scholarly journals Analysis of safety and efficacy of laparoscopic distal pancreatectomy in the treatment of left pancreatic malignant tumors

2021 ◽  
Vol 49 (12) ◽  
pp. 030006052110630
Author(s):  
Tang Hao ◽  
Jiang Shiming ◽  
Chen Yong
Keyword(s):  
Distal Pancreatectomy ◽  
Enhanced Recovery ◽  
Malignant Tumors ◽  
Enhanced Recovery After Surgery ◽  
Operation Time ◽  
Patient Characteristics ◽  
Laparoscopic Distal Pancreatectomy ◽  
Pancreatic Tumors ◽  
Open Distal Pancreatectomy ◽  
Minimal Trauma

Objective Distal pancreatectomy is the most extensive operation to treat malignant tumors of the left pancreas; however, malignant pancreatic tumors are prone to early invasion and metastasis. Methods The clinical data of 80 patients undergoing surgical treatment for malignant tumors of the pancreatic body or tail from January 2013 to December 2017 were retrospectively analyzed. The main clinical variables were compared between patients undergoing laparoscopic distal pancreatectomy (LDP) vs. open distal pancreatectomy (ODP). Results There were no significant differences in general patient characteristics, complications, and postoperative survival (χ2 = 0.09) between the groups. The operation time in the LDP group was significantly longer than that in the ODP group; however, the LDP group was superior to the ODP group regarding the length of postoperative hospital stay, diet recovery, and rectal exhaust and ambulation times. Conclusion LDP is a safe and feasible treatment for left pancreatic malignancies, with the same surgical efficacy as ODP. LDP also has the advantages of minimally invasive surgery, such as minimal trauma and enhanced recovery after surgery.

Implementation of enhanced recovery programme for laparoscopic distal pancreatectomy: Feasibility, safety and cost analysis

Pancreatology ◽  
2015 ◽  
Vol 15 (2) ◽  
pp. 185-190 ◽  
Author(s):  
John Richardson ◽  
Francesco Di Fabio ◽  
Hannah Clarke ◽  
Mohammed Bajalan ◽  
Joe Davids ◽  
...  
Keyword(s):  
Cost Analysis ◽  
Distal Pancreatectomy ◽  
Enhanced Recovery ◽  
Laparoscopic Distal Pancreatectomy ◽  
Enhanced Recovery Programme

scholarly journals Enhanced recovery after surgery in pediatric spine surgery: systematic review

2021 ◽  
Vol 18 (4) ◽  
pp. 6-27
Author(s):  
Aleksandr Petrovich Saifullin ◽  
Andrei Evgenievich Bokov ◽  
Alexander Yakovlevich Aleynik ◽  
Yulia Alexandrovna Israelyan ◽  
Sergey Gennadevich Mlyavykh
Keyword(s):  
Systematic Review ◽  
Children And Adolescents ◽  
Spinal Surgery ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Operation Time ◽  
Early Mobilization ◽  
Cochrane Library ◽  
Control Group ◽  
Review Of The Literature

