scholarly journals Laparoscopic Versus Open Hartmann Reversal: A Case-Control Study

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Paolo Panaccio ◽  
Tommaso Grottola ◽  
Rossana Percario ◽  
Federico Selvaggi ◽  
Severino Cericola ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Open Surgery ◽  
Operation Time ◽  
Hartmann’S Procedure ◽  
Morbidity Rate ◽  
Mortality And Morbidity ◽  
Conversion To Open Surgery ◽  
Hartmann's Procedure ◽  
Hartmann Reversal

Background. Laparoscopic reversal of Hartmann’s procedure (LHR) offers reduced morbidity compared with open Hartmann’s reversal (OHR). The aim of this study is to compare the outcome of laparoscopic versus open Hartmann reversal. Materials and Methods. Thirty-four patients who underwent Hartmann reversal between January 2017 and July 2019 were evaluated. Patients underwent either LHR (n = 17) or OHR (n = 17). Variables such as numbers of patients, patient’s age, sex, body mass index (BMI), comorbidities, ASA (American Society of Anesthesiology) score, indication for previous open sigmoid resection, mean operation time, rate of conversion to open surgery, length of hospital stay, mortality, and morbidity were retrospectively evaluated. Results. The two groups of patients were homogeneous for gender, age, body mass index, cause of primary surgery, time to reversal, and comorbidities. In 97% of the cases, HP was done by open surgery. Our data revealed no difference in mean operation time (LHR: 180.5 ± 35.1 vs. OHR: 225.2 ± 48.4) and morbidity rate, although, in OHR group, there were more severe complications. Less intraoperative blood loss (LHR: 100 ± 40 mL vs. OHR: 450 ± 125 mL; p value <0.001), shorter time to flatus (LHR: 2.4 days vs. OHR: 3.6 days; p value <0.021), and shorter hospitalization (LHR: 4.4 vs. OHR: 11.2 days; p value <0.001) were observed in the LHR group. Mortality rate was null in both groups. Discussion. LHR is feasible and safe even for patients who received a primary open Hartmann’s procedure. We suggest careful patient’s selection allowing LHR procedures to highly skilled laparoscopy surgeons.

scholarly journals Laparoskopinis žarnos vientisumo atkūrimas po Hartmanno operacijos

2012 ◽  
Vol 10 (1-2) ◽  
pp. 0-0
Author(s):  
Algimantas Stašinskas ◽  
Juozas Stanaitis
Keyword(s):  
Blood Loss ◽  
Open Surgery ◽  
Intraoperative Complications ◽  
Total Mortality ◽  
Operation Time ◽  
Bowel Function ◽  
University Hospital ◽  
Hartmann’S Procedure ◽  
Hartmann's Procedure ◽  
Study Results

Center of General Surgery, Faculty of Medicine, Republican Vilnius University Hospital, Šiltnamių Str. 29, Vilnius, Lithuania E-mail: [email protected]; [email protected], [email protected] Introduction A change in procedure from open to laparoscopic reversal of Hartmann’s colostomy was implemented at our department between May 2009 and December 2010. The aim of the study was to investigate whether this change was beneficial for the patients. Methods The medical records of all patients who underwent colostomy reversal after a primary Hartmann’s procedure during the period from May 2009 to December 2010 were reviewed retrospectively in a case control study. Results A total of 13 patients were included. Six had a laparoscopic and 7 an open procedure. The two groups matched with regard to age, sex, the American Society of Anaesthestist (ASA) score, body mass index and indication for Hartmann’s operation. A significantly longer operation time was found for laparoscopic than for open surgery (median 285 versus 158 minutes,p < 0.001), but with a less blood loss (median 100 versus 600 ml, p < 0.001), faster return of bowel function (median three versus four days, p < 0.01) and a shorter postoperative hospitalization (median four versus six days, p < 0.01). No intraoperative complications occurred. One laparoscopic operation was converted (16.6%). There was no difference in postoperative complications between the two groups (10 versus 14%) and no anastomotic leaks. The total mortality was 0. Conclusion It is possible for trained laparoscopic general surgeons to perform laparoscopic reversal of Hartmann’s procedure as safely as in open surgery and with a faster recovery, shorter hospital stay and less blood loss despite a longer knife time. Therefore, it seems reasonable to offer patients a laparoscopic procedure at departments skilled in laparoscopic surgery and use it for standard colorectal surgery. Key words: laparoscopic reversal of Hartmann’s colostomy; restoration of intestinal continuity

scholarly journals Prediction of the Risk of Laparoscopy-Assisted Gastrectomy by Comparing Visceral Fat Area and Body Mass Index

