Annals of surgery
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Comparative Study Clinical Trial
Intestinal permeability and systemic endotoxemia after laparotomic or laparoscopic cholecystectomy.
Because laparoscopic cholecystectomy (LC) is widely recognized as a "mild" or "mini-invasive" kind of surgery, in this prospective nonrandomized study, we investigated the effect of intestinal manipulation on intestinal permeability and endotoxemia, in patients undergoing elective cholecystectomy by comparing the laparoscopic with the laparotomic approach. ⋯ An increase in intestinal permeability and a greater degree of systemic endotoxemia are observed during laparotomic cholecystectomy. This suggests that intestinal manipulation may impair gut mucosal barrier function and contribute to the systemic inflammatory response see in open cholecystectomy.
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Comparative Study
Two hundred forty consecutive portal vein embolizations before extended hepatectomy for biliary cancer: surgical outcome and long-term follow-up.
To assess clinical benefit of portal vein embolization (PVE) before extended, complex hepatectomy for biliary cancer. ⋯ PVE has the potential benefit for patients with advanced biliary cancer who are to undergo extended, complex hepatectomy. Along with the use of PVE, further improvements in surgical techniques and refinements in perioperative management are necessary to make difficult hepatobiliary resections safer.
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We sought to develop a simple yet accurate prognostic scoring system to determine the severity of acute pancreatitis at admission. ⋯ The prognostic ability of the BALI 4-variable model was similar to the Ranson, Glasgow, and APACHE II systems but is unique in its simplicity and ability to accurately predict disease severity when used at admission or anytime during the first 48 hours of hospitalization.
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Editorial Comment
To simulate or not to simulate: what is the question?