Impact of Spleen Size on Outcomes in Laparoscopic Splenectomy in Children

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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Evaluation of the effectiveness of vacuum-assisted closure in the treatment of Fournier gangrene

10.31083/jomh.2021.089 ◽

2021 ◽

pp. 1

Keyword(s):

Hospital Stay ◽

Wound Closure ◽

Length Of Hospital Stay ◽

Vacuum Assisted Closure ◽

Analgesic Requirement ◽

Vac Therapy ◽

Fournier Gangrene ◽

Group I ◽

Group Ii ◽

Closure Method

Background and objective: To evaluate the effectiveness of vacuum-assisted closure (VAC) in the treatment of Fournier gangrene (FG). Material and methods: Forty-eight male patients treated for Fournier gangrene were included in the study. The patients were divided into two groups (Group I: conventional dressing, Group II: VAC therapy). Characteristics of the patients, laboratory parameters, number of debridement procedures, daily number of dressings, visual analogue scale (VAS) during dressing, analgesic requirement, colostomy requirement, time from the first debridement to wound closure, wound closure method, length of hospital stay, and mortality rates were compared. Results: Group I comprised 33 patients and Group II comprised 15 patients. The number of dressings, VAS score and daily analgesic requirement were statistically significantly lower in Group II (p < 0.05) than in Group I. The number of debridement procedures, colostomy requirement, orchiectomy rate, time from first debridement to wound closure, length of hospital stay, wound closure method and mortality rate were similar between these two groups (p > 0.05). Conclusion: The clinical results of conventional dressing and VAC therapy were similar for treating FG. VAC therapy is an effective postoperative wound care method that offers less requirement for dressing changes, less pain, less analgesic requirement and more patient satisfaction compared to conventional dressing.

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Comparative Efficacy of Nebulized 3% Hypertonic Saline versus 0.9% Normal Saline in Children with Acute Bronchiolitis

Bangladesh Journal of Child Health ◽

10.3329/bjch.v42i3.39264 ◽

2018 ◽

Vol 42 (3) ◽

pp. 130-137 ◽

Cited By ~ 1

Author(s):

Khandaker Tarequl Islam ◽

Abid Hossan Mollah ◽

Abdul Matin ◽

Mahmuda Begum

Keyword(s):

Hospital Stay ◽

Hypertonic Saline ◽

Normal Saline ◽

Severity Score ◽

Oxygen Therapy ◽

Length Of Hospital Stay ◽

Clinical Severity ◽

Acute Bronchiolitis ◽

Group I ◽

Group Ii

Background: Acute bronchiolitis is leading cause of hospitalization in infants below 2 years of age. Bronchiolitis being a viral disease, there is no effective treatment. 3% nebulized hypertonic saline and 0.9% nebulized normal saline are often used, although there is disagreement over their efficacy. The aim of this study was to evaluate the efficacy of 3% hypertonic saline in children with acute bronchiolitis in reducing clinical severity and length of hospital stay. Methodology: A randomized control trial carried out in the Department of Pediatrics, Dhaka Medical College Hospital from January 2013 to December 2013.Ninty children from 1 month to 2 years of age hospitalized with clinical bronchiolitis were randomized to receive 3% nebulized hypertonic saline(Group-I) or 0.9% nebulized normal saline (Group-II). Nebulization was done 8 hourly until discharge. Outcome variable were clinical severity score, duration of oxygen therapy and length of hospital stay. Results: Baseline clinical severity score and O2 saturation were in group-I 9.0±1.0 and 94.9±1.7 and in group- II 9.3±1.8 and 94.6±2.6 respectively (p>0.05). At 72 hours, the mean severity score for the group-I was 1.64±0.99 and that for the group-II was 3.0 ± 1.48 (95% CI -2.17 to - 0.53, p=0.002). The cases of group-I required a shorter duration of oxygen therapy compared to those of group-II (15.0±6.0 hours vs 26.4±5.37 hours, 95% CI -20.35 to -2.44, p<0.05). Forty two (93.3%) of the group-I children recovered by the end of72 hours and discharged whereas 26 (57.8%) of the group-II children recovered during the same period (p<0.05). Length of hospital stay was shorter in group-I compared to group-II (58.1±22.0 hours vs 74.7±27.2 hours, 95% CI -26.89 to- 6.17, p=0.002). None of the cases encountered any side-effects. Conclusion: Nebulization with 3% hypertonic saline significantly reduced clinical severity, length of hospital stay and duration of oxygen therapy in case of acute bronchiolitis in comparison to 0.9% normal saline and was safe. Bangladesh J Child Health 2018; VOL 42 (3) :130-137

