Duration Of Convalescence Research Articles

A novel tension relief technique to aid the primary closure of traumatic equine wounds under excessive tension.

To achieve an excellent functional and cosmetic result, primary closure is preferred over leaving wounds to heal by secondary intention. However, traumatic wounds are often under excessive tension during wound closure and incorrect suture technique can compromise microcirculation, leading to skin necrosis and impaired wound healing. To describe an inexpensive and effective tension relief technique that helps the successful primary closure of a variety of equine wounds at high risk of dehiscence. Retrospective case series. All wounds that were managed with the Tension Tile System (TTS) at four Equine Hospitals between March 2017 and May 2021 were evaluated. The wounds were classified according to various criteria including anatomical location, time elapsed prior to surgery, depth of wound and post-surgical use of immobilisation. Outcome criteria were based on the success of primary intention healing. The duration of convalescence (weeks) after surgery was also recorded. During the study period, the TTS was used in 191/860 (22%) wounds repaired under general anaesthesia or standing sedation. Overall, primary intention healing (Group A) was achieved in 132 of 191 cases (69%, CI 62%-75%), with partial dehiscence (Group B) in a further 30/191 cases (16%, CI 11%-22%). Severe dehiscence (Group C) was recorded in 29/191 cases (15%, CI 11%-21%). The median convalescence time was 4 weeks (Range 3-15, interquartile range 4-6) in Group A. Retrospective nature of the study and subjective outcome assessment. The technique was applied to wounds under significant tension; however, this was based on a subjective assessment by the surgeons involved. The Tension Tile System is an economical and effective technique for challenging equine wounds under tension, in a variety of anatomical locations.

Association between labor union presence and return to work after occupational injury or illness: A nationally representative longitudinal study in South Korea.

This study sought to examine the association between labor union presence and return to work after occupational injury or illness (RTW) among workers in South Korea. We analyzed the first (2018) and second (2019) wave data from the Panel Study of Workers' Compensation Insurance in South Korea. The cohort consisted of 3,294 workers who had suffered occupational injury or illness and completed their convalescence by 2017. We examined whether RTW was associated with the presence of labor unions in the workplace at the time of the occupational injury or illness occurred. Compared to workers without labor unions, those with labor unions were more likely to report RTW (prevalence ratio: 1.35, 95% confidence interval: 1.20-1.51) after adjusting for potential confounders, including employment status, duration of convalescence, and severity of injury or illness. This study found that labor union presence was associated with RTW among workers who suffered occupational injury or illness in South Korea.

A retrospective comparative study between laparoscopic and open appendectomy in teaching hospital of India

Background: This study was aimed to compare laparoscopic with open appendicectomy and ascertain the therapeutic benefit, in the overall management of appendicitis. Laparoscopic appendicectomy though widely practiced has not gained universal approval. Laparoscopic appendicectomy in India is relatively new and the literature is exiguous.Methods: The study group consisted of 100 patients suffering from appendicitis. 40 patients underwent laparoscopic appendicectomy (LA) and 60 patients underwent open appendecectomy (OA). Comparison was based on length of hospital stay, operating time, postoperative morbidity, postoperative complications, duration of convalescence and operative cost in terms of their medians.Results: The rate of infections and overall complications (LA: 5%, OA: 11.66% were significantly lower in patients undergoing LA. The median length of stay was significantly shorter after LA (45% discharged 2nd day) than after OA (36% discharged on 4th day). VAS WAS 0-2 IN 60% cases LA and9-10 in 00% cases as compared to OA VAS Was 0-2 in15% and 9-10 in 3.33% cases.Conclusions: LA is associated with increased clinical comfort in terms of fewer wound infections, faster recovery, earlier return to work and improved cosmesis. Hospital stay for LA is significantly shorter and the one-time operative charges appear to be almost the same.

Factors influencing women's preferences for subsequent management in the event of incomplete evacuation of the uterus after misoprostol treatment for miscarriage.

