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1.
Itawi EA Savoie LM Hanna AJ Apostolides GY 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》2011,15(4):492-498
Background and Objectives:
Alvimopan, a peripherally acting mu-opioid receptor antagonist, decreased time to gastrointestinal recovery and hospital length of stay in open bowel resection patients in Phase 3 trials. However, the benefit in laparoscopic colectomy patients remains unclear.Methods:
A retrospective case series review was performed to study addition of alvimopan to a well-established standard perioperative recovery pathway for elective laparoscopic colectomy. The main outcome measures were length of stay and incidence of charted postoperative ileus. Wilcoxon and chi-square tests were used to calculate P values for length of stay and postoperative ileus endpoints, respectively.Results:
Demographic/baseline characteristics from the 101 alvimopan and 64 pre-alvimopan control patients were generally comparable. Mean length of stay in the alvimopan group was 1.55 days shorter (alvimopan, 2.81±0.95 days; control, 4.36±2.4 days; P<.0001). The proportion of patients with postoperative ileus was lower in the alvimopan group (alvimopan, 2%; control, 20%; P<.0001).Conclusion:
In this case series, addition of alvimopan to a standard perioperative recovery pathway decreased length of stay and incidence of postoperative ileus for elective uncomplicated laparoscopic colectomy. The improvement in the mean length of stay for patients who receive alvimopan is a step forward in achieving a fast-track surgery model for elective laparoscopic colectomies. 相似文献2.
Bethany J. Slater 《Journal of pediatric surgery》2010,45(8):1682-1686
Background/Purpose
Moderate to severe hereditary spherocytosis (HS) is treated with splenectomy. However, total splenectomy leads to decreased immunologic function with the risk of overwhelming postsplenectomy sepsis. Splenic preservation is postulated as a method to avoid this potentially fatal complication. Although mainly performed through laparotomy, we report our experience with a laparoscopic approach to partial splenectomy for HS.Methods
A retrospective review was conducted on 9 laparoscopic partial splenectomies performed for HS at our institution. Follow-up was from 1 to 3.5 years. Data included preoperative and postoperative hemoglobin, absolute reticulocyte count, splenic size, operative time, complications, and length of stay.Results
All patients successfully underwent laparoscopic partial splenectomy with a radiologically determined upper-pole remnant of 10% to 30% and preservation of the blood supply through the upper short gastric arteries. The mean preoperative spleen length was 13 cm. Mean hospital stay was 3.6 days (range, 1-6 days). There was 1 intraoperative complication (a small bowel tear during spleen extraction) and 2 minor postoperative complications (ileus and wound infection). One patient underwent completion total splenectomy 2 years after partial splenectomy.Conclusion
Laparoscopic partial splenectomy is a feasible and effective procedure that addresses the hematologic consequences of HS while retaining a portion of functional spleen, in addition to conferring the advantages of laparoscopy. 相似文献3.
Novitsky YW Sechrist C Payton BL Kercher KW Heniford BT 《American journal of surgery》2009,197(2):227-231
Background
The nonoperative approach to recurrent and even multiple recurrent diverticulitis has recently been advocated. This approach, however, may result in more frequent acute attacks requiring emergent colectomy. Our aim was to compare the colectomy outcomes for diverticulitis in the elective and acute settings.Methods
All patients with diverticulitis undergoing elective (EL) and emergent (EM) colectomy selected from the 2001 to 2002 Nationwide Inpatient Sample Database were analyzed and compared.Results
Five thousand ninety-seven (27.1% emergent) colectomy cases were analyzed. EL patients had a significantly reduced length of stay (7.5 vs 13.3 days) and total hospital charges ($25,420 vs $51,170). Postsurgical morbidity and mortality were significantly higher in the EM group (29.0% vs 14.9% and 7.4% vs .8%, respectively). Colostomy was needed in 5.7% of EL and in 48.9% of EM patients (P = .001).Conclusions
Emergent colectomy in the setting of diverticulitis is associated with significantly higher morbidity, longer hospitalization, greater hospital charges, and a 9-fold increase in mortality. Prophylactic resection in the setting of recurrent diverticulitis should continue to be an acceptable and possibly more “conservative” approach. 相似文献4.
