Factors affecting perioperative ∆ALB and short term complications in pediatric patients undergoing major gastroenterology surgery

2020 ◽  
Author(s):  
Kai Gao ◽  
Qingshuang Liu ◽  
chunbao guo
Keyword(s):  
Risk Factors ◽  
Serum Albumin ◽  
Pediatric Population ◽  
Operating Time ◽  
Length Of Hospital Stay ◽  
Final Analysis ◽  
Postoperative Recovery ◽  
Perioperative Outcomes ◽  
Perioperative Morbidity ◽  
Charcot’S Triad

Abstract Background: Albumin is considered a negative acute-phase protein because its concentration decreases during injury and sepsis. The decrease in serum albumin might be important for perioperative morbidity, even in patients with normal preoperative levels in pediatric population. We here intend to determine the perioperative factors associated with the reduction in serum albumin within 2 postoperative days compared with the preoperative level (∆ALB) and its influence on the perioperative outcome in a pediatric general surgical cohort. Methods: This single-center retrospective review included 939 patients who underwent Roux-en-Y hepaticojejunostomy between August 2010 and Aug 2019. Based on the median ∆ALB (14.6%), patients were separated into two groups, including a high ∆ALB group (≥14.6%) and a low ∆ALB group (<14.6%). Multivariable logistic regression analyses were performed to determine the independent risk factors for the reduction in serum albumin. Propensity score matching was performed to adjust for any potential selection bios for the two groups. In 366 matched patients, influences of operating time on perioperative outcomes, including postoperative recovery, complications measurement, length of hospital stay between the two groups were analyzed. Results: For all 996 patients reviewed, 939 patient records were enrolled into the final analysis. Controlling for other factors, multivariate analysis showed that the high CRP on POD 3 or 4 (OR =2.36 [95% CI, 1.51-3.86]; p =0.007), presence of Charcot's triad (OR=1.73[95% CI, 1.05-2.83]; p = 0.031), the longer operating time (OR=1.18[95% CI, 1.00 -1.53]; p=0.014) were factors that predicted the high ∆ALB level. The high ∆ALB level was associated with postoperative gastrointestinal functional recovery, reflected by the first defecation (p= 0.013) and first bowel movement (p=0.019) and the high occurrence of postoperative complications (16.1% vs 10.9%, RR, 1.57; 95 %CI, 1.02-2.41, P=0.0026). The mean length of postoperative stay was longer than that of patients with ∆ALB < 14.0% group, although no statistic significant was stained (p=0.057). Conclusions: We showed that change in albumins was associated with postoperative outcomes. The risk factors for ∆ALB could be intervened in the perioperative period to permit patients gain a safe recovery and discharge after major abdominal operations

scholarly journals Factors affecting perioperative serum albumin variation and short term complications in pediatric patients undergoing major gastroenterology surgery

2020 ◽  
Author(s):  
Qingshuang Liu ◽  
Kai Gao ◽  
Xiaomin Sun ◽  
Chunbao Guo
Keyword(s):  
Risk Factors ◽  
Serum Albumin ◽  
Pediatric Population ◽  
Operating Time ◽  
Length Of Hospital Stay ◽  
Postoperative Recovery ◽  
Perioperative Outcomes ◽  
Perioperative Morbidity ◽  
Charcot’S Triad ◽  
The Mean

Abstract Background: Albumin is considered a negative acute-phase protein because its concentration decreases during injury and sepsis. The decrease in serum albumin might be important for perioperative morbidity, even in patients with normal preoperative levels in pediatric population. We here intend to determine the perioperative factors associated with the reduction in serum albumin within 2 postoperative days compared with the preoperative level (∆ALB) and its influence on the perioperative outcome in a pediatric general surgical cohort. Methods: This single-center retrospective review included 939 patients who underwent Roux-en-Y hepaticojejunostomy between August 2010 and Aug 2019. Based on the mean valure of ∆ALB (14.6%), patients were separated into two groups, including a high ∆ALB group (≥14.6%) and a low ∆ALB group (<14.6%). Multivariable logistic regression analyses were performed to determine the independent risk factors for the reduction in serum albumin. Propensity score matching was performed to adjust for any potential selection bios for the two groups. In 366 matched patients, influences of operating time on perioperative outcomes, including postoperative recovery, complications measurement, and length of hospital stay between the two groups were analyzed. Results: For all 996 patients reviewed, 939 patient records were enrolled into the final analysis. Controlling for other factors, multivariate analysis showed that the high CRP on POD 3 or 4 (odds ratio[OR] =2.36 [95% CI, 1.51-3.86]; p =0.007), presence of Charcot's triad (OR=1.73[95% CI, 1.05-2.83]; p = 0.031), the longer operating time (OR=1.18[95% CI, 1.00 -1.53]; p=0.014) were factors that predicted the high ∆ALB level. The high ∆ALB level was associated with postoperative gastrointestinal functional recovery, reflected by the first defecation (p= 0.013) and first bowel movement (p=0.019) and the high occurrence of postoperative complications (16.1% vs 10.9%, OR, 1.57; 95 %CI, 1.02-2.41, P=0.0026). The mean length of postoperative stay was longer than that of patients with ∆ALB < 14.0% group, although no statistic significant was stained (p=0.057). Conclusions: We showed that change in albumins was associated with postoperative outcomes. The risk factors for ∆ALB could be intervened in the perioperative period to permit patients gain a safe recovery and discharge after major abdominal operations.

