scholarly journals Laparoscopic approach for pancreato-splenic abscess from disseminated melioidosis: Surgical outcome and review of literature

2021 ◽  
pp. 241
Author(s):  
Keyword(s):  
Operative Time ◽  
Case Reports ◽  
Demographic Data ◽  
Splenic Abscess ◽  
Laparoscopic Approach ◽  
Systemic Infection ◽  
Management Options ◽  
Distal Pancreatosplenectomy ◽  
Complications And Mortality ◽  
Median Operative Time

Melioidosis is a severe systemic infection caused by Burkholderia pseudomallei. It commonly affects the lungs, liver and kidneys. Pancreatic and splenic abscess from melioidosis is rare, with few reports in the literature. We present a series of 4 patients with disseminated melioidosis of pancreas and spleen who required surgical intervention. A MEDLINE database review was conducted. Relevant publications were evaluated and demographic data, clinical, radiological findings as well as management options were collected. We found 10 case reports describing this clinical condition. In our series, median age was 57. Median operative time 260 minutes. All four patients failed trial of antibiotic therapy and required surgery. Three underwent distal pancreatosplenectomy and one underwent splenectomy alone. Laparoscopic distal pancreatosplenectomy was successful in two patients. Median length of stay 11.5 days. No post-operative complications and mortality reported. Surgery is indicated in failed medical therapy and laparoscopic approach is safe and feasible.

PS01.070: EVALUATION OF THE EFFECTIVENESS OF ROBOTIC FUNDOPLICATIONS IN THE TREATMENT OF GERD

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 69-69
Author(s):  
Mikhail Koshkin ◽  
Oleg Vasnev ◽  
Alexandr Belousov ◽  
Mikhail Mikhnevich ◽  
Magomet Baychorov ◽  
...  
Keyword(s):  
Operative Time ◽  
Conflicts Of Interest ◽  
Nissen Fundoplication ◽  
Laparoscopic Approach ◽  
Laparoscopic Group ◽  
Short Term ◽  
Antireflux Operations ◽  
Davinci System ◽  
Invasive Techniques ◽  
Median Operative Time

Abstract Background Surgical treatment is one of the most effective options for treatment of gastroesofageal reflux disease. Laparoscopic approach became is a ‘gold standard’ over the time demonstrating all advantages of minimally invasive techniques over the open procedures. However the utility of robotic antireflux operations still remains controversial. Methods Since the January till the December of 2017 thirty operations were operated on. Mean age was 57,2 (35–76), among them 21 (70%) were female and 9 (30%) were males. Mean BMI was 29,4 (24,1–41,0). Laparoscopic procedures were performed in15 patients (1st group), robotic procedures with DaVinci system were performed in 15 patients of the second group. Chernousov modified Nissen fundoplication was performed in 25 patients, Toupet fundoplication was used for 4 patients, Nissen type was performed in 4 cases. Results The median operative time in laparoscopic group was 125 min (80–200 min), in robotic group - 124 min (90–210 min). There were no statistical differences between two groups (P = 0,93).Blood loss was minimal in both groups. Mean postoperative hospital stay was 4 days (2–7 days) in the 1st group and 4 days (2–6 days) in the second. There were no statistical differences between two groups (P = 0,19). Postoperative course was uneventful in all patients of both groups. Conclusion Robotic antireflux operations are safe and effective in treatment of patients with reflux-esophagitis. There were no statistically significant differences in short-term results of laparoscopic and robotic operations. Disclosure All authors have declared no conflicts of interest.

scholarly journals Laparoscopic splenectomy: a personal series of 140 consecutive cases

2010 ◽  
Vol 92 (5) ◽  
pp. 398-402 ◽  
Author(s):  
Clare J Pattenden ◽  
Christopher D Mann ◽  
Matthew S Metcalfe ◽  
Martin Dyer ◽  
David M Lloyd
Keyword(s):  
Laparoscopic Splenectomy ◽  
Operative Time ◽  
Laparoscopic Approach ◽  
University Hospital ◽  
Safe Procedure ◽  
Median Hospital Stay ◽  
Open Procedure ◽  
Open Operation ◽  
Hand Assistance ◽  
Complications And Mortality

