1,721,086 research outputs found
Patients with Crohn's disease have longer post-operative in-hospital stay than patients with colon cancer but no difference in complications' rate
No full textBACKGROUND: Right hemicolectomy or ileocecal resection are used to treat benign conditions like Crohn's disease (CD) and malignant ones like colon cancer (CC). AIM: To investigate differences in pre- and peri-operative factors and their impact on post-operative outcome in patients with CC and CD. METHODS: This is a sub-group analysis of the European Society of Coloproctology's prospective, multi-centre snapshot audit. Adult patients with CC and CD undergoing right hemicolectomy or ileocecal resection were included. Primary outcome measure was 30-d post-operative complications. Secondary outcome measures were post-operative length of stay (LOS) at and readmission. RESULTS: Three hundred and seventy-five patients with CD and 2,515 patients with CC were included. Patients with CD were younger (median = 37 years for CD and 71 years for CC (P < 0.01), had lower American Society of Anesthesiology score (ASA) grade (P < 0.01) and less comorbidity (P < 0.01), but were more likely to be current smokers (P < 0.01). Patients with CD were more frequently operated on by colorectal surgeons (P < 0.01) and frequently underwent ileocecal resection (P < 0.01) with higher rate of de-functioning/primary stoma construction (P < 0.01). Thirty-day post-operative mortality occurred exclusively in the CC group (66/2515, 2.3%). In multivariate analyses, the risk of post-operative complications was similar in the two groups (OR 0.80, 95%CI: 0.54-1.17; P = 0.25). Patients with CD had a significantly longer LOS (Geometric mean 0.87, 95%CI: 0.79-0.95; P < 0.01). There was no difference in re-admission rates. The audit did not collect data on post-operative enhanced recovery protocols that are implemented in the different participating centers. CONCLUSION: Patients with CD were younger, with lower ASA grade, less comorbidity, operated on by experienced surgeons and underwent less radical resection but had a longer LOS than patients with CC although complications' rate was not different between the two groups
Total esophagectomy without thoracotomy: results of a European questionnaire (GEEMO).
No full textThe results of a questionnaire answered by the European Members of the GEEMO
concerning esophagectomy without thoracotomy are reported and discussed. 172
cases of esophagectomy without thoracotomy following benign lesions and 666 cases
following various levels of esophageal neoplasia were grouped in the 26 Centers
that have answered the questionnaire amounting to a total of 838 cases. The most
frequent indications for benign lesions were as follows: decompensated or
relapsed megaesophagus (83 cases), acute or stabilized lesions caused by caustic
agents (59 cases), stenoses from gastroesophageal reflux (17 cases), scleroderma
(7 cases) and spontaneous or iatrogenic perforation (6 cases). Concerning the
esophageal site where the technique was employed with esophageal carcinoma, the
most frequent was the cervical (201 cases), then the lower (150 cases), the
middle (91 cases) and upper thirds of the esophagus (48 cases). Adenocarcinoma of
the cardia seems to be an additional indication for many Surgeons to use
esophagectomy without thoracotomy (142 cases). In general, the most frequent
intra-surgical complications (from benign and malignant lesions) were as follows:
pleural lesions (34.4%), lesions of the left recurrent nerve (7.8%), severe
endo-mediastinic hemorrhages (8.5%), tracheo-bronchial (1.5%) and thoracic duct
(0.5%) lesions. The intra-operative mortality was 0.36%. The post-operative
complications were as follows: pleural effusion (17.8%), anastomotic fistulas
(15.2%), hemothorax (5%) and post-operative mortality (10.3%). Cancer of the
cervical esophagus and adenocarcinoma of the cardia were considered sensitive to
this radical treatment whereas in intra-thoracic cancer it can have only a
palliative effect
[Costs and benefits of mechanical sutures in esophageal surgery].
No full textThe cost/benefit ratio of mechanical sutures is a controversial issue. Aim of
this work was to compare the cost of esophago-visceral anastomoses performed with
staplers versus the cost of conventional anastomoses. Not only the cost of the
material, but also the economical impact of the hospital stay and operative
complications was evaluated. Results show a statistically significant decrease of
morbidity in patients treated with mechanical sutures (3.7% vs 18.8%, p =
0.0001). The overall cost of a single mechanical suture was markedly lower than
that of a single manual suture (934.000 vs 2,209.000 Italian lira). We conclude
that a significant decrease of hospital cost can be expected using mechanical
sutures. It has to be noted, however, that in order to achieve such results, an
adequate surgical training with staplers is mandatory
Thoracoscopic resection of benign tumours of the esophagus.
No full textThoracoscopic excision of an esophageal leiomyoma was successfully performed in 5
patients. The tumours were enucleated easily without intraoperative
complications. A patient in whom the muscular layer was not sutured after removal
of the myoma, one year after the operation presented an esophageal
pseudodiverticulum requiring a thoracotomy for resection. This new procedure
which reduces the operative trauma and postoperative pain and allows quick
recovery is described
Disconnection of the ampulla of Vater: a new technique for reconstruction.
No full textWe report the case of a 42 year-old patient who had undergone gastric resection
and Billroth I reconstruction for a duodenal ulcer 15 years earlier. The patient
was admitted to our Department for a high output biliopancreatic fistula which
developed after another gastric resection with Billroth II reconstruction which
was performed for a peptic stricture of the gastroduodenal anastomosis. At
laparotomy, a complete disconnection of the ampulla of Vater was found, with the
duodenal stump oversewn 5 cm distally to the papillary area. After plasty of the
biliary and pancreatic ducts, a direct anastomosis between the new ampulla and a
Roux-en-Y jejunal loop was performed. The post-operative course was uneventful.
The details of the surgical technique are reported
- …
