Differences in Outcome Between Open vs Laparoscopic Insertion of Ventriculoperitoneal Shunts

2021 ◽  
pp. 000313482110505
Author(s):  
Aaron B. Lopacinski ◽  
Kevin M. Guy ◽  
Jessica R. Burgess ◽  
Jay N. Collins
Keyword(s):  
Abdominal Surgery ◽  
General Surgery ◽  
Operation Time ◽  
Laparoscopic Group ◽  
Prior History ◽  
Team Approach ◽  
Tertiary Referral Hospital ◽  
Shunt Insertion ◽  
Vp Shunt ◽  
History Of

Background Abdominal access during ventriculoperitoneal (VP) shunt insertion has historically been obtained by neurosurgeons via an open abdominal approach. With recent advances in laparoscopy, neurosurgeons frequently consult general surgery for aid during the procedure. The goal of this study is to identify if laparoscopic assistance improves the overall outcomes of the procedure. Methods This retrospective study included all patients who underwent open or laparoscopic VP shunt placement between September 2012 and August 2020 at our tertiary referral hospital. Patient demographics, comorbidities, prior history of abdominal surgery, open vs. laparoscopic insertion, operation time, and complications within 30 days were obtained. Results Neurosurgery placed 107 shunts using an open abdominal technique and general surgery placed 78 using laparoscopy. The average OR time in minutes was 75.5 minutes for the open cohort and 61.8 for the laparoscopic cohort ( p = 0.006). In patients without a history of abdominal surgery, the average OR time in minutes was 79.4 in the open cohort and 57.1 in the laparoscopic cohort ( p = 0.015). The postoperative shunt infection rate was 10.2% in the open group and 3.8% in the laparoscopic group ( p = 0.077). Discussion Laparoscopic placement of VP shunts is a reasonable alternative to open placement and results in shorter OR times. There is also a trend toward few infections in the laparoscopic placement. There appears to be an advantage with a team approach and laparoscopic placement of the peritoneal portion of the shunt.

scholarly journals The Number of Myomas Is the Most Important Risk Factor for Blood Loss and Total Operation Time in Robotic Myomectomy: Analysis of 242 Cases

2021 ◽  
Vol 10 (13) ◽  
pp. 2930
Author(s):  
Sa Ra Lee ◽  
Ju Hee Kim ◽  
Sehee Kim ◽  
Sung Hoon Kim ◽  
Hee Dong Chae
Keyword(s):  
Blood Loss ◽  
Cesarean Section ◽  
Abdominal Surgery ◽  
Operation Time ◽  
Postoperative Fever ◽  
Factors Affecting ◽  
Maximal Diameter ◽  
Estimated Blood Loss ◽  
History Of ◽  
Robotic Myomectomy

To identify factors affecting blood loss and operation time (OT) during robotic myomectomy (RM), we reviewed a total of 448 patients who underwent RM at Seoul Asan Hospital between 1 January 2019, and 28 February 2021, at Seoul Asan Hospital. To avoid variations in surgical proficiency, only 242 patients managed by two surgeons who each performed >80 RM procedures during the study period were included in this study. All cases of RM were performed with a reduced port technique. We obtained the following data from each patient’s medical chart: age, gravidity, parity, body mass index, and history of previous abdominal surgery including cesarean section. We also collected information on the maximal diameter and type of myomas, number and weight of removed myomas, concomitant surgery, total OT from skin incision to closure, estimated blood loss (EBL), and blood transfusion. Data on preoperative use of gonadotropin-releasing hormone agonists (GnRHas) and perioperative use of hemostatic agents (tranexamic acid or vasopressin) were also collected. Data on the length of hospital stay, postoperative fever within 48 h, and any complications related to RM were also obtained. The primary endpoint in this study was the identification of factors affecting EBL and the secondary endpoint was the identification of factors affecting the total OT during multiport RM. Univariate and multivariate analyses were used to identify the factors affecting EBL and OT during multiport RM. The medians of the maximal diameter and weight of the removed myomas were 9.00 (interquartile range [IQR], 7.00 to 10.00) cm and 249.75 (IQR, 142.88 to 401.00) g, respectively. The median number of myomas was two (IQR, one to four), ranging from 1 to 34. Of the cases, 155 had low EBL and 87 had high EBL. Most myomas were of the intramural type (n = 179). The odds of EBL > 320 mL increased by 251% (odds ratio [OR], 2.51; 95% confidence interval [CI], 1.16–5.42) for five to nine myomas and by 647% (OR, 6.47; 95% CI, 1.87–22.33) for ≥10 myomas. The odds of subserosal-type myomas decreased by 67% compared with intramural-type myomas (OR, 0.33; 95% CI, 0.14–0.80). History of abdominal surgery other than cesarean section was positively correlated with EBL. The weight of the removed myomas and a history of previous cesarean section were not correlated with the EBL. Conclusion: The number of myomas (5–9 and ≥10), maximal myoma diameter, and history of abdominal surgery other than cesarean section affect the EBL in RM.

