History Of Open Surgery Research Articles

Risk Factors for Intra-operative Bleeding in Percutaneous Nephrolithotomy in an Academic Center: A Retrospective Study.

Percutaneous nephrolithotomy (PNL) is the treatment of choice for renal stones as a safe, effective, and minimally invasive method. However, bleeding remains a major concern in the procedure. This study aimed to investigate the risk factors of bleeding in PNL. This retrospective descriptive cross-sectional study was conducted in the Urology department of Razi hospital. The data of patients with urinary calculi staghorn type who underwent PNL in a prone position under general anesthesia were recorded. A checklist including patients' demographics, surgical characteristics, and outcomes was filled out for each patient. The data from 151 complete files were gathered. The mean age of the cases was 47.89 ± 12.41 years. The mean hemoglobin (Hb) drop was 1.92 ± 1.56 mg/dL. At least 1 mg/dL Hb drop was observed in all cases. The highest Hb drop was 3 mg/dL.). There was no significant relationship between stone bulk, age, BMI, GFR, surgery duration, and the number of tracts, and Hb drop during PNL (P > 0.05). But there was a positive correlation between Urinary Tract Infection (UTI) history (P = 0.01) and transfusion (P = 0.0001) and Hb drop during PNL. Also, the history of open kidney surgery (P = 0.031), nephrostomy insertion (P = 0.003), and extracorporeal shock wave lithotripsy therapy (ESWL) (P = 0.041) were correlated with the increased risk of Hb drop. Urinary tract infection, history of open surgery, nephrostomy implantation, and ESWL were significantly associated with more bleeding in PNL.

Factors Affecting Transfusion during Percutaneous Nephrolithotomy: A Retrospective Study of 665 Cases.

Objective This study was designed to evaluate the aspects that affect transfusion following percutaneous nephrolithotomy (PCNL). Patients and Methods. From 2016 to 2019, 665 patients underwent PCNL for the removal of renal calculi at our center (Department of Urology, Shanghai Xu-hui Central Hospital). Complications, including hemorrhages, have been reported. Twenty-three patients (3.5%) have received a blood transfusion, and 12 (1.9%) patients were treated with hyper-selective embolization. We focused on the influencing factors related to postoperative blood transfusion. The factors analyzed were age, sex, hypertension, diabetes, serum creatinine level, preoperative hemoglobin, and the use of anticoagulants or antiplatelet medications; renal and stone factors (i.e., previous surgery, abnormal anatomy, stone side, stone burden, and stone type); and surgical features (i.e., access number, the calyx of puncture, and stone-free rate). These data were analyzed for the presence of bleeding. Results Among individual factors, preoperative hemoglobin level (p < 0.001) and urinary infections (p < 0.001) were significantly correlated with blood transfusion. Among renal and stone factors, only a history of open surgery was significantly correlated with blood transfusion (p < 0.05). Stone type or stone burden did not correlate with transfusion. Furthermore, no statistically significant correlation was found between surgical features and bleeding, and a lower stone-free rate was reported for the transfusion group. Conclusion The obtained results demonstrated that PCNL is a safer surgical procedure in a high-volume center; however, anemic conditions, infections, and history of open surgery will significantly increase the transfusion rate following PCNL.

Outcomes of Percutaneous Nephrolithotomy in Patients with Previous Ipsilateral Open Renal Stone Surgery.

Nephrolithiais is a recurrent disease. Recent advances have enabled stone surgeries to be performed by minimal invasive techniques; but still a large number of patients present with history of ipsilateral open renal stone surgery. Previous scar to the kidney and overlying muscles are fraught with possibility of increased complications. This study was conducted to evaluate the perioperative results of percutaneous nephrolithotomy in patients with a history of open stone surgery and to compare with those undergoing percutaneous nephrolithotomy for the first time. A retrospective study of all the percutaneous nephrolithotomy performed by standard technique within four years at Bir Hospital was made. Patients were divided into those undergoing percutaneous nephrolithotomy for the first time and those who had undergone open renal stone surgery in the past. Preoperative and intraoperative variables were recorded and postoperative stone free status and complications were evaluated. Six hundred and twenty seven patients; out of 691, who had undergone percutaneous nephrolithotomy were included. Demographic variables and stone characteristics were similar in the two study groups. percutaneous nephrolithotomy was found to be statistically similar in the two groups in terms of the number of tracts made (p= 0.1642) and operative time (0.9197). Exit strategies were similar in both groups. Stone free rate was 83.33% in patients undergoing percutaneous nephrolithotomy for first time and 82.08% in those with history of open surgery. Average hospital stay was 3 days in both groups. Although the group with history of previous surgery had significantly more complications (p= 0.0207), Clavien grading was similar in the two groups. This study shows that the rate of complications is more in patients with history of open surgery, most complications are minor, not requiring intensive management. percutaneous nephrolithotomy is efficient and safe in patients with history of open renal stone surgery.

