Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland
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Letter
A new classification, treatment algorithm and prognosis-estimating system for ileosigmoid knotting.
Ileosigmoid knotting (ISK) is the wrapping of the ileum or sigmoid colon around the base of the other one, causing a double-loop intestinal obstruction. It requires urgent and effective resuscitation followed by emergency surgery, and its prognosis is poor [1,2]. ⋯ This article is protected by copyright. All rights reserved.
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Randomized Controlled Trial
Doppler-guided goal-directed fluid therapy does not affect intestinal cell damage but increases global gastrointestinal perfusion in colorectal surgery: a randomized controlled trial.
Individualized, goal-directed fluid therapy (GDFT), based on Doppler measurements of stroke volume, has been proposed as a treatment strategy in terms of reducing complications, mortality and length of hospital stay in major bowel surgery. We studied the effect of Doppler-guided GDFT on intestinal damage as compared with standard postoperative fluid replacement. ⋯ Doppler-guided GDFT during and in the first hours after elective colorectal surgery for malignancy increases global gastrointestinal perfusion, as measured by Pr-a CO2 -gap.
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Comparative Study
Robotic vs laparoscopic rectal surgery in high-risk patients.
Laparoscopic rectal surgery is associated with a steep learning curve and high conversion rate despite progress in equipment design and consistent practice. The robotic system has shown an advantage over the laparoscopic approach due to stable three-dimensional views, improved dexterity and better ergonomics. These factors make the robotic approach more favourable for rectal surgery. The aim of this study was to compare the perioperative outcomes of laparoscopic and robotic rectal cancer surgery in high-risk patients. ⋯ Robotic surgery in high-risk patients is associated with higher sphincter preservation, reduced blood loss, smaller conversion rates, and shorter operating time and hospital stay. However, further studies are required to evaluate this notion.