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Degloving injuries of trunk and limbs: comparison of outcomes of early versus delayed assessment by the plastic surgery team

Revista do Colégio Brasileiro de Cirurgiões ◽

10.1590/0100-69912015003003 ◽

2015 ◽

Vol 42 (3) ◽

pp. 143-148 ◽

Cited By ~ 6

Author(s):

Daniel Francisco Mello ◽

José Cesar Assef ◽

Sílvia Cristine Soldá ◽

Américo Helene Jr

Keyword(s):

Hospital Stay ◽

Plastic Surgery ◽

Skin Flap ◽

Length Of Hospital Stay ◽

Lower Limbs ◽

Trauma Patients ◽

Early Assessment ◽

Group I ◽

Group Ii ◽

Degloving Injuries

<sec><title>OBJECTIVE:</title> to analyze cases of degloving of the trunk and limbs, comparing outcomes of early versus delayed assessment by the plastic surgery team.</sec><sec><title>METHODS:</title> we conducted a retrospective analysis of medical charts. Patients comprised two groups: Group I - early assessment, performed within 12 hours post trauma; and Group II - delayed assessment, performed more than 12 hours post trauma. We defined primary grafting as the use of skin from the traumatized skin flap. We excluded cases involving hands, feet or genitalia.</sec><sec><title>RESULTS:</title> there were 47 patients treated with degloving injuries between 2002 and 2010. The mean body surface area affected was 8.2%. Lower limbs were the most frequently affected site (95.7%), whether alone or in association with lesions to other sites. Delayed assessment by the plastic surgery team occurred in 25 cases. Mean hospital stay was 36.1 days for Group I and 57.1 days for Group II (p=0.026). Regarding the number of surgical operations (skin grafts), Group I received a mean of 1.3, while Group II underwent 1.6 (p=0.034).</sec><sec><title>CONCLUSION:</title> based on length of hospital stay and number of operations in trauma patients with degloving of the trunk and limbs, plastic surgery assessment should be carried out early.</sec>

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Percutaneous endoscopic treatment of benign and malignant renal pelvis carcinoma: A single-center experience

10.21203/rs.3.rs-41645/v1 ◽

2020 ◽

Author(s):

Xin Zhang ◽

Wu Xiu Han ◽

Sheng Yan Li ◽

Hao Yuan Chen ◽

Zhe Yu Tang ◽

...

Keyword(s):

Blood Loss ◽

Hospital Stay ◽

Renal Pelvis ◽

Operation Time ◽

Laser Evaporation ◽

Pathological Grade ◽

Group I ◽

Grade Ii ◽

The Mean ◽

Group Ii

Abstract Background Percutaneous nephrolithotomy (PCNL) is a safe and efficient treatment for intro-renal diseases, most of which are calculus disease. In this study, we carried out percutaneous endoscopic nephron-sparing ablation for renal carcinoma in carefully selected patients. Our aim was to evaluate whether percutaneous endoscopic nephron-sparing operation was feasible for patients with renal cell carcinoma.Methods A total of 15 patients with renal pelvis carcinoma were treated with laser evaporation under percutaneous endoscopy between January 2015 and September 2019 ( group I ). Another 13 patients who received standard radical nephroureterectomy were recruited as the control group (group II). We recorded demographic data of the patients, the indication for surgery, tumor pathological grade, size and side of tumor, and the intraoperative and postoperative outcome, including the duration of surgery, length of hospital stay, and complication rate, as well as progression-free survival (PFS).Results In both groups, all of the patients received flexible ureteroscopy. In group I, 14 patients had transitional renal cell carcinoma (UCC), four had pathological grade I, nine had grade II, and one had hemangiopericytoma. In group II, all patients had UCC, five had pathological grade I, and eight had grade II. In group I, the mean operation time was 118 min (65–236 min), the mean blood loss was 110 ml (55–220 ml), and the mean hospital stay was 9 days (7–12 days). During follow-up, two patients died and two had recurrence; among them, one had systematic bone metastasis. The PFS rate was 66.7% (10/15). In group II, the mean operation time was 265 min (185–436 min), the mean blood loss was 133 ml (85–240 ml), and the mean hospital stay was 13 days (9–16 days). During the follow-up, two patients died and there was no local or systematic metastasis. The PFS rate was 84.6% (11/13). There was no significant difference in blood loss between the groups. However, the operation time and mean hospital stay were significantly shorter in group I compared with that in group II ( P < 0.05). But the PFS rate was significantly higher in group II than in group I (P < 0.05).Conclusions This study shows that laser evaporation under percutaneous endoscopy for renal pelvis carcinoma is a safe, effective, and technically feasible procedure for treating benign and malignant renal pelvis carcinoma.

