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1.
Hadar Rosen Jon Barrett Rania Okby Ori Nevo Nir Melamed 《International urogynecology journal》2016,27(5):757-762
Introduction and hypothesis
Risk factors for obstetric anal sphincter injuries (OASIS) have been well-established in singleton pregnancies. Considering the unique characteristics of twin deliveries, our aim was to identify risk factors for OASIS that are specific to twins.Methods
A retrospective study of all vaginal twin deliveries in a tertiary center between 2000 and 2014. Women who experienced OASIS (the OASIS group) were compared with those whose anal sphincter was intact (controls).Results
Overall 717 women were eligible for the study, of whom 20 (2.8 %) experienced OASIS. Women in the OASIS group were more likely to be nulliparous (95.0 % vs 53.7 %, p?<?0.001) and were characterized by a higher gestational age at delivery (36.1?±?2.5 vs 34.6?±?3.3, p?=?0.04), a higher birth weight for both twin A and twin B (2,507?±?540 g vs 2,254?±?525 g, p?=?0.03, and 25,49?±?420 g vs 2,232?±?606 g, p?=?0.004 respectively), and a higher rate of episiotomy (40.0 % vs 14.2 %, p?=?0.001), instrumental delivery for twin A (80.0 % vs 13.5 %, p?<?0.001) or twin B (80.0 % vs 18.7 %, p?<?0.001), and inter-twin delivery interval of over 30 min (20.0 % vs 7.5 %, p?=?0.04). The only factor that remained significant on multivariate analysis was instrumental delivery: forceps delivery of twin A (OR?=?8.8, 95 % CI 2.6–30.1), vacuum extraction of twin A (OR?=?9.2, 95 % CI 2.6–34.6), and forceps delivery of twin B (OR?=?15.4, 95 % CI 4.9–48.6). In women with certain combinations of risk factors the risk of OASIS was as high as 30 %.Conclusion
The overall rate of OASIS in twins is low and instrumental delivery, especially by forceps, is a risk factor.2.
Tsung-Ting Tsai Arun-Kumar Kaliya-Perumal Chang-Chyi Jenq Chi-Chien Niu Natalie Yi-Ju Ho Tung-Ying Lee Po-Liang Lai 《Journal of orthopaedic surgery and research》2017,12(1):194
Background
Dialysis-related destructive spondyloarthropathy caused by beta-2 microglobulin (β2M) amyloid deposits in intervertebral discs is a major burden for patients undergoing long-term dialysis. This study aimed to quantify the presence of β2M amyloid deposits in the intervertebral disc tissue of such patients and analyze whether there was a significant correlation between β2M accumulation and the duration of dialysis.Methods
Two groups of patients who had undergone surgery for degenerative spinal pathologies were selected: the dialysis group (n?=?29) with long-term dialysis and the control group (n?=?10) with no renal impairment. Tissue sections were prepared from specimens of intervertebral disc tissue obtained during spinal surgery and analyzed via histological staining, including immunohistochemistry (IHC) and Congo red.Results
There was a statistically significant multifold increase of β2M expression in the disc tissue of long-term dialysis patients when compared to non-dialysis patients, as shown by both IHC (0.019?±?0.023 μm2 vs. 0.00020?±?0.00033 μm2, respectively; p?=?0.012) and Congo red staining (0.027?±?0.041 μm2 vs. 9.240?×?10?5?±?5.261?×?10?5 μm2, respectively; p?=?0.047). We also note a moderate strength positive correlation between the duration of dialysis and positive IHC (r?=?0.39; p?=?0.015) and Congo-red staining (r?=?0.42; p?=?0.007).Conclusions
The problem of β2M amyloidosis in long-term dialysis patients remains unresolved even with predominant use of high-flux dialysis membranes. This highlights the insufficiency of current dialysis modalities to effectively filter β2M.3.
