Annals of surgery
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Randomized Controlled Trial Multicenter Study Comparative Study
HAnd Suture Versus STApling for Closure of Loop Ileostomy (HASTA Trial): results of a multicenter randomized trial (DRKS00000040).
The objective of the HASTA trial was to compare hand suture versus stapling loop ileostomy closure in a randomized controlled trial. ⋯ Hand-sewn anastomosis versus stapler ileo-ileostomy for ileostomy closure are equally effective in terms of postoperative bowel obstruction, with stapler anastomosis leading to a shorter operation time. Postoperative ileus after ileostomy reversal remains a relevant complication.
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Comparative Study
A survival analysis of the liver-first reversed management of advanced simultaneous colorectal liver metastases: a LiverMetSurvey-based study.
Liver-first reversed management (RM) for the treatment of patients with simultaneous colorectal liver metastases (CRLM) includes liver-directed chemotherapy, the resection of the CRLM, and the subsequent resection of the primary cancer. Retrospective data have shown that up to 80% of patients can successfully undergo a complete RM, whereas less than 30% of those undergoing classical management (CM) do so. This registry-based study compared the 2 approaches. ⋯ Classical and reversed managements of metastatic liver disease in colorectal cancer are associated with similar survival when successfully completed.
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To evaluate at a national level the incidence of liver resection, postoperative mortality, and variables that predict this outcome. ⋯ There were significant disparities in practice. In-hospital mortality underestimated true, postoperative mortality by more than 50%. The model created may be useful for more efficient regionalization of care and patient counseling.
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To integrate the amount of hepatic steatosis in modern liver allocation models. ⋯ Microsteatotic or 30% or less macrosteatotic liver grafts can be used safely up to BAR score of 18 or less, but liver grafts with more than 30% macrosteatotis should be used with risk adjustment, that is, up to BAR score of 9 or less.
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Low colorectal (LCRA) and coloanal anastomoses (CAA) are associated with high leakage rate. After such complication, around 17% of patients remain with their stoma. Treatment of failed LCRA and CAA is not frequently proposed. The aim of this study was to evaluate the results of redo surgery in such patients. ⋯ After failed LCRA or CAA, redo anastomosis has a high success rate and acceptable morbidity and function.