Diseases of the colon and rectum
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Multicenter Study Comparative Study
Laparoscopic peritoneal lavage or primary anastomosis with defunctioning stoma for Hinchey 3 complicated diverticulitis: results of a comparative study.
This study was designed to compare postoperative outcomes of laparoscopic peritoneal lavage and open primary anastomosis with defunctioning stoma in the management of Hinchey 3 diverticulitis. ⋯ In the management of Hinchey 3 diverticulitis, laparoscopic peritoneal lavage does not result in excess morbidity or mortality, it reduces the length of hospital stay and avoids a stoma in most patients, and it is, therefore, a reasonable alternative to primary anastomosis with defunctioning stoma.
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Multicenter Study Clinical Trial
Is sacral nerve stimulation an effective treatment for chronic idiopathic anal pain?
Chronic idiopathic anal pain is a common, benign symptom, the etiology of which remains unclear. Traditional treatments are often ineffective. This study investigated the efficacy of sacral nerve stimulation in treating chronic idiopathic anal pain. ⋯ Long-term follow-up data showing improvements in scores on the visual analog pain scale and quality of life questionnaire indicate that, before adopting more aggressive surgical procedures, SNS should be considered for patients with chronic idiopathic anal pain in whom pharmacologic and biofeedback treatments have failed to produce effective results.
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Randomized Controlled Trial Comparative Study
Unroofing and marsupialization vs. rhomboid excision and Limberg flap in pilonidal disease: a prospective, randomized, clinical trial.
The aim of the study was to compare clinical outcomes and quality of life in patients undergoing surgery for pilonidal disease with unroofing and marsupialization (UM) or rhomboid excision and Limberg flap (RELP) procedures. ⋯ The unroofing and marsupialization procedure provides more clinical benefits in the treatment of pilonidal disease than rhomboid excision and Limberg flap and should be considered the procedure of choice. However, it may be associated with more inconvenience in wound care and longer healing time than rhomboid excision and Lindberg flap.
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Comparative Study
Surgical site infections in a "high outlier" institution: are colorectal surgeons to blame?
In 2006, the Cleveland Clinic was a "high outlier" for surgical site infections in the National Surgical Quality Improvement Program. Because this finding may be due to a high proportion of colorectal procedures at the Cleveland Clinic, the purpose of the present study was to compare the national and Cleveland Clinic databases regarding proportion of colorectal procedures and to investigate the frequency of SSI after colorectal versus general and vascular surgery and the factors that predict risk of SSI. ⋯ Participation in the National Surgical Quality Improvement Program brought attention to our high rate of SSI, which appeared to be due to a high proportion of colorectal patients, a high-risk subset. Further analysis identified unique SSI risk factors in this subgroup; most are not amenable to modification. Colorectal surgery may require unique risk adjustment for SSIs because of the nature of the operations and inherent risk of SSIs.
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Comparative Study
Outcomes for patients developing anastomotic leak after ileal pouch-anal anastomosis: does a handsewn vs. stapled anastomosis matter?
Outcomes for patients developing a leak after ileal pouch-anal anastomosis have not been well investigated. This study explored whether the use of a stapled or handsewn anastomosis was associated with different outcomes when an anastomotic leak developed. ⋯ Outcomes including functional results and pouch failure rates for patients developing a leak after stapled anastomosis at ileal pouch-anal anastomosis were significantly better than outcomes for patients who develop a leak after handsewn anastomosis.