The British journal of surgery
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Randomized Controlled Trial Multicenter Study
Randomized clinical trial of sacral nerve stimulation for refractory constipation.
Open studies have reported favourable results for sacral nerve stimulation in the treatment of refractory constipation. Here, its efficacy was assessed in a double-blind crossover RCT. ⋯ These results do not support the recommendation of permanent implantation of a pulse generator in patients with refractory constipation who initially responded to temporary nerve stimulation. Registration number: NCT01629303 (http://www.clinicaltrials.gov).
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Comparative Study
Indications for major hepatectomy and combined procedures for advanced gallbladder cancer.
The clinical impact of major hepatectomy for advanced gallbladder cancer is currently unclear. ⋯ Major hepatectomy combined with portal vein resection or pancreatoduodenectomy, if necessary, may be considered in the treatment of advanced gallbladder cancer, especially in selected patients without liver metastasis or hepatic arterial invasion.
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RCTs testing surgical interventions can change clinical practice. The adequate reporting of surgical trials is an important issue. ⋯ The quality of reporting in surgical trials has improved in the past decade. Overall quality, however, remains suboptimal, particularly in relation to details regarding surgical interventions and management.
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Review Meta Analysis
Meta-analysis of prophylactic mesh to prevent parastomal hernia.
Rates of parastomal hernia following stoma formation remain high. Previous systematic reviews suggested that prophylactic mesh reduces the rate of parastomal hernia; however, a larger trial has recently called this into question. The aim was to determine whether mesh placed at the time of primary stoma creation prevents parastomal hernia. ⋯ Mesh placed prophylactically at the time of stoma creation reduced the rate of parastomal hernia, without an increase in mesh-related complications.
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Multicenter Study Clinical Trial
Ten-year report on axillary recurrence after negative sentinel node biopsy for breast cancer from the Swedish Multicentre Cohort Study.
The omission of axillary lymph node dissection (ALND) in patients with breast cancer with a negative finding on sentinel node biopsy (SNB) has reduced arm morbidity substantially. Early follow-up reports have shown the rate of axillary recurrence to be significantly lower than expected, with a median false-negative rate of 7 per cent for SNB. Long-term follow-up is needed as recurrences may develop late. ⋯ The risk of axillary recurrence remains lower than expected after a negative finding on SNB at 10-year follow-up. Axillary recurrences may occur long after primary surgery, and lead to a significant risk of breast cancer death.