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Turza KC, Brien T, Porbunderwala S, Bell CM, Lorenzo-Rivero S, Moore RA, Nelson EC, Stanley JD. The Ferguson Operating Anoscope for Resection of T1 Rectal Cancer. Am Surg 2016; 82:1105-1108. [PMID: 28206939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The Ferguson Operating Anoscope (FOA) is a surgical instrument, which can facilitate transanal excision of appropriate rectal tumors within 15 cm of the anal verge. Previous work showed low recurrence (4.3%) for favorable T1 tumors (no lymphovascular invasion, well/moderate differentiation, negative margins). This follow-up study evaluates outcomes in rectal cancer excised with FOA at a tertiary care center. T1 rectal cancer patients were identified in a prospectively maintained database. Tumor pathology and patient characteristics were reviewed. Primary outcomes include tumor recurrence and patient and disease-free survival. Secondary outcomes are quality of excision (intact specimen). Twenty-eight patients had pathologic stage T1 rectal cancer (average 8 ± 2.6 cm from the anal verge). Final path demonstrated 14 per cent to be well differentiated, 82 per cent moderately differentiated, and 93 per cent without angiolymphatic invasion. All specimens removed were intact. One patient had a true local recurrence and underwent a salvage operation 24 months after her index operation. Patient survival was 96.4 per cent (n = one death from primary lung cancer) at median follow-up 64 ± 35 months. With appropriate tumor selection and quality of initial resection, FOA has demonstrated utility in achieving optimal oncologic resection of T1 rectal tumors.
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Affiliation(s)
- Kristin C Turza
- The University of Tennessee College of Medicine Chattanooga, Chattanooga, Tennessee, USA
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2
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Zoog E, Turza KC, Major GR, Stanley JD. Adult Intussusception Caused by Ileocecal Clostridium difficile Pseudomembranous Colitis. Am Surg 2016; 82:e153-e154. [PMID: 27457842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Evon Zoog
- Department of Surgery, University of Tennessee College of Medicine at Chattanooga, Chattanooga, Tennessee, USA
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3
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Zoog E, Turza KC, Major GR, Stanley JD. Adult Intussusception Caused by Ileocecal Clostridium difficile Pseudomembranous Colitis. Am Surg 2016. [DOI: 10.1177/000313481608200709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Evon Zoog
- Department of Surgery University of Tennessee College of Medicine at Chattanooga Chattanooga, Tennessee
| | - Kristin C. Turza
- Department of Surgery University of Tennessee College of Medicine at Chattanooga Chattanooga, Tennessee
| | - G. Ralston Major
- Department of Surgery University of Tennessee College of Medicine at Chattanooga Chattanooga, Tennessee
| | - J. Daniel Stanley
- Department of Surgery University of Tennessee College of Medicine at Chattanooga Chattanooga, Tennessee
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Turza KC, Politano AD, Rosenberger LH, Riccio LM, McLeod M, Sawyer RG. De-Escalation of Antibiotics Does Not Increase Mortality in Critically Ill Surgical Patients. Surg Infect (Larchmt) 2016; 17:48-52. [DOI: 10.1089/sur.2014.202] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Kristin C. Turza
- Department of Surgery, Division of Acute Care Surgery, University of Virginia, Charlottesville, Virginia
| | - Amani D. Politano
- Department of Surgery, Division of Acute Care Surgery, University of Virginia, Charlottesville, Virginia
| | - Laura H. Rosenberger
- Department of Surgery, Division of Acute Care Surgery, University of Virginia, Charlottesville, Virginia
| | - Lin M. Riccio
- Department of Surgery, Division of Acute Care Surgery, University of Virginia, Charlottesville, Virginia
| | - Matthew McLeod
- Department of Surgery, Division of Acute Care Surgery, University of Virginia, Charlottesville, Virginia
| | - Robert G. Sawyer
- Department of Surgery, Division of Acute Care Surgery, University of Virginia, Charlottesville, Virginia
