A comparison of laparoscopy versus laparotomy for the management of adnexal masses during pregnancy over the last 16 years: retrospective study

Abstract Background Adnexal masses during pregnancy is not rare. More and more evidences imply that operative laparoscopy for adnexal masses performed during pregnancy could be safe and feasible. We procured and evaluated the surgical, obstetric outcomes between laparoscopy and laparotomy for the management of adnexal masses during first and second trimester period in our hospital. Results 117 pregnant women with adnexal masses were treated by laparoscopy (69 cases) or laparotomy (48 cases) between July 2003 and March 2019. The laparoscopy group had a significantly lower blood loss (22.0 ± 3.4ml vs 41.7 ± 4.3ml, P = 0.0004), a shorter onset of flatus after operation (24.2 ± 0.1h vs 41.6 ± 1.9h, P < 0.0001) and a shorter hospital stay (3.5 ± 0.2 days vs 6.6 ± 0.2 days, < 0.0001) than the laparotomy group. No patient from either group required a blood transfusion. There is no significant difference in obstetric outcomes, including preterm labor and fetal loss. The median follow-up time was 3.5 years (range, 1.5–11.5 years) after surgery. The median age of the children was 2.5 years (range, 1-9.5 years). No notable abnormality was found. Conclusions In this retrospective study, compared with laparotomy, laparoscopy has successful outcome with lower blood loss, shorter onset of flatus after surgery, and shorter hospital stay, all of those suggest that operative laparoscopy could be promising for adnexal masses performed during pregnancy.

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Is Obesity a Risk Factor for Spinal Surgeries? A Retrospective Study in a Specialized Orthopedic Spine Center

Journal of Research in Orthopedic Science ◽

10.32598/jrosj.8.1.759.1 ◽

2021 ◽

Vol 8 (1) ◽

pp. 37-42

Author(s):

Hasan Ghandhari ◽

◽

Ebrahim Ameri ◽

Mohsen Motalebi ◽

Mohamad-Mahdi Azizi ◽

...

Keyword(s):

Retrospective Study ◽

Postoperative Complications ◽

Blood Loss ◽

Hospital Stay ◽

Length Of Hospital Stay ◽

Obese Group ◽

Obese Patients ◽

Number Of Patients ◽

Significant Difference ◽

Duration Of Surgery

Background: Various studies have shown the effects of morbid obesity on the adverse consequences of various surgeries, especially postoperative infections. However, some studies have shown that the complications of spinal surgery in obese and non-obese patients are not significantly different. Objectives: This study investigated and compared the duration of surgery, length of hospital stay, and complications after common spinal surgeries by orthopedic spine fellowship in obese and non-obese patients in a specialized spine center in Iran. Methods: All patients who underwent decompression with or without lumbar fusion were included in this retrospective study. These patients were classified into two groups: non-obese (BMI <30 kg/m2) and obese (BMI ≥30 kg/m2). The data related to type and levels of surgery, 30-day hospital complications, length of hospital stay, rate of postoperative wound infection, blood loss, and need for transfusion were all extracted and compared between the two groups. Results: A total of 148 patients (74%) were in the non-obese group and 52 patients (26%) in the obese group. The number of patients that need packed cells was significantly higher in the obese group (51.8% vs 32.6%) (P=0.01). Otherwise, there were not a significant difference between type of treatment (fusion or only decompression) (P=0.78), interbody fusion (P=0.26), osteotomy (P=0.56), duration of surgery (P=0.25), length of hospital stay (P=0.72), mean amount of blood loss (P=0.09), and postoperative complications (P=0.68) between the two groups. Conclusion: Our results suggest that duration of surgery, length of hospital stay, and postoperative complications are not associated with the BMI of the patients.

