20 research outputs found
Surgery insight: minimally invasive surgery for IBD
No full textThe most frequently described laparoscopic operations for the management of patients with IBD are restorative proctocolectomy for ulcerative colitis and ileocolic resection for Crohn's disease. For patients with Crohn's disease, there is level 1b evidence that, in experienced hands, laparoscopic ileocolic resection enhances recovery and leads to a shorter hospital stay compared with conventional ileocolic resection. The demonstrated advantages of laparoscopic ileocolic resection with regard to cost and cosmesis, and the acceptable long-term results achieved (which are at least comparable to those achieved by conventional ileocolic resection) favor the use of laparoscopic ileocolic resection over conventional ileocolic resection in patients with ileocolic Crohn's disease. For patients with ulcerative colitis, the expected advantages of laparoscopic restorative proctocolectomy over conventional restorative proctocolectomy have yet to be clearly shown. Although there is a trend towards a reduced hospital stay (of only 1.6 days) when laparoscopic restorative proctocolectomy is performed, operating times are disproportionably prolonged. The most important argument for offering patients with IBD the chance to undergo a laparoscopic procedure, rather than conventional open surgery, is (particularly for women) the long-term superior cosmesis and body image it confer
Implementation of a fast-track perioperative care program: what are the difficulties?
No full textBACKGROUND: To evaluate the feasibility of a fast-track (FT) program and it's effect on postoperative recovery. METHODS: All patients, scheduled for elective segmental colorectal resection were treated in a FT program (FT group). Data were compared to a control group operated for elective colorectal resections and treated in a traditional care program (TC group). Data from the FT group were collected prospectively, data from the TC group retrospectively. Outcome parameters included the number of successfully applied FT modalities, patient satisfaction, morbidity rate, re-operation rate, primary (PHS) and total hospital stay (THS), and readmission rate. RESULTS: One-hundred and seven patients were included (55 FT group vs. 52 TC group). The groups were comparable for patient characteristics such as age and cr-POSSUM score (p = 0.22 and p = 0.40). An average of 7.4 of 13 predefined FT modalities were successfully achieved per patient. Patient satisfaction was comparable (p = 0.84). Seven versus 5 patients required a re-operation in the FT and TC groups, respectively (p = 0.52). Morbidity rate was comparable (n = 16 vs. 15, p = 0.83). Median PHS was 4.0 vs. 6.0 days and median THS was 4.0 vs. 6.5 days in the FT and TC groups (p < 0.01 and p < 0.03, respectively). Six vs. 3 patients were re-admitted in the FT and TC groups, respectively (p = 0.49). CONCLUSION: Implementation of all FT modalities was difficult since a rather low number of pre-defined FT modalities was effectively realized. Despite incomplete implementation, PHS and THS were shorter in the FT group without affecting patient satisfactio
Short-term outcomes after laparoscopic ileocolic resection for Crohn's disease. A systematic review
No full textBACKGROUND: No consensus exists whether ileocolic resection for Crohn's disease (CD) should be carried out by a laparoscopic or open approach. A systematic review was conducted to assess the evidence for short-term advantages of laparoscopic compared to open resection for ileocolic CD. METHODS: The literature search was conducted over the period 01/1991 to 02/2006. Only randomized controlled trials (RCTs), clinical controlled trials and comparative studies comparing laparoscopic with open resection for ileocolic CD were included. A quality assessment was performed for all retrieved articles. The main outcome parameters were operating times, conversion rates, major and minor morbidity and hospital stays. RESULTS: 14 publications encompassing 729 patients were included - 2 were RCTs, 12 were non-RCTs of which 2 were case-matched studies. Although pooling data of operating times was statistically not possible, they were longer for the laparoscopic procedure in the individual studies ranging from 75 to 185 min. Conversions varied between 0 and 16.7%. Postoperative complications requiring reoperation or reported overall morbidity were not different (risk difference -0.01 and -0.05, respectively). Hospital stay after the laparoscopic procedure was 1.90 days shorter (95% CI: 0.83-2.97). CONCLUSION: There is evidence that laparoscopic ileocolic resection for CD is associated with shorter hospital stay compared to open ileocolic resection, while morbidity rates are equal and conversion rates are acceptabl
