COMPARATIVE STUDY BETWEEN STANDARD AND TUBELESS PERCUTANEOUS NEPHROLITHOTOMY PROCEDURES FOR SURGICAL MANAGEMENT OF KIDNEY STONES.

Introduction: Percutaneous Nephrolithotomy (PCNL) is an effective treatment for renal stone. Due to significant pain and morbidity after standard PCNL because of nephrostomy tubes, various modifications of PCNL are being performed. We report a randomised trial comparing these modalities. Material and method: 50 patients were randomised in two groups of 25 each: standard PCNL with nephrostomy tubes (Group 1) and tubeless PCNL with ureteric stent and no nephrostomy (Group 2). At the end of procedure randomisation was done for those patients satisfying the inclusion criteria based on duration of surgery, single puncture tract, intraoperative bleeding, stone burden, intact pelvicalyceal system and no residual stone at end of procedure. Hb drop, haemorrhage, need for blood transfusion, pyrexia, urine leak, pain score, analgesic requirement and duration of hospital stay were measured. Results: No significant difference in haemorrhage was observed. Urinary leak was only seen in one patient of standard group. Duration of hospital stay and analgesic requirement attained statistical significance in favour of tubeless group compared to standard. Conclusion: Tubeless is effective and safe method for management of renal stones. It reduces postoperative pain and morbidity compared to standard group.

Download Full-text

Comparison of Tubeless Mini Percutaneous Nephrolithotomy with Conventional Technique in a Tertiary Care Center

Journal of Nepalgunj Medical College ◽

10.3126/jngmc.v19i1.40224 ◽

2022 ◽

Vol 19 (1) ◽

pp. 34-36

Author(s):

Dipesh Kumar Gupta ◽

Arun Gnyawali ◽

Deepak Jaiswal

Keyword(s):

Postoperative Pain ◽

Hospital Stay ◽

Percutaneous Nephrolithotomy ◽

Care Center ◽

Tertiary Care ◽

Postoperative Blood Loss ◽

Routine Practice ◽

Standard Group ◽

Nephrostomy Tube ◽

Analgesic Requirement

Introduction: Mini Percutaneous Nephrolithotomy (mPCNL) is a safe and efficient method for management of nephrolithiasis. Post procedure nephrostomy tube drainage is considered as the standard practice. In recent years, tubeless mPCNL with the use of double J (DJ) stent alone has replaced the placement of the nephrostomy tube. Aims: This study intends to evaluate the safety and efficacy of tubeless Mini Percutaneous Nephrolithotomy. Methods: A total of 80 patients with Nephrolithiasis, admitted to Urology Unit of Nepalgunj Medical College, between September 2018 and September 2019 were enrolled in the study and divided into two groups: Tubeless group where tube was omitted and Standard Group where it was placed. The two groups were compared with respect to hemoglobin drop and blood transfusion requirement, hospital stay and analgesic requirement in the post-operative period. Results: Mean age of the patients was 34.30 ± 13.19 years. Mean stone size was 19.03 mm. The mean change in hemoglobin after standard mPCNL was 1.68 gm/dl and that in the tubeless group was 1.11 (p=0.018). The tubeless group had a significantly (p=0.001) shorter hospital stay (3.05 ± 1.23 days) compared to standard group (3.85 ± 0.86). The postoperative pain as assessed by visual analogue scale, was more in the standard group necessitating additional analgesia. It was significantly higher in the standard group at 12, 24, 48 hours, as compared to the tubeless group. Conclusion: Placement of nephrostomy tube can be omitted as a routine practice as Tubeless mini PCNL has an added advantage of significantly reduced postoperative pain, less analgesic requirement, shorter hospital stay, less postoperative blood loss.

