Cosmesis in Patients after Multiport Laparoscopic Colorectal Surgery: Does the Extraction Incision Matter?

The ideal incision for specimen extraction during laparoscopic colorectal surgery is controversial. The objective of this study was to compare incision types (Pfannenstiel, periumbilical, lower midline, and right upper quadrant transverse) with regard to postoperative scar appearance, symptoms, preference, and satisfaction. This study is a retrospective survey review performed in an urban teaching hospital. The study participants were patients undergoing multiport laparoscopic colorectal surgery. Two web-based questionnaires, the Patient Scar Assessment Questionnaire and Photo-Series Questionnaire, were used to assess study parameters. The main outcome measures were incision symptoms and cosmetic satisfaction. The 112 study patients included 54 patients with a Pfannenstiel incision (Group P) and 58 patients with an alternate incision (Group A). Of the 58 patients in Group A, 19 (33%) had a periumbilical incision, 10 (17%) a lower midline incision, and 29 (50%) a right upper quadrant transverse incision. Although Groups P and Awere comparable in all five subscales of the Patient Scar Assessment Questionnaire, more Group P participants (n = 12; 22%) said their incision felt “fairly numb” than Group A participants (n = 2; 3%) (P = 0.008). There was no significant difference between study groups in all Photo-Series Questionnaire domains; however, after comparing patients’ own incisions with photographs of various alternative incisions, 36 (62%) Group A patients would choose an alternative incision compared with only 11 (19%) Group P patients (P = 0.001). Selection bias, recall bias, external validity, and variability of scar lengths were the limitations of the study. It was concluded that although a Pfannenstiel incision seems to be the optimal cosmetic choice, it is associated with a higher incidence of wound numbness than alternate extraction incisions.

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The Role of Obesity in Predicting the Clinical Outcomes of COVID-19

Obesity Facts ◽

10.1159/000517180 ◽

2021 ◽

pp. 1-9

Author(s):

Serdar Sahin ◽

Havva Sezer ◽

Ebru Cicek ◽

Yeliz Yagız Ozogul ◽

Murat Yildirim ◽

...

Keyword(s):

Clinical Outcomes ◽

Health Care Providers ◽

Study Groups ◽

Normal Weight ◽

Overweight And Obesity ◽

Care Providers ◽

Significant Difference ◽

Group A ◽

Group B ◽

Group D

Introduction: The aim of this was to describe the predictors of mortality related to COVID-19 infection and to evaluate the association between overweight, obesity, and clinical outcomes of COVID-19. Methods: We included the patients >18 years of age, with at least one positive SARS-CoV-2 reverse transcriptase-polymerase chain reaction. Patients were grouped according to body mass index values as normal weight <25 kg/m2 (Group A), overweight from 25 to <30 kg/m2 (Group B), Class I obesity 30 to <35 kg/m2 (Group C), and ≥35 kg/m2 (Group D). Mortality, clinical outcomes, laboratory parameters, and comorbidities were compared among 4 groups. Results: There was no significant difference among study groups in terms of mortality. Noninvasive mechanical ventilation requirement was higher in group B and D than group A, while it was higher in Group D than Group C (Group B vs. Group A [p = 0.017], Group D vs. Group A [p = 0.001], and Group D vs. Group C [p = 0.016]). Lung involvement was less common in Group A, and presence of hypoxia was more common in Group D (Group B vs. Group A [p = 0.025], Group D vs. Group A [p < 0.001], Group D vs. Group B [p = 0.006], and Group D vs. Group C [p = 0.014]). The hospitalization rate was lower in Group A than in the other groups; in addition, patients in Group D have the highest rate of hospitalization (Group B vs. Group A [p < 0.001], Group C vs. Group A [p < 0.001], Group D vs. Group A [p < 0.001], Group D vs. Group B [p < 0.001], and Group D vs. Group C [p = 0.010]). Conclusion: COVID-19 patients with overweight and obesity presented with more severe clinical findings. Health-care providers should take into account that people living with overweight and obesity are at higher risk for COVID-19 and its complications.

