Preoperative Mechanical Bowel Evacuation Reduces Intraoperative Bleeding and Operation Time in Spinal Surgery

Introduction: Although it is controversial whether appendectomy can be safely delayed, it is often unnecessary to postpone operation as a shorter delay may increase patient comfort, enables quicker recovery, and decreases costs. In this study, we sought to study whether the time of day influences the outcomes among patients operated on for acute appendicitis. Materials and Methods: Consecutive patients undergoing appendectomy at Tampere University Hospital between 1 September 2014 and 30 April 2017 for acute appendicitis were included. Primary outcome measures were postoperative morbidity, mortality, length of hospital stay, and amount of intraoperative bleeding. Appendectomies were divided into daytime and nighttime operations. Results: A total of 1198 patients underwent appendectomy, of which 65% were operated during daytime and 35% during nighttime. Patient and disease-related characteristics were similar in both groups. The overall morbidity and mortality rates were 4.8% and 0.2%, respectively. No time categories were associated with risk of complications or complication severity. Neither was there difference in operation time and clinically significant difference in intraoperative bleeding. Patients undergoing surgery during night hours had a shorter hospital stay. In multivariate analysis, only complicated appendicitis was associated with worse outcomes. Discussion: We have shown that nighttime appendectomy is associated with similar outcomes than daytime appendectomy. Subsequently, appendectomy should be planned for the next available slot, minimizing delay whenever possible.

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Laparoscopic splenectomy and porto-azygos disconnection: clinical research in the treatment of portal hypertension

Open Medicine ◽

10.1515/med-2015-0073 ◽

2015 ◽

Vol 10 (1) ◽

Author(s):

Wang Fengyong ◽

Sun Yuanshui ◽

Wu Yuewu ◽

Zhan Weihua ◽

Shi Jianfeng ◽

...

Keyword(s):

Computed Tomography ◽

Laparoscopic Splenectomy ◽

Operation Time ◽

Spleen Volume ◽

Spiral Computed ◽

Curative Effect ◽

Intraoperative Bleeding ◽

Safety And Efficacy ◽

Open Abdominal Surgery

Abstract To investigate the safety and efficacy of laparoscopic splenectomy and portaazygous devascularization, we studied laparoscopic splenectomy and porto-azygos devascularization patients within the peri-operative period. Clinical data and curative effect are detailed alongside statistical analysis. The laparoscopic splenectomy and porto-azygos devascularization operation time was 2.56 + 0.62 hours. The intraoperative bleeding and anal exhaust time was 149.5 + 32.7ml 3.47 + 1.32 days, and the hospitalization time was 5.05 + 1.22 days. When the spleen volume was greater than or equal to 1.5 liters, the rate of open abdominal surgery increased significantly. After 1, 2, 3, and 4 years of follow-up, cumulative recurrence bleeding rates were 0, 5.20%, 9.98%, and 15.83%, respectively. Laparoscopic splenectomy and pericardial devascularization is safe, effective, and feasible, and it can be confirmed by enhanced spiral computed tomography (CT). Whether spleen volume greater than 1.5L is suited to laparoscopic surgery requires further research.

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Enhanced recovery after surgery in pediatric spine surgery: systematic review

Hirurgiâ pozvonočnika ◽

10.14531/ss2021.4.6-27 ◽

2021 ◽

Vol 18 (4) ◽

pp. 6-27

Author(s):

Aleksandr Petrovich Saifullin ◽

Andrei Evgenievich Bokov ◽

Alexander Yakovlevich Aleynik ◽

Yulia Alexandrovna Israelyan ◽

Sergey Gennadevich Mlyavykh

Keyword(s):

Systematic Review ◽

Children And Adolescents ◽

Spinal Surgery ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Operation Time ◽

