scholarly journals A Retrospective Analysis of Peroperative Risk Factors Associated with Posttonsillectomy Reactionary Hemorrhage in a Teaching Hospital

2019 ◽  
Vol 23 (04) ◽  
pp. e403-e407 ◽  
Author(s):  
Vinoth Manimaran ◽  
Sanjeev Mohanty ◽  
Satish Kumar Jayagandhi ◽  
Preethi Umamaheshwaran ◽  
Shivapriya Jeyabalakrishnan
Keyword(s):  
Blood Loss ◽  
Pulse Rate ◽  
Tertiary Care ◽  
Operating Time ◽  
Positive Association ◽  
Care Hospital ◽  
Intraoperative Blood Loss ◽  
Surgeon Experience ◽  
Patients At Risk ◽  
Risk Of Hemorrhage

Abstract Introduction Tonsillectomy is one of the most common otolaryngology procedures performed worldwide. It is also one of the first procedures learnt by residents during their training period. Although tonsillectomy is viewed relatively as a low-risk procedure, it can be potentially harmful because of the chance of posttonsillectomy hemorrhage. Objective The objective of the present study is to analyze the effects of peroperative factors and experience of the surgeon on the incidence and pattern of posttonsillectomy reactionary hemorrhage. Methods A retrospective review of medical charts was performed from 2014 to 2017 in a tertiary care hospital. A total of 1,284 patients who underwent tonsillectomy and adenoidectomy were included in the study. The parameters assessed were experience of the surgeon, operating time, intraoperative blood loss, difference in mean arterial pressure (MAP) and pulse rate. Results A total of 23 (1.79%) out of the 1,284 patients had reactionary hemorrhage. Out of those 23, 16 (69.5%) patients had been operated on by trainees, while 7 (30.5%) had been operated on by consultants (p = 0.033, odds ratio [OR] = 0.04). Operating time, intraoperative blood loss, difference in MAP and pulse rate were significantly higher in the reactionary hemorrhage group, and showed a positive association with risk of hemorrhage (p < 0.05; OR >1). Re-exploration to control the bleeding was required in 10 (76.9%) out of the 23 cases. Conclusion The experience of the surgeon experience and peroperative factors have an association with posttonsillectomy hemorrhage. Close surveillance and monitoring of the aforementioned peroperative factors will help in the identification of patients at risk of hemorrhage.

scholarly journals Clinical study of Misgav Ladach technique of caesarean section

2017 ◽  
Vol 6 (12) ◽  
pp. 5532
Author(s):  
Shrinivas N. Gadappa ◽  
Pratibha V. Dixit ◽  
Deepika Sharma ◽  
Yogita Gavit
Keyword(s):  
Caesarean Section ◽  
Blood Loss ◽  
Suture Material ◽  
Tertiary Care ◽  
Operating Time ◽  
Individual Experience ◽  
Care Hospital ◽  
Section Technique ◽  
Duration Of Surgery ◽  
The Individual

Background: In the last decades caesarean section rates increased in many countries becoming the most performed intraperitoneal surgical procedure. The operative technique performed is made chiefly on the basis of the individual experience and preference of operators, the characteristics of patients, timing and urgency of intervention. Present study was undertaken to assess the benefits of the Misgav Ladach caesarean section technique in tertiary care hospital and evaluate the operative parameters like efficacy, safety, duration of surgery, blood loss, need for suture material, post-operative morbidity.Methods: Prospective surgical interventional study conducted in department of obstetrics and gynecology in tertiary care institute.Results: The duration of surgery, blood loss and post-operative complications were significantly less in the Misgav Ladach technique of LSCS.Conclusions: The choice of the Caesarean section technique is strictly linked to the individual experience and confidence of the surgical team. Misgav-Ladach technique proved to be associated to less complications, moreover, since its shorter operating time; it is to prefer in all that cases a prompt operation is required.

