Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 14.920
Filtrar
1.
J Surg Res ; 281: 282-288, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36219940

RESUMO

INTRODUCTION: Shift-based models for acute surgical care (ACS), where surgical emergencies are treated by a dedicated team of surgeons working shifts, without a concurrent elective practice, are becoming more common nationwide. We compared the outcomes for appendectomy, one of the most common emergency surgical procedures, between the traditional (TRAD) call and ACS model at the same institution during the same time frame. METHODS: A retrospective review of patients who underwent laparoscopic appendectomy for acute appendicitis during 2017-2018. ACS and TRAD-patient demographics, clinical presentation, operative details, and outcomes were compared using independent sample t-tests, Wilcoxon rank-sum tests and Fisher's exact or χ2 tests. Multiple exploratory regression models were constructed to examine the effects of confounding variables. RESULTS: Demographics, clinical presentation, and complication rates were similar between groups except for a longer duration of symptoms prior to arrival in the TRAD group (Δ = 0.5 d, P = 0.006). Time from admission to operating room (Δ = -1.85 h, P = 0.003), length of hospital stay (Δ = -2.0 d, P < 0.001), and total cost (Δ = $ -2477.02, P < 0.001) were significantly lower in the ACS group compared to the TRAD group. Furthermore, perforation rates were lower in ACS (8.3% versus 28.6%, P = 0.003). Differences for the outcomes remained significant even after controlling for duration of symptoms prior to arrival (P < 0.05). CONCLUSIONS: Acute appendicitis managed using the ACS shift-based model seems to be associated with reduced time to operation, hospital stay, and overall cost, with equivalent success rates, compared to TRAD.


Assuntos
Apendicite , Laparoscopia , Humanos , Apendicectomia/efeitos adversos , Apendicectomia/métodos , Apendicite/cirurgia , Apendicite/complicações , Resultado do Tratamento , Tempo de Internação , Doença Aguda , Estudos Retrospectivos , Laparoscopia/efeitos adversos
2.
J Surg Res ; 281: 307-313, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36228341

RESUMO

INTRODUCTION: One-half of Americans have limited access to health care; these patients often receive care through safety net hospitals, which are associated with worse medical outcomes. This study aims to compare the outcomes of patients who received foregut surgery at a safety net hospital to those at a private or university hospital. We hypothesized that patients treated at the safety net hospital will have a greater rate of radiographic recurrence and reoperations. METHODS: A retrospective study was conducted on patients who underwent hiatal hernia repair or fundoplication for gastroesophageal reflux disease at an affiliated safety net, private, or university hospital from June 2015 to May 2020. The primary outcome was radiographic recurrence. The secondary outcomes included reoperation and symptom recurrence. Analysis was performed using analysis of variance, chi-square, and logistic regression. RESULTS: A total of 499 patients were identified: 157 at a safety net hospital, 233 at a private hospital, and 119 at a university hospital. The median (interquartile range) follow-up was 16 (13) mo. The safety net hospital treated more Hispanics, females, and patients with comorbidities. Large hiatal hernias were more common at the safety net and private hospitals. Robotic surgery was more frequently at the university hospital. There was no difference in radiographic recurrence (13.4% versus 19.7% versus 17.6%; P = 0.269), reoperation (3.8% versus 7.2% versus 6.7%; P = 0.389), or postoperative dysphagia (15.3% versus 12.6% versus 15.1%; P = 0.696). On logistic regression, there were no differences in outcomes among institutions. CONCLUSIONS: This study suggests that despite the challenges faced at safety net hospitals, it could be feasible to safely perform minimally invasive foregut surgery with similar outcomes to private and university hospitals.


Assuntos
Hérnia Hiatal , Laparoscopia , Feminino , Humanos , Hérnia Hiatal/cirurgia , Hérnia Hiatal/complicações , Provedores de Redes de Segurança , Estudos Retrospectivos , Estudos de Viabilidade , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Fundoplicatura/efeitos adversos , Fundoplicatura/métodos , Resultado do Tratamento
3.
Reg Anesth Pain Med ; 48(1): 7-13, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36167477

RESUMO

BACKGROUND AND AIMS: An opioid-sparing postoperative analgesic regimen following laparoscopic hemicolectomy is optimal to promote minimal postoperative pain, early mobilization, and improved quality of recovery. Various regional anesthesia techniques have been tested to improve postoperative pain management after laparoscopic hemicolectomy. In this study, we aimed to assess the effect of administering a preoperative bilateral ultrasound-guided anterior quadratus lumborum nerve block on postoperative opioid consumption after laparoscopic colon cancer surgery. METHODS: In this randomized, controlled, double-blinded trial, 69 patients undergoing laparoscopic hemicolectomy due to colon cancer were randomized to receive an anterior quadratus lumborum block with ropivacaine 0.375% 30 mL on each side or isotonic saline (placebo). The primary outcome measure was total opioid consumption during the first 24 hours postsurgery. The secondary outcome measures were pain scores, accumulated opioid consumption in 6-hour intervals, nausea and vomiting, ability of postoperative ambulation, time to first opioid, orthostatic hypotension or intolerance, postoperative Quality of Recovery-15 scores, surgical complications, length of hospital stay, and adverse events. RESULTS: The total opioid consumption in the first 24 hours postsurgery was not significantly reduced in the ropivacaine group compared with the saline group (mean 129 mg (SD 88.4) vs mean 127.2 mg (SD 89.9), p=0.93). In addition, no secondary outcome measures showed any statistically significant intergroup differences. CONCLUSION: The administration of a preoperative bilateral anterior quadratus lumborum nerve block as part of a multimodal analgesic regimen for laparoscopic hemicolectomy did not significantly reduce opioid consumption 24 hours postsurgery. Trial registration number NCT03570541.


