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Postoperative Hospital Stay (postoperative + hospital_stay)

Distribution by Scientific Domains

Medical Sciences	95%

Kinds of Postoperative Hospital Stay

shorter postoperative hospital stay

Selected Abstracts

Surgical site infection rate and associated risk factors in elective general surgery at a public sector medical university in Pakistan

INTERNATIONAL WOUND JOURNAL, Issue 1 2008
Ahmed Khan Sangrasi
Abstract This prospective study aimed to determine the surgical site infection (SSI) rate and associated risk factors was carried in a general surgical ward at Liaquat University Hospital Jamshoro. A total of 460 patients requiring elective general surgery from July 2005 to June 2006 were included in this study. All four surgical wound categories were included. Primary closure was employed in all cases. Patients were followed up to 30th day postoperatively. All cases were evaluated for postoperative fever, redness, swelling of wound margins and collection of pus. Cultures were taken from all the cases with any of the above finding. Mean ± SD age of the patients was 38·8 ± 17·4 years with male to female ratio of 1·5:1. The overall rate of surgical site infection was 13·0%. The rate of wound infection was 5·3% in clean operations, 12·4% in clean-contaminated, 36·3% in contaminated and 40% in dirt-infected cases. Age, use of surgical drain, duration of operation and wound class were significant risk factors for increased surgical site infection (P < 0·05). Postoperative hospital stay was double in cases who had surgical site infection. Sex, haemoglobin level and diabetes were not statistically significant risk factors (P > 0·05). In conclusion, surgical site infection causes considerable morbidity and economic burden. The routine reporting of SSI rates stratified by potential risk factors associated with increased risk of infection is highly recommended. [source]

Prethymectomy plasmapheresis in myasthenia gravis

JOURNAL OF CLINICAL APHERESIS, Issue 4 2005
Jiann-Horng Yeh
Abstract Plasma exchange before thymectomy may decrease the time on mechanical ventilation (MV) and shorten the stay in the intensive care unit (ICU) for patients with myasthenia gravis (MG). This study evaluated the effects of prethymectomy plasmapheresis. A total of 29 myasthenic patients, 18 women and 11 men aged 20,73 years, were treated with double filtration plasmapheresis (DFP) for two to five consecutive sessions over a period between 2 and 21 days (mean 8.1 days) before transsternal thymectomy. Acetylcholine receptor antibody (AchRAb) titers, vital capacity (VC), maximal inspiratory pressure (Pimax), and MG score were measured before and after the course of DFP. Three outcome measures including duration of postoperative hospital stay, duration of ICU stay, and duration of MV were analyzed for correlation with clinical variables. The duration of MV ranged from 6 to 93 h, with a median of 21 h. The median ICU stay was one day and the median postoperative hospital stay was 10 days. A higher removal rate of AchRAb was associated with a shorter duration of ICU and postoperative hospital stay (P = 0.001 and 0.019, respectively). Postoperative hospital stay was strongly correlated with post-DFP Pimax (P = 0.010), and marginally correlated with pre-DFP VC (P = 0.047) and to a lesser extent with pre-DFP Pimax (P = 0.063). Univariate analysis using the log rank test revealed that removal rate of AchRAb <30% (P = 0.043) and pre-DFP Pimax <,60 cmH2O (P = 0.024) were significantly associated with prolonged ICU stay. Risk factors for prolonged postoperative stay included post-DFP Pimax <,60 cmH2O (P = 0.017), pre-DFP Pimax <,60 cmH2O (P = 0.031), and post-DFP VC < 1.0 L (P = 0.046). Our results confirmed the efficacy and safety of DFP in prethymectomy preparation for myasthenic patients. J. Clin. Apheresis, 2005 © 2005 Wiley-Liss, Inc. [source]

The influence of an Enhanced Recovery Programme on clinical outcomes, costs and quality of life after surgery for colorectal cancer

