Comparative Analysis of Pedicular Vascular Control Techniques during Laparoscopic Nephrectomy: En Bloc Stapling or Separate Ligation?

Objective: To compare the safety and efficacy of en bloc stapling and separate ligation techniques for renal vascular control during laparoscopic nephrectomy. Patients and Methods: Clinical data were collected from 60 patients who underwent laparoscopic nephrectomies using en bloc stapling (n = 27, group 1) or the separate ligation method (n = 33, group 2). Comparative analysis was carried out between the two groups, examining operative times, blood loss, intra- and postoperative complications and hospital stay. Results: Compared with the separate ligation method, the en bloc hilar control technique was associated with a shorter total operating time (98 vs. 121 min, p = 0.029). However, both groups were similar in terms of estimated blood loss, hemoglobin drop, changes in creatinine level and postoperative hospital stay. The total complication rates in group 1 and 2 were 3.7 and 15.1%, respectively, with a statistically significant difference. There were no complications related to the use of the endo-GIA stapler and no patients required conversion to open surgery in group 1. In group 2, 2 patients required conversion to open surgery, including 1 due to renal vein bleeding secondary to inaccurate vascular control and the other due to bleeding from the vena cava during dissection. In addition, 1 patient had a superficial bowel injury that was repaired laparoscopically and another had a superficial liver tear that was managed without conversion or transfusion. Conclusion: En bloc ligation of the renal hilum is an easy and reliable technique that allows safe and fast control of the renal pedicle.

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Which factors affect the success of pediatric PCNL? Single center experience over 20 years

Archivio Italiano di Urologia e Andrologia ◽

10.4081/aiua.2020.4.345 ◽

2020 ◽

Vol 92 (4) ◽

Author(s):

Volkan Izol ◽

Nihat Satar ◽

Yıldırım Bayazit ◽

Fatih Gokalp ◽

Nebil Akdogan ◽

...

Keyword(s):

Blood Transfusion ◽

Blood Loss ◽

Hospital Stay ◽

Percutaneous Nephrolithotomy ◽

Pediatric Patients ◽

Operation Time ◽

Fluoroscopy Time ◽

Postoperative Blood Transfusion ◽

Group 2 ◽

Group 1

Objective: We aimed to investigate the impact of surgeons’ experience on pediatric percutaneous nephrolithotomy (PCNL) outcomes. Materials and methods: Between June 1997 and June 2018, 573 pediatric patients with 654 renal units underwent PCNL for renal stone disease by senior surgeons. Data were divided into two groups, group-1 (n = 267), first ten years period, group-2 (n = 387); second ten years period. Results: Mean ± SD age of patients was 7.6 ± 4.9 (1-17) years. The stone-free rates (SFR) assessed after 4 weeks were 74.9% vs. 83.4% in group-1 vs. group-2, respectively (p = 0.03). The mean operation time, fluoroscopy time, and the number of patients requiring blood transfusion significantly decreased in group 2 (100.4 ± 57.5 vs. 63.63 ± 36.3, 12.1 ± 8.3 vs. 8.3 ± 5.4, and 24.3% vs. 2.9%; p < 0.001, p < 0.001, and p = 0.002 in group-1 versus group-2, respectively). On multivariate analysis, increasing stone size increased operation time (p < 0.001), fluoroscopy time (p < 0.001), intraoperative and postoperative blood transfusion rates (p = 0.006 and p = 0.018, respectively), and hospital stay (p = 0.002) but was not associated with change of glomerular filtration rate (GFR) (p = 0.71). Sheath size also correlated with increased fluoroscopy time (p < 0.001), operation time (p < 0.001), intraoperative blood transfusion (p < 0.001) and hospital stay, but sheath size did not affect postoperative blood transfusion (p = 0.614) or GFR change (p = 0.994). Conclusions: The percutaneous nephrolithotomy (PCNL) is a minimally invasive procedure and is well accepted because of its lower complication rate and high efficiency for pediatric patients. Stone and sheath size are predictive factors for blood loss and hospital stay. During 20 years, our fluoroscopy time, operation time, blood loss, and complication rates decreased, and stone-free rate increased.

