scholarly journals Stent or Surgery for Malignant Low Bileduct Obstruction?

HPB Surgery ◽  
1997 ◽  
Vol 10 (3) ◽  
pp. 179-181
Author(s):  
Ingemar Ihse ◽  
Lars Hansson ◽  
Lars-Erik Hammarström ◽  
Eva Lindström
Keyword(s):  
Controlled Trial ◽  
Surgical Techniques ◽  
Outlet Obstruction ◽  
Major Complication ◽  
Late Complications ◽  
Stent Insertion ◽  
Endoscopic Stenting ◽  
Total Hospital Stay ◽  
Significant Difference ◽  
Cast Doubt

The development of non-surgical techniques for the relief of malignant low bileduct obstruction has cast doubt on the best way of relieving jaundice, particularly in patients fit for surgery whose life expectancy is more than a few weeks.We did a randomised prospective controlled trial comparing endoscopic stent insertion and surgical biliary bypass in patients with malignant low bileduct obstruction. 204 patients were randomised (surgery 103, stent 101); 3 subsequently proved to have benign disease and were excluded, leaving 101 surgical and 100 stented patients for assessment. Technical success was achieved in 94 surgical and 95 stent patients, with functional biliary decompression obtained in 92 patients in both groups. In stented patients, there was a lower procedure-related mortality (3% vs 14%, p=0.01), major complication rate (11% vs 29%, p=0.02), and median total hospital stay (20 vs 26 days, p=0.001). Recurrent jaundice occurred in 36 stented patients and 2 surgical patients. Late gastric outlet obstruction occurred in 17% of stented patients and 7% of the surgical group. Despite the early benefits of stenting there was no significant difference in overall survival between the two groups (median survival: surgical 26 weeks; stented 21 weeks; p=0.065).Endoscopic stenting and surgery are effective palliative treatments with the former having fewer early treatment-related complications and the latter fewer late complications.

Comparative effects of suture and non-suture surgical techniques on platysma after Thyroid surgery

2021 ◽  
Vol 15 (7) ◽  
pp. 1661-1664
Author(s):  
Hafiz Ali Wasay ◽  
Muhammad Aamir Jameel ◽  
Muhammad Imran Anwar ◽  
HaroonJavaid Majid ◽  
Sameen Tahir
Keyword(s):  
Randomized Controlled Trial ◽  
Thyroid Surgery ◽  
Controlled Trial ◽  
Surgical Techniques ◽  
Platysma Muscle ◽  
Randomized Controlled ◽  
Post Operative Pain ◽  
Increased Risk ◽  
Significant Difference ◽  
The Mean

Background: Thyroidectomy is a routine general surgical procedure and pain after thyroidectomy is responsible for prolongation of hospital stay and increased risk of respiratory complications. Platysma is routinely sutured at the end of thyroidectomy before wound closure. This randomized controlled trial was conducted to compare the outcome of suturing platysma muscle versus not suturing in thyroid surgery patients. Aim: To compare the outcome of suturing platysma muscle versus not suturing in thyroid surgery patients. Place and duration of study: Dept. of Surgery at Sh. Zayed Hospital, Lahore from 26-12-2019 to 25-06-2020. Methodology: It is a randomized controlled trial study which consists of 92 patients, between 18 to 70 years of age in both gender and planned for thyroidectomy for nodular thyroid enlargement. Patients were randomly allocated into two treatment groups. After excision of thyroid, platysma was sutured as per conventional practice in one group while in the other group platysma was not sutured. For pain assessment Visual Analogue Scale (VAS) was used to 24 hours after surgery. Results: The mean age was 36.4±13.4 years. The mean VAS score for post-operative pain measured 24 hours after the surgery was significantly lower in patients undergoing thyroidectomy without platysmal suture as compared to those with conventional suturing of platysma during thyroidectomy (2.37±0.97 vs. 3.67±1.28; p <0.001). Similar significant difference was also noted between groups and subgroups which based on patient’s age, gender, BMI and educational status. Conclusion: Avoiding the suturing of platysma significantly reduced the post-operative pain which advocates a change in current practice and encourages non-suturing of platysma to decrease the morbidity of patients in post-operative period. Keywords: Thyroidectomy, Platysma, Suture, No Suture, Pain

scholarly journals Pediatric Tracheotomy: Comparison of surgical technique with early and late complications in 273 cases