COLORECTAL DISEASE, Issue 6 2006
P. M. King
Objective, Optimizing peri-operative care using an enhanced recovery programme improves short-term outcomes following colonic resection. This study compared a prospective group of patients undergoing resection of colorectal cancer within an enhanced recovery programme, with a prospectively studied historic cohort receiving conventional care. Patients and methods, Sixty patients underwent elective resection within an enhanced recovery programme (ERP). This incorporated pre-operative counselling, epidural analgesia, early feeding and mobilization. Clinical outcomes were compared with 86 prospectively studied historic control patients receiving conventional care (CC). All patients completed EORTC QLQ-C30, QLQ-CR38 and health economics questionnaires up to three months after surgery. Results, Baseline clinical data were similar in both groups. Postoperative hospital stay was significantly reduced in the ERP, with patients staying 49% as long as those in the CC group including convalescent hospital stay (95% CI 39% to 61%P < 0.001). There were no differences in the number of complications, readmissions or re-operations. There were no significant differences in quality of life or health economic outcomes. Conclusion, Patients undergoing colorectal resection within an ERP stay in hospital half as long as those receiving conventional care, with no increased morbidity, deterioration in quality of life or increased cost. [source]

Prethymectomy plasmapheresis in myasthenia gravis

Effect of being overweight on postoperative morbidity and long-term surgical outcomes in proximal gastric carcinoma,

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 3 2009
Sung Jin Oh
Abstract Background and Aim:, The prevalence of being overweight has risen remarkably in Korea. This study sought to clarify the relationship between being overweight and surgical outcomes in gastric cancer patients. Methods:, A total of 410 patients who underwent curative total gastrectomies with D2 dissection from January 2000 to December 2003 were retrospectively studied from a prospectively designed database. The patients were assigned to two groups based upon their body mass index (BMI): non-overweight, BMI < 25 kg/m2; overweight, BMI , 25 kg/m2. Perioperative surgical outcomes, postoperative morbidity, mortality, recurrence, and prognosis were analyzed. Results:, The overweight group had longer operation time and more postoperative complications than the non-overweight group. The two groups were similar in terms of transfusion volumes, postoperative bowel movement, time to initiation of a soft diet, and postoperative hospital stay. Patterns of recurrence and cumulative survival rates were similar for each group. Multivariate analysis showed that being overweight was not a risk factor for recurrence or poor prognosis. Conclusion:, Although being overweight was associated with increased operation time and higher risk of complications in gastric cancer patients undergoing curative total gastrectomy, it had no effect on recurrence or long-term survival. [source]

Polypropylene mesh used for adjuvant reconstructive surgical treatment of advanced pelvic organ prolapse

JOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 5 2010
Tzu-Yin Lin
Abstract Aim:, To elucidate the outcome of transvaginal pelvic reconstructive surgery using polypropylene mesh (Gynemesh; Ethicon, Somerville, NJ, USA) for patients with pelvic organ prolapse (POP) stage III or IV. Methods:, Thirty-nine patients who underwent transvaginal pelvic reconstructive surgery from September 2004 through December 2005 were collected and analyzed. All patients underwent pelvic reconstructive surgery with anterior and posterior colporrhaphy with Gynemesh reinforcement. Results:, The average age of the patients was 64.1 years and average parity was 3.9. Thirty-four patients had Pelvic Organ Prolapse Quantification (POP-Q) stage 0, four patients had stage I, and one patient had stage II at a median follow-up time of 18 months postoperatively. The success rate was 97.4%. Only one patient (2.6%) had recurrent genital prolapse (stage II) postoperatively. Quality of life was evaluated before and after the operations. The mean scores on the Urinary Distress Inventory-6 (UDI-6) and Incontinence Impact Questionnaire-7 (IIQ-7) were 5.0 ± 4.6 and 8.7 ± 6.2 before the operation and 3.0 ± 4.7 and 3.2 ± 5.6 after the operation, respectively (P = 0.03 and 0.01). The complication rate was 10.3 %, including one vaginal mesh erosion (2.6%), one dyspareunia (2.6%) and two prolonged bladder drainage (longer than 14 days, 5.1%). The mean duration of postoperative bladder drainage was 2.4 days and mean postoperative hospital stay was 5.1 days. Neither long-term nor major complication was identified. Conclusion:, Transvaginal pelvic reconstructive surgery with polypropylene mesh reinforcement is a safe and effective procedure for POP on 1.5 years' follow- up. It also has positive influence on quality of life. [source]

