Long-term surgical outcomes after repair of multiple ventricular septal defects in pediatrics

Background Surgical closure of multiple ventricular septal defects (VSDs) is challenging and associated with a high complication rate. Several factors may affect the outcomes after surgical repair of multiple VSDs. We aimed to report the outcomes after surgical repair of multiple VSDs before and after 1 year and identify the factors affecting the outcomes. We have studied forty-eight patients between 2016 and 2017 who had surgical repair of multiple VSDs. We grouped them according to the age at the time of repair. Study outcomes were hospital complications, prolonged hospital stay, and reoperation. Results There were 18 females (60%) in group 1 and 13 (72.22%) in group 2 (P = 0.39). There were no differences in the operative outcomes between the groups. Prolonged postoperative stay was associated with group 1 (OR 0.23 (0.055–0.96); P = 0.04) and lower body weight (OR 0.76 (0.59–0.97); P = 0.03). Hospital mortality occurred in 2 patients (6.67%) in group 1 and 1 patient (5.56%) in group 2 (P > 0.99). Five patients had reoperations: two for residual VSDs, two for subaortic membrane resection, and one for epicardial pacemaker implantation. All reoperations occurred in group 1 (log-rank P = 0.08). Two patients had transcatheter closure of the residual muscular VSDs; both were in group 2. Conclusions Surgical repair of multiple VSDs was associated with good hospital outcomes. The outcomes were comparable in patients younger or older than 1 year of age. Young age at repair could lead to prolonged postoperative stay and a higher reoperation rate.

EP.TH.462Elective colorectal procedures: postoperative stay & outcomes

Aim This was a re-audit of (ACPGBI) Association of Coloproctology of Great Britain and Ireland guidelines for the management of colorectal cancers 3 rd Edition 2007. “Surgeons should expect to achieve an overall anastomotic leak rate below 8% for anterior resections and below 4% for other types of resection. Surgeons should expect to achieve operative mortality of less than 7% for elective colorectal cancer surgery.” To ensure that our Anastomotic Leak rates & Mortality rates are below the recommended standards. Method All elective colorectal surgeries from 01/01/2011 to 31/06/2012 from a busy colorectal the firm were included in study. A thorough analysis & review of Discharge Summaries was done including type & number of elective colorectal surgeries, anastomotic Leak rate, 30 day mortality and readmission rate, average(Mean & median) postoperative stay and common postoperative complications were identified. The reasons for delayed discharge identified. Results The anastomotic leak rate was 3.0% (2/65). Thirty-day mortality was 1.53%(1/65). The mean postoperative stay was 9.1days (Median 7 days). Twenty postoperative complications were identified: 6 patients had ileus; 6 patients had minor wound infection; 2 patients had an anastomotic leak; 2 patients had stoma related complications; 2 post-op collections; 1 C-Diff infection & 1 Hospital-acquired Pneumonia. The common reasons for delayed discharges were Social reasons, ileus, reoperations, inability to cope with a stoma and Hospital-Acquired Pneumonia. Conclusions Our anastomotic leak rates (3.0%) & 30-day mortality (1.53%) are well below recommended standards by ACPGBI. Our median postoperative stay was below to National average (7days Vs 8days colonic cancer &10days rectal cancer).

Laparoscopic colorectal cancer surgery - a prospective study of short-term outcomes of consecutive cases over 3 years

