scholarly journals O-BN04 Laparoscopic assisted robotic Heller’s cardiomyotomy in achalasia: a 12-year experience

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Priyantha Siriwardana ◽  
Bruno Lorenzi ◽  
Mohammad Qamruddin ◽  
Sritharan Kadirkamanathan
Keyword(s):  
Quality Of Life ◽  
Hospital Stay ◽  
Da Vinci ◽  
Symptom Improvement ◽  
Median Length ◽  
Da Vinci Robot ◽  
Technical Data ◽  
Surgical Technical

Abstract Background Heller’s cardiomyotomy (HC) using a computer-enhanced (robotic) laparoscopic platform allows for a more precise dissection. This is achieved by utilizing the superior optics of a 3D camera and greater degrees of freedom provided by robotic instrumentation. Our aim was to assess short to long term outcomes in terms of mucosal integrity, hospital stay and symptom improvement and quality of life. Methods A retrospective review of prospectively collected data was performed of patients who underwent robotic HC between July 2009- May 2021. HC was performed using a Da Vinci robot S and Xi (Intuitive Surgical Inc.) with 4 laparoscopic ports and liver retractor. Anterior mobilization of the oesophagus was performed leaving the posterior component of phreno-oesophageal ligament intact. A longitudinal myotomy was made extending into the proximal stomach. An anti-reflux procedure (ARP) was not routinely performed. Data collected including demography, Eckardt symptom score, Quality of Life (QoL) with SF-36, surgical technical data and surgical outcome (post-op morbidity, mortality, hospital stay). Results Fifty-seven patients underwent surgery (28 males). Median age was 46 years (18-71). Two had surgery for recurrent dysphagia following laparoscopic HC elsewhere. Median length of myotomy was 8cm (5-11). No mucosal breaches were identified at surgery, but one had postoperative leak. Median length of hospital stay was 2 days (1-148). One had chest infection and another DVT. Median follow-up was 61 months (2- 86). There was no mortality. Three patients (5%) needed oesophageal dilatation during follow-up. There was a significant improvement in Eckardt score from 10 (9-12) to 2 (0-6), and in all components of QoL (p < 0.05). Conclusions Heller’s myotomy can be performed very precisely using a Da Vinci Robot. It minimises the risk of mucosal breach reflecting in the low leak rate. No patient had developed troublesome reflux which may well be due to the preservation of the posterior component of the phreno-oesophageal ligament. It also improves symptoms and quality of life for many years. Robotic HC may become the standard treatment for achalasia in the very near future.

Comparative Analysis of Patients with Robotic Hiatal Hernia Repairs with and without Collis Gastroplasty

2021 ◽  
pp. 000313482198905
Author(s):  
John A. Perrone ◽  
Stephanie Yee ◽  
Manrique Guerrero ◽  
Antai Wang ◽  
Brian Hanley ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Statistical Analysis ◽  
Hospital Stay ◽  
Hiatal Hernia ◽  
Collis Gastroplasty ◽  
Significant Difference ◽  
Related Quality

Introduction After extensive mediastinal dissection fails to achieve adequate intra-abdominal esophageal length, a Collis gastroplasty(CG) is recommended to decrease axial tension and reduce hiatal hernia recurrence. However, concerns exist about staple line leak, and long-term symptoms of heartburn and dysphagia due to the acid-producing neoesophagus which lacks peristaltic activity. This study aimed to assess long-term satisfaction and GERD-related quality of life after robotic fundoplication with CG (wedge fundectomy technique) and to compare outcomes to patients who underwent fundoplication without CG. Outcomes studied included patient satisfaction, resumption of proton pump inhibitors (PPI), length of surgery (LOS), hospital stay, and reintervention. Methods This was a single-center retrospective analysis of patients from January 2017 through December 2018 undergoing elective robotic hiatal hernia repair and fundoplication. 61 patients were contacted for follow-up, of which 20 responded. Of those 20 patients, 7 had a CG performed during surgery while 13 did not. There was no significant difference in size and type of hiatal hernias in the 2 groups. These patients agreed to give their feedback via a GERD health-related quality of life (GERD HRQL) questionnaire. Their medical records were reviewed for LOS, length of hospital stay (LOH), and reintervention needed. Statistical analysis was performed using SPSS v 25. Satisfaction and need for PPIs were compared between the treatment and control groups using the chi-square test of independence. Results Statistical analysis showed that satisfaction with outcome and PPI resumption was not significantly different between both groups ( P > .05). There was a significant difference in the average ranks between the 2 groups for the question on postoperative dysphagia on the follow-up GERD HRQL questionnaire, with the group with CG reporting no dysphagia. There were no significant differences in the average ranks between the 2 groups for the remaining 15 questions ( P > .05). The median LOS was longer in patients who had a CG compared to patients who did not (250 vs. 148 min) ( P = .01). The LOH stay was not significantly different ( P > .05) with a median length of stay of 2 days observed in both groups. There were no leaks in the Collis group and no reoperations, conversions, or blood transfusions needed in either group. Conclusion Collis gastroplasty is a safe option to utilize for short esophagus noted despite extensive mediastinal mobilization and does not adversely affect the LOH stay, need for reoperation, or patient long-term satisfaction.

