Average Duration Of Postoperative Hospital Research Articles

Modified layered hand-sewn cervical end-to-side anastomosis for minimally invasive McKeown esophagectomy.

Minimally invasive McKeown esophagectomy (MIE McKeown) with cervical anastomosis is a widely used approach for the treatment of esophageal cancer (EC). Anastomotic leak is one of the most serious complications following esophagectomy. This study aimed to summarize the anastomosis procedure and assess the clinical outcomes of our modified layered hand-sewn cervical end-to-side anastomosis for cervical anastomosis during MIE McKeown. We retrospectively reviewed clinical data of 508 consecutive EC patients who underwent MIE McKeown using the modified layered hand-sewn cervical end-to-side anastomosis between June 2016 and June 2020. The incidence of anastomotic leakage in our cohort was 2.0%. The postoperative stricture rate was 6.9% and the incidence of other postoperative complications was less than 9.3%. The mean time for setting up MIE McKeown was approximately 211.0 min and the average duration of postoperative hospital stay was 9.1 days. This modified layered hand-sewn cervical end-to-side anastomosis is a safe and effective method for MIE McKeown with a low incidence of anastomotic leakage, anastomotic stricture, or other postoperative complications.

Comparative assessment of the short-term and long-term results of traditional and original ways of terminoterminal pancreatojejunostomy at a subtotal resection of a head of a pancreas

Aim. Compare the short-term and long-term results of the traditional and original methods of terminoterminal pancreaticojejunostomy with subtotal resection of the pancreatic head.Materials and methods. The results of subtotal resection of the pancreatic head in 20 patients with chronic pancreatitis with pancreatic duct obstruction at the level of the head are analyzed. In 10 cases at the final stage of the operation, the traditional terminoterminal pancreaticojejunostomy was performed, in 10 – in the original way.Results. Biliary tract decompression was performed in 65% of patients. The average duration of operation from original terminoterminal pancreaticojejunostomy operation was 170 min. [165; 180], intraoperative blood loss – 210 ml [200; 240], the average duration of postoperative hospital stay – 16 days [14; 17]; there were no mortality. After 5 years, in all patients who underwent the original terminoterminal pancreaticojejunostomy, the expressiveness of pain according to the developed ten-point scale was <4 points. Frequency for the first time diagnosed diabetes was 50–60%. The need for enzyme drugs was noted in 37.5–40% of cases. The frequency of complications requiring repeated surgical interventions is 12%, persistent disability – 50%. The quality of life indicators for Medical Outcome Study Short Form-36 and European Organisation for Research and Treatment of Cancer quality of life questionnaire – C30 exceeded those of the traditional method of completing the surgery by 3.9–8.4% and 9.3–16.7%.Conclusion. The original way of a single-row terminoterminal pancreaticojejunostomy with subtotal resection of the pancreatic head allows to reduce averages operative time and postoperative hospital stay. The risk of hemorrhagic complications from the resected pancreatic head does not decrease (10%). After 5 years, an insignificant advantage of the original method of terminoterminal pancreaticojejunostomy compared with the traditional one was noted. The incidence of permanent disability was 15% less, the quality of life indicators for the Medical Outcome Study Short Form-36 and European Organisation for Research and Treatment of Cancer quality of life questionnaire – C30 were better.

Application value of fusion indocyanine green fluorescence imaging in the laparoscopic anatomical liver resection

Objective To investigate the application value of fusion indocyanine green fluorescence imaging (FIGFI) in the laparoscopic anatomical liver resection (ALR). Methods The retrospective cross-sectional study was conducted. The clinical data of 21 patients who underwent laparoscopic ALR using FIGFI in the Chinese People′s Liberation Army General Hospital between December 2015 and February 2017 were collected. Indocyanine green (ICG) staining included positive staining and negative staining. Observation indicators: (1) intraoperative situations: surgical procedures, extent of liver resection, methods and results of ICG staining, operation time, volume of intraoperative blood loss, cases with blood transfusion; (2) postoperative situations: postoperative complications, duration of postoperative hospital stay, postoperative pathological examination; (3) follow-up situations. Follow-up using outpatient examination and telephone interview was performed to detect the patients′ survival and tumor recurrence or metastasis up to March 2017. Measurement data with normal distribution were represented as average (range). Results (1) Intraoperative situations: of 21 patients, 20 underwent successful laparoscopic ALR and 1 had conversion to open surgery. The positive and negative stainings of ICG were respectively applied to 5 and 16 patients. Seventeen patients had successful staining and 4 had failed staining. Average operation time, average volume of intraoperative blood loss and cases with blood transfusion were respectively 268 minutes (range, 120-360 minutes), 388 mL (range, 100-800 mL) and 3. (2) Postoperative situations: 5 patients had postoperative complications, including 3 with Clavien-Dindo classification I and 2 with Clavien-Dindo classification II. Average duration of postoperative hospital stay of 21 patients was 9.3 days (range, 6.0-14.0 days). Sixteen patients with malignant tumor had negative surgical margins. (3) Follow-up situations: all the 21 patients were followed up for 1.0-14.0 months, with a median time of 3.3 months. During follow-up, all the patients survived, and 1 patient had tumor recurrence. Conclusion The FIGFI is safe and feasible in the laparoscopic ALR, with a good short-term outcome. Key words: Liver neoplasms; Carcinoma, hepatocellular; Hepatectomy, anatomy; Indocyanine green fluorescence imaging; Laparoscopy

