Video-Endoscopic Mobilization of the Gracilis Muscle for Rectourinary Fistula Repair

2021 ◽  
pp. 1-5
Author(s):  
Cesar Britto ◽  
Daniel Pfalzgraf ◽  
Ronnie Lima ◽  
Paulo Medeiros ◽  
Rafael Rebouças ◽  
...  
Keyword(s):  
Open Surgery ◽  
Gracilis Muscle ◽  
Rectourethral Fistula ◽  
Reconstructive Procedures ◽  
Conversion To Open Surgery ◽  
Perineal Region ◽  
The Mean ◽  
Minimally Invasive Access ◽  
Rectourinary Fistula ◽  
Mean Time

<b><i>Introduction:</i></b> Transposition of the gracilis has been used in a large number of reconstructive procedures. Its advantage is its proximity to these defects and a good blood supply. Traditionally, the gracilis mobilization is performed by open surgery with one or more incisions. We describe our initial experience with the video-endoscopic mobilization of gracilis. <b><i>Method:</i></b> We described a retrospective review of all patients who underwent gracilis muscle mobilization for treatment of rectourethral fistula, performed by video-endoscopy, between March 2013 and September 2017, for treatment of rectourethral fistula. Also, our surgical technique is described in detail. <b><i>Results:</i></b> Three patients, with a mean age of 66.6 years, underwent the procedures. The mean time for mobilization of the gracilis was 107 min (range 60–145). There was no case of donor area infection, no change in the sensitivity of the medial aspect of the thigh or chronic pain. Conversion to open surgery was not necessary in any case. The hospital discharge occurred in average after 4 days. The bladder catheter was removed after 4 weeks after cystography was performed without evidence of leakage. One patient had a recurrence of the fistula. <b><i>Discussion:</i></b> The gracilis is an excellent choice of tissue to be interposed in reconstructive procedures of the perineal region, especially in the treatment of rectourinary fistulas. However, endoscopic harvest of the gracilis muscle has not yet found its way into everyday practice. The results in the treatment of rectourinary fistulas are excellent, with a success rate of 87.7%. Our rate of 67% is below, probably due to the small number of cases. In open surgery, complications are uncommon; however, approximately half of the patients expressed concern about the painful scar, which can be reduced by minimally invasive access. <b><i>Conclusion:</i></b> Video-endoscopic mobilization of gracilis muscle for the treatment of rectourethral fistula is feasible and safe. Studies comparing this technique with the conventional mobilization are required.

scholarly journals Comparative study between hand sewn and stapled anastomosis in laparoscopic right hemicolectomy

2019 ◽  
Vol 6 (4) ◽  
pp. 1035
Author(s):  
SolimanAbd-Elrahaman El-Shakhs ◽  
Ahmed Shokry Hafez ◽  
Mohamed Sabry Ammar ◽  
Moamen Mohamed Eltoukhy
Keyword(s):  
Open Surgery ◽  
Right Hemicolectomy ◽  
Stapled Anastomosis ◽  
University Hospital ◽  
Long Term Results ◽  
Conversion To Open Surgery ◽  
Laparoscopic Right Hemicolectomy ◽  
The Mean ◽  
A Prospective Study ◽  
Mean Time

Background: Laparoscopic hemicolectomy for colonic cancer can be performed safely with morbidity, mortality and long-term results comparable to those of open surgery. Despite these advantages, laparoscopic right hemicolectomy is technically challenging and warrants intensive structured training to minimize conversion to open surgery and associated complications. Anastomosis could be done either by hand sewn or stapler.Methods: Present study was a prospective study. It included 30 patients presented to Menoufia University Hospital and El Salam Oncology Center with carcinoma of right colon from March 2016 until September 2018. The patients were divided into two groups each group of 15 patients. In the first group, author used the hand sewing for anastomosis compared to the stapled anastomosis in the second group.Results: In the first group, 11 of them were males (73.3%) and 4 were females (26.7 %) with the mean age was 55.93±8.64 years. In the second group, 6 of them were males (40%) and 9 were females (60%) with the mean age was 48.33±17.97 years. In the first group, the mean time of anastomosis was 36.0±4.71 minutes and in the second group the mean time of anastomosis was 21.67±5.56 minutes. In the first group, 1 case was complicated by leakage from anastomosis (6.2%), 1 case was complicated by wound infection (6.2%). In the second group, there was no complication.Conclusions: In this study, the main advantages of doing a stapled anastomosis are the operative time, hospital stay and intraoperative bleeding. Postoperative complications than the hand sewn anastomosis.