Meng Gu Chong Liu Yan-bo Chen Huan Xu Shi Fu Qi Chen Zhong Wang 《International urology and nephrology》2018,50(5):819-823
Purpose
This study aimed to estimate the validity and applicability of Vela laser enucleation of the prostate (VoLEP) in the management of benign prostatic hyperplasia (BPH).Methods
A retrospective chart review of 112 patients with BPH who underwent VoLEP (n?=?60) or holmium laser enucleation of the prostate (HoLEP) (n?=?56) was conducted at our institution from January 2015 to June 2015. The general and perioperative characteristics of the patients were collected. The 12-month follow-up data, including the lower urinary tract symptom (LUTS) indexes (International Prostate Symptom Score [I-PSS], quality-of-life [QoL] score and maximum flow rate [Qmax]), as well as rates of perioperative and late complications, were analyzed.Results
No significant differences were observed in pre- and perioperative parameters, including operation time (58.05?±?10.14 vs. 60.14?±?12.30 min, P?=?0.44), serum sodium decrease (3.49?±?0.83 vs. 3.48?±?0.84 mmol/L, P?=?0.97), hemoglobin decrease (1.28?±?0.38 vs. 1.24?±?0.77 g/dL, P?=?0.71), catheterization time (3.63?±?1.10 vs. 3.89?±?1.11 days, P?=?0.21) and hospital stay (4.57?±?1.25 vs. 4.68?±?1.18 days, P?=?0.63) between the two groups of patients. Compared with the HoLEP group, the noise during operation was lower in VoLEP group (47.22?±?10.31 vs. 59.45?±?9.65 db, P?<?0.05). During 1, 6 and 12 months of follow-up visits, the LUTS indexes (I-PSS, QoL score and Qmax) were remarkably improved in both groups when comparing with the baseline values. Furthermore, LUTS indexes were comparable in both groups (P?>?0.05).Conclusion
Similarly as the holmium laser, the Vela laser is a potent, safe, efficient durable and surgical treatment option for minimally invasive surgery in patients with BPH-induced LUTS.4.
Hyo-Seok Na Ah-Young Oh Jung-Hee Ryu Bon-Wook Koo Sun-Woo Nam Jihoon Jo Jae-Hee Park 《Journal of gastrointestinal surgery》2018,22(5):771-777
Background
We assessed whether intraoperative nefopam would reduce opioid consumption and relieve postoperative pain in patients undergoing laparoscopic gastrectomy.Methods
The 60 enrolled patients were randomly assigned to the control (n?=?32) or nefopam (n?=?28) group. All patients were blinded to their group assignment. We administered 100 ml of normal saline only (control group) or 20 mg of nefopam mixed in 100 ml normal saline (nefopam group) after anesthesia induction and at the end of surgery. The cumulative amount of fentanyl via intravenous patient-controlled analgesia (PCA), incidence of rescue analgesic medication, and numerical rating scale (NRS) for postoperative pain were evaluated along with the total remifentanil consumption.Results
The mean infusion rate of remifentanil was significantly lower in the nefopam group (0.08?±?0.05 μg/kg/min) than in the control group (0.13?±?0.06 μg/kg/min) (P?<?0.001). Patients in the nefopam group required less fentanyl via intravenous PCA than those in the control group during the first 6 h after surgery (323.8?±?119.3 μg vs. 421.2?±?151.6 μg, P?=?0.009). Additionally, fewer patients in the nefopam group than in the control group received a rescue analgesic during the initial 6 h postoperatively (78.6 vs. 96.9%, P?=?0.028). The NRS measured while patients were in the post-anesthetic care unit was significantly lower in the nefopam group than in the control group (3.8?±?1.1 vs. 4.8?±?1.4, P?=?0.012). The subsequent NRS obtained after patients had been transferred to the general ward was comparable between the two groups during the following postoperative period.Conclusions
Intraoperative nefopam decreased postoperative pain and opioid consumption in the acute postoperative period after laparoscopic gastrectomy. Hence, nefopam may be considered as a component of multimodal analgesia after laparoscopic gastrectomy.5.
Takayuki Tsuji Kazuhisa Ohishi Asumi Takeda Daiki Goto Taichi Sato Naro Ohashi Yoshihide Fujigaki Akihiko Kato Hideo Yasuda 《Clinical and experimental nephrology》2018,22(6):1300-1308
Background
Febuxostat is tolerable in chronic kidney disease (CKD) patients with hyperuricemia. However, the long-term effect of lowering uric acid with febuxostat on renal function and blood pressure has not been elucidated.Methods
This was a 2 years retrospective observational study. 86 CKD patients with hyperuricemia who continued with allopurinol (allopurinol group, n?=?30), switched from allopurinol to febuxostat (switched group, n?=?25), or were newly prescribed febuxostat (febuxostat group, n?=?31) were included in this study. Serum uric acid, estimated glomerular filtration rate (eGFR), blood pressure, and urinary protein were analyzed. Moreover, the impact of serum uric acid reduction on renal function and blood pressure was assessed.Results
Serum uric acid in the switched and febuxostat groups was significantly reduced at 6 months (switched group; 8.49?±?1.32–7.19?±?1.14 mg/dL, p?<?0.0001, febuxostat group; 9.43?±?1.63–6.31?±?0.90 mg/dL, p?<?0.0001). In the allopurinol group, serum uric acid was increased (6.86?±?0.87–7.10?±?0.85 mg/dL, p?=?0.0213). eGFR was significantly increased (35.2?±?12.8–37.3?±?13.9 mL/min/1.73 m2, p?=?0.0232), while mean arterial pressure (93.1?±?10.8–88.2?±?9.5 mmHg, p?=?0.0039) was significantly decreased at 6 months in the febuxostat group, resulting in the retention of eGFR for 2 years.Conclusions
The impact of serum uric acid reduction might have beneficial effects on CKD progression and blood pressure. However, a large prospective study is needed to determine the long-term efficacy of febuxostat therapy in CKD patients with hyperuricemia.6.
