scholarly journals Systematic Review of Surgical Approaches for Adrenal Tumors: Lateral Transperitoneal versus Posterior Retroperitoneal and Laparoscopic versus Robotic Adrenalectomy

2014 ◽  
Vol 2014 ◽  
pp. 1-11 ◽  
Author(s):  
Young Jun Chai ◽  
Hyungju Kwon ◽  
Hyeong Won Yu ◽  
Su-jin Kim ◽  
June Young Choi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Hospital Stay ◽  
Laparoscopic Adrenalectomy ◽  
Operation Time ◽  
Current Evidence ◽  
Surgical Approaches ◽  
Adrenal Tumors ◽  
Complication Rates ◽  
Conversion Rates ◽  
Robotic Adrenalectomy

Background. Laparoscopic lateral transperitoneal adrenalectomy (LTA) has been the standard method for resecting benign adrenal gland tumors. Recently, however, laparoscopic posterior retroperitoneal adrenalectomy (PRA) has been more popular as an alternative method. This systematic review evaluates current evidence on adrenalectomy techniques, comparing laparoscopic LTA with PRA and laparoscopic adrenalectomy with robotic adrenalectomy.Methods. PubMed, Embase, and ISI Web of Knowledge databases were searched systematically for studies comparing surgical outcomes of laparoscopic LTA versus PRA and laparoscopic versus robotic adrenalectomy. The studies were evaluated according to the PRISMA statement.Results. Eight studies comparing laparoscopic PRA and LTA showed that laparoscopic PRA was superior or at least comparable to laparoscopic LTA in operation time, blood loss, pain score, hospital stay, and return to normal activity. Conversion rates and complication rates were similar. Six studies comparing robotic and laparoscopic adrenalectomy found that outcomes and complications were similar.Conclusion. Laparoscopic PRA was more effective than LTA, especially in reducing operation time and hospital stay, but there was no evidence showing that robotic adrenalectomy was superior to laparoscopic adrenalectomy. Cost reductions and further technical advances are needed for wider application of robotic adrenalectomy.

scholarly journals The role of an anterior approach in the treatment of ankylosing spondylitis–associated cervical fractures: a systematic review and meta-analysis

2021 ◽  
Vol 51 (4) ◽  
pp. E9
Author(s):  
Vaidya Govindarajan ◽  
Jean-Paul Bryant ◽  
Roberto J. Perez-Roman ◽  
Michael Y. Wang
Keyword(s):  
Systematic Review ◽  
Ankylosing Spondylitis ◽  
Anterior Approach ◽  
Meta Analysis ◽  
Neurological Function ◽  
Surgical Approaches ◽  
Complication Rates ◽  
Neurological Improvement ◽  
Cervical Fractures ◽  
Anterior Posterior

OBJECTIVE Cervical fractures in patients with ankylosing spondylitis can have devastating neurological consequences. Currently, several surgical approaches are commonly used to treat these fractures: anterior, posterior, and anterior-posterior. The relative rarity of these fractures has limited the ability of surgeons to objectively determine the merits of each. The authors present an updated systematic review and meta-analysis investigating the utility of anterior surgical approaches relative to posterior and anterior-posterior approaches. METHODS After a comprehensive literature search of the PubMed, Cochrane, and Embase databases, 7 clinical studies were included in the final qualitative and 6 in the final quantitative analyses. Of these studies, 6 compared anterior approaches with anterior-posterior and posterior approaches, while 1 investigated only an anterior approach. Odds ratios and 95% confidence intervals were calculated where appropriate. RESULTS A meta-analysis of postoperative neurological improvement revealed no statistically significant differences in gross rates of neurological improvement between anterior and posterior approaches (OR 0.40, 95% CI 0.10–1.59; p = 0.19). However, when analyzing the mean change in neurological function, patients who underwent anterior approaches had a significantly lower mean change in postoperative neurological function relative to patients who underwent posterior approaches (mean difference [MD] −0.60, 95% CI −0.76 to −0.45; p < 0.00001). An identical trend was seen between anterior and anterior-posterior approaches; there were no statistically significant differences in gross rates of neurological improvement (OR 3.05, 95% CI 0.84–11.15; p = 0.09). However, patients who underwent anterior approaches experienced a lower mean change in neurological function relative to anterior-posterior approaches (MD −0.46, 95% CI −0.60 to −0.32; p < 0.00001). There were no significant differences in complication rates between anterior approaches, posterior approaches, or anterior-posterior approaches, although complication rates trended lower in patients who underwent anterior approaches. CONCLUSIONS The results of this review and meta-analysis demonstrated the varying benefits of anterior approaches relative to posterior and anterior-posterior approaches in treatment of cervical fractures associated with ankylosing spondylitis. While reports demonstrated lower degrees of neurological improvement in anterior approaches, they may benefit patients with less-severe injuries if lower complication rates are desired.