Laparoscopic splenectomy has emerged as a safe and effective treatment for a variety of haematological conditions. The objective was to review the results from a large personal series from the perspective of outcomes according to operative time, conversion to open operation, complications and mortality. The application of laparoscopic splenectomy to cases of splenomegaly without hand assistance is examined. A retrospective review of 140 patients undergoing laparoscopic splenectomy at a single university hospital by one surgeon during 1994-2006. Case notes were reviewed and data collected on operative time, conversion to open procedure, morbidity and mortality. Particular reference was made towards the results of cases of splenomegaly. In total 140 laparoscopic splenectomies were performed with a complication rate of 15% and no mortality. The median operative time was 100 min and conversion to open procedure was necessary in 2.1%. Conversion for cases of splenomegaly was only 5.7%. The median hospital stay was 3 days. Laparoscopic splenectomy is a safe procedure with acceptable morbidity. A laparoscopic approach for splenomegaly is feasible.

Facial Fractures Have Similar Outcomes When Managed by Either Otolaryngology or Plastic Surgery: Encounters From a Single Level I Trauma Center

2021 ◽  
pp. 194338752110206
Author(s):  
Ashton Christian ◽  
Beatrice J. Sun ◽  
Nima Khoshab ◽  
Areg Grigorian ◽  
Christina Y. Cantwell ◽  
...  
Keyword(s):  
Plastic Surgery ◽  
Trauma Center ◽  
Demographic Data ◽  
Open Reduction Internal Fixation ◽  
Facial Fractures ◽  
Chi Square ◽  
Single Level ◽  
Baseline Characteristics ◽  
Level I ◽  
Complications And Mortality

Study Design: Retrospective cohort. Objective: Traumatic facial fractures (FFs) often require specialty consultation with Plastic Surgery (PS) or Otolaryngology (ENT); however, referral patterns are often non-standardized and institution specific. Therefore, we sought to compare management patterns and outcomes between PS and ENT, hypothesizing no difference in operative rates, complications, or mortality. Methods: We performed a retrospective analysis of patients with FFs at a single Level I trauma center from 2014 to 2017. Patients were compared by consulting service: PS vs. ENT. Chi-square and Mann-Whitney-U tests were performed. Results: Of the 755 patients with FFs, 378 were consulted by PS and 377 by ENT. There was no difference in demographic data ( P > 0.05). Patients managed by ENT received a longer mean course of antibiotics (9.4 vs 7.0 days, P = 0.008) and had a lower rate of open reduction internal fixation (ORIF) (9.8% vs. 15.3%, P = 0.017), compared to PS patients. No difference was observed in overall operative rate (15.1% vs. 19.8%), use of computed tomography (CT) imaging (99% vs. 99%), time to surgery (65 vs. 55 hours, P = 0.198), length of stay (LOS) (4 vs. 4 days), 30-day complication rate (10.6% vs. 7.1%), or mortality (4.5% vs. 2.6%) (all P > 0.05). Conclusion: Our study demonstrated similar baseline characteristics, operative rates, complications, and mortality between FFs patients who had consultation by ENT and PS. This supports the practice of allowing both ENT and PS to care for trauma FFs patients, as there appears to be similar standardized care and outcomes. Future studies are needed to evaluate the generalizability of our findings.

scholarly journals Transischiorectal fossa approach for resection of pudendal nerve schwannoma: case report

2016 ◽  
Vol 25 (5) ◽  
pp. 636-639 ◽  
Author(s):  
Stephanie Chen ◽  
Brandon Gaynor ◽  
Allan D. Levi
Keyword(s):  
Pelvic Pain ◽  
Pudendal Nerve ◽  
English Language ◽  
Case Reports ◽  
Laparoscopic Approach ◽  
Direct Access ◽  
Surgical Approaches ◽  
Complete Relief ◽  
Pelvic Muscles ◽  
Intraoperative Electrophysiological Monitoring

Pudendal nerve schwannomas are very rare, with only two cases reported in the English-language literature. The surgical approaches described in these two case reports are the transgluteal approach and the laparoscopic approach. The authors present the case of a patient with progressive pelvic pain radiating ipsilaterally into her groin, vagina, and rectum, who was subsequently found to have a pudendal schwannoma. The authors used a transischiorectal fossa approach and intraoperative electrophysiological monitoring and successfully excised the tumor. This approach has the advantage of direct access to Alcock's canal with minimal disruption of the pelvic muscles and ligaments. The patient experienced complete relief of her pelvic pain after the procedure.

