Comparison of early postoperative functional levels following total hip replacement using minimally invasive versus standard incisions. A prospective randomized blinded trial Synthetic polyglycomer short-term absorbable sutures vs. polydioxanone long-term absorbable sutures for preventing incisional hernia and wound dehiscence after abdominal wall closure: a comparative randomized study of patients treated for gastric or colon cancer Comparison of a minimally invasive procedure versus standard microscopic discotomy: a prospective randomised controlled clinical trial [Minimally invasive posterior approach for total hip arthroplasty]. Minimally Invasive versus Classic Procedures in Total Hip Arthroplasty: A Double-blind Randomized Controlled Trial Randomised controlled trials: subgroup analyses A minimal-incision technique in total hip arthroplasty does not improve early postoperative outcomes. A prospective, randomized, controlled trial. A matched-pair comparison of laparoendoscopic single-site surgery and standard laparoscopic radical nephrectomy by a single urologist. ‘Fast-track’ multimodal rehabilitation program improves outcome after laparoscopic sigmoidectomy: a controlled prospective evaluation Fast-Track Versus Standard Care in Laparoscopic High Anterior Resection: A Prospective Randomized-Controlled Trial Treatment of subcutaneous abdominal wound healing impairment after surgery without fascial dehiscence by vacuum assisted closure™ (SAWHI-V.A.C.®-study) versus standard conventional wound therapy: study protocol for a randomized controlled trial Enhanced early outcomes with the anterior supine intermuscular approach in primary total hip arthroplasty. Early complications, pain, and quality of life after reconstructive surgery for abdominal rectus muscle diastasis: a 3-month follow-up. Laparoscopy in Combination with Fast Track Multimodal Management is the Best Perioperative Strategy in Patients Undergoing Colonic Surgery: A Randomized Clinical Trial (LAFA-study) Total hip arthroplasty through a minimally invasive lateral approach--our experience and early results. A multicenter randomized controlled trial evaluating the effect of small stitches on the incidence of incisional hernia in midline incisions Mininvasive abdominal aortic surgery. Early recovery and reduced hospitalization after multidisciplinary approach.
Objective : To compare the results of single-incision minimally invasive total hip replacement ( ≤ 10 cm ) to st and ard-incision ( 16 cm ) total hip replacement in the early postoperative period with respect to functional and mobilizing ability ( transfers , mobilizing , walking and stair assessment ) . Setting : Orthopaedic wards of a regional orthopaedic centre . Subjects : Two hundred and nineteen total hip replacement patients were tested between December 2003 and June 2004 . Interventions : Patients were r and omized to either total hip replacement through a minimally invasive ( ≤ 10 cm ) or st and ard incision ( 16 cm ) . A single surgeon performed all procedures using the same type of component fixation . Postoperative physiotherapy assessment and treatment was st and ardized . Analgesia was also st and ardized . All patients , physiotherapy staff and assessors were blinded to the incision used . Main outcome measures : Patients were tested two days post operatively and were assessed for the following activities : transfer from supine to sit , transfer from sitting to st and ing , mobilizing , ascending and descending stairs and weight-bearing . Results : The shorter incision offered no significant improvement in patient ability in relation to transfer from lying to sitting , transfer from sitting to st and ing , mobilizing or weight-bearing . Ascending/descending stairs gave a total time for the minimal incision of 38.7 s against 40.8 s for a st and ard incision . There was no difference in walking velocity between the st and ard incision and minimal incision groups two days post operatively ( minimal incision = 0.26 m/s versus st and ard incision = 0.26 m/s ) or six weeks post operatively ( minimal incision = 0.90 m/s versus st and ard incision = 0.93 m/s ) . There was no difference between groups with respect to walking aids at six-week review . The mean length of stay for the minimally invasive approach was 3.65 days ( SD 2.04 ) against 3.68 days ( SD 2.45 ) for the st and ard approach . This was not significantly different . Conclusion : Total hip replacement performed through a minimally invasive incision of ≤ 10 cm compared with a st and ard incision of 16 cm