scholarly journals Factors affecting perioperative serum albumin variation and short-term complications in pediatric patients undergoing major gastroenterology surgery

2020 ◽  
Author(s):  
Qingshuang Liu ◽  
Kai Gao ◽  
Xiaomin Sun ◽  
chunbao guo
Keyword(s):  
Risk Factors ◽  
Serum Albumin ◽  
Pediatric Population ◽  
Operating Time ◽  
Multivariable Analysis ◽  
Postoperative Recovery ◽  
Perioperative Outcomes ◽  
Charcot’S Triad ◽  
Significant Difference ◽  
The Mean

Abstract Background: Albumin is considered a negative acute-phase protein because its concentration decreases during injury and sepsis. The decrease in serum albumin may be important for perioperative morbidity, even in patients with normal preoperative levels in the pediatric population. Here, we intend to determine the perioperative factors associated with the reduction in serum albumin within 2 postoperative days compared with the preoperative level (∆ALB) and its influence on perioperative outcome in a pediatric general surgical cohort.Methods: This single-center retrospective review included 939 patients who underwent Roux-en-Y hepaticojejunostomy between August 2010 and August 2019. Based on the mean value of ∆ALB (14.6%), patients were separated into two groups, a high ∆ALB group (≥14.6%) and a low ∆ALB group (<14.6%). Multivariable logistic regression analyses were performed to determine the independent risk factors for a reduction in serum albumin. Propensity score matching was performed to adjust for any potential selection bias for the two groups. In 366 matched patients, the influences of operating time on perioperative outcomes, including postoperative recovery, complications measurement, and length of hospital stay between the two groups were analyzed.Results: Among the 996 patients reviewed, 939 patient records were enrolled in the final analysis. Controlling for other factors, multivariable analysis showed that a high CRP on POD 3 or 4 (odds ratio [OR] =2.36 [95% CI, 1.51-3.86]; p =0.007), the presence of Charcot's triad (OR=1.73 [95% CI, 1.05-2.83]; p = 0.031), and a longer operating time (OR=1.18 [95% CI, 1.00 -1.53]; p=0.014) were factors that predicted a high ∆ALB level. A high ∆ALB level was associated with postoperative gastrointestinal functional recovery, reflected by the first defecation (p= 0.013) and first bowel movement (p=0.019) and the high occurrence of postoperative complications (16.1% vs 10.9%, OR, 1.57; 95% CI, 1.02-2.41, P=0.0026). The mean length of postoperative stay of patients in the high ∆ALB group was longer than that of patients in the ∆ALB < 14.0% group, although no statistically significant difference was observed (p=0.057). Conclusions: We showed that a change in albumin level was associated with postoperative outcome. The risk factors for ∆ALB could be addressed in the perioperative period to permit patients to obtain a safe recovery and discharge after a major abdominal operation.

scholarly journals The Risk Factors for Perioperative Serum Albumin Variation in Pediatric Patients Undergoing Major Gastroenterology Surgery

2021 ◽  
Vol 7 ◽  
Author(s):  
Qingshuang Liu ◽  
Kai Gao ◽  
Chao Zheng ◽  
Chunbao Guo
Keyword(s):  
Risk Factors ◽  
Serum Albumin ◽  
Pediatric Patients ◽  
Operating Time ◽  
Multivariable Analysis ◽  
Postoperative Outcome ◽  
Perioperative Outcomes ◽  
Multivariable Logistic Regression Model ◽  
Perioperative Morbidity ◽  
Charcot’S Triad