scholarly journals A Study to Assess the Quality of Life of Postoperative Patients With Oral Cancer in B.R.A I.R.C.H., AIIMS, New Delhi

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 100s-100s
Author(s):  
N. Paulose ◽  
A. Sinha ◽  
S.V.S. Deo
Keyword(s):  
Quality Of Life ◽  
Weight Loss ◽  
Oral Cancer ◽  
Hospital Stay ◽  
Head And Neck ◽  
New Delhi ◽  
The World ◽  
Speech Problem

Introduction: Cancer is a leading cause of death in both developed and underdeveloped countries in the world. The Indian subcontinent accounts for one-third of the world burden of head and neck cancer. Surgery is the standard treatment of choice for head and neck cancers. It is imperative to give supportive care to improve the quality of life. Aim: To assess the quality of life of postoperative patients with oral cancer in B.R.A I.R.C.H, AIIMS, New Delhi. Methodology: The study was conducted at B.R.A.I.R.C.H, AIIMS, New Delhi. The data were collected by convenience sampling from 50 adults who underwent surgery for oral during June 2017 to December 2017. Standardized self-structured EORTC QOL(H&N) was used to assess the perceived level of the quality of life of postoperative patients with oral cancer during hospital stay and at one month follow-up. Ethical clearance was obtained from institutional ethics committee. Results: 80% patients were male. Majority of the patients underwent mandibulectomy (66%) modified neck dissection (60%) and regional flap reconstruction (56%). The major symptoms perceived during hospital stay were pain (98%), speech problem (84%), problem in opening mouth (82%), felt ill (80%), weight loss (74%), etc. and at one month follow-up were problem in opening mouth (90.6%), pain (90.5%), speech problem (83.6%), weight loss (82%), among many others. There was a significant decrease in the perceived pain (11.2 ± 2.99) at one month follow-up (9.12 ± 3.42). Conclusion: Most of the patients experience pain, problem in opening mouth, sticky saliva, speech problem, trouble in social contact, weight loss, etc.

scholarly journals Medial buttressing of the quadrilateral surface in acetabular and periprosthetic acetabular fractures

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0243592
Author(s):  
Pol Maria Rommens ◽  
Michiel Herteleer ◽  
Kristin Handrich ◽  
Mehdi Boudissa ◽  
Daniel Wagner ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Hospital Stay ◽  
Activity Level ◽  
Acetabular Fractures ◽  
Life Activity ◽  
Quadrilateral Plate ◽  
Group 2 ◽  
Group 1

Background In geriatric acetabular fractures, the quadrilateral plate is often involved in the fracture pattern and medially displaced. Open reduction and internal fixation (ORIF) includes reduction of the quadrilateral plate and securing its position. In this study, the concept of medial buttressing in acute and periprosthetic acetabular fractures is evaluated. Materials and methods Patients, who sustained an acetabular fracture between 2012 and 2018, in whom ORIF with a specific implant for medial buttressing was performed, were included in the study. Patients were divided in two groups; acute acetabular fractures (group 1) and periprosthetic acetabular fractures (group 2). Demographics, type of fracture, surgical approach, type of implant for medial buttressing, comorbidities, general and surgical in-hospital complications and length of hospital stay were recorded retrospectively. The following data were collected from the surviving patients by telephone interview: EQ-5D-5L, SF-8 physical and SF-8 mental before trauma and at follow-up, UCLA activity scale, Parker Mobility Score and Numeric Rating Scale. Results Forty-six patients were included in this study, 30 males (65.2%) and 16 females (34.8%). Forty patients were included group 1 and six patients in group 2. The median age of patients of group 1 was 78 years. Among them, 82.5% presented with comorbidities. Their median length of in-hospital stay was 20.5 days. 57.5% of patients suffered from in-hospital complications. The concept of medial buttressing was successful in all but one patient. ORIF together with primary total hip arthroplasty (THA) was carried out as a single stage procedure in 3 patients. Secondary THA was performed in 5 additional patients (5/37 = 13.5%) within the observation period. Among surviving patients, 79.2% were evaluated after 3 years of follow-up. Quality of life, activity level and mobility dropped importantly and were lower than the values of a German reference population. SF-8 mental did not change. The median age of patients of group 2 was 79.5 years, all of them presented with one or several comorbidities. The median length of in-hospital stay was 18.5 days. 50% of patients suffered from in-hospital complications. The concept of medial buttressing was successful in all patients. 5 of 6 patients (83.3%) could be evaluated after a median of 136 weeks. In none of these patients, secondary surgery was necessary. Quality of life, activity level and mobility importantly dropped as well in this group. SF-8 mental remained unchanged. Conclusion In geriatric acetabular fractures with involvement and medial displacement of the quadrilateral plate, medial buttressing as part of ORIF proved to be reliable. Only 13.5% of patients of group 1 needed a secondary THA within 3 years of follow-up, which is lower than in comparable studies. Despite successful surgery, quality of life, activity level and mobility dropped importantly in all patients. The loss of independence did however not influence SF-8 mental values.

