Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract
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J. Gastrointest. Surg. · Nov 2008
Randomized Controlled TrialMonopolar floating ball versus bipolar forceps for hepatic resection: a prospective randomized clinical trial.
Hepatic transection by Pean-clasia is the mainstream technique that can be used with different coagulators. Monopolar floating ball (MFB) is proposed for liver transection. Whether its value for liver transection is unclear, its efficiency as a coagulator only seems high. We compared in a prospective randomized study the standard Pean-clasia with bipolar forceps (BF) versus Pean-clasia with MFB in patients undergoing hepatic resection. ⋯ This study showed that association of Pean-clasia with MFB was safe and minimized the blood loss during hepatic resection. However, MFB did not offer significant benefits over BF, while its cost is not negligible.
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J. Gastrointest. Surg. · Nov 2008
Comparative StudyHow can we control intraoperative bacterial contamination and surgical-site infection during an anterior resection or Hartmann's/Miles' operation?
Intraoperative bacterial contamination (IBC) is a major cause of surgical-site infection (SSI). Therefore, we investigated whether the ingenuity of surgical procedures could reduce the incidence of IBC/SSI. ⋯ Shortening the exposure of the colonic mucosa decreased the incidence of IBC/SSI; thus, careful operations to minimize IBC are recommended.
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J. Gastrointest. Surg. · Nov 2008
Comparative StudyIncidence and management of chyle leaks following pancreatic resection: a high volume single-center institutional experience.
No data on incidence, management, or natural history of chyle leaks following pancreatic resection have been published. We sought to identify possible risk factors associated with chyle leaks following pancreatic resection, as well as determine the natural history of this rare complication. ⋯ Chyle leak was a rare (1.3%) complication following pancreatic resection that was associated with number of lymph nodes harvested and concomitant vascular resection. In general, chyle leaks were successfully managed with TPN with no adverse impact on outcome. Patients with chylous ascites, however, had a more protracted clinical course and tended to have a worse long-term survival.
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J. Gastrointest. Surg. · Nov 2008
Comparative StudyNodal microinvolvement in patients with carcinoma of the papilla of vater receiving no adjuvant chemotherapy.
To assess the prognostic significance of nodal microinvolvement in patients with carcinoma of the papilla of Vater. ⋯ The influence of occult tumor cell dissemination in LNs of patients with histologically proven carcinoma of the papilla of Vater supports the need for further tumor staging through immunohistochemistry.
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J. Gastrointest. Surg. · Nov 2008
Postoperative venous thromboembolism rates vary significantly after different types of major abdominal operations.
Venous thrombolism (VTE) is a significant cause of morbidity for surgical patients. Comparative risk across major procedures is unknown. ⋯ Highest risk for VTE was associated with splenectomy, lowest risk with bariatric surgery. Since bariatric patients are known to have greater risk for this complication, these findings may reflect better awareness/prophylaxis. Further studies are necessary to quantify effect of best-practice guidelines on prevention of this costly complication.