Laparotomy Procedures Research Articles

Comparative study of the open versus closed method of penumoperitoneum creation in laproscopic surgery

Background and Aim: In last few decades laparoscopy has gained more importance than conventional laparotomy procedure in day to day surgical practices. The different types of trocars, different sites and different positions adopted for safe entry means that the controversy is yet to be resolved. This study was conducted to compare peritoneal access with open vs closed technique in laparoscopic surgeries in terms of outcomes and complications. Materials and Methods: The total cases were divided in two groups with 50 cases were treated with open laparoscopy and 50 cases were treated with closed laparoscopy. The present prospective study involved the patients that presented with acute or chronic abdominal conditions like calculus cholecystitis, cholelithiasis, acute or subacute or chronic appendicitis, carcinoma rectum etc at medical college & hospital. Results: In the open group, gas leak occurred in 8 cases, port-site bleeding in 7 cases, port-site hematoma occurred in 3 case while port site wound infection occurred in 3 cases. In the closed group, gas leak occurred in 5 cases, port-site bleeding in 2 cases, port-site hematoma occurred in 1 case while port site wound infection occurred in 4 cases. There was one complication of extra peritoneal insufflations in closed method group.

The American Association for the Surgery of Trauma (AAST) Liver Injury Grade Does Not Equally Predict Interventions in Blunt and Penetrating Trauma

The AAST liver injury grade has a validated association with mortality and need for operation. AAST liver injury grade is the same regardless of the mechanism of trauma. A 5-year retrospective review of all liver injuries at an urban, level-one trauma center was performed. Totally, 315 patients were included (29% blunt, 71% penetrating). In blunt trauma, AAST grade was associated with need for laparotomy (0%, 7%, 5%, 33%, 29%, Grade 1-5, p = 0.01), angiography (0%, 7%, 25%, 40%, 57%, p < 0.001), embolization (0%, 7%, 15%, 33%, 43%, p = 0.01), and percutaneous drainage procedures (13% use in Grade 4, otherwise 0%, p = 0.04), but not ERCP (0% for all grades). In penetrating trauma, AAST grade was associated with need for angiography (7%, 4%, 15%, 24%, 30%, p < 0.01) and percutaneous drainage (7%, 2%, 14%, 18%, 26%, p = 0.03) and had a marginal association with embolization (0%, 4%, 11%, 13%, 22%, p = 0.06). Laparotomy, ERCP, sphincterotomy, and stenting rates increased with AAST grade, but this was not statistically significant. AAST grade is associated with the need for surgical hemostasis, angioembolization, and percutaneous drainage in both penetrating and blunt trauma. Operative, endoscopic, and percutaneous procedures are utilized more in penetrating trauma. Angioembolization was used more in blunt trauma. Mechanism should be considered when using AAST grade to guide management of liver injuries.

A Giant Ovarian Cystadenoma in A 20-Year-Old Nulliparous Woman: A Case Report

Giant ovarian cyst itself is defined as a cyst >10 cm in diameter from radiological- examination or the size of the cyst exceeds the umbilicus. Extra-large benign and malignant cysts of the ovary are uncommon and involve diagnostic and management challenges. We present the case of a 20-year-old nulliparous woman who was referred to our center with complaints of abdominal pain and heavy breathing. She benefited from a salphingo-oophorectomy laparotomy procedure. Benign and malignant gynecologic and non-gynecologic etiologies are included in the differential diagnosis of an abdominal mass. Because of the infrequent occurrence or absence of distinctive clinical presentation of the giant ovarian cyst, accurate preoperative diagnosis is challenging.

A rare case of three synchronous colorectal cancers and a closed loop large bowel obstruction

Colorectal malignancies are a common general surgical presentation. However, synchronous colorectal cancers are less frequent and typically account for only 3.5% of all colorectal cancers. Of these 3.5% of synchronous colorectal cancers, only approximately 4% are incidental appendiceal malignancies. An 80-year-old gentleman presented with abdominal pain and distension to the emergency department. On examination, the patient had a peritonitic abdomen and a CT scan revealed a large bowel obstruction secondary to sigmoid and rectal neoplasms, concerning for a closed loop obstruction. He underwent an emergency laparotomy and Hartman's Procedure. Intraoperatively the tip of the appendix appeared dilated and was removed. Histology revealed T3N0M0 synchronous sigmoid and rectal cancers, as well as a low-grade appendiceal mucinous tumour. Whilst synchronous colorectal malignancies are a relatively common presentation they typically present in adjacent segments of bowel. They are less frequently seen in association with incidental appendiceal malignancies and no cases have been published in combination with a closed loop large bowel obstruction. This is the first published case of three synchronous colorectal cancers causing a closed loop large bowel obstruction.

