scholarly journals Clinical outcome of laparoscopic and open colectomy for right colonic carcinoma

2011 ◽  
Vol 93 (8) ◽  
pp. 603-607 ◽  
Author(s):  
JS Khan ◽  
AK Hemandas ◽  
KG Flashman ◽  
A Senapati ◽  
D O'Leary ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Laparoscopic Group ◽  
Right Hemicolectomy ◽  
Curative Intent ◽  
Term Outcome ◽  
Mortality And Morbidity ◽  
Conversion To Open Surgery ◽  
Widespread Acceptance ◽  
Grade Tumour

INTRODUCTION Laparoscopic colorectal surgery has gained widespread acceptance. While many studies have compared laparoscopic and open left-sided resections, there is limited literature on right colonic resections. We aimed to analyse the short-term outcome of laparoscopic (LRH) and open right hemicolectomy (ORH) in our unit. METHODS Consecutive patients undergoing elective right hemicolectomies over a period of 28 months were included in the study. No selection criteria were used to allocate the surgical approach. Study parameters included surgical technique, demographic details, ASA grade, body mass index (BMI), length of hospital stay (LOS), post-operative mortality and morbidity, readmission rate and histopathological data. RESULTS A total of 164 patients underwent right hemicolectomies during the study period (LRH: 89, ORH: 75). Both groups were comparable in age, sex, BMI, ASA grade, tumour stage and lymph node harvest. Four patients (4.5%) in the laparoscopic group required conversion to open surgery. In resections with curative intent, microscopic margins were positive in two patients (3%) in the ORH group compared to one (1%) in the LRH group. Seven ORH patients had an adverse post-operative outcome (three anastomotic leaks, four deaths); there were no deaths/immediate complications in the LRH group (p<0.05). The median LOS for LRH patients (4 days, range: 2–21 days) was significantly shorter than for ORH patients (8 days, range: 3–38 days) (p<0.0001, Mann–Whitney U test). By day 5, 77% of LRH patients were discharged compared with only 21% of patients in the ORH group. There were two readmissions (2.7%) in the ORH group and nine (10.1%) in the LRH group. CONCLUSIONS Our findings demonstrate advantages in favour of LRH in terms of a shorter hospital stay and reduced post-operative major complications. LRH is safe and should therefore be available to all patients requiring colonic resection.

scholarly journals The art of robotic colonic resection: a review of progress in the past 5 years

2021 ◽  
Author(s):  
Hongyi Liu ◽  
Maolin Xu ◽  
Rong Liu ◽  
Baoqing Jia ◽  
Zhiming Zhao
Keyword(s):  
Robotic Surgery ◽  
Hospital Stay ◽  
Intraoperative Complications ◽  
Intestinal Anastomosis ◽  
Length Of Hospital Stay ◽  
Colonic Resection ◽  
Surgical Performance ◽  
Conversion To Open Surgery ◽  
Minimal Invasiveness ◽  
The Past

AbstractSurgery is developing in the direction of minimal invasiveness, and robotic surgery is becoming increasingly adopted in colonic resection procedures. The ergonomic improvements of robot promote surgical performance, reduce workload for surgeons and benefit patients. Compared with laparoscopy-assisted colon surgery, the robotic approach has the advantages of shorter length of hospital stay, lower rate of conversion to open surgery, and lower rate of intraoperative complications for short-term outcomes. Synchronous robotic liver resection with colon cancer is feasible. The introduction of the da Vinci Xi System (Intuitive Surgical, Inc., Sunnyvale, CA, USA) has introduced more flexibility to colonic operations. Optimization of the suprapubic surgical approach may shorten the length of hospital stay for patients who undergo robotic colonic resection. Single-port robotic colectomy reduces the number of robotic ports for better looking and faster recovery. Intestinal anastomosis methods using totally robotic surgery result in shorter time to bowel function recovery and tolerance to a solid diet, although the operative time is longer. Indocyanine green is used as a tracer to assess blood supplementation in the anastomosis and marks lymph nodes during operation. The introduction of new surgical robots from multiple manufacturers is bound to change the landscape of robotic surgery and yield high-quality surgical outcomes. The present article reviews recent advances in robotic colonic resection over the past five years.