What affects women's treatment preferences in the management of an incomplete evacuation of the uterus after misoprostol treatment for a first-trimester miscarriage? Women's treatment preferences in the management of an incomplete evacuation of the uterus after misoprostol treatment for miscarriage are most strongly influenced by 'the risk of a reduced fertility' followed by 'the probability of success'. Available treatment options in miscarriage are surgical, medical or expectant management. Treatment with misoprostol leads to an incomplete evacuation of the uterus and additional surgical treatment in 20-50% of women. To our knowledge, women's preferences for subsequent treatment of an incomplete evacuation of the uterus after misoprostol treatment for miscarriage have not been studied yet. Between April 2014 and January 2015, we conducted a prospective nationwide multicentre discrete-choice experiment (DCE). DCEs have become the most frequently applied approach for studying patient preferences in health care. In our DCE, which considerers five attributes, a target sample size was calculated including 20 patients per attribute for the main analysis. We intended to include 25% more patients, i.e. a total of 125 thus enabling us to assess heterogeneity of treatment choices. All women visiting the outpatient clinic with first-trimester miscarriage or incomplete miscarriage were invited to participate in the study. Women under 18 years of age, women who were unable to understand the Dutch questionnaire or women who already had received a treatment for the current miscarriage were excluded. Women's preferences were assessed using a DCE. A literature review, expert opinions and interviews with women from the general population were used to define relevant treatment characteristics. Five attributes were selected: (i) certainty about the duration of convalescence; (ii) number of days of bleeding after treatment; (iii) probability of success (empty uterus after treatment); (iv) risk of reduced fertility and (v) risk of complications requiring more time or readmission to hospital. Fourteen scenarios using these attributes were selected in the DCE. Each of these scenarios presented two treatment options, while treatment characteristics varied between the 14 scenarios. For each scenario, respondents were asked to choose the preferred treatment option. The importance of each attribute was analysed, and preference heterogeneity was investigated through latent-class analysis. One hundred and eighty-six women were included of whom 128 completed the DCE (69% response rate). The two attributes with the greatest effect on their preference were, probability of success and risk of reduced fertility. The latent-class analysis revealed two subgroups of patients with different preference patterns. Forty per cent of women were more influenced by treatment success and 59% were more influenced by risk. Most women were highly educated and were of Dutch origin, which limits the generalizability of our findings. Women with lower education levels, other cultural backgrounds and/or different previous experiences may differ from our findings. Patients preferences should be addressed when counselling patients with an incomplete miscarriage after misoprostol treatment. This study was embedded in the MisoREST trial, and funded by ZonMw, a Dutch organization for Health Research and Development, project number 80-82310-97-12066. There were no conflicts of interests. Dutch Trial Register NTR3310, http://www.trialregister.nl. 27 February 2012. 12 June 2012.

Randomized clinical trial of preoperative dexamethasone on postoperative nausea and vomiting after laparoscopy for suspected appendicitis.

Few studies have investigated the effects of preoperative dexamethasone in acute surgical patients. This study examined the effects of 8 mg dexamethasone administered intravenously 30 min before surgery for suspected acute appendicitis. A multicentre, parallel-group, double-blind, placebo-controlled study was conducted at two university hospitals in Denmark. Adults undergoing laparoscopic surgery for suspected appendicitis were eligible for inclusion. Participants, healthcare staff and investigators were blinded until all data analysis had been done. The primary outcome was the incidence of postoperative nausea and vomiting (PONV) during the first postoperative day. Secondary outcomes were pain, fatigue, sleep, opioid consumption, use of antiemetics, quality of recovery and duration of convalescence. Analysis was done according to the intention-to-treat principle. A total of 120 patients were enrolled; 57 patients in the dexamethasone group and 59 in the placebo group were eligible for primary analysis. In the dexamethasone group, 47 (95 per cent c.i. 35 to 60) per cent of patients experienced PONV compared with 63 (50 to 74) per cent) in the placebo group. The absolute risk reduction in PONV was 15 (-3 to 33) per cent in favour of the dexamethasone group (P = 0·098). Patients in the dexamethasone group had less pain at rest (difference in score on visual analogue scale (VAS) 9 (95 per cent c.i. 1 to 17) mm; P = 0·024), were less fatigued (difference in VAS score 7 (0 to 14) mm; P = 0·038), used fewer opioids (absolute risk reduction 17 (2 to 33) per cent; P = 0·033) and had better quality of recovery (difference in QoR-15 score 13 (4 to 22); P = 0·006) during the first postoperative day. There was no difference in postoperative complications (P = 0·595). Preoperative dexamethasone did not reduce PONV by the target level of 50 per cent. Registration number: NCT02415335 ( http://www.clinicaltrials.gov).

