Annals of surgery
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Multicenter Study
Mortality after bariatric surgery: analysis of 13,871 morbidly obese patients from a national registry.
To define mortality rates and risk factors of different bariatric procedures and to identify strategies to reduce the surgical risk in patients undergoing bariatric surgery. ⋯ Mortality after bariatric surgery is a rare event. It is influenced by different risk factors including type of surgery, open surgery, prolonged operative time, comorbidities, and volume of activity. In defining the best bariatric procedure for each patient the different mortality risks should be taken into account. Choice of the procedure, prevention, early diagnosis, and therapy for cardiovascular complications may reduce postoperative mortality.
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Multicenter Study
Predictive factors of outcome after gastric banding: a nationwide survey on the role of center activity and patients' behavior.
Systematic studies of postoperative outcome of bariatric surgery provide information on the predictors of success. Surgeon's and institution experience and patient's behavior after surgery are key determinant of success or failure. Data on clinical trials generally reflect the experience of skilled obesity surgery centers. Little is known about the current practice at a nationwide level. The present study was realized in the frame of a national survey on medical and surgical practices conducted by the public health insurance system. The objective was to analyze systematically and prospectively the outcome of all bariatric surgery procedures consecutively performed in a given period, as registered by the French National Medical Insurance Service. This study at a nationwide level focused on predictive factors of success and analyzed how the experience of the centers relates to the patients' outcomes at 1 and 2 years after surgery. ⋯ This nationwide survey shows that the best profile for a success after gastric banding is a patient <40 years, with an initial BMI <50 kg/m, willing to change his eating habits and to recover or increase his physical activity after surgery and who has been operated by a team usually performing >2 bariatric procedures per week. This study emphasizes that obesity surgery requires a significant experience of the surgical team and a multidisciplinary approach to improve behavioral changes.
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To study graft function and ischemia/reperfusion injury of porcine kidneys after preservation with the new Groningen Machine Perfusion (GMP) system versus static cold storage (CS). ⋯ It is concluded that the GMP system improves kidney graft viability and perfusion pressures are critically important for outcome.
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Randomized Controlled Trial Multicenter Study
The TME trial after a median follow-up of 6 years: increased local control but no survival benefit in irradiated patients with resectable rectal carcinoma.
To investigate the efficacy of preoperative short-term radiotherapy in patients with mobile rectal cancer undergoing total mesorectal excision (TME) surgery. ⋯ With increasing follow-up, there is a persisting overall effect of preoperative short-term radiotherapy on local control in patients with clinically resectable rectal cancer. However, there is no effect on overall survival. Since survival is mainly determined by distant metastases, efforts should be directed towards preventing systemic disease.
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Randomized Controlled Trial
Hand-assisted laparoscopic versus open right colectomy: a randomized controlled trial.
Laparoscopic colectomy has been proved to be both technically and oncologically feasible. However, the approach has been criticized for its procedural complexity and long operative time as a result of the loss of tactile feedback and absence of depth perception. The advent of hand-access devices offered a potential solution to these problems. This randomized controlled trial aims to compare hand-assisted laparoscopic colectomy (HALC) with open colectomy (OC) in the management of right-sided colonic cancer. ⋯ HALC retained the same short-term benefits of the pure laparoscopic approach. The technique is associated with a slightly increased but acceptable operative time. Aside as a useful adjunct in complex laparoscopic procedures, the hand-assisted laparoscopic technique is also a useful, if not more effective, alternative for patients with right-sided colonic cancer.