Effect of body mass index on operative time, hospital stay, stone clearance, postoperative complications, and postoperative analgesic requirement in patients undergoing percutaneous nephrolithotomy

Introduction The use of polymeric clips in securing the appendiceal stump has been increasingly reported as a viable alternative to current methods in emergency laparoscopic appendicectomy. We evaluated the operative outcomes following the use of polymeric clips versus endoscopic ligatures. The primary endpoint was operative time, with secondary outcomes including complications, inpatient stay, and cost analysis. Materials and methods Operative records were retrospectively analysed to identify patients undergoing laparoscopic appendicectomy between January 2014 and June 2015. Data collected included age, gender, body mass index, duration of surgery, length of hospital stay, antibiotic use, preoperative haematological and biochemical parameters, 30-day readmission rate and complications. Results A total of 125 patients were included within the study, with 78 within the endoloop group and 47 in the polymeric clip group. There were no differences in age, gender, body mass index, hospital stay, antibiotic use, 30-day readmission rates or postoperative complications. Operative time was significantly reduced in the polymeric clip group (59 vs. 68 minutes, P = 0.00751). The use of polymeric clips cost £21 compared with £49 for endoloops per operation, which rose to £70 if both clips and endoloops were used during the procedure. Discussion Polymeric clips are a safe, viable and economical method for securing the appendiceal stump during laparoscopic appendicectomy. The clinical significance of nine minutes of reduced operating time in the polymeric clip cohort warrants further study with an adequately powered randomised controlled trial.

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Tract Size in Percutaneous Nephrolithotomy (PCNL) : Does It Really Matter?

Chattagram Maa-O-Shishu Hospital Medical College Journal ◽

10.3329/cmoshmcj.v18i2.47767 ◽

2020 ◽

Vol 18 (2) ◽

pp. 18-22

Author(s):

Mofizur Rahman ◽

Mohammed Monowar Ul Hoque ◽

Kazi Md Monwarul Karim ◽

AKM Akramul Bari ◽

Tanvir Rahman ◽

...

Keyword(s):

Blood Transfusion ◽

Hospital Stay ◽

Percutaneous Nephrolithotomy ◽

Statistical Difference ◽

Pain Perception ◽

Operative Time ◽

Previous History ◽

Postoperative Fever ◽

Stone Clearance ◽

Significant Difference

Background : Percutaneous Nephrolithotomy (PCNL) is the treatment of choice in removal of renal and proximal ureteral calculi. The primary goal of PCNL is to achieve stone free status while minimizing morbidity and complications. In recent years, the instruments used have been miniaturized in an effort to decrease morbidity associated with standard PCNL as well as increase the efficacy of stone removal. The aim of this study is to compare the safety and efficacy of PCNL using different tract size. Materials and methods: This hospital based prospective interventional study was conducted on patients with 1 to 4 cm renal stones who underwent PCNL either by Minior Standard PCNL technique in Chattogram Medical College Hospital and different private hospitals in Chittagong from July 2016 to June 2018. Patients aged above 12 years of age, irrespective of gender with normal renal function were evaluated to compare stone clearance, total operative time, need for blood transfusion, postoperative pain and other complications. Those who had previous history of open renal surgery, active urinary tract infection, renal malformation, uncorrected coagulopathy and morbid obesity were excluded. Results: A total of 64 patients were enrolled consecutively for PCNL who were divided equally into two groups randomly for minimally invasive PCNL (Mini- PCNL) and Standard PCNL. The average stone size in mini-PCNL group was 2.64 ± 0.94 cm and 2.776 ± 0.97 cm in standard-PCNL group. Mean tract size was 18.44 ± 1.32 F (16-20) and 26.7 ± 5 F (24-30) respectively. In mini-PCNL operative time was significantly longer than that of standard PCNL with 110.31 ± 21.77 vs 95.94 ± 19.82 min respectively. Conversely, there was an advantage of mini-PCNL over the standard one in terms of a significantly reduced hemoglobin drop (0.5 ± 0.25 vs. 0.8 ± 0.34) gram and hospital stay (2.13 ± 0.79 vs.3.38 ± 1.13 days) respectively though there was no statistical difference in terms of stone clearance rates between two groups (86.7% vs. 93.33%). There was no statistical difference in terms of Visual Analogue Scale (VAS) score (5.44 ± 1.5 vs.6.19 ± 1.65) for pain perception. The complication rate of mini-PCNL had no significant difference with that of standard PCNL (10% vs 13.6%). No statistical difference was recorded in terms of postoperative fever (³38oC) between two groups (2 in each group, 6.67%, p=1). Blood transfusion requirement was much less in mini PCNL group (10% vs. 33.33%). Conclusion: In addition to minimal bleeding and excellent stone clearance, mini- PCNL has several features for which it should be considered as an alternative or adjunct to standard PCNL, URS and ESWL. These include safe supra-costal puncture, excellent access to nearly all calyces and upper ureter, less hospital stay and suitable for large stones also. Future studies should continue to refine methods to assess complexity and safety and to determine consensus on the use of mini- PCNL. Chatt Maa Shi Hosp Med Coll J; Vol.18 (2); July 2019; Page 18-22

