Langenbeck's archives of surgery
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Langenbecks Arch Surg · Sep 2021
Omitting nasogastric tube placement after gastrectomy does not enhance postoperative recovery: a propensity score matched analysis.
Enhanced recovery after surgery (ERAS) program has become the main trend in gastrointestinal surgery. This study aims to investigate factors influencing the decision-making of nasogastric tube (NGT) placement and its safety and efficacy after gastrectomy. ⋯ The decision-making of NGT placement is mainly influenced by the resection range. Omitting NGT is a safe approach in all types of gastrectomy but was not able to enhance the recovery in our practice.
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The delivery of surgical care in England has seen a momentum towards centralisation within larger volume hospitals and surgical teams. The aim of this study was to investigate outcomes in England in relationship to hospital and surgeon annual volumes for total thyroidectomy. ⋯ There is significant correlation between surgeon volume and clinical outcome for total thyroidectomy. The relationship was approximately linear, and a low-volume threshold could not be defined.
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Langenbecks Arch Surg · Aug 2021
Meta AnalysisLaparoscopic versus robotic right colectomy with extra-corporeal or intra-corporeal anastomosis: a systematic review and meta-analysis.
The aim of the present systematic review and meta-analysis is to compare laparoscopic right colectomy (LRC) versus robotic right colectomy (RRC) using homogeneous subgroup analyses for extra-corporeal anastomosis (EA) and intra-corporeal anastomosis (IA). ⋯ Most included articles are retrospective, providing low-quality evidence and limiting conclusions. The more frequent use of the IA seems to explain the advantages of RRC over LRC.
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Langenbecks Arch Surg · Jun 2021
Meta AnalysisEffects of preoperative oral carbohydrate on postoperative discomfort in patients undergoing elective surgery: a meta-analysis of randomized controlled trials.
Fasting is a standard preoperative procedure performed to prevent vomiting and pulmonary aspiration during anaesthesia and surgery. However, fasting can cause postoperative physical and psychological discomfort. Intake of oral carbohydrate (CHO) may mimic the intake of food, which prevents postoperative discomfort. We conducted a meta-analysis to evaluate the effect and safety of preoperative oral CHO in adult surgical patients. ⋯ Preoperative CHO can alleviate patient's discomfort without safety concerns. Surgeons and anaesthesiologists should strongly promote preoperative CHO as a strategy to enhance recovery after surgery protocols.
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Langenbecks Arch Surg · Mar 2021
ReviewQuantification of fluorescence angiography: Toward a reliable intraoperative assessment of tissue perfusion - A narrative review.
Accurate intraoperative assessments of tissue perfusion are essential in all forms of surgery. As traditional methods of perfusion assessments are not available during minimally invasive surgery, novel methods are required. Here, fluorescence angiography with indocyanine green has shown promising results. However, to secure objective and reproducible assessments, quantification of the fluorescent signal is essential (Q-ICG). This narrative review aims to provide an overview of the current status and applicability of Q-ICG for intraoperative perfusion assessment. ⋯ Intraoperative Q-ICG is clinically available; however, only feasibility studies have been performed, rendering an excellent usability score. Q-ICG in a post-operative setting could detect changes in perfusion following a range of interventions and reflect clinical endpoints, but only if based on inflow parameters. Thus, future studies should include the methodology outlined in this review, emphasizing the use of inflow parameters (slope or T1/2max), a mass-adjusted ICG dosing, and a fixed camera position.