THE DEPENDENCE OF DIRECT RESULTS OF DISTAL PANCREATECTOMIES ON DIFFERENT PANCREATIC STUMP CLOSURE TECHNIQUES

The OBJECTIVE is to study the effect of application of different pancreatic stump closure techniques to the postoperative period, the frequency and severity of postoperative complications including postoperative pancreatic fistulas after distal pancreatectomies. MATERIAL AND METHODS. The clinical material consisted of 126 patients who underwent distal pancreatectomies (isolated or in combination with surgical interventions on the adjacent organs of the abdominal cavity and retroperitoneal space). The patients were divided into 4 groups depending on the pancreatic stump closure techniques (isolated suturing of the main pancreatic duct of the pancreatic stump with its omentization by gastrocolic omentum or local sealing its by hemostatic sponge (control group); using a local biological glue 2-octylcyanoacrylate; using the Endoscopic Linear Cutter Echelon; external transduodenal transnasal drainage of the enlarged main pancreatic duct of the pancreatic stump). We evaluated the influence of different pancreatic stump closure techniques after distal pancreatectomies on the postoperative period as well the frequency and severity of postoperative pancreatic fistulas depending on the diameter of the main pancreatic duct of pancreatic stump. RESULTS. The overall rate of postoperative complications in the control group of patients was 45.8 %, and was due to an increase in the frequency of specific complications (35.4 %). The most frequent complication in the control group of patients was postoperative pancreatic fistulas – 29.2 %. The statistically significant decrease of frequency and severity of postoperative complications, frequency and severity of postoperative pancreatic fistulas and decrease of postoperative hospital-stay after the application of the proposed different pancreatic stump closure techniques were revealed in comparison with the control group of patients. There was no hospital mortality. CONCLUSION. Distal pancreatectomy with «standard» pancreatic stump closure techniques accompanied by high frequency and severity of postoperative complications, as well as postoperative pancreatic fistulas. The use of the proposed pancreatic stump closure techniques after distal pancreatectomy led to a decrease of the frequency and severity of postoperative complications, a decrease of the frequency and severity of postoperative pancreatic fistulas, and a decrease of the postoperative hospital-stay.

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Effect of different pancreatic stump closure techniques after distal pancreatectomy on frequency and severity of acute postoperative pancreatitis

Saratov Medical Journal ◽

10.15275/sarmj.2020.0104 ◽

2020 ◽

Author(s):

Sergei Voskanyan ◽

Evgeny Naydenov ◽

Igor Uteshev ◽

Aleksei Artemiev

Keyword(s):

Pancreatic Duct ◽

Distal Pancreatectomy ◽

Main Pancreatic Duct ◽

Severe Form ◽

Control Group ◽

Pancreatic Stump ◽

Postoperative Pancreatitis ◽

Stump Closure ◽

Group 2 ◽

Linear Cutter

Objective: to study the effect of different pancreatic stump closure techniques and diameter of the main pancreatic duct on frequency and severity of acute postoperative pancreatitis after distal pancreatectomy. Material and Methods. Distal pancreatectomy was performed on 126 patients with neoplasms of body and/or tail of the pancreas. Patients were distributed among four groups based upon the pancreatic stump closure technique applied after distal pancreatectomy: group 1 (control) included the patients with isolated suturing of the main pancreatic duct in the pancreatic stump with its subsequent sealing by the gastrocolic omentum or hemostatic sponge; group 2 patients underwent isolated suturing of the main pancreatic duct in the pancreatic stump with its subsequent sealing with 2-octyl cyanoacrylate biological glue; group 3 patients had their pancreatic stump closure performed with endoscopic linear cutter stapler; group 4 was composed of the patients with external transduodenal transnasal drainage of enlarged (D>3 mm) main pancreatic duct in the pancreatic stump. Results. The occurrence of acute postoperative pancreatitis in the control group amounted to 45.8%, while, in groups 2, 3 and 4, the frequencies were 44.4, 9.7 and 15.0(%), correspondingly. Besides, the control group was characterized by declined occurrence of the moderately severe form of acute postoperative pancreatitis. Use of endoscopic linear cutter stapler and external transduodenal transnasal drainage of the enlarged main pancreatic duct caused lower acute postoperative pancreatitis frequency in the patients with main pancreatic duct in their pancreatic stumps below 5 mm in diameter. Conclusion. Use of proposed pancreatic stump closure techniques after distal pancreatectomy resulted in lower frequencies of occurrence and severity of acute postoperative pancreatitis.

