Retroperitoneal laparoscopic adrenalectomy: its role in the management of adrenal tumour and tertiary care centre experience

Background: Laparoscopic adrenalectomy for adrenal tumour has gained increased popularity worldwide. To decrease the complications of commonly used transperitoneal approach, by not entering into peritoneal cavity the retroperitoneal laparoscopic adrenalectomy (RLA) has developed. It has several advantages over the transperitoneal approach and associated with reduced morbidity and excellent outcome. The objective of this study was to report our experience with RLA for treatment of adrenal tumour.Methods: The study was done from August 2014 and December 2017, data of 44 patients who underwent RLA for adrenal tumour in the institute were retrospectively reviewed. Patient’s demographical, clinical, diagnostic and procedural data were recorded. All patients were assessed by history, physical examinations, laboratory values with biochemical marker test and imaging by computed tomography/magnetic resonance imaging. Treatment outcome was assessed in terms of operative time, haemoglobin drop, conversion rate, hospital stay and complications.Results: In 44 adrenalectomy, 24 men and 20 women, with a mean age of 47.0±8.9 years were enrolled. Mean body mass index was 23.5±2.2 kg/m2. Right adrenal tumour was seen in 26 cases and left in 18 cases. Mean adrenal mass size was 2.6±0.85 cm. Mean operative time was 109.1±21.16 minutes, mean haemoglobin drop was 0.47±0.26 gram/L. Conversion to open surgery was necessary in 2 patients. Mean postoperative hospital stay was 4.0±0.91 days. Recovery time mean value was 12.18±1.7 days postoperatively. In final histopathology result adenoma was most prevalent (25 cases) and myelolipoma was least (1 case). Conclusions: RLA appears to be safe and effective alternative to transperitoneal adrenalectomy for moderate size adrenal tumour in particular less than 6 cm. It is associated with less blood loss, shorter hospitalization, low conversion rate, fewer complications and early recovery. RLA offers an alternative method for treating adrenal tumour with improved surgical outcomes.

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Mini percutaneous nephrolithotomy: its role in the management of renal stone and our tertiary care centre experience

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20200246 ◽

2020 ◽

Vol 8 (2) ◽

pp. 624

Author(s):

Avinash Pratap Singh Thakur ◽

Darsan S.

Keyword(s):

Hospital Stay ◽

Percutaneous Nephrolithotomy ◽

Renal Stone ◽

Operative Time ◽

Tertiary Care ◽

Renal Calculi ◽

Medium Size ◽

Tertiary Care Centre ◽

Excellent Outcome ◽

Stone Fragmentation

Background: Miniaturized percutaneous nephrolithotomy (PCNL) procedures for urolithiasis have gained increased popularity in recent years. To decrease the complications of conventional PCNL by reduced tract size led to the development of Mini PCNL, which makes the use of 15-18F sheaths in place of 24-30F of conventional PCNL. It has developed rapidly and become a popular technique of renal stone management with reduced morbidity and excellent outcome. Authors report our experience with Mini PCNL for the treatment of renal stone.Methods: In between his August 2015 and January 2018, sixty patients with the diagnosis of unilateral single medium size (8-20mm) renal stone were identified. Patient’s demographical, clinical, diagnostic and procedural data were recorded. All patients were evaluated by history taking, physical examination and laboratory investigations. Radiological evaluation was done with X ray kidney, ureter and bladder region (KUB) and also with renal ultrasonography followed by computed tomography (CT). All patients underwent Mini PCNL using 12F nephroscope and 16.5/17.5F sheath. Holmium: YAG laser was used for stone fragmentation. No nephrostomy tube was used routinely. Treatment outcome was assessed in terms of operative time, haemoglobin drop, hospital stay and stone free rate.Results: Complete stone fragmentation was achieved in 41 out of 60 patients using Mini PCNL, so initial stone free rate was 68.3%. After 4 weeks of surgery total 53 patients were stone free (88.3%), 5 patients required some auxiliary procedure for complete clearance of stone and other 2 were managed conservatively. The mean operative time was 48.28 min, mean haemoglobin drop was 0.74gm/l and mean postoperative hospital stay was 54.22 hours. After 12 weeks postoperatively all patients were stone free. There were no significant postoperative complications, and all had good quality of life.Conclusion: Mini PCNL technique appears to be safe and effective alternative to conventional PCNL for moderate size renal calculi. It is usually related to less blood loss and shorter hospital stay than the standard method. It can achieve good stone-free rates with minimal complications and low morbidity. Mini PCNL can also be considered as a good alternative to retrograde intrarenal surgery and shockwave lithotripsy in selected cases. However, further high quality studies with larger sample size are required in future.

