Venous resection for adenocarcinoma of head of pancreas: Does extent of portal vein resection affect outcomes?

BackgroundVenous resection with pancreaticoduodenectomy (PD) increases resectability rates in patients with adenocarcinoma of head of pancreas. The effect of extent of portal vein resection on perioperative morbidity and mortality is less clear. This retrospective cohort study compares results of PD with and without venous resection and explores the influence of extent of vein resection on perioperative morbidity and mortality.MethodsTotal 96 patients underwent standard PD (PD) and 20 patients had en bloc venous resections (VR). VR group was divided into segmental (VR-S) (6/20 patients) and tangential (VR-T) (14/20 patients) groups based on segmental or tangential type of venous resections. The groups were compared for morbidity, mortality and survival.ResultsPD and VR groups had comparable perioperative morbidity (p = 0.140) and mortality (p = 0.358) with a significantly higher operative time in VR (p < 0.001). Perioperative morbidity and mortality were similar in VR-S and VR-T groups (p = 0.690 and p = 0.157 respectively). Operative time and estimated blood loss were significantly higher in VR-S group over VR-T (p = 0.019 and p = 0.002 respectively). Median survival was similar for PD and VR (15 and 15.5 moths respectively; p = 0.278) and VR-S and VR-T groups (17 and 12.5 months respectively; p = 0.550). Expected blood loss and operative time were found to be independent predictors of morbidity.ConclusionsVenous resection with PD is associated with morbidity, mortality and overall survival comparable to that after standard resection. The extent of venous resection does not seem to affect perioperative morbidity and mortality.     

Does implant modularity affect radiographic outcome following anatomic shoulder arthroplasty?

BackgroundModularity in shoulder implants is a feature that is thought to allow for better anatomical recreation and subsequently improve clinical outcomes. This hypothesis was tested by retrospectively comparing the radiographic outcomes of 2 patient groups that received either modular (adaptable) or nonmodular shoulder implants during arthroplasty.Methods: Radiographic variables were measured to provide a comprehensive analysis of recreated shoulder anatomy.ResultsThe modular group demonstrated significant changes in humeral head height, greater tuberosity height, the radiographic distance from humeral head to acromion and center of rotation difference. In contrast, the nonmodular group demonstrated significant changes to humeral head height. A higher frequency of humeral radiolucent lines was noted in the non-modular group compared to the modular group.ConclusionsImplant modularity may produce measurable differences in radiographic anatomy and a lower measure of implant loosening in anatomic shoulder arthroplasty.Level of EvidenceLevel III; Retrospective Cohort Comparative Study     

Does detrusor underactivity affect the results of transurethral resection of prostate?

International Urology and Nephrology - We aimed to evaluate the outcome of transurethral resection of the prostate (TURP) in patients with benign prostatic hyperplasia (BPH) and diagnosed to have...     

Does a positive pretransplant crossmatch affect long-term outcome in liver transplantation?

Despite the historical success of liver transplantation in the face of a positive lymphocytic crossmatch, increased incidence of acute cellular rejection and graft loss have been reported in this setting. Given the potential adverse effects of antirejection treatment, especially in hepatitis C virus-positive recipients, identification of predisposing factors could allow for better surveillance, avoidance of rejection, and potentially better graft outcomes.     

Does anaesthetic technique affect the outcome after transurethral resection of the prostate?

OBJECTIVE: To determine if the choice of anaesthetic (spinal or general) has any influence on outcomes after transurethral resection of the prostate (TURP). PATIENTS AND METHODS: The records of 261 patients undergoing TURP between October 1995 and July 1998 were selected for a matched-cohort study. There were 87 complete datasets for cases performed under general anaesthesia and each was matched to two patients (174) from those undergoing spinal anaesthesia. The cohorts were matched by age, physical status score and date of operation. The primary outcome measures were length of stay in the recovery room and satisfaction with postoperative analgesia. RESULTS: There were no significant differences in major outcomes. There was a higher incidence of some minor adverse events in the group having general anaesthesia. Back pain was more common after spinal anaesthesia. CONCLUSION: Spinal anaesthesia was not associated with an improved outcome after TURP. The choice of anaesthesia should be made by the patient, surgeon and anaesthetist on the basis of the known risks of particular adverse events.     

