The British journal of surgery
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The purpose of this study was to investigate the prevalence of lower extremity amputation in England, to establish the associated mortality, and to determine the relationship with diabetes mellitus and previous revascularization. ⋯ Major and minor amputation rates were stable across England between 2003 and 2008, accompanied by a significant reduction in perioperative mortality. There were significant geographical variations in amputation rates, mortality rates and the below-knee : above-knee amputation ratio.
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Review Meta Analysis Comparative Study
Systematic review and meta-analysis of laparoscopic Nissen (posterior total) versus Toupet (posterior partial) fundoplication for gastro-oesophageal reflux disease.
Laparoscopic Nissen fundoplication (LNF) is currently considered the surgical approach of choice for gastro-oesophageal reflux disease (GORD). Laparoscopic Toupet fundoplication (LTF) has been said to reduce troublesome dysphagia and gas-related symptoms. A systematic review and meta-analysis of randomized clinical trials (RCTs) was performed to compare LNF and LTF. ⋯ LTF reduces postoperative dysphagia and dilatation for dysphagia compared with LNF. Reoperation rate and prevalence of gas-related symptoms were lower after LTF, with similar reflux control. These results provide level 1a support for the use of LTF as the posterior fundoplication of choice for GORD.
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Multicenter Study
Combined first-stage hepatectomy and colorectal resection in a two-stage hepatectomy strategy for bilobar synchronous liver metastases.
This study assessed the feasibility and outcomes of combined colorectal and hepatic resection as the first step of two-stage hepatectomy in patients with bilobar synchronous colorectal liver metastases. ⋯ In patients with bilobar synchronous colorectal liver metastases who are candidates for two-stage hepatectomy, combined resection of the primary tumour and first-stage hepatectomy reduces the number of procedures, optimizes chemotherapy administration and may improve outcome.
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Comparative Study
Short-term outcomes with intrathecal versus epidural analgesia in laparoscopic colorectal surgery.
Epidural analgesia is the mainstay of perioperative pain management in enhanced recovery programmes. This study compared short-term outcomes following epidural or intrathecal analgesia in patients undergoing elective laparoscopic colorectal surgery. ⋯ Intrathecal analgesia may have advantages over epidural analgesia in patients undergoing laparoscopic colorectal surgery.