Diseases of the colon and rectum
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Randomized Controlled Trial Multicenter Study Comparative Study
Safety and efficacy of methylnaltrexone in shortening the duration of postoperative ileus following segmental colectomy: results of two randomized, placebo-controlled phase 3 trials.
Postoperative ileus contributes to surgical morbidity and is associated with prolonged hospitalization and increased health care costs. The efficacy and safety of the peripherally acting μ-opioid receptor antagonist methylnaltrexone in shortening the duration of postoperative ileus following segmental colectomy was evaluated. ⋯ Although the efficacy of methylnaltrexone in reducing the duration of postoperative ileus was not demonstrated in these studies, intravenous methylnaltrexone at doses of 12 mg and 24 mg was safe, in general, and well tolerated in postcolectomy patients. The utility of intravenous methylnaltrexone in treating postoperative ileus remains unproven.
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There are few reports of long-term outcomes in elderly patients after open colectomy. ⋯ Emergent open colectomy in elderly patients is associated with a high morbidity and mortality rate. The mortality rate rises by >20% in both elective and emergent cases at discharge to 6 months. Length of procedure, postoperative complications, and colectomy for emergent indications predicted mortality.
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Recent studies have reported excellent healing and low recurrence rates for rhomboid flaps for pilonidal sinus disease. The cosmetic outcome has been less investigated and is the focus of this study following Limberg flap reconstruction of recurrent and complex pilonidal disease. ⋯ Initial wound closure and low recurrence rates after treatment with Limberg flap in pilonidal sinus disease lead to high patient satisfaction. The cosmetic outcome is acceptable, but an issue for some patients. These results support the use of the Limberg flap in complex pilonidal sinus disease after carefully informing patients about the cosmetic consequences.
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Doppler-guided hemorrhoidal artery ligation is a minimally invasive technique for the treatment of symptomatic hemorrhoids that has been applied successfully for grade II and III hemorrhoids but is less effective for grade IV hemorrhoids. Development of a special proctoscope enabled the combination of hemorrhoidal artery ligation with transanal rectoanal repair (mucopexy), which serves to lift and then secure the protruding hemorrhoids in place. ⋯ Doppler-guided hemorrhoidal artery ligation with rectoanal repair is safe, easy to perform, and should be considered as an effective option for the treatment of grade IV hemorrhoids.
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Editorial Comment
Multimodal rehabilitation in the laparoscopic era: still worth it?