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Kashi AH, Simforoosh N, Nouralizadeh A, Ghasemi SM, Nayebzade A, Bonakdar Hashemi M, Valipour R, Basiri A, Tabibi A, Zargar H, Dadpour M, Rouientan H, Narouie B. The experience of a tertiary referral center with laparoscopic pyelolithotomy for large renal stones during 18 years. Sci Rep 2023; 13:23102. [PMID: 38155230 PMCID: PMC10754888 DOI: 10.1038/s41598-023-50331-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 12/19/2023] [Indexed: 12/30/2023] Open
Abstract
This study aimed to evaluate the outcomes of laparoscopic pyelolithotomy, including its efficacy and feasibility in treatment of large renal stones. All patients who underwent laparoscopic pyelolithotomy operations in a referral center were enrolled from 2003 to 2020. The final analysis included 436 patients. The total stone free rate was 88.3% and the stone-free rate for staghorn/multiple stones versus other types of stones was 81% vs. 91% (P = 0.002). Likewise, the total operation duration was 158 ± 50 and the operation duration for staghorn/multiple stones versus other types of stones was 171 ± 51 min vs. 153 ± 49 min (P < 0.001). The operation duration (169 ± 51 vs. 155 ± 58 vs. 155 ± 42 min) and hospitalization (4.5 ± 2.3 vs. 4.0 ± 2.2 vs. 3.6 ± 1.8) decreased with increasing the surgeons' experience over time. The outcomes of laparoscopic pyelolithotomy for children versus adults versus geriatric patients and in patients with normal versus abnormal kidney anatomy did not reveal statistically significant differences. Laparoscopic pyelolithotomy could be employed as an alternative surgical approach for patients with large kidney stones of any age or with kidney abnormalities provided that appropriate expertise is available to carry out the procedure.
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Affiliation(s)
- Amir Hossein Kashi
- Urology and Nephrology Research Center (UNRC), Department of Urology, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran
| | - Nasser Simforoosh
- Urology and Nephrology Research Center (UNRC), Department of Urology, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran
| | - Akbar Nouralizadeh
- Urology and Nephrology Research Center (UNRC), Department of Urology, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran
| | - Seyed Mohammad Ghasemi
- Urology and Nephrology Research Center (UNRC), Department of Urology, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran
| | - Amirhossein Nayebzade
- Urology and Nephrology Research Center (UNRC), Department of Urology, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran
| | - Milad Bonakdar Hashemi
- Urology and Nephrology Research Center (UNRC), Department of Urology, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran
| | - Reza Valipour
- Department of Urology, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran
| | - Abbas Basiri
- Urology and Nephrology Research Center (UNRC), Department of Urology, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran
| | - Ali Tabibi
- Urology and Nephrology Research Center (UNRC), Department of Urology, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran
| | - Homayoun Zargar
- Department of Urology, Western Health, Melbourne, Australia
- Department of Urology, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
| | - Mehdi Dadpour
- Urology and Nephrology Research Center (UNRC), Department of Urology, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran
| | - Hamidreza Rouientan
- Urology and Nephrology Research Center (UNRC), Department of Urology, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran
| | - Behzad Narouie
- Urology and Nephrology Research Center (UNRC), Department of Urology, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran.
- Department of Urology, Zahedan University of Medical Sciences, Zahedan, Iran.
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Tummers FHMP, Peltenburg SI, Metzemaekers J, Jansen FW, Blikkendaal MD. Evaluation of the effect of previous endometriosis surgery on clinical and surgical outcomes of subsequent endometriosis surgery. Arch Gynecol Obstet 2023; 308:1531-1541. [PMID: 37639036 PMCID: PMC10520192 DOI: 10.1007/s00404-023-07193-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 08/13/2023] [Indexed: 08/29/2023]
Abstract
PURPOSE Patients often undergo repeat surgery for endometriosis, due to recurrent or residual disease. Previous surgery is often considered a risk factor for worse surgical outcome. However, data are scarce concerning the influence of subsequent endometriosis surgery. METHODS A retrospective study in a centre of expertise for endometriosis was conducted. All endometriosis subtypes and intra-operative steps were included. Detailed information regarding surgical history of patients was collected. Surgical time, intra-operative steps and major post-operative complications were obtained as outcome measures. RESULTS 595 patients were included, of which 45.9% had previous endometriosis surgery. 7.9% had major post-operative complications and 4.4% intra-operative complications. The patient journey showed a median of 3 years between previous endometriosis surgeries. Each previous therapeutic laparotomic surgery resulted on average in 13 additional minutes (p = 0.013) of surgical time. Additionally, it resulted in more frequent performance of adhesiolysis (OR 2.96, p < 0.001) and in a higher risk for intra-operative complications (OR 1.81, p = 0.045), however no higher risk for major post-operative complications (OR 1.29, p = 0.418). Previous therapeutic laparoscopic endometriosis surgery, laparotomic and laparoscopic non-endometriosis surgery showed no association with surgical outcomes. Regardless of previous surgery, disc and segmental bowel resection showed a higher risk for major post-operative complications (OR 3.64, p = 0.017 respectively OR 3.50, p < 0.001). CONCLUSION Previous therapeutic laparotomic endometriosis surgery shows an association with longer surgical time, the need to perform adhesiolysis, and more intra-operative complications in the subsequent surgery for endometriosis. However, in a centre of expertise with experienced surgeons, no increased risk of major post-operative complications was observed.
