Archives of surgery (Chicago, Ill. : 1960)
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Review Meta Analysis Comparative Study
Management of delayed postoperative hemorrhage after pancreaticoduodenectomy: a meta-analysis.
To determine whether interventional radiology (IR) or laparotomy (LAP) is the best management of delayed postoperative hemorrhage (DPH) after pancreaticoduodenectomy. Data Source We undertook an electronic search of MEDLINE and selected for analysis only original articles published between January 1, 1990, and December 31, 2007. ⋯ This meta-analysis, although based on data from small case series, is unable to demonstrate any significant difference between LAP and IR in the management of DPH after pancreaticoduodenectomy. The management of this life-threatening complication is difficult, and the appropriate treatment pathway ultimately will be decided by the clinical status of the patient and the institution preference.
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Randomized Controlled Trial Comparative Study
Occlusive vs gauze dressings for local wound care in surgical patients: a randomized clinical trial.
To compare effectiveness and costs of gauze-based vs occlusive, moist-environment dressing principles. ⋯ The occlusive, moist-environment dressing principle in the clinical surgical setting does not lead to quicker wound healing or less pain than gauze dressings. The lower costs of less frequent dressing changes do not balance the higher costs of occlusive materials. Trial Registration trialregister.nl Identifier: 56264738.
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Restrictive albumin use guidelines in the surgical intensive care unit (SICU) will not increase mortality and will result in cost savings. ⋯ The implementation of albumin use guidelines during critical care resuscitation using an educational approach in a SICU is associated with reduced albumin use, significant cost savings, and no negative impact on ICU outcome. Continued educational efforts promoting evidence-based practices in the ICU are warranted.
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Many surgeons believe that early mobilization of patients with blunt solid organ injuries increases the risk of delayed hemorrhage. ⋯ The timing of mobilization of patients with blunt solid organ injuries does not seem to contribute to delayed hemorrhage requiring laparotomy. Protocols incorporating periods of strict bed rest are unnecessary.
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Comparative Study
Portal vein ligation as an efficient method of increasing the future liver remnant volume in the surgical treatment of colorectal metastases.
To compare the volumetric increase of segments 2 and 3, segment 4, and the caudate lobe after portal vein ligation (PVL) and portal vein embolization (PVE). The small size of the remnant liver and chemotherapy-induced liver injury increase the risk of postoperative hepatic insufficiency after major hepatic resection for colorectal liver metastases. Portal vein ligation has been suggested to be less effective than embolization in inducing hypertrophy of the remnant liver. ⋯ Portal vein ligation is as effective as PVE in inducing hypertrophy of the remnant liver volume.