Video colposcopy versus headlight for large loop excision of the transformation zone (LLETZ): a randomised trial

Abstract Purpose To compare resected cone mass and resection margin status when performing Large Loop Excision of the Transformation Zone (LLETZ) using video colposcopy (LLETZ-VC) versus a headlight (LLETZ-HL) in women with cervical dysplasia. Methods Prospective, randomised trial (monocentric) at a specialised cervical dysplasia unit in a University Hospital. Women with a biopsy-proven CIN2 + or persisting CIN1 or diagnostic LLETZ were recruited and randomised. LLETZ was performed either under video colposcopic vision or using a standard surgical headlight. The primary endpoint was resected cone mass. Secondary endpoints were the rate of involved margins, fragmentation of the specimen, procedure time, time to complete haemostasis (TCH), blood loss, pain, intra- and postoperative complications, and surgeon preference. Results LLETZ-VC and LLETZ-HL (109 women each) had comparable cone masses (1.57 [0.98–2.37] vs. 1.67 [1.15–2.46] grams; P = 0.454). TCH was significantly shorter in the LLETZ-VC arm (60 [41–95.2] vs. 90 [47.2–130.2] seconds; P = 0.008). There was no statistically significant difference in involved resection margins (6/87 [6.5%] vs. 16/101 [13.7%], P = 0.068) and postoperative complications (13/82 [13.7%] vs. 22/72 [23.4%], P = 0.085). Patient-reported outcomes favoured LLETZ-VC with a lower use of analgesics (6/80 [7.0%] vs. 17/87 [16.3%]; P = 0.049). However, LLETZ-VC was more difficult to perform with significantly lower ratings for handling (7 [5–9] vs. 9 [8–10]; P < 0.001) and general satisfaction (7.5 [5–9] vs. 10 [8–10]; P < 0.001). Conclusion Intraoperative video colposcopy for LLETZ has minimal benefits at the cost of surgeons’ satisfaction. Clinical trial registration NCT04326049 (ClinicalTrials.gov).

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275 POSTOPERATIVE COMPLICATIONS DO NOT AFFECT QUALITY OF LIFE AFTER ESOPHAGECTOMY

Diseases of the Esophagus ◽

10.1093/dote/doaa087.59 ◽

2020 ◽

Vol 33 (Supplement_1) ◽

Author(s):

E Jezerskyte ◽

H Laarhoven ◽

M Sprangers ◽

W Eshuis ◽

M Hulshof ◽

...

Keyword(s):

Quality Of Life ◽

Postoperative Complications ◽

Term Survival ◽

Radio Therapy ◽

Significant Difference ◽

Patient Reported ◽

Short And Long Term ◽

Over Time

Abstract Despite the attempts to reduce postoperative complication incidence after esophageal cancer surgery, up to 60% of patients endure postoperative complications. These patients often have a reduced health related quality of life (HR-QoL) and it may also have a negative effect on long-term survival. The aim of this study is to investigate the difference in short- and long-term HR-QoL in patients with and without a complicated postoperative course. Methods A retrospective comparative cohort study was performed with data from the Dutch Cancer Registry (IKNL) and QoL questionnaires from POCOP, a longitudinal patient reported outcomes study. All patients with esophageal and gastroesophageal junction (GEJ) cancer after an esophagectomy with or without neoadjuvant chemo(radio) therapy in the period of 2015–2018 were included. Exclusion criteria were palliative surgery, patients with a recurrence, reconstruction with a colonic or jejunal interposition, no reconstruction and emergency surgery. HR-QoL was investigated at baseline and at 3, 6, 9, 12, 18 and 24 months postoperatively between patients with and without complications following an esophagectomy. Results A total of 486 patients were included: 270 with and 216 without postoperative complications. The majority of patients were male (79.8%) with a median age of 66 years (IQR 60–70.25). Significantly more patients had comorbidities in the group with postoperative complications (69.6% vs 57.3%, p = 0.001). A significant difference in HR-QoL over time was found between the two groups in “choked when swallowing” score (p = 0.028). Patients that endured postoperative complications reported more problems with choking when swallowing at 9 months follow-up (mean score 12.9 vs 8.4, p = 0.047). This difference was not clinically relevant with a mean score difference of 4.6 points. Conclusion Postoperative complications do not significantly influence the short- and long-term HR-QoL in patients following an esophagectomy. Only one HR-QoL domain showed difference over time, however, this was not clinically relevant.

