scholarly journals Radical Hemiscrotectomy and En Bloc Orchidectomy: Surgical Technique and Perioperative and Oncologic Outcomes of a Supra-Regional UK Referral Centre

2021 ◽  
Author(s):  
Christian Daniel Fankhauser ◽  
Allaudin Issa ◽  
Esther W. C. Lee ◽  
Christoph Oing ◽  
Pedro Oliveira ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Hospital Stay ◽  
Oncologic Outcomes ◽  
Safe Procedure ◽  
Referral Centre ◽  
En Bloc ◽  
Median Hospital Stay ◽  
Well Differentiated ◽  
Median Hospital

Abstract Background and Purpose Hemiscrotectomy with en bloc orchidectomy represents a radical primary, completion, or salvage option in men with inguinoscrotal cancers. We describe our surgical technique and peri-operative and oncological outcomes. Patients and Methods Retrospective cohort study of 16 men treated at a supra-regional referral centre with open radical hemiscrotectomy with or without en bloc orchidectomy between 2010 and 2020. Peri-operative and survival outcomes were analysed. Results Radical hemiscrotectomy with or without en bloc orchidectomy was performed on 16 patients comprising 7 well-differentiated liposarcomas, 4 dedifferentiated liposarcomas, 2 leiomyosarcomas, 1 mesothelioma, 1 rhabdomyosarcoma and 1 mammary type myofibroblastoma. Primary hemiscrotectomy was performed in four, completion hemiscrotectomy in nine and salvage hemiscrotectomy in three. The median hospital stay was 2 days [interquartile range (IQR) 2–4]. Four patients (25%) had post-operative complications including wound infection or haematoma. During a median follow-up of 18 months (IQR 2–66), one patient (6%) died following a recurrence in the pelvis and retroperitoneum. Discussion and Conclusions If careful dissection is performed, radical hemiscrotectomy and en bloc orchidectomy is a radical but safe procedure with a short hospital stay. Haematoma and infection represent the main complications, and within limited follow-up most men showed no recurrence.

scholarly journals Percutaneous or Transurethral Cystolithotomy for Bladder Lithiasis: Which is Safer?

2019 ◽  
Vol 36 (1-2) ◽  
pp. 17-22
Author(s):  
Joao Pimentel Torres ◽  
Vítor Fernandes ◽  
Nuno Morais ◽  
Sara Anacleto ◽  
Paulo Mota ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Prostate Hyperplasia ◽  
Median Hospital Stay ◽  
Urethral Strictures ◽  
Previous Diagnosis ◽  
Urethral Trauma ◽  
Significant Difference ◽  
Benign Prostate ◽  
Median Hospital

Introduction: Although the risk of urethral trauma while treating bladder stones is worrisome, evidence about the best treatment approach is scarce. The aim of this study is to compare the safety and efficacy of transurethral cystolithotomy and percutaneous suprapubic cystolithotomy in adults´ bladder lithiasis treatment. Methods: We retrospectively evaluated 120 patients (January 2012 to December 2017) who were surgically treated for bladder lithiasis with percutaneous suprapubic cystolithotomy (n= 20) and transurethral cystolithotomy (n= 100). Age, gender, calculi size, surgery duration, hospital stay, post-operative infections, haematuria, pain and urethral strictures were evaluated. Previous diagnosis of benign prostate hyperplasia and urethral strictures were also considered. Results: Both groups were homogeneous according to the pre-operative variables evaluated, including calculi dimensions and simultaneous diagnosis. Median surgery time in percutaneous suprapubic cystolithotomy and transurethral cystolithotomy were 65 and 58 minutes, respectively (p= 0.043). Pain and haematuria were similar in both groups. Median hospital stay was 2.0 days in both groups. Median follow-up time was 13 months. In the transurethral cystolithotomy, three patients (3%) developed urethral stricture while none of the patients treated with PSC developed urethral strictures during the follow-up (p= 0.435). Discussion: Percutaneous suprapubic cystolithotomy theoretically offers an advantage over transurethral cystolithotomy in terms of urethral trauma, although we did not observe a significant difference. However, it deserves to be considered, especially in patients with known urethral strictures that may hinder transurethral access. Further prospective studies with more patients may however confirm these theoretical advantages.

Radical hemiscrotectomy and en-bloc orchidectomy: Surgical technique, perioperative and oncologic outcomes of a supra-regional UK referral centre

2021 ◽  
Vol 79 ◽  
pp. S1764
Author(s):  
C.D. Fankhauser ◽  
A. Issa ◽  
E.W.C. Lee ◽  
C. Oing ◽  
P. Oliveira ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Oncologic Outcomes ◽  
Referral Centre ◽  
En Bloc

scholarly journals Is simultaneous surgery for nodes and primary in carcinoma penis safe?

