World Journal of Surgery (WORLD J SURG )

Publisher: International Society of Surgery, Springer Verlag

Description

World Journal of Surgery publishes original articles that offer significant contributions to knowledge in the broad fields of clinical surgery, experimental surgery and related sciences, surgical education and history, and the socioeconomic aspects of surgical care. The Journal has an international circulation and is designed to serve as a medium for rapid dissemination of new and important information about the science and art of surgery throughout the world. In the interests of a wide international readership, use of the English language is required. Articles that are accepted for publication are done so with the understanding that they, or their substantive contents, have not been and will not be submitted to any other publication.

  • Impact factor
    2.23
    Hide impact factor history
     
    Impact factor
  • 5-year impact
    2.75
  • Cited half-life
    6.80
  • Immediacy index
    0.48
  • Eigenfactor
    0.03
  • Article influence
    0.84
  • Website
    World Journal of Surgery website
  • Other titles
    World journal of surgery (Online), World j. surg
  • ISSN
    0364-2313
  • OCLC
    43477365
  • Material type
    Document, Periodical, Internet resource
  • Document type
    Internet Resource, Computer File, Journal / Magazine / Newspaper

Publisher details

Springer Verlag

  • Pre-print
    • Author can archive a pre-print version
  • Post-print
    • Author can archive a post-print version
  • Conditions
    • Author's pre-print on pre-print servers such as arXiv.org
    • Author's post-print on author's personal website immediately
    • Author's post-print on any open access repository after 12 months after publication
    • Publisher's version/PDF cannot be used
    • Published source must be acknowledged
    • Must link to publisher version
    • Set phrase to accompany link to published version (see policy)
    • Articles in some journals can be made Open Access on payment of additional charge
  • Classification
    ​ green

Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: Background Adrenocortical cancer (ACC) is a rare malignancy. In the absence of metastatic disease, the suspicion of ACC is based on size and radiological appearance. The aim of this study was to analyse the long-term outcome of patients with large adrenal cortical tumours (>8 cm). Methods A prospective database recorded clinical, biochemical, operative and histological data on patients operated for cortical adrenal tumours between January 2000 and February 2013. Out of 130 patients operated for cortical adrenal tumours, analysis was restricted to 37 cortical tumours >8 cm. Results There were 31 (84 %) ACCs and 6 (16 %) benign adenomas (p p = 0.08, stage II vs. stage III–IV, respectively). No mortality was observed in patients with benign tumours during a median follow-up of 70 months (range 36–99 months). Mortality in the ACC group occurred in 17/31 (55 %) patients. Mitotane was administered in 12 (71 %) patients with stage III–IV ACCs with a 5-year survival rate 25 % compared to 20 % in patients who did not receive Mitotane. In stage II ACC, eight (57 %) patients received Mitotane with a 50 % mortality at 5 years. Conclusions The high incidence of ACC in cortical tumours >8 cm underlines the need for adequate surgical resection via open surgery aiming to avoid local recurrence. Beyond surgery, the impact of other therapies is not fully characterised and the efficacy of adjuvant Mitotane treatment is yet to be proven.
    World Journal of Surgery 12/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Dr. Liu and coworkers in Taichung [1] have posed an important question regarding the surgical indications for hepatocellular carcinoma (HCC) in patients with gastroesophageal varices, which is a contraindication for surgery in the BCLC/EASL/AASLD guidelines. Since their original publication in 1999 [2], these guidelines have been repeatedly reported in prestigious journals [3], and the total number of citations for these publications has already exceeded 10,000. According to the guidelines, patients with portal hypertension (PH), defined by the presence of esophagogastric varices, splenomegaly, a platelet count of less than 100,000, or an elevated hepatic venous pressure gradient (HVPG), are clearly not candidates for liver resection. However, this recommendation was based solely on a small retrospective cohort study conducted in Spain with only 77 resected patients and published in 1999 [4]. The targeted long-term outcome for BCLC-A patients was set at a 5-year overall survival (OS) r ...