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Different selective dry cow therapy concepts compared to blanket antibiotic dry cow treatment

Tierärztliche Praxis Ausgabe G Großtiere / Nutztiere ◽

10.15653/tpg-170208 ◽

2017 ◽

Vol 45 (06) ◽

pp. 343-349 ◽

Cited By ~ 1

Author(s):

Nicole Wente ◽

Jan-Hendrik Paduch ◽

Doris Klocke ◽

Elisabeth Mansion-de Vries ◽

Martina Hoedemaker ◽

...

Keyword(s):

Rapid Test ◽

Study Groups ◽

Test Methods ◽

Farm Animals ◽

Control Group ◽

Dry Period ◽

Udder Health ◽

Significant Difference ◽

Group A ◽

The Right

SummaryObjective: The aim of the study was to investigate the use of somatic cell count (SCC) and aerobic bacterial counts as possible tools to choose animals for selective dry cow treatment (DCT) on cow level. Blanket antibiotic DCT is an approved and common method in Germany aimed at increasing the cure rate of existing intramammary infections (IMI) at the time of drying off and decreasing the risk of new infections during the dry period. However, not all animals benefit equally from an antibiotic DCT. Moreover, dairies, consumers and politicians demand a reduction in the use of antibiotics in farm animals. Several criteria for identifying animals which would benefit from antibiotic DCT have been described in the literature. Material and methods: Animals chosen for this investigation were divided into three study groups: Aerobic Count Petrifilm® group A (153 cows), SCC group S (160 cows) and control group C (169 cows). All quarters were treated with an internal teat sealant (ITS) no matter which group the cows belonged to. Results: Group C, in which all cows received an antibiotic DCT, achieved the best results referred to udder health, particularly regarding bacteriological dry period cure. However, the results of the two study groups A and S, in which the animals were dried off selectively, were only marginally worse. A significant difference regarding bacterial dry period cure was revealed between group S and group C (p = 0.039), whereas no significant difference concerning new IMI risk could be detected between the three study groups. Compared to a blanket antibiotic DCT of all cows in the corresponding study group, a reduction of the usage of antibiotics of 23.5 % (A) and 55 % (S) was noticed, respectively. Furthermore, it could be shown that the lactation number as well as the microorganisms present at the time of drying off influence udder health. Conclusion: Selective DCT is an alternative method to the widespread blanket antibiotic DCT. However, it has to be mentioned that selective DCT involves the described marginal decline in udder health and the additional amount of time, which might arise from the procedure of choosing the right animals and performing the applied rapid test methods.

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COMPARISON OF ONDANSETRON AND METOCLOPRAMIDE IN PATIENTS UNDERGOING LAPAROSCOPIC CHOLECYSTECTOMY UNDER GENERAL ANESTHESIA.

The Professional Medical Journal ◽

10.29309/tpmj/2019.26.07.3825 ◽

2019 ◽

Vol 26 (07) ◽

pp. 1197-1202

Author(s):

Hajra Shuja ◽

Mehmood Ali Shah ◽

Sadaf Bokhari

Keyword(s):

