Surgery
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Randomized Controlled Trial
Randomized phase II study of clinical effects of ghrelin after esophagectomy with gastric tube reconstruction.
Ghrelin is a peptide hormone with pleiotropic functions including stimulation of growth hormone secretion and appetite, and its levels decrease after esophagectomy. The aim of this study was to evaluate whether exogenous ghrelin administration can meliorate the postoperative decrease of oral food intake and body weight, which are serious complications after esophagectomy. ⋯ These preliminary results suggest that administration of ghrelin after esophagectomy increased oral food intake and attenuated weight loss together with maintenance of lean body weight.
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Randomized Controlled Trial
Restricted peri-operative fluid administration adjusted by serum lactate level improved outcome after major elective surgery for gastrointestinal malignancy.
Our objective was to compare the effect of a restricted intravenous fluid regimen adjusted by serum lactate level with a standard restricted regimen on complications after major elective surgery for gastrointestinal malignancy. ⋯ A fluid-restricted regimen after elective gastrointestinal operations for malignancy may lead to fluid insufficiency and low tissue perfusion in up to 28% of patients. Close monitoring of serum lactate levels with adjustment of intravenous fluid administration intraoperatively and in the early postoperative period may improve the early detection and correction of inadequate tissue perfusion, thereby decreasing the rate of complications.
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Randomized Controlled Trial
Repeated intraperitoneal instillation of levobupivacaine for the management of pain after laparoscopic cholecystectomy.
Laparoscopic cholecystectomy is the treatment of choice for symptomatic cholelithiasis. Postoperative pain, however, can prolong hospital stay and lead to increased morbidity. In the context of a multimodal approach to analgesia, intraperitoneal local anesthetic administration optimizes analgesia and facilitates early postoperative recovery, and it may be associated with a decreased risk of side effects. ⋯ Our study showed that 2 separate doses of intraperitoneally administered levobupivacaine significantly decreased postoperative pain and the need for opioids compared with placebo. This technique is simple, safe, and without adverse effects.
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Randomized Controlled Trial Comparative Study
Comparison of expert instruction and computer-based video training in teaching fundamental surgical skills to medical students.
Practice using computer-based video instruction (CBVI) leads to improvements in surgical skills proficiency. This study investigated the benefits of the introduction of (a) learner-directed, interactive video training and (b) the addition of expert instruction on the learning and retention of the basic surgical skills of suturing and knot-tying in medical students. ⋯ This study shows that in surgical novices, neither the inclusion of expert instruction nor the addition of self-directed interaction with video leads to further improvements in skill development or retention. These findings further support the possible implementation of CBVI within surgical skills curricula.
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Randomized Controlled Trial Comparative Study
Laparoscopic extraperitoneal inguinal hernia repair versus open mesh repair: long-term follow-up of a randomized controlled trial.
We have conducted a randomized controlled trial of totally extraperitoneal hernia repair (TEP) versus tension-free open repair (Lichtenstein repair); we have presented the results previously up to 1 year after the operation. The aim of this study was to compare patient outcome in both groups at a median follow-up of 7.3 years after operation. ⋯ Overall, both groups showed good long-term results with low rates of recurrences. However, the TEP group was associated with a higher proportion of patients with long-term testicular pain, whereas impaired inguinal sensibility was more common in the open group.