Invited Commentary

Cooperman and colleagues are to be commended for their ability to perform PRDs in 39 patients with minimal morbidity and mortality rates, little blood transfusion requirement, and short operation time and hospital stay. Their conclusion that PDR can be accomplished in a community hospital is rightly accompanied by a cautious statement that expertise, interest, and protocol should be available in the hospital. Of all these prerequisites, I would consider the surgical technique as the most important factor in determining the outcome. Only an operation devoid of technical mistakes will render intraoperative and postoperative management easy and smooth. Even if postoperative medical complications develop, the management of the patient will not be adversely affected by the presence of sepsis, leakage of gastrointestinal fluid, delayed gastric emptying, or lack of nutrient intake. The final dictum is the same, irrespective of the location of the operation: PRDs should be performed and managed by