Evaluation of Minimally Invasive Surgical Therapies for Ulcerative Colitis

2020 ◽  
Vol 86 (7) ◽  
pp. 782-786 ◽  
Author(s):  
Salini Hota ◽  
Salvatore Parascandola ◽  
Richard Amdur ◽  
Vincent Obias
Keyword(s):  
Ulcerative Colitis ◽  
Minimally Invasive ◽  
Postoperative Outcomes ◽  
Open Group ◽  
Open Approach ◽  
Cardiac Events ◽  
Improvement Program ◽  
Robotic Assisted ◽  
Confounding Variables ◽  
Significant Difference

Introduction Ulcerative colitis (UC) is a chronic inflammatory intestinal disorder that can be managed surgically with a proctocolectomy. Minimally invasive techniques such as laparoscopic or robotic-assisted surgery are available based on the surgeon’s preference and familiarity. To date, there is a paucity of literature evaluating the safety of these techniques in comparison to the open approach in patients with UC. Methods We surveyed the National Surgical Quality Improvement Program (NSQIP) database to select patients with the diagnosis of UC who underwent either robotic, laparoscopic, or open proctocolectomy between 2012 and 2017. A total of 2129 patients were included in the study. The 30-day postoperative outcomes were compared using multivariable logistic regression models after adjusting for confounding variables. The confounding variables were defined as any preoperative variable that was associated with the type of procedure. Results The 30-day postoperative outcomes reported in the NSQIP database were reviewed for each of the treatment groups (open, laparoscopic, and robotic). The anastomotic leak rate was significantly higher in the open group ( P = .022). The robotic and laparoscopic groups had significantly fewer occurrences of postoperative ileus ( P = .0006) and wound infections ( P < .0001). There were significantly more strokes, cardiac events, and pulmonary events in the open surgical group. Operative time was significantly shorter in the open group ( P < .0001). Reintervention rates were not significantly different among the groups. Conclusions Minimally invasive proctocolectomy has significantly fewer postoperative complications compared with open proctocolectomy for UC. There is no significant difference in the postoperative outcomes between robotic-assisted and laparoscopic proctocolectomy.

Surgical Complications Requiring Intervention in Open versus Minimally Invasive Radical Prostatectomy

2021 ◽  
pp. 1-5
Author(s):  
Lorine Haeuser ◽  
Stephen W. Reese ◽  
Marco Paciotti ◽  
Joachim Noldus ◽  
Ethan Y. Brovman ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Minimally Invasive ◽  
Surgical Approach ◽  
Large Bowel ◽  
Bowel Injury ◽  
Improvement Program ◽  
Significant Difference ◽  
American College Of Surgeons ◽  
Vascular Structures ◽  
Open Versus

<b><i>Introduction:</i></b> Injuries to surrounding structures during radical prostatectomy (RP) are rare but serious complications. However, it remains unknown if injuries to intestines, rectum, or vascular structures occur at different rates depending on the surgical approach. <b><i>Methods:</i></b> We compared the frequency of these outcomes in open RP (ORP) and minimally invasive RP (MIS-RP) using the national American College of Surgeons National Surgical Quality Improvement Program database (2012–2017). Along with important metrics of clinical and surgical outcomes, patients were identified as undergoing surgical repair of small or large bowel, vascular structures, or hernias based on Current Procedural Terminology codes. <b><i>Results:</i></b> In our propensity matched analysis, a total of 13,044 patients were captured. Bowel injury occurred more frequently in ORP than in MIS-RP (0.89 vs. 0.26%, <i>p</i> &#x3c; 0.01). By intestinal segment, rectal and large bowel injuries were more common in ORP than MIS-RP (0.41 vs. 0.11% and 0.31 vs. 0.05%, both <i>p</i> &#x3c; 0.01). However, there was no statistically significant difference between the groups for small bowel injury (0.17 vs. 0.11%, <i>p</i> = 0.39). Vascular injury was more common in MIS-RP (0.18 vs. 0.08%, <i>p</i> = 0.08). Hernias requiring repair were only identified in the MIS-RP group (0.12%). <b><i>Conclusion:</i></b> When considering surgical approach, rectal and large bowel injuries were more common in ORP, while vascular injuries and hernia repair were more common in MIS-RP. Our findings can be used in counseling patients and identifying risk factors and strategies to reduce these complications.

