Laparoscopic Primary Colorrhaphy for Acute Iatrogenic Perforations during Colonoscopy

Purpose. We present our experience with laparoscopic colorrhaphy as definitive surgical modality for the management of colonoscopic perforations.Methods. Over a 17-month period, we assessed the outcomes of consecutive patients presenting with acute colonoscopic perforations. Patient characteristics and perioperative parameters were tabulated. Postoperative outcomes were evaluated within 30 days following discharge.Results. Five female patients with a mean age of 71.4 ± 9.7 years (range: 58–83), mean BMI of 26.4 ± 3.4 kg/m2(range: 21.3–30.9), and median ASA score of 2 (range: 2-3) presented with acute colonoscopic perforations. All perforations were successfully managed through laparoscopic colorrhaphy within 24 hours of development. The perforations were secondary to direct trauma(n=3)or thermal injury(n=2)and were localized to the sigmoid(n=4)or cecum(n=1). None of the patients required surgical resection, diversion, or conversion to an open procedure. No intra- or postoperative complications were encountered. The mean length of hospital stay was 3.8 ± 0.8 days (range: 3–5). There were no readmissions or reoperations.Conclusion. Acute colonoscopic perforations can be safely managed via laparoscopic primary repair without requiring resection or diversion. Early recognition and intervention are essential for successful outcomes.

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Keystone-design perforator island flaps for the management of complicated epidermoid cysts on the back

Scientific Reports ◽

10.1038/s41598-019-51289-4 ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 4

Author(s):

Chi Sun Yoon ◽

Hyo Bong Kim ◽

Young Keun Kim ◽

Hoon Kim ◽

Kyu Nam Kim

Keyword(s):

Postoperative Complications ◽

Medical Records ◽

Summary Score ◽

Assessment Scale ◽

Complete Excision ◽

Epidermoid Cysts ◽

Scar Assessment ◽

Tension Change ◽

The Mean ◽

Surgical Modality

Abstract Complicated epidermoid cysts (ECs) occur commonly on the back, but few reports have described their management. We present our experience in managing patients with ECs on the back using a keystone-design perforator island flap (KDPIF) reconstruction, thereby focusing on reduction and redistribution of wound tension. Altogether, 15 patients (average age, 48.067 ± 14.868 years) underwent KDPIF reconstructions after complete excision of complicated ECs on the back. We retrospectively reviewed the medical records and clinical photographs of all patients. Final scar appearance was evaluated using the Patient and Observer Scar Assessment Scale (POSAS). All patients had ruptured ECs, while 6 patients also had cellulitis of the surrounding tissues. All defects, after complete excision of ECs and debridement of surrounding unhealthy tissues, were successfully covered with KDPIF. The mean ‘tension-change’ at the defect and donor sites was −4.73 ± 0.21 N and −4.88 ± 0.25 N, respectively (p < 0.001). The mean ‘rate of tension-change’ at the defect and donor sites was −69.48 ± 1.7% and −71.16 ± 1.33%, respectively (p < 0.001). All flaps survived with no postoperative complications. The mean observer scar assessment scale (OSAS) summary score and patient scar assessment scale (PSAS) total score were 14.467 ± 5.069 and 15.6 ± 6.512, respectively. Overall, we suggest that KDPIF reconstruction is a good surgical modality for the management of complicated ECs on the back.

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Expectations of Continuous Vital Signs Monitoring for Recognizing Complications After Esophagectomy: Interview Study Among Nurses and Surgeons (Preprint)

10.2196/preprints.22387 ◽

2020 ◽

Author(s):

Mathilde van Rossum ◽

Jobbe Leenen ◽

Feike Kingma ◽

Martine Breteler ◽

Richard van Hillegersberg ◽

...

Keyword(s):

