HE EFFECTIVENESS OF ELECTROHYDRAULIC LITHOTRIPSY IN THE MANAGEMENT OF RE-OPERATIVED BILIARY LITHIASIS

2012 ◽  
pp. 67-73
Author(s):  
Manh Ha Le
Keyword(s):  
Open Surgery ◽  
Operative Mortality ◽  
Intraoperative Complications ◽  
Transaminase Level ◽  
Biliary Lithiasis ◽  
T Tube ◽  
Electrohydraulic Lithotripsy ◽  
Operative Complications ◽  
The Times ◽  
Rate Female

Objective: To evaluate the effectiveness of electrohydraulic lithotripsy in the treatment of re-perated biliary lithiasis. Materials and Methods: Consist of 108 patients of recurrent biliary lithiasis, underwent diagnosed and re-perated by electrohydraulic lithiotripsy during open surgery or post-operative through a T-tube from january 2005 to may 2011 at Hue Central Hospital. Results: Age average 47.2 ± 6.4 (31-78), rate female/male 1.77/1. Jaundice 42.86%, hepatomegaly 19.44%, fever 66.6%, white blood cell uper 10.000/ml 61.12%, hyperbilirubinemia 88.89%, hight transaminase level 47,28%. Intraoperative complications 19.44%, common post-operative complications 26.8% and not operative mortality. Complete clearance of stones by open surgery accounted for 77.78%, the times of average electrohydraulic lithiotripsy for a patient is 2.19 times. Conclusion: Electrohydraulic lithotripsy in the the treatment of re-perated biliary lithiasis is highly effective and safe with less complication.

scholarly journals 236 Novel Guidelines to Avoid Routine Blood Tests After Robotic Assisted Radical Prostatectomy (RARP)

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
A Nathan ◽  
N Hanna ◽  
A Rashid ◽  
S Patel ◽  
Y Phuah ◽  
...  
Keyword(s):  
Blood Test ◽  
Open Surgery ◽  
Clinical Judgement ◽  
Robotic Assisted ◽  
Blood Tests ◽  
Routine Blood ◽  
Operative Complications ◽  
Robotic Assisted Radical Prostatectomy ◽  
The Uk ◽  
Post Operative Complications

Abstract Introduction Patients undergoing RARP commonly require routine post-operative blood tests. This practice dates from an era of open surgery, with increased blood loss and complications. We aim to improve specificity of blood test requests with novel guidelines. Method 1039 consecutive RARP patients at two tertiary urology centres in the UK were audited. Novel guidelines constructed based on risk stratified evidence from the initial audit were used to prospectively audit 133 patients. Results 16% had clinical concerns post-operatively. 1% and 4% had an intra- and post-operative complication. Intra- or post-operative clinical judgement flagged post-operative complications in 99.9%. 80% had routine blood tests with no clinical concerns. 6% had delayed discharge due to delayed processing of blood tests. 0.9% received a peri-operative transfusion. Re-Audit Novel guidelines reduced the number of blood tests requested from 100% to 36%. Specificity in diagnosing a complication improved from 0% to 67%. Discharge delays reduced from 6% to 0% and no post-operative complications were missed (sensitivity 100%). Conclusions Routine blood tests, without an indication, did not flag any additional post-operative complications. Blood transfusion is rare for RARP. Novel guidelines to request post-operative blood tests will reduce costs and discharge delays whilst maintaining appropriate patient safety and care.

scholarly journals Phaco-nucleotomy techniques in management of pseudoexfoliation syndrome

2017 ◽  
Vol 8 (2) ◽  
pp. 144-150 ◽  
Author(s):  
Amol Bansal ◽  
K. P.S. Malik ◽  
V. K. Malik ◽  
Kirti Jain
Keyword(s):  
Intraoperative Complications ◽  
Divide And Conquer ◽  
Pseudoexfoliation Syndrome ◽  
Extracellular Material ◽  
Ocular Tissues ◽  
Operative Complications ◽  
Pupil Constriction ◽  
The Mean ◽  
Almost All ◽  
Systemic Condition