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Yongke Liu ◽  
Dong Guo ◽  
Zhaojian Niu ◽  
Yuliang Wang ◽  
Guanghua Fu ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Blood Loss ◽  
Body Mass ◽  
Visceral Fat ◽  
Operation Time ◽  
Intraoperative Blood Loss ◽  
Imaging Data ◽  
Visceral Fat Area ◽  
Conversion To Open Surgery ◽  
Laparoscopic Assisted

Propose. The purpose of this study was to compare the accuracy of visceral fat area (VFA) and body mass index (BMI) in predicting the risk of laparoscopic-assisted gastrectomy. Methods. Clinicopathological and imaging data of 133 patients who underwent laparoscopy-assisted gastrectomy were recorded, including 17 cases of conversion to open surgery. The remaining 116 patients were retrospectively analyzed after we excluded 17 patients who had been transferred to laparotomy. The patients were divided into two groups according to BMI (≤25 kg/m2: BMI-L group; >25 kg/m2: BMI-H group) and VFA (≤100 cm2: VFA-L group; >100 cm2: VFA-H group). Clinical outcomes were compared between the BMI and VFA subgroups. Results. There were no differences in intraoperative blood loss and the number of harvested lymph nodes between low and high patients defined by BMI and VFA (p>0.050). However, in the comparison of patients who underwent laparoscopic resection only, it was found that the operation time and intraoperative blood loss of the VFA-H group were more than those of the VFA-L group (p<0.050). Compared to the VFA-L group, the VFA-H group had later first exhaust time (p=0.018), more complications (p<0.001), and longer hospital stays (p=0.049). However, no similar conclusion was obtained in the BMI group (p>0.050). Conclusion. This study demonstrates that VFA better evaluates the difficulty of laparoscopy-assisted gastrectomy and the risk of postoperative complications than BMI.

scholarly journals Clinical Study of Postoperative Bleeding after Tonsillectomy in 497 Cases

2021 ◽  
Vol 4 (01) ◽  
pp. e17-e20
Author(s):  
Takeshi Tanaka ◽  
Kenji Ishii ◽  
Kyoko Matsumoto ◽  
Koushirou Miura ◽  
Ayako Kihara ◽  
...  
Keyword(s):  
Risk Factors ◽  
Body Mass Index ◽  
Clinical Study ◽  
General Anesthesia ◽  
Retrospective Analysis ◽  
Body Mass ◽  
Smoking Habit ◽  
Postoperative Bleeding ◽  
Operation Time ◽  
History Of

AbstractWe conducted a retrospective analysis of 497 patients who underwent tonsillectomy at Kamio Memorial Hospital from September 2015 to August 2018. A total of 35 cases (7.0%) developed postoperative bleeding and three cases (0.6%) needed a second operation under general anesthesia to stop the bleeding. Postoperative bleeding most frequently occurred between 24 hours and 6 days after the operation. The incidence of postoperative bleeding was significantly higher in males and in patients aged 20 to 39 years old. The operation time, body mass index, smoking habit, and history of hypertension were not identified as clinical risk factors for bleeding after tonsillectomy in this study.

scholarly journals Reversal of the Hartmann's procedure: A comparative study of laparoscopic versus open surgery

2017 ◽  
Vol 13 (1) ◽  
pp. 47 ◽  
Author(s):  
Ernesto Melkonian ◽  
Claudio Heine ◽  
David Contreras ◽  
Marcelo Rodriguez ◽  
Patricio Opazo ◽  
...  
Keyword(s):  
Comparative Study ◽  
Open Surgery ◽  
Hartmann’S Procedure ◽  
Hartmann's Procedure

scholarly journals Reversión operación de Hartmann por vía laparoscópica

2021 ◽  
Author(s):  
Marcelo Viola Malet
Keyword(s):  
Multicenter Study ◽  
Open Surgery ◽  
Hartmann’S Procedure ◽  
Efficacy And Safety ◽  
Hartmann Procedure ◽  
Free Survival ◽  
Hartmann’S Reversal ◽  
Hartmann's Procedure ◽  
Colostomy Reversal ◽  
Hartmann's Reversal

