Early Postoperative Quality Of Life Research Articles

COMPARISON OF TOTAL EXTRAPERITONEAL (TEP) AND EXPANDED VIEW TOTAL EXTRAPERITONEAL (eTEP) METHODS AT INGUINAL HERNIA REPAIR

Abstract Background Laparoscopic hernia repair has been accepted as first-line treatment for inguinal hernia by major surgical institutions today, with low complication and recurrence rates. The aim of this prospective clinical study, we compared two different laparoscopic approaches in terms of technical ease, patients' early postoperative quality of life, pain management, complication and early recurrence rates. Method Patients with inguinal hernia who were planned to undergo laparoscopic hernia repair were randomized and operated with total extraperitoneal repair (TEP) and extended view total extraperitoneal repair (eTEP) methods in July and August 2023. During the postoperative follow-up, 24th-hour pain scores and 24th-hour quality of life scores were noted with a visual analogue scale (VAS) and quality of recovery test (QoR T15). At the 1st week outpatient clinic follow-up, their pain scores were questioned with VAS. They were checked by physical examination for complications or early recurrence. Patients were called for follow-up at the 1st and 3rd months after the surgery. Results The number of fixative staples was significantly higher in TEP group (p < 0.001). The operation time was significantly shorter in eTEP group (p: 0.031). Time to return to work was significantly longer in TEP group (p: 0.024). VAS scores on the 1st postoperative day were found to be significantly lower in eTEP group (p < 0.001), no significant difference was detected in the 1st week scores. The QoR test scores on the first postoperative day were significantly higher in eTEP group (p:0.006). The difference between number of patients with seroma, ecchymosis or hematoma was not significant in two groups. Conclusions Both methods we used did not make a significant difference in the incidence of complications. On the other hand, we revealed that eTEP method may be more advantageous in terms of ease of surgery, patients' quality of life in the early period.

Does quality of life influence retear rate following arthroscopic rotator cuff repair?

The primary objective was to assess whether a patient's early postoperative quality of life (QOL) correlates with the retear rate following single-tendon double-row rotator cuff repair. We performed a secondary analysis of a randomized clinical trial of 58 patients who underwent single-tendon arthroscopic rotator cuff repair of full-thickness tears performed by a single surgeon. Patients were randomized to an early- or delayed-motion protocol. At 6 months, all patients underwent magnetic resonance imaging to assess whether the rotator cuffs were intact or retorn. QOL was assessed preoperatively and at 3 weeks, 6 weeks, 12 weeks, 6 months, and 12 months postoperatively using the Western Ontario Rotator Cuff(WORC) index. After 6 months of rehabilitation, 41 patients (71%) had intact rotator cuff repairs whereas 17 (29%) had full-thickness tears. Patients with torn rotator cuffs at 6 months postoperatively had significantly lower WORC scores at 6 weeks postoperatively (P = .041). Patients with greater improvements in QOL perioperatively (preoperative WORC score minus 6-week postoperative WORC score > 264.5) were more likely to have full-thickness tears by 6 months postoperatively. Compliant patients assigned to the delayed-motion protocol had a failure rate of 11% (2 of 19) compared with 38% (15 of 39) in the noncompliant and early-motion protocol patients (P < .01). Overall, patients who were noncompliant with the shoulder immobilizer were 8.2 times more likely to have a failed repair on magnetic resonance imaging (P = .01). Patients with better QOL shortly after arthroscopic rotator cuff repair were more likely to have retears by 6 months.

Video assisted minimally invasive mitral valve replacement in rheumatic valve disease.

