Indications, Surgical Details and Complications of Total Laparoscopic Hysterectomy: A Single-Surgeon Experience of the Initial 80 Cases

The aim of this study was to determine the incidence of perioperative complications and evaluate risk factors for the major complications of total laparoscopic hysterectomy (TLH) using an early ureteral identification technique. We describe the technique we standardized and used for TLH, without exclusion criteria. A retrospective study was carried out at Kurashiki Medical Center, Japan, based on 1253 TLH procedures performed from January 2005 to March 2009. We reviewed records to identify the major perioperative complications, including bladder, ureteral, and intestinal injuries, and incidences of reoperation. Risk factors for major complications were analyzed using multivariate logistic regression models. A total of 24 patients encountered major complications (1.91%). Complications included 10 intraoperative urologic injuries, five cases of postoperative hydronephrosis, five cases of vaginal dehiscence, one bowel injury, one postoperative hemorrhage, one bowel obstruction, and one ureterovaginal fistula. All 11 cases of intraoperative visceral injury were recognized during the surgery and repaired during the same laparoscopic surgical procedure. Of the risk factors analyzed, a history of abdominal surgery was the only one associated with the occurrence of major complications, with an odds ratio of 2.48 (95% confidence interval 1.23-6.49). While complications are inevitable, even in the hands of the most skilled surgeon, they can be minimized without conversion to laparotomy by a sufficiently developed suturing technique and a precise knowledge of pelvic anatomy. The presented data indicate that our method allows for safe TLH and minimization of ureteral injury, without the use of stringent exclusion criteria.

To identify factors affecting blood loss and operation time (OT) during robotic myomectomy (RM), we reviewed a total of 448 patients who underwent RM at Seoul Asan Hospital between 1 January 2019, and 28 February 2021, at Seoul Asan Hospital. To avoid variations in surgical proficiency, only 242 patients managed by two surgeons who each performed >80 RM procedures during the study period were included in this study. All cases of RM were performed with a reduced port technique. We obtained the following data from each patient’s medical chart: age, gravidity, parity, body mass index, and history of previous abdominal surgery including cesarean section. We also collected information on the maximal diameter and type of myomas, number and weight of removed myomas, concomitant surgery, total OT from skin incision to closure, estimated blood loss (EBL), and blood transfusion. Data on preoperative use of gonadotropin-releasing hormone agonists (GnRHas) and perioperative use of hemostatic agents (tranexamic acid or vasopressin) were also collected. Data on the length of hospital stay, postoperative fever within 48 h, and any complications related to RM were also obtained. The primary endpoint in this study was the identification of factors affecting EBL and the secondary endpoint was the identification of factors affecting the total OT during multiport RM. Univariate and multivariate analyses were used to identify the factors affecting EBL and OT during multiport RM. The medians of the maximal diameter and weight of the removed myomas were 9.00 (interquartile range [IQR], 7.00 to 10.00) cm and 249.75 (IQR, 142.88 to 401.00) g, respectively. The median number of myomas was two (IQR, one to four), ranging from 1 to 34. Of the cases, 155 had low EBL and 87 had high EBL. Most myomas were of the intramural type (n = 179). The odds of EBL > 320 mL increased by 251% (odds ratio [OR], 2.51; 95% confidence interval [CI], 1.16–5.42) for five to nine myomas and by 647% (OR, 6.47; 95% CI, 1.87–22.33) for ≥10 myomas. The odds of subserosal-type myomas decreased by 67% compared with intramural-type myomas (OR, 0.33; 95% CI, 0.14–0.80). History of abdominal surgery other than cesarean section was positively correlated with EBL. The weight of the removed myomas and a history of previous cesarean section were not correlated with the EBL. Conclusion: The number of myomas (5–9 and ≥10), maximal myoma diameter, and history of abdominal surgery other than cesarean section affect the EBL in RM.

Objective To evaluate the feasibility and safety of laparoscopic choledochoscopy for common bile duct exploration in patients of common bile duct stones with a history of previous abdominal surgery. Methods From March 2015 to May 2016, 100 cases were divided into laparoscopic and open common bile duct exploration in our department. Hospital stay, costs and complications were compared. Results The blood loss, cost, fasting time and hospital stay in the laparoscopy group were less than those in the open group. There were no significant differences in alanine aminotransferase, total bilirubin, albumin, prothrombin time, leukocyte, C-reactive protein, operative time and complications between the two groups. Conclusion Laparoscopic choledochoscopy for common bile duct exploration is an effective and safe method for the treatment of common bile duct stones in patients with previous history of abdominal surgery. Key words: Choledocholithiasis; Reoperation; Laparoscopes