Early Mobilization ◽

Cochrane Library ◽

Control Group ◽

Review Of The Literature

Objective. To conduct a systematic review of the literature on the use of enhanced recovery after surgery (ERAS) protocols in spinalsurgery of children and adolescents to determine the existing evidence of the effectiveness of ERAS implementation in clinical practice.Material and Methods. The authors conducted a systematic review of the literature on ERAS in spinal and spinal cord surgery in children and adolescents selected in the databases of medical literature and search resources of PUBMED/MEDLINE, Google Scholar, Cochrane Library and eLibrary according to the PRISMA guidelines and the PICOS inclusion and exclusion criteria.Results. A total of 12 publications containing information on the treatment of 2,145 children, whose average age was 14.0 years (from 7.2 to 16.1), were analyzed. In the reviewed publications, the average number of key elements of the ERAS program was 9 (from 2 to 20), and a total of 23 elements used in spinal surgery in children and adolescents were identified. The most commonly used elements were preoperative education and counseling, prevention of infectious complications and intestinal obstruction, multimodal analgesia, refusal of routine use of drains, nasogastric probes and urinary catheters, standardized anesthesia protocol, early mobilization and enteral loading. The introduction of the ERAS protocol into clinical practice allowed to reduce the complication rate in comparison with the control group by 8.2 %(from 2 to 19 %), the volume of blood loss by 230 ml (from 75 to 427 ml), the operation time by 83 minutes (from 23 to 144 minutes), theduration of hospitalization by 1.5 days (from 0.5 to 3 days) and the total cost of treatment by 2258.5 dollars (from 860 to 5280 dollars).The ERAS program was implemented in pediatric clinics in the USA (75 %), France (8 %) and Canada (17 %).Conclusion. The conducted systematic review of the literature allows us to conclude that the technology of enhanced recovery after surgery is a promising technology that improves surgical outcomes and is applicable in pediatric practice. There is a significant shortage of published studies evaluating the implementation of ERAS in pediatric surgical practice in general, and in spinal surgery in particular, which requires further prospective randomized studies to evaluate ERAS in spinal surgery in children and adolescents.

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PS01.130: VIDEO-ASSISTED THORACOSCOPE 3D AND 2D MODE COMPARATIVE ANALYSIS FOR ESOPHAGEAL CHEST SURGERY

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps01.130 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 86-87

Author(s):

Jie Jiang ◽

Xiuyi Yu ◽

Guojun Geng ◽

Hongming Liu

Keyword(s):

Esophageal Cancer ◽

Postoperative Complications ◽

Lymph Nodes ◽

Chest Tube ◽

Statistical Difference ◽

Statistical Significance ◽

Operation Time ◽

Intraoperative Bleeding ◽

Advantages And Disadvantages ◽

Video Assisted

Abstract Background To study the advantages and disadvantages of 3D and 2D thoracoscope in the thoracic surgery of esophageal carcinoma. Methods Retrospectively analyze esophageal cancer cases between July 2013 and July 2017 of the first affiliated hospital to Xiamen University, depending on the different mode of Video-Assisted Thoracoscopic, which can be divided into 3D-VATS group 353 cases (observation group) and 2D-VATS group 351 cases (control group). Comparing the difference in operation time, intraoperative bleeding, lymph node transmission, volume of the drain by the first 24 hours, total volume of the drain, chest tube time and postoperative complications. Results All the 704 patients with esophageal cancer were performed under the video-assisted thoracoscope. In terms of surgery time, 3D-VATS group (51.4 ± 13.3min) was shorter than 2D-VATS group (65.7 ± 9.1min), with statistical significance (t = -9.751, P = 0.013); on blood loss, 3D-VATS group (34.1 ± 10.5ml) was less than 2D-VATS group (50.2 ± 9.4ml) with statistical significance (t = -9.274, P = 0.009); about lymph nodes transmission, 3D-VATS group (16.8 ± 3.2) was more than 2D-VATS group (13.1 ± 3.7), with statistical significance (t = 5.213, P = 0.007); in volume of the drain by the first 24 hours, 3D-VATS group (171.2.15 ± 20.2ml) was less slightly than 2D-VATS group (180.3 ± 35.2ml), no statistical difference (t = -1.347, P = 0.281); about total volume of the drain, 3D-VATS group (530.2 ± 53.4ml) was less slightly than 2D-VATS group (553.8 ± 57.5ml), no statistical difference (t = -1.911, P = 0.093); on chest tube time, 3D-VATS group (4.2 ± 0.7d) was less slightly than 2D-VATS group (4.9 ± 1.1d), no statistical difference (t = -1.806, P = 0.069); Postoperative complications in two groups including the incidence of arrhythmia, pulmonary infection, anastomotic leakage and recurrent laryngeal nerve injury has no obvious difference (P > 0.05). Conclusion Video-assisted thoracoscopic surgery of esophagectomy under 3D-mode has certain advantages in operation time, intraoperative bleeding and lymph nodes transmission over 2D-mode. While in the item of volume of the drain by 24 hours, total volume of the drain, chest tube time and postoperative complications, they have no obvious difference. Disclosure All authors have declared no conflicts of interest.

