Diseases of the colon and rectum
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The Karydakis flap for pilonidal sinus is associated with primary wound healing and infrequent recurrence. Previous studies had reported in-patient protocols. This cohort study was designed to assess the feasibility, safety, and practicalities of day-case Karydakis flap surgery. Factors relating to wound healing also were explored. ⋯ The Karydakis flap can offer the advantage of day-case surgery for pilonidal sinus patients in addition to primary wound healing and low sinus recurrence rates.
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Multicenter Study Comparative Study
Clinicopathologic characteristics and malignant potential of colorectal flat neoplasia compared with that of polypoid neoplasia.
Because of their potential for malignancy, flat colorectal neoplasias are a current topic of debate. This study was designed to investigate the clinicopathologic features of flat neoplasia and to compare them with those of polypoid neoplasia, as well as to identify the determinants of malignant transformation of both flat and polypoid colorectal neoplasia. ⋯ The clinicopathologic indices for the propensity of malignant transformation in colorectal neoplasias were a size > or =11 mm and location in the left colon rather than flat gross morphology.
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The incidence of invasive anal squamous-cell carcinoma in patients with HIV is increasing. We report the outcome after combined chemoradiotherapy for anal squamous-cell carcinoma in HIV-infected individuals. ⋯ Outcome after chemoradiotherapy for HIV-related anal squamous-cell carcinoma in the era of highly active antiretroviral therapy is comparable to outcome in patients without HIV. However, significant toxicity is seen with standard treatment regimens. Earlier diagnosis and risk-adapted therapy could lead to improved survival and decreased treatment-related morbidity.
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Review Meta Analysis
Use of chewing gum in reducing postoperative ileus after elective colorectal resection: a systematic review.
Published studies comparing the addition of chewing gum to standardized postoperative care to shorten postoperative ileus showed controversial results. This study was designed to conduct a systematic review of all relevant trials on chewing gum to reduce postoperative ileus after colorectal resection. ⋯ The use of gum chewing in the postoperative period is a safe method to stimulate bowel motility and reduce ileus after colorectal surgery.
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Randomized Controlled Trial Comparative Study
Continuous wound infusion of local anesthetic for the control of pain after elective abdominal colorectal surgery.
Local anesthetic wound infusion has been investigated in recent years as a potential alternative to standard analgesic regimens after major surgery. This study investigates the efficacy of a continuous wound infusion of ropivacaine in conjunction with best practice postoperative analgesia after midline laparotomy for abdominal colorectal surgery. ⋯ Management of pain after major abdominal colorectal surgery is best achieved through adopting a multimodal approach to analgesia. Delivery of ropivacaine to midline laparotomy wounds via a Painbuster Soaker device is safe, but we have not demonstrated any significant clinical advantage over current best practice.