Comparison of Treatment Outcomes of Endoscopic Stenting and Laparoscopic Gastrojejunostomy for Malignant Gastric Outlet Obstruction

2018 ◽  
Vol 84 (6) ◽  
pp. 991-995 ◽  
Author(s):  
Shuai Leiyuan ◽  
Xu Jianli ◽  
Zhao Zhengzhong ◽  
Ji Guangyan ◽  
Zhu Dailiang
Keyword(s):  
Hospital Stay ◽  
Gastric Outlet Obstruction ◽  
Outlet Obstruction ◽  
Length Of Hospital Stay ◽  
Operation Time ◽  
Laparoscopic Group ◽  
Endoscopic Stenting ◽  
Stent Group ◽  
Malignant Gastric Outlet Obstruction ◽  
Laparoscopic Gastrojejunostomy

To compare the clinic outcomes of endoscopic stenting and laparoscopic gastrojejunostomy (LGJ) for patients with malignant gastric outlet obstruction (GOO). We retrospectively reviewed 63 patients with malignant GOO that underwent endoscopic stenting [Stent Group (SG), n = 29] or LGJ [Laparoscopic Group (LG), n = 34]. Then, we evaluated the medical effects, postoperative hospital stay, and hospitalization expenses in both groups. Compared to LG, SG has a shorter operation time [SG: (41.1 ± 9.3) minutes vs LG: (137.4 ± 21.7) minutes, P = 0.000], less intra-operative blood loss [(23.7 ± 9.0) mL vs (121.1 ± 24.3) mL, P = 0.000], relatively lower hospitalization expenses [(2272.7 ± 413.9) $ vs (5182.4 ± 517.3) $, P = 0.000]. Besides, the median intake time was significantly shorter in the SG than that in the LG [(0.9 ± 0.3) days vs (4.1 ± 0.6) days, P = 0.000]. However, there were no significant differences between SG with LG in surgical success rate (100 vs 100%, P = 1.000), length of hospital stay [(6.1 ± 3.3) days vs (10.9 ± 4.7) days, P = 0.422], recurrent obstructive rate (37.9 vs 26.5%, P = 0.949) and median survivals [(141.4 ± 81.4) days vs (122.7 ± 88.8) days, P = 0.879]. Endoscopic stenting and LGJ are both relatively safe and effective treatments for patients with malignant GOO. But we suggest that endoscopic stenting should be considered first in patients with malignant GOO because it has many advantages over LGJ.

scholarly journals Blistering Diseases in a Tertiary Care Hospital: A 10-year Audit

2020 ◽  
Vol 18 (1) ◽  
pp. 24-27
Author(s):  
Niraj Parajuli ◽  
Laila Lama ◽  
Anupama Karki ◽  
Rushma Shrestha ◽  
Sumida Tiwari ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Tertiary Care ◽  
Length Of Hospital Stay ◽  
Referral Hospital ◽  
Care Hospital ◽  
Medical Sciences ◽  
Mortality And Morbidity ◽  
Autoimmune Blistering Disease ◽  
Dermatological Disease ◽  
Blistering Disease