This study was carried out with the objectives to study the feasibility of laparoscopic colorectal cancer resection, to observe short term outcome such as recovery parameters, oncologic safety, morbidity and mortality, and to analyze the experience of laparoscopic colorectal surgery in a teaching hospital. Between January 2007 and July 2009, all consecutive adult cases admitted to our department for colorectal cancer were assessed for eligibility. The ethical committee approved the protocol at the Sterling Hospital. Out of 31 patients,17 were males and 14 females. The mean age was 59 years. The most common clinical presentation was weight loss and altered bowel habits. Rectum (51.61%) was the most commonly involved organ followed by cecum (22.58%). - median time to liquid diet was two days (range 1-22), and a solid diet was three days (range 3-30). The median time to first flatus was two days (range 1-5), and the first stool was five days (range 3-7). The postoperative stay was eight days (range 6-30) median time to mobilization was 2.5 days. The postoperative stay is cumulative and includes patients who underwent reoperation for the anastomotic leak. The median operating time was 240 mins (range 116 – 520). The median length of incision was 6 cm (range 4 – 10 cm). The median blood loss was 170 ml. Blood loss was higher in patients with hemorrhage and tumor adhesions, and both of them were converted to open. These patients incidentally had a more extended hospital stay. The laparoscopic technique for colorectal cancer is feasible and safe. Laparoscopic colorectal surgery (LCS) is associated with short term benefits like the earlier return of gastrointestinal function and shorter length of hospital stay. From the oncologic point of view, tumor resections are adequate, taking into context numbers of lymph nodes retrieved and resectional margins in context to oncologic safety. The decreased postoperative wound infections and early recovery facilitate appropriate adjuvant therapy. Advanced laparoscopic surgery requires a team approach with proper case selection. Transvaginal delivery of specimens can give scar-less surgery and the option for assisted natural orifice surgery.

Umbilical two-port laparoscopic percutaneous extraperitoneal closure for patent processus vaginalis in boys: incision-hiding and solo-like surgery

Background Transumbilical two-port laparoscopic percutaneous extraperitoneal closure for the treatment of processus vaginalis patency in boys has been practising recent years. The applicable instruments and skills are still evolving. In this study, we used a self-made needle assisted by a disposable dissecting forceps to practise this minimal invasive method for patent processus vaginalis in boys. Its safety and effectiveness were studied. The methods for depth and orientation perceptions were analyzed. Methods From January 2020 to November 2020, boys characteristic of symtomatic patency of processus vaginalis were performed open surgery consecutively. From December 2020, the authors begun to propose transumbilical two-port laparoscopic percutaneous extraperitoneal closure for this kind of boy patients. The open group included fifteen boys and the laparoscopic group included ten ones. The data of the patients age, constituent ratios of unilateral and bilateral patency, operating time, postoperative stay in hospital, follow-up time, conversion, postoperative complications were assessed. Throughout the laparoscopic process, the parallel and synchronous movements of lens pole and dissecting forceps were maintained. Vas deferens protrude was imagined as one of the point to form the triangular manipulation plane. Results There were no statistically significant difference between the laparoscopic group and the open group for the following items: age, operating time, the constituent ratios of unilateral or bilateral patency of processus vaginalis (P > 0.05). Postoperative stay in hospital and follow-up time of the laparoscopic group was significantly shorter than that of the open group (P = 0.0000). No laparoscopic case was converted to open surgery. After 10 cases of laparoscopic practice, orientation perception was established. There were no postoperative complications for all the patients. Conclusion Our preliminary experience suggested that umbilical two-port laparoscopic percutaneous extraperitoneal closure is safe and convenient for patent processus vaginalis treatment in boys. It has the advantage of incision-hiding and can be manipulated like a solo-like surgery.

Comparison of three different modalities for the treatment of bladder calculi by size

Purpose: Treatment recommendations for kidney or ureteral stones are based on stone size; however, this is uncertain for bladder stones. This study aims to determine the best approach to bladder stones based on their size. Materials and methods: We retrospectively analyzed 401 patients with bladder stones. Patients were divided into three different groups according to stone size (11–20 mm, 21–30 mm, 31–40 mm as groups 1, 2, and 3 respectively). Patients had transurethral cystolithotripsy (TUCL), percutaneous cystolithotripsy (PCCL), and open cystolithotomy (OCL) performed. Results: Stone fragments were removed completely in all patients. When catheter time, postoperative stay, and hematocrit decrease values were compared, the results were significantly higher for OCL in all three groups ( p: 0.001). When the relationship between stone sizes and operation time is evaluated, TUCL had shorter operation times (34.1 ± 10.6 min) in group 1. However, TUCL had longer operation times in group 2 and group 3 compared to OCL and PCCL. Conclusion: TUCL may be preferable due to better postoperative outcomes and shorter operative time for ⩽2 cm stones. As the stone size increases, PCCL is more favorable in terms of operation time.