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Retrograde Intrarenal surgery- Our experience

Academia Journal of Surgery ◽

10.47008/ajs/2020.3.1.19 ◽

2020 ◽

Vol 3 (1) ◽

pp. 88-92

Author(s):

Nand Kumar B. Madhekar ◽

A. Nischal Prasad

Keyword(s):

Hospital Stay ◽

Operative Time ◽

Tertiary Care ◽

Renal Stones ◽

Tertiary Care Centre ◽

Renal Surgery ◽

Retrograde Intrarenal Surgery ◽

Residual Stone ◽

Stone Clearance ◽

Residual Stones

Background: RIRS has become an important treatment option for kidney stones in pediatric patients with the development of new-generation ureteroscopy and holmium laser. The present study was conducted to assess cases of retrograde intrarenal surgery. Subjects and Methods: The present study was conducted in a tertiary care centre over a period of one year on 120 cases of retrograde intra renal surgery (RIRS) performed in both genders. Renal stone location and stone clearance, laterality, stone size, operative time, hematuria, postoperative pain & fever, urosepsis, hospital stay, residual stones and need of an adjunctive procedure to achieve residual stone clearance. Results: Out of 120 patients, males were 70 and females were 50. Stones were detected in upper calyx in 50 cases, middle calyx in 40, lower calyx in 20 and pelvis in 10 cases. The mean size of stones was 8.1 mm, operative time was 62.1 minutes, hospital stay was 3.6 days, clinically insignificant radiological fragments were seen in 35 cases and residual stones were seen in 20 cases. Maximum cases of CIRF were seen in middle calyx (15) and residual stones were seen in lower calyx (7). The difference was significant (P< 0.05). Common complications were fever in 7, hematuria in 3, flank pain in 4 and urosepsis in 2 cases. Conclusion: Authors found that retrograde intrarenal surgery is a technically safe and effective procedure for the treatment of renal stones.

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Laparoscopic management of adnexal masses in admitted patients at tertiary care centre, Bhilai, Chhattisgarh, India

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20212965 ◽

2021 ◽

Vol 10 (8) ◽

pp. 3119

Author(s):

Meena Naik ◽

Pooja Singh ◽

Rekha Ratnani

Keyword(s):

Hospital Stay ◽

Ovarian Cyst ◽

Adnexal Mass ◽

Tertiary Care ◽

Medical Science ◽

Tertiary Care Centre ◽

Early Recovery ◽

Adnexal Masses ◽

Laparoscopic Management ◽

One Year

Background: Laparoscopy is most widely accepted procedure in gynaecological cases both for diagnostic and operative purposes. It is associated with early recovery, shorter hospital stay and significant patient satisfaction. This study has been conducted to evaluate the effectiveness and safety of laparoscopy in the management of adnexal masses. Our Primary aim was to find out indications, intraoperative findings and different interventions to deal with adnexal mass. The objective of the study was to determine laparoscopic management of adnexal mass in all women attending Obstetrics and Gynaecology department, Shanakaracharya Institute of Medical Science, Bhilai, Chhattisgarh.Methods: This is a retrospective record-based observational study conducted over a period of one year from March 2020 to March 2021 after getting approval from the institutional ethical committee. Patients diagnosed with adnexal mass were evaluated and data was collected and analyzed.Results: Of the 130 cases of adnexal mass admitted in the hospital during the period under review, 43 cases (33%) were diagnosed as ovarian cyst among which simple cystic ovarian cyst was found to be most common etiology followed by ectopic pregnancy (41 cases). Majority of cases were managed laparoscopically with a good success rate, better outcome and short hospital stay. Conversion rate to laparotomy was 3.8% mainly seen in cases with complex ovarian mass or dense adhesions.Conclusions: Diagnosis of adnexal mass is important and it may affect females of any age group. Laparoscopy is a better approach to deal with adnexal masses (except malignancy) as it has better paronamic vision with less complications, less post-operative pain, shorter hospital stay. Careful patient selection should also be taken into account. Current study is an overview in favor of laparoscopic management of adnexal mass.