scholarly journals Deciding the Appropriate Route and Method of Hysterectomy for Women with Benign Diseases: A Cross-sectional Study at a Tertiary Care Hospital, India

2021 ◽  
Author(s):  
Hiralal Konar ◽  
Madhutandra Sarkar ◽  
Dorothy Dessa
Keyword(s):  
Postoperative Pain ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Operating Time ◽  
Cross Sectional Study ◽  
Care Hospital ◽  
Intraoperative Blood Loss ◽  
Sectional Study ◽  
Benign Diseases ◽  
Cross Sectional

Introduction: Different factors may influence the route of hysterectomy for benign indications. Each of the three main approaches of hysterectomy has its own set of risks and benefits. A rational and evidence-based decision to select a right method for a particular patient is necessary to bring about the best possible outcome with least complications. Aim: To compare three groups of hysterectomy, i.e., laparotomy for Total Abdominal Hysterectomy (TAH), Non-descent Vaginal Hysterectomy (NDVH) and Total Laparoscopic Hysterectomy (TLH), with regard to the patient and clinical factors, surgical outcomes and complications, in order to decide the optimum route and method of hysterectomy in a patient with benign disease. Materials and Methods: In this hospital-based cross-sectional study, 120 women, with 40 patients each in the TAH, NDVH and TLH groups, were admitted due to benign gynaecological conditions in a tertiary care hospital in Kolkata, India from May 2013 to April 2014. They were operated, and then followed-up at 6-12 weeks after surgery. All the relevant information, e.g., clinical diagnosis, operating time, intraoperative blood loss, length of stay in hospital, postoperative pain score, intraoperative and postoperative complications, etc., were recorded. Data were analysed statistically by simple proportions and statistical tests, i.e., Chi-square test and F-test. Results: The most common indication for hysterectomy was benign diseases in all the groups, 47.5%, 40% and 37.5%, respectively in the TAH, NDVH and TLH groups. The mean operating time (minutes) was significantly higher in the TLH group (163.5) as compared to the TAH (75.03) and NDVH groups (84.88) (p=0.039). A significantly lesser mean intraoperative blood loss (mL) was observed in the NDVH (85.67) and TLH groups (98.63) as compared to the TAH group (168.47) (p=0.021). The observations in regard to other surgical outcome parameters, i.e., postoperative pain score, hospital stay, were also favourable in the NDVH or TLH group. The complication rate was higher in the TAH group (22/40 or 55%) as compared to the NDVH (14/40 or 35%) and TLH (17/40 or 42.5%) groups. Conclusion: NDVH or TLH is the preferred method over TAH in case of benign uterine disease due to lesser operative morbidity and faster recovery.

scholarly journals Severe intraoperative bleeding predicts the risk of perioperative blood transfusion after robot-assisted radical prostatectomy

2021 ◽  
Author(s):  
Antonio Benito Porcaro ◽  
Riccardo Rizzetto ◽  
Nelia Amigoni ◽  
Alessandro Tafuri ◽  
Aliasger Shakir ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Blood Transfusion ◽  
Blood Loss ◽  
Univariate Analysis ◽  
Operating Time ◽  
Primary Treatment ◽  
Intraoperative Blood Loss ◽  
Robot Assisted ◽  
Intraoperative Bleeding ◽  
Perioperative Blood Transfusion