23 Corneal ectopic pregnancy attended at a maternity hospital in the Western Amazon: Case report

Introduction: Corneal pregnancy represents about 1% of ectopic pregnancies. Risk factors include pelvic inflammatory disease, previous pelvic surgery, uterine abnormalities and the use of assisted reproduction techniques. In most cases, the diagnosis can be made by blood BhCG levels and transvaginal ultrasound. Laparoscopy has become the gold standard treatment for corneal pregnancies in recent years and has replaced laparotomic procedures. Objectives: to report a case of corneal pregnancy attended at a maternity hospital in the Western Amazon.

Identifying risk factors for abdominal adhesions: preliminary findings of a prospective study

The objective of this study is to identify relevant risk factors for development of abdominal and pelvic adhesions in women based on their prior medical and surgical history. The primary outcome of this study is the presence and severity of adhesions identified at the time of laparoscopy for benign gynecologic disease. This multi-site prospective study was approved by local IRB board. All laparoscopic cases performed by study staff on adult patients were eligible for inclusion. The anticipated study size is a minimum of 1,000 cases in an effort to account for more rare adhesion-promoting conditions. Cases were performed per standard protocol with entry approach and location per surgeon preference. Intraoperative photo documentation of four abdominal quadrants was obtained at the onset of each case. Following the case, a survey form was completed (Fig 1) to capture data on adhesiogenic events, time spent for adhesiolysis, route of entry, location, and grade of adhesions (Fig 2), if present. Herein we present interval findings from study onset in 2019 until 2021. A total of 490 laparoscopic cases have been collected, with an overall adhesion incidence of 58.98%. The most common prior inflammatory event was presence of endometriosis; among the endometriosis cases with no prior surgeries, the adhesion incidence was 61.29%. The most common preceding abdominal surgical event was a Cesarean section, with 82 patients having one or more prior Cesareans. Adhesions were present in 87.8% of cases with prior Cesarean, predominantly in the lower or midcentral abdomen and requiring on average 18.5 minutes of adhesiolysis; 44.4% of the adhesions were classified as filmy, 33.3% as dense, and 22.2% as cohesive. The second most common laparotomic procedure was abdominal myomectomy (n=22), of which 90.1% had adhesions predominantly in the central lower pelvis. There was a relatively even distribution of adhesion types, requiring an average of 24.4minutes of adhesiolysis. This is in contrast to the cases of laparoscopic myomectomy without prior abdominal surgery (n=10), of which 80% had adhesions noted in the lower or mid pelvis. These adhesions were filmy in 75% of the cases and required an average of 14.8 minutes for adhesiolysis. Our preliminary findings highlight the need for vigilance regarding anticipated intraabdominal adhesions. We anticipate that upon collecting a complete dataset, a model can be established for predicting risk factors for the development of abdominal adhesions. This project has important clinical implications and enables the provider to better counsel patients on rates of postoperative adhesion development, as well as guide operative decision-making for site of abdominal entry.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

​A Study on Intra-operative and Post-operative Analgesia with Intraperitoneal Ropivacaine and Dexmedetomidine in Pigs

Background: Laparotomy procedure involving caesarean sections, spaying and hernia correction are common in swine. But these animals are not receiving good standard perioperative as well as post-operative care and analgesia. The purpose of this study was to introduce an effective treatment method for the management of surgery related pain in pigs. Methods: Study was conducted in 18 clinical cases of pigs operated for the correction of either umbilical or ventral hernia. The animals were randomly divided into three groups. All the animals were premedicated with meloxicam and anaesthesia was induced and maintained with diazepam-ketamine combination. Intraperitoneal administration of ropivacaine or ropivacaine with dexmedetomidine or normal saline was given in the treatment groups. The animals were observed till 24 hours for the recording of clinical parameters such as time for induction, depth of anaesthesia, perioperative analgesia, muscle relaxation, quality of recovery, recovery time, post-operative analgesia and physiological parameters such as heart rate, respiratory rate, temperature and blood pressure. Result: Enhanced intraoperative and postoperative analgesia was observed following intraperitoneal infusion of ropivacaine and ropivacaine-dexmedetomidine combination in pigs. Clinical and cardio-respiratory changes were within the physiological limit after intraperitoneal administration of the drugs.