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Zhang Q, Hubenak J, Iyyanki T, Alred E, Turza KC, Davis G, Chang EI, Branch-Brooks CD, Beahm EK, Butler CE. Engineering vascularized soft tissue flaps in an animal model using human adipose-derived stem cells and VEGF+PLGA/PEG microspheres on a collagen-chitosan scaffold with a flow-through vascular pedicle. Biomaterials 2015; 73:198-213. [PMID: 26410787 DOI: 10.1016/j.biomaterials.2015.09.024] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 09/04/2015] [Accepted: 09/09/2015] [Indexed: 12/23/2022]
Abstract
Insufficient neovascularization is associated with high levels of resorption and necrosis in autologous and engineered fat grafts. We tested the hypothesis that incorporating angiogenic growth factor into a scaffold-stem cell construct and implanting this construct around a vascular pedicle improves neovascularization and adipogenesis for engineering soft tissue flaps. Poly(lactic-co-glycolic-acid/polyethylene glycol (PLGA/PEG) microspheres containing vascular endothelial growth factor (VEGF) were impregnated into collagen-chitosan scaffolds seeded with human adipose-derived stem cells (hASCs). This setup was analyzed in vitro and then implanted into isolated chambers around a discrete vascular pedicle in nude rats. Engineered tissue samples within the chambers were harvested and analyzed for differences in vascularization and adipose tissue growth. In vitro testing showed that the collagen-chitosan scaffold provided a supportive environment for hASC integration and proliferation. PLGA/PEG microspheres with slow-release VEGF had no negative effect on cell survival in collagen-chitosan scaffolds. In vivo, the system resulted in a statistically significant increase in neovascularization that in turn led to a significant increase in adipose tissue persistence after 8 weeks versus control constructs. These data indicate that our model-hASCs integrated with a collagen-chitosan scaffold incorporated with VEGF-containing PLGA/PEG microspheres supported by a predominant vascular vessel inside a chamber-provides a promising, clinically translatable platform for engineering vascularized soft tissue flap. The engineered adipose tissue with a vascular pedicle could conceivably be transferred as a vascularized soft tissue pedicle flap or free flap to a recipient site for the repair of soft-tissue defects.
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Affiliation(s)
- Qixu Zhang
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
| | - Justin Hubenak
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Tejaswi Iyyanki
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Erik Alred
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Kristin C Turza
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Greg Davis
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Edward I Chang
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Cynthia D Branch-Brooks
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Elisabeth K Beahm
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Charles E Butler
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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Iyyanki TS, Dunne LW, Zhang Q, Hubenak J, Turza KC, Butler CE. Adipose-derived stem-cell-seeded non-cross-linked porcine acellular dermal matrix increases cellular infiltration, vascular infiltration, and mechanical strength of ventral hernia repairs. Tissue Eng Part A 2014; 21:475-85. [PMID: 25156009 DOI: 10.1089/ten.tea.2014.0235] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Adipose-derived stem cells (ASCs) facilitate wound healing by improving cellular and vascular recruitment to the wound site. Therefore, we investigated whether ASCs would augment a clinically relevant bioprosthetic mesh-non-cross-linked porcine acellular dermal matrix (ncl-PADM)-used for ventral hernia repairs in a syngeneic animal model. ASCs were isolated from the subcutaneous adipose tissue of Brown Norway rats, expanded, and labeled with green fluorescent protein. ASCs were seeded (2.5×10(4) cells/cm(2)) onto ncl-PADM for 24 h before surgery. In vitro ASC adhesion to ncl-PADM was assessed at 0.5, 1, and 2 h after seeding, and cell morphology on ncl-PADM was visualized by scanning electron