Langenbeck's archives of surgery
-
Langenbecks Arch Surg · Jan 2014
Review Meta Analysis Comparative StudyFast-track surgery in gastrectomy for gastric cancer: a systematic review and meta-analysis.
Fast-track surgery aims to attenuate the surgical stress response, reduce complications, and shorten hospital stay. The goal of the present meta-analysis is to assess the safety and effectiveness of fast-track surgery in patients undergoing gastrectomy for gastric cancer compared with conventional perioperative care. ⋯ Fast-track surgery is safe and effective in gastrectomy for gastric cancer. Further randomized trials are needed to strengthen the conclusions.
-
Langenbecks Arch Surg · Jan 2014
Review Meta Analysis Comparative StudyLaparoscopic ventral hernia repair: is there an optimal mesh fixation technique? A systematic review.
The purpose of this study is to distinguish the optimal mesh fixation technique used in laparoscopic ventral hernia repair (LVHR). A particular fixation technique of the mesh to the abdominal wall is required, which should be strong enough to prevent migration of the mesh and, at the same time, keep injury to the abdominal wall minimal to prevent postoperative discomfort and pain. ⋯ None of the currently available mesh fixation techniques used for LVHR was found to be superior in preventing hernia recurrence as well as in reducing abdominal wall pain. The pain reported was remarkably high with all different fixation devices. Further research to develop solid and atraumatic fixation devices is warranted.
-
Langenbecks Arch Surg · Jan 2014
ReviewDiagnostics, therapy and outcome prediction in abdominal sepsis: current standards and future perspectives.
In the perioperative phase, sepsis and sepsis-associated death are the most important problems for both the surgeon and the intensivist. Critically ill patients profit from an early identification and implementation of an interdisciplinary therapy. The purpose of this review on septic peritonitis is to give an update on the diagnosis and its evidence-based treatment. ⋯ Despite many efforts, the mortality of surgical septic patients remains unacceptably high. Permanent clinical education and further surgical trials are necessary to improve the outcome of critically ill patients.
-
Langenbecks Arch Surg · Jan 2014
Randomized Controlled TrialFast-track surgery decreases the incidence of postoperative delirium and other complications in elderly patients with colorectal carcinoma.
This study aims to investigate the role of fast-track surgery in preventing the development of postoperative delirium and other complications in elderly patients with colorectal carcinoma. ⋯ Compared to traditional perioperative management, fast-track surgery decreases the LOS, facilitates the recovery of bowel movement, and reduces occurrence of postoperative delirium and other complications in elderly patients with colorectal carcinoma. The lower incidence of delirium is at least partly attributable to the reduced systemic inflammatory response mediated by IL-6.
-
Sepsis is an unsolved problem worldwide, with a 30-50 % mortality rate. The recent failures of anti-TLR4, recombinant activated protein C, and anti-TNF in clinical trials indicate a need to rethink our current understanding of sepsis’s pathophysiology. While the initial immune response is crucial for effective clearance of invading pathogens, an overly exuberant host response to infection can cause septic shock, tissue damage, and death. Profuse inflammation in sepsis is frequently followed by global immunosuppression that increases susceptibility to viral and bacterial infections. Despite the dangers of immune over-response, the immune system’s anti-inflammatory activities are likely necessary to reduce the initial over-activation of the immune system. ⋯ Future treatment strategies for sepsis should focus on maintaining balance between pro- and anti-inflammatory immune actions in a timely manner.