A minority of patients discharged within 24 hours after laparoscopic colon resection.

INTRODUCTION: Fast-track laparoscopic colon surgery has gained wide acceptance worldwide. Post-operative hospital stays of 2-5 days have typically been reported. However, in our department some of the patients have been discharged within 24 h after surgery. The aim of this study was to describe differences in demographic and perioperative data between those patients discharged within 24 h and those discharged on days 2-4 post-operatively. MATERIAL AND METHODS: Data were collected retrospectively from August 2008 to May 2012. A total of 24 patients undergoing elective right-sided hemicolectomy or sigmoidectomy for colon cancer were discharged within 24 h. These 24 patients were compared with 209 patients undergoing the same procedures, but discharged on the second to the fourth post-operative day. All patients were operated laparoscopically according to our fast-track regimen. Demographic data and short-term outcomes were compared between the two groups. RESULTS: We found that the median age (64 years versus 70 years) (p = 0.018) as well as the median operating time (120 min. versus 155 min.) (p = 0.002) were significantly lower for the 24-h stay group. No other significant differences were found between the two groups. CONCLUSION: This study showed that discharge within the first 24 h after elective laparoscopic fast-track colon surgery was significantly associated with lower age and shorter duration of surgery. FUNDING: not relevant. TRIAL REGISTRATION: not relevant.

Is laparoscopic colorectal cancer surgery in obese patients associated with an increased risk? Short-term results from a single center study of 425 patients.

INTRODUCTION: In laparoscopic colorectal cancer surgery, some authors still report increased conversion rates, operative duration and postoperative morbidity with longer hospital stay in obese patients. In our department, we had the impression that laparoscopic surgery in the obese was feasible and safe, leading to this study in which we evaluate laparoscopic surgery for colorectal cancers in the obese and measure the impact on short-term results. MATERIAL AND METHODS: In the period from November 2004 to May 2010, 425 patients were laparoscopically operated for a colon or rectal cancer in our center. Ninety-three patients had a body mass index (BMI) ≥ 30. Demographic data and short-term outcome in patients with a BMI ≥ 30 were compared to the same data in patients with a BMI < 30. RESULTS: The median operative time was significantly longer (240 vs. 225 min, p = 0.021) and the mean blood loss was significantly higher (348 vs. 285 ml, p = 0.034) in the group of patients with BMI ≥ 30. No other significant differences, including conversion to open surgery and postoperative morbidity, were found between the two groups. CONCLUSION: Laparoscopic colorectal cancer surgery is feasible and safe in obese patients with a BMI above 30, without the patients experiencing an increased risk of postoperative morbidity or mortality.

Risk factors for morbidity and mortality following gastroenterostomy.

BACKGROUND: Morbidity and mortality following traditional surgical treatment of gastric outlet obstruction is high. The aim of this work was to identify risk factors predictive of postoperative complications and mortality following gastroenterostomy. METHODS: One-hundred sixty-five consecutive patients subjected to open gastroenterostomy from January 1996 through July 2003 were included. Data on vital signs and operative variables were retrieved from medical records and recorded retrospectively. Risk factors for postoperative complications and mortality within 30 days after operation were analyzed with multiple logistic regression. RESULTS: The 30-day complication and death rates were higher after emergency operations (80% and 60%) than after elective operations (32% and 25%). A multivariate analysis disclosed that hypoalbuminemia (< or = 32 g/l), comorbidity, high age, and hyponatremia (< 135 micromol/l) were significantly associated with postoperative death, whereas hypoalbuminemia, comorbidity, high age, and emergency operation were predictors of postoperative complications. CONCLUSIONS: Complications and mortality after gastroenterostomy due to gastric outlet obstruction are associated with modifiable and non-modifiable risk factors. Prior to surgery means should be taken to correct low albumin and sodium levels to prevent complications. In addition, the surgeon should consider alternative treatment modalities including laparoscopic gastroenterostomy, self-expanding metallic stents, or tube gastrostomy to relieve or palliate gastric outlet obstruction.

[Reconstruction of anterior cruciate ligament using bone-patellar tendon-borne graft or fascia lata graft. A retrospective study of functional results]. / Rekonstruktion af forreste korsbånd med bone-patellar tendon-bone graft eller fascia lata-graft. Retrospektiv undersøgelse af funktionelle resultater.

INTRODUCTION: The purpose of this study was to compare the functional results using two different types of reconstruction of the anterior cruciate ligament. MATERIAL AND METHODS: A retrospective comparison of 34 patients operated with a fascia lata graft and 26 patients operated with a bone-patellar tendon-bone graft. The patients were evaluated twice with a postoperative Lysholm score, a preoperative and postoperative Tegner score, and a postoperative knee-laxity test. RESULTS: The Lysholm scores after the first (P = 0.07) and second (P = 0.29) postoperative control showed no difference between the two groups. There was no difference between the preoperative and postoperative Tegner scores of the two groups (P = 0.42). A total of 27 patients out of 60 practiced sports or had knee-straining work postoperatively at the same level as preoperatively. No difference was found between the two groups when comparing the knee-laxity tests (P = 0.12). DISCUSSION: This study did not find any difference in the final functional results when comparing the two operation techniques. Almost half of the patients can expect a return to sports at a preinjury level.