Laparoscopic Cholecystectomy ◽

General Anesthesia ◽

Controlled Trial ◽

Study Groups ◽

P Value ◽

Significant Difference ◽

High Incidence ◽

Group A ◽

Group B ◽

Trial Setting

Background: Laparoscopic cholecystectomy is a standard treatment for cholelithiasis. It is a safe and effective treatment in many cases. General anesthesia has a high incidence for PONV. But anti-emetic drugs can help in preventing PONV. Objectives: To compare the efficacy of ondansetron and metoclopramide in patients undergoing laparoscopic cholecystectomy under general anesthesia. Study Design: Randomized controlled trial. Setting: Department of Anaesthesia, Sheikh Zayed Hospital, Lahore. Period: 6 months i.e. from 15-2-2017 to 15-8-2017. Material & Methods: The patients were divided into two groups. Ondansetron was given to group A patients within 15 minutes of induction, and metoclopramide to group B patients within 15 minutes of induction. Then patients were shifted to the ward after surgery and followed-up for 24 hours for assessment of PONV. All the data was entered and analyzed on SPSS version 20. Results: The mean age of patients in group A was 38.40±12.07 years and in group B was 42.63±11.77 years. The efficacy achieved in 53 were from group A and 39 were from group B Statistically significant difference was found between the study groups i.e. p-value=0.003. Conclusion: Ondansetron showed significantly better efficacy than metoclopramide in preventing PONV after laparoscopic cholecystectomy under general anesthesia.

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Clinical and Postoperative Outcomes of Cancer Surgeries during the COVID-19 Pandemic: A Comparative Study with its Pre-COVID Surgical Audit at Five Major Tertiary Care Hospitals’ Cancer Departments in India

Indian Journal of Medical and Paediatric Oncology ◽

10.1055/s-0041-1732858 ◽

2021 ◽

Vol 42 (04) ◽

pp. 311-318

Author(s):

Anil Heroor ◽

Rajnish Talwar ◽

Rama Joshi ◽

Sandeep Nayak ◽

B. Niranjan Naik ◽

...

Keyword(s):

Tertiary Care ◽

Study Groups ◽

Mortality Rates ◽

Complication Rates ◽

Cancer Management ◽

Time Period ◽

Significant Difference ◽

Duration Of Surgery ◽

Group A ◽

Group B

Abstract Introduction There has been an exponential rise in number of coronavirus disease 2019 (COVID-19)-positive infections since March 23, 2020. However, cancer management cannot take a backseat. Objective The aim of this study was to identify any difference in the complication and mortality rates for the cancer patients operated during the ongoing COVID-19 pandemic. Materials and Methods This was a retrospective study of a prospectively maintained database of five centers situated in different parts of India. Variables such as demographics, intraoperative, and postoperative complications were compared between COVID-19 (group A—March 23, 2020–May 22, 2020) and pre-COVID time period (group B—January 1 to January 31, 2020). Results One-hundred sixty-eight cancer surgeries were performed in group B as compared with 148 patients who underwent oncosurgeries in group A. Sixty-two percent lesser cancer surgeries were performed in the COVID-19 period as compared with the specific pre-COVID-19 period. There was no significant difference in age group, gender, comorbidities, and type of cancer surgeries. Except for the duration of surgery, all other intraoperative parameters like blood loss and intraoperative parameters were similar in both the groups. Minimally invasive procedures were significantly lesser in group A. Postoperative parameters including period of intensive care unit stay, rate of infection, need for the change of antibiotics, and culture growth were similar for both the groups. While minor complication like Clavien-Dindo classification type 2 was significantly higher for group A, all other complication rates were similar in the groups. Also, postoperatively no COVID-19-related symptoms were encountered in the study group. A subset analysis was done among the study groups between those tested preoperatively for COVID-19 versus those untested showed no difference in intraoperative and postoperative parameters. No health-care worker was infected from the patient during the time period of this study. Conclusion Our study shows that there is no significant difference in the incidence of postoperative morbidity and mortality rates in surgeries performed during COVID-19 pandemic as compared with non-COVID-19 time period.

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SP1.2.5Robot-assisted Colorectal Surgery: Short-term Outcome of First 70 cases at Different Time-intervals along the Learning Curve

British Journal of Surgery ◽

10.1093/bjs/znab361.016 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Sandeep Singh ◽

William Rea ◽

Shaun Nai ◽

Tamas Sollei ◽

Neil Kukreja ◽

...