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Affiliation(s)
| | - Sophie I Peltenburg
- Department of Gynecology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeroen Metzemaekers
- Department of Gynecology, Leiden University Medical Center, Leiden, The Netherlands
| | - Frank Willem Jansen
- Department of Gynecology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - Mathijs D Blikkendaal
- Endometriosis Center, Haaglanden Medical Center, The Hague, The Netherlands
- Nederlandse Endometriose Kliniek, Reinier de Graaf Hospital, Delft, The Netherlands
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Fair L, Ward M, Vankina M, Rana R, McGowan T, Ogola G, Aladegbami B, Leeds S. Comparison of long-term quality of life outcomes between endoscopic vacuum therapy and other treatments for upper gastrointestinal leaks. Surg Endosc 2023:10.1007/s00464-023-10181-z. [PMID: 37308758 DOI: 10.1007/s00464-023-10181-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 05/30/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND While endoscopic vacuum assisted closure (EVAC) therapy is a validated treatment for gastrointestinal leaks, its impact on long-term quality of life (QoL) is uncertain. The purpose of this study was to evaluate the impact of successful EVAC management on long-term QoL outcomes. METHODS An institutional review board approved prospectively maintained database was retrospectively reviewed to identify patients undergoing treatment for gastrointestinal leaks between June 2012 and July 2022. The Short-Form 36 (SF-36) survey was used to assess QoL. Patients were contacted by telephone and sent the survey electronically. QoL outcomes between patients who underwent successful EVAC therapy and those who required conventional treatment (CT) were analyzed and compared. RESULTS A total of 44 patients (17 EVAC; 27 CT) completed the survey and were included in our analysis. All included patients had foregut leaks with sleeve gastrectomy being the most common sentinel operation (n = 20). The mean time from the sentinel operation was 3.8 years and 4.8 years for the EVAC and CT groups, respectively. When evaluating long-term QoL, the EVAC group scored higher in all QoL domains when compared to the CT group with physical functioning (87.3 vs 69.3, p = 0.04), role limitations due to physical health (84.1 vs 45.7, p = 0.02), energy/fatigue (60.0 vs 40.9, p = 0.04), and social functioning (86.2 vs 64.1, p = 0.04) reaching statistical significance. Overall, patients who achieved organ preservation via successful EVAC therapy scored higher in all domains with role limitations due to physical health (p = 0.04) being statistically significant. In a multivariable regression analysis, increased age and a history of prior abdominal surgery at the time of the sentinel operation were patient characteristics that negatively impacted QoL outcomes. CONCLUSION Patients with gastrointestinal leaks successfully managed by EVAC therapy have better long-term QoL outcomes when compared to patients undergoing other treatments.
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Affiliation(s)
- Lucas Fair
- Department of Minimally Invasive Surgery, Baylor University Medical Center, 3417 Gaston Avenue, Suite 965, Dallas, TX, 75246, USA
- Center for Advanced Surgery, Baylor Scott and White Health, Dallas, TX, USA
- Research Institute, Baylor Scott and White Health, Dallas, TX, USA
| | - Marc Ward
- Department of Minimally Invasive Surgery, Baylor University Medical Center, 3417 Gaston Avenue, Suite 965, Dallas, TX, 75246, USA
- Center for Advanced Surgery, Baylor Scott and White Health, Dallas, TX, USA
- Texas A&M College of Medicine, Bryan, TX, USA
| | | | - Rashmeen Rana
- Research Institute, Baylor Scott and White Health, Dallas, TX, USA
| | - Titus McGowan
- Research Institute, Baylor Scott and White Health, Dallas, TX, USA
| | - Gerald Ogola
- Research Institute, Baylor Scott and White Health, Dallas, TX, USA
| | - Bola Aladegbami
- Department of Minimally Invasive Surgery, Baylor University Medical Center, 3417 Gaston Avenue, Suite 965, Dallas, TX, 75246, USA
- Center for Advanced Surgery, Baylor Scott and White Health, Dallas, TX, USA
- Texas A&M College of Medicine, Bryan, TX, USA
| | - Steven Leeds
- Department of Minimally Invasive Surgery, Baylor University Medical Center, 3417 Gaston Avenue, Suite 965, Dallas, TX, 75246, USA.
- Center for Advanced Surgery, Baylor Scott and White Health, Dallas, TX, USA.
- Texas A&M College of Medicine, Bryan, TX, USA.
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Boyer N, Koliakos N, Pau L, Poras M, Maréchal MT, Farinella E. Is a giant incisional hernia a contraindication for laparoscopic cholecystectomy? J Surg Case Rep 2023; 2023:rjad305. [PMID: 37337539 PMCID: PMC10276978 DOI: 10.1093/jscr/rjad305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 05/03/2023] [Indexed: 06/21/2023] Open
Abstract
Laparoscopic cholecystectomy (LC) is one of the most commonly performed surgical procedures worldwide. A previous abdominal operation is not considered a significant risk factor for conversion to open cholecystectomy. We describe the case of an 80-year-old woman with a surgical history of a giant uncomplicated incisional midline hernia presenting at our department with choledocholithiasis and acute cholangitis. After an ERCP with extraction of common bile duct stones, a LC was planned. The first trocar was inserted in the right midclavicular line, using an open technique and a careful inspection of the abdominal cavity and the hernia sac content. An uncomplicated cholecystectomy was performed and the postoperative course was uneventful.
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Affiliation(s)
- Nicolas Boyer
- Correspondence address. Department of Digestive Surgery, Saint-Pierre University Hospital, Rue Haute 322, 1000, Brussels, Belgium. Tel: +3225354115; Fax: +32 2 535 40 70; E-mail:
| | - Nikolaos Koliakos
- Department of Digestive Surgery, Saint-Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Luca Pau
- Department of Digestive Surgery, Saint-Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Mathilde Poras
- Department of Digestive Surgery, Saint-Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Marie-Therese Maréchal
- Department of Digestive Surgery, Saint-Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Eleonora Farinella
- Department of Digestive Surgery, Saint-Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium
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Imaralu J, Ani F, Ayegbusi E, Oguntade F, Nwankpa C, Olaleye B. Peritoneal adhesion findings during laparoscopy: Determinants of occurrence and effect of severity on operative outcomes in a Nigerian Hospital. Ann Afr Med 2023; 22:145-152. [PMID: 37026194 DOI: 10.4103/aam.aam_43_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Abstract
Context Peritoneal adhesions unlike other immediately recognizable complications of the surgery may produce long-term consequences, which include infertility and intestinal obstruction. Aims The study aimed to determine the prevalence, the determinants, and the outcomes of laparoscopic surgery associated with intraperitoneal adhesion findings. Settings and Design This was a retrospective observational study. Materials and Methods The study included all laparoscopic gynecological surgeries done between January 2017 and December 2021. Adhesion severity was graded, using the peritoneal adhesion index (PAI), by Coccolini et al. Statistical Analysis The data were analyzed using the SPSS version 21.0. Binary logistic regression was used to assess the factors associated with adhesion finding during laparoscopy. Results There were 158 laparoscopic surgeries with 26.6% prevalence of peritoneal adhesions. The prevalence of adhesions among women with previous surgery was 72.7%. Previous peritoneal surgery was a significant determinant of occurrence of adhesions (odds ratio = 8.291, 95% confidence interval [CI] = 4.464-15.397, P < 0.001), and such patients had significantly (P = 0.025, 95% CI = 0.408-5.704) more severe adhesions (PAI = 11.16 ± 3.94) than those without prior surgery (PAI = 8.10 ± 3.14). Abdominal myomectomy (PAI = 13.09 ± 2.95) was the most important primary surgical determinant of adhesion formation. There was no significant relationship between adhesion occurrence and conversion to laparotomy (P = 0.121) or mean duration of surgery (P = 0.962). Greater adhesion severity was, however, observed in individuals with operative blood loss <100 ml (PAI = 11.73 ± 3.56, P = 0.003) and those hospitalized for ≤2 days (PAI = 11.12 ± 3.81, P = 0.022). Conclusion The prevalence of postoperative adhesions during laparoscopy in our center is comparable to what has been earlier reported. Abdominal myomectomy is associated with the greatest risk and severity of adhesions. Laparoscopy in patients with more severe adhesions resulted in less blood loss and shorter duration of hospitalization, suggesting an association of better outcomes with a cautious approach to adhesions.