Impact of Synchronous Liver Resection on the Perioperative Outcomes of Patients Undergoing CRS-HIPEC
Jordan M. Cloyd Sherif Abdel-Misih John Hays Mary E. Dillhoff Timothy M. Pawlik Carl Schmidt 《Journal of gastrointestinal surgery》2018,22(9):1576-1584
Background
While liver resection (LR) and cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) are commonly performed for hepatic and peritoneal metastases, respectively, the safety of synchronous LR and CRS-HIPEC has not been established.Methods
The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) databases from 2005 to 2016 were used to identify patients who underwent CRS-HIPEC. Demographic, clinical, and perioperative outcomes were compared among patients who underwent CRS-HIPEC with and without synchronous LR.Results
Among 1168 patients who underwent CRS-HIPEC, 100 (8.6%) underwent synchronous LR and 1068 (91.4%) did not. The most common primary diagnosis was unspecified (65.3%) followed by appendix (16.0%) and colorectal (12.5%). Among patients who underwent CRS-HIPEC plus LR, the majority had a partial hepatectomy (96.0%), while a small subset underwent trisegmentectomy (2.0%) or hemihepatectomy (2.0%). Patients who underwent CRS-HIPEC plus LR underwent a greater number of operative procedures (8.3?±?2.5 vs 6.7?±?2.5, p?<?0.001), had a longer operative time (520.7?±?155.3 vs 454.6?±?160.7 min, p?=?0.001), had a longer hospital length of stay (16.7?±?15.6 vs 11.1?±?11.5 days, p?<?0.001), were more likely to require reoperation (13.0 vs 6.9%, p?=?0.03), and experienced greater 30-day morbidity (47.0 vs 27.4%, p?<?0.001), but not mortality (3.0 vs 1.4%, p?=?0.22). On multivariate logistic regression, LR was strongly associated with increased risk of postoperative morbidity even after controlling for potential confounders (OR 1.65, 95% CI 1.03–2.64).Conclusions
Simultaneous LR and CRS-HIPEC was associated with increased operative time, length of hospital stay, reoperation, and postoperative morbidity compared to CRS-HIPEC alone. For patients with synchronous hepatic and peritoneal metastases, a staged operative approach should be considered.7.
Magdalena Emilia Grzybowska Dariusz Grzegorz Wydra 《International urogynecology journal》2017,28(5):697-704
Introduction and hypothesis
To assess the impact of coital incontinence (CI) on health-related quality of life (HRQoL) and quality of sexual function (QSF) in women with urodynamic stress urinary incontinence (SUI).Methods
Women were recruited for this cross-sectional study from among 289 patients with lower urinary tract symptoms, underwent clinical and urodynamic evaluation. Of these 289 women, 127 sexually active women with SUI completed the King’s Health Questionnaire (KHQ) and the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ), of whom 97 were enrolled for the study. The study group comprised 53 women with CI occurring ‘sometimes’, ‘usually’ or ‘always’, and the control group comprised 44 women without CI. Total and individual domain scores were evaluated.Results
CI was reported by 65.35 % of the women. The frequency of CI was correlated with lower educational level and higher body mass index (r?=?0.22 and r?=?0.23, respectively; p?=?0.01). The KHQ results showed significantly lower HRQoL in women with CI in all domains (p?<?0.05) apart from Sleep/energy’ (p?=?0.054). PISQ revealed no significant differences in QSF in the Behavioral/emotive and Partner–related domains (34.3?±?10.0 vs. 33.0?±?12.2 and 18.0?±?2.9 vs. 18.2?±?3.6, respectively). Women with CI reported a significantly lower QSF in the Physical domain (29.1?±?6.6 vs. 35.0?±?4.6, p?=?0.001), and the total PISQ score was lower but the difference was not significant (81.4?±?14.3 vs. 86.2?±?16.5). Total PISQ score was correlated with age (r?=??0.28, p?=?0.001). Women with CI were significantly more likely to admit that fear of incontinence or fear of embarrassment restricted their sexual activity (p?<?0.001).Conclusions
A large percentage (65.35 %) of women with SUI reported CI, which had a negative impact on HRQoL and QSF in the Physical domain, but no significant impact on overall QSF.8.
