Rib Plating as an Effective Approach to Managing Traumatic Rib Injuries: A Review of the Literature.

Timely repair is essential to maximizing outcomes in patients with traumatic rib injuries, whether in the presence or absence of flail chest (FC) or existing as single or multiple rib fractures (MRF), due to its high morbidity and mortality rate. This review focuses primarily on the plating system as an effective surgical approach to stabilizing these injuries. Literature was surveyed using the Google Scholar, PLOS One, and PubMed search engines between August 2021 and April 2022. A total of 34 articles were included herein, and primary and secondary outcomes were assessed. The primary outcomes of interest were intensive care unit length-of-stay (ICU LOS), hospital length-of-stay (HLOS), ventilatory requirements, and mortality rate. The secondary outcomes of interest were postoperative pain level and postoperative complications. The majority of the studies included herein reported lower ICU LOS, HLOS, and ventilation requirements in surgical patients when compared to conservatively managed patients. However, variables such as the presence or absence of FC also impacted outcomes in certain studies. Mortality rate and postoperative pain were largely underreported in the selected studies, but limited data from these studies suggest that these outcomes tend to be lower in surgical patients compared to those treated conservatively. When present, postoperative complications were often less severe amongst surgical patients compared to conservatively managed patients. Results further suggest that surgical repair is associated with lower pain severity as early as 72 hours postop. Likewise, findings suggest that early rib fracture stabilization is superior to late stabilization and often yields a sooner return to a baseline health status. Few studies report little to no statistical difference in primary and secondary outcomes between operative and conservative treatment. However, there is greater evidence that suggests the contrary, with better short-term and potential for better long-term outcomes in patients who undergo rib fixation.

Bariatric Surgery With Roux-En-Y Gastric Bypass or Sleeve Gastrectomy for Treatment of Obesity and Comorbidities: Current Evidence and Practice.

BACKGROUND: With the growing prevalence of obesity in the global population, alternative measures for weight loss and treatment of comorbidities must be considered due to the increasing difficulty of conservative management alone. Here we discuss the benefits of bariatric surgery on weight loss as well comorbidities that are present in a majority of obese patients.  Methods: In this review, we discuss the current practice and evidence of bariatric surgery as it pertains to weight loss and the beneficial effect on comorbidities commonly present in obesity. RESULTS:  Our review found that bariatric surgery with either the roux-en-y gastric bypass or laparoscopic sleeve gastrectomy can result in weight loss of up to 80% of excess weight. We also found that bariatric surgery has a profound effect on multiple comorbidities such as type 2 diabetes mellitus, hypertension, and hyperlipidemia through remission of the disease. CONCLUSION:  Bariatric surgery serves as an efficacious alternative for treatment of obesity and comorbidities.