The effects of individual, occupational, and supportive factors on successful return to work using a structural equation model.

ObjectivesWe aimed to ascertain the relationship between several factors and successful return to work using a structural equation model.MethodsWe used original data from the Panel Study of Worker’s Compensation Insurance, and defined four latent variables as occupational, individual, supportive, and successful return to work. Each latent variable was defined by its observed variables, including age, workplace size, and quality of the medical services. A theoretical model in which all latent variables had a relationship was suggested. After examining the model, we modified some pathways that were not significant or did not fit, and selected a final structural equation model that had the highest goodness of fit.ResultsAll three latent variables (occupational, individual, and supportive) showed statistically significant relationships with successful return to work. The occupational and supportive factors had relationships with each other, but there was no relationship between individual and the other factors. Nearly all observed variables had significance with their latent variables. The correlation coefficients from the latent variables to successful return to work were statistically significant and the indices for goodness of fit were satisfactory. In particular, four observed variables—handicap level, duration of convalescence, working duration, and support from the company—showed construct validities with high correlation coefficients.ConclusionsAll factors that we examined are related to successful return to work. We should focus on the supportive factor the most because its variables are modifiable to promote a return to work by those injured in their workplace.

Early herniorrhaphy of large traumatic abdominal wounds in horses and mules.

Surgical treatment of traumatic abdominal hernias is usually delayed for 2-3months following injury. The residual defects are then repaired by herniorrhaphy or mesh herniorrhaphy. To describe the outcome following herniorrhaphy (without a mesh) within 21days of initial injury to repair external traumatic lateral abdominal hernias in horses and mules. Descriptive case series. Twenty-two cases were included. Surgical treatment involved exposure of the hernia sac and closing of the abdominal wall defect with interrupted Mayo mattress or cruciate sutures after reduction of the herniated organ into the peritoneal cavity. Data collected included cause and site of the hernia, surgical findings, immediate and long-term post operative complications, return to use, duration of convalescence and hernia recurrence. Falling while crossing impassable pathways was the most common initial cause of the hernia (9/11 horses and 10/11 mules). Adhesion formation to underlying viscera was found intraoperatively in 2 cases. Uncomplicated healing occurred in all animals except 3 with suture abscesses and one with a subcutaneous seroma. At the time of follow-up (6-24months after surgery), complete recovery without recurrence of herniation was achieved and animals had returned to their previous use. Herniorrhaphy within 21days using interrupted Mayo mattress or cruciate pattern sutures can be effective for treating external traumatic abdominal hernias in horses and mules. The Summary is available in Chinese - see Supporting Information.

Multimodal pain management with glucocorticoids: killing two birds with one stone or shooting sparrows with cannons?

he main objectives for goal-directed postopera-tive pain management are optimal postopera-tive pain relief; reduction of adverse events such asnausea, vomiting, and sedation; and a shorter dura-tion of convalescence without compromising safety.To achieve these goals, it is most often necessary tocombine analgesics that target different sites or havedifferent mechanisms, resulting in additive or syn-ergisticeffects.Thismultimodalapproachinvolvesabalanced cocktail of different drugs such as opioids,paracetamol, nonsteroidal anti-inflammatory drugs(NSAIDs), local anaesthetics, and glucocorticoids.The aim of this approach is to reduce some of theadverse events postoperatively; however, the addi-tion of each new drug also increases the risk fordrug-related side effects and complications. Thus,the key question is: Does the benefit of adding asupplementary co-analgesic to a multimodal regimeoutweigh the harm?In the current issue of Acta AnaesthesiologicaScandinavica, Lunn and Kehlet investigated thisquestioninthepaper:‘Perioperativeglucocorticoidsin hip and knee surgery – benefit vs. harm? Areview of randomised clinical trials’.