Clinical value of the transluminal radiofrequency catheter ablation for malignant esophageal obstruction

Objective To investigate the clinical value of the transluminal radiofrequency catheter ablation (RFCA) for malignant esophageal obstruction. Methods The retrospective cross-sectional descriptive study was conducted. The clinicopathological data of 52 patients with malignant esophageal obstruction who underwent transluminal RFCA at the Affiliated Hospital of Shandong Academy of Medical Science between March 2013 and March 2016 were collected. Patients received the bipolar radiofrequency ablation (RFA) under dual-channel endoscopy and X-ray. Observation indicators: (1) intra- and post-operative situations: operation situations, operation time, time of RFA, postoperative complications and duration of postoperative hospital stay, (2) follow-up. Follow-up using outpatient examination and telephone interview was performed to detect the subsequent treatment, survival of patients and recurrence of esophageal obstruction up to June 2016. Measurement data with normal distribution were represented as average (range). Results (1) Intra- and post-operative situations: 52 patients underwent successful RFCA, without the occurrence of aspiration, asphyxia, hemorrhage and perforation. Esophageal obstruction was disappeared after treatment, X-ray findings showed a smooth esophagus. Average operation time and time of RFCA were respectively 58 minutes (range, 20-71 minutes) and 23 minutes (range, 8-42 minutes). Patients took liquid food at postoperative day 2 and normal food at postoperative day 3, without the sensations of esophageal obstruction. Of 52 patients, 1 with postoperative hypotension returned to normal level through rehydration and increasing blood volume. Five patients with postoperative substernal pain were improved after 2-day symptomatic treatment. And other 46 patients didn′t have postoperative complications. Average duration of postoperative hospital stay was 3 days (range, 1-5 days). (2) Follow-up: 52 patients were followed up for 3-24 months, with a median time of 13 months. Of 52 patients, 17 underwent single intravascular interventional therapy, 15 underwent intravascular interventional therapy combined with single systemic chemotherapy, 14 underwent single systemic chemotherapy and other 6 didn′t undergo antineoplastic therapy. During the follow-up, 9 patients didn′t have esophageal obstruction and 26 were complicated with esophageal obstruction again. Esophageal obstruction of 26 patients was respectively occurred at 3-8 months postoperatively, 20 patients were improved after bipolar transluminal RFCA under dual-channel endoscopy and X-ray and 6 received parenteral nutrition support therapy due to extreme exhaustion. Seventeen patients died of cachexia caused by terminal malignant tumors. Conclusion Transluminal RFCA is safe and effective for malignant esophageal obstruction, with a good short-term outcome. Key words: Esophageal neoplasms; Obstruction, malignant; Radiofrequency catheter ablation, transluminal

Clinical efficacy of submucosal tunnel endoscopic resection for upper gastrointestinal muscularis propria submucosal tumors