Keyword(s):

Colorectal Surgery ◽

Learning Curve ◽

Operating Time ◽

Total Duration ◽

Time Intervals ◽

Term Outcome ◽

Female Ratio ◽

Significant Difference ◽

Group A ◽

Group B

Abstract Aim To analyse the evolution of robot-assisted colorectal surgery (RACS). Methods All the patients who underwent RACS between June 2018 and December 2020 were selected. Study period was divided into 3 intervals along the learning curve; group A represents the 1st 10 months, group B 2nd 10 and group C last 11. Results Over the 31-month study period, 70 RACS were performed. Male to female ratio was 4:3, with mean age of 66 years and BMI 28.7. ASA score was reported as 1-2 in 65% patients and 35% as 3. Indication was malignancy for 89% patients and the remainder benign pathology. High or low anterior resection performed were 72%, right hemicolectomies 21%, Hartmann’s 3%, abdominoperineal resections 3%, and left hemicolectomy 1%. RACS performed in group A was 20 compared to 19 in B and 31 C. Type of RACS performed, BMI, ASA, complications, anastomotic leaks, R0 resections and harvested lymph nodes were unrelated to selected time-intervals along learning curve. Mean total duration of procedure dropped down to 247 minutes in group C from 375 in group A (p = <0.001). No significant difference in mean length of stay and readmission rate was observed in 3 groups (p = 0.7, p = 0.59). Conclusion The study demonstrates that introduction of this new surgical technique is safe even in the early phase of adoption with no significant difference in pre-and post-operative morbidities. Significant difference in time taken for surgery was observed with reduction of 88 minutes in average operating time between the start and end of the study.

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Hallux Limitus and Its Relationship with the Internal Rotational Pattern of the Lower Limb

Journal of the American Podiatric Medical Association ◽

10.7547/1010467 ◽

2011 ◽

Vol 101 (6) ◽

pp. 467-474 ◽

Cited By ~ 4

Author(s):

Guillermo Lafuente ◽

Pedro V. Munuera ◽

Gabriel Dominguez ◽

Maria Reina ◽

Blanca Lafuente

Keyword(s):

Internal Rotation ◽

Lower Limb ◽

Study Groups ◽

Control Group ◽

Hallux Limitus ◽

Foot Progression Angle ◽

Diminished Capacity ◽

Significant Difference ◽

Study Participants ◽

The Relationship

Background: The aims of this study were to determine whether individuals with mild hallux limitus show a diminished capacity of internal rotation of the lower limb compared with those without hallux limitus and whether individuals with mild hallux limitus show an increased foot progression angle. Methods: In 80 study participants (35 with normal feet and 45 with mild hallux limitus), the capacity of internal rotation of the lower limb (internal rotational pattern), hallux dorsiflexion, and the foot progression angle were measured. The values for internal rotational pattern and foot progression angle were compared between the two study groups, and the correlations between these variables were studied. Results: The capacity of internal rotation of the lower limb was significantly lesser in patients with mild hallux limitus (P < .0001). There was no significant difference in foot progression angle between the two groups (P = .115). The Spearman correlation coefficient was 0.638 (P < .0001) for the relationship between internal rotational pattern and hallux dorsiflexion. Conclusions: Patients with mild hallux limitus had a lesser capacity of internal rotation of the lower extremity than did individuals in the control group. The more limited the internal rotational pattern of the lower limb, the more limited was hallux dorsiflexion. The foot progression angle was similar in both groups. (J Am Podiatr Med Assoc 101(6): 467–474, 2011)

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Endonasal Dacryocystorhinostomy done with and without Silicon Tube Stents: A Comparative Case Series Analysis Study

International Journal of Head and Neck Surgery ◽

10.5005/jp-journals-10001-1116 ◽

2012 ◽

Vol 3 (3) ◽

pp. 147-153 ◽

Cited By ~ 1

Author(s):

Sudhir Naik ◽

Sarika S Naik ◽

S Ravishankara ◽

Mohan K Appaji ◽

MK Goutham ◽

...

