EP.TH.855Hartmanns reversal - Laparoscopic Vs Open, UHNM experience over the last 3 years

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Nandu Nair ◽  
Umar Haneef ◽  
Zehong Chen ◽  
Sudipta Roy
Keyword(s):  
Postoperative Morbidity ◽  
Postoperative Hospital Stay ◽  
Open Approach ◽  
Initial Operation ◽  
Patient Factors ◽  
Equal Distribution ◽  
Index Procedure ◽  
Clinical Notes ◽  
Primary Operation ◽  
Determining Factor

Abstract Aim Reversal of hartmanns is still an operation associated with significant morbidity. Although various studies have tried to assess the best time for attempting reversal after the primary operation, there is still no consensus. The aim of our study was to look at our experience over the last three years to find any possible factors which determine the duration between primary operation and reversal and compare laparoscopic vs open approach. Methods Prospective cohort including consisting of patients who underwent hartmanns reversal in 3 years was analysed (January-2017 to December-2019). Data was collected retrospectively from clinical notes. Results Among the patients (n = 50) there was equal distribution of males (52%) and females (48%). Although the initial operation was open in 74% patients, reversal was attempted laparoscopically in 46% with a conversion rate of 43.4%. Median duration between initial operation and reversal was 433 days. There was no significant association between duration before reversal and patient comorbidities or the indication for the index procedure. Also there was no statistical difference in postoperative hospital stay or immediate postoperative morbidity between laparoscopic and open hartmanns reversal. Conclusion There was no difference in immediate postoperative outcomes between patients who had laparoscopic or open hartmanns reversal. There was no determining factor which made the surgeon prefer laparoscopic over open approach nor was there a difference in duration between primary operation and reversal based of patient factors or method of approach. Hence timing of hartmanns reversal and the method of approach still depends on surgeon preference and experience.

scholarly journals Postoperative Morbidity by Procedure and Patient Factors Influencing Major Complications Within 30 Days Following Shoulder Surgery

2014 ◽  
Vol 2 (10) ◽  
pp. 232596711455316 ◽  
Author(s):  
Edward Shields ◽  
James C. Iannuzzi ◽  
Robert Thorsness ◽  
Katia Noyes ◽  
Ilya Voloshin
Keyword(s):  
Postoperative Morbidity ◽  
Shoulder Surgery ◽  
Patient Factors ◽  
Factors Influencing ◽  
Major Complications

Omentoplasty in Treatment of Early Bronchopleural Fistulas after Pneumonectomy

2005 ◽  
Vol 13 (3) ◽  
pp. 211-216 ◽  
Author(s):  
Dmitry Chichevatov ◽  
Alexander Gorshenev
Keyword(s):  
Hospital Mortality ◽  
Hospital Stay ◽  
Bronchopleural Fistula ◽  
Pleural Empyema ◽  
Postoperative Hospital Stay ◽  
The Other ◽  
Greater Omentum ◽  
Bronchial Stump ◽  
Primary Operation ◽  
Fistula Recurrence

This study was undertaken to assess the efficacy of omentoplasty in 12 cases of bronchopleural fistula after pneumonectomy. All fistulas formed within 16 days after the primary operation (median, 7 days). In 10 cases, omentoplasty was performed within 10 hours of diagnosis; the other 2 cases were treated at 28 and 31 hours. The greater omentum was mobilized through a laparotomy and secured tightly around the bronchial stump using original principles of fixation. After omentoplasty, dehiscence of the bronchial stump was observed in 5 (42%) patients, but owing to reinforcement with greater omentum, recurrence of the fistula was observed in only one case. In 3 patients, recurrence of pleural empyema did not lead to the return of the bronchopleural fistula. Hospital mortality was 8.3% (one patient). In patients without bronchopleural fistula recurrence, the median postoperative hospital stay was 31 days. Early omentoplasty for bronchopleural fistula after pneumonectomy is an effective procedure that eliminates purulent bronchopleural complications completely within the shortest possible period of time.