The role of trimetazidine in ischemia/reperfusion damage treatment in an ovary torsion model experimentally induced in rats

The aim of this experimental animal study was to investigate the histopathological and biochemical efficacy of trimetazidine (TMZ) in decreasing ovary damage in an ovary ischaemia/reperfusion (I/R) model in the rat. A total of 35 Wistar albino female rats were randomly separated into five groups, n = 7 per group: Group 1: Sham (S) was only given a laparotomy procedure. Group 2: Ischaemia (I) group with 2-hour ischaemia using a vascular sutur. Group 3: Ischaemia/Reperfusion (I/R) group with 2 hour ischaemia and 2-hour reperfusion. Group 4: Sham + 10 mg/kg orally TMZ (S + TMZ). Group 5: I/R + 10 mg/kg oral TMZ (I/R + TMZ) group with 2 hours ischaemia and 2 hours reperfusion after the administration orally 10 mg/kg oral TMZ. Two daily doses of TMZ were orally administered to Group 4 (S + TMZ) and Group 5 (I/R + TMZ) for three days. TMZ significantly decreased vascular congestion, haemorrhage, and polymorphonuclear leukocyte infiltration in group 5 compared to group 3 (p < .05). Despite TMZ decreased the malondialdehyde, total oxidant status, and oxidative stress index values, these decreases were not statistically significant (p > .05). TMZ which is an antioxidant agent can efficiently prevent in I/R damage in rat ovaries but further studies are necessary in order to implement it in the clinical settings. IMPACT STATEMENT What is already known on this subject? Adnexial torsion is the most common gynecological emergency and there are no specific clinical, laboratories, or radiological findings for adnexal torsion. Unfortunatelly, the currently accepted treatment is adnexal detorsion. Cytoprotective effects of Trimetazidine (TMZ), an antianginal drug, are well-defined and it has been demonstrated to improve oxidative stress markers and limits membrane damage induced by reactive oxygen species and protects tissues from free radicals with its antioxidant effects. The aim of this study is to investigate the effects of TMZ in experimentally induced adnexal torsion in rats and to investigate possible effects in maintaining ovarian reserve to prevent I/R damage or reperfusion damage. What do the results of this study add? Our study showed that TMZ significantly decreased vascular congestion, haemorrhage, and PMNL infiltration. TMZ decreased the malondialdehyde, total oxidant status, and the oxidative stress index values, but these decreases were not statistically significant. What are the implications of these findings for clinical practice and/or further research? Although various antioxidant drugs and chemicals have been used to protect the ovaries against I/R damage, they have not been demostrated to prevent it completely. TMZ, an antioxidant efficacy agent, has been shown to prevent ovarian I/R damage by suppressing inflammation in terms of histopathological parameters. Further studies involving a greater number of experimental animals are required before using TMZ for the treatment of humans with I/R damage in the clinical setting.

Comparative study of use of 32-F, multi-perforated tube drainage of subcutaneous plane versus no drainage, in laparotomy

Background: We are concerned about the wound management and wound healing amongst post-operative patients, as wound complications increase the morbidity of patients post-surgery. Most common wound complications post-surgery are wound seromas, hematomas and surgical site infections (SSIs). SSIs lead to increased hospital stay and increased morbidity alongside increasing unnecessary patient suffering and a decreased quality of life. The underlying principle for the use of subcutaneous drains is based on the belief that removal of serum or debris and eradication of dead space in subcutaneous plane will bring down the rate of infection and wound complications.Methods: A randomized control study was conducted at the General Surgery Department at SGT Medical College, Gurgoan, Haryana. In total, 60 patients were selected (after taking informed written consent) among those admitted to the Surgery Department for laparotomy procedure. Patients were divided randomly into two groups i.e., group-A (study group) and group-B (control group). In group-A patients, subcutaneous wounds were closed over a drain (32-F multi-perforated drain), while in group-B patients no drain was used. Intra-operative and post-operative findings were recorded and analysed to draw study conclusions.Results: SSIs were observed significantly higher among patients without subcutaneous drain (group-B). Patients of group-B had significantly higher incidence of seroma and pus as compared to group-A patients. Experience of pain was reported higher among the patients without subcutaneous drain (group-B).Conclusions: Subcutaneous drains play an important role in reducing the incidence of SSIs, wound complications, wound pain; thereby lead to better healing of the surgical wound.