scholarly journals The 90th anniversary of professor Marx Izrailevich Gulman

2021 ◽  
Vol 6 ◽  
pp. 106-112
Author(s):  
Yu.S. Vinnik ◽  
◽  
L.V. Kochetova ◽  
N.M. Tyukhteva ◽  
O.V. Teplyakova ◽  
...  
Keyword(s):  
Abdominal Surgery ◽  
General Surgery ◽  
X Ray ◽  
Krasnoyarsk Region ◽  
History Of Development ◽  
90Th Anniversary ◽  
Scientific Papers ◽  
History Of ◽  
Scientific Practical ◽  
Medical University

The article casts light upon the creative path of an outstanding surgeon from Krasnoyarsk Region, a honorary professor of Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University dedicated to the 90th anniversary from the date of his birth (23 September 1931). Under M.I Gulman’s guidance in tandem with Yu.S. Vinnik, the scientific-practical school of surgeons of the Krasnoyarsk Region productively operating to the date was established, over 100 candidate theses and 23 doctoral theses have been defended. Marx Izrailevich Gulman was the founder of X-ray endovascular surgery in Krasnoyarsk and Krasnoyarsk Region. A total of 11 monographs, over 400 scientific papers on issues of abdominal surgery were written by the scientist, pedagogue and surgeon M.I. Gulman. The article presents the key information regarding his biography, milestones in the history of development of the Department of General Surgery within the period of 1980-2014. The most important scientific and practical achievements and awards are presented.

scholarly journals Post-operative functional neurological symptom disorder after anesthesia

2020 ◽  
Author(s):  
Ryan S D'Souza ◽  
Matthew NP Vogt ◽  
Edwin Rho
Keyword(s):  
Neurological Symptom ◽  
Past History ◽  
Significant Proportion ◽  
Case Series ◽  
Pharmacologic Therapy ◽  
Prior History ◽  
General Anesthetic ◽  
Tertiary Referral Hospital ◽  
History Of ◽  
Functional Neurological Symptom Disorder

A rare manifestation during the post-anesthetic period may include the occurrence of functional neurological symptom disorder (FNSD). FNSD is described as neurological symptoms that are not consistently explained by neurological or medical conditions. We report a case series consisting of six patients who underwent a general anesthetic at a tertiary referral hospital and experienced FNSD in the immediate post-anesthetic period. Life-threatening causes were excluded based on benign physical exam findings and knowledge of past history. Five of six cases manifested with FNSD only in the immediate post-operative setting after exposure to anesthesia, and never otherwise experienced these symptoms during their normal daily lives. MEDLINE and Google Scholar were searched through October 2019 using a highly-sensitive search strategy and identified 38 published cases of post-anesthetic FNSD. Meta-analysis of pooled clinical data revealed that a significant proportion of patients were females (86%), reported a history of psychiatric illness (49%), reported a prior history of FNSD (53%), and underwent general anesthesia as the primary anesthetic (93%). The majority of patients were exposed to diagnostic studies (66% received radiographic tests and 52% received electroencephalogram) as well as pharmacologic therapy (57%). While no deaths occurred, many patients had unanticipated admission to the hospital (53%) or to the intensive care unit (25%). These data may help inform the anesthesia literature on presentation, risk factors, and treatment outcomes of FNSD in the context of anesthetic administration. We contemplate whether anesthetic agents may predispose a vulnerable brain to manifest with involuntary motor and sensory control seen in FNSD.

scholarly journals Experience with Ventriculoatrial Shunt

2021 ◽  
Vol 24 (4) ◽  
pp. 376-380
Author(s):  
Muna Saleh Alnamlah ◽  
Muhammad Sohail Umerani ◽  
Amjad Abdel Qader Darwish ◽  
Muhammad Shamoon Umerani ◽  
Asad Abbas
Keyword(s):  
Arabian Gulf ◽  
Standard Of Care ◽  
Gulf Region ◽  
Shunt Insertion ◽  
Vp Shunt ◽  
First Choice ◽  
History Of ◽  
Csf Diversion ◽  
Peritoneal Infection ◽  
Shunt Obstruction