Introduction: Cutaneous blisters can occur in variety of conditions. They are broadly classified as immunobullous or non-immunobullous. Immunobullous blistering diseases can further classify as intraepidermal or subepidermal. Non-immunobullous blistering disease are commonly due to infections, drugs among others. Some of the blistering disease carry significant mortality and morbidity. There are only limited data on blistering diseases from Nepal, so this study will provide details on the prevalence of this rare dermatological disease from one of the tertiary care referral hospital in the country. Objective: To assess the clinical pattern and prevalence of various blistering diseases in a tertiary care referral hospital. Materials and Methods: All of the data were obtained from the admission register maintained at department of dermatology and venereology, National Academy of Medical Sciences. All the patients admitted with blistering disease from year April 2008 till March 2018 were included. The details including age, sex, type of blistering disease and length of hospital stay were recorded.  Results: A total of 710 patients were admitted in the dermatology ward over the period of 10 years.  There were a total of 193 blistering disease admitted during this period. Autoimmune blistering disease was diagnosed in 59 patients whereas 100 patients had non-immunobullous disease. The age grouped range from 4- 93 years with the mean age of 43± 19.71 years. The average number of hospital stay of all blistering diseases was 11.73±11.36 days. Conclusion: Blistering diseases are one of the most common conditions requiring admission in dermatology ward. Some of these diseases carry a significant morbidity and mortality. So, prompt diagnosis and treatment is of utmost importance.

scholarly journals In-Hospital Outcomes in Patients With Hyperosmolar Hyperglycemic State With and Without Hypertriglyceridemia: Analysis of National Inpatient Sample

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A426-A426
Author(s):  
Genaro Velazquez ◽  
Hafeez Shaka ◽  
Mukunthan Murthi ◽  
Iriagbonse Asemota ◽  
Sujitha Velagapudi ◽  
...  
Keyword(s):  
Septic Shock ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Hospital Charges ◽  
Secondary Diagnosis ◽  
Total Hospital ◽  
Mortality And Morbidity ◽  
Lower Odds ◽  
Hyperosmolar Hyperglycemic State

Abstract Background: In patients hospitalized with Hyperosmolar hyperglycemic state (HHS) the presence of comorbid conditions including hypertension, heart disease, stroke, and dementia have been variably reported to be associated with higher mortality. HTG is increasingly prevalent in patients with DM, especially those with poor glycemic control who are more likely to suffer from HHS. Elevated triglyceride levels have independently been associated with higher mortality in certain conditions like coronary artery disease and acute pancreatitis. However, data on the effect of Hypertriglyceridemia (HTG) on mortality and morbidity in hospitalized patients with HHS is sparse. Objective: We wanted to compare the outcomes for HHS hospitalizations for patients with and without HTG. Methods: A retrospective cohort study was conducted using the Nationwide Inpatient Sample from 2016 and 2017. About 42 740 hospitalizations who had HHS as primary diagnosis were enrolled and further stratified based on the presence or absence of HTG as secondary diagnosis using ICD-10 codes. The primary outcome was inpatient mortality and secondary outcomes included length of hospital stay, total Hospital charges, Sepsis, Septic Shock, Acute Kidney Injury (AKI), and Acute Respiratory Failure (ARF). Multivariate regression analysis was done to adjust for confounders. Results: Out of the 42 740 hospitalizations with HHS, about 17 040 had HTG. The in-hospital mortality for patients with HHS was 305 overall, out of which 70 patients had HTG as secondary diagnosis. Compared with patients without HTG, patients with HTG had lower odds of in- hospital mortality (0.30, 95% CI 0.157–0.56, p&lt;0.005) when adjusted for patient and hospital characteristics. Patients with HHS and HTG had decreased length of hospital stay, less total Hospital charges, lower odds of Sepsis and Septic Shock, but similar odds of AKI and ARF in comparison to patients without HTG. Conclusion: Our study shows that HTG is associated with lower odds of in-hospital mortality in patients with HHS, even though the odds of AKI and ARF was same in both groups. A similar inverse relationship has already been reported between TG levels and mortality in stroke patients. Though the mechanism of this effect is unclear, one possible explanation could be that patients with HTG are more likely to be treated with statins and fibrates which have known anti-inflammatory effects. Further studies are required to evaluate this possible positive prognostic effect of TG.