scholarly journals Efficacy and Efficiency of Nutritional Support Teams

2019 ◽  
Vol 8 (9) ◽  
pp. 1281 ◽  
Author(s):  
Reber ◽  
Strahm ◽  
Bally ◽  
Schuetz ◽  
Stanga
Keyword(s):  
Nutritional Status ◽  
Hospital Stay ◽  
Nutritional Support ◽  
Care Plan ◽  
Current Evidence ◽  
Nutritional Management ◽  
Complication Rates ◽  
Nutritional Care ◽  
Support Teams

Malnutrition is frequent in patients during a hospital admission and may further worsen during the hospital stay without appropriate nutritional support. Malnutrition causes greater complication rates, morbidity, and mortality rates, which increases the length of hospital stay and prolongs rehabilitation. Early recognition of individual nutritional risk and timely initiation of a tailored nutritional therapy are crucial. Recent evidence from large-scale trials suggests that efficient nutritional management not only improves the nutritional status, but also prevents negative clinical outcomes and increases patients’ quality of life. Multifaceted clinical knowledge is required to ensure optimal nutritional support, according to a patient’s individual situation and to avoid potential complications. Furthermore, clear definition of responsibilities and structuring of patient, and work processes are indispensable. Interdisciplinary and multiprofessional nutritional support teams have been built up to ensure and improve the quality and safety of nutritional treatments. These teams continuously check and optimize the quality of procedures in the core areas of nutritional management by implementing nutritional screening processes using a validated tool, nutritional status assessment, an adequate nutritional care plan development, prompt and targeted nutritional treatment delivery, and provision of accurate monitoring to oversee all aspects of care, from catering to artificial nutrition. The foundation of any nutritional care plan is the identification of patients at risk. The aim of this narrative review is to provide an overview about composition, tasks, and challenges of nutritional support teams, and to discuss the current evidence regarding their efficiency and efficacy in terms of clinical outcome and cost effectiveness.

S164 – Comparison of Endoscopic and Conventional Parotid Surgeries

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P131-P131
Author(s):  
Shiou-Yu Yeh ◽  
Mu-Kuan Chen
Keyword(s):  
Hospital Stay ◽  
Operation Time ◽  
Medical Costs ◽  
Complication Rates ◽  
Advantages And Disadvantages ◽  
Parotid Tumors ◽  
Wound Size ◽  
Parotid Surgery ◽  
Changhua Christian Hospital ◽  
Christian Hospital

Objectives To compare the advantages and disadvantages between endoscopic and conventional parotid surgeries, and further evaluate the benefits of the new surgical approach - endoscopic parotidectomy. Methods From January 2002 to August 2007 in Changhua Christian Hospital, 33 endoscopic parotid surgeries for selected patients presenting with benign parotid tail disease were compared with one hundred 99 conventional parotid surgeries for the patients with benign parotid tumors by age, gender, wound size, operation time, complication, admission length, and medical cost, retrospectively. Results There is no difference between endoscopic parotid surgeries and conventional parotid surgeries in gender and age. For the wound size, the mean length of the endoscopic parotid surgeries is only 3.1 centimeter and the wounds are almost invisible due to its concealed location behind the ear. Shorter operation time and hospital stay are discovered in the endoscopic parotid surgeries. Less complication rates and medical costs are also found in the endoscopic parotid surgeries. Conclusions Minimally invasive endoscopic parotid surgery provides a safer, less costly, and aesthetic choice for the treatment of benign lesions located in the parotid tail. The advantages of this procedure include smaller operative scar with cosmetic results, shorter operation time and hospital stay, less complication rates and medical costs.

scholarly journals Timing of cholecystectomy after percutaneous cholecystectomy for acute cholecystitis- A systematic review and meta-analysis

2021 ◽  
Author(s):  
BHAVIN VASAVADA ◽  
Hardik Patel
Keyword(s):  
Systematic Review ◽  
Hospital Stay ◽  
Biliary Tract ◽  
Risk Ratio ◽  
Meta Analysis ◽  
Postoperative Mortality ◽  
Mean Difference ◽  
Complication Rates ◽  
Percutaneous Cholecystostomy ◽  
Timing Of Cholecystectomy

