scholarly journals A Prospective Interventional Study on LigaSureTM Haemorrhoidectomy as a Daycare Procedure

2021 ◽  
Vol 28 (5) ◽  
pp. 102-107
Author(s):  
Abdel Latif K Elnaim ◽  
◽  
Shareef Musa ◽  
Michael Pak-Kai Wong ◽  
Ismail Sagap ◽  
...  
Keyword(s):  
Blood Loss ◽  
Regional Anaesthesia ◽  
Operating Time ◽  
Anal Stenosis ◽  
Complication Rates ◽  
Day Case ◽  
Interventional Study ◽  
Urine Retention ◽  
Fourth Degree

Objective: This study was designed as a prospective and interventional study that evaluated LigaSure™ haemorrhoidectomies with regional anaesthesia as a daycare procedure. Methods: Patients with third- and fourth-degree haemorrhoids were recruited from the clinic from January 2018 to December 2019. The procedure was performed as a day case under regional anaesthesia. Using a LigaSureTM device, excisional haemorrhoidectomies (Milligan– Morgan haemorrhoidectomy) were performed without sutures or an anal sponge. We evaluated wound bleeding, pain and urinary retention per daycare protocols. Results: A total of 264 patients were enrolled. There were 153 males (57.9%) with a median age of 30 years old (range 16 years old–80 years old). A total of 142 patients (54%) had thirddegree haemorrhoids, while the rest had fourth-degree haemorrhoids. The median operating time was 8 min (range 4 min–17 min) and minimal blood loss was observed. During follow-up, the complications were one case (0.3%) had anal stenosis, one case (0.3%) had minimal bleeding and one case (0.3%) had urine retention. Upon discharge, four patients (1.5%) required additional analgesia and another four (1.5%) developed post-spinal headaches. No incontinence was encountered. Conclusion: LigaSure™ excisional haemorrhoidectomy is a safe and effective daycare procedure with acceptable re-admission and complication rates.

scholarly journals Surgical Outcomes of Haemorrhoidectomy along With Suture Haemorrhoidopexy in Multiple Haemorrhoids

2019 ◽  
Vol 6 (2) ◽  
pp. 73-76
Author(s):  
Mohammad Ibrahim Khalil ◽  
Md Ashiqur Rahman ◽  
Adnan Ahmed ◽  
Samia Shihab Uddin ◽  
Mohammad Alauddin ◽  
...  
Keyword(s):  
Operating Time ◽  
Pain Scale ◽  
Late Complications ◽  
Anal Stenosis ◽  
Safe Procedure ◽  
College Hospital ◽  
Primary Position ◽  
Medical College ◽  
Mucosal Oedema

Background: Haemorroid stapler becomes easier and safe to deal multiple and prolapsed haemorrhoid at a time. Objectives: The purpose of the present study was to evaluate the outcome of suture haemorrhoidopexy for secondary position haemorrhoids in addition to haemorrhoidectomy for primary haemorrhoids (multiple). Methodology: This prospective interventional study was performed in Dhaka Medical College Hospital, Dhaka, Bangladesh and in a private hospital in Gazipur, Bangladesh for over five (05) years from January 2012 to December 2016. Patients who were presented with secondary position haemorrhoids in addition to primary position haemorrhoids (multiple haemorrhoids) were included in this study. Open haemorrhoidectomy (Milligan-Morgan) followed by suture haemorrhoidopexy was done. All patients were followed up after 1, 2, 4, 8 weeks, 6 months and 1 yearly. Result: Total 18 patients were operated. Among those immediate complications were encountered in patients in the form of per rectal bleeding 1(5.55%), pain 3(visual pain scale 4)16.66%, mucosal oedema 6(33.33%), no patient developed early postoperative prolapse. No patient developed bowel incontinence. Late complications experienced as prolapse at 1 year follow up which was treated by conservative measures. No patient developed anal stenosis. Mean operating time was 25 minutes and duration of hospital stay was 1 day. Conclusion: Stapled haemorrhoidopexy is a safe procedure for circumferential excision of mucosa and submucosa dealing all haemorrhoids and prolapse simultaneously. Journal of Current and Advance Medical Research 2019;6(2): 73-76