Background: The albumin, a negative acute-phase protein, is important for perioperative morbidity, even in patients with normal preoperative levels. This study intend to determine the perioperative factors related with the postoperative reduction in serum albumin (ΔALB) and its influence on perioperative outcome in a pediatric general surgical cohort.Methods: This single-center retrospective review included 939 pediatric patients who underwent major gastroenterology surgery from August 2010 to August 2019. The patients were dichotomized into a high ΔALB group (≥14.6%) and a low ΔALB group (&lt;14.6%) based on the mean value of ΔALB (14.6%). the independent risk factors for ΔALB, were explored using the propensity score matching to minimize potential selection bias and subjected to method multivariable logistic regression model. Furthermore, in 366 matched patients, the influences of operating time on perioperative outcomes were analyzed.Results: Among the 996 patients reviewed, 939 patient records were enrolled in the final analysis. Controlling for other factors, multivariable analysis showed that a high CRP on POD 3 or 4 [odds ratio (OR) = 2.36 (95% CI, 1.51–3.86); p = 0.007], a longer operating time [OR = 1.18 (95% CI, 1.00–1.53); p = 0.014), and the presence of Charcot's triad [OR = 1.73 (95% CI, 1.05–2.83); p = 0.031] were factors that predicted a high ΔALB level. A high ΔALB level was also related with gastrointestinal functional recovery delay, reflected by the postoperative defecation (p = 0.013) and bowel movement (p = 0.019) delay and the high occurrence of postoperative complications (16.1 vs. 10.9%, OR, 1.57; 95% CI, 1.02–2.41, P = 0.0026).Conclusions: The high ΔALB level was correlated with postoperative outcome. To obtain a safe recovery and discharge after a major abdominal operation, the above risk factors for ΔALB could be addressed in the perioperative period.

The effects of COVID-19 on perioperative morbidity and mortality in patients with hip fractures

2020 ◽  
Vol 102-B (9) ◽  
pp. 1136-1145 ◽  
Author(s):  
Babar Kayani ◽  
Elliot Onochie ◽  
Vijay Patil ◽  
Fahima Begum ◽  
Rory Cuthbert ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hip Fractures ◽  
Smoking Status ◽  
Length Of Hospital Stay ◽  
Mortality Rates ◽  
Perioperative Outcomes ◽  
Perioperative Morbidity ◽  
Hip Fracture Surgery ◽  
Increased Risk ◽  
Fracture Surgery

Aims During the COVID-19 pandemic, many patients continue to require urgent surgery for hip fractures. However, the impact of COVID-19 on perioperative outcomes in these high-risk patients remains unknown. The objectives of this study were to establish the effects of COVID-19 on perioperative morbidity and mortality, and determine any risk factors for increased mortality in patients with COVID-19 undergoing hip fracture surgery. Methods This multicentre cohort study included 340 COVID-19-negative patients versus 82 COVID-19-positive patients undergoing surgical treatment for hip fractures across nine NHS hospitals in Greater London, UK. Patients in both treatment groups were comparable for age, sex, body mass index, fracture configuration, and type of surgery performed. Predefined perioperative outcomes were recorded within a 30-day postoperative period. Univariate and multivariate analysis were used to identify risk factors associated with increased risk of mortality. Results COVID-19-positive patients had increased postoperative mortality rates (30.5% (25/82) vs 10.3% (35/340) respectively, p < 0.001) compared to COVID-19-negative patients. Risk factors for increased mortality in patients with COVID-19 undergoing surgery included positive smoking status (hazard ratio (HR) 15.4 (95% confidence interval (CI) 4.55 to 52.2; p < 0.001) and greater than three comorbidities (HR 13.5 (95% CI 2.82 to 66.0, p < 0.001). COVID-19-positive patients had increased risk of postoperative complications (89.0% (73/82) vs 35.0% (119/340) respectively; p < 0.001), more critical care unit admissions (61.0% (50/82) vs 18.2% (62/340) respectively; p < 0.001), and increased length of hospital stay (mean 13.8 days (SD 4.6) vs 6.7 days (SD 2.5) respectively; p < 0.001), compared to COVID-19-negative patients. Conclusion Hip fracture surgery in COVID-19-positive patients was associated with increased length of hospital stay, more admissions to the critical care unit, higher risk of perioperative complications, and increased mortality rates compared to COVID-19-negative patients. Risk factors for increased mortality in patients with COVID-19 undergoing surgery included positive smoking status and multiple (greater than three) comorbidities. Cite this article: Bone Joint J 2020;102-B(9):1136–1145.

