Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract
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J. Gastrointest. Surg. · Nov 2015
Comparative StudyShort- and Long-Term Outcomes After Laparoscopic Versus Open Total Gastrectomy for Elderly Gastric Cancer Patients: a Propensity Score-Matched Analysis.
To date, it has been unclear whether laparoscopic-assisted total gastrectomy (LTG) was a suitable treatment for elderly patients (aged 65 years and older) with gastric cancer. The aim of the present study was to clarify the value of LTG in the elderly using a propensity score matching method. ⋯ LTG for elderly gastric cancer is feasible and safe with acceptable oncologic outcomes. Therefore, patient age alone should not be considered a contraindication in the decision between LTG and OTG treatment options. A high-volume prospective study is needed to confirm this rationale.
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J. Gastrointest. Surg. · Nov 2015
Negative-Pressure Wound Therapy in the Management of High-Grade Ventral Hernia Repairs.
Despite improved operative techniques, open ventral hernia repair (VHR) surgery in high-risk, potentially contaminated patients remains challenging. As previously reported by our group, the use of a modified negative-pressure wound therapy system (hybrid-VAC or HVAC) in patients with grade 2 hernias is associated with lower surgical site occurrence (SSO) and surgical site infection (SSI) rates. Accordingly, the authors aim to evaluate whether the HVAC would similarly improve surgical site outcomes following VHR in patients with grade 3 hernias. ⋯ Modified VHWG grade 3 ventral hernias are associated with significant morbidity. In our series utilizing the HVAC system after VHR, the observed rate of SSO and SSI compared favorably to reported series. Further prospective cost-effective studies are warranted to validate these findings.
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J. Gastrointest. Surg. · Nov 2015
Red Cell Transfusion Triggers and Postoperative Outcomes After Major Surgery.
The effect of packed red blood cell (PRBC) transfusion on postoperative outcomes of patients undergoing major surgery remains unclear. We sought to determine the impact of blood utilization, as well as transfusion practices, on perioperative outcomes of patients undergoing cardiothoracic-vascular (CT-V) and gastrointestinal (GI) procedures. ⋯ Liberal transfusion triggers after major surgery were more common than restrictive practice. Patients with restrictive transfusion trigger did not have increased risk for complications compared with patients transfused with a liberal trigger.
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J. Gastrointest. Surg. · Oct 2015
Review Meta Analysis Comparative StudyDuct-to-Mucosa Versus Invagination Pancreaticojejunostomy Following Pancreaticoduodenectomy: a Systematic Review and Meta-Analysis.
Postoperative pancreatic fistula (POPF) is one of the most common complications after pancreaticoduodenectomy (PD). The ideal choice of pancreaticojejunostomy (PJ) anastomosis remains a matter of debate. ⋯ Invagination PJ is not superior to duct-to-mucosa PJ in terms of POPF and other complications but appears to reduce clinically relevant POPF. Further well-designed RCTs that use ISGPS definition are still required before strong evidence-based recommendations can be formulated.
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J. Gastrointest. Surg. · Oct 2015
Perioperative Blood Transfusion and Postoperative Outcome in Patients with Crohn's Disease Undergoing Primary Ileocolonic Resection in the "Biological Era".
Perioperative blood transfusion has been shown to be associated with inflammatory response and immunosuppression. Patients receiving blood transfusion may have an increased risk for developing postoperative morbidities. The impact of blood transfusion on the postoperative recurrence of Crohn's disease (CD) has been controversial. The aim of this study was to assess the effect of blood transfusion on postoperative outcomes in CD in the current biological era. ⋯ Adverse outcomes after perioperative blood transfusion for the primary ileocolonic resection for CD resemble findings in surgery for other diseases. The presumed immunosuppressive effect of blood transfusion did not confer any protective effect on disease recurrence.