scholarly journals Postoperative intestinal obstruction in patients with biliary atresia impedes biliary excretion and results in subsequent liver transplantation

2021 ◽  
Author(s):  
Aitaro Takimoto ◽  
Wataru Sumida ◽  
Hizuru Amano ◽  
Chiyoe Shirota ◽  
Takahisa Tainaka ◽  
...  
Keyword(s):  
Intestinal Obstruction ◽  
Biliary Atresia ◽  
Postoperative Morbidity ◽  
Initial Operation ◽  
Negative Effects ◽  
Native Liver ◽  
Intestinal Obstructions ◽  
Postoperative Intestinal Obstruction ◽  
Free Status ◽  
Native Liver Survival

Abstract Purpose This study aimed to investigate the negative effects of intestinal obstruction for jaundice-free native liver survival after Kasai portoenterostomy (PE) for biliary atresia (BA). Methods We retrospectively reviewed the records of patients who underwent PE for BA between 2006 and 2019. We evaluated the postoperative morbidity of intestinal obstruction for up to 2 years after PE and the effects of intestinal obstruction on jaundice-free native liver survival. On the basis of their initial operation, patients were divided into open portoenterostomy (Open-PE) and laparoscopic portoenterostomy (Lap-PE) groups, and morbidity was compared. Results Of the 87 patients reviewed, 6 (6.9%) patients developed postoperative intestinal obstruction and underwent surgery to relieve the obstruction. The morbidity of early postoperative intestinal obstruction was 1.68 per 10,000 person days. The jaundice-free native liver survival rate among patients who once achieved jaundice-free status after PE was significantly lower in the patients with intestinal obstruction compared to in those without intestinal obstruction (0% vs. 73.8%; RR = 3.81, p = 0.007). No significant differences were seen in postoperative intestinal obstructions between the Open-PE and Lap-PE groups (p = 0.242). Conclusions Intestinal obstruction negatively impact jaundice-free native liver survival, even in patients who once achieved jaundice-free status after PE for BA.

scholarly journals LARAPOSCOPIC LIVER RESECTION IN SURGERY FOR COLORECTAL CANCER METASTASES

2019 ◽  
Vol 18 (1) ◽  
pp. 58-65
Author(s):  
N. R. Torchua ◽  
A. A. Ponomarenko ◽  
E. G. Rybakov ◽  
S. I. Achkasov
Keyword(s):  
Colorectal Cancer ◽  
Liver Resection ◽  
Blood Loss ◽  
Hospital Stay ◽  
Laparoscopic Liver Resection ◽  
Colorectal Liver Metastases ◽  
Postoperative Hospital Stay ◽  
Open Approach ◽  
Intraoperative Blood Loss ◽  
Liver Resections

BACKGROUND: nowadays laparoscopic liver resection (LapLR) in contrast to traditional open approach is more preferable because of reduction of intraoperative blood loss and postop morbidity, decrease of postop hospital stay. Unfortunately, the place of LapLR in surgery for colorectal liver metastases is still controversial because of small number of comparative studies. PATIENTS AND METHODS: between November 2017 and December 2018 fifty two patients with resectable colorectal liver metastases were included in our pilot study - 35 in the prospective group for laparoscopic liver resection and 17 patients in retrospective group of open-approach liver resections (selected group of historical control) (OLR). RESULTS: one patient was excluded from LapLR group because of absence of intraoperative evidence for metastatic disease (in spite of preop MRI). Two patients had lap-to-open conversion (in one case because of technical difficulties due to the location of the permanent ileostomy in the right mesogastric region; in the other case due to intraoperative bleeding). These patients were included into open group. Atypical liver resections were the most often procedures in both groups - 79% (23/32) and 76% (13/19), p=0.3 (LapLR and OLR, respectively). Duration of the procedure was shorter in the OLR group: 218+71 min vs. 237+101min in LapLR, p=0.6. The mediana for blood loss in LapLR was 100 ml (quartile 100; 200) vs. 320 ml (quartile 200;600) in OLR, p=0.0001. The rate of R0 resections was comparable in both groups (p=1.0). The patients of OLR group more often had >1 complication (16 vs. 13, p=0.01) and had higher frequency of bile fistulas, abscesses in the liver resection area and clostridial colitis. Postoperative hospital stay was shorter in the LapLR group: 11+3 vs. 14+5 days, p=0.008. CONCLUSION: laparoscopic liver resections for metastases of colorectal cancer were associated with less intraoperative blood loss, morbidity, and shorter postoperative hospital stay, with comparable rate of R0 resections.

scholarly journals Is there is a role for laparoscopy for treatment of appendicular mass?