microscopy. Ventral hernia defects (2×4 cm) were created and repaired with ASC-seeded (n=31) and control (n=32) ncl-PADM. Explants were harvested at 1, 2, and 4 weeks after surgery. Explant remodeling outcomes were evaluated using gross evaluation (bowel adhesions, surface area, and grade), histological analysis (hematoxylin and eosin and Masson's trichrome staining), immunohistochemical analysis (von Willebrand factor VIII), fluorescent microscopy, and mechanical strength measurement at the tissue-bioprosthetic mesh interface. Stem cell markers CD29, CD90, CD44, and P4HB were highly expressed in cultured ASCs, whereas endothelial and hematopoietic cell markers, such as CD31, CD90, and CD45 had low expression. Approximately 85% of seeded ASCs adhered to ncl-PADM within 2 h after seeding, which was further confirmed by scanning electron microcopy examination. Gross evaluation of the hernia repairs revealed weak omental adhesion in all groups. Ultimate tensile strength was not significantly different in control and treatment groups. Conversely, elastic modulus was significantly greater at 4 weeks postsurgery in the ASC-seeded group (p<0.001). Cellular infiltration was significantly higher in the ASC-seeded group at all time points (p<0.05). Vascular infiltration was significantly greater at 4 weeks postsurgery in the ASC-seeded group (p<0.001). The presence of ASCs improved remodeling outcomes by yielding an increase in cellular infiltration and vascularization of ncl-PADM and enhanced the elastic modulus at the ncl-PADM-tissue interface. With the ease of harvesting adipose tissues that are rich in ASCs, this strategy may be clinically translatable for improving ncl-PADM ventral hernia repair outcomes.
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Affiliation(s)
- Tejaswi S Iyyanki
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center , Houston, Texas
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Turza KC, Shafique M, Lobo PI, Sawyer RG, Keith DS, Brayman KL, Agarwal A. Infectious complications in living-donor kidney transplant recipients undergoing multi-modal desensitization. Surg Infect (Larchmt) 2014; 15:182-6. [PMID: 24773230 PMCID: PMC4696441 DOI: 10.1089/sur.2012.231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Pre-existing humoral barriers challenge the transplantation of living donor kidneys (LDK) into highly sensitized ABO- and human leukocyte antigen (HLA)-incompatible recipients. Conditioning these LDK recipients' immune systems is required before they undergo transplantation. We hypothesized that medical desensitization would yield higher post-transplantation rates of infection. METHODS We conducted a study in which matched controls consisting of non-desensitized (NDS) LDK recipients were compared with desensitized (DS) receipients. Pre-transplantation desensitization included treatment with rituximab and mycophenolate mofetil followed by intravenous immunoglobulin (IVIg) and plasmapheresis. All participants in the study underwent induction therapy and maintenance immunosuppression. Primary outcomes included infection (opportunistic, local, systemic) within 12 mo after transplantation. RESULTS Twenty-five patients underwent desensitization and LDK transplantation. Graft survival in the DS and NDS groups of patients was 96% and 98%, respectively. The mean 3- and 12-mo serum creatinine concentrations in the DS and NDS groups were 1.1±0.2 mg/dL and 1.2±0.3 mg/dL and 0.95±0.4 mg/dL and 0.73±0.8 mg/dL (p=0.3 and p=0.01), respectively. Thirty-six percent of the patients in the DS group had one or more infections, vs. 28% of those in the NDS group (p=0.1). No difference was observed in the frequency of opportunistic or systemic infections in the two groups. Local infections were statistically significantly more frequent in the DS group (60% vs. 30%, respectively; p=0.02). CONCLUSION Pre-operative desensitization in highly sensitized LDK recipients is followed by a similar incidence of opportunistic and systemic infections as in NDS patients. Local infections were significantly more frequent in the DS than in the NDS patients in the study. With careful monitoring of infectious complications, pre-transplant desensitization permits LDK transplantation into highly sensitized patients.