Dexamethasone for the Prevention of Recurrent Laryngeal Nerve Palsy and Other Complications After Thyroid Surgery

Recurrent laryngeal nerve dysfunction and hypoparathyroidism are well-recognized, important complications of thyroid surgery. The duration of convalescence after noncomplicated thyroid operation may depend on several factors, of which pain and fatigue are the most important. Nausea and vomiting occur mainly on the day of operation. Glucocorticoids are well known for their analgesic, anti-inflammatory, immune-modulating and antiemetic effects. However, there is little information in the literature on the use of steroids in thyroid surgery, and the information that is available is conflicting. To investigate whether preoperative dexamethasone could improve surgical outcome in patients undergoing thyroid surgery. A randomized double-blind placebo-controlled trial. A 30-day follow-up for morbidity was performed in all cases. All patients were hospitalized in a public hospital. From June 2008 through August 2011, 328 patients were randomized to receive either intravenous dexamethasone, 8 mg, administered 90 minutes before skin incision, or saline solution (placebo). Intravenous dexamethasone, 8 mg. The primary end points were temporary or permanent recurrent laryngeal nerve palsy. Transient and definitive hypoparathyroidism, pain and fatigue scores, nausea, and the number of vomiting episodes were also registered. Preoperatively and at several times during the first 24 postoperative hours, we measured C-reactive protein, interleukin 6, and interleukin 1β levels. In the dexamethasone group, the rate of temporary recurrent laryngeal nerve palsy (4.9%) was significantly lower compared with the placebo group (8.4%) (P = .04). Also, postoperative transient biochemical hypoparathyroidism occurred more frequently in the placebo group (37.0%) than in the dexamethasone group (12.8%). Dexamethasone use significantly reduced postoperative levels of C-reactive protein (P = .01) and interleukin 6 and interleukin 1β (P = .02), fatigue (P = .01), and overall pain during the first 24 postoperative hours (P = .04), as well as the total analgesic (ketorolac tromethamine) requirement (P = .04). Dexamethasone use also reduced nausea and vomiting on the day of operation (P = .045). Preoperative administration of dexamethasone, 8 mg, reduced postoperative temporary recurrent laryngeal nerve palsy and hypoparathyroidism rates and reduced pain, fatigue, nausea, and vomiting after thyroid surgery. However, these data require further analysis in randomized prospective studies. TRIAL REGISTRATION clinicaltrials.gov Identifier:NCT01690806.

L’ostéome ostéoïde du col fémoral du sportif : intérêt de la résection percutanée scanno-guidée (À propos de 11 cas avec revue de la littérature)

Introduction Treatment of the osteoid osteoma was based a long time on the surgical resection, but with a considerable frequency of complications. The percutaneous resection tomography-guided belongs to therapeutic progress of these last years, it became the method of choice for the treatment of osteoid osteoma in our institution. The purpose of our study is to evaluate effectiveness of this technic by analyzing the clinical evolution, the duration of convalescence and resumption of sports activities. Patients and methods It is a retrospective study concerning 11 observations of osteoid osteoma of the femoral neck, treated and followed to the service of Traumatology-Orthopedy II of the military hospital of the CHU Rabat between January 2004 and October 2009. Our series was composed of three professional athletes, two footballers exercising in national shampionship and six soldiers subjected to a constant and regular drive. Results This intervention was done in the day's hospital, all the patients left the hospital the same day with resumption of the total support in the 24 hours following operation. Nine patients (80%) observed a total disappearance of the pain a few hours after the intervention. With a minimal retreat one year, no case of complication was raised. And finally on the subjective level all the patients were satisfied and took again their sports activities on the same former level. Discussion The treatment for osteoid osteoma must be simple, precise, effective and the least expensive possible. In the light of our results and those brought back in the literature, the percutaneous resection tomography-guided is proven effective, sure, not very invasive and is associated with a reduction in the health expenditure. It can be recommended like the treatment of choice of osteoid osteoma as well for the femoral neck as for the other localisations. More aggressive and more expensive treatments are difficult to justify, in particular in sportsmen, thus allowing them a fast convalescence and an early recovery their sports activities.

How does dexamethasone influence surgical outcome after laparoscopic Nissen fundoplication? A randomized double-blind placebo-controlled trial

