scholarly journals ASSESSMENT OF LAPAROSCOPIC MANAGEMENT OF INTESTINAL PERFORATION

2021 ◽  
Vol 5 (2) ◽  
Author(s):  
Nitish Soni ◽  
Vineet Choudhary ◽  
Irfan Hussain Khan
Keyword(s):  
Hospital Stay ◽  
Intestinal Perforation ◽  
Open Surgery ◽  
Surgical Site Infections ◽  
Laparoscopic Management ◽  
Total Hospital Stay ◽  
Perforation Peritonitis ◽  
Laparotomy Wound ◽  
General Surgeons ◽  
Prolonged Hospital

Background: Intestinal perforation is a surgical emergency often, encountered. Usually, coelotomy is performed to manage intestinal perforation. It has been the gold standard approach to deal with intestinal perforation for the past decades in conjunction with various procedures. Post laparotomy wound related complications have been the biggest challenge for general surgeons till date, so much as to adding up to morbidity, as severe as burst abdomen. Laparoscopic management of perforation is a recent technique. Aim: The present study is aimed to assess the efficacy of laparoscopic management of intestinal perforation. Material and Method: Prospective study of 75 patient admitted and operated in National Institute of Medical Sciences & Research. Intestinal perforation (traumatic and not traumatic) will be managed through laparoscopic procedure. The perforated intestine will be – Identified and exteriorized with or without repair of perforation. Adequate peritoneal toilet would be performed. Sub diaphragmatic and pelvic spaces will be drained. The outcome of the patients will be assessed in regards to- Total hospital stay, Any associated complications – local or distant. Cause of mortality. Results: In present study the perforation peritonitis was found to be in 70.6% with 58.6% ileal perforation 17.1% jejunal perforation. In our study 52% patients managed laparoscopically 33.3% laparoscopic with exteriorization and 14.6% were converted to open surgery. Various cause for open surgery includes 27.2% multiple perforation,9.2% cardiac disease and 63.6v % site not identified laparoscopically. Patients managed laparoscopically had less complications as compared to open. Conclusion: dealing with intestinal perforation or associated peritonitis using minimal access technique is feasible and in turn helpful in minimizing the most dreaded morbidity i.e. the surgical site infections which can be reduced with improving skills and thorough lavage. Other factors associated with post-operative morbidity i.e. ambulation can be started as early as post operative day one. Prolonged hospital stay can be also be reduced and patients can be sent home early decreasing risk for nosocomial Keywords: Laparoscopic, intestinal, perforation, perforation peritonitis

Assessment of prolonged hospital stay attributable to surgical site infections using appropriateness evaluation protocol

2000 ◽  
Vol 28 (2) ◽  
pp. 109-115 ◽  
Author(s):  
Veronique Merle ◽  
Jeanne-Marie Germain ◽  
Pierre Chamouni ◽  
Herve Daubert ◽  
Loetizia Froment ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Surgical Site Infections ◽  
Prolonged Hospital Stay ◽  
Appropriateness Evaluation Protocol ◽  
Evaluation Protocol ◽  
Prolonged Hospital

scholarly journals THE VULKAN TECHNIQUE: A NOVEL OSTOMY-CLOSURE TECHNIQUE THAT REDUCES COMPLICATIONS AND OPERATIVE TIMES

2017 ◽  
Vol 30 (2) ◽  
pp. 139-142 ◽  
Author(s):  
Felix KRENZIEN ◽  
Christian BENZING ◽  
Fabian HARDERS ◽  
Tido JUNGHANS ◽  
Gyurdhan RASIM ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Surgical Complications ◽  
Subcutaneous Tissue ◽  
Operating Time ◽  
Length Of Hospital Stay ◽  
Surgical Site Infections ◽  
Skin Incision ◽  
Colostomy Closure ◽  
Hartmann Procedure ◽  
Prolonged Hospital

ABSTRACT Background: Ostomy reversals remain at high risk for surgical complications. Indeed, surgical-side infections due to bacterial contamination of the stoma lead to revision surgery and prolonged hospital stay. Aim: To describe the novel vulkan technique of ostomy reversal that aims to reduce operative times, surgical complications, and readmission rates. Methods: Ostomy closure was performed using the vulkan technique in all patients. This technique consists of external intestinal closure, circular skin incision and adhesiolysis, re-anastomosis, and closure of the subcutaneous tissue in three layers, while leaving a small secondary wound through which exudative fluid can be drained. The medical records of enterostomy patients were retrospectively reviewed from our hospital database. Results: The vulkan technique was successfully performed in 35 patients mainly by resident surgeons with <5 years of experience (n=22; 62.8%). The ileostomy and colostomy closure times were 53 min (interquartile range [IQR], 41-68 min; n=22) and 136 min (IQR: 88-188 min; n=13; p<0.001), respectively. The median hospital stay was seven days (IQR: 5−14.5 days); the length of hospital stay did not differ between ileostomy and colostomy groups. Major surgical complications occurred only in patients who underwent colostomy closure following the Hartmann procedure (n=2); grade≥IIIb according Clavien-Dindo classification. Conclusion: The vulkan technique was successfully applied in all patients with very low rates of surgical-site infections. Off note, residents with limited surgical experience mainly performed the procedure while operating time was less than one hour.

