The British journal of surgery
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Review Meta Analysis
Meta-analysis of the effect of goal-directed therapy on bowel function after abdominal surgery.
Intraoperative goal-directed therapy (GDT) was introduced to titrate intravenous fluids, with or without inotropic drugs, based on objective measures of hypovolaemia and cardiac output measurements to improve organ perfusion. This meta-analysis aimed to determine the effect of GDT on the recovery of bowel function after abdominal surgery. ⋯ GDT facilitated the recovery of bowel function, particularly in patients not treated within enhanced recovery programmes and in those undergoing colorectal operations.
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Randomized Controlled Trial Multicenter Study
Randomized multicentre feasibility trial of intermediate care versus standard ward care after emergency abdominal surgery (InCare trial).
Emergency abdominal surgery carries a considerable risk of death and postoperative complications. Early detection and timely management of complications may reduce mortality. The aim was to evaluate the effect and feasibility of intermediate care compared with standard ward care in patients who had emergency abdominal surgery. ⋯ NCT01209663 (http://www.clinicaltrials.gov).
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Randomized Controlled Trial
Randomized clinical trial of laparoscopic colectomy with or without natural-orifice specimen extraction.
Although conventional laparoscopic colectomy is a validated technique, laparoscopic natural-orifice specimen extraction (NOSE) colectomy might improve outcome. This randomized clinical trial compared analgesia requirements, postoperative pain, anorectal function, inflammatory response and cosmesis in laparoscopic NOSE colectomy and conventional laparoscopic colectomy. ⋯ NCT01033838 (http://www.clinicaltrials.gov).
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Multicenter Study
Surgical management of patients with colorectal cancer and simultaneous liver and lung metastases.
The management of patients with colorectal cancer and simultaneously diagnosed liver and lung metastases (SLLM) remains controversial. ⋯ Patients who had resection of liver and lung metastases had similar overall survival to those who had undergone removal of isolated liver metastases.
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Multicenter Study
Conditions, preventable deaths, procedures and validation of a countrywide survey of surgical care in Nepal.
To determine a true denominator of worldwide surgical need, it is imperative to include estimations at a population-based level, to capture those individuals unable to access surgical care. This study was designed to validate the Surgeons OverSeas Assessment of Surgical need (SOSAS) tool with the addition of a visual physical examination, and describe the prevalence of surgical conditions, deaths possibly averted with access to surgical care, and the number of surgical procedures performed annually, in Nepal. ⋯ The visual physical examination component validated the SOSAS tool, and justified the estimates of previous studies in Sierra Leone and Rwanda. These data provide insights into the health needs of Nepal and provide evidence to develop surgical programmes, assist with monitoring and evaluation, and help with advocacy for increased resources in Nepal.