Objective. To conduct a systematic review of the literature on the use of enhanced recovery after surgery (ERAS) protocols in spinalsurgery of children and adolescents to determine the existing evidence of the effectiveness of ERAS implementation in clinical practice.Material and Methods. The authors conducted a systematic review of the literature on ERAS in spinal and spinal cord surgery in children and adolescents selected in the databases of medical literature and search resources of PUBMED/MEDLINE, Google Scholar, Cochrane Library and eLibrary according to the PRISMA guidelines and the PICOS inclusion and exclusion criteria.Results. A total of 12 publications containing information on the treatment of 2,145 children, whose average age was 14.0 years (from 7.2 to 16.1), were analyzed. In the reviewed publications, the average number of key elements of the ERAS program was 9 (from 2 to 20), and a total of 23 elements used in spinal surgery in children and adolescents were identified. The most commonly used elements were preoperative education and counseling, prevention of infectious complications and intestinal obstruction, multimodal analgesia, refusal of routine use of drains, nasogastric probes and urinary catheters, standardized anesthesia protocol, early mobilization and enteral loading. The introduction of the ERAS protocol into clinical practice allowed to reduce the complication rate in comparison with the control group by 8.2 %(from 2 to 19 %), the volume of blood loss by 230 ml (from 75 to 427 ml), the operation time by 83 minutes (from 23 to 144 minutes), theduration of hospitalization by 1.5 days (from 0.5 to 3 days) and the total cost of treatment by 2258.5 dollars (from 860 to 5280 dollars).The ERAS program was implemented in pediatric clinics in the USA (75 %), France (8 %) and Canada (17 %).Conclusion. The conducted systematic review of the literature allows us to conclude that the technology of enhanced recovery after surgery is a promising technology that improves surgical outcomes and is applicable in pediatric practice. There is a significant shortage of published studies evaluating the implementation of ERAS in pediatric surgical practice in general, and in spinal surgery in particular, which requires further prospective randomized studies to evaluate ERAS in spinal surgery in children and adolescents.

Opioid Requirements in Laparoscopic Colectomies: Do Enhanced Recovery After Surgery Protocols Make a Difference?

2020 ◽  
pp. 000313482095631
Author(s):  
Samer Kawak ◽  
Joanna F. Wasvary ◽  
Matthew A. Ziegler
Keyword(s):  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Tertiary Care ◽  
Patient Characteristics ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Care Hospital ◽  
Pain Scores ◽  
Enhanced Recovery Pathways ◽  
Recovery Pathways

Background With the growing opioid epidemic and recent focus on the quantity of opioids prescribed at discharge after surgery, enhanced recovery pathways provide another tool to counteract this epidemic. The aim of this current study is to analyze the differences in opioid requirements and pain scores in the immediate postoperative period for patients who underwent laparoscopic colectomies before and after the implementation of enhanced recovery after surgery (ERAS) protocols. Materials and Methods This study is a retrospective review of patients and was conducted at an academically affiliated tertiary care hospital. In patients undergoing elective laparoscopic colectomies before December 1, 2013-July 31, 2015 and after September 1, 2015-May 31, 2018, the implementation of enhanced recovery pathways was included. The primary end point was opioid consumption from the end of surgery until 48 hours after surgery. Secondary end points included pain scores, surgery length of time, and hospital length of stay after surgery. Results A total of 242 patients (122 pre- and 120 postimplementation) were analyzed. Patient characteristics were similar between groups. Pain scores were higher in the preimplementation patients for postoperative day (POD) 0 scores ( P = .019). There was a decrease in the morphine milligram equivalents (MME) on POD 0-2 for the postimplementation patients. This decrease resulted in a 61% reduction in opioid requirements after implementation of ERAS protocols (32 vs. 12.5 MME, P < .0001). Discussion Enhanced recovery after surgery protocols can reduce opioid requirements after elective laparoscopic colectomies without negatively affecting pain scores.

scholarly journals The Usefulness of a Preoperative Nomogram for Predicting the Probability of Conversion from Laparoscopic to Open Distal Pancreatectomy: A Single-Center Experience

2020 ◽  
Vol 45 (1) ◽  
pp. 252-260
Author(s):  
Riccardo Casadei ◽  
Claudio Ricci ◽  
Carlo Ingaldi ◽  
Laura Alberici ◽  
Maria Chiara Vaccaro ◽  
...  
Keyword(s):  
Distal Pancreatectomy ◽  
Conversion Rate ◽  
Risk Groups ◽  
Laparoscopic Distal Pancreatectomy ◽  
Predictive Tool ◽  
Single Center Experience ◽  
Open Distal Pancreatectomy ◽  
Minimum Score ◽  
Beta Coefficient ◽  
High Conversion Rate