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OUTCOMES OF VIDEO ASSISTED THORACOSCOPIC DECORTICATION VERSUS CONVENTIONAL OPEN DECORTICATION IN PATIENTS WITH STAGE II OR STAGE III EMPYEMA

Pakistan Armed Forces Medical Journal ◽

10.51253/pafmj.v71i4.5436 ◽

2021 ◽

Vol 71 (4) ◽

pp. 1261-64

Author(s):

Ibrahim Baloch ◽

Bilal Umair ◽

Asif Asghar ◽

Muhammad Imtiaz Khan ◽

Muhammad Shoaib Hanif ◽

...

Keyword(s):

Blood Loss ◽

Hospital Stay ◽

Operative Time ◽

Stage Ii ◽

Stage Iii ◽

P Value ◽

Video Assisted ◽

Post Operative Pain ◽

Group 2 ◽

Group 1

Objective: To compare outcomes of video assisted Thoracoscopic Decortication (VATD) with conventional open decortication (COD) in patients with stage–II or stage–III empyema thoracic. Study Design: Prospective comparative study. Place and Duration of Study: Department of Thoracic Surgery, Combined Military Hospital, Rawalpindi, Pakistan, from Jun 2018 to May 2019. Methodology: A total 60 patients underwent in this study. Patients of both gender who reported for decortication of empyema thoracic were evaluated. All patients diagnosed to have Stage II or III empyema with age 25-50 years were studied for outcomes. All patients were evaluated for operative time, blood loss, post-operative pain, pneumonitis, duration of airleak and post-operative drainage, duration of chest drains and length of hospital stay. Results: Mean operative time in group-1 was 133.63 ± 8.55 min and in group-2 was 147.83 ± 10.36 min (p-value 0.037). Mean blood loss in group-1 was 296.66 ± 46.11 while in group-2 was 207.30 ± 53.81. Post-operative pain score on VAS for pain was 5.8 ± 1.7 for group-1 and 4.06 ± 1.4 for group-2 (p-value 0.032). Chest tubes were retained for an average of 5.58 ± 0.8 days in group-1 while 3.86 ± 0.8 days in group-2 (p-value <0.001). Conclusion: Video-Assisted Thoracoscopic Surgery Decortication is superior to open decortication in operative management of Stage II and Stage III Empyema thoracic in terms of post op pain, duration of chest intubation, air leak and hospital stay of the patient.

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EVALUATION OUTCOMES OF THE LAPAROSCOPIC RETROPERITONEAL NEPHRECTOMY FOR BENIGN NONFUNCTIONING KIDNEYS

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2017.5.14 ◽

2017 ◽

pp. 107-112

Author(s):

Duc Minh Hoang ◽

khoa Hung Nguyen ◽

Vinh Quy Truong ◽

Van Binh Nguyen ◽

Hong Duong Nguyen ◽

...

Keyword(s):

Blood Loss ◽

Hospital Stay ◽

Open Surgery ◽

Operating Time ◽

Indications For Surgery ◽

Conversion To Open Surgery ◽

Multicystic Kidney ◽

Post Operation ◽

The Mean ◽

Retroperitoneal Nephrectomy

Purpose: To assess results of retroperitoneoscopy nephrectomy for benign non-function kidneys from June 2013 to June 2017 at Quang Tri General Hospital. Materials and Methods: The study comprised 43 patients who underwent retroperitoneoscopic nephrectomy during a 4 years period beginning from June 2013. Results: Mean age of surgery was 52.6 years (28-72 years). 23 males and 20 females. 25 patients underwent left nephrectomy; 18 underwent right nephrectomy. Retroperitoneoscopic nephrectomy were completed successfully in 38 patients (88.4%). There was 5 patients required conversion to open surgery (11.6%), all cases by poor progression. The mean operating time was 112.7 minutes (range 70 to 210), mean blood loss was 45.7 ml (range 15 to 170 ml), and mean post-operation hospital stay was 4.3 days (range 3 to 9). A total of 21.1% complications (8/38 cases), no severe complications occurred. No re-intervention was needed. No case was mortality. The indications for surgery included hydronephrosis in 19/38 cases (50.0%), atrophic kidney in 13/38 cases (34.2%) and multicystic kidney in 6/38 cases (15.8%). Conclusions: Retroperitoneoscopic nephrectomy can be performed safely and successfully with obvious advantages for benign nonfunctioning kidneys regardless of the etiology or pathogenesis. Key words: nephrectomy, kidney, benign, retroperitoneoscopy

