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Median Hospital Stay (median + hospital_stay)
Selected AbstractsModel for end-stage liver disease (MELD) score, as a prognostic factor for post-operative morbidity and mortality in cirrhotic patients, undergoing hepatectomy for hepatocellular carcinomaHPB, Issue 4 2009Spiros G. Delis Abstract Background/aims:, To evaluate the ability of the model for end-stage liver disease (MELD) in predicting the post-hepatectomy outcome for hepatocellular carcinoma (HCC). Methods:, Between 2001 and 2004, 69 cirrhotic patients with HCC underwent hepatectomy and the results were retrospectively analysed. MELD score was associated with post-operative mortality and morbidity, hospital stay and 3-year survival. Results:, Seventeen major and 52 minor resections were performed. Thirty-day mortality rate was 7.2%. MELD , 9 was associated with no peri-operative mortality vs. 19% when MELD > 9 (P < 0.02). Overall morbidity rate was 36.23%; 48% when MELD > 9 vs. 25% when MELD , 9 (P < 0.02). Median hospital stay was 12 days [8.8 days, when MELD , 9 and 15.6 days when MELD > 9 (P = 0.037)]. Three-year survival reached 49% (66% when MELD , 9; 32% when MELD > 9 (P < 0.01). In multivariate analysis, MELD > 9 (P < 0.01), clinical tumour symptoms (P < 0.05) and American Society of Anesthesiologists (ASA) score (P < 0.05) were independent predictors of peri-operative mortality; MELD > 9 (P < 0.01), tumour size >5 cm (P < 0.01), high tumour grade (P = 0.01) and absence of tumour capsule (P < 0.01) were independent predictors of decreased long-term survival. Conclusion:, MELD score seems to predict outcome of cirrhotic patients with HCC, after hepatectomy. [source] Combined liver and inferior vena cava resection for hepatic malignancyJOURNAL OF SURGICAL ONCOLOGY, Issue 3 2007Spiros G. Delis MD Abstract Objective The experience from a single center, in combined liver and inferior vena cava (IVC) resection for liver tumors, is presented. Methods Twelve patients underwent a combined liver resection with IVC replacement. The median age was 45 years (range 35,67 years). Resections were carried out for hepatocellular carcinoma (n,=,4), colorectal metastases (n,=,6), and cholangiocarcinoma (n,=,2). Liver resections included eight right lobectomies and four left trisegmentectomies. The IVC was reconstructed with ringed Gore-Tex tube graft. Results No perioperative deaths were reported. The median operative blood transfusion requirement was 2 units (range 0,12 units) and the median operative time was 5 hr. Median hospital stay was 10 days (range 8,25 days). Three patients had evidence of postoperative liver failure, resolved with supportive management. Two patients developed bile leaks, resolved conservatively. With a median follow up of 24 months, all vascular reconstructions were patent and no evidence of graft infection was documented. Conclusions Aggressive surgical management of liver tumors, offer the only hope for cure or palliation. We suggest that liver resection with vena cava replacement may be performed safely, with acceptable morbidity, by specialized surgical teams. J. Surg. Oncol. 2007;96: 258,264. © 2007 Wiley-Liss, Inc. [source] Resection of ectopic mediastinal parathyroid glands with the da Vinci® robotic systemBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 3 2010M. Ismail Background: Mediastinal ectopic parathyroid adenoma is a frequent cause of persistent or recurrent hyperparathyroidism, traditionally treated by open surgery. Thoracoscopic access is associated with reduced morbidity in mediastinal surgery. The aim of this study was to evaluate the feasibility and effectiveness of robot-assisted dissection for mediastinal ectopic parathyroid glands. Methods: Two patients with recurrent secondary hyperparathyroidism and three with complicated primary hyperparathyroidism were operated on between July 2004 and August 2008 for ectopic mediastinal parathyroid glands. Fusion of single-photon emission computed tomography and computed tomography led to an exact identification of the culprit glands. Surgery was performed thoracoscopically with the da Vinci® robotic system using a three-trocar approach. Results: All procedures were completed successfully with the robotic system. No perioperative morbidity or mortality was noted. Median operating time was 58 (range 42,125) min. Intraoperative parathyroid hormone reduction indicated complete resection. Median hospital stay was 3 (range 2,4) days. Conclusion: Robot-assisted dissection is a promising approach for resection of ectopic parathyroid glands in remote narrow anatomical locations such as the mediastinum. Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Transanal endoscopic microsurgery is a safe and reliable technique even for complex rectal lesionsBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 7 2008R. J. Darwood Background: Transanal endoscopic microsurgery (TEM) is a minimally invasive technique for the excision of rectal lesions, with lower morbidity and mortality rates than open surgery. Following advances in laparoscopic colorectal surgery and endoscopic mucosal resection, this study evaluated the safety and efficacy of TEM in the treatment of complex rectal lesions. Methods: All patients were entered into a prospective database. Complex lesions were identified as high (more than 15 cm from anorectal margin), large (maximum dimension over 8 cm), involving two or more rectal quadrants, or recurrent. Results: Seventy-one lesions (13 carcinomas and 58 tubulovillous adenomas) were identified. The median duration of operation was 60 (interquartile range (i.q.r.) 30,80) min, with an estimated median blood loss of 0 (i.q.r. 0,10) ml. Median hospital stay was 2 (i.q.r. 1,3) days. One patient developed postoperative urinary retention and one returned with rectal bleeding that did not require further surgery. Two patients developed rectal strictures after operation that were dilated successfully. There was no recurrence of benign lesions during a median follow-up of 21 (i.q.r. 6·5,35) months. Conclusion: TEM is a safe technique with low associated morbidity, even when used to excise complex rectal lesions. As such it remains the treatment of choice for rectal lesions not requiring primary radical resection. Copyright © 2008 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Role of hepatectomy in the management of bile duct injuriesBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 3 2001C. H. Wakefield Background: Laparoscopic cholecystectomy is associated with bile duct injuries of a more severe nature than open cholecystectomy. This study examined the emerging role of hepatectomy in the management of major iatrogenic bile duct injuries in the laparoscopic era. Methods: This was a retrospective cohort study of patients referred to a tertiary hepatobiliary unit with bile duct injuries over a 16-year period until April 2000. Data are expressed as median (range). Results: Eighty-eight patients (34 men, 54 women) were referred during this interval; their median age was 55 (19,83) years. Injuries resulted from 50 laparoscopic cholecystectomies and 35 open cholecystectomies, with three occurring during gastroduodenal procedures. Laparoscopic surgery was associated with injuries of greater severity than open cholecystectomy: Bismuth type I,II, 32 per cent versus 69 per cent for the open operation; type III,IV, 66 per cent versus 31 per cent for the open procedure (P = 0·02, ,2 test). After referral 73 patients underwent definitive surgical interventions: 57 hepaticojejunostomies, 11 revisions of hepaticojejunostomy, two orthotopic liver transplants and three right hepatectomies. Two patients had subsequent hepatectomy following initial hepaticojejunostomy. Four of the five hepatectomies were for the management of injuries perpetrated at laparoscopic cholecystectomy. Criteria necessitating hepatectomy were liver atrophy on computed tomography (80 versus 11 per cent; P = 0·0001, ,2 test) and a greater incidence of angiographically proven vascular injury (40 versus 6 per cent; P = 0·006, ,2 test); in addition, type III,IV injuries were more frequent (60 versus 42 per cent) in the hepatectomy group. There were no procedure-related deaths. The overall postoperative morbidity rate was 13 per cent. Median hospital stay was 10 days. Conclusion: Major hepatectomy allows the successful and safe repair of cholecystectomy-related bile duct injuries complicated by concomitant vascular injury, unilateral lobar atrophy and destruction of the biliary confluence. © 2001 British Journal of Surgery Society Ltd [source] Changing patterns in the management of gastric volvulus over 14 yearsBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 3 2000W. J. Teague Background: Gastric volvulus is an uncommon condition, which can be difficult to diagnose and treat. This study represents a large series of patients with the condition. Methods: All patients presenting with gastric volvulus over a 14-year period were reviewed. Results: Some 36 patients (median age 75 years) were identified. Volvulus, usually