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Flexible Ureteroscopic Lithotripsy Based on the Concept of Enhanced Recovery After Surgery

10.21203/rs.3.rs-273736/v1 ◽

2021 ◽

Author(s):

Ling Shu ◽

Ping Ao ◽

Zhenxing Zhang ◽

Dong Zhuo ◽

Changbin Dong ◽

...

Keyword(s):

Postoperative Complications ◽

Hospital Stay ◽

Operative Time ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Postoperative Hospital Stay ◽

Control Group ◽

Ureteroscopic Lithotripsy ◽

Total Cost ◽

Stone Removal

Abstract Background: To evaluate the efficacy of flexible ureteroscopic lithotripsy (FURSL) based on the concept of enhanced recovery after surgery (ERAS).Methods: 435 patients with upper urinary calculi between 2017-2020 were retrospectively analysed and assigned to ERAS group (ERAS management) and control group (traditional management). Operative time, postoperative ambulation time, postoperative hospital stay, total cost of hospitalization, postoperative complications and stone removal were compared. Results: 427 cases were successfully performed FURSL procedure with 4 cases of ERAS group (n = 216) and 4 cases of control group (n = 219) failed respectively. No postoperative complications occurred in either group except for fever and hematuria. There were no significant difference in postoperative fever and stone removal between the two groups (all p > 0.05). The patients in ERAS group had shorter operative time, shorter postoperative ambulation time, less postoperative severe hematuria, shorter postoperative hospital stay and lower total cost of hospitalization than those in control group (all p < 0.05).Conclusions: FURSL based on the concept of ERAS for the treatment of upper urinary tract calculi is safe and reliable, with rapid postoperative recovery, low cost of hospitalization and worthy of clinical promotion.

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Comparison of patient outcomes with and without stenting tube in pancreaticoduodenectomy

Journal of International Medical Research ◽

10.1177/0300060517717400 ◽

2017 ◽

Vol 46 (1) ◽

pp. 403-410 ◽

Cited By ~ 2

Author(s):

Xiong Bin ◽

Bai Lian ◽

Gong Jianping ◽

Tu Bin

Keyword(s):

Postoperative Complications ◽

Hospital Stay ◽

Pancreatic Duct ◽

Postoperative Hospital Stay ◽

Operative Duration ◽

Abdominal Bleeding ◽

Pancreatic Duct Stent ◽

Pancreatic Duct Stenting ◽

Group A ◽

Group B

Objective To evaluate the clinical effect of different pancreaticojejunostomy techniques in the treatment of pancreaticoduodenectomy and investigate the applicability of pancreaticojejunostomy without pancreatic duct stenting. Methods From January 2012 to December 2015, 87 patients who underwent pancreaticoduodenectomy were randomly assigned to either Group A (duct-to-mucosa anastomosis with pancreatic duct stenting, n = 43) or Group B (pancreas–jejunum end-to-side anastomosis without stenting (n = 44). The operative duration of pancreaticojejunostomy, postoperative hospital stay, and incidence of postoperative complications were compared between the two methods. Results The operative duration of pancreaticojejunostomy without use of the pancreatic duct stent was significantly shorter in Group B than in Group A (t = 7.137). The postoperative hospital stay was significantly shorter in Group B than in Group A (t = 2.408). The differences in the incidence of postoperative complications such as pancreatic fistula, abdominal bleeding, abdominal infection and delayed gastric emptying were not significantly different between the two groups (χ2 = 0.181, 0.322, 0.603, and 0.001, respectively). Conclusion Pancreaticoduodenectomy without pancreatic duct stenting is safe and reliable and can reduce the operative time and hospital stay. No significant differences were observed in the incidence of postoperative complications.

