Natyvinės nefrektomijos, atliktos rengiant pacientus inkstų transplantacijai, rezultatai

TikslasNustatyti natyvinės nefrektomijos, atliktos rengiant pacientus inkstų transplantacijai, efektyvumą.Ligoniai ir metodaiRetrospektyviai išanalizuoti 49 pacientai, kuriems inkstų ligų baigčių stadijoje nuo 1999 iki 2009 metų atliktos natyvinės nefrektomijos rengiant recipientus inkstų transplantacijai. Pacientų vidutinis amžius 44,9 metų. Nefrektomijos atliktos dėl inkstų policistozės 23 (46,9 %), inkstų akmenligės – 13 (26,6 %), obstrukcinės nefropatijos – 8 (16,3 %), kitų priežasčių – 5 (10,2 %) pacientams. Vienmomentė abipusė nefrektomija atlikta 24 ligoniams. Tyrimo metu natyvinių nefrektomijų efektyvumas vertintas analizuojant intraoperacines, artimąsias pooperacines, arterioveninių jungčių komplikacijas bei išnagrinėjus inkstų transplantacijos atlikimo dažnį bei neatlikimo priežastis iki 2012 metų.RezultataiIntraoperacinės komplikacijos nustatytos 3 (5,4 %) pacientams. Pooperacinės komplikacijos diagnozuotos 8 (14,3 %) atvejais ir dažniausia komplikacija buvo pooperacinis kraujavimas. Mirė 3 (6,12 %) pacientai. Analizuojant šių komplikacijų priežastis paaiškėjo perireninės fibrozės, išsivysčiusios po buvusių chirurginių manipuliacijų bei dėl šlapimo takų infekcijos, lemiamas vaidmuo. Hemodializių procedūros komplikavosi 9 (18,4 %) pacientams įvykus arterioveninės jungties trombozei. Atlikus natyvinę nefrektomiją recipientais išliko 46 pacientai ir iš jų 28 (60,9 %) atlikta inkstų transplantacijos operacija.IšvadosNatyvinių inkstų šalinimo operacijos rengiant recipientus inkstų transplantacijai yra susijusios su intraoperacinių (5,4 %), ankstyvų pooperacinių komplikacijų (14,3 %), artrioveninių jungčių trombozės (18,4 %) rizika. Atliekant natyvines nefrektomijas, pagrindinis tikslas – paruošimas inksto transplantacijai – buvo pasiektas 69,6 %: transplantacija atlikta 60,9% pacientų, o 8,7 % pacientų išlieka aktyviame inksto transplantacijos laukimo sąraše.Reikšminiai žodžiai: ikitransplantacinė nefrektomija, inkstų policistozė, arterioveninė jungtis, inkstų transplantacijaResults of native nephrectomy before planned renal transplantation ObjectiveThe goal of this paper is to establish the efficiency of pretransplant native nephrectomies performed in the patients being prepared for renal transplantation.Patients and methodsA retrospective study has been performed with 49 patients who had native nephrectomies in the period 1999–2009. The average age of the patients was 44.9 years. Nephrectomies were performed in 23 patients (46.9%) due to a polycystic kidneydisease, in 13 patients (26.6%) due to a kidney stone disease, in 8 patients (16.3%) due to an obstructive nephropathy, and in 5 patients (10.2%) for other reasons. Simultaneous bilateral nephrectomy was performed in 24 patients. The effectiveness was evaluated by analysing intraoperatve postoperative complications of native nephrectomies, complications of haemodialysis assess, and the rate of kidney transplantations before the year 2012 was assessed.ResultsIntraoperative complications were diagnosed in 3 patients (5.4%) and postoperative complications in 8 (14.3%) cases. The most common complication was postoperative bleeding. Perirenal fibrosis was the most common cause of these complications.Nine patients (18.4%) had a thrombosis of the arteriovenous fistula. After pre-transplant native nephrectomies, 28 patients (60.9%) underwent the renal transplantation surgery.ConculusionsPretransplant native nephrectomies associated with intraoperative complications occurred in 5.4%, postoperative complications in 14.3%, and thrombosis of arteriovenous fistula in 18.4% of cases. When performing native nephrectomies, the maingoal – preparation for renal transplantation – was reached in 69.6% : 60.9% of patients had a transplantation, whereas 8.7% of patients remained on the active list of those waiting for renal transplantation.Key words: pretransplant nephrectomy, renal polycystosis, haemodialysis assessment, renal transplantation

