Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract
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J. Gastrointest. Surg. · Jul 2011
ReviewThe opioid component of delayed gastrointestinal recovery after bowel resection.
Patients undergoing bowel resection or other major abdominal surgery experience a period of delayed gastrointestinal recovery associated with increased postoperative morbidity and longer hospital length of stay. Symptoms include nausea, vomiting, abdominal distension, bloating, pain, intolerance to solid or liquid food, and inability to pass stool or gas. The exact cause of delayed gastrointestinal recovery is not known, but several factors appear to play a central role, namely the neurogenic, hormonal, and inflammatory responses to surgery and the response to exogenous opioid analgesics and endogenous opioids. ⋯ Stimulation of opioid receptors localized to neurons of the enteric nervous system inhibits coordinated gastrointestinal motility and fluid absorption, thereby contributing to delayed gastrointestinal recovery and its associated symptoms. Given the central role of opioid analgesics in delayed gastrointestinal recovery, a range of opioid-sparing techniques and pharmacologic agents, including opioid receptor antagonists, have been developed to facilitate faster restoration of gastrointestinal function after bowel resection when used as part of a multimodal accelerated care pathway. This review discusses the etiology of opioid-induced gastrointestinal dysfunction as well as clinical approaches that have been evaluated in controlled clinical trials to reduce the opioid component of delayed gastrointestinal recovery.
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J. Gastrointest. Surg. · Jul 2011
Comparative StudyCan laparoscopic pancreaticoduodenectomy be safely implemented?
The implementation of laparoscopic pancreaticoduodenectomy (LPD) has been appropriately met with apprehension, and concerns exist regarding outcomes early in a program's experience. We reviewed our early experience and outcomes of LPD. ⋯ LPD can be implemented in a high-volume pancreatic surgery center with acceptable oncologic and patient outcomes.
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J. Gastrointest. Surg. · Jul 2011
Comparative StudyCharacteristics of perforated appendicitis: effect of delay is confounded by age and gender.
The effect of age and gender on time to perforation in acute appendicitis has not been well characterized. This study examined the relationship between duration of disease and appendiceal perforation in different subgroups of age and gender. ⋯ There is an early risk of perforated appendicitis even within the first 36 h of symptoms. This risk appears to be higher in males and patients older than 55 years, a quarter of whom are perforated within the first 36 h of symptom duration. Additionally, perforation in acute appendicitis may be more of a continuous phenomena worsening exponentially with duration of symptoms rather than a threshold phenomenon.
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The Society for Surgery of the Alimentary Tract's (SSAT) mission is to advance the science and practice of surgery in the treatment of digestive disease. An essential core value of the SSAT is multidisciplinary collaboration with both its sister societies in the Digestive Disease Week (DDW) Council and other surgical societies in Gastrointestinal Surgery. In order to achieve the society's goals, the strategic plan rests on the society's values of interdisciplinary collaboration, scholarship, education, and discovery. ⋯ There is much to do in order to keep the SSAT the premier professional society for gastrointestinal surgery. Changes in the external environment may require modifications of the priorities or the plan itself in the coming years. Implicit in this plan is the need for annual review by the Board of Trustees at the May Board Meeting so that modifications can be made as the world around us changes.