Laparoscopic extended liver resection: are postoperative outcomes different?

Surgical Endoscopy - Although laparoscopic major hepatectomy (LMH) is becoming increasingly common in specialized centers, data regarding laparoscopic extended major hepatectomies (LEMH) and their...     

Minor laparoscopic liver resection: toward 1-day surgery?

Background

Technical advances in laparoscopy and enhanced recovery after surgery programs have progressively decreased the need for hospitalization. The present study aimed to explore the feasibility and safety of an early discharge protocol after minor laparoscopic liver resection (LLR).

Methods

The study sample consisted of patients with both benign and malignant hepatic lesions involving no more than two hepatic segments who underwent minor LLR and were discharged within 24 h. Patients were selected based on their fitness for surgery, proximity to the hospital, and availability of a responsible adult to care for them once discharged. Patients and their accompanying caregiver were instructed about the procedure, its potential complications, and the conditions required for an early discharge. They were also provided with a 24-h dedicated phone number for assistance.

Results

Twenty-four patients [mean age 48.9 year (SD 14.75); 12 women] with no more than one comorbidity were included. The majority (87.5%) was classified as ASA I or II. Thirteen patients (46%) were operated on for malignant lesions. The median operative time was 90 min, the median pneumoperitoneum time was 60 min, and the estimated blood loss was 50 mL. Mortality was zero. No transfusion, conversion, or pedicule clamping was necessary. No anesthesia-related complications occurred. All patients were discharged at 24 h. Only one patient (4.2%) was readmitted at postoperative day 3 for intolerable abdominal pain due to a wound abscess that was treated by antibiotics.

Conclusion

By applying a standardized protocol for admission, preoperative workup, and anesthesia, early discharge after minor LLR can be successfully carried out in highly selected patients with minimal impact on primary healthcare services.

     

Loop ileostomy following anterior resection: is it really temporary?

Introduction A temporary loop ileostomy is often created to minimize the impact of peritoneal sepsis if anastomotic dehiscence occurs following low colorectal anastomosis. Although it has been suggested that a loop ileostomy should be reversed within 12 weeks of formation, this is often not the case. We set out to analyse the use of loop ileostomy following elective anterior resection in England and to identify factors associated with non and delayed reversal. Method Hospital episode statistics for the years 2001–2006 were obtained from the Department of Health. Patients undergoing elective anterior resection with a loop ileostomy for a primary diagnosis of rectal or recto‐sigmoid cancer between April 2001 and March 2003 were identified as the study cohort. This cohort was followed until March 2006 to identify patients undergoing reversal of an ileostomy in an English NHS Hospital. Results A total of 6582 patients had an elective anterior resection between April 2001 and March 2003, of which 964 (14.6%) also had an ileostomy. Seven hundred and two (75.1%) patients were reversed before March 2006. Advancing age and comorbidity were statistically related to nonreversal. Median time to reversal was 207 days (Interquartile range 119–321.5 days). Postoperative chemotherapy and comorbidity significantly delayed reversal. Conclusions One in four loop ileostomies performed to defunction an elective anterior resection is not reversed, and in the presence of significant comorbidity one in three is not reversed. Only 12% is reversed within 12 weeks.     

How much liver resection is too much?

BACKGROUND: Hepatic failure occurring after liver resection carries a poor prognosis and is a complication dreaded by surgeons. Inadequate reserve in the remaining parenchyma leads to a steady decrease in liver function, inability to regenerate, and progression to liver failure. For this reason, many methods to quantify functional hepatic reserve have been developed. METHODS: This article reviews the main methods used in the assessment of hepatic reserve in patients undergoing hepatectomy and their use in operative decision making. RESULTS: A range of methods to categorically quantify the functional reserve of the liver have been developed, ranging from scoring systems (such as the Child-Pugh classification) to tests assessing complex hepatic metabolic pathways to radiological methods to assess functional reserve. However, no one method has or is ever likely to emerge as a single measure with which to dictate safe limits of resectability. CONCLUSIONS: In the future, the role of residual liver function assessment may be of most benefit in the routine stratification of risk, thus enabling both patient consent to be obtained and surgical procedure to be performed, with full information and facts regarding operative risks. However, there is no one single test that remains conclusively superior.