Use of the harmonic scalpel in thyroidectomy

Thyroidectomy is a surgical procedure that requires meticulous dissection, safe anatomical exposure and effective haemostasis. Use of the harmonic scalpel in thyroidectomy may assist in achieving these goals, particularly in respect to enabling efficient haemostatic coagulation and division of small vessels. This report demonstrates the results of utilizing the harmonic scalpel in a series of 88 prospective thyroidectomies in patients under the care of two surgeons over a 2‐year period recording a number of parameters, including operative times and post‐operative complications. These data were compared with a retrospective cohort of 57 patients who underwent thyroidectomies by the same two surgeons prior to the introduction of the harmonic scalpel. The results of this study show that the use of the harmonic scalpel decreased surgical operating time by 20 min (22.5%) for a hemithyroidectomy and 13.5 min (12%) for a total thyroidectomy. Harmonic scalpel use was not associated with an increased complication rate and has been demonstrated to be a very efficient and safe tool in assisting with the conduct of a thyroidectomy.     

Long-term effects of pancreaticoduodenectomy on glucose metabolism

Background: To analyse the association between pancreatogenic diabetes and the volume of the remnant pancreas after pancreaticoduodenectomy and to identify clinicopathologic factors correlated with pancreatogenic diabetes. Methods: Among the patients who underwent pancreaticoduodenenctomy from 2003 to 2004, 55 patients who survived by 2009 and were able to measure the volume of the pancreas pre‐ and post‐operatively by CT volumetry were included in this study. Twelve patients had diabetes before surgery. Median follow‐up duration was 55.2 and 67.3 months for CT volumetry, pancreatogenic diabetes, respectively. Results: Among 43 patients without preoperative diabetes, nine patients (21%) developed newly diabetes after surgery. Among 12 patients with diabetes, 10 patients had worsened glucose control. The immediate post‐operative Vol% was 46.5% and the last Vol% was 31.5% (P < 0.001). Preoperative diabetes, malignant pathology, absence of post‐operative pancreatic fistula, chemotherapy and radiotherapy were correlated with a lower Vol%. Atrophic changes were observed in 29 patients and hypertrophic changes in 13 patients. Comparative analysis according to the change in the Vol% revealed no differences in the clinicopathological factors associated with new‐onset pancreatogenic diabetes or aggravation of preoperative diabetes. Conclusions: While some patients had a hypertrophic pancreas at the last follow‐up, which reflected the capacity for pancreatic regeneration and some factors were associated with a lower volume of the remnant pancreas, the volume of the remnant pancreas seem not to be associated with pancreatogenic diabetes. There were no clinicopathologic factors identified associated with the risk for pancreatogenic diabetes.     

Accuracy of administrative coding data in colorectal cancer resections and short‐term outcomes

Background

Administrative data are routinely captured for each hospital admission and may serve as an alternative source for populating databases. This study aims to determine the accuracy of administrative data to provide tumour characteristics and short‐term post‐operative outcomes, after a colorectal cancer (CRC) resection, compared with clinical data.

Methods

A retrospective study of all CRC resections at a single hospital from 1 January 2008 to 31 December 2013 was conducted. Local administrative data were coded as per ICD‐10‐AM (International Classification of Diseases, Tenth Revision, Australian Modification) and Australian Classification of Health Interventions. Clinical data for all patients were extracted from the medical charts and compared with administrative data. Code combinations and algorithms were used to improve the accuracy of administrative data.

Results

A total of 436 patients were identified. The accuracy of algorithms combining tumour location and type of operation for right colon, left colon and rectum were 93, 89 and 88%, respectively. The accuracy of histological type was 89%, lymph node status 92% and metastasis status 88%. The accuracy of return to theatre and in‐hospital mortality was 100%.

Conclusion

Administrative data can provide reliable information on tumour details and short‐term post‐operative outcomes. The potential for administrative data to validate data captured in registries and be used independently for audit and research should be further explored.