AbstractTo evaluate potential factors associated with the risk of perioperative blood transfusion (PBT) with implications on length of hospital stay (LOHS) and major post-operative complications in patients who underwent robot-assisted radical prostatectomy (RARP) as a primary treatment for prostate cancer (PCa). In a period ranging from January 2013 to August 2019, 980 consecutive patients who underwent RARP were retrospectively evaluated. Clinical factors such as intraoperative blood loss were evaluated. The association of factors with the risk of PBT was investigated by statistical methods. Overall, PBT was necessary in 39 patients (4%) in whom four were intraoperatively. Positive surgical margins, operating time and intraoperative blood loss were associated with perioperative blood transfusion on univariate analysis. On multivariate analysis, the risk of PBT was predicted by intraoperative blood loss (odds ratio, OR 1.002; 95% CI 1.001–1.002; p < 0.0001), which was associated with prolonged operating time and elevated body mass index (BMI). PBT was associated with delayed LOHS and Clavien–Dindo complications > 2. In patients undergoing RARP as a primary treatment for PCa, the risk of PBT represented a rare event that was predicted by severe intraoperative bleeding, which was associated with increased BMI as well as with prolonged operating time. In patients who received a PBT, prolonged LOHS as well as an elevated risk of major Clavien–Dindo complications were seen.

A Comparative Study of Endoscopic Coblation Adenoidectomy and Regular Curettage Adenoidectomy in a Tertiary Care Hospital in Kerala

2021 ◽  
Vol 8 (41) ◽  
pp. 3559-3566
Author(s):  
Abdul Salam R. T. ◽  
Shahul Hameed A. ◽  
Meera Rajan
Keyword(s):  
Blood Loss ◽  
Comparative Study ◽  
Tertiary Care ◽  
Operation Time ◽  
Care Hospital ◽  
Adenoid Tissue ◽  
Significant Difference ◽  
Tube Function ◽  
Prospective Comparative Study ◽  
The Mean

BACKGROUND An ideal surgery to remove hypertrophied adenoid mass should be safe, with less bleeding and operation time along with post-operative improvement in the eustachian tubal ventilation and normal respiration. It should also have low morbidity and mortality. Among the various methods described for its removal, the two commonly used methods are conventional cold curettage method and coblation technique. The purpose of this study was to collate the safety and efficacy of endoscopic coblation adenoidectomy with the conventional curettage adenoidectomy. METHODS A prospective comparative study with fifty patients was studied who underwent adenoidectomy. Twenty five patients underwent endoscopy assisted coblation adenoidectomy and twenty five patients underwent regular adenoidectomy by curettage. RESULTS Patients who underwent coblation adenoidectomy showed better results during follow up in terms of completeness of removal. 80 % of children undergoing regular adenoidectomy by curettage method showed remnant adenoid tissue in the nasopharynx at the end of the procedure. But it was 6 % among the children undergoing endoscopic assisted coblation adenoidectomy. The mean duration of operation was higher for endoscopic assisted coblation adenoidectomy which was significant statistically. The mean blood loss was 30.36 ml in regular curettage adenoidectomy; 10.6 ml with endoscopic coblation adenoidectomy. The grading of pain was significantly lower in endoscopic assisted coblation adenoidectomy. There was no significant difference between two groups in terms of eustachian tube function after surgery. CONCLUSIONS Coblation adenoidectomy has significant advantages over conventional adenoidectomy in terms of completeness of removal, reduced blood loss, and lower post-operative pain grade. KEYWORDS Coblation, Adenoidectomy, Curettage, Haemorrhage and Complications

TO EVALUATE THE EFFECT OF PROPHYLACTIC USE OF TRENEXAMIC ACID ON BLEEDING DURING ELECTIVE LSCS. A STUDY CONDUCTED IN TERTIARY CARE HOSPITAL OF CENTRAL INDIA.

2021 ◽  
pp. 223-225
Author(s):  
Dhara Singh ◽  
Sujata bhargava
Keyword(s):  
Blood Loss ◽  
Tranexamic Acid ◽  
Tertiary Care ◽  
Alternative Methods ◽  
World Health ◽  
Study Cohort ◽  
Care Hospital ◽  
Total Blood ◽  
And Control ◽  
The Impact

