Outcomes of treatment of haemorrhoidal disease with KLS Martin maXium marClamp® CUT IQ thermal tissue fusion instrument based on offset electrode technology compared to the Milligan-Morgan procedure with bipolar coagulation for the excision of grade III and IV haemorrhoids

Nowa Medycyna ◽  
2021 ◽  
Vol 28 (1) ◽  
Author(s):  
Gniewomir Michał Ćwiertnia ◽  
Michał Dyaczyński ◽  
Mieczysława Lesiecka ◽  
Marek Dróżdż ◽  
Michał Glogasa ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Surgical Procedure ◽  
Length Of Hospital Stay ◽  
Tissue Fusion ◽  
Bipolar Coagulation ◽  
Postoperative Wound ◽  
Haemorrhoidal Disease ◽  
Group 2 ◽  
Grade Iii ◽  
Group 1

Introduction. The study compared the effects of surgical treatment of grade III and IV haemorrhoids achieved with a conventional operative technique and by using a thermal tissue fusion instrument based on offset electrode technology. A total of 60 patients with grade III and IV haemorrhoids were operated on in the Department of General and Oncologic Surgery, Municipal Hospital in Siemianowice Śląskie, and in the On-Clinic Medical Centre in Chorzów, between October 2011 and September 2015. Aim. The aim of the study was to compare the outcomes of treatment of haemorrhoidal disease using KLS Martin maXium marClamp® CUT IQ thermal tissue fusion instrument based on offset electrode technology and the Milligan-Morgan surgical procedure with bipolar coagulation for the excision of grade III and IV haemorrhoids. Material and methods. The patients were divided into two groups: Group 1 – patients operated on using KLS Martin maXium marClamp® CUT IQ thermal tissue fusion instrument based on offset electrode technology. Group 2 – patients operated on using the conventional Milligan-Morgan technique with electrocoagulation. The evaluated parameters included the length of hospital stay after surgery, duration of the surgical procedure, level of pain on the postoperative days 1 and 2 rated on a 10-point VAS scale, and postoperative wound healing time. Results. A reduction in postoperative pain, shorter procedure duration and hospital stay, and more rapid postoperative wound healing were observed in Group 1 compared to Group 2. Conclusions. In our study material, the application of a thermal tissue fusion instrument using offset electrode technology in surgeries to remove grade III and IV haemorrhoids, compared to the conventional Milligan-Morgan procedure with electrocoagulation, brought the following results: – less postoperative pain, – shorter duration of surgical procedure, – reduced length of hospital stay, – faster healing of postoperative wound.

PS01.218: MORBIDITY AND MORTALITY IN ELDERLY PATIENTS AFTER MINIMALLY INVASIVE ESOPHAGECTOMY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 112-112
Author(s):  
Jeroen Hol ◽  
Joos Heisterkamp ◽  
Barbara Langenhoff
Keyword(s):  
Minimally Invasive ◽  
Elderly Patients ◽  
Hospital Stay ◽  
Minimally Invasive Esophagectomy ◽  
Length Of Hospital Stay ◽  
Morbidity And Mortality ◽  
Tumor Type ◽  
Invasive Esophagectomy ◽  
Group 2 ◽  
Group 1

Abstract Background Elderly patients undergoing gastrointestinal surgery are at higher risk for postoperative complications and mortality. Currently available literature on elderly patients undergoing an esophagectomy is inconclusive and dates back from the time before minimally invasive techniques were implemented. Methods Length of hospital stay, 90-day morbidity and mortality were analyzed from patients undergoing minimally invasive esophagectomy (MIE) between 2014 and 2017 in a single center. Data from patients aged 76 years or older was compared to the cohort of patients aged 71 to 75 years old. Results From a consecutive series of in total 187 patients two cohorts were retrieved: 19 patients 76 years or older (group 1) were compared to 41 patients 71 to 75 years old (group 2). Median age was 77 years (76–83) in group 1 and 72 years (71–75) in group 2 (P < 0.05). There were no significant differences in sex, Charlson comorbidity score, number of patients undergoing neoadjuvant chemoradiaton, histological tumor type, tumor stage, number of lymph nodes harvested and type of anastomosis. There were no significant differences in length of hospital stay, 90-day morbidity and mortality. The percentage of anastomotic leakage was 21.2% in group 1 and 14.6% in group 2. Mortality was 10.5% and 4.9% respectively. Conclusion No difference was seen in morbidity and mortality after MIE comparing the eldest old to younger old patients. Therefore, patient selection should not be based on calendar age alone. Disclosure All authors have declared no conflicts of interest.