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Laparoscopic right colectomy with intracorporeal ileotransverse anastomosis (results of the pilot study)

Koloproktologia ◽

10.33878/2073-7556-2021-20-4-50-55 ◽

2021 ◽

Vol 20 (4) ◽

pp. 50-55

Author(s):

E. M. Romanova ◽

O. I. Sushkov ◽

E. S. Surovegin ◽

D. G. Shakhmatov

Keyword(s):

Postoperative Complications ◽

Hospital Stay ◽

Controlled Trial ◽

Right Hemicolectomy ◽

Main Group ◽

Postoperative Hospital Stay ◽

Right Colectomy ◽

Control Group ◽

Laparoscopic Right Colectomy ◽

Complications Rate

AIM: to evaluate the safety of intra- and extracorporeal ileotransverse anastomosis in laparoscopic right hemicolectomy.PATIENTS AND METHODS: a pilot «case-control» study included two groups of patients, who underwent laparoscopic right colectomy according to a standardized technique. An intracorporeal anastomosis (IA) was formed in the main group (n = 20), in the control group — extracorporeal anastomosis (EA) (n = 18).RESULTS: in main group the postoperative complications rate was 20%, in the control group — 28% (p = 0.71). The postoperative hospital stay in the main group was significantly less than in control (5.0 vs 7.3 days) (p < 0.001).CONCLUSION: the postoperative complications rate in both groups was not significant, but postoperative hospital stay was shorter in IA group. A randomized controlled trial is required.

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Efficacy of Neuroendoscopic Treatment for Septated Chronic Subdural Hematoma

Frontiers in Neurology ◽

10.3389/fneur.2021.765109 ◽

2022 ◽

Vol 12 ◽

Author(s):

Jianhong Deng ◽

Fangyu Wang ◽

Haojie Wang ◽

Mingpei Zhao ◽

Guorong Chen ◽

...

Keyword(s):

Postoperative Complications ◽

Hospital Stay ◽

Subdural Hematoma ◽

Chronic Subdural Hematoma ◽

Postoperative Hospital Stay ◽

Bone Flap ◽

Total Hospital ◽

Safety And Efficacy ◽

Total Hospital Stay ◽

Large Bone

Objective: Neuroendoscopic treatment is an alternative therapeutic strategy for the treatment of septate chronic subdural hematoma (sCSDH). However, the safety and efficacy of this strategy remain controversial. We compared the clinical outcomes of neuroendoscopic treatment with those of standard (large bone flap) craniotomy for sCSDH reported in our center. Furthermore, the safety and efficacy of the neuroendoscopic treatment procedure for sCSDH were evaluated.Methods: We retrospectively collected the clinical data of 43 patients (37 men and six women) with sCSDH who underwent either neuroendoscopic treatment or standard (large bone flap) craniotomy, such as sex, age, smoking, drinking, medical history, use of antiplatelet drugs, postoperative complications, sCSDH recurrence, length of hospital stay, and postoperative hospital stay. We recorded the surgical procedures and the neurological function recovery prior to surgery and 6 months following the surgical treatment.Results: The enrolled patients were categorized into neuroendoscopic treatment (n = 23) and standard (large bone flap) craniotomy (n = 20) groups. There were no differences in sex, age, smoking, drinking, medical history, antiplatelet drug use, postoperative complications, and sCSDH recurrence between the two groups (p > 0.05). However, the patients in neuroendoscopic treatment group had a shorter length of total hospital stay and postoperative hospital stay as compared with the standard craniotomy group (total hospital stay: 5.26 ± 1.89 vs. 8.15 ± 1.04 days, p < 0.001; postoperative hospital stay: 4.47 ± 1.95 vs. 7.96 ± 0.97 days, p < 0.001). The imaging and Modified Rankin Scale at the 6-month follow-up were satisfactory, and no sCSDH recurrence was reported in the two groups.Conclusions: The findings of this study indicate that neuroendoscopic treatment is safe and effective for sCSDH; it is minimally invasive and could be clinically utilized.