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Fournier's Gangrene: Conventional Dressings versus Dressings with Dakin's Solution

ISRN Urology ◽

10.5402/2012/762340 ◽

2012 ◽

Vol 2012 ◽

pp. 1-4 ◽

Cited By ~ 4

Author(s):

Bülent Altunoluk ◽

Sefa Resim ◽

Erkan Efe ◽

Mustafa Eren ◽

Can Benlioglu ◽

...

Keyword(s):

Povidone Iodine ◽

Length Of Hospital Stay ◽

Fournier’S Gangrene ◽

Morbidity And Mortality ◽

Wound Management ◽

Fournier's Gangrene ◽

Group I ◽

The Mean ◽

Group Ii ◽

Destructive Inflammation

Purpose. Fournier’s gangrene is a fulminant and destructive inflammation of the scrotum, penis, and perineum. The objective of this study was to compare 2 different approaches to wound management after aggressive surgical debridement. Methods. Data from 14 patients with Fournier’s gangrene were retrospectively collected (2005–2011). Once the patients were stabilized following surgery, they were treated with either daily antiseptic (povidone iodine) dressings (group I, n=6) or dressings with dakin’s solution (sodium hypochloride) (group II, n=8). Results. The mean age of the patients was 68.2 ± 7.8 (55–75) years in group I and 66.9 ± 10.2 (51–79) years in group II. Length of hospital stay was 13 ± 3.5 (7–16) days in group I and 8.9 ± 3.0 (4–12) days in group II (P<0.05). The number and rate of mortality was 1/6 (16.7%) in group I, and 1/8 (12.5%) in group II. Conclusions. The hospitalization time can be reduced with the use of dakin’s solution for the dressings in the treatment of FG. Also, dressings with dakin’s solution seems to have favorable effects on morbidity and mortality. Consequently dakin’s solution may alter the treatment of this disastrous disease by reducing cost, morbidity and mortality.

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Robotic vs. Laparoscopic Splenectomy in Management of Non-traumatic Splenic Pathologies: A Systematic Review and Meta-Analysis

The American Surgeon ◽

10.1177/0003134821995057 ◽

2021 ◽

pp. 000313482199505

Author(s):

Pratik Bhattacharya ◽

Liam Phelan ◽

Simon Fisher ◽

Shahab Hajibandeh ◽

Shahin Hajibandeh

Keyword(s):

Blood Loss ◽

Hospital Stay ◽

Wound Infection ◽

Laparoscopic Splenectomy ◽

Length Of Hospital Stay ◽

Perioperative Outcomes ◽

Procedure Time ◽

Open Procedure ◽

Operative Complications ◽

Post Operative Complications

We aimed to evaluate comparative outcomes of robotic and laparoscopic splenectomy in patients with non-traumatic splenic pathologies. A systematic search of electronic databases and bibliographic reference lists were conducted, and a combination of free text and controlled vocabulary search adapted to thesaurus headings, search operators and limits in electronic databases were applied. Intraoperative and post-operative complications, wound infection, haematoma, conversion to open procedure, return to theatre, volume of blood loss, procedure time and length of hospital stay were the evaluated outcome parameters. We identified 8 comparative studies reporting a total of 560 patients comparing outcomes of robotic ( n = 202) and laparoscopic ( n = 258) splenectomies. The robotic approach was associated with significantly lower volume of blood loss (MD: −82.53 mls, 95% CI −161.91 to −3.16, P = .04) than the laparoscopic approach. There was no significant difference in intraoperative complications (OR: 0.68, 95% CI .21-2.01, P = .51), post-operative complications (OR: .91, 95% CI .40-2.06, P = .82), wound infection (RD: -.01, 95% CI -.04-.03, P = .78), haematoma (OR: 0.40, 95% CI .04-4.03, P = .44), conversion to open (OR: 0.63; 95% CI, .24-1.70, P = .36), return to theatre (RD: −.04, 95% CI -.09-.02, P = .16), procedure time (MD: 3.63; 95% CI -16.99-24.25, P = .73) and length of hospital stay (MD: −.21; 95% CI -1.17 - .75, P = .67) between 2 groups. In conclusion, robotic and laparoscopic splenectomies seem to have comparable perioperative outcomes with similar rate of conversion to an open procedure, procedure time and length of hospital stay. The former may potentially reduce the volume of intraoperative blood loss. Future higher level research is required to evaluate the cost-effectiveness and clinical outcomes

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LAP STAPLER GASTROJEJUNOSTOMY WITH TOTAL TRUNCAL VAGOTOMY FOR BENIGN GASTRIC OUTLET OBSTRUCTION.