A clinical pathway for patients undergoing primary cytoreductive surgery with rectosigmoid colectomy for advanced ovarian or primary peritoneal cancer

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 5569-5569
Author(s):  
M. A. Gerardi ◽  
A. Santillan ◽  
B. Meisner ◽  
T. P. Diaz-Montes ◽  
G. J. Gardner ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Median Time ◽  
Cytoreductive Surgery ◽  
Clinical Pathway ◽  
Length Of Hospital Stay ◽  
Hospital Charges ◽  
Primary Peritoneal Cancer ◽  
Peritoneal Cancer ◽  
Group 2 ◽  
Group 1

5569 Background: To evaluate the safety, feasibility, and economic impact of a clinical pathway including rapid diet advancement for patients undergoing rectosigmoid colectomy as part of cytoreductive surgery for advanced ovarian or primary peritoneal cancer. Methods: Post-operative management was dictated by surgeon preference in 45 consecutive patients (Group 1) and according to the prescribed clinical pathway in 19 consecutive patients (Group 2). Critical elements of the clinical pathway included: rapid diet advancement, early discontinuance of nasogastric suction, criteria-based utilization of parenteral nutrition, selective laboratory testing, and deferring initiation of chemotherapy until after discharge. Results: The median age was 58 years for Group 1 patients and 67 years for Group 2 patients. Median time to flatus was 6 days for both groups; however, the median time to tolerating diet was 6 days for Group 1, and 4 days for Group 2. Patients in Group 1 had a median length of hospital stay of 12 days (range=5–30 days), a median total 30-day post-operative hospital charge of $42,868 (range=$19,960-$130,252), and a 30-day readmission rate of 33%, compared to 8 days (range=4–28 days) (p=0.020), $32,840 (range=$18,353-$140,283) (p=0.016), and 21% (p=0.379) for Group 2, respectively. Clinical pathway-directed management was associated with a median reduction in hospital charges of $10,027 per patient. Conclusions: A critical pathway incorporating rapid diet advancement for patients undergoing primary cytoreductive surgery with rectosigmoid colectomy for ovarian or primary peritoneal cancer is feasible, safe, and associated with a significant reduction in length of hospital stay and hospital-related charges and did not increase morbidity. No significant financial relationships to disclose.

Independent and Interdependent Influence of Number of CD34+ Cells and Use of G-CSF on Outcomes in Autologous PBSCT Patients

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 4319-4319
Author(s):  
Meghana Trivedi ◽  
Sue Corringham ◽  
Sam Martinez ◽  
Katherine Medley ◽  
Edward D Ball
Keyword(s):  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Post Transplant ◽  
Cd34 Cells ◽  
Significant Difference ◽  
Autologous Pbsct ◽  
Group 3 ◽  
Group 2 ◽  
Neutrophil Engraftment ◽  
Group 1

