Vascular Injury During Urologic Surgery: Somebody Call My Mother.

PURPOSE OF REVIEW: To provide the critical elements to effectively manage hemorrhage from vascular injuries sustained during planned urological interventions. RECENT FINDINGS: The frequency of intraoperative vascular injuries is increasing. However, literature concerning the management of iatrogenic operative vascular injuries is scarce. Although rare, intraoperative vascular injuries may be associated with potential catastrophic complications and death. The decision-making process following a potential life-threatening intraoperative vascular injury occurs in a very short time frame. Appropriate knowledge of the critical elements to identify the source of bleeding, initiate first-line hemostatic measures, select the candidate for damage control strategies, and perform the indicated operative repairing maneuvers and techniques have been proved crucial to ensure hemodynamic stability and bleeding cessation. The key surgical principles to counteract the impact of exsanguinating bleeding, and the aim to obtain the best achievable outcomes after definitive repair, are described in detail in this review.

Cost-benefit analysis comparing laparoscopic and open ventral hernia repair.

OBJECTIVE: Laparoscopic surgery is a successful treatment option offering significant advantages to patients compared with open ventral hernia repair. A cost-benefit analysis was performed to compare the clinical results and economic costs of the open and laparoscopic techniques for anterior abdominal wall hernia repair, in order to determine the more efficient procedure. MATERIAL AND METHODS: We performed a prospective study of 140 patients with primary and incisional hernia, and analyzed clinical data, morbidity, costs of surgery and hospital stay costs. RESULTS: The cost of disposable surgical supplies was higher with laparoscopic repair but reduced the average length of stay (P<.001) and patient morbidity (P<.001). The total cost of the laparoscopic procedure was, therefore, less than initially estimated, yielding a savings of 1,260€ per patient (2,865€ vs. 4,125€). CONCLUSIONS: Laparoscopic ventral hernia repair is associated with a reduced complication rate, a lower average length of stay and with lower total costs. Laparoscopic repair can save 1.260€ for each patient, and so this procedure should be considered a cost-effective approach.

Estudio de coste-beneficio comparando la reparación de la hernia ventral abierta y laparoscópica / Cost-benefit analysis comparing laparoscopic and open ventral hernia repair

OBJETIVO: La laparoscopia ofrece importantes ventajas clínicas respecto a la técnica abierta en la reparación de las hernias de pared abdominal. Se realiza un estudio coste-beneficio con el objetivo de analizar los resultados clínicos y los costes económicos comparando la técnica abierta y la laparoscopia en la reparación de la hernia de pared anterior abdominal y así determinar el procedimiento más eficiente. MATERIAL Y MÉTODOS: Estudio prospectivo de cohortes sobre 140 pacientes consecutivos con hernias ventrales, con el objetivo de evaluar el coste de ambas técnicas. Se analizan datos clínicos, morbilidad, estancia hospitalaria, complicaciones y costes. RESULTADOS: La vía laparoscópica presentó menor estancia media (p < 0,001), menor morbilidad postoperatoria y complicaciones (p < 0,001) y reducción en la tasa de reingresos. El coste del material laparoscópico fue más alto, aunque el coste total del procedimiento por paciente fue menor (2.865 Euros) vs. reparación abierta (4.125 Euros). CONCLUSIONES: La reparación laparoscópica de las hernias ventrales de pared abdominal aporta beneficios para los pacientes y presenta, además, un coste final del procedimiento sensiblemente menor, evitándose un gasto de 1.260 Euros por cada paciente intervenido por esta vía. Además de ser una técnica eficiente, la reparación laparoscópica es coste-efectiva

OBJECTIVE: Laparoscopic surgery is a successful treatment option offering significant advantages to patients compared with open ventral hernia repair. A cost-benefit analysis was performed to compare the clinical results and economic costs of the open and laparoscopic techniques for anterior abdominal wall hernia repair, in order to determine the more efficient procedure. MATERIAL AND METHODS: We performed a prospective study of 140 patients with primary and incisional hernia, and analyzed clinical data, morbidity, costs of surgery and hospital stay costs. RESULTS: The cost of disposable surgical supplies was higher with laparoscopic repair but reduced the average length of stay (P < .001) and patient morbidity (P < .001). The total cost of the laparoscopic procedure was, therefore, less than initially estimated, yielding a savings of 1,260 Euros per patient (2,865 Euros vs. 4,125 Euros). CONCLUSIONS: Laparoscopic ventral hernia repair is associated with a reduced complication rate, a lower average length of stay and with lower total costs. Laparoscopic repair can save 1.260 Euros for each patient, and so this procedure should be considered a cost-effective approach