Mario Testini Rinaldo Marzaioli Germana Lissidini Agostino Lippolis Francesco Logoluso Angela Gurrado Domenica Lardo Elisabetta Poli Giuseppe Piccinni 《Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie》2009,394(5):837-842
Background
The objective of this study was to compare the effectiveness of FloSeal® matrix hemostatic agent with hemostatic surgical procedures and Tabotamp® in thyroid surgery.Methods
One hundred fifty-five consecutive total thyroidectomy patients were recruited at our institution between January 2005 and December 2007. Exclusion criteria were applied. Patients were randomized to one of three hemostatic approaches: 49 received surgical procedures only, and 52 received oxidized regenerated cellulose patch (Tabotamp Fibrillar 2.5?×?5 cm) and 54 FloSeal (5,000 U/5 mL). The same surgeon performed all operations.Results
Mean operating time was reduced in the FloSeal group (105 min) vs. surgical (133 min, p?=?0.02) and vs. Tabotamp (122 min, p?=?0.0003). Also, wound drain removal occurred earlier with FloSeal (p?=?0.006 vs. surgical; p?=?0.008 vs. Tabotamp) resulting in shorter postoperative hospital stay in the FloSeal group (p?=?0.02 vs. surgical; p?=?0.002 vs. Tabotamp).Conclusions
FloSeal matrix is an effective additional agent to conventional haemostatic procedures in thyroid surgery.9.
Zachary?A.?Hamilton Robert?G.?Uzzo Alessandro?Larcher Brian?R.?Lane Benjamin?Ristau Umberto?Capitanio Stephen?Ryan Sumi?Dey Andres?Correa Madhumitha?Reddy James?A.?Proudfoot Ryan?Nasseri Kendrick?Yim Sabrina?Noyes Ahmet?Bindayi Francesco?Montorsi Ithaar?H.?Derweesh
Background
We compared renal functional outcomes of robotic (RPN) and open partial nephrectomy (OPN) in patients with chronic kidney disease (CKD), a definite indication for nephron-sparing surgery.Methods
A multicenter retrospective analysis of OPN and RPN in patients with baseline ≥?CKD Stage III [estimated glomerular filtration rate (eGFR) <?60 mL/min/1.73 m2] was performed. Primary outcome was change in eGFR (ΔeGFR, mL/min/1.73 m2) between preoperative and last follow-up with respect to RENAL nephrometry score group [simple (4–6), intermediate (7–9), complex (10–12)]. Secondary outcomes included eGFR decline >?50%.Results
728 patients (426 OPN, 302 RPN, mean follow-up 33.3 months) were analyzed. Similar RENAL score distribution (p?=?0.148) was noted between groups. RPN had lower median estimated blood loss (p?<?0.001), and hospital stay (3 vs. 5 days, p?<?0.001). Median ischemia time (OPN 23.7 vs. RPN 21.5 min, p?=?0.089), positive margin (p?=?0.256), transfusion (p?=?0.166), and 30-day complications (p?=?0.208) were similar. For OPN vs. RPN, mean ΔeGFR demonstrated no significant difference for simple (0.5 vs. 0.3, p?=?0.328), intermediate (2.1 vs. 2.1, p?=?0.384), and complex (4.9 vs. 6.1, p?=?0.108). Cox regression analysis demonstrated that decreasing preoperative eGFR (OR 1.10, p?=?0.001) and complex RENAL score (OR 5.61, p?=?0.03) were independent predictors for eGFR decline >?50%. Kaplan–Meier analysis demonstrated 5-year freedom from eGFR decline >?50% of 88.6% for OPN and 88.3% for RPN (p?=?0.724).Conclusions
RPN and OPN demonstrated similar renal functional outcomes when stratified by tumor complexity group. Increasing tumor age and tumor complexity were primary drivers associated with functional decline. RPN provides similar renal functional outcomes to OPN in appropriately selected patients.10.