scholarly journals To study the short-term outcome of multimodality treatment on morbidity and quality of life in patients with carcinoma oesophagus

2017 ◽  
Vol 5 (4) ◽  
pp. 1594
Author(s):  
Karamveer Singh ◽  
Navneet Jain ◽  
Sunil Saini
Keyword(s):  
Quality Of Life ◽  
Multimodality Treatment ◽  
Symptom Improvement ◽  
Life Questionnaire ◽  
Curative Intent ◽  
European Organization ◽  
Female Ratio ◽  
Carcinoma Oesophagus

Background: Oesophageal cancer is sixth most common cause of cancer related deaths worldwide. Despite complete resections, overall survival remained low. To improve the existing treatment combination of chemotherapy and radiotherapy in both neoadjuvant and adjuvant settings was introduced. Impact of treatment on quality of life, morbidities and toxicities associated with multimodality treatment in patients of carcinoma oesophagus was studied prospectively and retrospectively.Methods: A total of 40 patients histologically proven carcinoma of the oesophagus were enrolled in the study. Study included assessment of clinical features, risk factors, biopsy, multimodality treatment and associated morbidities and toxicities. Quality of Life (QOL) in patients of multimodality treatment assessed using European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 and Core 18 before, immediate post treatment and 6 months after completion of the planned treatment.Results: In 40 patients, male to female ratio was 1.10:1. Dysphagia was the leading complain. 3 patients were treated using neoadjuvant therapy (chemotherapy and radiotherapy followed by surgery) among them 2 patients expired, 1 patient is under regular follow up. 6 patients underwent upfront surgery followed by adjuvant therapy out of which 3 patients expired,15 patients were treated with curative intent by definitive chemotherapy and radiotherapy out of which only 7 patients survived for >1 year. 16 patients were treated with palliative intent (radiotherapy, chemotherapy, oesophageal stenting and feeding procedures) in which only 1 patient survived for 1 year.Conclusions: The present study demonstrates that patients over all QOL was reduced after treatment and in the follow up period which was due to the treatment related toxicities but in contrast symptom improvement was observed simultaneously.

scholarly journals Mind It: Increasing Rate of Mental Health Disorders in Hospitalized Sickle Cell Patients

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 4689-4689
Author(s):  
Nauman Siddiqui ◽  
Amandeep Godara ◽  
Amber Afzal ◽  
Mohammad Saud Khan ◽  
Satish Munigala ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
Hospital Stay ◽  
Sickle Cell ◽  
Length Of Hospital Stay ◽  
Mental Health Disorders ◽  
National Inpatient Sample ◽  
Median Length ◽  
Health Disorders