Jeffrey S. Fronza David J. Bentrem Marshall S. Baker Mark S. Talamonti Michael B. Ujiki 《American journal of surgery》2010,199(3):401-404
Introduction
The pancreatic remnant remains a significant source of morbidity during laparoscopic pancreatectomy. Previous series have relied heavily on the endoscopic stapler for transection. Our study is the first to report use of a laparoscopic radiofrequency device for pancreatic transection.Methods
The laparoscopic Habib 4x delivers high-energy radio waves through a hand-held device consisting of 4 electrodes and allows for bloodless tissue transection. We retrospectively evaluated prospectively collected data. Fourteen patients were identified and used in our analysis.Results
There were no conversions, blood transfusions, reoperations, or mortalities. Average length of stay was 4.6 days. There was 1 readmission. Clinically significant fistula occurred in 2 patients (14%), only one of which required an intervention.Conclusion
Radiofrequency energy is safe and feasible for use during laparoscopic pancreatic transection. Moreover, it is technically simple to use. 相似文献5.
Reismann M von Kampen M Laupichler B Suempelmann R Schmidt AI Ure BM 《Journal of pediatric surgery》2007,42(1):234-238
Background/Purpose
Fast-track surgery is not well established for infants and children. The aim of our prospective study was to investigate the feasibility of fast-track concepts for pediatric surgical procedures including laparoscopic techniques.Methods
Fast-track concepts, including immediate postoperative feeding, immediate mobilization, and morphine sparing pain treatment, were established for pyeloplasty, appendectomy, bowel anastomosis, fundoplication, hypospadia repair, and full/partial nephrectomy. All consecutive patients undergoing these procedures were prospectively investigated from June 2004 to June 2005. Patients with additional relevant diseases, reoperation, and perforated appendicitis were excluded from fast-track treatment. The length of hospital stay was compared with data derived from the German reimbursement system with German diagnosis-related groups for patients with a similar case mix index and hospitals with a similar structure.Results
Of a total of 159 patients (mean age, 5.8 ± 5.3 years), 113 (71%) were finally treated according to the fast-track protocols. There were no complications associated with fast-track surgery. The intensity of pain during the immediate postoperative period was higher than 5 on a 10-point scale in children older than 4 years. Analgesia was excellent at all other time points. The mean hospital stay of fast-track patients was 2.3 ± 1 days and was significantly shorter (P < .01) compared with German diagnosis-related group data for all procedures (pyeloplasty, 1.9 ± 0.9 vs 12.2 ± 0.2; nephrectomy, 1.9 ± 1.0 vs 14.4 ± 2.8; bowel anastomosis, 3.2 ± 0.6 vs 12.9 ± 2.4; fundoplication, 3.2 ± 0.8 vs 15.2 ± 4.2; appendectomy, 3.7 ± 2.4 vs 6.3 ± 1.8; hypospadia repair, 2.1 ± 1 vs 8.4 ± 1.4). Two readmissions were recorded. Ninety-six percent of patients and parents scored the fast-track concepts as excellent.Conclusion
The feasibility of fast-track concepts in children is excellent, with short duration of hospitalization and high comfort. 相似文献6.
Background
Although laparoscopic cholecystectomy has become the standard of care for symptomatic cholelithiasis and cholecystitis, 10% to 30% of cholecystectomies are still performed in open fashion. Because the total number of cholecystectomies is increasing with time, the average patient undergoing open cholecystectomy in the laparoscopic era is older and has more comorbidities.Methods
The records of 1629 consecutive patients who underwent cholecystectomy from July 1997 to September 2006 were evaluated. Analysis of variance, chi-square test, logistic regression, and linear regression were used to compare the following outcomes: length of procedure, length of stay, readmission (within 15 days and within 31 days), reoperation, and complication.Results
Major complications (death, bile duct injury, bile leak, or bleeding requiring reoperation or transfusion) occurred more frequently in laparoscopic cholecystectomy patients who were coverted to open procedure (5.9%) than in those who underwent open cholecystectomy (4.4%). Mortality rates were 2.9%, 1.5%, and 0% for open, converted, and laparoscopic cholecystectomy, respectively.Conclusions
Older patients, male patients, and patients with previous upper abdominal surgery are at higher risk for mortality. They should be considered for open cholecystectomy given their increased likelihood of major complications when laparoscopic cholecystectomy is converted to open surgery. 相似文献7.
