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Kazuhiro Imamura, Kensuke Adachi, Ritsuko Sasaki, Satoko Monma, Sadaaki Shioiri, Yasuji Seyama, Masaru Miura, Yoshihiko Morikawa, Tetsuji Kaneko
BACKGROUND: The incisional surgical site infection (SSI) is an extremely common complication following open abdominal surgery and imposes a considerable treatment and cost burden. METHOD: We conducted a multicenter open-label randomized controlled trial at three Tokyo Metropolitan medical institutions. We enrolled adult patients who underwent either an elective or an emergency open laparotomy. Eligible patients were allocated preoperatively to undergo wound closure with either subcuticular sutures or staples...
October 3, 2016: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
Henk-Thijs Brandsma, Birgitta M E Hansson, Theo J Aufenacker, Dick van Geldere, Felix M V Lammeren, Chander Mahabier, Peter Makai, Pascal Steenvoorde, Tammo S de Vries Reilingh, Marinus J Wiezer, Johannes H W de Wilt, Robert P Bleichrodt, Camiel Rosman
OBJECTIVE: The aim of this study was to investigate the incidence of parastomal hernias (PSHs) after end-colostomy formation using a polypropylene mesh in a randomized controlled trial versus conventional colostomy formation. BACKGROUND: A PSH is the most frequent complication after stoma formation. Symptoms may range from mild abdominal pain to life-threatening obstruction and strangulation. The treatment of a PSH is notoriously difficult and recurrences up to 20% have been reported despite the use of mesh...
July 29, 2016: Annals of Surgery
A Zada, M C L Peek, M Ahmed, B Anninga, R Baker, M Kusakabe, M Sekino, J M Klaase, B Ten Haken, M Douek
BACKGROUND: The standard for sentinel lymph node biopsy (SLNB), the dual technique (radiolabelled tracer and blue dye), has several drawbacks. A novel magnetic technique without these drawbacks has been evaluated in a number of clinical trials. It uses a magnetic tracer and a handheld magnetometer to identify and excise sentinel lymph nodes. A systematic review and meta-analysis was performed to assess the performance and utility of the magnetic in comparison to the standard technique...
October 2016: British Journal of Surgery
Eva Angenete, David Bock, Jacob Rosenberg, Eva Haglind
PURPOSE: Perforated diverticulitis often requires surgery with a colon resection such as Hartmann's procedure, with inherent morbidity. Recent studies suggest that laparoscopic lavage may be an alternative surgical treatment. The aim of this study was to compare re-operations, morbidity, and mortality as well as health economic outcomes between laparoscopic lavage and colon resection for perforated purulent diverticulitis. METHODS: PubMed, Cochrane, Centre for Reviews and Dissemination, and Embase were searched...
August 27, 2016: International Journal of Colorectal Disease
Deborah S Keller, Juan-Ramon Flores-Gonzalez, Sergio Ibarra, Ali Mahmood, Eric M Haas
BACKGROUND: Alvimopan's goal is to minimize postoperative ileus and optimize outcomes; however, evidence in laparoscopic surgery is lacking. Our goal was to evaluate the benefit of alvimopan in laparoscopic colorectal surgery with an enhanced recovery pathway (ERP). METHODS: Laparoscopic colorectal cases were stratified into alvimopan and control cohorts, then case-matched for comparability. All followed an identical ERP. The main outcomes were length of stay, complications, readmissions, and costs in the alvimopan and control groups...
May 10, 2016: American Journal of Surgery
Avery S Walker, Jason R Bingham, Karmon M Janssen, Eric K Johnson, Justin A Maykel, Omar Ocampo, John P Gonzalez, Scott R Steele
BACKGROUND: Modern 64- to 128-slice computed tomography (CT) scanners have questioned the need for routine colonoscopy after hospital admission for presumed uncomplicated diverticulitis. METHODS: This is a retrospective review of all patients (>18 years) who underwent planned colonoscopy after admission for Hinchey I or II acute diverticulitis (January 2009 to January 2014). The findings on the final radiologist report were then correlated with the colonoscopy results...
May 7, 2016: American Journal of Surgery
A Viúdez, A De Jesus-Acosta, F L Carvalho, R Vera, S Martín-Algarra, N Ramírez
Pancreatic neuroendocrine tumours (PanNETs) are considered a relatively unusual oncologic entity. Due to its relative good prognosis, surgery remains the goal standard therapy not only in localized disease but also in the setting of locally or metastatic disease. Most of the patients are diagnosed in metastatic scenario, where multidisciplinary approach based on surgery, chemotherapies, liver-directed and/or molecular targeted therapies are commonly used. Owing to a deeper molecular knowledge of this disease, these targeted therapies are nowadays widely implemented, being the likely discovery of predictive biomarkers that would allow its use in other settings...