Introduction: Pseudoexfoliation syndrome is a common clinically important systemic condition characterized by the pathological production and accumulation of an abnormal fibrillar extracellular material in many intraocular and extra ocular tissues. Many studies have shown that pseudoexfoliation syndrome patients have higher rates of intraoperative complications during cataract surgery compared to the patients without it. Objectives: To compare Phaco-chop and Divide and Conquer techniques of phacoemulsification, in the management of pseudoexfoliation syndrome in terms of intraoperative complications. Materials and methods: It is a hospital based prospective study of 90 patients with cataract and pseudoexfoliation syndrome attending ophthalmology outpatient department in our hospital. Results: The mean age of patients in the study was 61.7 years with equal number of unilateral and bilateral cases. Intra operative complications noted in vertical chopping technique was only pupil constriction in 6.7%, no other complications were seen in this technique, whereas in horizontal chopping, 13.3% had pupil constriction, 6.7% had difficulty in chopping, 3.3% had zonular dehiscence and 3.3% had posterior capsular rent . In divide and conquer technique 16.7% had pupil constriction, 10% had difficulty in trenching, 3.3% had posterior capsular rent. Almost all the patients (97.8%) were implanted with intraocular lens after employment of various surgical modifications. Conclusion: Vertical chopping techniques scores over horizontal chopping and divide and conquer technique of phacoemulsification with good surgical outcome because of less complications. 

scholarly journals Treating the patient with acute rupture of penetrating atherosclerotic ulcer of the thoracic aorta

2015 ◽  
Vol 96 (3) ◽  
pp. 377-380
Author(s):  
I R Yagafarov ◽  
R R Sayfullin ◽  
M M Iskhakov ◽  
N V Gazizov ◽  
M G Khatypov ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Thoracic Aorta ◽  
Spontaneous Rupture ◽  
Open Surgery ◽  
Intraoperative Complications ◽  
Long Term Results ◽  
Safe Procedure ◽  
Descending Thoracic Aorta ◽  
Prosthetic Repair ◽  
Penetrating Atherosclerotic Ulcer

Spontaneous rupture of the aorta - a violation of the integrity of the aortic wall which is not caused by an aneurysm, trauma, dissection or disintegrating tumor process, and is an acute life-threatening condition. According to some authors, the main cause of spontaneous rupture of the aorta is a penetrating atherosclerotic ulcer of the aorta, which is an ulceration of aortic atherosclerotic plaque leading to penetration of the internal elastic plate in media. We present a case of successful hybrid surgical treatment of patient with spontaneous rupture of the descending thoracic aorta with the formation of para-aortic hematoma and left-sided hemothorax. The patient underwent a hybrid operation - aortic arch and descending thoracic aorta prosthetic repair, subclavian bypass with left subclavian artery ligation, left-sided thoracotomy, and pleural cavity sanitation. No intraoperative complications were observed, the patient was taken off the ventilator on day 2. The control computed tomography performed on day 10, revealed correct and stable stent graft position with no signs of continued bleeding, endoleak. The patient was discharged in satisfactory condition on day 14. Due to the high hospital mortality of open surgery on the thoracic aorta in case of penetrating atherosclerotic ulcers, as well as the predominance of elderly patients with severe comorbidities that contraindicate open surgery using cardiopulmonary bypass, endovascular and hybrid technologies, which are minimally invasive and traumatic, come to the fore. Endovascular prosthetic repair in case of penetrating atherosclerotic ulcer of aortic arch and descending thoracic aorta is an effective and safe procedure in patients at high risk, showing encouraging long-term results.

scholarly journals Maternal morbidity in emergency lower segment cesarean section

2019 ◽  
Vol 8 (7) ◽  
pp. 2604
Author(s):  
P. Kalpana ◽  
T. Praveena
Keyword(s):  
Social Class ◽  
Tract Infection ◽  
Cesarean Section ◽  
Maternal Morbidity ◽  
Intraoperative Complications ◽  
Fetal Distress ◽  
Lower Segment ◽  
Mortality And Morbidity ◽  
Lower Segment Cesarean Section ◽  
Operative Complications

Background: With a steep fall in maternal mortality and morbidity and with much more liberalization of indications, the incidence of cesarean section rate has greatly increased over the last thirty years and almost doubled in the current decade. The objective of this study was to study incidence of maternal morbidity in emergency lower segment cesarean section.Methods: Hospital based prospective study was carried out among 200 women undergoing emergency lower segment cesarean section. Data relating to demographic characteristics, clinical characteristics, maternal and fetal indications, incidence of morbidity, and types of morbidities, Intra operative complications, and Post operative complications was noted down. Chi square and odds ratio was used for statistical analysis.Results: The incidence of LSCS was 24.21%. Incidence of emergency LSCS was 96.74%. 71% were having primary LSCS and 20.5% were booked cases. The most common maternal indication for emergency LSCS was pregnancy induced hypertension and eclampsia in 32.5% of the cases. The most common fetal indication for emergency LSCS was fetal distress in 60%. Incidence of morbidity was 35% and it was associated with booking status, parity and social class. Incidence of intraoperative complications was 23.5%. Majority (18.5%) developed febrile morbidity followed by wound sepsis in 12.5%, urinary tract infection in 8%, mastitis in 7.5%, respiratory tract infection in 7%, wound gaping in 4%, paralytic ileus in 3%, endometritis in 2.5%, postpartum hemorrhage in 1.5%, 2 cases of burst abdomen and one case of small bowel obstruction.Conclusions: Emergency LSCS was more common than elective LSCS and it was associated with booking status, parity and social class.

