1,721,102 research outputs found
Peri-operative outcomes in elderly undergoing minimally invasive right hemicolectomy
Full text linkDiversi studi dimostrano i vantaggi delle resezioni del colon minimamente invasive per il miglioramento dei risultati post-operatori a breve termine. Tuttavia, attualmente, la strategia di trattamento per i pazienti più anziani dipende dalle politiche di ciascuna istituzione. Lo scopo di questo studio è stato quello di indagare la sicurezza e la fattibilità dell’emicolectomia destra minimamente invasiva per i pazienti con il cancro al colon di età superiore ai 75 anni.
MATERIALI E METODI Questo è stato uno studio retrospettivo multicentrico su più pazienti sottoposti a emicolectomia destra elettiva. L’endpoint primario dello studio è stato analizzare i risultati post-operatori a breve termine dell’emicolectomia destra minimamente invasiva nei pazienti anziani. I pazienti sono stati suddivisi in tre gruppi di età: Gruppo I (gruppo di controllo, < 60 anni), Gruppo II (>60-75), Gruppo III (≧75), e secondo l’approccio operativo utilizzato: Laparoscopia (LrH) o Robotico (RrH) e Resezione aperta (OrH).
RISULTATI Sono stati considerati 618 pazienti: 267 (43.2%) nel Gruppo II, 268 (43.4 %) nel Gruppo III, 337 (54.5) LrH, 144 (23.3%) RrH e 137 (22.2%) OrH. I gruppi II e III non differivano per il tasso di complicanze chirurgiche a breve termine (p=0,392), né per la durata della degenza ospedaliera e il tasso di riammissione (p=0,944 e p=0,308 rispettivamente). Nessuno dei parametri post-operatori differiva tra LrH e RrH. OrH e LrH/RrH differivano statisticamente per complicanze intraoperatorie (6 vs 1; p=0,011), perdita ematica stimata (p=0,001) e complicanze postoperatorie (40 vs 82; p=0,22). La mortalità a 90 giorni è stata osservata in 5 pazienti (3,8%) nel gruppo OrH. OrH è stato associato a un tempo operatorio >180 min. La conversione alla chirurgia a cielo aperto è stata un fattore di rischio per complicanze e complicanze di classe III.
CONCLUSIONI L’indicazione per la chirurgia laparoscopica non dovrebbe essere abbandonata per i pazienti anziani esclusivamente sulla base dell’età avanzata. La decisione della procedura chirurgica ottimale deve essere presa in base alle condizioni del singolo paziente, all’aspettativa di vita, e alla volontà del paziente e non basata esclusivamente sull’età del paziente.Several studies demonstrate the advantages of minimally invasive colonic resections in improving short-term postoperative outcomes. However, currently, the treatment strategy for elderly patients depends on the policies of each institution. The aim of this study was to investigate the safety and feasibility of minimally invasive right hemicolectomy for patients with colon cancer aged over 75 years. MATERIALS AND METHODS This was a multicenter retrospective study on consecutive patients undergoing elective right hemicolectomy. The primary endpoint of the study was to analyse the short-term postoperative results of minimally invasive right hemicolectomy in elderly patients. Patients were divided into three age groups: Group I (control group, < 60 years), Group II (>60-75), Group III (≧75), and according to the operative approach used: Laparoscopic (LrH) or Robotic (RrH) and Open resection (OrH).