Assuntos
Neoplasias do Colo , Laparoscopia , Bloqueio Nervoso , Humanos , Analgésicos Opioides , Ropivacaina/uso terapêutico , Anestésicos Locais , Bloqueio Nervoso/efeitos adversos , Bloqueio Nervoso/métodos , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/prevenção & controle , Colectomia/efeitos adversos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Método Duplo-Cego , Analgésicos/uso terapêutico , Neoplasias do Colo/cirurgia , Neoplasias do Colo/complicações , Neoplasias do Colo/tratamento farmacológico
4.
Turk J Med Sci ; 52(3): 631-640, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-36326308

RESUMO

BACKGROUND: Although laparoscopic inguinal herniorrhaphy is associated with faster return to daily activity, inadequate postoperative pain control can cause prolonged hospital stays and patient discomfort. Erector spinae plane block (ESP) can be administered for postoperative pain management in abdominal and thoracic surgery. We investigated the effects of unilateral ESP block application in laparoscopic hernia surgery. METHODS: A total of 60 patients who were scheduled for laparoscopic inguinal hernia surgery were included. ESP block was performed in group E (n = 30) after induction of anesthesia. There was no intervention in Group C (n = 30). Postoperative pain was assessed by the patient using the numeric rating scale (NRS) at postanesthetic care unit (PACU),1, 4, 6, 12, and 24 h after surgery. The quality of postoperative functional recovery was evaluated using the quality of recovery-40 questionnaire. RESULTS: NRS scores were lower in Group E (n = 30) than in Group C (n = 30) at PACU, 1th, 4th, 6th hours in both rest and movement. Total tramadol consumption was reduced at postoperative 24 h by the ESP block [median(IQR), 60(40) versus 85(30)]. Quality of recovery score of the patients after operation was better in the ESP group than in the control group [mean(SD), 177.9(6.5) in group E and 173.2(7.09) in group C with mean differences: 4.633 and CI: 95% (1.11 to 8.15) respectively]. DISCUSSION: Unilateral ESP blocks in laparoscopic inguinal hernia surgery reduce both postoperative pain levels and analgesic consumption. In addition, the ESP block could be used safely in pain management of this type of surgery and improve the quality of recovery.


Assuntos
Hérnia Inguinal , Laparoscopia , Bloqueio Nervoso , Humanos , Hérnia Inguinal/cirurgia , Analgésicos Opioides , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/prevenção & controle , Analgésicos , Ultrassonografia de Intervenção/efeitos adversos , Laparoscopia/efeitos adversos
5.
Turk J Med Sci ; 52(4): 1322-1328, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-36326419

RESUMO

BACKGROUND: To evaluate hand-assisted laparoscopic donor nephrectomy (HALDN) in terms of intraoperative and postoperative results. METHODS: After institutional review board approval was obtained, a total of 1864 HALDN operations performed between March 2007 and January 2022 were retrospectively analyzed. Age, sex, body mass index (BMI), status of smoking and presence of previous abdominal surgery, laterality, operative time, transfusion requirement, port counts, length of extraction incision, time until mobilization, time until oral intake, donor serum creatinine levels before and one week after the surgery, length of postoperative hospital stay, intraoperative complications, and postoperative recovery and complications were recorded and statistically analyzed. Multiple renal arteries, BMI, right nephrectomy and male sex were also separately evaluated as risk factors for complications and operative time. RESULTS: A total of 825 (44.26%) male and 1039 (55.74%) female patients were enrolled in the study. The mean age of the patients was 45.79 ± 12.88 years. There were a total of 143 complications (7.67% of the total 1864 cases) consisting of 68 (3.65%) intraoperative and 75 (4.02%) postoperative complications. Open conversion was necessary for 10 patients (0.53%) to manage intraoperative complications. Reoperation was needed for 1 patient due to bleeding 6 h after the operation. Multiple renal arteries were a risk factor for intraoperative complications and prolonged operative time. Right nephrectomy and male sex were also related with longer operative times. DISCUSSION: HALDN is a safe procedure associated with low complication rates.


Assuntos
Laparoscopia Assistida com a Mão , Transplante de Rim , Laparoscopia , Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Laparoscopia Assistida com a Mão/efeitos adversos , Laparoscopia Assistida com a Mão/métodos , Doadores Vivos , Estudos Retrospectivos , Nefrectomia/efeitos adversos , Nefrectomia/métodos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Intraoperatórias/etiologia
6.
Medicine (Baltimore) ; 101(46): e31592, 2022 Nov 18.
Artigo em Inglês | MEDLINE | ID: mdl-36401493

RESUMO

BACKGROUND: The usefulness of the oxygen reserve index (ORi) in reducing hyperoxemia remains unclear. We designed this study to investigate whether fraction of inspired oxygen (FiO2) adjustment under a combination of ORi and peripheral oxygen saturation (SpO2) guidance can reduce intraoperative hyperoxemia compared to SpO2 alone. METHODS: In this prospective, double-blind, randomized controlled study, we allocated patients scheduled for laparoscopic gastrectomy to the SpO2 group (FiO2 adjusted to target SpO2 ≥ 98%) or the ORi-SpO2 group (FiO2 adjusted to target 0 < 0 ORi < .3 and SpO2 ≥ 98%). The ORi, SpO2, FiO2, arterial partial pressure of oxygen (PaO2), and incidence of severe hyperoxemia (PaO2 ≥ 200 mm Hg) were recorded before and 1, 2, and 3 hours after surgical incision. Data from 32 and 30 subjects in the SpO2 and ORi-SpO2 groups, respectively, were analyzed. RESULTS: PaO2 was higher in the SpO2 group (250.31 ± 57.39 mm Hg) than in the ORi-SpO2 group (170.07 ± 49.39 mm Hg) 1 hour after incision (P < .001). PaO2 was consistently higher in the SpO2 group than in the ORi-SpO2 group, over time (P = .045). The incidence of severe hyperoxemia was higher in the SpO2 group (84.4%) than in the ORi-SpO2 group (16.7%, P < .001) 1 hour after incision. Higher FiO2 was administered to the SpO2 group [52.5 (50-60)] than the ORi-SpO2 group [40 (35-50), P < .001] 1 hour after incision. SpO2 was not different between the 2 groups. CONCLUSION: The combination of ORi and SpO2 guided FiO2 adjustment reduced hyperoxemia compared to SpO2 alone during laparoscopic gastrectomy.