Mid-term to long-term clinical and functional outcomes of minimally invasive correction and fusion for adults with scoliosis

2010 ◽  
Vol 28 (3) ◽  
pp. E6 ◽  
Author(s):  
Neel Anand ◽  
Rebecca Rosemann ◽  
Bhavraj Khalsa ◽  
Eli M. Baron
Keyword(s):  
Blood Loss ◽  
Minimally Invasive ◽  
Interbody Fusion ◽  
Short Form ◽  
Operating Time ◽  
Adult Scoliosis ◽  
Estimated Blood Loss ◽  
The Mean

Object The goal of this study was to assess the operative outcomes of adult patients with scoliosis who were treated surgically with minimally invasive correction and fusion. Methods This was a retrospective study of 28 consecutive patients who underwent minimally invasive correction and fusion over 3 or more levels for adult scoliosis. Hospital and office charts were reviewed for clinical data. Functional outcome data were collected at each visit and at the last follow-up through self-administered questionnaires. All radiological measurements were obtained using standardized computer measuring tools. Results The mean age of the patients in the study was 67.7 years (range 22–81 years), with a mean follow-up time of 22 months (range 13–37 months). Estimated blood loss for anterior procedures (transpsoas discectomy and interbody fusions) was 241 ml (range 20–2000 ml). Estimated blood loss for posterior procedures, including L5–S1 transsacral interbody fusion (and in some cases L4–5 and L5–S1 transsacral interbody fusion) and percutaneous screw fixation, was 231 ml (range 50–400 ml). The mean operating time, which was recorded from incision time to closure, was 232 minutes (range 104–448 minutes) for the anterior procedures, and for posterior procedures it was 248 minutes (range 141–370 minutes). The mean length of hospital stay was 10 days (range 3–20 days). The preoperative Cobb angle was 22° (range 15–62°), which corrected to 7° (range 0–22°). All patients maintained correction of their deformity and were noted to have solid arthrodesis on plain radiographs. This was further confirmed on CT scans in 21 patients. The mean preoperative visual analog scale and treatment intensity scale scores were 7.05 and 53.5; postoperatively these were 3.03 and 25.88, respectively. The mean preoperative 36-Item Short Form Health Survey and Oswestry Disability Index scores were 55.73 and 39.13; postoperatively they were 61.50 and 7, respectively. In terms of major complications, 2 patients had quadriceps palsies from which they recovered within 6 months, 1 sustained a retrocapsular renal hematoma, and 1 patient had an unrelated cerebellar hemorrhage. Conclusions Minimally invasive surgical correction of adult scoliosis results in mid- to long-term outcomes similar to traditional surgical approaches. Whereas operating times are comparable to those achieved with open approaches, blood loss and morbidity appear to be significantly lower in patients undergoing minimally invasive deformity correction. This approach may be particularly useful in the elderly.

scholarly journals Ultrasound-Guided Thermal Ablation of Bethesda IV Thyroid Nodules: A Pilot Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Xinyang Li ◽  
Yu Lan ◽  
Nan Li ◽  
Lin Yan ◽  
Jing Xiao ◽  
...  
Keyword(s):  
Blood Loss ◽  
Thermal Ablation ◽  
Thyroid Nodules ◽  
Metastatic Lymph Node ◽  
Operation Time ◽  
Distant Metastases ◽  
Complication Rates ◽  
Incision Length ◽  
Hospitalization Time

ObjectiveThe purpose of our study was to evaluate the effectiveness of thermal ablation (TA) for Bethesda IV thyroid nodules, and to compare TA and surgery in terms of treatment outcomes, complications, and costs.MethodThis study was approved by the local ethics committee. From January 2017 to December 2019, 30 patients elected TA and 31 patients elected surgery for treatment of Bethesda IV thyroid nodules. Demographics information and conventional ultrasound before treatment for each patient was obtained. For the TA group, the ablation extent was 3 mm beyond the edge of the tumor to prevent marginal residual and recurrence. Patients were followed up at 1, 3, and 6 months after intervention, and every 6 months thereafter. Postoperative complications, operation time, hospitalization time, blood loss, and incision length were recorded.ResultsIn the TA group, the volume reduction ratio (VRR) was 94.63 ± 8.99% (range:76%-100%) at the final follow-up. The mean follow-up time was 16.4 ± 5.2months (range:12–24 months). No recurrences, no metastatic lymph node, and no distant metastases were detected during follow-up. The TA group had fewer complications, shorter operation time, smaller incision length, less blood loss, shorter hospitalization time, and lower treatment costs compared to the surgery group (all P<0.001).ConclusionsTA is technically feasible for the complete destruction of Bethesda IV thyroid nodules, and also safe and effective during the follow-up period, with high VRR and low complication rates, especially in patients who were ineligible for or refused surgery.