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A comparative study of functional outcome between posterior lumbar fusion and posterior lumbar interbody fusion in spondylolisthesis

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20211608 ◽

2021 ◽

Vol 7 (3) ◽

pp. 544

Author(s):

Harpreet Singh ◽

Dhruv Patel ◽

Sangam Tyagi ◽

Krushna Saoji ◽

Tilak Patel ◽

...

Keyword(s):

Functional Outcome ◽

Interbody Fusion ◽

Operative Time ◽

Lumbar Fusion ◽

Tertiary Care ◽

Posterior Lumbar Interbody Fusion ◽

Invasive Technique ◽

Lumbar Interbody Fusion ◽

Tertiary Care Centre ◽

Posterior Lumbar Fusion

Background: Spondylolisthesis is condition in which one vertebra slips over other vertebra. This study has been done to compare the functional outcome and complications of two techniques: posterior lumbar fusion (intertransverse fusion) and posterior lumbar interbody fusion.Methods: Total 20 patients with spondylolisthesis admitted in a tertiary care centre in Rajasthan were allotted alternatively in posterior lumbar fusion (PLF) group and posterior lumbar interbody fusion (PLIF) group. In PLF, fusion was done by placing bone graft between transverse processes and around facets. In PLIF, fusion was bone by placing cage in between vertebral bodies.Results: 20 patients were included in our study with female predominance (65%). Mean age was 54.2 years (PLF=58.4 and PLIF=50.2). 70% patients have L4-L5 level spondylolisthesis. Average operative time was less in PLF group, which is statistically significant. Functional outcome was measured by using visual analogue scale (VAS) score and Japanese orthopedics association score (JOAS) at 3 weeks, 3 months and 6 months. There is a significant decrease between preoperative VAS and at 6 months, in both PLF and PLIF group. JOAS was significantly increased at 6 months in both PLF and PLIF group as compared to preoperative score. But difference in JOAS at 6 months is not significant between PLF and PLIF.Conclusions: Both PLF and PLIF are equally effective for spondylolisthesis. Both techniques have same satisfactory results. As PLIF is more invasive technique, more operative time and more complications are seen.

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CLINICAL PROFILE AND MANAGEMENT OF PATIENTS OF AMOEBIC LIVER ABSCESS IN A TERTIARY CARE CENTRE

10.36106/ijsr/5406508 ◽

2020 ◽

pp. 5-7

Author(s):

Rakesh Mishra ◽

Debabrata Banerjee ◽

Debarshi Jana

Keyword(s):