secondary to a hiatus hernia, presented acutely in 29 patients. The major symptoms were abdominal pain, vomiting and upper gastrointestinal haemorrhage. The most useful investigations were barium contrast studies and upper gastrointestinal endoscopy, which were helpful in 21 of 25 and 11 of 18 patients respectively. Treatment was conservative in five patients, by open surgery in 13 and laparoscopic repair in 18 (three converted to open operation). There were no major complications and no deaths. Median hospital stay was shorter in patients treated by laparoscopic rather than open surgery (6 (range 4,36) versus 14 (7,50) days; P < 0·05). Conclusion: Acute and chronic gastric volvulus can be treated successfully by either open or laparoscopic surgery. However, laparoscopic surgery now represents a safe and acceptable approach, with minimal morbidity and a significantly shorter hospital stay. This is likely to be of considerable benefit for the treatment of a predominantly elderly population, often with significant co-morbidity. © 2000 British Journal of Surgery Society Ltd [source] Long-term results of palliative stenting or surgery for incurable obstructing colon cancerCOLORECTAL DISEASE, Issue 7 2008I. G. Faragher Objective, Self-expanding metal stents are an effective means of relieving left-sided malignant colonic obstruction, and in the setting of incurable disease may provide palliation while allowing the patients to avoid surgery altogether. With modern chemotherapy regimes, patients may have a long-life expectancy, even in the presence of metastases. The purpose of this study was to investigate the long-term results of palliative stent placement, compared with patients undergoing palliative surgery. Method, This is a retrospective study of 55 consecutive patients who underwent colonic stenting or palliative surgery for incurable, obstructing adenocarcinoma of the left colon. Results, Twenty-nine patients underwent colonic stenting, and 26 had surgery during the study period. Survival was similar in the two groups (14 months in the stent group, 11 months in the surgery group). Median hospital stay was shorter in the stent group (4 vs 13.5 days), and fewer patients in the stent group had complications (2 vs 14). Only four patients in the stent group went on to require later surgery. The median time to failure of the stents was 14 months. Conclusion, Colonic stenting provides effective and durable palliation for patients with incurable, obstructing adenocarcinomas of the left colon. It can be performed with less morbidity than palliative surgery, and offers similar long-term survival. [source] Laparoscopic emergency and elective surgery for ulcerative colitisCOLORECTAL DISEASE, Issue 4 2008L. Fowkes Abstract Objective, To analyse surgical outcomes of fulminate and medically resistant ulcerative colitis (UC) carried out laparoscopically. Method, A prospective database identified 69 consecutive patients who underwent surgery for UC under the senior author over a 5-year period to April 2006. Results, Thirty-two patients (18 male patients), median BMI 26, underwent laparoscopic subtotal colectomy (LSTC): 22 acute emergencies, 10 refractory to medical therapy and unfit for restorative proctocolectomy. All were receiving iv steroids; azathioprine (7), cyclosporin (5). The median operation time was 135 min (65,280). There was one conversion. Twenty-nine patients have subsequently undergone completion proctectomy and W-pouch formation [24 patients were performed laparoscopically , laparoscopic completion proctectomy (LCP)]; widespread adhesions precluded in five patients. Twenty-six patients underwent restorative laparoscopic proctocolectomy (LRP) , one conversion. Twenty patients underwent W-pouch reconstruction via a Pfannenstiel incision. Six J-pouches were constructed and returned via the ileostomy site. Three underwent a laparoscopic pan-proctocolectomy (LPPC); one conversion. Eight patients underwent open STC. The median time to normal diet was 48 h (1,7 days) for LSTC/LCP and 36 h (1,5 days) for LRP. There were two major complications following LRP, two following LSTC, one following LCP, one following LPPC and five following open surgery. Median hospital stay was 8 days (6,72) for LSTC, 7 days (6,9) for LCP and 5 days (3,45) for LRP. There were six 30-day readmissions following laparoscopic surgery (DVT, reactive depression, ileostomy hold up (2), abdominal pain and high output ileostomy). Conclusion, Laparoscopic subtotal and restorative proctocolectomies in