    World Journal of Surgery 12/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: To the EditorWe read with interest the paper of Gui et al. [1] on vacuum-assisted wound care for closure of low- and high-output enterocutaneous fistulas. We would like to share our observation of a simple bed-side test for the detection of low-output enterocutaneous fistulas.Up to 5 % of patients undergoing GI-tract surgery develop an anastomotic leak with the need of multiple reoperations, prolonged hospital stay, and a fatal outcome up to 24 % in this heterogenous subgroup [2]. Nearly 80 % of all leakages and fistulas can be visualized and verified by examination of drainage fluid, ultrasound, endoscopy, and instillation of water-soluble contrast media or methylene blue [3]. While high-output fistulas require surgical intervention, low-output fistulas, however, with a drainage volume of less than 200 ml/day often close spontaneously, and oral feeding is well tolerated [4]. High-output fistulas are easy to diagnose while low-output fistulas are difficult to prove.Three patients with ...
    World Journal of Surgery 12/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: While some data exist for the burden of pediatric surgical disease in low- and middle-income countries (LMICs), little is known about pediatric surgical capacity. In an effort to better plan and allocate resources for pediatric surgical care in LMICs, a survey of pediatric surgical capacity using specific tool was needed. Based on the previously published Surgeons OverSeas Personnel, Infrastructure, Procedure, Equipment, and Supplies (PIPES) survey, a pediatric PIPES (PediPIPES) survey was created. To ensure relevance to local needs and inclusion of only essential items, a draft PediPIPES survey was reviewed by nine pediatric surgeons and modifications were incorporated into a final tool. The survey was then distributed to surgeons throughout sub-Saharan Africa. Data from West Africa (37 hospitals in 10 of the 16 countries in the subregion) were analyzed. Fewer than 50 % (18/37) of the hospitals had more than two pediatric surgeons. Neonatal or general intensive care units were not available in 51.4 % (19/37) of hospitals. Open procedures such as appendectomy were performed in all the hospitals whereas less-invasive interventions such as non-operative intussusception reduction were done in only 41 % (15/37). Life-saving pediatric equipment such as apnea monitors were not available in 65 % (24/37) of the hospitals. The PediPIPES survey was useful in documenting the pediatric surgical capacity in West Africa. Many hospitals in West Africa are not optimally prepared to undertake pediatric surgery. Our study showed shortages in personnel, infrastructure, procedures, equipment, and supplies necessary to adequately and appropriately provide surgical care for pediatric patients.
    World Journal of Surgery 12/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background Clinicians often encounter left pleural effusion after esophagectomy, which sometimes necessitates thoracentesis. We have introduced a new drainage method, bilateral pleural drainage by single Blake drain (BDSD), which we have been using since April 2013. This study aims to evaluate the performance of the BDSD. Methods The BDSD method employs a 15-F Blake drain inserted from the right thoracic cavity to the left thoracic cavity across the posterior mediastinum. The conventional drain (CD) group consisted of 50 patients with a 19-F Blake drain placed in the right thoracic cavity during the period from April 2012 to March 2013. The BDSD group consisted of 54 patients treated from April 2013 to June 2014. Results The amount of total drainage in the BDSD group was significantly higher than that in the CD group (P P P Conclusions Compared with the conventional method, BDSD was able to evacuate bilateral pleural effusion more effectively, and the incidences of left pleural effusion and left atelectasis were lower. This method is therefore clinically useful after esophagectomy.