Assuntos
Laparoscopia , Oxigênio , Humanos , Oximetria , Estudos Prospectivos , Gastrectomia/efeitos adversos , Laparoscopia/efeitos adversos
7.
Prog Urol ; 32(14): 928-939, 2022 Nov.
Artigo em Francês | MEDLINE | ID: mdl-36410865

RESUMO

INTRODUCTION: Surgical techniques of radical and partial nephrectomy have changed over the last 20years. Indications for partial nephrectomy have widened and mini-invasive surgery (laparoscopy and robotic assistance) has become widely used. However, both still have a significant morbidity. The objective of this article is to review complications of renal surgery and their predictive factors and to offer algorithms of management. METHODS: Recent literature regarding complications of radical and partial nephrectomy was queried using Pubmed engine search. The most relevant articles were analyzed and served as a basis for this work. RESULTS: The literature on complications of radical and partial nephrectomy has a low level of evidence. There are only retrospective series. The most frequent complications of radical nephrectomy occur during surgery in 5-10% of the cases: wound of the pedicle or of an adjacent organ. The management can often be conservative. Laparoscopy has a similar morbidity compare to the open approach but has greatly increased postoperative outcomes and comfort. Partial nephrectomy has a 20% complication rate. Many factors have an impact on the risk of complications (tumor size, inflammation of perirenal fat, access, surgeon experience, centre volume, comorbidities and age of the patient) and must be taken into consideration before advising partial nephrectomy. The two most feared complications of partial nephrectomy are bleeding (per- or postoperative, 10% of the cases) and urinary fistula (<5% of the cases). Robotic assistance is associated with a lower morbidity in many publications. CONCLUSION: Complications after partial and radical nephrectomy are quite frequent but have decreased with the improvement of surgical techniques. French urologists should maintain their interest in novel technologies and simplification of perioperative pathway to further improve patients' outcomes.


Assuntos
Laparoscopia , Fístula Urinária , Humanos , Estudos Retrospectivos , Nefrectomia/efeitos adversos , Rim , Laparoscopia/efeitos adversos
8.
Medicine (Baltimore) ; 101(43): e31420, 2022 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-36316887

RESUMO

RATIONALE: Surgery is the treatment of choice for esophageal cancer. Since the 1990s, minimally invasive esophagectomy (MIE) has been developed using videoscope. Although MIE lowers mortality by reducing postoperative complications, the risk of carbon dioxide (CO2) insufflation related complications still exists. PATIENT CONCERNS: A 56-years-old male patient underwent elective MIE. The patient (body mass index, 15 kg/m2) had well-controlled hypertension, cardiomegaly, and severe emphysematous lungs. He had iatrogenic pneumothorax during central venous catheterization 3 weeks prior; however, the pneumothorax was resolved before surgery. DIAGNOSIS: During thoracoscopic surgery, respiratory acidosis was not corrected despite rapid respiratory rate and positive end-expiratory pressure. Intrathoracic CO2 pressure was lowered from 12 to 8 mm Hg, and laparoscopic surgery was performed through the diaphragm in the reverse Trendelenburg position. In 15 minutes at this position, pulseless electrical activity with respiratory failure and high peak inspiratory pressure developed. INTERVENTIONS: CO2 insufflation was stopped and drained as soon as hypotension developed. The patient was placed in the supine neutral position, and cardiopulmonary circulation was restored without further treatment. OUTCOMES: After the pneumomediastinum event, surgery was successfully performed. Respiratory acidosis due to CO2 insufflation was not corrected during surgery and the patient was transferred to intensive care unit without extubation. After 14 days, the patient was discharged without cardiopulmonary complications. However, the patient expired 2 years later due to cardiovascular disease. LESSONS: In MIE, there is always a risk of catastrophic tension pneumomediastinum along with intravascular volume depletion, surgical position, and ventilatory strategy depending on the surgical characteristics.


Assuntos
Neoplasias Esofágicas , Laparoscopia , Enfisema Mediastínico , Pneumotórax , Masculino , Humanos , Pessoa de Meia-Idade , Esofagectomia/efeitos adversos , Dióxido de Carbono , Pneumotórax/cirurgia , Enfisema Mediastínico/etiologia , Neoplasias Esofágicas/cirurgia , Hemodinâmica , Laparoscopia/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos , Resultado do Tratamento
9.
Medicine (Baltimore) ; 101(43): e31131, 2022 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-36316905