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Comparative study of surgical results between total abdominal hysterectomy and total laparoscopic hysterectomy in a tertiary hospital: a 2 year retrospective study

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20180884 ◽

2018 ◽

Vol 7 (3) ◽

pp. 1019

Author(s):

Kanmani M. ◽

Mirudhubashini Govindarajan ◽

Vishranthi Selvaraj

Keyword(s):

Retrospective Study ◽

Blood Loss ◽

Hospital Stay ◽

Laparoscopic Hysterectomy ◽

Total Abdominal Hysterectomy ◽

Abdominal Hysterectomy ◽

Total Laparoscopic Hysterectomy ◽

Pelvic Surgery ◽

Surgical Results ◽

Significant Difference

Background: Since the introduction of Laparoscopic hysterectomy by Reich in 1989, it has become a widely accepted technique worldwide. The aim of the study was to compare the surgical results between Total Laparoscopic Hysterectomy (TLH) and Total Abdominal Hysterectomy (TAH).Methods: We conducted a retrospective study at Women’s center and hospitals between June 2014 to May 2016, 32 patients who underwent TAH and 55 patients who underwent TLH, were included.Results: We observed that there was no significant difference between the two groups in respect to patient's demographic characteristics, indication of surgery, uterine size, or with history of previous pelvic surgery. Duration of surgery was found to be longer in TLH than TAH (124±39.7 min vs. 104.7±39.8 min). The length of hospital stay was less in TLH than TLH (P-0.0001) and the amount of blood loss were also less in TLH than TAH (103±149 ml versus 243±210 ml). There was no significant difference in view of intra and post operative complications. Hemoglobin change was statistically significant and is more with TAH than TLH (1.57±0.7g% versus 1.12±0.7g%).Conclusions: This study showed that TLH can be safely performed by the experienced surgeon in order to reduce the blood loss, duration of hospital stay and the quality of life.

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Restrictive Transfusion Strategy Does Not Affect Clinical Prognosis in Patients with Ectopic Pregnancy

BioMed Research International ◽

10.1155/2017/2679148 ◽

2017 ◽

Vol 2017 ◽

pp. 1-9 ◽

Cited By ~ 1

Author(s):

Yanjuan Huang ◽

Yi Liang ◽

He Ma ◽

Mei Ling ◽

Xuelian Ran ◽

...

Keyword(s):

Blood Loss ◽

Hospital Stay ◽

Ectopic Pregnancy ◽

Emergency Surgery ◽

Operation Time ◽

Transfusion Strategy ◽

Clinical Prognosis ◽

Restrictive Transfusion ◽

Significant Difference ◽

Restrictive Transfusion Strategy

To assess the effects of restrictive transfusion strategy on hemoglobin (Hb) levels and prognosis in patients with ectopic pregnancy and severe hemorrhage undergoing emergency surgery, patient data were collected from 2012 to 2016. Following transfusion guidelines, restrictive transfusion was performed; at Hb levels of 60–70 to 100 g/L, transfusion was continued or not based on disease status. The patients were divided into four groups: blood loss < 400 ml (N1), 400–799 ml (N2), 800–1199 ml (N3), and ≥1200 ml (N4). Several prognosis parameters were assessed. GroupN4 was further divided based on blood loss amounts (1200–1999, 2000–2999, 3000–3999, and 4000–5000 ml) for subgroup analyses. Blood loss, hemoglobin levels at discharge, and American Society of Anesthesiologists (ASA) scores were not associated with patient prognostic parameters, including intensive care unit (ICU) occupancy, cure, and healing rates, and surgical complications and hospital stay. No statistically significant difference was obtained in hospital stay amongN1,N2, andN3 groups. Compared withN1 patients, cases with blood loss ≥ 1200 ml had significantly longer hospital stay. Interestingly, hospital stay was correlated with surgical approach, location of pregnancy, and operation time. Restrictive transfusion strategy could be safely used for emergency surgery in ectopic pregnancy with acute blood loss.

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Open cystectomy is still alive and well: Outcomes from a single-centre 6-year review

Journal of Clinical Urology ◽

10.1177/2051415818759366 ◽

2018 ◽

Vol 12 (3) ◽

pp. 239-245

Author(s):

Alexios Dosis ◽

Blessing Dhliwayo ◽

Patrick Jones ◽

Iva Kovacevic ◽

Jonathan Yee ◽

...