    World Journal of Surgery 12/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Over 90 % of injury deaths occur in low-income countries. Evaluating the impact of focused trauma courses in these settings is challenging. We hypothesized that implementation of a focused trauma education initiative in a low-income country would result in measurable differences in injury-related outcomes and resource utilization. Two 3-day trauma education courses were conducted in the Rwandan capital over a one-month period (October-November, 2011). An ATLS provider demonstration course was delivered to 24 faculty surgeons and 15 Rwandan trauma nurse auditors, and a Canadian Network for International Surgery Trauma Team Training (TTT) course was delivered to 25 faculty, residents, and nurses. Trauma registry data over the 6 months prior to the courses were compared to the 6 months afterward with emergency department (ED) mortality as the primary endpoint. Secondary endpoints included radiology utilization and early procedural interventions. Univariate analyses were conducted using χ (2) and Fisher's exact test. A total of 798 and 575 patients were prospectively studied during the pre-intervention and post-intervention periods, respectively. Overall mortality of injured patients decreased after education implementation from 8.8 to 6.3 %, but was not statistically significant (p = 0.09). Patients with an initial Glasgow Coma Score (GCS) of 3-8 had the highest injury-related mortality, which significantly decreased from 58.5 % (n = 55) to 37.1 % (n = 23), (p = 0.009, OR 0.42, 95 % CI 0.22-0.81). There was no statistical difference in the rates of early intubation, cervical collar use, imaging studies, or transfusion in the overall cohort or the head injury subset. When further stratified by GCS, patients with an initial GCS of 3-5 in the post-intervention period had higher utilization of head CT scans and chest X-rays. The mortality of severely injured patients decreased after initiation of focused trauma education courses, but no significant increase in resource utilization was observed. The explanation may be complex and multi-factorial. Long-term multidisciplinary efforts that pair training with changes in resources and mentorship may be needed to produce broad and lasting changes in the overall care system.
    World Journal of Surgery 12/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Primary plantar hyperhidrosis is characterised by excessive secretion of the sweat glands of the feet and may lead to significant limitations in private and professional lifestyle. The aim of this prospective study was to assess the effect of endoscopic lumbar sympathectomy (ESL) on the quality of life (QL) of patients with primary plantar hyperhidrosis. Bilateral ESL was performed on 52 patients, 31 men and 21 women with primary plantar hyperhidrosis. Perioperative morbidity and clinical results were evaluated in all patients after a mean follow-up of 15 months. Postoperative QL was examined with the SF-36V2 questionnaire and the hyperhidrosis-specific questionnaires devised by Milanez de Campos and Keller. All procedures were carried out endoscopically with no perioperative morbidity. Plantar hyperhidrosis was eliminated in 50 patients (96 %) and two patients (4 %) suffered a relapse. Unwanted side effects occurred in the form of compensatory sweating in 34 (65 %) and in the form of postsympathectomy neuralgia in 19 patients (37 %). Ninety six percentage of patients were satisfied with the postoperative result and 88 % would have the surgery repeated. The SF-36V2 questionnaire revealed a significant improvement of QL after lumbar sympathectomy in physical health (physical component summary, p < 0.01) as well as mental health (mental component summary, p < 0.05). Improved QL was also demonstrated in the Milanez de Campos questionnaire in the dimensions functionality/social interactions (p < 0.01), intimacy (p < 0.01), emotionality (p < 0.01) and specific circumstances (p < 0.01) as well as in the Keller questionnaire in the area of plantar hyperhidrosis (p < 0.01). The performance of an ESL in patients with primary plantar hyperhidrosis leads to the effective elimination of excessive sweat secretion of the feet and to an increase in QL.
    World Journal of Surgery 12/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background Several challenging clinical situations in patients with peritonitis can result in an open abdomen (OA) and subsequent temporary abdominal closure (TAC). Indications and treatment choices differ among surgeons. The risk of fistula development and the possibility to achieve delayed fascial closure differ between techniques. The aim of this study was to review the literature on the OA and TAC in peritonitis patients, to analyze indications and to assess delayed fascial closure, enteroatmospheric fistula and mortality rate, overall and per TAC technique. Methods Electronic databases were searched for studies describing the OA in patients of whom 50 % or more had peritonitis of a non-traumatic origin. Results The search identified 74 studies describing 78 patient series, comprising 4,358 patients of which 3,461 (79 %) had peritonitis. The overall quality of the included studies was low and the indications for open abdominal management differed considerably. Negative pressure wound therapy (NPWT) was the most frequent described TAC technique (38 of 78 series). The highest weighted fascial closure rate was found in series describing NPWT with continuous mesh or suture mediated fascial traction (6 series, 463 patients: 73.1 %, 95 % confidence interval 63.3–81.0 %) and dynamic retention sutures (5 series, 77 patients: 73.6 %, 51.1–88.1 %). Weighted rates of fistula varied from 5.7 % after NPWT with fascial traction (2.2–14.1 %), 14.6 % (12.1–17.6 %) for NPWT only, and 17.2 % after mesh inlay (17.2–29.5 %). Conclusion Although the best results in terms of achieving delayed fascial closure and risk of enteroatmospheric fistula were shown for NPWT with continuous fascial traction, the overall quality of the available evidence was poor, and uniform recommendations cannot be made.