Less systemic cytokine response in patients following microendoscopic versus open lumbar discectomy

JOURNAL OF ORTHOPAEDIC RESEARCH, Issue 2 2005
Tsung-Jen Huang
Abstract The magnitude of the tissue damage from surgery impacts the trauma response. This response is proportional to the severity of surgical stress. Systemic cytokines are recognized as markers of postoperative tissue trauma. Microendoscopic discectomy (MED) recently has become popular for treating lumbar disc herniations, and is associated with favorable clinical outcomes compared with open discectomy (OD). This study postulates that MED is a less traumatic procedure, and therefore has a lower surgical stress response compared to OD. In this study, a quantitative comparison of the overall effects of surgical trauma resulting from MED and OD was performed through analyzing patient systemic cytokines response. From April, 2002 to June, 2003, 22 consecutive patients who had symptomatic lumbar disc herniations were prospectively randomized to undergo either intracanalicular MED (N = 10) or OD (N = 12). In this study, the Vertebroscope System (Zeppelin, Pullach, Germany) was used to perform the endoscopic discectomy procedure in all MED patients. Serum levels of tumor necrosis factor-, (TNF-,), Interleukin-1, (IL-1,), Interleukin-6 (IL-6), and Interleukin-8 (IL-8) were measured before surgery and at 1, 2, 4, 8 and 24h after surgery using an enzyme-linked immunosorbent assay. Serum C-reactive protein (CRP) was measured at the same time interval. The results showed the MED patients had shorter postoperative hospital stay (mean, 3.57 ± 0.98 vs. 5.92 ± 2.39 days, p = 0.025) and less intraoperative blood loss (mean. 87.5 ± 69.4 vs. 190 ± 115 ml, p = 0.042). The operating length, including the set-up time, was longer in the MED group (mean, 109 ± 35.9 vs. 72.1 ± 17.8 min, p = 0.01). The mean size of skin incision made for the MED patients was 1.86 ± 0.13cm (range 1.7,2.0cm); and 6.3 ± 0.98 cm for the OD patients (range 5.5,8cm), p = 0.001. The patients' pain severity of the involved limbs on 10-point Visual Analog Scale before operation in MED group was 7.5 ± 0.3 (range 6,9) and 8 ± 0.2 (range 7,9) in OD group, p = 0.17; and after surgery, 1.5 ± 0.2 (range 1,2) in MED group and 1.4 ± 0.1 (range 1,3) in OD group, p = 0.91. CRP levels peaked at 24h in both groups, and OD patients displayed a significantly greater postoperative rise in serum CRP (mean, 27.78 ± 15.02 vs. 13.84 ± 6.25mg/l, p = 0.026). Concentrations of TNF-,, IL-1,, and IL-8 were detected only sporadically. Serum IL-6 increased less significantly following MED than after OD. In the MED group, IL-6 level peaked 8 h after surgery, with the response statistically less than in the open group (mean, 6.27 ± 5.96 vs. 17.18 ± 11.60pg/ml, p = 0.025). A statistically significant correlation was identified between IL-6 and CRP values (r = 0.79). Using the modified MacNab criteria, the clinical outcomes were 90% satisfactory (9/10) in MED patients and 91.6% satisfactory (11/12) in OD patients at a mean 18.9 months (range 10,25) follow-up. Based on the current data, surgical trauma, as reflected by systemic IL-6 and CRP response, was significantly less following MED than following OD. The difference in the systemic cytokine response may support that the MED procedure is less traumatic. Moreover, our MED patients had achieved satisfactory clinical outcomes as the OD patients at a mean 18.9 months follow-up after surgery. © 2004 Orthopaedic Research Society. Published by Elsevier Ltd. All rights reserved. [source]

Laparoscopy-assisted distal gastrectomy with systemic lymph node dissection: A phase II study following the learning curve