Drug Treatment ◽

Liver Abscess ◽

Tertiary Care ◽

Clinical Manifestations ◽

Needle Aspiration ◽

Intestinal Disease ◽

Amoebic Liver Abscess ◽

Treatment Modalities ◽

Tertiary Care Centre ◽

Early Recovery

Introduction: Amoebiasis is caused by the protozoan Entamoeba histolytica. Most infections are asymptomatic; clinical manifestations include amoebic dysentery and extra intestinal disease. Amoebic liver abscess is the most common extraintestinal manifestation of amoebiasis. Amoebae establish hepatic infection by ascending the portal venous system. Aim: To study various aspects of Amoebic Liver Abscess like demographic profiles, clinical presentations, association with intestinal disease, radiological and laboratory findings, treatment modalities and complications. Materials and Methods: A hospital based prospective observational study was performed in the Department of Internal Medicine, Command Hospital (Eastern Command), Kolkata, from Jan 2018 to Jun 2019. All confirmed cases of amoebic liver abscess above the age of 18 years admitted in Command Hospital (EC) were included in this study. The patient were then subsequently followed up for 01 year with USG abdomen every 03 monthly. Results: Total 40 patients of Amoebic Liver Abscess with age more than 18 year were enrolled in the study. The age ranged from 26 to 70 years (mean age 46.2 year). Male patients were dominated over female. 80.0 % were from rural background. About 55% patients were addicted to alcohol & 25.0 % were known diabetics at presentation. In all, 07 (17.5%) patients with abscess size of 6 cm to 10 cm (Vol> 300 cc) were treated by needle aspiration and drug therapy. Remaining 17(42.5%) patients with abscess size more than 10 cm were treated with pigtail drainage and drug. Conclusion: There is significant advantage of pigtail drainage with drug treatment over needle aspiration with drug and only with drug treatment in terms of decrease in lesion size and early recovery.

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Accidental Hijab Pin Ingestion: 10 Years Experience from a Tertiary Care Centre

Integrative Gastroenterology and Hepatology ◽

10.18314/igh.v1i1.1178 ◽

2018 ◽

Vol 1 (1) ◽

pp. 54-59

Author(s):

Naim Abu Freha ◽

Muhammad Abu Tailakh ◽

Doron Schwartz ◽

Ohad Etzion ◽

Alex Rosenthal ◽

...

Keyword(s):

Emergency Room ◽

Hospital Stay ◽

Clinical Observation ◽

Tertiary Care ◽

Muslim Women ◽

Tertiary Hospital ◽

Care Centre ◽

Tertiary Care Centre ◽

Duration Of Hospitalization ◽

Time Of Admission

Background and Aim: Hijab pins ingestion is increasing. Some women hold the pin between their teeth while arranging the Hijab and the inadvertent ingestion of the pin can be the result of any careless movements. The aims of our study were to investigate the clinical outcomes of patients who underwent endoscopic pin removal via gastroscopy as opposed to patients who were treated conservatively with clinical observation, and to compare clinical and endoscopic data pertaining to patients who underwent early versus late gastroscopy.Methods: Muslim women hospitalized in a tertiary hospital from 2005-2015 due to ingestion of Hijab pin ingestion were included. Patients who underwent gastroscopy during 12 hours from the time of admission to Emergency Room (ER) were included in the “early” gastroscopy group, while endoscopy performed at a later time defined the “late” gastroscopy group.Results: During the study period 37 women were included. Twenty four patients (65%, mean age 20 ± 8.9) underwent gastroscopy; and thirteen (35%, mean age 19.9 ± 1.6) were hospitalized for observation. Six patients (25%) had normal gastroscopy; by 8 patients (33%) the pin was located in the antrum, 6 (25%) body, 2 (8.3%) and 1 (4.1%) in the duodenum. Fifteen patients underwent early gastroscopy and nine underwent late gastroscopy. The Duration of hospitalization was significantly shorter among patients who underwent early gastroscopy 1-day (1, 1) median, (IQR) compared with 2 days (1, 3) p < 0.02. Severe complications were found in one patient (2.7%) with stomach perforation which required surgery.Conclusion: Most pins will pass spontaneously, however severe complication may arise inadvertent Hijab pin ingestion. Early gastroscopy shortens the hospital stay.

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Determinants of Success in Single- and Multi-Digit Replant

Plastic Surgery ◽

10.1177/22925503211024767 ◽

2021 ◽

pp. 229255032110247

Author(s):

Zach Zhang ◽

Peter Credico ◽

Sean Bristol ◽

Sheina Macadam

Keyword(s):