Keyword(s):

Case Series ◽

Study Groups ◽

Success Rates ◽

Analysis Study ◽

Series Analysis ◽

Significant Difference ◽

Silicon Tube ◽

Group A ◽

Group B ◽

Primary Healing

ABSTRACT Background/objectives Neo-ostium cicatrization and closure is considered a major factor for surgical failure in endoscopic dacryocystorhinostomy (EnDCR). Wide neo-ostium, mucosal flaps, sac marsupialization with primary healing and silicone tube stent improves surgical outcomes of EnDCR. Materials and methods EnDCR were done in 238 patients. Group A included 172 patients where no stents were used and group B included 66 patients where silicon tube stents were used. All the surgeries were done under general anesthesia. Results In our study, 89.53% success in syringing patency was seen in group A, 89.39% success in syringing patency was seen in group B at 6 months of follow-up. No significant difference in success rate were seen in the two study groups. Conclusion No significant difference in EnDCR success rates were seen with the use of stents in our study. So stenting probing and dilatation are not advocated routinely in all cases and a wide neo-ostium with mucosal flaps and primary healing is the secret to success. How to cite this article Naik SM, Mushannavar AS, Ravishankara S, Appaji MK, Goutham MK, Devi NP, Naik SS. Endonasal Dacryocystorhinostomy done with and without Silicon Tube Stents: A Comparative Case Series Analysis Study. Int J Head Neck Surg 2012;3(3):147-153.

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The single-incision laparoscopic surgery technique has questionable advantages in colorectal surgery

Innovative Surgical Sciences ◽

10.1515/iss-2017-0048 ◽

2018 ◽

Vol 3 (1) ◽

pp. 77-84

Author(s):

Bernd Schneider ◽

Anne Catharina Brockhaus ◽

Marcos Gelos ◽

Claudia Rudroff

Keyword(s):

Laparoscopic Surgery ◽

Colorectal Surgery ◽

Hospital Stay ◽

Single Incision ◽

Laparoscopic Colorectal Surgery ◽

Postoperative Hospital Stay ◽

Colorectal Disease ◽

Single Incision Laparoscopic Surgery ◽

Surgery Technique ◽

Significant Difference

AbstractBackground:Laparoscopic procedures have increasingly been accepted as standard in surgical treatment of benign and malignant entities, resulting in a continuous evolution of operative techniques. Since one of the aims in laparoscopic colorectal surgery is to reduce access trauma, one possible way is to further reduce the surgical site by the single-incision laparoscopic surgery technique (SLS). One of the main criticisms concerning the use of SLS is its questionable benefit combined with its technical demands for the surgeon. These questions were addressed by comparing SLS versus conventional laparoscopic multitrocar surgery (LMS) in benign and malignant conditions with respect to technical operative parameters and early postoperative outcome of the patients.Methods:Between 2010 and 2013, we performed SLS for colorectal disease. Of the 111 patients who underwent colorectal resection, 47 patients were operated by SLS and 31 using the LMS technique. The collected data for our patients were compared according to operating time, postoperative morbidity and mortality, pain score numeric rating scale on day 1 and day 5 postoperatively and postoperative hospital stay. To complement the pain scores, the required pain medication for adequate pain relief on these days was given.Results:There was no significant difference in age, BMI or sex ratio between the two groups. The intraoperative and early postoperative course was comparable as well. Postoperative hospital stay was the only parameter with a significant difference, showing an advantage for SLS.Conclusion:SLS is a feasible surgical method and a technical option in laparoscopic colorectal surgery. However, we were not able to identify substantial advantages of SLS that would favor this technique.

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Bilateral Use of Iliac Branch Devices for Aortoiliac Aneurysms Is Safe and Feasible, and Procedural Volume Does Not Seem to Affect Technical or Clinical Effectiveness: Early and Midterm Results From the pELVIS International Multicentric Registry

Journal of Endovascular Therapy ◽

10.1177/15266028211016439 ◽

2021 ◽

pp. 152660282110164

Author(s):

Mario D’Oria ◽

Georgios A. Pitoulias ◽

Giovanni F. Torsello ◽

Apostolos G. Pitoulias ◽

Stefano Fazzini ◽

...

