nach oben

Erschienen in:

01.04.2015 | Original Scientific Report

Essential Surgery: The Way Forward

verfasst von: Jaymie Ang Henry, Chris Bem, Caris Grimes, Eric Borgstein, Nyengo Mkandawire, William E. G. Thomas, S. William A. Gunn, Robert H. S. Lane, Michael H. Cotton

Erschienen in: World Journal of Surgery | Ausgabe 4/2015

Einloggen, um Zugang zu erhalten

Abstract

Introduction

Very little surgical care is performed in low- and middle-income countries (LMICs). An estimated two billion people in the world have no access to essential surgical care, and non-surgeons perform much of the surgery in remote and rural areas. Surgical care is as yet not recognized as an integral aspect of primary health care despite its self-demonstrated cost-effectiveness. We aimed to define the parameters of a public health approach to provide surgical care to areas in most need.

Methods

Consensus meetings were held, field experience was collected via targeted interviews, and a literature review on the current state of essential surgical care provision in Sub-Saharan Africa (SSA) was conducted. Comparisons were made across international recommendations for essential surgical interventions and a consensus-driven list was drawn up according to their relative simplicity, resource requirement, and capacity to provide the highest impact in terms of averted mortality or disability.

Results

Essential Surgery consists of basic, low-cost surgical interventions, which save lives and prevent life-long disability or life-threatening complications and may be offered in any district hospital. Fifteen essential surgical interventions were deduced from various recommendations from international surgical bodies. Training in the realm of Essential Surgery is narrow and strict enough to be possible for non-physician clinicians (NPCs). This cadre is already active in many SSA countries in providing the bulk of surgical care.

Conclusion

A basic package of essential surgical care interventions is imperative to provide structure for scaling up training and building essential health services in remote and rural areas of LMICs. NPCs, a health cadre predominant in SSA, require training, mentoring, and monitoring. The cost of such training is vastly more efficient than the expensive training of a few polyvalent or specialist surgeons, who will not be sufficient in numbers within the next few generations. Moreover, these practitioners are used to working in the districts and are much less prone to gravitate elsewhere. The use of these NPCs performing “Essential Surgery” is a feasible route to deal with the almost total lack of primary surgical care in LMICs.

ICES consists of a group of surgeons, international leaders, public health specialists, and educators who aim to promote the effective provision of safe, essential low-cost surgical care to deal with the significant burden of surgical disease in LMICs. The group strives to 1. Advocate and promote the need for essential surgery. 2. Identify essential surgical procedures that are cost-effective and indispensible to a community. 3. Promote and support education and training programs. 4. Identify local and regional training centers to coordinate essential surgical care delivery. 5. Support local surgical societies in training activities. 6. Encourage established surgical societies to include surgical care to poorly served communities within their mission statement. 7. Facilitate international cooperation for educational efforts, research, and advocacy in support of the essential, safe surgical for all initiative. 8. Work across health care networks to recognize essential surgery as a significant component of Public Health.

Cotton MH (2005) Rural international surgery Letter. World J Surg 29(4):413. doi:10.1007/S00268-005-1104-8 CrossRefPubMed

Contini S (2007) Surgery in developing counries: why and how to meet surgical needs worldwide. Acta Biomed 78(1):4–5PubMed

Ozgediz G, Dunbar P, Mock C et al (2009) Bridging the gap between public health and surgery: access to surgical care in low and middle-income countries. Bull Am Coll Surg 94(1):14–20PubMed

Ozgediz SD, Riviello R (2008) The “other” neglected diseases in global public health: surgical conditions in sub-Saharan Africa. PLoS Med 5:e121CrossRefPubMedCentralPubMed

Farmer PE, Kim JY (2008) Surgeery and global health : a view from beyond the OR. World J Surg 32(3):533–536. doi:10.1007/s00268-008-9525-9 CrossRefPubMedCentralPubMed