fulminate and medically resistant UC are feasible, safe and largely predictable operations that allow for early hospital discharge. Laparoscopic colectomy facilitates subsequent proctectomy and pouch construction. [source] The effect of preoperative weight loss and body mass index on postoperative outcome in patients with esophagogastric carcinomaDISEASES OF THE ESOPHAGUS, Issue 7 2009J. Skipworth SUMMARY Studies have shown that weight loss is associated with adverse outcomes in all treatment modalities for esophagogastric carcinoma. Because of the increased prevalence of obesity and the effectiveness of perioperative nutrition, a number of patients are now obese or have normal body mass index (BMI) at the time of treatment. We investigated the relationship between weight loss, BMI, and outcome of surgery for patients with esophagogastric carcinoma. Data were collected over a 38-month period for all patients diagnosed with operable esophagogastric cancer at two UK centers. All patients underwent resection by a single Consultant Upper Gastrointestinal Surgeon and the use of perioperative jejunal feeding was universal. Ninety-three patients (57 male) underwent esophagogastric resection; 48 had no preoperative weight loss (34 with a BMI > 25 and 14 with a BMI < 25). Forty-five patients had preoperative weight loss (20 with BMI > 25 and 25 with BMI < 25). There was no significant difference in complication rates, median hospital stay, or mortality between the four groups. A significantly higher number of patients displaying preoperative weight loss were found to have stage III disease, but difference in survival of up to 3 years did not reach statistical significance on multivariate analysis. Preoperative weight loss and low BMI did not significantly influence the complication rate, perioperative mortality rate, length of hospital stay, or short-term prognosis. We conclude that preoperative weight loss can not be reliably used as an independent predictor of poor outcome in patients undergoing surgery for esophagogastric carcinoma. However, patients with preoperative weight loss and low BMI are more likely to have advanced disease. [source] Laparoscopic paraesophageal hernia repair: quality of life outcomes in the elderlyDISEASES OF THE ESOPHAGUS, Issue 8 2008E. J. Hazebroek SUMMARY Paraesophageal hernias (PEH) occur when there is herniation of the stomach through a dilated hiatal aperture. These hernias occur more commonly in the elderly, who are often not offered surgery despite the failure of medical treatment to address mechanical symptoms and life-threatening complications. The aim of this study was to assess the impact of laparoscopic repair of PEH on quality of life in an elderly population. Data were collected prospectively on 35 consecutive patients aged >70 years who had laparoscopic repair of a symptomatic PEH between December 2001 and September 2005. The change in quality of life was assessed using a validated questionnaire, the Quality of Life in Reflux and Dyspepsia questionnaire (QOLRAD), and by patient interviews. Patients were assessed preoperatively, and at 6 weeks, 6 months, 12 months, 1 year, and 2 years postoperatively. Mean patient age was 77 years (range 70,85); mean American Society of Anesthesiologists class was 2.7 (range 1,3). There were 28 women and 7 men. There was one readmission for acute reherniation, which required open revision. Total complication rate was 17.1%. All complications were treated without residual disability. There was no 30-day mortality, and median hospital stay was 3 days (range 2,14). Completed questionnaires were obtained in 30 of 35 patients (85.7%). There was a significant improvement in quality of life, as measured with QOLRAD, at all postoperative time points (P < 0.001). Laparoscopic PEH repair can be performed with acceptable morbidity in symptomatic patients refractory to conservative treatment and is associated with a significant improvement in quality of life. Our data support elective repair of symptomatic PEH in the elderly, a population who may not always be referred for a surgical opinion. [source] Early endoscopic realignment of traumatic anterior and posterior urethral disruptions under caudal anaesthesia , a 5-year reviewINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 1 2010E. O. Olapade-Olaopa Summary Objective:, We recently described early rigid retrograde endoscopic realignment of the disrupted urethra under caudal anaesthesia in the outpatient setting. This retrospective study was performed to evaluate our