scholarly journals Initial Canadian experience with robotic simple prostatectomy: Case series and literature review

2015 ◽  
Vol 9 (9-10) ◽  
pp. 626 ◽  
Author(s):  
Nathan Y. Hoy ◽  
Stephan Van Zyl ◽  
Blair A. St. Martin
Keyword(s):  
Blood Loss ◽  
Operating Time ◽  
Case Series ◽  
Transfusion Rate ◽  
Complication Rates ◽  
Intraoperative Blood Loss ◽  
Transfusion Requirements ◽  
Simple Prostatectomy ◽  
Significant Difference ◽  
The Mean

Introduction: Robotic-assisted simple prostatectomy (RASP) has been touted as an alternative to open simple prostatectomy (OSP) to treat large gland benign prostatic hyperplasia. Our study assesses our institution’s experience with RASP and reviews the literature.Methods: We performed a retrospective chart review from January 2011 to November 2013 of all patients undergoing RASP and OSP. Operative and 90-day outcomes, including operation time, intraoperative blood loss, length of hospital stay (LOS), transfusion requirements, and complication rates, were assessed.Results: Thirty-two patients were identified: 4 undergoing RASP and 28 undergoing OSP. There was no difference in mean age at surgery (69.3 vs. 75.2 years; p = 0.17), mean Charlson Comorbidity Index (2.5 vs. 3.5; p = 0.19), and mean prostate volume on TRUS (239 vs. 180 mL; p = 0.09) in the robotic and open groups, respectively. There was a significant difference in the mean length of operation, with RASP exceeding OSP (161 vs. 79 min; p = 0.008). The mean intraoperative blood loss was significantly higher in the open group (835.7 vs. 218.8 mL; p = 0.0001). Mean LOS was shorter in the RASP group (2.3 vs. 5.5 days; p = 0.0001). No significant differences were noted in the 90-day transfusion rate (p = 0.13), or overall complication rate at 0% with RASP vs. 57.1% with OSP (p = 0.10).Conclusions: Our data suggest RASP has a shorter LOS and lower intraoperative volume of blood loss, with the disadvantage of a longer operating time, compared to OSP. It is a feasible technique and deserves further investigation and consideration at Canadian centres performing robotic prostatectomies.

Single Incision Laparoscopic Cholecystectomy Performed via the “Marionette” Technique Shows Equivalence in Outcome and Cost to Standard Four Port Laparoscopic Cholecystectomy in a Selected Patient Population

2015 ◽  
Vol 81 (10) ◽  
pp. 1015-1020 ◽  
Author(s):  
Maryam N. Saidy ◽  
Sunal S. Patel ◽  
Mark W. Choi ◽  
Mohammed Al-Temimi ◽  
Deron J. Tessier
Keyword(s):  
Multivariate Analysis ◽  
Laparoscopic Cholecystectomy ◽  
Blood Loss ◽  
Hospital Stay ◽  
Operative Time ◽  
Single Incision ◽  
Univariate Analysis ◽  
Operating Time ◽  
Complication Rates ◽  
Single Incision Laparoscopic Cholecystectomy