Laparoscopic approach to early gastric cancer in a patient with a prior history of open right hepatectomy: a case report

BackgroundLaparoscopic gastrectomy is regarded a standard treatment procedure for early gastric cancer and is widely used in clinical practice. However, the feasibility of laparoscopic gastrectomy for patients with a prior history of open surgery, especially in the case of a complicated operation, remains unclear. Here, we report a laparoscopic gastrectomy case with a prior history of right hepatectomy.Case presentationA 70-year-old man was diagnosed with early gastric cancers preceding a right hepatectomy for a solitary hepatocellular carcinoma at risk of rupture. An additional gastrectomy, after non-curative endoscopic submucosal dissection, was planned after the hepatectomy. Extensive adhesions were found around the liver. Rigid adherence of the duodenum to the adjacent hepatoduodenal ligament had formed. In addition, identification of the hepatic artery was difficult due to stiffening of the mesentery. Peeling off the adhesions from the ventral side of the duodenum revealed the supra-pyloric vessels and enabled us to transect the duodenum safely. Further, exposing the proper hepatic artery via the dorsal side of the mesentery and subsequent supra-pancreatic dissection on the outermost layer allowed effective identification of the right gastric artery. The postoperative course was uneventful.ConclusionsWe successfully performed total laparoscopic distal gastrectomy on a patient with a prior history of major hepatectomy.

Laparoscopic common bile duct exploration in patients with previous abdominal biliary tract operations

BackgroundA history of abdominal biliary tract surgery has been identified as a relative contraindication for laparoscopic common bile duct exploration (LCBDE), and there are very few reports about laparoscopic procedures in patients with a history of abdominal biliary tract surgery.MethodsWe retrospectively reviewed the clinical outcomes of 227 consecutive patients with previous abdominal biliary tract operations at our institution between December 2013 and June 2019. A total of 110 consecutive patients underwent LCBDE, and 117 consecutive patients underwent open common bile duct exploration (OCBDE). Patient demographics and perioperative variables were compared between the two groups.ResultsThe LCBDE group performed significantly better than the OCBDE group with respect to estimated blood loss [30 (5–700) vs. 50 (10–1800) ml; p = 0.041], remnant common bile duct (CBD) stones (17 vs. 28%; p = 0.050), postoperative hospital stay [7 (3–78) vs. 8.5 (4.5–74) days; p = 0.041], and time to oral intake [2.5 (1–7) vs. 3 (2–24) days; p = 0.015]. There were no significant differences in the operation time [170 (60–480) vs. 180 (41–330) minutes; p = 0.067]. A total of 19 patients (17%) in the LCBDE group were converted to open surgery. According to Clavien’s classification of complications, the LCBDE group had significantly fewer postoperative complications than the OCBDE group (40 vs. 57; p = 0.045). There was no mortality in either group. Multiple previous operations (≥ 2 times), a history of open surgery, and previous biliary tract surgery (including bile duct or gallbladder + bile duct other than cholecystectomy alone) were risk factors for postoperative adhesion (p = 0.000, p = 0.000, and p = 0.000, respectively).ConclusionLCBDE is ultimately the least invasive, safest, and the most effective treatment option for patients with previous abdominal biliary tract operations and is especially suitable for those with a history of cholecystectomy, few previous operations (< 2 times), or a history of laparoscopic surgery.

Does peritrochanteric fat thickness increase the risk of early reoperation for infection or wound complications following total hip arthroplasty?