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Sadeghi S, Kalantari Y, Shokri S, Fallahpour M, Nafissi N, Goodarzi A, Valizadeh R. Immunologic response, Efficacy, and Safety of Vaccines against COVID-19 Infection in Healthy and immunosuppressed Children and Adolescents Aged 2 - 21 years old: A Systematic Review and Meta-analysis. J Clin Virol 2022; 153:105196. [PMID: 35716417 PMCID: PMC9162782 DOI: 10.1016/j.jcv.2022.105196] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 05/29/2022] [Accepted: 06/01/2022] [Indexed: 12/13/2022]
Abstract
Children and adolescents form a large proportion of societies and play an important role in the transmission of COVID-19. On the other hand, their education, mental and physical wellness, and safety are compromised which makes vaccination a crucial step to return to normal life. In the current systematic review, the COVID-19 vaccination was evaluated in a total of 50,148 children and adolescents in 22 published studies and 5,279 participants in two ongoing clinical trials. The study was registered in the PROSPERO with the ID# CRD42022303615. Data were collected about multiple vaccines including BNT162b2 (Pfizer), mRNA-1273 (Moderna), JNJ-78436735 (Johnson and Johnson), CoronaVac (Sinovac), BBIBP-CorV (Sinopharm), adenovirus type-5-vectored vaccine, ZyCov-D, and BBV152 (COVAXIN). The immune response and efficacy of such vaccines were 96% - 100% in healthy children and adolescents and were also acceptable in those with underlying diseases and suppressed immune systems. The current systematic review revealed favorable safety profiles of employed vaccines in children and adolescents; however, adverse reactions such as myocarditis and myopericarditis were reported which were transient and resolved entirely. Consequently, vaccinating children and adolescents aged 2 - 21 years old is beneficial to abort the COVID-19 pandemic. Moreover, the risk-benefit assessments revealed favorable results for vaccinating children and adolescents, especially those with underlying diseases and immunosuppressed conditions, alongside adults to prevent transmission, severe infection, negative outcomes, and new variants formation. Also, according to the meta-analysis, the efficacy and immune response of vaccines after the first and second doses were 91% and 92%, respectively. Meanwhile, overall immune response for all vaccines was 95% and 91% for Pfizer vaccine.
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Affiliation(s)
- Sara Sadeghi
- Department of Pediatrics, Division of Dermatology, University of Calgary, Alberta Children's Hospital, Calgary, AB, Canada; Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
| | - Yasamin Kalantari
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Sima Shokri
- Department of Pediatrics, Allergy and Clinical Immunology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
| | - Morteza Fallahpour
- Department of Pediatrics, Allergy and Clinical Immunology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
| | - Nahid Nafissi
- Department of General Surgery, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
| | - Azadeh Goodarzi
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences, Tehran, Iran; Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Iran Jordan Dermatology and Hair Transplantation Center, Tehran, Iran.
| | - Rohollah Valizadeh
- Department of Epidemiology, Student Research Committee, School of Public Health, Iran University of Medical science, Tehran, Iran and Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran.
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Kasap Y, Senel S, Tastemur S, Olcucuoglu E. Feasibility of E-PASS score to predict postoperative complications in laparoscopic nephrectomy. Int Urol Nephrol 2022; 54:2149-2156. [PMID: 35767201 DOI: 10.1007/s11255-022-03269-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 05/12/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the usefulness of E-PASS score to predict postoperative complications after laparoscopic nephrectomy. METHODS Between 2008 and 2020, 424 patients (179 patients: simple nephrectomy, 158 patients: radical nephrectomy, 87 patients: donor nephrectomy) who underwent laparoscopic nephrectomy in our clinic, were included in the study. Patient groups separated according to the presence of postoperative complications were compared retrospectively regarding demographic, clinical, intraoperative, and postoperative data, comorbidities, and E-PASS scores (PRS, SSS, and CRS). The relationship between postoperative complications and E-PASS scores was examined. RESULTS Postoperative complications occurred in 43 (10.1%) of the patients. Age, previous abdominal/retroperitoneal surgery, radical nephrectomy rate of surgeries, operation time, amount of bleeding, need for blood transfusion, rate of conversion from laparoscopic surgery to open surgery, hospitalization time, E-PASS PRS, SSS, and CRS were statistically significantly higher in the group with postoperative complications. The cutoff value of the E-PASS CRS was - 0.2996 to predict the development of postoperative complications (AUC = 0.706; 95% CI 0.629-0.783; p < 0.001). According to multivariate analysis, presence of previous abdominal/retroperitoneal surgery (OR 2.977; 95% CI 1.502-5.899; p = 0.002), laparoscopic radical nephrectomy (OR 2.518; 95% CI 1.224-5.179; p = 0.012), conversion from laparoscopic surgery to open surgery (OR 4.869; 95% CI 1.046-22.669; p = 0.044) and E-PASS CRS > - 0.2996 (OR 2.816; 95% CI 1.321-6.004; p = 0.007) were found to be independent risk factors predicting postoperative complications. CONCLUSION The E-PASS scoring system is an effective and convenient system for predicting postoperative complications after laparoscopic nephrectomy.