Brian F. Gilmore Zhifei Sun Mohamed Adam Jina Kim Brian Ezekian Cecilia Ong John Migaly Christopher R. Mantyh 《Journal of gastrointestinal surgery》2016,20(11):1854-1860
Background
HAL colectomy is a technique perceived to provide the benefits of laparoscopic surgery while improving tactile feedback and operative time. Published data are largely limited to small, single-institution studies.Methods
The 2012-2013 National Surgical Quality Improvement Program Participant Data Use File was queried for patients undergoing elective SL or HAL colectomy. Patients underwent 1:1 propensity matching and had outcomes compared. An additional subgroup analysis was performed for patients undergoing segmental resections only.Results
13,949 patients were identified, of whom 6084 (43.6 %) underwent HAL colectomy. Patients undergoing HAL versus SL colectomy had higher rates of postoperative ileus (8.7 vs. 6.3 %, p?<?0.001), wound complication (8.8 vs. 6.8 %, p?=?0.006), and 30-day readmission (7.5 vs. 6.0 %, p?=?0.002), without any differences in operative time (156 vs. 157 min, p?=?0.713). Amongst segmental colectomies, HAL remained associated with higher rates of wound complications (8.6 vs. 6.5 %, p?=?0.016), postoperative ileus (8.9 vs. 6.3 %, p?<?0.001), and 30-day readmission (7.1 vs. 5.9 %, p?=?0.041) with no difference in operative time between HAL and SL (145 vs. 145 min, p?=?0.334).Conclusions
Use of HAL colectomy is associated with increased risk of wound complications, postoperative ileus, and readmissions. Importantly, this technique is not associated with any decrease in operative time.11.
Chang In Choi Dong Hoon Baek Si Hak Lee Sun Hwi Hwang Dae Hwan Kim Kwang Ha Kim Tae Yong Jeon Dong Heon Kim 《Journal of gastrointestinal surgery》2016,20(6):1083-1090
Purpose
This study aims to compare the effectiveness of Billroth-II with Braun and Roux-en-Y reconstruction after laparoscopic distal gastrectomy.Methods
From April 2010 to August 2012, 66 patients underwent laparoscopic distal gastrectomy (Billroth-II with Braun reconstruction, 26; Roux-en-Y, 40). The patients’ data were collected prospectively and reviewed retrospectively.Results
The mean operation and reconstruction times were statistically shorter for Billroth-II with Braun reconstruction than Roux-en-Y (198.1?±?33.0 vs. 242.3?±?58.1 min, p?=?0.001). One case of postoperative stricture was observed in each group. One case each of intra-abdominal abscess and delayed gastric emptying occurred in the Billroth-II with Braun group. At 1 year postoperatively, gastric residue and reflux esophagitis were not significantly different between the groups. Gastritis and bile reflux were more frequently observed in the Billroth-II with Braun group (p?=?0.004 and p?<?0.001, respectively). At 2 years postoperatively, gastric residue was not significantly different, but gastritis, bile reflux, and esophagitis were more frequent in the Billroth-II with Braun group (p?=?0.029, p?<?0.001, and p?=?0.036, respectively).Conclusion
The postoperative effectiveness of Roux-en-Y reconstruction may be superior to Billroth-II with Braun reconstruction after laparoscopic distal gastrectomy.12.
Jiheum Paek Maria Lee Bo Wook Kim Yongil Kwon 《International urogynecology journal》2016,27(4):593-599
Introduction and hypothesis
The aim of this study was to compare robotic or laparoscopic sacrohysteropexy (RLSH) and open sacrohysteropexy (OSH) as a surgical treatment for pelvic organ prolapse (POP).Methods
Among 111 consecutive patients who had undergone sacrohysteropexy for POP, surgical outcomes and postoperative symptoms were compared between the RLSH (n?=?54; robotic 14 cases and laparoscopic 40 cases) and OSH (n?=?57). groups The medical records of enrolled patients were reviewed retrospectively.Results
Compared with the OSH group, the RLSH group had shorter operating time (120.2 vs 187.5 min, p?<?0.0001), less operative bleeding (median estimated blood loss 50 vs 150 ml; p?<?0.0001; mean hemoglobin drop 1.4 vs 2.0 g/dl; p?<?0.0001), and fewer postoperative symptoms (13 vs 45.6 %; p?<?0.0001). Patients’ overall satisfaction (94.4 vs 91.2 %; p?=?0.717) and required reoperation due to postoperative complications (3.7 vs 1.8 %; p?=?0.611) did not differ between groups.Conclusions
RLSH could be a feasible and safe procedure in patients with POP and should be considered as a surgical option that allows preservation of the uterus. Prospective randomized trials will permit the evaluation of potential benefits of RLSH as a minimally invasive surgical approach.13.