medium-term results. Patients and methods:, A retrospective review of patients who had early rigid retrograde endoscopic realignment of traumatic urethral disruptions in our institution over a 5-year period was done and the relevant data extracted and analyzed. Results:, Fourteen acutely ruptured urethras (10 posterior and four anterior) were endoscopically realigned early in the study period. Nine (90%) of the posterior disruptions occurred at bulbo-membranous urethra (distal to the external sphincter mechanism). Thirteen of the ruptured urethras (93%) were successfully realigned (nine posterior and four anterior) and postoperative clean intermittent self-calibration (CIC) was instituted in 10 patients. The mean follow-up period was 36.6 months (range 18,54 months). The mean operating time and the median hospital stay were 22 min (range 8,68 min) and 3 days (range 1,10 days), respectively, and were shorter in patients with injuries of the anterior urethra than those with posterior urethral tears (p , 0.0001). Post-realignment, all 13 patients were potent and continent. Two patients required additional procedures (direct vision internal urethrotomy or urethral dilation) and one patient has remained on CIC i.e. a stricture rate of 21%. Conclusion:, Early retrograde endoscopic realignment under caudal analgesia is suitable and cost-effective for patients with acute traumatic urethral disruptions and has good medium-term results. In addition, an early postoperative regimen of CIC significantly reduced stricture-formation in our series. [source] Rotavirus hospitalisation in New Zealand children under 3 years of ageJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 4 2006Keith Grimwood Objective: To describe the epidemiology of severe rotavirus gastroenteritis and to estimate the hospitalisation rates of this illness in New Zealand children under 3 years of age. Methods: Children under 3 years of age with acute diarrhoea admitted to 1 of 8 study hospitals between 1 May 1998 and 30 April 2000 were surveyed. Their socio-demographic, treatment and length-of-stay data were recorded and stool samples tested by a rotavirus-specific enzyme-linked immunoassay. National hospital discharge data for infectious diarrhoea (International Classification of Diseases, ninth revision, 003,009) were reviewed, allowing population-based estimates for rotavirus-related hospitalisation in New Zealand. Results: Of 2019 enrolled children, 1138 (56.4%) provided stools for testing, and of these 485 (42.6%) tested rotavirus positive. Rotavirus detection varied significantly by age (26.8% for 0 to 5 months, 42.5% for 6 to 11 months and 52.1% for children aged 12 to 35 months; P < 0.001), and by season (51.2% in winter/spring vs. 24.5% in summer/autumn; P < 0.001). While those infected with rotavirus were more likely to be dehydrated (50.6% vs. 37.4%; P < 0.001), their median hospital stay was similar (1.0 vs. 2.0 days; P = 0.09) to other children with acute gastroenteritis. The estimated national hospitalisation rate for rotavirus diarrhoea in children under 3 years, standardised for age and season, was 634 (95% CI 597, 672) per 100 000. In New Zealand, rotaviruses result in 1 in 52 children being hospitalised by 3 years of age. Conclusions: Rotavirus diarrhoea is an important, potentially vaccine-preventable cause of hospitalisation in New Zealand children, especially during winter and spring seasons. [source] BT02 LAPAROSCOPIC SLEEVE GASTRECTOMY AS A SINGLE-STAGE BARIATRIC PROCEDUREANZ JOURNAL OF SURGERY, Issue 2009T. Sammour Purpose: , Laparoscopic sleeve gastrectomy is increasingly being recognised as a stand-alone procedure in bariatric surgery, with long term follow-up data now emerging. We present our early experience patients with a mean BMI in the super-obese range. Methodology: , Retrospective review of laparoscopic sleeve gastrectomies performed by two surgeons at Middlemore Hospital, between March 2007 and July 2008. Results: , One hundred and one patients were identified, with a mean age of 42.7 years (95% CI 40.9,44.5). Maori and Pacific Islanders made up 31% of the patient subset. Patients had a mean BMI of 50.2 kg/m2 (95% CI 48.8,51.7), and 45 patients were super-obese. They had a median hospital stay of 2 days (1,7 days), and a mean follow-up of 6.0 months. Mean excess BMI loss (excluding patients with a major complication) was 46% (95% CI 43.3,48.7). 