May 2016: Critical Reviews in Oncology/hematology
Brian K Yorkgitis
BACKGROUND: Non-vitamin K oral anticoagulants have become an attractive alternative to warfarin when patients require anticoagulation. Until recently, one of the biggest challenges to these agents was the lack of specific reversal of their anticoagulation when bleeding occurs or urgent/emergent procedures are required. DATA SOURCES: This article is a narrative review of peer-reviewed publications with particular attention to authors that are experts in the field, society guidelines, and government publications...
July 2016: American Journal of Surgery
N Hyldig, H Birke-Sorensen, M Kruse, C Vinter, J S Joergensen, J A Sorensen, O Mogensen, R F Lamont, C Bille
BACKGROUND: Postoperative wound complications are common following surgical procedures. Negative-pressure wound therapy (NPWT) is well recognized for the management of open wounds and has been applied recently to closed surgical incisions. The evidence base to support this intervention is limited. The aim of this study was to assess whether NPWT reduces postoperative wound complications when applied to closed surgical incisions. METHODS: This was a systematic review and meta-analysis of randomized clinical trials of NPWT compared with standard postoperative dressings on closed surgical incisions...
April 2016: British Journal of Surgery
V Sallinen, E A Akl, J J You, A Agarwal, S Shoucair, P O Vandvik, T Agoritsas, D Heels-Ansdell, G H Guyatt, K A O Tikkinen
BACKGROUND: For more than a century, appendicectomy has been the treatment of choice for appendicitis. Recent trials have challenged this view. This study assessed the benefits and harms of antibiotic therapy compared with appendicectomy in patients with non-perforated appendicitis. METHODS: A comprehensive search was conducted for randomized trials comparing antibiotic therapy with appendicectomy in patients with non-perforated appendicitis. Key outcomes were analysed using random-effects meta-analysis, and the quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach...
March 17, 2016: British Journal of Surgery
Joseph D Feuerstein, Kenneth R Falchuk
Diverticular disease is a common condition that is associated with variable presentations. For this review article, we performed a review of articles in PubMed through February 1, 2016, by using the following MeSH terms: colon diverticula, colonic diverticulitis, colonic diverticulosis, colonic diverticulum, colonic diverticula, and diverticula. Diverticula are structural alterations within the colonic wall that classically form "pockets" referred to as diverticula. Diverticula form from herniation of the colonic mucosa and submucosa through defects in the circular muscle layers within the colonic wall...
August 2016: Mayo Clinic Proceedings
Lori-Ann Linkins
No abstract text is available yet for this article.
April 21, 2016: Blood
Michael Auerbach, John W Adamson
It is estimated that one-third of the world's population is anemic, the majority being due to iron deficiency (ID). In adults, ID is associated with fatigue in the absence of anemia, restless legs syndrome, pica and, in neonates, delayed growth and development. In adolescents, ID is associated with decrements in learning and behavioral abnormalities. In the absence of a clear cause, search for a source of bleeding is indicated. No single test is diagnostic of ID unless the serum ferritin is low or the percent transferrin saturation is low with an elevated total iron binding capacity...
January 2016: American Journal of Hematology
Nicholas J Battersby, Peter How, Brendan Moran, Sigmar Stelzner, Nicholas P West, Graham Branagan, Joachim Strassburg, Philip Quirke, Paris Tekkis, Bodil Ginnerup Pedersen, Mark Gudgeon, Bill Heald, Gina Brown
OBJECTIVE: This study aimed to validate a magnetic resonance imaging (MRI) staging classification that preoperatively assessed the relationship between tumor and the low rectal cancer surgical resection plane (mrLRP). BACKGROUND: Low rectal cancer oncological outcomes remain a global challenge, evidenced by high pathological circumferential resection margin (pCRM) rates and unacceptable variations in permanent colostomies. METHODS: Between 2008 and 2012, a prospective, observational, multicenter study (MERCURY II) recruited 279 patients with adenocarcinoma 6 cm or less from the anal verge...
April 2016: Annals of Surgery
James Fleshman, Megan Branda, Daniel J Sargent, Anne Marie Boller, Virgilio George, Maher Abbas, Walter R Peters, Dipen Maun, George Chang, Alan Herline, Alessandro Fichera, Matthew Mutch, Steven Wexner, Mark Whiteford, John Marks, Elisa Birnbaum, David Margolin, David Larson, Peter Marcello, Mitchell Posner, Thomas Read, John Monson, Sherry M Wren, Peter W T Pisters, Heidi Nelson
IMPORTANCE: Evidence about the efficacy of laparoscopic resection of rectal cancer is incomplete, particularly for patients with more advanced-stage disease. OBJECTIVE: To determine whether laparoscopic resection is noninferior to open resection, as determined by gross pathologic and histologic evaluation of the resected proctectomy specimen. DESIGN, SETTING, AND PARTICIPANTS: A multicenter, balanced, noninferiority, randomized trial enrolled patients between October 2008 and September 2013...
