scholarly journals P-EGS05 Assessment of acute cholecystitis management during COVID-19 pandemic in comparison to the CholeQuic approach : A single centre experience

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Mina Fouad
Keyword(s):  
Gall Bladder ◽  
Acute Cholecystitis ◽  
Conservative Management ◽  
Open Surgery ◽  
Operative Time ◽  
Operative Complications ◽  
Operative Difficulty ◽  
Operative Findings ◽  
The Uk ◽  
Post Operative Complications

Abstract Background Acute cholecystitis is an emergency condition, typically arising from gall bladder stones and often leading to unplanned surgical admissions to hospital. In the UK, gall stone disease accounts for approximately one third of all unplanned general surgical admissions. According to the The Royal College of Surgeons' Commissioning guidance, early management of acute cholecystitis in particular is the key to prevent further development of more serious complications that can lead to mortality (up to 10%). Therefore, urgent admission to secondary care and laparoscopic cholecytectomy are recommended once diagnosis is confirmed . Conservative management is not recommended as gallbladder inflammation often persists despite medical therapy which can lead to further attacks and risk of developing gall bladder perforation ( mortality in 30% of cases). Early laparoscopic cholecystectomy is also associated with reduced hospital costs and earlier recovery. During the first wave of COVID-19, the guidelines changed in order to limit the admission rates to free up spaces for possible COVID-19 infected patients. Crisis approach entailed conservative management with pain relief, antibiotics plus or minus cholecystostomy. However, reviews of this approach have not been widely published to assess the results and in turn planning our future management approach in case of other COVID-19 surge. Methods Our study included all the patients diagnosed with acute cholecystitis who needed surgical intervention in one medical Centre in the UK. The time table of the study is divided into 3 periods the pre- COVID era from 16/12/2019 to 15/03/2020 (group I), then during the first lock down era from 16/03/2020 to 30/06/2020 (group II) and, finally after the ease of the lock down from 01/07/2020 to 02/09/2020 (group III). Pre- and post-lockdown time periods the CholeQuIC approach was followed while during the lockdown era, patients were initially treated conservatively followed by surgical managemnt in case of failure to improve. Laparoscopic cholecystectomy was performed, however, in difficult cases conversion to open surgery occurred. The primary outcome was to Compare and perform analysis of the three distinctive periods regarding, delayed presentation, the degree of operative difficulty, which was quantified by analysing the operative time, blood loss, rate of drain insertion and rate of conversion into open surgery. Furthermore, a review of unfavourable intra-operative findings such as extensive adhesion to surrounding organs, hydrops, empyema, gangrene, and/or perforation of the gallbladder was done. The post-operative results were also analysed, according to the length of hospital stay, and the rate of post-operative complications. Results Operative difficulty The mean operative time before the lockdown was 71.6 minutes while it was 81.0 and 78.0 minutes during and post COVID respectively. In terms of conversion to open, the rate reached 10.5 % during the lockdown, while the figures were 4.9% and 3.13% during the pre and after lockdown respectively. Moreover, intra peritoneal drains were used in more than one quarter of the patients (28.9%) during the lockdown era compared to 11.5 % and 12.5% pre and post the lockdown respectively. Considerable blood loss occurred in 10.5%. Intra-operative findings During the lockdown, 28.9 % exhibited extensive adhesions between the gall bladder and surrounding structures. This level is almost three times the percentage during the pre and post-lockdown time periods (8.2% and 9.4% respectively). As for gangrenous cholecystitis, it was 18.4 % during the lockdown, 6.6% before and 6.3% after the lockdown respectively. Post-operative results Before the lockdown the average LOS was 2.9 days which increased to 8.9 days during the lockdown, followed by a decrease to 2.4 days following the ease of lockdown. The lockdown era depicted the highest rate of post-operative complications (bile leakage 7.9%, missed stones 5.3% and duodenal injury 2.6 %).  Conclusions During crisis periods tough measures and decisions are made to deal with the situation, however, these decisions can lead to grave consequences on the medical staff and most importantly on patients. As shown in this study and supported by the previous studies, conservative management of acute cholecystitis led to serious complications as many patients were re-admitted for emergency surgery as a result of failure of the non-surgical approach. Moreover, delayed emergency surgery was associated with increased operative difficulties and higher percentage of serious intra and post-operative complications. All this led to longer hospital stay which can prove the failure of this approach. Unfortunately in our Unit, whilst closely studying acute gall bladder disease, we have found that the conservative approach appears to have back-fired and did the exact opposite. Therefore, we believe that there is nil to support conservative treatment of acute cholecystitis in our Unit.  We believe that the evidence as displayed suggests that rapid surgery provides best outcome for individual patients and our system, perhaps especially when under strain for other reasons.

