6 research outputs found
Feasibility of laparoscopic abdomino - perineal resection for large - sized anorectal cancers : A single - institution experience of 59 cases
Surgery for malignant liver tumors
Recent decades have witnessed an increase in liver resections. There is
a need for an update on factors related to the management of liver
tumors in view of newer published data. A systematic search using
Medline, Embase, and Cochrane Central Register of Controlled Trials for
the years 1983-2008 was performed. The IHPBA classification provides a
suitable nomenclature of liver resections. While one randomized trial
has provided an objective time of 30 min as optimal for intermittent
pedicle occlusion, another randomized study has demonstrated the
feasibility of performing liver resections without pedicle clamping. A
randomized trial has demonstrated the benefit of clamp crushing over
newer techniques of liver transection. Cohort studies support
anatomical resections when feasible in terms of outcomes. Nonrandomized
studies also support nonanatomical and ablative therapies in patients
with cirrhosis and small remnant livers. A randomized trial has shown
comparable long-term outcomes of radiofrequency ablation (RFA) and
surgery for tumors < 5 cm. No randomized trials comparing
laparoscopy and open surgery exist. Surgery remains an important
treatment modality for malignant hepatic neoplasms. While anatomical
resections provide improved survival, the choice of nonanatomical
versus anatomical resections should be individualized taking into
account factors such as cirrhosis and function of the liver remnant. A
clear margin of resection is essential in all surgically resected
cases. RFA is emerging as a useful, often complimentary tool, to
surgery when dealing with complex tumors or tumors in patients with a
poor liver function. Laparoscopic ultrasonography is useful in staging
and performance of RFA
Post-operative abdominal drainage following major upper gastrointestinal surgery: Single drain versus two drains
Background: Traditionally, surgeons have resorted to placing drains following major gastrointestinal surgery. In recent years, the value of routine drainage has been questioned, especially in the light of their role in post-operative pain, infection, and prolonged hospital stay. The aim of this study was to compare the peri-operative outcomes following the use of a single versus two drains for gastric and pancreatic resections.
Materials and Methods: Patients undergoing resections for gastric and pancreatic malignancies were included in the study. Patients were subdivided into two groups depending on the number of drains placed, viz. one drain (Group 1) or two drains (Group 2). Clinico-pathologic outcomes were recorded and compared.
Results: Of the 285 patients included in the analysis, group 1 consisted of 226 patients while group 2 included 59 patients. Overall, drains alerted the surgeon to existence of complications in 62% of patients - 70% in group 1 and 44.4% in group 2 (P < 0.19). The morbidity and mortality rates in groups 1 and 2 were 25.2% and 3.9%, and 23.7% and 0%, respectively (P < 0.61 and P < 0.12). There were no drain-related complications. Median hospital stay was significantly lower in group 1 (11 vs. 14 days) (P < 0.001).
Conclusion: The insertion of drains did aid in the detection of complications following gastric and pancreatic surgery. Two drains offer no further advantage over one drain in terms of detection of complications. While the number of drains did not contribute to, or reduce, the morbidity and mortality in the two groups, the use of one drain significantly reduced hospital stay. Taken together, these findings support the prophylactic insertion of a single intra-abdominal drain following gastric and pancreatic resections