October 6, 2015: JAMA: the Journal of the American Medical Association
Andrew R L Stevenson, Michael J Solomon, John W Lumley, Peter Hewett, Andrew D Clouston, Val J Gebski, Lucy Davies, Kate Wilson, Wendy Hague, John Simes
IMPORTANCE: Laparoscopic procedures are generally thought to have better outcomes than open procedures. Because of anatomical constraints, laparoscopic rectal resection may not be better because of limitations in performing an adequate cancer resection. OBJECTIVE: To determine whether laparoscopic resection is noninferior to open rectal cancer resection for adequacy of cancer clearance. DESIGN, SETTING, AND PARTICIPANTS: Randomized, noninferiority, phase 3 trial (Australasian Laparoscopic Cancer of the Rectum; ALaCaRT) conducted between March 2010 and November 2014...
October 6, 2015: JAMA: the Journal of the American Medical Association
Bryan R Haugen, Erik K Alexander, Keith C Bible, Gerard M Doherty, Susan J Mandel, Yuri E Nikiforov, Furio Pacini, Gregory W Randolph, Anna M Sawka, Martin Schlumberger, Kathryn G Schuff, Steven I Sherman, Julie Ann Sosa, David L Steward, R Michael Tuttle, Leonard Wartofsky
BACKGROUND: Thyroid nodules are a common clinical problem, and differentiated thyroid cancer is becoming increasingly prevalent. Since the American Thyroid Association's (ATA's) guidelines for the management of these disorders were revised in 2009, significant scientific advances have occurred in the field. The aim of these guidelines is to inform clinicians, patients, researchers, and health policy makers on published evidence relating to the diagnosis and management of thyroid nodules and differentiated thyroid cancer...
January 2016: Thyroid: Official Journal of the American Thyroid Association
Carol-Anne Moulton, Chu-Shu Gu, Calvin H Law, Ved R Tandan, Richard Hart, Douglas Quan, Robert J Fairfull Smith, Diederick W Jalink, Mohamed Husien, Pablo E Serrano, Aaron L Hendler, Masoom A Haider, Leyo Ruo, Karen Y Gulenchyn, Terri Finch, Jim A Julian, Mark N Levine, Steven Gallinger
IMPORTANCE: Patients with colorectal cancer with liver metastases undergo hepatic resection with curative intent. Positron emission tomography combined with computed tomography (PET-CT) could help avoid noncurative surgery by identifying patients with occult metastases. OBJECTIVES: To determine the effect of preoperative PET-CT vs no PET-CT (control) on the surgical management of patients with resectable metastases and to investigate the effect of PET-CT on survival and the association between the standardized uptake value (ratio of tissue radioactivity to injected radioactivity adjusted by weight) and survival...
May 14, 2014: JAMA: the Journal of the American Medical Association
Timothy J Whelan, Ivo A Olivotto, Wendy R Parulekar, Ida Ackerman, Boon H Chua, Abdenour Nabid, Katherine A Vallis, Julia R White, Pierre Rousseau, Andre Fortin, Lori J Pierce, Lee Manchul, Susan Chafe, Maureen C Nolan, Peter Craighead, Julie Bowen, David R McCready, Kathleen I Pritchard, Karen Gelmon, Yvonne Murray, Judy-Anne W Chapman, Bingshu E Chen, Mark N Levine
BACKGROUND: Most women with breast cancer who undergo breast-conserving surgery receive whole-breast irradiation. We examined whether the addition of regional nodal irradiation to whole-breast irradiation improved outcomes. METHODS: We randomly assigned women with node-positive or high-risk node-negative breast cancer who were treated with breast-conserving surgery and adjuvant systemic therapy to undergo either whole-breast irradiation plus regional nodal irradiation (including internal mammary, supraclavicular, and axillary lymph nodes) (nodal-irradiation group) or whole-breast irradiation alone (control group)...
July 23, 2015: New England Journal of Medicine
Jordi Bruix, Tadatoshi Takayama, Vincenzo Mazzaferro, Gar-Yang Chau, Jiamei Yang, Masatoshi Kudo, Jianqiang Cai, Ronnie T Poon, Kwang-Hyub Han, Won Young Tak, Han Chu Lee, Tianqiang Song, Sasan Roayaie, Luigi Bolondi, Kwan Sik Lee, Masatoshi Makuuchi, Fabricio Souza, Marie-Aude Le Berre, Gerold Meinhardt, Josep M Llovet
BACKGROUND: There is no standard of care for adjuvant therapy for patients with hepatocellular carcinoma. This trial was designed to assess the efficacy and safety of sorafenib versus placebo as adjuvant therapy in patients with hepatocellular carcinoma after surgical resection or local ablation. METHODS: We undertook this phase 3, double-blind, placebo-controlled study of patients with hepatocellular carcinoma with a complete radiological response after surgical resection (n=900) or local ablation (n=214) in 202 sites (hospitals and research centres) in 28 countries...
October 2015: Lancet Oncology
2016-05-22 06:58:35
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