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Affiliation(s)
- Yusuf Kasap
- Department of Urology, Ankara City Hospital, Üniversiteler Mahallesi, 1604. Cadde No: 9 Çankaya, Ankara, Turkey
| | - Samet Senel
- Department of Urology, Ankara City Hospital, Üniversiteler Mahallesi, 1604. Cadde No: 9 Çankaya, Ankara, Turkey.
| | - Sedat Tastemur
- Department of Urology, Ankara City Hospital, Üniversiteler Mahallesi, 1604. Cadde No: 9 Çankaya, Ankara, Turkey
| | - Erkan Olcucuoglu
- Department of Urology, Ankara City Hospital, Üniversiteler Mahallesi, 1604. Cadde No: 9 Çankaya, Ankara, Turkey
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8
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Hurni Y, Romito F, Huber DE. Is transvaginal natural orifice transluminal endoscopic surgery (vNOTES) indicated in patients with previous extensive pelvic surgeries? A case report. Case Rep Womens Health 2022; 34:e00397. [PMID: 35198415 PMCID: PMC8851094 DOI: 10.1016/j.crwh.2022.e00397] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 02/07/2022] [Accepted: 02/08/2022] [Indexed: 11/28/2022] Open
Abstract
Transvaginal natural orifice transluminal endoscopic surgery (vNOTES) has been increasingly applied to perform multiple gynecologic procedures. However, evidence is lacking on whether this surgical approach is feasible for patients with prior extensive abdominopelvic surgeries. We report a case of prophylactic bilateral salpingo-oophorectomy (BSO) performed in a 51-year-old patient with previous laparotomic radical hysterectomy and pelvic lymphadenectomy for cervical cancer. The patient underwent rectovaginal examination and evaluation of the transvaginal sonographic sliding sign as preoperative screening to exclude the obliteration of the pouch of Douglas. The abdominal cavity was accessed by cautious endoscopic access to the pouch of Douglas. The BSO was realized in accordance with risk-reducing surgery guidelines. No intraoperative or postoperative complications were observed. We suggest that selecting patients carefully prior to operation and adapting intraoperative techniques could be a safe method for conducting vNOTES interventions in patients with extensive abdominopelvic adhesions. vNOTES has been increasingly applied to perform multiple gynecologic procedures. There is a lack of evidence for its feasibility for patients who have previously had extensive surgery. Careful preoperative evaluations and intraoperative adaptations are needed. Extensive pelvic adhesiolysis by vNOTES appears feasible. We report a vNOTES intervention in a patient with previous extensive surgery.
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Affiliation(s)
- Yannick Hurni
- Department of Pediatrics, Gynecology and Obstetrics, Geneva University Hospitals, Boulevard de la Cluse 30, 1205 Geneva, (Switzerland)
- Department of Gynecology and Obstetrics, Valais Hospital, Av. du Grand-Champsec 80, 1951 Sion, Switzerland
- Corresponding author at: Department of Gynecology and Obstetrics, Valais Hospital, Av. du Grand-Champsec 80, 1951 Sion, Switzerland.
| | - Fabien Romito
- Department of Gynecology and Obstetrics, Valais Hospital, Av. du Grand-Champsec 80, 1951 Sion, Switzerland
| | - Daniela Emanuela Huber
- Department of Pediatrics, Gynecology and Obstetrics, Geneva University Hospitals, Boulevard de la Cluse 30, 1205 Geneva, (Switzerland)
- Department of Gynecology and Obstetrics, Valais Hospital, Av. du Grand-Champsec 80, 1951 Sion, Switzerland
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Hiramitsu T, Tomosugi T, Futamura K, Okada M, Goto N, Narumi S, Uchida K, Watarai Y. Hand-Assisted Laparoscopic Donor Nephrectomy in Living Donors with a History of Abdominal Surgery: A Retrospective Cohort Study. Ann Transplant 2021; 26:e929752. [PMID: 33833210 PMCID: PMC8043656 DOI: 10.12659/aot.929752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Hand-assisted laparoscopic donor nephrectomy (HALDN) is frequently performed in living kidney transplantation donors. This study investigated the efficacy and safety of HALDN for living donors with abdominal surgical histories. Material/Methods A total of 573 living kidney donors underwent donor nephrectomies for living donor kidney transplantation between January 2008 and May 2015. Eighteen donors underwent open donor nephrectomy and were excluded from analyses. Left HALDN was performed in 533 donors, including 44 donors with abdominal surgical histories and 489 donors without abdominal surgical histories. Right HALDN was performed in 22 donors, including 11 donors with abdominal surgical histories and 11 donors without abdominal surgical histories. Graft quality including the lengths of arteries, veins and ureters, time to initial urination, recipient complications, and recipient estimated glomerular filtration rate (eGFR) and operation quality including warm ischemic time, blood loss, operation duration, donor complications and donor eGFR, were compared between donors with and without abdominal surgical histories in the left and right HALDN groups. Results The metrics of graft and operation quality were similar between living kidney donors with and without a history of abdominal surgery who underwent left or right HALDN. Conclusions The efficacy and safety of HALDN were not impaired by abdominal surgical histories.
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Affiliation(s)
- Takahisa Hiramitsu
- Department of Transplant and Endocrine Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Aichi, Japan
| | - Toshihide Tomosugi
- Department of Transplant and Endocrine Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Aichi, Japan
| | - Kenta Futamura
- Department of Transplant and Endocrine Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Aichi, Japan
| | - Manabu Okada
- Department of Transplant and Endocrine Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Aichi, Japan
| | - Norihiko Goto
- Department of Transplant and Endocrine Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Aichi, Japan
| | - Shunji Narumi
- Department of Transplant and Endocrine Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Aichi, Japan
| | - Kazuharu Uchida
- Department of Renal Transplant Surgery, Masuko Memorial Hospital, Nagoya, Aichi, Japan
| | - Yoshihiko Watarai
- Department of Transplant and Endocrine Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Aichi, Japan
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10
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Katar MK, Ersoy PE. Is Previous Upper Abdominal Surgery a Contraindication for Laparoscopic Cholecystectomy? Cureus 2021; 13:e14272. [PMID: 33954075 PMCID: PMC8091467 DOI: 10.7759/cureus.14272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background and objective In this era of minimally invasive surgery and enhanced recovery procedures, laparoscopic cholecystectomy (LC) is the prevailing treatment method for symptomatic cholelithiasis. However, there are some contraindications for this operation, such as a previous upper abdominal surgery. Additionally, the median conversion rate of LC is 5%. In this study, we aimed to investigate the effect of previous upper abdominal surgery on LC. Methods The study was designed as a single-center, retrospective, and observational analysis. A total of 277 LC patients were evaluated by classifying them into two groups - group A: those without previous upper abdominal surgery; group B: those with a history of previous upper abdominal surgery. Results Not surprisingly, the operation time and the degree of adhesions in group B were significantly higher compared to group A (p<0.001). On the other hand, there were no significant differences between the two groups in terms of complication rates, conversion rates, and the length of hospital stay (p=0.118, p=0.761, p=0.083, respectively). Conclusion LC is a safe method for cholelithiasis even in patients with a history of upper abdominal surgery. Previous upper abdominal surgery does not affect the conversion rates and length of hospital stay. Hence, previous upper abdominal surgery should not be accepted as a contraindication for LC.