Debas HT, Gosselin R, McCord C, et al (2012) Surgery. Promoting essential surgery in low- income countries; a hidden cost-effective treasure. In: Jamison DT, Breman JG, Measham AR, et al (ed). Disease Control Priorities in Developing Countries. 2nd ed. OUP, New York 1245–60. http://files.dcp2.org/pdf/DCP/DCP67.pdf

Norton R, Kobusingye O (2013) Global health: injuries. New Engl J Med 368(18):1723–1730CrossRefPubMed

Meo G, Andreone D, De Bonis U et al (2006) Rural surgery in Southern Sudan. World J Surg 30(4):495–504. doi:10.1007/s00268-006-0306-z CrossRefPubMed

King M, Bewes P, Cairns J et al (eds) (1990) Primary surgery. OUP/GTZ, Oxford, Delhi

10.

Funk LM, Weiser TG, Berry WR, Lipsitz SR, Merry AF, Enright AC et al (2010) Global operating theatre distribution and pulse oximetry supply: an estimation from reported data. Lancet 376(9746):1055–1061CrossRefPubMed

11.

Clegg HA (1971) Editorial. Trop Doct 2(2):1–2

12.

Mahler H. (1980) Surgery and Health for All. Address 22nd Biennial World Congress International College of Surgeons. Mexico City, 29 June. http://www.who.int/surgery/esc_component/en/index.html

13.

Rennie JA (1994) The poor cousin of medicine. Trop Doct 24(1):5–6PubMed

14.

Kitamura T, Obara H, Takashima Y et al (2013) World Health Assembly agendas and trends of international health issues for the last 43 years: analysis of World Health Assembly agendas between 1970 and 2012. Health Policy 110(2–3):198–206CrossRefPubMed

15.

Grimes CE, Law RSL, Dorgstein ES et al (2012) Systematic review of met and unmet need of surgical disease in rural sub-Saharan Africa. World J Surg 36(1):8–23. doi:10.1007/s00268-011-1330-1 CrossRefPubMed

16.

Weiser TG, Regenbogen SE, Thompson KD et al (2008) An estimation of the global volume of surgery: a modelling strategy based on available data. Lancet 372(9633):139–144CrossRefPubMed

17.

Linden A, Sekidde FS, Galukande M et al (2012) Challenges of surgery in developing countries: a survey of surgical and anesthesia capacity in Uganda’s public hospitals. World J Surg 36(5):1056–1065. doi:10.1007/s00268-012-1482-7 CrossRefPubMed

18.

World Health Organization. Emergency and Essential Surgical Care Programme. http://www.who.int/surgery/publications/Planning_toolEESC.pdf, Accessed April 2014

19.

Cotton MH (2005) The Delivery of Surgery in the Developing World (abstract). East & Cent Afr J Surg 10:89

20.

World Health Organization. Maternal Mortality (2014). http://www.who.int/mediacentre/factsheets/fs348/en/index.html, Accessed April 2014

21.

Ronsmans C, Holz S, Stanton C (2006) Socioeconomic differentials in caesarean rates in developing countries: a retrospective analysis. Lancet 368(9546):1516–1523CrossRefPubMed

22.

United Nations Population Fund and Gender Health (2003) Obstetric fistula needs assessment report: findings from nine African countries. United Nations Population Fund and Gender Health, New York (NY)

23.

Hilton P (2003) Vesicovaginal fistulas in developing countries. Int J Gynaecol Obstet 82(3):285–295CrossRefPubMed

24.

Chandran A, Hyder AA, Peek-Asa C (2010) The global burden of unintentional injuries and an agenda for progress. Epidemiol Rev 32(1):110–120CrossRefPubMedCentralPubMed

25.

Lagarde E (2007) Road traffic injury is an escalating burden in Africa and deserves proportionate research effoirts. PLoS Med 4(6):170CrossRefPubMedCentral

26.

Lozano R, Naghavi M, Foreman K et al (2012) Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380(9859):2095–2128CrossRefPubMed

27.