MRC SORCE trial: Analysis of patients' presenting characteristics, tumor staging, and surgical approach.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 496-496 ◽  
Author(s):  
Alastair W. S. Ritchie ◽  
Angela M. Meade ◽  
Louise Choo ◽  
Ben Smith ◽  
Andrew Welland ◽  
...  
Keyword(s):  
Lymph Node ◽  
High Risk ◽  
Hospital Stay ◽  
Lymph Node Dissection ◽  
Surgical Approach ◽  
Open Surgery ◽  
Node Dissection ◽  
Laparoscopic Procedures ◽  
Operative Complications ◽  
Post Operative Complications

496 Background: SORCE is a randomised double blind trial of sorafenib, given for one or three years, versus placebo for patients at moderate or high risk of disease recurrence after surgical excision of primary renal cell carcinoma (RCC). Methods: Between July 2007 and April 2013, 1,711 patients were recruited from the UK (78%), Australia, France, Belgium, Denmark, The Netherlands and Spain. We describe the presenting characteristics, staging and surgical details of the randomised population. The surgical approach was at the surgeon’s discretion. Results: Baseline information is available for 1,681 patients (98%). Median age was 59 years (range 19 to 86): 1,195 (71%) were male. Histology was conventional/clear cell in 86%. T category was pT1a (<1%), pT1b (11%), pT2 (23%), pT3a-4 (65%). 47% were at high risk of recurrence with Leibovich scores of ≥6. Surgical data are available for 1,528 patients (89%). Total (radical) nephrectomy was performed for 97% of patients with 44% having laparoscopic surgery, of which 60% had a transperitoneal approach and 10% required conversion to open surgery. Some form of lymph node dissection was performed in 25% of patients (33% of open procedures and 15% of lap. procedures). The ipsi-lateral adrenal was removed in 47% and 11% had simultaneous resection of other structures/organs. Excision of venous extension was required in 19%. Laparoscopic procedures were performed for 58% of patients with maximum tumour diameter (MTD) <10cm and 17% of those with MTD ≥ 10 cm. Intra-operative complications were reported in 6% and post-operative complications reported in 12%. Hospital stay was median (IQR) 4 days (3-5) for patients having laparoscopic procedures and 7 days (5-8) for open surgery. Hospital stay was median (IQR) 8 days (6-11) for those having post-operative complications compared to 5 days (4-7) for uncomplicated recovery. Conclusions: These data reveal the varied surgical approaches to excision of primary RCC and will inform future adjuvant trials. The use of lymph node dissection appears arbitrary and evidence of benefit from randomised controlled trials is required. Analysis of the effect of sorafenib on disease free survival is likely to be performed in 2016. Clinical trial information: ISRCTN38934710.

Selecting the surgical approach in complex reoperative partial nephrectomies: Does robotics have a role?

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 658-658
Author(s):  
Sandeep Gurram ◽  
Siobhan Telfer ◽  
Winston Li ◽  
Heather Chalfin ◽  
W. Marston Linehan ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Robotic Surgery ◽  
Surgical Approach ◽  
Open Surgery ◽  
Perioperative Outcomes ◽  
Open Approach ◽  
Renal Surgery ◽  
Estimated Blood Loss ◽  
Operative Complications ◽  
Post Operative Complications