    World Journal of Surgery 12/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Introduction Previous reports have indicated an association between blood transfusion and prognosis of hepatocellular carcinoma (HCC) after hepatectomy. However, clinicopathological biases were not adjusted in these studies. We aimed to clarify the effect of blood transfusions in patients with HCC and Child–Pugh class A after hepatectomy by using inverse probability of treatment weighting (IPTW) analysis for selection bias control. Materials and methods We enrolled 479 patients with primary HCC and Child–Pugh class A retrospectively (91 transfused and 388 nontransfused patients) who underwent curative hepatectomy. After adjusting for different covariate distributions for both groups by IPTW, we analyzed the prognostic outcomes. Results In the unweighted analyses, overall survival (OS) rate of transfused patients was significantly lower than in nontransfused patients (P P = 0.0024). Multivariate analysis showed that blood transfusion was an independent prognostic factor of OS and RFS. The different distributive covariates between the two groups were age, presence of liver cirrhosis, serum level of alpha-fetoprotein, maximum tumor diameter, and amount of intraoperative blood loss. After IPTW by these covariates, OS rate of transfused patients was not significantly lower than those of nontransfused patients, whereas RFS rate of transfused patients remained significantly lower than those of nontransfused patients (P = 0.038, adjusted HR 1.45; 95 % CI 1.0–2.1). Conclusions These results suggest that blood transfusion was associated with recurrence of HCC after hepatectomy in patients with HCC and Child–Pugh class A.
    World Journal of Surgery 12/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background Surgeons and anesthetists must respond to the perioperative mortality associated with general anesthesia in developing countries. The safety of performing major neonatal surgery under local anesthesia is one pragmatic response. This study describes and evaluates such practice in a tertiary pediatric surgery center in Bangladesh. Methods Seven hundred and twenty neonates were admitted for major surgery during a 3.5-year study period. Hundred and fifty two neonates died pre-operatively, and 568 underwent major neonatal surgery. 352 (62.0 %) neonates were operated under general anesthesia, while the 216 most fragile neonates (38.0 %) were operated with local infiltrative anesthesia alone. Medical files were reviewed; data were collected prospectively; mortality risk factors were assessed by univariate and multivariate analysis. Results Two hundred and sixteen procedures were performed under local anesthesia: sigmoid colostomies (37.5 %), laparotomies with anastomosis (21.3 %), anoplasties (18.1 %), laparotomies with enterostomy (8.3 %), closures of abdominal wall defects (6.9 %), fixations of silastic bags (3.7 %), peritoneal tube drainage (2.3 %), and gastrostomies (1.9 %). Median weight was 2,400 g (2,200–2,460), median gestational age was 37.0 weeks (36.0–38.0), and median age at surgery was 5.0 days (3.0–14.7). In-hospital postoperative mortality was 10.6 % among those selected for local anesthesia, and 11.4 % among neonates operated under general anesthesia. Low birth weight was an independent risk factor for mortality on multivariate analysis (OR 1.002 g−1, 95 % CI [1.000–1.004], p = 0.029). Conclusions Local anesthesia is an established option for the most fragile neonates with major surgical disease. Safe anesthesia ought to be accessible to all children of the world. The global pandemic of perioperative mortality needs to be addressed.