JOURNAL OF SURGICAL ONCOLOGY, Issue 1 2005
Michitaka Fujiwara MD
Abstract Background and Objectives A preliminary study on the use of laparoscopy-assisted approach to treat gastric carcinoma resulted in higher morbidity. Study Design A prospective phase II study of laparoscopy-assisted distal gastrectomy (LADG) was performed for patients with preoperative diagnosis of T1 N0 stage cancer located in the lower or middle-third stomach. Bleeding amount, operating time, mortality, morbidity, and the number of lymph node retrieval were recorded and compared with the preliminary series reported previously by the same authors. Results Between 2000 and 2002, 47 patients were accrued. The mean blood loss and postoperative hospital stay were significantly decreased compared with the previous series, whereas the operating time was not. There were no in-hospital deaths, with the incidence of anastomotic leakage significantly decreased. All patients remain disease-free to date. Conclusions LADG can be performed safely and morbidity, no longer, is a drawback by experienced hands that have reached plateau of the learning curve, although it remains a time-consuming procedure. Its application to gastric cancer surgery is feasible for early stage cancer, and its applicability to the treatment of T2 stage cancer will be the next issue to be explored. J. Surg. Oncol. 2005;91:26,32. © 2005 Wiley-Liss, Inc. [source]

Prevention and treatment of rethrombosis after liver transplantation with an implantable pump of the portal vein

LIVER TRANSPLANTATION, Issue 3 2010
Zhengrong Shi
Implantable pumps have been used to prevent deep vein thrombosis and other diseases. In this article, we report for the first time the prevention and treatment of rethrombosis of the portal vein in liver transplantation with an implantable pump of the portal vein. Four hundred four orthotopic liver transplantation cases were retrospectively reviewed and divided into 3 groups: portal vein thrombosis (PVT) patients with an implantable pump (n = 28), PVT patients without an implantable pump (n = 20), and patients without preexisting PVT (n = 356). The following parameters for the 3 groups of patients were calculated and compared: (1) preoperative parameters, including baseline data of the donors and recipients and times of graft ischemia; (2) intraoperative and postoperative parameters, including surgery time, red blood cell and plasma transfusion, platelet concentrate transfusion, bleeding and primary graft malfunction, and duration of the hospital and intensive care unit stays; and (3) follow-up information for the patency of the portal vein, rethrombosis rate, stenosis and reoperation (relaparotomy or retransplantation), in-hospital mortality, and actuarial 1-year survival rate. Among the 3 groups of recipients, no significant differences were detected in preoperative and intraoperative parameters. However, compared to PVT patients without an implantable pump, PVT patients with an implantable pump showed remarkable reductions in their postoperative hospital stay, rethrombosis, reoperation rate, and in-hospital mortality. An implantable pump of the portal vein in liver transplantation patients can prevent and facilitate the treatment of portal vein rethrombosis and is associated with a reduction of in-hospital mortality. Liver Transpl 16:324,331, 2010. © 2010 AASLD. [source]

Permanent Pacemaker Implantation Following Cardiac Surgery: Indications and Long-Term Follow-Up

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 1 2009
OFER MERIN M.D.
Background: Conduction disturbances requiring permanent pacemaker implantation after heart surgery occur in about 1.5% of patients. Early pacemaker implantation may reduce morbidity and postoperative hospital stay. We reviewed our experience with patients undergoing surgery to try and identify predictors for pacemaker requirements and patients who will remain pacemaker dependent. Methods: We performed a retrospective review of 4,999 patients undergoing surgery between the years 1993 and 2005. Patient age was 64 ± 12 years, and 71% were males. Coronary bypass was performed in 4,071 (81%), aortic valve replacement in 675 (14%), and mitral valve replacement in 968 (18%) patients. Results: Seventy-two patients (1.4%) required implantation of a permanent pacemaker after surgery. Indications for pacemaker implantation included complete atrioventricular block in 59, symptomatic bradycardia/slow atrial fibrillation in nine, second-degree atrioventricular block in two, and other conduction disturbances in two patients. Predictors for pacemaker requirement by multivariate analysis were left bundle branch block and aortic valve replacement (P < 0.001). Late follow-up was available in 58 patients, at 72 ± 32 months. Thirty-seven (63%) were pacemaker dependent. Predictors for late pacemaker dependency were third-degree atrioventricular block after surgery and preoperative left bundle branch block (P < 0.001). Conclusions: Patients at high risk for pacemaker implantation after heart surgery include those with preexisting conduction disturbances, and those undergoing aortic valve replacement. Of those receiving a pacemaker, about one-third will recover at late follow-up. For patients in the high-risk group who are pacemaker dependent after surgery, we recommend implanting a permanent pacemaker at 5 days after surgery, thus enabling early mobilization and early discharge. [source]