658 Background: Minimally invasive surgery (MIS) has shown equal oncologic efficacy as the open approach for treating small renal masses but results in improved perioperative parameters. Surgical principles also dictate that the open technique should be considered when facing difficult surgeries though this is experience and not evidenced based. The goal of our study is to explore differences in outcomes amongst open or robotic approaches in complex reoperative partial nephrectomies. Methods: 194 patients who had prior renal surgery from 2008 to 2019 were identified, the majority of which presented with multiple tumors due to known or suspected hereditary kidney cancer syndrome. Patients were stratified into the following cohorts based on surgical history: open after open surgery, open after MIS, robotic after open surgery, and robotic after MIS. Perioperative outcomes were compared amongst cohorts. Results: Significant differences were noted in estimated blood loss (EBL), number of tumors resected, and postoperative complications as assessed by Clavien score. Univariate regression analysis of EBL showed that the number of tumors resected (p <.0001, coefficient: 111 ml), number of prior renal procedures (p=.012, coefficient: 419 ml), hilar clamping (p = .015, coefficient: 840 ml), and intended surgical approach (p = .001; coefficient: 905 ml) were significant. On multivariate analysis, number of tumors resected (p<.0001, coefficient: 97 ml) was the only significant factor. Univariate analysis on post-operative complications showed that number of prior surgeries (p = 0.03, OR: 1.5) and final intended approach (p < .0001, OR: 4.6) were significant. On multivariate analysis, the final intended surgical approach (p = .001, OR: 4.3) was shown to be significant. Conclusions: These data show that the surgical approach of prior procedures is not a significant factor that affects perioperative outcomes, but the use of robotic surgery was associated with decreased post-operative complications in reoperative renal surgery . While open surgery will likely continue to be the standard of care for complex reoperative procedures, these data suggest that robotic surgery is safe and well tolerated in select cases.

Retrieval of retained Jamshidi needle fragments during minimally invasive surgery

2011 ◽  
Vol 14 (5) ◽  
pp. 681-684 ◽  
Author(s):  
Michael Y. Wang ◽  
Spencer Block
Keyword(s):  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Pedicle Screw ◽  
Invasive Surgery ◽  
Open Surgery ◽  
Intraoperative Complications ◽  
Surgical Techniques ◽  
Spinal Fixation ◽  
Anatomical Structures ◽  
Surrounding Bone

As surgical techniques evolve, new intraoperative complications are prone to occur. With percutaneous spinal fixation, the control of implants and instruments can be a challenge when compared with open surgery, particularly if unintended instruments are retained or difficult to retrieve. In this report, the authors describe a case in which Jamshidi needle fragments broke within the vertebral body. Extraction of the fragments was accomplished using a small pedicle screw tap to first engage the retained metal and then to loosen the surrounding bone to allow retrieval and preservation of the anatomical structures needed to complete the intended operation. This technique may prove useful for the retrieval of deformable, cannulated metal pieces in minimally invasive surgery.

scholarly journals Non-descent vaginal hysterectomy surgery associated with less complications and good prognosis

2022 ◽  
Vol 13 (1) ◽  
pp. 123-128
Author(s):  
Pranita Somani ◽  
Priyanka Singh ◽  
Mangala Shinde
Keyword(s):  
Blood Loss ◽  
Hospital Stay ◽  
Vaginal Hysterectomy ◽  
Vaginal Discharge ◽  
Operative Time ◽  
Intraoperative Complications ◽  
Vaginal Route ◽  
Background Removal ◽  
Operative Complications ◽  
Post Operative Complications

Background: Removal of the uterus through vagina when performed in a case without uterine descent or prolapse is known as “non-descent vaginal hysterectomy” or NDVH. Vaginal route is preferred as compared to laparoscopic and abdominal methods. The advantages of vaginal hysterectomy being fewer complications, less post-operative stay, cost effective, and useful in bulky uterus. Aims and Objectives: The aims of the study were as follows: (1) To study the intraoperative and post-operative complications encountered during NDVH and their management. (2) To assess the intraoperative blood loss, the operative time, and post-operative hospital stay. (3) To study and check the feasibility of vaginal route as the primary route for all hysterectomies in the absence of uterine prolapse. Materials and Methods: A total of 50 patients were included in the study. Detailed history was taken including obstetric history and menstrual history and clinical examination was performed. After taking written, informed consent and doing proper pre-operative preparation, the patient was posted for NDVH. Post-operative complications were noted. Patients were asked to come for follow-up after 15 days. Results: In 92% of cases operated, no intraoperative complications were found suggesting low morbidity associated with the procedure. Hemorrhage requiring blood transfusion was found in 4% of cases. Average operative time was 61.2 ± 27.89 min, average blood loss was 170 ± 81.44 ml, and average hospital stay was 5.94 ± 4.95 days. On histopathological examination, 40% were having leiomyoma and dysfunctional uterine bleeding was seen in 22% of cases. Pain was the most common complication seen in 30% of cases while vaginal discharge was seen in just 4% of cases. About 80% of patients were discharged on post-operative day 5. Conclusion: In 92% of NDVH cases, no intraoperative complications were found suggesting low morbidity associated with the procedure. The post-operative hospital stay was restricted to 5 days in 80% of cases which indicates early discharge of the patient. Post-operative complications such as vaginal discharge and fever were seen only in 4% of cases. NDVH should, therefore, be considered as the primary route for all hysterectomies unless contraindicated in the absence of prolapse.

