scholarly journals Postoperative complications of umbilical loop colostomy for anorectal malformations in neonates compared with the conventional abdominal stoma: a non-randomized study

2019 ◽  
Vol 2 (1) ◽  
pp. e000031
Author(s):  
Tatsuma Sakaguchi ◽  
Yoshinori Hamada ◽  
Takeshi Shirai ◽  
Hiroshi Hamada ◽  
Yusuke Shigeta ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Randomized Study ◽  
Anorectal Malformations ◽  
Loop Colostomy ◽  
University Hospital ◽  
Complication Rates ◽  
Safe Alternative ◽  
Stoma Creation ◽  
Significant Difference ◽  
Medical University

BackgroundWe previously reported a pilot study of temporary umbilical loop colostomy for neonates with intermediate-type anorectal malformations (ARM) and recommended this technique because of its cosmetic excellence. We herein report the postoperative complications of umbilical stomas (US) compared with traditional abdominal stomas (AS).MethodsFrom our institutional prospective database, we analyzed the patients with ARMs who underwent stoma creation at Kansai Medical University Hospital from January 1995 to November 2016. The surgical technique used to create the US had been performed since 2004.ResultsUS and AS were made for 12 and 27 patients with ARMs, respectively. The postoperative complication rates in patients who underwent US and AS had no significant difference (17% and 11%, p=0.6). The complications comprised a wound infection (one case of US), ileus (one case each of US and AS), mucosal prolapse (one case of AS), and depression (one case of AS). No emergency surgery was required for these complications.ConclusionFor patients with ARMs, the umbilicus appears to be a safe alternative site for temporary loop colostomy.

scholarly journals Intracameral Bevacizumab Versus Sub-Tenon’s Mitomycin C as Adjuncts to Trabeculectomy: 3-Year Results of a Prospective Randomized Study

2021 ◽  
Vol 10 (10) ◽  
pp. 2054
Author(s):  
Gerasimos Kopsinis ◽  
Dimitrios Tsoukanas ◽  
Dimitra Kopsini ◽  
Theodoros Filippopoulos
Keyword(s):  
Mitomycin C ◽  
Primary Outcome ◽  
Randomized Study ◽  
Primary Outcome Measure ◽  
Complication Rates ◽  
Filtration Surgery ◽  
Significant Difference ◽  
Exfoliative Glaucoma

Conjunctival wound healing determines success after filtration surgery and the quest for better antifibrotic agents remains active. This study compares intracameral bevacizumab to sub-Tenon’s mitomycin C (MMC) in trabeculectomy. Primary open-angle or exfoliative glaucoma patients were randomized to either bevacizumab (n = 50 eyes) or MMC (n = 50 eyes). The primary outcome measure was complete success, defined as Intraocular Pressure (IOP) > 5 mmHg and ≤ 21 mmHg with a minimum 20% reduction from baseline without medications. Average IOP and glaucoma medications decreased significantly in both groups at all follow-up points compared to baseline (p < 0.001), without significant difference between groups at 3 years (IOP: bevacizumab group from 29 ± 9.4 to 15 ± 3.4 mmHg, MMC group from 28.3 ± 8.7 to 15.4 ± 3.8 mmHg, p = 0.60; Medications: bevacizumab group from 3.5 ± 0.9 to 0.5 ± 1, MMC group from 3.6 ± 0.7 to 0.6 ± 1.1, p = 0.70). Complete success, although similar between groups at 3 years (66% vs. 64%), was significantly higher for bevacizumab at months 6 and 12 (96% vs. 82%, p = 0.03; 88% vs. 72%, p = 0.04, respectively) with fewer patients requiring medications at months 6, 9 and 12 (4% vs. 18%, p = 0.03; 6% vs. 20%, p = 0.04; 8% vs. 24%, p = 0.03, respectively). Complication rates were similar between groups. In conclusion, intracameral bevacizumab appears to provide similar long-term efficacy and safety results as sub-Tenon’s MMC after trabeculectomy.