Background: Recent guidelines of the World Health Organization (WHO) indicated administering tranexamic acid (TXA) in order to treat postpartum bleeding (PPH). Therefore, nding low-cost and lowrisk alternative methods to control obstetric bleeding is of great importance. The present study aimed to evaluate the prophylactic effect of TXA on bleeding during and after the LSCS. In addition, it was attempted to explore the impact of TXA as a safe and inexpensive method for decreasing bleeding during and after CS so that to decrease the hazard of blood transfusion or hysterectomy in these patients. Material and Methods: This prospective study conducted on 100 women in Department of Obstetrics &gynecolgy for one year period. They were divided in two groups: Cases: (n=50; women receiving prophylactic Tranexamic Acid) and Control: (n=50; women receiving saline). Estimated the amount of blood loss during surgery. The amount of blood loss during surgery were calculated Estimation of weight of dry towels and mops before autoclaving is noted. Results: Most common age group among Cases and Control was 26-30 years .%. Mean age among cases group (26.69±7.51 years) was signicantly lesser compared to control study cohort (29.75±7.72). Post operativehemoglobin level was signicantly higher among Case (11.26±12.03) as compared to Control (8.56±1.01). Comparing post operative complications revealedno signicant changes. Use of topical hemostatics was higher among the control (77%) as compared to Cases (57%). Conclusion: Prophylactic treatment with TXA in relation to elective LSCS reduces the overall total blood loss, and the risk of reoperations owing to postoperative hemorrhage as revealed by higher hemoglobin level among cases.

scholarly journals Our experience with laparoscopic total gastrectomy for gastric cancer: A case series

2020 ◽  
Vol 2 (3) ◽  
Author(s):  
Manash Ranjan Sahoo ◽  
Satyajit Samal ◽  
Jyotirmay Nayak
Keyword(s):  
Gastric Cancer ◽  
Blood Loss ◽  
Hospital Stay ◽  
Total Gastrectomy ◽  
Median Time ◽  
Operative Time ◽  
Laparoscopic Total Gastrectomy ◽  
Oral Feeding ◽  
Care Hospital ◽  
Intraoperative Blood Loss

Background: Though laparoscopic distal gastrectomy has become a standard procedure for treatment of gastric cancer, laparoscopic total gastrectomy has not been widely accepted as it requires more dexterity and lack of evidence about its feasibility and safety. Methods: Here retrospectively we review a series of 12 cases of gastric cancer undergone laparoscopic total gastrectomy with D1 or D2 lymphadenectomy over a period of 7 years at a tertiary care hospital. The patient demographic characteristics were reviewed and the outcomes after surgery was analyzed in terms of extent of lymphadenectomy, mean operative time, mean intraoperative blood loss median number of lymph nodes harvested, median time for postoperative ambulation, median time for postoperative oral feeding, median time of postoperative hospital stay, postoperative complications and mortality. Results: All patients had total gastrectomy entirely through laparoscopic method. Mean operative time was 282 minutes, mean intraoperative blood loss was 120 ml, median time for ambulation and oral feeding was 3 days and 6 days respectively. Median time of hospital stay was 16 days and 2 patients had complications as pancreatic fistula and port site abscess. No mortality was observed. Conclusion: With zero mortality and accepted rate of complications, laparoscopic total gastrectomy appears to be technically feasible and safe for management of gastric cancer. But more studies have to be conducted with comparison to other standard gastrectomies and long term follow up to be done to establish its standardized application.

scholarly journals Cynoacrylate surgical glue as an alternative to suturing for mesh fixation in lichtenstein hernia repair

2018 ◽  
Vol 5 (5) ◽  
pp. 1882
Author(s):  
Deepak Jaiswal ◽  
TRV Wilkinson ◽  
Murtaza Akhtar
Keyword(s):  
Inguinal Hernia ◽  
Hernia Repair ◽  
Inguinal Hernia Repair ◽  
Mesh Fixation ◽  
Tertiary Care ◽  
Operating Time ◽  
Recurrent Hernia ◽  
Care Hospital ◽  
Lichtenstein Hernia Repair ◽  
Average Pain

