This randomized clinical trial assesses the efficacy and safety of standard gastric bypass vs distal gastric bypass in patients with a BMI of 50 to 60.
This randomized clinical trial reports that in patients with a body mass index of 50 to 60 kg/m2, duodenal switch resulted in greater weight loss and greater improvements in low-density lipoprotein cholesterol, triglycerides, and glucose 5 years after surgery compared with gastric bypass while improvements in health-related quality of life were similar.
To study the impact of different adherence levels to the enhanced recovery after surgery (ERAS) protocol and the effect of various ERAS elements on outcomes following major surgery.
Single-center prospective cohort study before and after reinforcement of an ERAS protocol. Comparisons were made both between and across periods using multivariate logistic regression. All clinical data (114 variables) were prospectively recorded.
Ersta Hospital, Stockholm, Sweden.
Nine hundred fifty-three consecutive patients with colorectal cancer: 464 patients treated in 2002 to 2004 and 489 in 2005 to 2007.
The association between improved adherence to the ERAS protocol and the incidence of postoperative symptoms, complications, and length of stay following major colorectal cancer surgery was analyzed.
Following an overall increase in preoperative and perioperative adherence to the ERAS protocol from 43.3% in 2002 to 2004 to 70.6% in 2005 to 2007, both postoperative complications (odds ratio, 0.73; 95% confidence interval, 0.55-0.98) and symptoms (odds ratio, 0.53; 95% confidence interval, 0.40-0.70) declined significantly. Restriction of intravenous fluid and use of a preoperative carbohydrate drink were major independent predictors. Across periods, the proportion of adverse postoperative outcomes (30-day morbidity, symptoms, and readmissions) was significantly reduced with increasing adherence to the ERAS protocol (>70%, >80%, and >90%) compared with low ERAS adherence (<50%).
Improved adherence to the standardized multimodal ERAS protocol is significantly associated with improved clinical outcomes following major colorectal cancer surgery, indicating a dose-response relationship.
To perform a literature review examining the comparative benefits of laparoscopic vs open hepatic resection and to define the benefits and outcomes of laparoscopic liver resection in our own series of 314 patients.
Cited English-language publications from PubMed. In addition, between 2001 to 2010, hepatic resections were performed in our institution in 1294 patients, of whom 314 patients (24.3%) underwent laparoscopic liver resection for benign or malignant liver lesions.
Search phrases were “laparoscopic liver resection,” “open liver resection,” “versus,” “compared with,” and “advantages.”
Thirty-one studies were reviewed that directly compared laparoscopic with open hepatic resection in 2473 patients.
In case-cohort matched studies, and our institutional series, laparoscopic liver resection was associated with less blood loss, quicker resumption of oral diet, less pain medication requirement, and shorter length of stay, with no difference in complication rates. In those patients undergoing laparoscopic hepatic resection for malignancy, there was no difference in 3- or 5-year overall survival when compared with well-matched open hepatic resection cases. Financially, the total hospital costs of laparoscopic liver resection were either offset or improved because of a shorter length of stay.
Based on review of the literature and our institutional series, minimally invasive hepatic resection for benign and malignant liver lesions is safe and feasible with significant benefits for patients consisting of less blood loss, less narcotic requirements, and shorter length of hospital stay. There are no economic disadvantages to the laparoscopic approach, and case-cohort matched studies show no difference in oncologic outcomes between the laparoscopic and open groups.