Download Full-text

Dializuojamų ligonių šlapimo takų ligų chirurginis gydymas

Lietuvos chirurgija ◽

10.15388/lietchirur.2005.4.2296 ◽

2005 ◽

Vol 3 (4) ◽

pp. 0-0

Author(s):

Henrikas Ramonas ◽

Asta Kantaravičienė ◽

Audrius Rimas

Keyword(s):

Renal Failure ◽

Urinary Tract ◽

Surgical Treatment ◽

High Risk ◽

Postoperative Complications ◽

Obstructive Uropathy ◽

Intraoperative Complications ◽

Postoperative Bleeding ◽

Dialysis Access ◽

Infravesical Obstruction

Henrikas Ramonas, Asta Kantaravičienė, Audrius RimasVilniaus universiteto, Gastroenterologijos, nefrologijos,urologijos ir pilvo chirurgijos klinika,Vilniaus universiteto ligoninės Santariškių klinikosNefrologijos ir urologijos centras, 1 nefrourologijos skyrius,Santariškių g. 2, LT-08661, VilniusEl paštas: [email protected] Tikslas Nustatyti šlapimo takų ligų chirurginio gydymo rezultatus ligoniams, kuriems atliekamos hemodializės, ir operacinio gydymo įtaką hemodializės procedūroms. Ligoniai ir metodai Išanalizuoti chirurginio gydymo rezultatai 69 ligonių, kurie nuo 1999 iki 2004 metų operuoti ir gydyti hemodializėmis nuo ūminio inkstų nepakankamumo ir esant galutinei nepakankamumo stadijai. Vidutinis amžius – 57,07 ± 1,9 metų. Operuota dėl šių priežasčių: inkstų akmenligės – 26 (37,7%) ligoniai, inkstų policistozės – 7 (10,2%), obstrukcinės uropatijos – 13 (18,8%), infravezikinės obstrukcijos – 10 (14,5%), inksto vėžio – 5 (7,2%), dėl kitų priežasčių – 8 (11,6%) ligoniai. Dažniausiai atlikta nefrektomija – 46 (66,7%) pacientams, abipusė nefrektomija – vienuolikai. Rezultatai Intraoperacinių komplikacijų ir operavimo sunkumų buvo 21 (31,43%) pacientui. Pooperacinės komplikacijos diagnozuotos 14 (20,9%) ligonių. Pagrindinė komplikacija – pooperacinis kraujavimas. Mirė 5 (7,25%) ligoniai, trys iš jų – po abipusės nefrektomijos, pagrindinė mirties priežastis buvo pooperacinis kraujavimas. Analizuojant šiuos atvejus įsitikinta, kad operuojant per laparotominį pjūvį ir negalint gerai apriboti nefrektomijos zonos, komplikuotų operacijų atvejais sunkiai kontroliuojamas kraujavimas buvo pagrindinė mirties priežastis. Skubiosios hemodializės sėkmingiausiai integruotos su obstrukcinės uropatijos chirurginiu gydymu. Hemodializės procedūros komplikavosi 13 (18,84%) ligonių. Dažniausia komplikacija – arterinės-veninės jungties trombozė. Išvados Šlapimo takų ligų chirurginis gydymas ligoniams, kuriems lygia greta atliekamos hemodializės, susijęs su didele intraoperacinių, pooperacinių ir arterinių-veninių jungčių komplikacijų, dažniausiai okliuzinių, rizika. Jei šlapimo takų ligos komplikuotos, abipusės nefrektomijos nerekomenduojamos dėl didelės, sunkiai kontroliuojamo pooperacinio kraujavimo rizikos. Reikšminiai žodžiai: hemodializė, inkstų nepakankamumas, nefrektomija, obstrukcinė uropatija, infravezikinė obstrukcija Surgical treatment of urinary tract in haemodialysed patients Henrikas Ramonas, Asta Kantaravičienė, Audrius RimasVilnius University, Clinic of Gastroenterology, Urology andAbdominal Surgery, Center of Nephrology and Urology,Vilnius University Hospital "Santariškių klinikos",Vilnius, Santariškių str. 2, LT-08661, LithuaniaE-mail: [email protected] Background / objective To evaluate outcomes of urinary tract surgery in haemodialysed patients and determine the influence of surgery on haemodialysis procedures. Patients and methods We analysed results of urinary tract surgery in 69 patients with end stage renal impairment and acute renal failure in the period from 1999 till 2004. The mean age of patients was 57.07 ± 1.9 years. Operations were performed due to nephrolithiasis in 26 (37.7%) cases, polycystic kidneys in 7 (10.2%), obstructive uropathy in 13 (18.8%), infravesical obstruction 10 (14.5%), renal carcinoma 5 (7.2%), other causes in 8 (11.6%) cases. More frequently nephrectomy was done (in 46, or 66.67% of patients), and bilateral nephrectomy was performed in 11 cases. Results Intraoperative complications and surgery difficulties were defined in 21 (30.43%) patients. Postoperative complications were diagnosed in 14 (20,29%) cases, and the main complication was postoperative bleeding. Five (7.25%) patients died. Three patients died after bilateral nephrectomies, and the main cause of death was postoperative bleeding. Analysis of these cases showed that the laparotomic aproach and absence of the posibillity to isolate the renal area during complicated nephrectomies was the main cause of poorely controlled bleeding after operation. The urgent heamodialysis procedures were more successfully integrated with the surgical treatment of obstructive uropathy. Haemodialysis procedures were complicated in 13 (18.84%) patients. The common complication was thrombosis of arteriovenal dialysis access. Conclusions Urinary tract surgery in haemodialysis patients influences the high risk of intraoperative and postoperative complications, arteriovenal occlusive complications. Bilateral nephrectomies in complicated urinary tract diseases are not recommended due to a high risk of poorely controlled postoperative bleeding. Keywords: haemodialysis, renal failure, nephrectomy, obstructive uropathy, infravesical obstruction