    World Journal of Surgery 12/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Dear Sir,Thank you for the valuable feedback on the need for recognizing the pitfalls in breast cancer follow-up. However, the focus of this paper was on the advanced presentation at diagnosis. Indeed, this is just the tip of the iceberg as the whole continuum of care or journey of the breast cancer patients and poor survival outcomes remain a major challenge for the health care practitioner in the middle and low resource settings [1]. Although we do not have figures on the adherence rate of treatment for breast cancer recurrences, we have found in our hospital that non-adherence to chemotherapy for any indication was as high as 34 % [2].Current national and international guidelines rely heavily on clinical grounds on the identification of breast cancer recurrences. Scheduled imaging or tumor markers for recurrences are not currently recommended as evidence shows a lack in improved survival of treatment of asymptomatic recurrences. With the availability of effective systemic therapies, ...
    World Journal of Surgery 12/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objectives We sought to validate the feasibility of preserving a functioning recurrent laryngeal nerve (RLN) invaded by papillary thyroid carcinoma (PTC) using a shaving technique followed by high-dose radioactive iodine (RAI) therapy. Methods A retrospective review of 34 patients with locally invasive PTC who had exclusive tumor involvement of a functioning RLN was performed. All patients underwent total thyroidectomy and high-dose RAI therapy. A shaving technique was conducted with the goal of leaving the smallest amount of residual tumor as possible while attempting to preserve nerve function. Clinicopathologic factors and oncologic outcomes of the patients with resected RLN (group A, n = 14) and preserved RLN (group B, n = 20) were compared. Results The two groups showed no differences in clinicopathologic factors or follow-up period. Mean dose of radioiodine therapy was 245.0 ± 140.3 mCi (range 100–540 mCi). Permanent postoperative vocal cord paralysis after RLN shaving occurred in two patients of group B (10 %). Only one patient (5 %) in group B had local recurrence at the thyroid bed where the residual tumor was located. The overall recurrence rate was 35.7 % (5/14) and 20.0 % (4/20) in groups A and B, respectively showing no significant difference (p = 0.525). There were no cases of death due to PTC during the median follow-up of 75 months (range 36–159 months). Conclusions Patients with locally invasive PTC with exclusive involvement of a functioning RLN may be treated by nerve shaving followed by treatment of the macroscopic residual tumor with high-dose RAI therapy.
    World Journal of Surgery 12/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background Increasing patient demands, costs and emphasis on safety have led to performance tracking of individual surgeons. Several methods of using these data, including feedback have been proposed. Our aim was to systematically review the impact of feedback of outcome data to surgeons on their performance. Study design MEDLINE, Embase, PsycINFO, AMED and the Cochrane Database of Systematic Reviews (from their inception to February 2013) were searched. Two reviewers independently reviewed citations using predetermined inclusion and exclusion criteria. Forty two data-points per study were extracted. Results The search strategy yielded 1,531 citations. Seven studies were eligible comprising 18,632 cases or procedures by 52 surgeons. Overall, feedback was found to be a powerful method for improving surgical outcomes or indicators of surgical performance, including reductions in hospital mortality after CABG of 24 % (P = 0.001), decreases of stroke and mortality following carotid endarterectomy from 5.2 to 2.3 %, improved ovarian cancer resection from 77 to 85 % (P = 0.157) and reductions in wound infection rates from 14 to 10.3 %. Improvements in performance occurred in concert with reduced costs: for hepaticojejunostomy, implementation of feedback was associated with a decrease in overall hospital costs from $24,446 to $20,240 (P Conclusions The available literature suggests that feedback can improve surgical performance and outcomes; however, given the heterogeneity and limited number of studies, in addition to their non-randomised nature, it is difficult to draw clear conclusions from the literature with regard to the efficacy of feedback and the specific nuances required to optimise the impact of feedback. There is a clear need for more rigorous studies to determine how feedback of outcome data may impact performance, and whether this low-cost intervention has potential to benefit surgical practice.