RESUMO

Surgery is the only curative approach for resectable esophageal cancer. This retrospective study was to investigate the immediate effect and operative complications of conventional and modified thoracolaparoscopic esophagectomy with a cervical or abdominal incision to extract specimen for the treatment of patients with esophageal cancer. Eighty-one patients were enrolled, among which 55 patients underwent conventional McKeown thoracolaparoscopic esophagectomy (conventional MTE) and 26 patients underwent modified MTE with a cerivical incision (modified MTE). The clinical, surgical, and postoperative data were analyzed. No significant (P > .05) difference was detected in the clinical data between two groups. The surgical procedure was successful in all patients (100%). The surgical time was significantly (P = .018) shorter in the conventional MTE group than in the modified MTE group (280 min vs 317 min). However, no significant (P > .05) difference was found in blood loss (200 mL vs 180 mL), intensive care unit (ICU) stay (31.3 ± 11.3 vs 25.2 ± 6.4 hours), first flatus after surgery (2.9 ± 1.9 vs 3.3 ± 1.6 days), postoperative hospital stay (12.9 ± 5.6 vs 12.6 ± 3.3 days), total number of lymph nodes dissected (27.9 ± 4.1 vs 26.7 ± 5.7), types of carcinoma, and pathological classification. No significant (P > .05) differences were detected in postoperative complications between the two groups. Assessment of postoperative pain using the visual analogue scale (VAS) score showed a significant (P < .05) difference in the VAS score at day 2 (4.81 ± 1.70 vs 3.87 ± 1.14) and day 3 (5.10 ± 0.83 vs 4.61 ± 1.12) between the conventional and modified MTE groups. The modified McKeown thoracolaparoscopic esophagectomy with only one cervical incision is more minimally invasive, more cosmetic, and less painful than the conventional approach.


Assuntos
Neoplasias Esofágicas , Laparoscopia , Humanos , Esofagectomia/métodos , Estudos Retrospectivos , Neoplasias Esofágicas/patologia , Duração da Cirurgia , Excisão de Linfonodo/métodos , Complicações Pós-Operatórias/etiologia , Laparoscopia/efeitos adversos , Resultado do Tratamento
10.
BMJ Open ; 12(11): e062808, 2022 11 03.
Artigo em Inglês | MEDLINE | ID: mdl-36328387

RESUMO

INTRODUCTION: Placebo-controlled surgical designs are recommended to ascertain treatment effects for elective surgeries when there is genuine doubt about the effectiveness of the surgery. Some elective surgeries for pain have been unable to show an effect beyond sham surgery, suggesting contributions from contextual factors. However, the nature of contextual factors in elective surgery is largely unexplored. Further, methodological difficulties in placebo-controlled surgical trials impact the ability to estimate the effectiveness of a surgical procedure. These include an overall lack of testing the success of blinding, absence of comparison to a no-surgery control group and dearth of test for neuropathic pain.For women with peritoneal endometriosis, there is uncertainty regarding the pain-relieving effect of surgery. Surgery may put patients at risk of complications such as postsurgical neuropathic pain, without guarantees of sufficient pelvic pain relief. The planned placebo-controlled trial aims to examine the effect of surgery on pelvic pain, widespread pain and neuropathic pain symptoms in women with peritoneal endometriosis, and to test the contribution of contextual factors to pain relief. METHODS AND ANALYSIS: One hundred women with peritoneal endometriosis will be randomised to either diagnostic laparoscopy with excision of endometrial tissue (active surgery), purely diagnostic laparoscopy (sham surgery) or delayed surgery (no-surgery control group). Outcomes include pelvic pain relief, widespread pain, neuropathic pain symptoms and quality of life. Contextual factors are also assessed. Assessments will be obtained at baseline and 1, 3 and 6 months postrandomisation. Mixed linear models will be used to compare groups over time on all outcome variables. ETHICS AND DISSEMINATION: The trial is approved by the Regional Ethics Committee in the Central Denmark Region (1-10-72-152-20). The trial is funded by a PhD scholarship from Aarhus University, and supported by a grant from 'Helsefonden' (20-B-0448). Findings will be published in international peer-reviewed journals and disseminated at international conferences. TRIAL REGISTRATION NUMBER: NCT05162794.


Assuntos
Endometriose , Laparoscopia , Neuralgia , Feminino , Humanos , Endometriose/complicações , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Neuralgia/etiologia , Dor Pélvica/etiologia , Dor Pélvica/cirurgia , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto
11.
BMC Anesthesiol ; 22(1): 347, 2022 11 12.
Artigo em Inglês | MEDLINE | ID: mdl-36371148

RESUMO

BACKGROUND: To observe the effects of different positive end-expiratory pressure (PEEP) ventilation strategies on pulmonary compliance and complications in patients undergoing robotic-assisted laparoscopic prostate surgery. METHODS: A total of 120 patients with the American Society of Anesthesiologists Physical Status Class I or II who underwent elective robotic-assisted laparoscopic prostatectomy were enrolled. We randomized the patients divided into divided into three groups of 40 patients each: PEEP0, PEEP5, or PEEP10. Master Anesthetist used volume control ventilation intraoperatively with an intraoperative deep muscle relaxation strategy. Respiratory mechanics indexes were recorded at six time-points: 10 mimuts after anaesthesia induction, immediately after pneumoperitoneum establishment, 30 min, 60 min, 90 min, and at the end of pneumoperitoneum. Arterial blood gas analysis and oxygenation index calculation were performed 10 mimuts after anaesthesia induction, 60 mimuts after pneumoperitoneum, and after tracheal extubation. Postoperative pulmonary complications were also recorded. RESULTS: After pneumoperitoneum, peak inspiratory pressure (Ppeak), plateau pressure (Pplat), mean pressure (Pmean), driving pressure (ΔP), and airway resistance (Raw) increased significantly, and pulmonary compliance (Crs) decreased, persisting during pneumoperitoneum in all groups. Between immediately after pneumoperitoneum establishment, 30 min, 60 min, and 90 min, pulmonary compliance in the 10cmH2OPEEP group was higher than in the 5cmH2OPEEP (P < 0.05) and 0cmH2OPEEP groups(P < 0.05). The driving pressure (ΔP) immediately after pneumoperitoneum establishment, at 30 min, 60 min, and 90 min in the 10cmH2OPEEP group was lower than in the 5cmH2OPEEP (P < 0.05) and 0cmH2OPEEP groups (P < 0.05). Sixty min after pneumoperitoneum and tracheal extubation, the PaCO2 did not differ significantly among the three groups (P > 0.05). The oxygenation index (PaO2/FiO2) was higher in the PEEP5 group than in the PEEP0 and PEEP10 groups 60 min after pneumoperitoneum and after tracheal extubation, with a statistically significant difference (P < 0.05). In postoperative pulmonary complications, the incidence of atelectasis was higher in the PEEP0 group than in the PEEP5 and PEEP10 groups, with a statistically significant difference (p < 0.05). CONCLUSION: The use of PEEP at 5cmH2O during RARP increases lung compliance, improves intraoperative oxygenation index and reduces postoperative atelectasis. TRIAL REGISTRATION: This study was registered in the China Clinical Trials Registry on May 30, 2020 (Registration No. ChiCTR2000033380).