Abstract Introduction: The number of patients with sickle cell disease (SCD) approaches 100,000 in US after adjusting for early mortality (Hassell Am J Prev Med 2010). Management of SCD and its complications require frequent access to healthcare system lifelong, thus impacting patients' quality of life and cost of healthcare. Chronic pain inducing illnesses are known to increase susceptibility to mental health disorders (Rayner Pain 2016). Psychosocial disorders are common in this population and impact the course of hospitalization, however we have limited published data in this area. Hence, we performed a large retrospective study utilizing the National Inpatient Sample (NIS) data to evaluate the prevalence of mental health disorders in hospitalized sickle cell patients, and their influence on length of hospitalization. Methods: We identified hospitalized sickle cell patients using ICD 9 codes (282.5,282.6X -282.6X ) in the National Inpatient Sample (NIS) database. Similarly, ICD-9 codes were used to identify patients with mental health disorders of interest. The demographics and length of hospital stay of patients with and without mental health disorders were then compared. Surveyfreq was used to calculate proportions and surveymeans was used to calculate median length of stay and hospital charges. Cochran-Armitage test was used for analyzing trends. We used chi-square for categorical data frequency, P value of < 0.05 was considered statistically significant. All analysis was performed using SAS 9.4. Results: We identified a total of 1,349,701 hospitalizations for sickle cell patients between 2003-2014, of which 221,279 (16%) had associated mental health disorders. Mood disorders were most common (40%), followed by substance abuse (28%) and anxiety disorder (16%) (Table 1). Over the timeline of our study, we found a longitudinal trend towards higher prevalence of mental health disorders in hospitalized sickle cell patients (Figure 1). There was higher prevalence of mental health disorders among patients aged between 21-40 years (24%). No difference in the rate of mental health disorders was noted in patients admitted with or without acute sickle cell pain episode. Median length of hospital stay (LOS) was 4 days in patients with mental health disorders (95% CI 4.04-4.12) compared to 3 days in those without (95% CI 3.17-3.20). Conclusion: The prevalence of mental health disorders in hospitalized sickle cell patients has been gradually increasing from 2003 to 2014 and approaches 16% overall. The length of hospital stay is longer for the individuals with these disorders than those without hence, increasing the cost of health care and reducing patient satisfaction. Therefore, early recognition and intervention for mental health disorders is paramount to promote quality of life and reduce health care costs. This demands for a multidisciplinary approach to provide better access to mental health resources to this population in the outpatient setting. Disclosures No relevant conflicts of interest to declare.

scholarly journals Mannitol versus hypertonic saline for brain relaxation in patients undergoing craniotomy – A Cochrane Systematic Review

2017 ◽  
Vol 04 (02) ◽  
pp. 099-107 ◽  
Author(s):  
Hemanshu Prabhakar ◽  
Gyaninder Singh ◽  
Mani Kalaivani ◽  
Vidhu Anand
Keyword(s):  
Quality Of Life ◽  
Hospital Stay ◽  
Hypertonic Saline ◽  
Saline Group ◽  
Icu Stay ◽  
Brain Relaxation ◽  
The Mean

Abstract Background: Patients with brain tumour usually suffer from increased pressure in the skull due to swelling of brain tissue. A swollen brain renders surgical removal of the brain tumour difficult. To ease surgical tumour removal, measures are taken to reduce brain swelling, often referred to as brain relaxation. Brain relaxation can be achieved with intravenous fluids such as mannitol or hypertonic saline. The objective of this review was to compare the effects of mannitol versus those of hypertonic saline on intraoperative brain relaxation in patients undergoing craniotomy. Methods: We searched the Cochrane Central Register of Controlled Trials (2013, Issue 10), MEDLINE through OvidSP (1966 to October 2013) and EMBASE through OvidSP (1980 to October 2013). We also searched specific websites, such as www.indmed.nic.in, www.cochrane-sadcct.org and www.clinicaltrials.gov. We included randomised controlled trials (RCTs) that compared the use of hypertonic saline versus mannitol for brain relaxation. We also included studies in which any other method used for intraoperative brain relaxation was compared with mannitol or hypertonic saline. The primary outcomes were longest follow-up mortality, Glasgow outcome scale score at 3 months and any adverse event related to mannitol or hypertonic saline. The secondary outcomes were intraoperative brain relaxation, Intensive Care Unit (ICU) stay, hospital stay and quality of life. We used standardised methods for conducting a systematic review as described by the Cochrane Handbook for Systematic Reviews of Interventions. Two review authors independently extracted details of trial methodology and outcome data from reports of all trials considered eligible for inclusion. All analyses were made on an intention-to-treat basis. We used a fixed-effect model when no evidence was found of significant heterogeneity between studies and a random-effects model when heterogeneity was likely. Results: We included six RCTs with 527 participants. Only one RCT was judged to be at low risk of bias. The remaining five RCTs were at unclear or high risk of bias. No trial mentioned the primary outcomes of longest follow-up mortality, Glasgow outcome scale score at 3 months or any adverse event related to mannitol or hypertonic saline. Three trials mentioned that the secondary outcomes of intraoperative brain relaxation, hospital stay, ICU stay and quality of life were not reported in any of the trials. Brain relaxation was inadequate in 42 of 197 participants in the hypertonic saline group and 68 of 190 participants in the mannitol group. The risk ratio for brain bulge or tense brain in the hypertonic saline group was 0.60 (95% confidence interval 0.44–0.83, low-quality evidence). One trial reported ICU and hospital stay. The mean (standard deviation [SD]) duration of ICU stay in the mannitol and hypertonic saline groups was 1.28 (0.5) and 1.25 (0.5) days (P - 0.64), respectively; the mean (SD) duration of hospital stay in the mannitol and hypertonic saline groups was 5.7 (0.7) and 5.7 (0.8) days (P - 1.00), respectively. Conclusions: From the limited data available on the use of mannitol and hypertonic saline for brain relaxation during craniotomy, it is suggested that hypertonic saline significantly reduces the risk of tense brain during craniotomy. A single trial suggests that ICU stay and hospital stay are comparable with the use of mannitol or hypertonic saline. However, focus on other related important issues such as long-term mortality, long-term outcome, adverse events and quality of life is needed.