Objective To evaluate the clinical efficacy of submucosal tunnel endoscopic resection (STER) for upper gastrointestinal muscularis propria submucosal tumors (SMTs) with diameter≥3.5 cm. Methods The clinical data of 14 patients with SMTs≥3.5 cm who were admitted to the Second Xiangya Hospital of Central South University between October 2011 and July 2014 were retrospectively analyzed, including 13 patients with tumor at esophagus and 1 patient with tumor at cardia. All patients underwent STER and the observed indexes included operation tine, tumor location and diameter, results of pathological examination and occurrence of post-operative complications. All patients were followed up regularly at the out-patient department including reexamination of gastroscopy, endoscopic ultrasonography(EUS) and computed tomography (CT) till August 2014. Measurement data with normal distribution were presented as average (range). Results All the 14 patients underwent STER successfully with mean operation time of 83 minutes (range, 60-160 minutes). Fourteen tumors were exited, with 13 located at esophagus and 1 at gastric cardia. En bloc resection was achieved in 13 patients and the tumors were extracted through the tunnel. The tumor in the remaining 1 patient was large with a diameter of 5.3 cm and close to trachea, it was extracted by 2 pieces. The average diameter of 14 tumors extracted was 4.1 cm and postoperative pathological examination confirmed the tumors as leiomyomas. Three patients had postoperative complications, subcutaneous emphysema occurred in 1 patient and retrosternal pain in 1 patient. One patient suffered mucosal laceration and recovered after a metal stent was inserted for 2 weeks. The average duration of postoperative hospital stay was 6.4 days (range, 4.0-8.0 days) .All patients were followed up for a median time of 11.5 months (range, 1.0-24.0 months) with no recurrence. Conclusion STER is a safe and effective method for SMTs with diameter≥3.5 cm. Key words: Esophagus neoplasms; Cardia; Submucosal tunnel endoscopic resection

Aspiration drainage in the prevention of postoperative septic complications in rectum sphincter-sparing abdominoperitoneal resection

Aim. Explore the effectiveness of the double-barreled drainage tube «tube in tube», mounted by the developed technique after rectum sphincter-sparing abdominoperitoneal resection due to cancer.
 Methods. The data of 52 patients with rectal tumors who underwent rectum sphincter-sparing abdominoperitoneal resection in two surgical wards over the past 4 years were analyzed. At the surgery, the colon was brought down together with anal channel mucosa excision and bringing down the colon mucosa to the anal channel. Rectum sphincter-sparing abdominoperitoneal resection was finished in all patients by placing a double-barreled drainage tube of the original construction to the retroperitoneal part of the cavity of the true pelvis by an original method via the anterior abdominal wall incision. No one-step intestinal stoma was exteriorized in any of the patients.
 Results. The average duration of postoperative hospital stay was 17 days; in patients who underwent non-hybrid operation (50 of 52 patients) - 15.3 bed-days. Postoperative complications occurred in a total of 11 (21.1%) patients, and the rate of septic complications was 1.9%, which is lower compared to published data. It is worth noticing that the use of our original method of pelvic cavity draining totally excludes peritoneal fistula formation and facilitates post-operative care.
 Conclusion. The proposed method of pelvic cavity draining at rectum sphincter-sparing abdominoperitoneal resections might be effective, as is associated with lower chance of purulent and septic complications. It excludes the possibility of perineal fistula formation, facilitates the post-operative period management.

Аспирационное дренирование в профилактике послеоперационных гнойно-септических осложнений при брюшно-анальной резекции прямой кишки

Aim. Explore the effectiveness of the double-barreled drainage tube «tube in tube», mounted by the developed technique after rectum sphincter-sparing abdominoperitoneal resection due to cancer. Methods. The data of 52 patients with rectal tumors who underwent rectum sphincter-sparing abdominoperitoneal resection in two surgical wards over the past 4 years were analyzed. At the surgery, the colon was brought down together with anal channel mucosa excision and bringing down the colon mucosa to the anal channel. Rectum sphincter-sparing abdominoperitoneal resection was finished in all patients by placing a double-barreled drainage tube of the original construction to the retroperitoneal part of the cavity of the true pelvis by an original method via the anterior abdominal wall incision. No one-step intestinal stoma was exteriorized in any of the patients. Results. The average duration of postoperative hospital stay was 17 days; in patients who underwent non-hybrid operation (50 of 52 patients) - 15.3 bed-days. Postoperative complications occurred in a total of 11 (21.1%) patients, and the rate of septic complications was 1.9%, which is lower compared to published data. It is worth noticing that the use of our original method of pelvic cavity draining totally excludes peritoneal fistula formation and facilitates post-operative care. Conclusion. The proposed method of pelvic cavity draining at rectum sphincter-sparing abdominoperitoneal resections might be effective, as is associated with lower chance of purulent and septic complications. It excludes the possibility of perineal fistula formation, facilitates the post-operative period management.