RA05.04: MANAGEMENT & OUTCOMES OF ANASTOMOTIC LEAKS FOLLOWING ESOPHAGECTOMY: A PROSPECTIVE 10-YEAR SINGLE-SITE EXPERIENCE

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 28-28
Author(s):  
Joel Lambert ◽  
Sanya Caratella ◽  
Eloise Lawrence ◽  
Bilal Alkhaffaf
Keyword(s):  
Minimally Invasive ◽  
Anastomotic Leak ◽  
Surgical Intervention ◽  
Type I ◽  
Oral Contrast ◽  
Open Approach ◽  
Type Ii ◽  
Anastomotic Leaks ◽  
Type Iii ◽  
Significant Difference

Abstract Background Anastomotic leak after esophagectomy is associated with high levels of morbidity and may impact negatively on oncological outcomes. The aim of this single centre study was to describe our experience in managing these complications Methods From 2007–2017 data was reviewed retrospectively from our prospectively maintained electronic database. All patients underwent either 2 or 3 phase esophagectomy for cancer of the oesophagus or esophago-gastric junction. All histological sub-types and stage of cancer were included in the analysis. Anastomotic leaks were classified according to the Esophagectomy Complications Consensus Group (ECCG) guidelines; type I—conservative management, type II—non-surgical intervention, type III—surgical intervention. Results 224 esophagectomies were included in our analysis (104 (46%) minimally invasive, 120 (54%) open approach). The incidence of all anastomotic leaks was 10% (23/224). Surgical approach did not influence the incidence of anastomotic leak (minimally invasive 10 (43%), open approach 13(57%), P = 0.76). Five patients (22%) had a type I leak, 9 patients (39%) type II and 9 (39%) had a type III leak. There was an increase in the number of leaks managed non-surgically over the last 5 years compared to those in the first five years of our dataset (2012–2017: 11/23 (48%) vs 2007–2012: 4/23 (17%) P = 0.08). The median time for leak diagnosis was 8 days. Most leaks were diagnosed with oral contrast CT 19 (83%). Median hospital stay after anastomotic leak was 58.5 days. Type III leaks were associated with an increased length of stay (median 84 days) compared to type I&II leaks (median (38.5 days) (P = 0.002 95% CI 18.19- 74.41). There was no significant difference in 30-day mortality between type I&II (0 patients) and type III leaks (1 patient) P = 0.260. Conclusion Low mortality rates with anastomotic leak can be achieved. In centres with experienced radiological and endoscopic skills, most anastomotic leaks can be managed non-surgically. Disclosure All authors have declared no conflicts of interest.

scholarly journals Short-term Outcomes of Elective 2-Stage Restorative Proctocolectomy for Ulcerative Colitis in Korea: Does Laparoscopy Have Benefits?

2020 ◽  
Vol 36 (1) ◽  
pp. 41-47 ◽  
Author(s):  
Jun Woo Bong ◽  
Yong Sik Yoon ◽  
Jong Lyul Lee ◽  
Chan Wook Kim ◽  
In Ja Park ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Postoperative Complications ◽  
Restorative Proctocolectomy ◽  
Complication Rate ◽  
Laparoscopic Approach ◽  
Laparoscopic Group ◽  
Bowel Function ◽  
Open Group ◽  
Open Approach ◽  
Short Term

