Functional, morphological and operative outcome after pyeloplasty in adult patients: Laparoscopic versus open

2021 ◽  
pp. 039156032098792
Author(s):  
Erkan Merder ◽  
Ahmet Arıman ◽  
Kenan Sabuncu ◽  
Fatih Altunrende
Keyword(s):  
Renal Function ◽  
Blood Loss ◽  
Hospital Stay ◽  
Operative Time ◽  
Operation Time ◽  
Adult Patients ◽  
Success Rates ◽  
Analgesic Requirement ◽  
Operative Outcome ◽  
Open Pyeloplasty

Objective: The aim of this study is determine and compare improvement of hydronephrosis, renal function, and operative outcome between laparoscopıc and open pyeloplasty in adults. Material and methods: Sixty-five adult patients with primary ureteropelvic junction obstruction (UPJO) underwent pyeloplasty between January 2014 and September 2020. Thirty-four patients had laparoscopıc pyeloplasty (LP), 31 patients had open pyeloplasty (OP). In this retrospective study demographics, differential renal function (DRF), hydronephrosis, anteroposterior diameter of pelvis renalis (APD) and operative outcomes: operation time, blood loss, complications, hospital stay, etiology, analgesic requirement, complications, and success rates were compared between two groups. Results: Improvement of APD is higher in OP group ( p: 0.001). Improvement of DRF ( p: 0.713) and hydronephrosis ( p = 1.000), success ( p: 0.407) and complication rate ( p: 0.661) are comparable between two groups. Median hospital stay, postoperative analgesia requirement and blood loss was less in LP group, mean operative time was shorter in OP group ( p: 0.001). Conclusion: Pain complaints are greatly reduced after pyeloplasty in adult patients but the drainage of kidney, DRF and hydronephrosis does not improve as much as desired. Improvement of APD is better and median operative time is less in OP, intraoperative blood loss, hospital stay, and analgesic requirement is less in LP group in our study.

scholarly journals Outcome of Laparoscopic Versus Open Pyeloplasty in the Treatment of Pelviureteric Junction Obstruction: A Comparative Study

2020 ◽  
Vol 22 (2) ◽  
pp. 182-187
Author(s):  
Md Rokonuzzaman Khan ◽  
Md Fazal Naser ◽  
Md Mizanur Rahman ◽  
Mehbuba Yasmin ◽  
Md Mostafizur Rahman ◽  
...  
Keyword(s):  
Renal Function ◽  
Hospital Stay ◽  
Operative Time ◽  
Standard Of Care ◽  
Open Group ◽  
Success Rates ◽  
Laparoscopic Pyeloplasty ◽  
Analgesic Requirement ◽  
Pelviureteric Junction Obstruction ◽  
Open Pyeloplasty

Background: Ureteropelvic junction obstruction leads to progressive dilatation of the renal collecting system, and can result in pain and progressive deterioration of renal function but may be asymptomatic and result in complication such as pyelonephritis,calculus formation and deterioration of renal function may ensue if left untreated.Open pyeloplasty remains the gold standard against which new technique must be compared.we compared laparoscopic and open pyeloplasty in the treatment of pelviureteric junction obstruction. To see the outcome of laparoscopic pyeloplasty versus open A-H pyeloplasty in the management of pelviureteric junction obstruction. Methods and materials: A prospective quasi experimental study was done from july 2012 to December 2013 in which a total of 30 laparoscopic and 30 open pyeloplasty were done. All laparoscopic pyeloplasties were performed transperitoneally.Standard open A H pyeloplasty,spiral flap or VY plasty was done depending on anatomical consideration. Patients were followed with USG and IVU at three and six months interval.Perioperative parameters including operative time,analgesic use,hospital stay,and complication and success rates were compared. Results: Mean total operative time in LP group was 115±15 min compared to 75 ±15 in OP group, the postoperative analgesic requirement was sighnificantly less in LP group(mean 84.73±11mg) and OP group required mean of( 274.33±39.42mg).The mean blood loss in LP group was 118.26±110.74ml compared to open group 274.82±118.97ml.The postoperative hospital stay in LP was mean 4 days(2-7days) sighnificantly less than the open group mean of 8 days(7-9days). Conclusion: Lp has a minimal level of morbidity and short hospital stay compered to open approach.Although laparoscopic pyeloplasty has the disadvantages of longer operetive time and requires sighnificant skill of intracorporal knotting but it is here to stay and represents an emerging standard of care. Bangladesh Journal of Urology, Vol. 22, No. 2, July 2019 p.182-187