Weston HK, Boikhubo N, Bachani AM, et al (2013) Health Policy Planning 4 Oct

28.

Peden M, McGee K, Sharma G (2002) Injury chart book: a graphical overview of the global burden of injuries. WHO, Geneva

29.

Van Rooyen M. (2009) Know before you go: International Emergency Medicine. Am Coll Emergency Physicians: Annual Scientific Meeting. Boston 8 Oct

30.

Krug E, Sharma G, Lozano Q (2000) The global burden of injuries. Am J Public Health 90(4):523–526CrossRefPubMedCentralPubMed

31.

Peden M, Hyder A (2002) Road traffic injuries are a global health problem. BMJ 324(7356):1153–1154CrossRefPubMedCentralPubMed

32.

Editorial Mock C (2013) Confronting the global burden of surgical disease. World J Surg 37(7):1457–1459. doi:10.1007/s00268-013-2102-x CrossRef

33.

Parry E (1999) Essential surgery. Trauma Quarterly 14(3):329–333CrossRef

34.

Mock C, Cherian M, Juillard C et al (2010) Developing priorities for addressing surgical conditions globally: furthering the link between surgery and public health policy. World J Surg 34(3):381–385. doi:10.1007/s00268-009-0263-4 CrossRefPubMed

35.

Chu K, Rosseel P, Gielis P et al (2009) Surgical task shifting in Sub-Saharan Africa. PLoS Med 6(5):e1000078CrossRefPubMedCentralPubMed

36.

International Collaboration for Essential Surgery (2014) www.essentialsurgery.org

37.

Mullan F, Frehywot S (2007) Non-physician clinicians in 47 sub-Saharan African countries. Lancet 370(9605):2158–2163CrossRefPubMed

38.

S B. (2012) Repairing the surgery deficit. New York Times. http://opinionator.blogs.nytimes.com/2012/08/08/repairing-the-surgery-deficit/?_php=true&_type=blogs&_r=0, Accessed on April 2014

39.

McCord C, Mbaruku G, Pereira C et al (2009) The quality of emergency obstetrical surgery by assistant medical officers in Tanzanian district hospitals. Health Aff 28(5):w876–w885CrossRef

40.

van Amelsfoort JJ, van Leeuwen PA, Jiskoot P et al (2010) Surgery in Malawi–the training of clinical officers. Trop Doct 40(2):74–76CrossRefPubMed

41.

Pereira C, Cumbi A, Malalane R et al (2007) Meeting the need for emergency obstetric care in Mozambique: work performance and histories of medical doctors and assistant medical officers trained for surgery. BJOG 114(12):1530–1533CrossRefPubMed

42.

White SM, Thorpe RG, Maine D (1987) Emergency obstetric surgery performed by nurses in Zaire. Lancet 330(8559):612–613CrossRef

43.

Sani R, Nameoua B, Yahaya A et al (2009) The impact of launching surgery at the district level in Niger. World J Surg 33(10):2063–2068. doi:10.1007/s00268-010-0611-4 CrossRefPubMedCentralPubMed

44.

Hounton SH, Newlands D, Meda N et al (2009) A cost-effectiveness study of caesarean section deliveries by clinical officers, general practitioners and obstetricians in Burkina Faso. Hum Resour Health 7:34–43CrossRefPubMedCentralPubMed

45.

Sohier N, Frejacques L, Gaganye R (1999) Design and implementation of a training programme for general practitioners in emergency surgery and obstetrics in precarious situations in Ethiopia. Ann R Coll Surg Engl 81(6):367–375PubMedCentralPubMed

46.

De Brouwere V, Dieng T, Diadhiou M, Witter S, Denerville E (2009) Task shifting for emergency obstetric surgery in district hospitals in Senegal. Reprod Health Matters 17(33):32–44CrossRefPubMed

47.

Chu KM, Ford NP, Trelles M (2011) Providing surgical care in Somalia: a model of task shifting. Confl Health 5:12–16CrossRefPubMedCentralPubMed

48.