Download Full-text

Postoperative rendezvous endoscopic retrograde cholangiopancreaticography as an option in the management of choledocholithiasis

Surgical Endoscopy ◽

10.1007/s00464-019-07272-1 ◽

2019 ◽

Vol 34 (11) ◽

pp. 4883-4889 ◽

Cited By ~ 2

Author(s):

Eva-Lena Syrén ◽

Gabriel Sandblom ◽

Staffan Eriksson ◽

Arne Eklund ◽

Bengt Isaksson ◽

...

Keyword(s):

Postoperative Complications ◽

Intraoperative Complications ◽

Postoperative Bleeding ◽

Bile Leakage ◽

Endoscopic Retrograde ◽

Endoscopic Retrograde Cholangiopancreaticography ◽

Referral Hospitals ◽

Feasible Alternative ◽

Intraoperative Ercp ◽

Over Time

Abstract Background Rendezvous endoscopic retrograde cholangiopancreaticography (ERCP) is a well-established method for treatment of choledocholithiasis. The primary aim of this study was to determine how different techniques for management of common bile duct stone (CBDS) clearance in patients undergoing cholecystectomy have changed over time at tertiary referral hospitals (TRH) and county/community hospitals (CH). The secondary aim was to see if postoperative rendezvous ERCP is a safe, effective and feasible alternative to intraoperative rendezvous ERCP in the management of CBDS. Methods Data were retrieved from the Swedish registry for cholecystectomy and ERCP (GallRiks) 2006–2016. All cholecystectomies, where CBDS were found at intraoperative cholangiography, and with complete 30-day follow-up (n = 10,386) were identified. Data concerning intraoperative and postoperative complications, readmission and reoperation within 30 days were retrieved for patients where intraoperative ERCP (n = 2290) and preparation for postoperative ERCP were performed (n = 2283). Results Intraoperative ERCP increased (7.5% 2006; 43.1% 2016) whereas preparation for postoperative ERCP decreased (21.2% 2006; 17.2% 2016) during 2006–2016. CBDS management differed between TRHs and CHs. Complications were higher in the postoperative rendezvous ERCP group: Odds Ratio [OR] 1.69 (95% confidence interval [CI] 1.16–2.45) for intraoperative complications and OR 1.50 (CI 1.29–1.75) for postoperative complications. Intraoperative bleeding OR 2.46 (CI 1.17–5.16), postoperative bile leakage OR 1.89 (CI 1.23–2.90) and postoperative infection with abscess OR 1.55 (CI 1.05–2.29) were higher in the postoperative group. Neither post-ERCP pancreatitis, postoperative bleeding, cholangitis, percutaneous drainage, antibiotic treatment, ICU stay, readmission/reoperation within 30 days nor 30-day mortality differed between groups. Conclusions Techniques for management of CBDS found at cholecystectomy have changed over time and differ between TRH and CH. Rendezvous ERCP is a safe and effective method. Even though intraoperative rendezvous ERCP is the preferred method, postoperative rendezvous ERCP constitutes an acceptable alternative where ERCP resources are lacking or limited.