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Affiliation(s)
- Mehmet Kağan Katar
- General Surgery, Yozgat Bozok University Faculty of Medicine, Yozgat, TUR
| | - Pamir Eren Ersoy
- General Surgery, Yozgat Bozok University Faculty of Medicine, Yozgat, TUR
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11
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Zhang ZM, Zhang C, Liu Z, Liu LM, Zhu MW, Zhao Y, Wan BJ, Deng H, Yang HY, Liao JH, Zhu HY, Wen X, Liu LL, Wang M, Ma XT, Zhang MM, Liu JJ, Liu TT, Huang NN, Yuan PY, Gao YJ, Zhao J, Guo XA, Liao F, Li FY, Wang XT, Yuan RJ, Wu F. Therapeutic experience of an 89-year-old high-risk patient with incarcerated cholecystolithiasis: A case report and literature review. World J Clin Cases 2020; 8:4908-4916. [PMID: 33195660 PMCID: PMC7642542 DOI: 10.12998/wjcc.v8.i20.4908] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/24/2020] [Accepted: 09/10/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The global pandemic of coronavirus disease 2019 pneumonia poses a particular challenge to the emergency surgical treatment of elderly patients with high-risk acute abdominal diseases. Elderly patients are a high-risk group for surgical treatment. If the incarceration of gallstones cannot be relieved, emergency surgery is unavoidable.
CASE SUMMARY We report an 89-year-old male patient with acute gangrenous cholecystitis and septic shock induced by incarcerated cholecystolithiasis. He had several coexisting, high-risk underlying diseases, had a history of radical gastrectomy for gastric cancer, and was taking aspirin before the operation. Nevertheless, he underwent emergency laparoscopic cholecystectomy, with maintenance of postoperative heart and lung function, successfully recovered, and was discharged on day 8 after the operation.
CONCLUSION Emergency surgery for elderly patients with acute abdominal disease is safe and feasible during the coronavirus disease 2019 pandemic, the key is to abide strictly by the hospital’s epidemic prevention regulations, fully implement the epidemic prevention procedure for emergency surgery, fully prepare before the operation, accurately perform the operation, and carefully manage the patient postoperatively.
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Affiliation(s)
- Zong-Ming Zhang
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Chong Zhang
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Zhuo Liu
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Li-Min Liu
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Ming-Wen Zhu
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Yue Zhao
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Bai-Jiang Wan
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Hai Deng
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Hai-Yan Yang
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Jia-Hong Liao
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Hong-Yan Zhu
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Xue Wen
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Li-Li Liu
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Man Wang
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Xiao-Ting Ma
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Miao-Miao Zhang
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Jiao-Jiao Liu
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Tian-Tian Liu
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Niu-Niu Huang
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Pei-Ying Yuan
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Yu-Jiao Gao
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Jing Zhao
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Xi-Ai Guo
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Fang Liao
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Feng-Yuan Li
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Xue-Ting Wang
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Rui-Jiao Yuan
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Fang Wu
- Department of Pathology, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
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12
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Manno S, Dell'Atti L, Cicione A, Spasari A. Safety and efficacy of transperitoneal laparoscopic nephron sparing surgery in patients with previous abdominal surgery. Urologia 2020; 88:14-20. [PMID: 32484072 DOI: 10.1177/0391560320921728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE The aim of this study is to assess the safety and feasibility of the transperitoneal laparoscopic approach during nephron sparing surgery in patients with previous abdominal surgery. PATIENTS AND METHODS We retrospectively analyzed patients undergoing transperitoneal laparoscopic partial nephrectomy for renal masses. All patients had received a diagnosis of cT1a renal exophytic mass (⩽5 cm). Patients were divided into two groups, those with and without previous abdominal surgery. Patients with solitary kidney or major previous abdominal surgery were excluded in this study. The operative time, estimated blood loss, length of stay, surgical complications, and positive surgical margins were recorded to compare outcomes among two groups. RESULTS Of the 157 patients who were included in our study, 71 (45.3%) had a history of abdominal surgery (Group 1), while the remaining 86 (54.7%) had not (Group 2). Cholecystectomy was the most common previous surgery performed near the renal fossa. Patients with previous abdominal surgery experienced increased operative time (111.5 vs 83.2 min; p = 0.001). However, no statistically significant difference was found in estimated blood loss (122.1 vs 114.4 mL; p = 0.363), length of stay (4.1 vs 3.8 days; p = 0.465), rate of conversion to open surgery (2.8% vs 2.3%; p = 0.234), and rate of complications (p = 0.121). However, operative time (p = 0.003) and length of stay (p < 0.001) were greater in patients with versus those without previous open cholecystectomy. CONCLUSION Our results suggest that laparoscopic partial nephrectomy after minor previous abdominal surgery is safe and feasible in selected patients affected by renal masses with low nephrometry score. However, previous cholecystectomy results in an increased risk of conversion to open surgery and longer hospital stay in patients undergoing right laparoscopic partial nephrectomy.