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compare of outcomes of minimally invasive and open surgical techniques in patients with symptomatic lumbar spine stenosis on the background of scoliotic deformity

N.N. Priorov Journal of Traumatology and Orthopedics ◽

10.17116/vto201904133 ◽

2019 ◽

Vol 26 (4) ◽

pp. 33-42

Author(s):

S. G Mlyavykh ◽

A. E Bokov ◽

A. Ya Aleynik ◽

K. S Yashin

Keyword(s):

Quality Of Life ◽

Lumbar Spine ◽

Blood Loss ◽

Minimally Invasive ◽

Open Surgery ◽

Intraoperative Complications ◽

Scoliotic Deformity ◽

Group 2 ◽

Group 1

Objective: to compare the results of minimally invasive and open surgery in the treatment of the patients with combined symptomatic degenerative stenosis and scoliotic deformity of the lumbar spine. Patients and methods. A retrospective comparative analysis of the long-term results of 54 patients was performed. The patients were devided in two groups: open surgery (group 1, n=39) and minimally invasive surgery (group 2, n=15). Different approaches were used based on the type of deformity (according to Berzhano and Lamartine), localization and extent of lumbar stenosis. The evaluation of volume of decompression, blood loss, time of surgery and postoperative treatment, intraoperative complications, pain and patients condition were measured using clinical scales ODI, ZCQ, SF-12 was performed. Results. No differences in the type of deformity, the severity of stenosis and clinical manifestations between groups were discovered before treatment. All characteristics of the surgery (except the intraoperative complications) - blood loss, duration of surgery, and hospital stay - were significantly less in the minimally invasive group. Postoperative assessment has shown in group 1 greater regression of axial pain syndrome (p=0.03), in group 2 greater regression of radicular syndrome (p=0.03). Assessment of quality of life based on questionnaires after 2 years has revealed no differences between groups. Conclusion. Using of minimally-invasive decompression and decompression-stabilizing surgical technologies in patients with combined stenosis and deformity of the lumbar spine allow to eliminate the syndromes of neural compression, provide sufficient correction of segmental relationships and improve the quality of life.

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Laparoscopic Adrenalectomy: First Single-Center Experience in the Balkans

PRILOZI ◽

10.1515/prilozi-2015-0075 ◽

2015 ◽

Vol 36 (3) ◽

pp. 27-33

Author(s):

Zivko Popov ◽

Nikola Jankulovski ◽

Oliver Stankov ◽

Sotir Stavridis ◽

Skender Saidi ◽

...

Keyword(s):

Blood Loss ◽

Hospital Stay ◽

Laparoscopic Adrenalectomy ◽

Open Surgery ◽

Demographic Data ◽

Operating Time ◽

Conversion To Open Surgery ◽

The Balkans ◽

Estimated Blood Loss ◽

Number Of Patients

Abstract Introduction: Laparoscopic adrenalectomy has become the preferred approach for removal of the adrenal gland for the management of benign or malignant functioning or nonfunctioning adrenal masses. We aimed to present our initial experience with this procedure. In addition, we compare the clinical outcomes of laparoscopic (LA) vs. the open adrenalectomies (OA) performed at our institutions. Also we report a case of successful laparoscopic treatment of splenic artery aneurism involving laparoscopic splenectomy. Patients and Methods: A retrospective analysis of the data of all patients who underwent adrenalectomy at three institutions, over the last 12-year period, since the laparoscopic adrenal surgery was introduced in our country. All patients were assessed regarding the demographic data, hormonal status, operative time, estimated blood loss, complications, size of the tumor, number of patients requiring blood transfusion, hospital stay and conversion to open surgery for LA. Results: Thirty five consecutive patients, aged from 33 to 67 (average age 54 years) underwent unilateral LA adrenalectomy during the study period including 14 right and 21 left sided. The laparoscopic procedure was successfully completed in all except 4 cases, which were converted to open surgery to control bleeding from the avulsed adrenal veins. LA proved superior to OA, resulting in less estimated blood loss, shorter operating time, shorter time to resumption of oral intake, shorter postoperative hospital stay and less analgesic requirements. During the follow-up of 3 to 36 months no tumor recurrence and/or metastasis developed. Conclusions: Our results concur with other retrospective reviews comparing laparoscopic and open adrenalectomy, demonstrating unequivocal advantages in terms of reduced length of hospital stay, blood loss, return of bowel function, functional recovery and post-operative morbidity.