Laparoscopic floppy Nissen fundoplication (LFNF) is an effective treatment for gastroesophageal reflux disease. The duration of convalescence, after noncomplicated LFNF, may depend on several factors of which pain, fatigue and sociocultural factors are the most important. Nausea and vomiting occur mainly on the day of operation. Glucocorticoids are well known for their analgesic, anti-inflammatory, immune-modulating and antiemetic effects. We therefore undertook the present study to investigate whether preoperative dexamethasone could improve surgical outcome in patients undergoing uncomplicated laparoscopic floppy Nissen fundoplication. From March 2005 to April 2008, 82 patients were randomized to receive dexamethasone (8mg) intravenously, 90min before skin incision or saline (placebo). Patients received a similar standardized anesthetic, surgical and multimodal analgesic treatment. The primary end points were pain and fatigue. Preoperatively and at several times during the first 24 postoperative hours, we measured C-reactive protein (CRP), interleukin-6 and 1 (IL-6, IL-1), pain scores and nausea, and the number of vomiting episodes were registered. Dexamethasone significantly reduced postoperative levels of CRP (p=0.01), IL-6 and IL-1 (p<0.05), fatigue (p=0.01) and overall pain during the first 24 postoperative hours (p<0.05) and the total requirement of analgesic (ketorolac) (p<0.05). Dexamethasone also reduced nausea and vomiting on the day of operation (p<0.05). Preoperative dexamethasone (8mg) reduced pain, fatigue, nausea and vomiting in patients undergoing uncomplicated LNF when compared with placebo.

616 UNIVERSITY OF MICHIGAN SURGICAL EXPERIENCE WITH URETEROLYSIS FOR RETROPERITONEAL FIBROSIS: A COMPARISON OF LAPAROSCOPIC AND OPEN SURGICAL APPROACHES

You have accessJournal of UrologyInfections/Inflammation of the Genitourinary Tract: Kidney & Bladder1 Apr 2010616 UNIVERSITY OF MICHIGAN SURGICAL EXPERIENCE WITH URETEROLYSIS FOR RETROPERITONEAL FIBROSIS: A COMPARISON OF LAPAROSCOPIC AND OPEN SURGICAL APPROACHES Nicholas R. Styn, Sara Fraumann, Gary J. Faerber, and J. Stuart Wolf Nicholas R. StynNicholas R. Styn More articles by this author , Sara FraumannSara Fraumann More articles by this author , Gary J. FaerberGary J. Faerber More articles by this author , and J. Stuart WolfJ. Stuart Wolf More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.930AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Retroperitoneal fibrosis (RPF) is a rare process that can lead to extrinsic compression of ureters and subsequent renal failure. Active treatment options include medical management or surgical ureterolysis. Open surgical ureterolysis allows release of the ureters from the fibrotic environment. Laparoscopic ureterolysis has been reported to provide similar benefits with decreased intensity and duration of convalescence. We compared our experience with open surgical and laparoscopic ureterolysis to determine any difference in success and convalescence. METHODS We retrospectively reviewed 22 patients who underwent 25 ureterolysis procedures for RPF between 1997 and 2006 at our institution. Of the patients, 12 had open ureterolysis (OU), and 10 patients underwent laparoscopic ureterolysis (LU). Patients were followed for a median of 24 months. Operative and post-operative parameters, complications, and success rates were compared. RESULTS Laparoscopic ureterolysis was performed in 13 cases (10 patients) on a total of 16 ureters. No conversion to open surgery was required. OU was performed in 12 cases (12 patients) on a total of 16 ureters. LU was associated with a significantly shorter hospital stay than OU (mean 2.1 versus 5.9 days. p=0.004). Laparoscopic intraperitonealization of ureters was performed in 98% of all affected ureters compared to 50% in the OU group (p=0.02). There was no difference between the groups in ability to perform omental wrap, postoperative creatinine level, complication rate, operating time, or transfusion requirement. With a mean follow-up of 30 months in the OU group and 24 months in the LU group, the success rate is 88% after OU and 94% after LU. (p=1.0) CONCLUSIONS Laparoscopic ureterolysis is a safe and effective surgical management of RPF. Laparoscopic ureterolysis offers similar results and a shorter hospital stay compared to open surgical ureterolysis, and should be considered the technique of choice in most cases. Ann Arbor, MI© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e242 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nicholas R. Styn More articles by this author Sara Fraumann More articles by this author Gary J. Faerber More articles by this author J. Stuart Wolf More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

ESPEN Guidelines on Parenteral Nutrition: Geriatrics

Older subjects are at increased risk of partial or complete loss of independence due to acute and/or chronic disease and often of concomitant protein caloric malnutrition. Nutritional care and support should be an indispensable part of their management. Enteral nutrition is always the first choice for nutrition support. However, when patients cannot meet their nutritional requirements adequately via the enteral route, parenteral nutrition (PN) is indicated. PN is a safe and effective therapeutic procedure and age per se is not a reason to exclude patients from this treatment. The use of PN should always be balanced against a realistic chance of improvement in the general condition of the patient. Lower glucose tolerance, electrolyte and micronutrient deficiencies and lower fluid tolerance should be assumed in older patients treated by PN. Parenteral nutrition can be administered either via peripheral or central veins. Subcutaneous administration is also a possible solution for basic hydration of moderately dehydrated subjects. In the terminal, demented or dying patient the use of PN or hydration should only be given in accordance with other palliative treatments.

