International journal of surgery
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This best evidence topic was investigated according to a described protocol. The question asked was: should patients on acetylsalicylic acid (ASA) for secondary prevention stop or continue the medication prior to elective, abdominal surgery. Using the reported search 826 papers were found of which five represented the best evidence to answer the clinical question. ⋯ This heterogeneity in methodology makes it difficult to draw justifiable conclusions from the data. However, it appears that continuing ASA isn't associated with excessive bleeding. Further adequately powered trials with well-defined end points are needed to answer this important clinical question.
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Review
Benign cystic neoplasm and endocrine tumours of the pancreas--when and how to operate--an overview.
The recent evolution of limited local operative procedures for benign pancreatic lesions shifted surgical treatment options to the application of local techniques, although major resections of pancreatic head and left resection are still the standard. ⋯ The application of tumour enucleation, pancreatic middle segment resection and duodenum preserving subtotal or total pancreatic head resection are associated with low level surgery related early post-operative complications and a very low hospital mortality. The major advantage of the limited procedures is preservation of exo- and endocrine pancreatic functions.
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The World Health Organization Surgical Safety Checklist (WHO SSC) has demonstrated efficacy in developed and developing countries alike. Recent increases in awareness of surgical morbidity in developing countries has placed greater emphasis on strategies to improve surgical safety in resource-limited settings. The implementation of surgical safety checklists in low-income countries has specific barriers related to resources and culture. ⋯ This review will address the benefits and challenges of implementation of surgical safety checklists in developing countries. Moreover, inspiration for the original checklist is revisited to identify areas that will be of particular benefit in a resource-poor setting. Potential future strategies to encourage the implementation of checklists in these countries are also discussed.
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Partial hepatectomy with clear surgical margins is the main curative treatment for hepatic malignancies. The safety of liver resection, to a great extent, depends on the volume of future liver remnant. This manuscript reviews some important strategies that have been developed to increase resectability for patients with borderline volume of future liver remnant, particularly associating liver partition and portal vein ligation for staged hepatectomy (ALPPS). ⋯ ALPPS has emerged as a new strategy to increase resectability of hepatic malignancies. Due to high morbidity and mortality rates of ALPPS procedure, the surgical candidates should be selected carefully. Moreover, there are very limited available evidence for its technical feasibility, safety and oncological outcome which are needed for further evaluation in larger scale of studies.
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Randomized Controlled Trial
Role of prophylactic antibiotics in Milligan Morgan hemorrhoidectomy - a randomized control trial.
Role of prophylactic antibiotics in Milligan Morgan hemorrhoidectomy - A prospective, randomized control trial. ⋯ Prophylactic antibiotics have got no role in cases of Milligan Morgan hemorrhoidectomy.