Costs and benefits of different methods of esophagectomy for esophageal cancer

2017 ◽  
Vol 25 (7-8) ◽  
pp. 513-517 ◽  
Author(s):  
Alongkorn Yanasoot ◽  
Kamtorn Yolsuriyanwong ◽  
Sakchai Ruangsin ◽  
Supparerk Laohawiriyakamol ◽  
Somkiat Sunpaweravong
Keyword(s):  
Esophageal Cancer ◽  
Postoperative Pain ◽  
Minimally Invasive ◽  
Operative Time ◽  
Minimally Invasive Esophagectomy ◽  
Laparoscopic Approach ◽  
Costs And Benefits ◽  
Invasive Approach ◽  
Invasive Esophagectomy ◽  
Open Esophagectomy

Background A minimally invasive approach to esophagectomy is being used increasingly, but concerns remain regarding the feasibility, safety, cost, and outcomes. We performed an analysis of the costs and benefits of minimally invasive, hybrid, and open esophagectomy approaches for esophageal cancer surgery. Methods The data of 83 consecutive patients who underwent a McKeown’s esophagectomy at Prince of Songkla University Hospital between January 2008 and December 2014 were analyzed. Open esophagectomy was performed in 54 patients, minimally invasive esophagectomy in 13, and hybrid esophagectomy in 16. There were no differences in patient characteristics among the 3 groups Minimally invasive esophagectomy was undertaken via a thoracoscopic-laparoscopic approach, hybrid esophagectomy via a thoracoscopic-laparotomy approach, and open esophagectomy by a thoracotomy-laparotomy approach. Results Minimally invasive esophagectomy required a longer operative time than hybrid or open esophagectomy ( p = 0.02), but these patients reported less postoperative pain ( p = 0.01). There were no significant differences in blood loss, intensive care unit stay, hospital stay, or postoperative complications among the 3 groups. Minimally invasive esophagectomy incurred higher operative and surgical material costs than hybrid or open esophagectomy ( p = 0.01), but there were no significant differences in inpatient care and total hospital costs. Conclusion Minimally invasive esophagectomy resulted in the least postoperative pain but the greatest operative cost and longest operative time. Open esophagectomy was associated with the lowest operative cost and shortest operative time but the most postoperative pain. Hybrid esophagectomy had a shorter learning curve while sharing the advantages of minimally invasive esophagectomy.

scholarly journals Sutureless elastic ring silo for the gastroschisis

2010 ◽  
Vol 4 (5) ◽  
pp. 747-755 ◽  
Author(s):  
Piyawan Chiengkriwate ◽  
Surasak Sangkhathat ◽  
Sakda Patrapinyokul ◽  
Vorapong Chowchuvech ◽  
Waricha Janjindamai ◽  
...  
Keyword(s):  
Operative Time ◽  
Primary Repair ◽  
Demographic Data ◽  
Mode Of Delivery ◽  
Length Of Hospital Stay ◽  
Elastic Ring ◽  
First Feeding ◽  
Closure Duration ◽  
Abdominal Content ◽  
Average Operative Time