offers no significant benefit in terms of the rate or ability of patients to mobilize and perform functional tasks necessary for safe discharge Purpose To compare the results of abdominal wall closure using interrupted synthetic short-term vs. long-term tensile strength-retaining absorbable sutures . Methods The subjects were 55 patients undergoing elective laparotomy through a midline vertical incision for gastric or colon cancer surgery between November 2008 and August 2010 , at our hospital . After providing informed consent , the patients were r and omized for suturing with Polysorb ® , which provides short-term tensile strength , or with PDS ® II , which provides long-term strength . The primary outcome analyzed was the incidence of incisional hernia or wound dehiscence . Result There were 28 patients allocated to the Polysorb group and 27 to the PDS II group . Postoperative wound dehiscence was noted in two patients ( 3.6 % ) . Five of 51 patients ( 9.8 % ) suffered incisional hernia within 1 year after surgery , 6 of 41 patients ( 14.6 % ) within 2 years , and 6 of 35 patients ( 17.1 % ) within 3 years . There was no significant per year difference in the incidence of incisional hernia or wound dehiscence between the groups . Conclusion Outcomes were favorable in both groups and not inferior to reported outcomes of larger-scale studies . Verification of the equivalence between the two types of suture material necessitates larger-scale studies that adopt the same suture methods A Prospect i ve r and omised controlled study was done to determine statistical difference between the st and ard microsurgical discotomy ( MC ) and a minimally invasive microscopic procedure for disc prolapse surgery by comparing operation duration and clinical outcome . Additionally , the transferability of the results was determined by a bicentric design . The microscopic assisted percutaneous nucleotomy ( MAPN ) has been advocated as a minimally invasive tubular technique . Proponents have cl aim ed that minimally invasive procedures reduce postoperative pain and accelerate the recovery . In addition , there exist only a limited number of well- design ed comparison studies comparing st and ard microdiscotomy to a tubular minimally invasive technique that support this cl aim . Furthermore , there are no well- design ed studies looking at the transferability of those results and possible learning curve phenomena . We studied 100 patients , who were planned for disc prolapse surgery at two centres [ 50 patients at the developing centre ( index ) and 50 patients at the less experienced ( transfer ) centre ] . The r and omisation was done separately for each centre , employing a block-r and omisation procedure with respect to age and preoperative Oswestry score . Operation duration was chosen as a primary outcome parameter as there was a distinguished shortening observed in a preliminary study at the index centre enabling a sound case number estimation . The following data were compared between the two groups and the centres with a 12-month follow-up : surgical times ( operation duration and approach duration ) , the clinical results , leg and back pain by visual analogue scale , the Oswestry disability index , length of hospital stay , return to work time , and complications . The operation duration was statistically identical for MC ( 57.8 ± 20.2 min ) at the index centre and for MAPN ( 50.3 ± 18.3 min ) and MC ( 54.7 ± 18.1 min ) at the transfer centre . The operation duration was only significantly shorter for the MAPN technique at the index centre with 33.3 min ( SD 12.1 min ) . There was a huge clinical improvement for all patients regardless of centre or method revealed by a repeated measures ANOVA for all follow-up visits Separate post hoc ANOVAs for each centre revealed that there was a significant time– method ( MAPN vs. MC ) interaction at the index centre ( F = 3.75 , P = 0.006 ) , whereas this crucial interaction was not present at the transfer centre ( F = 0.5 , P = 0.7 ) . These results suggest a slightly faster clinical recovery for the MAPN patients only at the index centre . This was due to a greater reduction in VAS score for back pain at discharge , 8-week and 6-month follow up ( P < 0.002 ) . The Oswestry-disability scores reached a significant improvement compared to the initial values extending over the complete follow-up at both centres for both methods without revealing any differences for the two methods in either centre . There was no difference regarding complications . The results demonstrate