scholarly journals Surgical Site Infection after Gastrointestinal and Hepatobiliary Surgeries- A Retrospective Evaluation from a Single Center of Western India

2020 ◽  
Author(s):  
Bhavin B. Vasavada ◽  
Hardik Patel
Keyword(s):  
Multivariate Analysis ◽  
Surgical Site Infection ◽  
Hospital Stay ◽  
Univariate Analysis ◽  
Surgical Site Infections ◽  
Western India ◽  
Site Infection ◽  
Prolonged Hospital Stay ◽  
Hepatobiliary Surgery ◽  
Prolonged Hospital

Aim: Aim of our study to evaluate various factors responsible for surgical site infection after gastrointestinal and hepatobiliary surgeries. Material and Methods: Patient who underwent gastrointestinal and hepatobiliary surgery in our department were evaluated retrospectively. Various factors associated with surgical site infection were evaluated using univariate and multivariate analysis. Surgical site infection was defined as any culture positive discharge from the wound within 30 days of surgery.Statistical analysis was done using SPSS version 23. Results: We evaluated total 331 patients operated between April 2018 to March 2020. 14 patients were lost to follow up after discharge and before completing post operative day 30. 18 patients expired before 30 days without developing SSI and were excluded from the study as per exclusion criteria. 299 patient included in the study. Total 20 patients developed surgical site infection. It showed SSI rate in our study population was 6.68%. On univariate analysis prolonged hospital stay, more blood product used, higher cdc grade of surgery, higher ASA grade, more operative time, open surgeries,colorectal and HPB surgeries were associated with surgical site infections. On multivariate analysis only prolonged hospital stay independently predicted Surgical Site Infectins. (p=0.014,0dds ratio 1.223, 95% confidence interal 1.042-1.435). Conclusion: Prolonged hospital stay independently predicts surgical site infections after gastrointestinal and hepatobiliary surgery.

Can Laparoscopic Ileocolic Resection be Performed with Comparable Safety to Open Surgery for Regional Enteritis: Data from National Surgical Quality Improvement Program

2010 ◽  
Vol 76 (12) ◽  
pp. 1393-1396
Author(s):  
Hasan T. Kirat ◽  
Naveen Pokala ◽  
Jon D. Vogel ◽  
Victor W. Fazio ◽  
Ravi P. Kiran
Keyword(s):  
Quality Improvement ◽  
Hospital Stay ◽  
Open Surgery ◽  
Regional Enteritis ◽  
Surgical Site Infections ◽  
Quality Improvement Program ◽  
Smoking History ◽  
Ileocolic Resection ◽  
Improvement Program ◽  
Surgical Quality

Laparoscopic ileocolic resection is feasible for Crohn's disease but few studies adjust for the various preoperative, intraoperative, and postoperative variables that may confound comparisons with open surgery. The aim of this study is to compare outcomes after laparoscopic (LICR) and open ileocolic resection (OICR) performed for regional enteritis using National Surgical Quality Improvement Program (NSQIP) data. Retrospective evaluation of data prospectively accrued into the NSQIP database for patients undergoing ileocolic resection for Crohn's by LICR and OICR was performed. LICR (n = 104) and OICR (n = 203) groups had similar age ( P = 0.1), body mass index ( P = 0.9), smoking history ( P = 0.6), steroid use ( P = 0.7), diabetes ( P = 0.3), serum albumin ( P = 0.07), and American Society of Anesthesiologists class ( P = 0.13). LICR group had more female patients ( P = 0.005). Complications including surgical site infections ( P = 0.5), wound dehiscence ( P = 1), pneumonia ( P = 0.1), deep vein thrombosis ( P = 0.3), pulmonary embolism ( P = 1), urinary infection ( P = 0.1), and return to the operating room ( P = 0.2) were similar. LICR had shorter length of hospital stay than OICR ( P < 0.001). In current practice, as observed with the NSQIP data, LICR, performed by experienced surgeons, is comparable in safety to OICR and is associated with a shorter hospital stay.

scholarly journals Prolonged Hospital Stay is Associated with Increase Surgical Site Infection, Gastrointestinal and Hepatobiliary Surgery – A propensity Matched Analysis