Zhang Y Ortega G Camp M Osen H Chang DC Abdullah F 《Journal of pediatric surgery》2011,46(8):1475-1481
Objective
The objective of this study was to determine whether the outcomes of infants with surgically managed necrotizing enterocolitis (NEC) differ according to whether the location of NEC is in the small bowel, large bowel, or both.Study Design
A retrospective analysis was performed using the Healthcare Cost and Utilization Project Nationwide Inpatient Sample and Kids' Inpatient Database. A total of 5374 infants identified as having undergone surgical management of NEC were stratified by location of bowel affected as small bowel (SB) only, large bowel (LB) only, or both small and large bowel (SB&LB). The type of surgical operation performed was used as a proxy for the location of bowel affected.Results
Of the 5374 infants with a diagnosis of NEC, 4371 had an operation that allowed for stratification by location. The LB group (n = 963) fared the best in all outcomes. The SB group (n = 2126) had the longest length of stay and highest total hospital charges, and mortality was comparable with that of the SB&LB group (n = 1282).Conclusions
Mortality, length of stay, and total hospital charges varied according to location of bowel affected by NEC. 相似文献8.
Jonah J. Stulberg Brad J. Champagne Zhen Fan Mike Horan Vincent Obias Eric Marderstein Harry Reynolds Conor P. Delaney 《American journal of surgery》2009,197(3):296-301
Background
Laparoscopic colectomy has become the standard of care for elective resections; however, there are few data regarding laparoscopy in the emergency setting.Methods
By using a database with prospectively collected data, we identified 94 patients who underwent an emergency colectomy between August 2005 and July 2008. Laparoscopic surgeries were performed in 42 patients and were compared with 25 patients who were suitable for laparoscopy but received open colectomy.Results
The groups had similar demographics with no differences in age, sex, or surgical indications. Blood loss was lower (118 vs 205 mL; P < 0.01) and the postoperative stay was shorter (8 vs 11 d; P = 0.02) in the laparoscopic patients, and perioperative mortality rates were similar between the 2 groups (1 vs 3; P = 0.29).Conclusions
With increasing experience, laparoscopic colectomy is a feasible option in certain emergency situations and is associated with shorter hospital stay, less morbidity, and similar mortality to that of open surgery. 相似文献9.
Purpose
In fetuses with gastroschisis, the importance of ultrasonographic bowel dilation remains controversial. The outcome of patients with gastroschisis with and without prenatal bowel dilation is reported.Methods
From 2000 to 2004, 27 neonates with gastroschisis were followed at a single center. Thirteen patients had prenatal ultrasonographic bowel dilation (diameter, ≥6 mm; range, 6-35 mm). Outcomes of those with and without dilation were compared using 2 sample t tests and logistic regression.Results
Time to initiation of enteral nutrition varied significantly between groups (20.4 ± 11.7 days vs 12.5 ± 4.3 days, P < .05). A trend toward a reduced rate of primary closure was seen in those with dilation (23% vs 50%, P = .06). No significant difference was found when considering mortality, gestational age, time in the intensive care unit (ICU), time on parenteral nutrition, or length of stay. Prenatal bowel dilation, a longer ICU stay, and later gestational age independently predicted readmission for bowel obstruction (P < .001).Conclusion
Infants with gastroschisis and prenatal bowel dilation were significantly slower to initiate enteral feeding and tended to have a reduced incidence of primary closure. This did not translate into increased mortality, time on parenteral nutrition, time in the ICU, or length of stay. However, dilation was associated with readmission for bowel obstruction. 相似文献10.