Background: Tension free repair using mesh in open hernia repair has become more popular in recent years. Chronic pain remains a frequent complication after Lichtenstein inguinal hernia repair. The use of sutures to fix the mesh has been implicated. Fixing the mesh using cynoacrylate glue could avoid this complication. The purpose of the present study is to study the incidence of pain and other complications following inguinal hernia repair performed by the Lichtenstein technique with mesh fixation by cyanoacrylate surgical glue.Methods: T This study was conducted at tertiary care hospital. Inclusion criteria were all patients coming to the hospital with inguinal or inguinoscrotal hernias diagnosed clinically. Exclusion criteria were all complicated inguinal hernia namely obstructed, strangulated, and large hernias with scrotal abdomen, recurrent hernia. Patient not fit for surgery or not consenting to join the study. The patients will be informed about the surgery and thereafter requested to sign an informed consent. Primary outcome was postoperative pain. Secondary endpoints were operating time, surgical site infection and recurrence rate.Results: Total number of 31 cases enrolled in the study of which twenty-two had unilateral and seven had bilateral inguinal hernias. Average pain score on POD 1, 3, 7 was 5.75; 4.53; 3.32 respectively. One patient developed seroma which was managed conservatively. No evidence of recurrence during study period.Conclusions: Cyanoacrylate surgical glue is a reliable method and can be used as an alternative for conventional Lichtenstein hernia repair.

Outcomes of 27 gauge pars plana vitrectomy for a variety of posterior segment diseases

2021 ◽  
Vol 71 (11) ◽  
pp. 2570-2575
Author(s):  
Muhammad Amer Awan ◽  
Fiza Shaheen ◽  
Kholood Janjua
Keyword(s):  
Retinal Detachment ◽  
Pars Plana Vitrectomy ◽  
Tertiary Care ◽  
Operating Time ◽  
Retinal Vasculitis ◽  
Posterior Segment ◽  
Care Hospital ◽  
Silicon Oil ◽  
Operative Complications ◽  
Pars Plana

Objective:  To report our experience with 27 gauge (27G) pars plana vitrectomy (PPV) system for a variety of simple to complex posterior segment disorders Methods: Single center, Retrospective, Cohort study. Data of 665 eyes of 574 patients that underwent 27G PPV for a variety of indications from July 2015 to June 2019 at a tertiary care hospital was analyzed. Results: Common surgical indications included; Diabetic tractional retinal detachment (196, 29.5%), vitreous haemorrhage (191, 28.7%), full thickness macular hole (80, 12%), epiretinal membrane (66, 9.9%), endophthalmitis (26, 3.9%), tractional diabetic macular edema (14, 2.1%), ectopia lentis (11, 1.7%), dropped lens matter (13, 2%) and others (68, 10.2%). Mean operating time was 62 ± 37 minutes. With the exception of 2 cases where 20G fragmatome was utilized, no case required conversion to 20 gauge system while a 25G trocar was used for the silicon oil injection. Per-operative complications included; iatrogenic retinal tear (2 eyes, 0.3%) and supra choroidal silicon oil migration (1 eye, 0.15%). Post-operative complications were raised IOP (7 eyes, 1%), endophthalmitis (1 eye, 0.15%), hemorrhagic occlusive retinal vasculitis (1 eye, 0.15%) and retinal detachment (2 eyes, 0.3%). Mean Visual Acuity improved from 1.62 ± 0.68 logarithm of minimum angle of resolution (logMAR) to 0.4 ± 0.38 logMAR (P <0.001). Conclusion: With 3 months follow up time, 27 G PPV has proved to be a safe and effective system for both simpler and complex retinal pathologies requiring significant surgical manipulation. Continuous...

scholarly journals Comparative study to assess the outcome of omitting bladder flap formation from caesarean delivery