Objective To invastigate the etiology, diagnosis and treatment of mesenteric fibromatosis. Methods 7 cases of mesenteric fibromatosis was admitted into our hospital from Jan 2012 to Jan 2018. Reslut Among the 7 patients, there were 2 males and 5 females, with an average age of (40+ 16)years, 4 cases had had a history of abdominal surgery and 1 case was of familial polyp, the symptoms of organ compression were the first manifestation in 4 cases, abdominal mass as the first manifestation in 2 cases.The lesions were located on small mesentery in 5 cases, on mesenteric membrane in one, and on mesorectal membrane in one.All 7 patients underwent extensive tumor resection and the margins were negative, one of the tumors was located at the level of the duodenum, invading the superior mesenteric vein and the transverse mesocolon. Immunohistochemistry results: β-catenin(+ )、Ki-67(+ ), CD117(-), CD34(-)in 7 cases, SMA(+ )in 5 cases, Desmin (+ ) in 4 cases, ER (+ ) in 3 cases. Conclusion Most patients of mesenteric fibroma have a history of previous abdominal surgery, seconded by organ compression symptoms.β-catenin (+ ) , Ki-67 (+ ) and CD117 (-), CD34 (-) contribute to pathological diagnosis, Surgery-based comprehensive treatment can achieve therapeutic effect. Key words: Fibromatosis, aggressive; Mesentery; Surgical procedures, operative

BackgroundRobotic-assisted pancreatic surgery is limited to specialized high-volume centers and selected patient cohorts. Especially for patients with a history of previous abdominal surgeries, the standard procedure remains open surgery due to the fear of complications caused by abdominal adhesions.MethodsClinical data of all consecutive patients undergoing robotic-assisted pancreatic surgery using the daVinci Xi system (Intuitive Surgical) at our center (Department of Surgery, Universitätsmedizin Berlin, Germany) were collected prospectively and further analyzed from October 2017 to October 2020. Prior abdominal surgeries were specified according to the surgical approach and localization. In univariate and multivariate analysis, baseline and perioperative parameters of patients with a history of prior abdominal surgeries (PS) were compared to those of patients with no history of prior abdominal surgeries (NPS).ResultsOut of 131 patients undergoing robotic-assisted pancreatic surgery, 62 (47%) had a history of abdominal surgery. Previous procedures included most often appendectomy (32%) followed by gynecological surgery (29%) and cholecystectomy (27%). 24% of PS had received multiple surgeries prior to the robotic-assisted pancreatic resections. Baseline characteristics and comorbidities were comparable between the groups. We did not detect differences in the duration of surgery (262 min), conversion rates (10%), and postoperative complications between NPS and PS. Postoperative pancreatic fistula (POPF), postpancreatectomy hemorrhage (PPH), and in-house mortality showed no significant differences between the two groups. Multivariate analysis revealed male sex and high BMI as a potential predictive factor for severe postoperative complications. Other characteristics like the type of pancreatic resection, ASA, and underlying malignancy showed no difference in the multivariable analysis.ConclusionsWe propose robotic-assisted pancreatic surgery to be safe and feasible for patients with a history of minor prior abdominal surgery. Hence, each patient should individually be evaluated for a minimally invasive approach regardless of a history of previous operations.

Purpose: Overuse of colonoscopy affects the availability, quality, and cost of care. We sought to evaluate the frequency and indications for repeat colonoscopy within 60 days, and to evaluate whether baseline patient characteristics or the course during the first colonoscopy predicted the need for repeat procedures. Methods: We identified 781 patients who had more than one colonoscopy within 60 days, among 51559 patients (1.5%) who underwent colonoscopy during Jan 2004 to Dec 2006. Control patients who did not have repeat exams were matched with the study population with respect to procedure date and location. Medical records were reviewed for patient demographic and historical data and numerous procedural characteristics. Univariate and multivariate logistic regressions were performed to assess the association between the repeat colonoscopy and patient age, gender, BMI, history of abdominal surgery, procedure tolerance, size of largest polyp, endoscopist experience, inpatient vs. outpatient status, and use of anticoagulants, narcotics or benzodiazepines. Results: The most common reasons for repeat colonoscopy included poor bowel preparation (32%), “Need for Complex Therapy” (21%), bleeding management (13%), pathology follow-up (12%), stricture therapy (6%), failure due to intolerance (4%), failure due to anatomy (4%), and anticoagulant or antiplatelet agent mgmt (2%). Multivariate logistic regression showed statistically significant differences between the study and control populations in regard to age (OR = 1.01; 95% CI 1.003–1.017; P < 0.005), history of abdominal surgery (OR = 1.68; 95% CI 1.34–2.11; P < 0.0001), procedural tolerance level (OR = 4.01; 95% CI 2.20–7.30; P < 0.0001), inpatient versus outpatient status (OR = 1.78; 95% CI 1.31–2.41; P < 0.001), largest polyp size ≥ 2 cm (OR = 10.70; 95% CI 5.08–22.56; P < 0.0001), and use of anticoagulants (OR = 1.58; 95% CI 1.12–2.22; P < 0001). Endoscopist experience, and patient gender, BMI, or use of narcotics or benzodiazepines did not correlate with repeat procedures. Conclusion: Poor bowel preparation and referral for complex therapies are the dominant indications for repeating colonoscopy within 2 months. Variables associated with performance of repeat colonoscopy included older age, history of previous abdominal surgery, inpatient status, poor procedure tolerance, largest polyp size more than 2 cm, and use of anticoagulants at the time of the first colonoscopy.