Uncut Roux-en-Y Reconstruction in a Laparoscopic Distal Gastrectomy: A Single-Center Study of 228 Consecutive Cases and Short-Term Outcomes

2019 ◽  
Vol 26 (6) ◽  
pp. 698-704 ◽  
Author(s):  
Li Yang ◽  
Hao Xu ◽  
Dian-Cai Zhang ◽  
Feng-Yuan Li ◽  
Wei-Zhi Wang ◽  
...  
Keyword(s):  
Distal Gastrectomy ◽  
Laparoscopic Distal Gastrectomy ◽  
Short Term ◽  
Conversion To Open Surgery ◽  
Operative Duration ◽  
Single Center Study ◽  
Distal Gastric Cancer ◽  
The Mean ◽  
Diet Intake ◽  
Mean Time

Aims. We have established a procedure for uncut Roux-en-Y gastrojejunostomy after laparoscopic distal gastrectomy. This study aimed to evaluate the safety and technical feasibility of the procedure for patients with distal gastric cancer according to the short-term outcomes. Methods. Two hundred and twenty-eight consecutive patients who underwent a laparoscopic distal gastrectomy with uncut Roux-en-Y gastrojejunostomy from September 2014 to August 2018 were reviewed retrospectively. All the laparoscopic operations were performed successfully without conversion to open surgery. Results. The mean operative duration was 178.28 ± 32.82 minutes, the mean anastomotic process duration was 28.22 ± 7.50 minutes, the average blood loss was 48.97 ± 29.16 mL, and the overall number of lymph nodes harvested was 37.16 ± 11.47. The mean time of out-of-bed ambulation, anal exsufflation, liquid-diet intake, and duration of hospital stay were 41.99 ± 18.37 hours, 69.57 ± 23.17 hours, 5.06 ± 1.09 days, and 8.77 ± 2.42 days, respectively. Fifteen patients suffered postoperative complications, and the overall incidence rate was 6.58% (15/228). Seventeen patients experienced afferent recanalization, the mean time of which was 11 months after the operation. Conclusion. The laparoscopic uncut Roux-en-Y reconstruction is safe and technically feasible, and it has inspiring short-term outcomes for patients undergoing distal gastrectomy.

scholarly journals Laparoscopic Urological Surgery: Our Initial Experiences

2020 ◽  
Vol 23 (1) ◽  
pp. 17-23
Author(s):  
Shiba Prasad Nandy ◽  
AKM Akramul Bari ◽  
Anirban Ghose ◽  
Hasmot Ali Mia ◽  
Md Alamgir ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Hospital Stay ◽  
Radical Nephrectomy ◽  
Open Surgery ◽  
Renal Cyst ◽  
Conversion To Open Surgery ◽  
Cyst Excision ◽  
Excellent Outcome ◽  
Duration Of Surgery ◽  
The Mean

Introduction and Objective: Laparoscopic surgery is increasingly exercised in urology due to improvements in technical capabilities and experience. It comes with many advantages compared to open surgery such as lesser degree of pain and haemorrhage, shorter hospital stay and better cosmetic results. This study is carried out to evaluate the outcomes and complications of urological laparoscopic surgery cases performed Chittagong Medical College Hospital, Chattogram, Bangladesh. Methods: This was a hospital based prospective observational study of total 29 patients, who received laparoscopic surgery of different kinds between January 2017 and September 2019 for urological causes with a minimum one month follow-up. Included patients were assessed in terms of demographic characteristics, preoperative diagnosis, type of laparoscopic approach, duration of surgery and hospitalization, complications after surgery and need for conversion to open surgery. Results: The mean age was 45.03 years where 12 patients were women and 17 were male. All patients underwent trans-peritoneal procedures where2 patients received renal cyst excision, 4 simple nephrectomy, 5 ureterolithotomy, 9 radical nephrectomy, 1 radical cystectomy, 2 adrenalectomy, 3 pyelolithotomy and 3 pyeloplasty. Three of the 29 patients required conversion to open surgery. Except these patients, no major complication or mortality was encountered. The mean duration of surgery for the most commonly applied procedures were as follows: renal cyst excision 87.5 (70-105) min, simple nephrectomy 141.25 (120-170) min, ureterolithotomy 120 (100-140) min, radical nephrectomy 215.56 (180-260) min, pyelolithotomy 120 (100-140) min, and pyeloplasty 156.67 (130-190) min. The mean hospital stay was 4.59±1.7 (2-8) days. Conclusions: The success and complications rate of the laparoscopic urological surgeries performed in our hospital were consistent with those reported in the literature. In the light of technological advances and increasing experience, we believe that laparoscopic surgery is an effective technique with excellent outcome along with a safe and feasible alternative to open surgery in the field of urology. Bangladesh Journal of Urology, Vol. 23, No. 1, January 2020 p.17-23

scholarly journals LAPAROSCOPIC LIVER RESECTION VIA LAPAROSCOPY: EXPERIENCE IN OUR CENTRE