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v4i9.1409 ◽

2020 ◽

Vol 4 (9) ◽

Author(s):

Sahun .

Keyword(s):

Hospital Stay ◽

Postoperative Complication ◽

Operative Time ◽

Outlet Obstruction ◽

Length Of Hospital Stay ◽

Truncal Vagotomy ◽

Term Outcome ◽

Female Ratio ◽

Advantages And Disadvantages ◽

The Mean

Aims: To study the advantages and disadvantages of laparoscopic truncal vagotomy and gastrojejunostomy, the outcome of surgery in terms of – mean operative time, Conversion rate, Postoperative pain measurement, intraoperative and postoperative complication and duration of hospital stay. Methods: A prospective analysis of operative, postoperative and short term outcome of 21 patients were carried out during time period of 2016 to 2019. Results: Out of 21 patient,.64% patients were males and 36 % patients were females. Male to female ratio was 1.7: 1. The mean operative time required was 130 minutes and the mean pain scale measured was 3 ± 0.81 on second day .The incidence of intraoperative and early postoperative complication was 5.26 % and 10.52 % respectively. The mean length of hospital stay was 8 days. Average follow up duration was 12 months. Conclusion: It is viable and safe option with shorter operative time and length of stay. It can be performed successfully with minimal morbidity and no mortality. However extreme care and skill is required to identify anatomy and handling of stapler. Keywords: Laparoscopy; Stapler Gastrojejunostomy; Vagotomy; Endoscopy.

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Antegrade Percutaneous Versus Retrograde Ureteroscopic Lithotripsy in Upper Ureteric Cases

Academia Journal of Surgery ◽

10.47008/ajs/2020.3.1.18 ◽

2020 ◽

Vol 3 (1) ◽

pp. 84-87

Author(s):

A. Nischal Prasad ◽

Prasad PVGS

Keyword(s):

Operative Time ◽

Stone Size ◽

Ureteroscopic Lithotripsy ◽

Stone Clearance ◽

Medical College ◽

Ureteric Calculus ◽

Group I ◽

The Mean ◽

Group Ii ◽

The Difference

Background: The technical advancements in urology have profoundly changed the management of upper ureteric calculus. The present study compared antegrade percutaneous versus retrograde ureteroscopic lithotripsy in upper ureteric cases. Subjects and Methods: The present study was conducted at NRI Medical College & Hospital, Chinakakani, Mangalagiri Mandal, Andhra Pradesh from May 2013 to April 2014 on 60 patients with upper ureteric stones of both genders. Patients were divided into 2 groups. Group I patients were treated with antegrade percutaneous and group II with retrograde ureterolithotripsy. Outcome in both groups was recorded and compared. Results: The mean anesthetic time in group I was 82.4 minutes and in group II was 73.1 minutes, operative time was 45.2 minutes in group I and 58.4 minutes in group II, post- operative stay in group I was 2.6 days and in group II was 1.7 days, stone clearance was seen in 26 patients in group I and 22 in group II. Mean stone size in group I was 1.89 cm and in group II was 1.49 cm. Follow ups days were 71.2 in group I and 83.4 in group II. Clavien-Dindo categorization grade 0 was seen in 16 in group I and 13 in group II, grade 1 in 10 in group I and 12 in group II and grade 2 in 4 in group I and 5 in group II. The difference was significant (P< 0.05). There were 4 and 5 patients in group I and group II with post- operative complications (P< 0.05). Conclusion: Authors found that antegrade percutaneous has better stone clearance rates as compared to retrograde ureterolithotripsy for an upper ureteric calculus.

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Efficacy and Safety of Laparoscopic Appendectomy for Complicated Appendicitis in Children in Tertiary Care Hospital

Journal of Medical Science & Research ◽

10.47648/jmsr.2018.v2801.04 ◽

2018 ◽

Vol 28 (Number 1) ◽

pp. 21-26

Author(s):

Md. Anisuzzaman ◽

ASM A Kabir ◽

Md. A R l Sadiq ◽

Md. A Matin ◽

I Ahmed ◽

...