scholarly journals Hemi body irradiation: An economical way of palliation of pain in bone metastasis in advanced cancer

2014 ◽  
Vol 03 (01) ◽  
pp. 028-032 ◽  
Author(s):  
Santanu Pal ◽  
Samrat Dutta ◽  
Shyam Sundar Adhikary ◽  
Biswamit Bhattacharya ◽  
Balaram Ghosh ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Lung Cancer ◽  
Side Effects ◽  
Cancer Patient ◽  
Hospital Stay ◽  
Pain Score ◽  
Cancer Patients ◽  
Oral Morphine

Abstract Background: The primary aim of this prospective non-randomized study was to evaluate the effect of hemi-body irradiation (HBI) on pain and quality of life in cancer patients with extensive bone metastases. The secondary aim was to evaluate side-effects and cost-effectiveness of the treatment. Materials and Methods: Between March 2008 and December 2010, a total of 23 (male = 14, female = 9, median age = 60 years) diagnosed cases of metastatic cancer patients (prostate = 11, breast = 6, and lung = 6) received HBI, which was delivered as lower (n = 7) (dose = 8 Gy), upper (n = 8) (dose = 6 Gy), or sequential HBI (n = 8) with a Telecobalt unit (Theratron 780C). Among them, one lung cancer patient died at 2 months and one prostate cancer patient defaulted after the second follow-up. Thus, 21 patients (male = 13, female = 8, median age = 65 years) (prostatic cancer = 10, breast cancer = 6, and lung cancer = 5) were followed up for a minimum of 6 months. Evaluations were performed before and at 2, 4, 8, 16, and 24 weeks after treatment. Pain evaluation was done by Visual Analogue Scale (VAS), Verbal Rating Scale (VRS), Percentage of Pain Relief (PRR), and Global Pain Score (GPS). Toxicity was assessed by CTC v-3 toxicity scores in the medical record. Assessment of oral morphine consumption was done before and after radiation using paired t-test, and correlation analysis was also done with decrease of morphine consumption and reduction of pain score using statistical analysis. Results: Response (control of pain) was partial (PR) in 67% and complete (CR) in 22% of patients. For most patients, the pain control lasted throughout the follow-up period (6 months). From 66.66% patients requiring 13 or more Morphine (10 mg) tablets per day prior to HBI, none of the patients required to consume 13 or more Morphine (10 mg) tablets per day following HBI, which was correlated with significant reduction in various pain scores (P < 0.05). One way ANOVA with Dunnett′s Multiple Comparison Test (P < 0.05) was significant in VAS score changes, VRS score changes, PPR score changes, and GPS score changes. Along with the decrease in morphine tablets, the Linear Correlation of various scales for pain reduction like VAS, VRS, PPR, and GPS were significant. As such, the quality of life was better due to decreased pain and also, a decrease in the dose of analgesics. Grade 1 and 2 hematological toxicity and grade 1 diarrhea were observed as common side-effects. The average total cost of treatment including hospital stay, medicines, and radiation charges was around INR 400.00. Conclusion: This study shows that hemibody irradiation is not only an effective modality for palliation of severe bone pain in advanced cancer cases but also economical, involves short hospital stay, with acceptable side-effects, utilizes the simple Telecobalt machine, and is less cumbersome in comparison to other currently available pain palliation methods like oral morphine and radiopharmaceuticals.

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