64% of diabetics and 37% of hypertensives showed in an improvement in medication requirement. There was a major complication rate of 8%, including 3 staple line leaks (one of which required laparotomy), 2 staple line bleeds (one requiring laparotomy), 1 infected haematoma, and 1 critical stricture. There were no deaths. Conclusion: , Laparoscopic sleeve gastrectomy has achieved satisfactory weight-loss results with an acceptable complication rate in the short to medium term. [source] Laparoscopic treatment of lymphoceles in patients after renal transplantationCLINICAL TRANSPLANTATION, Issue 6 2001Hans-Joachim Duepree Postoperative lymphoceles after renal transplantation appear in up to 18% of patients, followed by individual indisposition, pain or impaired graft function. Therapeutic options are percutaneous drainage, needle aspiration with sclerosing therapy, or internal surgical drainage by conventional or laparoscopic approach. The laparoscopic procedure offers short hospitalisation time and quick postoperative recovery. From 1993 to 1997, 16 patients underwent laparoscopic fenestration of a post-renal transplant lymphocele, and were presented in a retrospective analysis. Three patients have had previous abdominal surgery. Following preoperative ultrasound and CT scan, 16 patients underwent laparoscopic drainage after drainage and staining of the lymphocele with methylene blue. No conversion was necessary. Mean operation time was 42 min, no intraoperative complications were seen. Oral nutrition and immunosuppression were continued on the day of surgery, and patients were discharged between the 2nd and 5th (median hospital stay 3.3 d) day after surgery. No recurrence was evident in a follow-up time of 15,54 months (median 31.4 months). Renal function remained unchanged in all patients postoperatively. [source] Laparoscopic colonic surgery , mission accomplished or work in progress?COLORECTAL DISEASE, Issue 6 2006H. Kehlet Abstract Laparoscopic colonic resection may facilitate early postoperative recovery due to reduced surgical stress, pain and ileus. However, large randomised studies have only shown marginal improvements in outcome compared with open surgery, reporting a median hospital stay of about 5,7 days. Concomitant with these developments multimodal rehabilitation, which involves a revision of general postoperative care principles, improved pain relief with epidural analgesia and early oral nutrition and mobilization, has demonstrated greater improvements in recovery after open surgery, resulting in a median hospital stay of about 2,4 days. Recent single centre, randomised studies where laparoscopic and open colonic resection are combined with multimodal rehabilitation have not resolved the debate regarding which is the optimal operative technique. Therefore, new strategies are required to integrate laparoscopy with multimodal rehabilitation in order to establish its advantages, cost effectiveness and indications in specific groups of patients or colorectal procedures, thus justifying widespread application of the laparoscopic technique. [source] Laparoscopic proctocolectomy with restorative ileal-anal pouchCOLORECTAL DISEASE, Issue 6 2004T. S. Gill Abstract Objective The aim of the study was to analyse the outcome of restorative proctocolectomy carried out by laparoscopic surgery. Methods A prospectively collected electronic database of all colorectal laparoscopic procedures performed between April 2001 and July 2003 has been used to identify surgical outcomes in 14 consecutive patients who have undergone laparoscopic RPC. Results Fourteen patients (5 male), median BMI 24 kg/m2 have undergone restorative laparoscopic proctocolectomy over a two year period: 13 (ulcerative colitis, one with cancer) and 1 (FAP). The median operation time was 260 min; time has not decreased with experience. There were no intra-operative surgical complications or deaths. Patient controlled analgesia continued for a median of 36 h. The median time to diet was 48 h and median hospital stay 7 days; three patients required nasogastric aspiration for delayed gastric emptying. Eighteen regional lymph nodes were retrieved local to the carcinoma. There was one anastomotic leak. All covering stomas were closed by 6 months (12 by eight weeks). All 14 patients are fully continent, able to suppress urgency and have a median pouch frequency of 4/24 h. None admit to having problems with potency, orgasm sensation, ejaculation, micturition. One lady reports dysparunia. All are highly satisfied with functional outcome and cosmesis. Conclusion We are encouraged to continue to offer our patients the option of a laparoscopic resection. [source] | ||||||||||