PubMed · 2018906
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J Colville. Needle-hook--a convenient retractor.. https://doi.org/10.1016/0007-1226(91)90055-o
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PURPOSE: Transverse and midline abdominal incisions are both commonly used for laparotomy to perform surgery on the pancreas and stomach, but comparative data are limited, especially from prospective randomized trials. METHODS: During a predefined 2-year recruitment period, 94 patients undergoing an elective major laparotomy for disorders of the pancreas or stomach were enrolled in this study. The outcome measures were pulmonary function, incisional pain, and wound characteristics. RESULTS: The operation groups were equally divided according to the type of incision used. The patients who underwent transverse incision laparotomy had significantly better postoperative pulmonary function and significantly less postoperative incisional pain than those who underwent midline incision laparotomy (P < 0.05), but there were no differences in morbidity and the incidence of wound complications. CONCLUSION: Performing a transverse incision for surgery on the pancreas or stomach results in better postoperative pulmonary function and less incisional pain than a midline incision, without affecting postoperative morbidity.
Stapled hemorrhoidopexy may leave residual skin tags or external components following its use in large prolapsed piles. Excision of redundant mucosa above the dentate line and reconstitution to the staple line reduces these prolapsed elements. We describe a novel technique that removes residual skin tags and piles while remaining true to the spirit of stapled hemorrhoidopexy.
The standard surgical ellipse, with 30 degrees apical angles and a length-to-width ratio of 2 or 3 to 1, works optimally on a flat surface. The same pattern, when used for excisions on strongly convex or concave surfaces, leads to distortions which may require significant revisions. The reason for these discrepancies is explainable by the mathematical differences between flat Euclidian geometry and curved non-Euclidian geometry. Understanding these basic mathematical principles as applied to cutaneous surgery should lead to better preoperative planning, fewer intraoperative surprises, and more pleasing results.