scholarly journals The risk factors related to operative duration and its relationship with clinical outcome in pediatric patients undergone Roux-en-Y hepaticojejunostomy

2020 ◽  
Author(s):  
Ang Li ◽  
Kai Gao ◽  
Qingshuang Liu ◽  
Jingyu Chen ◽  
Chunbao Guo
Keyword(s):  
Risk Factors ◽  
Clinical Outcome ◽  
Hospital Stay ◽  
Pediatric Patients ◽  
Operating Time ◽  
Postoperative Recovery ◽  
Perioperative Outcomes ◽  
Operative Duration ◽  
Long Time ◽  
Short Time

Abstract Background: The operative duration might be important for perioperative morbidity and the involvement has not been fully characterized in pediatric patients. We here determined the perioperative variables in association with operative duration and its influence on the clinical outcome in the pediatric patients.Methods: We retrospectively reviewed 701 patients who underwent elective choledochal cysts followed by Roux-en-Y hepaticojejunostomy between August 2010 and Aug 2019. Based on the median operating time (165 min), patients were separated into two groups, including a long-time group (>165 min) and a short-time group (<165 min). The independent risk factors for the operative time were determined usng the multivariable logistic regression analyses. To adjust for any potential selection bios, propensity score matching was performed for the long-time and short-time groups. In the 192 matched patients, perioperative outcomes, including postoperative recovery, complications measurement, and length of hospital stay were analyzed.Results: The operating time was often increased by excision difficulty caused by the lager choledochal cyst size (OR=1.56; 95% CI, 1.09-2.23; p<0.001), the greater BMI(OR=1.02; 95% CI, 1.00-1.15; p=0.018), older age (OR=1.17; 95% CI, 1.02-1.39; p=0.012) under multivariate analysis. The long-time surgical duration was associated with delay for gastrointestinal functional recovery, measured with the first defecation (p=0.027) and first bowel movement (p=0.019). Moreover, a significant decrease in serum albumin were presented in the long-time group compared with the short time group (p=0.0035). The total length of postoperative hospital stay was longer in patients with long-time group (7.51±2.03 days) than patients with short-time group (6.72±1.54 days, p = 0.006).Conclusions: Our data demonstrated that short operating time was associated with favorable postoperative results. The influencing factors for operating time could be ameliorated in the perioperative period to gain a better outcome after major abdominal operations.

ERAS Improves Postoperative Recovery in Children

2021 ◽  
Author(s):  
Tingmei Wu ◽  
Haiwen Li ◽  
Huixia Zhou ◽  
Xuemei Hao ◽  
Xiaojun Wang ◽  
...  
Keyword(s):  
Inflammatory Cytokine ◽  
Enhanced Recovery ◽  
Length Of Hospital Stay ◽  
Final Analysis ◽  
Postoperative Recovery ◽  
Controlled Study ◽  
Control Group ◽  
Robot Assisted ◽  
Cytokine Levels ◽  
Eras Protocol

Abstract Objective: Enhanced recovery after surgery (ERAS) protocols are established in adults but not fully evaluated in children. This study investigated whether an ERAS protocol improved recovery and influenced postoperative inflammatory cytokine levels in children undergoing surgery for hydronephrosis. Methods: This randomized controlled study included patients who underwent robot-assisted laparoscopic surgery for hydronephrosis at Bayi Children's Hospital (Beijing, China) between October 2018 and September 2019. Patients were randomized to an ERAS group (perioperative ERAS protocol) or control group (standard perioperative management). Outcomes related to postoperative recovery and inflammatory cytokine levels were evaluated. Results: The final analysis included 18 patients in each group. Five patients (27.78%) in each group experienced postoperative complications (abdominal pain, nausea and vomiting, subcutaneous emphysema or fever). The ERAS group had a shorter time to first postoperative flatus than the control group (25 vs. 49 hours; P =0.009), although the time for abdominal drainage flow to reach ≤20 mL/day, time to urinary catheter removal and length of hospital stay did not differ significantly between groups. Preoperative plasma cytokine levels were comparable between groups. Compared with the control group, the ERAS group had a higher IL-6 level on postoperative day 2 ( P <0.05) and a lower concentration of IL-1β on postoperative days 1 and 2 ( P <0.05). Postoperative levels of CRP, TNFα and IL-10 did not differ significantly between groups. Conclusions: ERAS may accelerate postoperative recovery and modulate the postoperative inflammatory response in pediatric patients undergoing robot-assisted laparoscopic pyeloplasty for hydronephrosis.

