Diseases of the colon and rectum
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The role of laparoscopic surgery in the cure of colorectal cancer is controversial. The aim of this study was to evaluate long-term survival after curative, laparoscopic resection of colorectal cancer. Specifically, we wanted to review those patients who now had complete five-year follow-up. ⋯ Laparoscopic colon resection for cancer is safe and feasible in a private setting. Our data suggest that long-term survival after laparoscopic colon resection for cancer is similar to survival after conventional surgery. Prospective, randomized trials presently under way will likely confirm these results.
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This article presents the first known case of pneumorrhachis (spinal air), pneumomediastinum, pneumopericardium, pneumoretroperitoneum, and subcutaneous emphysema after proctocolectomy for ulcerative colitis. We review the patient's medical history, clinical and laboratory findings, radiographic data, and operative records, as well as the relevant literature. ⋯ Unlike the case we report, previously described episodes of pneumomediastinum and subcutaneous emphysema in patients with ulcerative colitis developed before operative intervention. We offer possible explanations for these unusual complications based on analysis of this case and thorough review of the literature.
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Evidence-based medicine relies on reproducible, high-quality reporting in the literature. Previous evaluations, which have assessed 11 basic elements of design and analysis in top impact clinical journals (both nonsurgical and surgical), have demonstrated that the reporting quality is less than perfect, although improving. The current study evaluates the quality of reporting in Diseases of the Colon and Rectum and other clinically related journals to identify specific areas where future improvements may be made. ⋯ For Diseases of the Colon and Rectum, the number of randomized, controlled trials and the quality of reporting is improving. However, although certain research standards are reported adequately, others are not. The calculation of statistical power is clearly important when interpreting randomized, controlled trial results (whether differences are reported or not), yet only 11 percent of studies contained this information. Improving the reporting of this single item would likely lead to improving the overall quality of clinical studies in colorectal surgery. Improved reporting might be best facilitated by having authors adhere to a list of explicitly determined elements that should be included.
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Comparative Study
Cost structure of laparoscopic and open sigmoid colectomy for diverticular disease: similarities and differences.
Although laparoscopic colectomy has demonstrated a variety of advantages, it remains unclear whether the reductions in length of stay and faster return of bowel function will offset potential increases in cost caused by operating time and instrumentation. The purpose of this study was to compare the direct cost structure of elective open and laparoscopic resection for sigmoid diverticulitis. ⋯ The data demonstrate that laparoscopic colectomy is a cost-effective means of electively managing sigmoid diverticular disease. This operative approach may become very important in an era of increasing constraints on hospital occupancy rates and access to nursing services in many regions of the country.