2018 ◽  
Vol 5 (5) ◽  
pp. 1610
Author(s):  
Asem F. Mohammed ◽  
Mahmoud A. Shaheen ◽  
Mahmoud S. Eldesouky
Keyword(s):  
Hospital Readmission ◽  
Operative Time ◽  
Surgical Intervention ◽  
Postoperative Hospital Stay ◽  
Interquartile Range ◽  
Open Approach ◽  
Suspected Appendicitis ◽  
Generalized Peritonitis ◽  
Significant Difference ◽  
Appendicular Mass

Background: The surgical intervention for acute appendicitis presenting with appendicular mass is not well established. The aim of this study was to evaluate the benefits of early laparoscopy and laparoscopic appendectomy (LA) in the treatment of appendicular mass.Methods: During a 1-year period, 48 patients underwent LA for suspected appendicitis (n = 39), generalized peritonitis (n = 1), and an appendicular mass (n = 8).Results: All appendectomies were attempted and done laparoscopically except in one case (appendicular abscess), converted to an open approach. None of appendicular mass patients developed complications. There were no deaths. There was no significant difference between appendicular mass forming patients and non-mass-forming patients who underwent LA for an early appendicular mass as regard to the operative time (median [interquartile range]: 50 [36–60] vs 45 [25–50] min, p = 0.085) and postoperative hospital stay (median [interquartile range]: 2 [1–2] vs [1–2] days, p = 0.1).  Conclusions: Early LA for appendicular mass patients is feasible, safe, and avoids misdiagnoses and the need for hospital readmission.

scholarly journals Extended right hemicolectomy and left hemicolectomy for colorectal cancers between the distal transverse and proximal descending colon

2016 ◽  
Vol 98 (5) ◽  
pp. 303-307 ◽  
Author(s):  
G Gravante ◽  
M Elshaer ◽  
R Parker ◽  
AC Mogekwu ◽  
B Drake ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Postoperative Morbidity ◽  
Right Hemicolectomy ◽  
Open Approach ◽  
Single Institution ◽  
Tumour Site ◽  
Left Hemicolectomy ◽  
Patient Demographics ◽  
Duration Of Surgery ◽  
Descending Colon

Introduction We report our experience with extended right hemicolectomy (ERH) and left hemicolectomy (LH) for the treatment of cancers located between the distal transverse and the proximal descending colon, and compare postoperative morbidity, mortality, pathological results and survival for the two techniques. Methods A retrospective review was performed of a single institution series over ten years. Patients who underwent different operations, had benign disease or received palliative resections were excluded. Data collected were patient demographics, type and duration of surgery, tumour site, postoperative complications and histology results. Results Ninety-eight patients were analysed (64 ERHs, 34 LHs). ERH was conducted using an open approach in 93.8% of cases compared with 73.5% for LH. The anastomotic leak rate was similar for both groups (ERH: 6.3%, LH: 5.9%). This was also the case for other postoperative complications, mortality (ERH: 1.6%, LH: 2.9%) and overall survival (ERH: 50.4 months, LH: 51.8 months). All but one patient in the ERH cohort had clear surgical margins. Nodal evaluation for staging was adequate in 78.1% of ERH cases and 58.8% of LH cases. Conclusions In our experience, both ERH and LH are adequate for tumours located between the distal transverse and the proximal descending colon.

scholarly journals Modified 1-Layer Duct-to-Mucosa Pancreaticojejunostomy Reduces Pancreatic Fistula After Pancreaticoduodenectomy