The Self-Retaining Barbed Suture for Parenchymal Repair in Laparoscopic Partial Nephrectomy: A Systematic Review and Meta-Analysis

2019 ◽  
Vol 26 (6) ◽  
pp. 744-752
Author(s):  
Hailun Zhan ◽  
Chunping Huang ◽  
Tengcheng Li ◽  
Fei Yang ◽  
Jiarong Cai ◽  
...  
Keyword(s):  
Renal Function ◽  
Blood Loss ◽  
Hospital Stay ◽  
Partial Nephrectomy ◽  
Operative Time ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
The Self ◽  
Barbed Suture ◽  
Estimated Blood Loss

Objectives. The warm ischemia time (WIT) is key to successful laparoscopic partial nephrectomy (LPN). The aim of this study was to perform a meta-analysis comparing the self-retaining barbed suture (SRBS) with a non-SRBS for parenchymal repair during LPN. Methods. A systematic search of PubMed, Scopus, and the Cochrane Library was performed up to March 2018. Inclusion criteria for this study were randomized controlled trials (RCTs) and observational comparative studies assessing the SRBS and non-SRBS for parenchymal repair during LPN. Outcomes of interest included WIT, complications, overall operative time, estimated blood loss, length of hospital stay, and change of renal function. Results. One RCT and 7 retrospective studies were identified, which included a total of 461 cases. Compared with the non-SRBS, use of the SRBS for parenchymal repair during LPN was associated with shorter WIT ( P < .00001), shorter overall operative time ( P < .00001), lower estimated blood loss ( P = .02), and better renal function preservation ( P = .001). There was no significant difference between the SRBS and non-SRBS with regard to complications ( P = .08) and length of hospital stay ( P = .25). Conclusions. The SRBS for parenchymal repair during LPN can significantly shorten the WIT and overall operative time, decrease blood loss, and preserve renal function.

scholarly journals CHOLECYSTECTOMY;

2014 ◽  
Vol 21 (01) ◽  
pp. 005-009
Author(s):  
Iram Hassan ◽  
Muhammad Sohaib Khan ◽  
Naveed Akhtar Malik ◽  
Jahangir Sarwar Khan ◽  
Saadia Zaman ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Postoperative Pain ◽  
Blood Loss ◽  
Hospital Stay ◽  
Operative Time ◽  
Operation Time ◽  
Randomised Control Trial ◽  
Surgical Department ◽  
Class A ◽  
Pugh Class

Objective: To compare the operative time, blood loss, postoperative pain andlength of hospitalization between open (OC) and laparoscopic cholecystectomy (LC) in Livercirrhotic patients with Child –Pugh class A & B. Study Design: Randomised Control Trial (RCT).Setting and Duration: This study was conducted at Surgical department, Holy Family Hospital,Rawalpindi from Jan 2010 to Dec 2011. Subjects and Methods: A total of 142 patients havingLiver cirrhosis secondary to Hepatitis A & Hepatitis B, who presented in OPD and ER with signsand symptoms of gall stones were randomly allocated into two groups for open (OC) andlaproscopic cholecystectomy (LC). All of them were either in Child–Pugh class A or B. Data on theabove two groups( LC &OC) was collected and analyzed for operative time, blood loss andlength of hospitalization after operation. Results: The mean blood loss in LC group was61.33+39.64 ml vs 90.84+29.88 ml in OC group, Mean operation time was 50.49+18.26 min inLC group vs 59.22+15.66 in OC group which is statistically significant (p<.05). In LC group, themean hospital stay was 1.8+.97 days, while in OC group is 2.4+.91 days which is alsostatistically significant. Conclusions: LC (laparoscopic cholecystectomy) is a safe and effectiveapproach for the treatment of symptomatic cholelithiasis in patients with mild cirrhosis with lessblood loss, less postoperative pain, shorter operative time and decreased hospital stay.