The aim of our study is to compare single incision laparoscopic cholecystectomy (SILC) performed using the “marionette” technique (m-SILC), to the standard four-port technique [four-port laparoscopic cholecystectomy (4PLC)]. Patient information was extracted from a prospectively maintained database (n = 188). Our primary endpoint was operative costs (determined by operating time and instruments used). Secondary endpoints were length of stay, operative time, blood loss, and postoperative complication rates. Univariate and adjusted multivariate analysis was used to compare the outcomes. There were a total of 188 patients for this study. Gender, body mass index, American Society of Anesthesiologists class, and resident participation were similar. Patients undergoing m-SILC were younger (43.8 vs 49.8 years old), less likely to have cholangiogram (32% vs 54%), and were more likely to undergo cholecystectomy for chronic cholecystitis (73.3% vs 52%). In univariate analysis, cholecystectomy performed by the “marionette method” as compared with the 4PLC was associated with shorter operative time (67 vs 59 minutes respectively) and shorter hospital stay (1.2 vs 2.08 days respectively). In multivariate analysis, SILC was associated with shorter hospital stay and comparable operative time, blood loss, and postoperative complications. Instrumentation cost was less in SILC (by $94). SILC done by an experienced surgeon with the “marionette” technique on a carefully selected population shows a statistically significant cost benefit while maintaining clinically comparable outcomes to the standard 4PLC.

scholarly journals A prospective randomized controlled trial comparing the immediate post-operative complications between open and semi-open hemorrhoidectomy

2019 ◽  
Vol 22 (1) ◽  
pp. 18-22
Author(s):  
Bhuban Rijal ◽  
Robin Bahadur Basnet
Keyword(s):  
Wound Healing ◽  
Pain Score ◽  
Treatment Plan ◽  
Complication Rates ◽  
Open Technique ◽  
Narcotic Analgesics ◽  
Fourth Degree ◽  
Patient Discomfort ◽  
Open Hemorrhoidectomy

Introduction: Hemorrhoids are one of the most common anorectal pathologies encountered by general surgeons during their practice. Open technique as described by Milligan and Morgan and closed technique as described by Ferguson are the most widely used. A semi-open technique that has lesser complications than the conventional open hemorrhoidectomy has been described. This study aims to compare the immediate postoperative complications between open and semi-open hemorrhoidectomy. Methods: A prospective randomized study, where patients with third and fourth-degree hemorrhoids undergoing hemorrhoidectomy, were taken for the study. The subjects were randomized into two groups, where they underwent either open or semi-open hemorrhoidectomy. Both groups received standard postoperative care and were evaluated after 24 hours after surgery for pain and urine retention and were then discharged with the same treatment plan for both groups. First, follow up was done in one week and the second was done in two weeks after discharge, where pain score, bleeding, wound healing, use of narcotic analgesics and patient discomfort were recorded. Results: A total of 44 patients were divided into two groups, where the age, sex, and grade of hemorrhoids were matched. The pain score using VAS in the first week was compared and it showed that the pain perceived by the patients in the open hemorrhoidectomy was greater than in the semi-open method ((p=0.06, 95% CI= 0.22 to 1.23). Bleeding rate after the surgeries were not different between the two groups (p=0.43) and the urinary retention between them was also not significant (p=0.47). The use of breakthrough narcotic analgesics was more in the open hemorrhoidectomy group (p=0.01). On the fourteenth day follow up, the wound of those who underwent semi-open hemorrhoidectomy, had significantly healed as compared to those who had undergone the open procedure (p= 0.04, 95% CI=0.23 to 0.76), and the patients who had semi-open hemorrhoidectomy had lesser discomfort as compared to the open technique (p=0.02). Conclusion: Semi-open hemorrhoidectomy has fewer post-operative complication rates as compared to open hemorrhoidectomy with decreased pain, faster wound healing rates, and lesser patient discomfort.

scholarly journals The need for overcorrection: evaluation of computer-assisted, virtually planned, fronto-orbital advancement using postoperative 3D photography

2021 ◽  
Vol 50 (4) ◽  
pp. E5
Author(s):  
Nicole Frank ◽  
Joerg Beinemann ◽  
Florian M. Thieringer ◽  
Benito K. Benitez ◽  
Christoph Kunz ◽  
...  
Keyword(s):  
Blood Loss ◽  
Measurement Techniques ◽  
Computer Assisted ◽  
Complication Rates ◽  
Face Surface ◽  
Affected Side ◽  
Long Term Follow Up ◽  
Cad Cam ◽  
3D Printed