Cerebrospinal fluid (CSF) diversion through shunting, either internal or external, is the standard of care for hydrocephalic patients. Although Ventriculoperitoneal (VP) shunt is always the first choice, right atrium for Ventriculoatrial (VA) shunt is considered a suitable and convenient option for drainage of excess CSF in patients with history of abdominal surgeries, peritoneal infection or shunt obstruction.1 Here we are reporting our experience with a patient who underwent VA shunt insertion because of a previous malfunctioning VP shunt. A thorough review of the literature revealed that, although reported worldwide, there is an apparent deficiency of similar reports from Arabian Gulf region. Through this case report, we aim to shed light on this internal CSF diversion method, which could be considered in centers lacking advanced care facilities for procedures like Endoscopic 3rd Ventriculostomy (ETV).

scholarly journals Study on Assessment of Risk factors of Constipation among Patients Undergoing Abdominal Surgery

2021 ◽  
pp. 335-341
Author(s):  
Monali Walke ◽  
Sheetal Sakharkar
Keyword(s):  
Abdominal Surgery ◽  
Quantitative Research ◽  
Dietary Factors ◽  
Prior History ◽  
Research Approach ◽  
Functional Impairments ◽  
Cross Sectional ◽  
Minimum Risk ◽  
Rectal Pain ◽  
History Of

Objective: Aim of the study to assess the risk of constipation among patients undergoing abdominal surgery. Constipation is a gastrointestinal tract condition which can lead to abnormal stools, uncomfortable storage and passing with pain and stiffness. Constipation is one of the gastrointestinal system's functional impairments. Various symptoms also include bloating, pushing, abdominal and rectal pain, a feeling of fullness in the rectum or extreme defecation, a lack of full discharge, and stool infrequency (usually less than three times a week). Constipation problem is a condition that is prevalent in abdominal surgery patients in the preoperative and postoperative period due to physiological and psychological factors. While constipation does not endanger life. Bowel frequency is affected by many variables, including dietary factors, emotional state, immobility, prior history of bowel elimination problem, and psychological morbidity after abdominal surgery. Constipation is a common issue that many individuals face. Materials and Methods: The cross sectional research study conducted in AVBR hospital Sawangi Meghe, Wardha district with quantitative research approach. Sample size was 85. Sample was undergoing abdominal surgery patients. Tool was structured questionnaire including Patients characteristics & constipation risk assessment scale. Results: 48.24% of patients undergoing abdominal surgery had no risk of developing constipation, 29.41% had low risk of constipation, 14.12% had moderate and 8.23% of the patients undergoing abdominal surgery had severe risk of constipation. Minimum risk of constipation was 0 and maximum was 17. Mean risk of constipation was 5.14±5.71. Conclusion: This study can help to assess the risk of constipation among undergoing abdominal surgery patients and make them aware about risk of constipation.

scholarly journals Exuberant mesothelial proliferation mimicking malignant mesothelioma in a patient with prolonged VP shunt: A case report

2016 ◽  
Vol 4 (1) ◽  
pp. 4
Author(s):  
Mohamad Kanso ◽  
Cleo Massad ◽  
Nina Shabb ◽  
Bilal Anouti ◽  
Reem Akel ◽  
...  
Keyword(s):  
Malignant Mesothelioma ◽  
Cell Lymphoma ◽  
Final Diagnosis ◽  
Shunt Insertion ◽  
American University ◽  
Vp Shunt ◽  
American University Of Beirut ◽  
History Of ◽  
Nodular Lesions ◽  
Pathology Specimen

Background: Ventriculo-peritoneal shunt (VP shunt) surgery is the most widely used procedure in the treatment of hydrocephalus. Common complications post-VP shunt insertion are infection, mechanical failure, as well as functional complications such as overor underdrainage. Rarely, abdominal complications can present remotely after the time of VP shunt insertion. We found no reportsin the literature describing peritoneal exuberant mesothelial hyperplasia mimicking mesothelioma, clinically, radiologically, andpathologically in a setting of VP shunt.Case: A 22-year-old female with a history of T cell lymphoma in 2002, suffered from CNS recurrence and increased intracranialpressure (ICP) in 2004 necessitating a VP shunt insertion. In 2015, she presented with abdominal pain. CT scan of the abdomenshowed omental nodular lesions that were biopsied and read first by a private pathology center as atypical mesothelial proliferationfavoring malignant mesothelioma. However, after reviewing the full medical history and evaluating additional surgical materialfrom the patient, review of the pathology specimen at the American University of Beirut concluded that the final diagnosis isatypical mesothelial proliferation favoring exuberant mesothelial hyperplasia possibly as a reaction to the long-standing VPshunt.Conclusion: It is often difficult for the pathologist to differentiate a malignant from a reactive mesothelial hyperplasia especiallyon biopsies or limited material due to sampling issues. Many features of reactive mesothelial hyperplasia can mimic malignantmesothelioma. This complication took place in the setting of a VP shunt.