Cost-effective method for laparoscopic choledochotomy

ANZ JOURNAL OF SURGERY, Issue 1-2 2005
John Griniatsos
Background: Recent reports have noted that postoperative complications following open or laparoscopic choledochotomy for common bile duct (CBD) exploration are mainly related to the T-tube presence, and that there has been no trend of decrease in the laparoscopic era. Laparoscopic endobiliary stent placement with primary closure of the CBD has been proposed as a safe and effective alternative to T-tube placement. Methods: Between January 1999 and January 2003, 53 consecutive patients suffering from proven choledocholithiasis underwent laparoscopic common bile exploration (LCBDE) via choledochotomy. In the early period, a T-tube was placed at the end of the procedure (group A, n = 32) while, from June 2001 onwards, laparoscopic biliary stent placement and primary CBD closure were chosen as the drainage method (group B, n = 21). Results: Six patients developed T-tube-related complications postoperatively. Univariate analysis revealed statistically significant lower morbidity rate and shorter postoperative hospital stay for the stent group. Although not statistically significant, a median saving of £780 per patient was observed in the stent group. Conclusion: Biliary endoprosthesis placement following laparoscopic choledochotomy avoids the well-known complications of a T-tube, leading to a shorter postoperative hospital stay. The method is safe and effective and it should also be considered as cost-effective compared to T-tube placement. Further studies are required in order to document cost-effectiveness of the method. [source]

Clinical outcomes of laparoscopic colonic resection for diverticular disease in Japanese patients

ASIAN JOURNAL OF ENDOSCOPIC SURGERY, Issue 3 2010
T Akagi
Abstract Introduction: Indications for laparoscopic surgery for colonic diverticular disease have not been established in Japan despite this being a relatively common disease. We studied surgical outcomes of laparoscopic colon resection (LCR) versus open colon resection (OCR) for diverticular disease. Methods: We retrospectively reviewed surgical outcomes of 21 patients with colonic diverticulitis. Results: Of these 21 patients, 11 underwent OCR, and 10 underwent LCR. There were no differences in age, sex, and BMI between the groups. Diverticulitis in the LCR group, compared to the OCR group, was characterized as being of the uncomplicated type with a right-side location (P<0.01). Volume of blood loss and duration of postoperative hospital stay were less in the LCR group than in the OCR group (P<0.05). There were no significant differences in operative times, duration to start of solid food intake, and rate of postoperative complications. Conclusion: These results suggest that LCR for diverticulitis can be performed safely and less invasively without increased morbidity for uncomplicated diverticulitis. Further studies will be needed to determine the benefits of LCR for complicated diverticulitis. [source]

Laparoscopic sphincter-preserving surgery for low rectal tumor using prolapsing technique

ASIAN JOURNAL OF ENDOSCOPIC SURGERY, Issue 1 2010
M.H. Zheng
Abstract Introduction: With this study, we aimed to assess the feasibility and outcome of laparoscopy-assisted low anterior resection with a prolapsing technique for low rectal tumors. Materials and Methods: We studied surgical techniques, recovery status, complications, oncological clearance and the results of short-term follow-up in 15 patients who had received laparoscopy-assisted low anterior resection with a prolapsing technique for low rectal tumors between October 2005 and January 2008. Results: None of the cases was converted to open surgery. The mean operation time was 185 min (150,232 min), and the mean blood loss was 75 ml (25,105 ml). The mean time for passage of flatus, duration of urinary drainage, and postoperative hospital stay were 3 d (1,4 d), 6 d (5,10 d) and 11 d (7,20 d), respectively. The total amount of lymph nodes harvested was 15 (9,21), and the mean distal margin from the tumor was 2.5 cm (1.0,3.9 cm). No major complications were observed. The mean follow-up time was 13 months (4,27 months). Neither local recurrence nor metastasis was observed. Acceptable anal function results were obtained in most patients. Discussion: Laparoscopy-assisted low anterior resection with a prolapsing technique can be successfully performed. [source]