Long-Term Surgical Recurrence, Morbidity, Quality of Life, and Body Image of Laparoscopic-Assisted Open Ileocolic Resection for Crohn’s Disease: A Comparative Study
No full textPURPOSE: Several studies have compared conventional open ileocolic resection with a laparoscopic-assisted approach. However, long-term outcome after laparoscopic-assisted ileocolic resection remains to be determined. This study was designed to compare long-term results of surgical recurrence, quality of life, body image, and cosmesis in patients who underwent laparoscopic-assisted or open ileocolic resection for Crohn's disease. METHODS: Seventy-eight consecutive patients who underwent ileocolic resection during the period 1995 to 1998 were analyzed; 48 underwent a conventional open approach in the Academic Medical Centre (Amsterdam, The Netherlands) and 30 underwent a laparoscopic-assisted approach in the Leiden University Medical Centre (Leiden, The Netherlands). Primary outcome parameters were reoperation and readmission rate. Secondary outcome parameters were quality of life, body image, and cosmesis. RESULTS: The two groups were comparable for characteristics of sex, age, and immunosuppressive therapy. Seventy-one patients had a complete follow-up of median 8.5 years. Resection for recurrent Crohn's disease was performed in 6 of 27 (22 percent) and 10 of 44 (23 percent) patients in the laparoscopic and open groups, respectively. Reoperations for incisional hernia were only performed after conventional open ileocolic resection (3/44 = 6.8 percent). Quality of life and body image were comparable, but cosmesis scores were significantly higher in the laparoscopic group. CONCLUSIONS: Despite small numbers, we found that surgical recurrence and quality of life after laparoscopic-assisted and open ileocolic resection were comparable. Incisional hernias occurred only after open ileocolic resection, and laparoscopic-assisted ileocolic resection resulted in a significantly better cosmesi
Long‐Term Surgical Recurrence, Morbidity, Quality of Life, and Body Image of Laparoscopic‐Assisted vs. Open Ileocolic Resection for Crohn's Disease: A Comparative Study
No full textOlder living kidney donors: Surgical outcome and quality of life
No full textBackground. Older living kidney donors remain controversial because of their physiological decline in glomerular filtration rate and their increased susceptibility of surgical complications. Little is known about the quality of life (QOL) of this elderly group. The purpose of this study is to examine surgical outcome and the QOL in older living donors. Patients and Methods. All 105 consecutive living donors who underwent a laparoscopic donor nephrectomy between June 2002 and February 2006 were prospectively included in the Study. Intra- and postoperative complications were measured. Quality of life was recorded preoperatively and at several endpoints postoperatively. Older donors were defined as 55 years and older. Results. There were no significant differences in intra- and postoperative complication rates and 1-year graft survival rate between both groups. Elderly donors (n=34) had both a significant lower postoperative pain at rest at day I compared with the younger group (P=0.019) and a lower total pain score in the analysis for the whole follow-up period (P=0.002). Although small solitary significant differences in Short Form-36 Health Survey, Multidimensional Fatigue Inventory-20 and visual analogue scale measuring pain, between both groups were detected, in general QOL of older donors was not different than of younger donors. Conclusion. Although small solitary significant differences exist with respect to pain, social functioning and mental health older donors, in general, have similar surgical outcome and quality of life when compared with younger donors. There is no need to exclude older donors in screening programs for transplantatio
Total laparoscopic restorative proctocolectomy: are there advantages compared with the open and hand-assisted approaches?