Download Full-text

Photorefractive keratectomy for correction of myopia: Our one-year experience

Vojnosanitetski pregled ◽

10.2298/vsp1210852r ◽

2012 ◽

Vol 69 (10) ◽

pp. 852-857

Author(s):

Mirko Resan ◽

Miroslav Vukosavljevic ◽

Milorad Milivojevic

Keyword(s):

Visual Acuity ◽

Postoperative Complications ◽

Intraoperative Complications ◽

Mean Value ◽

Ablation Depth ◽

Laser In Situ Keratomileusis ◽

Photorefractive Keratectomy ◽

Corneal Tissue ◽

Surgical Method ◽

A Prospective Study

Background/Aim. Photorefractive keratectomy (PRK), after laser in situ keratomileusis (LASIK), is commonly performed refractive surgical method worldwide. The aim of this study was to examine the effectiveness and safety of PRK in correction of various strengths of myopia and to assess how much corneal tissue is being removed with one diopter sphere (Dsph) correction by using different optical zones (OZ). Methods. A prospective study with a follow-up period of 6 months included 55 patients of which 100 myopic eyes were treated by PRK method (one eye was included in 10 patients). Myopic eyes with a preoperative best corrected visual acuity (BCVA) = 1.0 (20/20) were analysed. In order to assess the effectiveness of PRK operated myopic eyes were divided into four groups according to the dioptric power: 1)? -1.75 Dsph (n = 26); 2) from -2 to -3.75 Dsph (n = 44); 3) from -4 to -6.75 Dsph (n = 23), and 4) ? -7 Dsph (n = 7). Myopic eyes with preoperative BCVA ? 0.9 (amblyopic eyes) were excluded from the study, as well as eyes with astigmatism > -1.5 Dcyl. To assess the effectiveness of PRK we examined the percentage of eyes in the mentioned groups, which derived uncorrected visual acuity (UCVA) 6 months after the intervention to the following: a) UCVA = 1.0 (20/20) and b) UCVA ? 0.5 (20/40). To assess the safety of PRK we examined the frequency of intraoperative and postoperative complications. To estimate how much corneal tissue was removed with one Dsph correction by using different OZ, we used preoperative and postoperative (after 6 months) central pachymetry values expressed in ?m and volume of cornea (central 7 mm) expressed in mm?. In that sense, we used only the myopic eyes with clear preoperative spherical refraction. The total number of these eyes was 27, of which 16 eyes were treated using a 6.5 mm OZ and 11 eyes using a 7 mm OZ. Results. Refractive spherical equivalent (RSE) for all eyes was in the range from -0.75 to -8.75 Dsph, and preoperative mean value of RSE with standard deviation (mean RSE ? SD) was -3.32 ? 1.83 Dsph. Six months after PRK, 91% of eyes had UCVA = 20/20, and 99% of eyes had UCVA ? 20/40. In the first group (? -1.75 Dsph) preoperative mean RSE ? SD was -1.34 ? 0.32 Dsph, six months after PRK, 96% of eyes had UCVA = 20/20, and 100% of eyes had UCVA ? 20/40. In the second group (from -2 to -3.75 Dsph) preoperative mean RSE ? SD was - 2.95 ? 0.57 Dsph, six months after PRK, 89% of eyes had UCVA = 20/20, and 100% of eyes had UCVA ? 20/40. In the third group (from -4 to -6.75 Dsph) preoperative mean RSE ? SD was - 4.93 ? 0.70 Dsph, six months after PRK, 100% of eyes had UCVA = 20/20. In the fourth group (? - 7 Dsph) preoperative mean RSE ? SD was -7.71 ? 0.67 Dsph, six months after PRK, 57% of eyes had UCVA = 20/20, and 86% of eyes had UCVA ? 20/40. There were no intraoperative complications while postoperative complications occurred in 2 patients - in both cases in one eye (2%). In that cases, epithelial defects were detected. In the group of eyes that were treated by 6.5 mm OZ mean RSE ? SD was -2.45 ? 0.99 Dsph, the ablation depth per 1 Dsph was 17.54 ? 5.58 ?m and ablated volume of central 7 mm cornea by 1 Dsph was 0.43 ? 0.18 mm?. In the group of eyes that were treated by 7 mm OZ mean RSE ? SD was -3.32 ? 2.26 Dsph, the ablation depth per 1 Dsph was 23.73 ? 6.91 ?m and ablated volume of central 7 mm cornea by 1 Dsph was 0.61 ? 0.31 mm?. Conclusion. PRK is effective and safe refractive surgical method for correcting myopia up to -8 .75 Dsph. OZ size is the main factor determining the depth of the excimer laser ablation of the corneal tissue volume consumed by 1 Dsph. Higher OZ value determines higher consumption of cornea tissue.