2018 ◽  
Vol 103 (7-8) ◽  
pp. 378-385 ◽  
Author(s):  
Jishu Wei ◽  
Xinchun Liu ◽  
Junli Wu ◽  
Wenbin Xu ◽  
Jia Zhou ◽  
...  
Keyword(s):  
Pancreatic Fistula ◽  
Postoperative Morbidity ◽  
Postoperative Hemorrhage ◽  
Postoperative Pancreatic Fistula ◽  
Postoperative Hospital Stay ◽  
Related Factors ◽  
Group 13 ◽  
Patient Demographics ◽  
Layer Technique ◽  
Pancreaticojejunal Anastomosis

Postoperative pancreatic fistula (POPF) is a major source of morbidity after pancreaticoduodenectomy (PD). The purpose of this retrospective study comparing 1-layer pancreaticojejunostomy (PJ) with 2-layer PJ after PD was to evaluate whether the 1-layer duct-to-mucosa PJ after PD can reduce the incidence of POPF. A total of 194 consecutive patients who underwent PD by one group of surgeons (led by Y.M.) from January 2011 to February 2014 were included in this study. Among those patients, 104 underwent 1-layer PJ (1-layer group), and 90 patients underwent 2-layer PJ (2-layer group). Preoperative clinicopathologic features, intraoperative parameters, and postoperative morbidity with a focus on POPF were compared between the 2 groups. The overall incidence of POPF was 19.6% (38 of 194 patients), and clinically relevant grade B and C POPF rates were 8.6% (16 of 194 patients) and 3.1% (6 of 194 patients), respectively. There were no differences in patient demographics and operation-related factors between the 2 groups. However, the incidence of POPF in the 1-layer group was significantly lower than in the 2-layer group [13.5% (14 of 104) of patients and 26.7% (24 of 90) of patients, respectively; P = 0.021]. The median postoperative hospital stay was also significantly shorter in the 1-layer group compared with the 2-layer group (13 versus 15 days, P = 0.035). One patient in the 2-layer group died of postoperative hemorrhage. One-layer duct-to-mucosa PJ is a simple and easy technique for pancreaticojejunal anastomosis after PD, and it can reduce the POPF rate in comparison with the 2-layer technique.

Examining the effect that prior bladder manipulation and BCG treatment have on false positive rates of blue-light cystoscopy biopsies.

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 416-416 ◽  
Author(s):  
Andrew Mount ◽  
Stephen Bentley Williams ◽  
Colin P. N. Dinney ◽  
H. Barton Grossman ◽  
Curtis Alvin Pettaway ◽  
...  
Keyword(s):  
Blue Light ◽  
False Positive ◽  
False Positive Rate ◽  
High Rate ◽  
Patient Factors ◽  
Exact Test ◽  
Clinical Notes ◽  
Real World Setting ◽  
Intravesical Bcg ◽  
Positive Rate

416 Background: One of the criticisms of blue-light cystoscopy (BL) is the relatively high rate of false positive biopsies when used in the real world setting. There is no consensus on which patient factors, if any, might be contributing to this high false positive rate. The purpose of this study is to determine whether having a cystoscopy, TURBT or BCG treatment recently resulted in higher rates of false positive blue-light (BL) biopsies. Methods: We performed an IRB-approved retrospective study looking at a total of 116 consecutive patients who underwent simultaneous BL and WL between January 2013 to December 2014. Pathology and operative reports were reviewed to determine the grade and stage of the tumors. Clinical notes were utilized to determine how recently they had a cystoscopy, TURBT, and BCG treatment. The false positive rates of both BL and WL were calculated, and Fisher’s exact test was utilized to determine if the time from the patients’ most recent bladder manipulation or BCG treatment had a significant effect on the false positive BL rate. Results: Of the 46 (28.6%) BL positive biopsies, 29 (63.0%) were false positives. When stratified by potential causes of false positive for BL we found the following: one (3.4%) had bladder manipulation within 14 days, 8 (27.6%) within 30 days, 19 (65.5%) within 60 days, and 10 (34.5%) had bladder manipulation beyond 60 days prior to the biopsy. When looking at intravesical BCG as a cause for false positive, we found prior BCG use in 18 (62%) patients of those with false positive BL compared to 12 (70.6%) patients of those with true positive BL biopsies (p = 1.0). Of the 18 patients with false positive BL biopsies who had BCG previously: 1 (5.6%) had BCG within 6 weeks, 5 (27.8%) had BCG within 12 weeks, and 13 (72.2%) had BCG greater than 12 weeks prior to biopsy. None of these associations were found to be statistically significant. Despite the high percentage of false positive lesions, it is important to note that in patients who had tumors visualized only with BL, 11 (26.8%) were high-grade, including one patient with T1 tumor and 8 with CIS. Conclusions: There was no relationship between recent bladder manipulation or BCG treatment and false positive BL biopsies.