scholarly journals 236 Novel Guidelines to Avoid Routine Blood Tests After Robotic Assisted Radical Prostatectomy (RARP)

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
A Nathan ◽  
N Hanna ◽  
A Rashid ◽  
S Patel ◽  
Y Phuah ◽  
...  
Keyword(s):  
Blood Test ◽  
Open Surgery ◽  
Clinical Judgement ◽  
Robotic Assisted ◽  
Blood Tests ◽  
Routine Blood ◽  
Operative Complications ◽  
Robotic Assisted Radical Prostatectomy ◽  
The Uk ◽  
Post Operative Complications

Abstract Introduction Patients undergoing RARP commonly require routine post-operative blood tests. This practice dates from an era of open surgery, with increased blood loss and complications. We aim to improve specificity of blood test requests with novel guidelines. Method 1039 consecutive RARP patients at two tertiary urology centres in the UK were audited. Novel guidelines constructed based on risk stratified evidence from the initial audit were used to prospectively audit 133 patients. Results 16% had clinical concerns post-operatively. 1% and 4% had an intra- and post-operative complication. Intra- or post-operative clinical judgement flagged post-operative complications in 99.9%. 80% had routine blood tests with no clinical concerns. 6% had delayed discharge due to delayed processing of blood tests. 0.9% received a peri-operative transfusion. Re-Audit Novel guidelines reduced the number of blood tests requested from 100% to 36%. Specificity in diagnosing a complication improved from 0% to 67%. Discharge delays reduced from 6% to 0% and no post-operative complications were missed (sensitivity 100%). Conclusions Routine blood tests, without an indication, did not flag any additional post-operative complications. Blood transfusion is rare for RARP. Novel guidelines to request post-operative blood tests will reduce costs and discharge delays whilst maintaining appropriate patient safety and care.

scholarly journals How to choose the most appropriate technique for the single-stage treatment of cholecysto-choledocolithiasis?

2019 ◽  
Vol 7 (4) ◽  
pp. 258-262
Author(s):  
Aldo Bove ◽  
Paolo Panaccio ◽  
Raffaella di Renzo ◽  
Gino Palone ◽  
Marco Ricciardiello ◽  
...  
Keyword(s):  
Bile Duct ◽  
Surgical Technique ◽  
Operative Time ◽  
Single Stage ◽  
Surgical Time ◽  
Rendezvous Technique ◽  
Conversion Rates ◽  
Operative Complications ◽  
The One ◽  
Post Operative Complications

AbstractBackgroundWe utilized transcystic clearance and intra-operative papillotomy through a rendezvous technique for the treatment of cholecysto-choledocolithiasis. The goal of this study was to evaluate the reliability of pre-operative parameters to address the most suitable surgical procedure.MethodsA total of 180 patients affected by calculi of the gallbladder and bile duct underwent the single-stage treatment. According to several pre-operative parameters, 141 patients had to supposedly undergo transcystic clearance of the bile duct, while 39 patients had to be treated with the rendezvous technique. All patients were treated with the sequential procedure: first, we tried the transcystic procedure and, if there was a failure, we used a rendezvous technique. We prospectively analysed each group based on a series of variables such as sex, age, operative time, success rate of proposed treatment, conversion rate, post-operative complications and hospital stay.ResultsTranscystic clearance was successful in 134 out of 141 patients (95.0%), while 2 patients needed to undergo a laparo-endoscopy procedure (failure). Thirty-five out of 39 patients (89.7%) obtained common bile-duct (CBD) clearance through the rendezvous technique, while 1 patient obtained clean-up through the simple transcystic procedure (failure). Five out of 141 patients with transcystic clearance and 3 out of 39 patients with the rendezvous technique underwent laparotomy CBD clearance with conversion rates of 3.5% and 7.7%, respectively. Post-operative complications showed similar percentages for both procedures. However, the surgical time turned out to be longer for the rendezvous technique.ConclusionsThe one-stage procedure for the treatment of cholecysto-choledocolithiasis was possible in 94% of the cases utilizing a surgical technique selected according to the patient’s case history. The pre-operative parameters, such as jaundice, CBD diameters and stone diameters, have certified their reliability as good predictors of the most suitable procedure to follow.