Assuntos
Laparoscopia , Pneumoperitônio , Atelectasia Pulmonar , Procedimentos Cirúrgicos Robóticos , Robótica , Masculino , Humanos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Próstata , Prostatectomia/efeitos adversos , Respiração com Pressão Positiva/efeitos adversos , Laparoscopia/efeitos adversos , Atelectasia Pulmonar/etiologia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/etiologia
12.
Int J Colorectal Dis ; 37(11): 2309-2319, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36319866

RESUMO

PURPOSE: Hand-assisted laparoscopic surgery (HALS) is an alternative to straight laparoscopy (LAP) in colorectal surgery. Many studies have compared the two in terms of efficacy, complications, and outcomes. This meta-analysis aims to uncover if there are any significant differences in conversion rates, operative times, body mass index (BMI), incision lengths, intraoperative and postoperative complications, and length of stay. METHODS: Comprehensive searches were performed on databases from their respective inceptions to 16 December 2021, with a manual search performed through Scopus. Randomized controlled trials (RCTs), cohort studies, and case series involving more than 10 patients were included. RESULTS: A total of 47 studies were found fitting the inclusion criteria, with 5 RCTs, 41 cohort studies, and 1 case series. Hand-assisted laparoscopic surgery was associated with lower conversion rates (odds ratio [OR] 0.41, 95%CI 0.28-0.60, p < 0.00001), shorter operative times (Mean Difference [MD] - 8.32 min, 95%CI - 14.05- - 2.59, p = 0.004), and higher BMI (MD 0.79, 95%CI 0.46-1.13, p < 0.00001), but it was also associated with longer incision lengths (MD 2.19 cm, 95%CI 1.66-2.73 cm, p < 0.00001), and higher postoperative complication rates (OR 1.15, 95%CI 1.06-1.24, p = 0.0004). Length of stay was not different in HALS as compared to Lap (MD 0.16 days, 95%CI - 0.06-0.38 days, p = 0.16, and intraoperative complications were the same between both techniques. CONCLUSIONS: Hand-assisted laparoscopy is a suitable alternative to straight laparoscopy with benefits and risks. While there are many cohort studies comparing HALS and LAP, more RCTs would be needed for a better quality of evidence.


Assuntos
Cirurgia Colorretal , Laparoscopia , Humanos , Cirurgia Colorretal/métodos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Colectomia/métodos , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto
13.
Zhonghua Wei Chang Wai Ke Za Zhi ; 25(11): 997-1004, 2022 Nov 25.
Artigo em Chinês | MEDLINE | ID: mdl-36396375

RESUMO

Objective: A permanent stoma can seriously affect patients' quality of life. Clinicians need to consider the risk of a permanent stoma when making clinical decisions. This study analyzed preoperative predictors of a permanent stoma after laparoscopic intersphincteric resection for low rectal cancer (LISR), and a prediction model was constructed validated. Methods: This was a retrospective study that analyzed clinical data of 331 ultralow rectal cancer patients who were diagnosed with primary rectal adenocarcinoma by endoscopy and pathology, including 218 males and 113 female, (58.8±11.2) years and (23.7±3.1) kg/m2. The patients underwent LISR with a preventive stoma from January 2012 to December 2020. Patients with multiple primary colorectal cancers, who underwent emergency surgery for intestinal obstruction or bleeding or perforation, and did not complete 18 months follow up were exclucled. R software was used to randomly select 234 patients as the modeling group with a ratio of approximately 7:3, and the remaining 97 patients comprised the validation group. The stoma site was determined by the surgeon before the operation, and the ileum 30 cm from the ileocecal valve was selected. The rates of a permanent stoma for the entire group and the preoperative clinical factors that may affect the permanency of a stoma in the modeling group were determined. A permanent stoma was defined as failure to close the stoma at 18 months after surgery. Multivariate logistic regression analysis was used to analyze the preoperative independent risk factors for a permanent stoma after LISR. R software was used to create the nomogram model, and the predictive ability of the nomogram model was evaluated by receiver operating characteristic (ROC) curve analysis. Results: Among the 331 patients who underwent LISR, 37 (26 cases in the modeling group and 11 cases in the validation group, 11.2%) developed a permanent stoma for the following reasons: anastomotic stenosis due to leakage (16 cases, 43.2%), distant metastasis (16 cases, 43.2%), intolerant to stoma closure surgery (3 cases, 8.1%), stenosis due to postoperative radiation (1 case, 2.7%), and poor recovery of anorectal function (1 case, 2.7%). Univariate analysis showed that preoperative neoadjuvant chemoradiotherapy, poorly differentiated tumor, cT3 stage, and distant metastasis were associated with a permanent stoma. Multivariate logistic regression analysis showed that neoadjuvant chemoradiotherapy [OR=3.078, 95% confidence interval (CI): 1.326-7.147; P=0.009], cT3 stage (OR=2.257, 95%CI: 1.001-5.091; P=0.049), and stage IV cancer (OR=16.180, 95%CI: 2.753-95.102; P=0.002) were independent risk factors for permanent stoma after LISR. Based on the selected risk factors, a nomogram model for predicting permanent stoma was constructed. The area under the ROC curve of the modeling group was 0.793, the optimal cut-off value was 0.890, the sensitivity was 0.577, and the specificity was 0.885. The area under the ROC curve of the validation group was 0.953. The corrected curves of the modeling group and the validation group showed a good degree of fit. Conclusion: Neoadjuvant chemoradiotherapy, cT3 stage, and distant metastasis are independent predictors of a permanent stoma after LISR, and the nomogram model is helpful to predict the probability of a permanent stoma. Patients with high-risk factors should be adequately informed of the risk of a permanent stoma before colorectal surgery.


