C-reactive protein is a predictor of complications after elective laparoscopic colorectal surgery: five-year experience

INTRODUCTION: With the development and improvement of laparoscopic surgery, procedures have become common. However, post-operative complications occur when patients are released from hospital. These complications increase patients’ morbidity and mortality. They also lead to re-hospitalization, an extended recovery period, and an increase in the cost of treatment. AIM: To evaluate and determine the prognostic properties of C-reactive protein in the early diagnosis of postoperative complications after a laparoscopic colon resection. MATERIAL AND METHODS: The prospective study included patients who underwent laparoscopic colorectal surgery in 2010–2014. The patients were divided into two groups – uncomplicated ones and those with complications. C-reactive protein concentrations in their blood serum were measured on the 2(nd), 4(th) and 6(th) day after surgery. Logistic regression analysis was used to evaluate the relation between C-reactive protein values measured on the 2(nd), 4(th) and 6(th) postoperative day and related complications. Receiver operating characteristic curves were used to determine the sensitivity and specificity of each C-reactive protein value measured on the 2(nd), 4(th) and 6(th) postoperative day. RESULTS: One hundred and six patients were included in the trial; 14 of them had complications. On the second day, a C-reactive protein cut-off value of 88.6 mmol/l provided the highest sensitivity and specificity for predicting evolving complications, being 71.4% and 84.8% respectively (p = 0.003). The significant predictive cut-off value decreases and becomes more sensitive and specific each post-operative day. CONCLUSIONS: It is possible to detect developing post-operative complications early on by monitoring C-reactive protein concentration levels in the blood serum on the 2(nd), 4(th), and 6(th) post-operative days

Dešiniosios hemikolektomijos vieno pjūvio laparoskopinė operacija: dviejų atvejų aprašymas

Single incision procedures are evolving as part of minimally invasive surgery. In 2008, the SILS approach was first described for a right hemicolectomy. We report and describe the first two transumbilical single incision laparoscopic right hemicolectomies for benign disease, which were performed in Lithuania Vilnius University Hospital Santariskiu Klinikos.Vieno pjūvio chirurginės procedūros vystosi kaip minimaliai invazinės chirurgijos dalis. Dešinioji hemikolektomija, atlikta SILS būdu, pirmą kartą aprašyta 2008 metais. Mes aprašome pirmąsias dvi laparoskopines transumbilikalines vieno pjūvio dešiniąsias hemikolektomijas, atliktas Vilniaus universiteto ligoninėje Santariškių klinikos

Tiesiosios žarnos iškritimo chirurginis gydymas – vieno centro patirtis

BackgroundNo consensus on the optimal procedure for repair of rectal prolapse (RP) exist. We present the results of our 10 year experience of Vilnius University Hospital Santariskiu Klinikos.Patients and methodsRetrospective review was performed of the patients, operated on for rectal prolapse between 2005 and 2016. Patients were divided into two groups – internal recal prolapse (IRP) and complete rectal prolapse (CRP). Perioperative data between two groups were analysed. Statistical data analysis was carried out using the SPSS 20.0 software. To assess the difference between rectal prolapse groups of statistical methods the χ2 test was used. Data were considered statistically significant at p < 0.05.Results89 patients between 2005 and 2016 underwent surgical treatment for rectal prolapse at our department. IRP group included 52 (58,4%), CRP – 37 (41,6%) patients. The male/female ratio was 1/6,4, the mean age was 58,3±15,2 years. Defecography was performed for 29 (32,6%)patients in IRP group and for 12 (13,5%) – in CRP group (p<0,001). 7 (7,9%) patients in CRP group had previous surgical procedure for RP while in IRP group there were none (p=0,02). The most common management of IRP included 6 strategies (n=25, 67,5% of group); of CRP – 3 different procedures (n=38, 73,1% of group) (p=0,003). Mean hospital stay in IRP group was significantly (p=0,014) longer (9,78±4,6 days) than in CRP group (7,58±3,7 days). Mortality rate was 0 %. Mean follow-up (14 patients) was 20,93±17,21 months.ConclusionThere is no evidence-based consensus regarding treatment of rectal prolapse. Management of IRP covered a more diverse range of surgical options, including of open approach. Thus, hospital stay was longer, but no mortality occurred. Further follow-up for evaluation of long-term outcome is necessary.ĮvadasDėl vienos tiesiosios žarnos iškritimo gydymo strategijos nesutariama. Mes apžvelgėme tiesiosios žarnos iškritimo gydymą Vilniaus universiteto ligoninėje Santariškių klinikose.Pacientai ir metodaiRetrospektyviai tirti pacientai, operuoti dėl tiesiosios žarnos iškritimo 2005–2016 metais. Pacientai suskirstyti į dvi grupes – viso storio iškritimo (CRP) ir vidinio iškritimo (IRP). Buvo palyginti perioperaciniai grupių duomenys. Duomenys apdoroti statistinio duomenų paketo SPSS 20.0 versija. Skirtumas tarp grupių lygintas remiantis chi kvadrato testu, vertintas kaip reikšmingas,jei p vertė buvo < 0,05.RezultataiMinėtu laikotarpiu operuoti 89 pacientai. Dėl vidinio iškritimo – 52 (58,4 %), dėl viso storio iškritimo – 37 (41,6 %). Vyrų ir moterų santykis buvo 1/6,4, vidutinis amžius – 58,3 ± 15,2 metų. Defekografija atlikta 29 (32,6 %) IRP grupės ir 12 (13,5 %) – CRP grupės pacientams (p < 0,001). Septyni (7,9 %) CRP grupės pacientai praeityje buvo operuoti dėl tiesiosios žarnos iškritmo, o IRP grupėje anksčiau operuotų pacientų nebuvo (p=0,02). IRP grupės pacientai buvo operuoti šešiais būdais, o CRP – trimis būdais (p = 0,003). Vidutinė IRP grupės pacientų hospitalizacijos trukmė buvo ilgesnė (p = 0,014) (9,78 ± 4,6 dienos) negu CRP grupės (7,58 ± 3,7 dienos). Mirštamumas buvo 0 %. Vidutinė 14 pacientų stebėjimo trukmė buvo 20,93±17,21 mėnesio.IšvadaIki šiol nesutariama dėl to, kuri operacija tinkamiausia sergantiesiems tiesiosios žarnos iškritimu. Laparoskopinė ventralinė rektopeksija tinkleliu šiuo metu yra populiariausia operacija šiai ligai gydyti

