Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract
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J. Gastrointest. Surg. · Apr 2014
Comparative StudyRetrospective comparison of robot-assisted minimally invasive versus open pancreaticoduodenectomy for periampullary neoplasms.
As with other open procedures now routinely performed using laparoscopy, minimally invasive pancreaticoduodenectomy (MIPD) may result in decreased pain, fewer wound complications, and accelerated recovery. However, when used for periampullary cancers, it is also important to assess if MIPD offers comparable oncologic outcomes. ⋯ MIPD is feasible with comparable technical success and outcomes to OPD. However, there is a learning curve to the procedure and further experience and prospective study will be required to better establish the oncologic efficacy of MIPD to open resection.
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J. Gastrointest. Surg. · Apr 2014
Assessment of ISGLS definition of posthepatectomy liver failure and its effect on outcome in patients with hepatocellular carcinoma.
Posthepatectomy liver failure (PHLF) is a major complication after hepatectomy. As there was no standardized definition, the International Study Group of Liver Surgery (ISGLS) defined PHLF as increased international normalized ratio and hyperbilirubinemia on or after postoperative day 5 in 2010. We evaluated the impact of the ISGLS definition of PHLF on hepatocellular carcinoma (HCC) patients. ⋯ The ISGLS definition of PHLF was associated with OS and RFS in HCC patients, and long-term survival will be improved by reducing the incidence of PHLF.
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J. Gastrointest. Surg. · Apr 2014
Randomized Controlled Trial Comparative StudyA comparative study of 'fast-track' versus traditional peri-operative care protocols in gastrointestinal surgeries.
A 'fast-track protocol' in surgery suggests the application of evidence-based practices to expedite patient recovery. It has shown to reduce hospital stay, hasten recovery as well as facilitate earlier return to work. It has a considerable impact in reducing healthcare costs. The basic tenet is to treat the patient's disease by minimal disturbance of their physiology. The protocol encompasses pre-operative, intra-operative and post-operative interventions which when carried out together would show maximal benefits. The surgeon is usually the leader of the team managing the patient, but it cannot be over-emphasised that this is a multi-disciplinary team approach. ⋯ The results have proved that implementing the fast-track protocol for gastrointestinal surgeries is not only safe and effective, but also improves patient outcome.
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J. Gastrointest. Surg. · Apr 2014
Comparative StudyPrevention of delayed gastric emptying after pylorus-preserving pancreatoduodenectomy with antecolic reconstruction, a long jejunal loop, and a jejuno-jejunostomy.
Delayed gastric emptying (DGE) is one of the major complications following pylorus-preserving pancreatoduodenectomy (PPPD). It leads to significant patient distress and prolonged hospitalization and therefore increased treatment costs. DGE etiology remains unclear but seems to be multifactorial. In order to decrease DGE rates, reconstruction methods have been modified. The presented retrospective study was to evaluate outcomes of different surgical techniques at our institution with special emphasis on retrocolic and antecolic reconstruction types. ⋯ The results of this retrospective study suggest that the antecolic route with a long jejunal loop and Braun's anastomosis minimizes DGE rates.
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J. Gastrointest. Surg. · Apr 2014
High 1-year complication rate after anterior resection for rectal cancer.
Surgical options after anterior resection for rectal cancer include a primary anastomosis, anastomosis with a defunctioning stoma, and an end colostomy. This study describes short-term and 1-year outcomes of these different surgical strategies. ⋯ This study showed a high 1-year morbidity rate after anterior resection for rectal cancer. A defunctioning stoma was associated with a high risk for late complications including anastomotic leakage. An end colostomy is a safe alternative to prevent anastomotic leakage, but stomal problems cannot be ignored. Selecting low-risk patients for an anastomosis may lead to favorable short- and 1-year outcomes.