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What is the role of incisional vacuum therapy in challenging spinal wounds? A single centre experience

Journal of Wound Care ◽

10.12968/jowc.2021.30.6.476 ◽

2021 ◽

Vol 30 (6) ◽

pp. 476-481

Author(s):

Marwan S Hajjar ◽

Georgio M Atallah ◽

Ahmad Oneissi ◽

Paul Beaineh ◽

Ghassan S Abu-Sittah

Keyword(s):

Spinal Surgery ◽

Wound Care ◽

Data Entry ◽

Length Of Hospital Stay ◽

Operation Time ◽

Wound Dehiscence ◽

Wound Complications ◽

Vacuum Therapy ◽

Medical Chart Review

Objective: A surgical approach to the treatment of spinal defects and disorders has become more common because of the medical and technological advancements achieved in the last decade. This rising trend in spinal surgeries is associated with adverse events, most notably wound complications. From its introduction, negative pressure wound therapy (NPWT) has proved to be essential in the management of complex wounds and in speeding up wound recovery. The aim of this study is to investigate the use of incisional NPWT in patients undergoing spinal surgery and its role in the prevention of wound complications. Method: This study is a retrospective medical chart review conducted on patients who underwent spinal surgery and received incisional vacuum therapy as part of their treatment. The apparatus was applied intraoperatively following the spinal surgery for all patients included in this study. All surgical procedures were conducted between September 2019 and May 2020. Data entry and analysis were performed between September and October 2020. Results: A total of five patients' records were reviewed. In our healthcare centre, three patients developed seroma, one developed haematoma, four required revision surgery and one patient required re-operation. There was no wound dehiscence and none of the wounds became infected. Mean length of hospital stay was 11.2 days (standard deviation (SD): 9.5 days) and mean operation time was 333 minutes (SD: 86.4 minutes). Conclusion: There is a scarcity of data on the role of incisional vacuum therapy in the prevention of wound complications associated with spine surgeries. Our study showed promising results for the use of incisional NPWT in the management of spinal wounds. Further research is required in order to enhance wound care by exploiting this potentially beneficial approach.

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Surgical Results of Laparoscopic Cholecystectomy for Gallbladder Torsion

The American Surgeon ◽

10.1177/000313481908500522 ◽

2019 ◽

Vol 85 (5) ◽

pp. 471-473 ◽

Cited By ~ 1

Author(s):

Sayuri Ezaki ◽

Yoshito Tomimaru ◽

Kozo Noguchi ◽

Shingo Noura ◽

Hiroshi Imamura ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Case Series ◽

Operation Time ◽

Type I ◽

Surgical Results ◽

Intraoperative Bleeding ◽

Conversion To Open Surgery ◽

Gallbladder Torsion ◽

Optimal Approach ◽

Median Operation Time

Gallbladder torsion (GT) causes ischemia of the gallbladder, which potentially leads to a fatal condition. Consequently, GT requires urgent treatment. An urgent laparoscopic cholecystectomy (LC) might be the optimal approach, in view of the anatomical abnormality, “floating gallbladder,” which is associated with GT. However, the feasibility of LC for GT has not been well investigated. Thus, in this study, we investigated the feasibility of LC for GT in a case series. A total of 393 patients underwent urgent LC for acute gallbladder diseases at our institution during the study period. Among these patients, six had GT (1.5%) and were enrolled in this study. We retrospectively analyzed the surgical results of LC. Of the six cases, four (66.7%) were correctly diagnosed with GT preoperatively. There were two cases of Type I and four cases of Type II, based on the Gross classification for GT. The median operation time and intraoperative bleeding volume were 64 minutes and 18 mL, respectively. No cases required conversion to open surgery. All six cases experienced an uneventful postoperative course. The median postoperative hospital stay was six days. The surgical results of LC were favorable for six cases of GT. These results showed that LC was feasible for GT.

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Topical Steroids in Rhinosinusitis and Intraoperative Bleeding: More Harm Than Good?

Ear Nose & Throat Journal ◽

10.1177/0145561319850817 ◽

2019 ◽

Vol 99 (6) ◽

pp. 388-394

Author(s):

Giancarlo Tirelli ◽

Umberto Lucangelo ◽

Giovanni Sartori ◽

Maria Cristina Da Mosto ◽

Paolo Boscolo-Rizzo ◽

...

