Current Issue : January - March Volume : 2016 Issue Number : 1 Articles : 8 Articles
Background: Major bleeding is rare but among the most serious complications of laparoscopic surgery. Still very\nlittle is known on bleeding complications and related blood component use in laparoscopic cholecystectomy (LC).\nThe aim of this study is to compare bleeding complications, transfusion rates and related costs between LC and\nopen cholecystectomy (OC).\nMethods: Data concerning LCs and OCs and related blood component use between 2002 and 2007 were collected\nfrom existing computerized medical records (Finnish Red Cross Register) of ten Finnish hospital districts.\nResults: Register data included 17175 LCs and 4942 OCs. In the LC group, 1.3 % of the patients received red blood\ncell (RBC) transfusion compared to 13 % of the patients in the OC group (p < 0.001). Similarly, the proportions of\npatients with platelet (0.1 % vs. 1.2 %, p < 0.001) and fresh frozen plasma (FFP) products (0.5 % vs. 5.8 %) transfusions\nwere respectively higher in the OC group than in the LC group. The mean transfused dose of RBCs, PTLs and FFP\nproduct Octaplas�® or the mean cost of the transfused blood components did not differ significantly between the\nLC and OC groups.\nConclusions: Laparoscopic cholecystectomy was associated with lower transfusion rates of blood components\ncompared to open surgery. The severity of bleeding complications may not differ substantially between LC and OC....
Abdominal wall hernia repairs are commonly performed worldwide in general surgery. There is still no agreed\nconsensus on the optimal surgical approach. Since the turn of the twenty-first century, minimally invasive\ntechniques have gained in popularity as they combine the advantages of limited abdominal wall dissection,\nreduced post-operative pain and risk of complications, and shorter hospital stay. Although the added cost incurred\nby using sophisticated laparoscopic instruments may be quite substantial, it is precisely counterbalanced by an\nimproved morbidity rate, faster discharge home and time to return to work. Laparoscopic abdominal wall hernia\nrepair is often challenging, as it requires good anatomical knowledge, eye-hand coordination and diversified\nlaparoscopic skills. The objective of this article is not to present another set of personal data and to compare it with\nalready published results on this matter, but simply to offer comprehensive guidelines on the practical aspects of\nthis relatively new technique. Some of these steps have already been discussed but most of the time in a scattered\nway in the surgical literature, while others are the fruit of a personal expertise grasped over the years....
Background: The recent push for the publication of individual surgeon outcomes underpins public interest in safer\nsurgery. Conventional, retrospective assessment of surgical performance without continuous monitoring may lead\nto delays in identifying poor performance or recognition of practices that lead to be better than expected\nperformance.\nDiscussion: The variable life adjusted display (VLAD) is not new, yet is not widely utilised in General Surgery. Its\nconstruction is simple and if caveats are appreciated the interpretation is straightforward, allowing for continuous\nsurveillance of surgical performance.\nSummary: While limitations in the detection of variations in performance are appreciated, the VLAD could\nrepresent a more useful tool for monitoring performance....
Background: Duodenal gastrointestinal stromal tumors (DGIST) are rare, and data on their management is limited.\nWe here report the clinicopathological characteristics, different surgical treatments, and long-term prognosis of DGIST.\nMethods: Data of 74 consecutive patients with DGIST in a single institution from June 2000 to June 2014 were\nretrospectively analyzed. The overall survival (OS) and recurrence/metastasis-free survival rates of 74 cases were\ncalculated using Kaplanââ?¬â??Meier method.\nResults: Out of 74 cases, 42 cases were female (56.76 %) and 32 cases (43.24 %) were male. Approximately 22.97, 47.30,\n16.22, and 13.51 % of the tumors originated in the first to fourth portion of the duodenum, respectively,\nwith a tumor size of 5.08 Ã?± 2.90 cm. Patients presented with gastrointestinal bleeding (n = 37, 50.00 %),\nabdominal pain (n = 25, 33.78 %), mass (n = 5, 6.76 %), and others (n = 7, 9.76 %). A total of 18 patients\n(24.3 %) underwent wedge resection (WR); 39 patients (52.7 %) underwent segmental resection (SR); and 17\ncases (23 %) underwent pancreaticoduodenectomy (PD). The median follow-up was 56 months (1ââ?¬â??159\nmonths); 19 patients (25.68 %) experienced tumor recurrence or metastasis, and 14 cases (18.92 %) died.\nThe 1-, 3-, and 5-year recurrence/metastasis-free survival rates were 93.9, 73.7, and 69 %, respectively. The 1-, 3-\nand 5-year OS were 100, 92.5, and 86 %, respectively. The recurrence/metastasis-free survival rate in the PD group\nwithin 5 years was lower than that in the WR group (P = 0.047), but was not different from that in the SR group\n(P = 0.060). No statistically significant difference was found among the three operation types (P = 0.294).\nConclusions: DGIST patients have favorable prognosis after complete tumor removal, and surgical procedures\nshould be determined by the DGIST tumor location and size....