2019 ◽  
Vol 35 (1) ◽  
Author(s):  
Murat Gumussoy
Keyword(s):  
Surgical Technique ◽  
Surgical Techniques ◽  
Skin Incision ◽  
Late Complications ◽  
Skill Level ◽  
Intubation Time ◽  
Early Complications ◽  
Creative Commons ◽  
Significant Difference ◽  
The Relationship

Objectives: This study was aimed to compare the early and late complications of tracheotomy in pediatric patient, with respect to surgical techniques. Methods: The relationship between demographic characteristics, surgical techniques obtained from the files of the children and complications developing after surgery were compared retrospectively. Results: One hundred fifty two out of 273 developed complications after tracheotomy. Among these, 75 were early complications and 77 were late complications. Results obtained concerning early complications showed a significant difference between Skin incision and Bleeding and Accidental decannulation; Tracheal incision and Subcutaneous emphysema; surgical time and accidental decannulation and tube/ventilation problem; Surgeon’s skill level and bleeding. As regards late complications there was a significant difference between Intubation Time and Stomal-tracheal granulation; Tracheal incision and Stomal infection; Surgeon’s skill level and Stomal-tracheal granulation. Conclusions: In pediatric tracheotomy the preferred skin incision and tracheal incision, surgeon’s experience, tracheotomoy time and intubation time are important as regards development of early or late complications. How to cite this:Gumussoy M. Pediatric Tracheotomy: Comparison of surgical technique with early and late complications in 273 cases. Pak J Med Sci. 2019;35(1):247-251. doi: https://doi.org/10.12669/pjms.35.1.132 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

One Decade of Experience with Endoscopic Stenting for Intrathoracic Anastomotic Leakage after Esophagectomy: Brilliant Breakthrough or Flash in the Pan?

2014 ◽  
Vol 80 (8) ◽  
pp. 736-745 ◽  
Author(s):  
Michael Schweigert ◽  
Norbert Solymosi ◽  
Attila Dubecz ◽  
Maria Posada GonzáLez ◽  
Hubert J. Stein ◽  
...  
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Neoadjuvant Therapy ◽  
Anastomotic Leakage ◽  
Fatal Outcome ◽  
Pleural Empyema ◽  
Stent Insertion ◽  
Endoscopic Stenting ◽  
Asa Score ◽  
Significant Difference

Management of intrathoracic anastomotic leakage after esophagectomy by means of endoscopic stent insertion has gained wide acceptance as an alternative to surgical reintervention. Between January 2004 and March 2013 all patients who underwent esophagectomy at a German high-volume center for esophageal surgery were included in this retrospective study. The study comprises 356 patients. Anastomotic leakage occurred in 49 cases. There were no significant differences in age, American Society of Anesthesiologists (ASA) score, or frequency of neoadjuvant therapy between cases with and without leak. However, leak patients sustained significantly more often postoperative pneumonia, pleural empyema, sepsis, and acute renal failure. Moreover, leak victims had higher odds for fatal outcome (16 of 49 vs 33 of 307; odds ratio, 5.94; 95% confidence interval, 2.65 to 13.15; P < 0.0001). The leakage was amendable by endoscopic stenting in 29 cases, whereas rethoracotomy was mandatory in 20 patients. Between stent and rethoracotomy cases, we observed no significant differences in age, ASA score, neoadjuvant therapy, occurrence of pneumonia, pleural empyema, or tracheostomy rate. Rethoracotomy patients sustained more often sepsis (16 of 20 vs 14 of 29; P = 0.04) and acute renal failure (nine of 20 vs four of 29; P = 0.02) as expression of more severe septic disease. Nevertheless, there was no significant difference in mortality (seven of 29 vs nine of 20; P = 0.21). Furthermore, we observed three cases of stent-related aortic erosion with peracute death from exsanguination. Despite being the preferred treatment option, endoscopic stenting was only feasible in approximately 60 per cent of all intrathoracic leaks. The results are marred by the occurrence of deadly vascular erosion. Therefore, individualized strategies should be preferred to a general recommendation for endoscopic stenting.

scholarly journals Dacryocystorhinostomy Stent Insertion in Initial Endoscopic Dacryocystorhinostomy

2016 ◽  
Vol 9 (3) ◽  
pp. 120-124 ◽  
Author(s):  
MM Rajshekar
Keyword(s):  
Controlled Trial ◽  
Nasolacrimal Duct ◽  
Stent Insertion ◽  
Stent Group ◽  
Excessive Bleeding ◽  
Endoscopic Dacryocystorhinostomy ◽  
Secondary Hemorrhage ◽  
Significant Difference ◽  
Endoscopic Dcr ◽  
Endoscopic Picture