Postoperative Complications ◽

Clinical Outcome ◽

Clinical Outcomes ◽

Early Recognition ◽

Vital Signs ◽

Patient Characteristics ◽

Situational Factors ◽

Vital Signs Monitoring ◽

Surgical Ward ◽

The Impact

BACKGROUND Patients undergoing esophagectomy are at serious risk of developing postoperative complications. To support early recognition of clinical deterioration, wireless sensor technologies that enable continuous vital signs monitoring in a ward setting are emerging. OBJECTIVE This study explored nurses’ and surgeons’ expectations of the potential effectiveness and impact of continuous wireless vital signs monitoring in patients admitted to the ward after esophagectomy. METHODS Semistructured interviews were conducted at 3 esophageal cancer centers in the Netherlands. In each center, 2 nurses and 2 surgeons were interviewed regarding their expectations of continuous vital signs monitoring for early recognition of complications after esophagectomy. Historical data of patient characteristics and clinical outcomes were collected in each center and presented to the local participants to support estimations on clinical outcome. RESULTS The majority of nurses and surgeons expected that continuous vital signs monitoring could contribute to the earlier recognition of deterioration and result in earlier treatment for postoperative complications, although the effective time gain would depend on patient and situational factors. Their expectations regarding the impact of potential earlier diagnosis on clinical outcomes varied. Nevertheless, most caregivers would consider implementing continuous monitoring in the surgical ward to support patient monitoring after esophagectomy. CONCLUSIONS Caregivers expected that wireless vital signs monitoring would provide opportunities for early detection of postoperative complications in patients undergoing esophagectomy admitted to the ward and prevent sequelae under certain circumstances. As the technology matures, clinical outcome studies will be necessary to objectify these expectations and further investigate overall effects on patient outcome.

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Evaluation of post-operative complications associated with tobacco use in thoracic surgery patients

International Surgery Journal ◽

10.18203/2349-2902.isj20213119 ◽

2021 ◽

Vol 8 (8) ◽

pp. 2272

Author(s):

Mehmet Degirmenci ◽

Celal Kus

Keyword(s):

Postoperative Complications ◽

Thoracic Surgery ◽

Tobacco Use ◽

Intensive Therapy ◽

Length Of Hospital Stay ◽

Patient Characteristics ◽

Thoracic Diseases ◽

Operative Complications ◽

Poor Outcomes ◽

Post Operative Complications

Background: Tobacco can make thoracic diseases more complicated by affecting their respiratory functions. Smoking causes many diseases that require surgical treatment and affects surgical results. The aim of the study was to determine the relationship between tobacco use and post-operative complications in thoracic surgery patients and contribute to public health.Methods: In this study, 754 patients were evaluated retrospectively. Patient characteristics and tobacco use habits of the patients were determined. Postoperative complications, admission to the intensive therapy unit, intubation, death, and length of stay in hospital were defined as surgical outcomes. These results were compared and analyzed with tobacco use.Results: The patients consisted of 536 (71.1%) men and 218 (28.9%) women. Tobacco use was more common in men (X2=223.216, p<0.001) and younger ages (X2=45.342, p<0.001). Complications occurred in 96 patients, 76 (79.2%) of whom used tobacco. Tobacco use (p<0.001, OR=3.547), ASA score (p=0.029, OR=2.004), major surgeries (p<0.001, OR=4.458), and minimally invasive surgeries (p=0.027, OR=2.323) are associated with complications. Length of hospital stay is related to the amount of tobacco (p<0.001, OR=3.706), size of surgery (p<0.001, OR=14.797), over 65 years (p<0.001, OR=2.635), and infectious diseases (p=0.039, OR=1.939).Conclusions: Tobacco use is related to poor outcomes in thoracic surgery patients, and it is a severe health problem, especially at young ages. Tobacco control programs should be supported to prevent the effects of tobacco use on thoracic diseases and postoperative complications.

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Outcomes following Boerhaave’ syndrome

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2013.95.8.557 ◽

2013 ◽

Vol 95 (8) ◽

pp. 557-560 ◽

Cited By ~ 2

Author(s):

CL Connelly ◽

PJ Lamb ◽

S Paterson-Brown

Keyword(s):