that a shorter operation duration and concomitant quicker recovery is comprehensible at an experienced minimally invasively operating centre . These advantages could not be found at the transfer centre within 25 minimally invasive procedures . In conclusion both procedures show equal mid term clinical results and the same complication rate even if the suggested advantages for the minimally invasive procedure could not be confirmed for the transfer centre within the framework of this study The mini-posterior approach for total hip arthroplasty ( THA )  belongs to the mini-incision approaches . In comparison to st and ard approaches , less muscle trauma result ing in less pain , less blood loss and faster rehabilitation in the early postoperative period are attributed to this approach , as known for all other minimally invasive approaches . In a prospect i ve study of 100 cases of THA it could be shown that this is true when comparing the mini-posterior approach with the posterolateral approach . Lower levels of muscle enzymes as a parameter for muscle trauma , could not be seen Background For total hip arthroplasty ( THA ) , minimally invasive surgery ( MIS ) uses a smaller incision and less muscle dissection than the classic approach ( CLASS ) , and may lead to faster rehabilitation . Questions / purpose sDoes minimally invasive hip arthroplasty result in superior clinical outcomes ? Patients and Methods In this double-blind r and omized controlled trial , 120 consecutive primary noncemented THAs in 120 patients were assigned to one of two groups ( MIS or CLASS ) . The r and omization sequence was stratified for two groups of surgeons , ie , those using a posterolateral approach ( PL-CLASS or PL-MIS ) and those using an anterolateral approach ( AL-CLASS or AL-MIS ) . Length of the incisions was 18 cm for the CLASS procedures . MIS incisions were extended at the skin level to 18 cm at the end of the procedure . The primary end point was the Harris hip score ( HHS ) at 6 weeks postoperatively . Patient-centered question naires were obtained preoperatively and after 6 weeks and 1 year . Results For the patients in the MIS group ( average 7.8 cm incision length ) , statistically significant increased mean HHSs were seen compared with the CLASS group at 6 weeks and 1 year . This difference was small and mainly caused by the favorable results of the PL-MIS . In the MIS group , surgical time was longer . A learning curve was observed based on operation time and complication rate . Although not statistically significant , the perioperative complication rate was rather high in the ( anterolateral ) MIS group . Conclusions The minimal invasive approach in THA did not show a clinical ly relevant superior outcome in the first postoperative year . Level of Evidence Level I , therapeutic study . See Guidelines for Authors for a complete description of levels of evidence The effectiveness of wound edge protection devices in reducing surgical site infection after abdominal surgery was investigated . A r and omised controlled trial was undertaken . The intervention was st and ard intraoperative care plus use of a wound edge protection device during the intra-abdominal part of the operation . The control was st and ard intraoperative care alone . The sample size for the trial was based on having 80 % power to detect a 50 % reduction in the infection rate , assuming a rate of 12 % under st and ard care . A total sample size of 710 participants ( 355 in each arm ) was needed . It was necessary to recruit 750 patients to the trial to allow for an estimated 5 % dropout rate . In total , 760 patients undergoing laparotomy were recruited ; 382 patients were allocated to the intervention group and 378 to the control group.1  The primary outcome was surgical site infection within 30 days of surgery , as assessed by clinicians who were blind to the patients ’ device group allocation . Secondary outcomes included quality of life and duration of hospital stay . Subgroup analyses that compared surgical site infection within 30 days of surgery between the device groups were performed , with the aim of establishing whether the intervention was beneficial in particular groups of patients . The analyses incorporated 15 characteristics of the patients and the operations . Six patients in the intervention group and five in the control group did not undergo laparotomy . Furthermore , seven patients in each group were lost to follow-up . Although the proportion of patients with surgical site infection was lower in the intervention