Comparison of Laparoscopic and Open Emergency Surgery for Colorectal Perforation: A Retrospective Study

Abstract Background This study aimed to clarify the safety and efficacy of laparoscopic surgery for colorectal perforation by comparing the clinical outcomes between laparoscopic and open emergency surgery for colorectal perforation. Methods We retrospectively reviewed the data of 100 patients who underwent surgery for colorectal perforation. The patients were categorized into two groups: the open group included patients who underwent laparotomy, and the laparoscopic group included those who underwent laparoscopic surgery. Clinical and operative characteristics and postoperative outcomes were evaluated. Results The open and laparoscopic groups included 58 and 42 patients, respectively. More than half of the patients in both groups developed perforation in the sigmoid colon (open, 55.2%; laparoscopic, 59.5%). The most common cause of perforation was diverticulum, followed by colorectal cancer. The mean intraoperative blood loss tended to be lower in the laparoscopic group than in the open group (78.8 mL versus 160.1 mL; P=0.0756). Hospital stay tended to be shorter in the laparoscopic group than in the open group (42.5 versus 55.7 days; P=0.0965). There were no significant differences in either the short- or long-term outcomes between the two groups. Univariate and multivariate analyses showed that the choice of surgical approach (open versus laparoscopic) did not affect overall survival in patients with colorectal perforation. Conclusions The laparoscopic approach for colorectal perforation in an emergency setting is a safe procedure compared with the open approach. The laparoscopic approach was associated with a decrease in intraoperative blood loss and a shorter length of hospital stay.

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Comparison of Perioperative Outcomes in Open and Laparoscopic Radical Cystectomy with Modified Ureterosigmoidostomy (MainzII): A Retrospective Analysis

10.21203/rs.3.rs-805660/v1 ◽

2021 ◽

Author(s):

Bin Zhang ◽

Yang He ◽

Duo Zheng ◽

Junyao Liu ◽

Peng Qi ◽

...

Keyword(s):

Blood Loss ◽

Hospital Stay ◽

Radical Cystectomy ◽

Urinary Diversion ◽

Open Surgery ◽

Operation Time ◽

Laparoscopic Group ◽

Postoperative Hospital Stay ◽

Intraoperative Blood Loss

Abstract Background: To analyze perioperative conditions and long-term efficacy of open modified ureterosigmoidostomy urinary diversion (OMUUD) in patients with bladder cancer who underwent open radical cystectomy (ORC) and laparoscopic radical cystectomy (LRC).Methods: In this retrospective study, the clinical data of patients who underwent open and laparoscopic radical cystectomy plus open modified ureterosigmoidostomy urinary diversion in our hospital were collected from January 2011 to December 2019. In addition, perioperative data of 56 patients who underwent ORC and OMUUD were compared with those of 118 patients who underwent laparoscopic radical cystectomy (LRC) plus OMUUD. A long-term follow-up was performed to compare the overall survival (OS) and progression-free survival (PFS) rate between the two groups.Results: Results showed that there was no significant difference between ORC+OMUUD group and LRC+OMUUD group in terms of gender, age, body index, pre-operative ASA grade, history of transurethral resection of bladder tumor (TURBT) before surgery, tumor T stage, lymph node dissection range, pathological grade, and positive postoperative surgical margin. The mean operation time in the open group was shorter than that in the laparoscopic group （P<0.001）. Moreover, the estimated intraoperative blood loss（P<0.001）and postoperative hospital stay（P=0.023）were better in the laparoscopic group than in the open group. The incidence of complications between 30 days (P=0.665) and 90 days (P=0.211) time-points after surgery was not significantly different. Similarly, the OS (P=0.237) and PFS (P=0.307) between the two groups were comparable.Conclusion: This study shows that the LRC group has long operation time, but less estimated intraoperative blood loss, short postoperative hospital stay, small trauma, and fast postoperative recovery compared to open surgery. Moreover, the incidence of complications at 30 - and 90-days postoperation, as well as the OS and PFS is not different between laparoscopy and open surgery.