    World Journal of Surgery 12/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background As the demographic transition occurs across developing countries, an increasing number of elderly individuals are affected by disasters and conflicts. This study aimed to evaluate the elderly population that underwent an operative procedure at MSF facilities. Methods A retrospective review of prospectively collected operative cases performed at MSF-Operational Centre Brussels (MSF-OCB) facilities between June 2008 and December 2012 was completed. Baseline demographic data, American Society of Anesthesiologists (ASA) physical status and surgical indications were collected for each patient. For each procedure, the degree of urgency, anesthesia type, and intra-operative mortality were noted. All patients aged 50 and over at the time of the procedure were considered elderly, as proposed by the World Health Organization (WHO). Comparisons were made with the 18–49 age group in order to elucidate differences between older and younger individuals. Results We reviewed a total of 93,385 procedures performed on 83,911 patients in 21 different countries. Patients aged 50 and over comprised 11.5 % (9,628/83,911) of all patients. While most procedures (57.6 %) in the comparison group were urgent, this proportion decreased substantially in the elderly. Intra-operative mortality was considerably lower in the 50–59 group (0.12 %) but increased with each age stratum. The most commonly performed surgical procedures in the elderly included herniorrhaphies, simple and extensive wound debridements, abscess incision and drainages, minor tumorectomies, and urological procedures. Conclusions In light of the increasing elderly population in developing countries, efforts should be made to better quantify and address their surgical needs.
    World Journal of Surgery 12/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background Transection along the anterior fissure was proposed as a mechanism by which to open the third door of the liver. In this study, we investigated surgical outcomes of a ventral segment-preserving right hepatectomy (VSPRH) compared with those of conventional right hepatectomy in patients with hepatocellular carcinoma (HCC). Methods Between January 2007 and December 2010, 595 primary HCC patients underwent liver resection at the authors’ institution. Among them, the 123 HCC patients who underwent a right hepatectomy were retrospectively analyzed. The patients were classified into two groups according to the type of resection: those who underwent a VSPRH (Group A; 27 cases) and those who underwent a conventional right hepatectomy (Group B; 96 cases). Results In Group A, expected remnant liver volume after a right hepatectomy was calculated to be 32.1 ± 7.2 % of functional total liver volume (FTLV); remnant liver volume increased up to 54.7 ± 7.2 % of FTLV after a VSPRH. Clinicopathologic characteristics and intraoperative data did not differ between the two groups. The liver-related complication rate was higher in Group B (P = 0.02). Overall survival and disease-free survival rates were similar (3-year disease-free survival (Group A: 67.8 %; Group B: 71.7 %; P = 0.65); 3-year overall survival (Group A: 91.7 %; Group B: 87.4 %; P = 0.26). In regard to long-term synthetic function, the 1-year postoperative serum albumin level was higher in Group A. Conclusions A VSPRH yielded fewer liver-related complications and similar long-term oncologic outcomes, compared with conventional right hepatectomy in cirrhotic patients with a small left lobe volume. Therefore, VSPRH can be considered to be an alternative procedure for a right hepatectomy.
    World Journal of Surgery 12/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: The splintering of general surgery into subspecialties in the past decade has brought into question the relevance of a continued emphasis on traditional general surgical training. With the majority of trainees now expressing a preference to subspecialise early, this study sought to identify if the requirement for proficiency in managing general surgical conditions has reduced over the past decade through comparison of general and specialty surgical admissions at a tertiary referral center. A cross-sectional review of all surgical admissions at Cork University Hospital was performed at three individual time points: 2002, 2007 & 2012. Basic demographic details of both elective & emergency admissions were tabulated & analysed. Categorisation of admissions into specialty relevant or general surgery was made using International guidelines. 11,288 surgical admissions were recorded (2002:2773, 2007:3498 & 2012:5017), showing an increase of 81 % over the 10-year period. While growth in overall service provision was seen, the practice of general versus specialty relevant emergency surgery showed no statistically significant change in practice from 2002 to 2012 (p = 0.87). General surgery was mostly practiced in the emergency setting (84 % of all emergency admissions in 2012) with only 28 % elective admissions for general surgery. A reduction in length of stay was seen in both elective (3.62-2.58 bed days, p = 0.342) & emergency admissions (7.36-5.65, p = 0.026). General surgical emergency work continues to constitute a major part of the specialists practice. These results emphasize the importance of general surgical training even for those trainees committed to sub-specialisation.