scholarly journals Renal access in PNL under sonographic guidance: Do we really need to insert an open end ureteral catheter in dilated renal systems? A prospective randomized study

2017 ◽  
Vol 89 (3) ◽  
pp. 226
Author(s):  
Bilal Eryildirim ◽  
Murat Tuncer ◽  
Emre Camur ◽  
Fatih Ustun ◽  
Fatih Tarhan ◽  
...  
Keyword(s):  
Randomized Study ◽  
Total Duration ◽  
Renal Stones ◽  
Complication Rates ◽  
Nephrostomy Tube ◽  
Ureteral Catheter ◽  
Sonographic Guidance ◽  
Hospitalization Period ◽  
Significant Difference ◽  
Group 2

Purpose: To evaluate the true necessity of open end ureteral catheter insertion in patients with moderate to severe pelvicalyceal system dilation treated with percutaneous nephrolithotomy (PNL) under sonographic guidance. Patients and methods: 50 cases treated with PNL under sonographic guidance in prone position for solitary obstructing renal stones were evaluated. Patients were randomly divided into two groups; Group 1: Patients in whom a open end ureteral catheter was inserted prior to the procedure; Group 2: Patients receiving no catheter before PNL. In addition to the duration of the procedure as a whole and also all relevant stages as well, radiation exposure time, hospitalization period, mean nephrostomy tube duration, mean drop in Hb levels and all intra and postoperative complications have been evaluated. Results: Mean size of the stones was 308.5 ± 133.2 mm2. Mean total duration of the PNL procedure in cases with open end ureteral catheter was significantly longer than the other cases (p < 0.001). Evaluation of the outcomes of the PNL procedures revealed no statistically significant difference between two groups regarding the stone-free rates (86% vs 84%). Additionally, there was no significant difference with respect to the duration of nephrostomy tube, hospitalization period and secondary procedures needed, complication rates as well as the post-operative Hb drop levels in both groups (p = 0.6830). Conclusions: Our results indicate that the placement of an open end ureteral catheter prior to a PNL procedure performed under sonographic access may not be indicated in selected cases presenting with solitary obstructing renal pelvic and/or calyceal stones.

scholarly journals Transpancreatic biliary sphincterotomy for biliary access is safe also on a long-term scale

2020 ◽  
Vol 35 (1) ◽  
pp. 104-112
Author(s):  
Vilja Koskensalo ◽  
Marianne Udd ◽  
Mia Rainio ◽  
Jorma Halttunen ◽  
Matias Sipilä ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
University Hospital ◽  
Long Term Results ◽  
Biliary Duct ◽  
Complication Rates ◽  
Biliary Sphincterotomy ◽  
Significant Difference ◽  
Upper Abdominal

Abstract Background Transpancreatic biliary sphincterotomy (TPBS) is an advanced cannulation method for accessing common bile duct (CBD) in endoscopic retrograde cholangiopancreatography (ERCP). If CBD cannulation is difficult, an endoscopist can open the septum between the pancreatic and biliary duct with a sphincterotome to gain access. Long-term results of this procedure are unclear. We wanted to evaluate the short- and long-term complications of TPBS on patients with native papilla and benign indication for ERCP. Patients and Methods ERCPs performed in Helsinki University Hospital between 2007 and 2013 were reviewed. The study group comprised 143 consecutive patients with TPBS and 140 controls (CG). Data were collected from patient records and a phone survey was performed as a follow-up ≥ 4 years after the index ERCP. Results Post-ERCP pancreatitis (PEP) developed in seven patients (4.9%) in TPBS and one patient (0.7%) in CG (p = 0.067). The rates of other acute complications were similar between the groups. ERCP ended with no access to CBD in four cases (2.8%) in TPBS. The median length of follow-up was 6 years in TPBS and 7 years in CG. During this period, three patients (2.1%) in TPBS and six patients (4.3%) in CG suffered from acute pancreatitis (AP) (p = 0.238). One (0.7%) patient in CG and none in TPBS developed chronic pancreatitis (CP). Abdominal pain was suffered by ten patients (6.9%) in TPBS and twelve patients (8.6%) in CG daily, whereas by six patients (4.2%) in TPBS and twelve patients (8.6%) in CG weekly. Conclusion TPBS is a useful procedure, with acceptable complication rates. No significant difference occurred between the groups when evaluating the short-term or long-term complications with a follow-up period of four to 10 years. Additionally, no significant differences occurred in upper abdominal pain, episodes of AP, or development of CP.