Michaela Jurakova Martin Huser Ivan Belkov Petr Janku Robert Hudecek Petr Stourac Jiri Jarkovsky Pavel Ventruba 《International urogynecology journal》2016,27(5):791-796
Introduction and hypothesis
The objective was to compare the efficacy and safety of an innovative single-incision sling (SIS) with the inside-out transobturator sling (TOT) in the treatment of female stress urinary incontinence (SUI).Methods
A prospective randomized trial was performed in a tertiary referral urogynecology center from January 2012 to December 2013. The study included women with pure urodynamic SUI. Patients were randomized to either the SIS or the TOT anti-incontinence procedure. Surgery duration, blood loss, and groin pain scores were recorded for each patient. The 1-year follow-up visit included objective and subjective cure parameters, postoperative de novo urgency, complications, and the impact on the patient’s life quality.Results
Of 285 patients assessed for eligibility, a total of 93 patients (32.6 %) were randomized into TOT (n?=?48) and SIS groups (n?=?45). There were no significant differences in either operating time or blood loss. A statistically significant difference between the two groups was found in pain scores three (5.6?±?1.8 vs 3.1?±?2.1, p?<?0.001) and 12 h postoperatively (3.8?±?1.7 vs 2.1?±?1.7, p?<?0.001). After 1 year, there were no significant differences between the TOT and SIS groups in objective cure rates (87.0 % vs 90.9 %; p?=?0.399) or patient-reported success rates (91.3 % vs 93.2 %; p?=?0.999). Incidence of postoperative de novo urgency did not differ between TOT and SIS patients. Both groups registered a significant improvement in quality of life.Conclusions
The Ophira SIS procedure has 1-year success rates comparable to standard TOT with significantly less groin pain in the early postoperative period. Both methods were safe and effective in terms of postoperative urgency and life quality improvement.14.
Aurélie?Baillot Warner?M.?Mampuya Isabelle?J.?Dionne Emilie?Comeau Anne?Méziat-Burdin Marie-France?Langlois
Background
Experts recommend physical activity (PA) to optimize bariatric surgery (BS) results. However, evidence on the effect of PA before BS is missing. The aim of this study was to assess the impact of adding a Pre-Surgical Exercise Training (PreSET) to an interdisciplinary lifestyle intervention on physical fitness, quality of life, PA barriers, and anthropometric parameters of subjects awaiting BS.Methods
Thirty candidates for BS (43.2?±?9.2 years, 47.5?±?8.1 kg/m2) have been randomized in two groups: one group following the PreSET (endurance and strength training) and another receiving usual care. Before and after 12 weeks, we assessed physical fitness with a battery of tests (symptom-limited exercise test, 6-min walk test (6MWT), sit-to-stand test, half-squat test, and arm curl test), quality of life with the laval questionnaire, and PA barriers with the physical exercise belief questionnaire.Results
One control group subject abandoned the study. Subjects in the PreSET group participated in 60.0 % of the supervised exercise sessions proposed. Results showed significant improvements in the 6MWT (17.4?±?27.2 vs. ?16.4?±?42.4 m; p?=?0.03), half-squat test (17.1?±?17.9 vs. ?0.9?±?14.5 s; p?=?0.05), arm curl repetitions (4.8?±?2.3 vs. 1.0?±?4.1; p?=?0.01), social interaction score (10.7?±?12.5 vs. ?2.1?±?11.0 %; p?=?0.02), and embarrassment (?15.6?±?10.2 vs. ?3.1?±?17.8 %; p?=?0.02) in completers (n?=?8) compared to the non-completers (n?=?21). No significant difference between groups in BMI and other outcomes studied was observed after the intervention.Conclusions
Adding a PreSET to an individual lifestyle counselling intervention improved physical fitness, social interactions, and embarrassment. Post-surgery data would be interesting to confirm these benefits on the long term.15.
Aimee L. Tieu Aparna Hegde Peter A. Castillo G. Willy Davila Vivian C. Aguilar 《International urogynecology journal》2017,28(3):461-467
Introduction and Hypothesis
To compare 1-year surgical outcomes following transobturator (TO) sling placement and single incision (SI) sling placement for the treatment of stress urinary incontinence (SUI).Methods
We performed a randomized trial at a single institution. Patients with urodynamically proven SUI were offered participation and randomized to placement of a TO sling (Monarc?) or a SI sling (MiniArc?) between 2008 and 2011. The primary outcome measure was urinary leakage during standardized cough stress test (CST). Forty subjects in each group were required to achieve 80 % power to detect an effect size of 0.25.Results
A total of 98 patients were randomized with 49 patients in the TO group and 49 patients in the SI group. Preoperative demographics were similar between the groups (Table 1). The TO group had a significantly longer sling operative time (10.7?±?4.8 min vs. 7.8?±?4.9 min, p?<?0.001) and greater estimated blood loss (31.6?±?26.6 mL vs. 22.9?±?22.1 mL, p?=?0.02). At the 1-year follow-up, there was no difference in the primary outcome with 9 TO patients (21 %) and 12 SI patients (29 %) having a positive CST (p?=?0.5). A composite measurement of ‘failure’, defined as patient-reported SUI and a positive CST, showed no difference between the TO group (17 %) and the SI group (27 %; p?=?0.3).Conclusions
The SI sling provides comparable objective efficacy to the TO sling at 1 year.16.