Download Full-text

Harmonic scalpel versus titanium clips and l-hook in the ligation of cystic duct and artery and gall bladder dissection in laparoscopic cholecystectomy

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20175075 ◽

2017 ◽

Vol 5 (12) ◽

pp. 5145

Author(s):

Anand Vijayvargiya ◽

S. K. Jain ◽

Varsha Soni

Keyword(s):

Laparoscopic Cholecystectomy ◽

Gall Bladder ◽

Hospital Stay ◽

Cystic Duct ◽

Harmonic Scalpel ◽

P Value ◽

Duration Of Hospital Stay ◽

Significant Difference ◽

Conversion To Open Cholecystectomy ◽

Duration Of Surgery

Background: Laparoscopic cholecystectomy is a gold standard for gall bladder stone surgery. The Aim and objective of study was to compare the total duration of surgery, intraoperative complication like bile leak from cystic duct stump, spillage of bile from gallbladder and post op pain and abdomen distension and jaundice.Methods: Study was carried out in dept. of gen Surgery, Govt medical college Kota in yr. 2015-16 in a total of 50 patients with cholelithiasis with cholecystitis. Patient were equally divided randomly into two groups (a) Harmonic scalpel group and (b) Titanium Clip and L hook group. All patients with medical comorbidities, Concomitant CBD calculi, cirrhosis and portal HT were excluded from study. Intraoperatively adhesions, bile spillage from GB and cystic duct stump noted Postoperatively complain like pain abdomen, Jaundice, and fever were noted. Duration of hospital stay was observed. All results were statistically analyzed using Chi square and ANOVA test.Results: Both groups were comparable on the basis of age and sex distribution, as no statistically difference was noted (P value 0.867 and 0.999 respectively). Intraoperative findings were adhesions 5 in clip group and 7 in harmonic group. Spillage from gall bladder was 2 in Clip group and 3 in harmonic group. Mean duration of surgery was 65.20 min in clip group and 63.68 in harmonic group with no statistically significant difference in both the group (P Value 0.727). Average duration of hospital stay was similar in both the groups with a mean of 2.6 days. Postoperative complication was fever, abdomen pain and distension were 3,1,1 were respectively in the clip group and 3,2,2 respectively in harmonic group with the P value of 0.999 which was statistically insignificant. No CBD injury was noted in any case. Conversion to open cholecystectomy was not done in any case. On 1week and 1 month follow up 2 cases in clip group and 1 in HS group had collection in gall bladder fossa and none at I month.Conclusions: Harmonic scalpel offers an effective, alternative and safe method to cystic duct division and Gallbladder dissection from liver bed.

Download Full-text

Three-port versus four-port laparoscopic cholecystectomy: a comparative study at a tertiary care centre in North India

International Surgery Journal ◽

10.18203/2349-2902.isj20180014 ◽

2018 ◽

Vol 5 (2) ◽

pp. 426

Author(s):

Peeyush Kumar ◽

Anil K. S. Rana

Keyword(s):

Laparoscopic Cholecystectomy ◽

Return To Work ◽

Hospital Stay ◽

Tertiary Care ◽

Gall Stone ◽

North India ◽

Duration Of Hospital Stay ◽

Conversion Rates ◽

Significant Difference ◽

Duration Of Surgery

Background: Improvement of Laparoscopic Cholecystectomy (LC) technique in terms of reduction in size and number of ports is being tried to improve patient satisfaction and outcome. Present study was conducted to evaluate and compare the safety outcome and advantages of three-port and four-port LC. Methods: This prospective study included 90 patients presenting with symptomatic gall stone disease or gall bladder polyp more than 1cm at base. Patients with jaundice and choledocholithiasis were excluded. Patients were divided into two groups: A and B, who underwent three-port and four-port LC respectively. Outcomes of the two groups were assessed and compared in terms of duration of surgery, intra-operative and post-operative variables including rate and nature of complications, conversion rates, post-operative pain, duration of hospital stay, return to work and cosmetic outcome.Results: Statistically significant difference was found between the two groups in terms of Visual Analogue Score for pain at 6 and 24 hours, analgesic requirement, duration of hospital stay and return to work; all being less in the three- port LC group. Cosmetic outcome as perceived by patients was also better in the three-port group. Results of other variables were comparable in the two groups. Conclusions: Three-port procedure is safe and appears to be more cost effective than four-port LC. If LC is performed by an experienced surgeon, it can be started with three ports, if required, a fourth port can be inserted.