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Affiliation(s)
- Kristin C. Turza
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Michael Shafique
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Peter I. Lobo
- Department of Medicine, University of Virginia, Charlottesville, Virginia
| | - Robert G. Sawyer
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Douglas S. Keith
- Department of Medicine, University of Virginia, Charlottesville, Virginia
| | - Kenneth L. Brayman
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Avinash Agarwal
- Department of Surgery, University of Virginia, Charlottesville, Virginia
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Affiliation(s)
| | - Kristin C Turza
- Department of Surgery, University of Virginia, Charlottesville
| | - Stephen L Cook
- Department of Pathology, University of Virginia, Charlottesville
| | - Philip W Smith
- Department of Surgery, University of Virginia, Charlottesville
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Yount KW, Mallory MA, Turza KC, Griffiths ER, Lau CL, Sawyer RG. Pneumomediastinum after percutaneous endoscopic gastrostomy tube placement. Ann Thorac Surg 2014; 97:e37-9. [PMID: 24484840 DOI: 10.1016/j.athoracsur.2013.10.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2012] [Revised: 09/27/2013] [Accepted: 10/11/2013] [Indexed: 10/25/2022]
Abstract
The incidence of esophageal perforation or confounding mechanisms of pneumomediastinum specifically introduced by the addition of percutaneous endoscopic gastrostomy (PEG) tube insertion to esophagogastroduodenoscopy have not been described, and pneumomediastinum in the absence of esophageal perforation after PEG has not been reported. Typically, pneumomediastinum is an ominous finding, although benign causes exist. We present two cases of post-PEG pneumomediastinum not correlated with esophageal perforation on follow-up imaging. When pneumomediastinum is detected after PEG, appropriate studies should be undertaken to confirm its cause and to determine treatment plans. Further investigation may be warranted to ascertain the true incidence, causes, and clinical significance of post-PEG pneumomediastinum.
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Affiliation(s)
- Kenan W Yount
- Division of Thoracic and Cardiovascular Surgery, University of Virginia Health System, Charlottesville, Virginia.
| | - Melissa A Mallory
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Kristin C Turza
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Eric R Griffiths
- Division of Thoracic and Cardiovascular Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Christine L Lau
- Division of Thoracic and Cardiovascular Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Robert G Sawyer
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
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Turza KC, Campbell CA, Rosenberger LH, Politano AD, Davies SW, Riccio LM, Sawyer RG. Options for closure of the infected abdomen. Surg Infect (Larchmt) 2012; 13:343-51. [PMID: 23216525 DOI: 10.1089/sur.2012.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The infected abdomen poses substantial challenges to surgeons, and often, both temporary and definitive closure techniques are required. We reviewed the options available to close the abdominal wall defect encountered frequently during and after the management of complicated intra-abdominal infections. METHODS A comprehensive review was performed of the techniques and literature on abdominal closure in the setting of intra-abdominal infection. RESULTS Temporary abdominal closure options include the Wittmann Patch, Bogota bag, vacuum-assisted closure (VAC), the AbThera™ device, and synthetic or biologic mesh. Definitive reconstruction has been described with mesh, components separation, and autologous tissue transfer. CONCLUSION Reconstructing the infected abdomen, both temporarily and definitively, can be accomplished with various techniques, each of which is associated with unique advantages and disadvantages. Appropriate judgment is required to optimize surgical outcomes in these complex cases.
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Affiliation(s)
- Kristin C Turza
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia 22908, USA.
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Davies SW, Turza KC, Sawyer RG, Schirmer BD, Hallowell PT. A comparative analysis between laparoscopic and open ventral hernia repair at a tertiary care center. Am Surg 2012; 78:888-892. [PMID: 22856497 PMCID: PMC3500604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Laparoscopic ventral hernia repair reportedly yields lower postoperative complications than open repair. We hypothesized that patients undergoing laparoscopic repair would have lower postoperative infectious outcomes. Also, certain preoperative patient characteristics and preoperative hernia characteristics are hypothesized to increase complication risk in both groups. All ventral hernia repairs performed at University of Virginia from January 2004 to January 2006 were reviewed. Primary outcomes included wound healing complications and hernia recurrence. Categorical data were analyzed with χ(2) and Fisher's exact tests. Continuous variables were evaluated with independent t tests and Mann-Whitney U tests. Multivariable logistic regression was performed. A total of 268 repairs (110 open, 158 laparoscopic) were evaluated. Patient and hernia characteristics were similar between groups, though the percents of wound contamination (5.4% vs 0.6%; P = 0.02) and simultaneous surgery (7.2% vs 0%; P = 0.001) were greater in the open procedures. Univariate analysis also revealed that open cases had a greater incidence of postoperative superficial surgical site infection (SSI) (30.0% vs 10.7%; P < 0.0001). Multivariable analysis revealed that both diabetes and open repair were associated with an increased risk of superficial SSI (P = 0.019; odds ratio = 3.512; 95% confidence interval = 1.229-10.037 and P = 0.001; odds ratio = 4.6; 95% confidence interval = 1.9-11.2, respectively). Laparoscopic ventral hernia repair yielded lower rates of postoperative superficial SSI than open surgery. Other preoperative patient characteristics and preoperative hernia characteristics, with the exception of diabetes, were not found to be associated with an increased risk of postoperative complications.