Purpose: This study aimed to compare the short-term outcomes of the open and laparoscopic approaches to 2-stage restorative proctocolectomy (RPC) for Korean patients with ulcerative colitis (UC).Methods: We retrospectively analyzed the medical records of 73 patients with UC who underwent elective RPC between 2009 and 2016. Patient characteristics, operative details, and postoperative complications within 30 days were compared between the open and laparoscopic groups.Results: There were 26 cases (36%) in the laparoscopic group, which had a lower mean body mass index (P = 0.025), faster mean time to recovery of bowel function (P = 0.004), less intraoperative blood loss (P = 0.004), and less pain on the first and seventh postoperative days (P = 0.029 and P = 0.027, respectively) compared to open group. There were no deaths, and the overall complication rate was 43.8%. There was no between-group difference in the overall complication rate; however, postoperative ileus was more frequent in the open group (27.7% vs. 7.7%, P = 0.043). Current smoking (odds ratio [OR], 44.4; P = 0.003) and open surgery (OR, 5.4; P = 0.014) were the independent risk factors for postoperative complications after RPC.Conclusion: Laparoscopic RPC was associated with acceptable morbidity and faster recovery than the open approach. The laparoscopic approach is a feasible and safe option for surgical treatment for UC in selective cases.

scholarly journals Hypoalbuminaemia and Postoperative Outcomes in Inflammatory Bowel Disease: the NSQIP Surgical Cohort

2019 ◽  
Vol 13 (11) ◽  
pp. 1433-1438 ◽  
Author(s):  
Geoffrey C Nguyen ◽  
Lillian Du ◽  
Rachel Y Chong ◽  
Timothy D Jackson
Keyword(s):  
Ulcerative Colitis ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Postoperative Outcomes ◽  
Improvement Program ◽  
Septic Complications ◽  
Bowel Surgery ◽  
Inflammatory Bowel ◽  
The Impact ◽  
Normal Albumin

Abstract Background The inflammatory bowel diseases [IBD], including Crohn’s disease [CD] and ulcerative colitis [UC], frequently lead to bowel surgery. Hypoalbuminaemia has been shown to be a prognostic factor for outcomes following surgery for other indications, and we sought to determine its role in predicting IBD-related postoperative outcomes. Methods We included patients who underwent IBD-related major abdominal surgery in the American College of Surgeons’ National Surgical Quality Improvement Program [ACS-NSQIP] between 2005 and 2012. We assessed the impact of indicators of protein-energy malnutrition [PEM] including hypoalbuminaemia, weight loss, and body mass index on postoperative outcomes. Results We identified 10 913 IBD patients [6082 Crohn’s disease and 4831 ulcerative colitis] who underwent bowel surgery. The prevalence of modest and severe hypoalbuminaemia was 17% and 24%, respectively; 30-day mortality was higher in Crohn’s patients with modest and severe hypoalbuminaemia compared with those with normal albumin levels preoperatively [0.7% vs 0.2%, p <0.05; 2.4% vs 0.2%, p <0.01]. The same was true for patients with UC with modest and severe hypoalbuminaemia [0.9% vs 0.1%, p <0.01; 5.6% vs 0.1%, p <0.01]. Overall infectious complications were more common in the presence of severe hypoalbuminaemia for CD [20% vs 13%, p <0.01]. and UC [28% vs 15%, p <0.01] patients. Last, there were higher rates of extra-intestinal, non-septic complications in both CD and UC patients with hypoalbuminaemia compared with those with normal albumin levels. Conclusions This study suggests that moderate-severe hypoalbuminaemia is associated with worse IBD-related postoperative outcomes and may have a role in preoperative risk stratification.

scholarly journals Comparison of open and minimally invasive surgery for intradural-extramedullary spine tumors

2015 ◽  
Vol 39 (2) ◽  
pp. E11 ◽  
Author(s):  
Albert P. Wong ◽  
Rishi R. Lall ◽  
Nader S. Dahdaleh ◽  
Cort D. Lawton ◽  
Zachary A. Smith ◽  
...  
Keyword(s):  
Minimally Invasive Surgery ◽  
Blood Loss ◽  
Minimally Invasive ◽  
Operative Time ◽  
Open Group ◽  
Perioperative Outcomes ◽  
Open Approach ◽  
Open Resection ◽  
Spine Tumors ◽  
Intradural Extramedullary

