Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract
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J. Gastrointest. Surg. · Nov 2007
The impact of perioperative dexmedetomidine infusion on postoperative narcotic use and duration of stay after laparoscopic bariatric surgery.
Dexmedetomidine (Precedex, Hospira, Lake Forest, IL) is an alpha-2 receptor agonist with sedative and analgesic sparing properties. This medication has not been associated with respiratory suppression, despite occasionally high levels of sedation. For 10 months, all patients undergoing a laparoscopic bariatric procedure received a dexmedetomidine infusion 30 min before the anticipated completion of the procedure (n = 34). ⋯ Dexmedetomidine infusion perioperatively is safe and may help to minimize narcotic requirements and decrease duration of stay after laparoscopic bariatric procedures. This may have important patient safety ramifications in a patient population with a high prevalence of obstructive sleep apnea. A well-organized prospective, randomized, double-blinded trial is necessary to confirm the benefits of dexmedetomidine suggested by this study.
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J. Gastrointest. Surg. · Nov 2007
Return of esophageal function after treatment for achalasia as determined by impedance-manometry.
Treatment for achalasia is aimed at the lower esophageal sphincter (LES), although little is known about the effect, if any, of these treatments on esophageal body function (peristalsis and clearance). We sought to measure the effect of various treatments using combined manometry (peristalsis) with Multichannel Intraluminal Impedance (MII) (esophageal clearance). ⋯ With treatment Achalasia patients exhibit some restoration in peristalsis as well as improved bolus clearance. After Heller Myotomy, the return of peristalsis correlates with esophageal clearance, which may partly explain its superior relief of dysphagia.
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J. Gastrointest. Surg. · Nov 2007
Systemic chemotherapy and two-stage hepatectomy for extensive bilateral colorectal liver metastases: perioperative safety and survival.
Two-stage hepatectomy has been proposed for patients with bilateral colorectal liver metastases (CLM). The aim of this study was to compare the outcome of patients with CLM treated with preoperative chemotherapy followed by one- or two-stage hepatectomy. ⋯ Two-stage hepatectomy with preoperative chemotherapy results in comparable morbidity and survival rates as one-stage hepatectomy. This approach enables selection and treatment of patients with multiple, bilateral CLM who will benefit from aggressive surgery with good outcomes.
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J. Gastrointest. Surg. · Oct 2007
Trends and disparities in regionalization of pancreatic resection.
The current recommendation is that pancreatic resections be performed at hospitals doing >10 pancreatic resections annually. ⋯ Whereas regionalization of pancreatic resection at high-volume centers in the state of Texas has improved slightly over time, 37% of patients continue to undergo pancreatic resection at low-volume centers, with more than 25% occurring at centers doing less than five per year. There are obvious demographic disparities in the regionalization of care, but additional unmeasured barriers need to be identified.
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J. Gastrointest. Surg. · Oct 2007
Comparative StudyAutologous versus allogeneic transfusions: no difference in perioperative outcome after partial hepatectomy. Autologous transfusion on hepatectomy outcome.
Blood transfusion is often necessary in patients undergoing liver resection. Because of the risks associated with allogeneic blood products, preoperative autologous blood donation has been advocated, but its benefit with respect to perioperative outcome remains unclear. This study compares perioperative outcome in patients transfused only with autologous blood to a matched cohort receiving only allogeneic blood. ⋯ The groups were similar with respect to age, comorbidities, and blood loss; the proportions receiving preoperative chemotherapy, requiring a major resection (>or=3 segments) or a complex procedure (concomitant major procedure in addition to the principal hepatic resection) were also similar. There were no differences between the autologous and allogeneic groups in length of hospitalization, complications, and operative mortality. In patients undergoing hepatic resection, autologous blood transfusion did not demonstrably improve perioperative outcome when compared to a matched cohort of patients receiving a similar number of allogeneic units.