Pectus Excavatum: A Comparison of the Ravitch Repair with the Nuss Thoracoscopic Technique with a Standard Metal Bar or an Absorbable Bar

Objective Although pectus excavatum repair has evolved to a minimally invasive technique in prepubescent patients, the best approach in adults is less clearly understood. The aim of this study was to identify the preoperative characteristics, operative variables, and postoperative outcomes in adult patients with pectus excavatum undergoing thoracoscopic repair using different bar stabilizers compared with the open surgical repair. Methods We conducted a prospective study between July 2009 and July 2012 in a single institution. Thirty-one patients (26 men and 5 women) aged 18 to 35 years were randomly assigned into three groups: group A, 9 patients underwent modified Ravitch repair; group B, 11 patients underwent video-assisted thoracoscopic repair using metal stabilizers; and group C, 11 patients underwent video-assisted thoracoscopic repair using absorbable stabilizers. Preoperative, intraoperative, and postoperative variables are compared between all groups. Results In all groups, the preoperative variables were well matched for age, sex, and Haller index. Operative time was 2 hours longer in group A (P = 0.0001). There was no intraoperative complication. Length of hospital stay was 4 days shorter in group A. Morbidity was 23% and composed of pneumothorax (three), wound seroma (two), pleural effusion (one), and stabilizer break (one), occurring more frequently in groups B and C. There was no perioperative mortality. All patients were satisfied with the cosmetic results. Conclusions Repair of pectus excavatum in adult patients can be performed effectively through either open surgical technique or thoracoscopy, with no intraoperative complications and with excellent immediate results. Although the operative time for the Ravitch repair was longer, the hospital stay was significantly shorter than that for the video-assisted method.

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Study of diagnostic and therapeutic utility of video assisted thoracoscopic surgery

International Surgery Journal ◽

10.18203/2349-2902.isj20182955 ◽

2018 ◽

Vol 5 (8) ◽

pp. 2751

Author(s):

Nilesh P. Mangam ◽

Aashish R. Chavan ◽

Ritesh Bodade ◽

Asmita Dhurve

Keyword(s):

Hospital Stay ◽

Operative Time ◽

Thoracoscopic Surgery ◽

Postoperative Bleeding ◽

Intraoperative Complication ◽

Video Assisted ◽

Significant Difference ◽

Prolonged Air Leak ◽

Video Assisted Thoracoscopic Surgery ◽

Therapeutic Utility

Background: Video-assisted thoracoscopic surgery (VATS) is rapidly becoming a popular method for diagnostic and therapeutic purposes. Many diseases of the chest can now be diagnosed by VATS due to ease of look and biopsy. Hence the present study was undertaken to determine diagnostic and therapeutic utility of VATS in different chest pathologies.Methods: In this prospective study, total 36 patients of different age group were subjected to VATS procedure, to measured operative time, intra and post- operative complications, post-operative pain and hospital stay. Then patient was followed up at 15 days, at 1 month, 3 month and at 6 months.Results: VATS was successfully carried out in 28 patients as the only procedure whereas 8 patients required conversion to thoracotomy. Average operative time for patients operated by VATS only was 94.9 minute and for patients operated by VATS converted to thoracotomy was 175.5 minute. Most common intraoperative complication was bleeding (16.66 %) followed by anaphylactic shock observed in only one patient. Most common postoperative complication was prolonged air leak (5.55%) followed by port site infection (2.77%) and postoperative bleeding (2.77%). At 24 hours postoperatively, average pain score observed in VATS group was 3.73 and in thoracotomy group was 6.28. The mean postoperative hospital stay for patients operated by VATS was 7.28 days and for patients operated by VATS converted to thoracotomy was 10.36 days. There was significant difference observed in diagnosis of various chest pathologies by radiological investigations and VATS.Conclusions: VATS should be offered as the first approach to various chest pathologies requiring surgical intervention and preferred over thoracotomy when feasible.