OBJECT Patients with symptomatic intradural-extramedullary (ID-EM) tumors may be successfully treated with resection of the lesion and decompression of associated neural structures. Studies of patients undergoing open resection of these tumors have reported high rates of gross-total resection (GTR) with minimal long-term neurological deficit. Case reports and small case series have suggested that these patients may be successfully treated with minimally invasive surgery (MIS). These studies have been limited by small patient populations. Moreover, there are no studies directly comparing perioperative outcomes between patients treated with open resection and MIS. The objective of this study was to compare perioperative outcomes in patients with ID-EM tumors treated using open resection or MIS. METHODS A retrospective review was performed using data collected from 45 consecutive patients treated by open resection or MIS for ID-EM spine tumors. These patients were treated over a 9-year period between April 2003 and October 2012 at Northwestern University and the University of Chicago. Statistical analysis was performed to compare perioperative outcomes between the two groups. RESULTS Of the 45 patients in the study, 27 were treated with the MIS approach and 18 were treated with the open approach. Operative time was similar between the two groups: 256.3 minutes in the MIS group versus 241.1 minutes in the open group (p = 0.55). Estimated blood loss was significantly lower in the MIS group (133.7 ml) compared with the open group (558.8 ml) (p < 0.01). A GTR was achieved in 94.4% of the open cases and 92.6% of the MIS cases (p = 0.81). The mean hospital stay was significantly shorter in the MIS group (3.9 days) compared with the open group (6.1 days) (p < 0.01). There was no significant difference between the complication rates (p = 0.32) and reoperation rates (p = 0.33) between the two groups. Multivariate analysis demonstrated an increased rate of complications in cervical spine tumors (OR 15, p = 0.05). CONCLUSIONS Thoracolumbar ID-EM tumors may be safely and effectively treated with either the open approach or an MIS approach, with an equivalent rate of GTR, perioperative complication rate, and operative time. Patients treated with an MIS approach may benefit from a decrease in operative blood loss and shorter hospital stays.

Minimally invasive hepatectomy conversions: An analysis of outcomes.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 430-430
Author(s):  
Jack P Silva ◽  
Nicholas G Berger ◽  
Susan Tsai ◽  
Kathleen K. Christians ◽  
Callisia Clarke ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Minimally Invasive ◽  
Open Approach ◽  
Short Term ◽  
Improvement Program ◽  
Data Set ◽  
Surgical Quality ◽  
Minimally Invasive Hepatectomy ◽  
Open Hepatectomy ◽  
Lower Morbidity

430 Background: Surgical approach has been described as a factor influencing morbidity in patients undergoing hepatectomy. Minimally invasive surgery (MIS) converted to open has previously been included in an open hepatectomy cohort of the National Surgical Quality Improvement Program (NSQIP) dataset for analysis. This study sought to compare MIS conversion to open hepatectomy cases and analyze factors leading to conversion. Methods: The NSQIP data set was queried for patients undergoing hepatectomy for liver disease between January 1, 2014 and December 31, 2014. Cases were divided into three cohorts: completely MIS (laparoscopic or robotic), open, or planned MIS converted to open approach according to the dataset definitions. Demographic, clinical-pathologic, and perioperative variables were described and short-term postoperative outcomes were compared between groups. Results: A total of 2,884 patients were identified. Open approach was performed most commonly (80.96%, n = 2,335), followed by minimally invasive (15.05%, n = 434) and MIS converted to open (3.99%, n = 115). Patients undergoing conversion were more likely to have higher BMI, hypertension, and hepatocellular carcinoma. Conversion patients suffered from significantly higher morbidity (p < 0.001) compared to MIS, but had comparable outcomes to open procedures. Conclusions: MIS hepatectomy has been shown to have lower morbidity but similar mortality to open hepatectomy. Conversion procedures appear to have similar outcomes to open procedures, with greater morbidity compared to MIS. Differences in morbidity from previous studies may be partially attributed to the inclusion of conversions in the open hepatectomy cohort.