Introducción. El procedimiento de Hartmann es una de las cirugías que se realizan con mayor frecuencia frente a una complicación oclusiva o perforativa de colon izquierdo; nos permite resolver el cuadro clínico de la complicación. El porcentaje de restitución del tránsito intestinal es muy bajo, promedialmente inferior al 50%. Ésto se debe a factores propios del paciente, la morbimortalidad de la cirugía, y a dificultades técnicas. El reestablecimiento del tránsito intestinal luego de un Hartmann puede llegar a ser una cirugía muy hostil. Tiene una morbilidadmortalidad propia no despreciable, independientemente de la vía de abordaje utilizada. La reversión por laparoscopía es uno de los procedimientos más complejos a realizar mediante este abordaje. Pero varios estudios han demostrado, que si bien requiere de una curva de aprendizaje más larga y un nivel de destreza técnica alto, tiene mejores resultados que el laparotómico.   Descripción. Presentamos el caso clínico de un hombre de 65 años, que consultó por una peritonitis purulenta diverticular un año atrás, al cual se le realizó una procedimiento de Hartmann. Se coordina para reconstrucción del tránsito intestinal por vía laparoscópica. Paciente en decúbito dorsal, Trendelemburg 30º y lateralizado a derecha. Neumoperitoneo hasta 12mmHg por técnica abierta en flanco derecho para un puerto de 12mm, inicialmente para la cámara, y luego para la mano izquierda del cirujano. Otro de 6mm en fosa ilíaca derecha para la mano derecha del cirujano, y  uno de 12mm supraumbilical para la cámara. Identificamos el muñón rectal en la pelvis. Liberamos el ostoma circunferencialmente, y confeccionamos una jareta con polipropileno 2-0. Colocacamos el anvil de la sutura mecánica 29mm, y reintroducimos el cabo colónico al abdomen. Se realiza cierre parietal en dos planos, y reinstalamos el neumoperitoneo. Colocacamos la sutura mecánica transrectal, engarzando la misma con el anvil a través de la cara anterior del muñón rectal, confeccionando la anastomosis colo-rectal término-lateral. La prueba hidroneumática fue negativa. El paciente tuvo un postoperatorio sin complicaciones, otorgándole el alta a las 72hs del procedimiento, tolerando vía oral, sin dolor, sin fiebre y habiendo movilizado el intestino.   Conclusiones. La cirugía de Hartmann sigue siendo uno de los procedimiento más realizados para tratar las complicaciones perforativas y oclusivas del colon izquierdo y recto. La restitución del tránsito intestinal luego de esta cirugía tiene un altísimo porcentaje de no concretarse por diferentes motivos. La cirugía miniinvasiva requiere de una larga curva de aprendizaje y destreza de alto nivel, pero hay varios trabajos que demuestran que la reversión de un Hartmann tiene mejores resultados por esta vía.   Bibliografía Hallam S, Mothe BS, Tirumulaju R. Hartmann's procedure, reversal and rate of stoma-free survival. Ann R Coll Surg Engl. 2018;100(4):301-307. doi:10.1308/rcsann.2018.0006 Horesh N, Lessing Y, Rudnicki Y, et al. Considerations for Hartmann's reversal and Hartmann's reversal outcomes-a multicenter study. Int J Colorectal Dis. 2017;32(11):1577-1582. doi:10.1007/s00384-017-2897-2 Melkonian E, Heine C, Contreras D, et al. Reversal of the Hartmann's procedure: A comparative study of laparoscopic versus open surgery. J Minim Access Surg. 2017;13(1):47-50. doi:10.4103/0972-9941.181329 Resio BJ, Jean R, Chiu AS, Pei KY. Association of Timing of Colostomy Reversal With Outcomes Following Hartmann Procedure for Diverticulitis. JAMA Surg. 2019;154(3):218-224. doi:10.1001/jamasurg.2018.4359 Park W, Park WC, Kim KY, Lee SY. Efficacy and Safety of Laparoscopic Hartmann Colostomy Reversal. Ann Coloproctol. 2018;34(6):306-311. doi:10.3393/ac.2018.09.07

Synergistic effect of age and body mass index on mortality and morbidity in general surgery

2013 ◽  
Vol 184 (1) ◽  
pp. 89-100 ◽  
Author(s):  
Federico J. Yanquez ◽  
John M. Clements ◽  
Dawn Grauf ◽  
Aziz M. Merchant
Keyword(s):  
Body Mass Index ◽  
Synergistic Effect ◽  
Body Mass ◽  
General Surgery ◽  
Mortality And Morbidity ◽  
Effect Of Age

scholarly journals Is it possible to reduce the complications and mortality of patients undergoing radical cystectomy? Effectiveness of pre-operative parameters. A prospective study

2021 ◽  
Vol 93 (4) ◽  
pp. 379-384
Author(s):  
Övünç Kavukoglu ◽  
Alper Coskun ◽  
Kubilay Sabuncu ◽  
Emre Çamur ◽  
Gökhan Faydaci
Keyword(s):  
Body Mass Index ◽  
Serum Albumin ◽  
Radical Cystectomy ◽  
Body Mass ◽  
Charlson Comorbidity Index ◽  
Univariate Analysis ◽  
Operation Time ◽  
Preoperative Serum ◽  
Age Dependent ◽  
Comorbidity Index