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The Pattern of Colorectal Cancer Surgery in Lithuania in 2005: Do Results Meet Expectations?

Medicina ◽

10.3390/medicina49030020 ◽

2013 ◽

Vol 49 (3) ◽

pp. 20 ◽

Cited By ~ 1

Author(s):

Eligijus Poškus ◽

Saulius Mikalauskas ◽

Valdemaras Jotautas ◽

Paulius Žeromskas ◽

Tomas Poškus ◽

...

Keyword(s):

Colorectal Cancer ◽

Postoperative Complications ◽

Demographic Data ◽

Preoperative Evaluation ◽

University Hospital ◽

Pathological Examination ◽

National Database ◽

Resection Margins ◽

Neoadjuvant Radiotherapy ◽

Vilnius University

The aim of this study was to expose the pattern of the surgical treatment of colorectal cancer in Lithuania in 2005. Material and Methods. A retrospective analysis of 590 patients treated for colorectal cancer in the surgical departments of the Hospital of Lithuanian University of Health Sciences, the Institute of Oncology of Vilnius University, and Vilnius University Hospital Santariškių Klinikos in 2005 was performed. Demographic data, preoperative evaluation, postoperative complications assessed according to the Clavien-Dindo classification, the quality of pathological examination, and survival rates were analyzed. Results. A total of 590 patients, 269 women (45.6%) and 321 men (54.4%), were included in this study; the mean age was 68.3 years (SD, 11.2). Tumors were found in the colon of 274 patients (46.4%) and in the rectum of 316 patients (53.6%). An abdominal ultrasound scan was preoperatively performed in 516 patients (87.5%) and a chest x-ray in 316 patients (53.6%); 35 patients (5.9%) underwent abdominal computed tomography. Endorectal ultrasound was done in 99 (31.7%) cases. Neoadjuvant radiotherapy for T3 and T4 rectal tumors was applied in 42 cases (18.1%). Besides, 211 patients (35.8%) developed postoperative complications with an anastomotic leak emerging in 20 cases (3.4%). Death occurred in 7 patients (1.18%). On the average, 11.15 lymph nodes (SD, 6.02) were found in pathological specimens. Circumferential resection margins were assessed in 58 cases (18.4%). The overall 5-year survival rate was 52.06%. Conclusions. The preoperative evaluation and the treatment of patients with colorectal cancer were not sufficiently consistent in Lithuania in 2005. In order to improve the treatment of colorectal cancer, standardization or the national database of colorectal cancer is necessary.

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The use of vaginal antimicrobial after large loop excision of transformation zone: a prospective randomised trial

Yearbook of Obstetrics Gynecology and Women s Health ◽

10.1016/s1090-798x(08)79039-8 ◽

2008 ◽

Vol 2008 ◽

pp. 235-236

Author(s):

J.S. Dungan

Keyword(s):

Randomised Trial ◽

Transformation Zone ◽

Large Loop ◽

Prospective Randomised Trial

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Clinical outcome following primary total hip or knee replacement in nonagenarians

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2016.0095 ◽

2016 ◽

Vol 98 (04) ◽

pp. 258-264 ◽

Cited By ~ 15

Author(s):

D Skinner ◽

BJ Tadros ◽

E Bray ◽

M Elsherbiny ◽

G Stafford

Keyword(s):