Abstract Background: Recovery of neutrophilic granulocytes after autologous peripheral blood stem cell transplantation (PBSCT), and thus overall outcome, depends on 2 main factors: the quality and quantity of mobilized peripheral blood progenitor cell products (CD34+ cells) and the use of myeloid growth factors, such as granulocyte colony stimulating factor (G-CSF). Methods: We performed a 5-year (from February 2003 to January 2008) retrospective analysis of data to evaluate independent and interdependent influence of number of CD34+ cells and use of G-CSF on outcomes in autologous PBSCT patients. At the time of analysis, the practice at our institution was as follows: Autologous PBSCT patients receiving infusion of &lt; 5×106 CD34+ cells/kg were treated with daily subcutaneous injection of G-CSF (filgrastim 300 mg for &lt; 80 kg; 480 mg for ≥ 80 kg). In these patients, G-CSF was started on Day +5 and was continued until the ANC was &gt; 500/μl. On the other hand, autologous transplant patients who received ≥ 5×106 CD34+ cells/kg did not typically receive G-CSF. If engraftment did not occur after an “expected” length of time, G-CSF treatment was initiated at the discretion of the treating physician. The definition of “expected” length of time, however, varied from practitioner to practitioner. For the analysis, patients were divided in 3 groups: patients who collected &lt; 5×106 CD34+ cells/kg and received G-CSF (group 1, n=103), patients who were infused with ≥ 5×106 CD34+ cells/kg and did not receive G-CSF (group 2, n=155), and patients who received ≥ 5×106 CD34+ cells/kg and were given G-CSF (group 3, n=47). Time to neutrophil engraftment (ANC &gt;500/ml), time to platelet engraftment (platelets &gt; 20,000/ml), and post-transplant length of hospital stay were compared. Results: Median time to neutrophil engraftment was significantly shorter in patients who were treated with G-CSF (11 days) in groups 1 and 3, compared to those who were not (13 days) in group 2 (table 1). Similarly, median post-transplantation hospital stay was significantly longer in patients who did not receive G-CSF (14 days) in group 2 compared to patients who were treated with G-CSF (13 days) in groups 1 and 3. There was no significant difference in time to neutrophil engraftment and post-transplant hospital stay between groups 1 and 3, suggesting that these outcome parameters did not significantly depend on number of CD34+ cells infused in our patients if G-CSF was used. Median time to platelet engraftment was significantly longer in patients receiving &lt; 5×106 CD34+ cells/kg (12 days) in group 1 compared to patients infused with ≥ 5×106 CD34+ cells/kg (10 days) in groups 2 and 3. There was no significant difference in time to platelet engraftment between groups 2 and 3, indicating that G-CSF use did not influence platelet engraftment. Summary: These results suggest that a higher number of CD34+ cells helps accelerate platelet engraftment, but does not influence neutrophil engraftment and post-transplant length of hospital stay, as long as G-CSF treatment is instituted. The use of G-CSF accelerates neutrophil recovery, regardless of the number of CD34+ cells infused, without affecting platelet engraftment in patients undergoing autologous PBSCT. Based on this analysis, the practice at our institution has been revised to use G-CSF in all autologous transplant patients, regardless of the number of CD34+ cells, since this practice reduces the length of hospital stay. Table 1. A retrospective data analysis for patients treated at the UCSD BMT unit with autologous PBPCT from February 2003 to January 2008. The data is represented as a median value with a range indicated in parenthesis. * indicates significant difference from group 1, † indicates significant difference from group 2, and ‡ indicates significant difference from group 3 (p &lt; 0.001, Mann Whitney U test; Graph Pad Prism, version 3.02 (Graph Pad Software, San Diego, CA)). Abbreviations: ANC-absolute neutrophil count, LOS-length of hospital stay. Group 1 &lt; 5×106/kg (G) (N = 103) Group 2 ≥5×106/kg (no G) (N = 155) Group 3 ≥5×106/kg (G) (N = 47) CD34+ cells (×106/kg) 3.2 †,‡ (1.4–4.98) 6.8 * (5.0–16.7) 7.0 * (5.0–12.3) Initiation of G-CSF Day +5 N/A Day +5 (day 0–day +16) Time to ANC &gt; 500/ml (days) 11 † (9–28) 13 *,‡ (9–21) 11 † (8–17) Time to Platelet &gt; 20,000/ml (days) 12 †,‡ (6–42) 10 * (0–29) 10 * (0–27) Post-Transplant LOS (days) 13 † (10–38) 14 *,‡ (1–43) 13 † (10–18)

scholarly journals Treatment of Cavitary Bone Defects in Chronic Osteomyelitis: Bioactive glass S53P4 vs. Calcium Sulphate Antibiotic Beads

2017 ◽  
Vol 2 (4) ◽  
pp. 194-201 ◽  
Author(s):  
Albert Ferrando ◽  
Joan Part ◽  
Jose Baeza
Keyword(s):  
Postoperative Complications ◽  
Hospital Stay ◽  
Chronic Osteomyelitis ◽  
Average Length ◽  
Length Of Hospital Stay ◽  
Calcium Sulphate ◽  
Bone Defects ◽  
Group 2 ◽  
Group 1