scholarly journals Intraoperative Complications Are Significantly Less in Pcnl in the Treatment of Large Renal Calculi : A Prospective Randomized Controlled Trial

2020 ◽  
Vol 17 (2) ◽  
pp. 71-74
Author(s):  
Syed Alfasani ◽  
Zamanul Islam Bhuiyan
Keyword(s):  
Hospital Stay ◽  
Kidney Stone ◽  
Open Surgery ◽  
Controlled Trial ◽  
Intraoperative Complications ◽  
Renal Calculi ◽  
Stone Disease ◽  
Controlled Clinical Trial ◽  
P Value ◽  
Significant Difference

Objective: To compare the safety and efficacy of percutaneous nephrolithotomy (PCNL) and open surgery in the treatment of patients having large kidney stone(>2 cm ). Materials & Methods: A Randomised controlled clinical trial (RCT ) of 80 patients diagnosed with kidney stone disease admitted in the NIKDU during the period of Jan’ to Dec’2009 were divided conveniently into two groups. Intervention was done in the form PCNL(40) and open surgery (40). Clinical outcome like, peroperativecomplications,durationof surgery,mean hospital stay,convalescence period, amount of analgesia required to relief pain, stone clearance rate were reviewed and compared between the groups. There was no significant difference in preoperative variables such as age,sex, stone size in cm, stone number- single/multiple and stag horn Stone. Results: There were statistically significant difference in the parameters between the groups,( PCNL vs open surgery [mean ± SD]): duration of operation (min), 97.90 ± 24.89 vs 136.62 ± 23.54, postoperative hospital stay (days) ,4.77 ± 3.98 vs 9.55 ± 3.65, mean time return to work (days) , 3.09 ± 1.21vs 6.25 ± 1.53, ( p value is <0.001). Intraoperative complications like bleeding requiring blood transfusion are significantly lower in PCNL (11 cases 34.1%) than in open surgery( 18 cases 45.0%), (Chi-square = 4.82; p = 0.049). Conclusion: PCNL is relatively safe & better treatment option than open surgery in the treatment of large renal calculi, It has definite advantages of statistically less peroperative bleeding and lower morbidity. Bangladesh Journal of Urology, Vol. 17, No. 2, July 2014 p.71-74

scholarly journals Laparoscopic repair of perforated peptic ulcers without omental patch versus conventional open surgery

2018 ◽  
Vol 5 (3) ◽  
pp. 927
Author(s):  
Vaibhav Srivastava ◽  
Gyanendra Singh ◽  
Santosh K. Singh
Keyword(s):  
Laparoscopic Surgery ◽  
Minimally Invasive ◽  
Hospital Stay ◽  
Open Surgery ◽  
Open Repair ◽  
Laparoscopic Group ◽  
Peptic Ulcers ◽  
Omental Patch ◽  
Operative Complications ◽  
Repair Group

Background: Perforation of peptic ulcer usually presents as an acute abdomen. Nearly one third of the patients have no history of the disease. Laparoscopic surgery, a minimally invasive technique, has recently begun to be used on perforated peptic ulcers effectively and frequently. This study aimed to evaluate the efficacy, safety and outcome of laparoscopic surgery without omental patch for perforated ulcers in comparison with conventional open surgery.Methods: All patients diagnosed clinically with perforated peptic ulcers presenting within 24 hours of symptoms and undergoing surgery under a single surgeon during 1-year interval were included in this study and randomly assigned to laparoscopic and open repair group. Patients who had to be converted from laparoscopic surgery to open surgery, were excluded.Results: A total of 69 patients were included in this study. Number of doses of analgesics required in laparoscopic group was 9.48 ± 1.82, while those required in conventional open group was 18.16±2.24. In laparoscopic duodenal perforation repair group, duration of hospital stay (in days) was 8.42±1.44 as compared to 12.08±4.82 in open repair group. Laparoscopic group had significantly fewer post-operative complications but had longer mean operative time (101.90 minutes compared to 60.32 minutes in open repair group).Conclusions: Laparoscopic closure of perforated duodenal ulcer is a simple and safe procedure in experienced hands. It maintains the benefits of the minimally invasive approach. It is associated with longer operating time, less postoperative pain, less post-operative complications, a shorter postoperative hospital stay, and earlier returns to normal daily activities.

Sign in / Sign up

Export Citation Format

Share Document