Postoperative Complications ◽

Knee Replacement ◽

Age Groups ◽

Mortality Rates ◽

Patient Reported Outcome Measures ◽

Control Group ◽

Joint Replacements ◽

Total Hip ◽

Significant Difference ◽

Patient Reported

Introduction The Elective Orthopaedic Centre in Epsom has an established patient reported outcome measures programme, into which all patients are enrolled. Postoperative complications, Oxford hip/knee scores (OHS/OKS) and EQ-5D™ (EuroQol, Rotterdam, Netherlands) scores are collected up to the second postoperative year. Our population is ageing and the number of joint replacements being performed on the very elderly is rising. The aim of this study was to investigate the outcome of joint replacements in a nonagenarian population. Methods Our dataset was reviewed retrospectively for a cohort of nonagenarians undergoing either a primary total hip replacement (THR) or total knee replacement (TKR) between April 2008 and October 2011. Postoperative complications, mortality rates and functional outcomes were compared with those of a time matched 70–79-year-old cohort. Results Nonagenarians requiring a THR presented with a lower preoperative OHS (p=0.020) but made a greater improvement in the first postoperative year than the younger cohort (p=0.040). The preoperative OKS was lower for nonagenarians than for the control group (p=0.022). At one and two years after TKR, however, there was no significant difference between the age groups. The nonagenarians had a greater risk of requiring a blood transfusion following both THR (p=0.027; 95% confidence interval [CI]: 1.11–5.75) and TKR (p=0.037; 95% CI: 1.08–16.65) while the latter cohort also required a longer stay than their younger counterparts (p=0.001). Mortality rates were higher in the nonagenarian group but these were in keeping with the life expectancy projections identified by the Office for National Statistics. Conclusions Over a two-year period, the functional outcome and satisfaction rates achieved by nonagenarians following a THR or TKR are comparable with 70–79-year-olds.

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Twenty-Year Experience with Large Loop Excision of the Transformation Zone at Sestre Milosrdnice University Hospital Centre

Acta Clinica Croatica ◽

10.20471/acc.2019.58.03.09 ◽

2019 ◽

Author(s):

Dražan Butorac

Keyword(s):

University Hospital ◽

Transformation Zone ◽

Large Loop

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Clinical outcome after liver resection for colorectal versus non-colorectal metastasis: a comparative study

International Surgery Journal ◽

10.18203/2349-2902.isj20180012 ◽

2018 ◽

Vol 5 (2) ◽

pp. 390

Author(s):

Ashraf M. El-Badry ◽

Omar Abdelraheem

Keyword(s):

Liver Resection ◽

Postoperative Complications ◽

Clinical Outcome ◽

Medical Records ◽

Multivisceral Resection ◽

University Hospital ◽

Significant Difference ◽

Complication Score ◽

Primary Neoplasm

Background: Liver resection is the only curative treatment option for specific types of metastatic neoplasms. Comparative studies on the clinical outcome of liver resection for colorectal liver metastasis (CRLM) and non CRLM (N-CRLM) in Egypt remain inadequate.Methods: Medical records of patients who underwent liver metastasectomy (April 2013-May 2017) at Sohag University Hospital were reviewed. Patients were categorized according to the origin of the primary tumor into CRLM versus N-CRLM. Demographic, clinical, operative and histopathologic data, postoperative surgical complications and survival were analyzed.Results: Twenty-six patients (15 CRLM and 11 N-CRLM) were retrospectively enrolled. N-CRLM group comprised metastatic gall bladder (6), pancreas (2), breast (1) lung (1) and recurrent ovarian (1) cancers. There was no significant difference regarding age or gender predilection. The complication score in CRLM group was not significantly different compared with N-CRLM patients. However, subgroups of multivisceral resections showed significantly higher grades of postoperative complications compared with sole liver resection in both groups. Elderly patients (>70-year-old) exhibited high risk of morbidity compared with younger patients. Early post-operative mortality within the first month was 7.7% (2 patients died, one per each group). After a mean follow up of 32 months, the overall survival rate among patients with CRLM and N-CRLM was 75% and 64% respectively.Conclusions: Liver resection for CRLM and N-CRLM can be safely accomplished. Multivisceral resection and advanced age were associated with increased severity of postoperative complications irrespective of the location of primary neoplasm.