Minimally invasive straight laparoscopic total proctocolectomy for ulcerative colitis

ASIAN JOURNAL OF ENDOSCOPIC SURGERY, Issue 1 2010
H. Ozawa
Abstract Introduction: We have performed straight laparoscopic total proctocolectomy for ulcerative colitis, in which all procedures, including transection of the rectum and anastomosis, were performed in the abdominal cavity. The primary objective of this study was to evaluate whether straight laparoscopic total proctocolectomy is technically feasible and safe. Methods: A retrospective database identified 22 consecutive patients who underwent straight laparoscopic total proctocolectomy for ulcerative colitis between March 1998 and September 2007. Patients were excluded if they required emergency surgery. First, to create a stoma site, a mini-laparotomy to insert a 15 mm trocar was performed. Seven other trocars, 5 mm in diameter, were then inserted. Mobilization and dissection of the colorectum and anastmosis were performed completely intracorporeally under laparoscopic guidance. Anastomosis of an ileal J-pouch to the anal canal was performed using the double-stapling technique. Results: Nineteen patients were underwent ileal pouch anal canal anastomosis; two underwent ileorectal anastomosis; and one underwent abdominoperineal resection. The median operation time was 355 min (range 255,605); the median blood loss was 50 g (range 0,800); and the median postoperative hospital stay was 24.5 d. Postoperative complications occurred in eight patients, including three (13.6%) with bowel obstruction, two (9.1%) with portal vein thrombosis, one (4.5%) with anastomotic leakage, and one (4.5%) with postoperative hemorrhage. The morbidity rate was 36.4%. There were no intraoperative complications or conversions to conventional surgery. Conclusion: In the context of this study, we have shown that straight laparoscopic total proctocolectomy is technically feasible and safe in patients with ulcerative colitis. [source]

Laparoscopic resection with transcolonic specimen extraction for ileocaecal Crohn's disease,

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 4 2010
E. J. Eshuis
Background: Ileocolic resection for Crohn's disease can be performed entirely laparoscopically. However, an incision is needed for specimen extraction. This prospective observational study assessed the feasibility of endoscopic transcolonic specimen removal. Methods: Endoscopic specimen removal was attempted in a consecutive series of ten patients scheduled for laparoscopic ileocolic resection. Primary outcomes were feasibility, operating time, reoperation rate, pain scores, morphine requirement and hospital stay. To assess applicability, outcomes were compared with previous data from patients who had laparoscopically assisted operations. Results: Transcolonic removal was successful in eight of ten patients; it was considered not feasible in two patients because the inflammatory mass was too large (7,8 cm). Median operating time was 208 min and median postoperative hospital stay was 5 days. After surgery two patients developed an intra-abdominal abscess, drained laparoscopically or percutaneously, and one patient had another site-specific infection. The operation took longer than conventional laparoscopy, with no benefits perceived by patients in terms of cosmesis or body image. Conclusion: Transcolonic removal of the specimen in ileocolic Crohn's disease is feasible in the absence of a large inflammatory mass but infection may be a problem. It is unclear whether the technique offers benefit compared with conventional laparoscopic surgery. Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source]

Multicentre study of the safety of laparoscopic subtotal gastrectomy for gastric cancer in the elderly