2021 ◽  
Vol 108 (Supplement_3) ◽  
Author(s):  
P del Val Ruiz ◽  
S Sanz Navarro ◽  
B Carrasco Aguilera ◽  
C García Bernardo ◽  
A Miyar de Leon ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Liver Surgery ◽  
Open Surgery ◽  
Cancer Metastasis ◽  
Initial Experience ◽  
Specific Training ◽  
Laparoscopic Liver Surgery ◽  
Conversion To Open Surgery ◽  
Colon Cancer Metastasis ◽  
The Mean

Abstract INTRODUCTION Laparoscopic liver surgery has undergone a great evolution in recent years, allowing increasingly complex resections without increasing complications and with evident postoperative benefits. Our purpose is to analyze our initial experience in this type of resection. MATERIAL AND METHODS We performed a retrospective observational study analyzing 41 patients who underwent liver resections by laparoscopy in our centre from March 2019 to January 2020. RESULTS The mean age of the patients was 64.5 years (SD 11) with a mean BMI of 27.56 (from 4.59). The most common surgical indication was colon cancer metastasis (41.4%), followed by hepatocarcinoma (36.6%) and usually single lesions (75.6%). The procedure passed without complications except in the case of 5 patients who required conversion to open surgery (12.5%) and 3 patients (7.5%) who required intraoperative transfusion. During the postoperative period 4 patients (9.8%) presented complications and all of them were classified as Clavien-Dindo II. We only reported 1 death (2.4%) in &gt; 90 days, which was not related to the reason for surgery. No reinterventions were necessary during admission and there were no readmissions in the first 30 days after discharge, CONCLUSIONS Laparoscopic liver surgery is technically demanding and requires previous experience in open surgery, as well as specific training, which makes a regulated implementation of the technique necessary.

EVALUATION OUTCOMES OF THE LAPAROSCOPIC RETROPERITONEAL NEPHRECTOMY FOR BENIGN NONFUNCTIONING KIDNEYS

2017 ◽  
pp. 107-112
Author(s):  
Duc Minh Hoang ◽  
khoa Hung Nguyen ◽  
Vinh Quy Truong ◽  
Van Binh Nguyen ◽  
Hong Duong Nguyen ◽  
...  
Keyword(s):  
Blood Loss ◽  
Hospital Stay ◽  
Open Surgery ◽  
Operating Time ◽  
Indications For Surgery ◽  
Conversion To Open Surgery ◽  
Multicystic Kidney ◽  
Post Operation ◽  
The Mean ◽  
Retroperitoneal Nephrectomy

Purpose: To assess results of retroperitoneoscopy nephrectomy for benign non-function kidneys from June 2013 to June 2017 at Quang Tri General Hospital. Materials and Methods: The study comprised 43 patients who underwent retroperitoneoscopic nephrectomy during a 4 years period beginning from June 2013. Results: Mean age of surgery was 52.6 years (28-72 years). 23 males and 20 females. 25 patients underwent left nephrectomy; 18 underwent right nephrectomy. Retroperitoneoscopic nephrectomy were completed successfully in 38 patients (88.4%). There was 5 patients required conversion to open surgery (11.6%), all cases by poor progression. The mean operating time was 112.7 minutes (range 70 to 210), mean blood loss was 45.7 ml (range 15 to 170 ml), and mean post-operation hospital stay was 4.3 days (range 3 to 9). A total of 21.1% complications (8/38 cases), no severe complications occurred. No re-intervention was needed. No case was mortality. The indications for surgery included hydronephrosis in 19/38 cases (50.0%), atrophic kidney in 13/38 cases (34.2%) and multicystic kidney in 6/38 cases (15.8%). Conclusions: Retroperitoneoscopic nephrectomy can be performed safely and successfully with obvious advantages for benign nonfunctioning kidneys regardless of the etiology or pathogenesis. Key words: nephrectomy, kidney, benign, retroperitoneoscopy

The initial evaluation of the retroperitoneoscopic pyelolithotomy for the partial staghorn renal stone

2019 ◽  
pp. 21-27
Author(s):  
Duc Minh Hoang ◽  
Van Binh Nguyen ◽  
Vinh Quy Truong
Keyword(s):  
Open Surgery ◽  
Renal Stone ◽  
Urinary Infection ◽  
Renal Stones ◽  
Stone Size ◽  
Conversion To Open Surgery ◽  
Laparoscopic Pyelolithotomy ◽  
Post Operation ◽  
The Mean ◽  
Selection Of

