Diseases of the colon and rectum
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Comparative Study
Risk of postoperative venous thromboembolism after laparoscopic and open colorectal surgery: an additional benefit of the minimally invasive approach?
Venous thromboembolism constitutes a major cause of morbidity associated with surgical procedures. Colorectal surgical patients are at an elevated risk for postoperative venous thromboembolism. Whether the laparoscopic approach influences this risk is not well defined. ⋯ The laparoscopic approach is associated with a lower venous thromboembolism rate in comparison with open surgery, despite controlling for other variables. This additional benefit of the minimally invasive approach further supports its use, whenever feasible, for a variety of colorectal conditions.
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Whereas Crohn's disease is traditionally thought to represent a wasting disease, little is currently known about the incidence and impact of obesity in this patient cohort. ⋯ Increasing BMI adversely affects perioperative morbidity in patients with Crohn's disease.
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There is a lack of knowledge on the incidence and management of suboptimal therapeutic effect and the complications associated with sacral nerve stimulation for fecal incontinence and constipation. ⋯ The incidence of untoward events associated with sacral nerve stimulation appears to be low. However, there is a significant underreporting of the incidence. Using the information from the structured and systematic literature review, we formulated a clinically relevant guideline for reporting and managing postoperative issues. The guideline can provide a framework for clinical practice.
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Randomized Controlled Trial
Diathermy excisional hemorrhoidectomy: a prospective randomized study comparing pedicle ligation and pedicle coagulation.
In hemorrhoidectomy, pedicle coagulation has been claimed to be associated with less postoperative pain compared with pedicle ligation. ⋯ Pedicle coagulation is safe and provides a superior alternative to pedicle ligation by decreasing postoperative pain in the first 6 postoperative days, as well as reducing parenteral analgesic requirements during the first 24 hours postoperatively.
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Multicenter Study
Early discharge and hospital readmission after colectomy for cancer.
Early discharge after colectomy has been shown to be feasible in studies from specialty centers, but we hypothesized that benefits of early discharge might be offset by higher risk of readmission in the surgical community as a whole. Minimizing readmissions is a national health policy priority. ⋯ Hospitals with a pattern of early discharge (median length of stay ≤ 5 d after surgery) do not have a higher risk-adjusted readmission rate than other hospitals. These results support the safety of early discharge programs in the Medicare population.