Keyword(s):

Blood Loss ◽

Hospital Stay ◽

Radical Cystectomy ◽

Length Of Hospital Stay ◽

Categorical Variables ◽

Complication Rates ◽

Intraoperative Blood Loss ◽

Single Centre ◽

Significant Difference ◽

Duration Of Surgery

Objectives: To compare perioperative and oncological outcomes between open and laparoscopic radical cystectomy in a single-centre setting. Materials and methods: This study was a retrospective cohort (level 2b evidence) non-randomised review of 228 radical cystectomies that were performed between January 2010 and February 2016. Primary outcome measures were operative time, complications, blood loss and length of hospital stay. Statistical analysis was performed using the SPSS v21.0. Quantitative values were compared with Student’s t-test; categorical variables with the chi-square test. Statistical significance was considered a result of an alpha value less than 0.05. A Kaplan–Meier survival analysis was also conducted. Results: Intraoperative blood loss was lower in laparoscopic surgery (855±673 vs. 716±570 mL, P=0.15), which had a significant impact on transfusion rates ( P=0.02). Operative times were lower in open surgery (339±52.9 vs. 353.1±67.1 minutes, P=0.10), while hospital stay was lower in the laparoscopic group (14.2±11.2 vs. 16.0±13.6 days, P=0.28). Five-year survival rates were superior for patients who underwent an open procedure but were not statistically significant ( P=0.10). Conclusion: This is, so far, the largest cohort to compare laparoscopic and open radical cystectomy. The laparoscopic approach can reduce the need for transfusion; however, there was no statistically significant difference in complication rates, duration of surgery, length of hospital stay or intraoperative blood loss, survival and margin positivity. Level of evidence: Not applicable for this multicentre audit.

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Modified Nuss operation using introducer-bar complex for pectus excavatum in adults: a retrospective study

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01624-6 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Lei Wang ◽

Juan Liu ◽

Yao Li ◽

Tienan Feng ◽

Beibei Cao ◽

...

Keyword(s):

Retrospective Study ◽

Blood Loss ◽

Pectus Excavatum ◽

Operation Time ◽

Nuss Procedure ◽

Plate Removal ◽

Traditional Procedure ◽

Group Outcomes ◽

Significant Difference ◽

Clinical Benefits

Abstract Background Shortcoming of traditional Nuss operation on adults is gradually found in the clinical practice. A new kind of introducer-bar complex was introduced. However, there is limited evidence regarding its safety and efficacy. Therefore, a single center, retrospective study was conducted to address this issue. Methods Patients with pectus excavatum who underwent surgery between January 2015 and June 2017 were consecutively enrolled in this study. In all, 52 patients underwent the modified procedure using the introducer-bar complex (new procedure group), whereas 48 underwent the traditional anti-Nuss procedure (traditional procedure group). Outcomes analysis of balanced baseline was performed to compare the intraoperative and postoperative short-term outcomes. Results All patients in the new procedure group had shorter operation duration (51.54 ± 20.32 vs. 79.45 ± 13.88 min, p = 0.017), postoperative hospitalizations (4.77 ± 1.62 vs. 6.86 ± 2.18 days, p = 0.028), plate removal surgery durations (39.30 ± 8.97 vs. 60.30 ± 10.49 min, p < 0.001), and less blood loss during operation (6.25 ± 4.88 vs. 10.90 ± 5.75 ml, p = 0.003) than patients in the traditional procedure group. There was no significant difference in the length of incision, postoperative Haller index, cost, number of steel bars, postoperative surgical outcome and incidence of complications between the two groups. Conclusion Through the main clinical outcome were similar, our results shown that modified procedure may have the shorter operation time, postoperative hospital stay, and operation time for plate removal and less blood loss, which may bring potential clinical benefits to patients.

