Laparoscopic hepatic lobectomy for symptomatic polycystic liver disease

BackgroundLaparoscopic fenestration has largely replaced open fenestration of liver cysts. However, most hepatectomies for polycystic liver disease (PCLD) are performed open. Outcomes data on laparoscopic hepatectomy for PCLD are lacking.MethodsPatients who underwent surgery for PCLD at a single institution between 2010 and 2019 were reviewed and grouped by operative approach. Pre- and post-operative volumes were calculated for patients who underwent resection. Primary outcomes were: volume reduction, re-admission and postoperative complications.ResultsTwenty-six patients were treated for PCLD: 13 laparoscopic fenestration, nine laparoscopic hepatectomy, three open hepatectomy and one liver transplantation. Median length of stay for patients after laparoscopic resection was 3 days (IQR 2–3). The only complication was post-operative atrial fibrillation in one patient. There were no readmissions. Overall volume reduction was 51% (range 22–69) for all resections, 32% (range 22–46) after open resection and 56% (range 39–69) after laparoscopic resection.ConclusionVolume reduction achieved through laparoscopic approach exceeded open volume reduction at this institution and is comparable to volume reduction in previously published open resection series. Adequate volume reduction can be accomplished by laparoscopic means with acceptable postoperative morbidity.     

Psoas:lumbar vertebra index: central sarcopenia independently predicts morbidity in elderly trauma patients

Introduction

Central sarcopenia as a surrogate for frailty has recently been studied as a predictor of outcome in elderly medical patients, but less is known about how this metric relates to outcomes after trauma. We hypothesized that psoas:lumbar vertebral index (PLVI), a measure of central sarcopenia, is associated with increased morbidity and mortality in elderly trauma patients.

Methods

A query of our institutional trauma registry from 2005 to 2010 was performed. Data was collected prospectively for the Pennsylvania Trauma Outcomes Study (PTOS). Inclusion criteria: age >55 years, ISS >15, and ICU LOS >48 h. Using admission CT scans, psoas:vertebral index was computed as the ratio between the mean cross-sectional areas of the psoas muscles and the L4 vertebral body at the level of the L4 pedicles. The 50th percentile of the psoas:L4 vertebral index value was determined, and patients were grouped into high (>0.84) and low (≤0.83) categories based on their relation to the cohort median. Primary endpoints were mortality and morbidity (as a combined endpoint for PTOS-defined complications). Univariate logistic regression was used to test the association between patient factors and mortality. Factors found to be associated with mortality at p < 0.1 were entered into a multivariable model.

Results

A total of 180 patients met the study criteria. Median age was 74 years (IQR 63–82), median ISS was 24 (IQR 18–29). Patients were 58 % male and 66 % Caucasian. Mean PLVI was 0.86 (SD 0.25) and was higher in male patients than female patients (0.91 ± 0.26 vs. 0.77 ± 0.21, p < 0.001). PLVI was not associated with mortality in univariate or multivariable modeling. After controlling for comorbidities, ISS, and admission SBP, low PLVI was found to be strongly associated with morbidity (OR 4.91, 95 % CI 2.28–10.60).

Conclusions

Psoas:lumbar vertebral index is independently and negatively associated with posttraumatic morbidity but not mortality in elderly, severely injured trauma patients. PLVI can be calculated quickly and easily and may help identify patients at increased risk of complications.     

The personal impact of pelvic floor symptoms and their relationship to age

Introduction and hypothesis

The aim was to evaluate the relationship between age and the impact of pelvic floor disorders (PFD) using a multi-dimensional pelvic floor questionnaire

Methods

Questionnaire data on 4,311 women attending urogynaecology clinics with PFD were stratified by age into four groups: ≤35, 36–50, 51–65 and >65 years. The symptom frequency (ranging from 0 to 100) was divided in to mild (0–33), moderate (34–67), and severe (68–100) symptoms. Impact scores for equivalent levels of symptom frequency (mild, moderate and severe symptoms) were compared in women of different ages.