Acetylsalicylic Acid ◽

Success Rate ◽

Operative Time ◽

Clinical Decision Making ◽

Tertiary Care ◽

Predictors Of Success ◽

Tertiary Care Centre ◽

Single Digit ◽

Operative Care ◽

Digital Replantation

Purpose: Understanding the variables that influence success in digital replant surgery is essential to guide clinical decision-making and to counsel patients. The purpose of this study was to determine the replant success rate and identify predictors of success at our tertiary care centre. Methods: This was a single centre, retrospective cohort study of consecutive patients who underwent digital replantation from January 2000 to September 2018. Adult patients with flexor zone I to III amputations were included. Patient demographics, comorbidities, injury pattern, operative data, and post-operative care were reviewed. The primary outcome was survival of the replanted digit at discharge. Results: A total of 146 patients met inclusion criteria. Of these, 100 had single-digit replants and 46 underwent multi-digit replants for a total of 220 digits. The success rate was 71%. Predictors of success included sharp mechanism of injury (P < .01), incomplete amputation (P < .01), amputation proximal to zone I flexor level (P = .02), post-operative acetylsalicylic acid use (P < .01), absence of leech use (P = .05), and absence of operative re-exploration (P < .01). Daytime replants had similar outcome compared to nighttime replants despite having increased ischemia time (7.9 ± 3.9 hours vs 6.8 ± 2.6 hours, P = .02). However, daytime operative time (7.8 ± 3.7 hours) was significantly shorter than nighttime replant time (9.6 ± 5.9 hours, P = .01). Conclusion: Sharp amputation, intact venous drainage, proximal amputation, and acetylsalicylic acid use were associated with replant survival and are factors to consider when managing patients for digital replantation. Leech therapy and operative re-exploration were associated with poor outcome. Nighttime replants required significantly longer operative time than daytime replants despite similar survival outcome.

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CLINICAL EVALUATION OF LAPAROSCOPIC CHOLECYSTECTOMY WITH REFERENCE TO CONVERSION RATE AND COMPLICATIONS- OUR EXPERIENCE IN A TERTIARY CARE CENTRE OF EASTERN INDIA

10.36106/ijsr/7609683 ◽

2020 ◽

pp. 7-10

Author(s):

Swapnil Sen ◽

Sandeep Kumar

Keyword(s):

Laparoscopic Cholecystectomy ◽

Conversion Rate ◽

Gallstone Disease ◽

Tertiary Care ◽

Gall Stone ◽

Injury Rate ◽

Large Series ◽

Care Centre ◽

Eastern India ◽

Tertiary Care Centre

Cholelithiasis is one of the most common surgical conditions requiring intervention worldwide. Since its introduction nearly four decades ago, laparoscopic cholecystectomy has become the gold standard of treatment for gallstone disease AIM: To critically evaluate our experience of laparoscopic cholecystectomy in a tertiary care centre of eastern India. MATERIALS AND METHODS: Hospital based observational study on 180 patients subjected to elective laparoscopic cholecystectomy with features of gall stone disease and meeting the inclusion and exclusion criteria. RESULTS: Our conversion rate of 10% is somewhat higher than that reported in any other series. This probably reflects that few of our surgeons are in their early learning curve. This can be reduced with the experience of the surgeons. A bile duct injury rate of 0.5% compares favourably with an incidence of 0-1% in several large series. Overall complication rate of 5.5% also compares favourably with an incidence of 1.6-8.6% in several large series. CONCLUSION: Laparoscopic cholecystectomy when performed in properly selected patients is very much effective in the treatment of symptomatic cholelithiasis – in terms of earlier return of bowel function, less postoperative pain, improved cosmesis, shorter length of hospital stay, earlier return of full activity and decreased overall cost. It is vital for the surgeons and patients to understand that conversion to open surgery is not failure; in fact, it implies a safe approach and a sound surgical judgment. The conversion rate is low with experienced surgeons indicating direct relationship between experience and conversion. It should be stressed that conversion if required should be done early rather than after an imminent complication.

