Open Cholecystostomy Under Local Anesthesia for Acute Cholecystitis in the Elderly and High-Risk Surgical Patients

2021 ◽  
pp. 000313482110505
Author(s):  
Eliza M. Slama ◽  
Motahar Hosseini ◽  
Ryan M. Staszak ◽  
Viney R. Setya
Keyword(s):  
Acute Cholecystitis ◽  
Local Anesthesia ◽  
Intraoperative Complications ◽  
Case Series ◽  
The Elderly ◽  
Tube Placement ◽  
Biliary Leakage ◽  
Alternative Treatment Strategy ◽  
Tube Removal ◽  
Cholecystostomy Tube

Background The morbidity and mortality rates associated with cholecystectomy for acute cholecystitis are higher in the critically ill elderly population. As an alternative to cholecystectomy, we report the results of treatment of acute cholecystitis in the elderly after open cholecystolithotomy with cholecystostomy tube placement under local anesthesia. Methods A case series was performed on 5 patients from August 2007 to April 2010 who presented with acute cholecystitis and underwent an open cholecystolithotomy and tube placement. Thirty-day mortality, intra- and immediate-postoperative complications, clinical improvement after drainage, additional biliary procedures needed, and outcome after cholecystostomy tube removal were recorded. Results Open cholecystolithotomy and tube placement were performed successfully in all patients and permitted resolution of the acute attack in all after a mean period of 3.75 days. Thirty-day mortality was 0%. Patients did not experience any intraoperative complications. We observed 100% rate of successful short-term outcomes in our patients including resolution pain, and objectively, normalization of leukocytosis, and defervescence. None of the patients required emergency cholecystectomy. All patients had their cholecystostomy tubes removed at a mean postoperative day 27. There were no cases of biliary leakage or tube dislodgement. There were no recurrences of acute cholecystitis within the mean follow-up of 20.75 months. Discussion Emergency open cholecystolithotomy and cholecystostomy tube placement represent an effective, safe, and definitive alternative treatment strategy for acute gallstone cholecystitis in selected elderly patients with a mortality rate of 0% in the authors’ experience.

scholarly journals Intraoperative Complications of Cataract Surgery Using Intracameral Illumination in the Elderly over 75 Years

2019 ◽  
Vol 2019 ◽  
pp. 1-5
Author(s):  
Yu Jeong Kim ◽  
Su Jin Park ◽  
Jong Yeon Lee ◽  
Dae Yeong Lee ◽  
Dong Heun Nam
Keyword(s):  
Cataract Surgery ◽  
Intraoperative Complications ◽  
Case Series ◽  
The Elderly ◽  
Posterior Capsule ◽  
Anterior Capsule ◽  
Intraoperative Complication ◽  
Surgery Group ◽  
Posterior Capsule Rupture ◽  
Capsule Rupture

Purpose. To evaluate intraoperative complications and utilization of adjunctive devices between microscope and intracameral illuminations during cataract surgery in the elderly over 75 years. Design. A retrospective, consecutive, interventional case series Participants. Two hundred eighty-six eyes of 184 patients older than 75 years who underwent cataract surgery using microscope and intracameral illuminations. Methods. A chart review was performed on an advanced cataract surgery group of 141 consecutive cases in which the intracameral illumination was used and on a standard cataract surgery group of 145 consecutive cases in which the intracameral illumination was not used. Main Outcome Measures. Intraoperative complications (posterior capsule rupture, radial tear of the anterior capsule, dropped nucleus, or sulcus-implanted/sclera-fixated IOL) and utilization of adjunctive devices (pupil expansion device or anterior capsule staining). Results. The frequency of use of the pupil expansion device was lower in the advanced cataract surgery group than that in the standard cataract surgery group (0.7% vs 6.9%; p=0.007). Furthermore, the rates of a posterior capsule rupture and at least one intraoperative complication were lower in the advanced cataract surgery group than those in the standard cataract surgery group (0.7% vs 4.8%; p=0.067) (0.7% vs 7.6%; p=0.004). Conclusions. In the current cohort of patients over 75 years, the rate of intraoperative complications was lower when using the intracameral illumination than that when using the conventional method. Cataract surgery using intracameral illumination would be good option for elderly people.

Cholecystostomy Tube Placement in Gallstone-Related Acute Cholecystitis: Implications From a National Survey

2017 ◽  
Vol 112 ◽  
pp. S20
Author(s):  
Ravi Babu Pavurala ◽  
Rohan M. Modi ◽  
Vimal K. Narula ◽  
Kyle Porter ◽  
Darwin L. Conwell ◽  
...  
Keyword(s):  
Acute Cholecystitis ◽  
National Survey ◽  
Tube Placement ◽  
Cholecystostomy Tube

scholarly journals Evaluation of Short-term Outcomes of Tracheostomy Procedures in a NICU Population With High Ventilator Settings

2021 ◽  
pp. 019459982199622
Author(s):  
Laura Banks ◽  
Noah Worobetz ◽  
Erin Hamersley ◽  
Amanda Onwuka ◽  
Edward Shepherd ◽  
...  
Keyword(s):  
Tracheostomy Tube ◽  
Neonatal Intensive Care ◽  
Pressure Support ◽  
Chart Review ◽  
Intraoperative Complications ◽  
Case Series ◽  
Peak Inspiratory Pressure ◽  
Tube Placement ◽  
Short Term ◽  
Ventilator Settings