     

Post-reperfusion syndrome during isolated intestinal transplantation: outcome and predictors

Siniscalchi A, Cucchetti A, Miklosova Z, Lauro A, Zanoni A, Spedicato S, Bernardi E, Aurini L, Pinna AD, Faenza S. Post‐reperfusion syndrome during isolated intestinal transplantation: outcome and predictors.
Clin Transplant 2011 DOI: 10.1111/j.1399‐0012.2011.01530.x
© 2011 John Wiley & Sons A/S. Abstract: Background: Post‐reperfusion syndrome (PRS) during isolated intestinal transplantation (ITx) is characterized by decreased systemic blood pressure, systemic vascular resistance, and cardiac output and by a moderate increased pulmonary arterial pressure. We hypothesize that the more severe PRS causes a poorer long‐term outcome. The primary aim of this study was to determine the independent clinical predictors of intra‐operative PRS, as well as to investigate the link between the severity of PRS and the intra‐operative profiles and to examine the post‐operative complications and their relationship with transplant outcome. Methods: This observational study was conducted on 27 patients undergoing isolated ITx in a single adult liver and multivisceral transplantation center. PRS was considered when the mean arterial blood pressure was 30% lower than the pre‐unclamping value and lasted for at least one min within 10 min after unclamping. Results and conclusions: The main results of this study can be summarized in two findings: in patients undergoing ITx, the duration of cold ischemia and the pre‐operative glomerular filtration rate were independent predictors of PRS and the occurrence of intra‐operative PRS was associated with significantly more frequent post‐operative renal failure and early post‐operative death.     

The association of hypotension during non‐cardiac surgery,before and after skin incision,with postoperative acute kidney injury: a retrospective cohort analysis

Intra‐operative hypotension is associated with acute postoperative kidney injury. It is unclear how much hypotension occurs before skin incision compared with after, or whether hypotension in these two periods is similarly associated with postoperative kidney injury. We analysed the association of mean arterial pressure < 65 mmHg with postoperative kidney injury in 42,825 patients who were anaesthetised for elective non‐cardiac surgery. Intra‐operative hypotension occurred in 30,423 (71%) patients: 22,569 (53%) patients before skin incision; and 24,102 (56%) patients after incision. Anaesthetised patients who were hypotensive had mean arterial pressures < 65 mmHg for a median (IQR [range]) of 5.5 (0.0–14.7 [0.0–60.0]) min.h^?1 before skin incision, compared with 1.7 [0.3–5.1 [0.0–57.5]) min.h^?1 after incision: a median (IQR [range]) of 36% (0%–84% [0%–100%]) of hypotensive readings were before incision. We diagnosed postoperative kidney injury in 2328 (5%) patients. The odds ratio (95%CI) for acute kidney injury was 1.05 (1.02–1.07) for each doubling of the duration of hypotension, p < 0.001. Postoperative kidney injury was associated with the product of hypotension duration and severity, that is, area under the curve, before skin incision and after, odds ratio (95%CI): 1.02 (1.01–1.04), p = 0.004; and 1.02 (1.00–1.04), p = 0.016, respectively. A substantial fraction of all hypotension happened before surgical incision and was thus completely due to anaesthetic management. We recommend that anaesthetists should avoid mean arterial pressure < 65 mmHg during surgery, especially after induction, assuming that its association with postoperative kidney injury is, at least in part, causal.     

Historical aspects of appendicitis in children

Evidence of appendicitis exists from ancient Egyptian mummies but the appendix was not discovered as an anatomical entity until the renaissance in Western European literature. Much confusion reigned over the cause of right iliac fossa inflammatory disease until the late 19th century, when the appendix was recognized as the cause of the great majority of cases. Coining the term ‘appendicitis’ and making the case for early surgery, Fitz in 1886 set the scene for recovery from appendicitis through operative intervention.