Download Full-text

Nineteen Years of Adult Congenital Heart Surgery in a Single Center

World Journal for Pediatric and Congenital Heart Surgery ◽

10.1177/2150135116682454 ◽

2017 ◽

Vol 8 (2) ◽

pp. 182-188

Author(s):

Madurra Perinpanayagam ◽

Signe H. Larsen ◽

Kristian Emmertsen ◽

Marianne B. Møller ◽

Vibeke E. Hjortdal

Keyword(s):

Risk Factors ◽

Congenital Heart Disease ◽

Cardiac Surgery ◽

Heart Disease ◽

Postoperative Complications ◽

Adverse Events ◽

Congenital Heart ◽

Postoperative Bleeding ◽

Registration System ◽

Growing Population

Background: Adults with congenital heart disease are a growing population. We describe surgical interventions, short- and long-term mortality and morbidity, and risk factors for adverse events in a population-based cohort. Methods: Patients over or equal to 18 years with congenital heart disease who underwent cardiac surgery at Aarhus University Hospital, Denmark, from 1994 to 2012 were included in the study. Diagnoses, surgical procedures, postoperative complications, and survival were identified in hospital databases, medical records, and the Danish Civil Registration System. Results: Four hundred seventy-four surgeries were performed in 445 adults (50% men). The median age was 39 years (range 18-83). Thirty-nine percent had previous surgical or catheter-based interventions. Thirty-day and in-hospital mortality were 1.1%. Postoperative complications occurred in 50% of cases, most were minor such as temporary arrhythmias and pneumonia. Major complications included postoperative bleeding necessitating intervention (6%), stroke (2%), and acute temporary renal failure (1%). Multivariate analysis identified RACHS-1 categories over or equal to 3 compared to category 1 (odds ratio (OR) = 2.3; 95% confidence interval (CI): 1.5-3.7), New York Heart Association functional class III and IV compared to class I (OR = 2.2; 95% CI: 1.3-3.7) and age at surgery (OR = 1.03, 95% CI: 1.01-1.04), as risk factors for adverse events. Survival during a median follow-up of 7.8 years (range 0 days-21.4 years) was 85% (95% CI: 80%-89%). Conclusion: Adults with congenital heart disease constitute a growing population with the need for cardiac surgery. Postoperative complications are frequent but early and late mortality are low.

Download Full-text

A modified ileal conduit technique in patients undergoing radical cystectomy: Single-centre experience

Journal of Clinical Urology ◽

10.1177/20514158211041483 ◽

2021 ◽

pp. 205141582110414

Author(s):

Francesco Chiancone ◽

Francesco Persico ◽

Marco Fabiano ◽

Maurizio Fedelini ◽

Clemente Meccariello ◽

...