2020 ◽  
Author(s):  
Bhavin Vasavada ◽  
Hardik Patel
Keyword(s):  
Surgical Site Infection ◽  
Hospital Stay ◽  
Malignant Disease ◽  
Surgical Site Infections ◽  
Site Infection ◽  
Prolonged Hospital Stay ◽  
Hepatobiliary Surgery ◽  
Small Intestinal ◽  
Prolonged Hospital ◽  
Upper Gastrointestinal

Aims: Primary AIM of the study was to evaluate effect of prolonged hospital stay on Surgical site infections We also evaluated effect of prolonged hospital stay on overall morbidity in Gastrointestinal and Hepatobiliary Surgery as secondary outcome. Methods: We retrospectively analysed all the patients who underwent gastrointestinal and hepatobiliary surgery between April 2017 to March 2020. On our analysis we found mean hospital stay in patient who did not develop SSI and/or morbidity was 4 days (Total hospital stay) vs 6 days who developed morbidity (hospital stay before diagnosis of SSI or diagnosis or morbid event). Based on this to avoid selection bias, we did 1:1 propensity score analysis between patients who had 4 or less than hospital stay vs patients who had 5 or more hospital stay before diagnosis of surgical site infection and/or morbid event. We took all the preoperative and intraoperative factors like Age, sex, malignant disease, ASA score, CDC grade of surgery, open or laparoscopic surgery, HPB surgeries, colorectal surgeries, Upper Gastrointestinal surgeries and small intestinal surgeries as covariates. We used nearest neighbor matching protocol with a calipher of 0.2. Cases were not reusable after matching. Statistical analysis was done using SPSS version 23. Results: We included 348 patients operated between April 2017 and March 2020 in our analysis. After 1:1 propensity score matching 58 patients included in study arm (prevent hospital stay more than 4 days) and 56 patients in control arm. Both groups were comparable with regard to Age, Sex, Surgery for malignant disease, ASA score, CDC grade of surgery, HPB surgeries, Small intestinal surgeries, Colorectal surgeries, upper gastrointestinal surgeries, intraoperative blood product requirement, intraoperative hypotension or any other event, operative time. Prolonged hospital stay (&gt; 4 days) was significantly associated with surgical site infections (p&lt;0.0001), morbidity (p=0.001). Open surgeries were associated with prolonged hospital stay. (p=0.032). Conclusion: Prolonged Hospital stay is associated with increase surgical site infection and morbidity in Gastrointestinal and Hepatobiliary Surgery.

scholarly journals Workplace-Related Traumatic Injuries: Insights from a Rapidly Developing Middle Eastern Country

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Hassan Al-Thani ◽  
Ayman El-Menyar ◽  
Husham Abdelrahman ◽  
Ahmad Zarour ◽  
Rafael Consunji ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Occupational Injury ◽  
Motor Vehicle ◽  
Negative Impact ◽  
Middle Eastern ◽  
Case Fatality ◽  
Traumatic Injuries ◽  
Total Hospital Stay ◽  
Fall From Height ◽  
Prolonged Hospital

Traumatic workplace-related injuries (WRIs) carry a substantial negative impact on the public health worldwide. We aimed to study the incidence and outcomes of WRIs in Qatar. We conducted occupational injury surveillance for all WRI patients between 2010 and 2012. A total of 5152 patients were admitted to the level 1 trauma unit in Qatar, of which 1496 (29%) sustained WRI with a mean age of34.3±10.3. Fall from height (FFH) (51%) followed by being struck by heavy objects (FHO) (18%) and motor vehicle crashes (MVC) (17%) was the commonest mechanism of injury (MOI). WRI patients were mainly laborers involved in industrial work (43%), transportation (18%), installation/repair (12%), carpentry (9%), and housekeeping (3%). Use of protective device was not observed in 64% of cases. The mean ISS was11.7±8.9, median ICU stay was 3 days (1–64), and total hospital stay was 6 days (1–192). The overall case fatality was 3.7%. Although the incidence of WRI in Qatar is quite substantial, its mortality rate is relatively low in comparison to other countries of similar socioeconomic status. Prolonged hospital stay and treatment exert a significant socioeconomic burden on the nation’s and families’ resources. Focused and efficient injury prevention strategies are mandatory to prevent future WRI.

scholarly journals A prospective study to assess clinical profile and golden period for operative intervention in patients with perforation peritonitis

2018 ◽  
Vol 5 (4) ◽  
pp. 1492
Author(s):  
Sandeep Malik ◽  
Amandeep Singh ◽  
Darshan Singh Sidhu ◽  
Nitin Nagpal ◽  
Deepika Sharma
Keyword(s):  
Prospective Study ◽  
Hospital Stay ◽  
High Morbidity ◽  
Diffuse Peritonitis ◽  
Total Hospital ◽  
Icu Stay ◽  
Surgical Emergencies ◽  
Total Hospital Stay ◽  
Perforation Peritonitis ◽  
A Prospective Study