RESULTS 618 patients were included: 267 (43.2%) in Group II, 268 (43.4 %) in Group III, 337 (54.5) LrH, 144 (23.3%) RrH and 137 (22.2%) OrH. Group II and III did not differ for short term major surgical complications rate (p=0.392), nor in the length of hospital stay and readmission rate (p=0.944 and p= 0.308 respectively). None of the postoperative parameters differed between LrH and RrH. OrH and LrH/RrH statistically differed in intraoperative complications (6 vs 1; p=0.011), estimated blood loss (p=0.001) and post-operative complications (40 vs 82; p=0.22). Mortality at 90 days was observed in 5 patients (3.8%) in the OrH group. OrH was associated with operative time >180 min. Conversion to open surgery was a risk factor for complication and class III complications. CONCLUSIONS Indication for laparoscopic surgery should not be abandoned for elderly patients solely based on older age. The decision of optimal surgical procedure should be taken based on the individual patient condition, life expectancy, and patient’s wishes and not specifically based on patient ag
Safety of hospital discharge before return of bowel function after elective colorectal surgery
Full text linkBackground Ileus is common after colorectal surgery and is associated with an increased risk of postoperative complications. Identifying features of normal bowel recovery and the appropriateness for hospital discharge is challenging. This study explored the safety of hospital discharge before the return of bowel function. Methods A prospective, multicentre cohort study was undertaken across an international collaborative network. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The main outcome of interest was readmission to hospital within 30 days of surgery. The impact of discharge timing according to the return of bowel function was explored using multivariable regression analysis. Other outcomes were postoperative complications within 30 days of surgery, measured using the Clavien-Dindo classification system. Results A total of 3288 patients were included in the analysis, of whom 301 (9 center dot 2 per cent) were discharged before the return of bowel function. The median duration of hospital stay for patients discharged before and after return of bowel function was 5 (i.q.r. 4-7) and 7 (6-8) days respectively (P < 0 center dot 001). There were no significant differences in rates of readmission between these groups (6 center dot 6 versus 8 center dot 0 per cent; P = 0 center dot 499), and this remained the case after multivariable adjustment for baseline differences (odds ratio 0 center dot 90, 95 per cent c.i. 0 center dot 55 to 1 center dot 46; P = 0 center dot 659). Rates of postoperative complications were also similar in those discharged before versus after return of bowel function (minor: 34 center dot 7 versus 39 center dot 5 per cent; major 3 center dot 3 versus 3 center dot 4 per cent; P = 0 center dot 110). Conclusion Discharge before return of bowel function after elective colorectal surgery appears to be safe in appropriately selected patients.Molecular tumour pathology - and tumour geneticsMTG2 - Moleculaire genetica van gastrointestinale tumore
Safety and efficacy of non-steroidal anti-inflammatory drugs to reduce ileus after colorectal surgery
No full textBackground: Ileus is common after elective colorectal surgery, and is associated with increased adverse events and prolonged hospital stay. The aim was to assess the role of non-steroidal anti-inflammatory drugs (NSAIDs) for reducing ileus after surgery. Methods: A prospective multicentre cohort study was delivered by an international, student- and trainee-led collaborative group. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The primary outcome was time to gastrointestinal recovery, measured using a composite measure of bowel function and tolerance to oral intake. The impact of NSAIDs was explored using Cox regression analyses, including the results of a centre-specific survey of compliance to enhanced recovery principles. Secondary safety outcomes included anastomotic leak rate and acute kidney injury. Results: A total of 4164 patients were included, with a median age of 68 (i.q.r. 57–75) years (54·9 per cent men). Some 1153 (27·7 per cent) received NSAIDs on postoperative days 1–3, of whom 1061 (92·0 per cent) received non-selective cyclo-oxygenase inhibitors. After adjustment for baseline differences, the mean time to gastrointestinal recovery did not differ significantly between patients who received NSAIDs and those who did not (4·6 versus 4·8 days; hazard ratio 1·04, 95 per cent c.i. 0·96 to 1·12; P = 0·360). There were no significant differences in anastomotic leak rate (5·4 versus 4·6 per cent; P = 0·349) or acute kidney injury (14·3 versus 13·8 per cent; P = 0·666) between the groups. Significantly fewer patients receiving NSAIDs required strong opioid analgesia (35·3 versus 56·7 per cent; P < 0·001). Conclusion: NSAIDs did not reduce the time for gastrointestinal recovery after colorectal surgery, but they were safe and associated with reduced postoperative opioid requirement
Transanal endoscopic microsurgery: indications, tips and long-term results. A single center experience
No full textTransanal endoscopic microsurgery (TEM) was introduced to combine the curativeness of full thickness excision with minimum morbidity, while traditional rectal surgery is burdened by high morbidity and mortality rates. However, while it is still a matter of considerable debate whether local excision is an adequate approach for curative resection of rectal cancer, new minimally invasive operative techniques have been introduced. The purpose of this paper was to show the indications, the tips and long term results of this technique through the review of the largest single-center database available to date. The showed results derived from the single center experience of the Clinica Chirurgica of Polytechnic University of Marche.
Methods: We retrospectively reviewed a 25-year database from May 1992 to May 2017. We divided the patients into three different groups of patients according to the preoperative diagnosis: rectal cancers, adenomas and other rectal lesions. Rectal adenomas were divided into two groups according to their diameter (> or <5 cm). Rectal cancer patients were divided into two groups according to the preoperative staging: early rectal cancer and irradiated rectal cancer.
Results: Among the 1324 patients who had rectal tumors excised with TEM at our institution, preoperative histology was rectal adenoma in 729 (55%) patients, adenocarcinoma in 536 (40.5%) patients and other lesions in the remaining 59 (4.4%) patients. 5 years overall survival (OS) and Recurrence free survival (RFS) were 93.3% and 98.6% for patients with rectal adenomas and 86.8% and 70.9% for patients with rectal cancer.
