International journal of surgery
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Randomized Controlled Trial Clinical Trial
Ramosetron vs. ramosetron plus dexamethasone for the prevention of postoperative nausea and vomiting (PONV) after laparoscopic cholecystectomy: prospective, randomized, and double-blind study.
Up to 75% of the patients undergoing laparoscopic cholecystectomy develop postoperative nausea and vomiting (PONV). Both ramosetron, a serotonin subtype 3 (5-HT3) antagonist, and dexamethasone are effective for PONV prophylaxis following laparoscopic cholecystectomy but their combined effect has not been investigated. We investigated the efficacy and tolerance of ramosetron alone and ramosetron with dexamethasone for PONV prophylaxis after laparoscopic cholecystectomy. ⋯ In patients undergoing laparoscopic cholecystectomy, the combined use of ramosetron and dexamethasone was more effective than ramosetron alone for reducing the need for rescue antiemetics and pain control following the procedure.
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Review
Is octreotide beneficial in patients undergoing pancreaticoduodenectomy? Best evidence topic (BET).
A best evidence topic was written according to a structured protocol. The question addressed was whether the prophylactic administration of somatostatin or somatostatin analogues in patients undergoing pancreaticoduodenectomy (Whipple's procedure) is beneficial in terms of improved surgical outcomes, reduced morbidity or reduced mortality. A total of 118 papers were found using the reported searches of which 5 represented the best evidence (1 meta-analysis, 1 systematic review and 3 randomized control trials). ⋯ Further adequately powered trials with low risk of bias are necessary. From the available data, somatostatin or somatostatin analogues have no effect on mortality post Whipple's. Interestingly, there are only limited data available on the cost-benefit and financial constraints imposed by this treatment, an issue that has only been addressed in a few studies.
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Ventral incisional hernias, especially large and giant, carry significant post repair complications. This retrospective review is undertaken to determine the outcomes of large and giant incisional hernia repair as well as the risk factors of recurrence and surgical site infection at a tertiary care hospital in developing country. ⋯ Repair of large and giant incisional hernia using prosthetic non-absorbable mesh, mainly onlay, carry acceptable rates of complications.
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Fast-track recovery protocols are applied to major surgeries, including hepatectomies. The optimal duration of thoracic epidural catheter has not yet been defined. ⋯ After major hepatectomy, a reduction from 4 to 2 days' duration of the epidural catheter may lead to a reduction in the length of hospital stay.