Zentralblatt für Chirurgie
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Randomized Controlled Trial Comparative Study
[Postoperative pain in the acute phase after surgery: VATS lobectomy vs. open lung resection - results of a prospective randomised trial].
Minimally invasive procedures, e.g. video-assisted thoracoscopic lobectomy, are less traumatic and thus one may expect a lower level of postoperative pain compared to open procedures. This assumption is supported by several studies/metaanalyses. However, confirmation by larger prospective randomised studies is lacking. In the present study we analysed 2 groups of patients with lobectomy for early-stage lung cancer performed by VATS or by antero-lateral thoracotomy. ⋯ Regardless of procedure (VATS vs. open) pain control can be achieved with an adequate analgetic regime. For VATS during the first days a lower amount of medication is required. The VATS group showed a higher proportion of patients with very low postoperative pain profile: patients with pain score always under 4 and patients without pain at certain points before the 10th postoperative day or at discharge.
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Randomized Controlled Trial Comparative Study
[Liberalisation of preoperative fasting guidelines: effects on patient comfort and clinical practicability during elective laparoscopic surgery of the lower abdomen].
In this study, the recently liberalised national guidelines for preoperative fasting were evaluated from the view point of the patients and according to their clinical usability. ⋯ The liberation of the national guidelines for preoperative fluid administration with unlimited intake of a carbohydrate drink offers the benefit of a significantly lower incidence of the preoperative item "feeling cold" and of the pre- and postoperative item "thirst / having a dry mouth". However, in daily clinical practice the length of fasting for fluids was conspicuously longer than that postulated by the new recommendations.
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Randomized Controlled Trial Comparative Study
[Efficacy of treatment with Repithel and Jelonet in comparison to treatment with Jelonet alone - a randomized clinical trial in patients receiving meshed skin grafts].
Moist wound treatment is a well recognized method for the treatment of aseptic acute and chronic wounds. While the moist environment is beneficial to the woundhealing process, it also increases the risk of bacterial superinfection. We here report on the results of a clinical phase-III-study in which we tested the effect of a new PVP-iodine liposomal hydrogel (Repithel) on split-thickness skin grafts. This formulation optimizes moist wound treatment by improving the cell proliferation rate while preventing wound infection. ⋯ Repithel supports healing of meshgraft transplants and reduces the risk of graft loss. Patients who heal poorly benefit particularly from the Repithel treatment.
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Randomized Controlled Trial Comparative Study
[Value of laparoscopic surgery in elective colorectal surgery with "fast-track"-rehabilitation].
Laparoscopic (LAP) versus open (CON) colonic resection with traditional perioperative care has some short term benefits postoperatively regarding functional recovery. Whether these benefits may also occur when all patients are treated with multimodal "fast-track"-rehabilitation programs is questionable. ⋯ Even with perioperative "fast-track"-rehabilitation programs short term advantages were found in laparoscopic compared with open colonic surgery in a non randomised population. The clinical relevance should be examined in controlled randomised trials.
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Randomized Controlled Trial
[Influence of laparoscopic or conventional colorectal resection on postoperative quality of life].
In a prospective randomised study the influence of the operative technique on postoperative quality of life was evaluated in 60 patients undergoing laparoscopic (n = 30) or conventional (n = 30) resection of colorectal tumors. Quality of life was assessed using the European Organisation for Research and Treatment of Cancer Quality of Life Core 30 Questionnaire (EORTC-QLQ-C30) before surgery as well as 1 week, 4 weeks and 3 months after surgery. Age, sex, sociological parameters, tumor characteristics and type of resection were comparable in both groups. ⋯ Pain, dyspnea and loss of appetite were more severe 1 week after conventional than laparoscopic surgery (each p < 0.05). There were no differences in quality of life in the further postoperative course. Laparoscopic resection of colorectal tumor is related with a better short-term quality of life than conventional resection, but a longer lasting effect of the laparoscopic technique on quality of life could not be detected with the EORTC-QLQ-C30.