Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland
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Randomized Controlled Trial
Prospective randomized, double-blind, placebo-controlled study of pre- and postoperative administration of a COX-2-specific inhibitor as opioid-sparing analgesia in major colorectal surgery.
To demonstrate the opioid-sparing effect and reduction in postoperative ileus obtained with valdecoxib 40 mg administered pre- and postoperatively in patients undergoing colorectal resection. ⋯ Patients treated with a cyclo-oxygenase 2-specific inhibitor have a shorter recovery time when compared with patients on a standard postoperative PCA morphine-only regimen after colorectal resection.
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We reviewed recent literature to assess the impact of hospital caseload, surgeon's caseload and education on long-term outcome following colorectal cancer surgery. ⋯ The data have provided evidence that long-term survival following colorectal cancer surgery in general improved significantly with increasing hospital caseload and surgeon's education.
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There is evolving interest in auditing and credentialling the performance of surgeons. The incidence of anastomotic leakage has been proposed as a measure of performance following colorectal surgery. The aim of this study was to evaluate the incidence and risk factors associated with anastomotic leakage in patients undergoing resections of the colon and rectum. ⋯ Within this surgical unit, the incidence of leaks from intraabdominal anastomoses was relatively low. However, leaks in patients undergoing extraperitoneal anastomoses continue to be a major cause of morbidity and mortality.
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The use of rectal tubes in colorectal surgery appears to be a matter of individual choice, with little documented evidence to support their use. This study assesses the current practice of rectal tubes amongst consultant members of the Association of Coloproctology of Great Britain & Ireland (ACPGBI). ⋯ Rectal tube placement is simple and safe and is used by a third of colorectal surgeons in UK and Ireland. Given their simplicity, the efficacy of rectal tubes in reducing local anastomotic complications requires further evaluation within the confines of a randomised controlled trial.