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A comparative study of two operative procedures in anterior hypospadias repair: limited urethral mobilization and tubularized incised plate urethroplasty.

The Professional Medical Journal ◽

10.29309/tpmj/2021.28.11.6506 ◽

2021 ◽

Vol 28 (11) ◽

pp. 1578-1584

Author(s):

Shafiq ur Rehman ◽

Fareena Ishtiaq ◽

Zarlish Fazal ◽

Muhammad Anwar ◽

Saad Fazal

Keyword(s):

Hospital Stay ◽

Functional Outcomes ◽

Operative Time ◽

Operation Time ◽

Cosmetic Appearance ◽

Tubularized Incised Plate ◽

Group A ◽

Tubularized Incised Plate Urethroplasty ◽

The Mean ◽

Group B

Objectives: This study is aimed to compare the results of limited urethral mobilization and tubularized incised plate urethroplasty in the management of anterior hypospadias, in terms of cosmetic and functional outcomes, complication rate, operative time, and hospital stay. Study Design: Prospective Randomized Controlled study. Settings: Department of Pediatric Surgery, DHQ Teaching Hospital Sahiwal. Period: January 2019 to December 2020. Material and Methods: A total of 89 patients with anterior hypospadias were included. Patients were divided randomly into two groups. In group A, limited urethral mobilization was performed and in group B, tubularized incised plate urethroplasty was carried out. A self-structured performa was used to collect the data of all patients. Both groups were compared in terms of the operation time, hospital stay, postoperative complications, cosmetic appearance, and functional outcomes. Results: Forty-five patients were included in group A, age ranged from 2.5 to 12 years (mean 4.83years). Forty-four patients were included in group B and their ages ranged from 3.5 to 11years (mean 4.76 years). The operation time was significantly less for group A than for group B. In group A, it ranged from 54 to 69 min with an average time of 60.51 min and in group B from 70 to 88 min, with an average of 79.34 min. The mean hospital stay period in group A was 7.37 days, ranged from 7 to 9 days, and in group B was 11.04 days, ranging from 10 to 13 days. The mean follow-up period in both groups was 7.45 months, ranging from 3 months to 12 months. Meatal stenosis was the most common complication in group A, which developed in 6.66% (n=3) patients. Urethrocutaneous fistula was the most common complication in group B, which developed in 6.81% (n=3) patients. Cosmetic appearance and functional outcome were good and comparable in both groups. Conclusion: Although both techniques, tubularized incised plate and limited urethral mobilization urethroplasty are acceptable modalities for the management of anterior hypospadias. But limited urethral mobilization urethroplasty seems to be a good option due to its simplicity, short hospital stay, significant shorter operative time, low fistula formation rate, and good cosmetic and functional outcomes.

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Laparoscopic Testicular Preservation in Adults with Intra-Abdominal Cryptorchidism: Is It Beneficial?

Advances in Urology ◽

10.1155/2012/329237 ◽

2012 ◽

Vol 2012 ◽

pp. 1-4

Author(s):

Fábio César Miranda Torricelli ◽

Marco Antonio Arap ◽

Ricardo Jordão Duarte ◽

Anuar Ibrahim Mitre ◽

Miguel Srougi

Keyword(s):

Postoperative Complications ◽

Hospital Stay ◽

Operative Time ◽

Testicular Tumor ◽

Adult Patients ◽

Patient Age ◽

Testis Development ◽

Patient Âgé ◽

Laparoscopic Evaluation ◽

Prospective Database

Purpose. To present the results in a midterm followup of laparoscopic testicular preservation in adults with intra-abdominal cryptorchidism.Methods. We analyzed 14 adult patients with cryptorchidism (19 testes) submitted to transabdominal laparoscopic evaluation and treatment of the condition. Data was collected retrospectively from a prospective database from August 2005 to May 2010. It analyzed patient age, affected side, procedure, mean operative time, mean hospital stay, postoperative testis position, intra- and postoperative complications, presence of malignancy in the removed testis, and midterm outcomes: size of the testis, development of tumors, and fertility.Results. Mean patient age was 29 (18–54) years. Thirteen (68.4%) testes were preserved. There were no intra- or postoperative complications. After a mean followup of 48.7 (20–64) months, all patients submitted to orchiopexy had the organs correctly positioned, although 2 testes were significantly smaller than before the procedure. No patient presented any signs of malignancy during the followup. Fertility was not preserved in bilateral cases.Conclusion. Laparoscopic testicular evaluation and eventual preservation are feasible and safe. In a midterm followup, testicular tumor is not a concern, and unfortunately, fertility may not be preserved in bilateral cases.