Transanalinė totalinė mezorektalinė ekscizija (taTME): pirmoji mūsų patirtis

Transanal total mesorectal excision (taTME) is a new natural orifice translumenal endoscopic surgery modality combined of three rectal surgery techniques. Detailed analysis of the taTME is the object of this article. We submit the report of three taTME procedures for histologically confirmed rectal adenocarcinoma that were performed for the first time in Lithuania, Vilnius University Hospital Santariskiu Klinikos.Transanalinė totalinė mezorektalinė ekscizija (taTME) yra naujas endoskopinis natūralių angų chirurgijos būdas, susidedantis iš trijų tiesiosios žarnos chirurginių metodų. Šiame straipsnyje detaliai aprašoma taTME chirurginė technika bei pristatomos pirmosios trys taTME procedūros, kurios buvo atliktos Vilniaus universiteto ligoninėje Santariškių klinikose

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Technique for Computer Aided Evaluation of Economic Indicators of a Construction Project

Abstract. The article deals with the computer aided design technology based on the concept of static graphical-information modeling, which has the following goal: to ensure the succession of the building design, its construction process and project maintenance management; to ensure the integrated management of graphical and information data flows under a unified software environment; to perform life cycle operations of a construction project better, cheaper, and faster. While implementing this design the concept of the relation between a graphical- information model of a building and estimate calculations has been formulated; technique for classifying design elements and materials has been generated, necessary programming tools and data structures have been developed; integration of CAD OM and EP systems has been performed; technique for computer aided evaluation of economic indicators of a construction project has been composed, enabling to price a project (or its individual elements) interactively. For effective design, technological and organizational variants of construction projects the proposed method of synthesis has been selected, which provides a user with the clearly classified result, i.e. priority row of the variants synthesize

Application of Building Information Modelling and Construction Process Simulation Ensuring Virtual Project Development Concept in 5D Environment

With the growth of information technologies in the field of construction industry over the last years, numerical building information modeling and process simulation has evolved to a fully accepted and widely used tool for project life circle management. A growing diversity between disciplines, participants, tasks, tools and events while project management in design and construction stages, the rising pressure of costing competition and tighter production deadlines, together with consistently increasing quality requirements and necessity of technological enhancements, have been the driving force of information modeling and numerical simulation in building industry. The range of applications covers virtually every phase of the specific construction product development process: planning, design, estimating, scheduling, fabrication, construction, maintenance and facility management. Theoretical background and practical innovative applications of building information modeling and construction process simulation technique ensuring Virtual Project Development (VPD) concept are observed in the article

Complex usage of 4D information modelling concept for building design, estimation, sheduling and determination of effective variant

With the growth of information technologies in the field of construction industry, the concept of CAD (Computer Aided Design), which denotes just design operations using a computer acquires a new meaning and changes the contents lightening design process based on product modelling and further numerical simulation construction process and facility managing. New definitions as Building Information Modelling (BIM) and Product Lifecycle Management (PLM) are more and more usable as the definition of a new way approaching the design and documentation managing of building projects. The presented computer aided design technology based on the concept of graphical ‐ information modeling of a building, is combined with resource demand calculations, comparison of alternatives and determination of duration of all the stages of investment project life. The software based on this combined 4D PLM model is to be created as a means to manage effectively the investment project, starting from planning, designing, economical calculations, construction and afterwards to manage the finished building and to utilize it. Complex usage of 4D information modelling concept for building design, estimation, sheduling and determination of effective variant Santrauka Besivystant informacinėms technologijoms kompiuterinio projektavimo srityje, sąvoka CAD įgyja naują prasmę ir keičia turinį, išryškinamas projektavimo procesas, pagristas projektuojamo objekto modeliavimo ir jo tolesnio statybos proceso ir turto valdymo virtualaus imitavimo technologijomis. Naujos sąvokos:&nbsp;Building Information Modeling –&nbsp;statinio informacinis modeliavimas (BIM) ir&nbsp;Product Lifecycle Management –&nbsp;produkto gyvavimo ciklo valdymas (PLM), taikomos naujam požiūriui į objekto projektavimo ir dokumentų valdymo procesą apibrėžti. Siūloma kompiuterinio projektavimo technologija grindžiama statinio grafinio‐informacinio modelio sukūrimo koncepcija, kuri savo ruožtu yra suderinta su išteklių poreikio skaičiavimais, alternatyvu lyginimais ir investuojamo projekto etapų gyvavimo trukmės nustatymu. Specializuota programinė įranga šiam kombinuotam 4D PLM modeliui sukurti naudojama, kai reali priemonė efektyviai valdyti investuojama projektą, pradedant planavimu, projektavimu, ekonominiais skaičiavimais, statybos organizavimu, baigiant pastato valdymu ir utilizavimu. First Published Online: 21 Oct 2010 Reikšminiai žodžiai:&nbsp;statinio informacinis modeliavimas,&nbsp;kompiuterinis projektavimas,&nbsp;objektinio modeliavimo technologijos, automatizuotas ekonominis įvertinimas, sprendimų paieškos sistem