Keyword(s):

Bladder Cancer ◽

Postoperative Complications ◽

Blood Loss ◽

Radical Cystectomy ◽

Ileal Conduit ◽

Intraoperative Complications ◽

Perioperative Outcomes ◽

Multivariate Logistic Regression Model ◽

Increased Risk

Objective: We aimed to evaluate perioperative outcomes and complications of a modified technique of ileal conduit diversion. Methods: Forty-seven cases of radical cystectomy with modified ileal conduit diversion were performed at our institution from January 2015 to January 2020. After radical cystectomy, a segment of ileum was used to pack the conduit and was placed below the digestive anastomosis. Then, the mesentery window of the ileo-ileal anastomosis was sutured. The ureters were anastomosed on their native side on single loop ureteral stents. All procedures were performed by a single surgical team. Intra- and postoperative complications were classified and reported according to the Satava and Clavien–Dindo grading systems. Results: The mean age of population was 66.40±10.14 years, and 76.6% were male. Concomitant diabetes was found in 31.9% of patients. About three quarters of patients had T2G3 bladder cancer. Mean blood loss was 449.36±246.50 ml, and hospitalization was 10.32±5 days. With a mean follow-up of 17.36±12.63 months, the recurrence rate was 17%, and 14.9% of patients died of bladder cancer. Out of the 47 patients, three (4.3%) experienced intraoperative complications, while 15 (31.9%) had postoperative complications. Of these, only three patients experienced Clavien–Dindo complications ⩾grade 3. Multivariate logistic regression model showed that diabetes ( p=0.023) and higher blood loss ( p=0.010) were significantly associated with an increased risk of postoperative complications. We reported one case of ureterointestinal anastomosis stenosis on the left side and none on the right side. Despite our results being promising, larger randomized trials with longer follow-up are needed to explore further the feasibility of this technique on a larger scale. Conclusion: We describe a safe and simple surgical technique with a similar postoperative complications rate and a lower incidence of ureteroileal anastomosis stenosis compared to the standard technique. Level of evidence 4.

Download Full-text

Deceased Donor Renal Transplantation Combined with Bilateral Nephrectomy in a Patient with Tuberous Sclerosis and Renal Failure

Case Reports in Transplantation ◽

10.1155/2019/2172163 ◽

2019 ◽

Vol 2019 ◽

pp. 1-5

Author(s):

R. Novotny ◽

J. Chlupac ◽

T. Marada ◽

S. Bloudickova-Rajnochova ◽

H. Vavrinova ◽

...

Keyword(s):

Renal Transplantation ◽

Tuberous Sclerosis ◽

Kidney Transplant ◽

Graft Function ◽

Waiting List ◽

Definitive Treatment ◽

Kidney Graft ◽

Bilateral Nephrectomy ◽

Midline Laparotomy ◽

The Right

Introduction. A 27-year-old female patient with known tuberous sclerosis complex (TSC), polycystic kidneys with multiple large bilateral angiomyolipomas, and failing renal functions with prehemodialysis values (urea: 19 mmol/L; creatinine: 317 μmol/L; CKD-EPI 0,27) was admitted to our department for pre-renal transplant evaluation. The patient was placed on the transplant waiting list as the living donor did not pass pretransplant workup and was subsequently contraindicated. Patient was placed on the “cadaverous kidney transplant waiting list”. Method. Computed tomography angiography revealed symptomatic PSA in the right kidney angiomyolipoma (AML). The patient underwent urgent transarterial embolisation of the PSA’s feeding vessel in the right kidney AML. Based on the “kidney transplant waiting list” order patient underwent a bilateral nephrectomy combined with transperitoneal renal allotransplantation of a cadaverous kidney graft through midline laparotomy, appendectomy, and cholecystectomy. Results. Postoperative period was complicated by delayed graft function caused by acute tubular necrosis requiring postoperative hemodialysis. The patient was discharged on the 17th postoperative day with a good renal graft function. Patient’s follow-up is currently 23 months with good graft function (urea: 9 mmol/L; creatinine: 100 μmol/L). Conclusion. Renal transplantation combined with radical nephrectomy provides a definitive treatment for TSC renal manifestations.