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DOES EARLY LAPAROSCOPIC CHOLECYSTECTOMY AFTER ERCP OFFERS SIGNIFICANT BENEFIT IN SURGICAL OUTCOME? A COMPARATIVE STUDY BETWEEN EARLY AND LATE GROUPS

10.36106/ijsr/3225443 ◽

2021 ◽

pp. 59-61

Author(s):

Anshul Mathur ◽

Ketan Patel ◽

Jitendra Kumar Mangtani ◽

K.K. Dangayach

Keyword(s):

Laparoscopic Cholecystectomy ◽

Hospital Stay ◽

Operative Time ◽

Open Cholecystectomy ◽

Endoscopic Retrograde ◽

Endoscopic Retrograde Cholangiopancreaticography ◽

Early Laparoscopic Cholecystectomy ◽

Conversion Rates ◽

Group A ◽

Group B

Introduction:- Endoscopic retrograde cholangiopancreaticography (ERCP) prior to Laparoscopic Cholecystectomy(LC) is most commonly practiced strategy worldwide for management of co-existing cholelithiasis with choledocholithiasis. The time interval between Endoscopic Retrograde Cholangiopancreaticography (ERCP) and Laparoscopic cholecystectomy (LC) is questionable and varies from 1 day to 6 weeks in different studies. Aims and objectives:- To compare two groups of patients managed with laparoscopic cholecystectomy (after ERCP), EARLY(24 to 72 hours), and LATE(> 6weeks) in terms of mean operative time in minutes, intraoperative difculties, conversion rates to open cholecystectomy, conversion rates to open cholecystectomy, drain insertion required or not, postoperative complications, and duration of hospital stay. Materials and methods:- A prospective randomized comparative study was conducted on 70 patients who presented with concomitant cholelithiasis with choledocholithiasis over a period of January 2019 to June 2020 at the Department of General Surgery, Mahatma Gandhi Medical College & Hospital, Jaipur. After ERCP and stone retrieval patients were randomised into 2 groups using sealed envelope method. Group A underwent early laparoscopic cholecystectomy (24 to 72hours) and Group B underwent late laparoscopic cholecystectomy (after 6 weeks). Data collected, statistical analysis done, results and observations concluded. Result:- We found that mean operative time, intraoperative difculties, post operative complications and mean hospital stay in days were signicantly higher in Group B as compared to Group A. Though the conversion rates to open procedure and requirement of drain insertion were comparatively higher in Group B but were found to be statistically non signicant. Conclusion:- We hereby conclude that early laparoscopic cholecystectomy (24 to 72 hours) after Endoscopic Retrograde Cholangiopancreaticography (ERCP) is better as compared to late laparoscopic cholecystectomy (>6 weeks) after ERCP in patients of cholelithiasis with coexisting choledocholithiasis. So, we recommend performing early Laparoscopic Cholecystectomy (24-72hours) after Endoscopic Retrograde Cholangiopancreaticography (ERCP)

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Intercostal nerve cryoablation versus thoracic epidural for postoperative analgesia following pectus excavatum repair: a systematic review and meta-analysis

Interactive CardioVascular and Thoracic Surgery ◽

10.1093/icvts/ivaa151 ◽

2020 ◽

Vol 31 (4) ◽

pp. 486-498

Author(s):

Jean H T Daemen ◽

Erik R de Loos ◽

Yvonne L J Vissers ◽

Maikel J A M Bakens ◽

Jos G Maessen ◽

...