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Comparison of Intestinal Stent Placement Followed By Laparoscopic Surgery and Emergency Surgery in Obstructive Colorectal Cancer: A Retrospective Analysis and Meta-analysis

10.21203/rs.3.rs-965424/v1 ◽

2022 ◽

Author(s):

Zhengwei Li ◽

Yan Lu ◽

Kang Wang ◽

Tianyou Liao ◽

Yongle Ju ◽

...

Keyword(s):

Colorectal Cancer ◽

Laparoscopic Surgery ◽

Hospital Stay ◽

Stent Placement ◽

Emergency Surgery ◽

Operating Time ◽

Postoperative Hospital Stay ◽

Postoperative Wound Infection ◽

Intraoperative Blood Loss ◽

Perioperative Mortality

Abstract Background: For patients with colorectal cancer and malignant intestinal obstruction, it is still controversial to perform endoscopic intestinal stent placement followed by laparoscopic surgery. This study compares the endoscopic intestinal stent placement followed by laparoscopic surgery and emergency surgery in patients with colorectal cancer and malignant intestinal obstruction.Method: 11 compliant publications from Pubmed, Cochrane and Embase databases were analyzed using Revies Manager 5.2 software. SPSS 21 was used to retrospectively analyze 99 patients admitted to our center from 2014 to 2019.Results: There were significant differences between the two groups in three of the five criteria. In the SBTS group, the perioperative mortality rate was lower, with an OR of 0.46 (95% CI: 0.22-0.95, P=0.04), the incidence of postoperative wound infection was lower; OR was 0.44 (95% CI: 0.24-0.82, P=0.009); Postoperative hospital stay was shorter, MD was -2.07 (95% CI: -2.55--1.59, P<0.00001).Retrospective analysis of the clinical outcome differences between the SBTS group and ES group in our center: Compared to the ES group, the SBTS group displayed lower infection rate of surgical incision (χ2=3.94,P =0.04) ); no difference in the frequency of occurrence of anastomotic leakage (χ2=0.18,P=0.67), did not reduce perioperative mortality (χ2=0.94,P=0.33);shorter operating time (204.13±37.35 min) (t=5.08,P=0.000), lower intraoperative blood loss (155.65±94.90 ml) (t=3.90,P=0.001); and shorter postoperative hospital stay (12.91±5.47 d) (t=2.64, P=0.01).Conclusion: Compared the emergency surgery group, endoscopic intestinal stent placement followed by the laparoscopic surgery can reduce perioperative mortality, postoperative wound infection, intraoperative blood loss, and the length of postoperative hospital stay. There was no difference between the two methods as far as the incidence of posterior anastomotic leakage and operating time were concerned.

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Laparoscopic Major Gastrointestinal Surgery Is Safe for Properly Selected Patient with COPD: A Meta-Analysis

BioMed Research International ◽

10.1155/2019/8280358 ◽

2019 ◽

Vol 2019 ◽

pp. 1-8

Author(s):

Yulin Guo ◽

Feng Cao ◽

Yixuan Ding ◽

Haichen Sun ◽

Shuang Liu ◽

...

Keyword(s):

Blood Loss ◽

Hospital Stay ◽

Meta Analysis ◽

Gastrointestinal Surgery ◽

Laparoscopic Approach ◽

Length Of Hospital Stay ◽

Pulmonary Complications ◽

Cochrane Library ◽

Chronic Obstructive ◽

Intraoperative Blood Loss

Background. Laparoscopy has been widely applied in gastrointestinal surgery, with benefits such as less intraoperative blood loss, faster recovery, and shorter length of hospital stay. However, it remains controversial if laparoscopic major gastrointestinal surgery could be conducted for patients with chronic obstructive pulmonary disease (COPD) which was traditionally considered as an important risk factor for postoperative pulmonary complications. The present study was conducted to review and assess the safety and feasibility of laparoscopic major abdominal surgery for patient with COPD. Materials and Methods. Databases including PubMed, EmBase, Cochrane Library, and Wan-fang were searched for all years up to Jul 1, 2018. Studies comparing perioperative results for COPD patients undergoing major gastrointestinal surgery between laparoscopic and open approaches were enrolled. Results. Laparoscopic approach was associated with less intraoperative blood loss (MD = -174.03; 95% CI: −232.16 to -115.91, P < 0.00001; P < 0.00001, I2=93% for heterogeneity) and shorter length of hospital stay (MD = -3.30; 95% CI: −3.75 to -2.86, P < 0.00001; P = 0.99, I2=0% for heterogeneity). As for pulmonary complications, laparoscopic approach was associated with lower overall pulmonary complications rate (OR = 0.58; 95% CI: 0.48 to 0.71, P < 0.00001; P = 0.42, I2=0% for heterogeneity) and lower postoperative pneumonia rate (OR = 0.53; 95% CI: 0.41 to 0.67, P < 0.00001; P = 0.57, I2=0% for heterogeneity). Moreover, laparoscopic approach was associated with lower wound infection (OR = 0.51; 95% CI: 0.42 to 0.63, P < 0.00001; P = 0.99, I2=0% for heterogeneity) and abdominal abscess rates (OR = 0.59; 95% CI: 0.44 to 0.79, P < 0.0004; P = 0.24, I2=30% for heterogeneity). Conclusions. Laparoscopic major gastrointestinal surgery for properly selected COPD patient was safe and feasible, with shorter term benefits.