Abstract Background Laparoscopic distal pancreatectomy (LDP) represents a challenging procedure with a high conversion rate. A nomogram is a simple statistical predictive tool which is superior to risk groups. The aim of this study was to develop and validate a preoperative nomogram for predicting the probability of conversion from laparoscopic to open distal pancreatectomy. Methods This is a retrospective study of 100 consecutive patients who underwent LDP. For each patient demographic, pre-intra- and postoperative data were collected. Univariate and multivariate analyses were carried out to identify the factors significantly influencing the conversion rate. The effect of each factor was weighted using the beta coefficient (β), and a nomogram was built. Finally, a logistic regression between the score and the conversion rate was carried out to calibrate the nomogram. Results The conversion rate was 19.0%. At multivariate analysis, female (β =  − 1.8 ± 0.9; P = 0.047) and tail location of the tumor (β =  − 2.1 ± 1.1; P = 0.050) were significantly related to a low probability of conversion. Body mass index (BMI) (β = 0.2 ± 0.1; P = 0.011) and subtotal pancreatectomy (β = 2.4 ± 0.9; P = 0.006) were factors independently related to a high probability of conversion. The nomogram constructed had a minimum value of 4 and a maximum value of 18 points. The probability of conversion increased significantly starting from a minimum score of 6 points (P = 0.029; conversion probability 14.4%; 95%CI, 1.5–27.3%) up to 16 (P = 0.048; 27.8%; 95%CI, 0.2–48.7%). Conclusion The nomogram proposed could serve as an effective preoperative tool capable of assessing the probability of conversion, allowing to take reliable decisions regarding indications and adequate stepwise training program of LDP.

Laparoscopic Distal Pancreatectomy for Pancreatic Tumors: Does Size Matter?

2016 ◽  
Vol 33 (4) ◽  
pp. 290-298 ◽  
Author(s):  
Laureano Fernández-Cruz ◽  
Ignasi Poves ◽  
Amalia Pelegrina ◽  
Fernando Burdío ◽  
Santiago Sánchez-Cabus ◽  
...  
Keyword(s):  
Distal Pancreatectomy ◽  
Laparoscopic Distal Pancreatectomy ◽  
Pancreatic Tumors ◽  
Size Matter

Laparoscopic Distal Pancreatectomy and Open Distal Pancreatectomy: A Nonrandomized Comparative Study

2008 ◽  
Vol 18 (4) ◽  
pp. 340-343 ◽  
Author(s):  
Toshifumi Matsumoto ◽  
Kohei Shibata ◽  
Masayuki Ohta ◽  
Kentaro Iwaki ◽  
Hiroki Uchida ◽  
...  
Keyword(s):  
Comparative Study ◽  
Distal Pancreatectomy ◽  
Laparoscopic Distal Pancreatectomy ◽  
Open Distal Pancreatectomy

Successful Implementation of Enhanced Recovery After Surgery in a Single-Surgeon Bariatric Practice

2021 ◽  
pp. 000313482110335
Author(s):  
Hung-Chieh Lo
Keyword(s):  
Gastric Bypass ◽  
Length Of Stay ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Operation Time ◽  
Successful Implementation ◽  
Low Volume ◽  
Eras Protocol ◽  
And Control

The feasibility and safety of unselectively applying an enhanced recovery after surgery (ERAS) protocol in a low-volume bariatric unit were determined. Retrospectively, review patients undergoing bariatric surgeries between 2015 and 2018 were included, and those receiving non-primary procedures or with BMI <32.5 kg/m2 were excluded. Demographics and 30-day outcomes were collected and compared between the ERAS (2017-2018) and control (2015-2016) groups. 62 (40.8%) were treated before and 90 (59.2%) were treated after ERAS. No differences in baseline demographics, except ERAS group had more Roux-en-Y gastric bypass procedures (58.9% vs. 12.9%). A markedly reduced operation time (101 min vs. 147 min) and shortened length of stay (2.6 days vs. 3.3 days) were observed with no increment of ER visits, readmissions (1.1% vs. 4.8%), or total complications between the groups (5.5% vs. 9.7%). Unselective ERAS implementation in low-volume units is feasible and safe, with significantly reduced operation times and shortened LOS without increased complications.

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