Patients' Surgical History Profile and Its Association With Complexity in Major Emergency Abdominal Surgery.

Laparoscopic colorectal surgery may be impeded by intraperitoneal adhesions caused by previous abdominal surgery. The aim of this study was to determine the effect of previous abdominal surgery on short- and long-term outcomes of laparoscopic colorectal surgery. We retrospectively reviewed 3188 patients with primary colorectal cancer who underwent laparoscopic colorectal surgery between January 2004 and December 2013. Patients with a history of abdominal surgery (n=593, 18.6%) were compared to those without such history (n=2595, 81.4%). Patients who had undergone previous abdominal surgery exhibited acceptable intraoperative outcomes, including conversion to open surgery, operative time, estimated blood loss, and the number of harvested lymph nodes. Overall, postoperative complication rates were similar between the groups (10.8 vs. 10.6%, p=0.885). Subgroup analysis revealed that patients with history of major abdominal surgery (n=165) had higher rates of conversion to open surgery (4.2 vs. 1.7%, p=0.033), prolonged postoperative ileus (5.5 vs. 2.0%, p=0.008), and wound complications (4.2 vs. 1.2%, p=0.006), when compared to those without prior abdominal surgery. Previous major abdominal surgery was an independent risk factor for conversion to open surgery [adjusted odds ratio=2.740; 95% confidence interval (CI) 1.197-6.269]. Disease-free survival [adjusted hazard ratio (HR)=0.847; 95% CI 0.532-1.346] and overall survival (adjusted HR=0.846; 95% CI 0.432-1.657) were not observed to differ between the previous major abdominal surgery group and those without previous abdominal surgery. Laparoscopic colorectal surgery in patients with a history of abdominal surgery exhibited acceptable short- and long-term outcomes. Patients with a history of previous abdominal surgery had relatively higher rate of conversion to open surgery as well as higher incidences of prolonged postoperative ileus and wound complications compared to patients without such history.

Aim: To study the frequency and factors associated with peritoneal involvement among patients operated for acute appendicitis in a tertiary care hospital. Place and duration of study: Department of Surgery, Benazir Bhutto Hospital Rawalpindi Pakistan from 1stJuly 2020 to 30thJune 2021. Methodology: This comparative cross-sectional study 500 patients diagnosed as acute appendicitis and operated by consultant surgeon were included. Peritoneal involvement was defined as signs of inflammation or infection on abdominal lining observed by operating surgeon during the time of surgery. Factors like age, gender, presence of comorbid illnesses and history of previous abdominal surgeries were associated with presence of peritoneal involvement. Results: There were 305 (61%) males while 195 (39%) were females with mean age was 32.331±4.544 years.Four hundred and forty two (88.4%) did not show any peritoneal involvement at the time of surgery while 58 (11.6%) had peritoneal involvement. Chi-square test revealed that history of previous abdominal surgeries and advancing age had statistically significant association with peritoneal involvement among the study participants (p-value&lt;0.05). Conclusion: Peritoneal involvement was found in considerable number of patients operated as acute appendicitis by the treating surgeons. Patients with previous history of abdominal surgeries and advancing age were more at risk of having peritoneal involvement in our study. Keywords: Acuteappendicitis, Peritonitis, Risk factors, Frequency

To evaluate the effects of previous abdominal surgery on the feasibility and the safety of total laparoscopic hysterectomy (TLH). One hundred seventy-four consecutive patients who underwent TLH in private hospital between February 2008 and December 2009 were retrospectively reviewed. Surgical history, operation time, blood loss, transfusion, conversion to an open surgery, complications and hospital stay were assessed in each patient. The patients were classified into two groups; patients with or without a history of abdominal surgery. Group 1 included patients with a history of abdominal surgery (n = 44) and Group 2 included patients without a history (n = 130). The complication rate was 6.8% in patients with (Group 1) and 5.4% in patients without (Group 2) a history of abdominal surgery, respectively. No bladder, bowel, ureteral, or vascular injuries occurred in either group. Transfusion was required in one patient without a history of abdominal surgery (Group 2; 0.8%). Three patients with (Group 1; 6.8%) and two patients without (Group 2; 1.5%) a history of abdominal surgery were converted to laparotomy. No statistically significant difference was noted between the groups with respect to the complication and conversion rates. In our study, TLH can be performed successfully in patients with a history of abdominal surgery.