BackgroundRadiographically measured subcutaneous peri-incisional tissue depth has been correlated with post-operative surgical site infection after cardiac, cervical spine, and total knee surgery. Its impact following primary total hip arthroplasty (THA) has not been studied. We compare the interobserver reliability of measuring peritrochanteric fat thickness on pre-operative radiographs and hypothesize that these measurements are a reproducible way to predict acute post-operative wound complications and infection in patients undergoing THA. MethodsA retrospective case-control analysis was performed at a single institution. Patients taken to the operating room within 90 days of their primary THA for a wound complication or deep infection between 2008 and 2016 were identified. Patients <18 years old, those with history of open surgery on the affected hip, or with inadequate radiographs were excluded. Patients were matched 1:1 for gender, age, BMI, and ASA score to THA patients without early wound complications. ResultsAll radiographic measurements performed were found to have excellent inter-rater reliabilities (range 0.96–0.98). There was no difference in peritrochanteric fat thickness measurements between the two groups including the sourcil to skin surface (89.5 mm vs. 91.9 mm, p = 0.5), tip of greater trochanter to skin surface (52.9 mm vs. 53.7 mm, p = 0.8), and lateral greater trochanter to skin surface (36.0 mm vs. 37.8 mm, p = 0.6) measurements. ConclusionContrary to other previously reported surgical procedures, radiographic measurement of subcutaneous depth is not a valid tool for predicting a return to the OR for wound complications in the early post-operative period following primary total hip arthroplasty.

Effect of the ultrasound-guided transperitoneal percutaneous nephrolithotomy in treatment of renal calculi in pelvic ectopic kidney

Objective To evaluate the safety and efficacy of ultrasound-guided transperitoneal PCNL for treatment of renal calculi in pelvic ectopic kidney. Methods The clinical data of 4 cases of pelvic ectopic kidney treated in our hospital from June 2016 to August 2017 were retrospectively analyzed. The patient's age ranged from 30 to 67 years with an average of 47.25 years. There were two male and two female patients. 2 cases suffered with left pelvic ectopic kidney stones. One case had right pelvic horseshoe ectopic kidney stones and one case had spinal deformity left pelvic ectopic kidney stones. Multiple stones were found in 2 cases. The mainly stones located in the renal pelvis in one case. Multiple stones in the lower calyx was found in another case. The remaining 2 cases had single stones in the renal pelvis. Stone size was 3.4 cm×2.1 cm, 3.0 cm×2.1 cm, 2.8 cm×2.4 cm and 2.1 cm×1.9 cm respectively. And 1 case with renal calculi in left pelvic ectopic kidney had a history of open surgery 11 years ago because of the same situation with pelvic ectopic kidney calculi. In this study, all operation was performed under general anesthesia. The ultrasound-guided percutaneous nephrolithotomy combined with preoperative CTU and intraoperative color Doppler ultrasound was used to find the target renal calyx or renal pelvis. And a certain pressure was applied to the abdominal wall to make the intestinal canal deviate from the surface of the pelvic ectopic kidney as much as possible. Under ultrasound real-time detection, it was punctured into the target renal calyx or renal pelvis to find and break stones. And F6 double J tube and F18 nephrostomy tube were left. Operative and post-operative related details (stone free, bleeding, abdominal infection) were reviewed. Results Stone free rate were 100% (4/4). The time of operation and hospital stay were 62, 59, 55, 51 min and 6, 6, 5, 5 days, respectively. None had significant intraoperative and postoperative complications, including haemorrhage, injury of mesenteric vessels, abdominal infection and hydrops. No one left residual stones during 1 month and 3 months of follow-up. Conclusions The ultrasound-guided transperitoneal PCNL is a safe and effective procedure for the treatment of patients with renal calculi in pelvic ectopic kidney. Key words: Percutaneous nephrolithotomy; Transperitoneal; Ultrasound-guided; Pelvic ectopic renal calculi

開腹歴のない若年女性に発生した巨大腹腔内デスモイド腫瘍の１切除例

開腹歴のない若年女性に発生した巨大腹腔内デスモイド腫瘍の１切除例

Pelvic venous reflux is a major contributory cause of recurrent varicose veins in more than a quarter of women