Objective:&#x0D; Assessment early outcome of video assisted minimally invasive mitral valve replacement, in rheumatic valve disease. Also, to evaluate early postoperative quality of life by SF 36 questionnaire.&#x0D; Methods: This is a prospective single center study which was conducted on 20 rheumatic heart patients, in Egypt; during the period from October 2015 to June 2018. The main pathological lesion was sever mitral regurgitation (MR), mitral stenosis (MS) or both. Patients underwent video assisted minimally invasive mitral valve replacement, through a right mini thoracotomy. 13 patients (65%) were via infra-mammary incision, 4 patients (20%) were via periareolar incision and 3 patients (15%) were via limited right anterolateral mini-thoracotomy.&#x0D; Results: Mean length of surgical incision was (6.60 ± 1.35 cm). Mean duration of operation, cardiopulmonary bypass, and cross clamp times were (4.32 ± 1.08 hr.), (2.85 ± 0.75 hr.) and (1.78 ± 0.47 hr.) respectively.&#x0D; ICU stay was 2.35 ± 1.14 days and Hospital stay was 6.45 ± 1.43 days.&#x0D; The mean amount of blood loss was 398.50 ± 245.79 ml with two patients of bleeding requiring re-opening.&#x0D; At discharge, all patients had normal mitral prosthetic valve function with no or trivial regurgitation, as shown by echocardiographic studies. The postoperative quality of life revealed faster recovery of usual activities.&#x0D; Conclusions: Video assisted minimally invasive mitral valve surgery in the surgically challenging rheumatic valve disease has less surgical trauma, blood loss and pain, which translates into short hospital stay, rapid return to normal activities, less use of resources.

Robotic versus Laparoscopic Ventral Hernia Repair: A Multicenter, Blinded Randomized Controlled Trial

Background: There has been a recent widespread performance of and publication on robotic ventral hernia repair (RVHR). A national database study demonstrated decreased hospital stay with RVHR compared to laparoscopic repair (LVHR). However, no randomized controlled trial (RCT) has evaluated RVHR. We hypothesized that RVHR compared to LVHR is associated with fewer days in the hospital 90-days post-operative. Methods: In this blinded, multicenter RCT, patients scheduled to undergo elective VHR were randomized to RVHR or LVHR and stratified by surgeon. Primary outcome was days in hospital within 90-days post-operative. Secondary outcomes included emergency room visits, operating room time, wound complications, hernia recurrence, reoperation, quality of life (QOL), and costs from the healthcare system perspective. Outcomes were assessed through frequentist (negative binomial, generalized linear or logistic regression) and Bayesian analyses. Findings: A total of 124 patients were enrolled and randomized: 65 underwent RVHR and 59 LVHR. Patients from both groups were similar at baseline. Ninetyday follow-up was completed in 123 patients (99·2%). There was no difference in days in hospital between the two groups (median 0 vs 0 days; RR=0·90 [95%CI=0·37-2·19]; p=0·822). On secondary outcomes, no differences were noted in emergency room visits, wound complications, hernia recurrence, or reoperation. However, RVHR had longer operative duration (141 vs 77 minutes; coefficient=62·89 [95%CI=45·75-80·01]; p=<0·001) and increased healthcare costs ($15,864 vs $12,954; RR=1·21 [95%CI=1·07-1·38]; p=0·004). In addition, RVHR had clinically important differences in enterotomies (3% vs 0%; p=0·996) and less median improvement in early post-operative QOL (3 vs 15, p=0·060). On Bayesian analysis, RVHR had a 78% probability of being associated with more enterotomies while LVHR had a 66% probability of having greater improvement in early post-operative QOL. Interpretation: Both RVHR and LVHR have similar 90-day postoperative hospital stays. However, RVHR increased operative duration, healthcare costs, and risk of enterotomy while LVHR had a greater improvement of patient QOL. Trial Registration: clinicaltrials.gov (NCT03490266). Funding Statement: This study was supported by an investigator initiated grant from Intuitive Surgical. Declaration of Interests: Dr. Shah receives consulting fees from C-SATS and educational honoraria from Gore. Also discloses past research grant support from Neosurgical and Medigus. Dr. Wilson receives consulting fees from Conmed and Livsmed. Also discloses being on advisory board of ColubrisMX. All other authors declare no conflicts of interest. Ethics Approval Statement: A multicenter, multi-blinded RCT was performed after obtaining institutional review board (IRB) approval. Participating centers included Memorial Hermann Hospital System and Lyndon Baines Johnson General Hospital. The Consolidated Standards of Reporting Trials (CONSORT) guidelines were followed. Patients who voluntarily agreed to participate in the study signed a surgical informed consent and a separate research consent prior to enrollment.

Six weeks finasteride monotherapy before TURP: Does it improve quality of life in early post operative period?