Abstract Background: The definitive surgical management of gastroschisis is the return of the eviscerated abdominal content into the abdomen as soon as possible. Objectives: Assess the efficacy of using a sutureless elastic ring silo (SERS) for the management of gastroschisis. Methods: Neonates with gastroschisis were enrolled at Songklanagarind Hospital between January 2006 and December 2008. A primary repair (PR) was attempted in all cases. If this was not possible due to concerns about abdominal compartment syndrome, a stage abdominal closure with a silo pouch was fashioned: a traditional silo (TS) or SERS. When the bowel was completely reduced, a second-stage closure was performed in the operating room. Data collected included general demographic data, size of defect, associated anomalies, hospital course, mode of gastroschisis closure, duration of parenteral nutrition (PN) and ventilator, first feeding age, complications, and length of hospital stay (LOS). Results: Twenty-nine children with gastroschisis were treated (PR: 9, TS: 9, and SERS: 11). There were no differences (p >0.05) concerning gender, mode of delivery, APGAR scores, gestational age, birth weight, or defect size. A preformed silo was employed in 20 of 29 cases, TS in nine (31%), and SERS in 11 (38%) cases in an average operative time of 80.6 and 40 minutes, respectively, a significantly shorter operative time in the SERS (p =0.007). Overall, there were no differences (p >0.05) concerning duration of ventilator support (10.2 days), duration of PN (21.3 days), first feeding age (15 days), LOS (26.5 days), and complication. Conclusion: The use of a sutureless elastic ring silo with readily available inexpensive materials is simple, safe and efficacious in our setting.

scholarly journals Operative Choice for Displaced Proximal Humeral Fractures in Adolescents with Open Visible Physis: A Comparative Study of External Fixator vs. Kirschner Wire

2020 ◽  
Author(s):  
Pan Hong ◽  
Saroj Rai ◽  
Huabing Qian ◽  
Ruikang Liu ◽  
Jin Li
Keyword(s):  
Clinical Outcomes ◽  
External Fixator ◽  
Operative Time ◽  
Rating Scale ◽  
Demographic Data ◽  
Kirschner Wire ◽  
Humeral Fracture ◽  
Good Choice ◽  
Proximal Humeral Fractures ◽  
Humeral Fractures

Abstract Background: For adolescents of severely displaced proximal humeral fracture (PHF), surgery is a good choice yielding excellent outcomes. Kirchner wire (KW) is a cost-effective choice for fixation, and this study aims to compare the clinical outcomes of external fixator (EF) vs. KW for the treatment of PHF in adolescents. To the best of our knowledge, it is the first report on external fixator for PHF in children and adolescents.Methods: Patients of PHF operated in our institute, from January 2008 to January 2016, were reviewed retrospectively. Demographic data, including sex, age at the time of surgery, operated side, and hardware choice, were collected from the hospital database. Preoperative radiographs were reviewed and classified according to Neer-Horwitz classification. Shoulder function was evaluated during 12th month follow-up using rating scale of the American shoulder and elbow surgeons (ASES). Complications, including infection, malunion, nonunion, stiffness of the shoulder joint, and failure of fixation were also recorded.Results: Thirty-five patients, including 23 males and 12 females, were included in the EF group, whereas 40 patients, including 25 males and 15 females, were included in the KW group (P = 0.867). The average age of patients in the EF group was 13.3 ± 1.7 years, and that of KW was 13.6 ± 1.8 years (P = 0.409). Patients in both groups were followed-up for at least 12 months. The operative time in the EF group (42.4 ± 11.2, min) was significantly shorter than those in the KW group (54 ± 13.6, min), P < 0.001. The frequency of fluoroscopy in the EF group (12 ± 2.4) was significantly less than those in the KW group (17 ± 2.8), P < 0.001. The rate of open reduction was significantly higher in KW (35%) group than those in the EF group (0%), P < 0.001. There was no nonunion, malunion cases in both groups.Conclusion: External fixator is superior to Kirschner wire in the treatment of proximal humeral fractures in adolescents with shorter operative time, lower rate of ORIF and comparable clinical outcomes.

scholarly journals Cardiovascular risk quantification using QRISK-3 score in people with intellectual disability

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S52-S53
Author(s):  
Jamie Sin Ying Ho ◽  
Vikram Rohra ◽  
Laura Korb ◽  
Bhathika Perera
Keyword(s):  
Intellectual Disability ◽  
Demographic Data ◽  
Cross Sectional Study ◽  
Outpatient Setting ◽  
National Guidelines ◽  
Cvd Risk ◽  
Management Options ◽  
Cross Sectional ◽  
Accessible Information ◽  
The Mean