Laparoscopic Radical Nephrectomy: The New Gold Standard Surgical Treatment for Localized Renal Cell Carcinoma

We will try to demonstrate that laparoscopic radical nephrectomy could be the new gold standard treatment for renal cell carcinoma with the aid of the current reports exploring the advantages and disadvantages of laparoscopic radical nephrectom overopen surgery.Reported perioperative outcomes like operating time, blood loss, postoperative analgesia requirement, and length of hospital stay and duration of convalescence had been found to be in favor of laparoscopic radical nephrectomy. Some technical issues like approach of laparoscopic technique (Transperitoneal versus retroperitoneal laparoscopic nephrectomy), removal of dissected specimen and need for lymph node dissection had been also discussed in detail in this review. Besides, oncological safety of laparoscopic radical nephrectomy had been explored. The overall five-year disease free survival rates of laparoscopic radical nephrectomy in recent series were found to be over 90%. All of the series including the present one at least confirmed the oncological efficacy of LRN as compared with open surgical approach. The contemporary review of the literature documents clearly demonstrated the perioperative benefits of laparoscopy compared to the open approach. Nevertheless, the development, however, more safe and reliable technique in laparoscopy is necessary for tumor extraction. Recent studies confirmed the long-term similar cancer control results of laparoscopic radical nephrectomy with open surgery. Despite some technical modifications by the different groups, it can be stated that laparoscopic radical nephrectomy is the new gold standard treatment modality for patients with localized renal cell carcinoma.

Laparoscopic versus open appendectomy in West Bengal, India

Laparoscopic appendectomy, although widely practiced, has not gained universal approval. Laparoscopic appendectomy in India is relatively new, and reports regarding its use are few. The aim of this study was to compare laparoscopic with open appendectomy and ascertain its therapeutic benefit, if any, in the overall management of acute appendicitis. The study group consisted of 279 patients suffering from acute appendicitis. One hundred patients underwent laparoscopic appendectomy (LA) and 179 patients underwent open appendectomy (OA). Comparisons were based on median values for length of hospital stay, operating time, postoperative morbidity, duration of convalescence and operative cost. Mann-Whitney statistics (T) were calculated and, because of the large sample size, the normal deviate test (Z) was used. Of the 100 patients who were to receive LA, six patients (6%) had the procedure converted to open surgery. The rate of overall complications (LA 15%vs OA 31.8%; P < 0.001) was significantly lower in patients undergoing LA. The median length of stay was significantly shorter after LA (3 days after LA vs 5 days after OA; P < 0.0001) than after OA. The operating time was shorter (median values: OA 25 min vs LA 28 min; 0.01 < P < 0.05) in patients undergoing OA compared with LA. For LA, hospital stay was significantly shorter, and the one-time operative cost appeared to be marginally the same as open surgery. Furthermore, LA was associated with increased clinical comfort in terms of fewer wound infections, faster recovery, earlier return to work and improved cosmesis.

Laparoscopic versus open appendicectomy: An Indian perspective

Background:Laparoscopic appendicectomy though widely practiced has not gained universal approval. Laparoscopic appendicectomy in India is relatively new and the literature is scant. This study was aimed to compare laparoscopic with open appendicectomy and ascertain the therapeutic benefit, if any, in the overall management of acute appendicitis.Materials and Methods:The study group consisted of two hundred and seventy nine patients suffering from acute appendicitis. One hundred patients underwent laparoscopic appendicectomy (LA) and one hundred seventy nine patients underwent open appendecectomy (OA). Comparison was based on length of hospital stay, operating time, postoperative morbidity, duration of convalescence and operative cost in terms of their medians. The Mann-Whitney statistics (T) were calculated and because of large samples, the normal deviate test (Z) was used.Results:Of the hundred patients, six patients (6%) had the procedure converted to open surgery. The rate of infections and overall complications (LA: 15%, OA: 31.8%, P < 0.001) were significantly lower in patients undergoing LA. The median length of stay was significantly shorter after LA (3 days after LA, 5 days after OA, P < 0.0001) than after OA. The operating time was shorter {OA: 25 min (median), LA: 28 min (median), 0.01< P < 0.05} in patients undergoing open appendicectomy compared to laparoscopic appendicectomy.Conclusion:Hospital stay for LA is significantly shorter and the one-time operative charges appear to be almost the same. LA is also associated with increased clinical comfort in terms of fewer wound infections, faster recovery, earlier return to work and improved cosmesis.