scholarly journals LAPAROSOPIC ASSISTED RIGHT HEMICOLECTOMY

2015 ◽  
Vol 22 (08) ◽  
pp. 1020-1023
Author(s):  
Jahangir Sarwar Khan ◽  
Muhammad Salman Shafique
Keyword(s):  
Surgical Site Infection ◽  
Hospital Stay ◽  
Oral Intake ◽  
Length Of Hospital Stay ◽  
Right Hemicolectomy ◽  
Site Infection ◽  
Carcinoma Colon ◽  
Duration Of Operation ◽  
Age Range ◽  
Surgical Unit

Objective: Experience with Laparosopic assisted Right Hemicolectomy ispresented. Study Design: Prospective study. Setting: Surgical Unit-I, Holy Family Hospital,Rawalpindi, Pakistan. Period: 2010 to 2014. Materials and Methods: 20 patients underwentlaparosopic assisted right hemicolectomy. Duration of operation, postoperative pain, durationof post operative analgesia, frequency of surgical site infection and length of hospital stay werenoted. Results: There were 13 male and 7 female patients with the age range of 25-70 years(45±11years). Eleven (11) patients were suffering from carcinoma colon wheras nine (09)were suffering from Tuberculosis. Mean operative time was about 92 minutes. Only four opiodinjections were required as post-operative analgesia. Oral intake was started after 24 hours. Themean length of hospital stay was 5.5 days with no case of surgical site infection. Conclusion:Laparoscopic assisted right hemicolectomy is a safe and viable option in our setup.

POST OPERATIVE LESS COMPLICATIONS IN ROBOTIC DONOR NEPHRECTOMY WITH MINIMAL HOSPITAL STAY

2021 ◽  
pp. 74-76
Author(s):  
Vinay Mahendra ◽  
Palash Saha ◽  
J.B. Roy ◽  
Tridibesh Mandal ◽  
Debarshi Jana
Keyword(s):  
Blood Loss ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Donor Nephrectomy ◽  
Postoperative Blood Loss ◽  
Minimally Invasive Surgical ◽  
Number Of Patients ◽  
Widespread Acceptance ◽  
Pain Duration ◽  
Group 2

Introduction: Minimally invasive surgical procedures have gained widespread acceptance in the eld of living kidney donation over the last decade. Ratner et al. were the rst to describe laparoscopic donor nephrectomy (LDN). Since then, compared to open donor nephrectomy, LDN has demonstrated several improvements in terms of decreased postoperative pain, decreased length of hospital stay (LOS), rapid patient rehabilitation, reduced postoperative blood loss, and superior cosmetic results. Aims And Objective: The aim of this study is to study less complication in robotic Donor nephrectomy with Respect to clinical outcome which include pordoprade pain, time and minimal stay in hospital. Materials And Methods: This study had been conducted on patients admitted for Robotic Donor Nephrectomy. This study done at Apollo Gleneagles Hospital, Kolkata. Prospective study was carried out in cases performed between which includes number of patients. All patients were older then 20years for this study. Result And Analysis: It was found that 49 (96.1%) patients had under vein group1, and 2(3.9%) patient had under vein group 2. 43 (84.3%) patients had under artery group1, and 8(15.7%) patient had under artery group 2. 1(2.0%) patient had acute graft rejection. 41 (80.4%) patients had Left site, and 10(19.6%) patient had Right site. Conclusion:Robotic donor Nephrotomy performed by the vinei Robot the use 7 Robot allows Minimum blood loss, Minimum OT time in their better result our study proven the ruperiority 7 then method and add then there were less complication. Pastopade pain Duration of hospital stay was less and return to regular life earlier so therefore Robot arrited Donor Nephrotomy is the method I choice for Renal tramplant Surgery.