Risk factors associated with hypoxaemia in horses undergoing general anaesthesia: A retrospective study.

Hypoxaemia is a common concern during equine general anaesthesia. The prevalence and predictors of hypoxaemia in horses undergoing elective anaesthesia in particular are poorly documented. To determine and compare the prevalence of hypoxaemia (defined as PaO2 ≤80mm Hg, on the lowest value recorded) in horses undergoing anaesthesia for exploratory laparotomy and elective procedures, and to identify risk factors in both subpopulations. Retrospective cohort study. Data were collected from 774 records of 708 horses undergoing general anaesthesia between April 2017 and August 2020. Potential predictors of hypoxaemia in horses undergoing anaesthesia for exploratory laparotomy or elective procedures were investigated separately by univariable penalised maximum likelihood logistic regression, followed by multivariable analysis. The lowest recorded PaO2 was used as a single data point for the determination of hypoxaemia and arterial oxygen partial pressure to fractional inspired oxygen ratio analysis. Hypoxaemia was recorded in 23% horses undergoing exploratory laparotomy compared with 3.8% horses undergoing elective anaesthesia (P<.001). Multivariable analysis showed that weight above 550kg, large intestinal lesions, and peak inspiratory pressure (PIP) above 30cmH2 O were significantly associated with hypoxaemia in horses undergoing exploratory laparotomy. Soft tissue procedures and PIP >30cmH2 O were significantly associated with hypoxaemia during elective anaesthesia. This study only considered the minimum PaO2 recorded during anaesthesia. Duration and treatment of hypoxaemia were not considered. Based on the lowest PaO2 value during anaesthesia, in our population, horses undergoing anaesthesia for exploratory laparotomy were over six times more likely to become hypoxaemic than horses undergoing elective procedures. Bodyweight, type of procedure, and high PIP were predictors of hypoxaemia.

Chronic gastrointestinal bleeding caused by a Dieulafoy\u2019s lesion in the\xa0small intestine: a case report

IntroductionDieulafoy’s lesion, first found by Paul Georges Dieulafoy, is an infrequent but important cause of recurrent upper gastrointestinal bleeding. The bleeding is usually severe, but patients rarely present with chronic, occult gastrointestinal bleeding.Case presentationIn this article, we discuss the case of a 68-year-old caucasian man with a history of recurrent hematemesis and chronic anemia with evidence of extravasation of contrast in the lumen of the bowel loop on computed tomography angiography. The patient was taken to the operating room, and a laparotomy procedure was performed.ConclusionDue to the infrequency of Dieulafoy’s lesion compared with other causes of gastrointestinal bleeding, it is often missed in the process of differential diagnosis. In this article, we have demonstrated the importance of this disease and different approaches to the treatment of this lesion, considering the location of the lesion among other factors.

Epidemiology of surgery in a protracted humanitarian setting: a 20-year retrospective study of Nyarugusu Refugee Camp, Kigoma, Western Tanzania