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Comparison of Therapeutic Effects of Laparoscopic and Open Operation for Congenital Choledochal Cysts in Adults

Gastroenterology Research and Practice ◽

10.1155/2014/670260 ◽

2014 ◽

Vol 2014 ◽

pp. 1-8 ◽

Cited By ~ 8

Author(s):

Yuan Liu ◽

Xu Yao ◽

Shuqiang Li ◽

Wenhan Liu ◽

Lei Liu ◽

...

Keyword(s):

Blood Loss ◽

Operative Time ◽

Laparoscopic Group ◽

Adult Patients ◽

Open Group ◽

Therapeutic Effects ◽

Intraoperative Blood Loss ◽

Choledochal Cysts ◽

Cyst Excision ◽

Postoperative Stay

Background. Laparoscopic cyst excision and Roux-en-Y hepaticojejunostomy for treating congenital choledochal cysts (CCCs) have proved to be efficacious in children. Its safety and efficacy in adult patients remain unknown. The purpose of this study was to determine whether the laparoscopic procedure was feasible and safe in adult patients.Methods. We reviewed 35 patients who underwent laparoscopic operation (laparoscopic group) and 39 patients who underwent an open procedure (open group). The operative time, intraoperative blood loss, time until bowel motion recovery, duration of drainage, postoperative stay, time until resumption of diet, postoperative complications, and perioperative laboratory values were recorded and analyzed in both groups.Results. The operative time was longer in the laparoscopic group and decreased significantly with accumulating surgical experience (P<0.01). The mean intraoperative blood loss was significantly lower in the laparoscopic group (P<0.01). The time until bowel peristalsis recovery, time until resumption of diet, abdominal drainage, and postoperative stay were significantly shorter in the laparoscopic group (P<0.01). The postoperative complication rate was not higher in the laparoscopic group than in the open group (P>0.05).Conclusions. Laparoscopic cyst excision and hepaticojejunostomy are a feasible, effective, and safe method for treating CCCs in adult patients.

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Laparoscopic or open treatment for liver hydatid cyst? A single-institution experience: a prospective randomized control trial

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v11i3.2417 ◽

2020 ◽

Vol 11 (3) ◽

pp. 3088-3095

Author(s):

Saad Ab-razq Mijbas ◽

Samer Makki Mohamed Al-Hakkak ◽

Ali Abood Alnajim ◽

Hassan Abdulla Abadi AL-Aquli

Keyword(s):