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Affiliation(s)
- Stefano Manno
- Urology Unit, Hospital "Pugliese Ciaccio," Catanzaro, Italy
| | - Lucio Dell'Atti
- Institute of Urology, University Hospital "Ospedali Riuniti," Marche Polytechnic University, Ancona, Italy
| | - Antonio Cicione
- Institute of Urology, University Hospital "S. Andrea," Roma, Italy
| | - Angelo Spasari
- Urology Unit, Hospital "Pugliese Ciaccio," Catanzaro, Italy
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13
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Kazmi SSH, Berge ST, Sahba M, Medhus AW, Sundhagen JO. A Short Series of Laparoscopic Mesenteric Bypasses for Chronic Mesenteric Ischemia. Vasc Health Risk Manag 2020; 16:87-97. [PMID: 32256075 PMCID: PMC7098165 DOI: 10.2147/vhrm.s243264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 02/14/2020] [Indexed: 12/13/2022] Open
Abstract
Background Laparoscopic aortomesenteric bypass may be performed to treat the chronic mesenteric ischemia patients who are not suitable for endovascular treatment. This study presents an initial experience with a limited series of laparoscopic mesenteric artery revascularization for the treatment of mesenteric ischemia. Methods Chronic mesenteric ischemia (CMI) patients with previous unsuccessful endovascular treatment or with arterial occlusion and extensive calcification precluding safe endovascular treatment were offered laparoscopic mesenteric revascularization. From October 2015 until November 2018, nine patients with CMI underwent laparoscopic revascularization. In addition to demographic data and perioperative results of the treatment, graft patency was assessed with Duplex ultrasound at 1, 3, 6 and 12 months, and annually thereafter. A descriptive analysis of the data was performed. Results All bypasses were constructed with an 8 mm ring enforced expanded polytetrafluoroethylene graft in a retrograde fashion (from infrarenal aorta or iliac artery) to either superior mesenteric artery or splenic artery (2 cases). Median operation time was 356 mins (range 247–492 mins). Five patients had a history of unsuccessful endovascular treatment. Laparoscopic technical success was 78%, and the primary open conversion rate was 22%. All laparoscopic revascularization procedures remained patent after discharge during a median follow-up time of 26 months (range 18–49 months). The primary graft patency at 30 days was 78%. Primary assisted, and secondary graft patency was 78% and 100%, respectively. Median weight gain was 2 kg (range 2–18 kg), and all patients achieved relief from postprandial pain and nausea. No mortality was observed during the follow-up period. Conclusion Laparoscopic aortomesenteric revascularization procedures for chronic mesenteric ischemia are feasible but require careful patient selection. These procedures should only be performed at referral centers by vascular surgeons with prior experience in laparoscopic vascular surgery.
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Affiliation(s)
- Syed Sajid Hussain Kazmi
- Department of Vascular Surgery, Heart, Lung and Vascular Clinic, Oslo University Hospital Aker, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Simen Tveten Berge
- Department of Vascular Surgery, Heart, Lung and Vascular Clinic, Oslo University Hospital Aker, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Mehdi Sahba
- Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Vascular Surgery, Ostfold Central Hospital, Kalnes, Norway
| | | | - Jon Otto Sundhagen
- Department of Vascular Surgery, Heart, Lung and Vascular Clinic, Oslo University Hospital Aker, Oslo, Norway
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14
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Breish MO, Whiting D, Sriprasad S. Laparoscopic Nephrectomy in Patients with Previous Abdominal Surgery. Cureus 2020; 12:e6991. [PMID: 32190519 PMCID: PMC7061772 DOI: 10.7759/cureus.6991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Laparoscopic nephrectomy is a minimally invasive procedure that provides significant benefits to the patient, such as reduced analgesic requirements and shorter recovery time. While the popularity of laparoscopy has grown substantially, there are associated risks of injury to the blood vessels and/or viscera during the insertion of the laparoscopic ports. Such injuries can lead to a significant increase in mortality rates. Patients who have had previous abdominal surgery have a higher risk of adhesions; this has been shown to increase the risk of complications from port placement. Consequently, previous abdominal surgery was viewed as a relative contraindication to laparoscopic surgery. However, studies have demonstrated the advantages of laparoscopic surgery over an open radical approach; hence, previous abdominal surgery is no longer viewed as a contraindication. Here, we describe the case of a 62-year-old man who presented with an incidental finding of right renal cell carcinoma (RCC). We performed a radical nephrectomy on this patient who had undergone multiple previous abdominal surgeries. During this procedure, a small bowel injury occurred. Herein, we review the available evidence and describe the risk factors and techniques to avoid injury from laparoscopic port-site placement in patients undergoing nephrectomy with a history of previous abdominal surgery.
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15
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Atasoy D, Aghayeva A, Sapcı İ, Bayraktar O, Cengiz TB, Baca B. Effects of prior abdominal surgery on laparoscopic cholecystectomy. Turk J Surg 2018; 34:217-220. [PMID: 30216161 DOI: 10.5152/turkjsurg.2017.3930] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 09/17/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVES With increased experience and technological advancement, laparoscopic cholecystectomy is reported to be safe and feasible even in the presence of most of the previously recognized contraindications. The purpose of this study was to explore the effects of prior upper and lower abdominal surgery on laparoscopic cholecystectomy. MATERIAL AND METHODS A retrospective evaluation of all sequential patients who underwent laparoscopic cholecystectomy from January 2014 to June 2016 was conducted. Patients were divided into three groups (Group A: patients without any prior abdominal surgical procedures; Group B: patients with prior upper abdominal surgical procedures; and Group C: patients with prior lower abdominal surgical procedures). RESULTS A total of 329 patients were assessed. Group A consisted of 223, Group B of 18, and Group C of 88 patients. A statistically significantly higher operative time, postoperative pain, and complication rate after laparoscopic cholecystectomy were noted in patients with prior upper abdominal surgery. The groups were comparable regarding patients' demographics and surgery indications. The length of hospital stay was not statistically different between the groups (p=0.065). CONCLUSION According to the results of the current study, prior upper abdominal surgery leads to a significantly longer procedure time, higher postoperative pain, and complication rates after laparoscopic cholecystectomy. However, the length of hospital stay was not affected by the parameters investigated.
