Annals of surgery
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Editorial Comment
Drainage after pancreaticoduodenectomy: controversy revitalized.
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Randomized Controlled Trial Multicenter Study
A randomized prospective multicenter trial of pancreaticoduodenectomy with and without routine intraperitoneal drainage.
To test by randomized prospective multicenter trial the hypothesis that pancreaticoduodenectomy (PD) without the use of intraperitoneal drainage does not increase the frequency or severity of complications. ⋯ This study provides level 1 data, suggesting that elimination of intraperitoneal drainage in all cases of PD increases the frequency and severity of complications.
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Review Comparative Study
A systematic review of economic evaluations of enhanced recovery pathways for colorectal surgery.
To perform a systematic review of economic evaluations of enhanced recovery pathways (ERP) for colorectal surgery. ⋯ The quality of the current evidence is limited but tends to support the cost-effectiveness of ERP. There is need for well-designed trials to determine the cost-effectiveness of ERP from both the institutional and societal perspectives.
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Comparative Study Clinical Trial
Postprandial metabolite profiles reveal differential nutrient handling after bariatric surgery compared with matched caloric restriction.
Roux-en-Y gastric bypass (RYGB) surgery results in exaggerated postprandial insulin and incretin responses and increased susceptibility to hypoglycemia. ⋯ RYGB surgery results in improved metabolic flexibility (ie, greater disposal of glucose and AAs and more complete β-oxidation of fatty acids) compared with CR. The changes in the AA kinetics may augment the hormonal responses seen after RYGB surgery. The reduction in key gluconeogenic substrates in the postprandial state may contribute to increased susceptibility to hypoglycemic symptoms in RYGB surgery subjects.