Purpose: To evaluate initial outcomes of retroperitoneoscopic pyelolithotomy for treating partial staghorn renal stones. Materials and Methods: 9 patients with partial staghorn renal stones were treated by retroperitoneal laparoscopic pyelolithotomy from June 2014 to June 2018. The mean age was 51.2 years (range 31-65); 5 males (55.6%) and 4 females (44.4%). The mean stone size was 5.1 cm (3.2 - 6.8 cm). Results: The retroperitoneoscopic pyelolithotomy procedures for treatment of staghorn renal stones were completely successful in 8/9 cases (88.9%), 1 case (11.1%) required conversion to open surgery by heavy bleed. The estimated blood lost was 20-50ml. The mean duration of the procedure is 95.3 mins (70-165 mins). All of cases (100%) was put the residual stent into the ureter. The mean post-operation hospital stay was 5.2 days (4 - 7 days). About complications: 1 cases (12.5%) of urinary infection; 3 cases (37.5%) of postoperative hematuria. Conclusions: Retroperitoneal laparoscopic pyelolithotomy could be indicated to remove the partial staghorn renal stones up to 6.8 cm in size. Success depends on the experience of surgeons and judicious selection of cases. Key words: Retroperitoneoscopic pyelolithotomy, Staghorn renal stones, Treatment

scholarly journals Transperitoneal Laparoscopic Pyelopyelostomy for Retrocaval Ureter without Excision of the Retrocaval Segment: Experience on Three Cases

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Y. El Harrech ◽  
O. Ghoundale ◽  
E. H. Kasmaoui ◽  
D. Touiti
Keyword(s):  
Open Surgery ◽  
Operative Time ◽  
Vena Cava ◽  
Intraoperative Complication ◽  
Conversion To Open Surgery ◽  
Retrocaval Ureter ◽  
The Mean ◽  
Jj Stent ◽  
Urological Diseases ◽  
Tomography Scan

Introduction. Retrocaval ureter is a rare congenital anomaly. Open surgery was the classic treatment for this condition. Laparoscopy is currently an admitted procedure to treat many urological diseases. The objective of our study is to present our experience and discuss the safety and the feasibility of transperitoneal laparoscopic pyelopyelostomy for treatment of retrocaval ureter (RCU).Materials and Methods. Three symptomatic patients underwent laparoscopic repair for RCU in our department. The diagnosis was suspected on the computed tomography scan (CT) and confirmed on ascending pyelography. After placement of a JJ stent, and, using the transperitoneal approach, the retro peritoneum was exposed; the ureter was identified in both sides of the vena cava. The retrocaval segment was entirely mobilized and pulled from behind of the vena cava after section of renal pelvis. A pyelopyelostomy was done in a normal anatomic position.Results. All operations were achieved laparoscopically without conversion to open surgery. The mean operative time was 140 minutes (110–190). No intraoperative complication occurred. Blood loss was less than 50 mL in all patients. The mean hospital stay was 5 days (4–6 days). All patients were symptom-free after surgery and had reduction of hydronephrosis in control imagery.Conclusion. Laparoscopy seems safe, feasible, and reproducible in managing retrocaval ureter.

scholarly journals The impact of the acute surgical assessment unit on the management of acute appendicitis: a single-centre review

2021 ◽  
Author(s):  
Enda Hannan ◽  
Sherif El-Masry
Keyword(s):  
Acute Appendicitis ◽  
Emergency General Surgery ◽  
Conversion To Open Surgery ◽  
Assessment Unit ◽  
The Mean ◽  
Negative Appendicectomy ◽  
The Impact ◽  
Mean Time ◽  
Surgical Condition

Abstract Background Acute surgical assessment units (ASAUs) aim to optimise management of surgical patients compared to the traditional ‘on-call’ emergency department (ED) system. Acute appendicitis (AA) is the most common acute surgical condition requiring emergency surgery. Aim We set out to assess if the ASAU improved care provided to patients with AA compared to those managed through the ED. Methods Patients admitted via the ED with AA in the 6 months prior to opening the ASAU were compared to those admitted via the ASAU in the first six months following its implementation. Relevant data was collected on key performance indicators from their charts. Results In the ASAU cohort, the mean time to be seen was one hour less than the ED cohort (21 min vs 74 min). The mean time to surgery was also 8.8 h shorter. Most patients in the ASAU group (78.6%) underwent surgery during the day, compared to 40.3% of ED patients. The ASAU patients also had a lower postoperative complication rate (0.9% vs 3.9%), as well as a lower negative appendicectomy rate (14.2% vs 18.6%) and lower conversion-to-open surgery rate. Greater consultant supervision and presence was observed. Conclusions The ASAU has resulted in better outcomes for patients with AA than those admitted via ED. More operations were performed in safer daytime hours with greater consultant presence, allowing for improved senior support for trainee surgeons. Our study supports the role of the ASAU in improving the quality and efficiency of emergency general surgery.