Download Full-text

Postoperative treatment compliance rate and complications with two different protocols after pterygium excision and conjunctival autografting

European Journal of Ophthalmology ◽

10.1177/1120672120917335 ◽

2020 ◽

pp. 112067212091733

Author(s):

Noelia Sabater-Cruz ◽

Marina Dotti-Boada ◽

José Rios ◽

Maria Teresa Carrion ◽

Lillian Chamorro ◽

...

Keyword(s):

Postoperative Complications ◽

Ocular Hypertension ◽

Intraoperative Complications ◽

Compliance Rate ◽

Treatment Compliance ◽

Postoperative Treatment ◽

First Year ◽

Topical Steroids ◽

Pterygium Excision ◽

Conjunctival Autografting

Aim: To evaluate compliance rate to pterygium postoperative treatment with two different protocols. Methods: Review of clinical data of patients submitted to pterygium excision and conjunctival autografting in a single centre (and a single surgeon) in Barcelona between March 2014 and December 2017. Initial postoperative protocol (protocol 1) consisted of 4 months of topical steroids in a tapering fashion. Protocol 2 consisted of topical steroids tapered over 5 weeks. Compliance rate, complications and clinical outcomes were evaluated, and statistical comparisons were made. Results: 120 surgeries were performed in 99 patients. Protocol 1 was applied in 63 cases and the next 57 followed protocol 2. Compliance with protocol 1 (57.6%) was lower than with protocol 2 (84.9%) (p = 0.002). Intraoperative complications (graft tear, corneal thinning, corneal perforation and bleeding) were found in 10 cases of protocol 1 and three cases of protocol 2, p = 0.08. Postoperative complications (graft dislocation, graft haematoma, ocular hypertension and recurrence) were found in 31 cases of protocol 1 (46.2%) and eight cases of protocol 2 (14%), p = 0.001. Six weeks after surgery, ocular hypertension was detected in eight cases corresponding to protocol 1 (13.6%) and two cases of protocol 2 (3.8%), p = 0.099. Recurrence rate during first year was higher in protocol 1 (26.3%) compared to protocol 2 (7.6%), p = 0.011. No cases of visual acuity worsening or infection were registered. Conclusion: Protocol 2 has shown to have higher compliance rate than protocol 1 and less postoperative complications, proving to be a safe and effective postoperative treatment after pterygium surgery.

Download Full-text

A Prospective Clinical Evaluation of the Effects of Intraoperative Systemic Anticoagulation in Patients Undergoing Arteriovenous Fistula Surgery

The American Surgeon ◽

10.1177/000313481007601020 ◽

2010 ◽

Vol 76 (10) ◽

pp. 1112-1114 ◽

Cited By ~ 5

Author(s):

Bonnie R. Wang ◽

Vincent L. Rowe ◽

Sung Wan Ham ◽

Sukgu Han ◽

Kaushal Patel ◽

...

Keyword(s):

Arteriovenous Fistula ◽

Postoperative Bleeding ◽

Bleeding Complications ◽

Controlled Study ◽

Control Group ◽

Heparin Group ◽

Av Fistula ◽

Fistula Surgery ◽

Significant Difference ◽

The Difference

No standard presently exists for the use of systemic heparin during angioaccess surgery to decrease the incidence of postoperative thrombotic complications. Our objective was to study the effects of intraoperatively administered heparin on 30-day patency and postoperative bleeding complications in patients undergoing autogenous arteriovenous (AV) fistula surgery. A prospective, double-blinded, randomized controlled study was performed on 48 patients undergoing AV fistula creation from April 2007 through November 2009. Of the 48 patients, 22 were randomized to the control group and received no heparin. Twenty-six were randomized to receive heparin (75 units/kg intravenously) before clamping of the artery. There was no significant difference in 30-day patency between the heparin and control groups (92% vs 86%, P = 0.65), respectively. Three patients (12%) developed hematomas in the heparin group compared with one (5%) in the control group; however the difference was not statistically significant ( P = 0.61). The results suggest that intraoperative administration of heparin has no statistically significant effect on 30-day patency rates or postoperative bleeding complications. Larger trials with longer term follow-up and assessment of maturation rates are needed to determine the effect of intraoperative anticoagulation on these outcomes of arteriovenous fistula surgery.