IntroductionBenign prostatic hyperplasia (BPH) is a common disease affecting men 50 years and older. Treatment options consist of observation, pharmacological treatment, minimally invasive surgery and traditional surgery. Alpha-blockers and 5-alpha-reductase inhibitors are the primary medications used to treat BPH. Transurethral resection of the prostate (TURP) is the gold standard of surgical management of BPH. ObjectiveTo evaluate the effect of six weeks finasteride therapy before TURP on overall surgical outcomes and early postoperative quality of life (QoL). Patients and methodsBetween June 2014 and August 2016, patients with BPH at our department were randomly assigned to one of two groups: group (A) receiving 5 mg of finasteride daily for six weeks and group (B) did not receiving finasteride before TURP. All patients were assessed using a modified validated Arabic version of the International Prostate Symptom Score (IPSS). Intra operative serum hemoglobin concentration and hemoglobin concentration in irrigating fluid were recorded. One month post-surgery, IPSS, storage, voiding subscores and QoL scores were measured. ResultsOut of a total of 115 patients, 98 patients completed the study. Before surgery, there was no significant difference between the two groups in prostate size (Prostate size was 54.52 ± 7.3 g in group A and 50.19 ± 6.8 g in group B, p value = 0.72), IPSS (19.86 ± 4.68 in group A vs. 21.14 ± 4.33 in group B, p value = 0.17), maximum urinary flow rate and post-void residual urine test results. No significant difference between Qol score in both groups before surgery (p value = 0.96). Group A patients had significantly less intraoperative blood loss than group B patients (308.29 ± 48.1 ml vs. 431.11 ± 96.4 ml, p = 0.001). One month postoperatively, group A patients showed greater improvement in QoL than group B patients (p = 0.03). ConclusionsFinasteride therapy for 6 weeks before TURP reduced intraoperative blood loss and statistically improved quality of life in the early postoperative period. However, larger number of patients and longer duration of follow up is recommended to confirm its clinical significance.

Quality of life in patients early after surgery

Background/Aim. Quality of life in patients early after elective surgery is related to postoperative pain and recovery rate. The aim of this study was to compare immediate preoperative and early postoperative quality of life after three common elective surgical interventions in hospital settings. Methods. Population of this prospective cohort study included patients who underwent one of the three surgical interventions: elective laparoscopic cholecystectomy (n = 40), open inguinal hernia repair (n = 40) or excision of pilonidal sinus (n = 40). Primary outcome of the study was quality of life measured once-daily, starting from the day before surgery, and then each postoperative day. It was measured by visual analogue scale (VAS) and by Serbian translation of short questionnaire on quality of life developed by World Health Organization. Results. Postoperative quality of life dropped to the lowest level on the first postoperative day, regardless of the type of surgery. The drop was the most pronounced in physical and psychological aspects of quality of life (e.g. after cholecystectomy from 15.4 ? 2.5 to 12.5 ? 2.0, and from 15.9 ? 2.0 to 14.9 ? 2.1, respectively) while social and environmental aspects were the least affected by the surgery (e.g., after excision of pilonidal sinus from 16.3 ? 2.6 to 15.7 ? 2.1, and from 14.3 ? 2.6 to 14.1 ? 2.2, respectively). Quality of life was rapidly restored on the second postoperative day, and on the last day before discharge of the patient from hospital it surpasses preoperative level (e.g., after open inguinal hernia repair from 14.6 ? 3.6 to 15.2 ? 3.0. Conclusions. Minor elective surgical interventions are associated with only moderate (less than 25%) and short (one day) immediate postoperative decrease in quality of life, which is followed by increase on discharge from hospital to the levels, higher than preoperative one.

Nasal septum suture combined with inferior turbinate coblation after septoplasty: Does it improve quality of life and reduce complications?

ObjectiveNasal packing is routinely applied after septoplasty. Patients, however, report feeling very uncomfortable while the packing is in place. The aim of this study was to compare the effects of nasal septum suture combined with inferior turbinate coblation to the effects of nasal packing after septoplasty.MethodsIn this study, 135 patients undergoing septoplasty were divided into 3 groups: group 1 patients had microdebrider with packing, group 2 received coblation with packing and group 3 had coblation with suture. Early postoperative quality of life and complications were compared between the 3 groups.ResultsThe patients in group 1 experienced the most postoperative nasal pain, headache, dysphagia, sleep disturbance and bleeding on the night of surgery; while the patients in group 3 experienced the fewest symptoms. No difference in epiphora was observed between the 3 groups. More pain and bleeding were experienced when comparing the pack removal (Group 1 and 2) with the clearance of the nasal cavity (Group 3). We noted one case of postoperative bleeding in group 1, one septal hematoma in group 1 and a second septal hematoma in group 2. No such postoperative complications were found in group 3.ConclusionNasal septum suture combined with inferior turbinate coblation was not only associated with less pain, increased patient satisfaction and an improved quality of life; but also reduced postoperative complications. Our results confirm that it is a more comfortable, reliable alternative to the more common nasal packing.