Hydatid Cyst ◽

Hospital Stay ◽

Surgical Complication ◽

Randomized Study ◽

Laparoscopic Approach ◽

Laparoscopic Group ◽

Laparoscopic Procedure ◽

Open Group ◽

P Value ◽

Liver Hydatid Cyst

The gold standard modality of management of cystic echinococcosis remains surgery. Regardless of the increased interest in nonsurgical techniques. The study aims to compare laparoscopic versus open methods of the hydatid cyst of the liver regarding complication rate, postoperative hospital stays, and effectiveness. A prospective randomized study. One hundred two patients with liver hydatid cyst in which 60 patients fulfil study requirements. Those undergone either open surgical or laparoscopic approaches under cover of albendazole treatment. The data divided into two groups, group 1 (28), group2 (32), we collected demographic data, surgical approach types, and postoperative data. The overall of 102 patients with hydatid cyst of the liver was randomized,60 patients full the study requirements, 28 patients (46.67%) had a laparoscopic procedure, and 32 patients (53.33%) had an open method. The total number of liver hydatid cysts was 70, and the operative time means 77 min (range,60–120 min) in the laparoscopic group and 55 min (range, 40–110 min) in the open group which is significant (P-value 0.0267). The postoperative hospital stay means time was 32 hours (range, 1–3 days) in the group of the laparoscopic procedure and 52 hours (range,2– 5days) in the group of open type. The postoperative surgical complication was significantly less in the laparoscopic group than the open group (p-value 0.014). A Hydatid liver cyst can be managed either by open surgical or laparoscopic techniques with comparable results. Still, the laparoscopic approach is superior in less postoperative pain, hospital stay and time, but it is essential in choosing the suitable patients.

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Laparoscopic Compared with Open D2 Gastrectomy on Perioperative and Long-Term, Stage-Stratified Oncological Outcomes for Gastric Cancer: A Propensity Score-Matched Analysis of the IMIGASTRIC Database

Cancers ◽

10.3390/cancers13184526 ◽

2021 ◽

Vol 13 (18) ◽

pp. 4526

Author(s):

Stefano Trastulli ◽

Jacopo Desiderio ◽

Jian-Xian Lin ◽

Daniel Reim ◽

Chao-Hui Zheng ◽

...

Keyword(s):

Gastric Cancer ◽

Overall Survival ◽

Propensity Score ◽

Hospital Stay ◽

Predictive Factors ◽

Laparoscopic Approach ◽

Laparoscopic Group ◽

Open Group ◽

D2 Lymphadenectomy

Background: The laparoscopic approach in gastric cancer surgery is being increasingly adopted worldwide. However, studies focusing specifically on laparoscopic gastrectomy with D2 lymphadenectomy are still lacking in the literature. This retrospective study aimed to compare the short-term and long-term outcomes of laparoscopic versus open gastrectomy with D2 lymphadenectomy for gastric cancer. Methods: The protocol-based, international IMIGASTRIC (International study group on Minimally Invasive surgery for Gastric Cancer) registry was queried to retrieve data on patients undergoing laparoscopic or open gastrectomy with D2 lymphadenectomy for gastric cancer with curative intent from January 2000 to December 2014. Eleven predefined, demographical, clinical, and pathological variables were used to conduct a 1:1 propensity score matching (PSM) analysis to investigate intraoperative and recovery outcomes, complications, pathological findings, and survival data between the two groups. Predictive factors of long-term survival were also assessed. Results: A total of 3033 patients from 14 participating institutions were selected from the IMIGASTRIC database. After 1:1 PSM, a total of 1248 patients, 624 in the laparoscopic group and 624 in the open group, were matched and included in the final analysis. The total operative time (median 180 versus 240 min, p < 0.0001) and the length of the postoperative hospital stay (median 10 versus 14.8 days, p < 0.0001) were longer in the open group than in the laparoscopic group. The conversion to open rate was 1.9%. The proportion of patients with in-hospital complications was higher in the open group (21.3% versus 15.1%, p = 0.004). The median number of harvested lymph nodes was higher in the laparoscopic approach (median 32 versus 28, p < 0.0001), and the proportion of positive resection margins was higher (p = 0.021) in the open group (5.9%) than in the laparoscopic group (3.2%). There was no significant difference between the groups in five-year overall survival rates (77.4% laparoscopic versus 75.2% open, p = 0.229). Conclusion: The adoption of the laparoscopic approach for gastric resection with D2 lymphadenectomy shortened the length of hospital stay and reduced postoperative complications with respect to the open approach. The five-year overall survival rate after laparoscopy was comparable to that for patients who underwent open D2 resection. The types of surgical approaches are not independent predictive factors for five-year overall survival.

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Improved Oncologic Outcomes Following Laparoscopic Surgery for Small T4 Colon Cancer : A Multi-center Comparative Study

10.21203/rs.3.rs-56052/v1 ◽

2020 ◽

Author(s):

Sung Sil Park ◽

Joon Sang Lee ◽

Hyoung-Chul Park ◽

Sung Chan Park ◽

Dae Kyung Sohn ◽

...