Assuntos
Laparoscopia , Neoplasias Retais , Masculino , Humanos , Feminino , Nomogramas , Estudos Retrospectivos , Qualidade de Vida , Constrição Patológica/etiologia , Neoplasias Retais/cirurgia , Neoplasias Retais/patologia , Laparoscopia/efeitos adversos , Fatores de Risco
14.
Zhonghua Wei Chang Wai Ke Za Zhi ; 25(11): 1039-1044, 2022 Nov 25.
Artigo em Chinês | MEDLINE | ID: mdl-36396382

RESUMO

The incidence of anastomotic leakage, a common and serious postoperative complication of low rectal cancer, remains high. Clarifying the risk factors for anastomotic leakage in patients with low rectal cancer after surgery can help guide clinical treatment and help patients improve their prognosis. The current literature suggests that the risk factors affecting the occurrence of anastomotic leakage after low rectal cancer include three aspects: (1) individual factors: male gender, high body mass index, malnutrition, smoking, alcoholism, and metabolic diseases; (2) tumor factors: the lower margin of tumor <5 cm from the anal verge, tumor diameter >2.5 cm, late tumor stage, high level of tumor markers and preoperative intestinal obstruction; (3) surgical factors: long operative time (>180 min), intraoperative bleeding (≥70 ml), more than 2 cartridges of stapling for anastomosis, contamination of the operative field, epidural analgesia and intraoperative hypothermia. Notably, the surgical approach (laparoscopic, open and hand-assisted laparoscopic surgery) was not a factor influencing the occurrence of postoperative anastomotic leakage in low rectal cancer. The findings on the effects of receiving neoadjuvant therapy, gut microbiota,intestinal bowel preparation, insufficient time for preoperative antibiotic prophylaxis, left colonic artery dissection, intraoperative blood transfusion, pelvic drainage, transanal drainage and combined organ resection, and postoperative diarrhea on postoperative anastomotic leakage in low rectal cancer are controversial. However, clinical workers can still take measures to reduce the risk of anastomotic leakage according to the above risk factors by making a good assessment before surgery, actively avoiding them during and after surgery, and taking measures for each step, so as to bring maximum benefits to patients.


Assuntos
Laparoscopia , Neoplasias Retais , Humanos , Masculino , Fístula Anastomótica/prevenção & controle , Reto/cirurgia , Neoplasias Retais/cirurgia , Neoplasias Retais/complicações , Anastomose Cirúrgica/efeitos adversos , Laparoscopia/efeitos adversos
15.
BMC Cancer ; 22(1): 1203, 2022 Nov 23.
Artigo em Inglês | MEDLINE | ID: mdl-36418995

RESUMO

BACKGROUND: The long-term oncologic outcomes after laparoscopic and open procedures for patients with intermediate­ and high­risk endometrial cancer (EC) remain unclear. Accordingly, laparoscopy cannot still be recommended as the standard choice for intermediate­ and high­risk EC. This retrospective study aimed to assess the perioperative and long-term oncologic outcomes of laparoscopy and open surgery in patients with intermediate- and high­risk ECs within a minimum 4-year follow-up. METHODS: We included 201 patients who underwent laparoscopic or open procedures for intermediate­ and high­risk EC between 2010 and 2017. Between-procedure comparisons of perioperative and oncological outcomes were performed using the independent t-test or Pearson's chi-squared test and the Kaplan-Meier method, respectively. RESULTS: Finally, there were 136 intermediate­ and 65 high­risk endometrial tumors in the laparoscopic and open groups, respectively. There were no between-group differences in all baseline characteristics. Compared with the open group, the laparoscopic group had a significantly longer mean operating time (p = 0.005) and a lower mean estimated blood loss (EBL) (p = 0.031). There was a higher possibility of postoperative complication in the open group than in the laparoscopic group (p = 0.048). There were no significant between-group differences in pathological outcomes as well as the recurrence-free survival and overall survival rates (p = 0.626 and p = 0.148, respectively). CONCLUSIONS: Among patients with intermediate­ and high­risk EC, laparoscopic surgery has an advantage over the open surgery in reducing EBL and the rate of postoperative complications without weakening the oncological control. There were no between-procedure differences in the recurrence-free and overall survival rates.