scholarly journals Robotic adrenalectomy in the pediatric population: initial experience case series from a tertiary center

BMC Urology ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Anirban P. Mitra ◽  
Evalynn Vasquez ◽  
Paul Kokorowski ◽  
Andy Y. Chang
Keyword(s):  
Hospital Stay ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Operating Time ◽  
Case Series ◽  
Length Of Hospital Stay ◽  
Open Approach ◽  
Invasive Approach ◽  
Patients Âgés ◽  
Tertiary Center

Abstract Background Laparoscopic resection is the most well described minimally-invasive approach for adrenalectomy. While it allows for improved cosmesis, faster recovery and decreased length of hospital stay compared with the open approach, instrument articulation limitations can hamper surgical dexterity in pediatric patients. Use of robotic assistance can greatly enhance operative field visualization and instrument control, and is in the early stages of adoption in academic centers for pediatric populations. Case presentation We present a single-institution series of pediatric adrenalectomy cases. The da Vinci Xi surgical system was used to perform adrenalectomies on three consecutive patients (ages, 2–13 years) at our center. Final pathology revealed ganglioneuroblastoma (n = 2) and pheochromocytoma (n = 1). Median operating time was 244 min (range, 244–265 min); median blood loss was estimated at 100 ml (range, 15–175 ml). Specimens were delivered intact and all margins were negative. Median post-operative hospital stay was 2 days (range, 1–6 days). All patients remain disease-free at median follow-up of 19 months (range, 12–30 months). Conclusion Our experience continues to evolve, and suggests that robotic surgery is safe, feasible and oncologically effective for resection of adrenal masses in well-selected pediatric patients.

International multi-centre study of incidence and risk factors of symptomatic deep venous thrombosis (DVT) and or pulmonary embolism (PE) in prostate cancer patients undergoing laparoscopic radical prostatectomy (LRP)

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 8555-8555 ◽  
Author(s):  
F. P. Secin ◽  
G. Fournier ◽  
I. S. Gill ◽  
C. C. Abbou ◽  
C. Schulmann ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hospital Stay ◽  
Operating Time ◽  
Length Of Hospital Stay ◽  
Lung Ventilation ◽  
The United States ◽  
P Value ◽  
Tobacco Exposure ◽  
Multi Centre Study ◽  
Exact Test

8555 Background: There is no data regarding the incidence and variables associated with symptomatic DVT and or PE in patients undergoing LRP. Our aim was to evaluate the multi-centric incidence and risk factors for perioperative symptomatic DVT and PE after LRP. Methods: Patients with symptomatic DVT and or PE occurring within 2 months of surgery since start of the respective institutional LRP experience were included. Eight academic centers from both the United States and Europe participated. Diagnoses were made by Doppler ultrasound for DVT; and lung ventilation/perfusion scan and or chest computed tomography for PE. Associations between variables and DVT and/or PE were evaluated using Fisher’s exact test for categorical predictors and logistic regression for continuous predictors. Results: Patient reoperation (p value) (<0.001), tobacco exposure (0.02), prior DVT (0.007), larger prostate size (0.02) and length of hospital stay (0.009) were significantly associated with higher risk of symptomatic DVT/PE. The nonuse of perioperative heparin was not a risk factor (1), as well as neoadjuvant therapy (1), perioperative transfusion (0.1), body mass index (0.9), surgical technique (0.3), operating time (0.2) and pathologic stage (0.5). There were no related deaths. Patients receiving preoperative heparin had significantly higher mean operative blood loss, 480cc vs 332cc (<0.001) However, this did not translate into longer hospital stay (0.07); higher transfusion rates (0.09) or reoperation rates (0.3). The estimated cost of heparin prophylaxis in these patients exceeded $2.5 million. Conclusion: The incidence of symptomatic DVT or PE was similar despite different prophylactic regimens. Our data does not support the administration of prophylactic heparin in LRP to low risk patients (no prior DVT, no tobacco exposure, no prostate enlargement and or no anticipation of prolonged hospital stay). [Table: see text] No significant financial relationships to disclose.

scholarly journals Effectiveness and safety of cemented and uncemented hemiarthroplasty in the treatment of intracapsular hip fractures