Saachi Sachdev Qi Wang Charles Billington John Connett Leaque Ahmed William Inabnet Streamson Chua Sayeed Ikramuddin Judith Korner 《Obesity surgery》2016,26(5):957-965
Background
This study aims to quantify changes in fibroblast growth factor 19 (FGF19) and bile acids (BAs) in patients with uncontrolled type 2 diabetes randomized to Roux-en-Y gastric bypass (RYGB) vs intensive medical management (IMM) and matched for similar reduction in HbA1c after 1 year of treatment.Methods
Blood samples were drawn from patients who underwent a test meal challenge before and 1 year after IMM (n?=?15) or RYGB (n?=?15).Results
Mean HbA1c decreased from 9.7 to 6.4 % after RYGB and from 9.1 to 6.1 % in the IMM group. At 12 months, the number of diabetes medications used per subject in the RYGB group (2.5?±?0.5) was less than in the IMM group (4.6?±?0.3). After RYGB, FGF19 increased in the fasted (93?±?15 to 152?±?19 pg/ml; P?=?0.008) and postprandial states (area under the curve (AUC), 10.8?±?1.9 to 23.4?±?4.1 pg?×?h/ml?×?103; P?=?0.006) but remained unchanged following IMM. BAs increased after RYGB (AUC ×103, 6.63?±?1.3 to 15.16?±?2.56 μM?×?h; P?=?0.003) and decreased after IMM (AUC ×103, 8.22?±?1.24 to 5.70?±?0.70; P?=?0.01). No changes were observed in the ratio of 12α-hydroxylated/non-12α-hyroxylated BAs. Following RYGB, FGF19 AUC correlated with BAs (r?=?0.54, P?=?0.04) and trended negatively with HbA1c (r?=??0.44; P?=?0.09); these associations were not observed after IMM.Conclusions
BA and FGF19 levels increased after RYGB but not after IMM in subjects who achieved similar improvement in glycemic control. Further studies are necessary to determine whether these hormonal changes facilitate improved glucose homeostasis.17.
Erinn M. Myers Catherine A. Matthews Andrea K. Crane AnnaMarie Connolly Jennifer M. Wu Elizabeth J. Geller 《International urogynecology journal》2017,28(10):1567-1572
Introduction and hypothesis
Post-operative voiding dysfunction is common after sling placement and is assessed with a voiding trial (VT) before discharge. We hypothesized that an operating room (OR) initiated retrograde VT (OR-fill) would decrease time to discharge compared with a post-anesthesia care unit (PACU) initiated retrograde VT (PACU-fill).Methods
This was a parallel non-blinded randomized trial, of women undergoing outpatient sling surgery at a university hospital. In the OR-fill group, fill was initiated after sling placement during cystoscopy by leaving fluid in the bladder. In the PACU-fill group, fill was initiated in the PACU. Pre-VT volumes were recorded and a PVR?≤?100 mL defined a passed VT. The primary outcome was total PACU time, defined as arrival in PACU until discharge home.Results
Thirty women were assigned to the OR-fill group and 29 to the PACU-fill group. Time from PACU arrival to VT was shorter in the OR-fill group (41.5 [31.0, 69.3] min vs 69.0 [44.0, 107.0] min, p?=?0.03), but total PACU time in the groups was similar (125.0 [90.5, 180.5] min vs 131.5 [93.5, 178.0] min, p?=?0.76). Bladder volume before VT was greater in the OR-fill group (557.3?±?187.3 mL vs 433.0?±?171.2 mL, p?=?0.01). VT pass rates of the two groups were not significantly different (OR-fill 16.7% vs PACU-fill 24.1%, p?=?0.48).Conclusions
OR-fill VT did not decrease total PACU time compared with PACU-fill VT. No overdistension was seen in either group; transient postoperative voiding dysfunction was common.18.
