Cardiac tamponade caused by incarcerated small bowel in the pericardium after coronary bypass grafting using the right gastroepiploic artery.

Although rare, herniation of the gastrointestinal contents into the pericardium after coronary artery bypass grafting using the right gastroepiploic artery has been previously described. The associated clinical symptoms vary from gastrointestinal obstruction to cardiac tamponade. We report a patient who presented with cardiac tamponade secondary to incarceration of the small bowel in the pericardium 1 year after coronary artery bypass grafting utilizing the right gastroepiploic artery.

Outpatient laparoscopic adrenalectomy: a Canadian experience.

BACKGROUND: We report our experience at The Ottawa Hospital with outpatient laparoscopic adrenalectomy. METHODS: We report a single surgeon experience. Seventeen consecutive outpatient laparoscopic adrenalectomy were performed between 1994 and 2006. Specific selection criteria were applied. Postoperatively patients were monitored and assessed before discharge. Full discharge instructions were provided. A prescription for analgesic was given. A call back system was put in place. The first postoperative office visit was scheduled within 7 days of surgery. RESULTS: Twelve of 17 patients were females. The mean age was 52.4 years. Our average operating room time was 130 minutes with no conversions. The average stay was about 5.5 hours. Three patients had a 23-hour stay. One admitted with atelectasis. Tumor size ranged from 1 to 5.8 cm. There were no reoperations, late admissions up to 30 days, and no deaths. One patient required admission. Thirteen of 17 patients were contacted by phone after discharge. At our hospital we found a cost saving of C$1478 is made per case. CONCLUSIONS: Laparoscopic adrenalectomy can be safely performed as an outpatient procedure. Strict selection criteria should be applied. Call back systems should be instituted. There is a cost benefit associated with this outpatient procedure.

Outpatient thyroid surgery: should patients be discharged on the day of their procedures?

BACKGROUND: Outpatient surgery benefits patients and surgeons alike, as it is convenient, safe and cost-effective. We sought to assess the safety and feasibility of outpatient thyroid surgery (OTS) at an ambulatory site affiliated with a teaching hospital. METHODS: We performed a retrospective chart review of patients who underwent hemithyroidectomy, subtotal thyroidectomy, total thyroidectomy or completion thyroidectomy between 2002 and 2004 at the Riverside campus of The Ottawa Hospital. We analyzed patient outcomes based on hospital admission and readmission rates as well as complication rates. RESULTS: Two hundred and thirty-two patients met our inclusion criteria. Most patients were women (84%) with a mean age of 47 years. Of these patients, 43 had total thyroidectomies, 75 had subtotal thyroidectomies, 42 had left hemithyroidectomies, 57 had right hemithyroidectomies and 18 had completion thyroidectomies; 26% of these procedures were performed to treat cancer. Other pathologies included multinodular goitre (37%), adenoma (21%), nodular hyperplasia (12%) and Hashimoto thyroiditis (4%). The mean duration of surgery was 87 (range 50-150) minutes. No patients died or underwent reoperation. Complications included hypocalcaemia in 6 patients, hematoma in 1 patient, vocal cord injury in 1 patient and wound infection in 2 patients. All patients but 1 were discharged within 10 hours of surgery; the hospital admission rate was 0.4%. Four patients were readmitted within 1 week of surgery (2 for hypocalcemia, 1 for wound infection and 1 for pain control). CONCLUSION: Outpatient thyroid surgery is safe and is associated with a low complication rate.

Advanced laparoscopic surgery in a free-standing ambulatory setting: lessons from the first 50 cases.

To decrease the impact and cost of surgery, there is a trend toward developing treatment models for complex conditions on a fully outpatient basis. This is a retrospective study of the initial experience of advanced laparoscopic procedures performed on a same-day outpatient basis in the ambulatory campus of a university hospital. Over 3 years, 55 patients underwent 50 Nissen fundoplications and 5 adrenalectomies. There were 2 intraoperative complications, with no mortality and no conversion. The median postoperative stay was 4.5 hours. Readmission at 1 month was 11%. Data on the nursing postoperative telephone follow-up were available for 50 patients; 34 (62%) were successfully contacted. Twenty four (70%) had no complaint. Preliminary high-level cost data indicate a cost advantage. Advanced laparoscopic procedures can be done safely in a pure ambulatory setting; the current readmission rate can be reduced with improved pain management and better telephone follow-up strategies. Cost savings are likely.