Background: Laparoscopic adrenalectomy is still controversial in cases where malignancy is suspected. However,\nmany proponents of this technique argue that in the hands of an experienced surgeon, laparoscopy can be safely\nperformed. The aim of this study is to present our own experience with the application of laparoscopic surgery for\nthe treatment of malignant and potentially malignant adrenal tumours.\nMethods: Our analysis included 52 patients who underwent laparoscopic adrenalectomy in 2003ââ?¬â??2014 due to a\nmalignant or potentially malignant adrenal tumour. Inclusion criteria were primary adrenal malignancy, adrenal\nmetastasis or pheochromocytoma with a PASS score greater than 6. We analyzed the conversion rate, intra- and\npostoperative complications, intraoperative blood loss and R0 resection rate. Survival was estimated using the\nKaplan-Meier method.\nResults: Conversion was necessary in 5 (9.7 %) cases. Complications occurred in a total of 6 patients (11.5 %).\nR0 resection was achieved in 41 (78.8 %) patients and R1 resection in 9 (17.3 %) patients. In 2 (3.9 %) cases R2\nresection was performed. The mean follow-up time was 32.9 months. Survival depended on the type of tumour\nand was comparable with survival after open adrenalectomy presented in other studies.\nConclusions: We consider that laparoscopic surgery for adrenal malignancy can be an equal alternative to open\nsurgery and in the hand of an experienced surgeon it guarantees the possibility of noninferiority. Additionally,\nstarting a procedure with laparoscopy allows for minimally invasive evaluation of peritoneal cavity. The key element\nin surgery for any malignancy is not the surgical access itself but the proper technique....
Background: Hardware removals are among the most commonly performed surgical procedures worldwide.\nCurrent literature offers little data concerning postoperative patient satisfaction. The purpose of our study was to\nevaluate the patients� point of view on implant removal.\nMethods: We surveyed patients of a German level one trauma center, who underwent hardware removal in 2009\nand 2010, with regard to their personal experiences on implant removal. Exclusively, data obtained out of the\nsurvey were analyzed.\nResults: In 332 patients surveyed, most hardware removals were performed at the ankle joint (21 %) followed by\nthe wrist (15 %). The most frequent indication was a doctor�s recommendation (68 %), followed by pain (31 %) and\nimpaired function (31 %). Patient reported complication rate of implant removal was 10 %. Importantly, after\nimplant removal because of pain or impaired function patients reported an improvement in function (72 %) as well\nas decreased pain (96 %). 96 % of all responding patients and 66 % of the patients who suffered from subsequent\ncomplications would opt for surgical implant removal again.\nConclusion: In summary, despite the challenging and frequently troublesome nature of surgical hardware removal\nour data contradicts the widely held view that implant removal is often without a positive effect on the patients.\nThese findings may influence the surgeons� attitude towards implant removal and their day-to-day routine in\npatient counseling....
Background: Pancreatic ductal adenocarcinoma (PDAC) patients frequently present with borderline resectable\ndisease, which can be due to invasion of the portal/superior mesenteric vein (PV/SMV). Here, we analyzed this\ngroup of patients, with emphasis on short and long-term outcomes.\nMethods: 156 patients who underwent a resection for PDAC were included in the analysis and sub-stratified into a\ncohort of patients with PV/SMV resection (n = 54) versus those with standard surgeries (n = 102).\nResults: While venous resections could be performed safely, there was a trend towards shorter median survival in the\nPV/SMV resection group (22.7 vs. 15.8 months, p = 0.157). These tumors were significantly larger (3.5 vs 4.3 cm; p = 0.026)\nand margin-positivity was more frequent (30.4 % vs 44.4 %, p = 0.046).\nConclusion: Venous resection was associated with a higher rate of margin positivity and a trend towards shorter survival.\nHowever, compared to non-surgical treatment, resection offers the best chance for long term survival....
Background: Recurrence of post-burn contractures, following inadequate management of post-burn contractures\n(PBC), is under reported. It is associated with multiple operations and an increased cost to patients and their\nfamilies. The purpose of this study was to determine the frequency of recurrence of PBC of the shoulder and the\nelbow joint three months after surgical intervention and the associated risk- factors.\nMethods: This was a prospective cohort study conducted at CoRSU hospital from March 2012 to November 2014.\nAll patients with PBC of the elbow and/or shoulder joint who consented to be in the study and met the inclusion\ncriteria were enrolled. Data was collected using a pretested, coded questionnaire. A goniometer was used to\nmeasure the active range of motion of the involved joint. The measurements were recorded in degrees. The data\nwas analysed with STATA version 12.1.\nResults: 58 patients were enrolled consecutively in the study. There were 36 females and 22 males, with a female\nto male ratio of 1.6:1. The age range was 0.75ââ?¬â??45 years, with a median age of 5 years. The average age at the time\nof injury was 3.4 years. The most common cause of initial burn injury was scalding. The average number of joints\ninvolved per patient was two. There was a high incidence of recurrence of PBC (52 %) among the participants. The\nshoulder had the highest frequency of recurrence at 67 %. The elbow joint had a frequency of recurrence of 27 %.\nAll participants with both elbow and shoulder joint involvement had PBC recur. The risk factors for recurrence were\nflame burn (p = 0.007), duration of PBC of more than 1 year (p = 0.018), and incomplete release of the contracture\n(p = 0.002). The presence of keloids, hypertrophic scars, ulcers and the occurrence of complications at the\ncontracture site were not associated with recurrence of PBC.\nConclusion: Recurrence of PBC of the elbow and shoulder joint is a common problem. The risk factors should be\nkept in mind during management of PBC to reduce the recurrence rate....
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