MRC SORCE trial: Analysis of patients' presenting characteristics, tumor staging, and surgical approach.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 496-496 ◽  
Author(s):  
Alastair W. S. Ritchie ◽  
Angela M. Meade ◽  
Louise Choo ◽  
Ben Smith ◽  
Andrew Welland ◽  
...  
Keyword(s):  
Lymph Node ◽  
High Risk ◽  
Hospital Stay ◽  
Lymph Node Dissection ◽  
Surgical Approach ◽  
Open Surgery ◽  
Node Dissection ◽  
Laparoscopic Procedures ◽  
Operative Complications ◽  
Post Operative Complications

496 Background: SORCE is a randomised double blind trial of sorafenib, given for one or three years, versus placebo for patients at moderate or high risk of disease recurrence after surgical excision of primary renal cell carcinoma (RCC). Methods: Between July 2007 and April 2013, 1,711 patients were recruited from the UK (78%), Australia, France, Belgium, Denmark, The Netherlands and Spain. We describe the presenting characteristics, staging and surgical details of the randomised population. The surgical approach was at the surgeon’s discretion. Results: Baseline information is available for 1,681 patients (98%). Median age was 59 years (range 19 to 86): 1,195 (71%) were male. Histology was conventional/clear cell in 86%. T category was pT1a (<1%), pT1b (11%), pT2 (23%), pT3a-4 (65%). 47% were at high risk of recurrence with Leibovich scores of ≥6. Surgical data are available for 1,528 patients (89%). Total (radical) nephrectomy was performed for 97% of patients with 44% having laparoscopic surgery, of which 60% had a transperitoneal approach and 10% required conversion to open surgery. Some form of lymph node dissection was performed in 25% of patients (33% of open procedures and 15% of lap. procedures). The ipsi-lateral adrenal was removed in 47% and 11% had simultaneous resection of other structures/organs. Excision of venous extension was required in 19%. Laparoscopic procedures were performed for 58% of patients with maximum tumour diameter (MTD) <10cm and 17% of those with MTD ≥ 10 cm. Intra-operative complications were reported in 6% and post-operative complications reported in 12%. Hospital stay was median (IQR) 4 days (3-5) for patients having laparoscopic procedures and 7 days (5-8) for open surgery. Hospital stay was median (IQR) 8 days (6-11) for those having post-operative complications compared to 5 days (4-7) for uncomplicated recovery. Conclusions: These data reveal the varied surgical approaches to excision of primary RCC and will inform future adjuvant trials. The use of lymph node dissection appears arbitrary and evidence of benefit from randomised controlled trials is required. Analysis of the effect of sorafenib on disease free survival is likely to be performed in 2016. Clinical trial information: ISRCTN38934710.

Selecting the surgical approach in complex reoperative partial nephrectomies: Does robotics have a role?