Abstract. Aim: To evaluate the efficacy of bioglass (BAG-S53P4) in the treatment of patients with chronic osteomyelitis and compare the results with calcium sulphate antibiotic beads in one medical centre.Methods: Retrospective analysis of 25 cases. Inclusion criteria: patients diagnosed clinically and radiographically of osteomyelitis and treated surgically (Group 1: cavitary bone defects treated with bioglass and Group 2: cavitary bone defects treated with calcium sulphate antibiotic beads) during the period of 2014 and 2015 in one medical centre.Results: Patients in group 1 (bioglass treatment): total of 12 patients (11 males and 1 female) with mean age: 50 years (30-86). Average length of hospital stay was 22 days and mean follow-up time: 23 months (16-33). Mean erythrocyte sedimentation rate (ESR) and mean c-reactive protein (CRP) before surgery: 55mm/hr and 54 mg/L, respectively. Mean ESR and mean CRP in last blood exam: 18 mm/hr and 8 mg/L, respectively. There were 2 postoperative complications: seroma formation and delayed wound healing. Only 1 patient had recurrence of infection.Patients in group 2 (calcium sulphate antibiotic beads treatment): total of 13 patients (9 males and 4 females) with mean age: 48 years (17-67). Average length of hospital stay was 21 days and mean follow-up time 22 months (16-29). Mean ESR and mean CRP before surgery: 51mm/hr and 41 mg/L, respectively. Mean ESR and mean CRP in last blood test: 15 mm/hr and 11 mg/L. 2 postoperative complications were registered: chronic expanding hematoma of the muscle flap donor site and seroma formation. 1 patient had recurrence of infection. Overall, there were no differences in recurrence of infection, p=0.740 and in complication rate, p=0.672. 11 (91,7%) patients in group 1 and 12 (92,3%) patients in group 2 showed no signs of recurrence of infection both clinically and radiologically at final follow-up.The most frequent cause of osteomyelitis in group 1 was post traumatic while a postsurgical aetiology was more frequent in group 2. The distal tibia was the most common location. The most frequent pathogen isolated in both groups was methicillin sensible staphylococcus aureus.Conclusions: An advance in treatment of patients with cavitary bone defects in chronic osteomyelitis is the use of synthetic bone substitutes although current evidence is low. In this study, we demonstrate how bioglass without local antibiotics and calcium sulphate antibiotic beads are both equally effective treatment options. Overall, there were no differences between groups in mean hospital stay, complication rates and recurrence of infection.

scholarly journals The use of tissue adhesive as an adjunct to wound closure in knee arthroplasty does not reduce wound ooze

2020 ◽  
Vol 32 (1) ◽  
Author(s):  
Mohamed A. Khalefa ◽  
Lindsay K. Smith ◽  
Riaz Ahmad
Keyword(s):  
Hospital Stay ◽  
Knee Arthroplasty ◽  
Case Series ◽  
Length Of Hospital Stay ◽  
Tissue Adhesive ◽  
Prolonged Length ◽  
Increased Risk ◽  
The Difference ◽  
Group 2 ◽  
Group 1

Abstract Introduction Persistent wound ooze has been associated with prolonged length of hospital stay and increased risk of infection. Recently, the use of tissue adhesive after hip and knee arthroplasty has been described. We believe that knee arthroplasty wounds exhibit different behavior compared to hip arthroplasty due to the increased wound-margin tension associated with knee flexion. Patients and methods Forty-three patients undergoing total knee arthroplasty (TKA) by a single surgeon were studied. All wounds were closed using staples with or without tissue adhesive. Post-operatively, the wounds were reviewed daily for ooze. Dressings were changed only if soaked > 50% or if there was persistent wound discharge of more than 2 × 2 cm at 72 h. Results There were 21 patients in the tissue adhesive (group 1), 22 in the non-tissue adhesive (group 2) with the average age for group 1 of 72.2 years and for group 2 of 69.3 years. The median length of stay for both groups was 4 days (range of 3–7 days for group 1 and 2–6 days for group 2) (P = 0.960). The tissue adhesive group showed a statistically significant reduction in wound ooze on day 1 (P = 0.019); however, the difference was not significant on the following days. The median for the number of dressing changes for group 1 was zero changes and for group 2, one change. This was not statistically significant (P = 0.112). No complications were observed in both groups and there were no reactions to the tissue adhesive. Conclusion The data from this case series suggest that the use of tissue adhesive may reduce wound ooze on day 1 only. The latter is most likely due to significant tensile forces to which the knee arthroplasty wound is subjected in the immediate post-operative rehabilitation. Further, the cost of tissue adhesive is not offset by reduced dressing changes or length of hospital stay.