Hospital Stay ◽

Primary Repair ◽

Length Of Hospital Stay ◽

Good Survival ◽

Boerhaave’S Syndrome ◽

Direct Closure ◽

Tube Drainage ◽

T Tube ◽

Boerhaave's Syndrome ◽

The Mean

Introduction Boerhaave’s syndrome is associated with high mortality and morbidity. This study aimed to assess outcome following treatment in a specialist upper gastrointestinal surgical unit. Methods Patients were identified from a prospectively collected database (Lothian Surgical Audit) and their records reviewed. Primary outcomes were mortality and serious morbidity. Secondary outcomes included time to theatre, operation undertaken and length of hospital stay. Results Twenty patients with Boerhaave’s syndrome were identified between 1997 and 2011. Four patients (20%) died in hospital. The mean time to theatre from symptom onset was 2.4 days. This was 7.3 days in the patients who died compared with 1.5 days in survivors. Five patients underwent primary repair of rupture, eleven underwent direct closure over a T-tube and one rupture was irreparable. Three patients were managed non-operatively and all survived. Outcomes were similar for the different surgical groups. There was one death following primary closure (20%) and two after T-tube drainage (18%). The mean length of hospital stay was 35.7 days after T-tube drainage and 20.5 days after primary repair. The 3 patients with small, self-contained leaks had a mean length of stay of 5.7 days. Conclusions Aggressive surgical management with direct repair is associated with good survival in patients with Boerhaave’s syndrome. Delayed time to theatre is associated with increased mortality. Patients with small, contained leaks without signs of sepsis can be managed non-operatively with a good outcome.

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Triple tubostomy and its outcome for blunt duodenal injury

Journal of Society of Surgeons of Nepal ◽

10.3126/jssn.v22i1.28710 ◽

2019 ◽

Vol 22 (1) ◽

pp. 12-17

Author(s):

Narendra Pandit ◽

Tek Narayan Yadav ◽

Laligen Awale ◽

Shailesh Adhikary

Keyword(s):

Hospital Stay ◽

Primary Closure ◽

Early Stage ◽

Primary Repair ◽

Length Of Hospital Stay ◽

Damage Control Surgery ◽

Duodenal Fistula ◽

Duodenal Injury ◽

Female Ratio ◽

The Mean

Introduction: Blunt duodenal injury in an uncommon form of abdominal injuries, which comprises less than 5% of all injuries. The diagnosis and management are challenging, because of delays in diagnosis due to subtle signs and symptoms in its early stage of presentation. Primary repair along with triple tubostomy (gastrostomy, retrograde duodenostomy and feeding jejunostomy) is a simple and safe method of damage control surgery in this group of patients. This study aims to report our experience in the management of this uncommon procedure. Methods: This is a retrospective analysis of the patients undergoing triple tubostomy (TT) for blunt duodenal injury at the Department of Surgery, B.P.Koirala Institute of Health Sciences (BPKIHS), Dharan, over a three and half years. The study included demographics, clinical profile, length of hospital stay, postoperative morbidity (duodenal fistula), rate and timing of spontaneous closure of fistula and mortality. Results: Eleven (6.7%) patients out of 164 blunt trauma abdomen had sustained a duodenal injury. Eight patients who underwent TT were included in the study. The mean age of the patient was 31.8 years (range: 18-67), with a male: female ratio of 3:1. The mean time to trauma and presentation was 4.25 days. The most common site of injury was the second part of the duodenum (87.5%), AAST grade III was seen in 62.5%, two (25%) patients were in shock at presentation. Eight patients required primary closure with triple tubostomy. Postoperatively, all patients had a duodenal fistula, which closed spontaneously in 6 (75%) patients at a mean duration of 17 days, with a mean postoperative length of hospital stay of 33.5 days. The remaining two (25%) patients died of an active fistula. Conclusion: Blunt duodenal trauma, when presented late can be managed with primary closure and triple tubostomy with acceptable postoperative outcomes.

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Impact of Spleen Size on Outcomes in Laparoscopic Splenectomy in Children

Gastroenterology Research and Practice ◽

10.1155/2015/603915 ◽

2015 ◽

Vol 2015 ◽

pp. 1-4 ◽

Cited By ~ 3

Author(s):

Cetin Ali Karadag ◽

Basak Erginel ◽

Ozgur Kuzdan ◽

Nihat Sever ◽

Melih Akın ◽

...

Keyword(s):

Hospital Stay ◽

Laparoscopic Splenectomy ◽

Operative Time ◽

Length Of Hospital Stay ◽

Time Rate ◽

Open Procedure ◽

Group I ◽

Longitudinal Length ◽

The Mean ◽

Group Ii

Background. The aim of our study is to compare the efficacy of laparoscopic splenectomy (LS) between enlarged spleens and normal sized spleens.Methods. From June 2006 to September 2012, 50 patients underwent LS. The patients consisted of 24 girls and 26 boys with the mean age of 8.64 years (1–18). The patients are divided into two groups according to spleen’s longitudinal length on the ultrasonography. Group I consisted of the normal sized spleens; Group II consisted of spleens that are exceeding the upper limit. Groups are compared in terms of number of ports, operative time, rate of conversion to open procedure, and length of hospital stay.Results. The mean number of ports was 3.27 and 3.46, the mean length of the operation was 116.36 min and 132.17 min, rate of conversion to open procedure was 9.09% and 10.25%, and the mean length of hospital stay was 3.36 days and 3.23 days, respectively, in Group I and Group II. Although there is an increase in the number of the ports, the operative time, rate of conversion to open procedure, and the length of hospital stay, the difference was not significant between groups (P>0.05).Conclusion. LS is safe and effective in enlarged spleens as well as normal sized spleens.