group , the difference was not significant ( 24.7 % ( n=91 ) v 25.4 % ( n=93 ) ; odds ratio 0.97 , 95 % confidence interval 0.69 to 1.36 ; P=0.85 ) . No significant difference was seen between the groups in the secondary outcomes ( quality of life and duration of hospital stay ) . The subgroup analysis did not BACKGROUND Minimally invasive total hip arthroplasty has stirred substantial controversy with regard to whether it provides superior outcomes compared with total hip arthroplasty performed through longer incisions . The orthopaedic literature is deficient in well- design ed scientific studies to support the clinical superiority of this approach . The objective of this study was to compare the results of a single mini-incision approach with those of a st and ard-incision total hip arthroplasty in the early postoperative period . METHODS Two hundred and nineteen patients ( 219 hips ) admitted for unilateral total hip arthroplasty between December 2003 and June 2004 were r and omized to undergo surgery through a short incision of < or=10 cm or a st and ard incision of 16 cm .  All patients were blinded to the size of the incision for the duration of the hospital stay . The anesthetic , analgesic , and postoperative physiotherapy protocol s were st and ardized , with the staff also blinded to the technique used . A single surgeon , who had performed more than 300 short-incision hip replacements prior to the start of this study and who performs an average of 415 primary total hip replacements a year , performed all procedures through a single-incision posterior approach using a cementless cup and cemented stem . RESULTS The two groups were matched for age , grade according to the system of the American Society of Anesthesiologists , and body mass index . No significant difference was detected with respect to postoperative hematocrit , blood transfusion requirements , pain scores , or analgesic use . We found no difference in early walking ability or length of hospital stay and no difference in component placement , cement-mantle quality , or functional outcome scores at six weeks . The patient variables significantly associated with a probability of early discharge independent of incision length were patient age and preoperative hemoglobin levels ( p < 0.05 ) . The surgical scars contracted significantly over six weeks ( p < 0.05 ) but by a similar proportion of 11 % to 12 % in both groups . CONCLUSIONS Minimally invasive total hip arthroplasty performed through a single-incision posterior approach by a high-volume hip surgeon with extensive experience in less invasive approaches to the hip is safe and reproducible . However , it offers no significant benefit in the early postoperative period compared with a st and ard incision of 16 cm . As it is not known whether lower-volume and less-experienced surgeons can achieve similar results , the mini-incision technique merits further study before wide dissemination and implementation of this family of surgical approaches can be recommended PURPOSE The aim of this study is to compare the perioperative outcomes after transumbilical laparoendoscopic single-site ( LESS ) radical nephrectomy ( LESS-RN ) performed by a surgeon during his learning curve of this novel procedure with the outcomes after st and ard laparoscopic radical nephrectomy ( LRN ) for patients with a solitary renal tumor . Using this information , we examined whether LESS exhibits any objective advantages over st and ard laparoscopy . PATIENTS AND METHODS Twenty patients who underwent LESS-RN for a solitary cT(1)N(0)M(0 ) renal mass ( group 1 ) were matched and compared with 33 patients who underwent st and ard LRN ( group 2 ) for tumors of similar sizes . Patient and surgical data , pathologic outcomes , and follow-up information , including patient responses regarding cosmetic satisfaction , were analyzed . RESULTS The minimum duration of follow-up was 6 months for both groups . Patients in group 1 had significantly ( P<0.05 ) quicker recoveries of bowel function , shorter postoperative analgesic time , and lower pain scores during their hospital stay . At the time of the last follow-up , all patients remained symptom free , and no evidence of recurrence was detected . Compared with that of st and ard LRN patients , LESS-RN patients exhibited better cosmetic satisfaction scores postoperatively at least to 6 months ( P=0.013 ) . CONCLUSIONS Transumbilical LESS-RN is a feasible , safe , and efficacious procedure with favorable perioperative outcomes that results in significantly improved