Jesús Sánchez-Beorlegui Pablo Soriano Eduardo Monsalve Nuria Moreno Roger Cabezali Ana Navarro 《Cirugía espa?ola》2009,85(4):246-251
Introduction
In the current article, we analyse the results and complications of laparoscopic cholecystectomy in octogenarian patients.Patients and method
Retrospective study in patients older than 80 years, who underwent laparoscopic cholecystectomy between January 2002 and August 2007. Variables analysed were presentation, physical condition, anaesthetic risk, conversion rate, morbidity and hospital stay. A comparison was made with patients aged between 70 and 79 years old. The χ2 and Student's t tests were used for statistical analysis. The level of significance was defined as a p value less than 0.05.Results
A total of 64 patients were operated on, of which 39 (63%) were women and 25 men, with a mean age 83.7 years. Surgery was scheduled in 40 (62.5%) cases and urgent in 24 cases. The conversion rate to open cholecystectomy was 10.9% and the average hospital stay was 3.9 days. Two patients required re-intervention and two patients died.Conclusions
Laparoscopic cholecystectomy is the treatment of choice for symptomatic cholelithiasis in octogenarians. The laparoscopic approach should be considered for the management of acute cholecystitis in the very old (except where contraindicated) before the development of complications. 相似文献11.
Kyle P. Harvey M.D. James D. Adair M.D. Mayyas Isho M.D. Robert Robinson M.D. F.A.C.S. 《American journal of surgery》2009,198(2):231-236
Background
This study examined whether systemic infusion of lidocaine, a local anesthetic with anti-inflammatory properties, can decrease surgical pain, length of postsurgical ileus, and hospital stay.Methods
Twenty-two patients at a community hospital were randomized into 2 groups. Subjects were allocated to receive either lidocaine or a placebo infusion for the first 24 hours after surgery.Results
Patients in the lidocaine group appeared to report less pain as reflected by a decrease in overall visual analogue scale pain scores 24 hours after surgery. The return of flatus after surgery was not considered significant (lidocaine 68.2 ± 9.7 hours vs placebo 86.9 ± 13.6 hours; P = .2802). The return of bowel movement after surgery was considered significant (lidocaine 88.3 ± 6.08 hours vs placebo group 116 ± 10.1 hours; P = .0286). The lidocaine group was discharged by mean day 3.76 ± .24 versus placebo at mean day 4.93 ± .42; P = .0277.Conclusions
Patients in the lidocaine group had bowel movements >24 hours earlier than those in the placebo group and were discharged earlier. 相似文献12.
Omar H. Llaguna 《American journal of surgery》2010,200(2):265-269
Background
There are few studies that compare the incidence of incisional hernia following elective laparoscopic colon resection to open colectomy and determine the risk factors for its development.Methods
Elective open and laparoscopic colon resections performed between February 2002 and May 2007 were reviewed. In the laparoscopic group, mesenteric transection was performed via intracorporeal division for left-sided colectomy and via extracorporeal technique for right-sided colectomy. The ileocolic anastomosis was performed by extracorporeal stapling for right colectomies and by intracorporeal for left colectomies.Results
Two hundred eighteen patients (mean age 62 years, 52% male) underwent elective colon resection (50% open, 5% hand-assisted, and 45% laparoscopic). Six percent of the cases that started as laparoscopic were converted and are included in the open group. Mean follow-up was 26 months. The overall incisional hernia rate was 16% (open and minimally invasive group 17% vs 15%, P = .14). Hernia was not dependent on the type of resection, indication, or extraction site. Body mass index >36 kg/m2, male gender, and surgical site infection were risk factors for hernia development.Conclusions
Laparoscopic colectomy does not reduce the development of incisional hernia. 相似文献13.