2020 ◽  
Vol 102-B (9) ◽  
pp. 1113-1121
Author(s):  
Nakulan Nantha Kumar ◽  
Setor K. Kunutsor ◽  
Miguel A. Fernandez ◽  
Elizabeth Dominguez ◽  
Nick Parsons ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Hip Fractures ◽  
Meta Analysis ◽  
Operating Time ◽  
Length Of Hospital Stay ◽  
Perioperative Outcomes ◽  
Cochrane Library ◽  
Uncemented Hemiarthroplasty ◽  
Mean Differences

Aims We conducted a systematic review and meta-analysis to compare the mortality, morbidity, and functional outcomes of cemented versus uncemented hemiarthroplasty in the treatment of intracapsular hip fractures, analyzing contemporary and non-contemporary implants separately. Methods PubMed, Medline, EMBASE, CINAHL, and Cochrane Library were searched to 2 February 2020 for randomized controlled trials (RCTs) comparing the primary outcome, mortality, and secondary outcomes of function, quality of life, reoperation, postoperative complications, perioperative outcomes, pain, and length of hospital stay. Relative risks (RRs) and mean differences (with 95% confidence intervals (CIs)) were used as summary association measures. Results A total of 18 studies corresponding to 16 non-overlapping RCTs with a total of 2,819 intracapsular hip fractures were included. Comparing contemporary cemented versus uncemented hemiarthroplasty, RRs (95% CIs) for mortality were 1.32 (0.44 to 3.99) perioperatively, 1.01 (0.48 to 2.10) at 30 days, and 0.90 (0.71 to 1.15) at one year. The use of contemporary cemented hemiarthroplasty reduced the risk of intra- and postoperative periprosthetic fracture. There were no significant differences in the risk of other complications, function, pain, and quality of life. There were no significant differences in perioperative outcomes except for increases in operating time and overall anaesthesia for contemporary cemented hemiarthroplasty with mean differences (95% CIs) of 6.67 (2.65 to 10.68) and 4.90 (2.02 to 7.78) minutes, respectively. The morbidity and mortality outcomes were not significantly different between non-contemporary cemented and uncemented hemiarthroplasty. Conclusion There are no differences in the risk of mortality when comparing the use of contemporary cemented with uncemented hemiarthroplasty in the management of intracapsular hip fractures. Contemporary cemented hemiarthroplasty is associated with a substantially lower risk of intraoperative and periprosthetic fractures. Cite this article: Bone Joint J 2020;102-B(9):1113–1121.

802 PERIOPERATIVE AND SHORT-TERM OUTCOMES FOR PRIMARY ANTIREFLUX SURGERY: FUNDOPLICATION VS. RNY RECONSTRUCTION

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Deepika Razia ◽  
Deepika Razia ◽  
Sumeet K Mittal
Keyword(s):  
Postoperative Complications ◽  
Hospital Stay ◽  
Antireflux Surgery ◽  
Operative Time ◽  
Length Of Hospital Stay ◽  
Perioperative Outcomes ◽  
Short Term ◽  
Perioperative Morbidity ◽  
Conversion To Open Surgery ◽  
Time Length

Abstract   Laparoscopic fundoplication is the gold standard for treatment of gastroesophageal reflux disease (GERD); however, RNY reconstruction may be an alternative option in patients with complex pathophysiology and other risk factors. This study aimed to compare perioperative and short-term outcomes between primary fundoplication and RNY reconstruction. Methods After IRB approval, a prospectively maintained esophageal surgery database was retrospectively reviewed to identify patients who underwent primary fundoplication or RNY reconstruction from September 2016 to July 2020. We retrieved perioperative outcomes (operative time, length of hospital stay, intraoperative and postoperative complications) along with GERD-Health-Related Quality of Life (HRQL) scores at annual follow-up. Results During the study period, 226 patients underwent surgery (fundoplication: 210; RNY: 16). The most common indication for RNY was severe esophageal dysmotility or morbid obesity. There was only one conversion to open surgery due to adhesions (fundoplication group). The operative time, length of hospital stay, and ICU stay were significantly lower in the fundoplication group. Rates of intraoperative (fundoplication: 3% vs RNY: 0) and postoperative complications (Clavien-Dindo ≥II) (fundoplication: 3% vs RNY: 6%) were not significantly different between groups. Both groups had a significant and similar improvement of GERD-HRQL scores 1 year after surgery (Table 1). Conclusion Primary antireflux surgery is associated with low perioperative morbidity and excellent short-term outcomes. RNY reconstruction and fundoplication have similar outcomes. More liberal use of RNY reconstruction as the primary antireflux surgery in patients at high risk of failure with fundoplication should be explored.

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