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 658-658
Author(s):  
Sandeep Gurram ◽  
Siobhan Telfer ◽  
Winston Li ◽  
Heather Chalfin ◽  
W. Marston Linehan ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Robotic Surgery ◽  
Surgical Approach ◽  
Open Surgery ◽  
Perioperative Outcomes ◽  
Open Approach ◽  
Renal Surgery ◽  
Estimated Blood Loss ◽  
Operative Complications ◽  
Post Operative Complications

658 Background: Minimally invasive surgery (MIS) has shown equal oncologic efficacy as the open approach for treating small renal masses but results in improved perioperative parameters. Surgical principles also dictate that the open technique should be considered when facing difficult surgeries though this is experience and not evidenced based. The goal of our study is to explore differences in outcomes amongst open or robotic approaches in complex reoperative partial nephrectomies. Methods: 194 patients who had prior renal surgery from 2008 to 2019 were identified, the majority of which presented with multiple tumors due to known or suspected hereditary kidney cancer syndrome. Patients were stratified into the following cohorts based on surgical history: open after open surgery, open after MIS, robotic after open surgery, and robotic after MIS. Perioperative outcomes were compared amongst cohorts. Results: Significant differences were noted in estimated blood loss (EBL), number of tumors resected, and postoperative complications as assessed by Clavien score. Univariate regression analysis of EBL showed that the number of tumors resected (p <.0001, coefficient: 111 ml), number of prior renal procedures (p=.012, coefficient: 419 ml), hilar clamping (p = .015, coefficient: 840 ml), and intended surgical approach (p = .001; coefficient: 905 ml) were significant. On multivariate analysis, number of tumors resected (p<.0001, coefficient: 97 ml) was the only significant factor. Univariate analysis on post-operative complications showed that number of prior surgeries (p = 0.03, OR: 1.5) and final intended approach (p < .0001, OR: 4.6) were significant. On multivariate analysis, the final intended surgical approach (p = .001, OR: 4.3) was shown to be significant. Conclusions: These data show that the surgical approach of prior procedures is not a significant factor that affects perioperative outcomes, but the use of robotic surgery was associated with decreased post-operative complications in reoperative renal surgery . While open surgery will likely continue to be the standard of care for complex reoperative procedures, these data suggest that robotic surgery is safe and well tolerated in select cases.

scholarly journals Non-descent vaginal hysterectomy surgery associated with less complications and good prognosis

2022 ◽  
Vol 13 (1) ◽  
pp. 123-128
Author(s):  
Pranita Somani ◽  
Priyanka Singh ◽  
Mangala Shinde
Keyword(s):  
Blood Loss ◽  
Hospital Stay ◽  
Vaginal Hysterectomy ◽  
Vaginal Discharge ◽  
Operative Time ◽  
Intraoperative Complications ◽  
Vaginal Route ◽  
Background Removal ◽  
Operative Complications ◽  
Post Operative Complications

Background: Removal of the uterus through vagina when performed in a case without uterine descent or prolapse is known as “non-descent vaginal hysterectomy” or NDVH. Vaginal route is preferred as compared to laparoscopic and abdominal methods. The advantages of vaginal hysterectomy being fewer complications, less post-operative stay, cost effective, and useful in bulky uterus. Aims and Objectives: The aims of the study were as follows: (1) To study the intraoperative and post-operative complications encountered during NDVH and their management. (2) To assess the intraoperative blood loss, the operative time, and post-operative hospital stay. (3) To study and check the feasibility of vaginal route as the primary route for all hysterectomies in the absence of uterine prolapse. Materials and Methods: A total of 50 patients were included in the study. Detailed history was taken including obstetric history and menstrual history and clinical examination was performed. After taking written, informed consent and doing proper pre-operative preparation, the patient was posted for NDVH. Post-operative complications were noted. Patients were asked to come for follow-up after 15 days. Results: In 92% of cases operated, no intraoperative complications were found suggesting low morbidity associated with the procedure. Hemorrhage requiring blood transfusion was found in 4% of cases. Average operative time was 61.2 ± 27.89 min, average blood loss was 170 ± 81.44 ml, and average hospital stay was 5.94 ± 4.95 days. On histopathological examination, 40% were having leiomyoma and dysfunctional uterine bleeding was seen in 22% of cases. Pain was the most common complication seen in 30% of cases while vaginal discharge was seen in just 4% of cases. About 80% of patients were discharged on post-operative day 5. Conclusion: In 92% of NDVH cases, no intraoperative complications were found suggesting low morbidity associated with the procedure. The post-operative hospital stay was restricted to 5 days in 80% of cases which indicates early discharge of the patient. Post-operative complications such as vaginal discharge and fever were seen only in 4% of cases. NDVH should, therefore, be considered as the primary route for all hysterectomies unless contraindicated in the absence of prolapse.

