Diseases of the colon and rectum
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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.
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There is an epidemic of obesity in the Western world and its associated substantial morbidity and mortality. This review examines the data on the impact of obesity on perioperative morbidity and mortality specifically in the context of colorectal surgery. ⋯ Obesity has a negative impact on outcome after colorectal surgery. To further clarify the impact of obesity on surgical outcome, it is recommended that future studies examine grades of obesity and include measures of abdominal obesity.
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Comparative Study Clinical Trial
Toxicity profile and efficacy of oral capecitabine as adjuvant chemotherapy for Chinese patients with Stage III colon cancer.
The Xeloda in Adjuvant Cancer Therapy trial, conducted in a white population of patients, established capecitabine (Xeloda) as adjuvant chemotherapy for Stage III colon cancer. Given the ethnical difference in toxicity of adjuvant chemotherapy in colon cancer, this study was designed to evaluate the safety and efficacy of adjuvant capecitabine in Chinese patients with colon cancer. ⋯ A different toxicity profile of adjuvant capecitabine was noted in this study on Chinese patients with colon cancer compared with that reported in the Xeloda in Adjuvant Cancer Therapy trial, whereas the efficacy outcomes were comparable.
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Surgery of the primary tumor in patients with colorectal cancer and unresectable synchronous liver metastases remains controversial. This study was designed to evaluate predictive preoperative factors of early postoperative death (<3 months) in such patients. ⋯ In patients with colorectal cancer and synchronous unresectable liver metastases, the three-month mortality rate was high (28 percent). Thus, better knowledge of risk factors could help select patients who could possibly benefit from surgery. The study suggested that age older than 75 years and liver cytolysis (>1.5 N) are associated with an increased three-month postoperative death risk. In these patients, surgery should be avoided.
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The Karydakis procedure is one of the asymmetric flap techniques used in the treatment of sacrococcygeal pilonidal sinus disease. The procedure consists of an asymmetrical elliptical excision, mobilization of the flap from the median side of the wound, fixation of the base of the flap to the sacrococcygeal fascia, and suturing of its edge to the lateral one. A modification of the original technique consisting of unfixing the base of the flap to the sacrococcygeal fascia with the purpose of flattening the natal cleft has been applied and its results evaluated. ⋯ The low complication rate, short hospital stay, short healing time, high degree of patient satisfaction, and absence of recurrence render the present modified technique a viable option in the management of sacrococcygeal pilonidal sinus disease.