Download Full-text

Post-procedural Drainage versus no Drainage in Laparoscopic Cholecystectomy at DHQ Hospital Charsadda, Pakistan

Journal of Islamabad Medical & Dental College ◽

10.35787/jimdc.v10i2.554 ◽

2021 ◽

Vol 10 (2) ◽

pp. 105-109

Author(s):

Muhammad Bilal ◽

Viqar Aslam ◽

Zaheer ud din ◽

Waqas Jan ◽

Inamullaha ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Postoperative Complications ◽

Hospital Stay ◽

Controlled Trial ◽

Statistical Significance ◽

Drainage Tube ◽

Duration Of Hospital Stay ◽

Number Of Patients ◽

Significant Difference ◽

Group A

Background: Laparoscopic cholecystectomy (LC) is the treatment of choice for symptomatic gall stones but controversy regarding the routine use of drainage after elective LC still exists. The objective of this study was to determine the efficacy of post-procedural drainage versus no drainage after simple laparoscopic cholecystectomy. The postoperative complications were also evaluated in both groups after the LC procedure.Material and Methods: This Randomized controlled trial (RCT) was conducted in patients who underwent Laparoscopic cholecystectomy according to a pre-set inclusion criterion. Ninety-three patients were randomly assigned into group A (with drainage tube) and group B (without drainage tube) using sealed opaque envelopes containing computer‐generated random numbers. Primary (like duration of hospital stay, Postoperative pain) and secondary outcomes (like postoperative complications) were noted in both groups. Chi-square, Fischer exact test and Mann witney U test were applied as appropriate and statistical significance was established at P < .05.Results: The number of patients with hospital stay exceeding two days were more in group A (n=23; 51.1%) than B (n=13; 28.8%) (P < .05). Group A presented with more postoperative complications but differences between the two groups were statistically non-significant. Both Groups experienced a high level of pain at six hours of surgery followed by progressive decrease in severity at 24 and 48 hours, respectively (P=.06).Conclusions: Post-procedural drain placement after laparoscopic cholecystectomy has no advantages as there is no significant difference in post-operative complications and duration of hospital stay in drainage versus no drainage groups.

Download Full-text

Is Obesity a Risk Factor for Spinal Surgeries? A Retrospective Study in a Specialized Orthopedic Spine Center

Journal of Research in Orthopedic Science ◽

10.32598/jrosj.8.1.759.1 ◽

2021 ◽

Vol 8 (1) ◽

pp. 37-42

Author(s):

Hasan Ghandhari ◽

◽

Ebrahim Ameri ◽

Mohsen Motalebi ◽

Mohamad-Mahdi Azizi ◽

...

Keyword(s):