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 12 2009
G. S. Cho
Background: The aim of this study was to assess the safety and short-term value of laparoscopic gastrectomy in the elderly with gastric cancer compared with a younger cohort. Methods: Data on all patients with gastric cancer undergoing laparoscopic gastrectomy at ten institutions in Korea between May 1998 and December 2005 were collected. Patients under the age of 45 years and those undergoing total gastrectomy, proximal gastrectomy and pylorus-preserving gastrectomy were excluded. An analysis of clinicopathological data for patients aged 45,69 years (average-age group) and those aged 70 years or more (elderly group) was undertaken. Results: Co-morbidity was more common and postoperative hospital stay was longer in elderly patients. Pre-existing pulmonary and cardiovascular disease in the elderly contributed to respiratory dysfunction and intraperitoneal complications respectively. Tumour size and location, stage, methods of reconstruction and the number of combined operations were similar in the two groups. There were no significant differences in postoperative morbidity or mortality. Conclusion: Although elderly patients had greater co-morbidity, laparoscopic gastrectomy was a safe treatment for gastric cancer in this age group. Copyright © 2009 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source]

Advantages of laparoscopic stented choledochorrhaphy over T-tube placement

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 7 2004
A. M. Isla
Background: Postoperative complications after laparoscopic choledochotomy are mainly related to the tube. Both laparoscopic endobiliary stent placement with primary closure of the common bile duct (CBD) and primary closure of the CBD without drainage have been proposed as safe and effective alternatives to -tube placement. Methods: This was a retrospective analysis of data collected prospectively on 53 consecutive patients suffering from proven choledocholithiasis who underwent laparoscopic CBD exploration through a choledochotomy between January 1999 and January 2003. In the early period a -tube was placed at the end of the procedure (n = 32). Biliary stent placement and primary CBD closure was performed from June 2001 (n = 21). Results: There were no significant differences in epidemiological characteristics, preoperative factors or intraoperative findings between the groups. Seven patients developed complications, six in the -tube group and one in the stent group. Univariate analysis revealed a significantly lower morbidity rate and shorter postoperative hospital stay in the stent group. Conclusion: Placement of a biliary endoprosthesis after laparoscopic choledochotomy achieves biliary decompression, and avoids the complications of a tube, leading to a shorter postoperative hospital stay. The method is a safe and effective alternative method of CBD drainage after laparoscopic choledochotomy. Copyright © 2004 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source]

Autologous or homologous transfusion in aortic surgery: randomized trial

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 4 2001
F. Torella
Background: Aortic surgery often requires blood transfusion, which may cause complications and postoperative infection. Autologous transfusion was evaluated in a multicentre clinical trial. Methods: Some 145 patients undergoing elective aortic surgery in eight hospitals were randomized to either ,homologous' or ,autologous' transfusion, a combination of acute normovolaemic haemodilution (ANH) and intraoperative cell salvage. Homologous blood was administered when the haemoglobin concentration fell below 8 g dl,1. Results: Median (interquartile range (i.q.r.)) blood loss was 668 (400,862) ml or 17 (10,24) per cent of blood volume in aortobifemoral bypass, and 1120 (765,1700) ml or 24 (17,36) per cent in aneurysm repair (P < 0·001). Autologous transfusion reduced homologous blood requirements from a median (i.q.r.) of 2 (0,4) units to 0 (0,2) units (P = 0·008). Independent predictors of blood transfusion were homologous transfusion strategy (odds ratio (OR) 2·3 (95 per cent confidence interval 1·1,5·0); P = 0·03), low preoperative haemoglobin concentration (OR 3·7 (1·7,8·2); P < 0·001), prolonged surgery (OR 2·1 (1·0,4·8); P = 0·05) and blood loss (OR 3·0 (1·4,6·5); P = 0·007). Patients with a preoperative haemoglobin concentration greater than 13·5 g dl,1 and who lost less than 20 per cent of their blood volume rarely required transfusion. There was no significant difference between the groups in terms of morbidity, mortality and postoperative hospital stay. Conclusion: Autologous transfusion reduced the need for homologous blood in aortic surgery, but was useful only in patients with low haemoglobin levels or when blood loss exceeded 20 per cent of the blood volume. ANH alone is indicated for patients undergoing aortobifemoral bypass and in those with a higher haemoglobin level and blood volume. © 2001 British Journal of Surgery Society Ltd [source]