2017 ◽  
Vol 03 (01) ◽  
pp. 050-053
Author(s):  
Senthil Chandrasekhar ◽  
Kathiresan Narayanswamy
Keyword(s):  
Hospital Stay ◽  
Median Hospital Stay ◽  
Staged Surgery ◽  
Surgery Group ◽  
Simultaneous Surgery ◽  
Simultaneous Group ◽  
The Mean ◽  
Carcinoma Penis ◽  
Median Hospital

Abstract Introduction: Historically, the combination of primary and nodal surgeries for carcinoma penis is thought to increase the morbidity and hospital stay. Despite the modifications in surgery including modified inguinal lymphadenectomies, morbidity of the procedure is high. Methods: A prospective, nonrandomized study to analyze a total of 56 consecutive patients from 2006 to 2009, who were evaluated and underwent surgery for primary and nodes for carcinoma penis at our center, was done. The median follow-up was 34 months (range from 12 to 48 months). The procedures included both prophylactic and therapeutic groin dissections. Various parameters were tested using SPSS version 17 statistics software. Results: Duration of drains, hospital stay, wound morbidity, and long-term complications were found to be similar in the simultaneous and staged surgery groups. The mean duration of drains for the simultaneous group of 18 patients was 12.56 days and the corresponding duration of drains for the staged surgery group of 36 patients was 12.83 days. The minor morbidity and major morbidity for the simultaneous group were 27.8% and 38.9% and the corresponding figures for the staged group were 22.2% and 44.4%, respectively. The mean and median hospital stay for the simultaneous surgery group were 21.5 and 27.5 days, respectively. The mean and median hospital stay for the staged surgery group were 17.5 and 21.36 days, respectively. The study revealed no statistically significant difference between the two groups with regard to all the above parameters. Conclusions: Simultaneous surgery for the primary and nodes in carcinoma penis is very much feasible. Simultaneous and early-staged lymphadenectomy have no difference in results with respect to drain duration, hospital stay, wound morbidity, and long-term complications. Simultaneous lymphadenectomy can be combined with penectomy both in the prophylactic and therapeutic settings.

scholarly journals Mandibular periosteal (juxtacortical) chondrosarcoma

2009 ◽  
Vol 20 (5) ◽  
pp. 428-433 ◽  
Author(s):  
Elisângela Maria Cunha Costa ◽  
Bárbara Lima Lucas ◽  
Mariana Reis Silva ◽  
Renata Hinhug Vilarinho ◽  
Paulo Rogério de Faria ◽  
...  
Keyword(s):  
Final Diagnosis ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Bone Surface ◽  
En Bloc ◽  
Grade Ii ◽  
Well Differentiated ◽  
Slow Growing ◽  
Tomography Scan

Periosteal (juxtacortical) chondrosarcoma (PC) is a well-differentiated malignant cartilage-forming tumor arising from the external bone surface, especially in long bones. The therapy of choice is en-bloc resection and, in general, its prognosis is good. This paper reports a rare case of PC affecting the mandible of a 41-year-old man. The lesion presented as a slow-growing-painless swelling that lasted 2 months. Computed tomography scan showed a tumoral mass arising from the external bone surface, extending into the adjacent soft tissue presenting patchy regions of popcorn-like calcifications. A final diagnosis of PC (grade II) was rendered after biopsy. Hemimandibulectomy was undertaken followed by complementary radiotherapy with 70 Gy. Although no episodes of recurrence or metastasis had been noticed after 18 months of follow-up, the patient died and causa mortis could not be established.

scholarly journals Early and Midterm Results of Stent Endarterectomy for Left Anterior Descending Coronary Artery “Full Metal Jacket”

2021 ◽  
Vol 24 (3) ◽  
pp. E467-E473
Author(s):  
Rafik Soliman ◽  
Sunil Ohri ◽  
Mohamed Hagag ◽  
Fouad Rasekh
Keyword(s):  
Coronary Artery ◽  
Hospital Stay ◽  
Ct Angiography ◽  
Artery Bypass ◽  
Positive Family History ◽  
Coronary Vessels ◽  
Safe Procedure ◽  
Midterm Results ◽  
Full Metal Jacket