Leg varicose veins are associated with pelvic venous reflux in approximately 20% of women who have had children. However, most venous units do not routinely look for pelvic venous reflux or treat it. We aimed to investigate what proportion of patients with recurrent varicose veins and a history of open surgery have pelvic venous reflux as a major contributing cause of their recurrence. A retrospective study was performed of all patients referred in the previous year with recurrent varicose veins or venous reflux disease who had previously had open surgery performed elsewhere. All patients had routine lower limb venous duplex ultrasonography, and those found to have reflux of pelvic origin underwent transvaginal duplex ultrasonography. Each case was assessed by a consultant vascular surgeon, and the major cause (or causes, if more than one) of the recurrent varicose veins was noted. A total of 109 patients with recurrent varicose veins in 172 legs were analyzed (mean age, 53.9years; female-to-male ratio, 97:12). Patients were divided into four groups: group 1, all patients; group 2, female patients; group 3, female patients with children; and group 4, female patients with children who had not had hysterectomy. Pelvic venous reflux was found to be a major contributing cause of recurrent varicose veins in 44 of 172 legs (25.6%). This rose to 43 of 154 legs (27.9%) in group 2, 40 of 131 legs (30.5%) in group 3, and 37 of 111 legs (33.3%) in group4. Pelvic venous reflux is a major contributing cause of recurrent varicose veins after open surgery that has rarely been reported previously. In view of this finding, we suggest that a duplex ultrasound protocol, incorporating a transvaginal duplex examination of the ovarian and internal iliac veins, be adopted for the investigation of pelvic venous reflux in female patients presenting with symptomatic leg varicose veins with duplex-observed reflux entering the leg vein pattern from the pelvis. In the event that it is found, we suggest that treatment and resolution of this source of venous reflux be considered before any intervention for the leg varicose veins, surgical or otherwise.

Does previous open nephrolithotomy affect the outcomes and complications of percutaneous nephrolithotomy in children?

ObjectiveTo analyze the success and complication rates of percutaneous nephrolithotomy (PCNL) performed in pediatric patients and to compare outcomes of the patients undergoing primary PCNL with those of patients who had undergone previous open nephrolithotomy. Materials and methodsBetween 2000 and 2011, PNL procedures were performed in 123 renal units (RU) of 111 children. We compared RU on which previous open surgery had been performed (group 1 RU = 26) on the same kidney with RU that had not been involved in previous surgery (group 2 RU = 97). Patient characteristics, pre- and postoperative hematocrit and creatinin levels, operative time, fluoroscopic screening time, stone free rate, complications and hospitalization time were documented and compared. ResultsThere were no significant differences between the groups in sex, stone burden, pre- and postoperative hematocrit levels. Mean age and pre- and postoperative creatinin levels were significantly higher in group 1 (p < 0.05). Mean operative time, fluoroscopic screening time and hospitalization times were similar in each group (p > 0.05). The stone free rates after PCNL were 65.4% in group 1 and 81.4% in group 2 (p > 0.05). Multiple access rate was higher in group 1; however, this was not statistically significant (27% vs. 15%, p > 0.05). ConclusionPCNL can be performed in pediatric patients who have previously undergone open nephrolithotomy but the success rates may be lower and risk of bowel injury higher. NCCT should be considered preoperatively for patients who have previously undergone open renal surgeries to investigate the presence of retrorenal colons. Our study includes relatively few patients with a history of open surgery and we believe that additional clinical studies with larger numbers of patients are needed to confirm our initial findings.

Pelvic Venous Reflux is a Major Contributory Cause of Recurrent Varicose Veins in more than a Quarter of Women.