scholarly journals Surgical Outcomes of LigaSure Hemorrhoidectomy in the Elderly Population: A retrospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Chuang-Wei Chen ◽  
Tzung-Ju Lu ◽  
Koung-Hung Hsiao
Keyword(s):  
Cohort Study ◽  
Postoperative Complications ◽  
Surgical Outcomes ◽  
Multivariate Logistic Regression Analysis ◽  
Operation Time ◽  
Admission Rate ◽  
Complication Rates ◽  
Time Duration ◽  
Significant Difference ◽  
Prone Jackknife Position

Abstract Background This study aims to assess the association between age and outcomes in patients undergoing hemorrhoidectomy. Methods This is a population-based cohort study. A retrospectively collected database with consecutive patients whose symptomatic prolapsed hemorrhoids managed by the LigaSure hemorrhoidectomy between Jan. 2015 and May 2017 was reviewed. Among 1238 patients, 1075 were under 65 years old (group 1), and 163 were 65 years old or older (group 2). Both groups were compared regarding baseline characteristics and surgical outcomes. Results All patients tolerated the whole course of the operation in the prone jackknife position without anesthetic-associated complications. There was no significant difference between these two groups regarding sex, hemorrhoids grade, operation time, duration of hospital stays, postoperative pain score, analgesic consumption, total postoperative complications, re-admission rate, reoperation rate and follow-up times. The multivariate logistic regression analysis that may contribute to postoperative complications revealed no significant difference for all complications between both groups. Conclusion The LigaSure hemorrhoidectomy for elderly patients is safe and effective without significant difference in short-term operative outcomes and all complication rates, compared with younger patients.

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

2018 ◽  
Vol 5 (2) ◽  
pp. 390
Author(s):  
Ashraf M. El-Badry ◽  
Omar Abdelraheem
Keyword(s):  
Liver Resection ◽  
Postoperative Complications ◽  
Clinical Outcome ◽  
Medical Records ◽  
Multivisceral Resection ◽  
University Hospital ◽  
Significant Difference ◽  
Complication Score ◽  
Primary Neoplasm

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

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

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Faried M. Wagdy ◽  
Hassan G. Farahat ◽  
Amin F. Ellakwa ◽  
Sameh S. Mandour
Keyword(s):  
Postoperative Complications ◽  
Mitomycin C ◽  
University Hospital ◽  
Time Interval ◽  
Randomised Study ◽  
Significant Difference ◽  
Recurrent Pterygium ◽  
Group B ◽  
Conjunctival Autografting

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

scholarly journals Socioenvironmental criteria and postoperative complications in ambulatory surgery in a French university hospital: a prospective cross-sectional observational study

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e036795
Author(s):  
Sorina-Dana Mihailescu ◽  
Isabelle Maréchal ◽  
Denis Thillard ◽  
André Gillibert ◽  
Vincent Compère
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Postoperative Complications ◽  
Observational Study ◽  
Emergency Department Visit ◽  
Public Transportation ◽  
Ambulatory Surgery ◽  
University Hospital ◽  
Complication Rates ◽  
Cross Sectional