Keyword(s):

Blood Loss ◽

Operation Time ◽

Treated Group ◽

Sinus Surgery ◽

Control Group ◽

Topical Steroids ◽

Intraoperative Bleeding ◽

Fibrous Stroma ◽

Preoperative Administration ◽

Snot 22

The aim of this study was to assess whether the chronic preoperative administration of intranasal corticosteroids (INCs) in chronic rhinosinusitis with/without nasal polyposis (CRSwNP/CRSsNP, respectively) could significantly influence bleeding during functional endoscopic sinus surgery (FESS). We prospectively enrolled 109 patients (56 CRSwNP and 53 CRSsNP) candidate for FESS who underwent clinical evaluation and anamnestic data collection. They were allocated to 2 groups depending on whether or not they were chronic INC users, as declared at their first medical evaluation: chronic “INC users” represented the treated group, while “INC nonusers” formed the control group. Lund-Mackay and American Society of Anesthesiology (ASA) scores, blood loss expressed both in milliliters and using the Boezaart scale, operation time in minutes, pre- and postoperative 22-item Sino Nasal Outcome Scores (SNOT-22) were collected. Each sample underwent histopathological evaluation. The results showed that anamnestic information, Lund-Mackay, and SNOT-22 scores were similar between the 2 groups ( P > .05). The average blood loss expressed in milliliters and operative time were slightly, but not significantly, higher in the INC user group, while the Boezaart scores proved significantly higher in the INC users ( P = .038). No differences emerged between CRSwNP and CRSsNP within each group in terms of bleeding. The pathologist described common features in the majority (78%) of INC group samples: ectatic venules embedded in a fibrous stroma and hypertrophy of the arterial muscular layer. In our experience, despite the presence of NP, chronic preoperative administration of INCs was associated with increased intraoperative bleeding according the Boezaart scale although objective recordings of blood loss were not statistically different between the INC users and nonusers.

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Application value of minimally invasive percutaneous dilational tracheostomy for ICU critical patients

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.36.2.594 ◽

2019 ◽

Vol 36 (2) ◽

Author(s):

Hongmei Gan ◽

Aihong Dong ◽

Haiyan Xu

Keyword(s):

Heart Rate ◽

Minimally Invasive ◽

Operation Time ◽

Healing Time ◽

Control Group ◽

Observation Group ◽

Percutaneous Dilational Tracheostomy ◽

Intraoperative Bleeding ◽

Incision Length ◽

Critical Patients

Objective: To find out the application value of minimally invasive percutaneous dilational tracheostomy in critically ill patients in intensive care unit (ICU). Methods: One hundred and forty critically ill patients who underwent tracheostomy in ICU of our hospital were included in the study from August 2016 to December 2017. They were divided into an observation group and a control group by random number table method, 70 in each group. The control group received conventional tracheotomy, while the observation group received percutaneous dilational tracheostomy. The operation time, incision length, amount of intraoperative bleeding and healing time of incision were compared between the two groups, and the changes of vital signs and complications after operation were recorded. The family members of the patients signed the informed consent. Results: The operation time, healing time and incision length of the observation group were (9.92±4.13) min, (1.31±0.21) cm and (6.91±0.72) respectively, shorter than (24.09±6.82) min, (3.40±0.65) cm and (67.48±0.61) d in the control group, and the differences were statistically significant (P<0.05). The amount of intraoperative bleeding of the observation group was (7.81±1.83) mL, less than (16.34±2.83) mL in the control group; the difference was statistically significant (P<0.05). The heart rate and oxygen saturation of the observation group before and during the operation were not significantly different (P>0.05). The heart rate of the control group during the operation was significantly higher than that before the operation (P<0.05); the oxygen saturation of the control group before and during the operation had no significant difference (P>0.05). The incidence of complications in the observation group was 24.3%, which was significantly lower than that in the control group (55.7%, X2=8.279, P=0.014). Conclusion: Minimally invasive percutaneous dilational tracheostomy has advantages of small trauma, less infection and beautiful incision, and it will not increase postoperative complications. It is of great value in the treatment of ICU critical patients. doi: https://doi.org/10.12669/pjms.36.2.594 How to cite this:Gan H, Dong A, Xu H. Application value of minimally invasive percutaneous dilational tracheostomy for ICU critical patients. Pak J Med Sci. 2020;36(2):---------. doi: https://doi.org/10.12669/pjms.36.2.594 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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