368 Perioperative Outcomes in Open versus Laparoscopic Surgery in Elderly Patients Undergoing Right Hemicolectomy

Introduction With the global aging population, elderly patients are increasingly undergoing colorectal surgery. This study aims to evaluate postoperative outcomes in open (OS) and laparoscopic surgery (LS) for right hemicolectomy in elderly patients. Method We retrospectively reviewed patients aged 70 and above undergoing right hemicolectomy for malignancies at our institution. Additionally, Embase and Medline databases were reviewed, and comparative meta-analysis was conducted. Results 84 patients were included in our cohort (OS = 34; LS = 50). No significant difference in anastomotic leak (AL) (OS = 4; LS = 2; p = 0.176), surgical site infection (SSI) (OS = 4; LS = 2; p = 0.216), and ileus (OS = 10; LS = 16; p = 0.801) was observed. LS was associated with decreased postoperative stay (p = 0.001). Additionally, LS had faster return of bowel function (ROBF) (p = 0.068) and resumption of diet (p = 0.147), albeit without significance. Overall survival (p = 0.062), and disease-free survival (p = 0.067) did not significantly differ between LS and OS. Pooled analysis of 463 patients yielded no significant difference in AL (OR:1.15; 95%CI: 0.17-8.01; p = 0.89), SSI (OR:0.88; 95%CI: 0.44-1.76; p = 0.71), and ileus (OR:1.42; 95%CI: 0.69 – 2.92; p = 0.35). Postoperative stay (WMD:1.90 days; 95%CI: -1.81–5.61 days; p = 0.31), and ROBF (WMD:14.49 hours; 95%CI: -4.07–33.05 hours; p = 0.13) were shortened in LS, although without significance. Conclusions LS is associated with improved functional outcomes without an increased risk of postoperative morbidity or mortality.

736 Optimal Time for Cholecystectomy After ERCP

Introduction Recent research on the management of cholecystolithiasis with co-existing choledocholithiasis suggests performing cholecystectomy within 24 hours after ERCP has favourable outcomes. However, this target can be difficult to achieve in the NHS due to limited resources. Method This retrospective study includes 444 patients who underwent successful ERCP before cholecystectomy. We examined the impact of the duration of ERCP to cholecystectomy and post ERCP complications on operative difficulty and patient outcomes. We also report on gallstone related readmissions and rate of retained stones. Results The median duration from ERCP to cholecystectomy was 75 days, with a 14% readmission rate between their first successful ERCP and cholecystectomy. Our analysis showed a statistically significant negative correlation between ERCP-to-cholecystectomy duration and postoperative stay. Readmissions increased with time, but this did not reach statistical significance. The occurrence of post ERCP complications significantly increased postoperative stay and the open conversion rate. Conclusions In contrast to recent research, our analysis suggests that early cholecystectomy post ERCP is not associated with better outcome. However, the impact of gallstone related readmissions needs further analysis. Post ERCP complication could serve as a predictor for operative difficulty and longer postoperative stay. It should be considered when planning the cholecystectomy.

Safe and effective protocol for discharge 3 days after cardiac surgery

The Enhanced Recovery After Surgery (ERAS) protocol affected traditional cardiac surgery processes and COVID-19 is expected to accelerate its scalability. The aim of this study was to assess the impact of an ERAS-based protocol on the length of hospital stay after cardiac surgery. From January 2019 to June 2020, 664 patients underwent consecutive cardiac surgery at a Latin American center. Here, 46 patients were prepared for a rapid recovery through a multidisciplinary institutional protocol based on the ERAS concept, the “TotalCor protocol”. After the propensity score matching, 46 patients from the entire population were adjusted for 12 variables. Patients operated on the TotalCor protocol had reduced intensive care unit time (P < 0.025), postoperative stay (P ≤ 0.001) and length of hospital stay (P ≤ 0.001). In addition, there were no significant differences in the occurrence of complications and death between the two groups. Of the 10-central metrics of TotalCor protocol, 6 had > 70% adherences. In conclusion, the TotalCor protocol was safe and effective for a 3-day discharge after cardiac surgery. Postoperative atrial fibrillation and renal failure were predictors of postoperative stay > 5 days.