ABSTRACT Aim To study surgical outcome in dacryocystorhinostomy (DCR) stent insertion in initial endoscopic DCR and the complications associated with the surgery. Study design This is a prospective, single-blinded, randomized, controlled trial. Materials and methods The study was carried in a tertiary level center (period between November 2009 and February 2015). A total of 50 patients with epiphora due to nasolacrimal duct obstruction were divided randomly into two groups – with one group undergoing endoscopic DCR with stent and the other group undergoing endoscopic DCR without stent. The postoperative results were assessed subjectively and objectively after 3 and 6 months and also for complications of the procedure. The results were statistically analyzed by chi-square test. Results There was significant postoperative improvement across all participants and within both groups. A total of 92% of patients in the stent group and 84% of patients in the without stent group improved. There was no significant difference with respect to complications. Synechiae and secondary hemorrhage were the most common complications in the without stent group and stent group respectively. Conclusion The present study shows that statistically significant difference in results is not achieved by inserting stents initially. But, whenever there is excessive bleeding during surgery, which masks endoscopic picture, or when bony stoma created is small because of thick bone and poor access, when atrophic sac is present, or when adhesions are expected due to pus in sac, then stenting should be done without hesitancy. Best time to do stenting is when surgeons’ first think of stenting. Regular postoperative follow-up is necessary as any defect like synechia and granulation tissue formation can be dealt with immediately. How to cite this article Rao SVM, Rajshekar MM. Dacryocystorhinostomy Stent Insertion in Initial Endoscopic Dacryocystorhinostomy. Clin Rhinol An Int J 2016;9(3):120-124.

scholarly journals Unilateral versus bilateral endoscopic stenting in patients with unresectable malignant hilar obstruction: a systematic review and meta-analysis

2020 ◽  
Vol 08 (03) ◽  
pp. E281-E290
Author(s):  
Mohamad Aghaie Meybodi ◽  
Delaram Shakoor ◽  
Julie Nanavati ◽  
Yervant Ichkhanian ◽  
Kia Vosoughi ◽  
...  
Keyword(s):  
Stent Placement ◽  
Meta Analysis ◽  
Late Complications ◽  
Stent Insertion ◽  
Endoscopic Stenting ◽  
Stent Occlusion ◽  
Endoscopic Stent ◽  
Bilateral Group ◽  
Malignant Hilar Obstruction ◽  
Unilateral Group

Abstract Background and study aims Endoscopic stent placement is used for palliative management of unresectable malignant hilar obstruction, which could be achieved by either unilateral or bilateral stent insertion. Materials and methods A literature search was performed to identify studies that reported outcomes of metallic biliary stent placement in patients with malignant hilar obstruction. Weighted pooled rates (WPR) along with 95 % confidence intervals (95 %CI) were calculated to determine and compare outcomes including technical and functional success, early and late adverse events, post procedure cholangitis, and stent occlusion between two groups. Results A total of 21 studies with 1292 patients were included. WPR of technical success was significantly higher in the unilateral group (97 %, 95 %CI: 93 –98 %) vs. bilateral group (89 %, 95 %CI: 84 –92 %) (P = 0.0.003). WPR for functional success in the unilateral and bilateral groups were 96 % (95 %CI: 91 –98 %) and 94 % (95 %CI: 91 –97 %), respectively (P = 0.48). The rate of early and late complications was comparable between the two groups. Conclusion In patients with unresectable malignant hilar obstruction, unilateral and bilateral metallic stenting techniques are comparable in terms of efficacy and safety.

Lack of Complications in Skin Surgery of Patients Receiving Clopidogrel as Compared with Patients Taking Aspirin, Warfarin, and Controls

2010 ◽  
Vol 76 (1) ◽  
pp. 11-14 ◽  
Author(s):  
Eyal Kramer ◽  
Eran Hadad ◽  
Melvyn Westreich ◽  
Avshalom Shalom
Keyword(s):  
Antiplatelet Agent ◽  
Surgical Techniques ◽  
Late Complications ◽  
Control Group ◽  
Study Group ◽  
Medical Conditions ◽  
Past Medical History ◽  
Significant Difference ◽  
Skin Surgery