scholarly journals LDLT Portal Vein Thrombosis: Technical Advances

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
M B Ahmed ◽  
M A Rady ◽  
M A Abd-errazik ◽  
A R M A Azzam
Keyword(s):  
Liver Transplantation ◽  
Blood Loss ◽  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Operative Time ◽  
Surgical Techniques ◽  
Vein Thrombosis ◽  
Operative Complications ◽  
End Stage ◽  
Post Operative Complications

Abstract Background portal vein thrombosis (PVT) is a common complication of end-stage liver disease with an incidence of 0.6–16% in patients with well-compensated disease (1–3), increasing up to 35% in cirrhotic patients with hepatocellular carcinoma. Aim of the Work the aim of the study is to compare between thrombectomy of PVT using vascular clamps “eversion” & manual technique “modified eversion” during liver transplantation regarding operative time, degree of blood loss, portal vein rethrombosis, and post-operative complications. Patients and Methods This is a retrospective cohort study to compare between thrombectomy of PVT using vascular clamps “eversion” & manual technique “modified eversion” during liver transplantation regarding operative time, degree of blood loss, portal vein rethrombosis & post-operative complications. The study was conducted as retrospective study of 33 adult patients who underwent LDLT at Ain Shams Specialized Hospital, Ain Shams University, Cairo, Egypt, between January 2016 and July 2018. Results the mean child score was 9.55 and the median hospital stay was 12 days. Based on review manager statics program, the PVT recurrence was non-significant (P = 0.295, Test value: 1.096). However, the blood loss was significant (p &lt; 0.029, test value: -2.186) and the surgical time was significant (p = 0.013, test value: 2.633). Conclusion portal vein thrombosis (PVT) represents a significant technical challenge in liver transplantation and for many years was considered a relative contraindication. While advances in surgical techniques, axial imaging, and alternative inflow reconstruction options have made liver transplantation possible in transplant candidates with PVT.

scholarly journals Increased use of pre-operative imaging and laparoscopy has no impact on clinical outcomes in patients undergoing appendicectomy

2011 ◽  
Vol 93 (8) ◽  
pp. 620-623 ◽  
Author(s):  
SR Markar ◽  
A Karthikesalingam ◽  
J Cunningham ◽  
C Burd ◽  
G Bond-Smith ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Acute Appendicitis ◽  
Medical Records ◽  
Operative Time ◽  
University Teaching ◽  
Complication Rates ◽  
Operative Complications ◽  
Negative Appendicectomy ◽  
Appendiceal Perforation ◽  
Post Operative Complications

INTRODUCTION The aim of this study was to review changes in the management of acute appendicitis in a ten-year period at a large university teaching hospital in London. METHODS This was a retrospective cohort study reviewing the medical records of patients who underwent an appendicectomy over a period of 12 months either in 1999 or 2009. Data collected included use of radiological investigations (ultrasonography, computed tomography [CT]), technique of appendicectomy (open [OA] or laparoscopic [LA]), operative time, histopathology and post-operative complications. Univariate and multivariate analysis was performed to assess the influence of variables on the incidence of negative appendicectomy, appendiceal perforation and post-operative complications. RESULTS All of the patients operated on in 1999 (n=109) had OA. Of the patients operated on in 2009 (n=164), 67 had OA, 91 had LA and 6 had LA converted to OA. None of the patients in 1999 had CT whereas in 2009 26% of patients had CT (sensitivity 94.7%, specificity 75.0%). This increased use of pre-operative imaging had no effect on negative appendicectomy (25.7% vs 12.8%, p=0.445), perforation (30.0% vs 21.3%, p=0.308) or complication rates (9.2% vs 10.4%). The complication rate was also similar regardless of whether patients had OA or LA (11.9% vs 9.9%). Multivariate analysis revealed that age was the only predictor of negative appendicectomy (p=0.029) or perforation (p=0.014). CONCLUSIONS This study shows that significant increase in the use of pre-operative imaging and laparoscopy in the management of patients with acute appendicitis failed to reduce negative appendicectomy, perforation and complications rates. The patient's age was the only predictor of negative appendicectomy and perforation.