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Clinical Outcomes of Modified versus Traditional Technique for the Surgery of Hydatid Cyst of the Liver: A Case Control Study

Middle East Journal of Digestive Diseases ◽

10.15171/mejdd.2019.142 ◽

2019 ◽

Vol 11 (3) ◽

pp. 152-157 ◽

Cited By ~ 1

Author(s):

Asieh Sadat Fattahi ◽

Seyed Hossein Fattahi Masoom ◽

Farjad Lorestani ◽

Mehrdad Fakhlai ◽

Fatemeh Sadat Abtahi Mehrjerdi ◽

...

Keyword(s):

Hydatid Cyst ◽

Hospital Stay ◽

Parasitic Infection ◽

Length Of Hospital Stay ◽

Modified Technique ◽

Significant Difference ◽

Postoperative Length ◽

The Mean ◽

Surgical Modality ◽

Control Study

BACKGROUND Echinococcus granulosis is a parasitic infection most commonly involving the liver. Iran is a hyperendemic area for this disease according to WHO. Despite improvements in medical and interventional radiological techniques, surgery remains the gold standard of treatment; however evidence on different surgical modalities were explained. Considering the high population of referring patients presenting to Omid and Ghaem Hospitals, Mashhad, Iran, we decided to compare the complications of our modified technique with routine technique in hydatid cyst surgery. METHODS 56 patients with hydatid cyst of the liver who underwent modified and routine surgical treatment in Ghaem and Omid Hospitals Mashhad, Iran were studied during Aug 2013- Nov 2015. 27 patients underwent modified surgical technique, whereas the remaining 27 patients were treated by using routine surgical method. These two groups of patients were compared with each other according to their postoperative length of hospital stay and resulting complications. RESULTS The mean age of our patients was 41 years. 27 patients were male and 29 were female. Our results showed no statistically significant difference regarding the incidence of postoperative complications between the two groups. However, mean length of hospital stay was significantly different between the groups (4.5 ± 1.87 and 7.6 ± 2.25 days, respectively, p < 0.001). CONCLUSION The method of modified surgery with closed cyst drainage, which does not use external drains, is a safe surgical modality in the treatment of hydatid cyst disease of the liver if applied properly on appropriate patients.

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Robotic thoracic surgery for inflammatory and infectious lung disease: initial experience in Brazil

Revista do Colégio Brasileiro de Cirurgiões ◽

10.1590/0100-6991e-20202872 ◽

2021 ◽

Vol 48 ◽

Author(s):

PEDRO HENRIQUE CUNHA LEITE ◽

ALESSANDRO WASUM MARIANI ◽

PEDRO HENRIQUE XAVIER NABUCO DE ARAUJO ◽

CARLOS EDUARDO TEIXEIRA LIMA ◽

FELIPE BRAGA ◽

...

Keyword(s):

Postoperative Complications ◽

Thoracic Surgery ◽

Hospital Stay ◽

Operative Time ◽

Length Of Hospital Stay ◽

Extent Of Resection ◽

Lung Abscess ◽

Safe Procedure ◽

Open Thoracotomy ◽

The Mean

ABSTRACT Objective: in Latin America, especially Brazil, the use of a robotic platform for thoracic surgery is gradually increasing in recent years. However, despite tuberculosis and inflammatory pulmonary diseases are endemic in our country, there is a lack of studies describing the results of robotic surgical treatment of bronchiectasis. This study aims to evaluate the surgical outcomes of robotic surgery for inflammatory and infective diseases by determining the extent of resection, postoperative complications, operative time, and length of hospital stay. Methods: retrospective study from a database involving patients diagnosed with bronchiectasis and undergoing robotic thoracic surgery at three hospitals in Brazil between January of 2017 and January of 2020. Results: a total of 7 patients were included. The mean age was 47 + 18.3 years (range, 18-70 years). Most patients had non-cystic fibrosis bronchiectasis (n=5), followed by tuberculosis bronchiectasis (n=1) and lung abscess (n=1). The performed surgeries were lobectomy (n=3), anatomic segmentectomy (n=3), and bilobectomy (n=1). The median console time was 147 minutes (range 61-288 min.) and there was no need for conversion to open thoracotomy. There were no major complications. Postoperative complications occurred in one patient and it was a case of constipation with the need for an intestinal lavage. The median for chest tube time and hospital stay, in days, was 1 (range, 1-6 days) and 5 (range, 2-14 days) respectively. Conclusions: robotic thoracic surgery for inflammatory and infective diseases is a feasible and safe procedure, with a low risk of complications and morbidity.