scholarly journals Comparison of Laparoscopic and Conventional Cystotomy/Partial Cystectomy in Treatment of Liver Hydatidosis

2019 ◽  
Vol 2019 ◽  
pp. 1-5 ◽  
Author(s):  
Huseyin Kazim Bektasoglu ◽  
Mustafa Hasbahceci ◽  
Yunus Tasci ◽  
Ibrahim Aydogdu ◽  
Fatma Umit Malya ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Operative Time ◽  
Length Of Hospital Stay ◽  
Partial Cystectomy ◽  
Complication Rates ◽  
First Choice ◽  
Group 2 ◽  
Liver Hydatidosis ◽  
Group 1

Introduction. Hydatidosis is a zoonotic infection and treatment is mandatory to avoid complications. Surgery remains the first choice in the treatment especially for CE2-CE3b cysts. Open or laparoscopic approaches are available. However, comparative studies are limited. Materials and Methods. Data of patients who underwent cystotomy/partial cystectomy for liver hydatidosis between January 2012 and September 2016 (n=77) were evaluated retrospectively. Recurrent cases and the patients with previous hepatobiliary surgery were excluded. 23 patients were operated upon laparoscopically and named as Group 1. 48 patients operated conventionally named as Group 2. Demographics, cyst characteristics, operative time, length of hospital stay, recurrences, and surgery related complications were evaluated. Results. Groups were similar in terms of demographics, cyst characteristics, and operative time. The length of hospital stay was 3.4 days in Group 1 and 4.7 days in Group 2 (p=0,007). The mean follow-up period was 17.8 months and 21.7 months, respectively (p=0.170). Overall complication rates were similar in two groups (p=0.764). Three conversion cases occurred (13%). One mortality was seen in Group 2. Four recurrences occurred in each group (17% versus 8.3%, respectively) (p=0.258). Conclusions. Laparoscopy is a safe and feasible approach for surgical treatment of liver hydatidosis. Recurrence may be prevented by selection of appropriate cases in which exposure of cysts does not pose an intraoperative difficulty.

scholarly journals Comparison of post-operative complications in modified radical mastectomy patients with full suction and compression bandage versus half suction and non-compression bandage

2020 ◽  
Vol 7 (5) ◽  
pp. 1541
Author(s):  
Mohammad Athar ◽  
Sanjay Kala ◽  
Abhineet Gupta ◽  
Ashish Varshney
Keyword(s):  
Hospital Stay ◽  
Skin Flap ◽  
Length Of Hospital Stay ◽  
Radical Mastectomy ◽  
Seroma Formation ◽  
Flap Necrosis ◽  
Suction Drainage ◽  
Superficial Skin ◽  
Group 2 ◽  
Group 1

Background: Modified radical mastectomy still remains the most common surgical procedure employed in definitive management of breast cancer. Post mastectomy problems include skin flap necrosis, prolonged axillary drainage, seroma formation, wound gaping etc., among all seroma is commonest. Drainage usage and dressing applied after this procedure is debatable due to varying recommendations.Methods: A prospective randomized control trial was conducted on 84 FNAC/TRUECUT biopsy proven cases of early and locally advanced breast cancer patients admitted in surgery department, GSVM Medical College, Kanpur over a period of two years. Aiming to compare full suction drainage and compression dressing (n=42) (group 1) with half suction drainage and non-compression dressing (n=34) (group 2), in terms of post-operative morbidities like skin flap necrosis, prolonged axillary drainage, seroma formation, wound gaping and length of hospital stay. Romsons 16 number Romovac drains were used for suction and 2 elastic 6” crape bandage were used for compression.Results: During follow-up there was significant lower incidence of seroma formation in group 1 patients compared to group 2 patients (p<0.0019). Full compression dressing patients have increased incidence of superficial skin necrosis compared to non-compression dressing patients (p<0.022). Patients with half suction drainage and non-compression dressing has early drain removal than patients with full suction drainage and compression dressing (p<0.05), the length of hospital stay was less in group 2 compared to group 1.Conclusions: There is markedly lesser incidence of post-operative seroma formation along with reduced morbidity in the form of patients discomfort and flap necrosis in post MRM patients with full suction drainage and compression dressing, but it requires a greater hospital stay and has slightly higher risk of superficial skin necrosis which can be easily managed with topical ointments, compared to patients with half suction drainage and non-compression dressing.