BackgroundThere are 80 million forcibly displaced persons worldwide, 26.3 million of whom are refugees. Many refugees live in camps and have complex health needs, including a high burden of non-communicable disease. It is estimated that 3 million procedures are needed for refugees worldwide, yet very few studies exist on surgery in refugee camps, particularly protracted refugee settings. This study utilizes a 20-year dataset, the longest dataset of surgery in a refugee setting to be published to date, to assess surgical output in a setting of protracted displacement.MethodsA retrospective review of surgeries performed in Nyarugusu Camp was conducted using paper logbooks containing entries between November 2000 and September 2020 inclusive. ed data were digitized into standard electronic form and included date, patient nationality, sex, age, indication, procedure performed, and anesthesia used. A second reviewer checked 10% of entries for accuracy. Entries illegible to both reviewers were excluded. Demographics, indication for surgery, procedures performed, and type of anesthesia were standardized for descriptive analysis, which was performed in STATA.ResultsThere were 10,799 operations performed over the 20-year period. Tanzanians underwent a quarter of the operations while refugees underwent the remaining 75%. Ninety percent of patients were female and 88% were 18 years of age or older. Caesarean sections were the most common performed procedure followed by herniorrhaphies, tubal ligations, exploratory laparotomies, hysterectomies, appendectomies, and repairs. The most common indications for laparotomy procedures were ectopic pregnancy, uterine rupture, and acute abdomen. Spinal anesthesia was the most common anesthesia type used. Although there was a consistent increase in procedural volume over the study period, this is largely explained by an increase in overall camp population and an increase in caesarean sections rather than increases in other, specific surgical procedures.ConclusionThere is significant surgical volume in Nyarugusu Camp, performed by staff physicians and visiting surgeons. Both refugees and the host population utilize these surgical services. This work provides context to the surgical training these settings require, but further study is needed to assess the burden of surgical disease and the extent to which it is met in this setting and others.

LMA PROSEAL: AN ALTERNATIVE TO ENDOTRACHEAL IN- TUBATION IN OPEN APPENDECTOMY OPERATION.' IN THE DEPARTMENT OF ANESTHESIOLOGY, MEDICAL COLLEGE, KOLKATA

INTRODUCTION One of the important responsibilities of an Anaesthesiologist is to maintain a patent airway during any surgical procedure. Since the early days of Anaesthesia, various efforts have been made to dispel the problem of airway maintenance. AIMS AND OBJECTIVES The study entitled “LMAProSeal: An alternative to endotracheal intubation in open appendicectomy operation” was conducted with the aims to compare the efcacy of LMA ProSeal and Endotracheal Tube in patients undergoing Open Appendectomy under General Anaesthesia. MATERIALAND METHODS Study Area: This study was conducted in Medical College, Kolkata (West Bengal), under the department of Anaesthesiology in General Surgery Operation Theatre (C. B. Top OT/ Green OTComplex), after clearance from the Hospital ethical committee, during the period from 1st may 2013 to 31st January 2014. Awritten informed consent was taken from all patients included in the study. StudyPopulation:Patients postedforopenAppendicectomyoperationwithBMIbetween18.50–24.99kg/m2andbodyweightbetween30—60kg. Sample Size: 100 RESULTS AND OBSERVATIONS The effects were observed by monitoring heart rate, blood pressure and SPO2 preoperatively (as baseline), after intubation or placement of LMAProSeal at 1 min, 3 mins, 5mins and every 5 mins thereafter till the reading at removal of the device. For both the groups baseline ETCO2 was taken from connection of ETCO2 cable following placement of airway devices. SUMMARY AND CONCLUSION The study revealed that both the airway devices (ET tube and LMA ProSeal) were successful in operative procedure (open appendicectomy) in all the patients without any signicant complication. In experienced hands and following a strict protocol of insertion, the LMA ProSeal can prove to be an efcient and safe alternative to endotracheal tube for airway management of elective patients undergoing laparotomy procedure like open appendicectomy.

A COMPARATIVE STUDY OF SUBCUTANEOUS SINGLE CLOSED SUCTION DRAIN VERSUS SIMPLE CLOSURE IN EMERGENCY MIDLINE LAPAROTOMY WOUNDS

Wound healing is major concern after surgical procedure, because of its association with quality of life and morbidity of patients. Infections that occur in the wound created by an invasive surgical procedure are generally referred to as Surgical Site Infections (SSIs).. Patients requiring Emergency laparotomy procedure has increased risk of surgical site infection and delayed wound healing. Complications following the closure of abdominal layers after correcting the pathology and peritoneal washings are surgical site infections, wound dehiscence, burst abdomen, wound seroma and wound hematoma. Negative suction in the subcutaneous plane decreases infection by removal of serum or debris and by elimination of dead space in the plane. This study is to compare the subcutaneous single closed suction drain and conventional simple closure of skin and subcutaneous tissue in emergency laparotomy cases.

Ectopic left renal artery originating from the left common iliac artery: a rare anatomic variation

We present the case of a rare anatomic variation observed during a laparotomy procedure for endometrial cancer of mixed endometrioid-serous type. It consists of an ectopic left renal artery originating...