BackgroundAmbulatory surgery lowers hospitalisation costs, shortens the time to return to work but requires caution regarding socioenvironmental risk factors for complications and rehospitalisation.MethodsThis was a single-centre prospective cross-sectional observational study conducted in a university hospital centrein January 2017. The primary objective was to assess the rate of conversion from ambulatory surgery to conventional hospitalisation or emergency department visit within 30 days following discharge from ambulatory unit. Secondary objectives were to describe the socioenvironmental characteristics of outpatients and to identify risk factors for severe postoperative complications.Results598 outpatients were included. The most represented surgical specialties were ophthalmology (23.5%), gynaecology (19%) and orthopaedics (17.7%). Patients’ mean age was 50.8 years (SD, 19.8) and the male/female sex ratio was 0.68. There were 22 (3.68%, 95% CI 2.32% to 5.52%) severe complications, including 11 (1.84%, 95% CI 0.92% to 3.27%) conversions to conventional hospitalisation and 11 (1.84%) conversions to emergency department visit, 3 of which led to readmission. Regarding socioenvironmental characteristics, 116 outpatients (19.7%) lived alone but were not isolated and 15 (2.6%) lived alone and were socially isolated. Following ambulatory surgery, 9 outpatients (1.6%) returned home on foot, 20 (3.4%) by public transportation and 8 (1.4%) drove home; 133 outpatients (13.7%) were alone the first night following surgery. Severe complication rates were not significantly different according to socioenvironmental subgroups.ConclusionIn our study, the prevalence of severe complications was low, conforming to the literature. The study was underpowered to estimate the effect of socioenvironmental variables.

scholarly journals Study comparing the efficacy and renal safety for patients with diabetes switching from dapagliflozin to empagliflozin

2020 ◽  
Author(s):  
Ai-Yu Yang ◽  
Hung-Chun Chen
Keyword(s):  
Outcome Measure ◽  
Primary Outcome Measure ◽  
University Hospital ◽  
Defined Daily Dose ◽  
Significant Difference ◽  
Patients With Diabetes ◽  
The Difference ◽  
Effective Group ◽  
Medical University ◽  
Renal Safety

AbstractBackground Previously, dapagliflozin was limited to patients with an estimated glomerular filtration rate (eGFR) ≥ 60 mL/min/1.73 m2, while empagliflozin can be used for those with an eGFR ≥ 45 mL/min/1.73 m2. Therefore dapagliflozin was switched to empagliflozin in many patients when eGFR decreased. However, the clinical efficacy and safety of these switcfhes are not clear. Objective In this study, we compared the efficacy and renal safety between patients switching from dapagliflozin to empagliflozin in patients. Setting This is a retrospective study of adult patients (aged ≥ 20 years) who had attended the Kaohsiung Medical University Hospital. Method This retrospective observational study included patients who were switched from dapagliflozin to empagliflozin. To assess the effect of other hypoglycemic drugs on efficacy, the types and dose alterations of other hypoglycemic drugs were classified on the defined daily dose (DDD). Main outcome measure The primary outcome measure was the change in hemoglobin A1c (HbA1c) level after 6 months. Patients with HbA1c levels at or lower than the baseline value after 6 months were defined as effective and patients with levels higher than the baseline were defined as invalid. Safety was evaluated by comparing the difference of eGFR between the baseline value and 6 months after treatment. Results Overall, 111 patients were enrolled in the study. Six months after switching from dapagliflozin to empagliflozin, HbA1c significantly reduced, with no statistically significant difference observed in eGFR. In our study, 78 patients were assigned to the effective group (70.3%) and 33 patients were invalid (29.7%). When the other hypoglycemic drugs were grouped by total dosage, fasting plasma glucose and HbA1c only decreased significantly in the "DDD decrease" and "DDD increase" groups. Conclusion Our study showed that switching from dapagliflozin to empagliflozin in patients with type 2 diabetes was effective for blood glucose maintenance and caused no significant changes in renal function. In addition, compared to similar sodium-glucose co-transporter-2 inhibitors, other hypoglycemic drugs may be factors that influence the efficacy of sugar-lowering treatments.

scholarly journals Isolated hip fracture in the elderly and time to surgery: is there an outcome difference?