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Affiliation(s)
- Stephen W Davies
- Department of General Surgery, University of Virginia, Charlottesville, Virginia, USA.
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Davies SW, Turza KC, Sawyer RG, Schirmer BD, Hallowell PT. A Comparative Analysis between Laparoscopic and Open Ventral Hernia Repair at a Tertiary Care Center. Am Surg 2012. [DOI: 10.1177/000313481207800825] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Laparoscopic ventral hernia repair reportedly yields lower postoperative complications than open repair. We hypothesized that patients undergoing laparoscopic repair would have lower postoperative infectious outcomes. Also, certain preoperative patient characteristics and preoperative hernia characteristics are hypothesized to increase complication risk in both groups. All ventral hernia repairs performed at University of Virginia from January 2004 to January 2006 were reviewed. Primary outcomes included wound healing complications and hernia recurrence. Categorical data were analyzed with χ2 and Fisher's exact tests. Continuous variables were evaluated with independent t tests and Mann-Whitney U tests. Multivariable logistic regression was performed. A total of 268 repairs (110 open, 158 laparoscopic) were evaluated. Patient and hernia characteristics were similar between groups, though the percents of wound contamination (5.4% vs 0.6%; P = 0.02) and simultaneous surgery (7.2% vs 0%; P = 0.001) were greater in the open procedures. Univariate analysis also revealed that open cases had a greater incidence of postoperative superficial surgical site infection (SSI) (30.0% vs 10.7%; P < 0.0001). Multivariable analysis revealed that both diabetes and open repair were associated with an increased risk of superficial SSI ( P = 0.019; odds ratio = 3.512; 95% confidence interval = 1.229–10.037 and P = 0.001; odds ratio = 4.6; 95% confidence interval = 1.9–11.2, respectively). Laparoscopic ventral hernia repair yielded lower rates of postoperative superficial SSI than open surgery. Other pre-operative patient characteristics and preoperative hernia characteristics, with the exception of diabetes, were not found to be associated with an increased risk of postoperative complications.
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Affiliation(s)
- Stephen W. Davies
- Department of General Surgery, University of Virginia, Charlottesville, Virginia
| | - Kristin C. Turza
- Department of General Surgery, University of Virginia, Charlottesville, Virginia
| | - Robert G. Sawyer
- Department of General Surgery, University of Virginia, Charlottesville, Virginia
| | - Bruce D. Schirmer
- Department of General Surgery, University of Virginia, Charlottesville, Virginia
| | - Peter T. Hallowell
- Department of General Surgery, University of Virginia, Charlottesville, Virginia
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Campbell CA, Turza KC, Morgan RF. Postoperative outcomes and reliability of “sensation-sparing” sural nerve biopsy. Muscle Nerve 2009; 40:603-9. [DOI: 10.1002/mus.21347] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Smith PW, Turza KC, Carter CO, Vance ML, Laws ER, Hanks JB. Bilateral Adrenalectomy for Refractory Cushing Disease: A Safe and Definitive Therapy. J Am Coll Surg 2009; 208:1059-64. [DOI: 10.1016/j.jamcollsurg.2009.02.054] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2008] [Revised: 01/29/2009] [Accepted: 02/02/2009] [Indexed: 10/20/2022]
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