    World Journal of Surgery 12/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background This study aimed to systematically review and compare the perioperative outcomes of video-assisted thoracoscopy (VATS) with open thoracotomy for chest trauma patients. Methods We conducted a systematic review and meta-analysis of randomized control trials and cohort studies comparing the perioperative outcomes of VATS with open thoracotomy for chest trauma patients. Clinical endpoints included postoperative complications, perioperative mortality rate, chest tube drainage volume, duration of tube drainage, duration of hospitalization, operation time, and amount of bleeding and transfusion volume in operation. A subgroup analysis was performed to explore the potential source of heterogeneity. Results Twenty-six studies were included. Pooled analyses showed significant reductions in the incidence of postoperative complications (risk ratio [RR] [95 % confidence interval (CI)], 0.47 [0.35, 0.64]), chest tube drainage volume (mean difference [MD] [95 % CI], −146.88 ml [−196.04, −97.72]), duration of tube drainage (MD, −1.71 days; 95 % CI −2.16 to −1.26), duration of hospitalization (MD, −4.67 days; 95 % CI −5.19 to−4.14), operation time (MD, −41.18 min; 95 % CI −52.85 to −29.51), and amount of bleeding (MD, −119.10 ml; 95 % CI −147.28 to −90.92) and transfusion volume (MD, −379.51 ml; 95 % CI −521.24 to−237.77) in chest trauma patients treated with VATS compared with open thoracotomy. The perioperative mortality rate was not significantly different between patients received VATS and open thoracotomy (RR, 0.52; 95 % CI 0.22–1.21). Conclusions Compared to open thoracotomy, VATS is an effective and even better treatment for improving perioperative outcomes of hemodynamically stable patients with chest trauma and reduce the complications. However, caution should also be exercised in certain clinical scenarios.
    World Journal of Surgery 12/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background Radiofrequency ablation (RFA) is a relatively novel procedure in the management of benign nodular goiter. This study was conducted to evaluate the safety and efficacy of ultrasound (US)-guided percutaneous RFA for benign symptomatic thyroid nodules as an alternative to surgery. Methods The study involved patients for whom a fine needle aspiration biopsy had proved a diagnosis of benign nodular goiter and had nodule-related symptoms such as dysphagia, cosmetic problems, sensation of foreign body in the neck, hyperthyroidism due to autonomous nodules or fear of malignancy. Percutaneous RFA was performed as an outpatient procedure under local anesthesia. The primary outcome was an evaluation of the changes in symptom scores (0–10) for pain, dysphagia and foreign body sensation at the 1st, 3rd, and 6th months after the RFA procedure. Secondary outcomes were assessing volume changes in nodules, complication rates, and changes in thyroid function status. Results A total of 33 patients (24 % female, 76 % male) and a total of 65 nodules were included into the study. More than one nodule was treated in 63.6 % of the patients. We found a statistically significant improvement from baseline to values at the 1st, 3rd, and 6th months, respectively, as follows: pain scores (2.9 ± 2.7, 2.3 ± 2.01, 1.8 ± 1.7, and 1.5 ± 1.2, p 0.005), dysphagia scores (3.9 ± 2.7, 2.6 ± 1.9; 1.7 ± 1.6, and 1.1 ± 0.3, p 0.032), and foreign body sensation scores 3.6 ± 3, 2.5 ± 2.2; 1.6 ± 1.5, and 1.1 ± 0.4, p 0.002).The mean pre-treatment nodule volume was 7.3 ± 8.3 mL. There was a statistically significant size reduction in the nodules at the 1st, 3rd, and 6th months after RFA (3.5 ± 3.8, 2.7 ± 3.4, and 1.2 ± 1.7 mL, p 0.002). The volume reduction was found to be 74 % at 6th months following the RFA (p 0.005). 8 patients had autonomously functioning nodules in the pre-treatment period, 50 % (n: 4) became euthyroid at the 6th month after RFA. There were no complaints other than pain (12 %). Conclusion RFA can be an alternative treatment modality in the management of benign symptomatic thyroid nodules. The results showed that it is a safe and effective procedure.
    World Journal of Surgery 12/2014;