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Comparison of Minimally Invasive Surgery versus Laparotomy for Surgical Staging of Endometrial Carcinoma: A Retrospective Study

Birat Journal of Health Sciences ◽

10.3126/bjhs.v5i1.29613 ◽

2020 ◽

Vol 5 (1) ◽

pp. 916-920

Author(s):

Mona Priyadarshini ◽

Rani Akhil Bhat

Keyword(s):

Endometrial Cancer ◽

Minimally Invasive Surgery ◽

Blood Loss ◽

Minimally Invasive ◽

Hospital Stay ◽

Endometrial Carcinoma ◽

Invasive Surgery ◽

Surgical Staging ◽

Duration Of Hospital Stay ◽

Significant Difference

Introduction: Endometrial carcinoma is one of the commonest gynaecological cancer in developed countries as well as developing countries. The mainstay of initial treatment of endometrial carcinoma is surgical staging which may be performed by either the conventional abdominal approach or by minimally invasive route i.e. laparoscopic or robotic. Objectives: The purpose of this study was to compare and evaluate the surgical staging, safety and clinical benefits of minimally invasive surgeries versus. laparotomy in patients with endometrial cancer. Methodology: We retrospectively analyzed 105 patients with endometrial cancer over a period of five years and compared the outcome of total hysterectomy with pelvic and para-aortic lymphadenectomy by abdominal, laparoscopic approach or robotic-assisted surgery. Comparison was done with respect to operative time, blood loss, number of lymph nodes retrieved, length of hospital stay, intraoperative and postoperative complications. The data were analyzed using paired “t”- test / Wilcoxon signed rank test ,χ2 - test, Pearson correlation coefficient “r” whenever found suitable. P value of less than 0.05 was considered as statistically significant. Result: There was no statistically significant difference seen in the baseline characteristics like age and BMI between the two groups. The laparotomies were done in a shorter time than the minimally invasive approach (p<0.001). The amount of blood loss (p=0.002), and the duration of hospital stay (p<0.001) was significantly less in the minimally invasive surgery group than the laparotomies. Not much difference in the lymph node retrieval was observed between the two arms (p=0.614). The number of complications were almost similar in both the groups. Conclusion: Minimally invasive surgery for surgical staging of endometrial carcinoma is feasible and effective than laparotomy. The amount of blood loss and duration of hospital stay is seen much lesser with MIS than laparotomy.

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Post neoadjuvant chemo-radiation positive anterior circumferential resection margin in carcinoma rectum: Extended resection of rectum versus total pelvic exenteration—Results from a single centre retrospective study.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e15156 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e15156-e15156

Author(s):

Kamlesh Verma ◽

Reena Engineer ◽

Vikas S. Ostwal ◽

Suman Kumar ◽

Supreeta Arya ◽

...

Keyword(s):

Retrospective Study ◽

Hospital Stay ◽

Circumferential Resection Margin ◽

Resection Margin ◽

Pelvic Exenteration ◽

Total Pelvic Exenteration ◽

Duration Of Hospital Stay ◽

Significant Difference ◽

Carcinoma Rectum

e15156 Background: Positive circumferential resection margin has been shown to be powerful predictor of poor prognosis in rectal CA. Radiologically positive anterior CRM (PACRM) after NACT+RT leads to either resection of involved organ alone ie.Extended resection of rectum (ERR) or Total pelvic exenteration (TPE). Purpose of this study is to compare recurrence rate and survival of patients undergoing ERR or TPE for PACRM after NACT+RT. Methods: Retrospective study of patients operated for rectal CA from January 2013 to December 2014. Results: Out of 237 patients with non-metastatic CA rectum, 51 patients (21.5%) had PACRM. After NACT+RT, 22 patients (43.1%) developed systemic metastases, 7 patients (13.8%) were downsized and underwent extra-mesorectal resection (AR/APR), remaining 22 patients (43.1%) had persistent PACRM. 13 patients with PACRM underwent ERR whereas 9 patients underwent TPE. Median duration of hospital stay in TPE group was 13 days (10 - 26) whereas it was 7 days (5 – 21) in ERR group. Negative pathological CRM was achieved in all TPE and 92.3% of ERR patients. After median follow-up of 31.6 months, 5 patients with TPE (55.6%) and 4 patients with ERR (30.7%) developed systemic recurrence. None of the TPE patient, whereas 3 patients with ERR (23.1%) developed local recurrence. Median D.F.S. was 12.3 months in TPE and 18.9 months in ERR whereas mean O.S. was 36.2 and 32.8 respectively. Conclusions: Due to lack of significant difference in O.S./ D.F.S. and low post-operative complication and duration of hospital stay, ERR can be considered acceptable alternative to TPE.

