Single-Port and Multi-Port Laparoscopic Left Lateral Liver Sectionectomy for Treating Benign Liver Diseases: A Prospective, Randomized, Controlled StudyWorld Journal of Surgery - Tập 38 - Trang 2668-2673 - 2014
Minggen Hu, Guodong Zhao, Fei Wang, Dabin Xu, Rong Liu
The use of single-port laparoscopy for left-lateral liver sectionectomy (LLLS) has been reported in the literature, but the effectiveness and safety of LLLS has not been validated in randomized, controlled trials. This prospective randomized controlled trial compared the effectiveness and safety of single-port and multi-port laparoscopic LLLS for the surgical treatment of benign liver disease.
Altogether, 38 patients aged 17–65 years (16 men, 22 women) with benign liver diseases were hospitalized for elective laparoscopic LLLS between January 2010 and December 2012. Patients were randomly assigned to either single-port (n = 19) or multi-port (n = 19) laparoscopic LLLS. Main outcome measures were operative time, volume of intraoperative blood loss, complication rates, and postoperative hospitalization. Baseline characteristics of the two groups were comparable. Single-port and multi-port laparoscopies were successfully completed in all but one patient (1/19, 5.3 %) who required conversion from a single-port to a multi-port procedure. The two groups had similar mean operative times and volumes of intraoperative blood loss. There were no clinically significant postoperative complications or deaths. The single-port group had a significantly shorter postoperative hospitalization than the multi-port group (2.5 ± 1.7 vs. 4.0 ± 2.1 days; p < 0.05). Single-port laparoscopic LLLS is a technically feasible, effective, safe alternative to multi-port laparoscopy for the treatment of benign liver diseases in cautiously selected patients.
Surgery for “Body Packers” — A 15‐year ExperienceWorld Journal of Surgery - Tập 30 Số 4 - Trang 541-546 - 2006
Daniel Silverberg, Tehillah S. Menes, Unsup Kim
AbstractBackground“Body packing” of illegal drugs has increased in the last decades, and with it our experience in treating these patients, yet no clear guidelines for surgical treatment are available. We examined the characteristics and outcomes of patients who required surgical intervention.
Study designCharts of all patients who underwent surgery at our institution for ingested drug packets between January 1990 and January 2005 were reviewed. Patients were identified by a pre‐existing list of names collected prospectively and by admission codes. Reviewed parameters included presentation, method of diagnosis, indication for surgery, procedure, and patient outcome.
ResultsTwenty‐five patients were identified, for whom charts were available for review. Main indications for surgery were drug toxicity and small bowel obstruction. Most packets were retrieved using a combination of milking and multiple enterotomies. A high rate (40%) of postoperative wound infection was found. The incidence of wound infection correlated significantly with the number of enterotomies.
ConclusionSurgical intervention for body packing remains the treatment for a minority of these patients. Patients should be placed in lithotomy to facilitate the exposure of the entire gastrointestinal tract, and to allow milking of the packets and their possible retrieval through the anus. The number of enterotomies should be minimized in order to reduce the risk of wound infection. If multiple enterotomies are used, the surgeon should consider leaving the wound open for delayed closure.
The Effect of Fibrinogen/Thrombin‐Coated Collagen Patch (TachoSil®) Application in Pancreaticojejunostomy for Prevention of Pancreatic Fistula After Pancreaticoduodenectomy: A Randomized Clinical TrialWorld Journal of Surgery - - 2019
Jae Woo Kwon, Sang Hyun Shin, Su-Kyung Lee, Guisuk Park, Yejong Park, Seung‐Jae Lee, Woo Hyung Lee, Ki Byung Song, Dae Wook Hwang, Song Cheol Kim, Jae Hoon Lee
AbstractBackgroundFibrin sealants and topical glue have been studied to reduce the incidence of postoperative pancreatic fistulas (POPF) after pancreatico‐enteric anastomosis, but a definitive innovation is still needed. We aim to evaluate the effectiveness of fibrin sealant patch applied to pancreatico‐enteric anastomosis to reduce postoperative complications, including POPF.
MethodsThis study was a single‐center, prospective, randomized, phase IV trial involving three pancreaticobiliary surgeons. The primary outcome was POPF; secondary outcomes included complications, drain removal days, hospital stay, readmission rate, and cost. Risk factors for POPF were identified by logistic regression analysis.
ResultsA total of 124 patients were enrolled. Biochemical leakage (BL) or POPF occurred in 16 patients (25.8%) in the intervention group and 23 patients (37.1%) in the control group (no statistical significance). Clinically relevant POPF occurred in 4 patients (6.5%) in both the intervention and control groups (p = 1.000). Hospital stay (11.6 days vs. 12.1 days, p = 0.585) and drain removal days (5.7 days vs. 5.3 days, p = 0.281) were not statistically different between two groups. Complication rates were not different between the two groups (p = 0.506); nor were readmission rates (12.9% vs. 11.3%, p = 1.000) or cost ($13,549 vs. $15,038, p = 0.103). In multivariable analysis, age and soft pancreas texture were independent risk factors for BL or POPF in this study. Applying fibrin sealant patch is not a negative risk factor, but the p value may indicate a likelihood of reducing the incidence of BL (p = 0.084).
ConclusionsFibrin sealant patches after pancreaticojejunostomy did not reduce the incidence of POPF or other postoperative complications. This study was registered at clinicaltrials.gov (NCT03269955).