Keyword(s):

Postoperative Pain ◽

Epidural Analgesia ◽

Hospital Stay ◽

Pectus Excavatum ◽

Operative Time ◽

Meta Analysis ◽

Length Of Hospital Stay ◽

Intercostal Nerve ◽

Nuss Procedure ◽

Thoracic Epidural

Abstract OBJECTIVES Minimally invasive pectus excavatum repair via the Nuss procedure is associated with significant postoperative pain that is considered as the dominant factor affecting the duration of hospitalization. Postoperative pain after the Nuss procedures is commonly controlled by thoracic epidural analgesia. Recently, intercostal nerve cryoablation has been proposed as an alternative method with long-acting pain control and shortened hospitalization. The subsequent objective was to systematically review the outcomes of intercostal nerve cryoablation in comparison to thoracic epidural after the Nuss procedure. METHODS Six scientific databases were searched. Data concerning the length of hospital stay, operative time and postoperative opioid usage were extracted. If possible, data were submitted to meta-analysis using the mean of differences, random-effects model with inverse variance method and I2 test for heterogeneity. RESULTS Four observational and 1 randomized study were included, enrolling a total of 196 patients. Meta-analyses demonstrated a significantly shortened length of hospital stay [mean difference −2.91 days; 95% confidence interval (CI) −3.68 to −2.15; P < 0.001] and increased operative time (mean difference 40.91 min; 95% CI 14.42–67.40; P < 0.001) for cryoablation. Both analyses demonstrated significant heterogeneity (both I2 = 91%; P < 0.001). Qualitative analysis demonstrated the amount of postoperative opioid usage to be significantly lower for cryoablation in 3 out of 4 reporting studies. CONCLUSIONS Intercostal nerve cryoablation during the Nuss procedure may be an attractive alternative to thoracic epidural analgesia, resulting in shortened hospitalization. However, given the low quality and heterogeneity of studies, more randomized controlled trials are needed.

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Comparison of minimally invasive total knee arthroplasty with standard approach total knee arthroplasty in terms of length of post-operative hospital stay.

The Professional Medical Journal ◽

10.29309/tpmj/2019.26.08.3552 ◽

2019 ◽

Vol 26 (08) ◽

pp. 1246-1250

Author(s):

Muhammad Usman Haider ◽

Raja Umar Liaqat ◽

Junaid Khan ◽

Islam Ud Din ◽

Muhammad Imran Aftab

Keyword(s):

Total Knee Arthroplasty ◽

Minimally Invasive ◽

Hospital Stay ◽

Knee Arthroplasty ◽

Length Of Hospital Stay ◽

Standard Approach ◽

Invasive Technique ◽

Group A ◽

Total Knee ◽

Group B

To compare the minimally invasive total knee arthroplasty with standard approach total knee arthroplasty in terms of mean length of post-operative hospital stay. Study Design: Randomized Controlled Trial. Setting: Department of Orthopaedics, Benazir Bhutto Hospital, Rawalpindi. Period: 06 months i.e. from 21st March 2018 to 20th September 2018. Materials and Methods: A total of one hundred (n=100) patients between age 30-80 years who were planned to undergo total knee arthroplasty (TKA) were enrolled and randomly allocated to two groups. The patients in group A were operated through minimally invasive technique and in group B, were operated through standard approach. Outcome was measured in terms of mean length of hospital stay in both groups. Results: Baseline characteristics were comparable in both the groups. In group A, mean length of hospital stay was 4.4±0.64 days while in group B it was 5.6±0.63 days (p=0.001). Similar trend was noted when data was stratified with respect to age, gender, anatomical side and BMI. Conclusion: Minimally invasive TKA resulted in shorter length of hospital stay following when compared with standard approach TKA.