Clopidogrel, a new antiplatelet agent that irreversibly inhibits platelet aggregation, is widely used today. This prospective work was conducted to evaluate the safety of performing skin surgery on patients taking clopidogrel. Patients undergoing surgery for excision of skin or subcutaneous lesions under local anesthesia taking clopidogrel were the study group. The control group comprised 2073 historical patients who had undergone a similar procedure. Data collected included: age, sex, past medical history, medications, and late complications. Follow-up was done at 1 to 2 weeks and 3 to 6 months. There were 32 patients on clopidogrel, having 38 lesions removed. Of these, seven patients were on aspirin and clopidogrel combined. The groups taking clopidogrel, aspirin, and warfarin had significantly more males, were older, and had significantly more comorbid medical conditions. There was no significant difference in the incidence of any of the complications in any of the groups. This study shows that patients taking clopidogrel before skin surgery, though older and with more associated medical conditions, do not experience a greater rate of complications. We conclude that patients undergoing minor excisional cutaneous surgery should continue taking clopidogrel because there is no apparent risk for increased complications when good meticulous surgical techniques are used.

scholarly journals A comparative study of exteriorization and intraperitoneal closure of uterus in caesarean delivery

2017 ◽  
Vol 6 (12) ◽  
pp. 5415
Author(s):  
Bharathi K. R. ◽  
Mahendra G. ◽  
Vindhyshree S. ◽  
Sonia Sherawath
Keyword(s):  
Caesarean Delivery ◽  
Controlled Trial ◽  
Operating Time ◽  
Surgical Techniques ◽  
Posterior Aspect ◽  
Infection Period ◽  
Pfannenstiel Incision ◽  
Advantages And Disadvantages ◽  
Significant Difference

Background: Caesarean delivery is the most common intraperitoneal surgical procedure in obstetrics. Many surgical techniques for caesarean delivery have been described, and the debate about the ideal caesarean technique to minimize morbidity is going on still. The aim of this study was to assess the intraoperative and postoperative advantages and disadvantages following exteriorization of uterus at caesarean section with intraperitoneal repair of uterus.Methods: It is a randomized controlled trial conducted at Adichunchanagiri Institute of Medical Sciences, B G Nagar, Mandya. Minimum of 100 cases, 50 each were randomly allocated into case and control groups. All patients who were undergoing emergency and elective caesarean delivery under spinal anaesthesia were randomly allocated into exteriorization and intraperitoneal group. In exteriorization group, uterus is exteriorized after delivery of foetus and placenta for repair, whereas in intraperitoneal group in situ repair was done. A pfannenstiel incision was taken for all the cases. Placenta was removed either by controlled traction after spontaneous separation or manually. Uterus was exteriorized after delivery of placenta and may be repaired by single or double layer. Visceral and parietal peritoneum are not closed.Results: There is significant difference in the operating time in the exteriorization group and in the in-situ group. But no significant difference between 2 groups regarding nausea, vomiting intra operatively, in return of bowel function, number of analgesic doses, incidence of cystitis, endometritis and wound infection. Period of hospitalization were also same in both groups.Conclusion: Exteriorization of uterus at caesarean delivery has the advantages less perioperative haemoglobin reduction, good exposure, good access to incision angle, especially during difficult extraction. Easy identification of uterine anomaly, adnexal mass if present and exposure of posterior aspect of lower segment.

Axial Triangle of the Maxillary Sinus, and its Surgical Implication With the Position of Maxillary Sinus Septa During Sinus Floor Elevation: A CBCT Analysis

2020 ◽  
Vol 46 (4) ◽  
pp. 415-422
Author(s):  
Junho Jung ◽  
Jung Soo Park ◽  
Seoung-Jin Hong ◽  
Gyu-Tae Kim ◽  
Yong-Dae Kwon
Keyword(s):  
Maxillary Sinus ◽  
Surgical Techniques ◽  
Lateral Sinus ◽  
Sinus Floor Elevation ◽  
Second Molar ◽  
Sinus Wall ◽  
Posterior Maxilla ◽  
Significant Difference ◽  
Sinus Floor ◽  
Molar Region