Retrospective Study ◽

Postoperative Complications ◽

Blood Loss ◽

Hospital Stay ◽

Length Of Hospital Stay ◽

Obese Group ◽

Obese Patients ◽

Number Of Patients ◽

Significant Difference ◽

Duration Of Surgery

Background: Various studies have shown the effects of morbid obesity on the adverse consequences of various surgeries, especially postoperative infections. However, some studies have shown that the complications of spinal surgery in obese and non-obese patients are not significantly different. Objectives: This study investigated and compared the duration of surgery, length of hospital stay, and complications after common spinal surgeries by orthopedic spine fellowship in obese and non-obese patients in a specialized spine center in Iran. Methods: All patients who underwent decompression with or without lumbar fusion were included in this retrospective study. These patients were classified into two groups: non-obese (BMI <30 kg/m2) and obese (BMI ≥30 kg/m2). The data related to type and levels of surgery, 30-day hospital complications, length of hospital stay, rate of postoperative wound infection, blood loss, and need for transfusion were all extracted and compared between the two groups. Results: A total of 148 patients (74%) were in the non-obese group and 52 patients (26%) in the obese group. The number of patients that need packed cells was significantly higher in the obese group (51.8% vs 32.6%) (P=0.01). Otherwise, there were not a significant difference between type of treatment (fusion or only decompression) (P=0.78), interbody fusion (P=0.26), osteotomy (P=0.56), duration of surgery (P=0.25), length of hospital stay (P=0.72), mean amount of blood loss (P=0.09), and postoperative complications (P=0.68) between the two groups. Conclusion: Our results suggest that duration of surgery, length of hospital stay, and postoperative complications are not associated with the BMI of the patients.

Download Full-text

Comparison of Retrograde Intrarenal Surgery and Micro-Percutaneous Nephrolithotomy for Kidney Stones: A Meta-Analysis

Urologia Internationalis ◽

10.1159/000506716 ◽

2020 ◽

pp. 1-7

Author(s):

Zhenhua Gu ◽

Yucheng Yang ◽

Rui Ding ◽

Meili Wang ◽

Jianming Pu ◽

...

Keyword(s):

Hospital Stay ◽

Percutaneous Nephrolithotomy ◽

Kidney Stones ◽

Operative Time ◽

Meta Analysis ◽

Length Of Hospital Stay ◽

Clinical Results ◽

Retrograde Intrarenal Surgery ◽

Alternative Approach ◽

Significant Difference

Background: Advances in micro-percutaneous nephrolithotomy (PCNL) for kidney stones have made it an alternative approach to the retrograde intrarenal surgery (RIRS) approach. Nevertheless, the superiority of micro-PCNL over RIRS is still under debate. The results are controversial. Objectives: The purpose of this study was to systematically evaluate the clinical results in patients presenting with kidney stones treated with micro-PCNL or RIRS. Methods: A literature search was done for electronic databases to identify researches that compared micro-PCNL and RIRS till December 2019. The clinical outcome included complications, stone-free rates (SFRs), hemoglobin reduction, length of hospital stay, and operative time. Results: Five articles were included in our study. The pooled results revealed no statistical difference in the rate of complications (OR = 0.99, 95% CI = 0.57–1.74, p = 0.99), length of hospital stay (MD = −0.29, 95% CI = −0.82 to 0.24, p = 0.28), and operative time (MD = −6.63, 95% CI = −27.34 to 14.08, p = 0.53) between the 2 groups. However, significant difference was present in hemoglobin reduction (MD = −0.43, 95% CI = −0.55 to 0.30, p < 0.001) and the SFRs (OR = 0.59, 95% CI = 0.36–0.98, p = 0.04) when comparing RIRS with micro-PCNL. Conclusions: Compared with micro-PCNL to treat kidney stones, RIRS is associated with better stone clearance and bearing higher hemoglobin loss. As the advantages of both technologies have been shown in some fields, the continuation of well-designed clinical trials may be necessary.

Download Full-text

Duration of Surgery, Ventilation, and Length of Hospital Stay Do Not Affect Breastfeeding in Newborns After Early Cleft Lip Repair

The Cleft Palate-Craniofacial Journal ◽

10.1177/1055665620949114 ◽

2020 ◽

pp. 105566562094911

Author(s):

Iva Burianova ◽

Milos Cerny ◽

Jiri Borsky ◽

Kristyna Zilinska ◽

Jana Dornakova ◽

...