Objective: Modern coronary interventional practice can result in coronary vessels that are totally stented. The term “full metal jacket” has been coined to refer to vessels that have an overlapping stent in series along the whole length of the vessel. This poses a serious challenge to surgical revascularization, particularly when a left internal thoracic artery (LITA) to the left anterior descending (LAD) needs to be undertaken. We evaluated the early and midterm results of on-pump coronary artery bypass grafting (CABG) following “stent endarterectomy” for the LAD with LITA to LAD grafting. Methods: During October 2017 to September 2020, 21 patients presented with multi-vessel disease and a totally occluded LAD with a stent full metal jacket. No distal target for LITA grafting was available, despite a viable myocardial territory. The LAD was endarterectomised, removing the column of totally occluded stents with the medial wall of the vessel, leaving the proximal stent in place to avoid competitive flow. Long length anastomosis was then undertaken with the LITA graft. Postoperatively, patients were followed up clinically and by coronary computed tomography (CT) angiography at 6- and 18-month intervals. All patients were discharged on a combination of aspirin and warfarin for three months and then aspirin and clopidogrel for the rest of the first year and then aspirin alone for life. Results: Patients had a mean age of 58.07 ± 2.06 yr. Sixteen (76.2%) were males, 13 (61.9%) patients were diabetics, 18 (85.7%) were hypertensive, 15 (71.4%) were dyslipidemic, six (28.6%) were obese, 11 (52.4%) were smokers, and five (23.8%) had positive family history of ischemic heart disease (IHD). The number of grafts per patient ranged 3-5, with a mean cross-clamp time of 64.71± 8.84 min. There were no postoperative deaths nor MI clinically, by electrocardiogram (ECG) criteria nor by troponin or CK-MB. In-hospital complications included one (4.8%) patient who required re-exploration for bleeding, one (4.8%) developed a superficial wound, and three (14.3%) developed atrial fibrillation (AF), during their hospital stay. Mean hospital stay was 7.71±1.73 days. All patients completed the 6-month follow up showing patent LITA to LAD with coronary CT angiography. One patient was lost to follow up after six months; five patients are awaiting their 18-month CT angiography, while 15 (71.4%) patients have completed their 18-month CT angiography, and all have a patent LITA to LAD. Conclusions: Stent endarterectomy for a totally occluded LAD with a full metal jacket and viable myocardial territory is a safe procedure with good early and midterm results. This technique should be considered in these difficult cases presenting for revascularisation when no other option is available.

scholarly journals Enhanced Recoveryafter Colorectal Surgery. Results from Aprospective Observational Two-Centre Study

2009 ◽  
Vol 98 (3) ◽  
pp. 155-159 ◽  
Author(s):  
A. C. Miohn ◽  
S. V. Bernardshaw ◽  
S.-M. Ristesund ◽  
P. E. Hovde Hansen ◽  
O. Rœkke
Keyword(s):  
Colorectal Surgery ◽  
Hospital Stay ◽  
Enhanced Recovery ◽  
Leisure Activities ◽  
University Hospital ◽  
Daily Activities ◽  
Median Hospital Stay ◽  
Surgical Department ◽  
Preparation Period ◽  
Median Hospital

Background and Aims: Enhanced recovery after surgery (ERAS) has reduced the median hospital stay from 8–10 days with traditional peri-operative routines to four days. The aim of the present study was to introduce the principles of ERAS in our hospital and measure the effect on hospital stay, complications and quality of life after discharge from hospital. Material and Methods: 94 consecutive patients, 40 males, 54 females, median age 66 years, were included in a prospective non-randomised observational study at Haukeland University Hospital and Haugesund Hospital from October 2000 until February 2003. After a three-month preparation period, the principles of ERAS were implemented. The results were evaluated with questionnaires and by follow-ups 8–10 and 30 days after surgery. The results were compared to the results of colorectal surgery before introduction of accelerated recovery. Results: 45 (48%) and 73 (78%) patients were discharged within three and five days after surgery with ERAS, compared to zero and seven (5%) patients with traditional recovery. The complication rate with ERAS was 31%, and the readmission rate was 15%. After one week, 57% had resumed their daily activities at home. After 30 days, 65% of the patients had resumed their normal and leisure activities. Conclusion: After a proper preparation period, ERAS principles may be implemented in surgical department, and is followed by a reduced median hospital stay and rapid return to normal daily activities for most patients after colorectal surgery.

scholarly journals Stapled Transanal Rectal Resection for the Surgical Treatment of Obstructed Defecation Syndrome Associated with Rectocele and Rectal Intussusception

ISRN Surgery ◽  
2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Hesham M. Hasan ◽  
Hani M. Hasan
Keyword(s):  
Surgical Technique ◽  
Rectal Resection ◽  
Obstructed Defecation ◽  
Circular Stapler ◽  
Rectal Intussusception ◽  
Prospective Clinical Study ◽  
Safe Procedure ◽  
Stapled Transanal Rectal Resection ◽  
Obstructed Defecation Syndrome