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Trunk fat volume can be a predictor of postoperative complications after gastrectomy: a retrospective cohort study

BMC Surgery ◽

10.1186/s12893-021-01221-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Shinichiro Shiomi ◽

Tetsuro Toriumi ◽

Koichi Yagi ◽

Raito Asaoka ◽

Yasuhiro Okumura ◽

...

Keyword(s):

Body Mass Index ◽

Postoperative Complications ◽

Lymph Nodes ◽

Body Mass ◽

Visceral Fat ◽

Operative Time ◽

Proximal Gastrectomy ◽

Postoperative Outcomes ◽

Visceral Fat Area ◽

Fat Volume

Abstract Background Obesity can affect postoperative outcomes of gastrectomy. Visceral fat area is superior to body mass index in predicting postoperative complications. However, visceral fat area measurement is time-consuming and is not optimum for clinical use. Meanwhile, trunk fat volume (TFV) can be easily measured via bioelectrical impedance analysis. Hence, the current study aimed to determine the ability of TFV to predict the occurrence of complications after gastrectomy. Methods We retrospectively reviewed patients who underwent curative gastrectomy for gastric cancer between November 2016 and November 2019. The trunk fat volume-to-the ideal amount (%TFV) ratio was obtained using InBody 770 before surgery. The patients were classified into the obese and nonobese groups according to %TFV (TFV-H group, ≥ 150%; TFV-L group, < 150%) and body mass index (BMI-H group, ≥ 25 kg/m2; BMI-L group, < 25 kg/m2). We compared the short-term postoperative outcomes (e.g., operative time, blood loss volume, number of resected lymph nodes, and duration of hospital stay) between the obese and nonobese patients. Risk factors for complications were assessed using logistic regression analysis. Results In total, 232 patients were included in this study. The TFV-H and BMI-H groups had a significantly longer operative time than the TFV-L (p = 0.022) and BMI-L groups (p = 0.006). Moreover, the TFV-H group had a significantly higher complication rate (p = 0.004) and a lower number of resected lymph nodes (p < 0.001) than the TFV-L group. In the univariate analysis, %TFV ≥ 150, total or proximal gastrectomy, and open gastrectomy were found to be potentially associated with higher complication rates (p < 0.1 for all). Moreover, the multivariate analysis revealed that %TFV ≥ 150 (OR: 2.73; 95% CI: 1.37–5.46; p = 0.005) and total or proximal gastrectomy (OR: 3.57; 95% CI: 1.79–7.12; p < 0.001) were independently correlated with postoperative morbidity. Conclusions %TFV independently affected postoperative complications. Hence, it may be a useful parameter for the evaluation of obesity and a predictor of complications after gastrectomy.

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Does body mass index impact the efficacy and complication rate of mini-percutaneous nephrolithotomy?