Keyword(s):

Colon Cancer ◽

Laparoscopic Surgery ◽

Blood Loss ◽

Open Surgery ◽

Disease Free Survival ◽

Laparoscopic Group ◽

Open Group ◽

Oncologic Outcomes ◽

Surgery Outcome ◽

T4 Colon Cancer

Abstract Background: Laparoscopic surgery for T4 colon cancer may be safe in selected patients. Based on the theory that small tumor size might preoperatively predict a good laparoscopic surgery outcome, we herein compare the clinicopathologic and oncologic outcomes of open and laparoscopic surgery in small T4 colon cancer.Methods: In a retrospective multicenter study, we reviewed the data of 449 patients, including 117 patients with tumors ≤4 cm, who underwent T4 colon cancer surgery between January 2014 and December 2017. We compared the clinicopathologic and 3-year oncologic outcomes between the laparoscopic and open surgery groups.Results: Blood loss, length of hospital stay, and postoperative morbidity were lower in the laparoscopic group than in the open group (86 mL vs. 278 mL, p < 0.001; 10.0 days vs. 12.5 days, p = 0.003; and 18.0% vs. 29.5%, p = 0.005, respectively). There were no intergroup differences in overall survival (OS) and 3-year disease-free survival (DFS; 87.8% vs. 83.2%, p = 0.117; 69.5% vs. 68.1%, p = 0.408, respectively). Among patients with tumors of size ≤4 cm, blood loss was lower in the laparoscopic surgery group than in the open group (80 mL vs. 208 mL, p = 0.001); despite no statistical difference observed in the 3-year OS (84.4% vs 78.7%, p = 0.442), the laparoscopic group had a better 3-year DFS (73.8% vs. 46.0%, p = 0.004).Conclusions: Laparoscopic surgery showed similar outcomes to open surgery in T4 colon cancer patients, and may have favorable short-term oncologic outcomes in patients with small T4 tumors.

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Antithrombotic drugs have a minimal effect on intraoperative blood loss during emergency surgery for generalized peritonitis: a nationwide retrospective cohort study in Japan

World Journal of Emergency Surgery ◽

10.1186/s13017-021-00374-z ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Tadashi Matsuoka ◽

Nao Ichihara ◽

Hiroharu Shinozaki ◽

Kenji Kobayashi ◽

Alan Kawarai Lefor ◽

...

Keyword(s):

Cohort Study ◽

Propensity Score ◽

Blood Loss ◽

Emergency Surgery ◽

Retrospective Cohort ◽

Confounding Factors ◽

Intraoperative Blood Loss ◽

Antithrombotic Drugs ◽

Generalized Peritonitis ◽

Blood Loss Volume

Abstract Background The effect of antithrombotic drugs on intraoperative operative blood loss volume in patients undergoing emergency surgery for generalized peritonitis is not well defined. The purpose of this study was to investigate the effect of antithrombotic drugs on intraoperative blood loss in patients with generalized peritonitis using a nationwide surgical registry in Japan. Method This retrospective cohort study used a nationwide surgical registry data from 2011 to 2017 in Japan. Propensity score matching for the use of antithrombotic drugs was used for the adjustment of age, gender, comorbidities, frailty, preoperative state, types of surgery, surgical approach, laboratory data, and others. The main outcome was intraoperative blood loss: comparison of intraoperative blood loss, ratio of intraoperative blood loss after adjusted for confounding factors, and variable importance of all covariates. Results A total of 70,105 of the eligible 75,666 patients were included in this study, and 2947 patients were taking antithrombotic drugs. Propensity score matching yielded 2864 well-balanced pairs. The blood loss volume was slightly higher in the antithrombotic drug group (100 [10–349] vs 70 [10–299] ml). After adjustment for confounding factors, the use of antithrombotic drugs was related to a 1.30-fold increase in intraoperative blood loss compared to non-use of antithrombotic drugs (95% CI, 1.16–1.45). The variable importance revealed that the effect of the use of antithrombotic drugs was minimal compared with surgical approach or type of surgery. Conclusion This study shows that while taking antithrombotic drugs is associated with a slight increase in intraoperative blood loss in patients undergoing emergency surgery for generalized peritonitis, the effect is likely of minimal clinical significance.