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Does Not Use of Closed Suction Drainage in Total Knee Arthroplasty with Tranexamic Acid Reduce Blood Loss?

Ortopedia Traumatologia Rehabilitacja ◽

10.5604/01.3001.0014.4224 ◽

2020 ◽

Vol 22 (5) ◽

pp. 343-352

Author(s):

Naci Ruşen Senih Ayan ◽

Yavuz Akalın ◽

Nazan Çevik ◽

Harun Sağlıcak ◽

Burak Olcay Güler ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Blood Transfusion ◽

Blood Loss ◽

Tranexamic Acid ◽

Hospital Stay ◽

Knee Arthroplasty ◽

Length Of Hospital Stay ◽

Total Knee ◽

Group 2 ◽

Group 1

Background. The aim of this study was to compare outcomes in patients who received intravenous tranexamic acid just before and after total knee arthroplasty with or without drains and to analyze whether there is any difference in terms of blood loss. Material and methods. This is a retrospective analysis of prospectively collected data of patients undergoing unilateral total knee arthroplasty. Between March 2017 and March 2019, 97 knees of 94 consecutive patients with osteoarthritis were divided into two groups (Group 1, with drain; and 2, without drain). Drainage group (53 knees; average age, 66,1±7,0 years; male, 10; female, 43) and a drainless group (44 knees; average age, 63,7± 7,5 years; male, 4; female, 40). All patients received systemic tranexamic acid (in 100 mL saline infusion iv in 30 minutes prior to the tourniquet inflation and 3 hours after the operation). Blood loss, allogeneic blood transfusion rates, complications such as swelling of the cruris, infection (deep or superficial), thromboembolic incidents (Deep venous thrombosis or pulmoner thromboembolism) and length of hospital stay were assessed postoperatively. Results. There was no difference in demographic parameters, body mass index, side ofsurgery, ASA score and anesthesia type between 2 groups. The preoperative Hb levels were comparable but on the postoperative day one, Hb level was lower in the drain group (p=0,017). Total blood loss (TBL) and allogeneic transfusion rates were lower in the drainless group, although did not differ signiﬁcantly between the two groups [TBL: 1360,9±502,5 / 646,1-2641,6 (1251,6) mL in the Group 1, 1205,6±505,0 / 396,6-2521,0 (1157,5) mL in Group 2 (p=0,134); Transfusion rates: 11 out of 53 cases (%20,8) in group 1 and 5 out of 44 cases (%11,4) in group 2]. The infection rate and length of hospital stay were lower in the drainless group. But there were no statistical difference was found in terms of complications and length of hospital stay between 2 groups. Conclusions. 1. Performing Total Knee Arthroplasty with preoperative and postoperative ivtranexamic acid and without drain decreased postoperative reduction in Hb level on the day after surgery in the current study. 2. But blood loss and blood transfusion rates when compared to patients with drain, no significant difference was found. 3. Drain use in knee replacements does not offer an advantage over drainless TKAs regarding the findings of our study. 4. Future studies with longer follow-up are needed in our opinion.

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Efficacy of Probiotic Saccharomyces boulardii as an Adjuvant Therapy in Acute Childhood Diarrhoea

Journal of Nepal Paediatric Society ◽

10.3126/jnps.v36i3.15539 ◽

2017 ◽

Vol 36 (3) ◽

pp. 250-255 ◽

Cited By ~ 5

Author(s):

Dillip Kumar Dash ◽

Mrutunjaya Dash ◽

M.D. Mohanty ◽

Naresh Acharya

Keyword(s):