Download Full-text

Factors Affecting Length of Stay Following 3-Column Spinal Osteotomies in Pediatric Patients

Global Spine Journal ◽

10.1177/2192568219895225 ◽

2019 ◽

pp. 219256821989522

Author(s):

So Kato ◽

Taylor Dear ◽

Stephen J. Lewis

Keyword(s):

Body Weight ◽

Postoperative Complications ◽

Length Of Stay ◽

Pediatric Patients ◽

Perioperative Complications ◽

Intraoperative Complications ◽

Operation Time ◽

Fluid Administration ◽

Prolonged Stay ◽

Factors Affecting

Study Design: A retrospective analysis. Objectives: Length of stay (LOS) is one of the important indicators for the quality of patient care. Although perioperative complications are known to be associated with longer LOS in general, little has been understood regarding LOS after 3-column spinal osteotomy for the rigid spinal deformity in pediatric population. The main objective of the article is to identify factors affecting the LOS in pediatric patients undergoing 3-column posterior spinal osteotomies. Methods: Following research ethics approval, a retrospective review was performed of 35 consecutive posterior 3-column spinal osteotomies performed on pediatric patients in a single academic institution. Patients’ demographic data, preoperative comorbidities, details of operative procedures, intraoperative complications, and postoperative complications were investigated, and LOS was compared among the groups. Results: The mean LOS was 9.0 days, and the median LOS was 7 days (range = 4-23 days). Low body weight and syndromic deformity were associated with longer LOS. Operation time ≥6 hours and total perioperative fluid administration greater than or equal to twice the estimated blood volume were associated with longer LOS. Among postoperative complications, those with respiratory complication had prolonged stay. Conclusions: Preoperative low body weight and syndromic scoliosis had longer LOS after 3-column osteotomies. Excessive fluid administration and respiratory complications were associated with longer LOS.

Download Full-text

In-hospital and mid-term outcomes in patients reoperated on due to bleeding following coronary artery surgery (from the KROK Registry)

Interactive CardioVascular and Thoracic Surgery ◽

10.1093/icvts/ivz089 ◽

2019 ◽

Vol 29 (2) ◽

pp. 237-243 ◽

Cited By ~ 2

Author(s):

Piotr Knapik ◽

Małgorzata Knapik ◽

Michał O Zembala ◽

Piotr Przybyłowski ◽

Paweł Nadziakiewicz ◽

...

Keyword(s):

Coronary Artery ◽

Postoperative Complications ◽

Hospital Mortality ◽

Hospital Discharge ◽

Postoperative Bleeding ◽

Low Risk ◽

Coronary Surgery ◽

Coronary Artery Surgery ◽

Starting Point ◽

Risk Patients

Abstract OBJECTIVES Surgical re-exploration due to postoperative bleeding that follows coronary artery surgery is associated with significant morbidity and mortality. The aim of this study was to assess a relationship between re-exploration, major postoperative complications, in-hospital mortality and mid-term outcomes in patients following coronary surgery, on the basis of nationwide registry data. METHODS We identified all consecutive patients enrolled in Polish National Registry of Cardiac Surgical Procedures (KROK Registry) who underwent isolated coronary surgery between January 2012 and December 2014. Preoperative data, major postoperative complications, hospital mortality and mid-term all-cause mortality were, respectively, analysed. Comparisons were performed in all patients, low-risk patients (EuroSCORE II < 2%, males, aged 60–70 years) and propensity-matched patients. The starting point for follow-up was the date of hospital discharge. RESULTS Among 41 353 analysed patients, 1406 (3.4%) underwent re-exploration. Reoperated patients had more comorbidities, more frequent major postoperative complications, higher in-hospital mortality (13.2% vs 1.8%, P < 0.001) and higher mid-term mortality in survivors (P < 0.001). In the low-risk population, 3.0% of patients underwent re-exploration. Reoperated low-risk patients and propensity-matched patients also had more frequent major postoperative complications and higher in-hospital mortality, but mid-term mortality in survivors was similar. In a multivariable analysis, re-exploration was an independent predictor of death and all major postoperative complications. CONCLUSIONS Surgical re-exploration due to postoperative bleeding following coronary artery surgery carries a high risk of perioperative mortality and is linked to major postoperative complications. Among patients who survive to hospital discharge, mid-term mortality is associated primarily with preoperative comorbidities.

Download Full-text