Keyword(s):

Hospital Stay ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Surgical Repair ◽

Artificial Ventilation ◽

Duration Of Hospital Stay ◽

Duration Of Surgery ◽

Ventilation Support ◽

Cleft Lip Repair ◽

The Impact

Objective: There are minimal data available on nutrition after early repair of cleft lip and the factors influencing initiation of breastfeeding. This study assessed the impact of the length of surgery, length of ventilation support, and duration of hospital stay on breastfeeding rates after early cleft lip surgery. Design: This is a prospective observational cohort study comparing 2 hospitals providing early surgical repair of facial clefts from January 2014 to December 2016. Both hospitals are designated as Baby-Friendly Hospitals. Demographic and anthropometric data from mothers and newborns were recorded. Setting: Tertiary neonatal and pediatric surgery center. Patients: Hospital A: 61 newborns, Hospital B: 157 newborns. Interventions: Early (day 5 to 14) cheiloplasty in newborns with cleft lip or cleft lip and palate. Main Outcome Measures: Influence of duration of hospital stay, length of operation, and artificial ventilation on the rate of breastfeeding. Results: Significantly, more newborns were breastfed following early surgical repair of an isolated cleft lip compared to those with both cleft lip and palate, in both hospitals (hospital A 82% vs 0%, P = .0001, hospital B 66% vs 5%, P = .0001). Duration of hospital stay, length of operation, and duration of artificial ventilation did not significantly affect the rate of breastfeeding. Conclusions: The factors associated with early cleft lip repair (length of operation, length of ventilation support, and duration of hospital stay) do not affect breastfeeding rate.

Download Full-text

A Comparison of Antegrade Percutaneous and Laparoscopic Approaches in the Treatment of Proximal Ureteral Stones

BioMed Research International ◽

10.1155/2014/691946 ◽

2014 ◽

Vol 2014 ◽

pp. 1-5 ◽

Cited By ~ 5

Author(s):

Hikmet Topaloglu ◽

Nihat Karakoyunlu ◽

Sercan Sari ◽

Hakki Ugur Ozok ◽

Levent Sagnak ◽

...

Keyword(s):

Hospital Stay ◽

Operation Time ◽

Ureteral Stones ◽

Surgical Equipment ◽

Duration Of Hospital Stay ◽

Stone Free Rate ◽

Surgical Expertise ◽

Significant Difference ◽

History Of ◽

Retroperitoneal Laparoscopic Ureterolithotomy

Purpose. To compare the effectiveness and safety of retroperitoneal laparoscopic ureterolithotomy (RLU) and percutaneous antegrade ureteroscopy (PAU) in which we use semirigid ureteroscopy in the treatment of proximal ureteral stones.Methods. Fifty-eight patients with large, impacted stones who had a history of failed shock wave lithotripsy (SWL) and, retrograde ureterorenoscopy (URS) were included in the study between April 2007 and April 2014. Thirty-seven PAU and twenty-one RLU procedures were applied. Stone-free rates, operation times, duration of hospital stay, and follow-up duration were analyzed.Results. Overall stone-free rate was 100% for both groups. There was no significant difference between both groups with respect to postoperative duration of hospital stay and urinary leakage of more than 2 days. PAU group had a greater amount of blood loss (mean hemoglobin drops for PAU group and RLU group were 1.6 ± 1.1 g/dL versus 0.5 ± 0.3 g/dL, resp.;P=0.022). RLU group had longer operation time (for PAU group and RLU group 80.1 ± 44.6 min versus 102.1 ± 45.5 min, resp.;P=0.039).Conclusions. Both PAU and RLU appear to be comparable in the treatment of proximal ureteral stones when the history is notable for a failed retrograde approach or SWL. The decision should be based on surgical expertise and availability of surgical equipment.

Download Full-text

Effect of anaesthesia on the perioperative outcomes of pelvi-acetabular fracture surgeries in the apex trauma centre of a developing country–a retrospective analysis

Burns & Trauma ◽

10.1186/s41038-015-0011-y ◽

2015 ◽

Vol 3 ◽

pp. 1-6

Author(s):

Naveen Yadav ◽

Suma Rabab Ahmad ◽

Nisha Saini ◽

Babita Gupta ◽

Chhavi Sawhney ◽

...