OBJECTIVE The main indication for craniofacial remodeling of craniosynostosis is to correct the deformity, but potential increased intracranial pressure resulting in neurocognitive damage and neuropsychological disadvantages cannot be neglected. The relapse rate after fronto-orbital advancement (FOA) seems to be high; however, to date, objective measurement techniques do not exist. The aim of this study was to quantify the outcome of FOA using computer-assisted design (CAD) and computer-assisted manufacturing (CAM) to create individualized 3D-printed templates for correction of craniosynostosis, using postoperative 3D photographic head and face surface scans during follow-up. METHODS The authors included all patients who underwent FOA between 2014 and 2020 with individualized, CAD/CAM-based, 3D-printed templates and received postoperative 3D photographic face and head scans at follow-up. Since 2016, the authors have routinely planned an additional “overcorrection” of 3 mm to the CAD-based FOA correction of the affected side(s). The virtually planned supraorbital angle for FOA correction was compared with the postoperative supraorbital angle measured on postoperative 3D photographic head and face surface scans. The primary outcome was the delta between the planned CAD/CAM FOA correction and that achieved based on 3D photographs. Secondary outcomes included outcomes with and those without “overcorrection,” time of surgery, blood loss, and morbidity. RESULTS Short-term follow-up (mean 9 months after surgery; 14 patients) showed a delta of 12° between the planned and achieved supraorbital angle. Long-term follow-up (mean 23 months; 8 patients) showed stagnant supraorbital angles without a significant increase in relapse. Postsurgical supraorbital angles after an additionally planned overcorrection (of 3 mm) of the affected side showed a mean delta of 11° versus 14° without overcorrection. The perioperative and postoperative complication rates of the whole cohort (n = 36) were very low, and the mean (SD) intraoperative blood loss was 128 (60) ml with a mean (SD) transfused red blood cell volume of 133 (67) ml. CONCLUSIONS Postoperative measurement of the applied FOA on 3D photographs is a feasible and objective method for assessment of surgical results. The delta between the FOA correction planned with CAD/CAM and the achieved correction can be analyzed on postoperative 3D photographs. In the future, calculation of the amount of “overcorrection” needed to avoid relapse of the affected side(s) after FOA may be possible with the aid of these techniques.

scholarly journals Clinical and Radiologic Outcomes of Minimally Invasive Surgery Transforaminal Lumbar Interbody Fusion with Computer Navigation

2021 ◽  
Vol 55 (3) ◽  
Author(s):  
Agustin Miguel G. Morales ◽  
Jose Joefrey F. Arbatin Jr. ◽  
Eric Astelo O. Belarmino ◽  
Oliver Y. Ong ◽  
Hester Renel L. Palma
Keyword(s):  
Blood Loss ◽  
Minimally Invasive ◽  
Hospital Stay ◽  
Interbody Fusion ◽  
Rating Scale ◽  
Operating Time ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Lumbosacral Spine ◽  
Lumbar Interbody Fusion

Objective. The main objective of this study was to evaluate clinical and radiographic outcomes of computer minimally invasive transforaminal lumbar interbody fusion (CNMIS TLIF). Methods. Blood loss, operating time, complications, and hospital stay were identified through chart review. Numeric rating scale (NRS) scores for pain were taken during recent follow-ups, and these were compared to the pre-operative scores. Three different examiners assessed the pre-operative lumbosacral spine radiographs. At a 2-years follow-up, the patients were evaluated with NRS and the radiographs reassessed by three other examiners. Results. Seventy-four patients with a mean age of 54 years underwent CNMIS TLIF. Average blood loss was 300 mL, operative time was 4.5 hours, and the average length of hospital stay was 8.5 days. A total of four complications were noted in our study. There was an improvement of mean local lordosis and regional lordosis. The paired-sample t-test showed that the anterior, middle, and posterior disc heights at the cage level were significantly increased compared to the pre-operative values. Conclusion. CNMIS TLIF is a safe and efficient method to achieve spinal fusion. There was a significant improvement in clinical outcomes in terms of pain relief. Radiologic parameters such as local lordosis, regional lordosis, and anterior, middle, and posterior disc heights showed significant improvements at 2-years follow-up.