Improving operative safety for cirrhotic liver resection

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 2 2001
Dr C.-C.
Background: Liver resection in a patient with cirrhosis carries increased risk. The purposes of this study were to review the results of cirrhotic liver resection in the past decade and to propose safe strategies for cirrhotic liver resection. Methods: Based on the date of operation, 359 cirrhotic liver resections in 329 patients were divided into two intervals: period 1, from September 1989 to December 1994, and period 2, from January 1995 to December 1999. The patient backgrounds, operative procedures and early postoperative results were compared between the two periods. The factors that influenced surgical morbidity were analysed. Results: In period 2, patient age was higher and the amounts of blood loss and blood transfused were lower. Although postoperative morbidity rates were similar, blood transfusion requirement, postoperative hospital stay and mortality rate were significantly reduced in period 2. No death occurred in 154 consecutive cirrhotic liver resections in the last 38 months of the study. Prothrombin activity and operative time were independent factors that influenced postoperative morbidity. Conclusion: With improving perioperative assessment and operative techniques, most complications after cirrhotic liver resection can be treated with a low mortality rate. However, more care should be taken if prothrombin activity is low or there is a long operating time. © 2001 British Journal of Surgery Society Ltd [source]

Morbidity and mortality of inadvertent enterotomy during adhesiotomy

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 4 2000
A. A. van der Krabben
Background: Inadvertent enterotomy is a feared complication of adhesiotomy during abdominal reoperation. The nature and extent of this adhesion-associated problem are unknown. Methods: The records of all patients who underwent reoperation between July 1995 and September 1997 were reviewed retrospectively for inadvertent enterotomy, risk factors were analysed using univariate and multivariate parameters, and postoperative morbidity and mortality rates were assessed. Results: Inadvertent enterotomy occurred in 52 (19 per cent) of 270 reoperations. Dividing adhesions in the lower abdomen and pelvis, in particular, caused bowel injury. In univariate analysis body mass index was significantly higher in patients with inadvertent enterotomy (mean(s.d.) 25·5(4·6) kg/m2 ) than in those without enterotomy (21·9(4·3) kg/m2 ) (P < 0·03). Patient age and three or more previous laparotomies appeared to be independent parameters predicting inadvertent enterotomy (odds ratio (95 per cent confidence interval) 1·9 (1·3,2·7) and 10·4 (5·0,21·6) respectively; P < 0·001). Patients with inadvertent enterotomy had significantly more postoperative complications (P < 0·01) and urgent relaparotomies (P < 0·001), a higher rate of admission to the intensive care unit (P < 0·001) and parenteral nutrition usage (P < 0·001), and a longer postoperative hospital stay (P < 0·001). Conclusion: The incidence of inadvertent enterotomy during reoperation is high. This adhesion-related complication has an impact on postoperative morbidity. © 2000 British Journal of Surgery Society Ltd [source]

The effect of spleen-preserving lymphadenectomy on surgical outcomes of locally advanced proximal gastric cancer

JOURNAL OF SURGICAL ONCOLOGY, Issue 5 2009
Sung Jin Oh MD
Abstract Background The aim of this study was to investigate the effects of D2 lymphadenectomy with spleen preservation on surgical outcomes in locally advanced proximal gastric cancer. Methods Between January 2000 and December 2004, a total of 366 patients who underwent curative total gastrectomy were studied retrospectively from a prospectively designed database. Results The spleen-preservation group experienced shorter operation times, a lower incidence of perioperative transfusion, and shorter postoperative hospital stays. Perioperative transfusion and splenectomy were independent risk factors for morbidity. There was no significant difference between the two groups in recurrence or cumulative survival rate when adjusted according to cancer stage. Multivariate analysis showed that tumor size, serosal invasion, and nodal metastasis were independent prognostic factors, while splenectomy was not. The cumulative survival rate in pN0-status patients was significantly higher in the spleen-preservation group, while there was no significant difference in the survival of pN1- or pN2-status patients between the two groups. Conclusions Splenectomy for lymph node dissection in proximal gastric cancer patients obviously showed poor short-surgical outcomes, but it did not affect long-term outcomes in terms of recurrence and overall survival rate. Therefore, spleen-preserving lymphadenectomy is a feasible method for radical surgery in locally advanced proximal gastric cancer. J. Surg. Oncol. 2009;99:275,280. © 2009 Wiley-Liss, Inc. [source]