13 research outputs found
Unusual site of recurrent musculoskeletal hydatid cyst: Case report and brief review of the literature
A case of a large multiplex recurrent hydatid cyst involving the left
gluteal muscle and the left iliopsoas, accompanied with degeneration of
the musculature of the left upper leg is presented along with a review
of the relevant literature. Very few such cases have been reported
worldwide. The presented case is also distinguished by the involvement
of muscles of distant anatomic areas. (C) 2006 The WJG Press. All rights
reserved
Prospective comparative study of the efficacy of staple-line reinforcement in laparoscopic sleeve gastrectomy
Background Staple-line reinforcement has been used with promising
results in laparoscopic gastric bypass in order to reduce leakage,
increase staple-line integrity, and diminish staple-site bleeding. The
purpose of this study was to determine if staple-line reinforcement with
bovine pericardial strips reduces surgical complications of laparoscopic
sleeve gastrectomy (LSG).
Methods This is a prospective comparative study of all patients who
underwent LSG by a standard operative team in an 18-month period.
Patients were enrolled in group A if they received staple-line
reinforcement and in group B when not. The staple line was reinforced
with bovine pericardium strips [Peri-Strips Dry (R) (PSD)].
Results In total, 187 patients, with a median preoperative BMI of 45.3
kg/m(2) (range = 35.1-72.7), underwent LSG. Ninety-six patients were
enrolled in group A and 91 in group B; the two groups were comparable in
their various characteristics. Morbidity rate representing grade III-IV
surgical complications reached 7.4% and mortality rate was 0.5%.
Reinforcement with PSD significantly reduced the occurrence of bleeding
from the staple line and intra-abdominal collections (P = 0.012 and
0.026). The leak rate was not significantly reduced in group A. Patients
in group A required fewer days of hospitalization.
Conclusions Reinforcement of the staple line in LSG resulted in
significantly fewer surgical complications compared to standard stapling
of the gastric tube. The additional cost due to the reinforcement of the
staple line may be counterbalanced by the reduction in the length of
hospitalization
The use of a harmonic scalpel in thyroid surgery: report of a 3-year experience
Background: Hemostasis in thyroid surgery is of utmost importance for a
successful surgery and an uneventful postoperative course. The present
article reports a single surgeon’s 3-year experience in the use of the
harmonic scalpel. The device was developed in the early 1990s and
offered adequate and safe hemostasis for vessels up to 3 min in width.
Methods: This was a prospective observational study. Data sheets from
all patients who had surgery by a single endocrine surgeon in the period
from 1999 to 2004 were evaluated. Patients were divided into 3 groups
based on the surgical technique used: group I comprised the conventional
knot-and-tie technique, group II comprised the ligation of all but the
superior thyroid vessels with a scalpel, and group III comprised
patients in whom the device was used exclusively. The groups were
compared in regard to surgical time, cost, and complication rate.
Results: A total of 272 patients were included in the study: 107
patients were included in group 1, 77 in croup 11, and 88 group III. The
surgical time of group I differed significantly compared with groups II
and III (P <.0001 in both cases). Surgical times between groups II and
III did not differ significantly (P = .701).
Conclusions: The use of the harmonic scalpel reduces surgical time, but,
it increases the cost of the surgery. It is our belief that by including
in the absolute cost the time saved and the reduction in human resources
needed, the use of the scalpel would prove to be economic. (C) 2007
Published by Excerpta Medica Inc
Prospective study of the incidence and risk factors of postsplenectomy thrombosis of the portal, mesenteric, and splenic veins
Hypothesis: Splenectomy is recognized as a cause of portal, mesenteric,
and splenic vein thrombosis. The exact incidence of the complication and
its predisposing factors are not known.
Design: Prospective observational cohort study. The median follow-up
time of the patients was 22.6 months.
Setting: University surgical clinic in a teaching hospital
Patients: A total of 147 consecutive patients who underwent splenectomy
in a 4-year period were enrolled in the study.
Interventions: Preoperative and postoperative evaluation included
ultrasonography with color Doppler flow imaging of the portal system,
results of blood coagulation tests, fibrinogen levels, D-dimer levels,
and complete blood counts. Operative sheets were recorded and reviewed.
When portal system thrombosis (PST) was diagnosed, a complete control
for acquired and congenital thrombophilia disorders was obtained.
Main Outcome Measures: Primary end points of the study were the
assessment of the incidence of postsplenectomy PST and the
identification of risk factors for its occurrence.
Results: Portal system thrombosis occurred in 7 (4.79%) of 146 patients
who underwent splenectomy. The age, sex, type or length of the
operation, and use of preoperative and postoperative thromboprophylaxis
with low molecular weight heparin did not prove to be significant
factors in the occurrence of PST. Platelet count of more than 650 X
10(3)/mu L and greater spleen weight (> 650 g) was associated with the
development of PST (P=.01, P=.03). Normal D-dimer levels on diagnosis of
the complication showed a negative predictive value of 98%. Two of the
affected patients were diagnosed with thrombophilia disorders. In a
median follow-up period of 22.6 months, no other case of PST was
recorded.