Results

Overall, bowel continence was associated with the greatest bother and constipation the least. Older women were significantly less bothered by mild to moderate urinary, bowel and vaginal symptoms (except IBS and vaginal capacity) than younger women. There was no difference in the impact of severe symptoms in different ages. In contrast, for sexual symptoms, there was a significant difference in the impact in older women for all grades of severity.

Conclusions

Women’s views and attitudes towards symptoms are variable and age is a significant factor. In women attending urogynaecology clinics with pelvic floor symptoms the impact of most symptoms (particularly sexual dysfunction) become less bothersome with age.     

Laparoscopic Bariatric Surgery Can Be Performed Through a Single Incision: A Comparative Study

Background

The application of single-incision laparoscopic surgery (SILS) in bariatric patients has been limited to less complex procedures. We evaluated the short-term outcomes of SILS sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB), compared to a group of well-established minimally invasive techniques.

Methods

Twenty-eight morbidly obese patients who underwent SILS SG (n?=?14) and RYGB (n?=?14) were compared to a matched control group composed of 28 cases of conventional laparoscopic surgery (CLS). A single vertical 2.5–3-cm intra-umbilical incision, three-ports placed trans-fascially, and a liver suspension technique were used to perform SILS.

Results

Both groups were comparable in terms of age (p?=?0.96), gender (p?=?1.0), type of procedure (p?=?1.0), and number of comorbidities (p?=?0.63). Two (7 %) SILS patients required placement of one additional port, and no conversions to CLS or open surgery were needed. The estimated blood loss (p?=?0.48), operative time (p?=?0.33), length of hospital stay (p?=?0.79), overall 90-day perioperative complication rate (p?=?1.0), and short-term weight loss (p?=?0.53) were comparable between the two groups. In terms of pain control, the frequency of patient-controlled analgesia use in both groups was similar. However, the pain score (assessed by visual analog scale) was significantly less for SILS patients on postoperative days 1 (5.0?±?2.1 vs. 6.5?±?1.8; p?=?0.007) and 2 (4.0?±?2.0 vs. 5.1?±?2.4; p?=?0.49). Cosmetic satisfaction with the scar was high in the SILS group. No patients required reoperation or readmission during the 90 days after surgery.

Conclusion

SILS is feasible in carefully selected bariatric patients and results in short-term outcomes comparable to those observed after CLS. Improved pain and cosmesis are potential benefits of SILS.     

Retrospective and prospective psychological and physical health as a function of negative affect and attributional style

Subjects completed questionnaires designed to assess (a) attributions along internal-external, stable-unstable, and global-specific dimensions subsequent to undersirable events; (b) negative affect; and (c) retrospective psychological and physical health. Subjects then kept weekly records, for 12 weeks, of their visits to doctors and days of illness (prospective physical health) and days they experienced emotional problems (prospective psychological health). Multiple regression analyses that used negative affect and attributional variables as predictors showed that negative affect was the best predictor of retrospective health and that global attributions were the best predictors of prospective health. Analysis of the comparative predictive value of the internal, stable, and global attributions revealed that global attributions were the most significant predictors of retrospective and prospective health.     

Changes in gastro-intestinal function in humans at an altitude of 3,500 m

Summary The gastric juice secretion, acid concentration and peptic activity were studied before and after pentagastrin stimulation in 10 sea level residents, first at sea level and then during 22 days sojourn at 3,500 m and in two other groups of 10 men, one of which consisted of natives of high altitude and the other of lowlanders acclimatized to high altitude. In addition, measurements of xylose excretion, energy, fat and protein utilization, along with fluid balance were made on sea level residents, referred to as sojourners, both at sea level and high altitude.The basal and maximal gastric juice volumes of the three groups at high altitude did not differ significantly. The maximal rate of acid production was lower in high altitude natives as compared to the other two groups. Peptic activity was higher in sojourners at high altitude, whereas it did not show any difference in acclimatised low landers as compared to sea level values of sojourners. There was no significant difference in D-xylose excretion in sojourners at high altitude. The food intake of sojourners was reduced at high altitude without any change in the efficiency of food utilization. There was no change in fluid balance.