Keyword(s):

Hospital Stay ◽

Wound Infection ◽

Laparoscopic Appendectomy ◽

Operative Time ◽

Length Of Hospital Stay ◽

Complicated Appendicitis ◽

Safe Procedure ◽

Care Hospital ◽

Efficacy And Safety ◽

The Mean

Laparoscopic appendectomy for uncomplicated appendicitis is associated with good outcomes but the role of laparoscopy in complicated appendicitis is more controversial because of high incidence of infectious complications. The aim of this current study is to evaluate the efficacy and safety of laparoscopic appendectomy in complicated appendicitis in children. This interventional study was carried out during the period from January 2015 to May 2018 in Holy Family Red Crescent Medical College Hospital. The study included 43 patients, age ranges from 3 years to 15 years who underwent laparoscopic appendectomy for complicated acute appendicitis. The following variables were analyzed : age, sex, operative findings, operative time, return of bowel function, resumption of oral feeds, length of hospital stay, postoperative complications such as deur, wound infection and intraabdominal abscess etc. The mean age of studied cases was 7.1 years. In 41 patients (95.3%) the procedure was completed laparoscopically. Two (4.7%) patients required conversion to open appendectomy. The operative time was 83.5+,25.8 minutes. Two patients (4.6%) had post-operative ileus. Four patients (9.7%) developed superficial wound infection. Three patients (7.3%) developed infra-abdominal collections. One (2.4%) patients were readmitted because of recurrent abdominal pain One patients (2.4%) developed postoperative pyrexia due to pneumonitis and Three patients (7.3) developed gastroenteritis. The mean length of hospital stay was 5.8±2.1 days. No mortality was recorded.Laparoscopic appendectomy can be the first choice for cases of complicated appendicitis in children. It is a feasible, safe procedure and is associated with acceptable post-operative morbidity with rapid recovery and better cosmetic results.

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The efficacy of corticosteroids therapy in patients with moderate to severe SARS-CoV-2 infection: a multicenter, randomized, open-label trial

Respiratory Research ◽

10.1186/s12931-021-01833-6 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Mostafa Ghanei ◽

Masoud Solaymani-Dodaran ◽

Ali Qazvini ◽

Amir Hosein Ghazale ◽

Seyed Amin Setarehdan ◽

...

Keyword(s):

Hospital Stay ◽

Length Of Hospital Stay ◽

Diabetic Patients ◽

Open Label ◽

Mitt Population ◽

Treatment Regimens ◽

Clinical Recovery ◽

Group I ◽

The Mean ◽

Open Label Trial

Abstract Background We performed a multicenter, randomized open-label trial in patients with moderate to severe Covid-19 treated with a range of possible treatment regimens. Methods: Patients were randomly assigned to one of three regimen groups at a ratio of 1:1:1. The primary outcome of this study was admission to the intensive care unit. Secondary outcomes were intubation, in-hospital mortality, time to clinical recovery, and length of hospital stay (LOS). Between April 13 and August 9, 2020, a total of 336 patients were randomly assigned to receive one of the 3 treatment regimens including group I (hydroxychloroquine stat, prednisolone, azithromycin and naproxen; 120 patients), group II (hydroxychloroquine stat, azithromycin and naproxen; 116 patients), and group III (hydroxychloroquine and lopinavir/ritonavir (116 patients). The mean LOS in patients receiving prednisolone was 5.5 in the modified intention-to-treat (mITT) population and 4.4 days in the per-protocol (PP) population compared with 6.4 days (mITT population) and 5.8 days (PP population) in patients treated with Lopinavir/Ritonavir. Results The mean LOS was significantly lower in the mITT and PP populations who received prednisolone compared with populations treated with Lopinavir/Ritonavir (p = 0.028; p = 0.0007). We observed no significant differences in the number of deaths, ICU admission, and need for mechanical ventilation between the Modified ITT and per-protocol populations treated with prednisolone and Lopinavir/Ritonavir, although these outcomes were better in the arm treated with prednisolone. The time to clinical recovery was similar in the modified ITT and per-protocol populations treated with prednisolone, lopinavir/ritonavir, and azithromycin (P = 0.335; P = 0.055; p = 0.291; p = 0.098). Conclusion The results of the present study show that therapeutic regimen (regimen I) with low dose prednisolone was superior to other regimens in shortening the length of hospital stay in patients with moderate to severe COVID-19. The steroid sparing effect may be utilized to increase the effectiveness of corticosteroids in the management of diabetic patients by decreasing the dosage.

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