The Psychometric Properties of the Abdominal Surgery Impact Scale

Background: Assessment of quality of life immediately after abdominal surgery is critical; however, potent tools that provide timely information about patient health are required in order to assess and improve postoperative quality of care. Interestingly, such assessment scales for early postoperative quality of life do not exist in German. The aim of this pilot study was to translate the English version of the "Abdominal Surgery Impact Scale" (ASIS) into German and to empirically test the German version. Methods: After the standardized translation, 30 German-speaking patients who had undergone visceral surgery (laparotomy) were recruited at the ward of the Bern University Hospital Visceral Surgery and Medicine. The internal consistency of the translated instrument (ASIS-D) was assessed on the third postoperative day; reliability, retest-reliability and construct validity were also assessed on the fifth postoperative day. Results: ASIS-D faithfully represented the content of the original version. Cronbach's α overall was 0.85 and for the 6 subscales 0.45-0.88. The overall score of retest-reliability was 0.57** and the construct validity was confirmed. Conclusion: The ASIS-D was shown to be reliable and valid even if other investigations are necessary. It provides specific insights into special postoperative symptoms such as wound pain and postoperative quality of sleep. After further tests, it might be suitable not only for capturing the short-term postal-surgical quality of life, but possibly also for evaluating nursing interventions.

Postoperative Quality of Life after Open Transinguinal Preperitoneal Inguinal Hernia Repair Using Memory Ring or Three-dimensional Devices

A transinguinal preperitoneal (TIPP) approach has become a common technique for inguinal hernia repair. Our goal was to compare the impact of the two mesh designs for this operation: a flat mesh with a memory ring device (MRD) or a three-dimensional device (3DD) containing both onlay and preperitoneal mesh components. The prospective International Hernia Mesh Registry (2007 to 2012) was queried for MRD and 3DD inguinal hernia repairs. Outcomes and patient quality of life (QOL), using the Carolinas Comfort Scale (CCS), were examined at 1, 6, 12, and 24 months. Standard statistical methods were used, and multivariate logistic regression was performed using a forward stepwise selection method. TIPP was performed in 956 patients. Their average age 57.4 ± 15.3 years, 94.0 per cent were male, and mean body mass index was 25.7 ± 3.2 kg/m(2). MRD was used in 131 and 3DD in 825. Follow-up was 97, 82, 87, and 80 per cent at 1, 6, 12, and 24 months, respectively. Complications were not significantly different (P > 0.05). Recurrence was 0.8 per cent for MRD and 2.1 per cent for 3DD (P = 0.45). Comparing patient outcomes of MRD with 3DD at 1 month, 18.9 versus 11.5 per cent had symptoms of mesh sensation (P = 0.02); 28.7 versus 14.8 per cent had movement limitations (P < 0.01). MRD use was a significant independent predictor of movement limitation (odds ratio, 2.3; confidence interval, 1.4 to 3.7). No significant differences in CCS scores were seen at 6, 12, and 24 months. TIPP repair is safe and has a low recurrence rate. Early postoperative QOL is significantly improved with a 3DD mesh compared with MRD.