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Evaluation of Conjunctival Autografting Augmented with Mitomycin C Application versus Ologen Implantation in the Surgical Treatment of Recurrent Pterygium

Journal of Ophthalmology ◽

10.1155/2021/8820926 ◽

2021 ◽

Vol 2021 ◽

pp. 1-7

Author(s):

Faried M. Wagdy ◽

Hassan G. Farahat ◽

Amin F. Ellakwa ◽

Sameh S. Mandour

Keyword(s):

Postoperative Complications ◽

Mitomycin C ◽

University Hospital ◽

Time Interval ◽

Randomised Study ◽

Significant Difference ◽

Recurrent Pterygium ◽

Group B ◽

Conjunctival Autografting

Objectives. To evaluate the safety and efficacy of augmenting conjunctival autografting with intraoperative mitomycin C (MMC) application versus Ologen implantation in the management of recurrent pterygium. Materials and Methods. This prospective randomised study included 63 eyes of 63 patients, with recurrent nasal pterygium, who presented to the outpatient clinic of Menoufia University Hospital in Shebin El Kom and Manshiet Soltan from January 2016 to December 2019. Patients were randomly enrolled into two groups. Group A included 32 eyes of 32 patients who underwent conjunctival autografting augmented with the topical application of MMC (0.2 mg/mL), and group B included 31 eyes of 31 patients who underwent conjunctival autografting augmented with Ologen implantation. All the patients underwent follow-up examinations for a period of 24 months. During each visit, a complete ophthalmic examination was performed. Pterygium regrowth of 1 mm or more, over the cornea, was considered a recurrence. Results. In the MMC group, no recurrence was reported during the 24-month follow-up period. In the Ologen implantation group, recurrence was reported in 2 (8%) eyes. The time interval from surgery to recurrence was 5 months in one case and 8 months in the other. No other serious postoperative complications were reported, and there was no statistically significant difference between the groups in this regard. Conclusion. Ologen implantation with conjunctival autografting shows promising results in the surgical management of recurrent pterygium with mild non-vision-threatening postoperative complications comparable to that of MMC application with conjunctival autografting. Registration number: ClinicalTrials.govNCT04419038.

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Reduction of opioid use using regional anesthetic blocks after inguinal hernia repair in a high risk, safety net population

Journal of Opioid Management ◽

10.5055/jom.2021.0665 ◽

2021 ◽

Vol 17 (4) ◽

pp. 327-335

Author(s):

Sayeeda Rab, BS ◽

Sudeepti Vedula, BS ◽

Aziz M. Merchant, MD, FACS

Keyword(s):

Inguinal Hernia ◽

Hernia Repair ◽

Inguinal Hernia Repair ◽

Safety Net ◽

Transversus Abdominis ◽

University Hospital ◽

Control Group ◽

Tap Block ◽

Significant Difference ◽

Patient Reported

Objective: The transversus abdominis plane (TAP) block is currently being used perioperatively to reduce postoperative opioid requirements. It is unclear whether TAP blocks reduce postoperative opioid requirements for inguinal hernia repairs. The purpose of this retrospective chart study was to determine whether a TAP block reduces postoperative opioid requirements after an inguinal hernia repair in a safety net hospital.Design: This was a retrospective chart review that evaluated patients at University Hospital in Newark, NJ, who had inguinal hernia repairs from January 2011 to July 2019. Patients were divided into two groups depending on whether they had a TAP block or not. The primary outcome was the amount of opioid required in the first 24 hours postoperatively by a patient reported as morphine equivalent dosing (MED).Results: The group that received the TAP block had a mean (95 percent CI) MED of 7.01 mg (6.70, 7.33), and the control group (no TAP block) had a mean MED of 11.6 mg within 24 hours of the inguinal hernia (p = 0.03). There was no significant difference for postoperative visual analog scale (VAS) pain score, presence of nausea, or length of stay.Conclusions: Patients with TAP block required less morphine equivalence of opioid within a 24 hours period after an inguinal hernia repair.

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