control of postoperative pain , more rapid recovery of bowel function , and increased cosmetic satisfaction . Additional research , including r and omized controlled trials and long-term follow-ups , however , will be needed to draw solid conclusions regarding the relative efficacy of this procedure compared with st and ard approaches Background  Laparoscopic colorectal resection improves patient outcome by reducing pain , postoperative pulmonary dysfunction , gastrointestinal paralysis , and fatigue . A multimodal rehabilitation program ( “ fast-track ” ) with epidural analgesia , early oral feeding , and enforced mobilization may further improve the excellent results of laparoscopic colorectal resection , enabling early ambulation of these patients . Methods Fifty two consecutive patients underwent laparoscopic sigmoidectomy with st and ardized regular perioperative treatment ( st and ard ) or multimodal rehabilitation program ( “ fast-track ” ) .  Outcome measures included pulmonary function , duration of postoperative ileus , pain perception , fatigue , morbidity , and mortality . Results Twenty nine st and ard-care patients ( 19 men and 10 women ) and 23 fast-track patients ( 15 men and eight women ) were evaluated . Demographic and operative data were similar for the two groups . On the 1st postoperative day , pulmonary function was improved ( p = 0.01 ) in fast-track patients . Oral feeding was achieved earlier ( p < 0.01 ) and defecation occurred earlier ( p < 0.01 ) in the fast-track group . Visual analogue scale scores for pain were similar for the two groups ( p > 0.05 ) , but fatigue was increased in the st and ard-care group on the 1st ( p = 0.06 ) and 2nd ( p < 0.05 ) postoperative days . Morbidity was not different for the two groups . Fast-track patients were discharged on day 4 ( range , 3–6 ) and st and ard-care patients on day 7 ( range , 4–14 ) ( p < 0.001 ) . Conclusion Multimodal rehabiliation can improve further on the excellent results of laparoscopic sigmoidectomy and decrease the postoperative hospital stay The value of fast-track ( FT ) multimodal recovery programs in improving hospitalization of surgical patients has been widely proved . The application of FT protocol s to laparoscopic colorectal surgery seems to maximize the effects of the minimally invasive approach . The objectives of this r and omized-controlled trial are to compare the short-term outcomes ( bowel function , return to oral nutrition , day of discharge , fatigue , time to resume normal activities , functional capabilities , and readmission rate ) of patients undergoing elective laparoscopic high anterior resection ( HAR ) following either a FT or a st and ard program . The prospect i ve r and omized-controlled trial included 52 consecutive patients undergoing elective laparoscopic HAR . Group 1 was treated with a FT rehabilitation program , and group 2 was treated with a st and ard care ( SC ) program . Patients were interviewed 14 and 30 days postoperatively . One patient in each group was excluded from the study . Mean hospital stay , time of first bowel movement , and bowel function resumption were significantly shorter in the FT group ( P<0.05 ) . Patients in the FT group referred more pain in day 0 versus patients in the SC group ( P<0.05 ) even though the difference disappeared from day 1 . Fatigue was significantly reduced at day 14 in the FT group compared with the SC group ( P<0.01 ) . Similarly , ability to resume the normal preoperative attitude ( walking stairs , cooking , housekeeping , shopping , and walking outdoors ) was significantly better at day 14 in the FT group ( P<0.005 ) . There was no significant difference between the 2 groups at day 30 for the same parameters . There were no readmissions in both the groups and no need for consultations from general practitioners . FT multimodal program is a safe approach effective on postoperative short-term outcome significantly reducing hospital stay . Early postoperative pain control needs to be optimized Abstract Background A decision of the Federal Joint Committee Germany in 2008 stated that negative pressure wound therapy is not accepted as a st and ard therapy for full reimbursement by the health insurance companies in Germany . This decision is based on the final report of the Institute for Quality and Efficiency in Health Care in 2006 , which demonstrated through systematic review s and meta- analysis of previous study projects , that an insufficient state of evidence regarding the use of negative pressure wound therapy for the