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Local anesthesia versus general anesthesia for evacuation of chronic subdural hematoma in elderly patients above 70 years old

Surgical Neurology International ◽

10.25259/sni_425_2021 ◽

2022 ◽

Vol 13 ◽

pp. 13

Author(s):

Ahmed Ashry ◽

Hieder Al-Shami ◽

Medhat Gamal ◽

Ahmed M Salah

Keyword(s):

Elderly Patients ◽

Hospital Stay ◽

Local Anesthesia ◽

Subdural Hematoma ◽

Complication Rate ◽

Operative Time ◽

Chronic Subdural Hematoma ◽

Length Of Hospital Stay ◽

Group A ◽

Group B

Background: The aim of this study was to assess the safety and efficacy of chronic subdural hematoma (CSDH) evacuation by two burr-hole craniostomies under local versus general anesthesia (GA) in elderly patients over 70 years. Methods: This retrospective study included 45 patients with CSDH aged over 70 years old treated from March 2018 to April 2020. The cases were subdivided into Group A (n = 22) that underwent evacuation under local anesthesia and Group B (n = 23) that was treated under GA. Patients’ demographics and history of comorbidities were recorded. Variables including pre- and post-operative neurological status and Markwalder’s score, complication rate, operative time, and length of hospital stay were evaluated. Results: The mean and standard deviation of patients’ age of groups (A) and (B) were 74.3 ± 2.5 and 73.2 ± 1.7 years, respectively. Postoperative Glasgow Coma Scale of group (A) was statistically higher than Group B at postoperative day 1 (P = 0.01). Operative time was statistically shorter in Group A than B (P < 0.0001). The length of hospital stay was found to be longer in group (B) than (A) (P = 0.0001). The complication rate was found to be higher in group (B) than (A) (P = 0.044). Conclusion: Evacuation of CSDH under local anesthesia in elderly patients over 70 years is effective, safe, and economic with less complication rate than the traditional technique with GA.

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Evaluation of mesh fixation versus non-fixation in laparoscopic mesh hernioplasty in inguinal hernias

International Surgery Journal ◽

10.18203/2349-2902.isj20204136 ◽

2020 ◽

Vol 7 (10) ◽

pp. 3354

Author(s):

Shubra Kochar ◽

Dipanshu Kakkar ◽

Devendra Pal Singh

Keyword(s):

Hospital Stay ◽

Operative Time ◽

Mesh Fixation ◽

Preperitoneal Space ◽

P Value ◽

Chi Square ◽

Analgesic Requirement ◽

Inguinal Hernias ◽

Group A

Background: Laparoscopic inguinal hernia repair (LIHR) is usually done by two methods, which vary in approach to the preperitoneal space; transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP). This study aimed at comparing the effect of mesh fixation and non-fixation in terms of operative time, hospital stay, analgesic requirement, complications and cost analysis with respect to fixation device in LIHR.Methods: This prospective randomized comparative study included 60 patients of inguinal hernias admitted to the Department of Surgery at Rajendra Hospital, G.M.C, Patiala from July 2016 to September 2017 (duration of study was 15 months). Cases were divided into two groups by draw of lots with group A as mesh fixation (n=30) and group B as non-fixation (n=30).Results: The results were calculated with chi square test (p value). Results were found to be not significant in two groups in the terms of postoperative analgesia, complications i.e. (intraoperative, postoperative and long term) postoperative hospital stay and time to return for work. The cost of procedure was found to be very high in Group A and results were highly significant (p<0.001).Conclusion: LIHR repair without mesh fixation shows advantages over mesh fixation, which includes significant less cost of surgery, with comparable intraoperative, postoperative and long-term complications (with no increase in hernia recurrence), hospital stay and mean operative time. Hence, our study favours LIHR without mesh fixation a valuable alterative option.