Comparison of the Postoperative rehabilitation and life quality between cholecystitis laparoscopy and open resection

Objective To investigate the postoperative rehabilitation and life quality of cholecystitis laparoscopy and open resection.Methods 41 patients with laparoscopic surgery and 41 cases with general surgery,compared postoperative recovery of gastrointestinal function and to predict patients recovery from surgery.Results Observation group with postoperative recovery of gastrointestinal function was faster than control group [ ( 1.2 ± 0.2 ) d vs(2.1 ±0.4)d,P ＜0.05],postoperative gastrointestinal function with grade I was more than control group(21 vs 6)( P ＜ 0.05 ),C-reactive protein value was lower than control group after surgery [ ( 21.3 ± 3.4 ) mg/L vs ( 32.7 ± 5.3 ) mg/L,P ＜ 0.05 ],it had a short time to decreease to normal in observation group [ ( 11.2 ± 1.8 ) d vs ( 16.1 ± 2.4 ) d(P＜0.05) ].Conclusion Laparoscopic surgery compared with open cholecystectomy,it could reduce surgical trauma to the patient's stress,rapid recovery of postoperative gastrointestinal function,so it can improve the early postoperative quality of life. Key words: Cholecystectomy; laparoscopic; Treatment outcome; Quality of life

Quality of life after sleeve gastrectomy and adjustable gastric banding

Background With the addition of laparoscopic vertical sleeve gastrectomy (SG) to the bariatric surgery procedural toolkit, patients desiring a restrictive bariatric procedure often choose between adjustable gastric banding (LAGB) and SG. One study compared quality of life after these 2 procedures and found no difference. The purpose of our study was to re-evaluate the postoperative quality of life in LAGB and SG patients at a military teaching hospital in the United States. Methods A retrospective review of 108 consecutive laparoscopic restrictive bariatric procedures performed within 15 months at a Department of Defense hospital was conducted. Of these 108 patients, 69 had undergone laparoscopic vertical SG and 39 LAGB. A validated quality of life questionnaire (Bariatric Quality of Life) was conducted a mean of 9.3 ± 3.2 months (range 5–16) postoperatively. The weight loss and standard laboratory parameters were measured at 0, 1, 3, 6, and 12 months. Results The quality of life assessment revealed significantly better scores after SG than after LAGB (66.5 versus 57.9, P = .0002). The excess weight loss and excess body mass index loss at 3, 6, and 12 months postoperatively were significantly greater in the laparoscopic SG group. The patients demonstrated a clear preference over time for SG once it was offered. Conclusion Early postoperative quality of life was superior after SG than after LAGB. SG also resulted in superior early excess weight loss. In a practice not constrained by reimbursement, these findings were associated with increased patient choice of SG after it began to be offered.

The negative effects of surgery persist beyond the early postoperative period after laparoscopic colorectal resection

The recovery benefits of laparoscopy are traditionally believed to minimize the initial negative impact of surgery on early postoperative quality of life (QOL). We evaluate whether laparoscopic colectomy leads to recovery of QOL early after surgery and evaluate factors associated with the change in QOL. Preoperative and early postoperative QOL data (SF-36) were prospectively accrued for patients undergoing laparoscopic colorectal resection (LCR) (2002-2009). Changes in postoperative QOL from preoperative values and effects of patient, disease, operation and postoperative outcomes on these changes were evaluated. One hundred and sixty-six patients (female = 86) underwent LCR for cancer (n = 79), Crohn's disease (n = 24), diverticulitis (n = 38), and ulcerative colitis (n = 25) with complete SF-36 scores. Median age was 56.9 (range: 15-91) years, mean body mass index 27.4 ± 6.2 kg/m(2) with American Society of Anesthesiologists (ASA) class being II in 94 patients. Median operative time was 152.5 (range: 50-358) min; mean length of stay (LOS) 4.5 ± 3.3 days. At 4 weeks, the postoperative SF-36 physical component scale (PCS) continued to be lower than the preoperative PCS (41.8 ± 8.8 vs. 47.1 ± 9.4, P < 0.001), while the postoperative SF-36 mental component scale (MCS) was similar to the preoperative MCS (45.6 ± 10.2 vs. 46.1 ± 11.9, P = 0.17). Gender, age, operation, LOS, surgeon, ASA, BMI, complications, and readmission were not associated with a change in QOL from preoperative values. Cancer as an indication for surgery was associated with less improvement of MCS and PCS (P = 0.024 and 0.004, respectively). Although patients who undergo LCR may have clinical evidence of healing at 4 weeks after surgery, QOL does not return to the preoperative level. This finding may help develop evidence-based recommendations pertaining to timing of return to full activity.

Advanced gastric cancer: is laparoscopic gastrectomy safe?