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Comparative study of nondescent vaginal hysterectomy and abdominal hysterectomy at tertiary care centre, Maharashtra

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20213458 ◽

2021 ◽

Vol 10 (9) ◽

pp. 3397

Author(s):

Sharayu Prashant Mujumdar ◽

Priyanka Kunal Purohit ◽

Shwetambari S. Navale ◽

Chintan M. Upadhyay

Keyword(s):

Blood Loss ◽

Hospital Stay ◽

Tertiary Care ◽

Study Groups ◽

Abdominal Hysterectomy ◽

Economic Benefits ◽

Tertiary Care Centre ◽

Abdominal Incision ◽

Operative Complication ◽

Duration Of Surgery

Background: Vaginal route of hysterectomy has distinct health and economic benefits in terms of less morbidity, better postoperative quality of life outcomes, reduced hospital stay and better patient satisfaction. Objectives of current study were to evaluate the appropriate route of hysterectomy (abdominal or vaginal) in terms of intra and post-operative complication, morbidity and blood loss. Methods: This prospective study was done among 100 cases of hysterectomy of which 50 patients underwent NDVH and 50 underwent abdominal hysterectomy. This study included all emergency and booked patients having Size of uterus less than 12 weeks size, adequate uterine mobility, adequate access, adenomyosis, dysfunctional uterine bleeding, chronic PID & fibroid uterus.Results: Study found statistically significantly higher number of the participants with parity 3 & 4 in both the study groups. Bulky uterus followed by 12 and 10 weeks uterus in statistically significantly higher number of the participants of both the study groups. Duration of surgery statistically significantly less in NDVH group compare to TAH group. Fibroid was the main indication of hysterectomy in both the groups. Hemorrhage was the main intra-operative complication in both the groups. Fever & respiratory tract infection was the main post-operative complications in both the groups.Conclusions: Benefits of NDVH over TAH are Cosmetic advantage as less invasive, No discomfort of abdominal incision, shorter operative time, lesser blood loss, lesser intraoperative and postoperative complications, postoperative comfort is more, lesser requirement of postoperative analgesia, early ambulation and shorter hospital stay.

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Comparison of lateral transperitoneal and retroperitoneal approaches for homolateral laparoscopic adrenalectomy

BMC Surgery ◽

10.1186/s12893-021-01422-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Zhao Liu ◽

Da-wei Li ◽

Lei Yan ◽

Zhong-Hua Xu ◽

Gang-li Gu

Keyword(s):

Blood Loss ◽

Laparoscopic Adrenalectomy ◽

Operative Time ◽

Oral Intake ◽

Patient Characteristics ◽

Retroperitoneal Approach ◽

Perioperative Outcomes ◽

Transperitoneal Approach ◽

Operative Data

Abstract Background There is a lack of data regarding the appropriateness of transperitoneal and retroperitoneal approaches for homolateral laparoscopic adrenalectomy. The aim of this study is to compare lateral transperitoneal and retroperitoneal approach for left-sided and right-sided laparoscopic adrenalectomy respectively. Methods Between January 2014 and December 2019, 242 patients underwent left-sided and 252 patients underwent right-sided laparoscopic adrenalectomy. For left side, transperitoneal approach was used in 132 (103 with tumors < 5 cm and 29 with tumors ≥ 5 cm) and retroperitoneal approach in 110 (102 with tumors < 5 cm and 8 with tumors ≥ 5 cm). For right side, transperitoneal approach was used in 139 (121 with tumors < 5 cm and 18 with tumors ≥ 5 cm) and retroperitoneal approach in 113 (102 with tumors < 5 cm and 11 with tumors ≥ 5 cm). Patient characteristics and perioperative outcomes were recorded. For each side, both approaches were compared for tumors < 5 cm and ≥ 5 cm respectively. Results For left-sided tumors < 5 cm, transperitoneal approach demonstrated shorter operative time, less blood loss and longer time to oral intake. For left-sided tumors ≥ 5 cm, the peri-operative data of both approaches was comparable. For right-sided tumors < 5 cm, transperitoneal approach demonstrated shorter operative time and less blood loss. For right-sided tumors ≥ 5 cm, the peri-operative data was comparable. Conclusions Lateral transperitoneal and retroperitoneal approach are both effective for laparoscopic adrenalectomy. Lateral transperitoneal approach is faster with less blood loss for tumors < 5 cm.

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