A retrospective study of ruptured tubal ectopic pregnancy managed by open and minimal invasive surgery

Ectopic pregnancy is a serious hazard to a woman’s health and requires prompt attention and early aggressive intervention. These complications are not only fatal loss but also causes significant maternal morbidity and mortality. Minimal invasive surgery is considered to be safest effective surgical solution for tubal ruptured ectopic pregnancy to reduce intra operative blood loss, analgesic requirements and hospital stay. A clinical retrospective study in an academic tertiary obstetrics and Gynaecology department of Pradyumna Bal Memorial hospital, Kalinga Institute of medical science (KIMS), Bhubaneswar, Odisha was conducted in the period of three years. A total of 90 confirmed case of ruptured tubal ectopic pregnancies were divided into 2 groups, laparoscopy(n=68) and laparotomy (n=22). The main outcome measures the demographic features like age, gravida, parity, previous spontaneous loss, previous MTP, Hb at admission, period of gestation, total blood loss and haemoperitonium and post-operative parameters blood loss, blood requirement and duration of hospital stay. No significant differences observed in age, gravida, parity, previous history of spontaneous loss and previous MTP in both laparoscopy and laparotomy procedure. Common demographic features were age (30 to 32 years), gravida (2-3) and parity (1). Patients with heavy blood loss &amp;#62;1000ml and massive hemoperitoneum were also undergone for laparoscopic procedure. Hospital stay and PRBC blood transfusion were less in patient undergone laparoscopic surgery. Laparoscopy is considered to be advantageous over laparotomy in terms of shorter hospital stay and speedy recovery and even in massive haemoperitoneum.

Pure Laparoscopic Donor Hepatectomy: Right Posterior Section Graft

BackgroundThe use of laparoscopic liver resection (LLR) is widespread owing to its several advantages, especially smaller incision (Kaneko et al., Ann Gastroenterol Surg 1:33–43, 1; Ciria et al., Surg Endosc 34:349–360, 2). However, both posterior sectionectomy and donor hepatectomy are extremely difficult procedures to perform in LLR (Hasegawa et al., Ann Gastroenterol Surg 2:376–382, 3; Soubrane and Kwon, J Hepatobiliary Pancreat Sci 24:E1–E5, 4; Takahara et al., Transplantation 101:1628–1636, 5; Lee et al., Clin Transplant 33:e13683, 6; Hong et al., Surg Endosc 33:3741–3748, 7; Rhu et al., J Hepatobiliary Pancreat Sci 27:16–25, 8). Moreover, the right posterior section graft procurement is also difficult even in open laparotomy procedure (Sugawara et al., Transplantation 73:111–114, 9; Hwang et al., Liver Transpl 10:1150–1155, 10; Hori, Kirino, and Uemoto, Hepatol Res 45:1076–1082, 11; Kusakabe et al., Liver Transpl 26:299–303, 12). The pure laparoscopic donor posterior sectionectomy has not been reported yet. Therefore, we aimed to introduce a novel procedure through a video clip. MethodsThe donor was placed in the semi-left lateral decubitus position with the reverse Trendelenburg position using a bean bag device. The right liver was mobilized, and the right hepatic vein was exposed. To adopt the liver hanging maneuver, a tape was inserted between the middle and right hepatic veins along the inferior vena cava. The posterior Glissonean pedicle was encircled and controlled, and the liver parenchyma was completely transected using the liver hanging maneuver. The vessels to the posterior section were respectively isolated. The posterior branches of the hepatic duct, hepatic artery, and portal vein were cut. The right hepatic vein was divided, and the graft liver was retrieved via a suprapubic incision. This study was approved by institutional ethics board (No. MH2019-119), and informed consent was taken from the patient. ResultsThe overall surgical time was 503 min, and the blood loss was 400 mL. No complications were observed, and the donor was discharged from the hospital on postoperative day 11. ConclusionThis is the first report of pure laparoscopic donor hepatectomy of the posterior section graft. This procedure is more difficult than other laparoscopic donor hepatectomies because it involves parenchymal transection in the right intersectional plane and dissection of the posterior branches of hilar vessels.