treatment of acute and chronic wounds exists . Further studies were therefore indicated . Methods / design The study is design ed as a multinational , multicenter , prospect i ve r and omized controlled , adaptive design , clinical superiority trial , with blinded photographic analysis of the primary endpoint . Efficacy and effectiveness of negative pressure wound therapy  for wounds in both medical sectors ( in- and outpatient care ) will be evaluated . The trial compares the treatment outcome of the application of a technical medical device which is based on the principle of negative pressure wound therapy ( intervention group ) and st and ard conventional wound therapy ( control group ) in the treatment of subcutaneous abdominal wounds after surgery . The aim of the SAWHI-VAC ® study is to compare the clinical , safety and economic results of both treatment arms . Discussion The study project is design ed and conducted with the aim of providing solid evidence regarding the efficacy of negative pressure wound therapy .  Study results will be provided until the end of 2014 to contribute to the final decision of the Federal Joint Committee Germany regarding the general admission of negative pressure wound therapy as a st and ard of performance within both medical sectors . Trial registration Clinical Trials.gov NCT01528033 German Clinical Trials Register The advantages of minimally invasive surgical approaches for total hip arthroplasty are reported to include reduced blood loss , less pain , and shorter hospital stays , which combine to afford a faster recovery1 - 4 . However , other studies have failed to show any significant advantage over the use of st and ard surgical approaches ( Fig. 1)5 - 8 . Reported disadvantages of minimally invasive techniques are the substantial learning curve required and an increased risk of early complications3,9 - 12 . In addition , the long-term outcomes of minimally invasive procedures in terms of implant fixation and longevity remain unproven . Fig. 1 The st and ard direct lateral approach to the hip previously described by Frndak et al.21 is performed with the patient in the lateral decubitus position . ( Printed with permission of Joint Implant Surgeons , Inc. ) There are three basic categories of so-called minimally invasive total hip arthroplasty approaches : an abbreviated incision ( small incision ) , modifications of st and ard approaches with smaller incisions and less soft-tissue dissection ( less invasive ) , and novel approaches that reportedly do not cut muscle ( minimally invasive ) . We have had a broad experience , over the past seven years , with a less invasive modification of the direct lateral approach ( a modified Hardinge approach ) ( Fig. 2 ) . We previously reported less blood loss and a shorter hospital stay in association with this approach13 . Others have argued that the less invasive direct lateral approach does not provide an advantage over the traditional approach5 . Importantly , the soft-tissue dissection still requires removing and repairing the abductor musculature . Fig. 2 The less invasive direct lateral approach is performed with the patient in the lateral decubitus position . This approach employs an abbreviated skin and fascial incision with a limited abductor muscle dissection13 . ( Printed with permission of Joint Implant Surgeons , Inc. ) Several recent reports have AIM The aim of this study was to evaluate early complications following retromuscular mesh repair with those after dual layer suture of the anterior rectus sheath in a r and omised controlled clinical trial for abdominal rectus muscle diastasis ( ARD ) . METHODS Patients with an ARD wider than 3 cm and clinical symptoms related to the ARD were included in a prospect i ve r and omised study . They were assigned to either retromuscular inset of a lightweight polypropylene mesh or to dual closure of the anterior rectus fascia using Quill self-locking technology . All patients completed a vali date d question naire for pain assessment ( Ventral Hernia Pain Question naire , VHPQ ) and for quality of life ( SF36 ) prior to and 3 months after surgery . RESULTS The most frequently seen adverse event was minor wound infection . Of the patients , 14/57 had a superficial wound infection ; five related to Quill and nine to mesh repair . No deep wound infections were reported . Patient rating for subjective muscular improvement postoperatively was better in the mesh technique group with a mean of 6.9 ( range 0 - 10 ) compared to a mean of 4.8 ( range 0 - 10 ) in the