scholarly journals Nonstructural bone graft for single-segment lumbar tuberculosis: surgical indications, clinical efficacy, and preliminary experiences in 34 patients

2021 ◽  
Vol 49 (1) ◽  
pp. 030006052098278
Author(s):  
Xing Du ◽  
Yunsheng Ou ◽  
Guanyin Jiang ◽  
Yong Zhu ◽  
Wei Luo ◽  
...  
Keyword(s):  
Blood Loss ◽  
Hospital Stay ◽  
Bone Graft ◽  
Cobb Angle ◽  
Clinical Efficacy ◽  
Operative Time ◽  
Bone Grafts ◽  
Surgical Indications ◽  
Operative Blood Loss ◽  
The Mean

Objective This study was performed to evaluate the surgical indications, clinical efficacy, and preliminary experiences of nonstructural bone grafts for lumbar tuberculosis (TB). Methods Thirty-four patients with lumbar TB who were treated with nonstructural bone grafts were retrospectively assessed. The operative time, operative blood loss, hospital stay, bone graft fusion time, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) concentration, visual analog scale (VAS) score, Oswestry Disability Index (ODI), American Spinal Injury Association (ASIA) impairment grade, and Cobb angle were recorded and analyzed. Results The mean operative time, operative blood loss, hospital stay, Cobb angle correction, and Cobb angle loss were 192.59 ± 42.16 minutes, 385.29 ± 251.82 mL, 14.91 ± 5.06 days, 9.02° ± 3.16°, and 5.54° ± 1.09°, respectively. During the mean follow-up of 27.53 ± 8.90 months, significant improvements were observed in the ESR, CRP concentration, VAS score, ODI, and ASIA grade. The mean bone graft fusion time was 5.15 ± 1.13 months. Three complications occurred, and all were cured after active treatment. Conclusions Nonstructural bone grafts may achieve satisfactory clinical efficacy for appropriately selected patients with lumbar TB.

scholarly journals Holmium laser enucleation of the prostate with Virtual Basket mode: faster and better control on bleeding

BMC Urology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Giorgio Bozzini ◽  
Matteo Maltagliati ◽  
Umberto Besana ◽  
Lorenzo Berti ◽  
Albert Calori ◽  
...  
Keyword(s):  
Blood Loss ◽  
Hospital Stay ◽  
Operative Time ◽  
Randomized Study ◽  
Urine Volume ◽  
Holmium Laser ◽  
Laser Enucleation ◽  
Holmium Laser Enucleation ◽  
Irrigation Volume