As experience with laparoscopically assisted distal gastrectomy (LADG) for early gastric cancer substantially increased, particularly in Korea and Japan [1], it was expected that the next step would be laparoscopic treatment of advanced gastric cancer. Indeed, unsurprisingly, Hwang et al. [2] reported on LADG for advanced gastric cancer in a recent issue of Surgical Endoscopy. However, evidence of laparoscopic surgery’s safety for early gastric cancer in terms of oncologic outcomes still is lacking. Nevertheless, several large randomized controlled trials and metaanalyses have demonstrated that laparoscopic surgery is a more patient-friendly procedure than open colectomy, offering better early postoperative quality of life and having no negative effect on recurrence or the survival of patients with advanced stages of colon cancer [3]. These findings and the positive results of retrospective studies investigating LADG for early gastric cancer justify the current study’s evaluation of LADG’s safety and efficacy for advanced gastric cancer [1]. Both open D2 lymphadenectomy and laparoscopic gastrectomy require a surgeon’s experience and skill for safe and effective treatment of resectable gastric cancer [4]. Korea, a country with a high incidence of gastric cancer, has a long-term experience with open standardized extended D2 gastrectomy and perhaps the largest experience with laparoscopic D2 gastrectomy worldwide. Hwang et al. [2] from an academic Department of Surgery in Seoul performed LADG for 45 patients with advanced gastric cancer in 3 years (2004–2007), then compared their clinical and pathologic data with that for 83 patients who underwent open distal gastrectomy (ODG) during this same period. Although the operation time was longer for LADG than for ODG, there was no significant difference in morbidity or mortality between the two groups. The mean number of resected lymph nodes was similar in the two groups (35 in LADG vs 38 in ODG). During a mean follow-up period of 23 months, six patients with stage 3a/3b disease in the LADG group experienced recurrence This small retrospective study had several limitations and weakness. Although the mean follow-up period was too short for conclusions on oncologic outcomes to be drawn, the data presented by the authors are promising and encourage phase 2 randomized trials to assess the safety and efficacy of LADG for patients with advanced stages 2 and 3 cancer. Recently, two large confirmatory randomized trials with excellent survival results indirectly demonstrated the clinical utility of open D2 surgery in terms of long-term survival for patients with advanced stages 2 and 3 gastric cancer [5, 6]. In the West, evidence from positive randomized trials is lacking, and controversy still exists on the potential survival benefit of D2 gastrectomy [7–10]. Data still are too scarce to determine whether perioperative, preoperative only, or postoperative chemotherapy should be added to D2 or limited to D1 gastrectomy [11–13]. Given the important role of locoregional tumor control not only in recurrence-free survival but also in the overall survival of patients with solid tumors, including breast cancer, recent findings [14] indicate that every effort should be made to prevent local or nodal recurrence [15–17]. Can laparoscopic gastrectomy worsen the survival of patients with advanced gastric cancer? Despite skepticism T. Liakakos (&) E. P. Misiakos A. Macheras Third Surgical Department, University of Athens, Athens, Greece e-mail: theodlia@otenet.gr

Predictors of Early Postoperative Quality of Life after Elective Resection for Colorectal Cancer

Measurement of quality of life (QoL) is assuming increasing importance in cancer care. Predictors of early postoperative QoL after colorectal cancer resection are not clear and the aim of this study was to identify these factors. A consecutive series of eligible patients undergoing elective resection for colorectal cancer were invited to participate. Standardised, reliable and validated psychological questionnaires (HADS, PANAS, MRS, FACT-C, EQ-5D) were administered seven days prior to surgery and then six weeks after discharge. One hundred and four patients with colorectal cancer were recruited. There were 70 males (67.3%) and the mean age of the group was 67.6 years. Postoperative anxiety and depression were closely related to the preoperative anxiety and depression scores (p < 0.001). Other QoL scores also showed significant correlation with the respective preoperative scores. Anxiety, depression, and FACT functional wellbeing scores were also correlated with the incidence of postoperative morbidity. On multiple regression analysis postoperative morbidity, tumour node metastasis (TNM) stage, presence of stoma and preoperative QoL scores were found to independently predict postoperative QoL scores. Routine preoperative QoL measurement in cancer patients can identify patients at risk of having a poor QoL postoperatively. Suitable psychological and pharmaceutical intervention can be planned in advance for this group.