International journal of surgery
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The exponential rise in published medical research on a yearly basis demands a method to summarise best evidence towards its application to patient care in clinical practice. A robust meta-analysis is a valid tool. It is often considered to be a simple process of pooling results from different studies. This is not true. It appears that surgeons lack a reference guide to help them conduct and appraise a meta-analysis. ⋯ Whereas meta-analyses of homogeneous studies are the highest form of evidence, poorly conducted meta-analyses create confusion and serve to harm the patient. Surgeons practising their art in an era of evidence-based surgery need to understand the principles of meta-analyses.
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Over the last decade, breast cancer surgery has become less invasive and potentially suitable for day surgery. The aim of this systematic review was to establish the benefits and disadvantages of day surgery for breast cancer. ⋯ Day surgery for breast cancer is safe, with equivalent complication rates, but there is lack of evidence from randomised controlled trials. Patient satisfaction and psychological well-being is high. Further trials with validated questionnaires are required to confirm this.
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Laparoscopic appendectomy has been widely practiced for uncomplicated appendicitis. The role of laparoscopy in management of complicated appendicitis remains undefined. We undertook this study to evaluate the efficacy of laparoscopic appendectomy in patients with complicated appendicitis. ⋯ Laparoscopic appendectomy for complicated appendicitis is feasible and safe. It is associated with less postoperative pain, lower incidence of infectious complications and reduced length of hospital stay when compared with patients who had open appendectomy.
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Randomized Controlled Trial
Effect of Helicobacter pylori eradication on ulcer recurrence after simple closure of perforated duodenal ulcer.
This study was conducted to elucidate the prevalence of Helicobacter pylori in patients with a perforated duodenal ulcer and to determine whether eradication of H. pylori prevent ulcer recurrence following simple repair of the perforation. ⋯ H. pylori was present in a high proportion of patients with duodenal ulcer perforation. Eradication of H. pylori after simple closure of a perforated duodenal ulcer reduced the incidence of recurrent ulcer.
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Review Meta Analysis
Gum chewing reduces postoperative ileus? A systematic review and meta-analysis.
An important cause of delayed recovery from intestinal surgery is postoperative ileus. Gum chewing is a form of sham feeding, which could encourage gastrointestinal motility through cephalic-vagal stimulation. ⋯ Chewing sugarless gum following elective intestinal resection is associated with improved outcomes. Insufficient data were available to demonstrate a reduced rate of clinical complications or reduced cost. An adequately powered, methodologically rigorous trial of gum chewing is required to confirm if there are any benefits and if these result in differences in clinical outcomes such as infection.