Assuntos
Neoplasias do Endométrio , Laparoscopia , Humanos , Feminino , Estudos Retrospectivos , Seguimentos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Complicações Pós-Operatórias , Neoplasias do Endométrio/cirurgia , Neoplasias do Endométrio/patologia
16.
Investig Clin Urol ; 63(6): 639-646, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-36347553

RESUMO

PURPOSE: Recently, the modified apical dissection (MAD) technique in robot-assisted laparoscopic radical prostatectomy (RARP) has shown excellent functional outcomes but has never been rigorously validated at various institutions. This study aimed to evaluate the effect of MAD on early continence and potency compared with the anterior suspension stitch (SS) technique. MATERIALS AND METHODS: A total of 100 patients who underwent RARP with SS and 100 who underwent RARP with MAD by a single surgeon were propensity score matched and retrospectively compared for continence and potency recovery at 1 week and 1, 3, 6, 9, and 12 months. RESULTS: Continence was reached in 20.6%, 33.3%, 67.2%, 74.1%, 81.1%, and 83.0% of patients in the SS group, compared with 49.2%, 73.3%, 86.8%, 96.6%, 100.0%, and 100.0% in the MAD group at postoperative 1 week and 1, 3, 6, 9, and 12 months, respectively. In the SS group, potency rates were 0.0%, 20.0%, 50.0%, 66.7%, 75.0%, and 83.3%; in the MAD group, the rates were 50.0%, 90.0%, 88.9%, 100.0%, 100.0%, and 100.0%. Recovery of continence was higher in the MAD group within the first 6 months (p=0.005, <0.010, 0.041, 0.016 at 1 week, 1, 3, and 6 months). There were no significant differences in potency recovery rates between the two groups (all p≥0.05). CONCLUSIONS: The MAD technique results in earlier recovery of continence compared with the SS technique.


Assuntos
Laparoscopia , Procedimentos Cirúrgicos Robóticos , Robótica , Incontinência Urinária , Masculino , Humanos , Incontinência Urinária/etiologia , Incontinência Urinária/prevenção & controle , Estudos Retrospectivos , Recuperação de Função Fisiológica , Resultado do Tratamento , Prostatectomia/efeitos adversos , Prostatectomia/métodos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Procedimentos Cirúrgicos Robóticos/métodos , Laparoscopia/efeitos adversos
17.
BMC Pregnancy Childbirth ; 22(1): 773, 2022 Oct 17.
Artigo em Inglês | MEDLINE | ID: mdl-36253759

RESUMO

BACKGROUND: Cervical cerclage has been proposed as an effective treatment for cervical insufficiency, but there has been controversy regarding the surgical options of cervical cerclage in singleton and twin pregnancies. This study aimed to compare the pregnancy outcomes between transvaginal cervical cerclage (TVC) and laparoscopic abdominal cervical cerclage (LAC) in patients with cervical insufficiency. We also aimed to evaluate the efficacy and safety, and provide more evidence to support the application of cervical cerclage in twin pregnancies. METHODS: A retrospective study was carried out from January 2015 to December 2021. The primary outcomes were the incidence of spontaneous preterm birth (sPTB) < 24 weeks, < 28, < 32, < 34 weeks, and < 37weeks, gestational age at delivery, and the incidence of admission for threatened abortion or preterm birth after cervical cerclage. The secondary outcomes included admission to the Neonatal Intensive Care Unit, adverse neonatal outcomes and neonatal death. We also analysed the pregnancy outcomes of twin pregnancies after cervical cerclage. RESULTS: A total of 289 patients were identified as eligible for inclusion. The LAC group (n = 56) had a very low incidence of sPTB ˂ 34 weeks, and it was associated with a significant decrease in sPTB < 28 weeks, ˂32 weeks, ˂34 and < 37 weeks, and admission to the hospital during pregnancy for threatened abortion or preterm birth after cervical cerclage (0 vs.27%; 1.8% vs. 40.3%; 7.1% vs. 46.8%; 14% vs. 63.5%, 8.9% vs. 62.2%, respectively; P < 0.001), and high in gestational age at delivery compared with the TVC group (n = 233) (38.3 weeks vs.34.4 weeks,P < 0.001). Neonatal outcomes in the LAC group were significantly better than those in the TVC group. The mean gestational age at delivery was 34.3 ± 1.8 weeks, with a total foetal survival rate of 100% without serious neonatal complications in twin pregnancies with LAC. CONCLUSION: In patients with cervical insufficiency, LAC appears to have better pregnancy outcomes than TVC. For some patients, LAC is a recommended option and may be selected as the first choice. Even in twin pregnancies, cervical cerclage can improve pregnancy outcomes with a longer latency period, especially in the LAC group.


Assuntos
Ameaça de Aborto , Cerclagem Cervical , Laparoscopia , Nascimento Prematuro , Incompetência do Colo do Útero , Cerclagem Cervical/efeitos adversos , Feminino , Humanos , Lactente , Recém-Nascido , Laparoscopia/efeitos adversos , Gravidez , Resultado da Gravidez/epidemiologia , Gravidez de Gêmeos , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/etiologia , Nascimento Prematuro/prevenção & controle , Estudos Retrospectivos , Incompetência do Colo do Útero/cirurgia
18.
World J Surg Oncol ; 20(1): 345, 2022 Oct 18.
Artigo em Inglês | MEDLINE | ID: mdl-36253768