Conclusions: Postsplenectomy PST occurs in approximately 5% of
patients. Possible risk factors are thrombocytosis, splenomegaly, and
congenital thrombophilia disorders
Clinical Implications of Sleeve Gastrectomy as a Source of Spleen Infarction or Ischemia
Splenic arterial demarcation has been observed during laparoscopic
sleeve gastrectomy (LSG). The present study aims to detect its actual
incidence during LSG and clarify its clinical significance. This is a
prospective observational study of 287 consecutive patients that
underwent LSG by the same surgical team over 3 years. In all patients,
the gastric fundus was mobilized using a standard technique. Before
withdrawal of the pneumoperitoneum, the spleen was exposed and carefully
inspected for evidence of arterial demarcation. Patients with a clear
demarcation were followed with Doppler ultrasound. Computed tomography
scan with oral contrast was performed to rule out septic complications.
Median preoperative body mass index was 46 kg/m(2) (range 35.1-78).
Median operative time was 58 min (range 42-185), median hospital stay
was 3 days (range 3-45), and overall morbidity rate was 8.6%.
Intraoperative demarcation of the upper splenic pole was evident in 12
patients (4.1%). Eleven patients had uneventful postoperative course.
One patient raised temperature of 38.5A degrees C at the 7th
postoperative day and was readmitted for further treatment. Once
afebrile, the patient was discharged on the 10th postoperative day and
continued on prophylactic low molecular weight heparin (tinzaparin,
7,500 U sc.) for 20 days. Splenic discoloration following LSG is an
uncommon complication with minimal clinical significance, which could be
related to hematoma, venous congestion, or ischemia. The possibility of
a late splenic abscess cannot be ruled out. No risk factors can be
identified preoperatively
The synergistic effect of enzymatic detergents on biofilm cleaning from different surfaces
Laparoscopic Sleeve Gastrectomy Performed with Intent to Treat Morbid Obesity: A Prospective Single-Center Study of 261 Patients with a Median Follow-up of 1 Year
European Society of Coloproctology Core Outcome Set for haemorrhoidal disease: an international Delphi study among healthcare professionals
30-Day morbidity and mortality of bariatric metabolic surgery in adolescence during the COVID-19 pandemic – The GENEVA study
Background: Metabolic and bariatric surgery (MBS) is an effective treatment for adolescents with severe obesity. Objectives: This study examined the safety of MBS in adolescents during the coronavirus disease 2019 (COVID-19) pandemic. Methods: This was a global, multicentre and observational cohort study of MBS performed between May 01, 2020, and October 10,2020, in 68 centres from 24 countries. Data collection included in-hospital and 30-day COVID-19 and surgery-specific morbidity/mortality. Results: One hundred and seventy adolescent patients (mean age: 17.75 ± 1.30 years), mostly females (n = 122, 71.8%), underwent MBS during the study period. The mean pre-operative weight and body mass index were 122.16 ± 15.92 kg and 43.7 ± 7.11 kg/m2, respectively. Although majority of patients had pre-operative testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (n = 146; 85.9%), only 42.4% (n = 72) of the patients were asked to self-isolate pre-operatively. Two patients developed symptomatic SARS-CoV-2 infection post-operatively (1.2%). The overall complication rate was 5.3% (n = 9). There was no mortality in this cohort. Conclusions: MBS in adolescents with obesity is safe during the COVID-19 pandemic when performed within the context of local precautionary procedures (such as pre-operative testing). The 30-day morbidity rates were similar to those reported pre-pandemic. These data will help facilitate the safe re-introduction of MBS services for this group of patients
30-Day Morbidity and Mortality of Bariatric Surgery During the COVID-19 Pandemic: a Multinational Cohort Study of 7704 Patients from 42 Countries.
BACKGROUND
There are data on the safety of cancer surgery and the efficacy of preventive strategies on the prevention of postoperative symptomatic COVID-19 in these patients. But there is little such data for any elective surgery. The main objectives of this study were to examine the safety of bariatric surgery (BS) during the coronavirus disease 2019 (COVID-19) pandemic and to determine the efficacy of perioperative COVID-19 protective strategies on postoperative symptomatic COVID-19 rates.
METHODS
We conducted an international cohort study to determine all-cause and COVID-19-specific 30-day morbidity and mortality of BS performed between 01/05/2020 and 31/10/2020.
RESULTS
Four hundred ninety-nine surgeons from 185 centres in 42 countries provided data on 7704 patients. Elective primary BS (n = 7084) was associated with a 30-day morbidity of 6.76% (n = 479) and a 30-day mortality of 0.14% (n = 10). Emergency BS, revisional BS, insulin-treated type 2 diabetes, and untreated obstructive sleep apnoea were associated with increased complications on multivariable analysis. Forty-three patients developed symptomatic COVID-19 postoperatively, with a higher risk in non-whites. Preoperative self-isolation, preoperative testing for SARS-CoV-2, and surgery in institutions not concurrently treating COVID-19 patients did not reduce the incidence of postoperative COVID-19. Postoperative symptomatic COVID-19 was more likely if the surgery was performed during a COVID-19 peak in that country.
CONCLUSIONS
BS can be performed safely during the COVID-19 pandemic with appropriate perioperative protocols. There was no relationship between preoperative testing for COVID-19 and self-isolation with symptomatic postoperative COVID-19. The risk of postoperative COVID-19 risk was greater in non-whites or if BS was performed during a local peak