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A comparative analysis of hysterectomies

Medicina ◽

10.3390/medicina43020014 ◽

2007 ◽

Vol 43 (2) ◽

pp. 118 ◽

Cited By ~ 4

Author(s):

Rosita Aniulienė ◽

Laima Varžgalienė ◽

Manvydas Varžgalis

Keyword(s):

Blood Loss ◽

Hospital Stay ◽

Complication Rate ◽

Vaginal Hysterectomy ◽

Length Of Hospital Stay ◽

Laparoscopic Hysterectomy ◽

Abdominal Hysterectomy ◽

Obstetrics And Gynecology ◽

Significant Difference ◽

The Mean

The objective of this study was to evaluate and compare operative and postoperative results and differences among laparoscopic, vaginal, and abdominal hysterectomies performed at the Department of Obstetrics and Gynecology of Kaunas University of Medicine Hospital. Methods. A retrospective review of medical histories was performed for women who had undergone three different types of hysterectomies (laparoscopic, vaginal, and abdominal) at the Department of Obstetrics and Gynecology of Kaunas University of Medicine Hospital during 2004–2005. Results. A total of 602 hysterectomies were performed: 51 (8.5%) laparoscopic, 203 (33.7%) vaginal, and 348 (57.8%) abdominal. The lowest complication rate occurred in patients who underwent laparoscopic hysterectomy (n=5, 9.8%) and the highest – abdominal hysterectomy (n=88, 25.2%) (P<0.05). More complication occurred after abdominal as compared to vaginal hysterectomy (n=88, 25.2% vs. n=20, 9.9%, respectively; P<0.05). There was no statistically significant difference in complication rate comparing laparoscopic and vaginal hysterectomies (P=0.26). The amount of blood loss depended on the type of hysterectomy – less blood was lost during laparoscopic and more during abdominal hysterectomy (123.4 vs. 308.5 mL, respectively; P<0.01). A significantly higher blood loss was observed during abdominal hysterectomy as compared to vaginal (195.3 mL) and vaginal as compared to laparoscopic hysterectomy (P<0.01). The mean length of hospital stay differed comparing all three types of hysterectomies: the shortest stay of 8.6 days was after laparoscopic, the longest of 13.7 days – after abdominal hysterectomy. The mean hospital stay was statistically significant shorter for vaginal hysterectomy compared to abdominal hysterectomy (9.1 vs. 13.7 days, P<0.01). The difference in mean length of hospital stay was insignificant comparing laparoscopic and vaginal hysterectomies (P>0.05). Conclusions. Abdominal hysterectomy was the most common procedure performed. The type of hysterectomy influenced the rate of complications – the lowest complication rate was after laparoscopic and vaginal hysterectomies. The amount of blood loss depended on the type of hysterectomy – the lowest was during laparoscopic hysterectomy. Abdominal hysterectomy required on average a longer hospital stay compared with laparoscopic and vaginal hysterectomies.

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Introduction of gasless laparoscopic surgery as a minimally invasive procedure for endometrial cancer and its usefulness from the viewpoint of the learning curve

World Journal of Surgical Oncology ◽

10.1186/s12957-021-02453-6 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Hiroe Ito ◽

Tetsuya Moritake ◽

Fumitoshi Terauchi ◽

Keiichi Isaka

Keyword(s):