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Our experience with laparoscopic total gastrectomy for gastric cancer: A case series

Journal of Gastric Surgery ◽

10.36159/jgs.v2i3.52 ◽

2020 ◽

Vol 2 (3) ◽

Author(s):

Manash Ranjan Sahoo ◽

Satyajit Samal ◽

Jyotirmay Nayak

Keyword(s):

Gastric Cancer ◽

Blood Loss ◽

Hospital Stay ◽

Total Gastrectomy ◽

Median Time ◽

Operative Time ◽

Laparoscopic Total Gastrectomy ◽

Oral Feeding ◽

Care Hospital ◽

Intraoperative Blood Loss

Background: Though laparoscopic distal gastrectomy has become a standard procedure for treatment of gastric cancer, laparoscopic total gastrectomy has not been widely accepted as it requires more dexterity and lack of evidence about its feasibility and safety. Methods: Here retrospectively we review a series of 12 cases of gastric cancer undergone laparoscopic total gastrectomy with D1 or D2 lymphadenectomy over a period of 7 years at a tertiary care hospital. The patient demographic characteristics were reviewed and the outcomes after surgery was analyzed in terms of extent of lymphadenectomy, mean operative time, mean intraoperative blood loss median number of lymph nodes harvested, median time for postoperative ambulation, median time for postoperative oral feeding, median time of postoperative hospital stay, postoperative complications and mortality. Results: All patients had total gastrectomy entirely through laparoscopic method. Mean operative time was 282 minutes, mean intraoperative blood loss was 120 ml, median time for ambulation and oral feeding was 3 days and 6 days respectively. Median time of hospital stay was 16 days and 2 patients had complications as pancreatic fistula and port site abscess. No mortality was observed. Conclusion: With zero mortality and accepted rate of complications, laparoscopic total gastrectomy appears to be technically feasible and safe for management of gastric cancer. But more studies have to be conducted with comparison to other standard gastrectomies and long term follow up to be done to establish its standardized application.

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Comparison of early clinical results for the femoral neck system and cannulated screws in the treatment of unstable femoral neck fractures

10.21203/rs.3.rs-129837/v2 ◽

2021 ◽

Author(s):

Xiaoqiang Zhou ◽

Zhiqiang Li ◽

Renjie Xu ◽

Yuanshi She ◽

Xiangxin Zhang ◽

...

Keyword(s):

Femoral Head ◽

Femoral Neck ◽

Blood Loss ◽

Hospital Stay ◽

Clinical Efficacy ◽

Operation Time ◽

Femoral Neck Fractures ◽

Femoral Head Necrosis ◽

Cannulated Screws ◽

Intraoperative Blood Loss

Abstract Objective: To compare early clinical effects of the femoral neck system (FNS) and three cannulated screws for the treatment of patients with unstable femoral neck fractures.Methods: A retrospective analysis with pair matching of 81 patients who received FNS or cannulated screw internal fixation for Pauwels type-3 femoral neck fracture in our hospital from January 2019 to December 2019 was conducted. Patients who received FNS were the test group, and those who received cannulated screws comprised the control group. Matching requirements were as follows: same sex, similar age and similar body mass index (BMI). A total of 30 pairs were successfully matched, and the average age was 53.84 years. The operation time, intraoperative blood loss, hospital stay, hospitalization cost, postoperative visual analogue scale (VAS) score, time to walking without crutches, Harris score, femoral head necrosis rate and complication rate were compared between the groups.Results: Postoperative re-examination of radiographs showed satisfactory reduction in all patients, and all patients were followed up for 10-22 months. Those in the FNS group had lower postoperative VAS scores, earlier times to walking without crutches, higher Harris scores at the last follow-up and lower complication rates (P<0.05). However, intraoperative blood loss and hospitalization costs were greater in the FNS group (P<0.05). No statistically significant difference in operation time, hospital stay or femoral head necrosis rate was observed between the two groups (P>0.05).Conclusion: For patients with unstable femoral neck fractures, FNS has better clinical efficacy than cannulated screws, though it is also more expensive. The excellent biomechanical performance and clinical efficacy of FNS make it a new choice for the treatment of unstable femoral neck fractures.

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