Modelling Benign Ovarian Cyst Risk Factors and Symptoms via Log-Linear Model

Ovarian cancer among women is known as “The Silent Killer”. It is caused by the malignant ovarian cyst, which can spread to other organs if it is not treated at an early stage. Some are benign ovarian cyst which can be treated through medical procedures such as laparoscopic and laparotomy. The type of medical procedure that the patients have to undergo depends on the size of cyst. A few risk factors that can cause benign ovarian cyst are age, pregnancy, menopause and menstrual cycle. Apart from that, there are a few symptoms of benign ovarian cyst which are fever, nausea and abdominal pain, abdominal distension, dysmenorrhea and intermenstrual bleeding. The association between these 12 discrete categorical data variables (factors, symptoms, treatment and size) are measured using the log-linear analysis in this study. According to the analysis, the patients who have large benign ovarian cyst need laparoscopic procedure, while those with smaller cyst need either laparotomy procedure or they do not have to undergo any surgery at all. Among all of the factors, menopause gives the highest risk factor of benign ovarian cyst, followed by age, pregnancy and menstrual cycle. Meanwhile, the interaction between nausea, abdominal pain and intermenstrual bleeding give the highest symptom rate to the benign ovarian cyst.

The use of CONOX as a guide to the general anesthesia on laparotomy patients compared with standard clinical care – A pilot study

Background: Avoiding excessive doses of anesthesia was fundamental, mainly to reduce the adverse effect of anesthesia. Electroencephalography (EEG)-based monitors can be used to measure the depth level of anesthesia and guide intraoperative hypnosis drug and opioid administration. This study aims to evaluate the benefit of using CONOX monitor when administering anesthesia drugs in laparotomy procedures.&#x0D; Method: Twenty patients aged 18-65 years with physical status ASA I-III who underwent major laparotomy surgery with general anesthesia total intravenous anesthesia (TIVA) were divided into two groups. Group A received general anesthesia guided with the CONOX monitor, while group B using standard clinical care. We later evaluate the total use of propofol and fentanyl, intraoperative hemodynamic profile, postoperative cognitive disorder (POCD), intraoperative awareness, postoperative nausea and vomiting (PONV), and moderate to severe pain in the post-anesthesia care unit (PACU).&#x0D; Results: The mean total propofol used is lower in CONOX group (63.6 ± 11.7 mcg/kg/min vs. 74 ± 17.87 mcg/kg/min). A similar result was obtained with fentanyl. The CONOX group use a lower total of fentanyl (212.5 ± 32.3 mcg vs. 249 ± 54.6 mcg) than the control group. POCD was found to be more prevalent in the control group (5 vs 2 patients). While there is no report of intraoperative awareness.&#x0D; Conclusion: The incidence of PONV and moderate to severe pain in PACU was similar between the two groups. This pilot study is a preliminary study to evaluate the benefit of using EEG-based monitors to adjust anesthesia drugs.

Optimization of postoperative opioid prescriptions in gynecologic oncology: Striking a balance between opioid reduction and pain control

ObjectiveTo implement a quality-improvement initiative to assess the impact various patient and procedural factors have on postoperative opioid use. To develop a tailored opioid prescribing algorithm for gynecologic oncology patients. MethodsA retrospective cohort study was performed of patients who underwent a laparoscopy or laparotomy procedure for a suspected or known gynecologic malignancy between 3/2019–9/2020. Patients were assessed preoperatively for the presence of suspected risk factors for opioid misuse (depression, anxiety, chronic pain, current opioid use, or substance abuse). Patients completed a 30-day postoperative questionnaire assessing for total opioid pill use and refills requests. Multivariate models were developed to estimate the independent effect of sociodemographic characteristics, risk factors for opioid misuse and procedural factors on patient reported postoperative opioid use. ResultsA total of 390 patients were analyzed. Thirty-nine percent (N = 151/390) of patients reported not using opioids after discharge and 5% (N = 20/390) received an opioid refill.For both minimally invasive procedures and laparotomy procedures, body mass index, comorbidities, intraoperative or postoperative complications and final diagnosis of malignancy were not associated with the amount of opioid consumption. However, younger age and history of risk factors for opioid misuse significantly impacted postoperative opioid use. In multivariate analysis, age (p = 0.038) and risk factors (p < 0.001) remained significant after controlling for other factors. ConclusionsTwo out of every five patients did not use opioids after surgery. Younger patients and those with risk factors for opioid misuse need a tailored approach to prescribing opioids to balance the need for adequate pain control with the risk of misuse.