Evidence Based Surgery
Much of we do in surgery is based on experience, knowledge and training
passed on from seniors, and reports from established reputable centers.
If one asks a group of surgeons how to manage a patient, one may probably
get as many different answers. Evidence based surgery is a move to find
the most appropriate way of managing patients using clinical evidence
from collected studies.
Primary repair for Penetrating Colon Injuries
(Five randomized control trials, evaluated mortality, total complications,
infectious complications, penetrating abdominal trauma index
PATI, and the length of hospital stay.)
Abdominal infections including dehiscence significantly favor primary
repair. The reviewers conclude that Primary repair may be safer than
repair with faecal diversion.
Surgery for Intestinal Obstruction in Advanced Gynecological and Gastrointestinal
Remains controversial. There is a large range of re obstruction from
10 to 50%.
Role of surgery needs careful evaluation, using validated outcome of
symptoms control and quality of life scores.
There needs to be greater standardization of management so that comparison
between different series can be made.
Antibiotic Prophylaxis for Cirrhotic Patients with Gastrointestinal
(Eight trials in 864 patients Placebo verses Antibiotic, Three
trials in 503 patients with different regime of antibiotics)
Efficacious in reducing the number of deaths and bacterial factors
are well tolerated and should be advocated.
Enteral Verses Parenteral Nutrition for Acute Pancreatitis
(Cochraine Controlled Trials Register, Medline, EMBASE)
Information was collected on death, hospital stay, systemic infection,
local septic and other complications.)
Although there is a trend towards reduction in the adverse outcomes
of acute pancreatitis after administration of enteral nutrition , clearly
there are insignificant data to draw firm conclusion verses TPN. Further
trials are required with sufficient size to account for clinical heterogeneity
and measure all relevant outcomes.