Zentralblatt für Chirurgie
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Randomized Controlled Trial Comparative Study
[Liberalisation of preoperative fasting guidelines: effects on patient comfort and clinical practicability during elective laparoscopic surgery of the lower abdomen].
In this study, the recently liberalised national guidelines for preoperative fasting were evaluated from the view point of the patients and according to their clinical usability. ⋯ The liberation of the national guidelines for preoperative fluid administration with unlimited intake of a carbohydrate drink offers the benefit of a significantly lower incidence of the preoperative item "feeling cold" and of the pre- and postoperative item "thirst / having a dry mouth". However, in daily clinical practice the length of fasting for fluids was conspicuously longer than that postulated by the new recommendations.
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Cytoreductive peritonectomy with hyperthermic intraoperative chemotherapy (HIPEC) is an established therapy for patients with gastrointestinal, gynaecological metastasised peritoneal carcinomatosis as well as primary peritoneal carcinomatous tumours. ⋯ The PET / CT scan may play an important role in forecasting the operability of patients with peritoneal carcinomatosis.
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Comparative Study Clinical Trial
["Fast-track" rehabilitation to enhance recovery after ileostomy closure--a prospective clinical trial].
After colorectal resections, concepts for early recovery (ERAS or fast-track) could reduce the length of the hospital stay. Whether or not such a multimodal treatment can shorten the hospitalisation after loop ileostomy closure was investigated in the present study. ⋯ "Fast-track" rehabilitation can shorten the length of hospitalisation after elective ileostomy closure.
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A multimodal perioperative therapy strategy (fast-track) decreases the morbidity of general thoracic interventions and increases postoperative reconvalescence after lung resections. Thoracic surgery is associated with relevant pain and sufficient pain relief is essential for postoperative recovery. Epidural analgesia leads to adequate pain control with only minor side effects and complications and can therefore be a reasonable supplementation in a modern fast-track setting. The purpose of this study was to evaluate the benefits and risks of an epidural catheter placed prior to surgery and to analyse the postoperative recovery of patients undergoing thoracic surgery. ⋯ We have shown that epidural analgesia in patients undergoing thoracotomy leads to sufficient pain control with only minor disadvantages and complications. These are easily mastered without expensive diagnostic or therapeutic interventions. Therefore, epidural analgesia is a safe and helpful tool for increased postoperative recovery within a modern fast-track setting.
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Ischaemia of the visceral arteries is considered to be an extraordinary challenge in the interdisciplinary therapeutic management. ⋯ Chronic ischaemia of the visceral arteries is characterised by an increasing incidence and a stealthy onset and requires an interdisciplinary approach to find the correct diagnosis using all available diagnostic procedures including sufficient periodic follow-up investigations. We favour the antegrade aortomesenteric revascularisation from the supracoeliac aortic segment as a promising surgical option in chronic ischaemia of visceral arteries.