A comparison of mini-open and open approaches for resection of thoracolumbar intradural spinal tumors

2011 ◽  
Vol 14 (6) ◽  
pp. 758-764 ◽  
Author(s):  
Daniel C. Lu ◽  
Dean Chou ◽  
Praveen V. Mummaneni
Keyword(s):  
Blood Loss ◽  
Scale Score ◽  
Tumor Resection ◽  
Open Group ◽  
Spinal Tumors ◽  
Open Approach ◽  
Score Improvement ◽  
Intradural Tumor ◽  
Significant Difference ◽  
Mini Open

Object Standard approaches to thoracic intradural tumors often involve a large incision and significant tissue destruction. Minimally invasive techniques have been applied successfully for a variety of surgical decompression procedures but have been rarely used for the removal of intradural thoracolumbar tumors. In this paper, the authors compare the clinical outcome of mini-open resection of intradural thoracolumbar tumors with a standard open technique. Methods The authors retrospectively reviewed their series of 18 consecutive mini-open thoracolumbar, intradural, tumor resection cases and compared the outcomes with a profile-matched cohort of 9 cases of open intradural tumor resection. Operative statistics, functional outcome, and complications were compared. Results Tumors were removed successfully using both approaches, except for 1 case in the mini-open cohort in which only biopsy was performed for a diffusely infiltrating tumor (glioblastoma). There was no statistically significant difference in operative duration, American Spinal Injury Association scale score improvement, or back pain visual analog scale score improvement between groups. However, the mini-open group demonstrated a significantly lower estimated blood loss (153 vs 372 ml, respectively) and a significantly shorter length of hospitalization (4.9 vs 8.2 days, respectively). There was 1 complication of pseudomeningocele formation in the mini-open cohort and 1 complication of cerebral infarction in the open cohort. Mean follow-up length was 16 months in the mini-open group compared with 20 months in the open group. Conclusions The mini-open approach allows for adequate treatment of intradural thoracolumbar tumors with comparable outcomes to standard, open approaches. The mini-open approach is associated with less blood loss and a shorter length of stay compared with standard open surgery.

scholarly journals Supratentorial and Infratentorial Approaches to Pineal Surgery: A Database Analysis

2018 ◽  
Vol 80 (04) ◽  
pp. 364-370
Author(s):  
David M. Rosenberg ◽  
Brett W. Geever ◽  
Akash S. Patel ◽  
Anisse N. Chaker ◽  
Abhiraj D. Bhimani ◽  
...  
Keyword(s):  
Pineal Gland ◽  
Clinical Decision Making ◽  
Tumor Resection ◽  
Postoperative Outcomes ◽  
Complication Rates ◽  
Database Analysis ◽  
Improvement Program ◽  
Multicenter Studies ◽  
Patient Demographics ◽  
Significant Difference

Objectives Neoplasms involving the pineal gland are rare. When they do occur, tumor resection is anatomically challenging and is traditionally addressed by either a supratentorial or an infratentorial approach. To date, no large, multicenter studies have been performed that systematically analyze outcomes comparing these two approaches. This study aimed to evaluate outcomes for patients undergoing pineal neoplasm resection, comparing supratentorial and infratentorial approaches. Design Retrospective database review. Setting Multi-institutional database. Participants From 2005 to 2016, 60 patients were identified, with 13 undergoing a supratentorial approach and 47 undergoing an infratentorial approach. Main Outcome Measures Patient demographics, comorbidities, and 30-day postoperative outcomes were investigated using the American College of Surgeons National Surgical Quality Improvement Program database. Demographics, readmission, reoperation, and complication rates were analyzed and compared with previous studies. Results Patient demographics were similar between these two groups. The overall complication rates for the supratentorial and infratentorial approaches were 30.8 and 17%, respectively, and the difference was not statistically significant. The most common medical complications encountered were respiratory and hematological. Conclusion As the first multi-institutional database analysis of approaches to the pineal gland, this study provides an analysis of patient demographics, comorbidities, and postoperative complications. After controlling for preoperative risk factors and demographic characteristics, no statistically significant differences in postoperative outcomes were found between infratentorial and supratentorial approaches. The mean readmission, reoperation, and complication rates were found to be 2.1, 8.3, and 20%, respectively. The lack of significant difference between approaches suggests that clinical decision-making should depend upon anatomical considerations and physician preference, although the complications illustrated here may provide some preoperative guidance.

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