J Visc Surg
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ERAS programs are based on a combination of perioperative measures with a proven efficacy, that combined with each other lead to an enhanced recovery after surgery through a synergistic pathway. Such programs help to decrease postoperative morbidity and to reduce length of hospital stay. Beside immunonutrition, carbohydrate loading until 2 hours before surgery and early postoperative oral feeding are safe and allows enhanced recovery after surgery.
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Gastrointestinal surgery is feasible in patients with Child A cirrhosis, but is associated with higher morbidity and mortality. Hernia repair, biliary and colonic surgery are the most frequently performed interventions in this context. Esophageal and pancreatic surgery are more controversial and less frequently performed. ⋯ During emergency surgery, histologic diagnosis of cirrhosis should be confirmed by liver biopsy because the histologic diagnosis has therapeutic and prognostic implications. The management of patients with Child A cirrhosis without portal hypertension is little different from the management of patients without cirrhosis. However, the management of patients with Child B or C cirrhosis or with portal hypertension is more complex and requires an accurate assessment of the balance of benefit vs. risk for surgical intervention on a case-by-case basis.
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Imaging detection of liver cancers and identification of the bile ducts during surgery, based on the fluorescence properties of indocyanine green, has recently been developed in liver surgery. The principle of this imaging technique relies on the intravenous administration of indocyanine green before surgery and the illumination of the surface of the liver by an infrared camera that simultaneously induces and collects the fluorescence. ⋯ Results suggest that indocyanine green fluorescence imaging is capable of identification of new liver cancers and enables the characterization of known hepatic lesions in real time during liver resection. The purpose of this paper is to present the fundamental principles of fluorescence imaging detection, to describe successively the practical and technical aspects of its use and the appearance of hepatic lesions in fluorescence, and to expose the diagnostic and therapeutic perspectives of this innovative imaging technique in liver surgery.
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Endpoints are measurable clinical and biological findings that are used for the development and assessment of treatment options. In the treatment of cancer, endpoints can be classified into two categories: "patient-centered clinical endpoints" including overall survival (OS) and health-related quality of life (QoL), and "tumor-centered clinical endpoints" such as progression-free survival. Surrogate endpoints are tumor-centered clinical endpoints that can be used as substitutes for patient-centered clinical endpoints, particularly OS. ⋯ In addition, the variability of their definition can strongly impact the trial's conclusions by affecting both statistical power and estimation. In this context, QoL constitutes an available and useful surrogate endpoint for trials to ensure treatment benefit from both the patient and public health points of view. Methodological research should be pursued to develop standard outcome definitions for use in cancer clinical trials and to define a standardized longitudinal analysis of QoL data.
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Ambulatory management is a modality of care defined in France by a hospitalization of less than 12h without an overnight stay. Currently, few data are available on its role in the management of gastrointestinal emergencies, such as appendectomy for acute appendicitis, cholecystectomy for acute cholecystitis or emergency proctologic surgery. The aim of this systematic review was to study the published data regarding the feasibility of ambulatory management of emergency visceral surgery and to enquire about the possibilities of further development of this form of management. ⋯ Ambulatory management has been sparingly studied in the setting of gastrointestinal surgical emergencies. However, there is probably a place for development of this form of management.