The Experts below are selected from a list of 40566 Experts worldwide ranked by ideXlab platform
Yusuke Akamaru - One of the best experts on this subject based on the ideXlab platform.
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subcuticular sutures versus staples for skin closure after open Gastrointestinal Surgery a phase 3 multicentre open label randomised controlled trial
The Lancet, 2013Co-Authors: Toshimasa Tsujinaka, Kazuyoshi Yamamoto, Junya Fujita, Shunji Endo, Junji Kawada, Shin Nakahira, Toshio Shimokawa, Shogo Kobayashi, Makoto Yamasaki, Yusuke AkamaruAbstract:Summary Background Staples have been widely used for skin closure after open Gastrointestinal Surgery. The potential advantages of subcuticular sutures compared with staples have not been assessed. We assessed the differences in the frequency of wound complications, including superficial incisional surgical site infection and hypertrophic scar formation, depending on whether subcuticular sutures or staples are used. Methods We did a multicentre, open-label, randomised controlled trial at 24 institutions between June 1, 2009, and Feb 28, 2012. Eligible patients aged 20 years or older, with adequate organ function and undergoing elective open upper or lower Gastrointestinal Surgery, were randomly assigned preoperatively to either staples or subcuticular sutures for skin closure. Randomisation was done via a computer-generated permuted-block sequence, and was stratified by institution, sex, and type of Surgery (ie, upper or lower Gastrointestinal Surgery). Our primary endpoint was the incidence of wound complications within 30 days of Surgery. Analysis was done by intention to treat. This study is registered with UMINCTR, UMIN000002480. Findings 1080 patients were enrolled and randomly assigned in a one to one ratio: 562 to subcuticular sutures and 518 to staples. 1072 were eligible for the primary endpoint and 1058 for the secondary endpoint. Of the 558 patients who received subcuticular sutures, 382 underwent upper Gastrointestinal Surgery and 176 underwent lower Gastrointestinal Surgery. Wound complications occurred in 47 of 558 patients (8·4%, 95% CI 6·3–11·0). Of the 514 who received staples, 413 underwent upper Gastrointestinal Surgery and 101 underwent lower Gastrointestinal Surgery. Wound complications occurred in 59 of 514 (11·5%, 95% CI 8·9–14·6). Overall, the rate of wound complications did not differ significantly between the subcuticular sutures and staples groups (odds ratio 0·709, 95% CI 0·474–1·062; p=0·12). Interpretation The efficacy of subcuticular sutures was not validated as an improvement over a standard procedure for skin closure to reduce the incidence of wound complications after open Gastrointestinal Surgery. Funding Johnson & Johnson.
Dn N Lobo - One of the best experts on this subject based on the ideXlab platform.
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enhanced recovery after Surgery eras for Gastrointestinal Surgery part 2 consensus statement for anaesthesia practice
Acta Anaesthesiologica Scandinavica, 2016Co-Authors: Aarne Feldheiser, Omer Aziz, Gabriele Baldini, B Cox, Kch C H Fearon, Ls S Feldman, Tj J Gan, Rh H Kennedy, Olle Ljungqvist, Dn N LoboAbstract:Background: The present interdisciplinary consensus review proposes clinical considerations and recommendations for anaesthetic practice in patients undergoing Gastrointestinal Surgery with an Enha ...
Toshimasa Tsujinaka - One of the best experts on this subject based on the ideXlab platform.
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subcuticular sutures versus staples for skin closure after open Gastrointestinal Surgery a phase 3 multicentre open label randomised controlled trial
The Lancet, 2013Co-Authors: Toshimasa Tsujinaka, Kazuyoshi Yamamoto, Junya Fujita, Shunji Endo, Junji Kawada, Shin Nakahira, Toshio Shimokawa, Shogo Kobayashi, Makoto Yamasaki, Yusuke AkamaruAbstract:Summary Background Staples have been widely used for skin closure after open Gastrointestinal Surgery. The potential advantages of subcuticular sutures compared with staples have not been assessed. We assessed the differences in the frequency of wound complications, including superficial incisional surgical site infection and hypertrophic scar formation, depending on whether subcuticular sutures or staples are used. Methods We did a multicentre, open-label, randomised controlled trial at 24 institutions between June 1, 2009, and Feb 28, 2012. Eligible patients aged 20 years or older, with adequate organ function and undergoing elective open upper or lower Gastrointestinal Surgery, were randomly assigned preoperatively to either staples or subcuticular sutures for skin closure. Randomisation was done via a computer-generated permuted-block sequence, and was stratified by institution, sex, and type of Surgery (ie, upper or lower Gastrointestinal Surgery). Our primary endpoint was the incidence of wound complications within 30 days of Surgery. Analysis was done by intention to treat. This study is registered with UMINCTR, UMIN000002480. Findings 1080 patients were enrolled and randomly assigned in a one to one ratio: 562 to subcuticular sutures and 518 to staples. 1072 were eligible for the primary endpoint and 1058 for the secondary endpoint. Of the 558 patients who received subcuticular sutures, 382 underwent upper Gastrointestinal Surgery and 176 underwent lower Gastrointestinal Surgery. Wound complications occurred in 47 of 558 patients (8·4%, 95% CI 6·3–11·0). Of the 514 who received staples, 413 underwent upper Gastrointestinal Surgery and 101 underwent lower Gastrointestinal Surgery. Wound complications occurred in 59 of 514 (11·5%, 95% CI 8·9–14·6). Overall, the rate of wound complications did not differ significantly between the subcuticular sutures and staples groups (odds ratio 0·709, 95% CI 0·474–1·062; p=0·12). Interpretation The efficacy of subcuticular sutures was not validated as an improvement over a standard procedure for skin closure to reduce the incidence of wound complications after open Gastrointestinal Surgery. Funding Johnson & Johnson.