scholarly journals Comparison of oral anticoagulant users with non-users admission laboratory parameters, length of hospital stay and outcomes in COVID-19 infection

2021 ◽  
Author(s):  
Faruk Karandere ◽  
Mehmet Hursitoglu ◽  
Erhan eroz ◽  
Ecenur Bilgin ◽  
Zeynep Karaali ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Statistical Significance ◽  
Oral Anticoagulants ◽  
Length Of Hospital Stay ◽  
Laboratory Parameters ◽  
Early Admission ◽  
Group 2 ◽  
Serum Crp ◽  
D Dimer ◽  
Group 1

Introduction Oral anticoagulants (OAs) are not in routine use during Coronavirus disease (COVID-19). Studies that compare the COVID-19 infection outcome of chronic OA users with their peers of non-OA users are available. To the best of our knowledge, none of these studies evaluated the effect of OA use on the COVID-19 related early admission laboratory parameters and/or length of the hospital stay. So, we will study these here. Methods  This retrospective study was included 2 groups; group 1 (n=62) consisted of OA users, and group 2 (n=75) of age, and sex-matched of OA non-users at the time of COVID-19 diagnosis. Early admission laboratory measures, numbers of comorbidities, length of hospital stay, and outcomes of these patients were recorded and analyzed Results Despite higher numbers of comorbidities in group 1, their serum CRP and D-dimer levels were significantly lower than the group 2. (p<0.05, all). The rate of mortality was higher in group 2 patients, but, it has not reached a statistical significance (p>0.05). Regression analysis showed that OA users (in comparison to non-OA users) had 0.980 and 0.520 times lower serum CRP and D-dimer levels, respectively.   Conclusions This study showed a beneficial effect of OA use on early admission serum CRP, and D-dimer levels, which are important prognostic predictors in COVID-19. Additionally, OA use associated with lesser hospital stay days of COVID-19 patients. These beneficial effects of OA use might help in improving the management of this infection after further dedicated studies in this field.

Does Not Use of Closed Suction Drainage in Total Knee Arthroplasty with Tranexamic Acid Reduce Blood Loss?

2020 ◽  
Vol 22 (5) ◽  
pp. 343-352
Author(s):  
Naci Ruşen Senih Ayan ◽  
Yavuz Akalın ◽  
Nazan Çevik ◽  
Harun Sağlıcak ◽  
Burak Olcay Güler ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Blood Transfusion ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Hospital Stay ◽  
Knee Arthroplasty ◽  
Length Of Hospital Stay ◽  
Total Knee ◽  
Group 2 ◽  
Group 1