Background Leg varicose veins are associated with pelvic venous reflux in approximately 20% of women who have had children. However, most venous units do not routinely look for pelvic venous reflux or treat it. We aimed to investigate what proportion of patients with recurrent varicose veins and a history of open surgery have pelvic venous reflux as a major contributing cause of their recurrence. Methods A retrospective study was performed of all patients referred in the previous year with recurrent varicose veins or venous reflux disease who had previously had open surgery performed elsewhere. All patients had routine lower limb venous duplex ultrasonography, and those found to have reflux of pelvic origin underwent transvaginal duplex ultrasonography. Each case was assessed by a consultant vascular surgeon, and the major cause (or causes, if more than one) of the recurrent varicose veins was noted. Results A total of 109 patients with recurrent varicose veins in 172 legs were analyzed (mean age, 53.9 years; female-to-male ratio, 97:12). Patients were divided into four groups: group 1, all patients; group 2, female patients; group 3, female patients with children; and group 4, female patients with children who had not had hysterectomy. Pelvic venous reflux was found to be a major contributing cause of recurrent varicose veins in 44 of 172 legs (25.6%). This rose to 43 of 154 legs (27.9%) in group 2, 40 of 131 legs (30.5%) in group 3, and 37 of 111 legs (33.3%) in group 4. Conclusions Pelvic venous reflux is a major contributing cause of recurrent varicose veins after open surgery that has rarely been reported previously. In view of this finding, we suggest that a duplex ultrasound protocol, incorporating a transvaginal duplex examination of the ovarian and internal iliac veins, be adopted for the investigation of pelvic venous reflux in female patients presenting with symptomatic leg varicose veins with duplex-observed reflux entering the leg vein pattern from the pelvis. In the event that it is found, we suggest that treatment and resolution of this source of venous reflux be considered before any intervention for the leg varicose veins, surgical or otherwise.

Is there a difference in percutaneous nephrolithotomy outcomes among various types of pelvicaliceal system?

During PNL procedures, stone clearance can be achieved by single access or multiple accesses for same stone size and configuration. At this point, we believed that pelvicaliceal system type may play a significant role on stone clearance. In our study, we aimed to investigate the effect of pelvicaliceal system type on PNL outcomes. A total of 498 patients who had preoperative intravenous urography were enrolled in our study. PCSs of the patients were classified as A1, A2, B1, and B2 according to Sampaio system after evaluation of IVU images. The exclusion criteria were unclassified pelvicaliceal system due to the presence of exaggerated renal hydronephrosis, IVUs with poor quality, radiolucent renal stones, and absence of CT or IVU in postoperative period. There was no clinically significant difference for patient gender, history of open surgery, and history of previous SWL. Success rates of PNL were 79.5, 82.0, 74.3, and 80.3 % in Sampaio type A1, A2, B1, and B2 PCS, respectively (p 0.61). Multiple accesses were required for 35 (18.8 %), 14 (17.9 %), 55 (30.1 %), and 6 (11.8 %) patients according to Sampaio classification type A1, A2, B1, and B2, respectively (p 0.008). There was no clinically significant difference for stone size, stone configuration (simple or complex), and complications. Sampaio type B1 PCSs require increased number of access for achieving stone clearance. Therefore, surgeons should be aware and also inform patients that treatment of patients with Sampaio type B1 PCS may need high number of access during PNL procedure.

Transabdominal laparoscopic nephrectomy for patients with previous history of open kidney surgery

Objective To explore the feasibility of transabdominal laparosCopic removal of the kidneys in patients with previous history of open renal surgery.Methods Transabdominal laparoscopic surgery was performed to resect 8 kidneys without finction.Two were male and three were female,with a mean age of 45 years ( 31 - 61 years ).6patients had giant hydronephrosis and the rest 2 had pyonephrosis and needed percutaneous nephrostomy.Results The procedure was successful in 7 patients and one patient had to receive open surgery during the procedure.No severe complications occurred postoperatively.One patient developed wound infection and was finally cured after treatment.The surgical duration was 120 - 205 min ( 160 min in average ); blood loss was 100 to 600 ml ( 180 ml in average ),with blood transfusion in one patient.Condusions For those with previous history of open kidney surgery,although surgical difficulty was increased because of scar adhesions,transabdominal laparoscopic nephrectomy is still feasible with an accumulation of experiences of laparoscopic surgery and improved surgical skills. Key words: Laparoscopy; Pyonephrosis; Nephrectomy

Invention of precise positioning instrument regulating puncture in percutaneous nephrolithotripsy and its clinical application