2019 ◽  
Vol 8 (3) ◽  
pp. 882
Author(s):  
Pratiksha Gupta ◽  
Suman Kumari
Keyword(s):  
Caesarean Section ◽  
Blood Loss ◽  
Caesarean Delivery ◽  
Operating Time ◽  
Randomised Control Trial ◽  
Control Group ◽  
Study Group ◽  
Care Hospital ◽  
Total Operating Time ◽  
Formation Step

Background: The aim of this study is to evaluate the effects of omitting the step of bladder flap formation at lower-segment caesarean delivery.Methods: It is a RCT (randomised control trial), non-blinded study conducted in a tertiary care hospital. A total of 104 women who underwent caesarean delivery (elective or emergency) were prospectively randomized to one of the two groups. In the study group (n= 54), caesarean was performed without formation of a bladder flap. In the control group (n=50), caesarean was performed with the formation of a bladder flap before the uterine incision.Results: There were differences of median skin incision to delivery interval (5 versus 6.5 minutes, P <0.0001), median total operating time (35 versus 44.5 minutes, P 0.0002), and median blood loss (haemoglobin 0.5 versus 1g/dl, P 0.0001) in favor of the study group. Postoperative incidence of urinary tract infection was reduced in the study group (1% versus 9%, P <0.0006) and bowel function returned early in the study group (day 2 versus 3, P<0.0001).  Bladder flap formation step was successfully omitted in (11/18, 61.11%) of previous CS (caesarean section) patients in the study group and (7/12, 58.33%) in control group illustrating that unless required, BF (bladder flap) formation step can even be omitted in previous CS patients.Conclusions: Omission of the bladder flap provides short term advantages such as reduction of total operating time, incision-delivery interval, and reduced blood loss and that this technique can even be applied in previous caesarean section patients.

scholarly journals Microendoscope-Assisted Decompression Surgery With Resection of Bony Fragment for Treating a Separation of Lumbar Posterior Ring Apophysis in Young Athletes

2020 ◽  
pp. 219256822092929 ◽  
Author(s):  
Motohiro Okada ◽  
Munehito Yoshida ◽  
Akihito Minamide ◽  
Kazunori Nomura ◽  
Kazuhiro Maio ◽  
...  
Keyword(s):  
Blood Loss ◽  
Japanese Orthopaedic Association ◽  
Operating Time ◽  
Case Series ◽  
Decompression Surgery ◽  
Return To Sports ◽  
Intraoperative Blood Loss ◽  
Young Athletes ◽  
The Mean ◽  
Posterior Ring

Study Design: Case series. Objectives: To report the clinical outcomes of the decompression procedure using the microendoscopic discectomy system for the treatment of a separation of lumbar posterior ring apophysis in young active athletes. Methods: We retrospectively reviewed 17 cases that underwent the microendoscopic surgery to treat a symptomatic separated lumbar ring apophysis between 2001 and 2014 at our institute or our associated hospital. The cases consisted of 15 males and 2 females, with their ages ranging from 12 to 19 years. The surgeries were performed at total of 18 lumbar levels, including 15 L4/5 and 3 L5/S1 levels. All patients were young athletes. We evaluated the following: (1) the Japanese Orthopaedic Association (JOA) score for low back pain, (2) recovery rates using Hirabayashi’s method, (3) operating time, (4) intraoperative blood loss, (5) perioperative complications, (6) the status of comeback to sports, and (7) the period taken to return to sports. Results: The JOA score was improved after the surgery in all cases. Recovery rate was 92.0% ± 8.1%. The mean operating time per level was 89.2 ± 33.3 minutes. The mean intraoperative blood loss per level was 95.3 ± 93.1 mL. A pinhole size dural tear occurred in one case as a perioperative complication. All cases returned to sports. The mean period taken to return to sports was 10.9 ± 3.5 weeks. Conclusion: Microendoscopic decompression surgery is useful for treating a separation of lumbar posterior ring apophysis.

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