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Affiliation(s)
- Deniz Atasoy
- Department of General Surgery, Acıbadem University School of Medicine, İstanbul, Turkey
| | - Afag Aghayeva
- Department of General Surgery, Acıbadem University School of Medicine, İstanbul, Turkey
| | - İpek Sapcı
- Student, Acıbadem University School of Medicine, İstanbul, Turkey
| | - Onur Bayraktar
- Department of General Surgery, Acıbadem University School of Medicine, İstanbul, Turkey
| | | | - Bilgi Baca
- Department of General Surgery, Acıbadem University School of Medicine, İstanbul, Turkey
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16
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Laparoscopic common bile duct exploration in patients with previous upper abdominal surgery. Surg Endosc 2018; 32:4893-4899. [PMID: 29869082 DOI: 10.1007/s00464-018-6248-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 05/29/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Although patients with previous upper abdominal surgery are no longer considered as a contraindication in laparoscopic surgery, laparoscopic common bile duct exploration (LCBDE) for these patients is still controversial. The aim of this study was to evaluate the safety and effectiveness of LCBDE for patients with previous upper abdominal surgery. METHODS Two hundred and seventeen patients with common bile duct stones who underwent LCBDE in our institution from January 2010 to September 2017 were enrolled in the retrospective study. They were divided into two groups: group A, with previous upper abdominal surgery (n = 50) and group B, without previous upper abdominal surgery (n = 167). Patients' demographic, intraoperative, and postoperative outcomes were retrospectively analyzed. RESULTS Group A exhibited a longer operative time compared to group B (179.7 ± 61.5 vs. 156.0 ± 46.8 min, p = 0.014). There was no significant difference in intraoperative blood loss (123.9 ± 99.5 vs. 99.5 ± 84.7 mL, p = 0.087), postoperative hospital stay (7.4 ± 2.6 vs. 6.8 ± 2.3 d, p = 0.193), and overall complication rate (8.0 vs. 5.4%, p = 0.732) between the two groups. There was no mortality in both groups. The initial stone clearance rate showed no significant difference between the two groups (98.0 vs. 98.2%, p = 1.000), and the final stone clearance rate was 100% in both groups (p = 1.000). The stone recurrence rate had no significant difference between the two groups (2.0 vs. 2.4%, p = 1.000). The conversion rate was comparable between group A and group B (6.0 vs. 4.8%, p = 0.718). CONCLUSIONS LCBDE is a safe and feasible procedure for patients with previous upper abdominal surgery. The keys of this procedure are carefully separating the adhesions and clearly exposing the common bile duct, and using a variety of methods to remove the stones.
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17
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Tsamalaidze L, Permenter SL, Stauffer JA. Subcostal Trocar Approach Using Four 5-mm with Exclusive Removal (STAUFFER): An Efficient and Useful Technique for Laparoscopic Cholecystectomy. J Laparoendosc Adv Surg Tech A 2018; 28:311-319. [DOI: 10.1089/lap.2017.0554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Affiliation(s)
| | - Samantha L. Permenter
- Mayo Clinic School of Health Sciences, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
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18
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Kobayashi T, Miura K, Ishikawa H, Soma D, Zhang Z, Ando T, Yuza K, Hirose Y, Katada T, Takizawa K, Nagahashi M, Sakata J, Kameyama H, Wakai T. Hand-assisted laparoscopic Hassab's procedure for esophagogastric varices with portal hypertension. Surg Case Rep 2017; 3:111. [PMID: 29058164 PMCID: PMC5651531 DOI: 10.1186/s40792-017-0387-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 10/17/2017] [Indexed: 11/21/2022] Open
Abstract
Background Laparoscopic surgery for patients with portal hypertension is considered to be contraindicated because of the high risk of massive intraoperative hemorrhaging. However, recent reports have shown hand-assisted laparoscopic surgery for devascularization and splenectomy to be a safe and effective method of treating esophagogastric varices with portal hypertension. The aim of this study is to evaluate the efficacy of hand-assisted laparoscopic devascularization and splenectomy (HALS Hassab’s procedure) for the treatment of esophagogastric varices with portal hypertension. Case presentation From 2009 to 2016, seven patients with esophagogastric varices with portal hypertension were treated with hand-assisted laparoscopic devascularization and splenectomy in our institute. Four men and three women with a median age of 61 years (range 35–71) were enrolled in this series. We retrospectively reviewed the medical records for the perioperative variables, postoperative mortality and morbidity, and postoperative outcomes of esophagogastric varices. The median operative time was 455 (range 310–671) min. The median intraoperative blood loss was 695 (range 15–2395) ml. The median weight of removed spleen was 507 (range 242–1835) g. The conversion rate to open surgery was 0%. The median postoperative hospital stay was 21 (range 13–81) days. During a median 21 (range 3–43) months of follow-up, the mortality rate was 0%. Four postoperative complications (massive ascites, enteritis, intra-abdominal abscess, and intestinal ulcer) were observed in two patients. Those complications were treated successfully without re-operation. Esophagogastric varices in all patients disappeared or improved. Bleeding from esophagogastric varices was not observed during the follow-up period. Conclusion Although our data are preliminary, hand-assisted laparoscopic devascularization and splenectomy proved an effective procedure for treating esophagogastric varices in patients with portal hypertension.
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Affiliation(s)
- Takashi Kobayashi
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chu-o-ku, Niigata, 951-8510, Japan.
| | - Kohei Miura
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chu-o-ku, Niigata, 951-8510, Japan
| | - Hirosuke Ishikawa
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chu-o-ku, Niigata, 951-8510, Japan
| | - Daiki Soma
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chu-o-ku, Niigata, 951-8510, Japan
| | - Zhengkun Zhang
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chu-o-ku, Niigata, 951-8510, Japan
| | - Takuya Ando
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chu-o-ku, Niigata, 951-8510, Japan
| | - Kizuki Yuza
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chu-o-ku, Niigata, 951-8510, Japan
| | - Yuki Hirose
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chu-o-ku, Niigata, 951-8510, Japan
| | - Tomohiro Katada
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chu-o-ku, Niigata, 951-8510, Japan
| | - Kazuyasu Takizawa
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chu-o-ku, Niigata, 951-8510, Japan
| | - Masayuki Nagahashi
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chu-o-ku, Niigata, 951-8510, Japan
| | - Jun Sakata
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chu-o-ku, Niigata, 951-8510, Japan
| | - Hitoshi Kameyama
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chu-o-ku, Niigata, 951-8510, Japan
| | - Toshifumi Wakai
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chu-o-ku, Niigata, 951-8510, Japan
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Ouellet S, Sabbagh R, Jeldres C. Transperitoneal laparoscopic nephrectomy: Assessing complication risk in cases of previous abdominal surgery. Can Urol Assoc J 2017; 11:131-135. [PMID: 28515813 DOI: 10.5489/cuaj.4107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION We aimed to assess the effect of previous abdominal surgery on perioperative outcomes in patients undergoing transperitoneal laparoscopic partial (LPN) or radical (LRN) nephrectomy for renal masses. METHODS We retrospectively reviewed all cases of LPN and LRN for renal masses at our institution between 2008 and 2014. Patients were divided in two groups, those with and without prior abdominal surgery. Four perioperative outcomes were compared, namely, operative time (OT), estimated blood loss (EBL), length of stay (LOS), and 30-days complications rate. A subanalysis was performed to address the impact of previous open cholecystectomy on right LPN or LRN. RESULTS Of 293 patients identified, 146 (49.8%) had previous abdominal surgery. In univariate analysis, no differences in operative time (136 vs. 144 minutes; p=0.154), EBL (88 vs. 100 mL; p=0.211), or 30-day complication rate (24 vs. 14%; p=0.069) were recorded between the groups. Only LOS favoured patients without previous abdominal surgery (3 vs. 4 days; p=0.001). In multivariate analysis, prior abdominal surgery was not associated with an increased OT, EBL, LOS, or complication rate. The analysis of right nephrectomies showed increased OT (148 vs. 128 minutes; p=0.049) and complication rate (42 vs. 16%; p=0.004) for patients with past open cholecystectomy compared to those without. Multivariate analysis revealed that prior open cholecystectomy was associated with a longer LOS (ORmedian=2.7 [1.2-8.0]) and an increased risk of complications (ORmedian=4.5 [1.6-10.5]). CONCLUSIONS In this cohort, previous abdominal surgery was not associated with worse perioperative outcomes after transperitoneal LPN and LRN for renal masses. However, previous open cholecystectomy resulted in a higher risk of complication and a longer LOS in patients undergoing right laparoscopic nephrectomy.