Prospective analysis of convalescence and early pain after uncomplicated laparoscopic fundoplication.

The aim of this study was to define factors that limit a short period of convalescence and to characterize the pain experienced after laparoscopic fundoplication. This prospective study included 60 consecutive patients who underwent uncomplicated laparoscopic Nissen fundoplication for gastro-oesophageal reflux disease. Patients were recommended to convalesce for 2 days after operation. Duration of convalescence, dysphagia, fatigue, nausea, vomiting and different pain components were registered daily during the first week and on days 10 and 30 after fundoplication. Thirty-nine patients took a median of 13 (range 3-41) days off work and 60 stayed away from recreational activity for a median of 4 (range 1-22) days. Pain, fatigue and plans made before operation were the main contributors to prolonged convalescence. Some 30-40 per cent of the patients reported moderate or severe dysphagia during the study period. Fatigue scores were significantly increased for 6 days after surgery (P < 0 . 001). Visceral pain dominated over incisional and shoulder pain throughout the study. At day 30, 17 per cent of the patients reported moderate or severe visceral pain. Pain and dysphagia are significant problems after uncomplicated total laparoscopic fundoplication. The time taken off work and away from recreational activity exceeded the recommended 2 days of convalescence, justifying further efforts to optimize early clinical outcome after total laparoscopic fundoplication.

Evaluation of a novel propylene oxide—treated collagen material as a dural substitute

The authors evaluated a new non-cross-linked, propylene oxide-treated, acellular collagen matrix for use as a dural substitute in rabbits. They then compared this material to a commonly used dural substitute as well as to native dura mater used during primary closure. Forty-six rabbits were randomly assigned to eight groups of five or six rabbits each. These groups differed according to the type of closure material that was used during surgery (native dura, control dural substitute, or experimental dural substitute) and the duration of convalescence. At the end of the experiment, the tightness of the duraplasty was assessed in each live rabbit by continuous infusion of fluid into the cistema magna until leakage was detected. The animals were killed and each specimen was sectioned and studied histologically. The authors found that the experimental dural substitute was safe in animals for this application, that it held sutures well, and that a watertight closure was usually achieved. There were fewer adhesions between the experimental material and neural tissue was less likely to adhere to the cranium than the control graft. Histological examination showed that the experimental material had slightly more spindle cells and vascularity than the control graft. The experimental graft material has several features that make it an attractive candidate for use as a dural substitute.

No recurrence of mature ovarian teratomas after laparoscopic cystectomy

Recurrence of ovarian teratomas was evaluated in a randomised trial to determine whether laparoscopic cystectomy had the same efficacy as laparotomy. Forty premenopausal non-pregnant women with a unilateral teratoma no larger than 10 cm were randomised to laparoscopy or laparotomy. Post-operative pain, duration of stay in hospital and duration of convalescence were compared. Women were reviewed every six months for five years. A higher proportion had milder pain, faster hospital discharge and faster recovery following laparoscopy than laparotomy. There were no recurrences of teratomas in both arms of the study, suggesting that laparoscopy has the same efficacy as laparotomy.

No recurrence of mature ovarian teratomas after laparoscopic cystectomy

Recurrence of ovarian teratomas was evaluated in a randomised trial to determine whether laparoscopic cystectomy had the same efficacy as laparotomy. Forty premenopausal non-pregnant women with a unilateral teratoma no larger than 10 cm were randomised to laparoscopy or laparotomy. Post-operative pain, duration of stay in hospital and duration of convalescence were compared. Women were reviewed every six months for five years. A higher proportion had milder pain, faster hospital discharge and faster recovery following laparoscopy than laparotomy. There were no recurrences of teratomas in both arms of the study, suggesting that laparoscopy has the same efficacy as laparotomy.