Background. The aim of this study was to compare outcomes in patients who received intravenous tranexamic acid just before and after total knee arthroplasty with or without drains and to analyze whether there is any difference in terms of blood loss. Material and methods. This is a retrospective analysis of prospectively collected data of patients undergoing unilateral total knee arthroplasty. Between March 2017 and March 2019, 97 knees of 94 consecutive patients with osteoarthritis were divided into two groups (Group 1, with drain; and 2, without drain). Drainage group (53 knees; average age, 66,1±7,0 years; male, 10; female, 43) and a drainless group (44 knees; average age, 63,7± 7,5 years; male, 4; female, 40). All patients received systemic tranexamic acid (in 100 mL saline infusion iv in 30 minutes prior to the tourniquet inflation and 3 hours after the operation). Blood loss, allogeneic blood transfusion rates, complications such as swelling of the cruris, infection (deep or superficial), thromboembolic incidents (Deep venous thrombosis or pulmoner thromboembolism) and length of hospital stay were assessed postoperatively. Results. There was no difference in demographic parameters, body mass index, side ofsurgery, ASA score and anesthesia type between 2 groups. The preoperative Hb levels were comparable but on the postoperative day one, Hb level was lower in the drain group (p=0,017). Total blood loss (TBL) and allogeneic transfusion rates were lower in the drainless group, although did not differ significantly between the two groups [TBL: 1360,9±502,5 / 646,1-2641,6 (1251,6) mL in the Group 1, 1205,6±505,0 / 396,6-2521,0 (1157,5) mL in Group 2 (p=0,134); Transfusion rates: 11 out of 53 cases (%20,8) in group 1 and 5 out of 44 cases (%11,4) in group 2]. The infection rate and length of hospital stay were lower in the drainless group. But there were no statistical difference was found in terms of complications and length of hospital stay between 2 groups. Conclusions. 1. Performing Total Knee Arthroplasty with preoperative and postoperative ivtranexamic acid and without drain decreased postoperative reduction in Hb level on the day after surgery in the current study. 2. But blood loss and blood transfusion rates when compared to patients with drain, no significant difference was found. 3. Drain use in knee replacements does not offer an advantage over drainless TKAs regarding the findings of our study. 4. Future studies with longer follow-up are needed in our opinion.

scholarly journals ‘Nephrostomy-Free’ Percutaneous Nephrolithotomy: Experience in a UK District General Hospital

2009 ◽  
Vol 91 (7) ◽  
pp. 570-577 ◽  
Author(s):  
DR Yates ◽  
RK Safdar ◽  
PA Spencer ◽  
BT Parys
Keyword(s):  
Hospital Stay ◽  
Percutaneous Nephrolithotomy ◽  
Length Of Hospital Stay ◽  
Late Complications ◽  
Immediate Early ◽  
Transfusion Rate ◽  
Nephrostomy Tube ◽  
Group 2 ◽  
Jj Stent ◽  
Group 1

INTRODUCTION Percutaneous nephrolithotomy (PCNL) is the first-line treatment for large and complex renal calculi. Accepted UK practice is to insert a nephrostomy tube at the end of the procedure to drain the kidney and reduce potential complications. ‘Tubeless’ or ‘nephrostomy-free’ PCNL has been advocated in selected patients as it is thought to reduce length of hospital stay, analgesia requirements and pain experienced. We present our outcomes of a consecutive series (n = 101) of ‘nephrostomy-free’ PCNLs compared to standard PCNL over a 4-year period. PATIENTS AND METHODS Between January 2004 and October 2006, we performed 55 standard (with nephrostomy tube) PCNLs (Group 1). From October 2006 onwards, we changed our technique and have performed 46 consecutive ‘nephrostomy-free’ PCNLs (JJ stent inserted), independent of patient and stone factors (Group 2). We have compared the two groups in terms of length of hospital stay (LOS), analgesia requirements, transfusion rates, haemoglobin (Hb) decrease and immediate, early and late complications. RESULTS ‘Nephrostomy-free’ PCNL significantly reduced the length of hospital stay (2.8 vs 5.1 days; P < 0.001), morphine-based analgesia requirements (23% no morphine required vs 2.8%; P < 0.001), transfusion rate (2.5% vs 7%; P < 0.01) and mean Hb decrease (1.89 g/dl vs 2.25 g/dl; P > 0.05). Overall, no patient experienced a serious complication. All attempted ‘nephrostomy-free’ PCNLs were completed (stone clearance 95%) and no patient needed an unplanned nephrostomy. Only 5% in Group 2 needed their ureteric JJ stent removing earlier than planned secondary to pain. Both groups were comparable in terms of immediate, early and late complications, though three patients in Group 1 developed chronic loin pain and one patient in the ‘nephrostomy-free’ group developed a delayed perirenal haematoma. CONCLUSIONS ‘Nephrostomy-free’ percutaneous nephrolithotomy is a safe, effective and feasible procedure independent of patient and stone factors. It decreases the length of hospital stay, the pain experienced and the need for morphine-based analgesia; we feel it should be the standard of care for patients undergoing a PCNL.

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