Leet SM, Gai AK, Adek A et al (2012) Can primary health care staff be trained in basic life- saving surgery? S Sudan Med J 5(3):69–71

49.

Indian Medical Association (2013) June 17. http://www.ima-india.org/Opinion_requested_on_course_Curriculum.html. Accessed Dec 2013

50.

Pereira C, Bugalho A, Bergström S et al (1996) A comparative study of Caesarean deliveries by assistant medical officers and Obstetricians in Mozambique. Br J Obstet Gynaecol 103(6):508–512CrossRefPubMed

51.

Vaz F, Bergstrom S, Vaz ML et al (1999) Training medical assistants for surgery. Bull World Health Organ 77(8):688–691PubMedCentralPubMed

52.

Bewes P (2004) Trained medical assistants can successfully do work of doctors. (Letter). BMJ 329(7475):1184CrossRefPubMedCentralPubMed

53.

Chiloopora G, Pereira C, Kamwendo F et al (2007) Postoperative outcome of caesarean sections and other major obstetric surgery by clinical officers and medical officers in Malawi. Hum Resour Health 5:17–23CrossRef

54.

Wilhelm TJ, Thawe IK, Mwatibu B et al (2011) Efficacy of major general surgery performed by non-physician clinicians at a central hospital in Malawi. Trop Doct 41(2):71–75CrossRefPubMed

55.

Syed NZ, McQueen KAK (2011) Surgery, public health, and Pakistan. World J Surg 35(9):2625–2634. doi:10.1007/s00268-011-1304-3

56.

Cometto G, Belgrano E, De Bonis U et al (2012) Primary surgery in rural areas of southern Sudan. World J Surg 36(3):556–564. doi:10.1007/s00268-011-1403-1 CrossRefPubMed

57.

Wilson A, Lissauer D, Thangaratinam S et al (2011) A comparison of clinical officers with medical doctors on outcomes of Caesarean Section in the developing world: meta-analysis of controlled studies. BMJ 342:d2600CrossRefPubMedCentralPubMed

58.

Hickman R (1999) From tennis courts to transplants. Arch Surg 134(4):451–452CrossRefPubMed

59.

Kristof ND. (2005) The Illiterate Surgeon. New York Times June 12. http://www.nytimes.com/2005/06/12/opinion/12kristof.html

60.

Groen RS, Samai M, Stewart KA et al (2012) Untreated surgical conditions in Sierra Leone: a cluster randomised, cross-sectional, countrywide survey. Lancet 380(9847):1082–1087CrossRefPubMed

61.

Kabia SA, Koroma ST, Bouré A et al (2008) Enhancing the capacity of regional & district facilities for emergency essential surgical care. WHO, Freetown

62.

Kingham TP, Kamara TB, Cherian MN et al (2009) Quantifying surgical capacity in Sierra Leone: a guide for improving surgical care. Arch Surg 144(2):122–127CrossRefPubMed

63.

Petroze RT, Nzayisenga A, Rusanganwa V et al (2012) Comprehensive national analysis of emergency and essential surgical capacity in Rwanda. Br J Surg 99(3):436–443CrossRefPubMed

64.

Henry JA, Frenkel E, Borgstein E, Mkandawire N, Goddia C (2014) Surgical and anaesthetic capacity of hospitals in Malawi: key insights. Health Policy Plan. doi:10.1093/heapol/czu102

65.

Henry JA, Windapo O, Kushner AL et al (2012) A survey of surgical capacity in rural Southern Nigeria: opportunities for change. World J Surg 36(12):2811–2818. doi:10.1007/s00268-012-1764-0 CrossRefPubMed

66.

Luboga S, Macfarlane SB, von Schreeb J et al (2009) Increasing access to surgical services in sub-saharan Africa: priorities for national and international agencies recommended by the Bellagio Essential Surgery Group. PLoS Med 6(12):e1000200CrossRefPubMedCentralPubMed

67.

