The British journal of surgery
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Comparative Study
Surgical stress after robot-assisted distal gastrectomy and its economic implications.
There is a lack of reports evaluating the outcomes of robotic gastrectomy and conventional laparoscopic surgery. The aim of this study was to compare the surgical stress response and costs of robot-assisted distal gastrectomy (RADG) with those of laparoscopy-assisted distal gastrectomy (LADG). ⋯ RADG did not reduce surgical stress compared with LADG. The substantial RADG costs due to robotic system expenses may not be justified.
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Bile acid signalling and farnesoid X receptor activation are assumed to be essential for liver regeneration. This study was designed to investigate the association between serum bile acid levels and extent of liver regeneration after major hepatectomy. ⋯ Initial liver regeneration after major hepatectomy was less after biliary drainage and was associated with serum bile acid levels. External biliary drainage should be used judiciously after liver resection.
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Review Meta Analysis Comparative Study
Systematic review and meta-analysis of duplex ultrasonography, contrast-enhanced ultrasonography or computed tomography for surveillance after endovascular aneurysm repair.
Previous analyses suggested that duplex ultrasonography (DUS) detected endoleaks after endovascular aneurysm repair (EVAR) with insufficient sensitivity; they did not specifically examine types 1 and 3 endoleak, which, if untreated, may lead to aneurysm-related death. In light of changes to clinical practice, the diagnostic accuracy of DUS and contrast-enhanced ultrasonography (CEUS) for types 1 and 3 endoleak required focused reappraisal. ⋯ Both CEUS and DUS were specific for detection of types 1 and 3 endoleak. Estimates of their sensitivity were uncertain but there was no evidence of a clinically important difference. DUS detects types 1 and 3 endoleak with sufficient accuracy for surveillance after EVAR.
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Randomized Controlled Trial
Randomized clinical trial on the influence of anaesthesia protocol on intestinal motility during laparoscopic surgery requiring small bowel anastomosis.
Hyperperistalsis of the small bowel during laparoscopic surgery may cause mucosal prolapse and reduce exposure, making laparoscopic suturing or stapling more demanding for the surgeon. Although it is commonly accepted that both opioids and volatile anaesthetics induce intestinal paralysis, intestinal hyperactivity during anaesthesia is not uncommon. This randomized trial investigated the effect of different volatile anaesthetics on intestinal motility and the impact on surgeon satisfaction. ⋯ B39620097060 (http://www.clinicaltrials.be).
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Surgery for small intestinal neuroendocrine tumours (SI-NETs) is limited by metastatic disease in most patients. However, resection of the primary lesion alone has been advocated in patients with unresectable liver metastases. The present systematic review investigated the value of surgical resection of the primary lesion in patients with unresectable metastatic disease. ⋯ Available data suggest a possible benefit of resection of the primary lesion in patients with unresectable liver metastases, but the studies have several limitations and the results should therefore be considered with caution.