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A comparative study to evaluate milligan morgan hemorrhoidectomy versus pile suture method in management of haemorrhoids

International Surgery Journal ◽

10.18203/2349-2902.isj20210381 ◽

2021 ◽

Vol 8 (2) ◽

pp. 664

Author(s):

Aditya . ◽

Kuldeep Raj ◽

P. N. Agarwal ◽

Md Abu Nasar

Keyword(s):

Return To Work ◽

Hospital Stay ◽

Operative Time ◽

Suture Technique ◽

Pain Scores ◽

Early Return ◽

Suture Group ◽

Group A ◽

The Mean ◽

Group B

Background: A pile suture technique was described originally by the Farag in 1978 was better in terms of post- operative pain, bleeding, hospital stay and early return to work which are the distressing effects of conventional Milligan Morgan Hemorrhoidectomy which is well accepted surgical procedure for haemorrhoids. This study is designed to compare the pile suture and Milligan Morgan Hemorrhoidectomy.Methods: After fulfilling the criteria, 60 patients were randomly allocated to the group A (Pile Suture [PS] n -30) and group B (Milligan Morgan Hemorrhoidectomy [MM] n – 30). The techniques were evaluated with respect to the operative time, pain scores, bleeding, hospital stay, return to work, and recurrence.Results: The mean age of patients was 44.33 years and 42.77 years in the pile suture group and MM group respectively. Grade III or IV hemorrhoids were more common in men (i.e., 80% and 60% in the pile suture and MM group, respectively). The mean operative time was shorter in the PS 20.10 minutes versus 51.47 minutes in the MM group (P .001). The bleeding and pain scores were less in the PS. Mean hospital stay was 4 days and 6.6 days in the PS and MM group, respectively. The patients in the pile suture group returned to their routine activities earlier (i.e., within 7.33 days) as compared with 16.87 days in the MM group.Conclusions: Therefore, pile suture method can be considered as less traumatic for the patients and method can be recommended as a safer alternative to Milligan Morgan haemorrhoidectomy.

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BENEFITS OF EARLY POST-ERCP LAPAROSCOPIC CHOLECYSTECTOMY: A SINGLE CENTRE PROSPECTIVE STUDY

Journal of University Medical & Dental College ◽

10.37723/jumdc.v12i3.567 ◽

2021 ◽

Vol 12 (3) ◽

Author(s):

Farhan javed ◽

Saira Saleem ◽

Ayesha Rehman ◽

Faiza Wattoo ◽

Nadia Bano ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Hospital Stay ◽

Operative Time ◽

Statistical Tests ◽

P Value ◽

Cross Sectional ◽

Increased Risk ◽

Group A ◽

Study Population ◽

Group B

ABSTRACT: BACKGROUND & OBJECTIVE: Laparoscopic cholecystectomy (LC) following Endoscopic retrograde cholangiopancreatography (ERCP) is associated with an increased risk of complications. ERCP is associated with increased incidence of complications during LC. Surgery may be performed in same anesthesia with ERCP or up to 6 weeks later. We aimed to determine the benefits of performing LC within 72hrs of ERCP. METHODOLOGY: After institutional ethical approval this prospective cross-sectional study was performed at Madinah Teaching Hospital Faisalabad from April 2019 to June 2020. By performing convenience sampling, all patients undergoing LC after uneventful ERCP in our hospital were included. Study population was divided based on interval between ERCP and Cholecystectomy; Group-A had LC within 72hrs of ERCP, Group B had LC in same hospital stay after 72hrs and Group-C patients were discharged after ERCP and readmitted for LC. Data was collected using custom designed questionnaire, tabulated using Microsoft Excel 2016 and subjected to statistical tests to compare outcomes. Primary outcome was incidence of complications, while operative time, hospital stay and cost were considered as secondary outcomes. p-value of <0.05 was considered significant. RESULTS: Total 75 patients were included in study, 32 in Group-A, 20 in Group-B and 23 in Group-C. Average age was 44.987 ± 14.819 and study population was predominantly female (86.67%). Complication rate, duration of hospital stay and average cost were less in Group A as compared to other groups (p<0.05). Mean operative time in 3 groups was similar. CONCLUSION: LC within 72hrs after ERCP provides superior results in terms of fewer complications, shorter hospital stays and lesser cost.

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