Tomasz Rogula Marijan Koprivanac Michał Robert Janik Jacob A. Petrosky Amy S. Nowacki Agnieszka Dombrowska Matthew Kroh Stacy Brethauer Ali Aminian Philip Schauer 《Obesity surgery》2018,28(9):2589-2596
Objective
The aim was to compare clinical outcomes of patients treated with totally robotic Roux-en-Y gastric bypass (TRRYGB) with those treated with the different laparoscopic Roux-en-Y gastric bypass (LRYGB) techniques.Summary Background Data
The clinical benefit of the robotic approach to bariatric surgery compared to the standard laparoscopic approach is unclear. There are no studies directly comparing outcomes of TRRYGB with different LRYGB techniques.Methods
Outcomes of 578 obese patients who underwent RYGB between 2011 and 2014 at an academic center were assessed. Multivariable analysis and propensity matching were used for comparing TRRYGB to different LRYGB techniques, including 21-mm EEA circular-stapled gastrojejunal anastomosis (GJA, LRYGB-21CS), linear-stapled GJA (LRYGB-LS), and hand-sewn GJA (LRYGB-HS).Results
The TRRYGB technique required a longer mean operative time compared to the other groups, respectively 204?±?46 vs. 139?±?30 min (LRYGB-21CS), 206?±?37 vs. 158?±?30 min (LRYGB-LS), and 210?±?36 vs. 167?±?30 min (LRYGB-HS). TRRYGB experienced a lower stricture rate (2 vs. 17%, P?=?0.003), shorter hospital stay (2.6?±?1.2 vs. 4.3?±?5.5 days, P?=?0.008), and lower readmission rate (12 vs. 28%, P?=?0.009). No significant differences in outcomes were observed when comparing RRYGB to LRYGB-LS or LRYGB-HS.Conclusions
TRRYGB increases operative time compared to all LRYGB techniques. TRRYGB was superior to LRYGB-21CS in terms of significantly shorter hospital stay, lower readmission rate, and less frequent GJA stricture formation. TRRYGB provides no clinical advantages over the LRYGB-LS and LRYGB-HS techniques.19.
Background
Gastric leak and hemorrhage are the most important challenges after laparoscopic sleeve gastrectomy (LSG). In order to reduce these complications, the staple line can be reinforced by absorbable sutures or by the use of glycolide trimethylene carbonate copolymer onto the linear stapler (Gore Seamguard®; W.L. Gore &; Associates, Inc, Flagstaff, AZ). To our knowledge, there are no randomized studies showing the utility of staple line reinforcement during LSG. The purpose of this study was to randomly compare three techniques in LSG: no staple line reinforcement (group 1), buttressing of the staple line with Gore Seamguard® (group 2), and staple line suturing (group 3).Methods
Between January 2008 and February 2009, 75 patients were prospectively and randomly enrolled in the three different techniques of handling the staple line during LSG. The patient groups were similar (NS).Results
Mean operative time to perform the stomach sectioning was 15.9?±?5.9 min (group 1), 20.8?±?8.1 min (group 2), and 30.8?±?10.1 min (group 3) (p?0.001). Mean total operative time was 47.4?±?10.7 min (group 1), 48.9?±?18.4 min (group 2), and 59.9?±?19.6 min (group 3) (p?=?0.02). Mean blood loss during stomach sectioning was 19.5?±?21.3 mL (group 1), 3.6?±?4.7 mL (group 2), and 16.7?±?23.5 mL (group 3) (p?0.001). Mean total blood loss was 48.9?±?67.1 mL (group 1), 32.5?±?46.5 mL (group 2), and 61.9?±?69.4 mL (group 3) (p?=?0.03). Mean number of stapler cartridges used was 5.6?±?0.7 (group 1), 5.7?±?0.7 (group 2), and 5.8?±?0.6 (group 3) (NS). Postoperative leak affected one patient (group 1), two patients (group 2), and one patient (group 3) (NS). Mean hospital stay was 3.6?±?1.4 days (group 1), 3.9?±?1.5 days (group 2), and 2.8?±?0.8 days (group 3) (p?=?0.01).Conclusions
In LSG, buttressing the staple line with Gore Seamguard® statistically reduces blood loss during stomach sectioning as well as overall blood loss. No staple line reinforcement statistically decreases the time to perform stomach sectioning and the total operative time. No significant difference is evidenced in terms of postoperative leak between the three techniques of LSG.20.
Petter Bjornstad Carlos Roncal Tamara Milagres Laura Pyle Miguel Angel Lanaspa Franziska K. Bishop Janet K. Snell-Bergeon Richard J. Johnson R. Paul Wadwa David M. Maahs 《Pediatric nephrology (Berlin, Germany)》2016,31(5):787-793