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Enhanced recovery protocol versus standard protocol for patients undergoing radical cystectomy: results of a prospective randomized study

African Journal of Urology ◽

10.1186/s12301-019-0012-3 ◽

2020 ◽

Vol 26 (1) ◽

Cited By ~ 1

Author(s):

Hisham Ibrahim ◽

Sameh Kotb ◽

Ahmed Abd Allah ◽

Ayman Kassem ◽

Ahmed Salem ◽

...

Keyword(s):

Postoperative Complications ◽

Hospital Stay ◽

Radical Cystectomy ◽

Enhanced Recovery ◽

Length Of Hospital Stay ◽

Standard Protocol ◽

Group A ◽

Enhanced Recovery Protocol ◽

The Mean ◽

Group B

Abstract Background To assess patients undergoing radical cystectomy using enhanced recovery protocol and standard protocol in terms of intraoperative and postoperative outcomes and complications. Results All operative and postoperative complications were recorded. In group B, time to normal bowel activity ranged from 1 to 4 days, and the mean was 1.8 days (± 1.02), while it ranged from 1 to 5 days, and the mean was 3.17 days (± 1.14) in group A which was statistically significant (p value < 0.001). The length of hospital stay in group B ranged from 6 to 50 days, the mean was 13.16 days (± 7.83), while it ranged from 8 to 35 days, and the mean was 14.71 days (± 5.78) in group A which was statistically significant (p value = 0.033). Postoperative mortality was similar in both groups. Conclusion In patients undergoing radical cystectomy, enhanced recovery protocol is considered as a safe procedure and not associated with any increase in intraoperative and postoperative complications compared to standard protocol. The length of hospital stay and time to return to full diet are reduced.

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Expectations of Continuous Vital Signs Monitoring for Recognizing Complications After Esophagectomy: Interview Study Among Nurses and Surgeons

JMIR Perioperative Medicine ◽

10.2196/22387 ◽

2021 ◽

Vol 4 (1) ◽

pp. e22387

Author(s):

Mathilde van Rossum ◽

Jobbe Leenen ◽

Feike Kingma ◽

Martine Breteler ◽

Richard van Hillegersberg ◽

...

Keyword(s):

Postoperative Complications ◽

Clinical Outcome ◽

Clinical Outcomes ◽

Early Recognition ◽

Vital Signs ◽

Patient Characteristics ◽

Situational Factors ◽

Vital Signs Monitoring ◽

Surgical Ward ◽

The Impact

Background Patients undergoing esophagectomy are at serious risk of developing postoperative complications. To support early recognition of clinical deterioration, wireless sensor technologies that enable continuous vital signs monitoring in a ward setting are emerging. Objective This study explored nurses’ and surgeons’ expectations of the potential effectiveness and impact of continuous wireless vital signs monitoring in patients admitted to the ward after esophagectomy. Methods Semistructured interviews were conducted at 3 esophageal cancer centers in the Netherlands. In each center, 2 nurses and 2 surgeons were interviewed regarding their expectations of continuous vital signs monitoring for early recognition of complications after esophagectomy. Historical data of patient characteristics and clinical outcomes were collected in each center and presented to the local participants to support estimations on clinical outcome. Results The majority of nurses and surgeons expected that continuous vital signs monitoring could contribute to the earlier recognition of deterioration and result in earlier treatment for postoperative complications, although the effective time gain would depend on patient and situational factors. Their expectations regarding the impact of potential earlier diagnosis on clinical outcomes varied. Nevertheless, most caregivers would consider implementing continuous monitoring in the surgical ward to support patient monitoring after esophagectomy. Conclusions Caregivers expected that wireless vital signs monitoring would provide opportunities for early detection of postoperative complications in patients undergoing esophagectomy admitted to the ward and prevent sequelae under certain circumstances. As the technology matures, clinical outcome studies will be necessary to objectify these expectations and further investigate overall effects on patient outcome.

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