Abstract Background To compare clinical intra and early postoperative outcomes between conventional Holmium laser enucleation of the prostate (HoLEP) and Holmium laser enucleation of the prostate using the Virtual Basket tool (VB-HoLEP) to treat benign prostatic hyperplasia (BPH). Methods This prospective randomized study enrolled consecutive patients with BPH, who were assigned to undergo either HoLEP (n = 100), or VB-HoLEP (n = 100). All patients were evaluated preoperatively and postoperatively, with particular attention to catheterization time, operative time, blood loss, irrigation volume and hospital stay. We also evaluated the patients at 3 and 6 months after surgery and assessed maximum flow rate (Qmax), postvoid residual urine volume (PVR), the International Prostate Symptom Score (IPSS) and the Quality of Life score (QOLS). Results No significant differences in preoperative parameters between patients in each study arm were found. Compared to HoLEP, VB-HoLEP resulted in less hemoglobin decrease (2.54 vs. 1.12 g/dl, P = 0.03) and reduced operative time (57.33 ± 29.71 vs. 42.99 ± 18.51 min, P = 0.04). HoLEP and VB-HoLEP detrmined similar catheterization time (2.2 vs. 1.9 days, P = 0.45), irrigation volume (33.3 vs. 31.7 l, P = 0.69), and hospital stay (2.8 vs. 2.7 days, P = 0.21). During the 6-month follow-up no significant differences in IPSS, Qmax, PVR, and QOLS were demonstrated. Conclusions HoLEP and VB-HoLEP are both efficient and safe procedures for relieving lower urinary tract symptoms. VB-HoLEP was statistically superior to HoLEP in blood loss and operative time. However, procedures did not differ significantly in catheterization time, hospital stay, and irrigation volume. No significant differences were demonstrated in QOLS, IPSS, Qmax and PVR throughout the 6-month follow-up. Trial Registration: Current Controlled Trials ISRCTN72879639; date of registration: June 25th, 2015. Retrospectively registred.

scholarly journals Robotically Assisted Hysterectomy versus Vaginal Hysterectomy for Benign Disease: A Prospective Study

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
M. Carbonnel ◽  
H. Abbou ◽  
H. T. N’Guyen ◽  
S. Roy ◽  
G. Hamdi ◽  
...  
Keyword(s):  
Blood Loss ◽  
Prospective Study ◽  
Hospital Stay ◽  
Vaginal Hysterectomy ◽  
Operative Time ◽  
Group Versus ◽  
Length Of Hospital Stay ◽  
Benign Disease ◽  
Post Surgery ◽  
A Prospective Study

Objectives. A prospective study was carried out to compare vaginal hysterectomy (VH) and robotically assisted hysterectomy (RH) for benign gynecological disease.Materials and Methods. All patients who underwent hysterectomy from March 2010 to March 2012 for a benign disease were included. Patients’ demographics per and post surgery results were collected from medical files. A questionnaire was also conducted 2 months after surgery.Results. Sixty patients were included in the RH group and thirty four in the VH one. Operative time was significantly longer in the RH group ( versus  min; ). Blood loss and length of hospital stay were significantly reduced: versus  ml; , and versus days; , respectively. Less pain was reported at D1 and D2 by RH patients, and levels of analgesia were lower compared to those observed in the VH group. No differences were found regarding the rate of conversion to laparotomy, intra- or postoperative complications.Conclusion. Robotically assisted hysterectomy appears to reduce blood loss, postoperative pain, and length of hospital stay, but it is associated with longer operative time and higher cost. Specific indications for RH remain to be defined.

scholarly journals Our experience with laparoscopic total gastrectomy for gastric cancer: A case series

2020 ◽  
Vol 2 (3) ◽  
Author(s):  
Manash Ranjan Sahoo ◽  
Satyajit Samal ◽  
Jyotirmay Nayak
Keyword(s):  
Gastric Cancer ◽  
Blood Loss ◽  
Hospital Stay ◽  
Total Gastrectomy ◽  
Median Time ◽  
Operative Time ◽  
Laparoscopic Total Gastrectomy ◽  
Oral Feeding ◽  
Care Hospital ◽  
Intraoperative Blood Loss