Background: Perforation peritonitis constitutes one of the most common surgical emergencies encountered by surgeons. Even with modern treatment, diffuse peritonitis carries a high morbidity and mortality rate.Methods: The prospective study was conducted at department of surgery on 50 patients of perforation peritonitis admitted in emergency department of hospital. Detailed history, clinical examination and investigations were carried out. Patients were operated upon and findings were noted. Comparisons were done for postoperative ICU stay, morbidity/ mortality, oral feed and total hospital stay between the patients who reported within 24 hours and after 24 hours of onset of symptoms to determine golden period for operative intervention.Results: Out of total 50 patients, 21(42%) patients presented within 24 hrs of onset of first symptom of perforation while 29(58%) patients presented after 24 hours. Postoperative ICU stay, morbidity/ mortality, delay in oral feed and total hospital stay was statistically more in patients presenting after 24 hours.Conclusions: It can be concluded that the golden period of 24 hrs between the onset of symptom and start of treatment is the most important factor to determine the outcome.

scholarly journals Surgical site Infection after gastrointestinal and hepatobiliary surgeries- A retrospective evaluation from a single center of western India

2020 ◽  
Vol 23 (2) ◽  
pp. 31-35
Author(s):  
Bhavin Vasavada ◽  
Hardik Patel
Keyword(s):  
Multivariate Analysis ◽  
Surgical Site Infection ◽  
Hospital Stay ◽  
Univariate Analysis ◽  
Surgical Site Infections ◽  
Western India ◽  
Site Infection ◽  
Prolonged Hospital Stay ◽  
Hepatobiliary Surgery ◽  
Prolonged Hospital

Introduction: Aim of our study to evaluate various factors responsible for surgical site infection after gastrointestinal and hepatobiliary surgeries. Methods: Patients who underwent gastrointestinal and hepatobiliary surgery in our department were evaluated retrospectively. Various factors associated with surgical site infection were evaluated using univariate and multivariate analysis. Surgical site infection was defined as any culture positive discharge from the wound within 30 days of surgery. Results: We evaluated a total of 331 patients operated between April 2018 and March 2020. 14 patients were lost to follow up after discharge and before completing post operative day 30. Eighteen patients expired before 30 days without developing SSI and were excluded from the study as per exclusion criteria. 299 patients were included in the study. Twenty patients developed surgical site infection. It showed SSI rate in our study population was 6.68%. On univariate analysis prolonged hospital stay, more blood product used, higher CDC grade of surgery, higher ASA grade, more operative time, open surgeries, colorectal and HPB surgeries were associated with surgical site infections. On multivariate analysis only prolonged hospital stay independently predicted SSI. (p=0.014, Odds ratio 1.223, 95% confidence interval 1.042-1.435.). Conclusion: Prolonged hospital stay independently predicts surgical site infections after gastrointestinal and hepatobiliary surgery.

Analysis of Nosocomial Infections in Post–Cardiac Surgery Extracorporeal Membrane Oxygenation Support Therapy

2018 ◽  
Vol 21 (5) ◽  
pp. E387-E391 ◽  
Author(s):  
Binfei Li ◽  
Geqin Sun ◽  
Zhou Cheng ◽  
Chuangchuang Mei ◽  
Xiaozu Liao ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Cardiac Surgery ◽  
Extracorporeal Membrane Oxygenation ◽  
Hospital Stay ◽  
Nosocomial Infections ◽  
Total Hospital ◽  
Secondary Infections ◽  
Total Hospital Stay ◽  
Mechanical Ventilation Time ◽  
Post Cardiac Surgery

Objectives: This study aims to analyze the nosocomial infection factors in post–cardiac surgery extracorporeal membrane oxygenation (ECMO) supportive treatment (pCS-ECMO). Methods: The clinical data of the pCS-ECMO patients who obtained nosocomial infections (NI) were collected and analyzed retrospectively. Among the 74 pCS-ECMO patients, 30 occurred with NI, accounting for 40.5%; a total of 38 pathogens were isolated, including 22 strains of Gram-negative bacteria (57.9%), 15 strains of Gram-positive bacteria (39.5%), and 1 fungus (2.6%). Results: Multidrug-resistant strains were highly concentrated, among which Acinetobacter baumannii and various coagulase-negative staphylococci were the main types; NI was related to mechanical ventilation time, intensive care unit (ICU) residence, ECMO duration, and total hospital stay, and the differences were statistically significant (P < .05). The binary logistic regression analysis indicated that ECMO duration was a potential independent risk factor (OR = 0.992, P = .045, 95.0% CI = 0.984-1.000). Conclusions: There existed significant correlations between the secondary infections of pCS-ECMO and mechanical ventilation time, ICU residence, ECMO duration, and total hospital stay; therefore, hospitals should prepare appropriate preventive measures to reduce the incidence of ECMO secondary infections.

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