Scientific Surgery

Abstract

Over 3000 patients were randomized in a four-way trial that tested whether various doses of metoclopramide gave additional benefit to dexamethasone prophylaxis. The addition of 50 mg metoclopramide produced the lowest rate of postoperative nausea and vomiting (14·5 per cent). There were no differences to the procedure, or complication rates during follow-up to 53 months in this trial that included 139 patients. Early results were better with the Ligasure procedure in this trial that included 84 procedures. The operation was quicker (11 versus 34 min, P < 0·0001), had less blood loss, less postoperative pain, a shorter hospital stay and a quicker return to work (all P < 0·0001). Complication rates were similar. This study compared calcium and vitamin D versus placebo in over 36 000 healthy women followed for a mean of 7 years. The incidence of invasive colorectal cancer was similar in the two groups: 168 versus 154 cases, hazard ratio 1·08, 95 per cent confidence interval 0·86 to 1·34, P = 0·51. A total of 473 women were included and followed for a median of 6·6 years. There were no differences in disease-free survival (67 versus 66 per cent, no axillary surgery) and overall survival (75 versus 73 per cent, respectively). Quality of life was better for 6-12 months in those with no axillary surgery. A total of 61 patients were included in this trial. Those randomized to early ERCP within 48 h for unrelieved duct obstruction had fewer complications after the procedure (P < 0·026) and were jaundiced for a shorter time (P = 0·016).