The British journal of surgery
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Bile duct injury is a serious complication following liver resection. Few studies have differentiated between leakage from small peripheral bile ducts and central bile duct injury (CBDI), defined as an injury leading to leakage or stenosis of the common bile duct, common hepatic duct, right or left hepatic duct. This study analysed the incidence, risk factors and consequences of CBDI in liver resection. ⋯ Patients undergoing extended left hemihepatectomy or repeat hepatectomy were at increased risk of CBDI.
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Sentinel lymph node (SLN) biopsy has replaced axillary lymph node dissection (ALND) as the standard axillary staging procedure in breast cancer. Follow-up studies in SLN-negative women treated without ALND report low rates of axillary recurrence, but most studies have short follow-up, and few are multicentre studies. ⋯ This study confirmed the low risk of axillary recurrence 5 years after SLNB for breast cancer without ALND.
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Randomized Controlled Trial
Randomized clinical trial of fluid restriction in colorectal surgery.
Perioperative fluid therapy can influence postoperative hospital stay and complications after elective colorectal surgery. This trial was designed to examine whether an extremely restricted perioperative fluid protocol would reduce hospital stay beyond the existing fast-track hospital time of 7 days after surgery. ⋯ Restricted perioperative intravenous fluid administration does not reduce length of stay in a fast-track protocol.
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Randomized Controlled Trial Multicenter Study
Selective decontamination of the oral and digestive tract in surgical versus non-surgical patients in intensive care in a cluster-randomized trial.
Selective digestive decontamination (SDD) and selective oropharyngeal decontamination (SOD) are effective in improving survival in patients under intensive care. In this study possible differential effects in surgical and non-surgical patients were investigated. ⋯ Subgroup analysis found similar effects of SDD in reducing mortality in surgical and non-surgical ICU patients, whereas SOD reduced mortality only in non-surgical patients. The hypothesis-generating findings mandate investigation into mechanisms between different ICU populations.
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Early warning scores (EWS) may aid the prediction of major adverse events in hospitalized patients. Recently, an expanded EWS was introduced in the Netherlands. The aim of this study was to assess the relationship between this EWS and the occurrence of major adverse clinical events during hospitalization of patients admitted to a general and trauma surgery ward. ⋯ An EWS of 3 or more is an independent predictor of major adverse events in patients admitted to a general and trauma surgery ward.