Hospital Stay ◽

Tertiary Care ◽

Acute Diarrhoea ◽

Oral Rehydration Therapy ◽

Saccharomyces Boulardii ◽

Care Hospital ◽

Oral Rehydration ◽

Group 2 ◽

A Prospective Study ◽

Group 1

Introduction: Administration of S. boulardii in addition to rehydration therapy in diarrhea found to be beneficial in many aspects owing to a variety of causes and importantly it is was not associated with any adverse effects.Material and Methods: We conducted a prospective study of children suffering from acute diarrhoea, at a private tertiary care hospital. Children were divided into 2 groups randomly as per odd(Group 1 ) and even (Group 2) bed allotted in indoor at the time of admission: Group 1 included children on oral rehydration therapy (ORT) + Zinc + Saccharomyces boulardii (Probiotic 5 billion CFU twice daily) and Group 2 comprised of children on ORT+ Zinc. Our objective was to systematically review data on the effect of S. boulardii on acute childhood diarrhoea.Results: Out of a total of 126 children less than 2 years, 2-6 years and 6-14 years were 72 (57.14%), 42(33.33%) and 12(09.52%) respectively. The duration of diarrhoea in Group 1 was 26.31 hours and Group 2 was 47.81 hours (p<0.01). The frequency of diarrhoea showed improvement within 24 and 72 hours in Group 1 and Group 2 respectively (p<0.01).Similarly, the mean duration of hospital stay was 2.68 days in Group 1 and 4.8 days in Group 2.The treatment cost was INR 850 and INR 1650 while social cost was INR 1250 and 2600 in Group 1 and 2 respectively.Conclusion:This study shows that S. boulardii reduced the duration, frequency and hospital stay of diarrhoea thereby reducing the treatment and social costs.J Nepal Paediatr Soc 2016;36(3):250-255

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Comparative analysis of physical development parameters of children with stages 1 to 3 of chronic kidney disease

Kazan medical journal ◽

10.17750/kmj2017-5 ◽

2017 ◽

Vol 98 (1) ◽

pp. 5-9

Author(s):

T L Nastausheva ◽

O A Zhdanova ◽

N S Nastausheva ◽

L I Stahurlova ◽

I V Grebennikova

Keyword(s):

Chronic Kidney Disease ◽

Comparative Analysis ◽

Kidney Disease ◽

Physical Development ◽

Average Height ◽

Time Period ◽

Ckd Stage ◽

Group 2 ◽

Stage 1 ◽

Group 1

Aim. To conduct comparative analysis of height, weight and body mass index in children with stages 1 to 3 of chronic kidney disease (CKD) caused by recurrent urinary tract infection due to congenital anomalies of kidney and urinary tract.Methods. The study was performed on 210 children: 110 patients examined in 2001-2002 (group 1) and 100 children examined in 2011-2012 (group 2). Stage 1 of CKD was observed in 94 (85.4%) children in group 1 and in 93 (93%) in group 2, stage 2 - in 16 (14.6%) and 7 (7%) patients, respectively. From both groups patients matched by sex, age, diagnosis and social status were selected: 20 patients with stage 1, 19 children with stage 2; in addition, 6 children with stage 3 were examined.Results. Nowadays children with CKD stage 1 are taller compared to patients of the beginning of the XXI century (Z-score: -0.14±1.43 and 0.20±0.98 respectively, p=0.01). Significant differences in weight were found in children with stage 1 in 2011-2012 compared to the patients in 2001-2002 (0.18±0.46 and 0.78±1.19 for groups 1 and 2, respectively, р=0.026). A tendency towards decrease of average height in children with stage 3 is observed compared to patients with stage 1, i.e. due to the progression of the disease.Conclusion. The data obtained reflect modern tendencies towards increase of children height and weight. No significant differences were found in physical development parameters of children with stages of chronic kidney disease 1 and 2 examined at the same time period but a tendency towards children’s height decrease from stages 1 to 3 of CKD of non-glomerular etiology was revealed.

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Application of Desmopressin and conjugated estrogens to reduce the volume of blood loss during arthroplsty of the hip joint in patients with end stage renal disease

The Scientific Notes of the I P Pavlov St Petersburg State Medical University ◽

10.24884/1607-4181-2019-26-3-57-63 ◽

2020 ◽

Vol 26 (3) ◽

pp. 57-63

Author(s):

N. E. Mushtin ◽

A. N. Tsed ◽

A. K. Dulaev ◽

A. A. Lednev ◽

K. G. Iljushenko ◽

...