Low Transverse versus Midline Abdominal Skin Incisions for in utero Spina Bifida Repair

<b><i>Objective:</i></b> The 2 types of maternal skin incisions for in utero spina bifida repair are low transverse (LT) incision perceived to be cosmetic benefit and midline longitudinal (ML) incision, typically associated with a reduction in surgical time and lower blood loss. Our objective was to compare short- and long-term outcomes associated with these 2 types of skin incisions following in utero spina bifida repair. <b><i>Methods:</i></b> Prospective observational cohort of 72 patients undergoing fetal spina bifida repair at a single institution between September 2011 and August 2018. The decision for the type of incision was at the discretion of the surgeons. The primary outcome was total operative time. Secondary outcomes included an analog scale of wound pain score on postoperative day 3, duration of postoperative stay, and postoperative wound complications within the first 4 weeks. The Patient Scar Assessment Questionnaire, a validated questionnaire, was obtained for all patients (≥6 months from delivery) using 4 categories (appearance, consciousness, satisfaction with appearance and with symptoms), with higher scores reflecting a poorer perception of the scar. <b><i>Results:</i></b> There were 43 women (59.7%) in the LT group and 29 (40.3%) in the ML group. In all patients, the same incision was used during cesarean delivery. The total operative time was higher in the LT group by 33 min (<i>p</i> &#x3c; 0.001), primarily due to abdominal wall incision time (open and closure). No significant differences were found between the groups in pain score, length of postoperative stay, or the rate of wound complications. Fifty-three patients (73.6%) responded to the questionnaire, 36/43 from the LT group and 17/29 from the ML group. There was no difference in the scores of appearance, consciousness, and satisfaction with appearance and symptoms between the groups. <b><i>Conclusion:</i></b> ML incisions shorten operative times without altering long-term incision-related satisfaction when compared to LT incisions.

Moving from an era of open Appendectomy to an era of Laparoscopic Appendectomy: A Nationwide Cohort Study of Adult Patients Undergoing Surgery for Appendicitis

Background and Aims: During the last decades, laparoscopic surgery has been introduced as an alternative to open surgery. We aimed to examine to what extent laparoscopic surgery has replaced open surgery for appendicitis in an entire nation during the last two decades. Second, we examined the effects of shifting to laparoscopic surgery for appendicitis on different quality indicators such as length of postoperative stay and mortality. We also examined age as a predictor of 30-day mortality. Materials and Methods: During the period 2000 to 2015, all adult patients with appendicitis and surgical removal of the appendix were identified in the Danish National Patient Register. Demographics, type of surgery, time of surgery, and duration of postoperative stay were retrieved form Danish National Patient Register. Vital status was retrieved from the Danish Civil Registration System. Results: A total of 58,093 patients underwent surgery for appendicitis. In 2000, a total of 274 out of 3717 (7.4%) had a laparoscopic appendectomy, and the postoperative stay was 55 (iqr: 35–88) h and 30-day mortality was 0.91%. In 2015, a total of 3995 out of 4296 (93.0%) had a laparoscopic appendectomy, and the postoperative stay was 16 (iqr: 9–56) h and 30-day mortality was 0.40%. Age as a predictor of 30-day postoperative mortality had an area under the curve of 0.93 (95% confidence interval: 0.92; 0.94). Conclusion: In Denmark, the standard surgical procedure for appendicitis has changed from open surgery to laparoscopic surgery during the period 2000–2015. At the same time, duration of postoperative stay and 30-day mortality has decreased.