scholarly journals Laparoscopic versus open approach in gastrectomy for advanced gastric cancer: a systematic review

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Zhipeng Zhu ◽  
Lulu Li ◽  
Jiuhua Xu ◽  
Weipeng Ye ◽  
Junjie Zeng ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Systematic Review ◽  
Blood Loss ◽  
Lymph Nodes ◽  
Advanced Gastric Cancer ◽  
Postoperative Morbidity ◽  
Meta Analysis ◽  
Positive Trend ◽  
Open Approach ◽  
Intraoperative Blood Loss

Abstract Background Additional studies comparing laparoscopic gastrectomy (LG) versus open gastrectomy (OG) for advanced gastric cancer (AGC) have been published, and it is necessary to update the systematic review of this subject. Objective We conducted the meta-analysis to find some proof for the use of LG in AGC and evaluate whether LG is an alternative treatment for AGC. Method Randomized controlled trials (RCT) and high-quality retrospective studies (NRCT) compared LG and OG for AGC, which were published in English between January 2010 and May 2019, were search in PubMed, Embase, and Web of Knowledge by three authors independently and thoroughly. Some primary endpoints were compared between the two groups, including intraoperative time, intraoperative blood loss, harvested lymph nodes, first flatus, first oral intake, first out of bed, post-operative hospital stay, postoperative morbidity and mortality, rate of disease recurrence, and 5-year over survival (5-y OS). Besides, considering for this 10-year dramatical surgical material development between 2010 and 2019, we furtherly make the same analysis based on recent studies published between 2016 and 2019. Result Thirty-six studies were enrolled in this systematic review and meta-analysis, including 5714 cases in LAG and 6094 cases in OG. LG showed longer intraoperative time, less intraoperative blood loss, and quicker recovery after operations. The number of harvested lymph nodes, hospital mortality, and tumor recurrence were similar. Postoperative morbidity and 5-y OS favored LG. Furthermore, the systemic analysis of recent studies published between 2016 and 2019 revealed similar result. Conclusion A positive trend was indicated towards LG. LG can be performed as an alternative to OG for AGC.

Some Clinical Notes on Forced Stuttering

1972 ◽  
Vol 37 (2) ◽  
pp. 177-186 ◽  
Author(s):  
Oliver Bloodstein ◽  
Roberta Levy Shogan
Keyword(s):  
Loss Of Control ◽  
Clinical Notes ◽  
High Degree

Stutterers sometimes report that by exerting articulatory pressure they can force themselves to have “real” blocks. A procedure was devised for instructing subjects to force stuttering under various conditions and for recording their introspections. Most subjects were able to force at least a few blocks which they regarded as real. Most of the words on which the attempts were said to succeed were feared or difficult words, and at times subjects assisted the process by “telling” themselves that they would not be able to say the word. Fewer subjects were able to force blocks on isolated sounds than on words, and almost none claimed to succeed on mere articulatory contacts. Subjects repeatedly characterized “real” stuttering as involving feelings of physical tension and loss of control over speech. The nature of the forced block is discussed with reference to a concept of stuttering as a struggle reaction which has acquired a high degree of automaticity.

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