Background: Though laparoscopic distal gastrectomy has become a standard procedure for treatment of gastric cancer, laparoscopic total gastrectomy has not been widely accepted as it requires more dexterity and lack of evidence about its feasibility and safety. Methods: Here retrospectively we review a series of 12 cases of gastric cancer undergone laparoscopic total gastrectomy with D1 or D2 lymphadenectomy over a period of 7 years at a tertiary care hospital. The patient demographic characteristics were reviewed and the outcomes after surgery was analyzed in terms of extent of lymphadenectomy, mean operative time, mean intraoperative blood loss median number of lymph nodes harvested, median time for postoperative ambulation, median time for postoperative oral feeding, median time of postoperative hospital stay, postoperative complications and mortality. Results: All patients had total gastrectomy entirely through laparoscopic method. Mean operative time was 282 minutes, mean intraoperative blood loss was 120 ml, median time for ambulation and oral feeding was 3 days and 6 days respectively. Median time of hospital stay was 16 days and 2 patients had complications as pancreatic fistula and port site abscess. No mortality was observed. Conclusion: With zero mortality and accepted rate of complications, laparoscopic total gastrectomy appears to be technically feasible and safe for management of gastric cancer. But more studies have to be conducted with comparison to other standard gastrectomies and long term follow up to be done to establish its standardized application.

scholarly journals Comparison of early clinical results for the femoral neck system and cannulated screws in the treatment of unstable femoral neck fractures

2021 ◽  
Author(s):  
Xiaoqiang Zhou ◽  
Zhiqiang Li ◽  
Renjie Xu ◽  
Yuanshi She ◽  
Xiangxin Zhang ◽  
...  
Keyword(s):  
Femoral Head ◽  
Femoral Neck ◽  
Blood Loss ◽  
Hospital Stay ◽  
Clinical Efficacy ◽  
Operation Time ◽  
Femoral Neck Fractures ◽  
Femoral Head Necrosis ◽  
Cannulated Screws ◽  
Intraoperative Blood Loss

Abstract Objective: To compare early clinical effects of the femoral neck system (FNS) and three cannulated screws for the treatment of patients with unstable femoral neck fractures.Methods: A retrospective analysis with pair matching of 81 patients who received FNS or cannulated screw internal fixation for Pauwels type-3 femoral neck fracture in our hospital from January 2019 to December 2019 was conducted. Patients who received FNS were the test group, and those who received cannulated screws comprised the control group. Matching requirements were as follows: same sex, similar age and similar body mass index (BMI). A total of 30 pairs were successfully matched, and the average age was 53.84 years. The operation time, intraoperative blood loss, hospital stay, hospitalization cost, postoperative visual analogue scale (VAS) score, time to walking without crutches, Harris score, femoral head necrosis rate and complication rate were compared between the groups.Results: Postoperative re-examination of radiographs showed satisfactory reduction in all patients, and all patients were followed up for 10-22 months. Those in the FNS group had lower postoperative VAS scores, earlier times to walking without crutches, higher Harris scores at the last follow-up and lower complication rates (P<0.05). However, intraoperative blood loss and hospitalization costs were greater in the FNS group (P<0.05). No statistically significant difference in operation time, hospital stay or femoral head necrosis rate was observed between the two groups (P>0.05).Conclusion: For patients with unstable femoral neck fractures, FNS has better clinical efficacy than cannulated screws, though it is also more expensive. The excellent biomechanical performance and clinical efficacy of FNS make it a new choice for the treatment of unstable femoral neck fractures.

scholarly journals Reducing Morbidity in Urgent Gastroenterologic Surgery; Propensity Score Analysis Using Triclosan-Coated Polydioxanone Sutures

2017 ◽  
Vol 102 (1-2) ◽  
pp. 58-63
Author(s):  
Shinsuke Takeno ◽  
Kanefumi Yamashita ◽  
Tomoaki Noritomi ◽  
Seichiro Hoshino ◽  
Yasushi Yamauchi ◽  
...  
Keyword(s):  
Propensity Score ◽  
Blood Loss ◽  
Hospital Stay ◽  
Propensity Score Matching ◽  
Propensity Score Analysis ◽  
Univariate Analysis ◽  
Operation Time ◽  
Surgical Site Infections ◽  
Propensity Score Matching Analysis ◽  
Abdominal Closure