Pneumonia Is Associated with Increased Mortality in Hospitalized COPD Patients: A Systematic Review and Meta-Analysis

Respiration ◽  
2021 ◽  
Vol 100 (1) ◽  
pp. 64-76
Author(s):  
Yan Yu ◽  
Wei Liu ◽  
Hong-Li Jiang ◽  
Bing Mao
Keyword(s):  
Systematic Review ◽  
Mechanical Ventilation ◽  
Hospital Stay ◽  
Readmission Rate ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
Mortality And Morbidity ◽  
Icu Stay ◽  
Copd Patients ◽  
The Impact

<b><i>Background:</i></b> Patients with chronic obstructive pulmonary disease (COPD) are at a heightened risk of pneumonia. Whether coexisting community-acquired pneumonia (CAP) can predict increased mortality in hospitalized COPD patients is still controversial. <b><i>Objective:</i></b> This systematic review and meta-analysis aims to assess the association between CAP and mortality and morbidity in COPD patients hospitalized for acute worsening of respiratory symptoms. <b><i>Methods:</i></b> In this review, cohort studies and case-control studies investigating the impact of CAP in hospitalized COPD patients were retrieved from 4 electronic databases from inception until December 2019. Methodological quality of included studies was assessed using Newcastle-Ottawa Quality Assessment Scale. The primary outcome was mortality. The secondary outcomes included length of hospital stay, need for mechanical ventilation, intensive care unit (ICU) admission, length of ICU stay, and readmission rate. The Mantel-Haenszel method and inverse variance method were used to calculate pooled relative risk (RR) and mean difference (MD), respectively. <b><i>Results:</i></b> A total of 18 studies were included. The presence of CAP was associated with higher mortality (RR = 1.85; 95% CI: 1.50–2.30; <i>p</i> &#x3c; 0.00001), longer length of hospital stay (MD = 1.89; 95% CI: 1.19–2.59; <i>p</i> &#x3c; 0.00001), more need for mechanical ventilation (RR = 1.48; 95% CI: 1.32–1.67; <i>p</i> &#x3c; 0.00001), and more ICU admissions (RR = 1.58; 95% CI: 1.24–2.03; <i>p</i> = 0.0002) in hospitalized COPD patients. CAP was not associated with longer ICU stay (MD = 5.2; 95% CI: −2.35 to 12.74; <i>p</i> = 0.18) or higher readmission rate (RR = 1.02; 95% CI: 0.96–1.09; <i>p</i> = 0.47). <b><i>Conclusion:</i></b> Coexisting CAP may be associated with increased mortality and morbidity in hospitalized COPD patients, so radiological confirmation of CAP should be required and more attention should be paid to these patients.

scholarly journals Cardiac Implantable Electronic Device Infections; Long-Term Outcome after Extraction and Antibiotic Treatment

2021 ◽  
Vol 13 (3) ◽  
pp. 627-635
Author(s):  
Jonas Hörnsten ◽  
Louise Axelsson ◽  
Katarina Westling
Keyword(s):  
Hospital Stay ◽  
Electronic Device ◽  
Length Of Hospital Stay ◽  
Systemic Infection ◽  
Extraction Methods ◽  
University Hospital ◽  
Term Outcome ◽  
Long Term Outcome ◽  
New Device ◽  
Pocket Infection

Background: The aim of the study was to examine the treatment outcome for patients with cardiovascular implantable electronic device (CIED) infections after extraction. Methods: Patients who underwent CIED extractions due to an infection at Karolinska University Hospital 2006–2015 were analyzed. Results: In total, 165 patients were reviewed, 104 (63%) with pocket infection and 61 (37%) with systemic infection. Of the patients with systemic infection, 34 and 25 patients fulfilled the criteria for definite and possible endocarditis, respectively. Complications after extraction occurred only in one patient. Reimplantation was made after a mean of 9.5 days and performed in 81% of those with pocket infection and 44.3% in systemic infection. Infection with the new device occurred in 4.6%. The mean length of hospital stay for patients with pocket infection was 5.7 days, compared to 38.6 days in systemic infection. One-year mortality was 7.7% and 22.2% in pocket infection and systemic infection, respectively. Patients with Staphylococcus aureus infection had a higher mortality. Conclusions: In this study, the majority of the patients had a pocket CIED infection, with a short hospital stay. Patients with a systemic infection, and S. aureus etiology, had a prolonged hospital stay and a higher mortality.