Quill group ( p=0.01 ) . The pre- and post-operative SF36 scores improved in both groups . CONCLUSIONS There was no significant difference between the two surgical techniques in terms of early complications and perceived pain at the 3-month follow-up . Both techniques may be considered equally reliable for ARD repair in terms of adverse outcomes during the early postoperative phase , even though patients operated with a mesh experienced better improvement in muscular strength . Clinical Trial.gov : 2009/227 - 31/3/PE/96 Objective : To investigate which perioperative treatment , ie , laparoscopic or open surgery combined with fast track ( FT ) or st and ard care , is the optimal approach for patients undergoing segmental resection for colon cancer . Summary Background Data : Important developments in elective colorectal surgery are the introduction of laparoscopy and implementation of FT care , both focusing on faster recovery . Methods : In a 9-center trial , patients eligible for segmental colectomy were r and omized to laparoscopic or open colectomy , and to FT or st and ard care  , result ing in 4 treatment groups . Primary outcome was total postoperative hospital stay ( THS ) . Secondary outcomes were postoperative hospital stay ( PHS ) , morbidity , reoperation rate , readmission rate , in-hospital mortality , quality of life at 2 and 4 weeks , patient satisfaction and in-hospital costs .  Four hundred patients were required to find a minimum difference of 1 day in hospital stay . Results : Median THS in the laparoscopic/FT group was 5 ( interquar-tile range : 4–8 ) days ; open/FT 7 ( 5–11 ) days ; laparoscopic/st and ard 6 ( 4.5–9.5 ) days , and open/st and ard 7 ( 6–13 ) days ( P < 0.001 ) . Median PHS in the laparoscopic/FT group was 5 ( 4–7 ) days ; open/FT 6 ( 4.5–10 ) days ; laparoscopic/st and ard 6 ( 4–8.5 ) days and open/st and ard 7 ( 6–10.5 ) days ( P < 0.001 ) . Secondary outcomes did not differ significantly among the groups . Regression analysis showed that laparoscopy was the only independent predictive factor to reduce hospital stay and morbidity . Conclusions : Optimal perioperative treatment for patients requiring segmental colectomy for colon cancer is laparoscopic resection embedded in a FT program . If open surgery is applied , it is preferentially done in FT care . This study was registered under NTR222 ( www.trialregister.nl ) BACKGROUND AIMS Evaluation of : 1 . early clinical and radiographic results of  total hip arthroplasty ( THA ) through a st and ard lateral direct approach , 2 . early clinical and radiographic results of THA through a minimal lateral approach , 3 . comparison of the results of THA in these two groups . MATERIAL AND METHODS 120 THAs ( 60 cementless and 60 cemented ) done in 120 patients due to degenerative changes were evaluated prospect ively . 60 THAs were done through a minimal lateral approach and constituted a study group . 60 THAs were done through a direct lateral approach and constituted a control group . The mean age of the 120 patients ( 98 women and 22 men ) was 45 y.o . ( range : 32 - 67 y.o . ) . The duration of follow-up in the study group was from 6 to 12 months ( mean : 8.5 months ) . The duration of follow-up in the control group was from 10 to 16 months ( mean : 10.5 months ) . Mean preoperative functional status of the study group was 44.5 points according to the Harris hip score . Radiographic evaluation of the results was done according to the criteria of the Joint Committee of the Hip Society , AAOS and SICOT . RESULTS 6 months after THA , clinical results were 92 pts in the study group and 88 pts in the control group . Radiographic outcomes were very good in all 120 patients from both arms : there were no differences between the control and study group . The incidence of complications was similar in both groups . CONCLUSIONS Minimally invasive THA demonstrated its value in the treatment of  degenerative changes of the hip joint  with regard to short-term outcomes . The clinical and radiographic outcomes were comparable between the st and ard and minimally invasive approaches . Success with THA using a minimally invasive approach depends on excellent operative technique and experience with st and ard hip approaches rather than on the use of special instruments Background The median laparotomy is frequently used by abdominal surgeons to gain rapid and wide access to the abdominal cavity with minimal damage to nerves , vascular structures and muscles of the abdominal wall . However , incisional hernia remains the most common