The British journal of surgery
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Randomized Controlled Trial Multicenter Study
Cost-effectiveness and cost-utility of endovascular versus open repair of ruptured abdominal aortic aneurysm in the Amsterdam Acute Aneurysm Trial.
Minimally invasive endovascular aneurysm repair (EVAR) could be a surgical technique that improves outcome of patients with ruptured abdominal aortic aneurysm (rAAA). The aim of this study was to analyse the cost-effectiveness and cost-utility of EVAR compared with standard open repair (OR) in the treatment of rAAA, with costs per 30-day and 6-month survivor as outcome parameters. ⋯ EVAR may be more effective for rAAA, but its increased costs mean that it is unaffordable based on current standards of societal willingness-to-pay for health gains.
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Randomized Controlled Trial Comparative Study
Randomized clinical trial of stapler versus clamp-crushing transection in elective liver resection.
Various devices have been developed to facilitate liver transection and reduce blood loss in liver resections. None of these has proven superiority compared with the classical clamp-crushing technique. This randomized clinical trial compared the effectiveness and safety of stapler transection with that of clamp-crushing during open liver resection. ⋯ NCT01049607 (http://www.clinicaltrials.gov).
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Right-sided hepatectomy is often selected for perihilar cholangiocarcinoma because the extrahepatic portion of the left hepatic duct is longer than that of the right hepatic duct. However, the length of resected left hepatic duct in right-sided hepatectomy has not been reported. ⋯ Compared with right hemihepatectomy, anatomical right hepatic trisectionectomy provides a greater length of resected hepatic duct, leading to a high proportion of negative proximal ductal margins even in patients with Bismuth type IV tumours.