Background/Purpose
Indications for a laparoscopic approach in the management of biliary atresia and choledochal cysts in children are not clearly defined. We present our initial experience with 9 consecutive laparoscopic cases, and compare them to the traditional open approach.Methods
A retrospective comparison of all consecutive operations for biliary atresia and choledochal cysts from January 2000 to May 2006 was undertaken. We evaluated the patient's age at operation, operative time, return of bowel function postoperatively, length of hospital stay, complications, and the need for subsequent liver transplantation. Mann-Whitney U test was used for statistical analysis.Results
A total of 45 portoenterostomies and choledochojejunostomies were performed, including 9 laparoscopic and 36 open procedures. Patients with choledochal cysts were older than patients with biliary atresia. All the compared parameters were similar and there was no difference in outcomes between the laparoscopic and the open groups.Conclusions
Our initial experience is encouraging and indicates that the laparoscopic approach is technically feasible, safe, and effective, with a low morbidity and a comparable outcome to the open technique. Longer follow-up of a larger patient cohort is needed. 相似文献14.
Taqi E Boutros J Emil S Dubé S Puligandla P Flageole H Laberge JM 《Journal of pediatric surgery》2007,42(5):865-868
Background
This study was conducted to evaluate the outcome of various approaches to pyloromyotomy: supraumbilical (SU), right upper quadrant (RUQ), and laparoscopic (LP).Methods
Single-center retrospective review from 1998 to 2005 with institutional review board approval, evaluating 192 pyloromyotomies based on surgical approach: RUQ (119), SU (64), and LP (9). Patient demographics, acid-base/electrolyte status on presentation, mean operative time, postoperative length of stay, and complications were evaluated.Results
Patient demographics, acid-base/electrolyte status, and mean operative time were not significantly different. The median length of stay was 34, 29, and 24.5 hours for SU, RUQ, and LP, respectively (P = .479). The frequency of duodenal/gastric perforations in the SU, RUQ, and LP groups were 1, 4, and 1, respectively. The LP perforation was not recognized intraoperatively, resulting in sepsis and multiorgan failure. One patient in the SU group had a late adhesive bowel obstruction requiring laparotomy and bowel resection. Wound infection rates did not differ significantly between groups (SU, 4; RUQ, 2; LP, 1; P = .113).Conclusion
Pyloromyotomy is associated with a low complication rate. Cosmetically, SU is superior to the RUQ approach. The added benefits of being able to examine the integrity of the duodenal mucosa intraoperatively and its short learning curve may make SU a safer alternative to LP for surgeons who are still practicing the RUQ approach. 相似文献15.
Purpose
The aim of this study was to evaluate the laparoscopic repair of isolated intestinal injuries in children who sustain focal abdominal trauma.Methods
A retrospective review was conducted of all patients 16 years and younger who required surgery for traumatic bowel injuries during a 5-year period at 2 university children's hospitals. The study population was composed of hemodynamically stable patients who sustained focal energy transfer to the abdomen and were diagnosed preoperatively with intestinal injury. Children sustaining multisystem injuries and gunshot wounds or who were hemodynamically unstable were excluded.Results
Fifty hemodynamically stable children were explored for preoperatively documented intestinal injury sustained after focal abdominal trauma. Laparoscopy was used to repair intracorporeally gastrointestinal injuries in 8 children. Mean operating time, time to diet, and time to discharge after laparoscopic bowel repair compared favorably with patients managed by laparotomy. An additional 6 patients had a laparoscopic-assisted bowel resection or repair after exteriorization only of the ruptured intestine through a short extension of the nearest port site. No early (missed injury, wound infection, bleeding) or late (obstruction) complications resulted after laparoscopic repair.Conclusions
Laparoscopic primary or assisted repair of injured bowel is an appropriate surgical option in hemodynamically stable children who sustain focal abdominal trauma and may be associated with a more prompt return of intestinal function and shorter hospital stay. 相似文献16.
