Diseases of the colon and rectum
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Multicenter Study Comparative Study
Bowel preparation for colectomy and risk of Clostridium difficile infection.
Mechanical bowel preparation before colectomy is controversial for several reasons, including a theoretically increased risk of Clostridium difficile infection. ⋯ In contrast to previous single-center data, this multicenter study showed that the preoperative use of mechanical bowel preparation was not associated with increased risk of C difficile infection after colectomy. Moreover, the addition of oral antibiotics with mechanical bowel preparation did not confer any additional risk of infection.
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Multicenter Study Comparative Study
Enhanced recovery after colon surgery in a community hospital system.
Enhanced recovery after colon surgery has not been widely adopted in the United States and Europe, despite evidence that postoperative complications and hospital length of stay are decreased. ⋯ A comprehensive enhanced-care colon surgery care process was successfully introduced in a community hospital system, as indicated by the clinical outcome measures.
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Randomized Controlled Trial Multicenter Study Comparative Study
The hemorrhoid laser procedure technique vs rubber band ligation: a randomized trial comparing 2 mini-invasive treatments for second- and third-degree hemorrhoids.
Hemorrhoid laser procedure is a new laser procedure for outpatient treatment of hemorrhoids in which hemorrhoidal arterial flow feeding the hemorrhoidal plexus is stopped by means of Doppler-guided laser coagulation. ⋯ Despite higher cost, the hemorrhoid laser procedure technique was more effective than rubber band ligation in reducing postoperative pain, resolving symptoms, and improving quality of life in patients with grade II or III hemorrhoids with incomplete mucosal prolapse.
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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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Multicenter Study
A clinical decision rule to establish the diagnosis of acute diverticulitis at the emergency department.
The aim of this study was to identify patients in whom the clinical diagnosis of diverticulitis can be made with a high certainty, distinguishing them from patients requiring imaging. ⋯ In a quarter of patients with suspected diverticulitis, the diagnosis can be made clinically based on a combination of direct tenderness only in the left lower quadrant, the absence of vomiting, and an elevated C-reactive protein. In patients without these features, imaging is required to reach adequate diagnostic accuracy.