scholarly journals A comparative study of non-descent vaginal hysterectomy and total laparoscopic hysterectomy

2020 ◽  
Vol 9 (2) ◽  
pp. 777
Author(s):  
Vijay Kansara ◽  
Jaydeep Chaudhari ◽  
Ajesh Desai
Keyword(s):  
Comparative Study ◽  
Hospital Stay ◽  
Vaginal Hysterectomy ◽  
Pap Smear ◽  
Operative Time ◽  
Laparoscopic Hysterectomy ◽  
Total Laparoscopic Hysterectomy ◽  
Significant Difference ◽  
Operative Complications ◽  
Post Operative Complications

Background: Hysterectomy is the second most common operation performed by the gynecologists, next only to caesarean section. Objective of the study was to compare fall in blood haemoglobin level, duration of operation, intra- and post-op complications between non-descent vaginal hysterectomy and total laparoscopic hysterectomy and establish the better method for hysterectomy in non-descent uterus.Methods: A retrospective comparative study of 90 hysterectomies was done from a period of May 2018 - April 2019 at GMERS Medical College and Hospital Sola, with 45 cases in group of non-descent vaginal hysterectomy (NDVH) and 45 in group of total laparoscopic hysterectomy (TLH). Demographic characteristics, co-morbid conditions, indications for surgery, operative time, intra- operative blood loss, post-operative analgesia requirements, post-operative hospital stay and post-operative complications were compared between both groups. Those patients having malignancy as diagnosed by Pap smear or by D and C were excluded from the studyResults: The most common age in both groups was 41-50 years. Adenomyotic uterus was the most common indication for surgery in both groups. The mean operative time in NDVH group was 45 min while it was 80 min in TLH group. p<0.001 suggested significant difference when operative time were compared between both groups. Both groups were similar in post-operative analgesia requirement and post-operative hospital stay. Post-operative complications were similar in both groups.Conclusions: In which way to approach the uterus shall depend upon skill of the surgeon, size and pathological nature of uterus, technology available in the hospital and preference of patient as well as surgeon.

scholarly journals Randomised controlled study of laparoscopic versus open reversal of Hartmann’s procedure

2020 ◽  
Vol 7 (11) ◽  
pp. 3563
Author(s):  
Tarek M. Sehsah ◽  
Osama H. Abd-Raboh ◽  
Taha A. Ismail ◽  
Soliman M. Soliman
Keyword(s):  
Hospital Stay ◽  
Operative Time ◽  
Laparoscopic Approach ◽  
Mean Value ◽  
Hartmann’S Procedure ◽  
Controlled Study ◽  
Hartmann's Procedure ◽  
Operative Complications ◽  
The Difference ◽  
Post Operative Complications

Background: Laparoscopic reversal of Hartmann’s procedure has been increasingly practiced worldwide since the laparoscopic era. However, so far only a few studies have been published regarding the results of this procedure. Aim of this study was to compare laparoscopic reversal of Hartmann’s (LHR) versus open reversal of Hartmann’s (OHR) procedure regarding to operative time, postoperative pain, hospital stay, postoperative complications and cost.Methods: This study was conducted on 40 patients with Hartmann’s colostomy admitted to the general surgery department, Tanta university hospitals, during the period from February 2017 to August 2019.Results: Regarding operative time, it was with a mean value 274.75±80.65 min in the LHR group and 156.75±32.81 min in the OHR group. The difference in time to pass flatus was with a mean value 1.78±0.68 days in the LHR group and 2.49±0.78 days in the OHR group. The difference in the hospital stay was with mean value 6.1±2.47 days in the LHR group and 9.3±2.20 days in the OHR group. Regarding post-operative complications; 6 patients (30%) developed post-operative complications while in the OHR group 10 (50%).Conclusions: In this era of minimal-access surgery and with increasing attention to fast-track protocols, we believe the laparoscopic approach should be the standard technique for patients undergoing reversal of Hartmann’s procedure. However, laparoscopic reversal of Hartmann’s procedure needs a surgical learning curve.

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