Superficial surgical site infections (S-SSIs), which prolonged hospital stay and increased costs, are a critical problem. The aim of the present study was to clarify the risk factors for S-SSIs after urgent gastroenterologic surgery and what surgeons can do to reduce their incidence and to shorten the hospital stay. A total of 275 patients who underwent urgent gastroenterologic surgery were enrolled in the present study. The correlations between the incidence of S-SSIs and clinicopathologic factors were retrospectively analyzed using propensity score matching. Of 275 cases, 43 (15.6%) patients had an S-SSI. On univariate analysis, the following factors were associated with a significantly higher incidence of S-SSI: American Society of Anesthesiologists score (P = 0.043); wound classification (P = 0.0005); peritonitis (P = 0.019); prolonged operation time (P = 0.0001); increased blood loss (P = 0.019); transfusion (P = 0.0047); and abdominal closure without triclosan-coated polydioxanone sutures (P = 0.042). However, a propensity score–matching analysis showed that abdominal closure using triclosan-coated polydioxanone sutures did not reduce the incidence of S-SSIs in patients who underwent urgent gastroenterologic surgery (P = 0.20), but it tended to be associated with a shorter hospital stay (P = 0.082). To reduce morbidity after urgent gastroenterologic surgery, surgeons should shorten the operation time and decrease the blood loss. In addition, abdominal closure using triclosan-coated polydioxanone sutures alone could not reduce the incidence of S-SSIs but might shorten the hospital stay after urgent gastroenterologic surgery by inhibiting bacterial activity and preventing prolongation of the infections.

The Hand-Assisted Laparoscopic Approach to Resection of Pancreatic Mucinous Cystic Neoplasms: An Underused Technique?

2018 ◽  
Vol 84 (1) ◽  
pp. 56-62
Author(s):  
Lauren M. Postlewait ◽  
Cecilia G. Ethun ◽  
Mia R. Mcinnis ◽  
Nipun Merchant ◽  
Alexander Parikh ◽  
...  
Keyword(s):  
Blood Loss ◽  
Minimally Invasive ◽  
Hospital Stay ◽  
Distal Pancreatectomy ◽  
Operative Time ◽  
Operative Blood Loss ◽  
Specimen Length ◽  
Cystic Neoplasms ◽  
Invasive Approach ◽  
Mucinous Cystic Neoplasms

Pancreatic mucinous cystic neoplasms (MCNs) are rare tumors typically of the distal pancreas that harbor malignant potential. Although resection is recommended, data are limited on optimal operative approaches to distal pancreatectomy for MCN. MCN resections (2000–2014; eight institutions) were included. Outcomes of minimally invasive and open MCN resections were compared. A total of 289 patients underwent distal pancreatectomy for MCN: 136(47%) minimally invasive and 153(53%) open. Minimally invasive procedures were associated with smaller MCN size (3.9 vs 6.8 cm; P = 0.001), lower operative blood loss (192 vs 392 mL; P = 0.001), and shorter hospital stay(5 vs 7 days; P = 0.001) compared with open. Despite higher American Society of Anesthesiologists class, hand-assisted (n = 46) had similar advantages as laparoscopic/robotic (n = 76). When comparing hand-assisted to open, although MCN size was slightly smaller (4.1 vs 6.8 cm; P = 0.001), specimen length, operative time, and nodal yield were identical. Similar to laparoscopic/robotic, hand-assisted had lower operative blood loss (161 vs 392 mL; P = 0.001) and shorter hospital stay (5 vs 7 days; P = 0.03) compared with open, without increased complications. Hand-assisted laparoscopic technique is a useful approach for MCN resection because specimen length, lymph node yield, operative time, and complication profiles are similar to open procedures, but it still offers the advantages of a minimally invasive approach. Hand-assisted laparoscopy should be considered as an alternative to open technique or as a successive step before converting from total laparoscopic to open distal pancreatectomy for MCN.

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