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Analysis of Clinical Efficiency and Safety of Laparoscopic Anus-Conserving Operation for Ultralow Rectal Cancer

The American Surgeon ◽

10.1177/000313481908500533 ◽

2019 ◽

Vol 85 (5) ◽

pp. 539-548

Author(s):

Zhongkun Zuo ◽

Ke Ding ◽

Tenglong Tang ◽

Leiyi Zhang ◽

Weihui Peng ◽

...

Keyword(s):

Rectal Cancer ◽

Postoperative Complications ◽

Hospital Stay ◽

Incidence Rate ◽

Anal Sphincter ◽

Resection Margin ◽

Survival Rates ◽

Incidence Rates ◽

Control Group ◽

Experimental Group

To explore the efficiency and safety of laparoscopic anus-conserving operation for ultralow rectal cancer, we retrospectively reviewed 236 patients with ultralow rectal cancer who underwent laparoscopic anus-conserving operation (experimental group, n = 124) or conventional open surgery (control group, n = 112). Operation-related indexes, pathological results of mesentery, incidence rates of postoperative complications, anus preservation rates, anal sphincter controllability after surgery, and survival rates of the first, second, and third years after operation were compared between the two groups. The amount of intraoperative bleeding, first postoperative exhaust time, abdominal drainage, pain score, and hospital stay in the experimental group were significantly less than those in the control group ( P < 0.05). There were no significant differences in the postoperative circumferential resection margin, distal resection margin, number of dissected lymph nodes, successful resection rate, and quality of mesorectum between the two groups ( P > 0.05). The total incidence rate of postoperative complications, anal sphincter controllability, and survival rates after surgery were similar between the two groups ( P > 0.05). The anus preservation rate of the experimental group (84.7%) was significantly higher than that of the control group (69.6%) ( P < 0.05). Laparoscopic anus-conserving operation is effective and safe in treatment of patients with ultralow rectal cancer, which has advantages such as small trauma, less intra-operative bleeding, short hospital stay, rapid recovery, a low incidence rate of postoperative complications, and a high anus-preserving rate, so it is worthy of clinical application.

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Pancreatic neuroendocrine tumor featuring growth into the main pancreatic duct and tumor thrombus within the splenic vein: a case report

Journal of Surgical Case Reports ◽

10.1093/jscr/rjaa155 ◽

2020 ◽

Vol 2020 (7) ◽

Author(s):

Takashi Miyata ◽

Hiroyuki Takamura ◽

Ryosuke Kin ◽

Hisashi Nishiki ◽

Akifumi Hashimoto ◽

...

Keyword(s):

Neuroendocrine Tumor ◽

Pancreatic Duct ◽

Main Pancreatic Duct ◽

Splenic Vein ◽

Pancreatic Neuroendocrine Tumor ◽

Ductal Adenocarcinoma ◽

Pathological Examination ◽

Left Edge ◽

Pancreatic Stump ◽

Pancreatic Body

Abstract A 48-year-old woman was admitted to our hospital because of upper abdominal pain. Computer tomography showed an enhancing mass in the pancreatic body, dilation of the main pancreatic duct (MPD) and a filling defect within the splenic vein. On the basis of the preoperative diagnosis of pancreatic body cancer, distal pancreatectomy was scheduled. The pancreas was divided along the left edge of the gastroduodenal artery; however, frozen pathological examination of the pancreatic stump was tumor positive, and therefore a total pancreatectomy was performed. The lesion was a white expansive nodular mass that had spread into the MPD and protruded into the splenic vein. A pathological diagnosis of non-functioning neuroendocrine tumor (NET) was made. In general, imaging findings of disruption of the MPD and tumor vein thrombus are characteristics of pancreatic ductal adenocarcinoma, but are uncommon in NET. However, NET should be included in the differential diagnosis for such patients.

