Archives of surgery (Chicago, Ill. : 1960)
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Many surgeons believe that early mobilization of patients with blunt solid organ injuries increases the risk of delayed hemorrhage. ⋯ The timing of mobilization of patients with blunt solid organ injuries does not seem to contribute to delayed hemorrhage requiring laparotomy. Protocols incorporating periods of strict bed rest are unnecessary.
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We hypothesized that the relationship among beta-blocker use, heart rate control, and perioperative cardiovascular outcome would be similar in patients at all levels of cardiac risk. ⋯ Among patients at all levels of cardiac risk undergoing noncardiac surgery, administration of beta-blockers should achieve adequate heart rate control and should be carefully monitored in patients who are not at high cardiac risk.
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Comparative Study
Portal vein ligation as an efficient method of increasing the future liver remnant volume in the surgical treatment of colorectal metastases.
To compare the volumetric increase of segments 2 and 3, segment 4, and the caudate lobe after portal vein ligation (PVL) and portal vein embolization (PVE). The small size of the remnant liver and chemotherapy-induced liver injury increase the risk of postoperative hepatic insufficiency after major hepatic resection for colorectal liver metastases. Portal vein ligation has been suggested to be less effective than embolization in inducing hypertrophy of the remnant liver. ⋯ Portal vein ligation is as effective as PVE in inducing hypertrophy of the remnant liver volume.
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Postoperative pancreatic fistula (POPF) is one of the most severe surgical complications of pancreatoduodenectomy (PD) with pancreaticojejunostomy (PJ) reconstruction. Recently, POPF has been classified as grade A, B, or C. Relaparotomy is mandatory for POPF associated with sepsis or hemorrhage (grade C). Peripancreatic drainage and completion pancreatectomy are the procedures most commonly used, but associated morbidity and mortality remain high. We hypothesized that the results of pancreatogastrostomy (PG) for treatment of grade C POPF following PD with PJ in the rare patients for whom relaparotomy is necessary would be similar to the results in a historical series of similar patients who underwent completion pancreatectomy. ⋯ In selected patients, salvage PG can be considered a safe and efficient alternative to completion pancreatectomy for the treatment of grade C POPF after PD with PJ.
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To critically analyze a large single-institution experience with distal pancreatectomy (DP), with particular attention to the risk factors, outcome, and management of the postoperative pancreatic fistula (PF). ⋯ Pancreatic fistula is the most common complication after DP and its incidence varies depending on the definition applied. Several risk factors for developing a PF were identified. Splenic preservation after DP is safe. The grade of a PF correlates well with clinical outcomes, and most PFs may be managed nonoperatively.