AimsThe prevalence of cardiovascular diseases (CVD) in people with intellectual disability (ID) is around 14%, higher than the general population. However, CVD risk assessments are not consistently performed. Given the high risk of premature deaths in people with ID, it is important to identify preventable risk factors and follow evidence-based interventions. QRISK-3 is a validated risk-stratification tool, which calculates the 10-year risk of developing a heart attack or stroke (https://qrisk.org/three/index.php). There are no published studies on the use of QRISK-3 in people with ID. This project aimed to understand the use of QRISK-3 in an ID clinic and to quantify individual CVD risks to recommend appropriate management options.MethodA cross sectional study was performed on 143 patients open to an ID psychiatry clinic. Patients and carers were sent an accessible information leaflet on this study. Basic demographic data and information on psychiatric diagnoses were collected. Patients were grouped according to the presence of severe mental illness (SMI) defined as schizophrenia, bipolar disorder and other psychotic illnesses. QRISK-3 ≥ 10% was defined as elevated risk in accordance with NICE guidelines. Patients who had a high QRISK-3 score were advised to contact their GP.ResultOf 143 patients, 73 (51.0%) had a mild ID and the remaining had a moderate to severe ID. The mean age was 43.3 years, 53.1% were male. Overall, 28 (19.6%) participants had an elevated CVD risk, of whom 16 (57.1%) were not on statins, which is the recommended treatment. The mean QRISK-3 score was 6.31 (standard deviation [SD] 8.95), and the relative risk is 3.50 (SD 7.13). The proportion of QRISK-3 ≥ 10% and mean score were not significantly different in those with SMI, but those with SMI were more likely to be prescribed statins than those without (14 [31.1%] vs 10 [10.2%], p = 0.002). Statins were given to 24 (16.8%) participants, of whom 12 (50%) had elevated CVD risk. 89% had a blood pressure recording within the past 5 years, 87% had height and 88% had weight recorded. 73% had lipid serology results recorded.ConclusionElevated CVD risk was common in this ID study population, and more than half with elevated QRISK-3 were not on the medical treatment recommended by national guidelines. QRISK-3 could feasibly be implemented in the outpatient setting. Increased routine CVD risk assessment and management should be considered as another measure to reduce morbidity and mortality.

scholarly journals Learning curve for laparoscopic Roux-en-Y gastric bypass based on the experience of a newly created bariatric center

2020 ◽  
Vol 92 (4) ◽  
pp. 23-30
Author(s):  
Jadwiga Dworak ◽  
Michał Wysocki ◽  
Anna Rzepa ◽  
Michał Pędziwiatr ◽  
Dorota Radkowiak ◽  
...  
Keyword(s):  
Morbid Obesity ◽  
Gastric Bypass ◽  
Adverse Events ◽  
Learning Curve ◽  
Operative Time ◽  
Perioperative Complications ◽  
Safe Procedure ◽  
Experienced Surgeon ◽  
Institutional Learning ◽  
Complications And Mortality

ntroduction: Laparoscopic Roux-en-Y gastric bypass (LRYGB) is one of the most common treatments for morbid obesity. The learning curve for this procedure is 50–75 cases for an independent surgeon, and it is considered the most important factor in decreasing complications and mortality. We present our experience and learning curve with LRYGB for a newly established bariatric center in Poland. Material and methods: A prospectively collected database containing 285 LRYGB procedures performed in the II Department of General Surgery of the Jagiellonian University MC in Krakow between 06.2010 and 03.2019 was retrospectively reviewed. Patients were divided into groups of 30 (G1–G10) in the order of the procedures performed by each surgeon. The study analyzed the course of the operation and patient hospitalization, comparing those groups. Learning curve for the newly created bariatric center was established. Results: Operative time in G1–G3 differed significantly from G4–G10 (P < 0.0001). The stabilization point was the 90th procedure. Perioperative complications were observed in 36 (12.63%) patients. Perioperative complications, intraoperative difficulties and adverse events did not differ importantly among groups. Liberal use of “conversions of the operator” from a surgeon to a senior surgeon provides reasonable safety and prevents complications. Conclusions: The institutional learning process stabilization point for LRYGB in a newly established bariatric center is around the 90th operation. LRYGB can be a safe procedure from the very beginning in newly established bariatric centers. Specific bariatric training with active proctoring by an experienced surgeon in a bariatric centre can improve the laparoscopic gastric bypass outcome during the learning curve.