B. Michael Ghadimi - One of the best experts on this subject based on the ideXlab platform.
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Standard perioperative management in Gastrointestinal Surgery
Langenbeck's Archives of Surgery, 2011Co-Authors: Marian Grade, Michael Quintel, B. Michael GhadimiAbstract:Introduction The outcome of patients who are scheduled for Gastrointestinal Surgery is influenced by various factors, the most important being the age and comorbidities of the patient, the complexity of the surgical procedure and the management of postoperative recovery. To improve patient outcome, close cooperation between surgeons and anaesthesiologists (joint risk assessment) is critical. This cooperation has become increasingly important because more and more patients are being referred to Surgery at an advanced age and with multiple comorbidities and because surgical procedures and multimodal treatment modalities are becoming more and more complex. Objective The aim of this review is to provide clinicians with practical recommendations for day-to-day decision-making from a joint surgical and anaesthesiological point of view. The discussion centres on Gastrointestinal Surgery specifically.
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Standard perioperative management in Gastrointestinal Surgery
Langenbeck's Archives of Surgery, 2011Co-Authors: Marian Grade, Michael Quintel, B. Michael GhadimiAbstract:Introduction The outcome of patients who are scheduled for Gastrointestinal Surgery is influenced by various factors, the most important being the age and comorbidities of the patient, the complexity of the surgical procedure and the management of postoperative recovery. To improve patient outcome, close cooperation between surgeons and anaesthesiologists (joint risk assessment) is critical. This cooperation has become increasingly important because more and more patients are being referred to Surgery at an advanced age and with multiple comorbidities and because surgical procedures and multimodal treatment modalities are becoming more and more complex.
Michael F Gerhards - One of the best experts on this subject based on the ideXlab platform.
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randomized clinical trial of perioperative selective decontamination of the digestive tract versus placebo in elective Gastrointestinal Surgery
British Journal of Surgery, 2011Co-Authors: Daphne Roos, Lea M Dijksman, H Oudemansvan M Straaten, L T De Wit, D J Gouma, Michael F GerhardsAbstract:Background: This randomized clinical trial analysed the effect of perioperative selective decontamination of the digestive tract (SDD) in elective Gastrointestinal Surgery on postoperative infectious complications and leakage. Methods: All patients undergoing elective Gastrointestinal Surgery during a 5-year period were evaluated for inclusion. Randomized patients received either SDD (polymyxin B sulphate, tobramycin and amphotericin) or placebo in addition to standard antibiotic prophylaxis. The primary endpoint was postoperative infectious complications and anastomotic leakage during the hospital stay or 30 days after Surgery. Results: A total of 289 patients were randomized to either SDD (143) or placebo (146). Most patients (190, 65·7 per cent) underwent colonic Surgery. There were 28 patients (19·6 per cent) with infectious complications in the SDD group compared with 45 (30·8 per cent) in the placebo group (P = 0·028). The incidence of anastomotic leakage in the SDD group was 6·3 per cent versus 15·1 per cent in the placebo group (P = 0·016). Hospital stay and mortality did not differ between groups. Conclusion: Perioperative SDD in elective Gastrointestinal Surgery combined with standard intravenous antibiotics reduced the rate of postoperative infectious complications and anastomotic leakage compared with standard intravenous antibiotics alone. Perioperative SD.D should be considered for patients undergoing Gastrointestinal Surgery. Registration number: P02.1187L (Dutch Central Committee on Research Involving Human Subjects). Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