Bansal S.(2012) Repairing the Surgery Deficit. Opinionator, New York Times Aug 8. http://opinionator.blogs.nytimes.com/2012/08/08/repairing-the-surgery-deficit

68.

Graduate Medical Education National Advisory Committee (GMENAC) report to the Secretary of the Department of Health and Human Services (http://mcacs.org/files/2010/Massachusetts-Surgeon-Map.pdf)

69.

Hostettler S, Kraft E (2014) Neuste Zahlen und Uebersicht zur Aerztestatistik 2013. Schw. Aerztezeitung 95(12):467–473

70.

Mensah KMM, Henry L (2005) The ‘Skills Drain’ of Health Professionals from the Developing World: a Framework for Policy Formulation. Med Act, London

71.

Kuehn BM (2007) Global shortage of health workers, brain drain stress developing countries. J Am Med Assoc 298(16):1853–1855CrossRef

72.

World Health Organization. (2006) Working together for health. The World Health Report 12–14

73.

Ramsay Smith S (1984) How might we improve surgical services for rural populations in developing countries? BMJ 289(6443):494–495CrossRef

74.

Atiyeh BS, Gunn SW, Hayek SN (2010) Provision of essential surgery in remote and rural areas of developed as well as low and middle income countries. Intern J Surg 8(8):581–585CrossRef

75.

Monjok E (2009) The neglect oft he global surgical workforce: experience and evidence from Uganda (Letter). World J Surg 33(1):150–151. doi:10.1007/s00268-008-9700-z CrossRefPubMed

76.

Watters DA, Bayley AC (1987) Training doctors and surgeons to meet the surgical needs of Africa. BMJ 295(6601):761–763CrossRefPubMedCentralPubMed

77.

Reid SJ, Chabikuli N, Jacques PH et al (1999) The procedural skills of rural hospital doctors. SA Med J 89(7):769–773

78.

Simba DO, Mbembati NA, Museru LM et al (2008) Referral pattern of patients received at the national referral hospital: challenges in low income countries. East Afr J Public Health 5:6–9PubMed

79.

World Bank. Physicians per 1000 people. http://data.worldbank.org/indicator/SH.MED.PHYS.ZS

80.

Kruk ME, Pereira C, Vaz F et al (2007) Economic evaluation of surgically trained assistant medical officers in performing major obstetric surgery in Mozambique. Br J Obset Gynaecol 114(10):1253–1259CrossRef

81.

Pollock JD, Love TP, Steffes BC et al (2011) Is it possible to train surgeons for Africa? A report of a successful International Program. World J Surg 35(3):493–499. doi:10.1007/s00268-012-1442-2 CrossRefPubMed

82.

World Health Organization. Statements by NGOs in official relations with WHO at the WHO governing body meetings, 5.1. https://apps.who.int/ngostatements/content/51-international-federation-surgical-colleges-ifsc. Accessed Oct 2014

83.

Murray CJ, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud C et al (2012) Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380(9859):2197–2223CrossRefPubMed

84.

Grimes CE, Henry JA, Maraka J, Mkandawire NC, Cotton M (2014) Cost-effectiveness of surgery in low- and middle-income countries: a systematic review. World J Surg 38(1):252–263. doi:10.1007/s00268-013-2243-y CrossRefPubMed

85.

Walfish M, Neuman A, Wlody D (2009) Maternal haemorrhage. Br J Anaesth 103(Suppl 1):i47–i56CrossRefPubMed

86.

World Health Organization. Understanding unsafe abortion (2014). http://www.who.int/reproductivehealth/topics/unsafe_abortion/en/. Accessed Dec 2013

87.

WHO Global Burden of Disease estimates (2014). http://www.who.int/healthinfo/global_burden_disease/gbd/en/. Accessed Oct 2014

88.

Peck MD (2011) Epidemiology of burns throughout the world. Part I: distribution and risk factors. Burns 37(7):1087–1100CrossRefPubMed

89.