RESUMO

BACKGROUND: Robotic surgery has been widely used in the radical treatment of colonic cancer. However, it is unclear what advantages the robotic approach offers over other approaches in left colectomy. This study aims to explore the advantage of robotic surgery in left colectomy by comparing open, laparoscopic, and robotic surgery. METHODS: A retrospective analysis was performed on the clinical data of patients with radical left colectomy for colon cancer who were admitted to the Department of General Surgery, The First Affiliated Hospital of Nanchang University, from November 2012 to November 2017. Two hundred eleven patients included were divided into the open surgery group (OS, n=49), laparoscopic surgery group (LS, n=92), and robotic surgery group (RS, n=70) according to surgical techniques. The clinicopathologic data were collected for clinical outcome assessment. Finally, the clinical value of RS in radical left colectomy was further evaluated by propensity score matching (PSM) analysis. RESULTS: Three groups were similar in demographics and clinical characteristics. Compared with OS, LS and RS groups had better intraoperative and perioperative clinical outcomes. Moreover, the RS group exhibited the minimum operative times, length of stay (LOS), and evaluated blood loss. LS and RS also exhibited less perioperative and postoperative long-term complications. Three groups showed similar postoperative pathological outcomes. The overall survival and disease-free survival were also similar among the three groups (all P > 0.05). Cox regression analysis showed surgical approach was not a prognostic factor for overall survival (P = 0.671) and disease-free survival (P = 0.776). PSM analysis of RS and LS by clinical characteristics showed RS showed shorter operation time (P < 0.001) and LOS for patients without complications (P = 0.005). However, no significant differences were found in perioperative and long-term postoperative complications, pathological outcomes, overall survival, and disease-free survival. CONCLUSIONS: Among three techniques for radical left colectomy, LS and RS had significant advantages over OS in short-term clinical outcomes, and no significant differences were found in overall, disease-free survival, local recurrence, and distant metastasis incidence. Moreover, RS shows better perioperative clinical outcomes but without compromising survival compared with LS.


Assuntos
Neoplasias do Colo , Laparoscopia , Procedimentos Cirúrgicos Robóticos , Colectomia/efeitos adversos , Colectomia/métodos , Neoplasias do Colo/patologia , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Tempo de Internação , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Procedimentos Cirúrgicos Robóticos/métodos , Resultado do Tratamento
19.
J Opioid Manag ; 18(5): 447-453, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36226784

RESUMO

BACKGROUND AND OBJECTIVE: Request for refills of opioids is one of the indicators of possible misuse. We aimed to investigate racial variations in request for refills of opioids after hospital discharge from robotic-assisted laparoscopic radical prostatectomy (RALP). METHODS: We conducted a retrospective study of a contemporary cohort of patients treated with RALP for prostate cancer and post-operative standardized pain control that employed nonopioid medications. Patients' request for refills of opioids (within 30 days) after discharge was examined, accounting for race, age, pain control after surgery, alcohol intake, marijuana consumption, pre-existing behavioral health diagnoses, and pre-existing chronic pain disorders using multivariate analysis. p-Value of < 0.05 was considered significant. RESULTS: We included a total of 282 adult patients in this study. African Americans (AA) patients comprised 24.5 percent of our post-prostatectomy individuals. Of the total cohort, 94.3 percent of patients reported adequate pain control in the hospital after surgery, and only 5.7 percent requested refills of opioid medications after discharge. No racial variations in request of refills were identified. Only pre-existing chronic pain disorders were found to be a significant predictor of requesting an opioid medication refill for pain control after discharge from the hospital. CONCLUSIONS: A combination of minimally invasive surgery and nonopioid heavy pain management leads to low level of post-hospital discharge request for refills of opioid medication in patients treated with RALP across racial groups. Awareness and better control of chronic pain perioperatively are needed to ensure better postdischarge pain control.


Assuntos
Analgésicos não Narcóticos , Dor Crônica , Laparoscopia , Neoplasias da Próstata , Procedimentos Cirúrgicos Robóticos , Adulto , Assistência ao Convalescente , Analgésicos não Narcóticos/uso terapêutico , Analgésicos Opioides/efeitos adversos , Dor Crônica/tratamento farmacológico , Hospitais , Humanos , Laparoscopia/efeitos adversos , Masculino , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/etiologia , Alta do Paciente , Prostatectomia/efeitos adversos , Neoplasias da Próstata/tratamento farmacológico , Neoplasias da Próstata/etiologia , Neoplasias da Próstata/cirurgia , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/efeitos adversos
20.
Oxid Med Cell Longev ; 2022: 1592786, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36193079

RESUMO

Obese patients can significantly reduce weight and have a positive impact on obesity-related diseases. However, the risk of infection complications in obese people is higher than that in normal people, especially the surgical site infection. This research investigates the effect of antibiotics on weight change of obese patients after laparoscopic sleeve gastrectomy (LSG). A retrospective analysis was performed on 131 morbidly obese patients or obese patients with complications who received LSG treatment in the Third Hospital of Shanxi Medical University from 2013 to 2020. Patients were separated into the antibiotic group (59 cases) and the normal group (72 cases) according to whether antibiotics were used after surgery. The differences of postoperative weight-related indexes, inflammation-related indexes, and short-term complications were compared between the two groups. At 12-month follow-up, the % excess weight loss (%EWL) in the antibiotic group was statistically abated than that in the normal group (92.99 ± 28.60, P < 0.01). In addition, the percentage of total weight loss (%total weight loss (%TWL)) was abated in the antibiotic group than in the normal group, but it was not significant (P > 0.05). White blood cell count and neutrophil count in the antibiotic group were statistically raised than those in the in normal group (P < 0.05), but neutrophil/lymphocyte ratio (NLR) showed no significant difference. Comparison of short-term postoperative complications between the two groups showed that the number of abdominal wall wound infection, body temperature > 38°C, and abdominal pain > 3 days in the antibiotic group were abated, but they were not statistically significant (P > 0.05). Short-term antibiotic exposure after sleeve gastrectomy had an adverse effect on postoperative weight loss, with no significant improvement in short-term complications.


Assuntos
Laparoscopia , Obesidade Mórbida , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Índice de Massa Corporal , Gastrectomia , Humanos , Laparoscopia/efeitos adversos , Obesidade Mórbida/complicações , Obesidade Mórbida/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Redução de Peso
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...