Outcomes of Laparoscopic Versus Open Colectomy in Elective Surgery for DiverticulitisWorld Journal of Surgery - Tập 35 - Trang 2143-2148 - 2011
Hossein Masoomi, Brian Buchberg, Brian Nguyen, Vicrumdeep Tung, Michael J. Stamos, Steven Mills
The role of laparoscopy in the management of diverticular disease is evolving. Concerns were raised in the past because laparoscopic resection for diverticulitis is often difficult and occasionally hazardous. This study was undertaken to evaluate the difference in overall outcomes between elective open and laparoscopic surgery with or without anastomosis for diverticulitis. Using the National Inpatient Sample (NIS) database, clinical data of patients who underwent elective open and laparoscopic surgery (lap) for diverticulitis from 2002 to 2007 were collected and analyzed. Patients who underwent emergent surgery were excluded. A total of 124,734 patients underwent elective surgery for diverticulitis: open, 110,172 (88.3%); lap, 14,562 (11.7%). The overall intraoperative complication rate was significantly lower in the laparoscopy group (0.63% vs. 1.15%, P < 0.01). However, there was no significant difference observed in ureteral injury between groups (open, 0.17%; lap, 0.12%, P = 0.15). All evaluated postoperative complications (ileus, abdominal abscess, leak, wound infection, bowel obstruction, urinary tract infection, pneumonia, respiratory failure, venous thromboembolism) were significantly higher for the open procedures. The laparoscopy group had a shorter mean hospital stay (lap, 5.06 days; open, 6.68 days, P < 0.01) and lower total hospital charges (lap, $36,389; open, $39,406, P < 0.01) than the open group. Also, mortality was four times higher in the open group (open, 0.54%; lap, 0.13%, P < 0.01). The laparoscopic operation was associated with lower morbidity, lower mortality, shorter hospital stay, and lower hospital charges compared to the open operation for diverticulitis. Elective laparoscopic surgery for diverticulitis is safe and can be considered the preferred operative option.
Book reviewsWorld Journal of Surgery - Tập 12 - Trang 423-425 - 1988
Irving S. Benjamin, Heinz Becker, P. Mulligan, T. E. Keane, S. Nicholson, L. Fernández-Cruz
Radiological evaluation of benign breast disordersWorld Journal of Surgery - Tập 13 - Trang 685-691 - 1989
I. H. Gravelle, Kathleen Lyons
The radiological features of common benign conditions of the breast and the radiological procedures used in the investigation of benign breast disorders are presented.
Extracapsular Hematoma of the Parathyroid GlandsWorld Journal of Surgery - Tập 27 - Trang 14-17 - 2003
Philippe C.J. Chaffanjon, Nicolas Chavanis, Olivier Chabre, Pierre Yves Brichon
The objective of this study was to standardize surgical treatment of cervicothoracic hematoma due to parathyroid gland rupture. Only 19 such hematomas have been reported in the literature, and there is no consensus about the best time to operate or the surgical approach. We have now treated four new cases of extensive hematoma from the time of the initial bleeding except in the case of severe hemodynamic or respiratory troubles or nerve compression. Two of the patients were operated on after a minimal 3 months delay, with perfect results. The other two were operated on during the first month with great technical difficulty and incomplete results. In one case the gland was not excised, but parathyroid apoplexy afforded a spontaneous remission, although the hyperparathyroidism recurred 7 years later. We concluded that, first, if there are no severe compressive or hemodynamic symptoms, the surgical treatment must be performed more than 3 months after the bleeding, as the dissection then is as simple as any well ordered surgery. In case of an extensive hematoma accompanied by shock or compression, we propose simple emergency drainage, with reoperation 3 months later. Second, parathyroid apoplexy sometimes offers spontaneous remission of primary hyperparathyroidism, although late recurrence is always possible and surgical treatment then cannot be avoided.
Complications following Repair of Extrahepatic Bile Duct Injuries after Blunt Abdominal TraumaWorld Journal of Surgery - Tập 25 Số 10 - Trang 1313-1316 - 2001
José Antonio Rodríguez-Montes, Esther García Rojo, Lindsay Martin
Abstract.Extrahepatic bile duct traumatic injuries are extremely rare and their treatment is difficult and with several controversies. The aim of this study was to offer some more clinical information on their surgical repair and outcome. We present seven patients with extrahepatic biliary tract lesions after blunt abdominal trauma, (isolated gallbladder lesions were excluded) four males and three females from 23 to 51 years of age (mean age 35.1 years). All patients had suffered high‐energy blunt abdominal trauma and presented associated injuries, mostly liver trauma and lung contusions. Six gallbladder lesions and six common bile duct injures were identified; a right hepatic duct laceration and a left hepatic duct transection were also present. Injuries were treated either with primary repair or with duct‐jejunal anastomoses with Roux‐en‐Y reconstruction. Principal complications were postoperative anastomotic leakage (1 case) and recurrent cholangitis (3 cases) with or without stricture. Not‐diagnosed injuries caused substantial morbidity. We prefer and recommend the use of primary repair in partial ruptures with no significant tissue loss and biliary‐enteric anastomoses in large injuries and complete transections because they offer the best long‐term drainage with less risk of stricture formation than end‐to‐end anastomoses. We defend the use of long duration (6 to 9 months) transanastomotic stents.
Book ReviewsWorld Journal of Surgery - Tập 23 - Trang 621-622 - 1999
