Hepato Gastroenterol
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Hepato Gastroenterol · Sep 2008
Strategies to reduce perioperative morbidity in cytoreductive surgery.
Peritoneal carcinoma has been regarded as a uniformly lethal clinical entity. Cytoreductive surgery and intraperitoneal hyperthermic chemoperfusion (HIPEC) is an aggressive treatment for patients with peritoneal malignancies. While promising, this therapeutic regimen has been associated with significant morbidity, long hospital stay and an increased risk for perioperative mortality. The purpose of this study was to evaluate the possibility to reduce morbidity by use of strategy aiming to reduce inflammatory response associated with cytoreductive surgery plus HIPEC. ⋯ The results of this study demonstrate the possibility to reduce the perioperative risk of cytoreductive surgery plus IPHC. The described strategy aiming the reduction of inflammatory response was able to reach a morbidity level which stands in line with other major oncologic operations.
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Hepato Gastroenterol · Sep 2008
Prolonged antibiotic prophylaxis longer than 24 hours does not decrease surgical site infection after elective gastric and colorectal surgery.
Prophylactic administration of antibiotics can decrease postoperative morbidity, shorten hospitalization, and reduce overall costs. In Western countries, it is stressed that antimicrobial prophylaxis was discontinued within 24 hrs after surgery in currently published guidelines. However, it is unclear how long we need to continue perioperative prophylaxis for gastrointestinal surgery. In this manuscript, we analyzed surgical site infection (SSI) in gastric and colorectal surgery according to the duration of antibiotics prophylaxis and discuss the duration of an antibiotic prophylaxis, and its relation to SSI. ⋯ From our findings, SSI rate did not decrease with longer duration of antimicrobial prophylaxis. We concluded that we must recognize that the cause of postoperative wound infection is multimodal, and should not rely on antibiotics to prevent postoperative SSI but that surgeons should reduce the risk for postoperative SSI.
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Hepato Gastroenterol · Sep 2008
Randomized Controlled TrialDefunctioning loop ileostomy with low anterior resection for distal rectal cancer: should we make an ileostomy as a routine procedure? A prospective randomized study.
Anastomotic leakage is a major problem in colorectal surgery particularly in low rectal cancer. The defunctioning loop ileostomy was introduced as a technique to create a manageable stoma that would divert the fecal stream from a more distal anastomosis in order to reduce the consequences of any anastomotic leakage. Therefore, the use of a defunctioning stoma has been suggested, but limited data exist to clearly determine the necessity of routine diversion. This study was designed to evaluate early morbidity, mortality and hospital stay in patients undergoing lower rectal cancer surgery concerned with or without loop ileostomy. ⋯ The use of defunctioning loop ileostomy in all patients undergoing lower rectal surgery with stapler anastomosis is beneficial and safe. Defunctioning loop ileostomy use has resulted in no anastomotic leak rate and considerable low morbidity. So according to our study, we strongly recommend defunctioning loop ileostomy as a routine procedure in patients undergoing lower rectal cancer surgery.
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Hepato Gastroenterol · Sep 2008
Incidence of gastric cancer in the remnant stomach after proximal gastrectomy.
Gastric cancer in the remnant stomach after proximal gastrectomy has not been studied in detail. The aim of this study was to clarify the incidence of this type of cancer. ⋯ The incidence of proximal gastrectomy after proximal gastrectomy is not high, and the risk in males is especially low. However, proximal gastrectomy may develop over 10 years after surgery, and long-term follow-up is essential.