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Affiliation(s)
- Simon Ouellet
- Division of Urology, Departments of Surgery, Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Robert Sabbagh
- Division of Urology, Departments of Surgery, Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Claudio Jeldres
- Division of Urology, Departments of Surgery, Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, QC, Canada
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Horovitz D, Feng C, Messing EM, Joseph JV. Extraperitoneal vs Transperitoneal Robot-Assisted Radical Prostatectomy in the Setting of Prior Abdominal or Pelvic Surgery. J Endourol 2017; 31:366-373. [DOI: 10.1089/end.2016.0706] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- David Horovitz
- Department of Urology, University of Rochester Medical Center, Rochester, New York
| | - Changyong Feng
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, New York
| | - Edward M. Messing
- Department of Urology, University of Rochester Medical Center, Rochester, New York
| | - Jean V. Joseph
- Department of Urology, University of Rochester Medical Center, Rochester, New York
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21
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Uçar MG, Şanlıkan F, Ilhan TT, Göçmen A, Çelik Ç. Management of intra-abdominally translocated contraceptive devices, is surgery the only way to treat this problem? J OBSTET GYNAECOL 2017; 37:480-486. [PMID: 28421909 DOI: 10.1080/01443615.2016.1268577] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
This study was a multi-centre retrospective review of patients with uterine perforation caused by intrauterine contraceptive devices (IUDs). A total of 15 patients were registered, in a seven year period. Among them, five were asymptomatic and the rest were symptomatic. Asymptomatic patients were managed conservatively, except in one case in which the patient requested surgery because she also wanted a tubal ligation. Symptomatic patients all underwent surgery. All the surgeries were elective and all the surgical procedures were initiated laparoscopically. There were seven complications in the surgically managed group: conversion to laparotomy (n = 3), bowel injury (n = 2), bladder injury (n = 1), and wound infection (n = 1). Mild and severe adhesions (81.8%), and abscess (18.1%) formation related to translocated IUD (TIUD) were observed during surgery. All the patients were uneventful at 1 to 5 years of follow-up. A TIUD, by causing adhesions, complicates future laparoscopic surgery and increases the likelihood of conversion to laparotomy. While surgery is indicated to prevent TIUD-induced adhesive complications, it may also be the cause of both adhesions and complications, resulting in a vicious cycle. Some asymptomatic women, especially elderly patients with comorbidities, may not need or may be better managed without treatment. Impact statement In this study we try to find an answer for the question of "Should removal of a translocated intrauterine contraceptive device (TIUD) routinely be performed even if patients are asymptomatic?" From only the theoretical point of view there were some reports supporting conservative management in asymptomatic patients. The other studies addressing this issue were case reports including few patients with a short-term follow-up. The novelties of the present study include multi-centre design, detailed clinical and surgical information about the patients and the long period of follow-up. Most clinicians have limited experiences in managing TIUD because perforation is a rare event. So it can be difficult to know exactly what the surgeon will encounter intraoperatively. We undertook this study with the aim of providing a perspective about patients with TIUD for those faced with this situation. This is a descriptive study reporting 15 cases of TIUDs and management. Asymptomatic patients were managed conservatively, and symptomatic patients were operated. There are important implications resulting from this study that in asymptomatic patients leaving the IUD in place may be a reasonable option, mostly as the risk of surgical intervention is quite high with a high rate of complications with surgical management.
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Affiliation(s)
- Mustafa Gazi Uçar
- a Department of Obstetrics and Gynaecology , Selçuk University Medicine Faculty , Selçuklu Konya , Turkey
| | - Fatih Şanlıkan
- b Department of Obstetrics and Gynaecology , Ümraniye Education and Research Hospital , Istanbul , Turkey
| | - Tolgay Tuyan Ilhan
- a Department of Obstetrics and Gynaecology , Selçuk University Medicine Faculty , Selçuklu Konya , Turkey
| | - Ahmet Göçmen
- b Department of Obstetrics and Gynaecology , Ümraniye Education and Research Hospital , Istanbul , Turkey
| | - Çetin Çelik
- a Department of Obstetrics and Gynaecology , Selçuk University Medicine Faculty , Selçuklu Konya , Turkey
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[Specific complications of minimally invasive surgery]. Chirurg 2015; 86:1097-104. [PMID: 26541448 DOI: 10.1007/s00104-015-0105-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Minimally invasive surgery (MIS) is fundamentally different from open surgery regarding positioning of the patient, access routes and instrumentation. Each of these aspects is associated with its own specific morbidity, such as positioning-related complications, trocar-induced lesions, hypercapnia-associated phenomena and thermal damage. The growing experience of surgeons and technological progress have increased patient safety to a maximum and have resulted in an impressive spread of MIS in the various fields of surgery including the most common, such as cholecystectomy and hernia repair and special fields, such as bariatric, thoracic and oncological surgery. This narrative review summarizes the current knowledge on the inherent complications of MIS.
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