Conclusions: TEM can be a valid alternative for the treatment of both benign and malignant rectal lesions, further studies are needed to define more specific indications to justify the survival of this technique in the future
Laparoscopic repair of inguinal hernia: Retrospective comparison of TEP and TAPP procedures in a tertiary referral center
No full textRobotic versus laparoscopic right colectomy for cancer: short-term outcomes and influence of Body Mass Index on conversion rate.
No full text
Telemedicine in surgery during COVID-19 pandemic: are we doing enough?
Full text linkIntroduction: The aim of this systematic review was to report and to analyze if there is and what is the impact of telemedicine in the surgical practice during COVID-19 pandemic. Many authors have posited that the pandemic urged a high implementation of the telemedicine service even in surgical specialties, however, the impact of this change of the clinical practice has been variably reported and its utilization in general surgery is uncertain. Evidence acquisition: All articles from any country written in English, Italian, Spanish, or French, about the use of telemedicine for indication to surgical treatment or for 30-day postoperative follow-up in general surgery during the COVID 19 outbreak, from the March 1, 2020, to December 1, 2020, were included. Evidence synthesis: Two hundred nine articles were fully analyzed, and 207 further articles were excluded. Finally, 2 articles, both published in October 2020, were included in the present systematic review. Conclusions: In conclusion, the rapid spread of SARS-CoV-2 pandemic has forced to review the traditional methods to deliver surgical assistance and urged surgeons to find alternative methods to continue their practice. The literature about this topic is yet scarce and many questions regarding its efficacy in improving patients' health, cost-effectiveness and user satisfaction remain unsolved
Is the bipolar vessel sealer device an effective tool in robotic surgery? A retrospective analysis of our experience and a meta-analysis of the literature about different robotic procedures by investigating operative data and post-operative course
No full textBACKGROUND:
The latest robotic bipolar vessel sealing tools have been described to be effective allowing to perform procedures with reduced blood loss and shorter operative times. The aim of this study was to assess the efficacy and reliability of these devices applied in different robotic procedures.
MATERIAL AND METHODS:
All robotic operations, between 2014 and 2016, were performed using the EndoWrist One VesselSealer (EWO, Intuitive Surgical, Sunnyvale, CA), a bipolar fully wristed device. Data, including age, gender, body mass index (BMI), were collected. Robot docking time, intraoperative blood loss, robot malfunctioning and overall operative time were analyzed. A meta-analysis of the literature was carried out to point the attention to three different parameters (mean blood loss, operating time and hospital stay) trying to identify how different coagulation devices may affect them.
RESULTS:
In 73 robotic procedures, the mean operative time was 118.2 minutes (75-125 minutes). Mean hospital stay was four days (2-10 days). There were two post-operative complications (2.74%).
CONCLUSIONS:
The bipolar vessel sealer offers the efficacy of bipolar diathermy and the advantages of a fully wristed instrument. It does not require any change of instruments for coagulation or involvement of the bedside assistant surgeon. These characteristics lead to a reduction in operative time
Laparoscopic transperitoneal adrenalectomy. A comparative study of different techniques for vessel sealing
No full textBACKGROUND:
Laparoscopic adrenalectomy is the standard surgical approach to adrenal lesions. Adrenal vessel sealing is the critical surgical phase of laparoscopic adrenalectomy. This study aimed at comparing perioperative outcomes of laparoscopic transperitoneal adrenalectomy by means of radiofrequency energy-based device (LARFD) to those performed with traditional clipping device (LACD), while focusing on the different adrenal vessel control techniques.
METHODS:
Patients who underwent adrenalectomy for adrenal disease between January 1994 and April 2019 at the Surgical Clinic, Polytechnic University of Marche were included in the study. Overall, 414 patients met inclusion criteria for study eligibility: 211 and 203 patients underwent LARFD and LACD, respectively. Multiple models of quantile regression, logistic regression and Poisson finite mixture regression were used to assess the relationship between operative time, conversion to open procedure, length of stay (LoS), surgical procedure and patient characteristics, respectively.
RESULTS:
LARFD reduced operative time of about 12 min compared to LACD. Additional operative time-related factors were surgery side, surgery approach, conversion to open procedure and trocar number. The probability of conversion to open procedure decreased by about 76% for each added trocar, whereas it increased by about 49% for each added centimeter of adrenal lesion and by about 25% for each added year of surgery. Two patient clusters were identified based on the LoS: long-stay and short-stay. In the long-stay cluster, LoS decreased of about 30% in LARFD group and it was significantly associated with conversion to open procedure and postoperative complications, whereas in short-stay cluster only postoperative complications had a significant effect on LoS.
CONCLUSION:
Laparoscopic transperitoneal adrenalectomy performed by means of radiofrequency energy-based device for the sealing of adrenal vessels is an effective procedure reducing operative time with potentially improved postoperative outcomes
- …