Introduction/BackgroundPrediction of the operative time of laparoscopic surgery for endometrial cancer is crucial in the preoperative workup to improve clinical outcomes since a prolonged operative time may be associated with...

Major complications of adult right lobe living liver donors

The small intestinal bacterial overgrowth (SIBO) breath test has had positive results in 84% of patients with irritable bowel syndrome vs 20% of controls. We hypothesized that SIBO would be more prevalent in patients with symptoms consistent with irritable bowel syndrome who have undergone previous abdominal surgery. To identify causative factors for SIBO. Retrospective review. Tertiary colorectal surgery clinic. Result of SIBO breath test. We identified 77 patients whose differential diagnosis included SIBO from January 1, 2005, to December 31, 2007; 18 were excluded because of noncompliance with testing and 2 because of a decision to treat SIBO without formal testing. Symptoms were chronic abdominal pain in 30 patients (53%), bloating in 25 (44%), constipation in 37 (65%), and diarrhea in 7 (12%). Mean (SD) symptom duration was 45 (22) months. Of the 57 patients enrolled in this study, 45 (79%) tested positive for SIBO and 37 (82%) of those had a history of surgery, whereas 12 (21%) tested negative for SIBO and 9 (75%) of those had a history of surgery. Of the 36 SIBO-positive patients with a history of abdominal surgery (mean number of procedures, 2), the surgery locations were as follows: female reproductive organs, 23 (64%); hindgut, 15 (42%); foregut, 8 (22%); and midgut, 6 (17%). Open surgery alone was performed in 32 patients (56%) vs laparoscopic surgery in 7 (12%). Both open and laparoscopic procedures had been performed in 6 patients (11%). Four patients (7%) had a history of small intestinal obstruction. The mean age of SIBO-positive patients was higher than that of SIBO-negative patients (57 vs 44 years; P < .01). Analysis did not reveal any clinically significant independent factor associated with SIBO. Physicians should consider SIBO in the differential diagnosis of patients with normal anatomic findings and chronic lower gastrointestinal complaints.

Background Urgent-start peritoneal dialysis (PD) is a practical and useful form of renal replacement therapy (RRT). The main methods used for PD catheter placement include open/laparoscopic surgery as well as percutaneous puncture using the Seldinger technique. Placing PD catheters using ultrasound-guided percutaneous techniques could reduce some complications associated with the blind technique. Hence, using the Argyle Dialysis Catheter Kit, we adapted a technique for ultrasound-guided percutaneous placement of PD catheters. This study aims to describe our technique and outcomes in urgent-start PD. Materials and Methods Data were collected retrospectively on all patients who underwent PD catheter insertion by a nephrologist in urgent-start PD. All catheters were evaluated for complications from insertion until discharge from the hospital. Results This technique was performed in 74 patients with urgent-start RRT. The mean age of the subjects was 54.2 ± 14.6 years, and 40.5% were women. The mean body mass index (BMI) was 26.4 ± 5 kg/m2, and 23% of the patients had a BMI of &gt; 30 kg/m2. A history of abdominal surgery was noted in 23%. No patient experienced tunnel infection or bowel perforation. Patients experienced transient PD dysfunction (21.6%), catheter migration (20.3%), leakage (8.1%), and peritonitis (13.5%). All complications were resolved before discharge. Conclusion Our adapted ultrasound-guided PD catheter placement technique with a prespecified kit was demonstrated to be safe and useful in patients with increased adiposity and/or a history of previous abdominal surgery. This procedure could reduce in-hospital costs for patients with end-stage kidney disease.

The primary aim of this study is to evaluate the effects of previous abdominal surgery on the feasibility of performing and the safety of total laparoscopic hysterectomy (TLH). In this retrospective study, we analysed 62 laparoscopic hysterectomies which were performed at our institute between February 2011 and January 2013. We chose to perform laparoscopic surgery for all patients, including those who had previously undergone abdominal surgery. The patients were classified into two groups: Group 1 included patients with a history of abdominal surgery (n=24) and Group 2 included patients without a history of abdominal surgery (n=38). THE OPERATING PERIOD WAS COMPARED IN BOTH GROUPS: 184.43±51.0 min. for Group 1 and 195.41±64.1 min. for Group 2 (p=0.471). Postoperative hospital stay and blood loss was also compared. There was just 1 conversion from TLH to a laparotomy in both groups. None of the patients in Group 1 needed a blood transfusion, whereas 1 in Group 2 did. We found that operation time, postoperative hospital stay, blood loss, rate of operative complications or conversion rate to open surgery between patients with and without a history of abdominal surgery were comparable. Therefore, it appears that a history of abdominal surgery does not adversely affect the safety of TLH.