Introduction: There is a controversy about the optimum timing of cholecystectomy after percutaneous cholecystostomy. This systematic review and meta-analysis aimed to evaluate outcomes of early versus late cholecystectomy after percutaneous cholecystectomy. Methods: The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and MOOSE guidelines. Heterogeneity was measured using Q tests and I2 statistics. The random-effects model was used. We evaluated cholecystectomy performed at different periods after percutaneous cholecystostomy within 72 hours or later, within or after one week or percutaneous cholecystostomy, within 10 days or after 10 days, less than 2 weeks or more than 2 weeks, less than 4 weeks or more than 4 weeks, less than 8 weeks or more than 8 weeks as per literature. Results: Six studies including 18640 patients were included in the final analysis. There was no difference in overall complications within or after 72 hours cholecystectomy group, but mortality and biliary complications were significantly high in the less than 72 hours group (p=0.05 and 0.0002 respectively). There was no difference in mortality, overall complication, biliary tract complications in less than 1 week versus more than 1 week and less than 10 days versus more than 10 days group. Overall complications were significantly less in the less than 2 weeks group compared to the more than 2 weeks group. There was no difference in mortality and biliary tract complications between less than 2 weeks and more than 2 weeks group. Overall complication rate (risk ratio 0.67, p <0.0001), postoperative mortality (risk ratio 0.46, p=0.003), bile duct injury (risk ratio 0.62, p=0.01) was significantly less in earlier than 4-week group. Hospital stay was not significantly different between less than 4 weeks versus more than 4 weeks group. (Mean difference= -2.74, p=0.12). Ove all complication rates were significantly more in less than 8 weeks group. (Risk ratio 1.07, p=0.01). Hospital stay was significantly less in less than 8 weeks group. (Mean difference 0.87, p=0.01). Conclusion: Early cholecystectomy preferably within 4 weeks after percutaneous cholecystostomy is preferable over late cholecystectomy.

scholarly journals Using inferior epigastric vascular anatomical landmarks for anterior inguinal hernia repair

BMC Surgery ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Weiming Li ◽  
Yijun Li ◽  
Lili Ding ◽  
Xiongzhi Chen ◽  
Qingwen Xu ◽  
...  
Keyword(s):  
Inguinal Hernia ◽  
Hernia Repair ◽  
Hospital Stay ◽  
Inguinal Hernia Repair ◽  
Foreign Bodies ◽  
Length Of Hospital Stay ◽  
Operation Time ◽  
Complication Rates ◽  
Anatomical Landmarks ◽  
Post Operative Pain

Abstract Background Inferior epigastric vascular anatomical landmarks for anterior inguinal hernia repair is an alternative surgical procedure. We present our experience and outcome of the way. Methods We performed a retrospective analysis of 230 patients who received anterior tension-free hernia repair between May 2016 to May 2017. Among these cases, 120 were performed using the traditional transinguinal preperitoneal (TTIPP) technique while 100 were performed using the vascular anatomic landmark transinguinal preperitoneal (VALTIPP) technique. Between these two groups, we compared the operation time, length of hospital stay, complication rates, and the visual analog scale (VAS) for pain at 2 days, 3 months, and 6 months after surgery. Results Surgery was well-tolerated in both groups with no significant hemorrhage or complications. The operation times for the VALTIPP and TTIPP groups were 42.52 ± 9.15 and 53.84 ± 10.64 min (P < 0.05), respectively. Ten patients in the VALTIPP group and 17 patients in the TTIPP group reported sensations of foreign bodies (P < 0.05). The VAS pain score in VALTIPP patients at 2 days (4.0 ± 0.5), 3 months (1.0 ± 0.3), and 6 months (0.9 ± 0.3) were significantly lower when compared with those of TTIPP patients (5.3 ± 0.9 at 2 days, 1.8 ± 0.4 at 3 months, and 1.1 ± 0.1 at 6 months, p < 0.05). No statistically significant differences were found in age, gender, BMI, hernia type and location, follow-up period, incidence of post-operative seromas, recurrence rate, or length of hospital stay. Conclusion Anterior inguinal hernia repair using inferior epigastric vascular anatomical landmarks may lead to reduced operation times, reduced sensations of foreign bodies, and reduced post-operative pain. This technique is simple, practical, and effective in the management of inguinal hernias.

Safety and Postoperative Outcomes of Regional versus Global Ischemia for Partial Nephrectomy: A Systematic Review and Meta-Analysis

2014 ◽  
Vol 94 (4) ◽  
pp. 428-435 ◽  
Author(s):  
Yiduo Wang ◽  
Huan Qu ◽  
Lei Zhang ◽  
Shuqiu Chen ◽  
Bin Xu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Partial Nephrectomy ◽  
Weighted Mean Difference ◽  
Meta Analysis ◽  
Global Ischemia ◽  
Current Evidence ◽  
Complication Rates ◽  
Regional Ischemia ◽  
Estimated Blood Loss ◽  
Ischemia Group

