Safety and effectiveness of outpatient laparoscopic cholecystectomy in a teaching hospital: a prospective study of 110 consecutive patients

<p>Abstract</p> <p>Background</p> <p>The aim of this study was to evaluate the safety and efficacy of outpatient laparoscopic cholecystectomy (OLC) in a day surgery unit in a teaching hospital. OLC was offered to patients with symptomatic cholelithiasis who met the following established inclusion criteria: ASA (American Society of Anesthesiology) physical status classification class I and II; age: 18 - 70 years; body mass index (BMI) < 30 kg/m²; patient acceptance and cooperation (informed consent); presence of a responsible adult to accompany the patient to his residency; patient residency in Athens. The primary study end-point was to evaluate success rates (patient discharge on the day of surgery), postoperative outcome (complications, re-admissions, morbidity and mortality) and patient satisfaction. A secondary endpoint was to evaluate its safe performance under appropriate supervision by higher surgical trainees (HSTs).</p> <p>Findings</p> <p>110 consecutive patients, predominantly female (71%) and ASA I (89%) with a mean age 40.6 ± 8.1 years underwent an OLC. Surgery was performed by a HST in 90 patients (81.8%). A mean postoperative pain score 3.3 (range 0-6) occurred in the majority of patients and no patient presented postoperative nausea or vomiting. Discharge on the day of surgery occurred in 95 cases (86%), while an overnight admission was required for 15 patients (14%). Re-admission following hospital discharge was necessary for 2 patients (1.8%) on day 2, due to persistent pain in the umbilical trocar site. The overall rate of major (trocar site bleeding) and minor morbidity was 15.5% (17 patients). At 1 week follow-up, 94 patients (85%) were satisfied with their experience undergoing OLC, with no difference between grades of operating surgeons.</p> <p>Conclusions</p> <p>This study confirmed that OLC is clinical effective and can be performed safely in a teaching hospital by supervised HSTs.</p

Synchronous gastric adenocarcinoma and gastrointestinal stromal tumor (GIST) of the stomach: A case report

Gastrointestinal stromal tumors (GISTs) are rare mesenchymal neoplasms of the gastrointestinal tract (1%), and stomach is the most common location involved. However, the co-existence of gastric adenocarcinoma and GIST is very rare. A case of an 80-year-old male with a simultaneous presentation of a gastric adenocarcinoma and GIST is presented. Various hypotheses have been proposed in order to explain this rare simultaneous development, but even though it's cause has not been proven yet

Political discourse during the European economic crisis: epistemic stance and legitimizing strategies in Greek political discourse (2010-2012)

This study presents a multidisciplinary framework for the analysis of evidential meaning in the Greek political discourse during the period of the current European debt crisis, and moving beyond a mere content analysis it sheds light on how political elites position themselves towards the knowledge they communicate, taking also into consideration the several ideological and political aims related with the legitimization of austerity. Our main point is that the construction of evidential meaning is a form of a social act, therefore an approach is developed that enhances the discursive approaches to the Epistemic Stance with a detailed theory of context. Emphasizing the context sensitivity of the expression of evidential meaning, we spell out the various Epistemic Stance types adopted by the political actors across several institutional genres, as well as their legitimizing function, since they enhance the speakers’ evidential standing and authority during the struggle for exercising epistemic control over the audience

Political discourse during the European economic crisis: epistemic stance and legitimizing strategies in Greek political discourse (2010-2012)

This study presents a multidisciplinary framework for the analysis of evidential meaning in the Greek political discourse during the period of the current European debt crisis, and moving beyond a mere content analysis it sheds light on how political elites position themselves towards the knowledge they communicate, taking also into consideration the several ideological and political aims related with the legitimization of austerity. Our main point is that the construction of evidential meaning is a form of a social act, therefore an approach is developed that enhances the discursive approaches to the Epistemic Stance with a detailed theory of context. Emphasizing the context sensitivity of the expression of evidential meaning, we spell out the various Epistemic Stance types adopted by the political actors across several institutional genres, as well as their legitimizing function, since they enhance the speakers’ evidential standing and authority during the struggle for exercising epistemic control over the audience

Is the Routine Use of Drainage After Elective Laparoscopic Cholecystectomy Justified? A Randomized Trial

Background: Laparoscopic cholecystectomy (LC) is the gold standard for the surgical treatment of cholelithiasis. However, the use of drainage after elective LC in literature remains controversial. Methods: A randomized study was performed in Larnaka General Hospital. The purpose of the study was to evaluate drainage of the gallbladder bed after elective LC. One hundred sixteen patients were randomly allocated in two groups, sustained an uneventful LC, and were included in the study after an informed consent was obtained. Sixty-three patients were included in drainage group (YD) and 53 patients in nondrainage group (ND). Drain tubes, made of polyethylene, were placed at the end of the procedure in the patients of YD group. Postoperative pain was assessed using two scales: a 10-point visual analog scale and a 5-point verbal response scale. The two groups were evaluated and compared regarding postoperative pain, the time needed for surgery, length of postoperative hospital stay, the postoperative collection of fluid in the subhepatic space, and the incidence of postoperative complications. Chi-square and t-tests were used to evaluate the data, and statistical significance was established at P &lt; .05. Results: The mean operative time in YD patients was 6.9 minutes longer compared with ND patients (P = .056). The postoperative pain was higher in the YD group by more than one point on the average in the visual analog scale both at 6 and 24 hours (P = .01 and &lt; .001, respectively). When measured with the verbal response scale, the difference in the reported pain was very significant at 24 hours (mean level for YD 1.24 and for ND 0.75). The proportion of patients staying in hospital for &gt; 2 days was higher in the YD group: 28.6% of the patients versus 13.2% in the ND group (P = .05). Subhepatic fluid was more often observed in the YD group (47% versus 34% in the ND), but the difference was not statistically significant. There was no statistical difference in the rate of wound infections, shoulder pain, nausea, vomiting, and respiratory infections between the two groups. Conclusions: Our results indicate that routine drainage of gallbladder bed after elective LC may not be justified. Drainage causes more postoperative pain, prolongs the operative time and hospital stay, increases the occurrence of fluid in the subhepatic space, and does not protect from other complications

The Role of TAMIS (Transanal Minimally Invasive Surgery) in the Management of Advanced Rectal Cancer – One Shared Story of Three Exceptional Cases

Purpose of the study: The current gold standard for contemporary treatment of rectal cancer is total mesorectal excision (TME), achieving excellent local disease control and low recurrence rates. However, TME may be associated with postoperative mortality and quality of life deterioration. Therefore, the need to develop less radical treatment strategies has emerged. Transanal minimally invasive surgery (TAMIS) is currently indicated only for early rectal cancer. However, local excision following chemoradiation has yielded promising clinical outcomes in selected cases with more advanced disease. Materials and methods: We describe three cases of patients with advanced rectal cancer, who were managed with TAMIS, either due to patients' unwillingness to tolerate permanent colostomy or due to significant comorbidities. Results: Two of the three patients who also received adjuvant chemoradiation are still in remission for 18 and 15 months respectively. The third patient died early after hospital release due to unrelated causes. Conclusions: Local excision utilizing minimally invasive techniques, alongside with chemoradiotherapy and close follow up can be a viable alternative in carefully selected rectal cancer patients with advanced disease who deny permanent colostomy or are ineligible for major operations