Endometrial Cancer ◽

Laparoscopic Surgery ◽

Blood Loss ◽

Learning Curve ◽

Hospital Stay ◽

Open Surgery ◽

Operative Time ◽

Perioperative Complications ◽

Survival Rates ◽

Significant Difference

Abstract Background We investigated the usefulness of gasless laparoscopic surgery (GLS) using a subcutaneous abdominal wall lifting method for endometrial cancer. Methods We studied 105 patients with early endometrial cancer who underwent GLS (55) or open surgery (50). A uterine manipulator was used in all GLS cases. We compared operative time, blood loss, number of lymph nodes removed, hospital stay, perioperative complications, cases converted to laparotomy, and recurrence and survival rates. We also studied the learning curve and proficiency of GLS. Results The GLS group had significantly longer operative time (265 vs. 191 min), reduced blood loss (184 vs. 425 mL), shorter hospital stay (9.9 vs. 17.6 days), and fewer postoperative complications (1.8 vs. 12.0%) than the open group. No case was converted to laparotomy. Disease-free and overall survival rates at 4 years postoperatively (GLS vs. open groups) were 98.0 versus 97.8 and 100 versus 95.7%, respectively, and there was no significant difference between the groups. Regarding the learning curve for GLS, two different phases were observed in approximately 10 cases. Operator 2, who was not accustomed to laparoscopic surgery, showed a significant reduction in operative time in the later phase 2. Conclusions GLS for endometrial cancer results in less bleeding, shorter hospital stay, and fewer complications than open surgery. Recurrence and survival rates were not significantly different from those of open surgery. This technique may be introduced in a short time for operators who are skilled at open surgery but not used to laparoscopic surgery.

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Novel Extravesical Versus Transvesical Technique for Abdominal Repair of Vesicovaginal Fistula

Société Internationale d’Urologie Journal ◽

10.48083/tvyu2515 ◽

2021 ◽

Vol 2 (2) ◽

pp. 113-119

Author(s):

Ibrahem Ismail Samaha ◽

Kareem M. Taha ◽

Islam Elbabouly ◽

Maged Ali

Keyword(s):

Urinary Tract ◽

Blood Loss ◽

Hospital Stay ◽

Lower Urinary Tract Symptoms ◽

Lower Urinary Tract ◽

Vesicovaginal Fistula ◽

Urinary Tract Symptoms ◽

Significant Difference ◽

Abdominal Repair ◽

Lower Urinary

Objectives: To compare the transvesical transabdominal repair of vesicovaginal fistula with novel extravesical transabdominal repair with respect to operative time, blood loss, hospital stay, catheterization time, postoperative lower urinary tract symptoms, urodynamic changes, and recurrence rate. Methods: A prospective randomized controlled study of 94 consecutive female patients who underwent transabdominal vesicovaginal fistula (VVF) repair from March 2013 to March 2018 in our center. The patients had high vesicovaginal fistula that could not be operated on transvaginally: 47 cases were treated with extravesical transabdominal technique, and 47 cases were treated with transvesical transabdominal technique. The primary endpoint is the functional outcome regarding postoperative lower urinary tract symptoms (LUTS); secondary outcomes are early recovery and success rates. The follow-up period was 3 months for reporting and dealing with any complications. Results: There was no significant difference between the groups regarding demographic data. Extravesical repair of VVF had significantly higher (106.56±10.46 min) operating time than transvesical repair (95.08±7.6 min) P <0.001. There was no significant difference regarding intraoperative blood loss between the extravesical (365.42±81.29 mL) and transvesical (353.12±73.9 mL) groups; P = 0.44). The extravesical group had a significant shorter hospital stay (62.35±12.25 hours) than the transvesical repair group (85.07±12.0 hours) P < 0.001. Postoperative storage LUTS 6 weeks assessed by Overactive Bladder Symptom Score was significantly lower for extravesical repair (1.75±0.59) than for transvesical repair (6.87±2.24) P = 0.001). This was confirmed by urodynamic evaluation. Two patients (4.2%) in the transvesical group but none in the extravesical group experienced fistula recurrence. Conclusions: The extravesical transabdominal approach for repair of vesicovaginal fistula is a novel, successful, and versatile technique with reduced hospital stay, reduced postoperative LUTS and possibly fewer recurrences than the transvesical technique, and should be considered for all VVF requiring abdominal repair.

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