Objective: To analyze current evidence comparing the safety and outcomes of regional and global ischemia for partial nephrectomy (PN). Materials and Methods: A systematic search of the PubMed and Web of Science databases was conducted in May 2014 to identify studies comparing the safety and outcomes of regional and global ischemia for PN. A systematic review and meta-analysis was also performed. Results: Six retrospective observational studies were selected for the analysis, including 363 patients who underwent PN (162 regional ischemia and 201 global ischemia cases). Operation times were not statistically different [weighted mean difference (WMD) = 20.35 min, 95% CI: -0.28-40.97, p = 0.05], but estimated blood loss was significantly higher in the regional ischemia group (WMD = 52.04 ml, 95% CI: 14.30-89.78, p = 0.007) than in the global ischemia group. Complication rates [odds ratio (OR) = 1.16; 95% CI: 0.63-2.15, p = 0.63] and blood transfusion rates (OR = 1.85; 95% CI: 0.86-4.01, p = 0.12) of the two groups were not significantly different. The regional ischemia group showed better postoperative renal function (WMD = 4.23 ml/min, 95% CI: 2.61-5.85, p < 0.00001) than the global ischemia group, and all cases in the regional ischemia group showed negative margins. Conclusions: Regional ischemia is as safe to perform as global ischemia, and the former leads to better postoperative renal functions than the latter. These findings support the application of regional ischemia for PN.

scholarly journals Experience in laparoscopic cholecystectomy in Nobel Medical College, Nepal

2019 ◽  
Vol 3 (Issue 1) ◽  
pp. 11
Author(s):  
Ruslan Sulaimankulov ◽  
Chittaranjan Das ◽  
Gulmira Jolochieva ◽  
Ashok Koirala ◽  
Rupak Bhattarai
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Hospital Stay ◽  
College Teaching ◽  
Operation Time ◽  
Research Centre ◽  
Surgical Experience ◽  
Medical College ◽  
Conversion Rates ◽  
Group 3 ◽  
Group 1

Objective: A laparoscopic cholecystectomy (LC) is the treatment of choice for gallbladder diseases. The aim of this study is to analyze laparoscopic cholecystectomies performed by a single surgeon over 8 years at Nobel Medical College Teaching Hospital and Research Centre Pvt. Ltd. of Biratnagar, Nepal (NMCTH). Methods: We performed a retrospective analysis of 7557 patients that underwent a LC by a single surgeon, from October 2010 to July 2018. We divided it into 3 groups that include data of every three years. Results: The hospital stay, operation time and conversion rates were decreased by years of experience. Female patients outnumbered male (M:F=1:3.7) patients in this study. The hospital stay (3 days), operation time (21 min), conversion (0.3%) and complications (1.9%) rates decreased from Group 1 to Group 3 (p&lt;0.05). Conclusion: As surgical experience increased with a rising number of cases, the conversion rate, complications, hospital stay and mean operation time decreased. Key words: cholecystectomy, laparoscopy, elective, conversion, complications, mortality, gallstone, cholecystitis

scholarly journals Characteristics and Outcomes of Acute Appendicitis Cases During the COVID-19 Pandemic

2020 ◽  
Author(s):  
Murat Başer ◽  
Mehmet Kağan Katar
Keyword(s):  
Acute Appendicitis ◽  
Hospital Stay ◽  
Open Surgery ◽  
Open Appendectomy ◽  
Length Of Hospital Stay ◽  
Operation Time ◽  
Complication Rates ◽  
Duration Of Symptoms ◽  
Conversion To Open Surgery ◽  
Group B

Abstract Background: Our aim in this study was to investigate the effects of the COVID-19 pandemic on acute appendicitis cases.Methods: This study was designed as a single-center, retrospective, and observational study. The patients were divided into three groups relative to the date of the first COVID-19 case in Turkey, which was March 10, 2020 (Group A: before the pandemic; Group B: pandemic period; Group C: the same period one year before the pandemic). A total of 413 patients were included in the study.Results: In terms of treatment modality, the rate of open appendectomy was significantly higher in group B (p<0.001). Rates of conversion to open surgery, as well as rates of complicated appendicitis were also significantly higher in group B (p=0.027, p=0.024, respectively). While there was no difference between the groups in terms of preoperative hospitalization duration (p=0.102), it was found that the duration of symptoms, operation time, and postoperative length of hospital stay were significantly higher in Group B (p<0.001, p=0.011, p=0.001, respectively). In addition, the complication rate in group B (8.9%) was also significantly higher than in the other two groups (p=0.023).Conclusion: We found that the rate of open surgery, the rate of conversion of laparoscopic surgery to open surgery, complication rates, mean operation time, and postoperative hospital stay were significantly higher in acute appendicitis patients that underwent surgery during the COVID-19 pandemic period. We believe that the main reason for this negative outcome is the late admission of the patients to the hospital.

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