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Goal-directed Intraoperative Fluid Administration Reduces Length of Hospital Stay after Major Surgery

Anesthesiology ◽

10.1097/00000542-200210000-00012 ◽

2002 ◽

Vol 97 (4) ◽

pp. 820-826 ◽

Cited By ~ 659

Author(s):

Tong J. Gan ◽

Andrew Soppitt ◽

Mohamed Maroof ◽

Habib El-Moalem ◽

Kerri M. Robertson ◽

...

Keyword(s):

Stroke Volume ◽

Hospital Stay ◽

Elective Surgery ◽

Length Of Hospital Stay ◽

Postoperative Hospital Stay ◽

Fluid Administration ◽

Major Surgery ◽

Control Group ◽

Surgical Morbidity ◽

Protocol Group

Background Intraoperative hypovolemia is common and is a potential cause of organ dysfunction, increased postoperative morbidity, length of hospital stay, and death. The objective of this prospective, randomized study was to assess the effect of goal-directed intraoperative fluid administration on length of postoperative hospital stay. Methods One hundred patients who were to undergo major elective surgery with an anticipated blood loss greater than 500 ml were randomly assigned to a control group (n = 50) that received standard intraoperative care or to a protocol group (n = 50) that, in addition, received intraoperative plasma volume expansion guided by the esophageal Doppler monitor to maintain maximal stroke volume. Length of postoperative hospital stay and postoperative surgical morbidity were assessed. Results Groups were similar with respect to demographics, surgical procedures, and baseline hemodynamic variables. The protocol group had a significantly higher stroke volume and cardiac output at the end of surgery compared with the control group. Patients in the protocol group had a shorter duration of hospital stay compared with the control group: 5 +/- 3 versus 7 +/- 3 days (mean +/- SD), with a median of 6 versus 7 days, respectively ( = 0.03). These patients also tolerated oral intake of solid food earlier than the control group: 3 +/- 0.5 versus 4.7 +/- 0.5 days (mean +/- SD), with a median of 3 versus 5 days, respectively ( = 0.01). Conclusions Goal-directed intraoperative fluid administration results in earlier return to bowel function, lower incidence of postoperative nausea and vomiting, and decrease in length of postoperative hospital stay.

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Immediate and long-term results of laparoscopic hernioplasty in inguinal hernias with and without mesh endoprosthesis fixation

Grekov s Bulletin of Surgery ◽

10.24884/0042-4625-2020-179-4-22-28 ◽

2020 ◽

Vol 179 (4) ◽

pp. 22-28

Author(s):

O. V. Zaitsev ◽

A. V. Koshkina ◽

D. A. Khubezov ◽

V. A. Yudin ◽

V. V. Barsukov ◽

...

Keyword(s):