Journal of Clinical Urology ◽

10.1177/2051415820936887 ◽

2020 ◽

pp. 205141582093688

Author(s):

Hannah Burns ◽

Nafees Ahmad ◽

Jane Hendry ◽

Sarath Nalagatla

Keyword(s):

Body Mass Index ◽

Length Of Stay ◽

Body Mass ◽

Percutaneous Nephrolithotomy ◽

Complication Rate ◽

Clearance Rate ◽

Obese Patients ◽

Clearance Rates ◽

Stone Clearance ◽

Severely Obese

Aim: This was a retrospective cohort study exploring the efficacy of mini-percutaneous nephrolithotomy in obese patients and whether stone clearance, complication rate and length of stay is impacted by an increasing body mass index. Method: Data was collected retrospectively for all mini-percutaneous nephrolithotomies performed at a single centre over a 21-month period commencing March 2017. The primary outcomes included length of stay, stone clearance rates and complications. Results: Fifty-eight percutaneous nephrolithotomies were undertaken during the study period and of these cases 81% of patients had a body mass index of 25 or greater. The stone clearance rate was 83%. However, severely obese patients were noted to have a lower stone clearance rate. No complications occurred in the normal body mass index cohort. However, there was no difference in the complication rate for the remaining groups. Post-operative stay was approximately 3 days. Conclusion: This study demonstrates that supine mini-percutaneous nephrolithotomies are a safe option in obese patients with no increased risk of serious complication. Whilst stone clearance rates were lower in the severely obese category, clearance was complete in the majority of cases. Level of evidence: 3

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Outcome of mini percutaneous nephrolithotomy ‘miniPCNL’ in children

Journal of Patan Academy of Health Sciences ◽

10.3126/jpahs.v5i2.23983 ◽

2018 ◽

Vol 5 (2) ◽

pp. 12-17

Author(s):

Samir Shrestha ◽

Pukar Maskey ◽

Jay N Shah

Keyword(s):

Hospital Stay ◽

Percutaneous Nephrolithotomy ◽

Operative Time ◽

Pediatric Population ◽

Renal Stones ◽

Safe Procedure ◽

Gross Hematuria ◽

Residual Stone ◽

Stone Clearance ◽

Conversion To Open Surgery

Introductions: Renal stone disease is one of the common urological disorders with prevalence approximately 2-3% in the general population and the incidence in children is increasing at a rate of 4% per year. Miniaturization of endoscopic instruments, minimally invasive endoscopic procedures of mini percutaneous nephrolithotomy (miniPCNL) in children is increasingly used. This study was conducted to assess the outcome of miniPCNL in pediatric population. Methods: This retrospective study analyzed the outcome of miniPCNL in children below 18 years of age from August 2015 to July 2018 at Patan Hospital, Nepal. Ethical approval was obtained. Outcome was assessed descriptively on stone localization, puncture success, stone clearance, bleeding requiring transfusion, gross hematuria, urosepsis, operative time, hospital stay, mortality and need of second procedures. Results: A total of 26 patients underwent miniPCNL, mean age 10.8±5.45 years (1-18 years), mean operative time was 122±26.03 minutes and mean hospital stay was 3.2±1.12 days. Postoperative transfusion was required in 1 (2.6%), gross hematuria occurred in 1 (2.6%), no urosepsis, no conversion to open surgery. Complete stone clearance was achieved in 22 (84.61%) patients. Mortality was nil. Second procedure was required in 4 (15.38%) to achieve residual stone clearance. Conclusions: Our study shows miniPCNL is an effective and safe procedure with minimal morbidity for the treatment of pediatric renal stones.

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Comparison of retrograde intrarenal surgery and mini-percutaneous nephrolithotomy for lower calyx renal stones

Asian Journal of Medical Sciences ◽

10.3126/ajms.v12i10.37949 ◽

2021 ◽

Vol 12 (10) ◽

pp. 111-116

Author(s):

Ershad Hussain Galeti ◽

Saqib Shahab ◽

Mriganka Deuri Bharali ◽

Rajaboina Yakaiah

Keyword(s):