scholarly journals Use of Boey’s score in peptic perforation disease in the Nepalese population: a prospective observational study

2019 ◽  
Vol 22 (1) ◽  
pp. 2-6
Author(s):  
Rabin Koirala ◽  
Paras Pant ◽  
Nikhil Acharya ◽  
Asish Rajbhandary
Keyword(s):  
Peptic Ulcer ◽  
Observational Study ◽  
Hospital Stay ◽  
Prospective Observational Study ◽  
Postoperative Mortality ◽  
Length Of Hospital Stay ◽  
Morbidity And Mortality ◽  
Peptic Ulcer Perforation ◽  
Mortality And Morbidity ◽  
Ulcer Perforation

Introduction: Peptic ulcer perforation carries high mortality and morbidity. Boey’s score is shown to be a simple scoring system to help predict morbidity and mortality. This is a prospective observational study to evaluate the applicability of Boey’s score in predicting mortality and morbidity in Nepalese patients. Methods: This study was conducted in the Dept. of Surgery, Nepal Medical College and Teaching Hospital (NMCTH), Attarkhel, Jorpati between 1st of July 2012 to 30th June 2019 over a period of 7 years. This was a prospective observational study. All patients who underwent laparotomy for suspected peptic ulcer perforation peritonitis were included in the study. Results: Fourty-seven patients were included in the study. Male patients outnumbered females by a ratio of almost 4:1. Eighteen (38%) patients had Boey’s score of 1, and 7 (15 %) patients had a Boey’s score of 3. Overall postoperative mortality was 7 (15%). Boey’s score predicted morbidity and mortality with a p-value of <0.01. The length of hospital stay was also more in patients with a higher score and it was statistically significant. Conclusions: Boey’s score is both easy and effective in predicting postoperative morbidity, mortality and length of hospital stay.

scholarly journals LAP STAPLER GASTROJEJUNOSTOMY WITH TOTAL TRUNCAL VAGOTOMY FOR BENIGN GASTRIC OUTLET OBSTRUCTION.

2020 ◽  
Vol 4 (9) ◽  
Author(s):  
Sahun .
Keyword(s):  
Hospital Stay ◽  
Postoperative Complication ◽  
Operative Time ◽  
Outlet Obstruction ◽  
Length Of Hospital Stay ◽  
Truncal Vagotomy ◽  
Term Outcome ◽  
Female Ratio ◽  
Advantages And Disadvantages ◽  
The Mean

Aims: To study the advantages and disadvantages of laparoscopic truncal vagotomy and gastrojejunostomy, the outcome of surgery in terms of – mean operative time, Conversion rate, Postoperative pain measurement, intraoperative and postoperative complication and duration of hospital stay. Methods: A prospective analysis of operative, postoperative and short term outcome of 21 patients were carried out during time period of 2016 to 2019. Results: Out of 21 patient,.64% patients were males and 36 % patients were females. Male to female ratio was 1.7: 1. The mean operative time required was 130 minutes and the mean pain scale measured was 3 ± 0.81 on second day .The incidence of intraoperative and early postoperative complication was 5.26 % and 10.52 % respectively. The mean length of hospital stay was 8 days. Average follow up duration was 12 months. Conclusion: It is viable and safe option with shorter operative time and length of stay. It can be performed successfully with minimal morbidity and no mortality. However extreme care and skill is required to identify anatomy and handling of stapler. Keywords: Laparoscopy; Stapler Gastrojejunostomy; Vagotomy; Endoscopy.

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