Surgery
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Randomized Controlled Trial Comparative Study
Comparison between oral antibiotics and probiotics as bowel preparation for elective colon cancer surgery to prevent infection: prospective randomized trial.
We have already reported that, for patients undergoing elective colon cancer operations, perioperative infection can be prevented by a single intravenous dose of an antibiotic given immediately beforehand if mechanical bowel preparation and the administration of oral antibiotics are implemented. Synbiotics has been reported to reduce the rate of infection in patients after pancreatic cancer operations. The effectiveness of oral antibiotics and probiotics in preventing postoperative infection in elective colon cancer procedures was examined in a randomized controlled trial. ⋯ We recommend oral antibiotics, rather than probiotics, as bowel preparation for elective colon cancer procedures to prevent surgical-site infections.
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Clinical Trial
Recurrent laryngeal nerve palsy during surgery for benign thyroid diseases: risk factors and outcome analysis.
We investigated the risk factors for postoperative recurrent laryngeal nerve (RLN) palsy and related outcomes in patients with benign thyroid diseases. ⋯ Complete resection of the thyroid lobe and reoperation for postoperative bleeding are the risk factors for postoperative RLN palsy in patients with benign thyroid nodules. In Graves' disease, smaller weight of the residual thyroid tissue contributes to the occurrence of RLN palsy. Most RLN palsies that do not require amputation of the nerve resolve spontaneously within 12 months after surgery. In this study, the palsy remained in 1.3% (11/844) of patients.
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It remains unclear whether primary colorectal cancer and synchronous liver metastases (SLMs) should be resected simultaneously or with a staged procedure. ⋯ Simultaneous resection can be performed safely in patients with colorectal cancer and SLM.
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Evidence suggests that statins may decrease inflammation, airway hyperreactivity, and hypercoagulability while improving revascularization mediated by cholesterol-independent pathways. This study evaluated whether the preoperative use of statins is associated with decreased postoperative major noncardiac complications in noncardiac procedures. ⋯ The preoperative use of statins is independently associated with decreased risk of major complications. This effect is likely driven by reduction in respiratory, VTE, and infectious complication rates. These results warrant future clinical trials to assess the perioperative benefit of statin use in noncardiac procedures.
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In 2011, the International Study Group of Liver Surgery defined posthepatectomy liver failure using the prothrombin time-international normalized ratio (PT-INR) and total serum bilirubin concentration (T-Bil). Data analyzing the clinical impact of PT-INR and T-Bil on postoperative mortality, however, remain limited, especially for major hepatectomy with extrahepatic bile duct resection (HEBR). ⋯ We recommend monitoring both PT-INR and T-Bil to predict accurately which patients are at a high risk after HEBR.