Keyword(s):

Study Groups ◽

Primary Patency ◽

Type I ◽

Mortality And Morbidity ◽

Procedural Volume ◽

Significant Difference ◽

Group A ◽

Group B ◽

The Impact

Objective To evaluate early and follow-up outcomes following bilateral use of iliac branch devices (IBD) for aortoiliac endografting and assess the impact of center volume. We used data from the pELVIS international multicentric registry. Methods For the purpose of this study, only those patients receiving concomitant bilateral IBD implantation were analyzed. To assess the impact that procedural volume of bilateral IBD implantation could have on early and follow-up outcomes, participating institutions were classified as Site(s) A if they had performed >10 and/or >20% concomitant bilateral IBD procedure, otherwise they were classified as Site(s) B. Endpoints of the analysis included early (ie, 30-day) mortality and morbidity, as well as all-cause and aneurysm-related mortality during follow-up. Additional endpoints that were evaluated included IBD-related reinterventions, IBD occlusion or stenosis requiring reintervention (ie, loss of primary patency), and IBD-related type I endoleak. Results Overall, 96 patients received bilateral IBD implantation (out of 910 procedures collected in the whole pELVIS cohort), of whom 65 were treated at Site A (ie, Group A) and 31 were treated at Site(s) B (ie, Group B). In total, only 1 death occurred within 30 days from bilateral IBD implantation, and 9 patients experienced at least 1 major complication without any significant difference between subjects in Group A versus those in Group B (10.8% vs 6.5%, p=0.714). In the overall cohort, the 2-year freedom from IBD-related type I endoleaks and IBD primary patency were 96% and 92%, respectively; no significant differences were seen in those rates between Group A or Group B (95% vs 100%, p=0.335; 93% vs 88%, p=0.470). Freedom from any IBD-related reinterventions was 83% at 2 years, with similar rates between study groups (85% vs 83%, p=0.904). Conclusions Within the pELVIS registry, concomitant bilateral IBD implantation is a safe and feasible technique for management of aortoiliac aneurysms in patients with suitable anatomy. Despite increased technical complexity, effectiveness of the repair is satisfactory with low rates of IBD-related adverse events at mid-term follow-up. Procedural volume does not seem to affect technical or clinical outcomes after bilateral use of IBD, which remains a favorable treatment option in selected patients.

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Bite Force Assessment of Mandibular Interforaminal Fractures Treated with Combination of Microplate and Miniplate—A Randomized Control Study

Craniomaxillofacial Trauma & Reconstruction Open ◽

10.1055/s-0038-1646776 ◽

2018 ◽

Vol 2 (1) ◽

pp. s-0038-1646776 ◽

Cited By ~ 1

Author(s):

D. Anand ◽

Kavitha Prasad ◽

RM Lalitha ◽

K. Ranganath ◽

BR Rajnikanth ◽

...

Keyword(s):

Randomized Study ◽

Study Groups ◽

Bite Force ◽

Control Group ◽

Mandibular Fractures ◽

Clinical Parameters ◽

Hardware Failure ◽

Significant Difference ◽

Group A ◽

Group B

The purpose of this study was to compare the mechanical behavior of combination of microplate and miniplate with two standard miniplates for fixation of mandibular fractures in the interforaminal region on the basis of bite force and other clinical parameters. A prospective randomized study was conducted on 20 patients with mandibular fracture requiring open reduction and internal fixation (ORIF) who were randomly categorized into Group A and Group B with 10 patients in each group. Ten healthy persons whose age and gender matched with study groups were included in control Group C. Pre- and postoperative bite force was measured at specified intervals in both the study groups and was compared with the control group. The bite force values were comparatively less in Group A than Group B, although there was no statistically significant difference. Also, bite force values were less in both the study groups when compared with the control group. No statistically significant difference was found in other clinical parameters such as infection, fracture mobility, and hardware failure. The results were suggestive that the use of microplate and miniplate combination in management of minimally displaced mandibular fractures in the interforaminal region provides stable fixation comparable to two miniplate combination.

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