No full textPURPOSE: A randomized, controlled trial comparing hand-assisted laparoscopic restorative proctocolectomy with open surgery did not show an advantage for the laparoscopic approach. The trial was criticized because hand-assisted laparoscopic restorative proctocolectomy was not considered a true laparoscopic proctocolectomy. The objective of the present study was to assess whether total laparoscopic restorative proctocolectomy has advantages over hand-assisted laparoscopic restorative proctocolectomy with respect to early recovery. METHODS: Thirty-five patients underwent total laparoscopic restorative proctocolectomy and were compared to 60 patients from a previously conducted randomized, controlled trial comparing hand-assisted laparoscopic restorative proctocolectomy and open restorative proctocolectomy. End points included operating time, conversion rate, reoperation rate, hospital stay, morbidity, quality of life, and costs. The Medical Outcomes Study Short Form 36 and the Gastrointestinal Quality of Life Index were used to evaluate general and bowel-related quality of life. RESULTS: Groups were comparable for patient characteristics, such as sex, body mass index, preoperative disease duration, and age. There were neither conversions nor intraoperative complications. Median operating time was longer in the total laparoscopic compared with the hand-assisted laparoscopic group (298 vs. 214 minutes; P < 0.001). Morbidity and reoperation rates in the total laparoscopic, hand-assisted laparoscopic, and open groups were comparable (29 vs. 20 vs. 23 percent and 17 vs.10 vs. 13 percent, respectively). Median hospital-stay was 9 days in the total laparoscopic group compared with 10 days in the hand-assisted laparoscopic group and 11 days in the open group (P = not significant). There were no differences in quality of life and total costs. CONCLUSIONS: There were no significant short-term benefits for total laparoscopic compared with hand-assisted laparoscopic restorative proctocolectomy with respect to early morbidity, operating time, quality of life, costs, and hospital sta
The green solar collector: optimization of microalgal areal productivity
No full textDe Groene Zonnecollector (GZC) is een fotobioreactor die is ontworpen voor efficiënte teelt van microalgen op zonlicht. De zon wordt gevolgd door lenzen die het zonlicht op zogenaamde light guides focussen en waarin het licht reflecteerd en naar de algen geleid wordt. Ray-tracing simulaties laten zien dat bij een hogere zonnestand het zonlicht efficient wordt ingevangen en met een lagere intensiteit aan de algen wordt aangeboden. Deze vermindering van de intensiteit van zonlicht resulteert in hogere opbrengsten, als de bijbehorende biomassa concentratie en lichtweg verder is geoptimaliseerd. Een lage biomassa concentratie zal leiden tot grote reactorvolumes. Hoge biomassa dichtheden hebben dan ook de voorkeur. Echter, wanneer hoge biomassa concentraties worden gecombineerd met een grote lichtweg, dan is de gemiddelde lichtintensiteit in de fotobioreactor te laag. Dit zal leiden tot een geringe specifieke groeisnelheid en door de energiebehoefte voor onderhoud zal dit resulteren in een verlaging van de productiviteit
Continuous metadata flows for distributed multimedia
No full textThe practical use of temporal multimedia has increased markedly in recent years as enabling technologies for the distribution and streaming of media have become available. As a part of this trend, hypermedia systems and models have adapted accordingly to incorporate such distributed multimedia for presentation. Structured interpretation of information has long been a fundamental feature of both open hypermedia systems and knowledge systems. Metadata, in its many forms, has become the cornerstone for providing this structured knowledge above and beyond basic data and information. This thesis presents the rationale and requirements for continuous metadata, which supports the metadata accompanying distributed multimedia throughout the lifecycle of streamed media, from generation, through distribution, to presentation. Throughout this process it is the temporal and continuous nature of the metadata which is paramount. A conceptual framework for continuous metadata is proposed to encapsulate these principles and ideas. Continuous metadata and the associated framework enable the development, in particular, of real-time, collaborative, semantically enriched distributed multimedia applications. Experience building one such system using continuous metadata is evaluated within the framework. An ontology is developed for the system to enable the collation, distribution, and presentation of structure aiding navigation of multimedia, and it is shown how continuous metadata utilising the ontology can be distributed using multicas