Hospital Stay ◽

Pain Score ◽

Percutaneous Nephrolithotomy ◽

Visual Analog Score ◽

Clearance Rates ◽

Retrograde Intrarenal Surgery ◽

Analgesic Requirement ◽

Stone Clearance ◽

Operative Duration ◽

Hemoglobin Drop

Background: Due to the anatomic characteristics of the lower calyx, lower polar stones are difficult to be removed through the ureter, retrograde intrarenal surgery (RIRS) can be used to deal with lower polar stones, while mini-percutaneous nephrolithotomy(mini-PCNL) is mainly used to deal RIRS failed to eliminate the stone. Aims and Objectives: Prospective comparison of mini-PCNL and retrograde intrarenal surgery outcomes in lower calyx managementwith respect to surgery duration, pain score (visual analog score), analgesic requirement, hemoglobin drop, and hospital stay. Materials and Methods: This is a prospective study in 50 patients (25 cases of RIRS and 25 cases of MINIPERC) over 2 years who came to the urology departme with lower calyx stone of size up to 20mm. The selection of the management methods was primarily based on the patient’s preferences. Preoperatively, all patients underwent routine workup and CT KUB plain. The primary and secondary objective was stone clearance rates, retreatment rate, complications, surgical duration, pain score (visual analog score [VAS]), analgesic requirement, hemoglobin drop, and hospital stay. Results: Miniperc and RIRS had stone clearance rates of 100% and 96%, respectively. In the RIRS group, one patient required retreatment for 1month. Hospital stay, intraoperative and post-operative complications were non-significant between both groups. Operative duration (P=0.003) was lower in the Miniperc group. Hemoglobin drop (P<0.0013), patient pain, and visual analog scale score at 6, 24, and 48 h, as well as an analgesic requirement (P<0.020), were all lower in the RIRS group. Conclusion: The stone clearance rates in both modalities are high, and complications are low. RIRS requires a longer operative duration, and it is associated with favorable pain scores and a lower hemoglobin drop.

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Impact of body mass index on hospital mortality and postoperative complications in a recent cohort of patients undergoing cardiac surgery

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0030-1269143 ◽

2011 ◽

Vol 59 (S 01) ◽

Author(s):

PB Rahmanian ◽

A Kröner ◽

G Langebartels ◽

T Wahlers

Keyword(s):

Body Mass Index ◽

Cardiac Surgery ◽

Postoperative Complications ◽

Hospital Mortality ◽

Body Mass ◽

Recent Cohort

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Laparoscopic surgery for endometrial cancer: increasing body mass index does not impact postoperative complications

Journal of Gynecologic Oncology ◽

10.3802/jgo.2011.22.3.168 ◽

2011 ◽

Vol 22 (3) ◽

pp. 168 ◽

Cited By ~ 9

Author(s):

C. William Helm ◽

Cibi Arumugam ◽

Mary E. Gordinier ◽

Daniel S. Metzinger ◽

Jianmin Pan ◽

...

Keyword(s):

Body Mass Index ◽

Endometrial Cancer ◽

Laparoscopic Surgery ◽

Postoperative Complications ◽

Body Mass

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Surgical Loupe at 4.0× Magnification in Pancreaticoduodenectomy—Does It Affect the Surgical Outcomes? A Propensity Score–Matched Study

Surgical Innovation ◽

10.1177/1553350618812322 ◽

2018 ◽

Vol 26 (2) ◽

pp. 201-208

Author(s):

Mohamed El Shobary ◽

Ayman El Nakeeb ◽

Ahmad Sultan ◽

Mahmoud Abd El Wahab Ali ◽

Mohamed El Dosoky ◽

...

Keyword(s):

Postoperative Complications ◽

Propensity Score ◽

Hospital Stay ◽

Pancreatic Fistula ◽

Surgical Outcomes ◽

Operative Time ◽

Postoperative Pancreatic Fistula ◽

Tube Removal ◽

Matched Study ◽

The Impact

Background. There is paucity of data about the impact of using magnification on rate of pancreatic leak after pancreaticoduodenectomy (PD). The aim of this study was to show the impact of using magnifying surgical loupes 4.0× EF (electro-focus) on technical performance and surgical outcomes of PD. Patients and Method. This is a propensity score–matched study. Thirty patients underwent PD using surgical loupes at 4.0× magnification (Group A), and 60 patients underwent PD using the conventional method (Group B). The primary outcome was postoperative pancreatic fistula. Secondary outcomes included operative time, intraoperative blood loss, postoperative complications, mortality, and hospital stay. Results. The total operative time was significantly longer in the loupe group ( P = .0001). The operative time for pancreatic reconstruction was significantly longer in the loupe group ( P = .0001). There were no significant differences between both groups regarding hospital stay, time to oral intake, total amount of drainage, and time of nasogastric tube removal. Univariate and multivariate analyses demonstrated 3 independent factors of development of postoperative pancreatic fistula: pancreatic duct <3 mm, body mass index >25, and soft pancreas. Conclusion. Surgical loupes 4.0× added no advantage in surgical outcomes of PD with regard to improvement of postoperative complications rate or mortality rate.

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