scholarly journals Prevention of vault prolapse in cases of procedentia using combined vaginal and laparoscopic approach for vault suspension: Agrawal’s technique

2020 ◽  
Vol 10 (1) ◽  
pp. 296
Author(s):  
Priti Agrawal ◽  
Rishi Agrawal ◽  
Jyotirmay Chandrakar
Keyword(s):  
Intraoperative Complications ◽  
Operating Time ◽  
Laparoscopic Approach ◽  
Complication Rates ◽  
Vault Prolapse ◽  
Duration Of Surgery ◽  
Vault Suspension ◽  
Average Operating ◽  
Average Operating Time

Background: The objective of the current study was to assess the need of vault suspension after completion of hysterectomy in all cases of procedentia to prevent vault prolapse and to reduce the operating time for sacrocolpopexy using combined vaginal and laparoscopic approach by two surgeons.Methods: A total of 25 women undergoing surgery for procedentia were included. After completion of hysterectomy the need for vault suspension was assessed intraoperatively. In all cases polypropelene mesh was fixed vaginally to the uterosacral and cardinal ligaments. Vaginal vault was closed vaginally. Laparoscopic surgeon did laparoscopic sacrocolpopexy (LSC). Intraoperative and post-operative complications were then evaluated.Results: Our average operating time was 35 minutes for vaginal hysterectomy and 15 minutes for LSC. The shorter duration of surgery was because mesh was fixed vaginally and trackers were used to fix the mesh to sacral promontory. Intraoperative complications like bladder, ureteric, bowel injuries and hemorrhage were nil in our series. Postoperative stay in hospital was uneventful and all cases were discharged on second postoperative day. Conversion rate to laparotomy was nil. All cases have completed follow up for 5 years with 100% subjective and objective improvement.Conclusions: Restoration of vagina to its normal anatomic position remains the most important fact to prevent vault prolapse. Our technique is very easy, less time taking with negligible complication rates.

Doppler-Guided Hemorrhoid Artery Ligation with Recto-Anal Repair Outcome on Female Patients in Basra: Assessment Study

2021 ◽  
Vol 3 (1) ◽  
pp. 84-92
Author(s):  
Ohood Leabi ◽  
Alaa Abed ◽  
Wafa Al-Maliki
Keyword(s):  
Postoperative Complications ◽  
Anal Stenosis ◽  
Urine Retention ◽  
Artery Ligation ◽  
Assessment Study ◽  
Hemorrhoidal Artery Ligation ◽  
Hemorrhoidal Artery ◽  
New Treatment ◽  
Rectoanal Repair

Background: Hemorrhoidal disease is a common morbidity seen by general surgery clinics. Transanal Doppler guided (DG) hemorrhoidal artery ligation (HAL) with rectoanal repair (RAR) has been invented as a new treatment option. HAL-RAR was associated with mild to moderate postoperative complications in the literatures; and considered easy, safe, mostly painless procedure with very good results in treating hemorrhoids. Objective: This study was conducted to evaluate the outcome of using DG-HAL-RAR procedure through documenting postoperative complications during a median follow-up period of 18 months. Method: The study included 151 women presented with hemorrhoids in Basra, operated upon using the DG-HALRAR and complications assessed. Results: The patients’ mean age was 40–99 years. Most of the hemorrhoids were internal plus external (86.1%), of third degree (68.2%) and non-recurrent (90.1%). The surgical management needed an average of 6 ligations and 3 mucopexies. During the follow up periods, the most frequent complication was early bleeding, while the least was hemorrhoids recurrence. Discussion: During the follow up period, the postoperative complications were early bleeding, early pain, urine retention, late bleeding, anal stenosis, and hemorrhoids recurrence, the incidence of which were similar or close to the incidence of documented by other studies, except for early bleeding which was much higher than in our study. Some complications, reported by other studies,were not reported in this study. Conclusions: DG-HAL-RAR procedure can be used effectively and safely in second or third degree hemorrhoids. Keywords: Hemorrhoidectomy, Anal surgery, DG-HAL-RAR, Basra

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