Annals of surgery
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Meta Analysis
A meta-analysis of outcomes following use of somatostatin and its analogues for the management of enterocutaneous fistulas.
Several randomized control trials (RCTs) have compared somatostatin and its analogues versus a control group in patients with enterocutaneous fistulas (ECF). This study meta-analyzes the literature and establishes whether it shows a beneficial effect on ECF closure. ⋯ Somatostatin and octreotide increase the likelihood of fistula closure. Both are beneficial in reducing the time to fistula closure. Neither has an effect on mortality. The risk ratio (RR) for somatostatin was higher than the RR for analogues. This may suggest that somatostatin could be better than analogues in relation to the number of fistulas closed and time to closure. Further studies are required to corroborate these apparent findings.
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We conducted a systematic review of published literature to gain a better understanding of the impact of advanced fellowships on surgical resident training and education. ⋯ The overall impact of advanced surgical fellowships on surgical resident education and training remains unclear, as most studies rely on limited data of questionable generalizability. A careful study of the national database of surgery resident case logs is essential to better understand how early surgical specialization and fellowships will impact the future of general surgery education.
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Randomized Controlled Trial Comparative Study
Long-term outcomes of the australasian randomized clinical trial comparing laparoscopic and conventional open surgical treatments for colon cancer: the Australasian Laparoscopic Colon Cancer Study trial.
: We report a multicentered randomized controlled trial across Australia and New Zealand comparing laparoscopic-assisted colon resection (LCR) with open colon resection (OCR) for colon cancer. ⋯ : In spite of some differences in short-term surrogate oncological markers, LCR was not inferior to OCR in direct measures of survival and disease recurrence. These findings emphasize the importance of long-term data in formulating evidence-based practice guidelines.
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Little is known about how quality of life (QOL) changes over time after gastrectomy. We prospectively examined changes of QOL in Korean patients with gastric cancer after curative resection. ⋯ Our findings show that there are various functional and symptomatic problems, which health care providers need to manage during the postsurgical period. We need to continuously address fatigue, diarrhea, dysphagia, eating restrictions, body image disturbance, and cognitive functioning. In addition, it would be necessary to inform patients about possible QOL outcomes while they are receiving information about surgery and signing informed consent for surgery.
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Case Reports
Extracorporeal life support for pancreatitis-induced acute respiratory distress syndrome.
Adult respiratory distress syndrome (ARDS) secondary to acute pancreatitis is associated with a poor prognosis. We hypothesized that extracorporeal life support (ECLS) may be an effective treatment option for the most severe cases of pancreatitis-induced ARDS. ⋯ ECLS is useful in treating severe pancreatitis-induced ARDS. Pancreatic debridement can be performed during ECLS, using a comprehensive protocol to minimize bleeding complications.