Postoperative Bowel Symptoms Improve over Time after Rectosigmoidectomy for Endometriosis.

STUDY OBJECTIVE: To evaluate bowel function (changes in stool caliber, sensation of incomplete evacuation, stooling frequency, and rectal bleeding) and urinary function (dysuria and retention) after segmental resection in patients with bowel endometriosis. DESIGN: Retrospective study. SETTING: Tertiary hospital. PATIENTS: A total of 413 (mean age = 33.6 ± 5.1 years) of reproductive aged women, with bowel endometriosis that underwent segmental bowel resection of the rectosigmoid from 2005 to 2018, without history of prior bowel surgery, without existing or history of malignancy. INTERVENTIONS: Laparoscopic segmental bowel resection performed by the same team and with the same technique. MEASUREMENTS AND MAIN RESULTS: Data collected from the patients' records included length of resected segment, distance of the lesion from the anal verge, and complications. Information on intestinal and urinary function was obtained from a questionnaire applied before the surgery and at 2, 6, and 12 months after the surgery. There was a significant increase in the incidence of stool thinning and rectal bleeding 2 months after surgical procedure; these symptoms decreased significantly over time. The incidence of urinary symptoms decreased significantly over time after surgery. The length of the bowel segment resected was not associated with the postoperative symptoms, but the rectosigmoid lesion was significantly closer to the anal verge in patients with rectal bleeding and urinary symptoms. There was no association between the length of intestinal segment resected and the frequency of stooling. At 6 months, patients who had a decreased frequency of stooling underwent a resection closer to the anal verge (9.7 cm) in comparison with the ones with unchanged or increase frequency of stooling (10.1 cm and 10.7 cm, respectively; p <.05). CONCLUSION: Patient complaints on bowel and urinary alterations after segmental resection were transient with significant improvement over time up to 12 months. Bowel and urinary symptoms were not associated with the size of the bowel segment resected, whereas rectal bleeding at 2 months after surgery was significantly associated with the distance from anal verge. Segmental resection was also associated with a great improvement in constipation at 12 months postoperative.

The Use of Cryotherapy in the Early Postoperative Period after Total Hip Arthroplasty.

BACKGROUND: Recent evidence suggests that cryotherapy may be beneficial in reducing postoperative pain and blood loss in joint arthroplasty. The objective of this study was to review the use of cryotherapy in the early postoperative phase after total hip arthroplasty to assess the benefits in terms of pain relief and reduction in postoperative blood loss. MATERIAL AND METHODS: A prospective cohort study of the use of a cryotherapy device (Hilotherm) was performed in patients following total hip arthroplasty. The primary outcome measures were visual analogue score (VAS) for pain (at 24 and 48 hours postoperatively), and amount of postoperative blood loss, measured by change in haemoglobin (g/L). The secondary outcome measures were length of stay (days), duration of patient controlled analgesia (PCA) administered postoperatively (hours) and amount of analgesia used (mg) in the first 48 hours. RESULTS: 28 patients were recruited (n=13 Hilotherm; n= 15 non-Hilotherm). Hilotherm application reduced pain in the first 24 hours, non-significantly, (3.50±2.41 vs 4.90±2.95; p=0.185). This effect was not carried through at 48 hours postoperatively (5.68±1.94 vs 3.72±2.46; p=0.029). Hilotherm application significantly reduced postoperative blood loss (22.38±5.71 g/L vs 29.13±10.22 g/L; p=0.045). Hilotherm reduced length of stay by almost 1 day; however, this was not statistically significant (4.46±2.33 vs 5.20±3.55; p=0.528). There was no difference in the length of time PCA was administered (22.30±0.75 vs 22.02±3.26; p=0.763). Patients in the non-Hilotherm group required more paracetamol on average (p=0.001). CONCLUSIONS: 1. Hilotherm application does not appear to significantly reduce pain postoperatively but re-sults in less postoperative blood loss. 2. There may be a role for the continued use of cryotherapy in the early period of rehabilitation following total hip arthroplasty, as it appears to result in more rapid ambulatory rehabilitation in patients, resulting in reduced length of stay.

Estimating the transfusion risk following total knee arthroplasty.

Patients undergoing total knee arthroplasty (TKA) are likely to receive a blood transfusion, which may increase the risk of complications and prolong hospital stay. Considerable variation exists in transfusion practice among orthopedic surgeons following elective TKA. Previous studies have investigated the relationship between preoperative risk factors and the requirement for blood transfusions in patients undergoing a total hip or knee arthroplasty, but few have focused on transfusion risk in those specifically undergoing TKA.The authors performed a retrospective review of a prospectively collected database of 2281 patients undergoing unilateral TKA in a district general hospital over a 10-year period. Multiple regression analysis models were used to identify risk factors associated with postoperative blood transfusion. A predictive model was created based on the regression coefficients and factor levels. The risk of transfusion was independently predicted by the patients' age at surgery (P<.001), preoperative hemoglobin (P<.001), weight (P=.009) and lateral retinacular release (P<.001). The preoperative variables of age, hemoglobin, and weight were incorporated into a model to provide an estimation of the transfusion risk. The area under the receiver operating characteristic curve was 74% (95% confidence interval, 70%-77.5%). This study identifies risk factors independently associated with the risk of requiring a blood transfusion following TKA. The predictive model stratifies the risk according to the individual patient in the preoperative setting, allowing preventative measures to take place preoperatively. It also helps in the counseling of patients at high risk of requiring a postoperative blood transfusion.