The aim of this study was to measure the convexity of the lateral wall of the maxillary (Mx) sinus and identify the locational distribution of antral septa in relation to the zygomaticomaxillary buttress (ZMB), in order to suggest another anatomical consideration and surgical modification of sinus floor elevation procedures. This study was designed as a cross-sectional study, and a total of 134 patients and 161 sinuses containing edentulous alveolar ridges were analyzed. The angle between the anterior and lateral walls of the Mx sinus (lateral sinus angle [LSA]), and the angle between the midpalatal line and the anterior sinus wall (anterior sinus angle [ASA]) were measured. Mean LSAs and ASAs were 105.9° ± 9.86° and 58.4° ± 6.43°, respectively. No significant difference between left and right sides was found (LSA, P = .420; right = 105.5° ± 9.27°; left = 105.5° ± 9.27° and ASA, P = .564; right = 57.9° ± 6.80°; left = 58.8° ± 6.02°). The prevalence of septa was 37.3%, and it was most frequently noted in the second molar region (32.8%), followed by the first molar (20.9%), retromolar (16.4%), and second premolar regions (14.9%). Septa were most frequently located posterior to the ZMB (49.2%), while ZMB was mostly located in the first molar region (66.4%). Narrow LSAs may complicate the surgical approach to the posterior maxilla, especially when sinus elevation should be used in the second molar region. Considering the occasional presence of antral septa, membrane elevation may be complicated when a septum is encountered during the procedure. These results suggest that 3-dimensional examination of the convexity of the Mx sinus should be performed preoperatively to choose proper surgical techniques and minimize surgical complications.

Reducing the Social Stigma Associated with Obsessive Compulsive Disorder: A Controlled Trial of an Intervention Program in a Turkish Community Sample

2020 ◽  
Vol 20 (2) ◽  
pp. 101-120
Author(s):  
Ayça Aktaç Gürbüz ◽  
Orçun YORULMAZ ◽  
Gülşah DURNA
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Intervention Program ◽  
Controlled Trial ◽  
Community Sample ◽  
Case Vignette ◽  
Control Group ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Significant Difference ◽  
The Impact

Scientific research into the reduction of stigmatization, particularly related to specific problems such as Obsessive-Compulsive Disorder (OCD), is scarce. In the present study, we examine the impact of a video-based antistigma intervention program for OCD in a pretest-posttest control group research. After being randomly assigned to either an intervention (n= 101) or control group (n= 96), the participants reported their attitudes on a hypothetical case vignette before and after OCD vs. Multiple Sclerosis (MS) videos, and again six months later as a follow up assessment. The mixed design analyses for the group comparisons indicated that although there was no significant difference in the measures of the control group, the participants watching the anti-stigma OCD video, in which the focus was psychoeducation and interaction strategies, reported significantly lower scores on social distances and negative beliefs for the case vignettes they read, and this difference was maintained six months later. Then, the present results indicate the effectiveness of our anti-stigma intervention program for OCD. Interventions to reduce stigmatization can also be viewed as effective tools for changing the attitudes of people toward OCD, although further research and applications are needed related to specific disorders if a longlasting impact is to be achieved.

Breastfeeding Training through Role-Play and Effects on Mother-infant Attachment Behaviours: A Randomised Controlled Trial

2020 ◽  
Vol 22 (1) ◽  
Author(s):  
Farokh Saljughi ◽  
Mitra Savabi-Esfahani ◽  
Shahnaz Kohan ◽  
Soheila Ehsanpour
Keyword(s):  
Pregnant Women ◽  
Maternal Employment ◽  
Controlled Trial ◽  
Role Play ◽  
Intervention Group ◽  
Control Group ◽  
Maternal Behaviour ◽  
Infant Attachment ◽  
Significant Difference ◽  
History Of

Mother-infant attachment is an intimate, lasting and satisfying relationship that leads to better cognitive, emotional and social growth of the infant. The aim of this study was to determine the effects of breastfeeding training by role-play on mother-infant attachment behaviours. This research was a randomised clinical trial (parallel design). Inclusion criteria were: no history of mental disorders; ability to read and write the Persian language to complete the questionnaire; no history of drug and tobacco intake in primigravida women. The sample comprised 100 pregnant women (in 2 groups), selected through simple random sampling at healthcare centres. The researcher reviewed prenatal care registries of selected healthcare centres and extracted the names of pregnant women in their early third trimester. The data were imported into randomisation software. The control group received routine breastfeeding training, while the intervention group received routine training together with training through role-play. The data collection tool was the Maternal Behaviour Inventory Questionnaire. Consequently 75 samples were analysed in SPSS16. Independent t-tests and chi-square tests were used to examine the difference between the two groups. Results showed that the mean score of mother-infant attachment one week after delivery was significantly higher in the intervention group in comparison to that in the control group (p<0.001). No significant difference was observed between the two groups in maternal age, age of marriage, neonatal gender, maternal employment and education, number of parity, and number of abortions (P>0.05). Since breastfeeding training through role-play could affect mother-infant attachment, it is suggested that this type of training should be provided for pregnant women to promote mother-infant attachment and exclusive breastfeeding.

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