Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract
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J. Gastrointest. Surg. · Sep 2012
Randomized Controlled Trial Comparative StudyRandomized controlled single-center trial comparing pancreatogastrostomy versus pancreaticojejunostomy after partial pancreatoduodenectomy.
The aim of this single-center randomized trial was to compare the perioperative outcome of pancreatoduodenectomy with pancreatogastrostomy (PG) vs pancreaticojejunostomy (PJ). ⋯ Our randomized controlled trial shows no difference between PG and PJ as reconstruction techniques after partial pancreatoduodenectomy. POPF rate, DGE, and bleeding were not statistically different. Operation time was significantly shorter in the PG group.
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J. Gastrointest. Surg. · Sep 2012
Randomized Controlled Trial Comparative StudyAnterior 90° partial vs Nissen fundoplication--5 year follow-up of a single-centre randomised trial.
Nissen fundoplication can be followed by side effects, and this has driven modifications, including partial fundoplications. We previously reported early outcomes from a randomised trial of Nissen vs anterior 90° partial fundoplication. This paper reports 5-year follow-up outcomes to determine whether anterior 90° fundoplication achieves a satisfactory longer-term outcome. ⋯ At 5 years, anterior 90° partial fundoplication was associated with less side effects, offset by greater use of antisecretory medication. Reflux symptoms and overall satisfaction were similar to Nissen fundoplication. Laparoscopic anterior 90° partial fundoplication is an effective treatment for gastro-esophageal reflux.
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J. Gastrointest. Surg. · Sep 2012
Methodological and ethical quality of randomized controlled clinical trials in gastrointestinal surgery.
The randomized controlled trial (RCT) is the gold standard tool used to evaluate therapeutic interventions. Methodological and ethical aspects should be adequately reported to enable readers to make informed and justified judgments regarding the validity of a trial and the treatment effectiveness. ⋯ The reporting of gastrointestinal surgery RCTs is less than optimal. In our study, the trials of higher methodological quality were more likely to provide information about their ethical aspects. These results suggest the need for more attention to be paid to the conduct of clinical research and the reporting of ethical aspects. The appropriation of the ethical rules by surgeons involved in human clinical trials could improve the methodology and reporting of RCTs in gastrointestinal surgery.
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J. Gastrointest. Surg. · Sep 2012
Case ReportsBlunt diaphragmatic rupture--a rare injury in blunt thoracoabdominal trauma.
Blunt traumatic rupture of the diaphragm is rare. ⋯ We provide a case report of rupture of the diaphragm with visceral herniation in blunt thoracoabdominal trauma.
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J. Gastrointest. Surg. · Sep 2012
Risk of morbidity and mortality following hepato-pancreato-biliary surgery.
Hepatic, pancreatic, and complex biliary (HPB) surgery can be associated with major morbidity and significant mortality. For the past 5 years, the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) has gathered robust data on patients undergoing HPB surgery. We sought to use the ACS-NSQIP data to determine which preoperative variables were predictive of adverse outcomes in patients undergoing HPB surgery. ⋯ While overall morbidity and mortality for HPB surgery are low, peri-operative outcomes are heterogeneous and depend on diagnosis, procedure type, and key clinical factors. By combining these factors, an ACS-NSQIP "HPB Risk Calculator" may be developed in the future to help better risk-stratify patients being considered for complex HPB surgery.