von Allmen D Markowitz JE York A Mamula P Shepanski M Baldassano R 《Journal of pediatric surgery》2003,38(6):963-965
Background/purpose
Minimally invasive approaches have been shown to decrease hospital length of stay (LOS), decrease postoperative pain, and speed return to normal activity for a number of intraabdominal procedures. In this study, laparoscopic (LAP)-assisted bowel resection is compared with an open technique for patients undergoing an initial bowel resection.Methods
A retrospective review was conducted of 28 patients (12 LAP, 16 open) undergoing initial bowel resection for segmental Crohn’s disease.Results
Patients in the LAP group had decrease LOS (5.5 days v 11.5 days) decreased days of parenteral narcotics (3 days v 5 days) and more rapid return to regular diet (3 days v 5 days).Conclusions
The data suggest that the laparoscopic approach may offer advantages to pediatric patients undergoing an initial bowel resection for segmental Crohn’s disease. 相似文献17.
Background/Purpose
Laparoscopic pyloromyotomy (LP) is used widely for treatment of hypertrophic pyloric stenosis. We examined the results of pyloromyotomy at a high-volume pediatric teaching hospital to compare outcomes of laparoscopic and open pyloromyotomy (OP).Methods
We reviewed the records of all patients who underwent pyloromyotomy at our institution over a 5-year period. Data were collected regarding operative time, time to full feeds, length of hospital stay, complications, and frequency of postoperative emesis.Results
There were 335 pyloromyotomies: 212 laparoscopic and 123 open. Five patients in the laparoscopic group required conversion to an open procedure. There were no significant differences in operative time (LP, 30.5 minutes; OP, 32.0 minutes), time to full feeds (LP, 22.4 hours; OP, 23.5 hours), frequency of postoperative emesis (LP, 1.8; OP, 2.2), or length of hospital stay (LP, 49.3 hours; OP, 50.5 hours). There were 5 mucosal perforations in the laparoscopic group and 2 in the open group (LP, 2.3%; OP, 1.6%). There were 3 incomplete pyloromyotomies in the laparoscopic group and none in the open group. Four perforations and all incomplete myotomies occurred in the first 2 years after the laparoscopic technique was introduced at our institution. The overall complication rate was similar (LP, 3.7%; OP, 3.2%).Conclusions
Laparoscopic pyloromyotomy is a safe and effective alternative to OP. There appears to be an institutional learning curve when the laparoscopic technique is introduced as reflected by slightly higher rates of mucosal injury and incomplete pyloromyotomy. 相似文献18.
19.
Ikeda H Ishimaru Y Takayasu H Okamura K Kisaki Y Fujino J 《Journal of pediatric surgery》2004,39(11):1680-1685
Purpose
To address whether laparoscopic appendectomy could be an alternative to conventional open appendectomy in children with complicated appendicitis as well as uncomplicated appendicitis, a retrospective study comparing laparoscopic and open appendectomies was performed.Methods
One hundred patients who were treated by immediate appendectomy, either laparoscopically or by the open method, between May 2000 and August 2003 were included in the study. There were 53 patients in the laparoscopic appendectomy group and 47 patients in the open appendectomy group.Results
The operating time was significantly longer for laparoscopic appendectomy than for open appendectomy (P < .001). The length of hospital stay was significantly shorter in laparoscopic appendectomy in patients with uncomplicated appendicitis (P = .001). Thirteen of the 100 patients (13.0%) had 15 postoperative complications including wound infection (n = 8), intraabdominal abscess (n = 4), stitch abscess (n = 2), and small bowel obstruction (n = 1). In both uncomplicated and complicated appendicitis, there was no significant difference between laparoscopic and open appendectomies in the complication rates, and the incidences of each complication did not differ between the procedures. Among the 14 patients with generalized peritonitis, postoperative complications were seen in 5 patients (35.7%). Although the presence of generalized peritonitis was associated significantly with postoperative complications (P = .017), there was no significant association between the procedure and complications. Overall treatment costs were increased by 26.0% in laparoscopic appendectomy.Conclusions
Laparoscopic appendectomy should remain an option in children with uncomplicated and complicated appendicitis, and when laparoscopy is selected, consideration of the advantages and disadvantages of the procedure is essential. 相似文献20.