Objective To summarize the research and manufacturing ideas of precise positioning instrument and its feasibility and safety in the minimally invasive percutaneous nephrolithotripsy. Methods The precise positioning instrument was preliminarily made by integrating ruler with protractor.Fifty cases of kidney stones or upper ureteral stones were recruited in the study.There were 32 males and 18 females with mean age of 47 years (21 -75 years).Of them,6 cases had open surgery history and 31 cases had different degrees of hydronephrosis.The distance from the mid-point of renal pelvis to the plane of the dorsal surface and the distance from the incident point of the mid-point of pelvis on the dorsal surface to spinous process were measured by ruler on the preoperative CT images.According to the measured results,the point,angle,direction and depth of needle were calculated by geometric formula,and then fix position puncture and percutaneous puncture channel expansion were completed by precise positioning instrument and calibrated by Carm X-ray machine. Results The puncture channels were established successfully in all of the 50 cases.Forty-six cases were punctured successfully by just one try,and the success rate of one puncture only was 92.0％.C-arm was used in none of the cases during the channel establishing process.Each patient was Xrayed 1 -3 times,and the average was 1.4 times.Targeting deflection or renal pelvis injury occurred in none of these cases. Conclusion The application of the homemade precise positioning instrument is a safe and quick method for the establishment of puncture channel during percutaneous nephrolithotripsy,meanwhile the surgeons can reduce the exposure to radiation. Key words: Nephrostomy, percutaneous; Percutaneous nephrolithotripsy; Location; Punctures

Variables That Influence Operative Time During Percutaneous Nephrolithotomy: An Analysis of 1897 Cases

Operative time is an important perioperative factor and is related to postoperative complications and procedural cost-effectiveness. There are few studies, however, investigating factors that affect operative time during percutaneous nephrolithotomy (PCNL). In this study, patient and kidney stone-related factors that influence operative time were analyzed. Clinical records from 1897 patients with renal calculi who underwent PCNL were retrospectively reviewed, and these patients were divided into two groups based on their median operative time (group 1: ≤60 min; group 2: >60 min). Multivariate analyses as well as univariate analyses including chi-square, Fisher exact and Mann Whitney U tests were used to investigate the effects of independent variables on operative time, including patient and kidney stone-related factors such as age, sex, body mass index, history of ipsilateral open surgery, shockwave lithotripsy, presence of hydronephrosis, stone burden, stone type and opacity, and surgical experience. The mean operative time was 64.9±27.6 minutes (range 10-220 min). Univariate analyses determined that a history of open surgery, presence of hydronephrosis, stone type and size, and surgical experience correlated with operative time (P<0.05 for all). Multivariate analyses revealed that presence of hydronephrosis (odds ratio [OR]: 1.44, 95% confidence interval [CI]: 1.17-1.78, P=0.002), stone type (OR: 2.12, 95% CI: 1.69-2.70, P<0.0001), stone burden (OR: 2.44, 95% CI: 1.85-3.12, P<0.0001), and surgical experience (OR: 0.56, 95% CI: 0.46-0.70, P<0.0001) were significant independent factors in influencing operative time. Presence of hydronephrosis, renal stone size and type significantly affect the operative time during PCNL. The duration of the operation was also observed to decrease with increased surgical experience.

Cystine Stones: The Impact of New Treatment

The hardness and frequent recurrence of cystine stones present a special challenge to the urologist. In this study, 15 cystinuric patients (11 males, 4 females; mean age 36 years, range 17-54) were treated and followed up over a period of 30 months (range 2-40). Most patients had previous history of open surgery. The diagnosis of cystinuria was confirmed by metabolic studies and infrared spectrometry of stones. Over the follow-up period recurrence was observed in 23 instances in 11 patients, leading to 38 "stone treatments" on 74 cystine stones. The percutaneous approach was used alone in 9 cases and in association with extracorporeal shock wave lithotripsy (ESWL) in 9 cases. ESWL was used alone in 18 cases. Medical treatment included high fluid intake, alkalinisation and Thiola (tiopronin, N-(2-mercaptopropionyl)glycine) in 6 patients. The overall stone-free rate assessed 3 months after treatment was 44.7%, which compares poorly with the rate for non-cystine stones. The recurrence rate is very high and instrumental treatment should not therefore be used excessively; it is indicated only for stones that are symptomatic or refractory to intensive medical therapy.