complication after median laparotomy , with reported incidences varying between 2 - 20 % . Recent clinical and experimental data showed a continuous suture technique with many small tissue bites in the aponeurosis only , is possibly more effective in the prevention of incisional hernia when compared to the common used large bite technique or mass closure . Methods / Design The STITCH trial is a double-blinded multicenter r and omized controlled trial design ed to compare a st and ardized large bite technique with a st and ardized small bites technique . The main objective is to compare both suture techniques for incidence of incisional hernia after one year . Secondary outcomes will include postoperative complications , direct costs , indirect costs and quality of life .  A total of 576 patients will be r and omized between a st and ardized small bites or large bites technique .  At least 10 departments of general surgery and two departments of oncological gynaecology will participate in this trial . Both techniques have a st and ardized amount of stitches per cm wound length and suture length wound length ratio 's are calculated in each patient . Follow up will be at 1 month for wound infection and 1 year for incisional hernia . Ultrasound examinations will be performed at both time points to measure the distance between the rectus muscles ( at 3 points ) and to objectify presence or absence of incisional hernia . Patients , investigators and radiologists will be blinded during follow up , although the surgeon can not be blinded during the surgical procedure . Conclusion The STITCH trial will provide level 1b evidence to support the preference for either a continuous suture technique with many small tissue bites in the aponeurosis only or for the commonly used large bites technique . Trial registration Clinical trials.gov AIM Clinical experience in gastrointestinal surgery demonstrated that a multimodal approach can improve the outcome and reduce the length of hospital stay . In this paper we investigate the impact of a multimodal clinical program , based on mininvasive surgery , epidural anesthesia and early feeding and mobilization , on postoperative morbidity and hospitalization after abdominal aortic surgery . METHODS A 2-armed study was design ed . All patients undergoing abdominal aortic surgery between May 2000 and April 2001 were enrolled in a multidisciplinary clinical program including thoracic epidural anesthesia and analgesia , left sub-costal minilaparotomy without evisceration , encouragement to feed and mobilize soon after surgery ( Multidisciplinary group : n=82 ) . For comparison purpose s , a retrospective analysis was conducted using the data of all patients operated on between January and December 1997 , receiving st and ard anesthesia care and a st and ard surgical and nursing program ( St and ard group : n=64 ) . RESULTS In the Multidisciplinary group we observed significantly better pain relief ( p<0.01 ) , earlier restoration of ambulation ( p<0.01 ) , earlier feeding ( p<0.01 ) and passage of stools ( p<0.01 ) . The incidence of complications was significantly lower in the Multidisciplinary group : pulmonary ( 0 % vs 14.1 % ) , cardiac ( 2.4 % vs 9.4 % ) and gastrointestinal ( 0 % vs 10.9 % ) . None of the patients in the Multidisciplinary group required admission to Intensive Care . Median postoperative hospitalization was 3 days in the Multidisciplinary group compared to 9 days in the St and ard group ( p<0.01 ) . CONCLUSION These results suggest that a multidisciplinary intervention with review of the traditional surgical care program would enhance recovery , decrease morbidity and hospitalization after abdominal aortic surgery
There was no major difference in the rate of complications .
Conclusions Short-term recovery favors limited incision over st and ard incision THA .
Background The literature comparing  limited incision and st and ard incision THAs  is confusing regarding whether limited incision THA improves short-term recovery without compromising long-term durability and survival .
Further , previously published meta-analyses can not conclude that limited incision THA is better .
With new data , we seek to discover if the answers now exist .
Purpose We used meta- analysis to compare surgical and hospitalization data , clinical outcomes , and complication rates , and thus ( 1 ) confirm whether limited incision THA is at least comparable to st and ard incision THA ; and ( 2 ) determine whether limited incision THA is an improvement over st and ard incision THA .