Keyword(s):

Body Weight ◽

Renal Replacement Therapy ◽

Kidney Disease ◽

Blood Loss ◽

Replacement Therapy ◽

Hip Joint ◽

Conjugated Estrogens ◽

Significant Difference ◽

Group 2 ◽

Group 1

The objective was to determine the possibilities of using desmopressin and conjugated estrogens during primary hip joint arthroplasty in patients receiving renal replacement therapy.Methods and materials. The material for the study was data on 53 patients with pathology of the hip joint, who underwent primary arthroplasty from 2016 to 2018. All patients were divided into 2 groups. Group 1 (n=23) – patients not suffering from kidney diseases. Group 2 (n=30) – patients receiving renal replacement therapy. Each group was divided into 2 subgroups: 1 subgroup – comparisons, where the combination of desmopressin/conjugated estrogens was not used. 2 subgroup – control, where desmopressin was used at a dosage of 0.4 mg/kg 2 hours before the incision, conjugated estrogens was used at a dosage of 0.6 mg / kg of body weight within 5 days before the operation.Results. In group 1 (patients not suffering from kidney disease), there was no statistically significant difference between the subgroups. In group 2 (patients receiving hemodialysis), there was a statistically significant difference in the volume of blood loss. Thus, in the subgroup without using additional techniques, the volume of intraoperative blood loss was 769.5±389.3 ml; in the second subgroup (using desmopressin and estrogens) – 479.1±245.2 ml. The difference was statistically significant, p<0.05. The efficiency was 27.9 %.Conclusion. The additional use of conjugated estrogens at a dose of 0.6 mg/kg of body weight within 5 days before the operation, desmopressin at a dose of 0.4 mg/kg of body weight 2 hours before the incision reduced blood loss by 27.9 %. The use of combination of conjugated estrogens and desmopressin in patients not suffering from kidney disease did not affect the amount of blood loss.

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Revisiting conventional adenoidectomy using technology

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20202603 ◽

2020 ◽

Vol 6 (7) ◽

pp. 1232

Author(s):

Kiran Gangadhar S. ◽

Sonee Thingujam ◽

Jayita Poduval

Keyword(s):

Blood Loss ◽

Paediatric Population ◽

Lateral View ◽

Respiratory Pathogens ◽

Moderate Degree ◽

Ventilation Tubes ◽

The Mean ◽

Group 2 ◽

Mean Time ◽

Group 1

Background: Adenoidectomy is one of the most frequently applied surgical procedures in the paediatric population, either alone or in conjunction with tonsillectomy and/or insertion of ventilation tubes. The main purpose of the adenoidectomy is to eliminate the nasopharyngeal respiratory pathogens and to remove nasal airway obstruction. Aim of the study was to compare the outcomes of conventional and endoscopic assisted curettage adenoidectomy.Methods: In this comparative study, 50 patients were divided into 2 groups. Group 1 (25 patients) underwent endoscopic curettage adenoidectomy and group 2 (25 patients) underwent conventional curettage adenoidectomy. Intraoperative time, complications and postoperative pain were recorded. Results: 72% in group 1 and 64% in group 2 had grade 2 adenoid hypertrophy. 68% in group 1 and 64% in group 2 had a moderate degree of obstruction in lateral view of soft tissue X-ray nasopharynx. The mean time taken for surgery in group 1 was 13.29±3.28 minutes, and in group 2,6.28±2.31 minutes. Minimal loss of blood was recorded in group 1 with less than 20 ml, whereas in group 2, the blood loss was high; 30% of patients had blood loss more than 30 ml. In group 1, the mean VAS was 3.25 and 2.55 in group 2 2.55. In group 1, 4% of patients had primary haemorrhage and in group 2, 8% of patients had primary haemorrhage. No patient had velopharyngeal dysfunction in either group.Conclusions: More operative time but less blood loss were noted in endoscopic adenoidectomy. Intraoperative visualisation of the nasopharynx in endoscopic procedures showed no significant advantage over conventional adenoidectomy.

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