Retroperitoneal laparoscopic surgery in managing the urinary anormalies in children at Viet Duc Hospital

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Việt Hoa Nguyễn
Keyword(s):  
Laparoscopic Surgery ◽  
Retrospective Study ◽  
Plastic Surgery ◽  
Operative Time ◽  
Laparoscopic Approach ◽  
Multicystic Dysplastic Kidney ◽  
Gender Ratio ◽  
Laparoscopic Pyeloplasty ◽  
Ureteral Duplication ◽  
Dysplastic Kidney

Tóm tắt Đặt vấn đề: Đánh giá kết quả phẫu thuật nội soi sau phúc mạc điều trị bệnh lý thận, tiết niệu ở trẻ em Phương pháp nghiên cứu: Nghiên cứu hồi cứu người bệnh phẫu thuật nội soi sau phúc mạc điều trị bệnh lý thận, tiết niệu trong thời gian từ 1/1/2014 - 31/12/2017. Kết quả: Phẫu thuật nội soi sau phúc mạc cho 110 người bệnh trong đó hẹp khúc nối bể thận - niệu quản là 49 người bệnh (44,54%), thận niệu quản đôi 23 người bệnh (20,91%), thận đa nang 21 người bệnh (19,1%), thận teo mất chức năng 17 người bệnh (15,43%). Tuổi phẫu thuật trung bình là 4,5 ± 3,72 tuổi (từ 1 tuổi- 15 tuổi), tỉ lệ nam/ nữ = 3,3/1. Phẫu thuật nội soi cắt thận cho 52 người bệnh (47,27%), nội soi tạo hình cho 11 người bệnh (10%), nội soi hỗ trợ tạo hình cho 47 người bệnh (42,73%). Thời gian phẫu thuật trung bình 100 ± 20 phút. Thời gian nằm viện sau mổ trung bình là 3 ± 2,3 ngày. Không có biến chứng nặng. Kết quả theo dõi sau mổ 3- 36 tháng cho kết quả tốt 88%, trung bình 10%, xấu 2% Kết luận: Nội soi sau phúc mạc điều trị các bệnh lý thận, tiết niệu ở trẻ em là một phương pháp phẫu thuật an toàn, không có biến chứng, thẩm mỹ và cho kết quả tốt. Abstract Introduction: To evaluate the retroperitoneal laparoscopic surgery in children having the urinary anomalies Material and Methods: Retrospective study for children suffering from urinary anomalies underwent retroperitoneal laparoscopic surgery. Results: 110 children were operated by retroperitoneal laparoscopic approach included: 49 patients (44.54%) with ureter pelvic junction obstruction, 23 patients (20.91%) with ureteral duplication, 21 patients (19.1%) with multicystic dysplastic kidney, 17 patients (15.45%) with atrophy kidney. Mean age was 4.5± 3.72 years old (from 1 year to 15 years old); Gender ratio: male/female = 3.3/1. Laparoscopic nephrectomy for 52 cases (47.27%), 58 cases including 11 cases (10%) retroperitoneal laparoscopic pyeloplasty and 47 cases (42.27%) with assisted laparoscopic plastic surgery. Mean operative time was 100 ± 20 minutes, mean hospitalization length stay was 3 ± 2.3 days. No major complications occurred. Followed from 3 to 36 month are favorable with good outcome in 88%, average in 10%, poor in 2%. Conclusion: Retroperitoneal laparoscopic surgery is safe and feasible procedure in children with urinary anomalies. Keyword: Laparoscopic surgery; Retroperitoneal laparoscopic surgery; Urinary anomalies in children.

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