Postoperative Complications ◽

Postoperative Period ◽

Mesh Fixation ◽

Long Term Results ◽

Control Group ◽

Inguinal Hernioplasty ◽

Inguinal Hernias ◽

Laparoscopic Hernioplasty ◽

Mesh Endoprosthesis

The objective of this study was to conduct comparative analysis of the immediate and long-term results of laparoscopic inguinal hernioplasty performed with and without fixation of the mesh endoprosthesis.Methods and materials. The base group included 77 patients who underwent laparoscopic inguinal hernioplasty without fixation of the mesh by herniostepler. The control group included 76 patients who underwent laparoscopic inguinal hernioplasty with mesh fixation by herniostepler. To assess the postoperative period, the following criteria were studied: the severity of postoperative pain on a Visual Analog Scale; postoperative complications on the Clavien-Dindo scale; an early recurrence of inguinal hernias determined by ultrasound.Results. In both groups, the severity of postoperative complications did not exceed grade I. Among the entire list of complications, there were observed: pain in the area of surgery, an increase in body temperature above 38.5 °C, acute urinary retention, swelling and hematoma of the scrotum, seroma. There were no cases of conversion, intraoperative damage to internal organs and vascular structures. Complications in both groups do not differ significantly and do not depend on the method of laparoscopic inguinal hernioplasty: with fixation of the endoprosthesis by herniostepler or without fixation. The level of pain in the early postoperative period in patients operated by laparoscopic inguinal hernioplasty with mesh fixation was significantly higher. During control examinations of patients on the day after surgery, at the time of discharge and 6 months after surgery, no cases of dislocation of mesh endoprosthesis and relapse of inguinal hernia were detected.Conclusion. The obtained data indicate the effectiveness of laparoscopic hernioplasty in inguinal hernias with polypropylene mesh without fixing with herniostepler.

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Diagnostics and treatment of abdominal complications after gynecological endoscopic operations

Reproductive health of woman ◽

10.30841/2708-8731.1.2021.229720 ◽

2021 ◽

Vol 1 ◽

pp. 75-79

Author(s):

Yu.P. Vdovichenko ◽

V.I. Boyko ◽

V.A. Terehov

Keyword(s):

Postoperative Complications ◽

Postoperative Period ◽

Diagnostic Laparoscopy ◽

Abdominal Cavity ◽

Early Postoperative Period ◽

Main Group ◽

Laparoscopic Technique ◽

Control Group ◽

Diffuse Peritonitis ◽

Abdominal Complications

The objective: to analyze the results of repeated laparoscopy in gynecological patients with suspected intraperitoneal postoperative complications.Materials and methods. The study involved 42 patients (mean age 46±11,3 years), in whom postoperative abdominal complications after surgical treatment of various gynecological diseases required repeated operations. Depending on the method of re-intervention, the patients were divided into 2 groups: the main group (n=20) – women who only used laparoscopy to correct postoperative complications; control (n=22) – women who were given indications for relaparotomy to correct postoperative complications during diagnostic laparoscopy. Relaparotomy was performed in 8 patients of the control group. All patients underwent a comprehensive examination using clinical, instrumental and laboratory research methods. The groups were homogeneous in terms of age and structure of operations performed on the pelvic organs, and statistically comparable.Results. During the study, the results of repeated laparoscopy of 34 gynecological patients with suspected intraperitoneal postoperative complications were analyzed. In all patients of the main group (47,6%), laparoscopy was revealed as the only and final method of treatment of postoperative complications, while in 7 women repeated relaparoscopy was used from 2 to 4 times, and in 13 women laparoscopy was performed once. In the control group (53,3%), 10 patients during diagnostic laparoscopy were exposed to indications for relaparotomy, in 4 patients the capabilities of the operating team and laparoscopic technique allowed performing some elements of the operation and completing it with a minilaparotomy approach, and 8 patients underwent relaparotomy immediately.Peritonitis and intraperitoneal bleeding prevail in the structure of early abdominal complications. The use of the video laparoscopic technique made it possible in 28,6% of patients with diffuse peritonitis to successfully eliminate the developed complication, eliminate its source and sanitize the abdominal cavity. Laparoscopic hemostasis was successfully performed in 7 patients.Compared with the standard, the use of video endoscopic technique allowed improving the indicators of diagnostic value: to increase the sensitivity level by 1,07 times, specificity by 1,39 times and diagnostic accuracy by 1,11 times.Conclusion. In general, in the early postoperative period, 47 relaparoscopies were performed for suspected complications, which is explained by programmed abdominal sanitization and the use of dynamic laparoscopy to control the course of intraperitoneal complications. Based on the analysis of the material under study, we proposed general indications and contraindications for relaparoscopy in the early postoperative period in order to diagnose and treat postoperative complications. Justifying each of the points, we were guided by the real possibilities of the method in general clinical practice, which in some cases are inferior in their effectiveness to relaparotomy.

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