Objective To investigate whether tracheostomy placement in infants requiring high ventilator pressure is safe and effective. Study Design Case series with chart review. Setting Tertiary children’s hospital. Methods Fifty ventilator-dependent neonatal intensive care unit patients who underwent tracheotomy from 2009 to 2018 were included. Patients requiring high ventilator pressures were compared to those requiring low ventilator pressures. Demographics, comorbidities, and surgical and clinical data were recorded. Results Thirty-two percent (n = 16) had low ventilator settings at the time of tracheostomy tube placement, and 68% (n = 34) had high ventilator settings. The median peak inspiratory pressure of the high ventilator group was 29.5 cm H2O, positive end-expiratory pressure (PEEP) was 8 cm H2O, mean airway pressure was 13 cm H2O, pressure support (PS) was 14 cm H2O, PS above PEEP was 6 cm H2O, and inspiratory time was 0.65 seconds. The high ventilator cohort had a higher median age at the time of surgery compared to the low ventilator group ( P = .02). Female patients were more likely to have high ventilator settings ( P = .02). There were no intraoperative complications or deaths within the first 7 days of tracheostomy tube placement. Pneumonia incidence and rate of mortality during admission did not vary by ventilator settings ( P = .92 and P = .94, respectively). Conclusion Few differences in tracheostomy tube placement outcomes were observed for patients with high ventilator settings compared to low ventilator settings. These data demonstrate that patients requiring high ventilator pressures can benefit from tracheostomy tube placement with no additional short-term risks.

scholarly journals Fluoroscopically Guided Subacromial Spacer Implantation for Massive Rotator Cuff Tears: Two Years of Prospective Follow-up

2021 ◽  
Vol 9 (4) ◽  
pp. 232596712199346
Author(s):  
Enrico Gervasi ◽  
Eran Maman ◽  
Assaf Dekel ◽  
Elana Markovitz ◽  
Enrico Cautero
Keyword(s):  
Rotator Cuff ◽  
Local Anesthesia ◽  
Case Series ◽  
The Elderly ◽  
Shoulder Function ◽  
Rotator Cuff Tears ◽  
Level Of Evidence ◽  
Safety And Efficacy ◽  
Massive Rotator Cuff Tears

Background: Massive rotator cuff tears (MRCTs) are common and have been estimated to account for nearly 40% of all rotator cuff tears. An evolving strategy for management of MRCTs has been the implantation of a degradable subacromial spacer balloon that attempts to restore normal shoulder biomechanics. Purpose: To assess the safety and efficacy of fluoroscopically guided balloon spacer implantation under local anesthesia in a cohort of patients with 2 years of postoperative follow-up. Study Design: Case series; Level of evidence, 4. Methods: The safety and efficacy of using fluoroscopically guided subacromial spacer implantation was assessed in 46 patients. Follow-up visits were scheduled according to routine clinical practice. Shoulder function was evaluated using Constant and American Shoulder and Elbow Society (ASES) scores. Results: Overall, 87.5% (35/40) of patients saw clinically significant improvement in the total Constant and ASES scores from 6 weeks postoperatively, with improvement maintained up to 24 months postoperatively. Conclusion: The data suggest that fluoroscopically guided subacromial spacer implantation under local anesthesia is a low-risk, clinically effective option, especially for the elderly population and those patients who have multiple comorbidities or a contraindication to general anesthesia. Patients undergoing subacromial spacer implantation for the treatment of MRCTs had satisfactory outcomes at 2-year follow-up, with a low rate of complications.

scholarly journals Laparoscopic cholecystostomy tube placement

2020 ◽  
Vol 10 (3) ◽  
pp. 70-72
Author(s):  
 Abhiman Cheeyandira
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Acute Cholecystitis ◽  
Open Surgery ◽  
Tube Placement ◽  
Safe Alternative ◽  
Excessive Bleeding ◽  
Conversion To Open Surgery ◽  
The World ◽  
Cholecystostomy Tube ◽  
Laparoscopic Cholecystostomy

Laparoscopic cholecystectomy is one of the most common procedures performed in the world today Acute calculus cholecystitis is the most frequent complication of cholelithiasis. Laparoscopic cholecystectomy is the best treatment for acute calculus cholecystitis when performed within 72 hours. Acute cholecystitis tends to be one of the highest risks for conversion to open surgery-due to unclear anatomy, excessive bleeding or technical complications. Here we present 2 cases with severe acute cholecystitis that required placement of laparoscopic cholecystostomy (LC) tube. Patient subsequently underwent interval cholecystectomy, when the inflammation had subsided. LC tube placement can be a safe alternative in such situations to avoid complications and conversion to open procedure.

Percutaneous Sacroplasty for Sacral Insufficiency Fractures: Case Series and Review of Presentation, Diagnosis, and Treatment

2019 ◽  
Vol 3 ◽  
pp. 4
Author(s):  
Andrew C. Clark ◽  
Devang Butani
Keyword(s):  
Low Back Pain ◽  
Elderly Population ◽  
Case Series ◽  
The Elderly ◽  
Treatment Method ◽  
Open Reduction Internal Fixation ◽  
Low Back ◽  
Insufficiency Fractures ◽  
Invasive Treatment ◽  
Sacral Insufficiency Fractures

Sacral insufficiency fractures (SIFs) are a cause of debilitating low back pain that is often difficult to diagnosis and manage. The diagnosis of SIF is often delayed due to inaccurately attributing symptoms to spondylosis, which is a commonly present in the elderly population where SIFs are most prevalent. Historically, treatment consisted of medical management and open reduction internal fixation reserved for severe cases. However, percutaneous sacroplasty has emerged as a minimally invasive treatment option which provides early pain relief without significant complications. The objective of this article is to raise awareness of SIFs and percutaneous sacroplasty as an effective and safe treatment method.

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