2018 ◽  
Vol 3 (1) ◽  
pp. e000212 ◽  
Author(s):  
Adel Elkbuli ◽  
Alyssa Eily ◽  
Valerie Polcz ◽  
Dessy Boneva ◽  
Paul J Spano II ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Postoperative Complications ◽  
Surgical Intervention ◽  
The Elderly ◽  
Future Research ◽  
P Value ◽  
Complication Rates ◽  
Time To Surgery ◽  
Life Years ◽  
Significant Difference

BackgroundEarly operative intervention for hip fractures in the elderly is advised to reduce mortality and morbidity. Postoperative complications impose a significant burden on patient outcomes and cost of medical care. Our aim was to determine the relationship between time to surgery and postoperative complications/mortality in patients with hip fracture.MethodsThis is a retrospective review of data collected from our institution’s trauma registry for patients ≥65 years old with isolated hip fracture and subsequent surgery from 2015 to 2017. Patients were stratified into two groups based on time to surgery after admission: group 1: <48 hours versus group 2: >48 hours. Demographic variables included age, gender, race, and Injury Severity Score (ISS). The outcome variables included intensive care unit length of stay (ICU-LOS), deep venous thrombosis (DVT), pulmonary embolism (PE) rate , mortality, and 30-day readmission rates. Analysis of variance was used for analysis, with significance defined as a p value <0.05.ResultsA total of 485 patients with isolated hip fracture required surgical intervention. Of those, 460 had surgery <48 hours and 25 had surgery >48 hours postadmission. The average ISS was the same in both groups. The average ICU-LOS was significantly higher in the >48 hours group compared with the <48 hours group (4.0 vs. 2.0, p<0.0002). There was no statistically significant difference between groups when comparing DVTand PE rate, 30-day readmission, or mortality rates.DiscussionTime to surgery may affect overall ICU-LOS in patients with hip fracture requiring surgical intervention. Time to surgery does not affect complication rates, 30-day readmission, or mortality. Future research should investigate long-term outcomes such as functional status and disability-adjusted life years.Level of evidenceIII. Retrospective/ prognostic cohort study

Safety of arterial catheterization using the distal radial approach in intensive care unit management: A pilot study

2021 ◽  
pp. 112972982110033
Author(s):  
Marina Oi ◽  
Takaaki Maruhashi ◽  
Ai Ishikura ◽  
Yutaro Kurihara ◽  
Yukiko Yaguchi ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Insertion Site ◽  
University Hospital ◽  
Complication Rates ◽  
Radial Approach ◽  
Unit Management ◽  
Significant Difference ◽  
Joint Flexion ◽  
Intensive Care Unit Management

Background: Arterial catheter (A-line) is essential for managing severely ill patients, and the radial artery is the most common insertion site in the intensive care unit (ICU). However, many accidental removals occur because the insertion site of A-line in the traditional radial approach (TRA) overlaps with the joint flexion. Recent reports have shown no significant difference in the complication rates between coronarography using the distal radial approach (DRA) and that using TRA. However, to date, no report has examined accidental removals of DRA in the ICU. This study aimed to retrospectively evaluate the safety of the DRA A-line in ICU management. Methods: This retrospective, descriptive, and observational study enrolled patients who underwent A-line insertion using the DRA at the authors’ facility, which is a university hospital with approximately 1100 beds, from January 1, 2019 to August 31, 2019. The participants’ clinical data were extracted from their medical records. The primary outcome was the number of accidental removals. Results: The study included 20 patients with a median age of 70 (interquartile range (IQR): 58.5–77) years: 10 patients with traumas, 6 with cerebral hemorrhages, 2 with gastrointestinal perforations, and 2 with other diagnoses. The number of punctures was 1 in 15 patients, 2 in 4 patients, and 3 in 1 patient. Only 1 patient required ultrasound guidance, whereas 12 patients required the use of guidewires. The median duration after insertion was 3 (IQR 2.5–5.5) days. Accidental removal was noted in only one patient. No other complications were observed during the period from insertion to removal. Conclusions: DRA may be a safe option for insertion of a new A-line in the ICU.

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