The British journal of surgery
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Review Meta Analysis
Systematic review and meta-analysis of oesophageal Doppler-guided fluid management in colorectal surgery.
Oesophageal Doppler monitor (ODM)-guided fluid therapy has been recommended for routine use in patients undergoing colorectal surgery. However, recent trials have suggested either equivalent or inferior results for patients randomized to ODM-guided fluid management, especially when compared with fluid restriction or within the context of optimized perioperative care. Hence, an updated systematic review and meta-analysis was conducted. ⋯ ODM-guided fluid therapy did not influence LOS or complications in patients undergoing colorectal surgery. Results favouring the ODM were seen only in early studies, whereas newer trials did not show any benefit from such monitoring.
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The British Society of Gastroenterology recommends that all familial adenomatous polyposis (FAP) and Lynch syndrome (LS) families are screened in the context of a registry. This systematic review was performed to appraise the published evidence for registration and screening in relation to colorectal cancer (CRC) incidence and mortality. ⋯ Studies consistently report that registration and screening result in a reduction of CRC incidence and mortality in patients with FAP and LS (level 2a evidence, grade B recommendation). Funding and managerial support for hereditary CRC registries should be made available.
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Comparative Study
Portal vein embolization improves rate of resection of extensive colorectal liver metastases without worsening survival.
Most patients requiring an extended right hepatectomy (ERH) have an inadequate standardized future liver remnant (sFLR) and need preoperative portal vein embolization (PVE). However, the clinical and oncological impact of PVE in such patients remains unclear. ⋯ PVE enabled curative resection in two-thirds of patients with CLM who had an inadequate sFLR and were unable to tolerate ERH at presentation. Patients who underwent curative resection after PVE had overall and disease-free survival rates equivalent to those of patients who did not need PVE.
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Rates of emergency admission with femoral hernia are high compared with those for other hernias. This study aimed to determine the modes and consequences of presentation to primary care before admission to hospital. ⋯ A large proportion of patients with femoral hernia present late to primary care and are operated on as an emergency, with worse outcomes.
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Postoperative adverse outcomes in patients with liver cirrhosis are not completely understood. This study evaluated the association between liver cirrhosis and adverse outcomes after non-hepatic surgery. ⋯ Patients with liver cirrhosis had increased mortality and complications after non-hepatic surgery, particularly those with cirrhosis-related clinical indicators.