Obstructed defecation syndrome (ODS) is one of the most widespread clinical problems which frequently affects middle-aged females. There is a new surgical technique called stapled transanal rectal resection (STARR) that makes it possible to remove the anorectal mucosa circumferential and reinforce the anterior anorectal junction wall with the use of a circular stapler. This surgical technique developed by Antonio Longo was proposed as an effective alternative for the treatment of ODS. In this study we present our preliminary results with the STARR operation for the treatment of ODS. For this purpose, 40 consecutive female patients with ODS due to rectal intussusception (RI) and/or rectocele (RE) were recruited in this prospective clinical study, from May 2008 to October 2010. No major operative or postoperative complications were recorded, and after 12-month follow-up, significant improvement in the ODS score system was observed, and the symptoms of constipation improved in 90% of patients; 20% of patients judged their final clinical outcome as excellent, 55% as good, and 15% as moderate, with only 10% having poor results. After analyzing our results we can conclude that STARR is an effective and safe procedure for the treatment of obstructed defecation syndrome due to rectal intussusception and/or rectocele and can be performed safely without major morbidity.

scholarly journals Laparo-endoscopic resection for extensive and inaccessible colorectal polyps: a feasible and safe procedure

2011 ◽  
Vol 93 (3) ◽  
pp. 241-245 ◽  
Author(s):  
JJ Wood ◽  
AC Lord ◽  
JMD Wheeler ◽  
NR Borley
Keyword(s):  
Hospital Stay ◽  
Endoscopic Resection ◽  
Colonic Polyps ◽  
Right Hemicolectomy ◽  
Colorectal Polyps ◽  
Colonic Resection ◽  
Safe Procedure ◽  
Median Hospital Stay ◽  
Laparoscopic Right Hemicolectomy ◽  
Laparoscopic Colon

INTRODUCTION Polypectomy at colonoscopy may be difficult or dangerous. In such instances colonic resection may be indicated. Novel combined laparoscopic-endoscopic procedures have the potential to allow safe extensive extramucosal resection, thus avoiding resection. Laparoscopic colon mobilisation provides a more favourable orientation for endoscopic mucosal resection and facilitates identification of possible perforation sites with immediate laparoscopic repair or resection if necessary. This study aimed to assess the efficacy and safety of laparo-endoscopic resection (LER) of colonic polyps. PATIENTS AND METHODS Data were collected prospectively on consecutive patients undergoing LER. The mode of presentation, referral pattern, lesion site and size, hospital stay, procedural details, complications, histology and further treatment were recorded. RESULTS A total of 13 patients underwent attempted LER (16 polyps in total) and this was completed for 10, with a median hospital stay of 2 days. Five polyps were removed whole and eight piecemeal. Excision was clinically complete in all cases. Three procedures were converted to colonic resection. One lesion appeared malignant, indicating a conversion to laparoscopic right hemicolectomy. Two polyps were not amenable to LER and resection was performed. One patient underwent subsequent colonic resection based on the histological findings. There were no perforations or serious complications. CONCLUSIONS LER is a safe and effective treatment for large and inaccessible colonic polyps that would otherwise be treated by colonic resection.

scholarly journals An Algorithm for the Management of Bile Leak Following Laparoscopic Cholecystectomy

2007 ◽  
Vol 89 (1) ◽  
pp. 51-56 ◽  
Author(s):  
F Ahmad ◽  
RN Saunders ◽  
GM Lloyd ◽  
DM Lloyd ◽  
GSM Robertson
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Minimally Invasive ◽  
Hospital Stay ◽  
Bile Leak ◽  
Median Hospital Stay ◽  
Management Protocol ◽  
The Impact ◽  
Median Hospital ◽  
Bile Leaks

INTRODUCTION The management of bile leaks following laparoscopic cholecystectomy has evolved with increased experience of ERCP and laparoscopy. The purpose of this study was to determine the impact of a minimally invasive management protocol. PATIENTS AND METHODS Twenty-four patients with a bile leak following laparoscopic cholecystectomy were recorded consecutively between 1993 and 2003. Between 1993–1998, 10 patients were managed on a case-by-case basis. Between 1998–2003, 14 patients were managed according to a minimally invasive protocol utilising ERC/biliary stenting and re-laparoscopy if indicated. RESULTS Bile leaks presented as bile in a drain left in situ post laparoscopic cholecystectomy (8/10 versus 10/14) or biliary peritonitis (2/10 versus 4/14). Prior to 1998, neither ERC nor laparoscopy were utilised routinely. During this period, 4/10 patients recovered with conservative management and 6/10 (60%) underwent laparotomy. There was one postoperative death and median hospital stay post laparoscopic cholecystectomy was 10 days (range, 5–30 days). In the protocol era, ERC ± stenting was performed in 11/14 (P = 0.01 versus pre-protocol) with the main indication being a persistent bile leak. Re-laparoscopy was necessary in 5/14 (P = 0.05 versus preprotocol). No laparotomies were performed (P < 0.01 versus pre-protocol) and there were no postoperative deaths. Median hospital stay was 11 days (range, 5–55 days). CONCLUSIONS The introduction of a minimally invasive protocol utilising ERC and re-laparoscopy offers an effective modern algorithm for the management of bile leaks after laparoscopic cholecystectomy.

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