Early experience with laparoscopic surgical operations in Aminu Kano Teaching Hospital, Kano, Northwestern Nigeria

Background: New knowledge in health sciences, advances in technology, and a greater awareness of human rights add up to the need for higher standards in medical training and health services. Laparoscopic surgery is a major breakthrough in surgical practice that is now virtually integrated into all surgical fields. Its benefits have been recognized over many conventional open surgical procedures. However, its appropriateness and our readiness for the practice of laparoscopic surgery in Nigeria is yet to be determined. The objective of this study was to describe early experience, challenges, and prospect with laparoscopic surgical operations in Aminu Kano Teaching Hospital Kano, northwestern Nigeria. Materials and Methods: The case notes of patients admitted into the Surgical Wards of Mallam Aminu Kano Teaching Hospital in Kano, northwestern Nigeria that had laparoscopic surgical operations from October 2005 to October 2013 were retrieved and studied. The data collected from these was entered into Minitab Statistical Software. Relevant statistical indices were calculated. Results: A total of 42 patients were the subject of this review. Their mean age was 37 years, ranged 13-62 years. The male:female (M:F) was 1:1.2. The most common indication of laparoscopic operation was gallbladder disease in 38 (90.5%) patients. Laparoscopic cholecystectomy was the most common laparoscopic procedure performed. Two patients were converted to open surgery. The average duration of post-operative hospital stay was 4 days and the average operating time was 3 h. Conclusion: Experience with laparoscopic surgery is still early in our center, nevertheless the prospect is enormous. There is need for further skills acquisition and effective organization in order to maintain these services. Involvement of the National Health Insurance Scheme should assuredly bring about technological developments and subsidize the services to meet the socioeconomic challenges and changing disease pattern in our environment.

Indications and outcome of childhood preventable bowel resections in a developing country.

While many bowel resections in developed countries are due to congenital anomalies, indications for bowel resections in developing countries are mainly from preventable causes. The aim of the following study was to assess the indications for, morbidity and mortality following preventable bowel resection in our centre. Retrospective analysis of all cases of bowel resection deemed preventable in children from birth to 18 years from June 2005 to June 2012. There were 22 preventable bowel resections with an age range of 7 days to 17 years (median 6 months) and male:female ratio of 2.1:1. There were 2 neonates, 13 infants and 7 older children. The indications were irreducible/gangrenous intussusceptions (13), abdominal gunshot injury (2), gangrenous umbilical hernia (2), blunt abdominal trauma (1), midgut volvulus (1), necrotizing enterocolitis (1), strangulated inguinal hernia (1), post-operative band intestinal obstructions (1). There were 16 right hemicolectomies, 4 small bowel resections and 2 massive bowel resections. Average duration of symptoms before presentation was 3.9 days (range: 3 h-14 days). Average time to surgical intervention was 42 h for survivors and 53 h for non-survivors. Only 19% presented within 24 h of onset of symptoms and all survived. For those presenting after 24 h, the cause of delay was a visit to primary or secondary level hospitals (75%) and ignorance (25%). Average duration of post-operative hospital stay is 14 days and 9 patients (41%) developed 18 complications. Seven patients died (31.8% mortality) which diagnoses were irreducible/gangrenous intussusceptions (5), necrotising enterocolitis (1), midgut volvulus (1). One patient died on the operating table while others had overwhelming sepsis. There is a high rate of morbidity and mortality in these cases of preventable bowel resection. Typhoid intestinal perforation did not feature as an indication for bowel resection in this series.

Surgically-challenging chondrosarcomas of the chest wall: five-year follow-up at a single institution

Surgically-challenging chondrosarcomas of the chest wall: five-year follow-up at a single institution

Myomectomy during cesarean section

Objectives: To assess the intra- and post-operative complications of cesarean myomectomy. Methods: The study design was descriptive, and the setting was the Department of Obstetrics and Gynaecology, University of Benin Teaching Hospital and two private consultant units, all in Benin City. The subjects were 25 pregnant women undergoing elective or emergency cesarean section at these units. The outcome measures were blood loss and need for blood transfusion, intra- and post-operative complications and duration of hospital stay. Results: Eighty-four fibroids of various sizes (2–10 cm) were removed from the 25 women. The fibroids were on the anterior uterine wall with most (94.8%) being sub-serous or intramural, and only few (five) sub-mucous. The mean blood loss was 876±312 ml, range 400–1700 ml. Five patients (20%) had two units of whole blood transfusion. There was no case of severe hemorrhage necessitating hysterectomy. Eighteen patients (72%) had post-operative morbidities mainly of anemia [15 (60%); hematocrit 26±2.9%). The average duration of post-operative hospital stay was 7.4±2.2 days (range 3–12 days). Three (12%) patients have subsequently become pregnant, two (66.7%) of whom had normal vaginal deliveries, while the third had a repeat elective cesarean section. Conclusions: With adequate experience and the use of high dose oxytocin infusion (intra- and post-operatively), myomectomy at cesarean section is not as hazardous as many now believe.