopexy is suggested to reduce the risk of postoperative retinal detachment.
BACKGROUND: The success of nonoperative management of injuries has diminished the operative experience of trauma surgeons. To enhance operative experience, our trauma surgeons began caring for all general surgery emergencies. Our objective was to characterize and compare the experience of our trauma surgeons with that of our general surgeons. METHODS: We reviewed records to determine case diversity, complexity, time of operation, need for intensive care unit care, and payor mix for patients treated by the trauma and emergency surgery (TES) surgeons and elective practice general surgery (ELEC) surgeons over a 1-year period. RESULTS: TES and ELEC surgeons performed 253 +/- 83 and 234 +/- 40 operations per surgeon, respectively (p = 0.59). TES surgeons admitted more patients and performed more after-hours operations than their ELEC colleagues. Both groups had a mix of cases that was diverse and complex. CONCLUSION: Combining the care of patients with trauma and general surgery emergencies resulted in a breadth and scope of practice for TES surgeons that compared well with that of ELEC surgeons.
BACKGROUND: There is little available evidence on the optimal management of recurrent inguinal hernia, particularly if the original procedure involved the use of mesh. This study was a review of recurrent hernia repair in a district hospital, involving both laparoscopic and open procedures. METHODS: The case notes of all patients who had a repair of a recurrent hernia between 1991 and 2000, inclusive, were examined; 171 procedures were included. Where known, the original repair was a nylon darn in 31%, mesh repair in 18%, and laparoscopic repair in 8%. RESULTS: The recurrent hernia was repaired using a Lichtenstein open mesh technique in 63% and by the totally extraperitoneal (TEP) method in 22%. Complication rates were highest after emergency surgery (all had open surgery), where 71% had complications and one patient died. For elective repairs, complication rates were similar after open (13%) and TEP (8%) repairs. The duration of hospital stay was also similar (1.2 vs 1.3 days, respectively), and a single recurrence was seen in each group. Patients with recurrence after primary mesh repair were also managed by both techniques with similar results. Open re-operation for mesh failure was technically straightforward. CONCLUSIONS: Most recurrent hernias are still repaired by open techniques. There was no convincing evidence of different outcomes for open and TEP repairs in this review. Even when the original hernia repair involved the use of mesh, further open repair by an experienced surgeon is justified.