Cerebellar Infarction and Factors Associated with Delayed Presentation and Misdiagnosis

2016 ◽  
Vol 42 (5-6) ◽  
pp. 476-484 ◽  
Author(s):  
Zeljka Calic ◽  
Cecilia Cappelen-Smith ◽  
Craig S. Anderson ◽  
Wei Xuan ◽  
Dennis J. Cordato
Keyword(s):  
Acute Stroke ◽  
Prior History ◽  
Cerebellar Infarction ◽  
Delayed Presentation ◽  
Vascular Territory ◽  
Tertiary Referral Hospital ◽  
Early Presentation ◽  
Presenting Symptoms ◽  
Neurological Signs ◽  
History Of

Background and Purpose: The diagnosis of cerebellar infarction (CBI) is often challenging due to non-specific or subtle presenting symptoms and signs. We aimed to determine whether a common syndromic cluster of symptoms, signs or vascular risk factors were associated with delayed presentation or misdiagnosis to an Emergency Department (ED). The degree of misdiagnosis between ED and neurology physicians and the influence of delayed presentation or misdiagnosis on outcome were also investigated. Methods: A prospective study of CBI patients at a large tertiary-referral hospital with a comprehensive stroke service. Data are reported with OR and 95% CIs. Results: Of 115 consecutive CBI patients (mean age ± SD 66 ± 14 years, 51% male), infarction was isolated to the cerebellum in 46%; the remainder had additional vascular territory involvement (‘mixed CBI'). Most patients (n = 79, 69%) had a mild stroke (National Institute of Health Stroke Scale score ≤4), and tended to present late to ED (>4.5 h; p = 0.05). Dysarthria (OR 3.9, 95% CI 1.6-9.6, p = 0.003) and prior history of atrial fibrillation (AF; OR 3.0, 95% CI 1.02-9.1, p = 0.047) predicted early presentation (<4.5 h; in 52%). Neurological signs (as determined by neurology physicians) were more commonly absent in patients with isolated CBI (OR 4.0, 95% CI 1.2-13.3, p = 0.03) who were also less likely to receive acute stroke therapy (p = 0.03). ED physicians detected fewer neurological signs than neurology physicians (mean 1 vs. 2 signs, p < 0.001), and 34% of CBI patients were misdiagnosed, with peripheral vestibulopathy being the most common alternative diagnosis. Nausea and vomiting (OR 2.3, 95% CI 1.01-5.5, p = 0.046), absence of neurological signs as determined by ED physicians (OR 3.5, 95% CI 1.5-8.0, p = 0.003) and isolated CBI (OR 2.2, 95% CI 1.01-4.8, p = 0.047) correlated with misdiagnosis. Vascular territory involvement did not correlate with time to presentation or misdiagnosis. At 3 months, 65% of patients were functionally independent (modified Rankin Scale (mRS) score 0-2). History of hypertension (p = 0.008), AF (p = 0.012), mixed CBI (p = 0.004) and in-hospital stroke-related complications (p < 0.001) were associated with patients having a poor outcome (mRS ≥3). At 3 months, mortality was 16%, and AF was the only predictor of death (OR 3.2, 95% CI 1.1-8.9, p = 0.03). Late presentation to ED and misdiagnosis did not significantly influence 3-month functional outcome. Conclusions: Late ED presentation and misdiagnosis are common for CBI. Timely diagnosis of CBI may increase opportunity for acute stroke therapies and reduce risk of stroke-related complications.

Abdominal lump with intestinal obstruction: Prior history of abdominal surgery is a clue to diagnosis

2014 ◽  
Vol 13 (2) ◽  
pp. 95 ◽  
Author(s):  
Debajyoti Mohanty ◽  
PankajKumar Garg ◽  
Anjay Kumar ◽  
BhupendraKumar Jain
Keyword(s):  
Abdominal Surgery ◽  
Intestinal Obstruction ◽  
Prior History ◽  
History Of
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