Keyword(s):

Postoperative Complications ◽

Blood Loss ◽

Hospital Stay ◽

General Anaesthesia ◽

Acetabular Fracture ◽

Regional Anaesthesia ◽

Trauma Centre ◽

Intraoperative Blood Loss ◽

Duration Of Hospital Stay ◽

Duration Of Surgery

Abstract Background Regional anaesthesia has been proposed to reduce intraoperative blood loss, duration of hospital stay and in-hospital complications with improved postoperative pain control. General anaesthesia is advantageous for prolonged surgeries. We hypothesized that combined regional and general anaesthesia would offer advantages of both in pelvi-acetabular fracture surgeries. Methods We identified 71 patients who underwent open reduction and internal fixation of pelvi-acetabular fractures from May 2012 to 2013 in our trauma centre. We excluded patients with incomplete records (n = 4) and other injuries operated along (n = 8). Hence, 59 patients were divided into three groups: G group (general anaesthesia), R group (regional anaesthesia) and GR group (combined regional and general anaesthesia). Main outcome measurements studied were intraoperative blood loss, duration of hospital stay, duration of surgery and intraoperative and postoperative complications. Results No differences were obtained in between the groups in terms of age, gender, Injury Severity Score, number of comorbidities, or duration from injury to surgery. No significant differences were found between the three groups for intraoperative blood loss, days of hospital stay and duration of surgery. Intraoperative and postoperative complications were also comparable between the groups (p > 0.05). Conclusions There is no specific significant advantage of the technique of anaesthesia on the observed perioperative complications in pelvi-acetabular fracture surgeries.

Download Full-text

Open cystectomy is still alive and well: Outcomes from a single-centre 6-year review

Journal of Clinical Urology ◽

10.1177/2051415818759366 ◽

2018 ◽

Vol 12 (3) ◽

pp. 239-245

Author(s):

Alexios Dosis ◽

Blessing Dhliwayo ◽

Patrick Jones ◽

Iva Kovacevic ◽

Jonathan Yee ◽

...

Keyword(s):

Blood Loss ◽

Hospital Stay ◽

Radical Cystectomy ◽

Length Of Hospital Stay ◽

Categorical Variables ◽

Complication Rates ◽

Intraoperative Blood Loss ◽

Single Centre ◽

Significant Difference ◽

Duration Of Surgery

Objectives: To compare perioperative and oncological outcomes between open and laparoscopic radical cystectomy in a single-centre setting. Materials and methods: This study was a retrospective cohort (level 2b evidence) non-randomised review of 228 radical cystectomies that were performed between January 2010 and February 2016. Primary outcome measures were operative time, complications, blood loss and length of hospital stay. Statistical analysis was performed using the SPSS v21.0. Quantitative values were compared with Student’s t-test; categorical variables with the chi-square test. Statistical significance was considered a result of an alpha value less than 0.05. A Kaplan–Meier survival analysis was also conducted. Results: Intraoperative blood loss was lower in laparoscopic surgery (855±673 vs. 716±570 mL, P=0.15), which had a significant impact on transfusion rates ( P=0.02). Operative times were lower in open surgery (339±52.9 vs. 353.1±67.1 minutes, P=0.10), while hospital stay was lower in the laparoscopic group (14.2±11.2 vs. 16.0±13.6 days, P=0.28). Five-year survival rates were superior for patients who underwent an open procedure but were not statistically significant ( P=0.10). Conclusion: This is, so far, the largest cohort to compare laparoscopic and open radical cystectomy. The laparoscopic approach can reduce the need for transfusion; however, there was no statistically significant difference in complication rates, duration of surgery, length of hospital stay or intraoperative blood loss, survival and margin positivity. Level of evidence: Not applicable for this multicentre audit.

Download Full-text