scholarly journals A study of pre-operative predictors for conversion to open surgery in emergency laparoscopic appendectomy

2020 ◽  
Vol 7 (8) ◽  
pp. 2499
Author(s):  
Harsha B. Kodliwadmath ◽  
B. Srinivas Pai ◽  
K. Sphurti Kamath
Keyword(s):  
Laparoscopic Appendectomy ◽  
Open Surgery ◽  
Laparoscopic Approach ◽  
Complicated Appendicitis ◽  
Total Leucocyte Count ◽  
Conversion To Open Surgery ◽  
Male Preponderance ◽  
The Mean ◽  
One Year ◽  
Open Surgical Approach

Background: Acute appendicitis is one of the most common emergencies encountered by surgeons. Although laparoscopic appendectomy is the preferred approach complicated appendicitis with a mass, abscess or perforation do present with a challenge to the operating surgeon compelling him to convert to open surgery. Our study aimed at identifying pre-operative factors that would help us predict the risk of conversion to open surgery.Methods: This was a prospective analytical study. All cases admitted over a period of one year undergoing emergency appendectomy were included in the study. The duration of history, clinical presentation, laboratory and radiological investigations were noted. The reason for conversion to open surgery was recorded. The post-operative stay and complications were analyzed.Results: A total of 160 patients fulfilling the inclusion criteria were included in the study. The mean age was 33.78 years with a male preponderance of 58%. The duration of history, clinical and radiological evidence of complicated appendicitis and peritonitis, total leucocyte count and serum bilirubin levels were identified as pre-operative predictors for risk of conversion to open surgery from laparoscopic appendectomy.Conclusions: These predictors are useful in predicting conversion to open surgery in laparoscopic emergency appendectomy. In these cases, proceeding with an open surgical approach may be beneficial to the patient in reducing operative time, cost, hospital stay and complications as laparoscopic approach may prove to be unsuccessful. This would help in enhanced communication between the surgeon and the patient with respect to the outcome and prognosis. 

Predicting Daily Maintenance Dose of Fluindione, an Oral Anticoagulant Drug

1996 ◽  
Vol 75 (05) ◽  
pp. 731-733 ◽  
Author(s):  
V Cazaux ◽  
B Gauthier ◽  
A Elias ◽  
D Lefebvre ◽  
J Tredez ◽  
...  
Keyword(s):  
Effective Dose ◽  
Maintenance Dose ◽  
Successive Approximations ◽  
Hemorrhagic Complication ◽  
Simple Method ◽  
Individual Variations ◽  
Anticoagulant Drug ◽  
The Mean ◽  
Mean Time ◽  
Daily Maintenance Dose

SummaryDue to large inter-individual variations, the dose of vitamin K antagonist required to target the desired hypocoagulability is hardly predictible for a given patient, and the time needed to reach therapeutic equilibrium may be excessively long. This work reports on a simple method for predicting the daily maintenance dose of fluindione after the third intake. In a first step, 37 patients were delivered 20 mg of fluindione once a day, at 6 p.m. for 3 consecutive days. On the morning of the 4th day an INR was performed. During the following days the dose was adjusted to target an INR between 2 and 3. There was a good correlation (r = 0.83, p<0.001) between the INR performed on the morning of day 4 and the daily maintenance dose determined later by successive approximations. This allowed us to write a decisional algorithm to predict the effective maintenance dose of fluindione from the INR performed on day 4. The usefulness and the safety of this approach was tested in a second prospective study on 46 patients receiving fluindione according to the same initial scheme. The predicted dose was compared to the effective dose soon after having reached the equilibrium, then 30 and 90 days after. To within 5 mg (one quarter of a tablet), the predicted dose was the effective dose in 98%, 86% and 81% of the patients at the 3 times respectively. The mean time needed to reach the therapeutic equilibrium was reduced from 13 days in the first study to 6 days in the second study. No hemorrhagic complication occurred. Thus the strategy formerly developed to predict the daily maintenance dose of warfarin from the prothrombin time ratio or the thrombotest performed 3 days after starting the treatment may also be applied to fluindione and the INR measurement.

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