Irwin DE, Kopp ZS, Agatep B, Milsom I, Abrams P (2011) Worldwide prevalence estimates of lower urinary tract symptoms, overactive bladder, urinary incontinence and bladder outlet obstruction. BJU Int 108(7):1132–1138CrossRefPubMed

90.

Kingsworth A, LeBlanc K (2003) Hernias: inguinal and incisional. Lancet 362:1561–1571CrossRef

91.

Murray CJL, Lopez AD (1997) Global mortality, disability, and the contribution of risk factors: Global Burden of Disease Study. Lancet 349:1436–1442CrossRefPubMed

92.

Wynne-Davies R (1972) Genetic and environmental factors in the etiology of talipes equinovarus. Clin Orthop 84:9–13CrossRefPubMed

93.

IPDTOC Working Group. (2011). Prevalence at birth of cleft lip with or without cleft palate: data from the International Perinatal Database of Typical Oral Clefts (IPDTOC)

Titel: Essential Surgery: The Way Forward
verfasst von: Jaymie Ang Henry
Chris Bem
Caris Grimes
Eric Borgstein
Nyengo Mkandawire
William E. G. Thomas
S. William A. Gunn
Robert H. S. Lane
Michael H. Cotton
Publikationsdatum: 01.04.2015
Verlag: Springer US
Erschienen in: World Journal of Surgery / Ausgabe 4/2015
Print ISSN: 0364-2313
Elektronische ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-014-2937-9

Neu im Fachgebiet Chirurgie

Wie erfolgreich ist eine Re-Ablation nach Rezidiv?

23.04.2024 Ablationstherapie Nachrichten

Nach der Katheterablation von Vorhofflimmern kommt es bei etwa einem Drittel der Patienten zu Rezidiven, meist binnen eines Jahres. Wie sich spätere Rückfälle auf die Erfolgschancen einer erneuten Ablation auswirken, haben Schweizer Kardiologen erforscht.

Hinter dieser Appendizitis steckte ein Erreger

23.04.2024 Appendizitis Nachrichten

Schmerzen im Unterbauch, aber sonst nicht viel, was auf eine Appendizitis hindeutete: Ein junger Mann hatte Glück, dass trotzdem eine Laparoskopie mit Appendektomie durchgeführt und der Wurmfortsatz histologisch untersucht wurde.

Mehr Schaden als Nutzen durch präoperatives Aussetzen von GLP-1-Agonisten?

23.04.2024 Operationsvorbereitung Nachrichten

Derzeit wird empfohlen, eine Therapie mit GLP-1-Rezeptoragonisten präoperativ zu unterbrechen. Eine neue Studie nährt jedoch Zweifel an der Notwendigkeit der Maßnahme.

Ureterstriktur: Innovative OP-Technik bewährt sich

19.04.2024 EAU 2024 Kongressbericht

Die Ureterstriktur ist eine relativ seltene Komplikation, trotzdem bedarf sie einer differenzierten Versorgung. In komplexen Fällen wird dies durch die roboterassistierte OP-Technik gewährleistet. Erste Resultate ermutigen.

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Aktuelle BDC Leitlinien-Webinare

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare

CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare

CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske

Dr. med. Benjamin Meyknecht

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare

CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric

Springer Medizin

Abstract

Introduction

Methods

Results

Conclusion

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 4/2015

Innovative Bridging of the Rural–Urban Divide: Comparison of Scope, Safety, and Impact of Collaborative Rural Surgery Camps and an Urban Surgical Program

Wound Management in Disaster Settings

Major Neonatal Surgery Under Local Anesthesia: A Cohort Study from Bangladesh

Systematic Review and Meta-analysis of the Open Abdomen and Temporary Abdominal Closure Techniques in Non-trauma Patients

A comparison of Video-Assisted Thoracoscopic Surgery with Open Thoracotomy for the Management of Chest Trauma: A Systematic Review and Meta-analysis

Essential Pain Management: An Educational Program for Health Care Workers

Update Chirurgie