Objective: To evaluate the relationship between serum albumin, hematocrit (HTC), age-dependent Charlson comorbidity index, body mass index (BMI), and deleted operation time in predicting mortality and complications associated with radical cystectomy. Materials and methods: All patients planned for radical cystectomy owing to bladder cancer were investigated prospectively between 2015 and 2016 in our clinic. A total of 55 cases were included in the study. Patients' characteristics, preoperative serum albumin values, hematocrit level, age-dependent Charlson comorbidity index (CCI), body mass index and deleted operation time, drainage catheter time, gas-stool expulsion time were recorded. The patients were followed up for 90 days. Results: Age of cases, Charlson comorbidity index scores, and HCT were not different in patients with or without complications (overall) or severe complications nor in patients who died or survived after the procedure. The albumin value of the cases with observed mortality and complications was significantly lower than that of the cases with no mortality and complications. In multivariate and univariate analysis, low albumin level was established to be meaningful in predicting mortality and serious complications. The cut-off point for albumin, according to mortality, was found to be 4.1. Mortality within 90 days was 16.3% (n = 9). Conclusions: We have evaluated albumin as a marker that could indicate both mortality and the presence of severe complications after radical cystectomy and urinary diversion.

scholarly journals Blood pressure and lipid profile in young women: the role of anthropometric measurement

2014 ◽  
Vol 28 (4) ◽  
pp. 553-560 ◽  
Author(s):  
Marcelo Custódio Rubira ◽  
Ana Paula Fernandes de Angelis Rubira ◽  
Lucas De Angelis Rubira ◽  
Milton Carlos Martins Lima ◽  
Roberto Jorge da Silva Franco ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Body Mass Index ◽  
Body Mass ◽  
Body Fat ◽  
Bioelectrical Impedance ◽  
Impedance Analysis ◽  
Anthropometric Measurement ◽  
Normal Body Mass Index ◽  
Fat Percentage ◽  
Mortality And Morbidity

Body composition has fundamental importance in the quality of life and is a powerful predictor of mortality and morbidity in humans. The identification and monitoring of the amount of body fat have been receiving special attention in aspects related to health promotion, not just for its actions in the prevention and in the control of cardiovascular diseases but also for their induction and association with risk factors, especially in the plasmatic lipid levels and arterial pressure. It was investigated the relationship between body mass index (BMI) and body fat percentage (%BF) by bioelectrical impedance analysis (BIA) with the blood pressure levels (systolic and diastolic) and serum lipids (TC, HDL-c, LDL-c, VLDL-c, TG). In a group of fifty seven women (aged 18 to 26 years old ), obesity was detected in 5 and 19 women by BMI (≥ 30 kg/m2) and %BF (≥ 30%), respectively. BMI and % BF were positively correlated with blood pressure (systolic and diastolic), and highly significant in the obese group by %BF. Moreover, BMI and % BF were significantly correlated with all lipids and lipoprotein fractions VLDL-c and triglyceride, respectively. These results suggest that %BF is a good indicator of “occult obesity” in subjects with normal body mass index. The associated use of BMI and %BF to better evaluate obesity may improve the study of blood pressure levels and serum lipid changes that are commonly associated with obesity.

scholarly journals Laparoscopic-assisted reversal of Hartmann's procedure

2010 ◽  
Vol 57 (3) ◽  
pp. 59-65 ◽  
Author(s):  
S. Achkasov ◽  
G. Vorobiev ◽  
A. Zhuchenko ◽  
M. Rinchinov
Keyword(s):  
Wound Infection ◽  
Operation Time ◽  
Main Group ◽  
Hartmann’S Procedure ◽  
Control Group ◽  
Open Approach ◽  
Hartmann's Procedure ◽  
Comparable Control ◽  
Hospital Stays ◽  
Laparoscopic Assisted

BACKGROUND: Postoperative morbidity after reversal of Hartmann's procedure remains high. AIM: to evaluate efficacy of laparoscopic-assisted approach. PATIENTS AND METHODS: 36 patients (19 men, aged 55.71+1.5 years) underwent laparoscopic-assisted reversal procedures in May 2008 - June 2010. The comparable control group consisted of 35 patients (16 men, aged 51.5+13.9 years). RESULTS: operation time was 179.5+65.1 min, 266.9+71.8 min in controls. Blood loss was 64.7+33.7 ml, 181.8+120.4 ml in controls. No conversions occurred in the main group. In three patients of the main group preventive ileostomy was performed. There were 11 diverting stomas in the control group. Postoperative hospital stays were 9.1+2.7 days (12.9+3.4 days in controls). There were 2 (5.9%) postoperative complications in the main group: one wound infection and one parastomal fistula. No mortality occurred. In the control group 3 (9.1%) complications (wound infection and haematoma) were detected. CONCLUSION: laparoscopic-assisted reversal of Hartmann's procedure promotes faster rehabilitation, its results are not worse than after open approach.

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